FINAL

Page 1: Overview of Final Exam Study Guide

  • This guide focuses studies for the MCN273 final exam.

  • Important to review OB terminology and abbreviations.

  • Exam Details:

    • Approximately 80 questions total.

    • 120 minutes time limit.

    • 5-7 questions from each module.

  • Unit 1: Approximately 30 questions

    • Module 1: Intro & Clinical Overview

      • Review OB terminology and clinical overview.

      • Determine Gravida and Para from OB history.

      • Interpret SVE (e.g., 8/75/+1; 3/2/0).

      • Understand common prenatal labs.

    • Module 2: Normal Newborn

      • Expected findings based on age.

      • Immediate intervention findings.

      • Physiologic vs Pathologic jaundice (risk factors & treatments).

      • Phototherapy (nursing interventions, difference between lights and bili-blanket).

      • Understand fetal circulation and newborn adaptations (respiratory & cardiovascular).

      • Circumcision care.

      • Determine APGAR score and thermoregulation mechanisms.

    • Module 3: Fetal Development & Women's Health

      • Understanding hormones' roles in conception/pregnancy.

      • Management and treatments for STIs.

      • Nutritional needs in pregnancy and weight gain based on BMI.

      • Infertility criteria and risk factors.

    • Module 4: Pregnancy Changes & Assessment/Testing

      • Recognize presumptive, probable, and positive changes.

      • Physical changes: causes, signs/symptoms.

      • Calculate EDC/LMP and expected vs unexpected findings.

      • Correct placement of tocotransducer and ultrasound.

      • Components of BPP and criteria for reactive NST.

Page 2: Unit 2 Content

  • Unit 2: Approximately 30 questions

    • Module 5: Normal Labor

      • Differentiate true vs false labor and phases/stages of labor.

      • Identify fetal position and appropriate interventions.

    • Module 6: Birth-Related Procedures

      • Pain relief options (types, stages, risks/benefits).

      • Birth-related procedure types, their risks/benefits, nursing interventions, associated teaching, rationale.

    • Module 7: EFM

      • Expected findings and interpretation of EFM tracings (FHR baseline, variability, U/C frequency/duration, accelerations/decelerations).

      • Nursing interventions based on EFM findings (reactive vs non-reactive).

    • Module 8: Normal Postpartum

      • Newborn nutrition options (breastfeeding/formula feeding risks/benefits).

      • Postpartum physical adaptations and expected findings.

      • Rh and ABO incompatibility and Rhogam administration.

Page 3: Unit 3 Topics

  • Unit 3: Approximately 20-25 questions

    • Module 9: Pregnancy at Risk

      • Gestational DM management, maternal/fetal influences/complications.

      • Management of bleeding in pregnancy/SAB and risk factors.

      • Hypertensive disorders classifications, management, and signs/symptoms.

    • Module 10: Childbirth at Risk

      • Uterine rupture: risk factors and plan of care.

      • Patient education for PPROM, expected/unexpected findings.

      • Oligo/polyhydramnios: risk factors and implications.

      • Preterm labor: symptoms, screening, management, and tocolytics.

      • Umbilical cord prolapse: risk factors and management.

    • Module 11: Postpartum at Risk

      • PP hemorrhage causes and management.

      • Postpartum infections risk factors.

    • Module 12: Newborn at Risk/Prematurity

      • Newborn risk factors, complications, and management.

Gravida and Para

  • Gravida: Refers to the number of times a woman has been pregnant, regardless of the outcome (including pregnancies that ended in miscarriage or abortion).

  • Para: Refers to the number of pregnancies that have proceeded to a viable gestational age (typically 20 weeks or more). It is usually represented with a system denoting the number of term births, preterm births, and living children.

Terminology Breakdown

  • GTPAL System: A system often used to summarize obstetric history, where:

    • G: Total number of pregnancies (Gravida)

    • T: Number of term deliveries (≥37 weeks)

    • P: Number of preterm deliveries (20-36 weeks)

    • A: Number of pregnancies ending in abortion (spontaneous or induced)

    • L: Number of living children

  • Example: A woman who is Gravida 3, Para 1-1-1 (1 term, 1 preterm, 1 living child) has been pregnant three times, delivered one child at term, one preterm, and has one living child.

Module 1: Intro & Clinical Overview

  • Overview of OB Terminology: Familiarize yourself with essential obstetric terms and abbreviations used in practice.

  • Determining Gravida and Para: Learn to assess the Gravida and Para from a patient's obstetric history to understand their pregnancy experiences.

  • Interpreting SVE: Understand how to interpret the results of a sterile vaginal exam (SVE), including notation like 8/75/+1 and 3/2/0, indicating cervical dilation, effacement, and fetal head station.

  • Common Prenatal Labs: Identify and understand the purpose and expected results of common prenatal laboratory tests to assess maternal and fetal health.

Terms for the Final Exam Study Guide

  • Gravida: The total number of times a woman has been pregnant, regardless of outcome.

  • Para: The number of pregnancies that resulted in a viable gestational age (typically 20 weeks or more).

  • GTPAL System:

    • G: Total pregnancies (Gravida)

    • T: Term deliveries (≥37 weeks)

    • P: Preterm deliveries (20-36 weeks)

    • A: Abortions (spontaneous or induced)

    • L: Living children

  • SVE: Sterile Vaginal Exam, interpreting results like dilation and fetal head station (e.g., 8/75/+1).

  • Physiological Jaundice: Understanding the difference between normal physiological and pathological jaundice in newborns.

Prenatal Labs for OB Nursing

Prenatal labs are essential tools for monitoring maternal and fetal health during pregnancy. Key laboratory tests typically include:

  1. Complete Blood Count (CBC): Assesses overall health and detects anemia and infections.

  2. Blood Typing and Rh Factor: Determines maternal blood type and Rh factor to prevent Rh incompatibility issues.

  3. Urinalysis: Screens for urinary tract infections, protein, and glucose levels, indicating preeclampsia or gestational diabetes.

  4. Serology Tests: Includes testing for infectious diseases like syphilis (RPR), hepatitis B, and HIV.

  5. Glucose Screening: Identifies gestational diabetes through a glucose challenge test.

  6. Alpha-Fetoprotein (AFP): Screens for neural tube defects and chromosomal abnormalities.

  7. Ultrasound: While not a lab test, it is critical for assessing fetal development and abnormalities.

These tests help inform care and guide interventions during pregnancy, ensuring optimal outcomes for both mother and baby.

Interpreting SVE in OB Nursing

Definition: SVE (Sterile Vaginal Exam) is a clinical assessment performed to evaluate the state of the cervix and fetal position during labor.

Key Components:

  • Dilation: Measurement in centimeters (0-10 cm) indicating how open the cervix is.

  • Effacement: Measured in percentages (0%-100%) indicating the thinning of the cervix.

  • Fetal Head Station: Describes the position of the fetal head in relation to the ischial spines, noted as either positive, negative, or zero (e.g., +1, 0, -2).

Example Notation:

  • Notation like 8/75/+1 indicates:

    • 8 cm dilation

    • 75% effacement

    • Fetal head at +1 station indicating descent into the pelvis.

Importance:

  • Assists in determining the stage of labor, guides intervention decisions, and helps plan for delivery.

OB Terminology

  • Gravida: Total number of times a woman has been pregnant, including all outcomes.

  • Para: Number of pregnancies reaching a viable gestational age (≥20 weeks).

  • GTPAL System:

    • G: Total pregnancies (Gravida)

    • T: Term deliveries (≥37 weeks)

    • P: Preterm deliveries (20-36 weeks)

    • A: Abortions (spontaneous or induced)

    • L: Living children

  • SVE (Sterile Vaginal Exam): A clinical assessment to evaluate cervical changes and fetal position during labor, noted in terms of dilation, effacement, and fetal head station.

  • Physiological Jaundice: A condition in newborns where yellowing of the skin occurs due to immaturity of hepatic conjugation, usually mild compared to pathological jaundice.

  • APGAR Score: A quick assessment of a newborn's health, evaluating Appearance, Pulse, Grimace response, Activity, and Respiration.

Expected Findings Based on Age for Normal Newborns

  • Birth to 1 Month:

    • Weight: Typically loses 5-10% of birth weight in the first few days, should regain by 2 weeks.

    • Length: Average about 18-22 inches.

    • Head circumference: Increases approximately 0.5 inches each month.

    • Dexterity: Reflexes such as grasping and rooting are strong.

    • Skin: May present with vernix caseosa and lanugo.

    • APGAR Score: Ideally 7-10 at 1 minute and 5 minutes after birth, indicating normal transition.

  • 1 to 3 Months:

    • Social Interaction: Begins to show social engagement, coos, and smiles.

    • Physical Growth: Gains about 5-7 ounces per week; length increases 1-1.5 inches.

    • Motor Skills: Begins lifting head while on stomach and can follow objects with eyes.

  • 3 to 6 Months:

    • Weight: At least double birth weight by 5 months.

    • Development: Starts rolling over and may begin to sit with support.

    • Vision: Can track moving objects and recognize familiar faces.

    • Vocalization: Coos and babbles are typical.

  • 6 to 12 Months:

    • Mobility: May crawl, pull up to stand, and even take first steps by 12 months.

    • Social Skills: Increased interest in social interaction, possible attachment to caregivers.

    • Weight: Triples birth weight by 1 year.

    • Teething: Common occurrence around 6 months, with first teeth typically erupting.

These findings can vary based on individual newborn development but serve as general benchmarks for assessing normal growth and adaptation in infants.

Immediate Intervention Findings for Normal Newborns

  1. Thermal Stability: Ensure the newborn is dried immediately after birth to prevent hypothermia; warmers may be used if necessary.

  2. Breathing Assessment: Monitor for respiration rate (30-60 breaths per minute) and ensure that the newborn demonstrates normal respiratory effort without distress (no grunting, retractions, or cyanosis).

  3. APGAR Scoring: Conduct APGAR scoring at 1 and 5 minutes post-birth to evaluate the newborn's condition based on Appearance, Pulse, Grimace response, Activity, and Respiration. A score of 7-10 is considered normal.

  4. Umbilical Cord Care: Ensure the umbilical cord is clamped and cut properly; assess for bleeding or signs of infection.

  5. Identification Bands: Place identification bands on the infant and mother to ensure proper matching upon discharge.

  6. Initial Feeding: Promote early initiation of breastfeeding or formula feeding within the first hour, assessing the newborn’s ability to latch and feed.

  7. Newborn Screenings: Prepare for state-mandated screenings, including metabolic and genetic screenings, as well as hearing assessments, if applicable.

Pathological vs. Physiological Jaundice in Normal Newborns

Physiological Jaundice:

  • A common condition in newborns, typically appearing after the first 24 hours of life and resolving within two weeks.

  • Caused by the immaturity of liver enzymes necessary for bilirubin conjugation.

  • Generally mild and resolves without treatment.

  • Risk Factors:

    • Prematurity

    • Bruising during birth

    • Exclusive breastfeeding (due to inadequate intake)

Pathological Jaundice:

  • Occurs when bilirubin levels rise too high or too quickly, usually within the first 24 hours after birth.

  • Can indicate underlying conditions such as hemolytic disease, infections, or metabolic disorders.

  • Requires prompt evaluation and may need treatment such as phototherapy or exchange transfusion.

  • Risk Factors:

    • Blood type incompatibility (e.g., Rh or ABO incompatibility)

    • Hemolytic conditions (e.g., G6PD deficiency)

    • Significant bruising or cephalohematoma during delivery

    • Infections (e.g., congenital infections)

Phototherapy for Normal Newborns

Definition: Phototherapy is a common treatment method used to reduce bilirubin levels in newborns diagnosed with jaundice.

Bili-Banket: A type of phototherapy device that emits blue light to help break down bilirubin in the baby's skin. It is particularly beneficial for mild to moderate cases of physiological jaundice.

Indications:

  • Appropriate for newborns with elevated bilirubin levels, typically above the designated treatment threshold based on age and weight.

Nursing Interventions:

  • Ensure the bili-blanket is properly positioned to cover as much skin area as possible while maintaining a comfortable temperature.

  • Monitor the infant's temperature regularly, ensuring they do not become overheated or hypothermic.

  • Protect the newborn's eyes using eye patches to prevent damage from bright light.

  • Continuously assess the infant's skin and overall clinical status, noting any changes in jaundice severity.

Benefits:

  • Non-invasive treatment option.

  • Effective in reducing bilirubin levels and preventing potential complications such as kernicterus.

Expected Outcome:

  • A decrease in bilirubin levels often observed within 24-48 hours of initiation of therapy.

Difference Between Lights and Bili-Blanket for Treatment of Normal Newborn Jaundice

  • Phototherapy Lights:

    • Type: Utilizes overhead fluorescent or LED lights to deliver blue light therapy.

    • Mechanism: Light penetrates the skin, helping to break down bilirubin in the bloodstream.

    • Setup: Newborns are placed under the lights in a crib, exposing most of their skin while protecting their eyes.

    • Indications: Generally used for moderate to severe jaundice where higher intensity is required.

  • Bili-Blanket (Fiber-Optic Blanket):

    • Type: A portable device with fibers that emit blue light.

    • Mechanism: Light is directed onto the newborn’s skin while they lie on top of the blanket.

    • Setup: Can be used in a crib or while holding the infant, allowing for greater mobility.

    • Indications: Typically utilized for mild to moderate jaundice where continuous treatment during feeding or caregiving is desired.

Key Differences:

  • Intensity: Lights provide stronger intensity; bili-blankets offer a more localized treatment.

  • Mobility: Bili-blankets allow for easier handling of the infant, while lights require the baby to be stationary under the apparatus.

Fetal Circulation and Newborn Adaptations

Fetal Circulation:

  • In the fetus, oxygenated blood is delivered from the placenta through the umbilical vein to the fetus.

  • The blood bypasses the non-functioning lungs via:

    • Foramen Ovale: An opening between the right and left atrium that allows blood to flow directly from the right atrium to the left atrium.

    • Ductus Arteriosus: A vessel connecting the pulmonary artery to the aorta, allowing most of the blood to bypass the pulmonary circulation.

  • Deoxygenated blood returns to the placenta via the umbilical arteries.

Newborn Adaptations:

  • Upon birth, several changes occur to transition the newborn to breathing air:

    • Respiratory Adaptation:

      • The lungs begin to expand, and the newborn takes their first breath.

      • Residual fluid is cleared, and the alveoli expand with air, facilitating gas exchange.

      • Increased pulmonary blood flow occurs, which helps close the foramen ovale and ductus arteriosus over hours to days after birth.

    • Cardiovascular Adaptation:

      • The systemic vascular resistance increases as the umbilical cord is clamped, leading to higher pressure in the left atrium than in the right, aiding in the closure of the foramen ovale.

      • Blood flow to the lungs increases, allowing for efficient oxygenation.

      • Transition to adult-type circulation is completed as the ductus arteriosus constricts and eventually becomes the ligamentum arteriosum.

These adaptations are crucial for the newborn's transition from a fetus to an independent respiratory and circulatory system.

Circumcision Care for Normal Newborns

  1. Post-Procedure Care:

    • Monitor the circumcision site for excessive bleeding. It is normal for the penis to oozed a small amount of blood after the procedure.

    • Apply gentle pressure with sterile gauze if bleeding occurs.

  2. Cleaning:

    • Do not clean the area with soap until the area has healed (usually within 1 to 2 weeks).

    • Use plain water to clean the area during diaper changes.

    • Allow any yellowish crust to form and fall off naturally; do not try to remove it.

  3. Diapering:

    • Change diapers frequently to keep the area clean and dry.

    • Use a loose-fitting diaper to reduce friction.

    • Consider using a non-adherent dressing if advised by the healthcare provider.

  4. Signs of Complications:

    • Watch for signs of infection, such as redness, swelling, or pus at the site.

    • Be alert for any signs of excessive pain, changes in urination, or any indication of a potential complication.

  5. Follow-Up:

    • Schedule a follow-up appointment with a healthcare provider to assess healing and address any concerns.