Maternity File PDF

1Page 0402233050 ‫واتساب‬ https://wa.me/message/EU4QBUCQKSDXC1  Occurs at day 14th before the next period.  Union of egg and sperm.  Normally occurs in outer third of fallopian Which of the following is the location where fertilization occurs? o o o o Ovaries Vagina Uterus Fallopian Tubes ...

1Page 0402233050 ‫واتساب‬ https://wa.me/message/EU4QBUCQKSDXC1  Occurs at day 14th before the next period.  Union of egg and sperm.  Normally occurs in outer third of fallopian Which of the following is the location where fertilization occurs? o o o o Ovaries Vagina Uterus Fallopian Tubes  union of sperm and ovum  Implantation ovcurs at 7_10 days When the Zygote enter to the uterus after fertilization? o o o o 2 days 4 days 6 days 8 days 3Page 0402233050 ‫واتساب‬ https://wa.me/message/EU4QBUCQKSDXC1 pituitary gland (in your brain) and your ovaries make and release certain hormones at certain times during your menstrual cycle Fsh phase o Menstrual phase (From day 1 to 5) o Follicular phase (From day 1 to 13) LH phase o Ovulation phase (Day 14( o Luteal phase (From day 15 to 28) Menstrual phase (day 1-5) o begins on the 1st day of menstruation and lasts till the 5th day of the menstrual cycle. The following events occur during this phase:  The uterus sheds ‫ يفقد‬its inner lining of soft tissue and blood vessels which exits the body from the vagina in the form of menstrual fluid.  Blood loss of 10 ml to 80 ml is considered normal. 2Page 0402233050 ‫واتساب‬ https://wa.me/message/EU4QBUCQKSDXC1 Follicular phase (day 6-13) o estrogen level rises causes the endometrium to grow and thicken. o follicle-stimulating hormone (FSH) causes follicles in your ovaries to grow. o During days 10 to 14, one of the developing follicles will form a fully mature egg (ovum) Ovulation phase (day 14) o A sudden increase in luteinizing hormone (LH) causes your ovary to release its egg. Luteal phase (day 15-28) o The egg cell released during the ovulation phase stays in the fallopian tube for 24 hours. o The level of the hormone progesterone rises to help prepare your uterine lining for pregnancy o If the egg becomes fertilized by sperm and attaches itself to your uterine wall (implantation), you become pregnant. o If pregnancy doesn’t occur, estrogen and progesterone levels drop and the thick lining of your uterus sheds during your period. 5Page 0402233050 ‫واتساب‬ https://wa.me/message/EU4QBUCQKSDXC1 Android o similar to shape of male pelvis o not favorable for vaginal birth Anthropoid o usually adequate for vaginal birth Platypelloid o not favorable for vaginal birth Gynecoid o “classic” female pelvis o approximately 50 percent of women o it’s the best for vaginal birth 1. Which of the following female pelvis is favorable for vaginal delivery?  Gynacoid 4Page 0402233050 ‫واتساب‬ https://wa.me/message/EU4QBUCQKSDXC1  Android  Platepelloid Functions of Amniotic Fluid o Allows embryo or fetus to move about freely. o Prevents amnion from adhering and against injury from external sources. o Prevents umbilical cord compression. Function of placenta o Secrete estrogen at month three o Provide fetus with O2 and nutrition and remove baby waste product. hCG: Human chorionic gonadotropin o hormone for the maternal recognition of pregnancy. Fetal circulation o umbilical cord contains 2 arteries(carry deoxygenated blood) and one vein(carry oxygenated blood). Fetal heart rate: o 110 to 160 beats per minute (bpm) in the in utero period. The doctor ordered human chorionic gonadotropin hormone for woman with uterine fibroid. What is the Side effect for HCG hormone? 0Page 0402233050 ‫واتساب‬ https://wa.me/message/EU4QBUCQKSDXC1 A. Depression B. Anorexia C. Osteoarthritis D. Menopause What is hormones for biological difference between male and female? o Estrogen and HCG o Testosterone and progestron o Testosterone and estrogen Hegar’s sign o softening of the lower uterine segment Goodell’s sign: o softening of the cervix Chadwick’s sign:  bluish mucous membranes discoloration of the vagina, cervix and vulva due to increased vascular congestion  The definite tool is check fetal heart rate by doppler. G = Gravida ‫عدد مرات الحمل‬ Nulligravida ‫وال مرة حملت‬ Primigravida ‫اول حمل‬ 3Page 0402233050 ‫واتساب‬ https://wa.me/message/EU4QBUCQKSDXC1 Multigravida ‫حامل اكثر من مره‬ T= full term birth ‫ اسبوع وأكثر‬73 ‫عدد الوالدات من‬ P = preterm birth ‫ أسبوع‬73 ‫ اسبوع واقل من‬02 ‫عدد الوالدات المبكرة من‬ A=Abortion ‫ اسبوع‬02 ‫عدد مرات االجهاض اقل من‬ L= children Living ‫عدد االطفال االحياء‬ A pregnant client is making her first Antepartum visit. She has a two year old son born at 40 weeks. A 5 year old daughter born at 38 weeks. And 7 year old twin daughters born at 35 weeks. She had a spontaneous abortion 3 years ago at 10 weeks. Using the GTPAL format. The nurse should identify that the client is‫؟‬ o o o o A-G4 T3 P2 A1 L4 B-G5 T2 P2 A1 L4 C-G5 T2 P1 A1 L4 D-G4 T3 P1 A1 L4 from Conception to 28 weeks o "Every 4 weeks" 29 to 36 weeks o "Every 2 weeks" • 37 weeks to birth "Weekly" Fundal height 8Page 0402233050 ‫واتساب‬ https://wa.me/message/EU4QBUCQKSDXC1 At 12th week symphis pubis At 20th week umblicus At 36th week x.phoid process At 16 th week between umblical and symphis pubis At is the recommended weight gain during pregnancy of a woman with MI of < 18.5? o o o o 12.5 -18 Kg 11.5 -16 Kg 7 -11.5 Kg 5- 9 Kg Normal weight gain during pregnancy.? A. 12.5 -18 Kg B. 11.5 -16 Kg C. 7 -11.5 Kg D. 5-9 kg Hyperemesis Gravidarum : Nausea and vomiting in 1st trimester due to increase estrogen level Action  Eat few crackers before arising from bed  Ginger drink Nursing diagnosis 9Page 0402233050 ‫واتساب‬ https://wa.me/message/EU4QBUCQKSDXC1 o High risk for Fluid volume deficit Gestational diabetes (GDM) o Pregnant should be screened for gestational diabetes between 24and 28 weeks of gestation Signs & Symptoms     Polyphagia Polydipsia Polyurea Blurred vision The major fetal complications are:     Macrosomia ‫وزنه اكبر من الطبيعي‬ Hypoglycemia ‫نقص في معدل السكر للطفل‬ Large for gestational age and hypo glycemia Rds ,hypocalecemia.jaundice What is the management for woman who has gestational diabetes? o Diet management o Insulin o Oral diabetic drugs  Blood pressure elevation without proteinuria  Can be mild or severe, leading to preeclampsia and then eclampsia (seizures) 10Page 0402233050 ‫واتساب‬ https://wa.me/message/EU4QBUCQKSDXC1  gestational hypertension plus proteinuria  usually occurs after 20 wk of gestation Interventions for mild preeclampsia      bed rest place the client in the lateral position Administer magnesium sulphate prevent seizures. 4. Administer antihypertensive 5. Prepare for the induction of labor Occurrence of seizures in a preeclampsia woman Complications of gestational hypertension  Abruption placentae  Disseminated intravascular coagulation  HELLP syndrome (a laboratory diagnosis for severe preeclampsia characterized by hemolysis, elevated liver enzyme levels, and low platelet count A patient with pregnancy-induced hypertension probably exhibits which of the following symptoms? o o o o Proteinuria, headaches, vaginal bleeding. Headaches, double vision, vaginal bleeding. Proteinuria, headaches, double vision. Proteinuria, double vision, uterine contractions. When evaluating a client's knowledge of symptoms to report during her pregnancy, which statement would indicate to the nurse in charge that the client understands the information given to her? 11Page 0402233050 ‫واتساب‬ https://wa.me/message/EU4QBUCQKSDXC1 o "I'll report increased frequency of urination." o "If I have blurred or double vision, I should call the clinic immediately." o "If I feel tired After resting, I Should report it immediately." Which of the following from pregnents mothers is priority? o o o o Vaginal bleeding Eclampsia Diabetes headache Mother with hyperthyroidism high risk for?? o o o o Preterm labor Pre-eclampsia Hemorrhage D.Congenital anomalies Pregnant women came to ER. She diagnosed with preeclampsia. She was crying and feeling anxious that may affect her baby. What is describe woman situation according to Maslow hierarchy needs? o o o o 13Page Self esteem Safety Physiological needs Love and belonging 0402233050 ‫واتساب‬ https://wa.me/message/EU4QBUCQKSDXC1 A patient with pre-eclampsia is admitted to the unit with an order for magnesium sulfate. The nurse will understand that the therapy effective if? A. Scotomas are present B. Ankle clonus is increased C. No seizures occur D. Blood pressure drops The three most common causes of hemorrhage during the first half of pregnancy are: 1.Abortion 2.Ectopic pregnancy 3.hydated mole Abortion o A pregnancy that ends before 20 weeks’ gestation. Types of Abortions Threatened: Spotting and cramping occur without cervical change. Inevitable: Spotting and cramping occur and cervix begins to dilate and efface. Incomplete: Loss of some of the products of conception occurs, with part of the products retained (most often placenta is retained). 12Page 0402233050 ‫واتساب‬ https://wa.me/message/EU4QBUCQKSDXC1 Complete: Loss of all products of conception. Missed: Products of conception are retained in utero after fetal death. Habitual: Spontaneous abortions occur in 3 or more successive pregnancies. Interventions Maintain bed rest as prescribed. Count perineal pads to evaluate blood loss, and save expelled tissues and clots. Maintain intravenous (IV) fluids Prepare the client for dilation and curettage as prescribed for incomplete abortion. In Missed abortion Pregnancy tests for hCG show adecline abnormal form of pregnancy )grape like cluster) Rapid increase in uterine growth Avoid pregnancy for 1year 15Page 0402233050 ‫واتساب‬ https://wa.me/message/EU4QBUCQKSDXC1 A client makes a routine visit to the prenatal clinic. Although she is 14 weeks pregnant, the size of her uterus approximates that in an 18to-20-week pregnancy. Dr. Charles diagnoses gestational trophoblastic disease and orders ultrasonography. The nurse expects ultrasonography to reveal: A. An empty gestational sac. B. Grapelike clusters. C. A severely malformed fetus. D. An extrauterine pregnancy. A female adult patient is taking a progestin use may increase the patient's risk for: o o o o Endometriosis. Female hypogonadism. Premenstrual syndrome. Tubal or ectopic pregnancy. What is the characteristics of ectopic pregnancy pain? A. Abdominal cramp B. Throbbing pain in lower part C. Sudden pain in upper part D. No pain What percentage of patients with ectopic pregnancy will have normally rising HCG levels? A. 10% 14Page 0402233050 ‫واتساب‬ https://wa.me/message/EU4QBUCQKSDXC1 B. 25% C. 50% D. 95% A woman was diagnosed gestational trophoblastic disease what is the lab investigation was done to diagnose condition? o o o o Cervical pap smear Serum HCG levels Serum estrogen level Plasma thyroxin level o Painless bright red vaginal bleeding with relaxed abdomen Types 10Page 0402233050 ‫واتساب‬ https://wa.me/message/EU4QBUCQKSDXC1 Management of placenta previa.  Bed rest  Avoid stress  Avoid vaginal examination to prevent abortion pregnant client is diagnosed with partial placenta previa. In explaining the diagnosis, the nurse tells the client that the usual treatment for partial placenta previa is which of the following? A. Activity limited to bed rest. B. Platelet infusion. C. Immediate cesarean delivery. D. Labor induction with oxytocin. Which of the following are necessities for caesarean section? A. B. C. D. preterm labor severe preeclampsia total placenta previa partial placenta previa  Premature separation of normal implanted placenta Assessment: • Painful dark red vaginal bleeding •Uterine rigidity 13Page 0402233050 ‫واتساب‬ https://wa.me/message/EU4QBUCQKSDXC1 •Rigid&tenderness abdomen Which of the following would the nurse most likely expect to find when assessing a pregnant client with abruption placenta? o o o o Excessive vaginal bleeding. Rigid, board-like abdomen. Titanic uterine contractions. Premature rupture of membranes. Which of the following is described as premature separation of a normally implanted placenta during the second half of pregnancy usually with severe hemorrhage? o o o o 18Page Placenta previa Ectopic pregnancy Incompetent cervix Abruption placentae 0402233050 ‫واتساب‬ https://wa.me/message/EU4QBUCQKSDXC1 Fetal lie : Relation of longitudinal axis of fetus to longitudinal axis of mother. Fetal Presentation : First body part of fetus that enter mother’s pelvis. Cephalic ,head presentation is normal Fetal Position: 19Page 0402233050 ‫واتساب‬ https://wa.me/message/EU4QBUCQKSDXC1 Relation of the presenting part to the quadrants of the maternal pelvis. During vaginal examination the nurse palpated the anterior fontanel to be at the right side and upper quadrant of the maternal pelvis? o ROP o LOP. o ROA o LOA Fetal Attitude: o Relation of fetal parts to one another. 30Page 0402233050 ‫واتساب‬ https://wa.me/message/EU4QBUCQKSDXC1 Immediately after delivery, the nurse-midwife assesses the neonate's head for signs of molding. Which factors determine the type of molding? o Fetal body flexion or extension. o Maternal age, body frame, and weight. o Maternal and paternal ethnic backgrounds. fetal station o where the presenting part is in your pelvis. After completing a second vaginal examination of a client in labor the nurse-midwife determines that the fetus is in the right occiput anterior position and at (-1_ station. Based on these findings, the nurse-midwife knows that the fetal presenting part is: A. 1cm below the ischial spines. B. Directly in line with the ischial spines. C. 1 cm above the ischial spines. D.In no relationship to the ischial spines. 31Page 0402233050 ‫واتساب‬ https://wa.me/message/EU4QBUCQKSDXC1 Powers: Uterine contractions Passageway: The birth canal. Passenger: The fetus and placenta. Psych: A women's emotions. Position:  False contraction felt in the abdomin not achieve cervical dilatation Stage1:"Cervix dilation" 0-10 cm . it consists of 3 phases Stage 1: cervical dilatation Latent phase Longest and mild intensity Cervical dilation is 1 to 4 cm. Uterine contractions occur every 15 to 30 minutes, are 15 to 30 seconds in duration, 33Page 0402233050 ‫واتساب‬ https://wa.me/message/EU4QBUCQKSDXC1 Active phase Cervical dilation is 4 to 7 cm. Uterine contractions occur every 3 to 5 minutes, are 30 to 60 seconds in duration, Moderate intensity. Transition phase Cervical dilation is 8 to 10 cm. Uterine contractions occur every 2 to 3 minutes, are 45 to 90 seconds in duration, strong intensity Stage 2 fetal expulsion Cervical dilation is complete. Uterine contractions occur every 2 to 3 minutes, lasting 60 to 75 seconds, and are of strong intensity. Perform assessments every 5 minutes. Stage 3 Expulsion of the placenta Occurs 5 to 30 minutes after the birth of the infant. After expulsion of the placenta, uterine fundus is located 2 fingerbreadths below the umbilicus. Examine placenta verify that it is intact. 32Page 0402233050 ‫واتساب‬ https://wa.me/message/EU4QBUCQKSDXC1 Stage 4 Period 1 to 4 hours after birth Perform maternal assessments every 15 minutes for 1st hour, every 30 minutes for 2nd hour, hourly for 2 hours A 31-year-old multipara is admitted to the birthing room. after initial examination reveals her cervix to be at 8 cm, completely effaced (100%), and at 0 station. What phase of labor is she in o Active phase. o Latent phase. o Expulsive phase. o Transitional phase. While the client is in active labor with twins and the cervix is 5dilates, the nurse observes contractions occurring at a rate of every 7 to 8 minutes in a 30-minute period. Which of the following would be the nurse's most appropriate action? A. Note the fetal heart rate patterns. B. Notify the physician immediately. C. Administer oxygen at 6 liters by mask. D. Have the client pant-blow during the contractions. Rubra "Birth-3 days bright red Serosa "4-10 days" Pinkish brown 35Page 0402233050 ‫واتساب‬ https://wa.me/message/EU4QBUCQKSDXC1 Alba "day 11-14" Whitish-yellow Fleshy odor normal Normal lochial findings in the 24 hours postdelivery include: A. Bright red blood. B. Large clots tissue fragments. C. Afoul odor. D. The complete absence of lochia. first or COLOSTRUM: o is produced in the late stage of pregnancy till 4 days after delivery and is rich in antibodies 34Page 0402233050 ‫واتساب‬ https://wa.me/message/EU4QBUCQKSDXC1 Transitional milk: o produced from 4-10 days Mature milk: produced from day 10 until the termination of Breast feeding. Taking-in phase First 2 days postpartum  Mom is self-focused  Allow mother to express fleeing to prevent post partum blues ❖ Taking-hold phase (3-10days)  Mom is infant-focused .  the mother is ready to take responsibility for her care and the infant's care . Letting-go (11-several weeks) Adjust to life as a family with new child. Letting go of pregnancy period & birth experience into new family life Forty-eight hours after delivery, the nurse in charge plans discharge teaching for the client about infant care. By this time, the nurse expects that the phase of postpartum psychological adaptation that the client would be in would be termed which of the following? A. Taking in. 30Page 0402233050 ‫واتساب‬ https://wa.me/message/EU4QBUCQKSDXC1 B. Letting go. C. Taking hold. D. Resolution. Puerperal sepsis  Fever more than 38 last from 2_10 days Breast engorgement  Due to poor feeding techniques Management     Breast feeding Antibiotic Analgesic Bra Caused by staphylococcus aurus Management     Continue Breast feeding from affected breast. Antibiotic Analgesic Bra A nurse is giving health education for a mother who has mastitis. Which of the following if stated by the mother about what she needs to do, indicate the additional education is needed? 33Page 0402233050 ‫واتساب‬ https://wa.me/message/EU4QBUCQKSDXC1 o o o o Take antibiotics Use analgesics Wear a supportive bra. Stop breast-feeding The nurse was planning care for a 25-year-old primigravida postpartum mother who had engorgement due to poor feeding technique. the left breast appeared red and swollen and was diagnosed as mastitis. Which of the following is the best education for the mother? o o o o Avoid wearing brassiere. Begin suckling on the right breast. Stop pumping milk from the left breast. Take antibiotics till the soreness subside Post partum Hemorrhage uterine atony  Uterus not contractrd well (boggy uterus) Management ‫بالترتيب‬  Massage fundus 38Page 0402233050 ‫واتساب‬ https://wa.me/message/EU4QBUCQKSDXC1  Evacuate bladder  Notify HCP Uterine involution Uterine subinvolutio  Uterus not back to normal position  Methergine is given( monitor Bp) 39Page 0402233050 ‫واتساب‬ https://wa.me/message/EU4QBUCQKSDXC1