N306 Study Guide – Final Exam Notes Latest Update 2025., Exams of Neurology

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All page numbers refer to Durham 3ra 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 c Look at each and understand what risks/complications it may pose to baby or pregnancy co 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 aflect 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 il? Menstrual Cycle * Consists of two cycles working simultaneously (ovarian and endometrial) } what are levels and roles of estrogen and * progesterone in each cycle 0 When is a woman most fertile? o What is considered a woman’s LMP (know that this is Day #1 of her cycle) © 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 0 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 {or regulating glucose availabilily in the newborn? + Purposes of amniotic fluid + Normal structure of the umbilical cord Infertility + Definition of infertility * Common causes of infertility 0 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) 0 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 | 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 Ist and 2na time pregnancies? c 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 [have finding larger than expected, what might be reasons? = IF Thave 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 ay a Basic nutritional requirements (calorics needed and what extra vitamins and minerals are needed) « Maternal weight gain distribution (box 4-3, pg 83) Schedule of prenatal visits o Know what is done in first trimester, 2na trimester, 3-4 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) © 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 sceing thos . as in, what change is happening physiologically that is resulling 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, laligue, insomnia, emotional lability, tender/enlarged breasts, Braxton Hicks contractions, increased cervical/vaginal secretions (yeast infections), dyspareunia, supine and orthostatic HIN, 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. © 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 thal accompany pregnancy Special needs regarding specific patient populations o Teenagers = Specific concerns regarding teenage parents © 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 sercen for’? Anatomy US o When is il performed? o What does it look for? Indication for umbilical artery Doppler flow CVS o Indication o Procedure o Timing in pregnancy o Risks co Pros and cons for parents Amniocentesis + Possible causes + Effects on fetus + Effects on mother « BPP o Secmiteria o Which scores indicate fetal well-being and which indicate need for immediate intervention © 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 (EEW)O0 o Which pt is a candidate for LA? **Which is NOT? = How do you perform IA? o When is continuous EFM indicated? * Ilow often should you assess? And what are you assessing for?0 o Example: If mom comes in and is in active labor and is low risk ... you can do 1A 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 oc What may cause minimal variability and what can you do to intervene? ¢* Moderate « **Understand this is BES does it really mean? ¢ Marked o What may cause marked variability and what can you do to intervene? = Are there accelerations? « Yes «+ No ' indicator for fetal well being © What © Is it ok for her not to have accelerations while in labor? © What do accelerations mean when we do an NST (what are they telling me?) = Are there decelerations? + Ifno, great «If yes, what kind (and then know vour interventions for cach 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 loco) vs TUPC = What is ulerine relaxation/tone? How long of a period of relaxation to we want for adequate oxygenation O Category I, I, TH tracingsO co Know what criteria make it category I co Know what criteria make it category III (what does this indicate?) o Everything else that is not I or His II Chapter 8 Labor « — Signs/Symptoms of Labor o Truevs. 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? * 5Ps of labor0 c 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 tic 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 Examf © Dilation o Effacement 0 Station © 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 “T think my water broke”? © 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, tment o GBS - understand when we screen for il, how we screen for il, and what we are doing with that information during L&D. Tow 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 LaborO o Know cach stage and the phases of 1st 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 stage to determine progress’? * What are you assessing for in 2nd stage to determine progress? © Know what your nursing roles/interventions are in each stage © 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? © 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? ° Changes in Endocrine System = Night sweats = Decreased levels of what hormone? # Elevated temp vs infection? o Changes to GI and GU system and comfort medications/nursing actions. How is diuresis involved with increasing b/h? How can you tell if its cystitis or normal PP physiologic change? Hemorrhoids ° 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 ° DIC (s/s, risks) ... labs? Understand there also is a tie with fetal demise, sepsis, and preE Chapter 13 O Transition to Parenthood0 c 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 unil) © Postpartum Blues vs Postpartum Depression vs Postpartum Psychosis * Primary concern with PPD = How do we diagnose/rule out? Hint- screening tools! Chapter 16 O Newborn Nutrition and FeedingO o Assessment of adequate feedings, number of wet and dirty diapers o Increasing milk supply © Formula feeding, how long do you keep milk in fridge/freezer/room-temp 0 AWHONN, WHO recommendations for length of breastfeeding (exclusive) o Contraindications to breastfeeding © 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 rellex © Newborn hunger cues and appropriate times to feed infant c Breastfeeding techniques and positions = Assessment of adequate feedings, number of wet and dirty diapers = Increasing milk supply ° Engorgement ys Mastitis = S/s, Interventions 0 Newborn careQ o All listed from pg 493-500 ¢ 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)- + Neonate Transition to Extrauterine LifeO o Changes in respiratory system (first breath) © Changes [rom fetal (o newborn circulation o Importance of surfactant o RDS (“risk factors, *s/s) = Which babies are at highest risk? © Thermoregulation (heat loss, cold stress) = Cold stress: understand how it works, nursing actions lo prevent il, what s/s you would see = Hypoglycemia + What babies are at risk? + Interventions for yerv 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 Ist week o Signs/Symptoms of dehydration Newborn assessment (sec pictures and tables in textbook)O o Be able to recognize what is normal o Watch the newborn assessment video posted in week 4, Know how to do a head we 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 Pt. care = Benign lesions ys 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 cach 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.466 = Know how to look at a premature baby vs a term baby and use the Ballard gestational age ‘sessment 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 al the s/s of each and know which s/s for hypoglycemia don’t fall under withdrawal)O Importance of understanding periods of reactivity in relation to skin to skin and breastfeeding (pg. 467)0 Preterm neonatel] 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 arc preterm babies at risk for? = EVERYTHING! But specifically: o *Transient tachypnea . What ba re at highest 2 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 TUGR?- think vasoconstriction LGA vs post-term babies = Ptpresentation = Diagnostic findings O Fetal fibronectin (fKn)- 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=It3nPxVTCSMO * PPROM (Can happen with or without preterm labor)0 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) ¢ Patient teaching + Ilypertensive disorders of pregnancy0 © 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 . . = 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 co 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=70tpgg58Ougl * — bttps://www.youtube.com/watch?v=ylaSRRJ-Mg80 ° — https://www.youtube.com/watch?v=R B5s85xDshAO * — https://www.youtube.com/watch?v=Gmh01SOmsfYO * — bttps://www.youtube.com/watch?v=Gmh01SO0ms¥ &t=217s0 go pico © Understand basic pathophysiology © Risk factors © Signs and symptoms © Treatment and nursing care * Amniotic Fluid Embolism o When can it happen? o Ilow 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 © Findings/assessments/monitoring c Nursing care/management & interventions o https://www.youtube.com/watch?v—79NnsYrAX74 + Placenta Previa o Delinilion o Risk factors o Types/Degrees 0 S/s o Assessment . How and when is il usually diagnosed? o Interventions/patient teaching o Contraindications o Nursing actions © https:/Avww.youtube.com/watch?v=DMCowiplXgE&t=7s + Prolapsed Cord o Definition © Signs/symptoms/assessment findings © Risk factors/prevention © Nursing actions/management + Placenta Accreta o Definition’3 different classifications (which is more common) * How and when is il usually diagnosed? 0 Risk factors o Assessment findings o Medical management / nursing actions o https://www.youtube.com/watch?v=x3EMTOQjoA0&t=20s + Trauma o Tow and why does trauma complicate pregnancy? o Assessment findings / management / questions to ask on admission + Cardiac pts during labor © What interventions do you take during 2na phase of labor? (labor down) 0 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 © hitps://www.youtube.com/watch?v=e4baNHUxPsl&=3 10s + DVT and PE o Risk factors o Assessment findings © Understand that pregnancy increases the risk of venous thromboembolism (VTE) 4- to 5-fold over that in the nonpregnant state. WHY? . The two manilestations of VTE are DVT and PE Chapter 10 * Dystocia o What factors influence labor? (SPs) 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? © Methods of induction- which method is indicated when cervix is ripe vs. unripe * Mcchanical 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 co Lactational Amenorrhea Method- know what to teach the patient about the 3 criteria she need to meet for il to be effective © 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 © Common side effects Progesterone-only Methods (mini-pill, Depo, Nexplanon, Mirena /Skyla /Liletta IUD) o Mechanism of action o Instructions on use o Common side effects Paragard IUD (copper) o Mechanism of action © Patient teaching (checking for strings) © Common side effects Permanent Sterilization o Bilateral tubal ligation (basic idea of surgical procedure) o Post surgical pt instructions to prevent pregnancy Emergency Contraception © ‘Types and Mechanism of action o Instructions on use o Common side effects COMMON CONTRAINDICATIONS TO CONTRACEPTION USE Combined hormonal methods of contraception (pills, patch, ring) o Estrogen-dependent tumor (breast or gynecologic cancer) oo Liver disease o. Past or present h/o thromboembolism o Cardiac abnormalities o Congenital hyperlipidemia o Undiagnosed uterine bleeding o ** Use with extreme caution under close surveillance with: Age over 40 ge over 35 with cigarette smoking Hypertension Migraines Breastfeeding Diabetes Gall bladder disease Progesterone-only Methods (**Very few contraindications) to use, which is why emergency contraception is available over the counter) o Breast cancer o Suspected or confirmed pregnancy TUDs o Fibroids © Uterine abnormalities Vv VVV WV vv CHAPTER 18 & CHAPTER 19 Please refer to the PP'I's and your textbook for detailed guidance o Leading Causes of Death for Women in the U.S. Heart Attack = Risk factors = Signs and symptoms o Stroke = Risk factors = Signs and symptoms Health Promotion/Screenings for Women in their 20’s o Health Promotion/Screenings for Women in their 30’s o Health Promotion/Screenings for Women in their 40’s **Health Promotion/Screening for Women in their 50’s and older o With all the health promotions, know: = When do we start and end screenings for cervical cancer?) How do we screen for it? What increases risk? O Vaccine for HPV = When do we start and end screenings for breast cancer? [low do we screen for it? = When do we start and end screenings for osteoporosis? How do we sereen for it?" When do we start and end screenings for colon cancer? How do we screen for it? o Signs of puberty © Common issues in adolescent health o Common problems, issues related to teenage pregnancy o Perimenopause/Menopause o Normal physiological changes o Typical age of onset Time leading up to last menstrual cycle «© Main reason for symptoms- think hormonal changes/decreased levels of? © Signs and symptoms © Treatment, comfort measures [or physiologic changes © Osteuporosis o Risk factors © Prevention- patient teaching on lifestyle and habits o Diagnostic tests- How is it diagnosed? o ‘Treatment- Whatis the drug of choice? o PCC Definition, cause, s/s, risks/complications, treatment and goals of treatment © Associated conditions Endometritis o What patient has an increased risk? o Endometriosis o Pathophysiology © Definition, cau: risks/complications, treatment and_goals of treatment © Psych-social ci erations © Leiomyoma (Fibroids) o Definition/types, cause, s/s, risks/complications, treatment and goals of treatment © Breast Cancer © Risk factors (genes responsible), modifiable and not. What is the biggest risk factor? o Patient teaching on sel{-breast examinalion o Nursing care s/p teclomy, chemotherapy, tion, = Normal adaptation Therapeutic communication © Cervical Cancer, Endometrial/aterine Cancer, Ovarian Cancer, Vaginal cancer o Risk factors o Screening and diagnosis © Signs and symptoms © Treatments eo Incidence, morbidity and mortality o Hysterectomy © Various types of surgical procedures o Nursing care = Patient teaching post-op o Violence against women o Who do we screen? Ilint- Everyone! © Stats, nursing actions/care o Sexually transmitted infections (STIs) PID o S/s o Risk factors © Pathophysiology Treatment Potential long-term complications Vaginitis o Definition o S/s Bacterial vaginosis o Vulvovaginal candidiasis Gonorrhea o } ‘iated complications ‘Trichomoniasis « Associated complications © List ofall the other STIs on the slides for Chapter 18