Maternal newborn 1
Nagele's Rule
1st day of last period + 7 days - 3 months
Latent phase of labor:
1st part of the 1st stage of labor, lasts 4-6h, cervix 0-3cm, contractions irregular, mild to mod frequency 5-30m and duration of 30-45s, some dilation and effacement, pt talkative and eager Use slow/ deep breathing
Active phase of labor:
4-7 cm moderate to strong contractions regular q 3-5 min lasts 40-70 sec
A nurse is assessing a pt who is at 35 wks and has pre-eclampsia without severe features. Which of the following findings should the nurse identify as priority? 1. 480 ml urine/24 hr 2. BP 144/92 3. +2 edema of feet 4. 1+ protein in urine
480 mL/hr is less than the expected 30 mL/hr
How often should you feel fetal movement at 30 weeks gestation?
At least three times hourly
A nurse is assessing a pt who is at 34 wks gestation, and has a mild placental abruption. Which of the following findings should the nurse expect? a. increased platelet count b. Fetal distress c. Decreased urinary output d. dark reg vaginal bleeding
Dark red vaginal bleeding (minimal)
preterm labor
Uterine contractions and cervical changes occurring between 20 and 37 weeks gestation, persistent low back ache
Pre-eclampsia
When a pregnant woman develops high blood pressure and protein in the urine after the 20th week (late 2nd or 3rd trimester) of pregnancy.
What is betamethasone?
a glucocorticoid that can be used during preterm labor to stimulate fetal lung maturity and help prevent respiratory depression
what is methylergonovine (Methergine) used for?
administered to stimulate uterine contractions for a pt who is experiencing postpartum hemorrhage
A nurse is caring for a pt who is in the latent phase of labor and is experiencing low back pain; which of the following actions should the nurse take? 1. instruct the pt to pant during contractions 2. position the pt supine w/legs elevated 3. encourage the pt to soak in a warm bath 4. apply pressure to the pt's sacral area during contractions
apply pressure to the sacral area during contractions; counter-pressure lifts the fetal head away from the sacral nerves, which decreases pain
A nurse is caring for a pt who is at 32 wks gestation and is experiencing preterm labor. Which of the following medications should the nurse plan to administer? 1. detamethasone 2. misoprostol 3. methylergonovine 4. poractant alfa
betamethasone (IM -- it is a glucocorticoid and will stimulate fetal lung maturity and help prevent respiratory depression
chadwick's sign
bluish discoloration in the cervix, vagina, and vulva that occurs at 6-8 weeks; probably sign of pregnancy, but may remain this color after first pregnancy
magnesium sulfate antidote
calcium gluconate
What is misoprostol?
can be administered to stimulate uterine contractions for a pt who is undergoing labor induction
A nurse is caring for a pt who is 35 weeks and has severe pre-eclampsia. Which of the following assessments provides the most accurate information regarding the pts fluid and electrolyte status 1. BP 2. I/O 3. daily weight 4. severity of edema
daily weight
When should hydrotherapy be initiated during labor?
during the active phase, or approx 5 cm dilated if started during latent phase, can prolong labor process
polyhydramnios
excessive amniotic fluid
T/F during mild placental abruption, there will be fetal distress
false; there should be a reassuring fetal heart rate
A nurse is teaching a pt who has pre-eclampsia and is to receive magnesium sulfate via continuous IV infusion about expected adverse effects. Which of the following adverse effects should the nurse include in the teaching? 1. elevated BP 2. feeling of warmth 3. hyperactivity 4. generalized pruritus
feeling of warmth decreased BP might feel sedated
At 39 weeks gestation, what is an expected finding with polyhydramnios? 1. fundal height of 34 cm (13.4 in) 2. total pregnancy weight gain of 3.6 kg (8 lb) 3. gestational HTN 4. Fetal gastrointestinal anomaly
fetal gastrointestinal anomaly
what are some expected findings of polyhydramnios?
gastrointestinal malformations and neurologic disorders of fetus
what might cause oligohydramnios
gestational hypertension
placenta previa
implantation of the placenta over the cervical opening or in the lower region of the uterus
A nurse is reviewing labs for pt who is 37 wks; nurse notes pt is rubella non-immune, positive for group A beta-hemolytic streptococci, and has a blood type of O-neg. Which of the following actions should the nurse take? 1. administer a dose of Rh0(D) immune globulin 2. request a prescription for an antibiotic until delivery 3. instruct pt to obtain a rubella immunization after delivery 4. inform pt that she will need to deliver via cesarean birth
instruct pt to obtain a rubella immunization after delivery
why should pts not consume mineral oil during pregnancy for constipation
it can lead to severe cramping, diarrhea, fluid loss, and preterm contractions
what is poractant alfa for?
it is a synthetic lung surfactant given to preterm newborn experiencing respiratory distress
What are some indications of magnesium sulfate toxicity?
loss of deep tendon reflexes, RR less than 12
Other than pregnancy, what might cause a positive pregnancy test?
menopause, choriocarcinoma, hydatidiform mole
A nurse is caring for a pt who believes she may be pregnant; which of the following findings should the nurse identify as positive signs of pregnancy? 1. palpable fetal movement 2. chadwick's sign 3. positive pregnancy test 4. amenorrhea
palpable fetal movement
placental abruption
premature separation of the placenta
A nurse is caring for a pt who has oligohydramnios. Which of the following fetal anomalies should the nurse expect? 1. atrial septal defect 2. renal agenesis 3. spinal bifida 4. hydrocephalus
renal agenesis
A nurse is teaching a pt who is at 12 wks gestation about manifestations of potential complications that she should report to her provider; which of the following information should the nurse include in the teaching? 1. swelling of the face 2. urinary frequency 3. white vaginal discharge 3. intermittent nausea
swelling of the face; can indicate hypertensive disorder or preeclampsia
Quickening
the first movement of the fetus in the uterus that can be felt by the mother
Why would the nurse instruct a client to pant during contractions?
to prevent bearing down or pushing before it is time
oligohydramnios
too little amniotic fluid
T/F mild constipation is an expected finding in pregnancy
true
t/f nasal congestion is an expected finding during pregnancy
true
A nurse is assessing a pt who is at 35 weeks of gestation and is receiving mag sulfate via continuous IV infusion for severe pre-eclampsia. Which of the following findings should nurse report to the provider? 1. deep tendon reflexes 2+ 2. BP 150/96 3. urinary output 20 mL/hr 4. RR 16
urinary output 20 mL/hr can indicate inadequate renal perfusion which will increase the risk of magnesium sulfate toxicity
A nurse is assessing a pt who is 37 weeks and has suspected pelvic fracture due to blunt abdominal trauma. Which of the following findings should the nurse expect? 1. bradycardia 2. uterine contractions 3. seizures 4. bradypnea
uterine contractions
A nurse is teaching a pt who is at 30 weeks of gestation about warning signs of complications that should report to her provider. Which of the following findings should the nurse include in the teaching? 1. mild constipation 2. nasal congestion 3. vaginal bleeding 4. 10 fetal movements per hour
vaginal bleeding; might indicate a complication such as placental abruption, placenta previa, or preterm labor.
What should urinary output look like during milk placental abruption?
within expected reference range (1.5-2 mL/kg/hr)
What should the platelet count look like during a mild placental abruption?
within normal range 150k-450k
A nurse is caring for a pt who is at 26 weeks and reports constipation. Which of the following responses by the nurse is appropriate? 1. you should drink 1 ounce of mineral oil every morning 2. you should walk at least 30 mins daily 3. you should eat at least 3 oz red meat daily you should stop taking your prenatal vitamin
you should walk for at least 30 mins daily
A nurse is teaching a pt who is at 10 weeks gestation about an abdominal ultrasound in the first trimester; which of the following information should the nurse include in the teaching? 1. you will have a nonstress test prior to the ultrasound 2. you will need to have a full bladder during the ultrasound 3. the ultrasound will determine the length of your cervix 4. you will experience uterine cramping during the ultrasound
you will need to have a full bladder to help life the gravid uterus out of the pelvis during examination