N306 Exam 1 Study Guide Latest Updated/Hartman., Exams of Health sciences

Download N306 Exam 1 Study Guide Latest Updated/Hartman. and more Exams Health sciences in PDF only on Docsity! * Test 1 * Final N306 Exam 1 Study Guide (40 questions) Antepartum Assessments & Care 1. Reproductive Cycle & Fertilization ● https://www.youtube.com/watch?v=MLJTLAKFM3k A nurse is teaching a woman about her menstrual cycle. The nurse states that ● Proliferation of the endometrium is the most important change that happens before the secretory phase of the menstrual cycle. The clinic nurse knows that the part of the endometrial cycle occurring from ovulation to just prior to menses is known as the secretory phases occurs from the time of ovulation to the period just prior to menses, or approximately days 15 to 26. ● ➢ The secretory phases occurs from the time of ovulation to the period just prior to menses, or approximately days 15 to 26. ➢ Amniotic fluid first appears at about 3 weeks. ➢ There are approximately 30 mL of amniotic fluid present at 10 weeks’ Reproductive Cycle: Menstrual Cycle 28 days MENSTRUAL CYCLE Ovarian Cycle: the maturation of the ova consisting of Follicular Phase - (from the 1st day of menstruation to 12-14 days) LH & FSH cause graafian follicle to mature producing Estrogen Ovulatory Phase - (begins when estrogen levels peak until oocyte released from graafian follicle) = OVULATION ^LH Luteal Phase - (begins after ovulation and lasts 14 days) ^ estrogen & progesterone If pregnant, know that the corpus luteum secretes estrogen & progesterone until placenta matures and assumes this function > If pregnant, corpus luteum will continue to secrete estrogen & progesterone until placenta matures > If NOT pregnant, corpus luteum degenerates = < in progesterone and beginning of menstruation Endometrial “Uterine” Cycle: changes in the endometrium of the uterus in response to the ovarian cycle Proliferative Phase - (occurs following menstruation ending with ovulation) endometrium preparing for implantation =more THICK & VASCULAR Secretory Phase - (after ovulation and ends with onset menstruation) = continues to THICKEN ^progesterone Menstrual Phase - sloughing off of the endometrium = PERIOD . Fertilization: “Conception” occurs when the sperm nucleus enters the nucleus of the oocyte within the outer third of the fallopian tube . The fertilized egg is then called a ZYGOTE and contains a diploid number of chromosomes = 46 gestation, and this amount increases to approximately 800 mL at 24 weeks’ gestation. After that time, the total fluid volume remains fairly stable until it begins to decrease slightly as the pregnancy reaches term. 3. Physiological changes pregnancy by system (pg 54) CHADWICKS SIGN: BLUISH DISCOLORATION OF THE CERVIX Cardiovascular system: 10-15bmp increase heart rate (Woman feels palpitations at second trimester, assessed low blood pressure) NORMAL 4. Psychological & Developmental Tasks Psychological: Developmental Tasks > The events of pregnancy and childbirth are considered a developmental “maturational” crisis is the life of a family All family members are affected Acquiring knowledge and plans for the specific needs of pregnancy, childbirth, and early parenthood Preparing to provide for the physical care of the newborn Adapting financial patterns to meet increasing needs Realignment of tasks and responsibilities Adjusting patterns of sexual expression to accommodate pregnancy Expanding communication to meet emotional needs Reorienting of relationships with relatives Adapting relationships with friends and community to take account of the realities of pregnancy and the anticipated newborn Nursing Tasks Assess knowledge related to pregnancy, childbirth, and early parenting. Assess progress in developmental tasks of pregnancy. Explore patterns of communication related to emotional needs, responsibilities, and new roles. Include the entire family; assessments and interventions must be considered in a family-centered perspective. Provide education and guidance related to pregnancy, childbirth, and early parenting ● ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ 5. Fetal & Placental Development The fetal circulatory structure that connects the pulmonary artery with the descending aorta is known as which of the following? Ductus arteriosus An ultrasound of a fetus’ heart shows that “normal fetal circulation is occurring.” Which of the following statements is consistent with the finding? A r i g h t t o l e f ●t shunt is seen between the atria known as foramen ovale (after 3 months after delivery the the foramen ovale closes n response to increased blood return to the L atrium. Information provided by the nurse that addresses the function of the amniotic● fluid is that the amniotic fluid helps the fetus to maintain a normal body ● temperature and also Cushions the fetus from mechanical injury ○ The perinatal nurse explains to the student nurse that in the fetal circulation, ● the lowest level of oxygen concentration is found in the umbilical arteries = ○ TRUE, The highest oxygen concentration (PO2 = 30–35 mm Hg) is found in the blood returning from the placenta via the umbilical vein; the lowest oxygen concentration occurs in blood shunted to the placenta where reoxygenation takes place. The blood with the highest oxygen content is delivered to the fetal heart, head, neck, and upper limbs, and the blood with the lowest oxygen content is shunted toward the placenta. After birth, the perinatal nurse explains to the new mother that prolactin is the hormone responsible for stimulating milk production. During prenatal class, the childbirth educator describes the two membranes that envelop the fetus. The amnion contains the amniotic fluid, and the chorion is the thick, outer membrane. The perinatal nurse is teaching nursing students about fetal circulation and explains that fetal blood flows through the superior vena cava into the right atrium via the foramen ovale. Embryo and Fetal Development: first 8 wks= Organogenesis Ectoderm Mesoderm Endoderm After 9th wk = Fetus Fetus Circulation: ^ levels of oxygenated blood enter the fetal circulatory system from the Placenta -> Umbilical Vein Ductus Venosus connects Umbilical Vein to Inferior Vena Cava Foramen Ovale (opening between L & R atrium) after delivery shunt closes within 3 months from blood returning to the L atrium Ductus Arteriosus (connects Pulm Artery to Descending Aorta) after delivery it constricts in response to ^ blood oxygen levels and prostaglandins ● ● ○ ● ○ Ductus Venosus connects Umbilical Vein to Inferior Vena Cava Foramen Ovale (opening between L & R atrium) after delivery shunt closes within 3 months from blood returning to the L atrium Ductus Arteriosus (connects Pulm Artery to Descending Aorta) after delivery it constricts in response to ^ blood oxygen levels and prostaglandins ● ○ ● ○ Placenta Development: formed from both fetal and mother tissue Chorionic Membrane (trophoblast & chorionic villi) Form fetal blood vessels of the placenta Endometrium (decidua) = 3 layers Decidua Basalis: forms maternal side of the placenta > Placenta is divided into lobes “cotyledons” > Placental membrane separates maternal/fetal blood from mixing but allows for exchange of nutrients, gases and electrolytes through diffusion and active transport ● ● ● ● Major Hormones of the Placenta Progesterone: < in uterine contractility & facilitates implantation Estrogen: “enlargement” breasts and uterus hCG: + preg test, ^ in 1st trimester as it stimulates corpus luteum to keep secreting estrogen and progesterone until placenta is able to secrete it (6-7wks) hPL: promotes fetal growth by regulating glucose and stimulates breasts to lactate Umbilical Cord = 1 vein (oxygenated blood) and 2 arteries (deoxygenated blood) A.V.A ● ○ ○ ○ ● ○ ○ ■ ○ ○ ● ○ ○ ○ ● ○ ○ ○ ○ ○ ● ○ ○ ○ ○ ○ ○ ○ ● ○ ○ ○ ● ○ ○ ● ○ Hemorrhoids Take warm sitz bath Use witch hazel pads Apply topical ointments to relieve discomfort Backaches Exercise regularly Perform pelvic tilt exercises Arching & straightening back Use proper body mechanics -use legs to lift Use side-lying position SOB or Dyspnea Maintain good posture Sleep with extra pillows Contact HCP if symptoms worsen Leg Cramps Extend the affected leg Keep knee straight Dorsiflex the foot (toes towards head) Apply heat while extended Contact HCP if persists Varicose Veins & Lower Extremity Edema Rest with legs elevated Avoid tight/constricting clothing Wear support hose Avoid sitting & standing in one position for long periods of time Do not sit with legs crossed at the knees Sleep in the left-lateral position Exercise moderately with frequent walking to stimulate venous return Gingivitis, Nasal Stuffiness, Epistaxis Gently brush teeth/Good dental hygiene Use a humidifier Use normal saline drops or Spray Braxton Hicks contractions Instruct client to change position & walking should cause contractions to subside If contractions increase in intensity and become frequent with regularity - Notify HCP Supine Hypotension Lie in a side-lying or semi-sitting position with her knees slightly flexed 8. Anticipatory Teaching & Health Promotion >>>>>> 9. Danger Signs & Interventions during pregnancy ● True anemia, or iron-deficiency anemia, occurs when the hemoglobin level ○ drops below 10 g/dL. The blood’s decreased oxygen-carrying capacity causes a○ reduction in oxygen transport to the developing fetus. Decreased fetal oxygen ○ transport has been associated with intrauterine growth restriction (IUGR) and○ preterm birth . ○ ○ ● ○ ○ ○ ○ ○ Warning/Danger Signs First Trimester Abd Cramping/Pain: poss threatened abortion, UTI, appendicitis Vaginal Spotting/Bleeding: “ “ Absent Fetal Heart Sound: poss missed abortion Dysuria, Freq, Urgency: poss UTI Fever/Chills: poss infection Prolonged N/V: hyperemesis gravidarum, ^ risk for dehydration Second Trimester Abd/Pelvic Pain: poss appendicitis, UTI, PTL or pyelonephritis Vaginal Bleeding: poss infection, friable cervix from preg changes, placenta previa, abruption placenta or PTL Absent Fetal Heart Sound: poss missed abortion Dysuria, Freq, Urgency: poss UTI Fever/Chills: poss infection ● ● External & Internal Electronic Fetal and Uterine Monitoring Influences on FHM 11. Utero-Placental pg. 238 Utero-Placental Unit ● ● Oxygenated blood from mother is delivered to the intervillous space in the placenta via uterine arteries Nutrients, gas exchange, O2, CO2, water and wastes products are also exchanged in the intervillous space across the membranes ★ ○ ○ Effective O2 & CO2 transfer are dependent on Adequate uterine flow Sufficient placental area ○ Prolonged N/V: hyperemesis gravidarum, ^ risk for dehydration ● ○ ■ Third Trimester S/S of PTL (abruptio placenta: placenta detaches from womb) rhythmic lower abd cramping, lower backache, pelvic pressure, ○ ■ leaking of amniotic fluid, ^ vaginal dc S/S of HTN disorder severe headache (not relieved), visual changes, facial or generalized ○ edema “ “ 10. Maternal Screening & Fetal Surveillance Tests & Labs ● Genetic Counseling ○ ○ A diagnostic test commonly used to assess problems of the fallopian ■ tubes is: Hysterosalpingogram provides information on the ■ endocervical canal, uterine cavity, and fallopian tubes. ■ ■ The nurse takes the history of a client, G2 P1, at her first prenatal visit○. The client is referred to a genetic counselor, due to her previous child ■ having a diagnosis of sickle cell anemia (autosomal recessive illness)○ Maternal Screening Risk Factors Biophysical Factors: genetic, nutritional, medical or obstetric issues Psychosocial Factors: negative maternal behaviors affecting fetus Smoking Caffeine use Alcohol/drug use Psychological status Sociodemographic Factors Age, prenatal care, parity, marital status, income and ethnicity Environmental Factors: hazards in workplace or home ○ Unconstricted umbilical cord ★ Appropriate oxygenation to the fetus depends on adequate ○ Oxygen to the mother ○ Blood flow to the placenta ○ Uteroplacental circulation ○ Umbilical circulation ○ The fetus own ability to initiate compensatory mechanism to regulate the FHR 12. Autonomic Nervous System pg. 239 Parasympathetic Nervous System (rest and digest/ homeostasis) ● ● Stimul ation < HR Mediated by the vagus nerve innervating sinoatrial (SA) & atrioventricular (AV) ★ Vagus Nerve stimulations SLOWS FHR & helps maintain variability (variability develops 28-30wks) ● ● ● ● Sympathetic Nervous System (fight or flight) Stimulation ^ FHR Responsible for FHR variability Occurring through the release of norepinephrine May be stimulated during Hypoxemia 13. Central Nervous System pg. 240 Central Nervous System (CNS) (controls activities of the body) ● Responsible for variations in FHR ● Responsible for baseline variability RT fetal activity ● Regulates & coordinates autonomic activities ● Responds to fetal movement ● Mediates cardiac & vasomotor reflexes 14. Chemoreceptors pg. 240 ● Chemoreceptors: located in the aortic arch & CNS Respond to changes in fetal O2/CO2 & pH levels = Well oxygenated fetus with normal acid-base balance > Know this is NORMAL -keep monitoring - MARKED: amplitude range > 25 bpm ★ Fetal Bradycardia: FHR <110 bpm for at least 10 min ○ ○ ○ ○ ○ ■ ● ● ● ● ● ■ ● ● ● ● ● ● ● ○ ○ ■ <FRH may lead to <CO = < umbilical cord blood flow leading to fetal hypoxia (needs immediate intervention) < 80 bpm = obstetric emergency Brady with normal variability is Benign Brady with loss of variability/late decelerations is a sign of current/impending fetal hypoxia Causes: Maternal related Supine position Hypotension Dehydration Meds: (ANAESTHETICS/ADRENERGIC RECEPTORS) Rupture of the uterus/vasa previa or placental abruption Fetal related Fetal response to hypoxia Cord occlusion Acute/late/profound hypoxemia Hypothermia Hypokalemia Chorionic head compression Fetal bradyarrhythmia TX: treat underlying cause/consider delivery Nursing Actions: Confirm EFM ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ Assess fetal movement Fetal scalp stimulation Perform vaginal exam -assess for prolapsed cord Maternal VS Have mother change in position Discontinue oxytocin to < UC’s Give O2 10L/min via non-breather mask Stop < pushing support family contact HCP ★ Fetal Tachycardia: FHR >160 bpm for at least 10 min ○ ○ ○ ■ ● ■ ○ ○ ■ ■ ■ ■ ■ ■ ■ May be a sign of fetal hypoxemia, especially with decreased variability and decelerations If tachy = 200-220 bpm, fetal demise Causes: Maternal fever/related causes Infection Exposure to meds (Terbutaline) TX: treat underlying cause & consider delivery Nursing Actions: Assess maternal VS Give meds as ordered Use ice packs, if fever Assess for dehydration - IV fluids Change the mother’s position Decrease/Stop Pitocin (Oxytocin) Notify HCP ★ ○ ○ Periodic v. Episodic Changes Periodic = accelerations/decelerations in FHR due to UC & persist Episodic = accelerations/decelerations in FRH not associated with UC (accelerations common) ★ ○ ○ ○ FHR Accelerations = predictive of adequate central fetal oxygenation and absence of fetal acidemia Visually abrupt transient increases above the FHR baseline 15 beats above the baseline (15 sec-2 min) Prolonged accelerations >2 min but < 10 min ★ ○ ○ ○ ○ FHR Decelerations = transitory decreases in the FHR baseline Classified according to shape, timing & duration in relationship with the contraction RECURRENT if occur in at least 50% of UC’s within 20 min INTERMITTENT if occur fewer that 50% of UC’s within 20 min Nadir: lowest point of the deceleration (occurs at the peak of the contraction) ● ● - EARLY Decelerations: visibly apparent & symmetrical Mirrors the UC’s Normal VEAL CHOP Variable (commonCord compression Early Head compression Accelerations Oxygenation okay Late Placental insufficiency ● ● ● ● VARIABLE Decelerations: visibly apparent, abrupt decrease in FHR Most common during labor Decrease FHR is > 15 bpm for > 15 sec and <2min in duration Can be a V, W or U shaped May be due to umbilical cord occlusion/ cord compression REPOSITION THE PATIENT > Consider Amnioinfusion, tocolytics, delivery ● ● LATE Decelerations: visibly apparent, symmetrical gradual decrease of FHR due to UC’s May be a sign of fetal intolerance to labor Nadir occurs after peak of contraction ○ Move pt to OR 21. Amnioinfusion pg. 251 Amnioinfusion: room temp normal saline is infused into the uterus transcervically via an intrauterine pressure catheter to increase intra amniotic fluid cushioning the umbilical cord and reducing cord compression. > Used when there are Variable Decelerations in the first stage of l abor due to a decrease in amniotic fluid Also know the functions of the amniotic fluid: provides cushion for the fetus and prevents the fetus from getting contractures when bending arms and legs > mother is able to exercise, encouraged to walk daily Antenatal Assessments ● ○ ● 22. Biophysical assessments (US) pg. 116 ● ○ ○ ○ ○ ○ ○ ○ ● Ultrasonography: high frequency sound waves producing an image or an organ or tissue Gestational Age Fetal Growth Fetal Anatomy Placental Abnormalities & location Fetal Activity Amount of Amniotic Fluid Visual Assistance for invasive procedures -> amniocentesis > Standard Ultrasounds are typically done in 1st trimester to confirm preggo & calculate gestational age Transvaginal Ultrasound - done at 1st trimester ● ★ ○ ○ ○ ○ Abdominal Ultrasound - supine position To calculate gestational age = measurements of Fetal-crown rump length Biparietal Diameter Femur Length Most accurate <20 wks 23. Biochemical assessments pg. 121 Amniocentesis meconium fetal feces CVS Amniocentesis: less than 1% fetal loss rate after 15 weeks gestation ● ● ● ● ○ ○ ○ ● Chorionic Villus Sampling (CVS): the aspiration of a small amount of placental tissue for chromosomal, DNA and metabolic testing Done within 10-12 weeks for chromosomal analysis to detect fetal abnormalities caused by genetic disorders It tests for Cystic Fibrosis but NOT for Neural Tube Defects Performed ideally at 10-13 wks - NOT recommended before 10 weeks Procedure Supine/Lithotomy position A catheter/needle is inserted transvaginally with ultrasound guiding it (teaching) Sample of chorionic “placental” tissue is removed Risks ○ ○ ● ○ ○ ○ ○ ○ ○ ○ 10% of women experience bleeding 7% fetal loss rate due to bleeding or infection Nursing Actions Review procedure with mother & fam Instruct breathing exercises Assist into position Label specimens Auscultate FHR after procedure twice in 30 min Assess mother’s well being Instruct mother to notify HCP if there is any abd cramping, fever, chills, bleeding Adm RhoGam to RH-negative women post procedure as indicated Amniocentesis: a diagnostic procedure in which a needle is inserted through the maternal abdomen wall into the uterine cavity to obtain amniotic fluid Not part of a normal prenatal visit Genetic testing (mother older than 35) Hemolytic disease Fetal lung maturity testing: Lecithin/sphingomyelin (L/S) ratio L:S ratio >2:1 indicates fetal lung maturity L:S ratio <2:1 indicates fetal lung immaturity in increased risk of respiratory distress syndrome. Phosphatidyl glycerol (PG) + PG indicates fetal lung maturity. - PG indicates immature fetal lungs. Lamellar body count (LBC) LBC of ≥50,000/μL is highly indicative of fetal lung maturity. LBC of ≤15,000/μL highly indicative of fetal lung immaturity. LBC results can be hindered by the presence of meconium, vaginal bleeding, vaginal mucous, or hydramnios. Hemolytic disease in the fetus Intrauterine infection Performed at 14-20 weeks (Hartman said 16-20wks) Results are in 2 weeks Risks Trauma to the fetus/placenta RH sensitization from fetal blood in mother’s circulation Bleeding Preterm labor Infection Nursing Actions Review the procedure with the mother If < 20 wks, a full bladder may be required for full visualization Breathing & Relaxation techniques Explain a local anaesthetic will be used Prep abd with antiseptic (Betadine) Label specimens Instruct woman not to lift anything heavy for 2 days Auscultate FHR after procedure twice in 30 min Assess mother’s well being Instruct mother to notify HCP if there is any abd cramping, fever, chills, bleeding Adm RhoGam to RH-negative women post procedure as indicated Ultrasonography to guide placement LESS THAN 1%FETAL LOSS RATE AFTER 15 WEEKS GESTATION! ○ ● ● ● ○ ■ ■ ○ ■ ■ ○ ■ ■ ■ ● ● ● ● ● ○ ○ ○ ○ ○ ● ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ Q: on why amniocentesis is done: Genetics testing and fetal lung maturity testing One of the two (its both so idk which one is the right ● answer) depending on how far along she is 24. Maternal Assays (AFP, multiple marker screen) pg. 123 trisomies - genetic disorder - 3 copies instead 2 of a chromosome ● Neural tube defects are birth defects of the brain, spine, or spinal● cord. ● ○ ○ ○ ● ● ○ ○ ○ ● ○ ● ○ ○ ■ Alpha-fetoprotein (AFP): a glycoprotein produced in the fetal liver, gastrointestinal tract, and yolk sac in early gestation. Used to screen for NTD (spinal defects) & Ventral Abd Wall defects 95% of NTD are occur in the absence of risk factors, it is done routinely Procedure: blood sample is taken and sent to the lab < Levels may be Chromosome 21 defect (Trisomy 21/ Down Syndrome) (follow up with amniocentesis  then administer RhoGAM if indicated by physician > Levels may be NTD, anencephaly, omphalocele, and gastroschisis (follow up with ultrasound) Further tests are done Risks for high false-positives & negatives may also occur causing stress to the mother & family Nursing Actions Educate mother about the screening Support mother & assist in scheduling Provide support group information Multiple Marker Screen Triple Marker Screening: combines all three chemical markers AFP Human chorionic gonadotropin (hCG) Estriol levels —With maternal age to detect some trisomies and NTDs . Used as an alternative to amniocentesis Quad screen: adds inhibin-A to the triple marker screen to increase detection of trisomy 21 to 80% Done at 15-16 weeks Maternal blood is drawn & sent to lab Low levels of maternal serum alpha-fetoprotein (MSAFP) and Assessment of fetal breathing movement, gross body movement, fetal tone, amniotic fluid volume, and heart rate reactivity. Indicated in pregnancies involving increased risk of fetal hypoxia and placental insufficiency such as maternal diabetes and hypertension. An NST with the addition of 30 minutes of ultrasound observation for four indicators: fetal breathing movements, fetal movement, fetal tone, and measurement of amniotic fluid. Assess fetal breathing movements: One or more episodes of rhythmic breathing movements of 30 seconds or movement within 30 minutes is expected. Assess fetal movement: Three or more discrete body or limb movements in 30 minutes are expected. Assess fetal tone: One or more fetal extremity extension with return to fetal flexion or opening and closing of the hand is expected. Assess amniotic fluid volume: A pocket of amniotic fluid that measures at least 2 cm in two planes perpendicular to each other is expected. A score of 2 (present) or 0 (absent) is assigned to each of the five components. A total score of 8/10 is reassuring. A score of 6/10 is equivocal and may indicate the need for delivery depending on gestational age. A score of 4/10 means delivery is recommended because of a strong correlation with chronic asphyxia A score of 2/10 or less prompts immediate delivery. Fetal activity decreases or stops to reduce energy and oxygen consumption as fetal hypoxemia worsens. Decreased activity occurs in reverse order of normal development. Process of Labor 26. Factors affecting labor (5 Ps) pg. 186 Powers Passage Passenger Psyche Intrapartum Period = with onset of reg uterine contractions lasting until placental expulsion > Labor is triggered by Both Maternal & Fetal factors 1. Powers “Contractions” - involuntary uterine contractions (UC) of labor and voluntary pushing or bearing down process Frequency (mins): time from beginning of one contraction to the beginning of another Duration (sec): time from beginning of one contraction to the end. Intensity: strength (mild, moderate, or strong) Bearing-down: occurs once the cervix is fully dilated (10 cm) and the woman feels the urge to push 2. Passage “Pelvis & Birth Canal”- the bony pelvis and the soft tissues of the cervix, pelvic floor, vagina, and introitus (external opening to the vagina) Station: refers to the relationship of the ischial spines to the presenting part of the fetus and assists in assessing for fetal descent during labor Soft tissue- effaces and dilates, allowing the descending fetus into the vagina 3. Passenger “Fetus” - fetal skull, fetal attitude, fetal life, fetal presentation, fetal size Fetal skull- molding (the ability of the fetal head to change shape to accommodate/fit through the maternal pelvis) two parietal bones, two temporal bones, the frontal bone and occipital bone fetal attitude or posture- proper attitude → head is in complete flexion in a vertex presentation Position ● ● ● ● ● ● ● ○ ● ● fetal presentation: cephalic (head first), breech (pelvis first), and shoulder (shoulder first) ● ● ● ● 4. Psyche “Woman’s Response” factors that influence the woman’s coping mechanism include: culture- important to have a general understanding of birth practices of the groups with which they work expectations- how childbirth is viewed by the woman/past experiences support system- gives the mother a good sense of control labor support- helps with anxiety and fear ● ● ● 5. Position first stage of labor- an upright position second stage- fetus aligns with pelvic inlet births- lithotomy position 27. Onset of labor True vs False labor pg. 195 ● ● True Labor Contractions occur at REGULAR intervals and Increase in Frequency, Duration and Intensity TRUE Labor: contractions bring about changes in cervical effacement and dilation FALSE Labor: irregular contractions with little or No cervical changes 28. Stages of Labor & Childbirth pg. 198 While performing Leopold’s maneuvers on a woman in early labor, the nurse palpates a flat area in the fundal region, a hard round mass on the left side, a ● soft round mass on the right side, and small parts just above the symphysis. ○The nurse concludes which of the following? The fetal presentation is scapular – shoulder ○ ○ ● ● ● Labor or “Parturition” is the process in which the fetus, placenta, and membranes are expelled through the uterus First Stage: Onset of Labor -> Complete Cervical Dilation Latent Phase (0-3 cm) Woman feels a surge of energy Active Phase (4-7 cm) Transition Phase (8-10 cm) Woman feels irritable, tells people to get out of the room Second Stage: 10 cm -> Birth Third Stage: Delivery of the Placenta Fourth Stage: Postpartum 29. Episiotomy & Lacerations pg. 212 ○ ○ ○ ○ Episiotomy: an incision in the perineum to provide more space for the presenting part at delivery > no longer typical Median/Midline = at the midline Heals More Quickly with less discomfort Mediolateral = cut at a 45 degree angle to the L or R and may by used for a large infant. Heals Slowly Causes greater blood loss More painful Lacerations: tears in the perineum that may occur at delivery > They may occur in the Cervix Vagina and/or Perineum ● ● ● ● Degrees 1st Degree - perineal skin & vaginal mucous membrane 2nd Degree - skin, mucous membrane & fascia of the perineal body 3rd Degree - skin, mucous membrane & fascia of the perineal body & extends to the rectal sphincter 4th Degree - extends into the rectal mucosa and exposes the lumen of the rectum 30. Newborn transition & Apgar scoring pg. 216 Newborn transition & initial care occur in labor & delivery room. > APGAR Scores should be obtained at 1 Minute and 5 Minutes after Birth. APGAR Score is a rapid assessment of 5 physiological signs that indicate the physiological status of the newborn including Activity (Muscle Tone) Muscle Tone on degree of flexion & movement of extremities Pulse HR based on auscultation Grimace Reflex Irritability on response to tactile stimulation Appearance Color on observation Respirations RR based on observed movement of the chest Rubella titer is negative: must give immunization after delivery NAEGELES RULE GRAAFIAN FOLLICLE: LH & FSH HORMONES CORPUS LUTEUM: PROGESTERONE AND ESTROGEN GTPAL Infertility: combination of women and male factors ( man blames his wife that she is the cause of them not being able to conceive. The nurse intervenes and tells them that it can be cause by both male and female causative factors. 1/3 True/ false labor Woman calls the hospital and says that she has been laying down watching TV and she has sudden dizziness : nurse ask if she has been laying on her back for a long time ( woman is 28weeks pregnant) Woman has been in labor for 12 hours: her baseline is 140 150 and rises to 170-> causes fetal stress Ambivalence is normal Amniotic fluid -> cushions the baby First 8 weeks if pregnancy is most crucial Woman feels the baby moving -> this is a Presumptive sign (Quickening) Stage 2 labor What is the most important thing about FHR monitoring? Non stress test: do not give oxytocin to stimulate contractions 7. A woman you are caring for in labor requests an epidural for pain relief in labor. Included in your preparation for epidural placement is a baseline set of vital signs. The most common vital sign to change after epidural placement: a. Blood pressure, hypotension b. Blood pressure, hypertension c. Pulse, tachycardia d. Pulse, bradycardia 14. During preconception counseling, the clinic nurse explains that the time period when the fetus is most vulnerable to the effects of teratogens occurs from: a. 2 to 8 weeks b. 4 to12 weeks c. 5 to 10 weeks d. 6 to 15 weeks 13. Information provided by the nurse that addresses the function of the amniotic fluid is that the amniotic fluid helps the fetus to maintain a normal body temperature and also: a. Facilitates asymmetrical growth of the fetal limbs b. Cushions the fetus from mechanical injury c. Promotes development of muscle tone d. Promotes adherence of fetal lung tissue 3. During a routine prenatal visit in the third trimester, a woman reports she is dizzy and lightheaded when she is lying on her back. The most appropriate nursing action would be to: a. Order an EKG. b. Report this abnormal finding immediately to her care provider. c. Teach the woman to avoid lying on her back and to rise slowly because of supine hypotension. d. Order a nonstress test to assess fetal well-being. 1. 2 questions on GTPAL (complicated like 2 sets of twin, 2 abortions, 2 miscarriage, 1 stillborn-which is considered preterm labor) 2. 2 questions on apgar (fill in the blank, give score based on the given data on the baby) 3. Present trends- select all 4. Food high in folic acid-select all; strawberry, green leafy, lentils, milk, or beans 5. Menstrual cycle-when is the best time to have sex? 6. Which one is NOT! correct about implantation? That it occurs 2-3 weeks after conception 7. BMI is 26.5, how much weight can the women gain? 15-25 8. Nursing intervention on a variable deceleration? I think reposition the women 9. Substance abuse-select all-> abortion, low birth weight 10. Smoking- what is wrong- “I can smoke during pregnancy because I will have an easier delivery with a smaller baby 11. Teratogens-correct statement- first 8 weeks 12. August 1st is the LMP- what is the EDD? 13. Progesterone questions- increases vascularity of uterus 14. Expected cardiovascular change? I put increased heart rate by 15-20bpm 15. What do you check after 1 hours of epidural? Hypotension or headache? 16. Nursing teaching about amnionic villi sampling? Catheter is inserted 17. What is not part of the routine exam? Amniocentesis 18. Nausea and vomiting in the morning- select all- small meals, dry crackers 19. Normal skin changes-select all- chloasma, strae gravidarum, lenia nigra 20. When do you listen for the baby’s heart rate when based on the leopold maneuver you feel something round and firm in the fundus and something long and smooth on the right side? I put right upper quadrant 21. Women is having long labor with sever back pain, why? I don’t know the answer… options were Longitudinal fetal lie, womens pelvic structure and 2 more 22. What needs to be reported to HCP? Late deceleration 23. FHR has decelerations with each contractions and goes back to normal before contraction ends- what do you do? I put document and keep monitoring 24. Women’s membrane has ruptured-what is she at risk at? I put Intrauterine infection 25. Function of amniotic fluid- I put provides nutrition (cushions and temperate was already in the questions) 26. True labor- contractions are getting closer and stringer 27. 2-3 questions on genetics like the mom and dad are careers, what do you teach the patient 28. The women’s blood test shows negative rubella titer-what does this mean? I put it means that the mom is not immune and needs to get a vaccine after delivery 29. Questions on RhoGAM. Who do you give it to and why-options were weird