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61 Cards in this Set

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What is the normalrange for haemoglobin?

The normal range forhaemoglobin in pregnant women is 100-150 g/l.

Which blood tests areroutinely offered at booking?

First antenatal:


- Full blood count


- antibodies


- ABO group


- rhesus


- syphilis


- rubellaantibodies


- Hep B


- HIV may be offered but is not included automatically andneeds to be consented for separately.


- Maternal serum screening is alsoroutinely offered


- HBA1C may be offered if the woman has risk factors fortype 2 diabetes.

When might you offer anMSS2?

2nd trimester, 14-20 weeks

At which gestation are the “second antenatal” bloodtests offered?


a. 20-24 weeks


b. 24-26 weeks


c. 26-28 weeks


d. 28-30 weeks

C is correct

What components areincluded in a full blood count (aka complete blood count)?

RBCs, WBCs, heamaglobin, haemacrit, Platelets

What components make upthe MSS1?

The MSS1 or first trimester combined screeningconsists of a blood test, and ultrasound scan to look at nuchal translucency.They also take into consideration maternal age and weight, and calculate a riskfactor. The blood test looks at two things, beta human chorionic gonadotropin levelsand pregnancy plasma protein A, or PAPP -A.

What is included in the“second antenatal” blood tests?

CBC and antibodies

What tests in midwiferyscope can you offer to screen for and/or diagnose diabetes (including gestational diabetes) and when would these be offered?

- HBA1C can be offered at booking (prior to 20weeks)


- glucose tolerance test and glucose challenge test (polycose) are offered between 24-28 weeks. - Urinalysis to detect glucose should be offered at every visit.

Where would you expect to palpate the fundus in a woman who is 18 weeks pregnant?


a. Just above the pubis symphysis


b. Midway between the pubis symphysis and the umbilicus


c. Just below the umbilicus


d. At the umbilicus

C is correct

What is the consensusstatement on the observation of mother and baby in the immediate postnatalperiod?

All mothers and their babies must receiveactive and ongoing assessment in the immediate postnatal period, regardless ofthe context around their birth. During this time, the mother and baby shouldnot be left alone – even for a short time. Ongoing assessment is for a minimumof one hour. Assessment will be longer than one hour if the mother or baby hasexperienced factors that increase their risk of adverse outcomes.

How long do you need to stay with thewoman and her baby after birth?

Under the Notice Pursuant to Section 88 forthe New Zealand Public Health & Disability Act 2000 all midwives must stayuntil 2 hours after delivery of the placenta.

How much placental bloodwill be transferred to the baby if the cord is uncut until after the placentais born?

90% is correct. If left alone up to 90% of theblood in the placenta will naturally transfer to the foetus. The exact amountvaries depending on the position of the baby relative to the placenta.

What initial assessments ofthe woman's wellbeing do we make after a normal birth?

- Uterine palpation to checkfor tone and position


- Fullness of bladder and need to urinate


- Ongoing assessment of lochia/vaginal bleeding - Temperature, pulse and blood pressure


- Assessment of perineum and vulval area for trauma

Explain how to examine the placenta andmembranes?

1) completeness and condition


2) 3 blood vessels in cord


3) two membranes present


4) clots or missing pieces


5) check around the edge of the placenta to identify blood vessels that mightsuggest another lobe (succenturiate lobe).


6) colour and calcification

True or false? Frequent contractions mean labour is progressing.

False

Where are living ligatures located?

It's the musclecells of the myometrium that contract and constrict the blood vessels leadingto ischemia of the endometrium.

What reasons might youconsider NOT doing a vaginal examination in normal labour?

- Woman's consent declined.


- History of sexual abuse.


- Potential for introduction of infection.


- Disruption of woman's focus and confidence.


- Presence of other positive signs that labour is progressing.

What is a partogram andwhen should it be used?

Partograms are a visual display of a woman's progress in labour and can be useful when multiple care-givers are involved orthe labour is prolonged.

How often should awoman's blood pressure, temperature and pulse be taken in active labour?

Every four hours

True or false, somewomen do not experience a definable transition

True

What is the normalfetal heart rate range?

110-160bpm

According to theguidelines how often should the fetal heart rate be checked in active labour?

In the active stages of labour, intermittentauscultation should occur (with the woman's permission) after a contraction,for a minimum of 60 seconds, and at least:every 15 minutes in the first stage.every 5 minutes in the second stage.

What is the expectednumber of LMC postnatal visits at the woman’s home?

between 5 and 10 home visitsby a midwife (and more if clinically needed) including 1 home visit within 24hours of discharge from a maternity facility.

What is section 88?

Section 88 of the NewZealand Public Health and Disability Act 2000 is the legislative framework that outlines the model of care and gives notice of the terms and conditions for the provision of maternity services.

When must the LMC give a written referral to the woman’s general practitioner?

The LMC must give a written referral to the woman’s general practitioner that meets the guidelines agreed by the New Zealand College of Midwives and the Royal New Zealand College of General Practitioners before discharge from lead maternity care.

What is the expected frequency of LMC postnatal visits while the mother and baby are receiving inpatient postnatal care at a maternity facility?

A daily visit while the woman is receiving inpatient postnatal care, unless otherwise agreed by the woman and the maternity facility.

What health status information must a LMC submit regarding the woman at registration to well child provider?

- height


- weight


- smoking status at the time of registration


- baby’s breastfeeding status at 2 week


- woman’s smoking status at 2 weeks following birth

True or false? The midwife can request that a well child provider becomes involved from as early as 2 weeks from birth if the baby has unusually high needs.

true- If the baby has unusually high needs, the LMC may request that a well child provider becomes involved as early as 2 weeks from birth to provide concurrent and co-ordinated care with the LMC.

When should newborn examinations be undertaken by the LMC?

- Within 24 hours


- 5-7 days


- before discharge

Explain (step by step) how to assess a woman’s perineum

- Check for grazes


- Check inside vagina, working from introitus to cervix


- Look for the apex


- Visualise vaginal wall checking lateral, anterior and posterior walls


- Check for rectal damage

What are the reasons (in normal labour) for IV cannulation.

Fluid replacement


Delivery of medicine


Delivery of blood or blood products


PPH


Epidural


Drug treatment


Blood transfusion


Induction/augmentation


Premature labour/PIH/diabetesLSCS/manual removal/repair of tear

Identify the 9 steps of communication and information sharing (for all skills).

1) Introduce self and provide woman with an explanation of student role


2) Interact with client in a culturally safe manner


3) Approach the interaction with appropriate body language, eye contact, demeanour, manner and tone of voice


4) Ascertain woman’s knowledge and understanding of procedure


5) Facilitate the opportunity for the woman to ask questions


6) Elicit verbal consent to procedure


7) Facilitate information sharing (giving feedback and eliciting feedback) andthe woman’s involvement throughout procedure


8) Respond appropriately to shared information or non verbal cues


9) Correctly identifies client for procedure and performs correct procedure

During the newborn examination what assessments are you making of the musculoskeletal system?

1. level of tone and spontaneous movement


2. Observe and palpate the spine – noting positing and integrity


3. Note any abnormalities of the spine (scoliosis, tuft of hair, sacral dimple)


4. Assess hip joint stability (Ortolani and Barlow procedures)

Identify the “safety components” of the urinary cathetarisation skill?

- Consent


- correct woman


- Wash hands


- sterile field


- dispose of equipment.

What reasons would you consider urinary cathetarisation?

- Reduced bladder tone


- Epidural


- Fear of micturition


- Obstructing labour progress


- Retained placenta


- PPH


- Prior to caesarean section


- Prior to instrumental delivery





What questions would you ask the woman to ascertain newborn behaviour?

1. Feeding (frequency, duration, attachment, satisfaction)


2. Urination and stool patterns (frequency, consistency, colour)


3. Sleep and wake patterns


4. Bonding and parental/infant relationship development


5. Discusses age appropriate developmental milestones

Outline the steps you must take (after you have gained consent) to prepare for vaginal examination.

- Who does the woman want present?


- Can the woman empty her bladder


- Get equipment (sterile gloves, lubricant),


- palpation & FHR


- position of woman


- wash hands and sterile gloves on


- Explain you can stop at any time


- Wait till contractions gone

What woman’s details must you put on all prescriptions for pharmaceuticals, referrals for laboratory tests, referrals for ultrasound scans, and referrals to specialists?

- name and address


- the woman and baby’s NHI


- the woman or baby’s date of birth where they are under 12 years of age or if no NHI number is available


- the woman or baby’s gender if no NHI number is available

What tests can midwives order, within their scope of practice, when offering pre-conception care?

We cannot offer any tests during pre-conception care except pregnancy test. If you are giving preconception advice to a couple and they want tests then they will have to see their GP.

HBA1C, GTT (Polycose),and OGTT all test for diabetes. Explain when and why you would use each one.

HBA 1C screening if there is family history.Glucose loading test is screening.


GTT diagnostic testing

True or false? After 24 weeks midwives "landmark" guided fundal height assessment is recommended.

it is false. After 24 weeks midwives do fundal height measurements. It is prior to 24weeks that they do landmark guided fundal height assessments.

In a full blood count what components of RBCs are being tested?

Hb (heamoglobin)


HCT (heamatocrit)


MCV (mean corpuscular volume)


MCH (mean corpuscularhaemaglobin)


MCHC (mean copuscular Hb concentration

what are the cons of using naegles rule?

Assumes 28 day cycle


Assumes 280 day pregnancy


Does not measure conception!

At booking visit: A. List the 'examination and assessment' done at booking visit.

- Obtain medical history and gynaecological/obstetric history


- ask her weight and height and smoking status


- offer urinalysis and to take baseline obs (BP, temp, pulse, rests)


- offer abdominal palp.


- Offer first antenatal bloods


- HIV screening,


- STI swab


- MSS1 or 2 dependant on woman's gestation. If clinically indicated offer MSU,HBA1C, ferritin...

What is the differencebetween physiological and pathological jaundice?

Physiological jaundice occurs as a result of the normal breakdown of HbF. Physiological jaundice occurs in more than 60% of term babies. It is usually apparent at about 72 hours, peaks on day 4 and declines over a week. As long as the baby is alert, self waking, has good tone and movements, is feeding well and PU and settled between feeds then nothing needs to be done.


Pathological jaundice can occur within the first 48 hours (but assessment should continue for the first weeks of life as it can occur later too in response to bacterial infection) and is usually due to haemolysis (ABO incompatibility, Rh immunisation or sepsis). Pathological jaundice can lead to developmental delay, cerebral palsy and death.

How can you assess a woman's progress in the first stage of labour?

- Length, strength and frequency of contractions, - Vocalising, Woman’s state (which would include - language, grunting, eating, v & d),


- Offer abdominal palpation


- Offer VE


- Purpleline's a good one

How long do we have to keep woman's notes?

10 years

What are the signs of placental separation?

- Lengthening of the umbilical cord


- Rising up of the uterus/uterine


- contractions


- Reduced pulse in the cord


- Urge to push


- A gush of blood per vaginum

At booking visit: A. List the 'information' you would share with the woman

options of care, referral;


provider feedback including standard review and complaints procedure;


documentation incl. privacy ac;


planre:


pregnancy, birth, parenting, antenatal class;


self care;


nutrition and exercise;


smoking cessation, alcohol and drugs, support

At discharge visit:A. What assessment would you do on the baby?

Development assessment

At booking visit: A. List the 'active decision making' to be done/considered by the woman.

LMC;


screening options;


involvement of student midwife,


referral if indicated or wanted;


time, place, frequency of antenatal care.

At discharge visit:A. What assessment would you do on the mother?

If they have perineal tear,or caesarean wound, or breast trauma (I assume any problems found in the entirepost natal visit) it needs to be checked, confirmed problem resolved or plan of action, which need to be documented

At discharge visit:A. What health information would you provided?

immunisation; sexuality; referral to GP, othe rhealth proffesionals, community agencies as appropriate; discuss Midwifery Standard Review and consumer feedback. Contraception advice/prescription (if not already done). Ongoing self-care advice.

What assessments should be offered at every antenatal visit?

BP, urinalysis, abdo palp, fhr, ask about any odema, measurement of fundus

What are you assessing when you do an APGAR?

-Heart Rate


-Respiratory State


-Reflex Irritability


-Muscle Tone


-Colour

Explain (step by step)how to repair perineal trauma.

After consent gained, wash hands, prepare equipment, light, position the woman, wash hands, gloves, examine the tear:degree, if other structures involved such as anus, urethra, alignment of the tear, bleeding, tampon if necessary - don't forget to clamp the thread of the tampon. Start suturing from the apex of the tear in the vaginal mucosa, leave abit of length, tied and clamp. Do continuous suture to the line between vagmucosa and skin.

At booking visit: A. List the 'Health information and education you would share with the woman.

The decision point consist: information shared, assessment and screening, active decision making, and health info andeducation. My understanding is: the information shared is from both sides: mwand woman - so the midwife will let the woman knows her practice and ask the woman of her history,expectation, etc. The health ed come from the midwife - I think. And thedecision making come from the woman. That's how I tried to make sense of it (?)

What is naegle's rule?

Naegele's rule is stated as take the LMP add one year then subtract 3 months and add 7 days.

What are the reasons toconsider performing a vaginal examination in normal labour?

Womens request, to check progress, prior to epidural, transportation

What does"Bubbles" stand for?

Breast UterusBladderBowelLockieEmotions Social support

Bonus question, why dopeople chose to use Syntocinon vs Syntometrine?

Syntometrine works for longer and is good forPph but is associated with nausea and vomitingecause syntometrine has ergometrine in itwhich has longer lasting effects and also says you should avoid BF. You cangive sytocinon again after 2 hours but not syntometrine