Spec Maternity

Question 1

Hormone that induces amenorrhea

Answer 1

Progesterone. It also makes the temperature go UP

Question 2

Signs and symptoms of pregnancy are classified to

Answer 2

Presumptive signs which could be something else and client will be the one to recognize

Probable signs which the HCP will recognize

Positive signs which is sure evidence

Question 3

Presumptive signs

A BUN

Answer 3

Amenorrhea is the absence of menstruation

Breast tenderness can occur throughout the pregnancy due to excess hormones
Urinary frequency, wherein after implantation uterus starts to stretch and applies pressure on bladder
Nausea and vomiting

Question 4

Probable signs

Positive PT
("HCG 242")
Hegar's sign
Chadwicks sign
Goodell's sign
Braxton-hicks
Uterine enlargment
Pigmentation changes

Answer 4

Pregnancy test is positive.it is based on hcg levels. Other conditions that increases hcg are hydatidiform pregnancy (molar pregnancy) which is benign neoplasm of grape like vesicles that can become malignant or some meds
Hegar’s is the softening of the lower uterine segment; 2nd or 3rd month
Chadwicks is the bluish color of the vagina and cervix due to vasocongestion on the 4th week.
Goodells is the softening of the cervix which is usually in second month
Uterine enlargement which is assessed by the HCP
Braxton-hicks is the contraction that occurs throughout pregnancy. False contractions that progresses in pregnancy
Pigmentation changes like:
Linea nigra, the dark line down the center of the abdomen
Facial chloasma mask of pregnancy
Stretch marks
Dsrkening of areola

Question 5

Positive signs of pregnancy

Heartbeat
Movement
UTZ

Answer 5

Fetal heartbeat:
Doppler: 10 to 12 weeks
Fetoscope: 17 to 20 weeks

Fetal movement Which means you feeling the baby move.

Ultrasound

Question 6

Gravidity is

Parity is

Viability is

TPAL

Answer 6

The number of times someone has been pregnant

The number of pregnancies that fetus reaching 20 weeks

The ability of infant to live outside uteruswhich is at 24 weeks

Term
Preterm
Abortion which include miscarriage and elective abortions
Living children

Question 7

Spontaneous abortion
Think miscarriage if these s/s appear
Hcg
Occurs

Answer 7

Also called miscarriage
Bleeding,cramping,backache
Hcg will drop with an imminent miscarriage
Mostly occurs before 20 weeks

Question 8

First trimester

Nutrition
Weight gain
Prenatal vitamins(i C FA)
Exercise
Temp
Danger signs and potential complications
PAIN BLEED

Answer 8

Week 1 through week 13

Have a well balanced diet
Increase protein to 60 grams/day. Also consider culture nutritional influences like kosher and fasting

Expect weight gain of 1 to 4 pounds. It will also be dependent on pts. BMI. Some lose weight because they are very sick

Iron that can cause constipation and GI upset. That is why always take iron with vit. C(which promotes absorption of iron). Folic acid which prevents neural tube defects with a daiky dose of 400 mcg/day

Walking and swimming are best exercises. NO heavy exercise program and DONT LET HR GO >140!!! this could lead to decreased CO and decreased uterine perfusion thus the baby will not have enough blood
Dont get overheated.No hot tubs or heating blankets because these will increase body temperature and can cause birth defects.

Persistent vomiting
Abdominal pain
Increased temperature
No fetal movement

Bleeding
vaginaL fluid(sudden)
sEvere headache
Edema

Question 9

Common discomforts of pregnancy

CAN BUT F

HI NaVaL BaHe

Answer 9

Constipation
Ankle edema
Nausea and vomiting

Breast tenderness
Urinary frequency
Tender Gums

Fatigue

Heartburn
Increased vaginal secretions

Nasal congestion
Varicose veins
Leg cramps

Backache
Hemorrhoids

Question 10

Medications during pregnancy?

Smoking in pregnancy?

How many visits in pregnancy?

Ultrasounds
Before
What about ultrasound before a procedure like an amniocentesis?

Answer 10

No medications without prescription

Stop smoking. It is associated with low birth weight babies, cleft lip or palate, and risk for abruptio placenta doubles

First 28 weeks: once a month
28 weeks to 36 weeks: 2/week or 2x per month
After 36 weeks: weekly until delivery

But high risk clients have to visit more

Before an ultrasound ask client to drink water to distend the bladder which pushes uterus up closer to abdominal surface. It is easier to get a good pictude
We want them to void to decrease puncture of bladder

Question 11

Second Trimester

Calorie diet
Weight Gain

Should the client still be experiencing
Nausea and vomiting?
Breast tenderness?
Urinary frequency?

Answer 11

Week 14 through week 26

Increase intake of calorie to 300 per day. If they are an adolescent, they can increase their calories by 500 a day

Expected weight gain is 1lb per week. Depends also on the bmi of client

NO
Yes
NO
In the first trimester the uterus is a pelvic organ while in second trimester uterus rises and relieves pressure on the bladder.

Question 12

Second trimester

Quickening is
FHR
Kegels

Answer 12

A fetal movement that occurs 16 to 20 weeks
110 to 160 is the normal range. But if less than 110, you should PANIC.
Kegels exercise must be done frequently to strengthen the pubococcygeal muscles. Because the pubococcugeal muscles help stop the urine flow, they keep the uterus from falling out

Question 13

Third trimester

Assessment

Weight gain
Monitor BP

Pre-eclampsia
DOC
-vasodilates
What is the difference of pre-eclampsia and eclampsia?

Answer 13

Weeks 37 through 49. It is considered term if it advances to this stage.

No more than 1lb a week. If greater than 11 lbs then assume the worst. ☆WEIGHT GAIN of 2 or more lbs a week should be watched closely and worry about possible pre-eclampsia

Pre-eclampsia develops after 20 weeks gestation and the client will have, increased blood pressure, proteinuria and edema

Pre eclampsia is defined as BP of 160/110 or greater that is 6 hours apart. Pre-eclampsia clients can have seizure.
DOC is magnesium sulfate which is given IV and watched closely. Acts like a anticonvulsant and sedates. With vasodilation,this will decrease blood pressure and increase placental perfusion
SEIZURE. It is called eclampsia when they have a seizure.

Question 14

Fetal position is determined by

What should the client do first?

If contractions is present?

Where to listen FHR?

Answer 14

Leopold’s Maneuver

Void first to relieve the pressure.

Do leopolds maneuver between contractions. Because during contractions, you cant feel the baby because the uterine is hard

Fetal back

Question 15

Signs of Labor

Lightening
-occurs
-presenting part
-breathe more
-urinary frequency
Engagement
Fetal Stations

Answer 15

Usually occurs 2 weeks before term
Presenting part which is usually the head descends into the pelvis
The client will notice that she is able to breathe more easily because the pressure on diaphragm decreases
Urinary frequency is a problem again because of increased pressure on the bladder
The largest presenting part is in the pelvic inlet,hopefully fetal part is presenting first
Measured in cm, which neasures the relationship of presenting part of fetus to the ischial spines of mother

Question 16

Other signs of labor
Braxton
Softening of cervix
Bloody show
Sudden
Watery stool
ROM

When should the client go to the hospital?
What are we worried about when membranes rupture?

Answer 16

Braxton hicks-contractions more frequent and stronger than before
Not heavy bleeding
Sudden burst of energy called NESTING
Diarrhea
Rupture of membranes

When the contractions are 5 mins apart and membranes rupture
Prolapsed Cord which is acute

Question 17

Diagnostic Tests in pregnancy

Non-stress test (NST)

Acceleration definition

Each increase

Do you want test to be reactive or non reactive?

Answer 17

2 or more accelerations of 15 bpm with or without fetal movement

Is an abrupt increase of fetal heart rate from baseline and is visualized by the fetal heart monitor. The increase is greater than or equal to 15bpm above the baseline and lasts at least 15 seconds, but heart rate should come back to baseline within 2 mins

Each increase should last for 15 seconds and is recorded for 20 mins

Reactive. Which means accelerations are present

Question 18

Diagnostic tests

Biophysical profile test (BPP)

How often this is done

Measurements obtained by

Observation time is

Parameters are

Evaluation:

Answer 18

Commonly done at the last trimester but can be done at 28th weeks in a high risk pregnancy

High risk pregnancy may have BPP every week or even twice a week in 3rd trimester

Measurements are obtained by ultrasound and each of the parameters count 2 points with a perfect score of 10/10

30 minutes by sonogram

Parameters:
Heart rate, muscle tone, movement, breathing and the amount of amniotic fluid around the baby

8-10:good
6: worrisome, should consider repeating test in 24 hours
<4: ominous, consider immediate delivery

Question 19

Diagnostic tests

CST or contraction stress test

High risk pregnancies
Uterine contraction

Decelerations
Late decelerations - positive or negative?
This test is RARELY performed on how many weeks?
Results

Answer 19

Aka Oxytocin challenge test. This is done if NST is non-reactive

Performed on preeclampsia, maternal diabetes, and any condition in which placental insufficiency is suspected
This test is done to determine if the baby can handle stress of a uterine contraction. Uterine contractions decreases blood flow to the uterus and placenta

When the blood flow decreases enough to cause hypoxia in the fetus, then the fetal heart rate will decrease from the baseline this is called decelerations
We DONT WANT late decelerations because this means that the placenta is wearing out. We want it to be negative.
28th weeks, because it induces contraction which could lead to birthing of pre term baby
Results are only good for 1 week

Question 20

In NST we sre looking for?

In CST we are looking for?

Answer 20

Accelerations in HR, reactive test

Late Decelerations in HR, negative test

Question 21

3 types of decelerations

Early
Late
Variable

Answer 21

Early (not bad)- is benign and caused by physiological hypoxia from fetal head compression

Late (bad) - caused by uteroplacental insufficiency

Variable (bad) caused by umbilical cord compression

Question 22

True labor

Contractions are

What happens to pain level with a change in activity?

Answer 22

Regular
Increasing in frequency and duration
Discomfort in back and radiates to abdomen

Pain increases

Question 23

False labor

Contractions are

What happens to pain with activity?

Answer 23

Irregular

Discomfort just in front in the abdomen

Decreases or goes away( braxton hicks contraction

Question 24

Preterm Labor

Contractions occur

Goal

Hydration often what
Placed on
Medications that may be prescribed

Answer 24

Occur with dilation between 20 and 37 weeks

Goal is to stop labor

Hydrating the mom often stops preterm labor
Client will be placed on bedrest
Magnesium sulfate IV- relaxes uterus
Betamethasone IM - steroid that helps lung mature
Terbutaline SQ
Nifedipine and Indomethacin PO

Question 25

Epdiural anesthesia Position Given in stage Major complication IVF is given to Position after Vena cava Side ti side UO

Answer 25

Lie on left side, legs flexed, prop up over the bedside table 1 at 3 to 4 cm dilation Hypotension is the major complication so monitor for BP IVF is given to fight the complication of hypotension. BOLUS 1000ml of NS or LR is prescribed. Should be in semi-fowlers position,tilted on their side to prevent vena cava compression. Compression of vena cava decreases venous return which reduces cardiac output and blood pressure thus decreases placental perfusion Alternate position side to side hourly Assess urine output and bladder

Question 26

Client receiving oxytocin High risk Position Nx considerations One on one Complications: HFU Contraction rate Discontinue when Piggybacked

Answer 26

Oxytocin is a high risk alert drug. Dont underestimate what can occur. Any position except FLAT!! On left side if decrease uterine perfusion One on one care is needed for close monitoring Complications: Hypertonic labor Fetal distress Uterine rupture from a scar of previous C-section or VBAC ( vaginal birth after C-Section) Contraction rate must be 1 every 2-3 minutes that lasts up to 60 seconds. We want pause during contraction because this is where the baby can get 0xygen Stopped when Contractions are too often,lasts to long or any signs of Fetal Distress or Late decelerations Oxytocin is piggybacked to main IV fluid, so if oxytocin is stopped, make sure main IV is open.

Question 27

Medication alert in oxytocin Label Administer only Attach to port proximal or distal to site? If discontinued, remove

Answer 27

Always label IV bag and IV tubings Only administer oxytocin with its own bag Must attached to port closer to site If discontinued, remove tubings and bags from room

Question 28

Emergency delivery ``` Pant or blow Wash hands Elevate HOB Under buttocks Decrease touching As head crowns Hand on fetal head Nuchal cord Shoulder is Head down ☆dry baby Placenta Tie cord with Check uterus ```

Answer 28

Tell the client to pant or blow to decrease urge to push. Client should only push during contraction. Wash hands Elevate hob for better breathing Place something clean under buttocks Decrease touching of vaginal area As head crowns tear the amniotic sac Place hand on fetal head to ease the baby out with gentle pressure If head is out feel for the cord around the neck, this is called nuchal cord Then shoulder is eased out. Then the rest will deliver fast The babys head should be kept down to prevent aspiration The baby must be dry because it cannot regulate its own temperature. Cover baby or skin to skin contact with mom also known as kangaroo care Wait for placenta to separate should be oit within 30 mins.Can also push to deliver placenta and the placenta must be inspected for intactness Tie cord with a clean shoestring or a narrow strip of cloth. It must be tied no closer than 4 inches from navel of baby and a second knot is tied 8 inches from navel of baby. This is done to prevent circulation of baby to placenta Check for firmness of uterus can lead to hemorrhage

Question 29

Normal post partal period assessment V/S Temp BP HR. Why? Tachycardia+postpartum =

Answer 29

Temp may increase to 100.4°f during the first 4 hours, think infection Blood pressure is stable HR of 50 to 70 is common 6 to 10 days after delivery Because during pregnancy blood volume is increased by 50% which the heart compensates by increasing HR but after delivery mom will diurese and the HR decreases or back to normal Think HEMORRHAGE!!

Question 30

Normal post partal assessment Breasts are soft for Abdomen GI

Answer 30

Soft for 2 to 3 days then ENGORGEMENT occurs Soft/loose Hunger occurs which is common, because client cant eat during labor

Question 31

Normal post partal assessment Uterus Fundus is Want to be firm,if boggy? Why is bladder distention suspected? Could lead to? Fundal height descends Involution After pains are common why?

Answer 31

Fundus is in midline 2 to 3 finger breadths below umbilicus. But a few hours just after birth it rises to level of umbilicus or to one FB above We want fundus to be firm. If fundus is boggy, massage it until it is firm then check for bladder distention It is suspected when the uterus is above the expected level or not in midline( usually moved to the right). A distended bladder does not allow proper uterine contraction which could lead to hemorrhage Fundal height descends one FB per day Involution is when fundus descends and uterus returns normal. If not involuted, worry about hemorrhage Afterpains are common for the first 2 to 3 days especially if breastfeeding because everytime she feeds the baby,surge of oxytocin then the uterine also contracts.

Question 32

Fundal height ``` During pregnancy it reflects 12 wks 20 wks 36 wks 37 to 40 wks ``` ``` After birth 1 cm decrease 24 hrs 48 hrs 7 days >10 days 6 wks ```

Answer 32

Fundal height reflects weeks of pregnancy after 20 to 36 weekswith + or - 2cm 12 wks: above symphisis pubis 20 wks: level of umbilicus 36 wks: xiphoid process, issues of breathing at this level 37 to 40 wks: moves down 4cm where body prepares for delivery ``` After birth 1cm decrease per day 1 cm below belly button 2 cm below belly button 7 days:Symphisis pubis 10 days:Cant palpate 6 weeks: symphisi pubis, normal ```

Question 33

Normal post partal assessment Lochia Rubra Serosa Alba. Clots? Urine Output Diurese Dehydration possible? Legs inspected for?

Answer 33

Rubra lasts for 3 to 4 days. Color is Dark red Serosa lasts for 4 to 10 days. Color is Pinkish Brown Alba lasts for 10 to 28 days and can be as long as 6 weeks. Color is whitish yellow. Clots are okay as long as they are not larger than a nickel Diurese the excess fluid around 24 hours after delivery Yes because of losing fluid DVT

Question 34

Normal post partal Treatment Perineal care ``` Ice packs Rinse with Sitz bath Anesthetic spray, prescribed for? Peripad rule Foul smell ```

Answer 34

Intermittent ice packs for the first 24 hours to decrease edema Rinse with warm water 2 to 4 times per day Anesthetic spray promotes healing and is prescribe hemorrhoids or lacerations or epsiotomy. Also given for vaginal delivery We dont want to saturate peripad more than 1 peripad per hour. More than 1, assume hemorrhage. Change pads frequently. Teach to report foul smells and any lochia changes

Question 35

Normal post partal treatment Bonding Bonding in infant Benefits of physiologic bonding Skin to skin contact

Answer 35

Bonding between mother and baby and father and baby develops trust Bonding does not only develops trust in infants but it is also a physiologic need to them Benfits: Increased temp, stabilizes HR, improves Oxygen sats, conserves calories and breasts can change in temp to warm or cool Is called kangaroo care. Baby is wrapped inside a parents shirt or blanket and held for 1 hour at least 4 times a week

Question 36

Normal post partal treatment Breast care ``` Breastfeeding mothers: Cleanse breasts with Support Ointment for Breast pads Express colostrum Initiate breastfeeding when? If breastfeeding is interrupted? Caloric intake is Fluid/milk intake should ``` ``` Non-breastfeeding mothers: Ice packs Binders Chilled cabbage leaves Stimulation? ```

Answer 36

Cleanse with warm water after each feeding and let it air dry Support BRA is used Ointment can be used for soreness Breast pads are used to absorb moisture after milk comes in Colostrum is expressed and air dried ASAP after birth and alternate breasts Mother can use breastpump if interrupted 500 calories/day Fluid or milk intake should be increased to 8 to 10 glasses (8ounces) to prevent constipation and mastitis Ice packs is used for breast engorgements Breast binders is used Chilled cabbage leaves is used to decrease INFLAMMATION and decrease ENGORGEMENT. The cabbage leaves promotes vasodilation of capillaries and increase blood flow No stimulation of breasts

Question 37

Normal post partum complications Infection: E-coli or beta hemolytic strep Handwashing Wipe from ``` Hemorrhage: Early(first 24 hours) Late(after 24 hours) Causes "ULR" Medications "MOM C" ```

Answer 37

Infection within 10 days after birth which is usually caused by E-coli or beta hemolytic strep Good hand washing must be observed Teach client to wipe from front to back In the first 24 hours When client loses more than 500 ml of blood AND a 10% decrease of hematocrit from admission. Must have both to be true. ``` Aftee 24 hours and could last up to 6 weeks for late hemoerhage Causes: Uterine atony where uterus does not have a tone Lacerations Retained fragments and forceps delivery Meds: Misoprostol(cytotec) Oxytocin(pitocin) Methylergonovine maleate(methergine) Carboprost tromethamine(hemabate) ```

Question 38

Normal post partal complicationz ``` Mastitis Bacteria Occurs when S/S Treatment BR Binders Meds Heat Feed the baby ```

Answer 38

The bacteria is caused staphylococcus Usually occurs 2 to 4 weeks Rapid onset of fever and chills Malaise Breasts are swollen, hard and tender to touch Treatment: Bed rest Binders and chilled cabbage leaves are only used if mom discontinued breastfeeding permanently Pain and antibiotics depends on when to take it and when breastfeeding the baby Heat such as hot shower to relieve the pressure on breasts and soften it also causes breasts to leak due to vasodilation If mom continues to breastfeed, then The baby must be fed frequently and ALWAYS offer AFFECTED breast first

Question 39

New born care Immediatetly after birth Phytonadione Erythromycin ``` Cord care: Falls off in Cleanse with Fold diaper No immersion ```

Answer 39

Dry the baby to regulate temperature and Do APGAR scoring at 1 and 5 mins. Assessed are the Color,HR,muscle tone,reflex irritability and respirations Phytonadione aka vit K or Aquamephyton is given IM vastus lateralis to promote formation of clotting factors Erythromycin is an eye ointment given to babies to kill chlamydia and neisseria gonococcus Cord dries and falls off in 10 to 14 days Cord must be cleanse with alcohol or NS with each diaper change Fold diaper BELOW the cord No immersion is done until the cord falls off because infection can occur due to bacterias thriving in moist environments

Question 40

Newborn complications Hypoglycemia after birth can occur? Why? Babies at greatest risk: Pathologic Jaundice Occurs Usually means Physiologic Jaundice (HYPERBILIRUBINEMIA) Occurs Due to

Answer 40

They experience hypoglycemia because babies are not getting glucose from the mom anymore At risk babies: LGA ( large for gestational age), SGA(small for gestational age) and babies woth diabetic moms Pathologic jaundice occurs FIRST 24 hours afterbirth. And usually means Rh/ABO incompatibility ``` Physiologic jaundice (HYPERBILIRUBINEMIA) occurs AFTER 24 hours. Due to both normal hemolysis of excess RBC releasing bilirubin and immaturity of the liver ```

Question 41

``` ☆☆Rh sensitization First pregnancy: Occurs when Can be transferred by Mothers body develops First offspring ``` Second pregnancy: Increase with each pregnancy,why? If Rh negative mother is sensitized and is pregnant with Rh positive baby what happens?

Answer 41

Occurs when the mother is Rh negative and baby is Rh positive Can be transferred by Amniocentesis,miscarriage,placenta separates or when trauma to moms abdomen Mothers body develops antibodies to fight the positive Rh of the baby First offspring is not affected by the antibodies, mom has not developed antibodies yet 2nd pregnancy: Because with every pregnancy of Rh positive baby there is more chance of contact with the Rh negative Mother The antibodies mother develops enters baby through the placenta causing the Babys Rbc to breakdown, called hemolysis. The baby tries to compensate by releasing IMMATURE Rbc, this increase is called ERYTHROBLASTOSIS FETALIS

Question 42

Rh sensitization Diagnosis: Direct coomb's Indirect coomb's Treatment Precention: RhoGAM is given at? Given how many times? Also given with How RhoGAM works?

Answer 42

Direct coombs is done on the baby, tells if there are any antibodies stuck to the Rbcs. Done on the cord blood. Indirect coombs is done on the Mother to measure number of antibodies in blood Frequent ULTRASOUNDS RhoGAM is given to the mother within 72 hours after birth 2x at 28 weeks and within 72 hours after birth Also given with any bleeding episode during pregnancy It destroys the fetal blood cells that get into contact with mothers negative blood and it must do this before antibodies are formed