Maternal-Newborn Final Exam- Part 1

Front 1

breast self exam pt teaching

Back 1

staring at age 20
should be performed 1 week after onset of menses
client should notify provider is discharge or bleeding

Front 2

where is ovum fertilized

Back 2

outer third of fallopian tube

Front 3

nutrient that can reduce incidence of neural tube defect

Back 3

folic acid
0.4mg daily recommended for prevention
1 mg daily for treatment

Front 4

what hormonne maintains the corpus luteum during early preg.

Back 4

human chorionic gonadotropin (hCG)

Front 5

what is goodell's sing

Back 5

softening of cervix

Front 6

what is chadwick's sign

Back 6

blue-purple discoloration of cervix

Front 7

describe function of hCG

Back 7

produced by the developing embryo, hCG's function is to prevent the disintegration of the corpus luteum and thus maintain progesterone (and estrogen) production that is critical for pregnancy. hCG may affect the immune tolerance of the pregnancy. Early pregnancy testing measures hCG level.

Front 8

when does the corpus luteum disintegrate

Back 8

@ about 4 months when the placenta takes over

Front 9

what does the corpus luteum secrete in early preg.

Back 9

progesterone to maintain the endometrium until the placenta takes over

Front 10

vaginal secretions pH during preg.and normal reproductive years

Back 10

acidic; 3.5-6

Front 11

tidal volume during pregnancy

Back 11

increases through preg. by 30-40%

Front 12

vital capacity during preg.

Back 12

increases

Front 13

O2 consumption during preg.

Back 13

↑15-20%

Front 14

breathing pattern during preg.

Back 14

thoracic, shallow is common

Front 15

estrogen induced edema and vascular congestion during preg. results in

Back 15

rhinnitis, epistaxis,

Front 16

blood volume change in preg.

Back 16

↑40-45%, peaks in 3rd trimester

Front 17

vascular resistance change during preg

Back 17

↓

Front 18

cardiac output change during preg.

Back 18

↑

Front 19

pulse change during preg.

Back 19

↑10-15 bpm

Front 20

BP change in preg.

Back 20

↓ in 1st & 2nd trimester- returns to pre- preg by 3rd trimester

Front 21

what is physiologic anemia of pregnancy

Back 21

↑ rbc by 30% and ↑ of plasma by 50%

Front 22

iron absorption change during preg.

Back 22

moderately ↑

Front 23

t/f pregnancy is hypercoaguable state

Back 23

true b/c ↑ plasma fibrinogen
↑ RISK OF DVT

Front 24

GI changes in preg

Back 24

slowed peristalsis and slow gall bladder emptying and hemorrhoids b/c of smooth muscle relaxation from progesterone
↑ RISK OF GALLSTONES

Front 25

what is the mask of preg.

Back 25

chloasma
ACCENTUATED BY SUN EXPOSURE

Front 26

pigmentation changes in preg. client

Back 26

chloasma, linea nigra, striae

Front 27

normal weight gain during preg. for normal weight client

Back 27

25-35 lbs

Front 28

normal weight gain during preg. for under weight client

Back 28

25-35 lbs

Front 29

normal weight gain during preg. for over weight client

Back 29

15-25 lbs

Front 30

weight gain by trimester in lbs

Back 30

st-3.5-5
2nd- 12-15
3rd- 12-15

Front 31

subjective signs of preg.

Back 31

aka presumptive: amenorrhea, n.v,fatigue, breast tenderness, urinary frequency, quickening
IT'S WHAT THE CLIENT FEELS

Front 32

objective signs of preg.

Back 32

aka probable: changes in pelvic organs, Goodell, Chadwick, Hegar, and McDonald's signs, uterine souffle, abd. enlargement, BALLOTMENT, Hcg TEST . IT' S WHAT THE PROVIDER OBSERVES

Front 33

positive signs of preg.

Back 33

aka objective: fetal heart beat (10 weeks ega w/ doppler & 17 weeks w/ fetoscope), fetal movement (20 weeks), ultrasound visualization of fetus

Front 34

psych. tasks of preg. (Rubin's)

Back 34

1-ensuring safe passage
2-seeking acceptance of baby by others
3-seeking commintment and acceptance of self as mother (binding-in)
4-learning to give of onself on behalf of one's child

Front 35

what is couvade

Back 35

unintentional development of physical symptoms similar to preg. in the male (↑ appetite, backache, diff. sleeping)

Front 36

Hegar's sign

Back 36

softening of the lower uterine segment (isthmus)

Front 37

McDonald sign

Back 37

uterus becomes flexible at the uterocervical junction-easing of flexing of body of uterus against cervix

Front 38

define abortion

Back 38

birth before 20 weeks

Front 39

define term preg.

Back 39

normal duration of preg. (38-42 weeks)

Front 40

define preterm

Back 40

birth after 20 before 37 weeks gestation

Front 41

quickening

Back 41

fetal movement felt by mom can be felt as early as 16 weeks as late as 22 weeks
multiparous usually report earlier than primigravida

Front 42

McDonald's method of fundal height assessment

Back 42

used to determine the age of gestation by measuring from the fundus (obtaining the fundal height) to the symphysis pubis. The distance in centimeters will determine the age of gestation from 22-34 (=/- 2cm is WNL) weeks.

Front 43

danger signs during preg.

Back 43

1-sudden gush of fuid
2-vag. bledding
3-abd. pain
4-temp above 101F
5-dizziness, blurred vision, double vision, seeing spots
6-persistent vomiting
7-severe HA
8-edema of face, hands, legs, feet
9-epigastric pain
10-oliguria
11-dysuria
12-absence of fetal movement

Front 44

common discomforts in preg

Back 44

N and V d/t ↑ hCG, gastric overloading, slowed peristalsis,
Usually resilved by 16 weeks

Front 45

PT TEACHING for N/V management

Back 45

-small frequent meals
dry crackers before getting out of bed
avoid strong odors
restrict fats
accupressure wristbands
vit. B6 (pyridoxine)
ginger

Front 46

exercise during preg.- pt teaching

Back 46

-low impact, keep HR below 140 bpm, avoid hot tubs
use perceived rate of exertion is more reliable than HR : if unable to talk or has difficulty breathing effort is too high

Front 47

constipation during pt teaching

Back 47

↑ fiber, ↑ fluids, prunes and prune juice (start slowly), exercise, good posture, colace

Front 48

hemorrhoids during preg. pt teaching

Back 48

avoid straining, warm bath, prevent constipation, witch hazel cpmresses, epsom salt compresses, analgesic ointment, iron tablets may be constipating

Front 49

Round ligament pain pt teaching

Back 49

shooting pain in inguinal area, worsened by activity,
To relieve:flex knees on abdomen , warm bath and heating pads, rest, change positions,

Front 50

breast care

Back 50

clean with warm water, no drying soap, supportive bra

Front 51

what is the Cardiff count to 10 method

Back 51

Beginning at 27-28 weeks
Mom can monitor's her unborn child's well-being
Begin at the same time each day (usually in the morning, after breakfast)
Lie quietly ON SIDE
Count each fetal movement, noting how long it takes to count 10 fetal movements (
Expected findings – 10 movements in 1 hour or less
Warning signs
-no movements in morning
- more then 1 hour to reach 10 movements
less then 10 movements in 3 hours(non-reactive- fetal distress)
longer time to reach 10 FMs than on previous days movement are becoming weaker, less vigorous
Movement alarm signals < 3 FMs in 8 hr
warning signs should be reported to care provider immediately; often require further testing.

Front 52

fetal activity monitoring methods

Back 52

Cardiff count to ten
non stress test

Front 53

Possible effects of DM on fetus

Back 53

congenital anomalies
macrosomia
IUGR, if vascular damage
↑ risk of fetal death r/t uncontrolled glucose
↑ risk of poly hydramnios

Front 54

Anemia feect on mom and fetus

Back 54

MOM: ↑ risk of infection, fatigue, ↑ risk of PIH, ↑ risk of PP hemorrhage, delayed tissue healing, cardiac failure w/ severe anemia
Fetus:↑ risk of low birth weight, stillbirth, and neonatal death

Front 55

PT teaching r/t anemia

Back 55

iron supplement 27mg
if anemic dose should be higher (60-120 mg daily)
take iron on empty stomach with orange juice
may have tarry stools, keep iron pills away from children-could be fatal

Front 56

Sickle Cell pt teaching

Back 56

folic acid supplement
avoid dehydration, high temperatures,
treat infections early, infection prevention,

Front 57

Thalassemia pt teaching

Back 57

folic acid supplement

Front 58

HIV patient teaching

Back 58

asymptomatic pt: pregnancy does not accelerate disease
symptomatic: preg. does accelerate disease

w/o prophylactic rate of transmission to newborn id 15-25%
best option for HIV+: ZDV treatment, C?S at 38 weeks before ROM, no breastfeeding (rate of transmission drops below 2%)

Front 59

AIDS in infants

Back 59

90% encephalopathy (↓ in cognitive abilities)
delayed development, fail to thrive
neuro issues
hepatosplenomegaly, recurring infections( esp pneumonia)

Front 60

CD recs for HIV screening

Back 60

recommend that all preg.pt be screened
screening is voluntary and informed

Front 61

Recommended caloric increase in preg.

Back 61

Calories
300 calories/day above the prepregnancy daily requirement to maintain ideal body weight and meet energy requirement to activity level
- Begin increase in second trimester
- Use weight – gain pattern as an indication of adequacy of calorie intake.
- Failure to meet caloric requirements can lead to ketosis as fat and protein are used for energy; ketosis has been associated with fetal damage.

Front 62

classification of cardiac functional capacity

Back 62

Class I: cardiac disease but no limitations of physical activity and no sx of cardiac insuff.
Class II:cardiac disease w/ slight limitations of physical activity , ordinary phys activity may cause fatigue, dyspnea, anginal pain
Class III:cardiac disease w/ marked limitations of physical activity and less than ord. phys activity can cause dyspnea, anginal pain, fatigue
Class IV:cardiac disease w/o ability to carry out any phys. activity.SX of cardiac insufficiency even at rest
ANEMIA AND INFECTION WILL WORSEN CARDIAC CONDITION

Front 63

clinical Tx of cardiac disorders

Back 63

Class I & II: spntaneous labor w/ pain management, careful monitoring recommended
Class III & IV: hospitalization prior onset of labor, vag. delivery possible
epidural anesthesia to reduce stress, maybe low forceps and vacuum assistance
** treat anemia and infection early
**may need to limit weight gain and sodium intake
**screen monthly for asymptomatic bacteruria
** home BP monitoring
**adequate rest
drug tx: diuretics, antihypertensives (esp if BP>150-16-/100-110), antiarrhythmics, anti-coagulants

Front 64

SX of hypovolemic shock

Back 64

pallor, clammy skin, diaphoresis, dyspnea, restlessness, confusion, anxiety, tachycardia, ↓ urine output, ↓ BP

Front 65

Tx hypovolemic shock

Back 65

O2, IV therapy, type and cross match blood, elevate legs to help heart and brain perfusion, position pt on left side to improve placental perfusion

Front 66

causes of bleeding and hemorrhage during preg

Back 66

placenta precia, placenta abruptio, ectopic preg., gestational trophoblastic disease, molar preg (rare), preterm labor, spontaneous abortion

Front 67

what is gestational trophoblastic disease

Back 67

group of rare tumors that involve abn. growth of cells in woman's uterus. GTD does not develop from cells of the uterus like cervical cancer or endometrial (uterine lining) cancer do. Instead, these tumors start in the cells that would normally develop into the placenta during preg. This disease begins in the layer of the trophoblast that normally surrounds an embryo. (Tropho- means "nutrition," and -blast means "early developmental cell.") Early in normal development, the cells of this layer form villi. These villi grow into the lining of the uterus. In time, the trophoblast layer develops into the placenta.

Most GTDs are benign & don't invade deeply into body tissues or spread to other parts of the body. But some are cancerous. B/c not all of these tumors are cancerous, this group of tumors may be referred to as gestational trophoblastic disease, gestational trophoblastic tumors, or gestational trophoblastic neoplasia.

All forms of GTD can be treated. And in most cases the treatment produces a complete cure. (source: cancer.org)

Front 68

causes of spontaneous abortion:

Back 68

faulty implantation, teratogens, placental abnormalities, weak cervix, hormonal imbalance (↓ hCG, ↓ estrogen, ↓ progesterone), maternal infection

Front 69

Tx for spontaneous abortion

Back 69

bed rest
pelvic rest
maybe D&C
Rh immune globulin if Rh neg

Front 70

Sx of ectopic preg

Back 70

one-side lower abd. pain
referred right shoulder pain
adnexal tenderness/mass
bleeding
rigid abd.
lower hCG

Front 71

TX of ectopic preg

Back 71

menstrual HX, esp LMP
pelvic exam
ultrasound
labs ( will show ↓H&H, , ↑ leukocytes, lower hCG*)
laparoscopy
methotrexate IM if pt desires future preg if fertilized ovum is unruptured and < 3.5 cm and pt condition is stable
surgical removal
Rhogam if Rh neg.

* in normal preg. hCG doubles Q 48hrs from3 to 6 weeks' gestation

Front 72

care of D&C pt

Back 72

someone should remain w/ discharged pt for 1st 24-48 hours
report any heavy bleed, fever, chills, foul smelling vag. discharge, abd. tenderness

Front 73

Sx of placenta previa

Back 73

Painless vagina bleed after 20 weeks

Front 74

Nursing implications of placenta previa

Back 74

NO VAG EXAMS
draw labs
sonogram

Front 75

Sx of abruptio placenta

Back 75

pain disproportionate to the strength of contractions, may or may not be accompanied by bleed
may necessitate C?S in moderate or severe cases

Front 76

what is hydatidiform mole (molar peg. and what are sx

Back 76

type of gestational trophoblastic disease (GTD)
placenta characterized by fluid-filled, grape-like clusters
2 types of molar preg.: partial and complete
unclear cause
Sx:prune juice-like vag. bleed.
anemia
uterine enlargement > than expected
no FHT
hCG> than expected
very low maternal serum alpha-fetoprotein (MSAFP)
hyperemesis gravidum b/c of ↑ hCG
preeclampsia
DIC
infection (late sx)

Front 77

how is molar preg diagnosed

Back 77

w/ ultrasound

Front 78

TX of molar preg

Back 78

evacuation and curettage
oxytocin to keep uterus contracted and prevent hemorrhage
typed and cross match blood
monitor urine output
hysterectomy if older pt has completed childbearing to ↓ chances of future malignancy

Front 79

what is incompetent cervix and what are sx

Back 79

incomp. cervix is painless dilation of cervix w/o contractions
sx: low back pain, pelvic pressure, changes in vag. discharge

Front 80

hyperemesis DX and TX

Back 80

intractable vomiting in 1st half of preg that causes dehydration and ketonuria and weight↓ of 5% pre-pregnancy weight

tx: restore 'lytes, hydrate, control vomiting (antiemetics, IV), small meals, simple carbs
TPN if necessary, B6, B!, D5W, ginger syrup, acupuncture

Front 81

herbs to avoid in preg

Back 81

blue cohosh, black cohosh, chamomille, valeria, comfrey, dong quai, ephedra, goldenseal, gingko, ginseng, horehound, horseradish (fresh)
caution w/ garlic, ginger, turmeric

Front 82

Immunization during preg

Back 82

Inactivated viruses:
Influenza: after 1st trimester
Hep A & B

Front 83

Contraindicated immunization during preg

Back 83

Measles, rubella, mumps, varicella zoster, smallpox, polio, yellow fever (unless in high-risk area),
typhoid,

Front 84

Gestational Diabetes (GD) definition

Back 84

Carb intolerance of variable severity w/ onset or 1st recognition during pregnancy

Front 85

GD- screening

Back 85

50g- 1hr glucose test
done b/w 24 and 28 weeks
if plasma glucose >140 do 3-hr diagnostic test

Front 86

3-hr 100g glucose test

Back 86

done if 1-hr glucose test result is >130-140
pt eats unrestricted diet that includes 150g minimu of carbs for 3 days prior
Pt ingests 100g oral glucose solution in moring after an overnight fast
plasma glucose is measured at1,2,3 hours
Pt should remain seated, not smoke throughout the test
GD is DX is 2= values are met or exceeded:
fasting: 95mg/dL
1hr:180mg/dL
2hr:155mg/dL
3hr:140mg/dL

Front 87

normal fasting and 2hr blood glucose

Back 87

non-pregnant:
fasting:70-80
2hr postprandial60-110

pregnant:
fasting:65
2hr postprandial:<140

Front 88

normal preg H&H

Back 88

Hgb:11-15 (1g less than nonpreg.)
Hct:32-42 %(5% less than nonpreg)
anemia is < 11mg/dL in preg

Front 89

fetal assessment of diabetic mother

Back 89

MSAFP
fetal activity monitoring
NST
BPP
Ultrasound

Front 90

what is NST

Back 90

non-stress test
usual baseline fetal heart rate is between 120 and 160 beats per minute. Once monitor is in place, practitioner will look for certain measurements to see how the baby is faring, including if his heart rate rises when he moves. An NST is considered reassuring if there are accelerations of the fetal heart rate of at least 15 beats per minute over the baseline, lasting at least 15 seconds, occurring within a 20-minute time block. This is called a reactive NST. If these accelerations don't occur, the test is said to be nonreactive. In addition, since many women have mild contractions that they may not even notice, your practitioner will note any of the baby's responses to contractions or if the fetal heart rate dips below baseline.
(source: drspock.com)

Front 91

what is 1st NST is non-reactive

Back 91

prolong test for another 20 minutes

Front 92

what is nitrazine paper used for

Back 92

assessment of luid with ROM
blue=alkaline=amniotic fluid
nitrazine paper can yeild false positive if sample is contaminated w/ semen, urine, blood, soap, bact vaginosis, soap

Front 93

what is pre-term labor (PTL)

Back 93

labor before 37 completed weeks of preg.

Front 94

Risk Factors of PTL

Back 94

uterine/cervical problems
hx of cone biopsy
low weight
undernourished
chronic illness:HTN< renal, cardiac)
previous PTL
previous pre-termbirth
febrile illness
subs abuse
2nd trimester abortion
more than 2 1st trimester abortions

Front 95

neonatal risks associated with maternal anemia <6g/dL

Back 95

low birth weight
prematurity
stillbirth
neonatal death