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NUR 230
EXAM 1 STUDY GUIDE
OB/Peds
Galen College of Nursing
This document provides a focused study guide
It summarizes key concepts, lecture highlights, and
exam-relevant material to support efficient last-
minute review. The guide is structured to help
students reinforce understanding, identify weak
areas, and prepare confidently for the assessment.
OB EXAM 1 STUDY GUIDE
Unit 1: The Menstrual Cycle: Starts on the first day of menstruation. Ovulation typically occurs 14 days before next menstruation. A mature ovum lives 12-24 hours then starts to degenerate. Sperm can live up to 5 days in the female system.
- Signs of Pregnancy: o Presumptive – (subjective)(something said) “My breasts are sore and tingling”, amenorrhea (missed period), N & V o Probable – (objective)(we can see but may be other reasons as to why) Goodall’s sign, Chadwick’s sign, Hegar’s sign, enlarging uterus, positive pregnancy test, Striae gravidarum (stretch marks), Braxton hick’s contractions, ballottement o Positive – ultrasound showing fetus around 6th^ week, fetal heart tones at 12 weeks, fetal movement at 18 weeks
Diagnostic Testing:
- HIV testing-further testing if positive, Hep B, drug screening (with consent)
Specific labs (blood work) specific to pregnancy:
- CBC (anemia, infection or clotting disorder)
- Blood type (group A, B, AB, O) & Rh status (if blood type -, Mom gets Rhogam)
- Rubella/varicella titers. If not immune, offer vaccine postpartum never given during pregnancy
- STIs (syphilis, gonorrhea, chlamydia)
Uterus/Cervical changes
- Hegar’s sign – softening of lower uterine segment
- GI: N & V (should lessen by end of first trimester/14 weeks), Hyperemesis gravidarum (excessive vomiting), stomach and gallbladder are slower, increased chance of gallstones and constipation. Can lead to URQ pain. Heart burn (teach to eat small frequent meals, avoid spicy foods, good posture) 8-10 servings of fluid per day water preferred) ❖ Best sources of iron and calcium: Organ meats, sardines, fish, legumes, enriched breads, dark greens, milk and iron supplements. Avoid undercooked or raw fish.
- Renal/urinary: increased urinary frequency and nocturia (peeing at night) because of uterine pressure on bladder, dilation of uterus can increase risk of bacterial infections!!!!!! Smooth muscles of bladder relax, not emptying all the way- leads to UTI. BUN, creatinine, Uris acid, glucose
- Integumentary: striae gravidum (stretch marks), spider veins: vascular malformation, palmar erythema (red palm), increased sweating/metabolic rate
Role of progesterone and estrogen:
- Progesterone: keeps fetus inside uterus, smooth muscle relaxant, keeps uterus quiet. Develop alveoli (milk secretion) & ductal system for lactation.
- Estrogen: Increase blood flow to uterus (vasodilation), change sensitivity of respiratory system to carbon dioxide. Soften cervix, initiate uterine activity, maintain labor. Develop breasts for lactation, secretion of prolactin
Assessments during the initial prenatal visit:
- Childbearing, reproductive history/current pregnancy
- Health history; Review of systems, mental health history, nutrition history, drug history, herbal preparations use, family history, social, experiential, occupational history, and history of physical abuse
- Physical examination; laboratory tests
Estimate due date, feelings towards current pregnancy (mental health assessment, alcohol/tobacco use, support system, barrier to prenatal care, economic status, healthcare coverage, home safety and injury prevention), GTPAL, urine screening, often times first ultrasound done to be sure EDD correlates with fetal development, possibly blood test for hCG levels, weight, nutrition status (increase calorie in second and third trimester, folic acid, fluid intake), vital signs. We want to promote a safe and secure environment! Common discomforts during pregnancy:
- Gastrointestinal: Nausea and vomiting, Ptyalism(hyper salivation), Dyspepsia, Flatulence, Constipation; hemorrhoids
- Respiratory: Nasal Congestion, Shortness of breath/hyperventilation
- Musculoskeletal: Backache, leg cramps, Dependent edema, Varicosities
- Vaginal and Urinary: Leukorrhea, Urinary frequency, Dyspareunia, Nocturia, Round Ligament, Supine Hypotensive Syndrome
Symptoms that can be experienced:
- Each trimester: 13 & 1/3 weeks long. o 1 st^ trimester: breast enlargement/pain/tingling/tenderness, urinary urgency/frequency, fatigue, N/V, Ptyalism (hyper salivation), gingivitis/epulis, nasal stuffiness, leukorrhea (clear/light discharge. o 2 nd^ trimester: acne/pigmentation changes, palmar erythema, pruritus (itching), palpitations, supine hypotension, faintness, syncope, heartburn, constipation, headache, carpal tunnel, round ligament pain, joint pain, backache, pelvic pressure.
dried fruits
- Pt with low iron is constipated & refusing iron supplement what, foods to suggest? Highin iron
The effects of nutritional deficits:
- Macrosomia (large for gestational age), congenital anomalies, birth trauma, perinatal asphyxia, respiratory distress syndrome, hypoglycemia, hypocalcemia, cardiomyopathy, hyperbilirubinemia, polycythemia.
Foods and substances that should be avoided:
- Tobacco, Alcohol, Caffeine, Artificial sweeteners, Marijuana, Cocaine
What is pica? What can this lead to?
- Practice of consuming nonfood substances, maybe cultural. Can lead to anemia and other complications. (Nail polish, hair, rocks, clay, dirt, paint)
Understand glucose tolerance testing and what it means –
- Done between 24-28 weeks, establishes the presence of gestational diabetes, helps understand if it can be controlled by diet or if insulin is needed
Group B streptococcus (GBS) testing, when and why –
- 36 weeks, part of our normal flora but very harmful for baby. Testing at 36 weeks, treat with antibiotics for two weeks, given two rounds during labor before delivery (IV), may need c section
Why is oral health so important?
- There is a link between periodontal disease and preterm labor, increase in plaque during pregnancy
Why do we give Rhogam? When do we give it?
- Given if, mom Is Rh (-) and fetus is Rh (+), risk for iso-immunization. Given between 26 and 28 weeks, and again within 72 hours of delivery
What populations are at higher risk of developing preeclampsia?
- Higher in woman who have multi fetal gestation, chronic hypertension, a history of preeclampsia in previous pregnancies, pre-gestational diabetes, or preexisting thrombophilias.
What organs does preeclampsia effect, and what effects does it have?
- Decreased placental perfusion and hypoxia result. Poor tissue perfusion in all organ systems , increased peripheral resistance and BP, increased endothelial cell permeability, leading to intravascular protein and fluid loss and ultimately to less plasma volume
- Reduced kidney perfusion resulting from spasm of rental blood vessels and decreased the GFR. Plasma colloid osmotic pressure decrease. Decreased liver perfusion can lead to impaired liver function and elevated liver enzymes. Neurological complications such as cerebral edema and hemorrhage increase CNS irritability.
What are symptoms of preeclampsia?
- Hypertension (BP increases > 30 systolic, > 15 diastolic from baseline, proteinuria, oliguria, visual disturbances, pulmonary edema, epigastric pain, elevated liver enzymes, thrombocytopenia
What are the differences between preeclampsia and HELLP syndrome?
- Preeclampsia: protein in urine & high BP
- HELLP: can occur with severe preeclampsia, hemolysis (breakdown of RBC), elevated liver enzymes, low platelets
HELLP increases the risks for:
- HELLP = H: hemolysis. EL: Elevated Liver Enzymes. LP: Low Platelets
- Increases the risk for maternal death and adverse perinatal outcomes
- Increased risk for: pulmonary edema, acute renal failure, disseminated intravascular coagulation (DIC), placental abruption, liver hemorrhage or failure, acute respiratory distress syndrome (ARDS), sepsis, stroke
What assessments are done for patients with preeclampsia and HELLP?
- UA to assess proteinuria
- CBC- liver functions, anemia
- Urinalysis for uric acid, BUN, and creatinine levels that may be elevated
- Coagulation studies to asses PT and PTTUltrasound- liver abnormalities, hemorrhage, fetal assessment (placental abruptio)
What is the treatment for preeclampsia?
- Delivering the baby is the ultimate treatment
- Labetalol: treatment for BP
- Corticosteroids to enhance fetal lung maturity
- Magnesium: treatment to prevent seizures o Low stimulation, seizure pads, monitor for toxemia (> 9 = toxic) o Magnesium given as 4-6 g/h loading dose followed by 1-2 g/h maintenance dose o Reverse agent: calcium gluconate IV to prevent cardiac arrest
What treatment do we use for managing patients with hyperemesis gravidum?
- Hyperemesis Gravidum: when vomiting during pregnancy becomes excessive enough to cause weight loss, electrolyte imbalance, nutritional deficiencies, and ketonuria.
- Inter-professional care: obstetric care, clinic or home care nurse, dietician, pharmacist, social worker, and maternal-fetal medicine specialist
- Decrease activity/lifting/riding long distances, hydration,
- Tocolytic medications relax smooth muscle o Magnesium sulfate (decrease seizure risk) o Terbutaline: (pulse rate, > 120 hold) o Indomethacin o Nifedipine
Factors increasing the risk for preterm labor:
- Hx of PTL (#1 risk), multiple gestation, gestational diabetes, advanced maternal age, obesity, 2nd^ trimester bleeding, African American, low pregnancy weight, urogenital tract infections
What would you teach a patient with a placenta previa?
- Placenta previa: the placenta is implanted in the lower uterine segment such that it completely or partially covers the cervix or close enough to the cervix to cause bleeding
- Teach: painless, bright red vaginal bleeding is normal. NO vaginal exams. Have to have a C section.
How would a patient present if they were having a placental abruption?
- Placental abruption: premature separation of placenta from implantation site > 20 weeks.
- Signs: vaginal bleeding, abdominal pain-possibly severe, rigid to board-like fundus, uterine contractions, hypertonic, port wine-stained amniotic fluid, 30% bleeding in pregnancy abruption
Risk factors that increase the risk of a placental abruption?
- HTN with this pregnancy, abdominal trauma, cigarette smoking, alcohol, cocaine use, blood clotting disorders, diabetes, previous Hx
Complications related to a placental abruption:
- Anemia, hemorrhage, clotting issues, cesarean delivery
Conditions that can impact clotting:
- Placental abruption, preeclampsia, eclampsia, HELLP syndrome, postpartum hemorrhage, sepsis, acute fatty liver, retained IUFD (delayed birth of a dead fetus)
Hypo-coagulation- cannot clot
- Platelet disorders (thrombocytopenia, aplastic anemia, leukemia, VonWillebrand disease)
- Decreased activity of clotting factors (liver disorder, meds: anticoagulants, NSAIDS,aspirin)
- Blood vessel defects, vitamin K deficiency
Hyper-coagulation: clotting too much
- Normal increase in clotting factors late pregnancy
- Thrombophilia: V Leiden
- Polycythemia
- Risks: venous thrombosis, miscarriage & intrauterine growth restriction
Complications of urinary tract infections:
- Asymptomatic bacteriuria: bacteria with no symptoms
- Cystitis: Dysuria, frequency, urgency
- Pyelonephritis: develops most second trimester, hospitalization possible
How would you teach a patient to do kick counts?
- Beginning at 28 weeks, pt sits quietly or lies on their side and counts fetal kicks.
- Teach that it is necessary for the client to feel 10 movements within a 2-hr. period, less movement is felt if the baby is sleeping.
Complications of an amniocentesis:
- Risk factors are family history of diabetes, previous pregnancy that resulted in stillbirth, obesity, hypertension, glycosuria, and maternal age older than 25.
- Diagnosis: 1 hour 50g oral glucose tolerance test, if test is positive, there will be a 3 hour 100g test, if negative continue routine prenatal care
What changes happen postpartum in insulin requirements? What would you assess for in mom and baby? Insulin requirements decrease, monitor mom and baby for hypoglycemia Unit 3 Understand fetal monitoring and what different variability means
- V: variable C: Cord Compression
- E: early deceleration H: Head Compression
- A: acceleration O: Oxygenation
- L: late deceleration P: Placental Insufficiency
- Normal fetal heart rate: 120-160 bpm o Bradycardia: HR less than 110 beats/min for 10 min or longer o Tachycardia: HR greater than 160 beats/min for 10 min or longer
- Variability: irregular waves or fluctuations in the baseline FHR of two cycles per minute or greater o Absent: amplitude range of the FHR fluctuations that is not detectable to the unaided eye o Minimal: amplitude range that is 5 beats/min or less o Moderate: NORMAL. Amplitude range 6-25 beats/min o Marked: amplitude range greater than 25 beats/min Identify decelerations and what it means
- Early Deceleration:
o The fetal heart rate will mirror the contraction o Cause: head compression o Intervention: continue to monitor, no intervention needed
- Late Deceleration: o The fetal heart rate will come after the contraction o Cause: uteroplacental insufficiency o Intervention: d/c oxytocin, position Change, O2, IV fluids, elevate legs
- Variable Decelerations: o Looks V shaped o Cause: cord compression o Intervention: d/c oxytocin, amnioinfusion, position change (side lying or knee chest helps relieve cord compression), breathing techniques, oxygen What accelerations mean and what measurement is considered an acceleration?
- Acceleration: visually apparent, abrupt increase in FHR above the baseline rate. The peak is at least 15 beats/min above the baseline, and the acceleration lasts 15 sec or more, with the return to baseline less than 2 min from the beginning of the acceleration. o Before 32 weeks gestation: peak of 10 beats/min above the baseline and a duration of at least 10 seconds. o Can be periodic (occur with uterine contractions) or episodic (occur without uterine contractions) How do you count contractions?
- From the time it starts to time it stops: duration
- Beginning of one to the beginning of the next: frequency What do we assess with rupture of membranes?
OR
- Presentation with regular uterine contractions and cervical dilation of at least 2cm that occurs at a preterm gestation. Risk factors for pre-term labor
- Hx of previous spontaneous preterm birth between 16 and 36 weeks of gestation
- Hx of genital tract colonization, infection, or instrumentation
- Black race
- Bleeding of uncertain origin in pregnancy
- Uterine anomaly
- Use of assisted reproductive technology
- Multifetal gestation
- Cigarette smoking, substance abuse
- Prepregnancy underweight (BMI <19.6) and pregnancy obesity (BMI >30)
- Periodontal disease
- Limited education and low socioeconomic status
- Late entry into prenatal care
- High levels of personal stress in one or more domains of life Management for pre-term labor:
- Can be prevented in some woman by administering prophylactic progesterone supplementation
- Interventions for Pre-Term Labor o Transfer mother to hospital equipped to care for preterm infant o Administer antibiotics during labor to prevent neonatal group B strep infections o Administer antenatal glucocorticoids to reduce respiratory distress and intraventricular hemorrhage
o Administer magnesium sulfate to woman giving birth before 32 weeks gestation to reduce incidence of cerebral palsy
- What to do if symptoms of preterm labor occur: Patient Teaching o Stop what you are doing o Lie down on your side o Drink 2-3 glasses of water or juice o Wait 1 hour o If symptoms get worse, call you OB or go to birthing facility o If symptoms go away, tell your OB what happened your next visit What is considered post-term and risks associated
- Post-term pregnancy: one that reaches 42 0/7 weeks of gestation or more
- Risk Factors: placental decaying, hemorrhage (uterus is exhausted, placenta not working as effectively) What is a dysfunctional labor
- Dysfunctional labor: long, difficult, or abnormal labor
- Dystocia: lack of progress in labor for any reason
- Dysfunction labor is suspected when there is an alteration in the characteristics of uterine contractions, a lack of progress in the rate of cervical dilation, or a lack of progress in fetal descent and expulsion, resulting in an abnormal labor pattern. Effects of obesity in pregnancy
- BMI greater than 30 = obese
- More likely to begin pregnancy with preexisting conditions: chronic hypertension, type 2 diabetes
- Higher risk for spontaneity’s abortive and stillbirth
