Maternal Newborn ATI Study Guide

Types of barrier methods

condoms, diaphragms

A client must be fitted every ___ years for a diaphragm.

2

Reasons clients will have to be refitted for diaphragm:

-Every 2 years

-Gained 15 pounds (7 kg)

-had full term pregnancy

-had 2nd term abortion

What must be used in addition will diaphragms?

spermicide

A diaphragm must remain in place for ___ hours after intercourse.

6

True or False: Spermicide must be used with diaphragm for each act of intercourse.

True

Side effects of hormonal methods (oral, patch, Nuva Ring) of contraception:

chest pain, SOB, leg pain (possible clot), headache, eye problems, HTN

Hormonal methods risks

-blood clots, leading to a stroke or PE

-HTN

Smokers should not take:

hormonal contraceptives

Contraindications of hormonal contraceptives:

hx of blood clots, stroke, cardiac problems, breast/estrogen related cancers, smoker

Depo-provera

injectable progestin

Depo-provera can cause:

decreased bone mineral density

Education for client receiving Depo injection:

receive adequate intake of calcium and vitamin D

IUDs increase the risk of:

pelvic inflammatory disease, uterine perforation, and ectopic pregnancy

Clients who had IUDs must be on the look out for:

increase in string length, foul smelling vaginal discharge, pain w/ intercourse, fever, chills

Definition of infertility

the inability to conceive after trying for 12 months

Workup after determining infertility:

-Sperm analysis on male (done 1st)

- Woman tested if male comes out negative

The nurse must ensure that the client receiving a test with dye does not have hx or allergy to __ or ___.

iodine or seafood

Presumptive signs of pregnancy

amenorrhea, fatigue, nausea, vomiting, urinary frequency, breast changes, quickening

Probable signs of pregnancy

abdominal enlargement, hegar sign (softening of uterus), chadwick's sign (bluish color of cervix, Goodell's sign (softening of cervical tip), ballottement (rebound of unengaged fetus), braxton hicks contractions, positive pregnancy test, fetal outline felt by examiner

Positive signs of pregnancy

hearing fetal heart sounds, see baby with ultra sounds, feeling of movement in uterus

Presumptive signs can:

be explained for problems other than pregnancy

Positive signs of pregnancy are:

very distinct

Naegele's rule

subtract 3 months, add 7 days, add 1 year

**Easier way: Add 9 months, add 1 week**

GTPAL

G- gravitity (# of times woman has been pregnant, including the current pregnancy)

T- pregnancies of 38 wks or more

P- pregnancies of less than 38 wks

A- abortions/miscarriages

L- living children

weight gain range for pregnant woman who is a normal weight

25-35 pounds

weight gain range for woman who is overweight

15-25 pounds

Weight gain range for woman who is underweight

28-40 pounds

During 1st trimester, a woman shouldn't gain more than:

2-4 lbs (1-2 kg)

Once past 1st trimster, weight gain is expected as ___

1 pound per week

Expected extra calories per day for 2nd trimester

340 extra cal per day

Expected extra calories per day for 3rd trimester

450 extra calories per day

True or false: Mothers who are breastfeeding after pregnancy need extra daily calories

true

Range for extra daily calories when breastfeeding

300-400 cal/day

Folic acid helps prevent:

fetal neural tube defects

Pregnant women should drink how much water per day?

2-3 L

Pregnant women should limit caffeine intake to ___ mg per day

300 mg

Sources of folic acid:

dark, green leafy veggies, orange juice

When client is having ultrasound, the bladder should be:

full (helps sounds waves resonate better)

When client is having diagnostic test where belly is being poked (amniocentesis), the bladder should be:

empty

Biophysical profile (BPP)

-score given between 0-10

-measures reactive heart, breathing, body movements, fetal tone, and amniotic fluid volume

- each section is given score of 2 if normal and 0 if not normal

Normal score for BPP

between 8-10 (indicated healthy baby)

Nonstress test

-non invasive

-measures fetal well being within the last trimester of pregnancy

-measures response of fetal heart rate to fetal movement (button given to woman to press when she feels baby move and then HR is measured in response to the movement)

Non stress test is considered reactive if:

Fetal HR accelerates during movement

True or false: Reactive non stress test is normal

true

Non stress test is considered non reactive if:

fetal HR does not accelerate adequately

Is nonreactive non stress test good or bad?

bad

If non stress test is nonreactive, what other tests may be performed?

biophysical profile, contraction stress test (CST)

During a contraction stress test, contractions are brought on by the use of:

pitocin (oxytocin) or nipple stimulation

What is monitored during the contraction of a contraction stress test?

Fetal HR to see if late deceleration occur

If no late decelerations occur during contraction stress test, then the result is:

negative (what you want)

If late decelerations do occur during contraction stress test, the result is:

positive (not a good thing)

Risk of contraction stress test

can potentially send woman into preterm labor

When is amniocentesis usually done?

14 wks

What does amniocentesis test for?

genetic abnormalities

What is looked at for amniocentesis?

AFP (alpha fetoprotein)

LS Ratio (lecithin sphingomyelin ratio)

If levels of afp are high, then it is associated with:

neural tube defects

If levels of afp are low, then it is associated with:

chromosomal disorders (Down syndrome)

What does LS ratio test for?

fetal lung maturity

Risks associated with amniocentesis:

amniotic fluid embolism, hemorrhage, infection, laking of amniotic fluid, ruptured membranes, or miscarriage

When can Chorionic villus sampling be done?

10-12 wks

What does chorionic villus sampling test for?

genetic abnormalities

Advantage of chorionic villus sampling as opposed to amniocentesis

can be done early to detect the genetic abnormalities

Ectopic pregnancy

ovum is planted outside the uterus (often in fallopian tube)

Main symptom of an ectopic pregnancy:

unilateral stabbing pain and abdominal tenderness in LLQ

Molar pregnancy

proliferation and degeneration of trophoblastic villi in the placenta

Main symptom of molar pregnancy

bleeding that resembles prune juice (dark brown)

Placenta previa

placenta abnormally implants in the lower segment of the uterus by the cervix as opposed to near the fundus

Complete placenta previa

cervix is completely covered by the placental attachment

incomplete/partial placenta previa

cervix is partially covered

Main symptom of placenta previa:

painless, bright red bleeding during 2nd or 3rd trimester

Placenta previa vs abruptio placenta

placenta previa is painless whereas abruptio placenta is painful

abruptio placenta

premature separation of placenta from uterus

abruptio placenta has high rate of fetal and maternal:

mortality and morbidity

main symptom of abruptio placenta is:

sudden onset of intense localized uterine pain with dark red vaginal bleeding

What infection is common for pregnant women?

yeast infection

s/s of yeast infection

cottage cheese looking discharge, vulvar redness, white patches on the vaginal wall

Incompetent cervix

recurrent premature dilation of the cervix

If woman has incompetent cervix, then what will she get?

cervical cerclage (keep cervix closed)

When is cervical cerclage removed?

37 wks gestation or when spontaneous labor occurs

Hyperemesis gravidarum

excessive n/v past the first 12 wks of pregnancy

Interventions for hyperemesis gravidarum

-IV fluids

-administration of B6

-antiemetic medications (Reglan, Zofran)

What should a client take with iron supplements?

food that is rich in vitamin C

Foods high in vitamin C

orange juice

What is woman at higher risk for if she has gestational diabetes?

diabetes after pregnancy

Tests that will be done if mother is diagnosed with gestational diabetes

non stress test, biophyiscal profile

What will be used to control sugar levels during gestational diabetes

insulin (oral antidiabetics are contraindicated during pregnancy)

When does test to diagnosed gestational diabetes occur?

24-28 wks gestation

What is done to test for gestational diabetes

-start with 1 hour glucose tolerance test

- if blood sugar from tolerance test is above 130-140, then oral glucose tolerance test is done.

True or false: fasting is not required for 1 hour glucose tolerance test

true

How is 1 hour glucose tolerance test done?

-woman given 50 grams of oral glucose and blood sugar is tested 1 hour later

Does oral glucose tolerance test required fasting?

yes. Must fast overnight, no caffeine or smoking

Oral glucose tolerance test procedure

-test fasting blood sugar

-give 100 grams of glucose

-test blood sugar at 1 hr, 2, hr, and 3 hr.

What is gestational HTN caused by?

vasospasm, which causes poor tissue perfusion

s/s gestational HTN

bp over 140/90 after 28 wks of pregnancy recorded at least twice 4-6 hours apart within 1 week period.

True or false: there is no protein in the urine with gestational HTN

true

s/s mild pre-eclampsia

bp over 140/90 after 28 wks of pregnancy recorded at least twice 4-6 hours apart within 1 week period, protein in urine at level of 1+

Severe pre-eclampia s/s

bp over 160/100, protein in urine at level of 3+, creatinine level greater than 1.2, headache, blurred vision, hyperreflexia, peripheral edema, epigastric pain.

s/s of eclampsia

bp over 160/100, protein in urine at level of 3+, creatinine level greater than 1.2, headache, blurred vision, hyperreflexia, peripheral edema, epigastric pain, seizures

HELLP syndrome

H-hemolysis

EL-elevated liver enzymes (ALT & AST)

LP- low platelets (levels below 100,000)