N306 OB: WEEK 1-FOCUS FOR THE QUIZ 1
What is a non-stress test (NST)?
- non invasive procedure to assess FHR 2 external monitor (doppler transducer to monitor fetal FHR, tocotransducer to monitor uterine contraction) nurse evaluate the FHR & uterine contraction from the strip ACTIONS: instruct mom to press the button if feel fetal movement
. While caring for a mother during a transabdominal ultrasound procedure, which finding would the nurse be most concerned about? 1. The radiology technician inserted a sterile sheathed probe into the vagina. 2. The client is in lithotomy position. 3. The client is in high-fowler position. 4. The client has pillow under her head.
3
The nurse reviews the client's amniotic fluid index (AFI) report and the AFI shows 24 cm. The nurse's best action would be to: 1. Inform the charge nurse. 2. Assess the maternal vital signs. 3. Call the physician. 4. Administer IV fluids
3 Amniotic fluid (5-24) < 5 oligohydramnios > 24 polyhydramnios (NDTS, Obstructions, of fetal GI)
A gravid patient at 8 weeks gestation presents to the emergency department reporting unilateral sharp lower abdominal pain, shoulder pain, and light vaginal bleeding. The nurse knows these signs and symptoms are associated with which pregnancy complication? 1. Ectopic pregnancy 2. Hydatidiform mole 3. Spontaneous abortion 4. Therapeutic abortion
Rationales Option 1: Unilateral pain is more indicative of ectopic pregnancy, while shoulder pain is referred to as visceral pain from a ruptured tube. Option 2: Molar pregnancy is not associated with unilateral abdominal pain or shoulder pain. Option 3: Pain in spontaneous abortion is not commonly unilateral, but is described as pelvic cramping. Option 4: This is a pregnancy termination for serious maternal medical indications of serious fetal anomalies.
Interpret good result of biophysical profile?
Reactive stress test fetus get a score of 8-10 (low risk of chronic fetal asphyxia "deprive of O2 =cause fetal distress or death")
"You have a female patient, 38 years old, smoker, BMI of 20. She has used an IUD for contraception for the last 10 years and is now seeking information regarding pregnancy. What would be her risk factors for infertility, what would be some screenings the provider may order, diagnostics, and some patient education you may provide as the nurse"
Risk factor of infertility= older age "38", smoker, Screening for infertility= hormone analysis or ovulatory dysfuntion analysis, Laparoscopy, Endometrial biopsy, Hysterosalpingogram, ovarian reserve testing Education: explain role of gemetic counselor, reproductive specialist genetics, & pharmacist
A client is scheduled for an amniocentesis. Which is the most important instruction that the nurse would include in the plan of care? 1. Tell the client to drink 2 L of fluids. 2. Instruct the client not to have anything by mouth for eight hours. 3. Place the client in a lithotomy position. 4. Provide breathing and relaxation techniques the client can use.
4
The nurse is caring for a pregnant client and knows that this test is done for chromosomal analysis between 10-12 weeks' gestation to detect fetal anomalies caused by genetic disorders. It does not test for neural tube defects (NTDs). The nurse identified the following test as: . Amniocentesis 2. Triple marker screening 3. Percutaneous umbilical cord sampling 4. Chorionic villus sampling (CVS)
4
A gravid woman at 30 weeks gestation presents to the labor and delivery unit reporting painless, bright red vaginal bleeding. Which condition would the nurse suspect? Placental abruption 2. Urinary tract infection 3. Placenta previa 4. Placenta accreta
Rationales Option 1: Abruption is usually associated with pain and/or contractions. Option 2: A urinary tract infection does not cause vaginal bleeding. Option 3: A classic sign of placenta previa is painless, bright red bleeding. Option 4: Placenta accreta is an abnormal invasion of the placenta into the uterine wall and does not cause bleeding prior to the third stage of labor.
Amniocentesis can be use to detect what
levels of alpha fetoprotein high levels of AFP= neural tube defects Low levels of AFP= chromosomal disorder
During a health assessment, a client was asked to state her last menstrual period. She replied, "This is my second day of having my menstrual flow." Which phase of the ovarian cycle would the nurse determine the client is in currently? 1. Luteal phase 2. Follicular phase 3. Proliferative phase 4. Ovulatory phase
luteal phase= after ovulation, last 14 days, Follicular= onset of mestruation & ends before ovulation, last12-14 days Proliferative= occur following mentruation & ends w/ ovulation, controll by estrogen Ovulatory phase= begin w/ estrogen rise, followed by LH surge 24-36 hrs & release of oocyte
OXYTOCIN IV (Pitocin) is ?
method for contraction stress test if nipple stress test is not successful (no FHR) - require informed consent - helps uterine contraction to evaluate FHR - if result is POSITIVE CST (late decelation w/ > 50% of contractions)
chorionic villus sampling (CVS) cannot detect what genetic disorder but amniocentesis can:
neural tube defects & microcephaly
Pior to amniocentesis procedure, the pt empty the bladder already, what else does the nurse do for the FHR?
obtain FHR baseline mom is supine w/ wedge at the back= prevent infeior vena cava compression
Contraindication of Oxytocin (Pitocin) for contraction stress test is?
placenta previa vasa previa multiple gestation (twins or triplets or more) previous incision of cesarean reduced cervical competence
A pregnant client in her second trimester is in the provider's office for an ultrasound. Her provider finds that the fetus has a congenital heart defect. Which condition is the client at risk for during pregnancy? Select all that apply.. 1.Oligohydramnios 2. Polyhydramnios 3. One-vessel umbilical cord 4. Two-vessel umbilical cord 5. Three-vessel umbilical cord
polyhyramnios two-umbilical vessels Rational 1.Oligohydramnios = dec placental funtion 2. Polyhydramnios = chromosomal disorder, GI disorder, cardiac, neural tube defects (NTD) 3. One-vessel umbilical cord = incompatible w/ life 4. Two-vessel umbilical cord= should have 3 vessels ( 1 vein, 2 arteries) 5. Three-vessel umbilical cord = normal finding
Probable sign of pregnancy would be a
positive pregnancy test: Goodgle sign (softening of cervix & vagina) Hegar signs (softening of lower uterine segment) Bluish-purple color of vaginal mucosa (Chadwick sign ) positive pregnancy test (hCG) these s/s cannot observe by pregnant women only the examiner while presumptive s/s of pregnancy, a woman can assume/think that she might pregnant due to: no mestruation over a month darkened areola enlarge breast enlarge tummy quickening (movement inside the uterus maybe to baby) urinary frequency N/V & fatigue
Complication of administering oxytocin for contraction stress test is>
preterm labor due to overstimulation of uterus uterus does not stop contracting ACTIONS: admin tocolytics (its not time yet to delivery the baby to stop uterine contractions)
In amniocentesis, mom lay in supine, how can you prevent compression of vena cava?
put wedge at her back
biopsy needle
remove endometrial tissue, assess uterus hormonal signal occur in the cycle
Clients with abnormal findings of Maternal Alpha-Fetoprotein
should be referred to quad marker screening, genetic counseling, ultrasound & amniocentesis
amniocentesis
the sampling of amniotic fluid using a hollow needle inserted into the uterus, to screen for developmental abnormalities in a fetus. ex. neural tube defects
transvaginal ultrasonography (TVUS)
ultrasonography of the pelvic area performed with a probe inserted into the vagina, which provides sharper images of pathological and normal structures within the pelvis, uterus, fallopian tube best in 3rd trimester
Kegel exercises helps what?
urinary incontinence for pregnant women bc it can ^ pelvic floor muscle strength NOT emptying bladder every 1 hr
Do you need consent in amniocentesis?
yes, consent is require for all procedures that is invasive
What is the effect of hemodilution (^ plasma volume than RBC volume)?
decrease Hgb and Hct w/c result to anemia Actions: treat anemia with iron supplementation 31mg
MRI (magnetic resonance imaging)
detect brain anomalies
if there is something wrong with anterior pituatary, what happen to the FSH & LH level?
down women cannot ovulate
In amniocenteses, the bladder should be?
empty (reduce its size & not include in poking of the needle for safety
Doppler Velocimetry
- Assesses placental function - Measures bloodflow changes in maternal and fetal circulation - S/D over 3 = decreased placental perfusion
After assessing a couple that was referred to have a gamete intrafallopian transfer (GIFT) done, the nurse documented "knowledge deficit". Which statement made by the couple would have prompted the nurse to document "knowledge deficit"? Select all that apply. 1. "GIFT allows fertilization to take place inside the fallopian tube." 2. "Through in vitro fertilization, our embryo will be placed in the uterine cavity via a catheter." 3. "Our oocytes will be harvested and fertilization will occur outside the female body in a laboratory." 4. "The sperms that were aspirated directly from the testicles will be injected into the harvested eggs." 5. "During GIFT our sperm and oocytes will be mixed outside of the woman's body and then placed in the fallopian tube via laparoscopy."
1 Rational GIFT = fertilization to take place inside the fallopian tube. sperm & oocyte mixed outside the moms body, then place back to the fallopian tube via laparoscopy to be fertilized
The nurse is reviewing a client's charts before admission for an induction of labor. Which client would have extra assistance at delivery? 1. The client who was diagnosed with oligohydramnios 2. The client who is having her fifth baby 3. The client who is pregnant with her first baby and had a treated UTI during pregnancy 4. The client who has had hyperemesis gravidarum during the pregnancy
1 This delivery will require an extra person who is trained in neonatal resuscitation to manage an infant in distress due to low amniotic fluid volume.
A pregnant client with four living children, one preterm infant, and one abortion visits the clinic. How is the nurse expected to record the client's data? 1. G 6 T 3 P 1 A 1 L 4 2. G 5 T 2 P 1 A 1 L 4 3. G 4 T 4 P 1 A 1 L 4 4. G 3 T 1 P 1 A 1 L 4
1) G 6 T 3 P 1 A 1 L 4
Which statements indicate a phenotype? Select all that apply. The child has brown hair." 2. "Wow, he sounds exactly like his father." 3. "She has the most beautiful blue eyes." 4. "I carry the mutation in my genes for diabetes." 5. "He is short like his mother."
1, 2, 3, 5 Rational Brown hair is an outward expression of a phenotype. Option 2: The sound of your voice is an outward expression of a phenotype. Option 3: Blue eyes are an outward expression of a phenotype. Option 4: Diabetes mutation genes are examples of genotypes. Option 5: Height is an example of a phenotype.
The nurse is teaching the new pregnant mother about the placenta and its many roles in fetal development. Which statements show an understanding of the hormones the placenta produces? Select all that apply. 1."Progesterone is the hormone that makes you feel bloated." 2. "Testosterone is produced only if you are having a boy." 3. "Human chorionic gonadotropin doubles or triples the longer you are pregnant." 4. "Human placental lactogen helps in the production of breast milk." 5. "Estrogen is the reason for my pregnancy glow."
1, 4, 5. Placenta produce= estrogen for breast dev, ^ vacularity, make you glow progesteron, hcg (not last long, ^ 1st trimester then declines, human placetal hormone (PTL) for milk production
When a women is trying to get pregnant, the HCP will do what first to find what's wrong in her reproductive organ?
1- ask risk factors 2- Hormonal analysis 3. Lab works Find out level of : FSH helps the growth of follicular so mature follicular will release Estrogen (helps elevate that cramping pain/discomfort), rise of estrogen helps surge of LH 36-72 hrs --> LH (help release the eggs to be fertilized in the fallopina tube)= OVULATION occur if prengnancy occur= rise of progesterone & no menstruation occur (corpus luteum stay- will not turn to corpus albicans) if pregnancy occur= decrease progesterone (estrogen will rise back & mestruation happen)
The nurse is caring for a patient with congenital heart disease who is beginning her prenatal care. Which normal cardiac changes during pregnancy can exacerbate cardiac disease during pregnancy? Select all that apply.
1. Increase in total blood volume from 30 to 50% 2. Decrease in heart rate by 10 to 20 beats per minute 3. The weight of the gravid uterus can lie on the inferior vena cava 4. Increased peripheral vascular resistance 5. Increased cardiac output
The nurse educator is teaching a class of pregnant teenagers about the importance of receiving regular prenatal care. which are the maingoals of prenatal care that the nurse would include in the teaching? Select all that apply. 1. To complete a one-time assessment of health risk status of the pregnancy 2. To provide referrals to resources 3. To maintain maternal fetal health 4. To build rapport with the physician and nursing staff 5. To determine the gestational age of the fetus
2, 3, 5, Rationales Option 1: Prenatal care is an ongoing assessment of risk factors and risk-appropriate interventions. It is not a one-time visit. Option 2: Referrals to appropriate resources may be implemented during prenatal care visits. Option 3: Ongoing assessment throughout the pregnancy helps identify abnormalities early. Early intervention improves health outcomes for mother and infant. Option 4: A goal of prenatal care is to build rapport with the patient and her family. Option 5: Prenatal care helps determine accurate gestational age. This is important in monitoring the growth and development of the fetus as well as guiding teaching during the pregnancy.
A nursing student is examining a client's chart on the Antepartum unit and asks why an umbilical artery Doppler flow test is ordered. which would be an appropriate response for the nurse? Select all that apply. 1. "It is used for some mothers to identify the gestational age of the fetus." 2. "It is used to detect any abnormal structures of the fetus." 3. "It is non-invasive screening technique that uses advanced ultrasound technology to assess resistance to blood flow in the placenta." 4. "Images are obtained of blood flow in the umbilical artery." 5. "This test assesses placental perfusion."
3,4,5 Doppler assess tissue perfusion from placenta to umbilical vein to the fetus' effect
A woman visits the clinic and stated that she has missed four menstrual periods and remains unsure whether or not she is pregnant. The nurse informs her that a ballottement test will be done to diagnose whether or not she is pregnant. How can a ballottement test assist the nurse in confirming a pregnancy? 1. By using a transvaginal ultrasound the nurse will be able to visualize the gestational sac. 2. By detecting the presence of the human chorionic gonadotropin in the urine sample in a laboratory. 3. By detecting the presence of the human chorionic gonadotropin in the blood sample in a laboratory. 4. By tapping on the cervix the fetus will rise in the amniotic fluid and then rebound to its original position.
4 Rationales Option 1: Transvaginal ultrasound involves using a vaginal probe to visualize the gestational sac as early as 5- weeks gestation. Option 2: Doing a laboratory test can detect human chorionic gonadotropin in the maternal urine. Option 3: Doing a laboratory test can detect human chorionic gonadotropin in the maternal blood. Option 4: Tapping on the cervix causes the fetus to rise in the amniotic fluid, and then rebound to its original position.
Pregnant women underg many physiological chnages such as ^ of blood, plasma by how much
40-45% RBC volume 50% plasma volume
How many day for the egg to travel to the fallopian tube?
7 days possible fertilization
Fetal Kick Counts (2 hour method)
A maternal assessment of fetal movement - In the 2 hour approach, the baby should move 10 times in 2 hours - performed same time everyday -call HCP if baby not move as unsual count kick or flutter
amniocentesis and chorionic villus sampling
AMNIOCENTESIS: invasive techniques in which amniotic fluid or fetal cells are obtained for genetic analysis CHORNIC VILLUS SAMPLING: catheter is inserted in the cervic guided by ultrasound & take tissue to detect genetic disorder
Biophysical Profile (BPP)
ASSESS 5 VARIABLES: -FHR (good if reactive in NST)= score of 2 -breathing ( 1 episode > 30 seconds in 30 min) - fetal tone (1 extension to flexion) - body movement (3 body or limbs extension to flexion in 30 min) -qualitative amniotic fluid (> 1 pocket of fluid
Ultrasonography has 3 types
Abdominal Transvaginal Doppler
Which ultrasonography procedure that is invasive and which one is not/
Abdominal & Doppler ultrasound = not invasive bc the ultrasound transduce is moved over pt's tummy (externally) Transviganal (inserted interally-vagina)
If a women is seeking help to get pregnant, what are some factors to assess by doctor?
Assess the following: age > 35 Tissue scarring from: IUD surgery spontaneous abortions uterine contours frequent intercourse Untreated STI (sexually transmitted disease) ex. Gonorrhea & Chlamidya (untonice bc women think it is just a vaginal dischange, doesnt concern them to get treated--> lead to PID--> cause tissue scarring in the reproductive organ overweight/underweight alcohol, smoking, heroin, metadone menstruation (irregular or regular) at normal times
The nurse is reviewing the biophysical profile (BPP) results and would expect which variables to be included in this test? Select all that apply. 1. Fetal position 2. Fetal tone 3. Amniotic fluid volume 4. Fetal breathing movements 5. Fetal movement
BPP includes fetal tone, amniotic fluid > 2cm fetal movement fetal breathing
What is BPP? Why it is important?
Biophysical Profile = assess well being of the fetus "visualize physical & physiological characteristics" combine test: non stress test, ultrasound in a real time
Risk involve in transvaginal & abdominal ultrasonogphy is?
TRASVAGINAL: infection (transducer inserted in vagina) vaginal bleeding ABDOMINAL: may have compression of vena cava bc pt is in supine position??? Action: give one pillow, & wipe the gel after procedure
A woman experiencing preterm labor has an order to receive betamethasone. Which statement is correct regarding antenatal corticosteroids? Select all that apply. 1. They reduce the risk of GBS sepsis in the newborn. 2. They are most beneficial from 24 to 34 weeks' gestation. 3. They accelerate fetal lung maturity. 4. They reduce the risk of necrotizing enterocolitis in the neonate. 5. They decrease the contractility of the uterus.
Corticosteroids: enhance lung maturation beneficial 24-34 weeks gestation reduce risk of RDS bc of it helps ^ surfactant production helps ^ mature small bowel in neonate NOT tocolytics (dec uterine contractions)
Indications of Ultrasonography in pregnancy
DETERMINE: gestational age gestional sac fetal Activity: FHR, growth, #of Fetuses, age size, viability or death fetal structure & anotomy (boy or girl) amount of amniotic fluid placement of placenta assess visualization of amniocentesis, Chronic villus sampling ectopic pregnancy preterm labor
A neonate was admitted shortly after birth with a history of the mother who consumed at least six alcoholic beverages per day during pregnancy. For which feature of fetal alcohol syndrome should the nurse expect to assess? Select all that apply. 1. Microcephaly 2. Cardiac defects 3. Cerebral infarction 4. Neural tubal defects 5. Unusual facial features
FAS (Fetal Alcoholic Syndrome has effect of: microcephaly cardiac defects unsual facial features
The nurse taking a patient's history at her initial prenatal appointment assesses her risk factors for high-risk pregnancy. Which finding increases her risk for pregnancy complications? Select all that apply. 1. Prior pregnancy complications 2. Current hypertension 3. Father with hypertension 4. Smoking 5. Maternal aunt with breast canc
Family history & father's baby medical history is not at risk of pregnancy comlication
he nurse is preparing the necessary equipment for a client to have hysterosalpingogram done. Which equipment is the nurse expected to have prepared for this procedure?
Fluoroscope = to observe the dye injcted thru cerical canal into the uterus
"What is the importance of gNRH in the menstrual cycle, fertility and infertility? What are the cycles of the menstrual cycle? What are the hormones that contribute to mensuration, infertility and fertility? What is the function of each hormone?"
GnRH of hypothalmus causes release of FSH & LH to stimulate reproductive hormone such as estrogen & progesteron
Tocolysis
Inhibition of uterine contractions
A client's first day of last menstrual period (LMP) was April 6, 2018. Using the Naegele's rule, what estimated date of delivery (EDD) will the nurse communicate to the client?
Jan 13, 2019
2 methods of Contraction Stress Test (CST) are?
NIPPLE CONTRACTION & Oxytocin IV (Pitocin)
NIPPLE CONTRACTION is ?
NIPPLE CONTRACTION: -brush the nipple stimulate uterine contraction - if FHR accelerate in 3 contraction during 10 min & last 40-60 sec= its BAD finding due decrease blood placental blood flow & tachysystole of uterus "prolonged uterus contraction" - fetus hypoxemia --> hypoxia ACTIONS: stimulate nipple 2 min, rest for 5 min
Interpret Non stress test (NST) findings
NORMAL: reactive NST if (FHR accelerated > 15/min (10/min prior 32 weeks) occur > 2 times during 20 min period) ABNORMAL NST if (no FHR acceleration w/in 20 min) ACTIONS: further assessment via Contraction stress tesst (CST)or Biophysical profile (BPP)
What are the screenings the doctor want to performed to find if the women is ovulating or not?
ORder labs: Hormonal analysis: FSH = 2-10 LH = 4-21 TSH = 1-8 (hypothyroidism Testasterone = 300 - 1000 Urine analysis
What are the producers for high risk pregnancy?
Percutaneous umbilical blood sampling (PUBS) Chorionic Villus Sampling (CVS) Quad marker Screening (QMS) Maternal alpha fetoprotein (MSAFP)
The nurse is teaching a gravid patient in her second trimester about smoking during pregnancy. Which statements would be included? Select all that apply. 1. "Since fetal development is most important during the first 8 weeks, it won't really do any good to quit smoking now." 2. "Each time you smoke, there is less oxygen to the baby. So, any amount of smoking you can reduce will be better for the baby." 3. "Smoking increases your risk of a preterm delivery and a low birth weight baby." 4. "Smoking increases your risk of placenta problems, such as placenta previa and placental abruption." 5. "Once the baby is born you can resume smoking."
Smoking bad for the baby, the lesser you smoke the better bc smoke can dec O2 to the baby
Complication of chorionin villus sampling
Spontaneous abortion Loss of fetal limbs Misscarriage Chorioamnionitis Rupture of membrane (when the thin catheter is inserted in the cervix is this not rupture the membrane)
A pregnant client presents to the clinic after a prenatal test detected that her baby boy had a Y-linked inheritance disorder. The client indicates an understanding of Y-linked inheritance disorder when she makes which statement? 1. "Both my partner and I carry this trait and passed it along to our baby." 2. "I am a carrier, so I passed this disease to my baby." 3. "I understand that I also present with this trait and need to be tested." 4. "This disease was passed from my male partner to my baby."
Y-linked disorder pass from male chromosomes
What indicated worsening of preeclampsia?
^ RR & ^ SOB NOT BP of 158/98 mmHg, protien, dec platele
Doppler ultrasonography
a noninvasive procedure that uses high-frequency sound waves reflecting off internal body parts to create images and assess blood flow velocity, direction, and occlusions DETECT: low O2 supply from placenta to fetus via umbilical vein RBC velocity is low or high intrauterine growth restiction (IUGR) poor perfusion of blood to fetus HTN, diabetes, twins, preterm labor
Wthat is quad screen for?
a prenatal test for 2nd trimester to measure 4 substance in pregnant women: Alpha-Fetoprotein (AFP) -protein made by developing baby hCG= hormone made by placenta= maintain corpus luteum until placenta fully functional Estriol= hormone made by placenta & baby's liver (^ breast size & function, make vasculaity, ^ blood flow) Inhibin A = hormone made by placenta to see if baby has down syndrome
Mutiparous
a woman who has given birth two or more times
. A nurse is discussing the indications for an ultrasound with pregnant women in a prenatal education class. A client, who is in her first trimester, asks the nurse which tests the ultrasound could assess for at this time. Which would be an appropriate nursing response? Select all that apply. 1. Estimate gestational age 2. Evaluate the uterus structures 3. Confirm intrauterine pregnancy 4. Detect fetal anomalies 5. Confirm fetal cardiac activity
all answers are correct
molar pregnancy
also known as gestational trophoblastic disease; abnormal proliferation of trophoblastic cells in the first trimester = abnormal growing of cell called tropoblast that produce hCG to help luteal stay in shape & not die "corpus albican" = ^ risk of cancer hCG > 100,000 snow storm pattern
When do we perform Chorionic villus sampling (CVS)?
as early as 10-13 weeks
Non-stress test (NST)
assess fetal acceleration & decelaration to determine fetal well being- a test that monitors fetal heart rate. A positive test would be in which the heart rate accelerates by at least 15 beats per minute for at least 15 seconds, with at least two acceleration episodes, in a 20 minute period. For "high risk maternal or fetal factors"
Body basal temperature
assess if you are ovulating (^ temp mean release of ovum from ovary to fallopian tube
What is a Quad marker screening? When is it performed?
blood test is drawn to determine mom's level of : alpha fetoprotein (AFP) hCG estriol inhibin A 16-18 weeks performed
RhoGam is given to pt with what blood type?
blood type O- negative & their baby is Rh + positive prevent forming of moms antibody against baby's RBC cell= prevent RBC hemolysis RhoGAM is given to women who have Rh-negative blood to prevent isoimmunization.
If a women cannot ovulate (no release of eggs) in the fallopian tube, then what is the consequence?
cannot be pregnant
Intervention for Contraction stress test that has positive finding
cesarean delivery
What us cerclage?
for pt w/ cervical insufficiency, cannot close, risk forPTL stitch is done, & remove once you go in labor
causes of vaginal bleeding with no history of trauma
friable cervix placenta previa
chorionic villus sampling (CVS) is performed to detect what?
genetic disorder except neural tubes defects
Interpret bad "abnormal" result of biophysical profile
get a score of 4-6 (chronic fetal asphyxi "fetus deprived of oxygen") worst score of < 4 (strongly suspect of fetal asphyxia) MAYBE DUE TO: Polyhydramnios or Oligohydramnios Fetal hypoxemia or hypoxia (low perfusion of O2 from placenta, maybe placenta is compromised)
abdominal ultrasonography
high frequency sound waves, not invasisve & painless to visualize inter organs like reproductive strucstures
Interpretation of Quad screen marker
high level of Alpha fetoprotein (AFP) = neural tubes defects low levels of AFP= down syndrome (LOW= DOWN) Low level of estriol = down syndrome high level of hCG & inhibin A = down syndrome
GDM occurs in pregnancy because of
hormone chorionic somatiomammotropin (hCS) inhibits maternal insulin, thus glucose unble to enter the cell result in hyperglycemia of mom.
A women trying to get pregnant for 14 months, what question you want to ask her?
how long have been in birth control? What kind of birth control? = IUD for 14 months (suspect tissue scarring that leads to infertility bc IUD ^ risk of pelvic inflammatory disease--> leads to scarring tissue) Do you history of STI (cause scar tissue)
Indication of Vibroacoustic Stimulation (VAS)
if there's no fetal movement during stress test bc fetus is sleeping
LH function
helps release the eggs
When do you recomment for pregnant w/ Group B Strep (GBS) to have screening done?
35-37 weeks of gestation (last trimester) 10-12 weeks = Doppler ultrasound- assess fetal heart tones 15-23 weeks = neural tube defects (NTD screening) 24-28 weeks = gestational diabetes mellitus (GDM) screening 35-37 weeks = GBS screening
The nurse is reading the contraction stress test (CST) result and interprets it as a negative result. Which is the criteria for interpretation of a negative result? 1. There are two late decelerations of fetal heart rate (FHR) with 50% of uterine contractions noted on the EFM. 2. There are significant variable decelerations. 3. There is no fetal activity. 4. There are no decelerations (variable or late) in a 10-minute EFM strip with three uterine contractions greater than 40 seconds.
4
IVF CONCEPT What medication that can help to mature ovum?
Clominihene citrate (Clomid) to stimulate FSH, estrogen, LH hormone
What helps the follicle to grow?
FSH & LH (majority FSH bc level of LH during early phase of follicular is low, it will surge only when, the egg is about to release 36-72 hr prior to ovulation, helps w/ release of mature ovum)
Impact of Estrogen in pregnancy
Skin Changes: Melasma (Chloasma)- mask of pregnancy Linia nigra (dark line from umbilicus to the pubis Striae (stretch marks); the skin is stretch due growth of breast, hip, abdomen " baby in the uterus" Darken areola & nipple) scars & moles oily skin & acne (educate pt that skin color changes is normal during pregnancy & will fade once hormone back to normal (before pregnancy) educate to avoid sun exposure
Woman who have reproductive hormone problem & want to have baby can participate in assisted fertization:
Take Clomid= make mature the ovum--> relase the eggs as ovulation occur, then, eggs are harvested: IVF= eggs are harvested, put in the petri dish w/ the sperm= together the egg & spem unite & fertilize in the lab, outside the woman's body--> the fertilize eggs is put back in the fallopean tube= (pump up of steroid hormone "progesterone" to maintained pregnancy. ZIFT: zygote (fertilized eggs) back to fallopian tube GIFT: Gamete (ooctes) are place with the sperm in the catheter, then injected back to the fallopean tube
Gestational Diabetes Mellitus (GDM)
any degree of glucose intolerance with onset or first recognition during pregnancy RISK FACTORS: MOMMA m-maternal age > 25 o- obesity or overweight macrosomia (large baby) does the pt has previous large baby m- multiple pregnancy Ahistory (prevous dx in the past or family.
Impact of Progesterone in pregnancy?
its a muscle relaxant= inhibit contraction, decrease motility= contipation (fiber, exercise, 8-10 glasesse of water) hot & facial flashing sweating due to thermalregulation from thyroid hormone edema weight gain ^
A student nurse in developing a plan of care documented, "Altered pattern of elimination" for a pregnant client who complained of not having regular bowel movements. Which nursing action by the student nurse is appropriate for the client to resume regular bowel patterns? Select all that apply. 1. Advise the client to avoid high-fat and spicy food. 2. Assist the client to establish regular time for bowel movement. 3. Suggest the client eat small, frequent meals instead of large meals. 4. Encourage the client to eat high-fiber foods and fresh vegetables. 5. Discuss with the client prior strategies used successfully to relieve constipation.
2, 4, 5, Rationales Option 1: Advising the client to avoid high-fat and spicy food will decrease nausea and vomiting. Option 2: Establishing a regular time for bowel movement will help the client to resume regular bowel patterns. Option 3: Suggesting to the client they eat small, frequent meals, instead of large meals, will decrease nausea and vomiting. Option 4: Encourage the client to eat high-fiber foods and fresh vegetables to resume regular bowel patterns. Option 5: Discussing prior strategies used successfully to relieve constipation with the client will help to resume regular bowel patterns.
Which Ultrasound procedure that need full bladder and & which one is not?
Abdominal ultrasound= full bladder for uterus visualization Transvaginal ultrasound=no need full bladder to
Indication for contraction stress test
Abnormal NST (no FHR acceleration during 20 min
Estrogen function
cause cramping pain in women to
Birthcontrol indirectly interfere a women to get pregnant, what should the women do?
need to wait 2-3 cycles to make sure eggs drops, fertilized and implants properly (this time progesterone is important to help continue the lining to thickens, relax the uterine muscle & not contract to maintain pregnancy for 9 months Need estrogen at normal level to help mature the egg & release the egg & thickens the lining of uterus
In preparing a client for endometrial biopsy, the nurse stated that this procedure is usually performed at the end of the menstrual cycle. Which is the indication for doing this procedure during this time? 1. To assess the response of the uterus to hormonal signals that occur during the cycle 2. To detect a rapid increase in the luteinizing hormone 36 hours before ovulation 3. To detect tubal adhesions, fibroids, and uterine fistulas 4. To determine the size of the remaining egg reserve
Rationales Option 1: Endometrial biopsy is done to assess the response of the uterus to hormonal signals that occur during the cycle. Option 2: Luteinizing hormone surge is done to detect a rapid increase in the luteinizing hormone 36 hours before ovulation. Option 3: A hysterosalpingogram is used to detect tubal adhesions, fibroids, and uterine fistulas. Option 4: Ovarian reserve testing is done to determine the size of the remaining egg reserve.
The nurse is caring for a patient with placenta previa. Which would be included in the plan of care? Select all that apply.Promptly report any increase in vaginal bleeding. 2. Assess fetal heart rate continuously with fetal scalp electrode. 3. Limit vaginal exams to once a shift. 4. Establish and maintain intravenous (IV) access. 5. Ensure the availability of blood products.
Rationales Option 1: Rapid and massive blood loss may necessitate immediate delivery. Option 2: Internal monitoring is contraindicated, and only external monitoring should be used. Option 3: Vaginal exam should not be performed, as this increases the risk of initiating severe hemorrhage. Option 4: Hemorrhage may occur, requiring immediate fluid replacement and/or blood transfusion. Option 5: Transfusion of blood products may be needed.
he nurse is assessing all assigned patients and notes that one patient is at risk for preterm labor. Which of the following criteria does the nurse recognize as putting the patient at risk? 1. G2P0 at 35 0/7 weeks reporting four contractions in one hour 2. G6P5 at 37 5/7 weeks with cervical dilation of 3 cm 3. G1P0 at 32 3/7 weeks with regular contractions and a change in cervical dilation 4. G3P2 at 28 0/7 weeks complaining of increased vaginal discharge and low back ache
Rationales Option 1: The diagnosis should be based on regular contractions with cervical change. Option 2: Preterm labor is less than 37 0/7 weeks. Option 3: This patient meets the criteria for preterm labor. Option 4: These are potential signs and symptoms, but don't meet the criteria for diagnosis of preterm labor.
Impact of human Placental lactogen to Gestational Diabetes mellitus
controls carbs, protein, lipid assess fetal growtn by altering mom's metabolism= hPL acts as insulin antagonist (meaning makes glucose available in the blood so that baby cells can use to for enengy) Increase level of cortisol makes insulin resistant = leads to hypergylemia 2 sources that increase insulin in the blood (hPL & cortisol)= sugar level may be elevated TO CONFIRM BLOOG GLUCOSE: Do 1hr glucose test (drink concentrated sugar solution) Next, draw blood sample after 1 hr, No fasting required If pass the test, get blood level of < 140 mg/dL (no need to 3hr glucose test) If not pass the test, get a blood test of > 140 mg/dL Because pt failed the test, then pt have to 3hr glusose test (fasting necessary 8 hrs) drink the concentrated glucose wait for 1 hr, then draw the blood after 2nd hr, draw blood & check 3rd hr, draw blood & check 2 eleveted blood sugar level reading of > 160 mg/dL = pt diagnose w/ gestational diabetes TREATMENT: NO insulin bc mom is resistant to insulin, hPL inhibit insulin to make glucose available to the fetus= if we're given insulin to mom, what is the use? important to be pt compliant by exercising 30 mins, 5x/day, nutrient dense food, no saturated fat, empty calories sugar, less dense food, high salt because: it can ^ HR, edema, weight gain, fluid retention
What is Zift
fertilize
Describe how hormone develope during pregnancy
initially= corpus luteum= high progesteron, low estrogen support the development of placenta, once placenta implanted= fertilized ovum & chorionic villi produce hCG 13-14 weeks placenta became functional d/t support from ^ hCG once placenta become functional= produce 4 hormone called highr progesterone, not so high estrogen, hPL & relaxin FUNCTIONS: Progesterone= a relaxant muscle, inhibit contraction to maintain pregnancy, constipation (reduce motlity) ^ vacularity, thickens the endometrium lining, promotes elasticity edema weight gain waddle gait d/t 2 hormone (progesteron & relaxin), center of gravity change d/t enlarge uterus, increase risk of falls Estrogen has many effect too (please refer to the other slide) human Placental Lactogen (hPL)= breast development controls carbs, protein, lipid assess fetal growtn by altering mom's metabolism= hPL acts as insulin antagonist (meaning makes glucose available in the blood so that baby cells can use to for energy these hormones makes less sensitivity to insulin
