Family (OB) Exam 3

Probable signs of pregnancy (10)

**objective signs to the medical professional** - Chadwick's sign: Bluish-purple coloration of the vaginal mucosa, cervix, and vulva seen at 6 to 8 weeks - Goodell's sign: Softening of the cervix and vagina with increased leukorrheal discharge; palpated at 8 weeks - Hegar's sign: Softening of the lower uterine segment; palpated at 6 weeks - Uterine growth and abdominal growth - Skin hyperpigmentation - Melasma (chloasma), also referred to as the mask of pregnancy: Brownish pigmentation over the forehead, temples, cheek, and/or upper lip - Linea nigra: Dark line that runs from the umbilicus to the pubis - Ballottement: A light tap of the examining finger on the cervix causes fetus to rise in the amniotic fluid and then rebound to its original position; occurs at 16 to 18 weeks - Positive pregnancy test results (The tests are extremely accurate but not 100%. There can be both false-positive and false-negative results. Because of this, a positive pregnancy test is considered a probable rather than a positive sign of pregnancy) - Laboratory tests are based on detection of the presence of hCG in maternal urine or blood. (The tests are extremely accurate but not 100%. There can be both false-positive and false-negative results. Because of this, a positive pregnancy test is considered a probable rather than a positive sign of pregnancy.)

Genetic Disorder: Huntington's disease

- Dominant Disorder - Uncontrollable muscle contractions between the ages of 30 and 50 years, followed by loss of memory and personality. - There is no treatment that can delay mental deterioration.

Genetic Disorder: Duchenne's muscular dystrophy

- X-linked disorder - Replacement of muscle by adipose or scar tissue, with progressive loss of muscle function - often fatal before age 20 years due to involvement of cardiac muscle.

Emergency conditions (4)

- abnormal or non-reassuring FHR pattern - Inadequate uterine relaxation - Bright red vaginal bleeding ( can indicate placenta abruption) - Prolapse of umbilical cord

steps of intrauterine resuscitation

- change to lateral postion - administer oxygen - initiate IV fluid bolus

Indications of true labor (3)

- contractions are closer - patient is reporting stronger contractions - cervical change has occurred

What is the placenta?

- formed from both fetal and maternal tissue - consists of three layers: •Viruses can cross placenta and cause birth defects or death •Drugs can cross placenta •Drug categories C, D, or X cross placenta and should be avoiding during pregnancy

frank breech presentation

Flexion at thighs, extension at knees, feet up by head, buttocks present

G T P A L

G = total number of times pregnant T = number of term infants born P = number of preterm infants born A = number of abortions L = number of children currently living

mood swing cause?

Hormones

Which medication would the nurse anticipate giving to a newborn that was born within 1 hour of administration of opioid analgesic to the mom?

Narcan (naloxone)

Folic acid prevents what in fetus?

Neural Defects

Contraindication for epidural?

Thrombocytopenia (Low Platelet count)

VEAL CHOP MINE

V = Variable decelerations E = Early decelerations A = Acceleration L = Late decelerations C = Cord Compression H = Head Compression O = OK! P = Placenta Insufficiency M = Move position I = Initiate secondary measures N = Nothing! E = Emergency Delivery

A nurse is caring for a client who follows a vegan diet. What is the most concerning to the nurse? a. lacking B12 b. lacking magnesium c. Lacking calcium d. lacking folic acid

a. lacking B12

The patient is requesting an epidural. You contact the physician and page the anesthesiologist. You start an IV and run a liter fluid bolus of LR. Why are you administering a fluid bolus prior to the epidural procedure?

attempting to prevent hypotension following the epidural

The nurse is speaking to a client at the pre-conception appointment, The client states she had 3 previous miscarriages at 10 and 11 weeks with undetermined reasons. What is the first response the nurse should give to the client? a. consider adoption b. plan for fertility testing c. seek genetic studies d. attend counseling

c. seek genetic studies

A patient is in their third trimester of pregnancy and expressing concerns to the nurse about changes to her muscles, joints, and bones. Which of the following would the nurse find concerning and not a normal change during pregnancy? a. waddling gait b. lower back pain c. severe muscle aches d. increased risk of falls

c. severe muscle aches

The nurse is discussing genetically linked disease with a couple planning a pregnancy. The female states "I am concerned because there is a history of PKU in my family". Which information from the nurse is correct? a. any offspring will have the disease b. only males will have the disease c. the male partner needs to have genetic testing d. the couple should not become pregnant

c. the male partner needs to have genetic testing

How to get folic acid in diet?

green leafy veggies

Internal electronic fetal monitoring contraindication

intact membranes

antepartum

last menstrual period and onset of labor.

Umbilical Cord

one vein carrying oxygen to the fetus, 2 arteries carrying deoxygenated blood away from the fetus

When the nurse takes the client back to the room for appointment. She is now 23 weeks pregnant. The provider enters the room and assesses the fetal heart rate via doppler and palpates fetal movement. These are examples of:

positive signs of pregnancy

The client is discussing signs and symptoms that she is having. She has report nausea and vomiting, breast tenderness, fatigue, and states that she has not gotten her period. These are examples of:

presumptive signs of pregnancy

The provider has now come in to assess the patient. He observes cholasma, Chadwick's sign and notes that the patient has a positive pregnancy test. These are all examples of:

probable signs of pregnancy

Disadvantages of the epidural procedure are explained to the woman. She is already aware that she will not be able to get out of bed and move on her own which is worrisome to her. What other concern would you share with her?

she may have a higher body temperature

Frequent postition changes help to relieve pain and decrease fatigue. What is the least effective postitoon a woman can in during labor?

supine

low platelet count is called

thrombocytopenia

Placenta

responsible for metabolic/ gas exchange, and hormone production

A woman experiencing back labor, what non-pharmacological intervention can be initiated?

sacrum counter pressure

Minimum level of care =

standard of care

Multigravida

woman who has been pregnant more than once

Definition of Preterm

20 0/7 weeks to 36 6/7 weeks

1 Parent is a carrier of a dominant disorder =

50% chance of each child they have can have the disorder

Common discomforts during pregnancy? (7)

1. nasal congestion and epitaxis 2. nausea/vomiting 3. heart burn 4. lower back pain 5. headaches 6. skin hyperpigmentation 7. urinary frequency

Normal fetal heart rate (baseline)

110-160 bpm

second trimester length

15 weeks through 28 completed weeks

You perform an SVE (Sterile vaginal examination) or cervical exam. You note that she is 2/40/-2. You interpret this as:

2 centimeters dilated, 40 percent effaced, and 2 cm above the ischial spines

Viability occurs when?

25 weeks

Both Parents are a recessive carrier of a disorder =

25% chance of each child they have can have the disorder

The client is currently pregnant. She has had a twin delivery at 30 weeks gestation. She has had a singleton delivery at 34 weeks gestation and 39 weeks gestation. All children are living. She miscarried two times during the first trimester. What is the GTPAL?

6-1-2-2-4

It has been determined that both parents carry one copy of mutation for cystic fibrosis. You are educating your clients on the likelihood of passing the disorder on to their future children. The parents believe that each child will end up with cystic fibrosis. What is the best response by the nurse? 1. there is a 50 % chance that each child will have the disease 2. if one child has the disease any future children will not 3. there is a 25 % chance that each child will have the disease 4. future children will become carriers, but will not have the disease

3. there is a 25 % chance that each child will have the disease

Definition of Term

37 0/7 weeks to 41 6/7 weeks

The patient is currently taking Yasmin to prevent pregnancy. You are educating your patient on some actions they should take prior to trying to conceive. Which of the following would not be included in your teaching? 1. It is important to stop taking Yasmin and have three normal menstrual cycles prior to conceiving. 2. You should start to taking folic acid prior to conceiving. 3. There is no safe amount of alcohol in pregnancy. 4. A the length of pregnancy is 265 days

4. A the length of pregnancy is 265 days

Definition of Postterm

42 weeks and beyond

viability

Ability of the fetus to survive outside the womb

Vitamin missing in some vegetarians

B12

Risk factors for infertility include what? A. Maternal obesity B. Paternal smoking C. Heavy alcohol use D. All of the above

D. All of the above

What cardiovascular changes occur during pregnancy? A. Increased cardiac output B. Dependent edema C. Increased plasma volume D. All of the above

D. All of the above

Who should get prenatal HIV testing?

Every women

Alcohol use and pregnancy—risks

Fetal alcohol spectrum disorders: • Range of disorders • Can very from little to no symptoms to severe symptoms Risk for: • Fetal death • Low birth weight • Mental retardation

First trimester length

First day of LMP through 14 completed weeks

What is Wharton's Jelly?

Jelly in the umbilical cord that protects vessels from compression

The anesthesiologist responds to their page. They ask for a brief history and ask what the labs are. Which lab specifically is the anesthesiologist inquiring about?

Platelets

nulligravida or GRAV-0

a woman who has never been pregnant

The nurse is counseling a female patient about alcohol use during pregnancy. Which statement by the patient demonstrates successful patient teaching? a. "I will limit my drinking to just one alcoholic beverage a day" b. "It's best for my baby if I avoid drinking during pregnancy" c. "An occasional drink on special occasions is okay." d. "Drinking alcohol is only acceptable in the first trimester."

b. "It's best for my baby if I avoid drinking during pregnancy"

The nurse is discussing signs of pregnancy with the client and ones that would be determined by the provider. Which of the following is an example of a probable sign of pregnancy? a. fetal outline per Leopold's maneuver b. chadwick's sign c. verification of fetal movement d. amenorrhea

b. chadwick's sign

The nurse is discussing ways to help prevent neural tube defect in the fetus. what recommendations does she make? a. folic acid every other day and eat green leafy veggie b. folic acid daily and green leafy veggie c. prenatal vitamins and iron d. folic acid and Iron

b. folic acid daily and green leafy veggie

complete breech presentation

buttocks and feet present, fetal hips and knees are flexed, lower legs crossed

Amniotic fluid

cushions fetus from sudden movements, prevents developing human from sticking to amniotic membranes, allows freedom of movement, provides consistent thermal environment

The nurse is caring for a 16 year old client who is 16 weeks pregnant. The nurse knows the client is at risk for having an infant who is all of the following except? a. low birth weight b. premature c. experiencing respiratory distress d. not covered in lanugo

d. not covered in lanugo

Internal electronic fetal monitoring

electrode placed on presenting part of fetus to directly detect the fetal heart rate

Nursing Action for Umbilical Cord at birth?

•Document how many vessels are present at birth (after cord has been cut)

Labor induction agents (3)

- Pitocin (Oxytocin) - Cytotec (Misoprostol) - Cervadil (dinoprostone vaginal insert = Prostaglandin E2)

Genetic Disorder: Phenylketonuria (PKU)

- Recessive Disorder - Lack of an enzyme to metabolize the amino acid phenylalanine leads to severe mental and physical retardation. - These effects may be prevented by the use of a diet (beginning at birth) that limits phenylalanine.

Genetic Disorder: Sickle-cell anemia

- Recessive Disorder - The most common genetic disease among people of African ancestry. - Sickle-cell hemoglobin forms rigid crystals that distort and disrupt red blood cells - the oxygen-carrying capacity of the blood is diminished.

Genetic Disorder: Cystic fibrosis

- Recessive Disorder - The most common genetic disease among people of European ancestry. - Production of thick mucus clogs in the bronchial tree and pancreatic ducts. - Most severe effects are chronic respiratory infections and pulmonary failure.

Genetic Disorder: Tay-Sachs disease

- Recessive Disorder - The most common genetic disease among people of Jewish ancestry. - Degeneration of neurons and the nervous system results in death by the age of 2 years.

What are the 12 AWHONN Perinatal Quality Measures (12)

- Triage of a Pregnant Woman and Her Fetus(es) - Freedom of Movement During Labor - Second Stage of Labor: Mother-Initiated, Spontaneous Pushing - Perinatal grief support - Women's Health and Wellness Coordination Throughout the Life Span - Continuous Labor Support - Duration of Uninterrupted Skin-to-Skin Contact - Eliminating Supplementation of Breast Milk-Fed, Healthy, Term Newborns - Protect Maternal Milk Volume for Premature Infants Admitted to the NICU - Initial Contact With Parents Following a Neonatal Transport - Skin-to-Skin Is Initiated Immediately Following Birth - Partial Labor Support

Ethics in Assisted Reproductive Technologies (art therapy) (6)

- Who owns the embryos—the woman or the man? -Who decides what will happen to the surplus embryos? -Who has access to ART, which has substantial costs that are often not covered by health insurance providers? - At what point should the health care provider recommend that the couple stop using ART? - When artificial insemination with donor sperm or surrogacy is used, do you tell the child, and if so, when? - Does the sperm donor have any rights or responsibilities regarding the child produced from his donation?

Genetic Disorder: Hemophilia

- X-linked disorder - Lack of factor VIII impairs chemical clotting - may be controlled with factor VIII from donated blood

History of what previous conditions should a nurse follow up on/investigate further? (5)

- anemia - hemorrhage - infection - malnutrition - hypertension

What does LMP stand for?

last menstrual period

AWHONN perinatal quality measures

- How care provided by nurses is measured

Basic Prenatal Testing (12)

- IPV - HIV - Blood Type - Rh Factor - CBC - Glucose - IGG - Rubella Titer - TB - RPR - Urinalysis - STI culture swaps

Well Women Recommended Screening (2)

- Mammogram: breast cancer screening - PAP Smear: cervical cancer screening

Presumptive signs of pregnancy (7)

** Objective = changes that might make a woman think she is pregnant. ** -such as: - amenorrhea - fatigue - nausea - vomiting - polyuria - breast changes(darkened areolae, enlarged Montgomery glands) - quickening( slight fluttering movements of the fetus felt by the women, usually between 16-20 wks of gestation).

Postive Signs of pregnancy (family feud) (4)

- Fetal Heartbeat - fetal movement - fetal visualization - palpate fetal outline

The patient states that her LMP was January 9, 2020. What is here EDD based on Naegele's rule?

October 16, 2020

The patient is currently 37.2 weeks or 37 an 2/7 weeks gestation. You determine that this is considered:

Term

DIet/Supplemental recommendations when pregnant (5)

- Folic Acid (found in green leafy vegetables) - Iron - B12 - Magnesium - Vitamin D

Well Women Recommended Immunizations

- HPV Vaccine

Ethical dilemma with ART (family feud) (6)

- Owner - Surplus - Stop trying - Tell child? - Donor rights - finances

There are two universal screenings that must be completed on all pregnant clients. Select all that apply 1. RPR 2. HIV 3. Intimate Partner Violence 4. urinalysis

2. HIV 3. Intimate Partner Violence

Third trimester length

29 weeks through 40 completed weeks

When obtaining an obstetric history you have determined that your client is pregnant for the third time. She had one twin delivery at 35 weeks and a spontaneous abortion at 16 weeks. She has two living children. Determine GTPAL

3-0-1-1-2

When going through her history you see she has had a singleton delivery at 38 weeks and a twin delivery at 34 weeks. All children are living. What is her GTPAL?

3-1-1-0-3

Wharton's jelly

Helps prevent compression of the umbilical cord

primigravida

a woman who is pregnant for the first time

Positive signs of pregnancy

*signs only attributed to fetus* - Auscultation of the fetal heart, by 10 to 12 weeks' gestation with a Doppler - Observation and palpation of fetal movement by the examiner after about 20 weeks' gestation - Sonographic visualization of the fetus: Cardiac movement noted at 4 to 8 weeks.

Umbilical Cord anatomy/function?

- 2 arteries and 1 vein - Arteries carry deoxygenated blood from the fetus and places it back into the mother's circulation - Vein carries oxygenated blood to fetus - Vessels are surrounded by Wharton's Jelly

PAP Smear frequency by age

- 21 to 29: every 3 years - 30 to 64: every 5 years - 65 and up: based on PAP Hx

Pregnancy length

- 40 weeks - 9 months = 10 lunar months

5 P's of labor

•Powers (contractions) •Passage (pelvis and birth canal) •Passenger (fetus) •Psyche (response of woman) •Position (maternal postures, physical positions)

Level of care that a responsibly prudent nurse should be able to provide?

Standard of care

Naegele's rule

- is the standard formula for determining an EDD based on the LMP: - First day of LMP - 3 months + 7 days. Example: LMP = SEPTEMBER 7 - 3 months = June 7 + 7 days = EDD of June 14

Teen pregnancy—increased risks to child

- prematurity - low birth weight - increased mortality rates - mortality problems - decreased academic achievement - increase of placement in foster homes - increased incarceration rates

which induction medication stimulate contractions and is not used for ripening the cervix?

Pitocin (oxytocin)

Risks for epidural

- reduced movement - maternal hypotension - increase in maternal temp

What is the nurse's role in Assisted Reproductive Technologies?

- teaching client(s) - supporting client(s) - counseling client(s) - assisting with procedures - Must be aware of emotional impact infertility has had on individual(s)

Placenta functions

- the placental membrane separates the maternal and fetal blood and prevents fetal blood from mixing with maternal blood, but it also allows for the exchange of gases, nutrients, and electrolytes. - Fetal waste products and CO2 are transferred from the fetal blood into maternal blood by diffusion - Has nutrients and hormones (glucose and amino acids)

Increases risks of having a child with genetic disorder:

- Age Over 35 - History of pregnancy resulting in child with genetic disorder - One or both partners with genetic disorder - Family history of genetic disorder

Fetal Heart Rate Tracing Nomenclature (3)

- Category 1 - Category 2 - Category 3

Probable signs of pregnancy (family feud) (8)

- Chadwicks - Goodells - Hegers - Postive pregnancy test - chloasma - linea migra - ballottement - uterine growth

Teen pregnancy—increased risks to parents

- Higher STD rates - Poverty/Welfare - Decrease rate of H.S. completion

What structure provides cushioning and warmth to the fetus? A. The placenta B. Embryonic membranes C. Amniotic fluid D. The umbilical cord

C. Amniotic fluid

Upon initial assessment the FHR is 140 bpm, moderate variability and there are accelerations. You determine that this is a normal and reassuring tracing. You also palpate her contractions and they are mild. Which category is the FHR?

Category 1

Listening, using theraputic communication skills, using non-verbal communication appropriately, avoiding stereotyping and learning expectations of the support person are examples of?

Culturally sensitive care

Eating chalk, dirt, ice-chips. What is missing in diet?

Iron (anemia)

Upon initial assessment you first want to determine the clients expected date of delivery (EDD). She tells you that her last menstrual period was June 8th 2020. Using Naegele's Rule, you determine that her due date is:

March 15, 2021

What interventions are you going to do to help improve maternal and fetal status?

turn the patient on her side, increase IV fluids, apply O2

You have the patient walk around the unit. She has been eating ice chips the since she first got to the unit. This can be a sign of:

anemia

After the epidural procedure is complete you lay the patient back down in bed and adjust her electronic fetal monitors. She is now reporting pain at a 3/10 and her legs feel heavier. Her BP is 84/53. You see late decelerations and minimal variability for FHR. You know this is category 2. What could be the cause of the category 2 FHR?

maternal hypotension

what are assisted reproductive technologies?

medical techniques used to increase fertility.

footling breech presentation

one or both feet are present first at the cervix

Eating non food items is called

pica

When monitoring fetal heart tones, prematurity and sleep patterns are reasons for minimal what?

variability