Download Maternal Newborn Study Guide: Contraception, Pregnancy Signs & Physiological Changes and more Exams Nursing in PDF only on Docsity!
OB Maternal Newborn ATI Exam Study Guide Video #1: Contraception & Infertility Diaphragms : client must be refitted for a diaphragm for the following conditions:
- It’s been 2 years since she has been fitted
- Gained more than 15 pounds (7kg)
- Had a full-term pregnancy
- Had a second term abortion o When you use a diaphragm, you need to use spermicide with every act of coitus (withdrawal of penis from vagina prior to ejaculation). Every time you withdrawal, instill more spermicide. o Diaphragm must stay inserted for 6hrs after act of coitus. Hormonal Contraceptives (Oral ) o Side effects : Chest pain, SOB, Leg pain (from a possible clot), headache or eye problems (from a stroke or hypertension) o Contraindications : Women with a history of blood clots, stroke, cardiac problems, smoker, breast or estrogen related cancers (pill contains estrogen) Depo-Provera/Medroxyprogesterone o Injectable progestin o Can cause decreased bone mineral density or loss of calcium Nursing action : Ensure patient has adequate intake of calcium and vitamin D IUD o Increase risk for PID o Can cause uterine perforation or ectopic pregnancy (increases risk for ectopic pregnancy) o Look out for/Notify PCP: Change in string length IUD is moving and not in the right place Foul smelling vaginal discharge Pain with intercourse Fever/Chills (infection) Infertility is defined as an inability to conceive desire engaging in unprotected sexual intercourse for a prolonged period of time or at least 12 months. Common factors associated with infertility include: o Decreased sperm production (Sperm analysis) o Endometriosis o Ovulation disorders o Tubal occlusions If you test and use DYE (used in the fallopian tubes), make sure the woman is not allergic to iodine or shellfish/seafood Video #2: Signs of Pregnancy Presumptive : Can be defined by things/reasons other than pregnancy Amenorrhea Can be anorexic or exercising too much Fatigue Didn’t sleep well Nausea/Vomiting Sick Urinary Frequency UTI
Quickening/Fluttering in stomach Gas
and the umbilicus.
At 20 to 22 weeks, the fundus is approximately at the location of the umbilicus. At 36 weeks, the fundus is at the xiphoid process.
- When assessing fundal height, monitor the client closely for supine hypotension when place in the supine position. Measuring fundal height :
- Place the client in a supine position
- Place the end of the tape measure at the level of symphysis pubis
- Stretch the tape to the tope of the uterine fundus
- Note and record the measurement. Physiological Maternal Changes: Cardiovascular system : Circulating blood volume increases by approximately 40 – 50%; physiological anemia may occur as the plasma increase exceeds the increase in the production of red blood cells. Heart size is increased, and the heart is elevated upward and to the left because of displacement of the diaphragm as the uterus enlarges. There is an increase in the body’s demand for iron. Sodium and water retention may occur, which can lead to weight gain. Respiratory system : Oxygen consumption increases by approximately 15% to 20% Diaphragm is elevated as a result of the enlarged uterus Shortness of breath may be experienced.
- During pregnancy, a woman’s pulse rate may increase about 10 to 15 beats/minute, the blood pressure slightly decreases in the second trimester, then increases in the third trimester but not above the pregnancy level; and the respiratory rate remains unchanged or slightly increases. Gastrointestinal System : Nausea and vomiting, which usually subsides by the 3rd^ month, may occur as a result of the secretion of human chorionic gonadotropin (hCG); hCG stabilizes or decreases around week 12 Poor appetite may occur because of decreased gastric motility. Alterations in taste and smell may occur. Constipation may occur because of an increase in progesterone production or pressure of
Flatulence and heartburn may occur because of decreased GI motility and slowed emptying of the stomach cause by an increase in progesterone production. Gum tissue may become swollen and easily bleed because of increasing levels of estrogen. Ptyalism (excessive secretion of saliva) may occur because of increasing levels of estrogen. Renal System : Frequency of urination increases in the 1 st^ and 3 rd^ trimesters because of increased bladder sensitivity and pressure of the enlarging uterus on the bladder, Decreased bladder tone may occur and is caused by an increase in progesterone and estrogen levels; bladder capacity increases in response to increasing levels of progesterone. The renal threshold fir glucose may be reduced. Reproductive system :
1. Uterus a) Uterus enlarges, increasing in mass from approximately 60 g to 1000 g as a result of hyperplasia (influence of estrogen) and hypertrophy. b) Size and number of blood vessels and lymphatics increase c) Irregular contractions occur, typically beginning after 16 weeks gestation. 2. Cervix a) Cervix becomes shorter, more elastic, and larger in diameter. b) Endocervical glands secrete a thick mucus plug, which is expelled from the canal when dilation begins. c) Increased vascularization and an increase in estrogen causes a softening and a violet discoloration ( Chadwick’s sign ), which occurs at about week 6. 3. Ovaries a) Secrete progesterone for first 6 to 7 weeks of pregnancy b) Block maturation of new follicles c) Cease ovum production. 4. Vagina a) Hypertrophy and thickening of the muscle occurs. b) Increase in vaginal secretions is experienced: secretions are usually, thick, white, and acidic. 5. Breasts a) Breast changes occur because of the increasing effects of estrogen and progesterone b) Breast size increases and breasts may be tender. c) Nipples become more pronounced and the areolae become darker. d) Superficial veins become prominent e) Montgomery’s follicles become hypertrophied f) Colostrum may leak from the breasts. Skin: Changes in skin occur because of increased levels of melanocyte-stimulating hormone, which increase secondary ot increases in estrogen and progesterone; these changes include the following: a) Increased pigmentation
b) Dark streak down the midline of the abdomen may appear (linea nigra).
Increased vaginal discharge : o Interventions : Using proper cleansing and hygiene techniques, wearing COTTON underwear, avoiding douching, informing the client of the signs of infection and to consult the PHCP if an infection is suspected. Fatigue. o Interventions : arranging frequent rest periods throughout the day, using correct posture and body mechanics, obtaining regular exercise, performing muscle relaxation and strengthening exercises for the legs and hip joints, and avoiding eating and drinking foods that contain stimulants throughout the pregnancy. Heartburn. o Interventions : eating small frequent meals and avoid fatty and spicy foods, sitting upright for 30 minutes after a meal, drinking milk between meals, and consulting with the PHCP about the use of antacids. Ankle Edema : o Interventions : elevating the legs at least twice a day and when resting, sleeping in a side-lying position, wearing supportive stockings or supportive hose as prescribed, avoiding sitting or standing in one position for long periods. Varicose veins : o Interventions : wearing supportive stockings or support hose, elevating the feet when sitting, lying with the feet and hips elevated, avoiding long periods or standing or sitting, moving about while standing to improve circulation, avoiding leg crossing, avoiding constriction articles of clothing such as knee high stockings. Thrombophlebitis (is rare but can occur): o Interventions : teaching leg exercises and avoiding airline travel if possible. Headaches : o Interventions : changing positions slowly, applying a cool cloth to the forehead, eating a small snack, using acetaminophen only if prescribed by the PHCP Hemorrhoids : o Interventions : soaking in a warm sitz bath, sitting on a soft pillow, eating high fiber foods, and drinking sufficient fluids to avoid constipation, increasing exercise, such as walking, and applying ointments, suppositories, or compresses as prescribed by the PHCP. Constipation : o Interventions : eating high fiber foods such as whole grains, fruits, and vegetables, drinking no less than 2000 mL per day, exercising regularly, such as a daily 20 minute walk, and consulting with the PHCP about interventions such as the use of stool softeners, laxatives, or enemas. Backache : o Interventions: obtaining rest, using correct posture and body mechanics, wearing low- heeled, comfortable, and supportive shoes, performing pelvic tilt (rock) or tailor- sitting exercises and conscious relaxation exercises, sleeping on a firm mattress. Leg cramps : o Interventions: getting regular exercise, such as walking, dorsiflexing the foot of the affected leg, and increasing calcium intake. Shortness of breath : o Interventions: taking frequent rest periods and avoiding overexertion, sitting
and sleeping with the head elevated or on the side, avoiding overexertion.
Chlamydial infection. o Transmission may occur during vaginal birth and can result in neonatal conjunctivitis or pneumonitis. o Infection can cause premature rupture of the membranes, premature labor, and postpartum endometritis. Trichomoniasis. o Associated with premature rupture of the membranes and postpartum endometritis. Genital herpes simplex virus. o Characterized by painful lesions, fever, chills, malaise, and severe dysuria and may last 2 to 3 weeks. o Assessment includes questioning all women about signs/symptoms and inspecting the vulvar, perineal, and vaginal areas for vesicles or areas of ulceration or crusting; this is done during pregnancy and at the onset of labor. o Vaginal birth may be acceptable; cesarean birth is recommended if visible lesions are present. o Infants who are born through an infected vagina should be carefully observed, and samples should be taken for culture. Human immunodeficiency virus (HIV). o HIV is transmitted via blood, blood products, and other body fluids such as urine, semen, and vaginal secretions; the virus is also transmitted through exposure to infected secretions during birth and via breast milk. o Repeated exposure to the virus during pregnancy through unsafe sex practices and/or intravenous drug use can increase the risk of transmission to the fetus. o Perinatal administration of zidovudine may be recommended to decrease risk of transmission of HIV from mother to fetus. Substance abuse. o Substance abuse threatens normal fetal growth and the successful term completion of the pregnancy. o Substance abuse places the pregnancy at risk for fetal growth restriction, abruptio placentae, and fetal bradycardia. o Many substances cross the placenta and can be teratogenic; (drugs, tobacco, alcohol, medications, certain foods such as raw fish); no OTC medications should be taken unless prescribed. o Smoking (tobacco) can lead to low birth weight, a higher incidence of birth defects, and stillbirths. o Physical signs of drug abuse may include dilated or contracted pupils, fatigue, track (needle) marks, skin abscesses, inflamed nasal mucosa, and inappropriate behavior by the mother. o The consumption of alcohol during pregnancy may lead to fetal alcohol syndrome and can cause jitteriness, physical abnormalities, congenital anomalies and growth deficits. Video #3: Weight Gain & Nutrition During Pregnancy AND Diagnostic Tests During Pregnancy Weight Gain & Nutrition Normal weight gain = 25- 35 pounds Overweight person weight gain = 15- 25 pounds
Underweight person weight gain = 28-40 pounds
Non-invasive Measures fetal well-being within the last trimester of pregnancy Measures response of FHR to Fetal Movement
@ShopWithKey on Etsy 1 o Reactive: FHR accelerates during movement (normal; positive) o Nonreactive : No accelerations during movement (not normal; negative) If non-reactive, the DR will perform another test called: Contraction Stress Test (CST) or a BPP. Video #4: Diagnostic Tests Contraction Stress Test (CST) Induce contraction with administration of Pitocin/oxytocin or nipple stimulation During the contraction, monitor FHR for late decelerations Negative CST Response (no late decelerations, which is what you want) Positive CST (late decelerations happen, not a good thing) Risk o Can send woman into PTL Amniocentesis. Aspiration of amniotic fluid; best performed between 15 and 20 weeks of pregnancy because amniotic fluid volume is adequate and many viable fetal cells are present in the fluid by this time. Performed to determine genetic disorders, metabolic defects, and fetal lung maturity You want an empty bladder because you will poke into amniotic sac to test for genetic abnormalities (levels of AFP aka alphafeto-protein) o Interventions : if less than 20 weeks gestation, the woman should have a full bladder to support the uterus. If more than 20 weeks gestation, the woman should have an empty bladder to minimize the chance of puncture. Prepare the client for ultrasonography, which is performed to locate the placenta and avoid puncture of it. Obtain baseline vital signs and fetal heart rate. Monitor every 15 minutes. Position the client supine during the procedure and on the left side after the procedure. o High AFP = NTD o Low AFP = Chromosomal disorders such as down syndrome LS Ratio (Lecithin Sphingomyelin) tests for fetal lung maturity o Ratio of 2:1 = fetal lung maturity o Ratio of 2.5:1 or 3:1 = fetal lung maturity for client with DM Risks/Complications : o Amniotic Fluid Emboli (AFE) o Maternal Hemorrhaging o Infection o Premature rupture of the membranes o Rh isoimmunization o Miscarriage o Abruptio placentae Chorionic Villus Sampling (CVS) Alternative to Amniocentesis: Performed for the purpose of detecting genetic abnormalities; the PHCP aspirates a small ample of chorionic villus tissue at 10 to 13 weeks gestation. Can be done between 10-12 weeks Also tests for genetic abnormalities by testing the placenta instead of the amniotic fluid.
@ShopWithKey on Etsy o Interventions : the client may need to drink water to fill the bladder before the procedure to aid in visualizing the uterus for catheter insertion; obtain baseline vital signs and fetal heart rate (monitor frequently after the procedure); Rh-negative women may be given Rh (D) immune globulin, because chorionic villus sampling increases the risk of Rh sensitization; make sure informed consent is signed. After chorionic villus sampling and amniocentesis, instruct the client that if chills, fever, bleeding, leakage of fluid at the needle insertion site, decreased fetal movement, uterine contractions, or cramping occurs she must notify the PHCP. Kick counts (fetal movement counting ): The client is instructed to sit quietly or lie down on her side and count fetal kicks for a specific period of time. Instruct the client to notify the PHCP if there are fewer than 10 kicks in two consecutive 2- hour periods or as instructed by her PHCP. Fern Test : A microscopic slide test to determine the presence of amniotic fluid leakage. Using sterile technique, a specimen is obtained form the external os of the cervix and vaginal pool and examined on a slide under a microscope. A fern like pattern that results from the salts of the amniotic fluid indicates the presence of amniotic fluid. o Interventions : position the client in the dorsal lithotomy position; instruct the client to cough. This causes the fluid to leak from the uterus of the membranes are ruptured. Doppler blood flow analysis : Noninvasive (ultrasonography) method of studying blood flow in the fetus and placenta Percutaneous umbilical blood sampling : Performed if fetal blood sampling is necessary; involves insertion of needle directly into fetal umbilical vessel under ultrasound guidance. Fetal heart rate monitoring is necessary for 1 hour after procedure, and a follow-up ultrasound to check for bleeding or hematoma formation is done for 1 hour after the procedure. Alpha-fetoprotein (AFP) screening : Assess the quantity of fetal serum proteins; abnormal protein levels are associated with open neural tube and abdominal wall defects. Can screen for spina bifida and down syndrome; if abnormal, the test is repeated; a false-positive test result is common. o Interventions : the AFP level is determined by a maternal blood sample drawn between 16- and 18-weeks’ gestation. o If the level is abnormal and the gestation is less than 18 weeks, a second sample is drawn and screened. o An ultrasound is performed for elevated levels to rule out fetal abnormalities or multiple gestation.
@ShopWithKey on Etsy Biophysical profile : Noninvasive assessment of the fetus that includes fetal breathing movements, fetal movements, fetal tone, amniotic fluid index, and fetal heart rate patterns via a nonstress test. Normal fetal biophysical activities indicate that the central nervous system is functional, and the fetus is not hypoxemic. Nitrazine test : A Nitrazine test strip is used to detect the presence of amniotic fluid in vaginal secretions. Vaginal secretions have a pH of 4.5 to 5.5 and do not affect the color of the Nitrazine strip or swab. Amniotic fluid has a pH of 7.0 to 7.5 and turns the Nitrazine strip or swab blue in color. o Interventions : position the client in the dorsal lithotomy position, touch the test tape to the fluid, check the test tape for a blue0green, blue-gray, or deep-blue color, which indicates that the membranes are probably ruptured, causing leakage or amniotic fluid. Fibronectin Tests : Sampling of cervical and vaginal secretions for fetal fibronectin is done (a protein present in fetal tissues normally found in cervical and vaginal secretions until 16-20 weeks gestation and again at or near term). Positive results indicate the onset of labor in 1 to 3 weeks; negative test results are more predictive that preterm labor will not begin. Test is used if the client is at risk for preterm labor, before 37 weeks gestation. o Interventions : client is placed in lithotomy position for a sterile speculum examination, cervical secretions are obtained with a cotton swab, and laboratory tests are done for the presence of fibronectin. Nonstress test : Performed to assess placental function and oxygenation; determines fetal well-being; and evaluates fetal heart rate (FHR) in response to fetal movement. o Interventions : an external ultrasound transducer and tocodynamometer are applied to the mother, and a tracing of at least 20 minutes duration is obtained so that the FHR and the uterine activity van be observed. o Obtain a baseline blood pressure reading and monitor frequently. o Position the mother in left lateral position to avoid vena cava compression. o The mother may be asked to press a button every time she feels fetal movement. The monitor recorded a mark at each point of fetal movement, and this is used as a reference point to assess FHR response. Contraction Stress Test : Assesses placental oxygenation and function; determines fetal ability to tolerate labor and determine fetal well-being. Fetus is exposed to the stress of contraction to assess the adequacy of placental perfusion under simulated labor conditions. Performed if the nonstress test is abnormal. o Interventions : the external fetal monitor is applied to the mother, and a 20 to 30- minute baseline strip is recorded. o The uterus is stimulated to contract, either by the administration of a dilute doe
