Maternal Newborn NCLEX Prep (Solved) what is the average weight gained during pregnancy - 25-35 lbs what are presumptive signs of pregnancy - amenorrhea fatigue N/V urinary frequency breast changes - darkened areola, enlarged montgomery's glands quickening what is quickening when should it occur - fluttering movements by the fetus, usually occurs 16- 20 weeks gestation what are probable signs of pregnancy - cervical changes hegars sign - softening of lower uterus chadwicks sign - bluish color of vagina goodells sign - softening of cervical tip ballottment - rebound of unengaged fetus braxton hicks - painless, irregular, usually relieved by walking positive pregnancy test positive signs of pregnancy - fetal heart tones visualization of fetus via ultrasound fetal movement how many days does it take for Hcg to be detected in the blood and urine after conception blood - 6-11 days urine - 26 days what is nageles rule - to calculate the estimated date of birth, subtract 3 months and add 7 days to the first day of last period what is mcdonalds rule - measure fundal height in cm. between weeks 18-32 fundal height should approximate gestational age. what is the most widely used test for evaluating fetal well being - non stress test non stress test results - reactive vs non reactive - reactive NST (normal) 2+ fetal accelerations in 20 mins nonreactive NST (abnormal) less than 2 accelerations in 20 mins describe an acceleration - increase in FHR by 15 above baseline and last for 15 seconds.
Contraction stress test results - negative and positive - negative - normal at least 3 uterine contractions in 10 mins with no late deceleration. positive - late deceleration occur with 50% or more of contratcions, suggestive of uteroplacental insufficiency What does a Biophysical profile assess - ultra sound to visualize physiological characteristics of fetus. Assesses fetal breathing movements gross body movements fetal heart rate nonstress test amniotic fluid volume scoring 8-10 normal 6 borderline 0-4 abnormal what is amniocentesis used for in early pregnancy - genetic work up for fetal anomalies ex - down syndrome, trisomy 18 & 13 done at 14-16 weeks what is amniocentesis used for in late pregnancy - assess fetal lung maturity L:S ratio of 2:1 indicates fetal lung maturity what is the normal fetal heart rate - 110- 160 what is the age of viability in weeks - 20 weeks what is the 5 digit system for describing pregnancies (GTPAL) - G - gravidy (number of pregnancies including current one) T - term births (38 weeks +) P - preterm births (20 weeks to 37 completed weeks) A - abortions/miscarriages prior to 20 weeks L - living children What are teratogens, when are they most dangerous - fetus most vulnerable in first t trimester drugs, cigarettes, alcohol, excessive temperatures, infections Group B strep -
when is culture done? what is done during pregnancy? - culture at 35-36 weeks treat positive culture with PCN every 4 hours while in labor. what tests are preformed at 28 weeks - screening for diabetes administer rhogam (D) immune globulin (Rhogam) if Rh negative begin NST testing twice a week for any pregnancy at risk for intrauterine death S/S of gestational hypertension - onset after 20 weeks gestation elevated BP of 140/90 or greater on 2 occasions at least 4 hours apart within 1 week no proteinuria mild preeclampsia - all signs of gestational hypertension with the addition of proteinuria of 1-2+ Severe preeclampsia - BP 160-110 or greater on 2 seperate occasions 6 hours apart on bed rest proteinuria 3+ oliguria headache/blurred vision hyperreflexia extensive peripheral edema what is the anticonvulsant drug used for preeclampsia? - mag sulfate drug of choice for prophylaxis and treatment. reduces seizure threshold, also reduces BP because it relaxes smooth muscles. what is a side effect you should tell the pt they might experience with mag sulfate - may feel hot, flushed, sedated. S/S of mag sulfate toxicity - absence of patellar deep tendon reflex UO less than 30 ml/ hour RR less than 12/ min decreased LOC cardiac dysrhythmias what should you do if mag sulfate toxicity is suspected - discontinue give calcium gluconate notify HCP Manifestations of hypoglycemia - nervous headache weakness irritable
hunger blurred vision tingling of mouth or extremities manifestations of hyperglycemia - thirst nausea abdominal pain frequent urination flushed dry skin fruity breath Explain the 1 hour Glucose tolerance test - at 24-28 weeks gestation: 50 g of oral glucose given. 1 hour later plasma glucose is taken. do not need to fast positive test is 140 or greater (70-110 normal) will then have 3 hour glucose tolerance test. Explain the 3 hour Glucose tolerance test - overnight fasting prior, no caffeine or smoking 12 hours prior fasting blood glucose is obtained, 100 g glucose given, blood glucose taken at 1, 2, 3 hours following glucose ingestion. 140 is positive for gestational diabetes what are the insulin needs during each trimester - 1st - need less insulin 2nd and 3rd - need more insulin Hyperemesis Gravidarum diet teaching - eat small frequent meals. dry food like crackers may help nausea. increase fluid intake when not feeling nauseated. seltzer, ginger ale and sparkling waters may be helpful. causes of abruptio placentae - trauma preeclampsia multi parity cocaine use S/S - abruptio placentae - dark red PAINFUL bleeding board like abdomen immediate C-section S/S - placenta previa - painless bright red bleeding can be treated with bed rest
Hydatidifrom Mole / molar pregnancy - grapelike clusters of brown vaginal bleeding, rapid uterine growth have persistently high HCg levels need elective expulsion should avoid becoming pregnant for 1 year or until hcg levels return to normal how do you determine frequency of contractions - beginning of one contraction to beginning of another. how do you monitor intensity of contractions - can only be accurately measured with an internal uterine pressure catheter (IUPC) what are stations? - negative station is above the ischial spine 0 station is at the ischial spine or engaged positive station are below ischial spine S/S of false labor - contractions braxton hicks, irregular, do not increase in frequency or intensity, felt in lower back or abdomen above belly button. decrease with walking or position changes. S/S of true labor - regular in frequency, become stronger and last longer, walking increases intensity, continue despite comfort measures. felt in lower back radiating to abdomen. bloody show present What occurs in the 1st stage of labor - cervix dilates from 0-10 cm latent phase 0-3 cm frequency of contractions 5- 30 mins active stage 4-7 cm frequency of contractions 3-5 mins transition phase 8-10 cm frequency of contractions 2-3 mins what occurs in the 2nd stage of labor - pushing stage: complete dilation through delivery of baby. assess FHR every 15 mins what occurs in the 3rd stage of labor - delivery of bay until delivery of placenta what occurs in the 4th stage of labor - 1-2 hours after delivery of placenta asses vitals, fundus and lochia every 15 minutes x4 and every 30 minutes x2 and every 60 minutes x1.
hemorrhage is a priority concern. Explain the 3 categories of FHR - category 1 baseline FHR 110-160 moderate variability can have accelerations and early deceleration but no variable or late deceleration category 2 anything that is not cat 1 or 3 category 3 sinusoidal pattern recurrent variable or late deceleration bradycardia What is classified as an acceleration - baseline up 15 beats a min lasting 15 seconds types of deceleration's - VEAL CHOP Variable - cord compression - move client early - head compression acceleration - okay! late - placental insufficiency - actions needed ASAP What med: contracts the uterus after delivery, used to treat post postpartum hemorrhage. need baseline BP before giving - Methylergonovine What med: induces labor or contracts the uterus after delivery. stop immediately if there is late deceleration's - Oxytocin What med: Stimulates fetal lung maturation between 24- 32 weeks gestation Betamethasone What med: softens and thins the cervix - Misoprostol What med: prostaglandin synthetase inhibitor. can be used as a tocolytic in preterm labor. Indomethacin What med: used during labor when client is positive for group b strep. - Penicillin G What med: may be used with ectopic pregnancy to stop the growth of the embryo to save the tube - Methotrexate What med: Beta adrenergic agonist. last resort for preterm labor. call provider if HR is greater than 130. - Terbutaline sulfate.
Ob client with tachycardia what do you think is the problem? - hemorrhage never place laboring client on back could cause supine hypotension - always place a wedge under the hip if laying supine how should oxygen be delivered to laboring clients - 8-10 L via nonrebreather face mask what do you do for shoulder dystocia - mcroberts maneuver and supra pubic pressure. NOT fundal pressure! NEVER PERFORM A VAG EXAM ON A CLIENT WITH UNEXPLAINED VAG BLEEDING when does colostrum transition into milk - 2-3 days post partum Client teaching for engorgement - breastfeed every 2-3 hours. encourage a warm shower prior to feeding immediately after and in between feedings apply cold compress. engorgement vs mastitis - untreated engorgement leads to mastitis. S/S tenderness in one are of breast, hot red area on breast, flu like symptoms. Lochia types/ duration - RARE STEAK ALWAYS rubra - bright red, may have small clots lasts 1-3 days Serosa - brownish red or pink days 4-10 Alba - yellowish, white creamy can last 6 weeks postpartum what do you assess while examining the perineum post partum while assessing episiotomy - REEDA : redness edema ecchymosis drainage approximation what are indicators of hemorrhage post partum - saturated pad in 15 mins or less numerous large clots pooling under butt boggy uterus change in LOC persistent lochia rubra beyond day 3 (retained placental fragments) spurting of bright red blood- cervical/ vaginal laceration
Focused assessment of mom post partum - BUBBLE HERV : b-breasts u - uterus (fundal height, uterine placement, consistency) b - bowel and Gi function b - bladder l - lochia (color, consistency, odor, amount) e - episiotomy (REEDA) h - hemorrhoids e- emotions r- rubella (no pregnancy 1 month after receiving ) v- vaccines (influenza, pneumonia, tdap) where is the fundus located after delivery - umbilicus which blood type will recieve rho gam - a Rh - mom with Rh+ baby with negative maternal coombs umbilical cord vessels - 2 arteries 1 vein what is included in the APGAR when is it done & scoring - APGAR done at 1 & 5 minutes heart rate - greater or less than 100 respiratory effort - weak or good cry muscle tone - poor or good flexion of extremities reflex irritability - grimace or cry color - blue extremities or all pink rating: 7-10 normal 4-6 moderately distressed 0-3 severely distressed scored 0-2 in each category. newborn vitals - HR - 110- 160 RR- 40- 60 temp - axillary 97.7 -99. 1 ...dont take rectal temp! BP - 60-80 over 40-50 when do the fontanels close - anterior - 18 months posterior - 8- 12 weeks when is meconium passed - within 48 hours after delivery
When using a bulb suction what do you do first nose or mouth? - M BEFORE N mouth before nose how many wet diapers should a newborn have a day - 6-8 when does pathologic jaundice occur - appears before 24 hours or is persistent after day 7 indicates underlying disease, usually Rh incompatibility or infection when does physiologic jaundice occur - appears after 24 hours of age caused by breakdown of RBC, excessive bruising and immature liver where is the best place to assess for jaundice - blanching skin on sternum or cheek feeding for jaundice - feed every 3-4 hours to prevent dehydration and promote bilirubin excretion through stool what is kernicterus - bilirubin levels 25+ can lead to anemia and brain damage. will receive exchange transfusion what is the most common organism in yeast infections - candida albicans what is responsible for most cases of cervical cancer - HPV what is the Ca 125 blood test used to detect - ovarian cancer. more than 35 is considered abnormal what are factors contributing to breast cancer - first degree relative early menarche (before 12) and late menopause (after 51) nulligravida early or prolonged use of oral contraceptives long term use of hormone replacement therapy overweight, sedentary, excessive alcohol intake when and how often should you get a mammogram - 40+ should get mammograms every 1-2 years get clinical breast exam annually when should you do a breast self exam - monthly 1 week after period mastectomy post op care: - HOB at 30 degrees, arm on pillow no injections, blood draws or pressures on affected side sling on affected side when walking
Hematologic condition that coexists with severe preeclampsia involving hepatic dysfunction - HELLP syndrome why do newborns receive erythromycin ointment in their eyes within 1 hour after birth preventative treatment for chlamydia and gonorrhea HIV and pregnancy - no breast feeding elective C section at 38 weeks When is the HPV vaccine (Gardasil) given to girls - given as 3 injections over a 6 month period given between ages of 11- 26 girls boys get it at 11-12