NUR 238 - Lecture Notes

Question 1

What is Viability?

Answer 1

Ability for fetus to survive outside of uterus.

Question 2

Survival of fetus under 32 weeks depends on what?

Answer 2

• CNS maturity

- Oxygenation

Question 3

What week are all the major organs in place?

Answer 3

By week 8.

Question 4

Mapping of Fetal Development

Answer 4

• 4 Weeks: Fetal heart begins to beat
• 8 Weeks: All body organs formed
• 8-12 Weeks: Fetal heart can be detected by ultrasound, doppler
• 16 Weeks: Baby’s sex can be seen
• 20 Weeks: Fetal heart detected by fetoscope “quickening”, regular schedule of sleeping, kicking, sucking, hand grasp, vernix & lanugo
• 24 Weeks: weigh 780 grams, increased activity, respiratory & sucking movements
• 28 Weeks: Eyes open & close, surfactant is formed, 2/3rds its final length
• 32 Weeks: fingernails & toenails

Question 5

What is Foramen Ovale?

Answer 5

Connects right atrium to left atrium.

Question 6

Primary Powers

Answer 6

Involuntary cxs, originate in upper uterine segment and travel downward.

Question 7

Secondary Powers

Answer 7

Involuntary urge to push down, voluntary bearing down efforts by mother to expulse fetus using diaphragm and abdominal muscles.

Question 8

Negative effect of epidural?

Answer 8

Removes the urge to push due to lack of sensation.

Question 9

What are Primary Powers responsible for?

Answer 9

The thinning of the cervix (effacement).

Degree of effacement is expressed in percentage

Dilation: widening of cervical opening (os) from 1cm-10cm
- 10cm signifies end of first stage

Question 10

First stage: onset of regular uterine cxs to full dilation
Latent: 0-3 - effacement of cervix, little increase in descent
Active: 4-7 - more rapid dilation, of cervix and descent of presenting part
Transitional: 8-10 (starts second stage)

Answer 10

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Question 11

First Stage of labor Characterized by?

Answer 11

• Regular uterine cxs that increase in frequency, strength, duration
• Blood-tinged vaginal discharge (bloody show)

Question 12

Clues to Contractions

Answer 12

• Duration; from start of one contraction to the end
• Intensity; how severe the pain is
• Frequency; Time between contractions (how often)

Question 13

Cardinal Movements

Answer 13

• Engagement
• Descent
• Flexion (chin to chest)
• Internal rotation
• Extension
• External rotation
• Expulsion

DO NOT MEMORIZE

Question 14

Second Stage: Full dilation of cervix to birth of fetus
Third Stage: birth of fetus to expulsion of placenta
Fourth stage: delivery of placenta

Answer 14

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Question 15

If there is question regarding saving the mom or the baby? Save the mom.

Answer 15

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Question 16

3 main tests for prenatal individuals

• CBC
• Syphilis
• Blood Type

Answer 16

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Question 17

Reassuring FHR Patterns

Answer 17

• Baseline within 110-160bpm
• Early decelerations
• Mild decelerations

Question 18

When the water breaks, you want to see how the baby adjusts to the new atmospheric pressure change

Answer 18

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Question 19

Non-reassuring FHR patterns

Answer 19

• Progressive increase/decrease of baseline FHR
• Tachycardia of 160 or >
• Bradycardia or < 110
• Decrease in baseline variability or absent variability
• Prolonged decelerations
• Late decelerations

Question 20

Fetal Tachycardia Causes

Answer 20

• Early fetal hypoxemia

- Always administer O2 to non-reassuring FHR

Question 21

Variable Decelerations are usually related to what?

Answer 21

Cord issues.

Question 22

Amnioinfusion

Answer 22

Try to infuse fluid in the uterus

Question 23

Amnioinfusion

Answer 23

Try to infuse fluid in the uterus

Question 24

• 2 dose calcs
• what the biophysical profile is
• what lightening is (when the baby drops)
• know effects of smoking (low birth weight/IUGR[growth restriction])
• know about culturally competent care/therapeutic conversation (use translator, etc)
  _ basic thing to prevent preterm labor/delivery - prenatal care and hydrate
• normal weight gain in preg (25-35 lbs)
• stages of labor (3 phases)
• know purpose of amniotic fluid
• slide on last lecture on fetal circulation (how it works, etc)
• normal blood volume in pregnancy increases - hematocrit will change because everything else increases
• when should you start preparing for pregnancy (before, genetic counseling/testing)
• prenatal care of the adolescent (communication/build trust)
• GDMs - 25-26 weeks to check
• Rubi strep - 35-37 weeks to check
• negative rH - not compatible with rH positive baby
• normal fetal heart rate - 110-160
• amniocentesis, why? - looking for disorders early, later we are looking for lung maturity (LS ratio - 2:1 ratio)
• study pregnancy hormone (progesterone (maintains pregnancy), estrogen (provides nutrients), HCG (detect it to know you’re pregnant)
• know differences between discomfort and warning signs (edema)
• know goals of healthy people 2020 - increase prenatal care
• Alpha fetal protein is looking for spinal tissues, if it’s elevated (down syndrome)
• IUPC - measures intracranial pressure
• Contraction duration
• How to release discomfort - pelvic rocks for back pain, flex the feet for leg cramps
• never put mom on back
• know signs of pregnancy (presumptive/probable)
• nutrition during pregnancy (iron, what promotes calcium aTI book pg. 27)
• kick counts (3 or more in an hour is good)
• ATI - nausea in pregnancy (no greasy food, dry crackers)
• favorite nagels rule for NMP
• GTPAL
• Gravida = amount of pregnancy, Term = Births, Perm = pregnancy, A = abortion, L = living
• You will only change G & L
• AFI, FHR, fetal movement, big movement, tone (8-10 is normal [4, you will try to deliver pt - fetal distress])
• Evidence based care
• Task of pregnancy - acceptance
• Fundal height, measurements
• Rogam, why we give it
• Who gets genetic counseling

Answer 24

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