MCN Exam 1 Review PDF

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NUR2513 Maternal-Child Nursing Study Guide – Exam 1 Describe current trends / resources influencing maternal - child health care i. Women’s roles a. Have changed - more women are working now and not stay at home mothers b. No longer the “nuclear family” - divorce, remarriages, cohabitation, women entering workforce and becoming primary earners. Children raised by grandparents, single parents, stepparents, aunts, uncles, and foster parents c. Single-family structures - both parent and child show increased resilience d. Those who would rather put their career first vs those that dream of becoming a mother

ii.

Trends a. Community growth b. Home births i. More of a say/voice - birth plan ii. Parent voicing concerns c. Maternal age i. Increasing ii. Increased age = increased risk. Genetics. Down’s syndrome. Co-morbidities / Chronic Disease. iii. Over 35 is AMA - advanced maternal age d. Infant mortality i. Racial disparity ii. All mothers need care e. Maternal Mortality rates i. Increasing ii. Gestational hypertension 1. Dying due to high blood pressure

i.

Understand lab work needed in each trimester 1st trimester (1-12 weeks) i. ii. iii. iv. v. vi. vii. viii.

ii.

Blood type and Rh Antibody screen CBC RPR Hep B and C HIV GC/CT Urine and drug screening

2nd trimester (13-27 weeks) a. b. c. d. e.

Labs typically drawn (together) between 24 and 28 weeks: Repeat CBC Repeat HIV 1 hour glucose tolerance test Repeat antibody screen in Rh negative

iii.

3rd trimester (28-40 weeks) a. b. c. d.

Group Beta Strep (GBS) - rectovaginal cultures at 36 weeks If they have cramping or dysuria = UA If they have had a + UDS (Urine Drug Screen) = recollect Having symptoms or known exposure = repeat STI screening

2020 health goals: nutrition Healthy People 2020 (Reviewed / Changed every 10 years) i. The focus is on… 1. Health Promotion 2. Disease Prevention LGBT – There has been an emphasis on meeting the needs for this population.

Vegan diet deficiency a.

Vitamin B12

Function of amniotic fluid (possible select all that apply?) i. Cushions the fetus and protects against mechanical injury ii. Helps the fetus to maintain a normal body temperature iii. Allows for symmetrical fetal growth iv. Prevents adherence of the amnion to the fetus v. Aids in fetal musculoskeletal development by providing freedom of movement. vi. Essential for normal fetal lung development. Societal changes in maternal-child health issues i. ii. iii. iv. v. vi.

Emphasis on meeting the needs for this vulnerable population. Lack of access to non-biased health care, disrespectful treatment EMR does not always match the situation as described… Male vs female. What about transgender? Fertility concerns when biological means of fertility is affected. Fertility preservation with some transgender treatments What about ambiguous genitalia? Gender assignment. Gender affirmative care. Mental Health Needs

vii. Pre-term labor interventions i.

ii.

Care of the patient experiencing preterm labor might include: a. IV fluids (correct dehydration that could be causing the uterus to contract) b. Bedrest c. Administration of tocolytics (terbutaline, nifedipine, magnesium sulfate) d. Monitor both FHR and uterine activity Goals: a. Inhibit or reduce the strength and frequency of contractions, thus delaying the time of delivery b. Optimize the fetal status before preterm delivery

Diaphragm teaching i. ii. iii. iv.

Diaphragms should remain in place for at least 6 hours after coitus Wash hands thoroughly with soap and water before insertion or removal. They may be left in place for as long as 24 hours. Leaving them in place longer than this can cause cervical inflammation (erosion) or urethral irritation A diaphragm is removed by inserting a finger into the vagina and loosening the diaphragm by pressing against the anterior rim and then withdrawing it vaginally

v.

A diaphragm should be washed in mild soap and water, dried gently, and stored in its protective case. It will last for 2 years, after which it should be replaced. Be aware of the symptoms of TSS, such as elevated temperature, diarrhea, vomiting, muscle aches, and a sunburn-like rash. Do not use if on a menstrual cycle

vi. vii. viii.

Omphalocele development A protrusion (herniation) of abdominal contents through the abdominal wall at the point of the junction of umbilical cord and abdomen Herniated organs usually involved are the intestines but may include stomach and liver CONTAINED by a thin transparent layer of amnion and chorion with the umbilical cord protruding from the exposed sac.

i. ii. iii.

Cardiovascular changes in each trimester i. ii. iii. iv. v.

Blood volume increases to support the growing fetus. blood volume increases (40-50% by term) Blood pressure decreases in second trimester, rises to pre-pregnancy level in third trimester Rate of blood flow through an umbilical cord is rapid (350 ml/min at term) Uteroplacental blood flow in pregnancy increases from about 50 ml/min at 10 weeks to 500 to 600 ml/min at term.

Delivery presentations i. ii. iii.

Cephalic presentation (head first)- most common Breech presentation (buttocks or feet first) Shoulder presentation (scapula)

Smoking risks i. ii. iii. iv. v.

Preterm birth Low birth weight Baby with breathing problems Higher risk of SIDS Cleft lip or cleft palate

Family preparation for new baby Signs of HSV 1 & 2 i. Herpes simplex 2 viral infection appears as clustered, pinpoint vesicles on an erythematous (reddened) base on the vulva that feel painful when touched or irritated

ii. Herpes simplex 1- sores on the mouth, commonly known as cold sores Nicotine effects i. Fetal growth restrictions Why folic acid i. ii. iii. iv.

given prenatal for its benefit of reducing NTD (Neural Tube Defects) It is recommended that women who are planning to become pregnant begin taking this supplement 3 months prior to conception. Nurses should educate women on the benefits of folic acid supplementation at preconception counseling visits. Take the prescribed prenatal vitamins with 400 MCG of Folic Acid

Medications for STD's and education

Normal/ expected breast changes i.

breasts also experience physiological changes; Montgomery tubercles, Increased pigmentation (areolae), Discuss bra size changes, options for infant feeding, and strategies for successful breastfeeding.

Pap smear guidelines i. A Pap smear is taken from the endocervix at a first prenatal visit School age mortality reasons

Menstrual cycle phases i. ii. iii. iv.

First phase: Proliferative Second phase: Secretory Third phase: Ischemic Fourth phase: Menses

Pregnancy classification ??? Quickening: define/ timing i. ii.

First movemens of the fetus felt in utero. Occurs from the 18-20th week of pregnancy

Ferrous sulfate teaching (Iron) i. ii. iii. iv. v.

vi. vii.

Physiologic anemia of pregnancy or pseudo anemia due to increased plasma vol that dilutes H/H. The normal mean hemoglobin level in pregnancy is 11-12g/dL of blood. Should encourage adequate hydration with 6-8 glasses of water each day and increase the intake of protein and iron via dietary sources. Sometimes moms will need an iron supplement in their prenatal vitamin (PNV). IRON: RDA for prepregnant women ages 14 to 18 is 15 mg/day, for women age 19 and older, 18 mg/day, and for pregnant women, this amount increases to 27 mg/day, starting by 12 weeks of gestation SOURCES: fortified ready-to-eat cereals, white beans, lentils, spinach, kidney beans, lima beans, soybeans, shrimp, and prune juice. Red meats, including beef, duck, and lamb GI side effects: constipation, black tarry stools, nausea, and abdominal cramping

viii.

Iron supplements should be taken with water or juice to enhance the absorption; milk and tea block the absorption

Variability: absent (top left), minimal (top right), normal (bottom left), marked (bottom right)

Risk/ cause of cervical cancer i. ii. iii. iv. v.

Certain types of HPV cause cervical cancer Having several sexual partners Smoking Having HIV Oral contraceptives

Why frequent urination i. ii. iii.

iv.

Bladder changes during pregnancy. Early pregnancy: The uterus presses against the bladder, causing frequent urination. Middle pregnancy: Urinary frequency is relieved. Late pregnancy: The uterus is again pressing on the bladder, leading to the recurrence of urinary frequency.

Education for managing blood glucose i. ii. iii. iv.

Those who develop Gestational diabetes will be required to self-monitor their serum glucose level at least once daily, some 3 or 4 daily Eating slowly digested carbs, fiber-rich vegetables increase fertility and can prevent Gestational diabetes when a woman becomes pregnant Gestational diabetes increases the risk the client will deliver via cesarean obesity in pregnancy increases health risks for mother and baby; for the mother, Gestational diabetes should be considered as it is diabetes that is first diagnosed in pregnancy.

Fundal Heights and corresponding gestation i. ii.

iii. iv.

Gross measurement for fetal growth, but also changes with increased amniotic fluid, ect. Landmarks a. 12 weeks@ symphysis b. 20 weeks @ umbilicus c. After 20 weeks, measure from the symphysis to the fundus and the # in CM will correspond with the # in weeks gestation Measuring in cm -/+ 2 Discordant data

Nonpharmacological interventions for non-medicated births

i. ii. iii. iv. v. vi. vii. viii. ix. x.

Massage Hypnosis Reflexology Birth ball Biofeedback Intracutaneous nerve stimulation Acupuncture/acupressure Breathing patterns Hydrotherapy Imagery/Focal point

Why a non-stress test and how do you conduct it FHR baseline Variability Presence of accelerations (HR rises 15 beats above the baseline for a duration of at least 15 seconds) iv. Absence of decelerations *Note: For an NST to be reactive, there must be 2 accelerations that meet criteria within 20 minutes of each other. If not reactive after 40 minutes  Biophysical Profile i. ii. iii.

Fetal circulation, respiration, development (stages) i. ii. iii. iv.

Fetal circulation bypasses the liver and lungs, and they are not functional during fetal development. The placenta takes on the role of respiratory and gas exchange. The fetus’s heart starts to beat around 22 days from conception. 2 arteries, 1 vein = A.V.A

Placental roles and placement i. ii.

iii.

Takes on role of respiratory gas exchange Produces hormones a. hCG - acts as a fail-safe measure to ensure the corpus luteum of the ovary continues to produce progesterone and estrogen so the endometrium of the uterus is maintained. b. Progesterone i. Hormone that maintains pregnancy c. Estrogen i. Contributes to woman’s mammary gland development in preparation for lactation and stimulates uterine growth to accommodate developing fetus d. Human Placental Lactogen (Human Chorionic Somatomammotropin) i. hPL - growth-promoting and lactogenic (milk producing) properties Placental Proteins a. Function unknown

What does surfactant do i. ii.

A phospholipid substance, is formed and excreted by the alveolar cells of the lungs beginning approximately the 24th week of pregnancy Decreases alveolar surface tension on expiration, preventing alveolar collapse and improving infants ability to maintain respirations outside of the womb

Contraindications for oral , IUD contraception i.

IUD: Distorted uterus, copper IUD use also is not advised for a woman with severe dysmenorrhea or menorrhagia, women with anemia

ii. a. b. c. d. e. f. g. h. i. j. k. l.

Oral: Breastfeeding and less than 6 weeks postpartum Aged 35 years or older and smoking 15 or more cigarettes per day Multiple risk factors for arterial cardiovascular disease, such as older age, smoking, diabetes, moderate or severe hypertension Current or history of deep vein thrombosis or pulmonary embolism Major surgery that requires prolonged immobilization Current or history of ischemic heart disease or cerebrovascular accident Complicated valvular heart disease Migraine with focal neurologic symptoms (migraine with aura) Current breast cancer or diabetes with nephropathy, retinopathy, neuropathy, vascular disease, or diabetes of more than 20 years’ duration Severe cirrhosis or liver tumors Women taking certain seizure drugs such as phenobarbital or phenytoin (Dilantin) and women taking rifabutin for tuberculosis treatment Women prescribed certain broad-spectrum antibiotics such as tetracycline

What causes and what are the responses of early/ late decels

Deceleration type

What does it look like

What does it mean

What to do

Late

begin after the peak of the contraction

Uteroplacental insufficiency

Intrauterine resuscitation, notify provider

Early

Occur simultaneously with the contraction

Fetal head compression

Check the cervix to evaluate labor progress

Variable

just like it sounds, occur more randomly, not directly in relationship to a contraction

Cord compression

Change position then evaluate improvement… if no improvement proceed to IV bolus and O2… and cervical exam, notify provider

What are the stages of Labor i.

Patient must be actively contracting

ii.

iii. iv.

First stage is from 0-10cm (longest stage) a. Latent phase-0-3 cm- slow cervical change  mild contractions, more widely spaced (Newer sources are saying latent phase may last until 5 cm) b. Active phase- 4-7 cm cervical change of 0.5-1cm/hr, contractions are longer (60 seconds) and more frequent (q 2-3 min) c. Transition- 8 – 10 cm- more rapid cervical change 1-1.5cm/hr  contractions are longer (60-90 seconds), stronger, and more frequent (q2-3min)may start to feel pelvic or rectal pressure Second Stage: fully dilated  pushing  delivery Third Stage: after delivery of the fetus through placental delivery

Practice estimated date of delivery (EDD) i.

Naegel’s rule: LMP – 3 months + 7 days (then add a year) = EDD LMP +280 days= EDD

GTPAL practice (DO NOT FORGET CURRENT PREGNANCY IF QUESTIONS STATES PREGNANT PATIENT) i. ii. iii. iv. v.

Gravid- how many times has she ever been pregnant Term- how many pregnancies did she carry to term (after 37 completed weeks) Preterm- how many preterm (prior to 38 weeks) deliveries Abortions- Spontaneous and elective- how many pregnancies ended prior to 20 weeks Living children – (Was the child living at birth?)

Examples of presumptive, probable, and positive signs of pregnancy i.

ii.

iii.

Presumptive a. Amenorrhea (absence of menstruation) b. Nausea and vomiting c. Urinary frequency d. Breast tenderness Probable a. Hagar’s sign - softening of lower uterine segment b. Goodell sign - cervical softening c. Chadwick’s sign - bluish purple coloring of cervix d. Uterine enlargement e. Positive pregnancy test i. Due to high levels of hCG hormone ii. Other conditions that can cause this - medications, hydatidiform Positive- definite signs a. Can only be attributed to a fetus b. Fetal heartbeat c. Visualization of fetus- ultrasound d. Fetal movement palpated by doctor

What are tests for early labor symptoms i. ii.

Fetal Fibronectin test Amniocentesis for L:S ratio

How is sickle cell inherited i. ii.

Abnormal shape of hemoglobin, cannot carry as much hemoglobin, causes clumping Genetics – Increased prevalence in Blacks

iii.

iv.

Recessive a. Sickle Cell Trait (heterozygous) b. Sickle Cell with Disease Expression (homozygous) Sickle cell gene inherited from both parents= born with sickle cell disease

Magnesium sulfate education/ care of client and epidural considerations i. ii. iii. iv. v. vi. vii. viii.

Always use an infusion pump for administration and run the medication piggyback, not as the main line. Monitor pulse, blood pressure, respirations, and ECG frequently throughout parenteral administration. Respirations should be at least 16/min before each dose. Monitor neurological status before and throughout therapy. DTRs…note changes Institute seizure precautions. Pad the bedrails, have suction available. Keep the room quiet and darkened to decrease the likelihood of triggering seizure activity. Monitor intake and output: Urine output should be maintained at a level of at least 100 mL/4 hr. Serum magnesium levels and renal function should be monitored periodically throughout administration of parenteral magnesium sulfate Have 10% calcium gluconate available should toxicity occur. Administer 10 mL IV over 1 to 3 minutes until signs and symptoms are reversed. Provide 1:1 nursing care for women in labor who are receiving magnesium sulfate.

Appropriate pregnancy weight gain i.

Total Weight Gain a. Underweight: 28-40 pounds b. Normal weight: 25-35 pounds c. Overweight: 15-25 pounds d. Obese: 11-20 pounds

Problems with gestational hypertension – mom/baby i. ii. iii.

Gestational Hypertension is high blood pressure that is diagnosed after the 20th week of gestation. Vasospasms and decreased perfusion to mom and to placenta and fetus. Growth restriction. Complications for mom include seizure, stroke.

Amniocentesis: why, what disease can it detect i. Done between 15–18 weeks ii. Diagnostic for fetal karyotype; shows common chromosomal disorders iii. Down syndrome and spina bifida iv. Family hx of birth defects, AMA greater than 35, +AFP (Alpha-fetal protein) Preeclampsia: what is it and risks i. Risks: ii. iii. iv. v. vi.

Pre-E: Severe pregnancy-related disease process evidenced by increased blood pressure and proteinuria after the 20th week of gestation. Eclampsia, seizures, altered blood flow for mom and fetus Maintain strict bedrest Reduce stimulation Monitor: BP, respirations, DTRs, clonus, epigastric pain, visual disturbance, mental status, proteinuria, I&O Administer Magnesium sulfate for seizure prophylaxis (see considerations for magnesium sulfate)

Symptoms: i. Headache (not relieved with Tylenol) ii. Visual disturbances iii. Edema of the hands, feet, and face iv. Epigastric pain v. Changes in mental status On assessment: i. Brisk deep tendon reflexes (DTR)- 3-4+ ii. Presence of clonus (uncontrollable shaking movements) iii. Proteinuria

HELLP : what is it , orders to anticipate

Placenta previa: what is it, nursing care i. ii. iii.

Placenta previa is an improperly implanted placenta in the lower uterine segment near or over the internal cervical os. Sudden onset of painless, bright red vaginal bleeding, the uterus is soft and relaxed, and fundal height may be more than expected for gestational age. Nursing interventions include monitoring VS, fetal heart rate (FHR) and fetal activity, ultrasound, avoid vaginal exams, bed rest with a side-lying position, monitoring amount of bleeding (treat signs of shock if present), IV fluids, blood products if needed or tocolytic medications, plan for a cesarean if heavy bleeding.

Hyperemesis gravidarum: teaching, difference to average nausea/vomiting i. ii. iii.

Persistent vomiting unrelated to other causes, a measure of acute starvation (usually large ketonuria), and some discrete weight loss, most often 5% of the prepregnancy weight Often requires short term hospitalization for...