MNN Mod I Exam PDF

Maternal-Neonatal Nursing Module I Exam Chapter 1: Past, Present, and Future (6 questions) ❖ Obstetrics: branch of medicine o Pregnancy (antepartum: baby in uterus) o Childbirth o Postpartum (puerperium- 6 months after birth) ❖ Midwives: attend to uncomplicated deliv...

Maternal-Neonatal Nursing Module I Exam Chapter 1: Past, Present, and Future (6 questions) ❖ Obstetrics: branch of medicine o Pregnancy (antepartum: baby in uterus) o Childbirth o Postpartum (puerperium- 6 months after birth) ❖ Midwives: attend to uncomplicated deliveries; must be RNs and graduated from accredited midwife program; pre and postnatal care ❖ Pediatrics: child development and healthcare ❖ Maternal nurses: before, during, and after pregnancy ❖ Government influences o Sheppard-Tower Act of 1921: state-funded maternity care o Title V of social security: funds for maternity care o Title V amendment of public health services: established care centers in public o Fair Labor Standards 1938: established minimum working age ▪ 16 for non-hazardous & 18 for hazardous jobs o Title XIX of Medicaid: increased access to care for indigenous women o Head Start: establishment to increase educational exposure of preschoolers o National Center for Family planning: contraceptive information o WIC: supplemental food and education for those in need o Family Medical Leave Act (FMLA): 1993 law that allows employees to take up to 12 weeks of unpaid leave to care for newborn or family member; protects them from losing benefits or pay status o HIPPA: 2003; set standards to protect patient info o Patient Protection and Affordable Care Act of 2010: “affordable care act”; expands health care coverage to millions who were previously uninsured ▪ Those with preexisting conditions can no longer be denied access to affordable health insurance coverage ❖ Family-centered care o Importance of family to be involved throughout pregnancy and birthing process in order for bonding to take place ❖ Nursing process for maternal-newborn clients o ADPIE o ALWAYS assess any cultural or religious beliefs ❖ Healthy people 2030 o Access to health care o Clinical preventative services o Environmental quality o Injury and violence  o Maternal, infant, and child health services o Mental health o Nutrition, physical activity, and obesity o Oral health o Reproductive health o Social determinants o Substance abuse o Tobacco (helps with cessation) ❖ LVN role in maternity care o Directed practice (by RNs) o Predictable needs o Focused assessment (initial done by RN) o Assist with nursing process o Assign tasks o Professional accountability Chapter 2: Human Reproductive and Anatomy (12 questions) ❖ Male (***be familiar with anatomy***) o Testosterone: increases; growth of long bone, increased muscle mass/strength, RBC production, increased BMR, enlargement of vocal cords, distribution of hair o Nocturnal emissions (wet dreams) o Testes location: allows for cooling (warmth can decrease sperm production) ▪ Undescended: higher risk for infertility (sterile males) ▪ Descended: healthy testes (how it should be) o Ducts: story and carry sperm o Accessory glands: nourish, protects, and enhances motility of sperm ❖ Female (***be familiar with anatomy***) o Perineum: will most likely tear during childbirth o Vagina: passageway for sperm and babies; allows menstrual blood to drain o Uterus: where fetus grows and develops ▪ Endometrium: innermost layer of uterus; where implantation occurs (usually upper section, of posterious uterus) ▪ Myometrium: middle layer ▪ Perimetrium: outermost/serosal layer o Fallopian tubes: site of fertilization o Ovaries: production of estrogen and progesterone o Types of pelvis (others: anthropoid, android) ▪ Gynecoid: most favorable ▪ Platypelloid: most unfavorable ▪ Bony pelvis True/false pelvis= upper/lower pelvis  ▪ Pelvic inlet: measures pelvis to see if it’s favorable for vaginal delivery o Breasts: accessory organ where milk is produced and provides nourishment and maternal antibodies ▪ Educate about how oral contraceptives cannot be taken until lactation is well established ❖ Reproductive cycle o Hormones ▪ FSH: follicle stimulating hormone ▪ LH: luteinizing hormone o Ovulation ▪ Teach about normal discharge (will be thin and slippery) o Corpus luteum o Menstrual cycle ▪ Teach about changing tampons Q4H to prevent toxic shock syndrome ❖ Human sexual response: o 4 phases: excitement, plateau, orgasmic, resolution Chapter 3: Fetal Development (19 questions) ❖ Fertilization: when sperm penetrates an ovum and unite o Takes place in fallopian tube o Egg contains 46 chromosomes (23 from mom and 23 from dad) ▪ Ovum/egg can survive up to 24 hours after ovulation o Educate how sperm can survive in cervix area for up to 5 (pregnancy is possible) ❖ Sex determination o Sperm carries either X or Y (males determine gender) o Ovum is always X o X= female (XX) o Y= male (XY) ❖ Cell differentiation o Chorion: embryonic side of placenta (coves amnion and yolk sak) o Amnion: fluid that protects fetus (bag of water) ❖ Fetal development (***go over handout***) ❖ Placenta: organ for fetal respiration, nutrition, and excretion (accessory organ) o Progesterone ▪ Maintains uterine lining ▪ Reduces contractions (prevents spontaneous abortion or preterm labor) ▪ Prepares breasts for lactation ▪ Stimulates testes to produce testosterone o Estrogen ▪ Increases blood flow to uterine vessels ▪ Stimulates development of the breast ducts to prepare for lactation  o ***estrogen and progesterone do the opposite of one another*** o Human chorionic gonadotropin (hCG) ▪ Corpus luteum produces estrogen and progesterone ▪ Detectable in maternal blood as soon as implantation occurs (7-9 days after fertilization o Human Placental Lactogen (hPL) ▪ Decreased insulin sensitivity and utilization of glucose by mother ▪ Helps to make more glucose available for fetus to meet growth needs ❖ Umbilical cord: lifeline (***think of AVA***) (accessory organ) o 2 arteries carries blood away from fetus o 1 vein returns blood to fetus o Wharton’s jelly covers and cushions ❖ Fetal circulation: supports fetus (accessory organ) o Foramen ovale: diverts most blood from the right atrium directly to left atrium rather than bringing it to lungs ▪ Bypasses lungs o Ductus arteriosus: diverts blood from pulmonary artery into aorta o Ductus venosus: diverts some blood away from liver as it returns from placenta ▪ Bypasses liver ❖ Formation of twins o Monozygotic: identical; 1 egg (ovum) and 1 sperm; share 100% genes o Dizygotic: fraternal twins; 2 eggs and 2 sperm; share 50% Chapter 11: The Nurse’s Role in Women’s Healthcare (10 questions) ❖ Natural Family Planning (NFP): basal body temperature, cervical mucous, calendar ❖ Temporary contraception: abstinence, hormonal contraceptives, barrier methods ❖ Hormonal contraceptives: prevents ovulation, makes cervical mucus thick and sperm- resistant, makes endometrium less hospitable for a fertilized ovum o Oral contraceptives: “the pill”, requires prescription, monthly contraception ▪ Extended dose: patient has choice of taking “sugar pills” so body can have period ▪ Warning signs when taking (ACHES- pg 276) Abdominal pain (severe) Chest pain, dyspnea, bloody sputum Headache, weakness, or numbness of extremities Eye problems (blurring, double vision, vision loss) Severe leg pain or swelling, speech disturbance ▪ Contraindications Blood clots, undiagnosed bleeding Heart disease  Breast cancer Smoking >15 cigarettes/day for women older than 35 Possible pregnancy ▪ Pt teaching: Take at same time every day If miss one dose, double up next day; if miss two days in a row, double up for 2 days then get back on track Teach ACHES (and to report them immediately) They don’t protect against STIs Antibiotics have potential of decreasing effectiveness o Hormonal implants: “Implanon”; placed in nondominant arm; removed/inserted in outpatient clinic ▪ Pt teaching Fertility will come back rapidly after removal o Medroxyprogesterone acetate (Depo-Provera): injectable form of slow releasing progestin every 3 months; fertility won’t return until about 1 year after stopping ▪ Side effects Irregular menstruation Beakthrough bleeding Amenorrhea ▪ Pt teaching Continuously get injection every 3 years Fertility will come back in a year after you stop taking No protection against STIs o Intrauterine devices ▪ “ParaGuard”: no hormones; 12 years effectiveness ▪ “Mirena”: contains hormones; “3-6 years effectiveness ▪ Side effects Cramps Irregular bleeding Dysmenorrhea Amenorrhea (possibly) ▪ Pt teaching Teach how to feel string to check for placement (check weekly for first 4 weeks then monthly after that) Report s/s of infection (fever, pain, change in discharge) No protection against STIs Report severe abdominal pain (due to risk of ectopic pregnancy) o Transdermal Patch: “ortho-evra”; applied 1 time a week for 3 weeks with 1 week patch free  o Vaginal ring: “Nuva-ring”; worn in vagina for 3 weeks then removed for 1 week ❖ Barrier methods: blocks semen from woman’s cervix o Diaphragm and cervical cap: used with spermicides to kill sperm (better option), can insert several hours before intercourse and remain for at least 6 hours after (no more than 24 hours) ▪ Also includes vaginal sponge ▪ Must be refitted yearly and after birth, abortions, or weight change of 10 lbs or more ▪ Side effects Dryness, irritation, pressure on bladder (increases UTI risk) ▪ Pt teaching Reapply spermicides for repeat intercourse (effective up to 1hr) Report sensitivity to product (irritation or itching) Report s/s of infection (uterine- pain or foul-smelling discharge, fever; UTI- fever, pain, burn with urination, urgency/frequency) o Male condoms: with or without spermicides (***look at skill 11.3 on pg 280***) ▪ Latex condoms: can protect against STIs ▪ Natural membrane condoms: no prevention of virus entering passage ▪ Pt teaching (DON’T) Allow penis to lose erection Open with teeth or sharp object Unroll before applying Use out of date condoms or reuse them Storing in wallet Forget to leave space between tip of penis and condom Use petroleum jelly, cold cream, veggie oil o Female condoms: 2 flexible rings that are pre-lubricated o Spermicides: neutralize vaginal secretions, destroy sperm, and block entrance into vagina ▪ Only effective up to 1 hour ▪ Reapply with repeated coitus o Emergency Contraception: “morning after pill”; “plan B” ▪ Take within 72 hours after intercourse for most effectiveness (may be effective up to 120 hours after) ▪ May not be effective if woman weighs over 165 pounds o Permanent sterilization ▪ Male: vasectomy; no immediate, takes about 1-3 months to heal properly ▪ Female: tubal ligation; blocks or ligates the fallopian tubes ***3 dosage calc questions***