Nursing 166 Exam Review Notes

Overview of Pelvis Types

  • Four Types of Pelvises in Adult Women:
    • Gynaecoid: Most favorable for vaginal births.
    • Android: Male-type pelvis; less favorable for vaginal births.
    • Platypoid: Varied shape which can impact delivery but not as favorable.
    • Anthropoid: Similar considerations as platypoid but generally manageable.
  • Importance: The shape of the pelvis can necessitate a cesarean section if it does not accommodate the size of the baby’s head.

Prenatal Testing Overview

  • First Trimester Tests:

    • CBC (Complete Blood Count): Checks for anemia by measuring hemoglobin and hematocrit.
    • TORCH Panel: Screens for infections harmful to the fetus:
    • Syphilis
    • Rubella
    • Hepatitis B
    • HIV
    • TB Test and Urinalysis: To rule out tuberculosis and urinary infections, respectively.
    • Pap Smear: Screening for cervical health.
    • STI Panel: Tests for syphilis, chlamydia, and gonorrhea.

  • Second Trimester Tests:

    • Oral Glucose Tolerance Test: Done between 24-28 weeks for gestational diabetes.
    • 1-Hour Test: If glucose is ≥130 mg/dL, proceed to a 3-hour test.
    • AFP (Alpha Fetoprotein): Blood test for Down syndrome and neural tube defects.

  • Third Trimester Tests:

    • Group Beta Strep Test: Vaginal swab after 35 weeks to identify potential infection that could harm the baby during delivery.

TPAL (Term, Preterm, Abortions, Living Children) System

  • T: Count of term pregnancies (≥37 weeks).
  • P: Count of preterm births (20-36 weeks).
  • A: Abortions (≤20 weeks, includes miscarriages).
  • L: Living children.
  • Understanding TPAL is crucial for accurately assessing a mother’s obstetrical history.

Nagel's Rule for Estimated Delivery Date (EDD)

  • Begin with the first day of the last menstrual period (LMP):
    • Count back three months.
    • Add seven days.
    • Adjust year if necessary.

Signs of Pregnancy

  • Presumptive Signs: Amenorrhea, nausea.
  • Probable Signs: Associated with physician findings (e.g., Chadwick’s, Hegar’s signs).
  • Positive Signs: Confirmed by healthcare provider (fetal heartbeat, movement, ultrasound detection).
Cardiovascular Changes During Pregnancy
  • Increased Blood Volume: By 45-50%.
  • Vena Cava Syndrome: Pressure from the growing uterus causing dizziness, lightheadedness; women should sleep on their side to avoid this.

Maternal Nutritional Requirements

  • Caloric Increase: 340 calories/day in the second trimester, 450 in the third.
  • Essential Nutrients:
    • Protein
    • Calcium (taken separately from iron for absorption)
    • Iron (important for fetal reserves)
    • Folic Acid (for CNS development and defect prevention).

Vaccination Guidelines During Pregnancy

  • Safe Vaccines: Tdap, hepatitis B, injectable flu vaccine.
  • Vaccines to Avoid: Live vaccines (MMR, flu mist).

Complications During Pregnancy

  • Hyperemesis Gravidarum: Extreme nausea/vomiting leading to dehydration and weight loss.
  • Gestational Diabetes: Manage through diet, insulin if necessary.
    • Risks include macrosomia (large baby).

TORCH Infections

  • Toxoplasmosis: Transmitted through cat litter or gardening.
  • Other Infections: Zika, syphilis, HIV.
  • Cytomegalovirus and Rubella: Can cause severe fetal complications.

Bleeding Disorders

  • Spontaneous Abortion: Definitions include threatened, incomplete.
  • Ectopic Pregnancy: Fertilized egg implantation outside uterus.
  • Hydataform Mole: Abnormal growth without a viable fetus.

Late Pregnancy Bleeding Disorders

  • Placenta Previa: Placenta implantation over the cervix; causes painless bright red bleeding.
  • Abruptio Placentae: Premature separation of the placenta from the uterus, causing pain and potential emergency.

Hypertensive Disorders of Pregnancy

  • Gestational Hypertension and Preeclampsia: Increased blood pressure after 20 weeks; preeclampsia includes proteinuria.
    • Risk of seizures (eclampsia).
    • Treatment includes magnesium sulfate for severe cases.

Rh and ABO Incompatibility

  • Rh Disease: Antibodies from Rh- mother attack Rh+ fetal red blood cells; RhoGAM administered at 28 weeks to prevent complications.

Stages of Labor

  • First Stage: Cervix dilation; includes latent, active, and transition phases.
  • Second Stage: From full dilation to baby’s birth.
  • Third Stage: Delivery of the placenta.
  • Fourth Stage: Recovery period.

Fetal Heart Rate Monitoring

  • Decelerations:
    • Variable: Due to cord compression.
    • Late: Sign of placental insufficiency.
    • Early: Caused by head compression.

Induction and Augmentation of Labor

  • Induction: Requires medical indication (e.g., preeclampsia, fetal distress).
  • Augmentation: Enhancing inadequate contractions.

Preterm Labor Management

  • Fetal Fibronectin Test: Indicates risk of preterm labor.
  • Magnesium Sulfate: Used to relax the uterus; corticosteroids administered for fetal lung maturity.

Medications to Know

  • Cytotec: Used for cervical ripening.
  • Magnesium Sulfate: For preventing seizures and relaxing uterus.
  • Labetalol: For managing hypertensive disorders.