N306 Study Guide- FINAL EXAM,NEWLY UPDATED., Exams of Health sciences

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N306 Study Guide – Final

This guide includes all content that is important to understand in each chapter. A comprehensive level of understanding will ensure your success. For more focused guidance: If something is bolded/underlined , then it’s probably going to be on your exam. All page numbers refer to Durham 3 rd^ ed.

Chapter 3

Genetics  Nurse role and relevance of genetics to childbearing families  Common genetic (inherited) conditions that you would counsel and screen patients either prior to pregnancy or at their first prenatal visit  Testing women of advanced maternal age (AMA) (who is considered AMA) and increased risk of chromosomal abnormalities  Teratogens and at what crucial time exposure will cause the most damage o Look at each and understand what risks/complications it may pose to baby or pregnancy o Fetal alcohol syndrome  Causes? Fetal characteristics? o TORCH  Look at each and understand mode of transmission, is there treatment for it? Do we screen for it during prenatal care? How might it affect the pregnancy and baby?  What about viruses and placenta?  How long is zika in male system for? What can zika lead to in newborn who is affected by it? Menstrual Cycle  Consists of two cycles working simultaneously (ovarian and endometrial)  what are levels and roles of estrogen and * progesterone in each cycle  When is a woman most fertile? o What is considered a woman’s LMP (know that this is Day #1 of her cycle) o What happens at time of ovulation (typically what day during the cycle, what the ovaries are doing, the hormone levels, and what the endometrial lining is doing) o What day does conception occur? o When does implantation occur? What part of the blastocyst is involved in implantation? Where does implantation usually happen? What will happen if implantation occurs too early? Embryonic and Fetal Development  When to expect to see fetal cardiac activity on ultrasound  Summary of fetal development - table 3-4, p. 49.  What is considered a term pregnancy?  Difference between identical and fraternal twins  Fetal circulations (ductus venosus, foramen ovale, ductus arteriosis)  Basic concepts of placenta physiology and its purpose o Hormones produced by the placenta (what roles do these hormones play? Which is used to diagnose pregnancy? Which hormone is responsible for regulating glucose availability in the newborn?  Purposes of amniotic fluid  Normal structure of the umbilical cord Infertility  Definition of infertility  Common causes of infertility  Basic work up for infertility

Chapter 4

Prenatal Care  What is goal and purpose of prenatal care?  Diagnosing pregnancy o Most likely cause of amenorrhea? (Pregnancy) o Know presumptive, probable and positive signs of pregnancy

 Definition of Goodell’s Sign, Chadwick’s sign, Hegar’s sign, quickening  Know what symptoms could possibly attributed to something else versus what actually gives you the diagnosis pf pregnancy

o When can I hear baby’s heartbeat with an ultrasound, with a hand held Doppler o When can mom feel quickening? (baby moving) …is there a difference b/w 1 st^ and 2 nd^ time pregnancies? o Where am I expecting to find the fundus at during different gestational ages?…Where would I palpate the fundus at 24 weeks? At 28 weeks? What is normal deviation from this finding?  IF I have finding larger than expected, what might be reasons?  IF I have finding smaller than expected, what might be reasons?  Nutrition- prevention of neural tube defects- ie. spina bifida  Weight gain in pregnancy o Recommended weight gain for underweight, normal, overweight and morbidly obese (box 4-2, pg 83) o Basic nutritional requirements (calories needed and what extra vitamins and minerals are needed) o Maternal weight gain distribution (box 4-3, pg 83)  Schedule of prenatal visits o Know what is done in first trimester, 2 nd^ trimester, 3 rd^ trimester during visits (what tests are done? What is screened for? What vaccines can be given, and which can’t?)  What happens at a first prenatal visit- procedures and work up (know all the prenatal labs that need to be drawn)  Naegele’s Rule in calculating a due date (need LMP) o What is most accurate dating of gestational age?  What to expect the fundal height to be based on the number of weeks gestation= McDonald’s Rule  Definitions of gravida and para, and the TPAL system of term, preterm, abortions and living. Physiological changes of pregnancy (table 4-1, pg 58-62) & Self-Care/Relief Measures (Table 4-5, pg. 88-93)  Go through EACH system and look at the right side of the table with clinical s/s and know what those are and then make sure you know WHY you are seeing those s/s … as in, what change is happening physiologically that is resulting in the clinical s/s the client will be reporting? THEN once you know/understand this, be able to tell client that what they report is normal and what they can do about it (table 4-5). o N/V during pregnancy, fatigue, insomnia, emotional lability, tender/enlarged breasts, Braxton Hicks contractions, increased cervical/vaginal secretions (yeast infections), dyspareunia, supine and orthostatic HTN, anemia, dependent edema, varicosities, hyperventilation and dyspnea, nasal and sinus congestion, bleeding gums, flatulence, heartburn, constipation, hemorrhoids, low back pain, round ligament spasms and pain, leg cramps, stretch marks, skin hyperpigmentation, acne, headaches. o Make sure you understand physiological adaptations of pregnancy especially CARDIAC (how does the body prepare to prevent PPH, physiologically). Re-read pg. 63, 64, 65, 66 and 67.

Chapter 5

Overview of the transition the woman goes through into her new maternal role  Common psycho-social changes that accompany pregnancy  Special needs regarding specific patient populations o Teenagers  Specific concerns regarding teenage parents o Older mothers, lesbian mothers, single parents

Chapter 6

Antepartal tests  Indications for first trimester ultrasound o Best indicator of accurate dating o Why is accurate dating of pregnancy so important?  What does nuchal translucency screen for?  Anatomy US o When is it performed? o What does it look for?  Indication for umbilical artery Doppler flow  CVS o Indication

o Procedure o Timing in pregnancy o Risks o Pros and cons for parents

 Amniocentesis o Indication o Procedure o Timing in pregnancy o Risks o Pros and cons for parents  PUBS o Indication o Procedure o Timing in pregnancy o Risks o Pros and cons for parents  NIPT o Indication o Procedure o Timing in pregnancy o Risks o Pros and cons for parents  California Prenatal Screening Program (Quad Screen or Multiple Markers Screen) o Indication o Procedure o Timing in pregnancy o Risks o Pros and cons for parents  Fetal Kick Counts o Patient teaching on how to perform  NST o Indications o Procedure o Interpretation-Be sure to consider normal baseline and moderate variability in addition to accels  Reactive  What does moderate variability indicate?  What do accelerations indicate?  What teaching do we give when an NST is reactive?  Nonreactive  Vibroacoustic Stimulation  Next steps for further evaluation  CST o Indications o Procedure o Interpretation  Positive  Negative  AFI o Indications o Procedure o Interpretation (normal levels)  Oligohydramnios-know definition  Possible causes  Effects of fetus  Polyhydramnios  Possible causes  Effects on fetus

 Ef fects on mother  BPP o 5 criteria

o Which scores indicate fetal well-being and which indicate need for immediate intervention o What is a modified BPP and when might you do that instead of the entire thing?

Chapter 9

Fetal heart monitoring Be able to interpret strips in terms of baseline HR, variability, presence of accels, decels, tachysystole etc.

 http://ob-efm.com/2418.htm

 https://ncc-efm.org/game/efmgame.cfm

 **Intermittent auscultation (IA) VS continuous electronic fetal heart monitoring (EFM) o Which pt is a candidate for IA? Which is NOT?  How do you perform IA? o When is continuous EFM indicated?  How often should you assess? And what are you assessing for? o Example: If mom comes in and is in active labor and is low risk … you can do IA every 30 minutes or if she is on continuous EFM you are continuously watching the monitor, but you chart on it every 30 minutes. o You are charting:  What is the baseline  What is the variability?  Absent o What may cause absent variability and what can you do to intervene?  Minimal o What may cause minimal variability and what can you do to intervene?  **Moderate o Understand this is BEST indicator for fetal well being o What does it really mean?  Marked o What may cause marked variability and what can you do to intervene?  Are there accelerations?  Yes  No o Is it ok for her not to have accelerations while in labor? o What do accelerations mean when we do an NST (what are they telling me?)  Are there decelerations?  If no, great  If yes, what kind (and then know your interventions for each and what the cause is) o Early o Late o Variable o Prolonged  Reasons for fetal tachycardia  How frequent are her contractions?  How long do her contractions last?  What is the strength of her contractions?  Mild/moderate/strong  What does “strength mean” … as in understand there is a difference between palpation (external toco) vs IUPC  What is uterine relaxation/tone? How long of a period of relaxation to we want for adequate oxygenation  Category I, II, III tracings o Know what criteria make it category I o Know what criteria make it category III (what does this indicate?)

o Everything else that is not I or III is II

Chapter 8

Labor  Signs/Symptoms of Labor

o True vs. false labor  What kind of questions are you asking her on admission to figure out if she is in true vs false labor? o What are the main labor hormones?  Which of these hormones can we “control”? o What is the definition of labor?  5 Ps of labor o Know how each of the Ps below may have an effect on labor progress and outcome o How do we assess the “P”s?  Powers  Contractions  Pushing  Passage and position  Pelvic Types  CPD and fetal station  Understand that the positions mom is in during labor may have an effect on her labor progress and outcomes and how that will tie into her power and the passenger and fetal position  Passenger & Fetal Positions  Cardinal Movements in Labor (you don’t need to know them in order, but you need to know their significance in the labor process and how the passenger and his/her position will have an effect on the cardinal movements in labor)  Risk with transverse lie and breech  Psyche  Vaginal Exam o Dilation o Effacement o Station o Possible risks related to frequent vaginal exams  Should be for medical (maternal or fetal) indication only  Rupture of Membranes o How to assess (testing) o Importance of color of fluid o What kind of questions are you asking her on admission if she comes in saying “I think my water broke”? o Length of SROM. How long is OK? Expectant management vs induction? o **Chorioamnionitis – what is it, when does it happen, when is risk increased, what s/s will you see in mom and on FHR, treatment o GBS – understand when we screen for it, how we screen for it, and what we are doing with that information during L&D. How and when do we treat for GBS? What if we don’t know the results? What if it’s a scheduled c-section? Review Pg. 533-534 in your textbook  Stages of Labor o Know each stage and the phases of 1 st^ stage  Have a general understanding of how long is normal and what your nursing assessment is … do you think “she is ok, let her labor” or do you think “this is not OK, we need to go for a section” based on certain assessments.  What are you assessing for in 1 st^ stage to determine progress?  What are you assessing for in 2 nd^ stage to determine progress? o Know what your nursing roles/interventions are in each stage o Know how to tell if someone is in latent vs active vs transition phase (aside form a vaginal exam … what will the patient be doing/acting like)? What questions can you ask to determine? o When can meds be given? Which type of meds are you giving at what point in labor? What type of nonpharmacological interventions can you do/suggest in different phases of labor? o What is active management of labor? What is your nursing responsibility during this phase?  Meds? Fundus? Vitals?

o What are signs of placental separation? o Benefits of skin to skin for both mom and baby o APGAR score

 Know what the 5 things are and how to assign an APGAR score (FOLLOW YOUR BOOK’S VERBIAGE)  What is normal score? How often do you do it? o Pain Management in Labor  What are available options, Pros and cons of each? When can they be given? General administration process, Nursing actions, assessments, interventions, priorities, teaching, complications  IV  N2O  Epidural/Spinal o What is your priority nursing action before and after pt gets epidural?

Chapter 12 (normal PP) / Chapter 14 (high risk PP)-NEW CONTENT

 Postpartum o Be able to recognize normal vs. abnormal findings o BUBBLEDE  Know what you are assessing for each letter, why you are assessing that, and what normal abnormal finding are. o Changes to uterus/endometrium  Bleeding- How to assess normal vs abnormal  Uterine atony-common reasons this occurs (think overdistension) o Initial intervention  Lacerations-common reasons this occurs (think operative deliveries) o If the uterus is firm & midline, think laceration as the source of bleeding  Greatest risk for PPH is during which time in post delivery  Risk factors for PPH  S/s of PPH (vital signs)?  Causes of PPH (table 14-1, pg. 420) … which is the MAJOR cause of PPH?  PPH assessment and interventions (make sure you know your PPH meds!!! AND when certain PPH meds are contraindicated)  Definition of PPH  Know both the book definition and the ACOG definition  EBL vs QBL  Endometritis (definition, what increases risk, s/s, management/treatment)  Lochia, clots, education on this, danger signs  Proper fundal check and level of fundus  Where do you expect to find the fundus on PP day1 vs PP day3? 1 week PP?  After-pains (more painful for 2 nd^ and 3 rd^ time moms than G1P1. It goes away a few days later.) o Hematoma  S/s o Postpartum infection  S/s-think endometritis o Perineal Care o Breast Changes  New bra  When is colostrum formed?  Oxytocin, prolactin/placenta  Engorgement vs Mastitis - s/s, interventions o Cardiovascular changes  What are they at risk for?  Understand why pt is increased risk for thrombosis (again see pg. 64 and pg. 375)  How do you get them out of bed?  Why is there a big fluid shift?  What does this fluid shift lead to?

 Fluid shift, PP chills o Postpartum vaccinations (again, this ties back with prenatal care visits. What can you give during pregnancy? What can you not give that you have to give PP?)

o Changes in Endocrine System  Night sweats  Decreased levels of what hormone?  Elevated temp vs infection? o Changes to GI and GU system and comfort care/medications/nursing actions. How is diuresis involved with increasing h/h? How can you tell if its cystitis or normal PP physiologic change? Hemorrhoids o Important/Key components of discharge teaching  Contraception  How long is recommended time interval b/w pregnancies  PPD screening and teaching o Definition of PPH  Know both the book definition and the ACOG definition  EBL vs QBL o DIC (s/s, risks) … labs? Understand there also is a tie with fetal demise, sepsis, and preE

Chapter 13

 Transition to Parenthood o Role Transition to Motherhood/Fatherhood  What factors affect transition?  What are influencing factors? Refer to pg 414 for concept map  Taking in vs taking hold vs letting go … which is best time to teach? o Special populations: Adolescent parents o Signs of normal bonding and attachment  When to intervene when it is abnormal  Why is early bonding important? o Change in family dynamics (effects of new member on each unit) o Postpartum Blues vs Postpartum Depression vs Postpartum Psychosis  Primary concern with PPD  How do we diagnose/rule out? Hint- screening tools!

Chapter 16

 Newborn Nutrition and Feeding o Assessment of adequate feedings, number of wet and dirty diapers o Increasing milk supply o Formula feeding, how long do you keep milk in fridge/freezer/room-temp o AWHONN, WHO recommendations for length of breastfeeding (exclusive) o Contraindications to breastfeeding o Maternal and newborn advantages to breastfeeding  What is right time to wean baby? o Differences in breast milk (colostrum, transitional milk, foremilk, hindmilk) o Anatomy and physiology of milk production. Oxytocin vs prolacin hormone roles o Let down reflex o Newborn hunger cues and appropriate times to feed infant o Breastfeeding techniques and positions  Assessment of adequate feedings, number of wet and dirty diapers  Increasing milk supply o Engorgement vs Mastitis  S/s, Interventions  Newborn care o All listed from pg 493- o See which ATI skills apply here and make sure to watch those videos and review those skills.

Chapter 15 (normal NB) / Chapter 17 (high risk NB)-NEW CONTENT

 Neonate Transition to Extrauterine Life

o Changes in respiratory system (first breath) o Changes from fetal to newborn circulation o Importance of surfactant o RDS (risk factors, s/s)

 Which babies are at highest risk? o Thermoregulation (heat loss, cold stress)  Cold stress: understand how it works, nursing actions to prevent it, what s/s you would see  Hypoglycemia  What babies are at risk?  S/s  Interventions for very low BS (40 and <)-think feedings o Hyperbilirubinemia/ Newborn Jaundice  Physiologic jaundice vs pathologic jaundice  Risk factors, assessment, testing, interventions (breastfeeding/feeding regimens) , treatment o GI system- Vitamin K production, differences in poop, normal stooling pattern in baby’s 1 st^ week o Signs/Symptoms of dehydration  Newborn assessment (see pictures and tables in textbook) o Be able to recognize what is normal o Watch the newborn assessment video posted in week 4. Know how to do a head-to-toe newborn assessment, what you are checking for, why, what do normal and abnormal finding indicate?* o Cephalohematoma- common causes, findings o S/s of dehydration- Fontanelle assessment o Skin/Integumentary system- newborn lesions, rashes  Skin care  Benign lesions vs concerning lesions –parent-teaching o Newborn reflexes- know all of them and importance of assessment  How are you assessing reflexes? What are you assessing for with each reflex? What does an abnormal finding indicate? Ex/what does it mean if moro reflex has abnormal finding o Checking for hip dysplasia o Gestational age assessment (neuromuscular and physical maturity scoring) p.  Know how to look at a premature baby vs a term baby and use the Ballard gestational age assessment chart. Focus on the physical maturity scoring assessment o Pain assessment o Substance abuse  Neonatal abstinence syndrome, S/s of withdrawal  Nursing care  Fetal alcohol syndrome  Be able to differentiate s/s of cold stress VS hypoglycemia VS withdrawal in a newborn (for example, look at the s/s of each and know which s/s for hypoglycemia don’t fall under withdrawal)  Importance of understanding periods of reactivity in relation to skin to skin and breastfeeding (pg. 467)  Preterm neonate o UNDERSTAND:  One of the primary causes of illness and death in the neonate is complications r/t prematurity  Prematurity is a primary reason for LBW  The two most important predictors of infant health and survival are: Period of gestation and birthweight o What are preterm babies at risk for?  EVERYTHING! But specifically:  *RDS o Transient tachypnea  What babies are at highest risk? o Persistent pulmonary HTN  ROP  Intraventricular hemorrhage (IVH)  Necrotizing Enterocolitis (NEC)

o S/s  BPH  Infections o Modes of transition/types

 SGA vs IUGR (what is the difference? What is the difference b/w symmetrical and asymmetrical growth?) o What are common reasons for SGA?- think placental insufficiency o What are common reasons for IUGR?- think vasoconstriction  LGA vs post-term babies  Post-term babies o Expected assessment findings  Understand which babies you need to do blood sugars on

Chapter 7

 Spontaneous Abortion (Miscarriage) o Incidence o Signs and symptoms o Possible causes / risk factors o 3 different types of management (expectant, medication administration, surgery) o Nursing actions  Ectopic Pregnancy o Incidence & Most likely place of implantation o Possible causes / risk factors o Signs and symptoms o Diagnostic findings o Different types of management o nursing actions  Hydatidiform Mole o Definition  Pathophysiology o Signs and symptoms o Management o Nursing actions o Discharge teaching and follow up care  Hyperemesis o Signs, symptoms, assessment o Expected nursing care and treatments  Incompetent Cervix o Signs and symptoms  Key word is “painless”. Her cervix is changing (funneling and possibly dilating) WITHOUT her feeling contractions. Has to do with the matrix of the tissue in the lower uterine segment/cervix. If it progresses, it can cause contractions and preterm labor. o Management o Nursing actions o Discharge teaching and follow up care  Obesity-increases risk for which complications?  Infections o Know which ones are a problem in pregnancy and why  Risks during pregnancy or delivery o Effects on mother o Effects on fetus/newborn o Treatment o Patient teaching o Also review GBS o HIV- contraindications in labor  Diabetes o Pregestation  Tight glycemic control

 Patient teaching  Risks to pregnancy  Effects of Type 2 (preexisting DM) on mother and fetus

o Gestational Diabetes  Incidence of GDM  Risk factors (during pregnancy and then labor/delivery and then PP)  Effects on fetus  Screening VS diagnosing GDM  Management  Patient teaching on lifestyle changes  Patient teaching on monitoring fetal well-being Great explanation of gDM:  https://www.youtube.com/watch?v=N3jnRuzseoM  Preterm labor o Incidence is high in the United States- significant cause of neonatal morbidity and mortality o *Risk factors- Hint- infection! o S/s  Pt presentation  Diagnostic findings  Fetal fibronectin (fFn)- what is this test? o Drugs/Medication used in treatment  Know indications for use, common side effects, patient teaching  Medications- Magnesium sulfate-What is the primary reason for use with Preterm labor?  Know common side effects of Mag versus Mag toxicity  Therapeutic serum levels are 5-7 in your textbook Great explanation of PTL:  https://www.youtube.com/watch?v=lt3nPxVTC5M  PPROM (Can happen with or without preterm labor) o Risk factors /possible causes o Assessment and diagnostics-what tests do we do to r/o ROM o Treatments / Management (similar decisions for management of PTL) o Patient teaching  Hypertensive disorders of pregnancy o Chronic hypertension and Gestational hypertension  When can gestational HTN be diagnosed?  Assessment, monitoring, patient teaching, lifestyle interventions  Medical management o Preeclampsia  Diagnosis, B/P readings, lab values  S/s  Basic idea of current research on pathophysiology  Risk factors  Risks to mother  Risks to fetus  Signs and symptoms/ Maternal manifestations  Differentiate between mild and severe  Management  Medications- Magnesium sulfate-What is the primary reason for use with Pre-E?  What medications are contraindicated?  BP meds to lower/control  Delivery o Eclampsia  Interventions/Nursing actions  Effect on fetus (fetal heart rate monitor changes) o HELLP

 Know signs and symptoms  Abnormal lab values  Management / Treatment

Helpful videos on Pre-E:  https://www.youtube.com/watch?v=70tpqg58Oug  https://www.youtube.com/watch?v=yta5RRJ-Mg 8  https://www.youtube.com/watch?v=RB5s85xDshA  https://www.youtube.com/watch?v=Gmh01S0msfY  https://www.youtube.com/watch?v=Gmh01S0msfY&t=217s  DIC o Understand basic pathophysiology o Risk factors o Signs and symptoms o Treatment and nursing care  Amniotic Fluid Embolism o When can it happen? o How does it happen? o What is the result of amniotic fluid embolism (aka anaphylactoid syndrome of pregnancy)? o Risks / assessment findings / management & interventions / outcomes  Multiple Gestation o Risks during pregnancy and delivery process and PP o Increased risks for shared placentas and/or chorionic sacs  Placental Abruption (Abruptio Placentae) o Definition  Difference between concealed and visible bleeding o Risk factors o *S/s o Findings /assessments/monitoring o Nursing care/management & interventions o https://www.youtube.com/watch?v=79NnsYrAXz4  Placenta Previa o Definition o Risk factors o Types/Degrees o S/s o Assessment  How and when is it usually diagnosed? o Interventions/patient teaching o Contraindications o Nursing actions o https://www.youtube.com/watch?v=DMCowipIXgE&t=7s  Prolapsed Cord o Definition o Signs/symptoms/assessment findings o Risk factors/prevention o Nursing actions/management  Placenta Accreta o Definition/ 3 different classifications (which is more common)  How and when is it usually diagnosed? o Risk factors o Assessment findings o Medical management / nursing actions o https://www.youtube.com/watch?v=x3EMTQQjoA0&t=20s  Trauma o How and why does trauma complicate pregnancy?

o Assessment findings / management / questions to ask on admission  Cardiac pts during labor o What interventions do you take during 2 nd^ phase of labor? (labor down)  Anemia and Iron-Deficiency Anemia

o Definition  How and when is it usually diagnosed? o Risk factors o S/S/assessment findings o Management / nursing actions o https://www.youtube.com/watch?v=e4baNHUxP8I&t=310s  DVT and PE o Risk factors o Assessment findings o Understand that pregnancy increases the risk of venous thromboembolism (VTE) 4- to 5-fold over that in the nonpregnant state. WHY?  The two manifestations of VTE are DVT and PE

Chapter 10

 Dystocia o What factors influence labor? (5Ps) o Hypertonic uterine dysfunction  Definition  Findings  Management and nursing actions o Hypotonic uterine dysfunction  Definition  Findings  Management and nursing actions  Labor Induction o Reasons? What factors are considered in the decision? o Bishop score  Know the components of the bishop score  Understand why those are things we look at to determine whether the cervix is favorable for induction. What do low and high scores indicate? o Methods of induction- which method is indicated when cervix is ripe vs. unripe  Mechanical  Balloon, AROM  Pharmacological  ****Cervidil, Misoprostol (Cytotec), Pitocin  Induction vs augmentation  Which methods of induction can also augment labor?  Which methods are only for induction only? o Tachysystole (hyperstimulation)  Definition  Nursing actions o Nursing actions/interventions/responsibilities for  AROM  Amnioinfusion  Precipitous Labor o Definition o Risk factors / complications for mom  Operative vaginal delivery o Vacuum vs forceps  Risks for mom vs baby  Nursing actions  Post term pregnancy o Definition

o Risk factors o Risks for mom vs baby  Macrosomia/Shoulder dystocia

o Definition o Risks o S/s o Nursing interventions  Suprapubic pressure, McRobert’s maneuver  Uterine rupture o Who is at highest risk? o Definition o S/s, assessment findings o Management and nursing actions  IUFD o Definition o Risks & causes o Management and nursing actions Make sure you can assess the difference b/w placental previa and placental abruption

CHAPTER 11

 C-sections  Indications  General procedure  VBAC o Risks-think uterine rupture (scar tissue) o Definition o Contraindications  Risks related to C-sections  Nursing care and responsibilities o Pre-op care o Intra-op care o Post-op care  Risks and interventions (think bowels)

NEW CONTENT

CHAPTER 12-

Please refer to the PPT for more guidance

 Of the types of contraception, understand the basic principles (teaching a patient how to use) the various methods of birth control o Know what methods might be indicated for whom? (Think emergency contraception) o Most important factor when using birth control? o Know pros and cons for each one. Who are good candidates of each type? What is the “best” birth control?  Teaching associated with use- when might fertility return after use of certain methods?  Natural Family Planning Methods o Abstinence- teaching about ‘outercourse’ and how to avoid pregnancy o Fertility awareness- what indicates “fertile time” when checking basal body temperature, cervical mucous and tracking menstrual cycles o Withdrawal method (coitus interruptus)- effectiveness, advantages and disadvantages o Lactational Amenorrhea Method- know what to teach the patient about the 3 criteria she need to meet for it to be effective o Know how to teach patients about condoms and spermicides… and can you use them together??  Combined Hormonal Methods of Birth Control (pills, patch, ring) o Mechanism of action o Instructions on use o Common side effects  Progesterone-only Methods (mini-pill, Depo, Nexplanon, Mirena /Skyla /Liletta IUD)