Download OB Exam #1 Study Guide: Ethics, Standards, Genetics & Reproduction and more Study Guides, Projects, Research Obstetrics in PDF only on Docsity!
OB Exam #1 Study Guide
Ethics and Standards of Practice (Chapter 2): Ethical Principles: Provide examples and definitions Beneficence: obligation to do good o Educating the pt Nonmaleficence: obligation to do no harm o Not holding med if they are needed Fidelity: being accountable for your responsibilities and loyal to your commitments o Sun down rule Veracity: being truthful o Not withholding information Autonomy: right to self-determination (basis of informed consent) o Respecting the pts choices Justice: equal allocation of resources (who receives an organ transplant) o Provide everyone with the same care ANA Code of Ethics: See Table 2-1 for provisions of the code of ethics- understand these provisions o Provision #7: The nurse, in all roles and settings, advances the profession through research and scholarly inquiry development of professional standards and policy Healthy People 2030 What is Healthy People 2030 and what are their main goals? o Identifying intervention to improve social determinants of health o Reduce health disparities o Improve maternal and infant outcomes Genetics, Conception, Fetal Development, and Reproductive Technology (Chapter 3): Placenta, Membranes, and Amniotic Fluid: What hormones are released by the placenta and what are their functions? o HCG: stimulates the corpus luteum so that it will continue to secrete estrogen and progesterone until the placenta is mature enough to do so Hormone assessed in pregnancy tests Hormone rapidly rises during the first trimester and then rapidly declines o hPL human placental lactogen: promotes fetal growth by regulating available glucose and stimulates breast development in preparation for lactation o Estrogen: thicker uterus. Estrogen promotes the maturation of the ovum o Progesterone (Progestin): released by the placenta. Decreases the uterine contractility o Relaxin: increased levels of relaxin leads to increased elasticity and relaxation of ligaments How many vessels are in the umbilical cord?
o 3 o Contains 2 small arteries and 1 large vein o AVA, arteries are blue Infertility and Reproductive Technology: What are 5 categories of infertility in males and include example(s)? o Endocrine causes – hormone levels o Gonadtoxins – drugs, infection, systemic illnesses, prolonged heat exposure, tight underwear, frequent bike riding Spermatogenesis: production of sperm o Sperm antibodies – vasectomy o Sperm transport factor – blocked duct o Disorder of intercourse – ED o What is the treatment for these? Hormonal therapy Lifestyle changes Corticosteroids Antibiotics Repair of varicocele or hernia Transurethral resection o What are common complications after a vasectomy reversal? Sperm antibodies What testing is completed for this complication? Sperm antibodies test o What education is provided about male infertility? Stay away from heat, hot tubs, avoid drugs and ETOH, treat STIs What are 3 categories of infertility in females? o Ovulatory dysfunction – hormonal imbalance, hyperthyroidism, high prolactin level, premature ovarian failure, PCOS o Tubal and pelvic pathology factors – damage to fallopian tube or uterine fibroids miscarriage o Cervical mucous factors – infection or cryotherapy, life style changes to help change mucous membrane o What is the treatment for these? Anovulation – clomiphene clomid, lifestyle changes Surgery to open fallopian tubes Removal of uterine fibroids Antibiotic for cervical infections o What are emotional implications for infertility? Stress, anxiety, depression, guilt Martial strain Sexual dysfunction Extended family strain Lack of support network Self-esteem issues Most couples can benefit from counseling
N/V
o What are probable signs of pregnancy? OBJECTIVE Braxton hick’s contractions Positive pregnancy test Abdominal enlargement Goodell’s, Hagar and Chadwick’s sign o What are positive signs of pregnancy? How we verify it Pregnancy: o How is EDD determined using Naegele’s Rule? LMP, first day – 3 months + 7 days o What factors influence the accuracy of Naegele’s Rule? Regularity of woman’s menstrual cycles Length of menstrual cycles Cycles greater than 28 days apart o Prenatal Assessment Terminology: What is G/P? Gravida – number of total pregnancies Para – births past 20 weeks, live or still birth What is GTPAL and what do each of the letters stand for? Gravida – total # of times pregnant Term – # of pregnancies (37 weeks) Preterm - # of preterm pregnancies 20-36.6 weeks Abortion - # of abortions under 20 weeks Living – number of children living Make sure you know how to calculate GTPAL o What is the timing for routine prenatal visits for: Up to 22 weeks’ gestation? 4 weeks 23 weeks to 36 weeks’ gestation? 2 weeks 37 to 40 weeks’ gestation? Once a week After 40 weeks’ gestation? Twice a week o What is quickening and when should it occur? o Laboratory Tests: Know normal values for each of these: Platelets: 140- 400 Hbg: WBC: 5.6- 17 PT: 5- 10 o How is uterine growth assessed? After how many weeks can this be assessed?
What are common sibling adaptations to a new pregnancy? What education can the nurse provide to lessen sibling distress? How should the numbers correlate? What are nursing actions if the numbers do not correlate? o What are important education points for the following: Exercise Body system complaints Sexual activity Body positions to avoid STIs Vaccines o What is intimate partner violence? Who is screened for this? Nutritional Assessment and Education o What is a normal BMI? How much weight should be gained per month? How much weight should a pregnant woman gain if her BMI is elevated? How much weight should a pregnant woman gain if her BMI is low? What education should be provided about nutritional information during pregnancy?- see page 80 What are recommended supplements, and how much should be taken? The Psycho-Social-Cultural Aspects of Pregnancy (Chapter 5): Factors that Influence Maternal Adaptation: What are factors that influence maternal adaptation to pregnancy? Adolescent mothers are at a higher risk for what complications of pregnancy? What are potential harms to the health of adolescents during pregnancy? See Critical Component Nursing Actions That Facilitate Adaptation to pregnancy (page
- Paternal and Partner Adaptation During Pregnancy What are common feelings during a pregnancy? What is the nurse’s role to help with adaptation to the pregnancy? Family Adaptation to Pregnancy: Antepartal Tests (Chapter 6): Chori o ni c Vi ll us S a m pl
o Bleeding o Increase transmission of HIV or hepatitis to baby When is this performed? o 10-13 weeks gestation o During first or second trimester What are nursing actions related to this procedure? o Review procedure o Lithotomy position for transvaginal aspiration o Abd – supine w/ wedge under butt o Fetal heart tracing assessment and stress test before performing o Administer Rhogam after procedure o Notify provider for abd pain, leaking fluid, fever, bleeding Daily Fetal Movement: What are kick counts? o Same time everyday and same position and counts kick o So they know baby is doing well and moving How are these measured? o Baby should have at least 10 kicks or fetal movements in 2 hours o Same time everyday for 1-2 hours What are nursing actions regarding kick counts? o Teach pt how to perform them o Lie on side o Try to stimulate movement by eating Amniocentesis: What is this test for? o Used for obtaining fetal cells for genetic testing mainly o Can also be done for assessment of fetal lung maturity o Assessment of hemolytic dx o Intrauterine infection o Therapy for polyhydramnios What is a normal L/S ratio and what does it indicate? o L/S ratio greater than 2:1 indicates fetal lung maturity What are complications of this procedure? o Infection o Trauma to fetus or placenta Fetal death o Bleeding or leaking of amniotic fluid o Preterm labor o increase risk of transmission (Hep B, HIV, viruses) What is the procedure for this test? o Stress test first done with an US, empty bladder before, injection US guided needle, aspirate fluid and send it to lab, apply pressure to the side and cover it with a STERILE dressing, left on until provider states to remove it
Stress test Listening to HR and fetal heart tones Invasive so Rhogam is given to moms with negative blood tests Non-Stress Test: What is this? o Contractions or fetal heart tones What is the procedure & position for this test? o Sitting in a chair How is this test interpreted? o Reactive: two accelerations in 20 min time frame o Non-Reactive: no accelerations o Acceleration: HR increased for a little length of time; 15 bpm higher for at least 15 seconds Complications of Pregnancy (Chapter 7): Preterm Labor and Birth: What is medical management to prevent preterm birth? o Tocolytics o Terbutaline – injection, most given, directly in uterus o Nifedipine o Progesterone: hx of PTB, preventative (given vaginally or PO) Are antibiotics administered for preterm labor? o When are corticosteroids administered for preterm labor and what do they do? o Betamethasone Vastas lateralis – deep IM Given 24 hours apart Cervical Insufficiency: What does this mean? What are risk factors? o Hx of PTB before 24 weeks o Short cervix o Leep procedures Who is a candidate for a cerclage? o Hx of PTB less than 24 weeks What is medical management for a cerclage? o Invasive Removed infection or labor o OP procedure o Monitor uterine activity
Pallor Hypertensive Disorders in Pregnancy Preeclampsia: o What is this? Hypertension dx o What are signs/symptoms? Elevated BP HA, blurry vision Epigastric pain top of the liver Decreased UO edema Increased waist edema o What are risk factors for developing this? Being prego Obesity Nulliparity Increased maternal age Multiple gestation Previous preeclampsia or eclampsia GDM Assisted reproductions o How is this managed in the hospital? Mag Sulfate bolus 4-6 g then maintenance dose Antihypertensives Severe features induce labor Seizure precautions Foley cath to keep in bed Decrease stimulation o What is the purpose of Magnesium sulfate in pregnant women? CNS protection neuro depressant Stop contractions Prevents seizures in preterm baby o What does BURP acronym stand for in the management of Magnesium sulfate toxicity? B: BP down severe hypertension U: Urine OP down R: Respiration rate down P: Patellar reflex: DTR down o What are immediate nursing actions with suspected Magnesium toxicity? Stop infusion Call provider o What is the antidote for Magnesium sulfate? Calcium Gluconate o What medications are administered in the hospital for continued hypertension while receiving Magnesium sulfate?
Labetalol Hydralazine Eclampsia: o What is the Eclampsia Protocol? What are Nursing interventions for eclampsia? See box 7-4 on page 189 Seizure precaution Have IV Remain with pt Call for help Recording seizure HELLP Syndrome: o What is HELLP syndrome? Form of preeclampsia o What does each letter of HELLP syndrome stand for? H: Hemolysis E: elevated L: Liver enzymes L: Low P: Platelets o What is the significance of bilirubin associated with HELLP syndrome? By product of RBC breakdown Jaundice Placental Abnormalities and Hemorrhagic Complications: Placenta Previa: o What is this? Placenta attaches to lower uterine segment o What are complications related to this? Hemorrhage Bright red and painless bleeding o What nursing interventions are contraindicated? DO NOT STICK YOUR HAND IN THERE!!! No speculum UNTIL R/O of this Placental Abruption: o What is this? Placenta detaches from uterus o What are cardinal S/S? Dark red and painful bleeding Related to trauma or cocaine and meth and smoking use Placenta Accreta Spectrum: o What is this? Placenta embeds into uterine muscle o What are possible complications after delivery?
Mom is asymptomatic Test 36-37 weeks Tx as if they are positive o What complications can occur in the newborn? Sepsis Pneumonia Meningitis o How and when is this treated? During labor 2 doses, 4 hours apart Ampicillin, Penicillin G, or Cephazolin HIV: o What therapy is recommended for women with HIV during pregnancy? Antiretroviral virus Reduce transmission risk Decrease viral load Substance Use: o What are the effects of Marijuana on a fetus? Neurological CNS defects Educate bc everyone is doing it Illicit Drugs: What do drugs like cocaine, amphetamines, and methamphetamines have in common? o Vasoconstrictions decrease prefusion to the baby WHICH IS BAD How do they affect the perfusion to the fetus? o Low birth wt o PTB o Developmental issues o Placental abruptions affect spiral ateries o PPROM o Placenta Previa affect uterus What are potential complications if the woman is taking illicit drugs? o Preterm labor, premature ROM, poor wt gain and nutritional status, low birth rate, placenta previa, placental abruption Med Math: Know how to perform the following calculations: mL per hour mL per dose mg/dose Review your rounding rules!
