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MCH NUR 2633 – Study Guide Test 1/50 questions
1. Women’s health encompasses breast care, GYN exams, and assessments. Be comfortable with the parameters of education for Self breast exams, and what is normal for a woman to note when doing breast exam. Know normal menstrual cycle - what is the most common complaint with the menstrual cycle, and complications; (dysmenorrhea) Know STI’s and risks. a. The most common compliant women have with menstrual cycle is abnormal bleeding, painful menses (dysmenorrhea), treatment is heating pad and NSAIDs. Other OBGYN complaints are fibroids, ovarian cysts, and endometriosis. Self-breasts exams monthly 7- 10 days after the cycle. Two hormones with women's health are Estrogen(growth hormone makes everything bigger), Progesterone(slows things down, makes lining thicker, the pregnancy will not survive without enough of this hormone) 2. If a patient finds a breast lump how will you advise her? a. It’s never normal to feel a lump, make sure you follow up and have other testing, discharge is not normal unless it's a milk discharge after pregnancy b. web-x all women should be doing breast exams once they start menses (10 days after) c. if a lump is found make an appointment d. ultrasound, mammography e. breast cancer at all ages 3. What is your role in the GYN exam a. Our role in the GYN exam assisting the physician and the patient, explain to her what is happening so she is not nervous, pap smears are never down in the E 4. Contraception - Forms of birth control – good subject for your postpartum patients as well – know them, know the risks and some of the educational points to share with them regarding each type. Remember birth control choice should be based on a patient’s lifestyle – if she cannot swallow pills do not offer oral contraception – right? Etc… a. Types of birth control- diaphragm, IUD, the pill, condoms, depo shot(12 week injection), patches, sponge, cervical cap, nuva ring, rod in arm, abstinence, withdrawal, sterilization b. web-x c. patient education: does not prevent std d. same-time everyday e. for depo take ca because it depletes mineralization of bones f. based on lifestyle g. IF BREAST FEEDING DO NOT TAKE ANYTHING ESTROGEN BASED BC IT WILL IMPEDED THE BREAST MILK. The prolactin will be affected by the estrogen because they work against each other h. When the estrogen levels are high. The prolactin is depleted and vice-vers 5. Emergency contraception – know education. a. Plan B used as soon as possible up to 72 hours, doesn't cause abortion, if your pregnant it won't hurt the baby, high dose birth control, bad side effects-N/V, headache. b. web-x does not cause abortions-spotting n/v c. does not protect from sti d. follow- up for cultures for sti e. messes with menstrual cycle f. OTC
6. Preconceptual care is provided for a means to identify risks and provide nutrition – not to establish who should become pregnant. a. Identify risk factors, is it safe for them to become pregnant. Healthy nutrition and lifestyle. Weight and folic acid. Immunizations. Are they smoking or drinking? b. web-x genetics/ genetic counseling c. starting prenatal vitamins d. community referrals 7. Pregnancy – understand the structure and function of the external and internal genitalia. Know the purpose of each in the process of pregnancy. You must understand the changes that occur to each system – a. Uterus has two functions that are to house the baby and expel it (menses). Vagina is a collapsible tube that stretches to deliver baby. Cervix is usually closed but will thin and open to 10cm to allow baby to come out. b. Ovaries are egg storage, you start with all the eggs you have, and you don't make new ones. If the Bladder is inflamed, or UTI can cause preterm labor. Bowel, if you have diarrhea, if you use enema or laxative, can start preterm labor. Illegal drugs can also can use preterm labor. Three things uterus needs are food, fluids and rest if it doesn't have these things if can cause muscle irritation and preterm labor. c. web-x d. ovaries house eggs & produce hormones: estrogen- growth hormone and progesteroneacquiescent/quieting hormone e. Progesterone better than estrogen because it progestation/ pro-life hormone. without, it many women have multiple loses f. synthetic progesterone to maintain pregnancy g. Fallopian tubes transport. Gets the egg from one place to the other h. Egg & sperm fertilized in the ampula of the tube. largest, most distal part of the tube- goes through tube and ends up in the endometrial lining i. Bladder if the bladder is infected, spasming, or is distended can cause a lot of problems with pregnancy. If we see issues with preterm labor, or with bleeding, n/v, prone to uti. uti can cause problems. 8. Please identify pregnancy history – G, F, P, A, L – know how to complete this given each women’s obstetrical history. a. Only for delivery, doesn't matter how many times went into labor even if went into labor. doesn't matter if pre/post term if baby survived, or didn't survive b. Gravida- Number of pregnancies c. Full term pregnancies- Live or dead 37-40 weeks d. Pre term pregnancies-Live or dead 20-37 weeks e. Abortion/Miscarriages- Prior to 20 weeks f. Living- children that are living g. Twins are one pregnancy 9. What is fetal well- being and how do we measure it. Can you date a pregnancy using Naegele’s Rule? Can you measure fundal height? Know the normal parameters of fetal growth. When are fetal heart tones audible with a Doppler? What are the parameters and what does it mean if the fetus falls outside those parameters?
10. Fetal development from the conception through the embryonic (critical) period, to the placental development and beyond. – It is all about the placenta. What risk factors will impede placental perfusion to the baby? a. A baby is completely developed by 12 weeks, the embryonic/critical stage where you need to be the most cautious about what you put into your body. The pregnancy is tucked away in the pelvis for 12 weeks protecting the baby from trauma. b. web-x c. If something happens to the baby during the embryonic period, or if there is some kind of insult at any kind, you're going to find anomalies (genetic insult, environment insult) because of infection, or moms lifestyle choices. we can pinpoint that to the weeks of gestation, so during the 1st 12 weeks the baby stays in the pelvic organ to try to protect it somewhat from trauma, after that once it becomes and abdominal organ it is cushioned by amniotic fluid: cushions the baby from injury, cushions the cord from being collapsed, or restricted, helps the lungs from sticking- temp control free movement, so the muscles can dev. so they can get stronger and when they are born have the ability suck/swallow/push/pull d. Oligohydramnios- too little fluid e. polyhydramnios- when the fluid is too much( diabetes in mom) f. oligo- look for renal issues in baby g. The placenta is the work organ of pregnancy, if something happens to the placenta it happens to the baby as well. IT’S ALL ABOUT PERFUSION. It's all about the blood flow to and from the placenta. Baby's blood does not come in contact with mother's blood. A gas exchange takes place at the chorionic villi, where nutrients and oxygen are given to the baby then the baby gives back carbon dioxide. Carbon dioxide is given to the mother's lungs to be expelled this makes the mother breathe a little bit faster/deeper. Mother needs more lung capacity, diaphragm pushes on the lungs, so she uses a lateral lung expansion (arches back to receive more lung capacity). h. The kidneys need to work harder because the filtration rate is greater because they can't filter all the extra fluids/salts/proteins. i. PREGNANCY IS ALL ABOUT PERFUSION j. The placenta is a huge filtering organ and everything has to go placenta for the baby. Bad/good things go through the placenta 11. Know normal discomforts of pregnancy and what is not normal and how do nurses educate their patients on the difference. Look at each system. What a normal change means to her and what education you would give. a. Headaches in pregnancy are NOT normal. A lot of times it is preeclampsia. 12. What activity is appropriate for the pregnant patient? a. Walking is best to get heart rate up b. also swimming, bicycling c. as long as Heart rate doesn't go up over 140 d. Don't start a new exercise you didn't do before pregnancy e. be careful with bending/ supine position because of blood flow- heavy uterus sits on superior vena cava and causes hypertension for mom and decrease blood flow to baby
f. no pregnant woman should lay flat on their back- continue doing what you were doing before, as long as it doesn’t impede blood flow g. low impact, not high impact because joints become more flexible (Hormone called relaxin h. relaxin: helps the pelvic bone to separate just a little to help baby to snuggle before birth to expand i. also knees and elbows hyperextend- discourage high active sports with women who are pregnant- jet ski's j. no alcohol
13. Placenta is the ‘work horse’ organ of pregnancy – what does it provide/what it doesn’t provide. a. Placenta has two sides the fetal side and maternal side. b. Maternal side (dirty dunkin) has 15-20 tissue pads called Catalina pads (where the gas exchange takes place), count and make sure they're all there after birth. c. Fetal side is the Shiny Schultz side is translucent and you can see through it but you can't break it without an sharp instrument. d. The placenta is made up of two layers of tissue the chorion and amnion. The chorion is on the outside of the balloon and the amnion is on the inside with the baby inside. e. The three vessels in the umbilical cord are two arteries (deoxygenated blood baby to mother) and a vein (take oxygenated blood mother to baby). The vessels wrap around each other, to keep the cord from being compressed is Wharton's jelly. Inside the amnion sac is fluids. The reasons we have fluid are to protect the baby and cord, temperature control and free movement. f. Sugar, caffeine, Nicotine, Carbon monoxide and any drugs mom takes crosses the placental barrier, but heparin and insulin do not. 14. Amniotic fluid what is the purpose? What is the issue with oligohydramnios, and polyhydramnios. a. Purpose of amniotic fluid is protect fetus and cord from trauma and temperature control. b. Oligohydramnios is losing fluid or not enough fluid. PROM can result (premature rupture of membranes) c. Polyhydramnios is too much fluid.- cause shortness of breath and preterm labor 15. Nutrition is a key factor in pregnancy outcome – what is essential to include. What do most women need additional supplements for? Explore the vegetarian diet. Explore the problem of generalized nausea and vomiting – not severe – explore food fads. What are the risks to the fetus if mom does not gain weight or does not eat properly? And keep in mind the questions regarding the use of alcohol in pregnancy – it is never acceptable. a. Drink enough fluids(water) and fiber for constipation b. Vegetarian needs to increase protein, iron, folic acid, calcium c. IUGR- intrauterine growth restriction, baby doesn't grow to normal weight during pregnancy. d. Mother is diabetic not taking care of herself eating a lot of sugar, baby will be macrosomia (baby grows too much in the trunk). These babies get stuck in the birth canal and causes fetal injuries.
e. serious s/e of pregnancy f. must report bleeding to physician g. pain/cramping h. RUPTURED MEMBRANES- WATER BREAKING report to hcp i. bleeding disorders j. 1. postcoital bleeding=bleeding in the first trimester: miscarriage, abortion, implantation, sex, infections, eptopic k. 2. 2nd trimester l. eptopic is distinguishable because the uterus stretches bigger than ever before, pain on one side (unilateral) m. Interventions for eptopic- (early stage) chemical (methotrexate) tube can maybe be saved and sx removes the entire tube leaving one Fallopian tube left. n. they try to keep the ovaries intact because that is the hormone producer- keeps people feeling a little healthier o. Placenta previa: bleeding d/o placenta has attached itself in the lower part of the uterus even to be completely over the cervix which would be a complete previa- painless p. placenta previa if there is bleeding, we want to identify where the bleeding is coming from the ultrasound that will tell us where the placenta is q. if we let someone go home and they have placenta previa we must educate them on they need a pelvic rest, nothing in the vagina. r. if she should start to bleed again because she is dilating (labor) we are going to have to do a c-section s. she cannot give a vaginal delivery with a placenta previa because the placenta will be delivered 1st and that is the babies way to maintain life t. Placenta abruption: painful the placenta is tearing away from the uterus, but it is not falling out of the uterus, so the uterus is filling up with blood causing the abdomen to get very tense causing the belly to feel very rigid- painful *torn away from the uterine wall causing bleeding eternally which is life threatening which calls for a c section u. this causes the baby heart tones to drop rapidily v. going to need a blood transfusion w. need to know is RH negative- need to know CBC x. big bore IVs in each side y. go to operating room to get baby out and placenta- stop bleeding z. traumatic events to the abdomen causes abruption, nva, drug use, anything that’s going to cause the bv to collapse- Hypertensive crisis- smoking, stroke, seizures aa. cesections for both is how we manage that bleeding d/o if active bleeding
18. Preterm labor – know signs and symptoms, treatment, nursing interventions. Know the drugs - that are used as a tocolytic (a drug that stops preterm labor) a. Preterm labor can happen because of smoking malnourishment or recreational drugs. b. S/S are cramping, low back ache, increase vaginal discharge, feels like the baby is pushing down. c. We lay mom on her left side to give the baby oxygen from the placenta. Hook up the fetal monitor to mom, IV fluids (Lactated Ringers) 500ml bolus minimum, most preterm labor is because of dehydration or UTI. Check UA. Preterm labor would be regular uterine contractions that cause cervical change of 2cm or 80% effaced (thin) before 37
weeks. Fetal fibronectin (fFN) is a test can show if your body is getting ready to give birth. Also do a vaginal ultrasound to check cervix it should be 4cm in length if not she could be in preterm labor. If mom continues to contract we would give her Terbutaline subcut, if that doesn't work we give Magnesium Sulfate 4g bolus then 2 g maintenance. Mag sulfate works on the smooth muscle to relax it. This can relax diaphragm so we must listen to lung sounds. Vital signs, output, DTR (deep tendon reflexes) every hour. Baby will need NICU to watch the breathing.
19. Pre – eclampsia – know signs and symptoms (subjective and objective), treatment and nursing interventions. a. Pre-eclampsia usually seen after 24 weeks. S/S is Hypertension, edema and proteinuria. Can affect the brain, heart, liver and kidneys. If mom comes in with higher than normal blood pressure lay her on her LEFT SIDE. Mom is going to have headache, heartburn, epigastric pain, vision problems, pitting edema and high BP. Hook her up to monitor. Give her Mag sulfate 4g bolus and 2g maintenance. Keep Mag on 24 hours post- delivery. This is to prevent or treat the seizures because it's a smooth muscle relaxant. Put in a foley catheter, to see how much urine she is putting out. She will start out with less than 30ml/hr until the mag starts working and relaxes. Cure for pre-eclampsia is to have the baby and placenta. We have to give Oxytocin to go into labor because the mag stops this process. b. Mom is now at risk for postpartum hemorrhage because the uterus doesn't contract after birth because of the mag sulfate. We need to keep the Pitocin (oxytocin) running after birth to get that uterus to contract. If we have a boggy uterus then we need to massage the fundus. 20. Know the medications used in pregnancy both the normal supplementation and those used to manage preterm labor and pre-eclampsia. a. Betamethasone is a steroid that is given to help fetal lung maturity, given 24- weeks for preterm labor (two shots given 24 hours apart takes 24 hours to be affective). b. Magnesium Sulfate is a muscle relaxant for preterm labor and preeclampsia. 4g bolus and 2g maintenance. c. Terbutaline is a tocolytic in treatment of preterm labor to stop uterine contractions before 37 weeks. 3 times an hour, can cause cardiac issues d. Oxytocin(Pitocin) strengthen labor contractions used during preeclampsia 21. Know specifically magnesium sulfate since it is used for both reasons – preterm labor and pre- eclampsia due to the effect – it is a smooth muscle relaxant – hence the uterus is a smooth muscle and will respond well to the drug – your blood vessels and the tissue surrounding relax hence having a hypotensive response if using Mag. Please know magnesium well. It is the first line defense in pre-eclampsia….not to prevent hypertension but to................................................................................................................?? Also know the nursing interventions to be monitored closely. a. This info in in with preeclampsia and preterm labor b. web-x c. preterm contraction- regular uterine contractions occurring before 37 weeks- it has to have cervical change
ag. if a baby is born with magnesium sulfate on board baby is going to be lethargic and not breathe, can work mag out of system just going to take a little longer ah. magnesium sulfate is continued for another 24 hrs. post-delivery-prefer to deliver these babies vaginally (pull foley before vaginal delivery- new foley will be places after she has the baby) ai. b4 they go home: check vitals, fundus, bleeding because open vessels, even bleeds post- partum, urine output, dtr, loc aj. if a women is pregnant and had hypertension throughout her whole pregnancy she didn’t come in for prenatal care, she comes and she is 8 1/2 months pregnant 34- 35 weeks. she shows up for her 1st visit: DOA ak. fundal height measurement 28-29cm- this is a red flag. We presume her dates are good, what are we thinking? is the baby small. al. we call babies that are less than the gestational age, there size is less than date called iugr am. Risk Factors an. smoking, alcohol, drugs, poor nutrition all affect the growth of the baby and therefore can have a baby with iugr ao. if you put 2 babies together one iugr one not iugr the 5lb baby in a healthy environment is going to have more body fat- the iugr baby is not going to have no body fat: there skin is going to be skinnier, wrinkled and dry ap. Their heads are going to be a bigger proportion to their body, more so disproportionately iugr. aq. need to find iugr when we’re doing our leopolds when we’re measuring- we need to be feeling around to see how big these babies feel
22. What is the effect on the baby of the risk factors that may impede placental perfusion? a. Two things can happen if the placenta is insulted, IUGR (Intrauterine growth restriction) and macrosomia. 23. Diabetes in pregnancy is a big problem. Know the differences of fetal surveillance with Type 1 vs Type 2, vs Gestational DM – what is the risk to the baby. a. Type 1 Diabetes means the pancreas is not working is not producing insulin. Type 1 can cause defects including ventricular septal defect, skeletal issues and neuro issues. Insulin dependent. NUMBER ONE CONCERN IS FETAL ANOMALIES BC THEY'RE ALREADY IN INSULIN b. Type 2 is managed by diet or insulin. Type 2 no anomalies but at risk for macrosomia. CNTRL WITH DIET, AS LONG AS NOT ON INSULIN FOR THE FIRST 12 WEEKS, IF THE BLOOD SUGARS GET OUT OF CNTRL AFTER THAT ITS NOT AN AMOLIE ISSUE ANYMORE, IT IS A GROWTH ISSUE babies that get all that sugar, because sugar passes the placenta insulin does not, so mom is pumping sugar into baby. if blood sugars spike and were unable to control the diet then we add insulin, but adding insulin would add risk to the perfusion of the placenta and risk babies getting big macrosomia- lung maturity is also a problem c. What happens to baby when mom has sugars out of contril? macrosomia (macro-large) (somia chest or body gets larger and head and body become equal) head should always be a little bigger than chest if equal at risk for shoulder Dystonia and birth injuries
d. Gestational Diabetes unless other signs we do not look for this until 24-28 weeks, this is diet control with fasting blood sugar to be 60-90. Gestational DM can cause macrosomia. Gestational diabetes don't have the risk of anomalies e. Whenever insulin is given the perfusion is at risk and we need to watch the fetus carefully with a non-stress test. We don't want the baby to be big so we may need to deliver early, need to check for lung maturity with an L/S ratio. Watch blood sugar for baby post-delivery, hypoglycemia. f. web x g. once we start insulin it becomes a vascular issue, we know that someone with long- term insulin dependent diabetes can have problems with their eyes, heart, or kidneys this is a vascular or perfusion issue h. type one comes into the pregnancy with a vascular component because she is on insulin coming into the pregnancy i. Fetal development is happening during the first 12 weeks of pregnancy- IF I HAVE A VASCULAR INSULT DURING THE DEV. I AM GOING TO HAVE ANOMOLIES j. diabetic babies tend to be bigger and fatter babies because they're full with fluid also has a risk for not being able to breathe because the lungs do not mature when there is excess sugars in the body, birth injuries because they get so big during there vaginal descent. Babies with a lot of sugar become very jittery and hypoglycemic and may not be breathing very well DO NOT IGNORE A BABY WHO IS VERY QUIET(FLACCID) THAT 1ST HR. THOSE ARE SICK BABIES. 1 may be sugars the other might be drugs, may be bc he has mag. Babies should not be flaccid because they're going to stop breathing. They can only breathe for so long if they don’t have the reserves k. Watching them very closely in the 1st hour of life- if we check the sugars and the sugars are low, we have to feed them, or start iv with sugars if they can’t eat. we are trying to prevent hypoglycemia l. watch blood sugars- manage bld sugar app. if the ct requires insulin now we have a risk to baby vasculature and the placenta can be affected if the baby has no perfusion the baby can die m. moms who sugars are out of control we do surveillance every week with a non-stress test/ ultrasound, something to make sure the placenta perfusion is adequate enough to maintain the pregnancy n. caution mom to tell us if they is fetal change in activity o. active babies are healthy babies p. non active babies are sick babies
24. Hyperemesis Gravidarum - a problem of extreme nausea and vomiting causing electrolyte imbalance , dehydration and severe weight loss – what is the nursing intervention? a. Hyperemesis Gravidarum usually during the first trimester. May need IV therapy for the dehydration. Eat small more frequent meals. Antiemetic for the N/V. causes electrolyte imbalance to the point of weight loss b. hospitalization: for observation to replace fluids- once gets fluids the appetite comes back once they get enough fluids 25. Do you understand the concept of perfusion, oxygenation, the hormone feedback system, and the responses of the body under the hormone influences? You will do well.
- Multipara: has completed two or more pregnancies to
- stage of viability
- Viability: the point in time when an infant has the
- capacity to survive outside the uterus. There is not a
- specific weeks of gestation; however, infants born between
- 22 to 25 weeks are considered on the threshold of viability.
- GTPAL acronym
- ● Gravidity
- ● Term births (38 weeks or more)
- ● Preterm births (from viability up to 37 weeks)
- ● Abortions/miscarriages (prior to viability)
- ● Living children
- **Nägele's rule: Take the first day of the woman's last
- menstrual cycle, subtract 3 months, and then add 7 days
- and 1 year, adjusting for the year as necessary**
- Measurement of fundal height in centimeters from
- the symphysis pubis to the top of the uterine fundus
- (between 18 and 32 weeks of gestation). Approximates the
- gestational age
- Pregnancy Trimesters
- First: weeks 1-
- Second: weeks 14-
- Third: weeks 27-
- antepartum- conception until onset labor
- intrapartum-labor and delivery
- Postpartum- after birth til 6 weeks
