Maternity

Question 1

Cardiovascular system

Answer 1

Pulse may increase 10b/minutes

Question 2

Blood pressure

Answer 2

May decrease in second trimester

Question 3

 Endocrine system

Answer 3

BMI raises, body weight increases

Question 4

Respiratory system

Answer 4

Oxygen consumption increases by 15% to 20%

Question 5

Gastro intestine system

Answer 5

Nausea, vomiting, constipation,and hemorrhoids

Question 6

renal system

Answer 6

Frequency of urination increases in first and third Trimester

Question 7

Reproductive system

Answer 7

Uterus enlarges, cervix changes.
Leukorrhea is normal- White milky discharge PV-due to hormonal changes (if foul smelling /itching/ burning-need to report)

Question 8

Skin

Answer 8

Linea Negra /striae(stretch marks)/chloasma(blackish color on the face)vascular spider Navi (very very small and tiny-blood vessels)

Question 9

Skeletal system

Answer 9

Center of gravity changes -lordosis

Question 10

Weight gain during pregnancy

Answer 10

Weight gain 11.2 to 15.9kg KG  (25 to 35 LB)
1st trimester 1 to 2kg(2.2to4.4lb)
2nd to3trimester 0.4 KG (1 lb)
under weight woman total 28 to 40 gain
Overweight woman 15 to 25 Lb

Question 11

Pica

Answer 11

Pica is the abnormal, compulsive craving for and consumption of substances normally not considered nutrionally not valuable or edible
Common substance include ice,corn starch, chalk,clay,dirt,and paper
associated with iron identification anemia.so monitor the Hb and Hct.

Question 12

Laboratory tests Blood type and Rh factor

Answer 12

mother is Rh negative and it has negative antibody screen should be given Rho(D)immune globulin (RhoGAM) within 72 hours of birth of first baby when detected
With every other pregnancy, should be given RhoGAM at 28 week ago gestational and within 72 hours of birth of baby

Question 13

Other pregnancy tests

Answer 13

Tuberculin-skin test (if needed) positive test indicates need for chest x-ray to rule out active disease. In Pregnant client, x-ray cannot be performed until after 20th week of gestation
urine glucose-?Diabetes, protein-? Preeclampsia,nitrates and WBC? Infection
May be decreased and a specific gravity may be increased (vomiting )
blood:hCG levels (human chorionic gonadotrophin)
diagnostic test: ultrasonography
outline define identifies fetal and maternal structures.
Assist in confirming gestational age and estimated date of confinement.
Avoid supine position-reduced venous return -hypotension dizziness,fall

Question 14

Chorionic villus sampling (high risk)genetic problem

Answer 14

Assessment of portion of the developing placenta (chronic villi) which is aspirated through a thin sterile catheter accident or syringe (10 to 12 weeks)
detects genetic abnormalities by sampling chronic villus tissue at 8 to 12 week of gestation
kick counts (fetal movement counting)- 10 times into 2hrs.

Question 15

amniocentesis

Answer 15

Aspiration of amniotic fluid may be done from 13 to 14 weeks of gestation
Used to determine genetic disorders, metabolic defects , fetal lung maturity.
Risks maternal hemorrhage,infection,abruptio placenta, premature rupture of membranes.
(AFP)alpha-fetoprotein can be measured from the amniotic fluid
high levels of AFP are associated with neural tube defects,anencephaly (incomplete development of fetal skull and brain), Omphalocele(abdominal wall defect)

Question 16

Amniosynthesis:high levels of AFP.

Answer 16

High levels of AFP also May be present with a normal multi fetal pregnancies
Low levels of AFP are associated with chromosomal disorder (down syndrome) or gestational trophoblastic disease (hydatidiform mole)

Question 17

fetal lung test

Answer 17

Lecithin/Sphingomyelin(L/S)ratio is 2:1ratio indicating

fetal lung maturity (2.5:1or 3:1for a client who has diabetes mellitus)

Question 18

Present of phosphatidylglycerol(PG)



Answer 18

Absence of PG is associated with respiratory distress
after amniocentesis:administer Rho(D)immune globulin RhoGAM to the client if she’s Rh negative
advise the client to report to her provider if she’s experience fever, chills, leakage of fluid, or bleedingfrom the incision site, decreased fetal movement, vaginal bleeding,or uterine contractions after the procedure

Question 19

Fern test

Answer 19

Microscopic slide to determine in presence of amniotic fluid leakage

Question 20

Nitrazine test

Answer 20

Determines present of amniotic fluid in vagina secretions; shades of blue indicate that membranes probably ruptured. blue green/ blue gray/ deep blue = positive

Question 21

Quad marker screening

Answer 21

A blood test that ascertain information about fetal birth defects,it does not diagnose the actual defect. Check HCG,AFP, Estriol,inhibin-all proteins from fetus and placenta

Question 22

Sustained Fetal Tachycardia

Answer 22

> 160/min for>10mts is concerning finding that requires further follow up

Question 23

Nonstress test positive - reactive it’s normal

Answer 23

Performed to assess placenta function and oxygenation
Assesses fetal well-being-FHR-vs fatal moment
Normal increased the fetal heart rate with fetal movement
outpatient clinic external monitor
the non stress test is reactive- (normal) when 2 or more fhr acceleration of at least 15 beats/mts (each with a duration of at least 15 seconds ) occur in a 20 minuets Period Test
(wait at least for 40 minutes if no fetal heart rate acceleration, before saying it it’s abnormal)

Question 24

contractions stress test(positive is abnormal)

Answer 24

Performed to access placental function, oxygenation and baby tolerated labor ?
Fetal heart rate versus contractions -nipple stimulation/ oxytocin(Oct)
Normal-no late deceleration, no variable deceleration
early decerlaration is OK -due to head compression to maternal pelvis
assess fetal ability to tolerate labor,fetal well-being

Question 25

late deceleration and variable decelerations: not OK uteroplacental insufficiency

Answer 25

A variable decelerations- maybe due to cord compression, cord prolapse, uterine tachysystole ( first constructions) chorioamnionitis, Pleasant abruption, nactual cord , PROM with the fetal distress,maternal pushing during labor. Late decelerations:due to decreased cardiac output from mother/ decreased blood to the placenta : common causes maternal dehydration, anemia, hypoxia, hypertension epidural analgesia , uterine tachysystole, placental abruption.

Question 26

Fetal monitoring

Answer 26

External fetal monitoring: non-invasive, performed using transducer or Doppler Transducer,fastened with belt,should be placed on side of mother where fetal back is located (find using Leopold’s maneuvers) Internal fetal monitoring invasive , requires rupturing of membranes, attachment of electrode to presenting part of fetus, mother must be dilated 2 to 3 cm to perform this procedure contraindications-closed cervix, placenta previa,STD, breach, AIDS, hepatitis B.

Question 27

fetal assessment biophysical profile BPP

Answer 27

Check fightings on score 0 to 20 by Dr. with the help of ultrasound 1-fetal heart rate/NST 2-fetal breathing moment 3-fetal body movements 4-Fetal muscle tone 5-amount of amniotic fluid score 8 to 10=reassuring=good 6-Equivocal (suspicious)need another BPP With in the next 12 to 24hrs 4 or less non-reassuring- may needed immediate attention/delivery

Question 28

Nagele’s Rule

Answer 28

to estimate date of confinement,delivery date: 1-subtract 3 months from the first day of the last menstrual period, 2-add 7 days,and 3-Adjust the year

Question 29

McDonalds Method-

Answer 29

Fundal height-correlate with you gestational age until 3rd trimester. Consistency (same person same measurement) is important

Question 30

GTPAL acronym: Gravidity number of pregnancies

Answer 30

Nulligravida woman has never been pregnant. primigravida: a woman in her first pregnancy, multigravida: a woman who has had two or more pregnancies

Question 31

GTPAL acronym

Answer 31

``` G= gravida T- term baby P-preterm Baby A-abortion L- living ```

Question 32

Gravida

Answer 32

The number of times the woman has been pregnant, regardless of pregnancy outcome

Question 33

Term term

Answer 33

The number of pregnancies delivered at 37 weeks zero days and beyond

Question 34

Preterm 

Answer 34

The number of pregnancy delivered from 20 weeks zero days gestation through 36 weeks six days risk gestation

Question 35

Abortion

Answer 35

The number of pregnancy sending before 20 weeks zero days gestation this may be spontaneous miscarriages are induced abortions

Question 36

Living

Answer 36

The number of currently living children

Question 37

Torch: malformations, fetal death

Answer 37

Toxoplasmosis:uncooked meals, cat litter- avoid backyard gardens/soil food cats and kittens prefer litter boxes, garden soil and sand boxes for elimination

Question 38

toxoplasmosis other infections(TORCH) Malformation, fetal death

Answer 38

Other infections( usually hepatitis): poor hand washing, blood and body fluids contamination, rubella:: droplet spread-rubella virus, cytomegalovirus:droplet, body fluids (including Tears , saliva breast milk),Handwashing. herpes simplex STI

Question 39

Presumptive signs(subjective) Change that the woman experiences that make her think that she may be pregnant

Answer 39

 amenorrhea, fatigue , nausea and vomiting, urinary frequency Breast changes-darkened areolae,Montgomery ‘s glands around the breast quickening - slight fluttering movements of the fetus felt by a woman between 16 to 20 weeks of the gestation uterine enlargement, probable signs

Question 40

Probable signs : (objective )

Answer 40

Change that make the examiner suspect a woman is pregnant (primarily related to physical changes of the uterus) abdominal enlargement related to changes in uterine size,shape,and position

Question 41

Braxton hicks Contractions – false contractions

Answer 41

painless, irregular, and usually relieved by walking. | positive pregnancy test, fetal outline felt by examiner

Question 42

Hegar sign:

Answer 42

Softening and thinning of lower uterine segment at about sixth week of gestation 

Question 43

Goodells sign:

Answer 43

Softening of cervix, beginning at second month of gestation

Question 44

Chadwick’s signs:

Answer 44

Bluish coloration of mucous membrane’s of cervix, vagina,vulva at about sixth week of gestation

Question 45

Ballottement:

Answer 45

Rebounding of fetus against examiner’s fingers on palpation

Question 46

Positive sign

Answer 46

fetal heart rate; 120 to 160 per minute, active fetal movement outline of fetus on x-ray or ultrasonogram

Question 47

Common discomforts of pregnancy

Answer 47

Urinary frequency, avoid UTI. Encourage the client to wipe the perineal area from front to back after voiding; avoid bubblebaths,wear cotton underpants, avoid tight fitting pants, consume plenty of water (eight glasses of water per day). Avoid urinary stasis

Question 48

Other common problem in pregnancy :nausea and vomiting

Answer 48

Nausea and vomiting;: eat crackers or dry roast dry toast 30 minutes to 1 hour rising in the morning to relieve discomfort small frequent meals, high-protein snacks. Instruct the client to avoid heaving empty stomach and ingesting spicy ,greasy, And gas forming foods. Encourage the client to drink fluids between meals, consume food high in vitamin B6 (example nuts ,seeds, legumes)

Question 49

Other symptoms in pregnancy Heartburn

Answer 49

Eat more small frequent meals, not allow the stomach to get empty or to full , sit up for 30 minutes after meals, check with her provider to using any over-the-counter antacids

Question 50

Other common problems in pregnancy period

Answer 50

Fatigue: may occur during the first and third trimester -frequent rest periods Beckache: exercise regularly, perform pelvic tilt exercises (alternately arching and straightening the back). Use proper body mechanics by using the legs to lift rather than the back, and use the side lying position

Question 51

Common discomfortable pregnancies

Answer 51

Constipation: the client is encouraged to drink plenty of fluids, Eat a diet high in fiber, and exercise regularly bulk forming fiber supplements:Psyllium methylcellulose, wheat dextrin. Hemorrhoids: A warm sitz bath and application of topical ointments will help relieve discomfort

Question 52

Ectopic pregnancy

Answer 52

Abnormal implantation of a fertilized ovum outside of the uterine cavity. Usually in the fallopian tube, which can result in a Tubal rupture causing a fatal hemorrhage.

Question 53

Ectopic pregnancy symptoms

Answer 53

Unilateral stabbing pain and tenderness in the lower abdominal quadrant, Reffered shoulder pain and due to blood in the peritoneal cavity irritating the diaphragm or phrenic nerve after tubal rupture nursing action: replace fluids and maintain electrolyte balance to avoid shock provide medical and educational psychological support. Rh negative mom -give Rh immunoglobulin.

Question 54

Hyperemesis gravidarum

Answer 54

Excessive nausea and vomiting past 12 weeks and result in a 5% weight loss, electrolyte in balance and ketosis nursing care:monitor the client intake output (urine specific gravity - increase if dehydration) give the client IV fluids. Assess the clients a skin turgor, and mucous membrane’s. monitor the client Vital signs (hypotension,Tachycardia) monitor the client’s wait. Have the client remain NPO for 24 to 48 hours med/easily digestible foods (low fat/simple carbs like cereal rice pasta.)

Question 55

Gestational diabetes

Answer 55

Screen all pregnant woman’s between 24th to 28th week of gestation. can be treated by diet alone;some may need insulin during second and third trimester, maternal insulin needs increased (placental hormones- increase insulin resistance). Fetus produces own insulin and pulls glucose from mother, predisposing mother to hypoglycemia.

Question 56

Risk for polyhydramnios :(excessive accumulation of amniotic fluid,(>1200to 2000ml ) clumsy eclampsia,dystocia, infections (yeast)

Answer 56

Newborn infant of diabetic mother at risk for hypoglycemia, hyperbilirubinemia, respiratory distress syndrome, hypocalcemia, congenital anomalies

Question 57

polyhydramnios assessment

Answer 57

Signs similar to those of diabeties Mellitus in nonpregnant woman. polyuria, polydipsia polyphagia monitor the client blood glucose, monitor the fetus, administer insulin.

Question 58

Polyhydramnios client education

Answer 58

Instruct the client to perform daily kicks counts. Educate the client about diet and exercise Educate the client about self administration of insulin

Question 59

Hypoglycemia signs 

Answer 59

Nervousness, headache,weakness, irritability, hunger,blurred vision, tingling of mouth or extremities

Question 60

Hyperglycemia signs

Answer 60

Thirst,nausea, abdominal pain, frequent urination, flushed dry skin, fruity breath)

Question 61

Gestational trophoblastic pregnancy,molar pregnancy

Answer 61

No fetus, but uterus swollen, fluid filled, and takes on the appearance of grape like clusters. excessive vomiting (hyperemesis gravidarum)due to elevated hCG levels in rapid uterine growth more than expected for the duration of the pregnancy due to the over proliferation of cells. An Ultrasound reveals a dense growth with characteristics vesicles , but no Fetus in Uterus 

Question 62

Gestational trophoblastic disease,Hydatidiform mole,Molar pregnancy:

Answer 62

nursing actions: Measure fundal height. Symptoms of preeclampsia may be present Assess vaginal bleeding and discharge. Rho(D)immunoglobin RhoGAM to the client who is Rh negative

Question 63

Preterm labor

Answer 63

Occurs after 20th week, but before 37 the week of gestation. risk factor:H/O preterm delivery or cervical surgery (cone biopsy), mother age (< 17 or>35)current infection, (Dental/ UTI),substance-abuse, malnutrition. Contractions occur more frequently than every 10 minutes, last 30 seconds or longer persist. (Patient may complain of low back pain/ pelvic pressure or heaviness /abdominal cramps) assessment:Rapture of amniotic membranes

Question 64

Preterm interventions/med

Answer 64

Maintain left lateral position, monitor fetal status. Betamethasone:to hasten surfactant production. Administer tocolytics.to stop Contractions, Retrodrine, Turbutaline,mag sulphate,Nefidipine,Indomethacine.

Question 65

Preterm labor client education

Answer 65

Give me the attention immediate action for patient experiencing suspected preterm labor at home 1- empty bladder, 2-left laying position, 3drink 3 to 4 cups of water, 4-palpate abdomen to assist contractions, 10 minutes apart or closer contact doctor 5-rest for 30 minutes and slowly resuming activity if symptoms disappear. If symptoms persist up to one hour,contact doctor 

Question 66

Contraction for tocolytics

Answer 66

active vagina bleeding , dilation of the cervix greater than 6 cm,chorioamnitis,greater than 34 weeks of gestation, and acute fetal distress. betamethasone:pulmonary edema and hyperglycemia indomethacin:PP hemorrhage, blood tinged sputum, magnesium sulfate toxicity blood BLURP

Question 67

Premature rupture of membranes(PROM)

Answer 67

rupture of the amniotic sac before Onset of the labor, regardless of length of gestation. assessment: nitrazine test,Fern test positive, presence of pool of fluid near cervix.

Question 68

rupture of membranes interventions

Answer 68

May remain in hospital or at home on bedrest/activity limitations no PV ( unless absolutely necessary, sterile technique), temperature 2hrs,Hydration. If home:Educate to avoid sexual intercourse, insertion of anything into a vagina. Avoid breast stimulation if gestation is preterm, monitor temperature report temperature;of 100° immediately, admission antibiotics to mother as prescribed

Question 69

placenta previa

Answer 69

improperly implanted placenta into lower uterine segment, near are over the Internal cervical os.Maybe total, marginal,or or low- lying depending on how much is covered assessment: sudden onset of painless, bright red vagina bleeding.

Question 70

Placenta previa mads:

Answer 70

Corticosteroids, such as betamethasone (Celestone),promote fetal lung maturation if delivery is anticipated (cesarean birth). Have oxygen equipment available in case of fetal distress.

Question 71

Placenta previa interventions

Answer 71

Monitor maternal and fetal status, assess for bleeding, leakage or contractions. Maintain mother inside lying position as prescribed, monitor amount of bleeding; assess for development of shock refrain from the performing vaginal exam (may exacerbate bleeding) Administer IV fluids, blood products,and medications as prescribed mother -OK to be home if no bleeding and baby’s status is good. pelvic rest-no P/V,No sexual activity -injury to placenta Plan for C-section. Additional ultrasounds will be needed to assess progress

Question 72

Abruptio placenta

Answer 72

Premature separation of the placenta from the uterine wall after 20th week of gestation , before fetus is delivered A complication associated with gestational hypertension

Question 73

Abruptio Placenta assessment

Answer 73

Assessment:dark red, painful vaginalbleeding ,intra uterine rigidity(uterine muscle contraction,tenderness and stiffness)

Question 74

Abruptio placenta interventions

Answer 74

interventions: monitor maternal fetal status, maintain bedrest, administer oxygen. Risk factor:gestation hypertension, fall accident. Prepare for delivery of fetus as  Quickly as possible; vaginal delivery preferred but, because of emergency, cesarean section may be done. palpate the uterus for tenderness and tone. Assess fetal heart rate pattern. Administer IV fluids,blood products and medication‘s :corticosteroids to promote fetal lung maturity administer oxygen 8 to 10 L per minute via facemask assess urinary output and monitor fluid balance Prepare for delivery as quickly as possible; vaginal delivery preffered but,because of emergency cesarean section may be done

Question 75

placenta accreta

Answer 75

The placenta implantation in the myometrium normal implantation is in the endometrium. During delivery,placenta accreta is suspected if the placenta has not been delivered within 30 minutes of the infants delivery/attempts at manual removal cannot create a plan of separation/placental traction causes large volume hemorrhage. during labor and delivery, placenta accreta can results in life-threatening hemorrhage and retained placental fragments. The client should have a type and cross match on the chart in case an immediate blood transfusion is needed they also required two large board IV sites

Question 76

Supine hypotensive syndrome(vena cava syndrome)

Answer 76

Occurs whenVenous returns to heart is impaired by weight of uterus; results in partial occlusion of vena cava and descending aorta and in reduced cardiac return,cardiac output, blood pressure Assessments:Faintness,lightheadedness,vertigo, hypertension, fetal distress interventions: position client in a lateral recumbent position to shift weight of fetus off inferior vena cava monitor maternal and fetal vital signs

Question 77

HIV aids

Answer 77

Routine laboratory testing in the early prenatal period | Procedures,such as amniocenteses and Episiotomy, should be avoided due to the risk of maternal blood exposure

Question 78

HIV aids

Answer 78

Avoid internal fetal monitors, vacuum extraction, and forceps during labor. No oxytocin induction-to avoid strong uterine contractions and vaginal tear

Question 79

How to take care the infection HIV AIDS internal fetal monitoring 

Answer 79

Administration of injections and blood testing should not be place until the first bath given to newborn Instruct the client not to breast feed. postpartum Period: if mother immune compromised, placed in protective isolation Antiviral prophylaxis (Retrovir-zidovudine)may be given to the mother, administer Retrovir at 14 weeks of gestation, throughout the pregnancy, and before the onset of labor Cesarean birth Administer Retrovir to the infant at delivery and for 6weeks following birth 

Question 80

Group B, streptococcus B– hemolytic 

Answer 80

GBS is a bacterial infection that can be passed to a fetus during labor and delivery 

Question 81

Positive GBS (Group B streptococcus B hemolytic

Answer 81

positive GPS may have maternal and fetal effects, including premature rupture of membranes, preterm labor and delivery, Choreoamnionitis infections of the urinary track, and maternal sepsis. vaginal and Rectal cultures are performed at 36 to 37 weeks of gestation  Administer intrapartum antibiotics prophylaxis(IAP) penicillin .

Question 82

Group B streptococcus B-hemolytic

Answer 82

Client who delivered previous infant with GBS infection/GBS bacteria during current GBS-positive screening during current pregnancy. Client who has unknownGBS status who is delivering it less than 37 weeks of gestation,client who has maternal fever of 38°C (100.4°F),client who has rupture of membranes 18 hours or longer

Question 83

Bleeding during pregnancy

Answer 83

Vaginal bleeding during pregnancy is always abnormal. Spontaneous abortion:when a pregnancies terminated before 20 weeks of the gestation (the point of fetal viability)are fetal weight less than 500 g. Abortion: pregnancy that ends before 20thweek of gestation, spontaneously or electively. Spontaneous: pregnancy ends because of natural causes. Reduced induced: Therapeutic or elective reasons for terminating pregnancy. Threatened: developing spontaneous abortion. inevitable: Threatened’s loss that cannot be prevented.

Question 84

oligohydramnios: Amnioinfusion

Answer 84

Aminoinfusion-increasing isotonic saline to add volume-through intrauterine pressure catheter- transvaginal ( monitor for over a fluid – uterine tone >20 MM of Hg). Decrease fundal height, irregular contour of metal abdomen. Major complication: pulmonary hypoplasia,due to the lack of normal alveolar distention by amniotic fluid- baby might needed resuscitation. umbilical cord compression-monitor for variable decelerations.

Question 85

Anemia

Answer 85

Predisposes Client to postpartum infection assessment: fatigue, headache,pallor,, tachycardia, hemoglobin level lower than 10mg/dl hematocrit level lower than 30mg/dl. interventions: monitor hemoglobin levels every two weeks. Instruct client to take iron and folic acid supplements. medications: Ferrous sulfate(325mg)iron supplements twice daily. instruct the client to take supplements on an empty stomach. Encourage a diet rich in vitamin C-containing foods to increase absorption

Question 86

Anemia a | about food

Answer 86

``` Suggest that the client increased roughage and fluid intake diet to assist with the discomfort of constipation. Iron dextran (Imferon):used in the treatment of iron deficiency anemia when oral iron supplements cannot be tolerated by the client who is pregnant. Ferrous sulfate iron supplements may also cause constipation. High-fiber diet, fluids, exercise and bulk forming fiber supplements will help ```

Question 87

Gestational hypertension

Answer 87

Acute hypertensive state the develops after 20th week of gestation. Hypertensive disorder of pregnancy where by the woman has elevated blood pressure at 140/90 MM of Hg or greater recorded at least twice, 4 to 6 hours apart, with in 1-week Period, after 20thweek of pregnancy

Question 88

Gestational hypertension condition

Answer 88

Condition can be mild or severe: can progress to eclampsia, characterized by presence of seizures associated with placental abruption, kidney failure, hepatic rapture, preterm birth, fetal and maternal death. Predisposing conditions: chronic conditions, such as renal disease, hypertension, diabetes mellitus, primigravida, especially woman younger than 19 years or older than 40 years of age

Question 89

Gestational hypertension assessment

Answer 89

Mildelevated blood pressure, usually 15 to 30 MM of Hg above baseline; Weight gain of 1 Lb/week or more in last trimester,; mild generalized even though edema; proteinuria of 1+to 2+ severe:severe hypertension, systolic blood pressure at least 160 MM of Hg or diastolic at least 110 MM of Hg; massive,generalized edema; weight gain;proteinuria 3+to 4+;visual disturbances; headache; HELLP syndrome of laboratory findings – hemolysis, elevated liver enzymes, low platelets . eclampsia: characterized by generalized Seizures,