NURS450 Exam #3 Study Guide 2020 PDF

Preview

Summary

EXAM 3 STUDY GUIDEMaternal Mortality ● How does the US rate compare to other large, industrialized countries? o The us ranks the worst ● Racial/ethnic disparities o Higher rates with women of culture ● Define “Pregnancy-related Death” o Pregnancy-associated death caused by a pregnancy complication o...

Description

NURS 450.01

21 April 2020

EXAM 3 STUDY GUIDE Maternal Mortality ● How does the US rate compare to other large, industrialized countries? o The us ranks the worst ● Racial/ethnic disparities o Higher rates with women of culture ● Define “Pregnancy-related Death” o Pr e g n a n c y a s s oc i a t e dd e a t hc a u s e db yap r e gn a n c yc o mp l i c a t i o n o Pr e g n a n c yc o mp l i c a t i o n=i ni t i a t e db yp r e g n a n c yo ra g g r a v a t i o nofun r e l a t e dc o n di t i o nb yt h e ph y s i o l o g i ce ffe c t so fp r e g n a n c y ▪ Di a b e t e s ● Wh e ni sg r e a t e s tr i s ko fma t e r na ld e a t h o Pos t p a r t u m Electronic Fetal Monitoring (EFM) • What is a normal fetal heart rate range? o 110-60 beats per minute • Types of Fetal Monitoring (External vs. Internal) o External ▪ Ul t r a s o u n dt r a n s d u c e ro rd o pp l e r ● Re c o r d st hef e t a lh e a r tr a t e ▪ To c o d y n a mo me t e r ▪ Re c o r d st hef r e que nc ya n ddur a t i o no ft hec o n t r a c t i o n s o Internal: ▪ Fe t a lSc a l pEl e c t r od e( FSE)i sa t t a c he dt ot h eb a b y ' ss c a l pt or e c o r dt hee l e c t r i c al c o nduc t i o no ff e t a lh e a r t ▪ I n t r a u t e r i nePr e s s ur eCa t h e t e r( I UPC)i sat h i nt ubei n s e r t e di n s i det h eu t e r i nec a v i t yt o me a s u r ed u r a t i o n , f r e qu e n c ya n ds t r e ngt ho fu t e r i n ec o n t r a c t i o n s • Risks and/or benefits of intermittent versus continuous fetal monitoring o What is the intention of fetal monitoring: what are we trying to prevent (2 things)? ▪ Fe t a lSc a l pEl e c t r od e( FSE)i sa t t a c he dt ot h eb a b y ' ss c a l pt or e c o r dt hee l e c t r i c al c o nduc t i o no ff e t a lh e a r t ▪ I n t r a u t e r i nePr e s s ur eCa t h e t e r( I UPC)i sat h i nt ubei n s e r t e di n s i det h eu t e r i nec a v i t yt o me a s u r ed u r a t i o n , f r e qu e n c ya n ds t r e ngt ho fu t e r i n ec o n t r a c t i o n s ▪ Re du c en e o na t a lde a t h ▪ Av o i dn e u r o l og i c / b r a i ni n j u r y o I n t e r mi t t e nta u s c u l t a t i o n ▪ i sl i s t e n i n gt ot h ef e t a lh e a r ta tr e gu l a ri n t e r v a l su s i n gah a n d he l dd o p pl e r o Con t i n u o usEFM ▪ i smo n i t o r i n gb o t hf e t a lhe a r tr a t ea n dc o n t r a c t i o n sc on t i n u ou s l y o Intention of fetal monitoring ▪ Reduce neonatal death ▪ Avoid neurologic/brain injury ▪ HOWEVER… e x t e n s i v es t u d i e so fc on t i n u o usEFM a n di nt e r mi t t e n ta u s c u l t a t i o ns h o w…

NURS 450.01

21 April 2020

● Ne i t h e ra c h i e v et h e s eg o a l s ● On ed o e s n ’ tp e r f o r mb e t t e rt h a nt heo t h e r ● Co n t i nu o u sEFM l e dt oh i g h e rs u r g i c a lr a t e swi t h o uta n yn e on a t a lb e n e fit Normal Vaginal Delivery ● Define: o 4 stages of labor s t ▪ 1 s t a g e :Co nt r a c t i o nsa n ddi l a t i o n nd ▪ 2s t a g e :Pu s hi n ga n dd e l i v e r yo ft h eb a b y r d ▪ 3 s t a g e :De l i v e r yo ft h ep l a c e n t a t h ▪ 4 s t a g e :Po s t p a r t u mr e c o v e r y o Dilation ▪ Op e n i n g01 0 c m ▪ Va g i n a le x a m ▪ Ea r l yp h a s e =g r a d u a lc h a n g e( c a nt a k eh o u r so rd a y s ) ▪ Ac t i v ep h a s e =“ e xp e c t a t i o n ”i s1 c m/ h o u r ▪ Wi d ev a r i a t i o no f‘ n o r ma lp r o g r e s s ” o Effacement ▪ Thinning of cervix o Station and Engagement ▪ Station describes fetus head to mother’s vaginal exam ▪ 0s t a t i o n =“ e n g a g e d ” ▪ +/ -=a b o v e / b e l o wt h ei s c h i a ls p i n e so fpe l vi s o Crowning ● Define Vertex, Breech, Transverse: which is the ideal position for vaginal delivery? o Ve r t e x( c e p h a l i c :h e a d fir s t )i n t e n d e d ▪ Mi l i t a r y :c h i nt u c k e dd o wno nc h e s t ▪ Br o w ▪ Fa c e o Br e e c h( 1 3 %a tt e r m)( b o t t o mfir s t ) ▪ Co mp l e t e5 1 0 % ▪ I n c o mp l e t e / f o ot l i n g1 0 3 0 % ▪ Fr a nk5 0 7 0 % o Transverse/shoulder (sideways) ● Define Leopold’s Maneuver and External Version, when do we use them? o Leopold’s feeling mothers’ stomach to determine babies’ position o External version is when the baby is trying to be turned pulling down on pelvis (epidural if wanted) ● What is Friedman’s Curve? Is it effective: why/why not? o Old fashioned; thinking labor shouldn’t be as long as it is o No it isn’t effective because it increases c-sections ● How are first labors different from subsequent labors (2nd...or 5th baby)? o Less time in labor ● Benefit/risk of delayed cord clamping o Be n e fit so fDe l a y i n g

NURS 450.01

21 April 2020

▪ Hi g h e ri nf a n ti r o ns t o r e s ▪ He l p f u lf o rp r e ma t u r eorc o mp r o mi s e di n f a n t s o Ri s k so fDe l a y i n g ▪ Po l y c y t he mi a ▪ J a u n d i c e ? ▪ De l a yt or e s u s c i t a t i o n ?

Labor Induction & Augmentation ● Define: cervical ripening, labor induction, labor augmentation o Ce r v i c a lr i p e n i n g ▪ Th ep r o c e s so fs of t e n i n ga n dt h i n ni n gt h ec e r v i xb ya r t i fic i a lme a n s o La b o ri n d u c t i on ▪ Th ep r o c e s so fi n i t i a t i n gl a b o rb ya r t i fic i a lme a n s ▪ Tr y i n gt oma k ec o n t r a c t i o n sh a p pe n o Au g me n t a t i o n ▪ Th ep r o c e s so fa c c e l e r a t i n gt h eq u a l i t yo fl a b orb ya r t i fic i a lme a n s ▪ Tr y i n gt oma k ec o n t r a c t i o n ss t r o n g e r ● What is Bishop Score? o Toa s s e s sc e r v i c a lf a v o r a b i l i t y ● When is cervical ripening preferred? How is it done? o Ce r v i c a lr i p e n i n g ▪ Bi s h o pSc o r e=5 ▪ r up t u r eo fme mb r a n e s ▪ Bi s h o ps c o r ei s>9f o rs u c c e s s f u li n du c t i o n! ! o Me c h a ni c a lme t h o d s ▪ Amn i ot o my ● AROM u s i n g‘ a mn i h oo k ’ ▪ St r i p p i n go ft heme mb r a n e s ● Li k ei n s i dea no r a n g ep e a l o Lo wt e c hme t h o d s ▪ he r b a lc o mp o u nd s ▪ c a s t o ro i l ▪ ho tb a t hs ▪ e n e ma s ▪ s e xu a li n t e r c o u r s e ▪ ni p p l es t i mu l a t i o n ▪ a c u p u n c t u r e ▪ a c u pr e s s u r e ▪ t r a n s c u t a n e ou sn e r v es t i mu l a t i o n( TENS) ● e l e c t r o d e s o Pha r ma c ol o gi c a lme t h od s ▪ Me d i c a t i o n ● Pi t o c i n( s y n t h e t i co x y t o c i n) o I smo s tc o mmonme t h o do fl a b o ri n d u c t i o n o Gi v e nI V o Nos t a n da r dp r o t o c olo nd o s eo rl e n g t ho ft i meonPi t oc i n o Mo s tho s p i t a l sr e q ui r ec o n t i n u o u sEFM ● Pr o s t a g l a n d i n sa r eal e s sc o mmo no p t i on ● Pitocin for labor/induction/post C-section ▪ Pi t o c i n( s y n t h e t i co x y t o c i n) ● I smo s tc o mmo nme t h o do fl a b o ri n du c t i o n ● Gi v e nI V ● Nos t a n d a r dp r ot o c o lo ndo s eo rl e n g t ho ft i meo nPi t oc i n ● Mo s th o s p i t a l sr e q ui r ec o n t i n u o u sEFM ▪ Pr o s t a g l a n d i n sa r eal e s sc o mmo no p t i o n Pain Management • Natural pain relief options

NURS 450.01

•

•

•

o Wa t e ri mme r s i o n o Re l a x a t i o n o Tou c ha n dma s s a g e o Ac u p u n c t u r e / a c u p r e s s u r e o Cou n t e r p r e s s ur e o He a ta n dc o l d o Ar o ma t h e r a p y o Di s t r a c t i o n o Hy pn o s i s Twilight sleep: define o Amn e s i a , a s s i s t e df o r c e pd e l i v e r y o Wo me nwe r et i e dd o wn ;n oa c t i v ep a r t i c i p a t i o ni nd e l i v e r yp r o c e s s ▪ Us e df o r c e p st op u l l t h eb a b you t Nitrous Oxide – when can it be used? o I n h a l e dg a s( o d o r l e s s , t a s t e l e s s ) o Re s u l t swi t h i ns e c o n d s , e ffe c t swe a ro ffq u i c kl y o Ca nb eu s e df orl a b o r , de l i v e r , p o s t p a r t u mr e p a i r o Ma yc a u s ed i z z y / d i s o r i e n t e df e e l i n g o Ri s k sa r emi n i ma l , s a f ef o rf e t u s Epidural: o Where is it placed, specifically? ▪ Ad mi n i s t e ri nt ot h ee pi d u r a ls pa c e( flu i da r o un ds p i n a lc o r d ) o Does it usually relieve pain? ▪ yes o Does it have a sedative effect? ▪ Mild sedation o What are the major risks? ▪ Du r a lp un c t ur e / s e v e r eh e a d a c h e ▪ Lo wBPwi t hn a u s e aa n dv o mi t i n g ▪ Pr o l o n g e dpu s h i n g ▪ Effe c t sonf e t u s / n e wb o r ni n c l u s i v e

Assisted & Surgical Delivery • True emergency deliveries? • Define nuchal cord and shoulder dystocia • Assisted or Operative Deliveries o Episiotomy: Risks? When is it necessary? o Forceps vs Vacuum: Risks and benefits of each? o Odon device • Cesarean section: define and major risks o Current C/S rate in the US? o When is a C-section absolutely necessary? • Vaginal Birth After Cesarean (VBAC) o Success rate o Benefit/Risk

21 April 2020

NURS 450.01

Newborns, Postpartum & Parenting • Postpartum phase: o Role of Pitocin o What does the uterus do? • Postpartum blues and depression: define • Breastfeeding o Define colostrum o Benefits to mom and baby o Common breastfeeding issues • Circumcision o Is it recommended and/or medically necessary? • Procedures done to newborn o Vitamin K – why? o Ophthalmic ointment – why? • What is the APGAR test? When is it performed? Premature & Sick Newborns • •

• •

What is the leading global cause of newborn death? Prematurity o Definition o What factors help determine survival rate? o What are the causes? Define kangaroo care and main risk/benefit Cerebral palsy o Is it progressive? (Does it continually get worse) o When does damage normally occur? (pregnancy/labor/delivery)

• • • •

Meconium aspiration syndrome – define Jaundice – define, common? Serious? Treatment? Congenital diaphragmatic hernia – define Equipment for Sick Newborns – define generally what each does: o Continuous Positive Airway Pressure (CPAP) o Cardio-Respiratory Monitor o Extracorporeal Membrane Oxygenation (ECMO) o Bili-light

Care Providers & Homework videos ● Role of providers for labor o Doula o Midwife o Obstetrician o Registered Nurse

21 April 2020

NURS 450.01

● Homebirth philosophy and interventions (BOBBce, Born in USA) ● Birth trends in US through 1900’s and today (Born in USA) ● Father's role expectations in hospital care (Motherland)

21 April 2020...