Mod 1 ATI Notes

Fertility

ability to achieve pregnancy without medical intervention. Pregnancy occurs within 6 to 12 months for most of clients who are actively attempting conception.

risk factors that may affect fertility

advancing age, obesity, smoking, and vigorous exercise

infertility

​An inability to get pregnant when having regular, unprotected sexual intercourse for at least 12 months or difficulty with the client’s ability to reproduce.

At around age 32

fertility begins to decline in female clients

oocytes

​​​​​Immature egg cell in the ovary. (The quality of the oocytes also decreases with increasing age, which can cause irregularities in the oocytes and may decrease fertility.)

Clients who are overweight (a body mass index [BMI] of 25 to 29.9) or obese (a BMI of greater than 30) have

decreased fertility rates.

For every 5 kg (11 lb) of weight that a client gains, the length of time to get pregnant increases by

5%.

There also has been evidence to suggest that there is ovulatory dysfunction associated with a BMI less than

17

A nurse is teaching a client about how age affects infertility. Which of the following information should the nurse include in the teaching?

Irregularities in the oocytes can decrease fertility.

Fertility begins to decline in clients 32 years of age and older.

The live birth rate for clients older than 40 years of age is approximately 8%.

For clients attempting conception after age 40, the live birth rate is approximately

8% due to diminished ovarian reserve

Untreated or undiagnosed celiac disease

may lead to problems with fertility by causing later-onset menstruation, early menopause, or secondary amenorrhea.

celiac disease

Chronic immune disorder in which the ingestion of gluten causes inflammation of the intestinal lining.

amenorrhea

​The lack of a menstrual period in a female client who is of reproductive age.

increased duration and intensity of exercise can

decrease fertility rates in females.

anovulation

​A lack of ovulation.

Which of the following maternal clients have an increased risk for infertility?

A 23-year-old client who has a BMI of 21 who runs 10 miles a day 

A 38-year-old client who has never been pregnant

A 25-year-old client who smokes

Severe maternal morbidity (SMM)

any unintended, serious complication that occurs during labor, birth, or postpartum and has the potential to lead to death.

• postpartum hemorrhage, amniotic fluid embolism, sepsis, acute renal failure, eclampsia, and cardiac arrest.

postpartum hemorrhage (PPH)

Blood loss of greater than 1,000 mL during and immediately after giving birth, or a cumulative loss of greater than 1,000 mL within 24 hr of birth with manifestations of hypovolemia.

Causes of PPH

• Uterine atony

• Trauma to tissues, such as cervical or vaginal lacerations

• Retained placental tissue

• Bleeding disorders (e.g., Von Willebrand’s disease)

uterine atony

​Loss of uterine tone due to ineffective contractions.

A nurse is caring for several clients who have just given birth. The nurse suspects postpartum hemorrhage in some of the clients. Which of the following findings is an indication of this condition?

Vaginal birth with a blood loss of 600 mL

Blood pressure of 90/52 mm Hg following a blood loss of 400 mL   
Cesarean birth with a cumulative blood loss of 1,050 mL

chorioamnionitis

​​​​​An infection within the amniotic sac.

endometritis

​An infection in the lining of the uterus.

embolism

An obstruction or blockage in the bloodstream caused by a blood clot, fat deposit, or other substance.

preeclampsia

A serious complication of pregnancy occurring after 20 weeks of gestation, in which a client’s blood pressure is above 140/90 mm Hg. It can be accompanied by proteinuria, edema, headache, and vision changes. Preeclampsia can become severe, resulting in seizures. 

malignant hyperthermia

​​​​​​​Severe reaction to anesthetic agents that causes a fast rise in body temperature and severe muscle contractions.

disseminated intravascular coagulopathy

​​​​​A condition in which blood clots excessively form in blood vessels. As a result, clotting factors are used up, and then bleeding occurs excessively anywhere in the body.

Common Causes of Maternal Morbidity

• Cardiovascular problems

• Diabetes

• High blood pressure

• Infection

• Blood clots

• Hemorrhage

• Anemia

• Nausea/vomiting

• Depression and anxiety

A nurse is teaching a group of students about common causes of maternal morbidity. Which of the following should the nurse include in the teaching?

Depression

Diabetes mellitus

Infection

perinatologist

​​A medical doctor (either a primary care provider or consultant) who specializes in care for high-risk pregnancies, fetal therapy, and fetal and maternal testing.

abortion

Any pregnancy loss prior to viability.

A nurse is caring for a client who reports marijuana use. Which of the following is the client at risk for if they continue marijuana use?

Low birth weight in infant

Spontaneous abortion

Preterm birth

social determinants of health (SDOH)

The conditions in the environments where people are born and live that affect their health, well-being, and quality of life. 

intrauterine fetal demise

Also known as stillbirth. Legal definitions vary somewhat by state, but it is generally considered to be a fetal death occurring at around 20 weeks of gestation or if the fetus weighs 350 to 500 g or more.

vasa previa

A condition that occurs when some of the umbilical cord blood vessels run near or across the internal cervical orifice.

infant mortality

​​​​An infant death occurring before the first birthday.

sudden unexpected infant death (SUID)

The unexpected death of an infant under the age of 1 year. Prior to investigation, there may not be a known cause of death.

Black Maternal Mortality

greater risk of pregnancy-related death than White, Asian, or Hispanic Americans.

• underlying chronic conditions, differences in the quality of health care, implicit bias, and structural racism.

racial disparities in maternal and infant health outcomes

• contributing factors

• preexisting medical conditions

• structural barriers

• social determinants of health

racial disparities in maternal and infant health outcomes

• not contributing factors

• equal access to resources

• genetic disposition

In the U.S., a maternal client dies every 12 hr from

complications of pregnancy or birth.

A first pregnancy does

not increase the risk of maternal morbidity and mortality.

• Risks increase with an increased number of pregnancies.

therapeutic communication

Communication techniques (active listening, repeating information, using open-ended questions) used to enhance the physical, mental, and emotional well-being of clients and their families.

therapeutic communication

Communication techniques (active listening, repeating information, using open-ended questions) used to enhance the physical, mental, and emotional well-being of clients and their families.

active listening

The act of receiving the message, interpreting its meaning, and responding to the client; giving complete attention to the speaker. 

​​​​​​​A nurse is teaching a group of nursing students about potential ways to promote health with maternal clients. Which of the following should the nurse include in the teaching?

Fundraising for research to address racial disparities

Volunteering to teach a CPR class at the community center

Joining the state nursing organization

Performing discharge instructions for a maternal client

Participating in a community research project about newborn birth injuries

A nurse is educating a client about breastfeeding. The client has changed their mind about breastfeeding after having difficulty and expresses a desire to give their infant formula instead. Which of the following actions should the nurse take?

Offer to assist the client with breastfeeding if they would like to continue.

Provide education on how to safely prepare infant formula.

Ensure that the client has information about both breastfeeding and formula feeding.

What are the basic ethical principles that nurses must follow?

The nurse practices with compassion and respect for every client and family.

The nurse has accountability for their nursing practice.

The nurse owes the same duty to themselves as to clients.

The nurse advocates for and defends the rights of the client.

beneficence

An ethical principle that addresses the obligation to protect others from harm and to act in a manner that promotes the health and well-being of others.

autonomy

The freedom and ability to make one’s own decisions.

moral distress

A condition of suffering due to a moral conflict or other distressing event that conflicts with a person’s personal values and beliefs.

Which of the following is an example of community-based care? 

Home visits

A food bank for pregnant clients

A breastfeeding support class at a local school

A church group that supports new caregivers

induction

Use of pharmacological or mechanical interventions to prompt labor to begin.

augmentation

Use of pharmacological or mechanical interventions to increase contraction frequency, strength, or duration after the onset of labor.

episiotomy

A surgical incision made to the perineum during the labor process.

A certified nurse-midwife (CNM)

has completed nursing school and received a registered nurse (RN) license. They also have a graduate degree, which is a master’s degree or higher.

A certified midwife (CM)

has attained a graduate degree and completed science and health training required by a midwife program. They do not have an RN license.

​​​​​​​A nurse is caring for a client who is planning a home birth. Which of the following should the nurse identify as indications for a transfer to a hospital setting?

Meconium-stained amniotic fluid

Unexpected maternal bleeding

Client request for pain medication

A nurse is reviewing the responsibilities of a practical nurse (PN). Which of the following tasks are appropriate for a PN to perform?

Reinforce client education.

Delegate to assistive personnel.

ectopic pregnancy

Implantation of a pregnancy in an area outside the uterus, often occurring in the fallopian tubes.

A nurse is teaching a newly hired nurse about abortion. Which of the following conditions should the nurse identify as qualifying as a therapeutic abortion?

Fallopian tube ectopic pregnancy

Suspected ectopic pregnancy

Severe maternal illness that is life threatening

uterine leiomyoma

Benign tumors that originate from the uterine smooth muscle; also known as fibroids.

Mifepristone

Class: Antiprogestational agent

Action: Blocks the effect of progesterone on endometrial and myometrial tissues

Therapeutic Use: Termination of pregnancy

Adverse Effects: Headache, dizziness, abdominal pain, diarrhea, nausea, vomiting, uterine bleeding, pelvic pain, uterine cramping, rupture of ectopic pregnancy

Interactions: Increased blood levels and risk of toxicity from dihydroergotamine, ergotamine, lovastatin, simvastatin, cyclosporine, fentanyl, pimozide, quinidine, sirolimus, tacrolimus, diltiazem, verapamil, or fluconazole. Decreased effectiveness when used in conjunction with rifampin, phenytoin, or dexamethasone.

Contraindications: Hypersensitivity, presence of intrauterine device, ectopic pregnancy, bleeding disorders, adrenal failure, concurrent use of corticosteroids. Use with caution in the presence of cardiovascular, respiratory, hepatic, or renal disease; clients over the age of 35 years; and clients who smoke 10 or more tobacco cigarettes daily.

Client Teaching: Take medication as prescribed and go to all follow-up provider visits. Bleeding or spotting usually occurs for 9 to 16 days but can last more than 30 days. Notify provider if client soaks two maxi pads per hour for 2 consecutive hours and experiences abdominal pain, nausea, vomiting, or diarrhea with or without fever greater than or equal to 38° C (100.4° F) for longer than 24 hours after taking mifepristone, or fever greater than or equal to 38° C (100.4° F) for more than 4 hr

Misoprostol

Class: Prostaglandin

Action: Acts as a prostaglandin analogue to decrease gastric acid secretion and increase the production of protective mucus. Causes uterine contractions.

Therapeutic Use: Termination of pregnancy

Adverse Effects: Abdominal pain, diarrhea, constipation, headache, dyspepsia, nausea, vomiting

Interactions: Risk of diarrhea with magnesium-containing antacids

Contraindications: Hypersensitivity to prostaglandins

Client Teaching: Take the full course of medication. Do not share medication. Diarrhea may occur; notify provider if it lasts more than 1 week. Report onset of black, tarry stools or severe abdominal pain. Bleeding, cramping, and passage of tissue may occur. Notify provider if client soaks two maxi pads per hour for 2 consecutive hours.

neonatal encephalopathy

Central nervous system dysfunction in newborns.

statute of limitations

The period in which a lawsuit may be filed.

burden of proof

The amount of evidence needed for a lawsuit to be considered.

breach of contract

The provider did not give care that met the standard and/or act as a reasonably prudent health care professional would act.

A nurse is preparing a presentation on malpractice for a group of newly licensed nurses. Which of the following are requirements for proving malpractice occurred?

The provider owes the client a duty of appropriate care.

The provider failed to provide competent care.

The harm was caused by the provider’s failure to provide competent care.

A nurse is reviewing the medical record of a client who is 4 weeks postpartum. Which of the following findings should the nurse identify as clinical manifestations of postpartum depression?

Despondency for the past three weeks

Negative thoughts regarding the infant's behaviors

Anxiety about their ability to care for the infant

Concern about the health of the infant

A nurse is caring for a postpartum client. Which of the following assessment findings should the nurse anticipate if the client develops postpartum psychosis?

Hallucinations

Delusions

Confusion