ATI 2023 Maternal Newborn Proctored Exam

FHR can be heard by Doppler at:

10-12 weeks GA

Between 18 and 30 weeks the fundal height should measure what?

It should equal the week of gestation

MSAFP screening is done:

15-22 weeks of gestation

maternal serum alpha-fetoprotein (MSAFP) screen. It's usually as part of a set of tests, which screen for genetic problems, called the quad screen.

AFP is a substance made in the liver of an unborn baby (fetus).

Smoking tobacco during pregnancy is associated with :

Low Birth Weight

Pregnant mothers should consume how much water each day?

2 to 3 Liters of water from food and beverage sources.

Regarding kick counts, what are signs that a woman needs further evaluation?

Fetal movements of less than 3 in one hour

No fetal movement for 12 hours

The recommended weight gain during pregnancy is usually:

25-35lbs

3-4 lb in first trimester

1 lb per week in the last two trimesters

Foods high in folic acid are:

Leafy vegetables

Dried peas

Dried beans

Seeds

Orange juice

It is recommended that _____ mcg of folic acid be taken during pregnancy.

600

It is recommended that clients who are lactating consume ____ mcg of folic acid.

500

What vitamin aids in the absorption of Iron?

Vitamin C

The clients bladder needs to be _____ before an ultrasound.

Full

biophysical profile (BPP) normal score is

A biophysical profile (BPP) test measures the health of your baby (fetus) during pregnancy.

8-10

BPP abnormal score is

<4

If a BPP comes back as 6.....

It should be retested

BPP assess for

Fetal well being

non-stress test ( NST)

most widely used technique for antepartum evaluation of fetal well being performed during the third trimester.

Reactive NST

FHR is a normal baseline rate with moderate variablity

Two accelerations to 15 bpm for at least 15 secs in 20 min period

A non reactive NST would indicate what about the fetus?

The fetal heart rate does not accelerate adequately with fetal movement.

-A BPP or CST will need to be done now

Positive CST is normal or abnormal

abnormal

The contraction stress test — also called a stress test or an oxytocin challenge test — may be done during pregnancy to measure the baby's heart rate during uterine contractions. Its purpose is to make sure the baby can get the oxygen he needs from the placenta during labor.

Positive CST is indicated when:

Persistent and consistent late decels on more than half of the contractions.

An amniocentesis may be performed when?

After 14 weeks gestation

AFP can be measured from the amniotic fluid between:

16 and 18 weeks

alpha-fetoprotein

Presence of PG on a fetal lung test is associated with:

Respiratory distress

CVS can be done at

10-12 weeks

Chorionic villus sampling (CVS) is a prenatal test that diagnoses chromosomal abnormalities such as Down syndrome, as well as a host of other genetic disorders. The doctor takes cells from tiny fingerlike projections on your placenta called the chorionic villi and sends them to a lab for genetic analysis.

First stage of labor:

1-1.5 cm (onset of labor)

Latent phase of labor:

0-3 cm

mild to moderate contractions

irregular

q 5-30 min

lasts 30-40 sec

Active phase of labor:

4-7 cm

moderate to strong contractions

regular

q 3-5 min

lasts 40-70 sec

Transition phase of labor

8-10 cm

strong to very strong contractions

q 2-3 min

lasts 45-90 sec

Second stage of labor:

Full dilation

Intense contractions

BIRTH!!

Third stage of labor:

Delivery of placenta

Fourth stage:

Maternal stabilization of vital signs

First stage pain:

internal visceral

may be felt as back/leg pain

Second stage pain:

somatic

occurs with fetal descent and expulsion

Third stage pain:

similar to first stage pain

Pain S&S:

Increased BP

Tachycardia

Hyperventilation

Absent or undetectable variability is considered:

Non-reasurring

Minimal variability:

> undetectable but <5/min

Moderate variability:

6-25/min

Marked variability:

>25/min

Accelerations mean:

Healthy fetal/placental exchange

Fetal bradycardia means (less than 60)

Uteroplacental insufficiency

Umbilical cord prolapse

Maternal hypotension

Prolonged umbilical cord compression

Fetal congenital heart block

Anesthetic meds

Fetal tachycardia means:

Maternal infection

Fetal anemia

Fetal heart failure

Fetal cardiac dysrythmias

Maternal use of cocaine or meth

Maternal dehydration

Decrease or loss of variability means:

Meds that depress the CNS

Fetal hypoxemia w/resulting acidosis

Fetal sleep cycle

congenital abnormalities

Early decels mean:

Compression of the fetal head resulting from uterine contraction

Vaginal exam

Fundal pressure

Late decels mean:

UPI causing inadequate fetal oxygenation

Maternal hypotension

placental abruption

Uterine hyperstimulation w/pitocin

Variable decels mean:

Umbilical cord compression

Short cord

Prolapsed cord

Nuchal cord

Oligohydraminos

Fetal descent and cervical dilation are caused by

Frequency, duration, and strength of contractions

What is the sensation the patient will feel when completion of dilation and fetal descent?

She will feel like she needs to take a big ole poooo!

First degree laceration extends through:

skin of perineum

Second degree laceration extends through:

skin of perineum

muscles of perineum

Third degree laceration extends through:

skin of perineum

muscles of perineum

anal sphincter

Fourth degree laceration extends through:

skin of perineum

muscles of perineum

anal sphincter

anterior rectal wall

Third stage:

Signs of placental separation from the uterus are indicated by:

fundus firmly contracting

swift gush from introitus of dark blood

umbilical cord appears to lengthen as placenta descends

vaginal fullness of exam

There is a high risk of _________ surrounding external cephalic version.

Cord prolapse

Regarding BISHOP scoring, when is a woman ready for labor?

A score of

9 for nulliparas

5 or more for multiparas

Mechanical methods to ripen cervix:

balloon caths

hydroscopic dilators and sponges

laminara tents

synthetic dilators and sponges

Methods of induction

prostaglandins applied cervically

admin of IV oxytocin

amniotomy

stripping of membranes

nipple stimulation

Dystocia

prolonged, difficult labor

Before administering pitocin, where should the fetus be?

engaged in the birth canal at a minimum of 0 station.

Discontinue oxytocin if:

contraction frequency more often than every 2 mins

contraction duration longer than 90 seconds

no relaxation of uterus between contractions

uterine resting tone greater than 20 mmHg between ctx

Labor typically begins within ___ hours after ROM.

12

An amnioinfusion can be used to:

Reduce severity of variable decelerations (cord compression)

Dilute meconium-stained amniotic fluid

Caput Succedaneum is:

Normal

Should resolve within 24 hrs

For breast engorgement:

apply cool compresses b/t feedings

apply warm compresses

take warm shower b4 breast feeding

Cold cabbage leaves

may also be applied to breasts to decrease swelling and relive discomfort

Postpartum the mother should not lift anything that is heavier than:

the infant

PP the mom should consume ______ to_______ ml of water each day.

2000-3000

Encourage women who are lactating to add an additional ___ calories/day to their prepregnancy diet.

500

Teach the clent to avoid sexual intercourse until:

episiotomy/laceration is healed

&

vaginal discharge has turned white

Postpartum disorders are:

unexpected events or occurrences that may happen during the PP period

Deep Vein Thrombosis S&S

Leg pain

Chills

Unilateral swelling, warmth, redness

Warm extremity

Calf tenderness

Elevated temp

Cough

Tachycardia

Thrombophlebitis: position arm:

Above the lever of the heart

Thrombosis tx drugs:

Heparin

Warfarin (coumadin)

Pulmonary Embolus S&S

Chills

Apprehension

Pleruitic Chest pain

Dyspnea

tachypnea

hemoptysis

heart murmurs

peripheral edema

distended neck veins

elevated temp

hypotension

hypoxia

DIC risk factors

abruptio placenta

AFE

missed abortion

fetal death in utero

Severe preeclampsia or eclampsia (GHTN)

Septicemia

cardiopulmonary arrest

hemorrhage

hydatiform mole

Post partum hemorrhage is considered to occur if the client loses how much blood?

more than 500 mL after vaginal birth

more than 1000 mL after c/s

Two complications that can occur following PP hemorrhage include:

hypovolemic shock

anemia

PP hemorrhage VS findings:

Tachycardia

Hypotension

Meds given to tx PP hemorrhage

Oxytocin

Methergine

Cytotec

Hemabate

Subinvolution is when:

The uterus remains enlarged with continued lochial discharge and may result in PP hemorrhage

Subinvolution s&s

increased vag bleeding

uterus enlarged and higher than normal in the abd relative to umbilicus

boggy uterus

prolonged lochia d/c with irregular or excessive bleeding

Risk factors for subinvolution of uterus:

Pelvic infection and endometritis

Retained placental fragments not completely expelled from the uterus

Inversion of the uterus

Retained placenta

Uterine atony

Excessive fundal pressure

Abnormally adherent placental tissue

Multiparity

Fundal implantation of the placenta

Extremem traction applied to the umbilical cord

Leiomyomas

Inversion of uterus s&s

pain in lower abd

vag bleeding

dizziness

low BP

pallor

Retained placenta:

Placenta or fragments of the placenta remain in the uterus preventing the uterus from contracting which leads to uterine atony or subinvolution

Med given: oxytocin....if unsuccessful then tocolytic for d&c

APGAR scoring is:

a brief physical exam done immediately following birth to rule out abnormalities.

APGAR of 0-3 indicates

severe distress

APGAR or 4-6 indicates

moderate distress

APGAR of 7-10 indicates

no distres

APGAR

Heart rate scoring

0= absent

1= <100

2= >100

APGAR

RR scoring

0= absent

1= slow, weak cry

2= good cry

APGAR

Muscle tone scoring

0= Flaccid

1= some flexion

2= well-flexed

APGAR

Reflex irritability

0= none

2= grimace

3= cry

APGAR

Color scoring

0= Blue, pale

1= pink body, cyanotic hands and feet (acrocyanosis)

2= Completely pink

Normal newborn weight range:

2500-4000 grams

Low birth weight

less than 2500 grams

Term birth

between 38 weeks and 42 weeks

Grunting and nasal flaring are:

signs of respiratory distress

crackles and wheezing are signs of

fluid or infection in the lungs