Kaplan review

1. Fetal Development at 20 Weeks Gestation

At 20 weeks of pregnancy:

• The fetal heartbeat can be heard using a fetoscope.
  
  

• The mother can usually begin to feel fetal movement, known as quickening.
  
  

• The fetus begins to develop a predictable schedule of sleeping, sucking, and kicking.
  
  

• Physical characteristics such as vernix caseosa (a white, creamy biofilm covering the fetus’s skin) and lanugo (fine body hair) are present.
  
  

• These developments help nurses educate patients on fetal well-being and confirm appropriate gestational milestones.
  
  

2. Cesarean Section (C-Section): Indications and Nursing Responsibilities

Reasons for Scheduled Cesarean:

• Known risk factors like breech presentation or placenta previa.
  
  

Emergency Indications Include:

• Decrease in fetal heart rate (FHR)
  
  

• Signs of fetal distress such as insufficient oxygen supply
  
  

• Lack of cervical dilation despite strong contractions
  
  

• Ineffective uterine contractions
  
  

Intraoperative Monitoring:

• Fetal heart rate
  
  

• Maternal vital signs
  
  

• Pulse oximetry
  
  

• Electrocardiogram (ECG)
  
  

Common Complications Post-C-Section:

• Infection at the surgical site
  
  

• Hemorrhage
  
  

• Risk of blood clots (especially DVT or PE)
  
  

• Reactions to anesthesia
  
  

• Bladder laceration or injury
  
  

3. Client Education Topics for Health Maintenance

Nurses should provide education in these key areas:

• Medication usage and awareness of possible adverse effects
  
  

• Importance of weight control and balanced nutrition
  
  

• Increasing physical activity as tolerated
  
  

• Smoking cessation and avoiding second-hand smoke
  
  

• The critical need to attend all prenatal and postpartum appointments for ongoing monitoring
  
  

4. Hormonal Contraceptive Education

Types:

• Combined (estrogen and progestin)
  
  

• Progestin-only
  
  

How It Works:

• Suppresses ovulation by preventing the luteinizing hormone (LH) surge.
  
  

• Results in anovulatory menstrual cycles.
  
  

Adverse Effects:

• Nausea and vomiting
  
  

• Increased susceptibility to vaginal infections
  
  

• Risk of venous thromboembolism (blood clots)
  
  

Contraindications:

• Hypertension
  
  

• History of thromboembolic disorders
  
  

• Circulatory diseases
  
  

• Varicose veins (in some cases)
  
  

5. Prenatal Care and Naegele’s Rule

Comprehensive Prenatal Care Includes:

• Physiological assessment
  
  

• Psychological and emotional support
  
  

• Consideration of sociocultural and economic factors
  
  

Importance of Consistent Prenatal Visits:

• Monitors maternal health and fetal development
  
  

• Conducts timely screenings (bloodwork, ultrasounds, glucose tolerance, etc.)
  
  

Naegele’s Rule to Estimate Due Date:

• Take the first day of the Last Menstrual Period (LMP)
  
  

• Subtract 3 months
  
  

• Add 7 days
  
  

• Add 1 year
  
  

This rule is standard for estimating the Estimated Date of Delivery (EDD) unless corrected by early ultrasound.

6. Formula Feeding Guidelines

Key Teaching Points for Parents:

• Always cradle the infant during feeding to promote bonding and reduce the risk of aspiration.
  
  

• Do not prop the bottle.
  
  

• Ensure the bottle nipple allows milk to flow in slow drops, not a stream.
  
  

• Position the nipple at the tip of the baby’s tongue.
  
  

• Burp the baby frequently during feedings to reduce gas and spitting up.
  
  

7. Partner’s Reaction to Pregnancy by Trimester

First Trimester:

• May experience ambivalence or emotional detachment.
  
  

• Might accept or reject the partner’s experience of pregnancy.
  
  

• Some become quiet or uncommunicative.
  
  

• Begins internalizing the idea of becoming a parent.
  
  

Second Trimester:

• May begin engaging more with the pregnancy.
  
  

• Listens to the fetal heartbeat, feels fetal movement.
  
  

• If the partner is struggling, they may withdraw or find outside distractions.
  
  

• Some experience jealousy if they feel left out.
  
  

Third Trimester:

• Begins thinking about fatherhood more seriously.
  
  

• Concerns may shift to financial responsibility and preparing for the baby’s arrival.
  
  

• Shows tenderness and involvement but may picture the child as a toddler rather than a newborn.
  
  

8. Immediate Postpartum Nursing Assessments

Frequency of Assessments:

• Every 15 minutes for the first hour
  
  

• Every 30 minutes for the second hour
  
  

• Every hour for the next 2 hours or as per facility policy
  
  

Key Assessments:

• Vital signs (BP, pulse, respirations)
  
  

• Uterine fundus (location and firmness)
  
  

• Lochia (amount, color, clots)
  
  

  • Day 1-3: Rubra (dark red)
    
    

  • Day 4-9: Serosa (pink/brown)
    
    

  • Day 10+: Alba (yellow/white)
    
    

• Bladder (output, distention, possible urinary retention)
  
  

Fundal Height:

• Approximately 1 cm above umbilicus in the first 12 hours
  
  

• Descends about 1 fingerbreadth per day
  
  

• Returns to pelvic cavity by around day 10
  
  

9. Postpartum Hemorrhage (PPH)

Warning Signs:

• Soaking a pad in less than 1 hour
  
  

• Boggy (soft) uterus on palpation
  
  

• Signs of shock may be delayed and not reliable early indicators
  
  

Interventions:

• Fundal massage to stimulate uterine contractions
  
  

• Administer uterotonic medications:
  
  

  • Oxytocin (Pitocin)
    
    

  • Methylergonovine (Methergine)
    
    

  • Ergonovine
    
    

  • Prostaglandin F2 analogs
    
    

• Relieve bladder distention via catheterization
  
  

• Blood or fluid replacement
  
  

• Surgical options if bleeding continues (D&C or hysterectomy)
  
  

10. Contraction Stress Test (CST)

Purpose:

• Performed after 28 weeks to evaluate placental respiratory function and fetal well-being
  
  

How it’s performed:

• Contractions induced via oxytocin or nipple stimulation
  
  

• Fetal monitoring performed to assess decelerations
  
  

Interpretation:

• A positive CST is abnormal, indicating late decelerations with 50% or more of contractions
  
  

11. Iron Supplementation Instructions

Key Points:

• Take with citrus juice (like orange juice) to enhance absorption
  
  

• Avoid taking with food if possible (though food may reduce GI upset)
  
  

• Use a straw with liquid preparations to avoid staining teeth
  
  

• Monitor for constipation and black stools (normal side effect)
  
  

12. Lightening (Sign of Impending Labor)

Definition:

• When the fetus descends into the pelvic inlet
  
  

Associated Symptoms:

• Relief from pressure on the diaphragm (easier breathing)
  
  

• Increased pressure on the bladder
  
  

• Leg cramps
  
  

• Increased vaginal discharge
  
  

13. Cold Stress in Newborns

Causes:

• Exposure to cold environments or inadequate warming
  
  

Signs:

• Mottled skin
  
  

• Increased respiratory rate
  
  

• Cyanosis (blue discoloration)
  
  

• Metabolic acidosis (from altered blood gases)
  
  

Complications:

• Can interfere with thermoregulation and oxygenation
  
  

• Must be prevented with warm blankets, radiant warmers, and skin-to-skin contact
  
  

14. Fontanelle Assessment in Infants

Normal Fontanelles:

• Anterior: Diamond-shaped, closes by 12–18 months
  
  

• Posterior: Triangular-shaped, closes by 2–3 months
  
  

Abnormal Findings:

• Depressed fontanelle = dehydration
  
  

• Bulging fontanelle = increased intracranial pressure (e.g., hydrocephalus, meningitis)
  
  

• Premature closure or abnormally small fontanelle = possible craniosynostosis
  
  

• Large fontanelle = possible malnutrition or hypothyroidism
  
  

15. True Labor vs False Labor

True Labor Signs:

• Painful contractions that become regular and stronger
  
  

• Cervical effacement and dilation occur
  
  

• Bloody show may be present
  
  

• Contractions increase with activity and do not subside with rest
  
  

False Labor Signs:

• Irregular contractions
  
  

• No cervical change
  
  

• Contractions lessen with rest or hydration
  
  

16. Timing Uterine Contractions

Frequency:

• From the start of one contraction to the start of the next
  
  

Duration:

• From the beginning to the end of the same contraction
  
  

Intensity and Pattern:

• Should increase in strength and regularity over time in true labor
  
  

17. Alpha-Fetoprotein (AFP) Screening

Purpose:

• Detects risk for neural tube defects (e.g., spina bifida, anencephaly)
  
  

Timing:

• Typically performed between 16–18 weeks of pregnancy
  
  

Considerations:

• Has a high false-positive rate
  
  

• May be paired with acetylcholinesterase testing for better specificity
  
  

18. Hemolytic Disease of the Newborn

Causes:

• Rh incompatibility or ABO incompatibility
  
  

Physiology:

• Maternal antibodies destroy fetal red blood cells
  
  

Effects:

• Increased bilirubin levels (jaundice)
  
  

Increased reticulocyte count (due to RBC destruction)