Maternal ~ Exam 1.pdf

Exam 1 1) Presumptive signs of pregnancy a) Amenorrhea, nausea & vomiting, fatigue, urinary frequency, breast & skin changes, Chadwick’s sign (cervix, vagina, labia ~ from pink to dark bluish purple), quickening b) Amenorr...

Exam 1 1) Presumptive signs of pregnancy a) Amenorrhea, nausea & vomiting, fatigue, urinary frequency, breast & skin changes, Chadwick’s sign (cervix, vagina, labia ~ from pink to dark bluish purple), quickening b) Amenorrhea, Fatigue, nausea & vomiting, urinary frequency, breast changes (darkened areolae, enlarged Montgomery’s glands), quickening (felt between 16 to 20 weeks), uterine enlargement 2) Foods to avoid in pregnancy & why a) Listeria infections = soft & moldy cheeses, deli meats, hot dogs, raw dairy products, raw produce, refrigerated smoked seafood b) Raw or lightly cooked sprouts (alfalfa, clover, radish, mung bean sprouts c) Avoid luncheon meats and hot dogs unless reheated until steaming hot d) Avoid soft cheeses unless made with pasteurized milk. e) Do not consume refrigerated pate, meat spreads, or smoked seafood. f) Do not consume raw (unpasteurized) milk or milk products. 3) Leading cause of neonatal mortality a) The leading causes of infant mortality are congenital malformations, premature birth, and maternal complications of pregnancy b) Neonatal morbidity & mortality are related to gestational age and birth weight. c) Preterm labor 4) Expected changes in pregnancy a) Uterus increases in size and changes shape and position b) Cardiac output increases (30% to 50%) and blood volume increases (30% to 45% at term) to meet the greater metabolic needs. Heart rate increases during pregnancy beginning around week 5 and reaches a peak (10 to 15/min above prepregnancy rate) around 32 weeks of pregnancy. i) The most common variations in heart sounds include splitting of the first heart sound and a systolic murmur that is found in more than 95% of pregnant women. The murmur is best heard at the left sternal border. Up to 90% of pregnant women have a third heart sound. c) Oxygen needs increase. During last trimester = size of chest might enlarge (allow lung to expansion as uterus pushes upward. Respiratory rate increases and total lung capacity decreases d) Pelvic joints relax e) Filtration rate increases due to hormones & increased blood volume & metabolic demands. Amount of urine the same but urinary frequency is common. 5) HIV patients - precautions a) Early identification and treatment significantly decreases the incidence of perinatal transmission. b) Procedures such as amniocentesis and episiotomy should be avoided due to the risk of maternal blood exposure c) Avoid: internal fetal monitors, vacuum extraction & forceps during labor d) Newborn administration of injections and blood testing should not take place until after the first bath is given e) Review plan for scheduled cesarean birth at 38 weeks for maternal viral load of more than 1,000 copies/mL. f) Vaginal birth can be an option for a client who has a viral load of less than 1,000 copies/mL at 36 weeks of gestation g) most infants do not contract the virus if the medication regimen is followed carefully h) Do not breastfeed 6) Safe exercises in pregnancy/how much to exercise a) Exercise during pregnancy yields positive benefits & should consist of 30 min of moderate exercise (walking or swimming) daily if not medically or obstetrically contraindicated 7) Reasons why someone might have a spontaneous abortion  a) Chromosomal abnormalities, maternal illness (type 1 DM), advanced maternal age, premature cervical dilation, chronic maternal infections, maternal malnutrition, trauma/injury, anomalies in fetus or placenta, substance use, antiphospholipid syndrome b) Folate deficiency, lupus, obesity, hypoglycemia, hyperglycemia, ketosis, cervical incompetence, heavy smoking & drinking, most common cause of spontaneous abortion is severe congenital abnormalities that are often incompatible with life, 8) Warning signs in pregnancy-teaching a) contact the provider immediately if there is any bleeding, leakage of fluid, or contractions at any time during the pregnancy b) Hypertension, swollen hands & legs, protein in urine c) Headache, blurred vision, epigastric pain 9) Signs & symptoms of human trafficking a) 10) Ethical principles ~ what do they mean etc a) 11) Teen pregnancy education a) 12) Priority interventions for abruptio placentae a) Start an IV line, Evaluation focuses on the cardiovascular status of the expectant mother and the condition of the fetus. b) Immediate birth is the management, Administer IV fluids, blood products, and medications as prescribed, Administer oxygen 8 to 10 L/min via face mask, Monitor maternal vital signs, observing for declining hemodynamic status, Perform continuous fetal monitoring, Assess urinary output and monitor fluid balance c) 13) Rhogam ~ who gets it, when, what is it for a) Administered to Rh-negative women who have been exposed to Rh-positive blood by doing the following: Delivering an Rh-positive infant, Aborting an Rh—positive fetus, Undergoing chorionic villus sampling, amniocentesis, or intraabdominal trauma while carrying an Rh—positive fetus, Receiving inadvertent transfusion of Rh-positive blood b) One standard dose (300 mcg) IM: i) At 28 weeks of pregnancy and within 72 hours of delivery of an Rh-positive infant, undergoing chorionic villus sampling, amniocentesis, or intraabdominal trauma. ii) Within 72 hours after termination of a pregnancy of 13 weeks or more of gestation. c) immune globulin IM around 28 weeks of gestation for clients who are Rh-negative. d) immune globulin administered IM within 72 hr of the newborn being 14) Glucose challenge test ~ why done & for who is it done a) administered between 24 and 28 weeks of gestation  b) Fasting is not necessary for a GCT, and the woman is not required to follow any pretest dietary instructions. c) ingest 50 g of oral glucose solution d) A blood sample is taken 1 hour later. If the blood glucose concentration is 140 mg/dL or greater, a 3-hour oral glucose tolerance test (OGTT) is recommended 15) Complications of GDM a) Increased neonatal morbidity & mortality, macrosomia, neonatal hypoglycemia, hypocalcemia, hyperbilirubinemia, respiratory distress 16) Chorioamnionitis ~ who is at risk & why a) inflammation of the amniotic sac, usually caused by bacterial and viral infections b) should be suspected with the occurrence of elevated temperature and tachycardia c) Long labor 17) Signs & symptoms of gestational diabetes & what to monitor/check for a) S/S i) Hypoglycemia (nervousness, headache, weakness, irritability, hunger, blurred vision), hyperglycemia (polydipsia, polyphagia, polyuria, nausea, abdominal pain, flushed dry skin, fruity breath), shaking, clammy pale skin, shallow respirations, rapid pulse, vomiting, excess weight gain during pregnancy b) Monitor/check i) Monitor the client’s blood glucose. ii) Monitor the fetus iii) Perform daily kick count iv) Perform v) The surveillance testing often includes “kick counts,” ultrasonography for fetal growth and amniotic fluid volume, BPP, NSTs, contraction stress test, or amniocentesis for fetal lung maturity 18) Nutritional education & substitutes for special diets a) Diet lacks adequate calcium, iron, zinc, riboflavin & vitamin D, b6, B12 b) Lactovegetarians (diet include milk products); ovovegetarians (diet include eggs), lacto-ovovegetarians (include milk & eggs) c) Energy i) Low in calories & fat ii) High in fiber & cause feeling of fullness before enough calories are eaten iii) Can increase caloric intake by eating snacks & higher calorie foods iv) If carbohydrate & fat intakes ~ too low = body may use protein for energy making unavailable for other purposes d) Protein i) Vegetarians get enough protein; need consideration in vegan diets ii) Complete proteins contain all essential amino acids iii) Animal proteins are complete; plant proteins (except soybeans) are incomplete proteins ~ lacking one or more essential amino acids  iv) Diet with only plant proteins can meet needs of pregnancy v) Combining incomplete plant proteins with other plant foods with complementary amino acids vi) Dishes with grains (wheat, rice, corn) & legumes (garbanzo, navy, kidney, pinto beans, peas, peanuts) combination provide complete protein vii) Incomplete proteins can be combines with small amounts of complete protein foods such as cheese or milk to provide all amino acids e) Calcium i) Vegans obtain calcium from dark green vegetables & legumes = high-fiber diet may interfere with calcium absorption ii) Calcium-fortified juices or soy products (soy milk or tofu) may meet requirements iii) Calcium supplements may be necessary iv) Vitamin D supplements is important if drinks no milk & little exposure to sunlight v) Soy milk be enriched with vitamin D f) Iron i) Iron from plants is poorly absorbed ii) Absorption is enhanced by eating food with vitamin C in same meal / cooking food in iron pans iii) Iron supplements important during pregnancy g) Zinc i) Best sources meat & fish ii) Fortified cereals, nuts & dried beans increase intake iii) Vegan need zinc supplements h) Vitamin B12 i) Only animal products ii) Diet has high amount of folic acid = anemia from inadequate intake b12 iii) Vegans may eat fortified foods = cereal & soy or take b12 i) Vitamin A i) Abundant in vegetarian diet ii) If taking multiple vitamin-mineral supplement; vitamin a intake may be excessive iii) Toxic effects include: anorexia, irritability, hair loss, dry skin, damage to fetus iv) Supplementation should be individualized per woman on basis of diet & needs. 19) Normal discomforts in pregnancy, pt teaching 20) Labs that are expected to be abnormal in pregnancy a) Low hemoglobin & hematocrit b) Elevated white blood cell count = 5.7-15 OR 13.8-19.6 21) Signs & symptoms: ectopic vs gestational trophoblastic disease  a) Ectopic i) Missed menstrual period, positive pregnancy test, abdominal pain, vaginal spotting, sudden severe pain in LQ, radiating pain under scapula ii) Unilateral stabbing pain & tenderness in LQ abdomen, Scant, dark red, or brown vaginal spotting 6 to 8 weeks after last normal menses; red, vaginal bleeding if rupture has occurred, referred shoulder pain, hemorrahge & shock (hypotension, tachycardia, pallor, dizziness) b) Gestational trophoblastic disease i) Rapid uterine growth, Bleeding is often dark brown resembling prune juice, or bright red that is either scant or profuse and continues for a few days or intermittently for a few weeks and can be accompanied by passage of vesicles, anemia, clinical findings of preeclampsia occur prior to 24 weeks ii) Higher level of beta-hCG, snowstorm ultrasound, uterus larger than expected for gestational age, vaginal bleeding varies from dark-brown spotting to profuse hemorrhage, excessive nause & vomiting or hyperemesis gravidarum (HEG), early development of preeclampsia before 24 weeks 22) Medication math a) Do your math and double check. 23) Educating on kick counts a) Clients should count fetal activity two or three times a day for 2 hr after meals or bedtime. Fetal movements of less than 3 per hr or movements that cease entirely for 12 hr indicate a need for further evaluation. b) Women are instructed to rest in a quiet location and count distinct fetal movements, such as kicks or rolls. Maternal perception of 10 distinct movements in a 1- to 2-hour period is reflective of a nonhypoxic fetus at that point in time. The count is discontinued once 10 movements are perceived 24) Risks for ectopic pregnancy a) Previous ectopic preganncies, age 25-34, hx of STD (gonorrhea, chlamydia), multiple sex partners, tubal sterilization & tubal reconstruction, infertility, gamete intrafallopian transfer, intrauterine device, multiple induced abortions b) STIs, assisted reproductive technologies, tubal surgery, and contraceptive intrauterine device (IUD) 25) What are the skin changes some women get during pregnancy a) Chloasma (increase pigmentation on face), linea nigra (dark line from umbilicus to pubic area), striae gravidarum (stretch marks on abdomen & thighs)  b) melasma, chloasma, or the “mask of pregnancy.” Melasma involves the forehead, cheeks, and bridge of the nose, angiomas (vascular spiders, telangiectasia), striae gravidarum 26) Safe vaccines in pregnancy a) Inactive influenza, tetanus, diphtheria, pertussis, Tdap (27-36weeks) 27) Complications from smoking in pregnancy a) Spontaneous abortion, low birth weight, placental abruption, placenta previa, preterm birth, perinatal mortality, sudden infant death syndrome (SIDS) 28) Signs & Symptoms of placenta previa & how to diagnose a) S/S i) Sudden onset of painless uterine bleeding in the last half of pregnancy ii) Painless bright red bleeding (2nd & 3rd trimes), uterus soft relaxed nontender with normal tone, fundal height greater than usually, fetus in breech oblique or transverse position, reassuring FHR, vital signs within normal limits, decreasing urinary output (better indicator of blood loss) b) Diagnoses i) Ultrasound examination ii) Transabdominal or transvaginal ultrasound for placement of placenta, fetal monitoring for fetal well-being assessment 29) Education about blood transfusions a) Cosent forms b) Start an IV c) Get blood tested and matched d) Education on allergic reaction 30) GTPAL a) Gravidity: number of pregnancies i) Nulligravida: a client who has never been pregnant ii) Primigravida: a client in their first pregnancy iii) Multigravida: a client who has had two or more pregnancies b) Parity: number of pregnancies in which the fetus or fetuses reach 20 weeks of pregnancy, not the number of fetuses. Parity is not affected whether the fetus is born stillborn or alive. i) Nullipara: no pregnancy beyond the stage of viability ii) Primipara: has completed one pregnancy to stage of viability iii) Multipara: has completed two or more pregnancies to stage of viability c) Term birth (37 weeks or more) d) Preterm births ( from viability up to 37 weeks) e) Abortions/miscarriages (prior to viability) f) Living children g) Viability: the point in time when an infant has the capacity to survive outside the uterus. There is not a specific weeks of gestation; however, infants born between 22 to 25 weeks are considered on the threshold of viability 31) Actions to take for severe preeclampsia a) inpatient hospitalization b) Bed rest & fetal monitoring c) Antihypertensive medicatication i) Systolic BP 160 mm or greater; Diastolic BP 110 mm or greater = decrease risk for stroke or congestive heart failure ii) Labetalol: Has less maternal tachycardia and fewer adverse effects; contraindicated in patients with asthma, heart disease, or CHF; associated with hypoglycemia and small for gestational age infants  iii) Hydralazine (Apresoline)—Higher doses are associated with maternal hypotension, headaches, & fetal distress iv) Nifedipine—May be associated with refleX tachycardia & headaches; because of mechanism of action, a synergistic effect with magnesium sulfate may result in hypotension & neuromuscular blockade d) Anticonvulsant medications i) Magnesium sulfate is the drug most often used to prevent seizures (1) Antidote = calcium gluconate 32) Why does GDM happen and who is at risk a) impaired tolerance to glucose with the first onset or recognition during pregnancy b) Having larger babies previously, overweight, hx of abnormal glucose tolerance, hx of PCOS, older than 25 years c) Obesity, hypertension, glycosuria, older than 25, family hx of DM, previous delivery of large infant or stillborn 33) What are maternal AFP tests for a) used to detect neural tube defects or chromosome disorders b) Screening occurs between 15 to 22 weeks of gestation c) Low levels of AFP can indicate a risk for Down syndrome; High levels of AFP can indicate a risk for neural tube defects 34) BPP ~ what is it, why done, what does it tell us a) uses a real-time ultrasound to visualize physical and physiological characteristics of the fetus & observe for fetal biophysical responses to stimuli b) BPP assesses fetal well-being by measuring five variables with a score of 2 for each normal finding, and 0 for each abnormal finding for each variable. i) FHR (fetal heart rate) (1) Reactive (nonstress test) = 2 (2) Nonreactive = 0 ii) Fetal breathing movements (1) At least 1 episode of greater than 30 seconds duration in 30 min = 2 (2) Absent or less than 30 seconds duration = 0 iii) Gross body movements (1) At least 3 body or limb extensions with return to flexion in 30 min = 2 (2) Less than 3 episodes = 0 iv) Fetal tone (1) At least 1 episode of extension with return to flexion = 2 (2) Slow extension and flexion, lack of flexion, or absent movement = 0 v) Qualitative amniotic fluid volume (1) At least 1 pocket of fluid that measures at least 2 cm in 2 perpendicular planes = 2 (2) Pockets absent or less than 2 cm = 0 c) Score i) 8 TO 10: normal, low risk of chronic fetal asphyxia ii) 4 TO 6: abnormal, suspect chronic fetal asphyxia iii) LESS THAN 4: abnormal, strongly suspect chronic fetal asphyxia 35) Folate ~ how to get it a) leafy vegetables, dried peas and beans, seeds, and orange juice. Breads, cereals, and other grains are fortified with folic acid 36) Fetal lung development ~ when complete, etc a) Usually around 37 weeks 37) RN responsibilities after amniocentesis  a) Preprocedure i) NURSING ACTIONS: Explain the procedure to the client, and obtain informed consent. ii) CLIENT EDUCATION: Empty the bladder prior to the procedure to reduce its size and reduce the risk of inadvertent puncture. b) Intraprocedure i) Obtain and document baseline vital signs and FHR prior to the procedure. ii) Assist client into a supine position, and place a wedge under their right hip to displace the uterus off the vena cava, & place a drape over the client exposing only the abdomen. iii) Prepare client for an ultrasound to locate the placenta. iv) Cleanse client’s abdomen with an antiseptic solution prior to the administration of a local anesthetic by the provider. v) CLIENT EDUCATION: Understand there will be a feeling of slight pressure as the needle is inserted. Continue breathing, because holding breath will lower the diaphragm against the uterus and shift the intrauterine contents c) Postprocedure i) Monitor fetal heart rate. ii) Administer Rho(D) immune globulin to the client if they are Rh-negative (standard practice after an amniocentesis for all clients who are Rh-negative to protect against Rh isoimmunization) iii) CLIENT EDUCATION: Report to the provider if experiencing fever, chills, leakage of fluid or bleeding from the insertion site, decreased fetal movement, vaginal bleeding, or uterine contractions after the procedure. d) Monitor vital signs, temperature, respiratory status, FHR, uterine contractions, and vaginal discharge for amniotic fluid or bleeding. e) Administer medication as prescribed. f) Offer support and reassurance. 38) CST ~ what is it & why done, what does positive test & negative test mean a) determine fetal well-being by monitoring FHR responses to contractions. CST measures how well the fetus can tolerate the temporary reduction in blood flow and oxygen that occurs during contractions b) The test evaluates whether the fetus can maintain a stable FHR and oxygenation during uterine contractions, which simulate the stress of labor c) NEGATIVE CST (NORMAL FINDING): Indicated if within a 10-min period, with three uterine contractions, there are no late decelerations of the FHR. consistently associated with fetal well-being, meaning the stillbirth rate is less than 1 per 1000 as long as an acute event does not occur d) POSITIVE CST (ABNORMAL FINDING): Indicated with persistent and consistent late decelerations with 50% or more of the contractions. This is suggestive of uteroplacental insufficiency. Variable deceleration can indicate cord compression, and early decelerations can indicate fetal head compression. Based on these findings, the provider may determine to induce labor or perform a cesarean birth. linked to an increased incidence of fetal growth restriction, late decelerations in labor, meconium-stained fluid, low 5-minute 39) Infections in pregnancy ~ how to prevent a) Personal hygiene, hand washing b) Immunizations for influenza, pertussis, and pneumonia are available c) Stay away from people who are sick 40) Safety for moms with herpes a) Transmission Risk: i) Can occur via direct contact during birth or after rupture of membranes. ii) Primary infection poses a higher risk than recurrent infection. b) Pregnancy Complications: i) Primary herpes infections may lead to spontaneous abortion, IUGR, and preterm labor.  ii) Neonatal herpes is rare but potentially severe, with a 50% risk of death or serious complications if systemic. c) Labor and Delivery: i) Vaginal birth is allowed if no active genital lesions are present. ii) Cesarean section is recommended if active genital lesions are present during labor to avoid transmission. d) Antiviral Treatment: i) Acyclovir may be prescribed during late pregnancy to reduce the risk of active lesions at birth. ii) Acyclovir is also used to treat suspected neonatal herpes infections. e) Post-Delivery Care: i) No need for isolation if the mother avoids contact with lesions and practices good hand hygiene. ii) Breastfeeding is safe if there are no lesions on the breasts. iii) Infants are monitored for signs of infection (e.g., lethargy, poor feeding, seizures). f) Emotional Support: i) Mothers may need reassurance regarding privacy and support to address feelings of anxiety, shame, or concern. 41) Weight gain for BMIs 42) When is heartbeat heard, sex of baby seen, etc a) 8 weeks ~ heartbeat detectable with ultrasound b) 10-12 weeks ~ may be possible to detect heartbeat with doppler transducer c) 20 weeks ~ heartbeat should be detectable with regulat fetoscope d) By end of week 12 ~ fetal gender can be determined by appearance of external genitalia 43) NST ~ how & why done, what does it tell us a) What It Is: i) Noninvasive test performed in the third trimester to assess fetal well-being. ii) Monitors Fetal Heart Rate (FHR) in response to fetal movement. iii) Uses a Doppler transducer for FHR and a tocotransducer for uterine contractions, both attached to the mother's abdomen. b) How It’s Done: i) Client preparation: (1) The mother is seated in a semi-Fowler’s or left-lateral position to prevent aortocaval compression. (2) Conductive gel and two belts are applied to the abdomen for monitoring FHR and uterine activity. ii) Test process:  (1) The mother pushes a button whenever she feels fetal movement, marking the FHR tracing. (2) If no movement is felt (e.g., fetus is sleeping), vibroacoustic stimulation may be used to wake the fetus. (3) The test lasts about 20–30 minutes, though it may extend to 40 minutes due to fetal sleep cycles. c) What It Tells Us: i) Reactive NST: Indicates healthy oxygenation, CNS integrity, and absence of fetal metabolic acidosis. (1) Two or more accelerations of 15 bpm lasting 15 seconds (or 10 bpm for 10 seconds if