Final Exam Review Fall 24 PDF

Exam Review Keepcalm.net  GTPAL  Gravity- The number of times pregnant  Term- the number of babies>37 weeks  Preterm- The number of babies 20-36.6 weeks  Abortion- the number of spontaneous or therapeutic abortions  Living- the number of living...

Exam Review Keepcalm.net  GTPAL  Gravity- The number of times pregnant  Term- the number of babies>37 weeks  Preterm- The number of babies 20-36.6 weeks  Abortion- the number of spontaneous or therapeutic abortions  Living- the number of living children EDC/Due Date-Naegele’s Rule  Presumptive Probable Positive Breast changes Goodell sign Visualization of fetus by real- time ultrasound Amenorrhea Chadwick sign Fetal heart tones (FHT) detected by ultrasound N&V (“morning Hegar sign Visualization of fetus by x-ray sickness”) Urinary frequency Positive preg. test (serum) FHT detected by Doppler Fatigue Positive preg. test (urine) FHT detected by fetal stethoscope (fetoscope) Quickening Braxton Hicks contractions Fetal movements palpated by examiner Ballottement Fetal movements visible to Hyperpigmentation examiner Prenatal Visits Tests  How often?  Amniocentesis  What assessments  Kick counts are done?  Fetal Fibronectin  Common  Amnisure Discomforts  NST, CST, BPP  Danger signs  Education  Fundal height STAGE 1: Contractions  effacement and dilation Involuntary power Two phases: early and active Dilation, Effacement, Station Early phase Active Phase Dilation: 0-5 cm Dilation: 6-10 cm Effacement 100% Effacement continues Contractions: 60-90 sec, Contractions: strong-very strong, q2-3 min Mild-moderate, q5-30 min peaks quickly; peak lasts longer Pressure may be felt in Backaches, nervous trembling/ abdomen, bowel or low back shakes in thighs Bloody show/mucus plug Bloody show copious; bloody Behavior: Difficulty relaxing, Behavior: sociable, alert, sleep between contractions; open to instructions; irritable, quiet, not want to be talkative/quiet, eager for touched, loses modesty; doubts progress, some sense of ability to continue/cope, apprehension preoccupied with self What happens in: Stage II Stage III Stage IV What is the primary focus for each stage? Give an example of a nursing approach/intervention for each stage.  STAGES OF LABOR STAGES OF LABOR STAGES OF LABOR STAGE 4 STAGE 2 STAGE 3 Delivery of the Immediate Contractions + pushing  placenta postpartum birth of infant Assessments Involuntary and voluntary Signs of placental powers separation: Observe for bonding Pushing Firmly contracting behaviors and infant Pushing: gentle vs uterus feeding Uterus to globular forceful shape Positions Sudden gush of dark blood Apparent lengthening of umbilical cord Vaginal fullness on Assessments: exam or fetal Uterus membranes at Bleeding introitus Perineum What aspects of the fetal heart rate are assessed to determine fetal wellbeing during labor?  Fetal Heart Rate Baseline & Contraction Characteristics *Red line to red line: 1minute *10-second intervals between  Normal at term is 110-160 bpm. May be lower if postdates and higher if preterm.  Bradycardia: 160 for 10 min or increase of >30 from Frequency Duration Intensity previous Fetal Heart Rate Variability Definition: the normal irregularity of the cardiac rhythm. Absent 0 bpm Absent Minimal 1-5 bpm Minimal Moderate 6-25 bpm Moderate Marked > 25 bpm Single most important indicator of an adequately oxygenated  Changes in FHR Baseline: Accelerations  Common with fetal movement  Indicative of fetal well being  A reassuring sign Doctorlib.info  Increase 15 bpm for 15 seconds or more; if 2 min) Olarte slide 29  Etiology: caused by fetal head Early Decelerations compression  Uniform shape, gradual, early onset and mirror UC  No treatment necessary, continue nccwebsite-org to observe, may check cervix  If occurs with minimal variability, intervene:  Change mom’s position May be seen:  In active labor  Increase IV fluids  During Stage 2  Check cervical dilation- determine if ready to push Late Decelerations  Etiology: caused by uteroplacental insufficiency what can cause this?  Non-reassuring pattern oatext-com Nursing Interventions  Associated with  d/c Pitocin (if administered)  Turn mother to side (left is optimal) hypoxemia progressing  Correct maternal hypotension (increase to hypoxia and acidosis fluids, legs up)  Smooth, curvilinear and  Palpate uterus/observe monitor:  Assess for >5 UC in 10 minutes uniform. The lowest (uterine tachysystole) point is after the contraction peak.  Slow to return to Variable Deceleration  Etiology: caused by cord compression what can cause this?  Can occur with or without contractions Abrupt descent (140 and/or >90 + Continues past 6 weeks + New onset, diagnosed after 20 weeks Gestational Hypertension + Resolves before 6 weeks postpartum >140 and/or >90 + No proteinuria Preeclampsia + Hypertension and proteinuria or severe (With or Without Severe features features) + After 20 weeks gestation Eclampsia + Preeclampsia with seizures/coma Superimposed preeclampsia/ + Chronic hypertension eclampsia + Addition of preeclampsia signs/ symptoms + Laboratory involvement HELLP syndrome  Pre-eclampsia: Pathology Inadequate vascular remodeling Vasospasm (generalized) Decreased Decreased placental Increased peripheral tissue perfusion and hypoxia resistance & increased perfusion BP in all organs Endothelial cell dysfunction Increased endothelial (r/t placental ischemia) cell permeability Intravascular Reduced protein and fluid plasma loss volume Severe features and Interventions o History: blood pressure; risk factors o Current assessment  BP ≥160 systolic or ≥110 diastolic o Blood pressure  o Edema (distribution, degree, pitting; daily Cerebral or visual changes weight)  Severe headaches o Reflexes, deep tendon  Impaired liver function with o CNS status/clonus  Severe/persistent epigastric /right o Proteinuria upper quadrant pain o Lab work  Progressive renal insufficiency o CBC, metabolic panel, urine, UPC  Oliguria (12; reflexes present; urine >30cc/hr.; normal LOC seizure (CNS depressant) Preterm labor Possible neuroprotection against cerebral palsy Stop contractions/tocolytic; same parameters as for pre- eclampsia Calcium gluconate Antidote for MgSO4 toxicity Terbutaline Preterm labor Stop contractions/tocolytic/relaxes smooth muscle Nifedipine Preterm labor Stops contractions/tocolytic/relaxes smooth muscle; used to (calcium channel stop labor long enough to give corticosteroid and allow its blocker) action Can cause hypotension Betamethasone/ Threat of preterm birth Stimulates fetal lung maturation/promotes release of enzymes dexamethasome that  production of surfactant RhoGam Mother Rh-/baby Rh+ Prevent maternal formation of anti-Rh antibodies Erythromycin ointment Newborn eye Prevent ophthalmia neonatorum; damage d/t gonorrhea prophylaxis