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Maternal Child EXAM 1 Study Guide
Maternal Child Health Nursing (NUR 2633)
Rasmussen University
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NUR2513 Maternal-Child Nursing
Study Guide – Exam 1
Describe current trends / resources influencing maternal - child health care - Community services
Understand lab work needed in each trimester
- 1 ST TRIMESTER: BLOOD TYPE, RH ANTIBODIES, CBC, RPR, HEP B AND C, GC/CT (CHLAMYDIA AND
GONORRHEA), URINE DRUG SCREEN.
- 2 ND TRIMESTER: CBC, HIV, 1-HOUR GLUCOSE, REPEAT ANTIBODY SCREEN FOR RH NEGATIVE.
- 3 RD TRIMESTER: GROUP BETA STREP-RECTOVAGINAL CULTURE @ 36 WEEKS.
2020 health goals: nutrition - Increasing the proportion of mothers who achieve a recommended weight gain during their pregnancies is a goal of Healthy People 2020.
Vegan diet deficiency - Vegetarian / vegan diets might have decreased intake of protein, calcium, zinc, and Vit B12.
Function of amniotic fluid - Surrounds the baby, temperature control, cushions the baby from Minor injury. - A low amount of fluid may indicate that there are kidney problems with the fetus. - SYMMETRICAL FETAL GROWTH, PREVENTS ADHERENCE OF THE AMNION TO THE FETUS, FETAL MUSCULOSKELETAL DEVELOPMENT BY PROVIDING FREEDOM OF MOVEMENT, ESSENTIAL FOR NORMAL FETAL LUNG DEVELOPMENT.
Societal changes in maternal-child health issues - Delaying childbearing until later age - Smaller families
Pre-term labor interventions - Activity restriction: Modified bed rest with bathroom privileges. Left lateral position to increase blood flow to uterus and decrease uterine activity. Avoid sexual activity. - Ensure hydration: Preventing dehydration prevents release of oxytocin. - ID and TX infection. - Monitor for chorioamnionitis (elevated temp and tachycardia) - Monitor FHR and contraction pattern - Monitor Fetal tachycardia. >160 BPM can indicate infection.
- Medications: Nifedipine: CCB that suppresses contractions by prevent Ca+ from entering smooth muscles. Monitor for orthostatic hypotension. DO NOT GIVE CONCURRENTLY WITH MAG SULFATE OR BETA BLOCKER.
Magnesium Sulfate: CNS depressant, smooth muscle relaxant. Monitor for s/sx of pulmonary edema, s/sx of Toxicity: Loss of DTRs, less than 30 mL of urine output Q 1hr
or 100 mL Q 4 hrs, RR < 12 / min, pulmonary edema, hypotension, or chest pain.
When is the IUD contraindicated - Active pelvic infection, abnormal uterine bleeding, severe uterine distortion.
Diaphragm teaching - Replace Q 2 years - Must be properly fitted, especially after weight fluctuation of 20% or more, ABD or pelvic surgery, and after every pregnancy - Must be placed properly prior to coitus with spermicide, no more than 6 hrs before sex, and must be removed no EARLIER than 6 hrs and no LATER than 24 hrs after. - Empty the bladder prior to insertion - Wash with mild soap and water after each use.
Omphalocele development - As the baby develops during weeks six through ten of pregnancy, the intestines get longer and push out from the belly into the umbilical cord. By the eleventh week of pregnancy, the intestines normally go back into the belly. If this does not happen, an omphalocele occurs.
Cardiovascular changes in each trimester - Cardiac output increases 30-50% and blood volume increases 30-45% at term. - Heart rate increases around week 5 and peaks at 10-15 bpm more than pre-pregnancy rate around 32 weeks of pregnancy.
Delivery presentations - Occiput posterior presentation (also called sunny-side up), the fetus is head first but is facing up (toward the mother's abdomen). It is the most common abnormal position or presentation. - When a fetus faces up, the neck is often straightened rather than bent, and the head requires more space to pass through the birth canal. Delivery by a vacuum extractor or forceps or cesarean delivery may be necessary. - Breech presentation: The buttocks or sometimes the feet present first. Breech presentation occurs in 3 to 4% of full-term deliveries. It is the second most common type of abnormal presentation. - In face presentation , the neck arches back so that the face presents first. - In brow presentation , the neck is moderately arched so that the brow presents first. - In transverse lie , the fetus lies horizontally across the birth canal and presents shoulder first. A cesarean delivery is done, unless the fetus is the second in a set of twins. In such a case, the fetus may be turned to be delivered through the vagina. - Shoulder dystocia: The fetus is positioned normally (head first) for delivery, but the fetus’s shoulder becomes lodged against the woman’s pubic bone as the fetus’s head comes out. Consequently, the head is pulled back tightly against the vaginal opening. The baby cannot breathe because the chest and umbilical cord are compressed by the birth canal.
Smoking risks - Preterm birth , low birth weight, and birth defects of the mouth and lip. - Smoking during and after pregnancy also increases the risk of sudden infant death syndrome (SIDS).
- RECOMMENDED EVERY 3 YEARS for normal pap smears
- Should be started after age 21 OR 3 years after first sexual intercourse
- TEST FOR CANCERS OR PRE CANCERS IN THE CERVIX OR COLON.
School age mortality reasons – Accidents
Menstrual cycle phases
- PROLIFERATIVE: THICKENING OF LINING
- SECRETORY/LUTEAL: OVULATION
- ISCHEMIC: EGG RELEASED/NOT PREGNANT-STARTS SHEDDING
- MENSES: BLEEDING
Pregnancy classification
- PROBABLE SIGNS : ABDOMINAL ENLARGEMENT, HEGARS SIGN (SOFTENING OF LOWER UTERUS),
CHADWICKS SIGN (VIOLET/BLUISH COLOR OF CERVIX AND VAGINAL MUCOUS), GOODELLS SIGN
(SOFTENING OF CERVIX TIP), BRAXTON HICKS CONTRACTIONS, POSITIVE PREGNANCY TEST.
- POSITIVE SIGNS: FETAL HEART SOUNDS, FETAL MOVEMENT, VISUALIZATION OF FETUS ON
ULTRASOUND.
- PRESUMPTIVE SIGN: AMENORRHEA, NAUSEA BREAST ENLARGEMENT/TENDERNESS, FATIGUE,
POOR SLEEP, BACK PAIN, CONSTIPATION, FOOD CRAVINGS/AVERSION.
Quickening: define/ timing - Slight fluttering movements of the fetus felt by the client between 16-20 weeks gestation.
Ferrous sulfate teaching - Should encourage adequate hydration with 6-8 glasses of water each day and increase the intake of protein and iron via dietary sources. Sometimes moms will need an iron supplement in their prenatal vitamin (PNV). - Iron is best absorbed BETWEEN meals, and best to give with Vitamin C. - Milk and caffeine inhibit Iron absorption - Food rich in iron: beef liver, red meats, fish, poultry, dried peas and beans, fortified cereals and breads.
Variability: absent, minimal, normal, marked
- ABSENT: NO CHANGE FROM BASELINE
- MINIMAL: CHANGE IS BETWEEN 0-5 BPM FROM BASELINE
- MODERATE: NORMAL CHANGE BETWEEN 6-25 BPM FROM BASELINE
- MARKED: GREATER THAN 25 BPM FROM BASELINE
Risk/ cause of cervical cancer
- HPV exposure / infection
Why frequent urination
Education for managing blood glucose
- APPROPRIATE CARB AND PROTEIN INTAKE
- APPROPRIATE CALORIC CONSUMPTION
Fundal Heights and corresponding gestation - Measure fundal height starting the 2nd trimester. Fundal height should correspond to weeks of gestation. - Measured in centimeters (cm) from the pubic bone to the top of the uterus. The cm should match the week of gestation ± 2. - The fundal height can be inaccurate when the pregnant client is obese, has a history of fibroids, or is carrying multiples. T - he importance of the fundal height helps assess the growing fetus over time.
- 12 WKS FUNDAL HEIGHT: SYMPHYSIS
- 20 WKS FUNDAL HEIGHT: UMBILICUS
- AFTER 20 WEEKS FUNDAL HEIGHT: CORRELATE TO CM PLUS 2 CM
Nonpharmacological interventions for non-medicated births
Why a non-stress test and how do you conduct it - Monitors fetal HR response to fetal movement - Uses doppler and tocotransducer. Client pushes button when fetal movement is felt. - Assess for intact fetal CNS during third trimester. - R/O risk for fetal death in clients who have DM. - Completed twice a week starting at week 28-32 of gestation.
What does surfactant do - Surfactant is made by the cells in the airways and consists of phospholipids and protein. - It begins to be produced in the fetus at about 24 to 28 weeks of pregnancy, and is found in amniotic fluid between 28 and 32 weeks. - By about 35 weeks gestation, most babies have developed adequate amounts of surfactant. it helps lower surface tension in the airways, which helps keep the lung alveoli (air sacs) open.
Contraindications for oral , IUD contraception - Oral BCPs: HX of DVTs, PEs, CVAs, MIs, CAD - Gallbladder disease, Cirrhosis or tumor of liver, - HA with focal neurologic findings, uncontrolled HTN, - DM with vascular involvement, - Breast or estrogen related cancers, - Pregnancy, lactating, less than 6 weeks postpartum, smoking.
What causes and what are the responses of early/ late decels - Early decels: Slowing of FHR at start of contraction with return to normal FHR to baseline at end of contraction. Causes: Compression of fetal head due to contraction. Vaginal exam. Fundal pressure.
- Late decels: Slowing of FHR after contraction has started with return to normal FHR to baseline at end of contraction. Causes: Uteroplacental insuff. => inadequate fetal oxygenation. Maternal hypotension, placental previa, abruptio placentae, uterine hyperstimulation with oxytocin, preeclampsia, late or post term pregnancy, maternal DM.
What are the stages of Labor - First stage Latent phase: Onset of labor, irreg contractions that are mild to moderate Q 5-30 min, lasting 30-45 seconds. Dilation 0-3 cm. Active phase: Contractions become more regular: Q 3-5 min, lasting 40-70 seconds. Dilation 4-7 cm. Transition: Contractions strong to very strong. Q 2-3 min lasting 45-90 seconds. Full dilation.
- Second stage: Full dilation. Intense contractions Q 1-2 minutes. Birth. - Third stage: Delivery of neonate and placenta. - Fourth stage: Delivery of placenta. Maternal VS stabilize.
- The first stage is defined from the beginning of labor until complete.
- The second stage is when the baby is born.
- The third stage is the delivery of the placenta.
- The fourth stage is the recovery.
Practice estimated date of delivery (EDD)
GTPAL practice
- GRAVIDA: HOW MANY PREGNANCIES INCLUDING CURRENT
- TERM: HOW MANY FULL BIRTHS 38 WEEKS
- PRETERM: BEFORE 38 WEEKS
- ABORTIONS: SURGICAL OR MISCARRIAGES
- LIVING: HOW MANY LIVING CHILDREN
Examples of presumptive, probable, and positive signs of pregnancy - Presumptive: Amenorrhea, Fatigue, N/V, urinary freq, Breast changes, quickening, uterine enlargement. - Probable: ABD enlargement, Hegar’s Sign, Chadwick’s Sign, Goodell’s sign, Ballottement, Braxton Hicks Contractions, Positive pregnancy test, fetal outline. - Positive: Fetal heart sounds, visualization of fetus by ultrasound, fetal movement.
What are tests for early labor symptoms - Fetal fibronectin: Swab vaginal secretions. Expected during early and late pregnancy. But, presence between 24-34 weeks 6 days indicates inflammation => risk for preterm labor within the next 2 weeks. - Cervical Culture: Check for presence of infectious pathogens. Obtain C&S to determine appropriate course of TX. - CBC
How is sickle cell inherited - To be born with sickle cell disease, a child has to inherit a copy of the sickle cell gene from both their parents. - This usually happens when both parents are "carriers" of the sickle cell gene, also known as having the sickle cell trait. - Or it can happen when 1 parent has sickle cell disease and the other is a carrier of it.
Magnesium sulfate education/ care of client and epidural considerations
- STRICT BED REST, ALWAYS USE AN INFUSION PUMP FOR ADMINISTRATION AND RUN IT
PIGGYBACK NOT AS THE MAIN LINE.
- MONITOR ALL VS, RR SHOULD BE AT LEAST 16/MIN BEFORE EACH DOSE.
- MONITOR I & O AND HAVE 10% CALCIUM GLUCONATE AVAILABLE SHOULD TOXICITY OCCUR.
INSTITUTE SEIZURE PRECAUTIONS.
Appropriate pregnancy weight gain - During the first trimester recommended weight gain is 2-4 lbs. - In the second and third trimester 1lb per week.
- Placenta previa is an improperly implanted placenta in the lower uterine segment near or over the internal cervical os.
- Nursing assessment of placenta previa includes sudden onset of painless, bright red vaginal bleeding occurring in the last half of pregnancy, the uterus is soft and relaxed, and fundal height may be more than expected for gestational age.
- Nursing interventions include monitoring VS, fetal heart rate (FHR) and fetal activity, ultrasound, avoid vaginal exams, bed rest with a side-lying position, monitoring amount of bleeding (treat signs of shock if present), IV fluids, blood products if needed or tocolytic medications, plan for a cesarean if heavy bleeding.
Hyperemesis gravidarum: teaching, difference to average nausea/vomiting - Severe nausea, vomiting, weight loss, and electrolyte disturbance.
Morning Sickness: Hyperemesis Gravidarum: Nausea sometimes accompanied by vomiting Nausea accompanied by severe vomiting Nausea that subsides at 12 weeks or soon after Nausea that does not subside Vomiting that does not cause severe dehydration Vomiting that causes severe dehydration Vomiting that allows you to keep some food downVomiting that does not allow you to keep any food down
Gestational diabetes: risks to mom/ baby, diet - POSTPRANDIAL BLOOD GLUCOSE GREATER THAN 140 DURING 2 OR MORE CHECKS DURING THE 3 HOUR GLUCOSE EXAM. DEVELOPS IN THE LATER HALF OF THE PREGNANCY AS RESULT OF THE ALTERED HORMONAL MILIEU. - RISKS: MACROSOMIA-INCREASES RISK FOR BIRTH TRAUMA LIKE SHOULDER DYSTOCIA, IMPACTS FETAL BLOOD GLUCOSE REGULATION FOLLOWING DELIVERY. FETAL HYPERINSULINEMIA DEVELOPS AND ACTS AS A GROWTH HORMONE THAT CONTRIBUTES TO DEVELOPMENT OF MACROSOMIA AND A DECREASE IN PULMONARY SURFACTANT PRODUCTION. BECAUSE INSULIN DOESN’T CROSS THE PLACENTA, THE FETUS MUST INCREASE ITS OWN INSULIN PRODUCTION. - NUTRITION: APPROPRIATE CARBOHYDRATE AND PROTEIN INTAKE, APPROPRIATE CALORIC CONSUMPTION. - EXERCISE: MAINTAIN ACTIVE PLAN OF EXERCISE, DO NO INITIATE A NEW STRENUOUS PLAN, STICK WITH LOW IMPACT, ENERGY CONSUMPTION WILL BE INCREASED DURING EXERCISE, EAT APPROPRIATE CARB SUSTAINING SNACK PRIOR TO EXERCISE. - EFFECTS IN 1ST TRIMESTER: LINKED TO CONGENITAL ABNORMALITIES AFFECTING CNS, MUSCULOSKELETAL SYSTEM, RENAL SYSTEM, CARDIOVASCULAR, GASTROINTESTINAL.
Meconium aspiration: risks, what is it - Meconium aspiration is when a newborn has aspirated a sterile fecal material called meconium into the lungs before or around time of birth. - Fetuses sometimes pass meconium into the amniotic fluid before birth, either normally or in response to stress, such as a lack of oxygen. - Stress may cause fetuses to gasp reflexively, thus inhaling amniotic fluid containing meconium into their lungs.
- Greatest risk is baby that is post term.
RH factor : rhogam, why - What makes blood types positive or negative. - Could potentially make mom and baby’s blood incompatible. - RhoGam is given to prevent hemolysis due to mom-baby blood incompatability – Hemolytic disease of newborn.
IUGR: identification/ parameters - a fetus whose estimated weight is below the 10th percentile for its gestational age and whose abdominal circumference is below the 2 percentile. - IDENTIFICATION: ULTRASOUND BIOMETRY IS THE GOLD STANDARD FOR ASSESSMENT OF FETAL SIZE AND THE AMOUNT OF AMNIOTIC FLUID. GROWTH RESTRICTION IS CLASSIFIED AS SYMMETRIC AND ASYMMETRIC. A LAG IN FUNDAL HEIGHT OF 4CM OR MORE SUGGESTS IUGR.
What is oligohydramnios - Oligohydramnios refers to amniotic fluid volume that is less than expected for gestational age - MAY BE DESCRIBED QUALITATIVELY (REDUCED AMNIOTIC FLUID VOLUME) OR QUANTITATIVELY (AMNIOTIC FLUID INDEX <5 CM, SINGLE DEEPEST POCKET <2CM)
Heartburn causes and treatments
Practice tracing sheets; what actions for which type of tracing
What are: Goodell’s sign/ Hagar’s sign/ Chadwick’s sign/ positive ferning - Goodells’ Sign: Softening of the cervical tip - Hagar’s Sign: Softening and compressibility of lower uterus - Chadwick’s Sign: Deepened violet- bluish color of cervix and vaginal mucosa. - Positive Ferning: A simple and inexpensive test is described which permits positive identification of amniotic fluid by its fern-type crystallization
What are abnormal results of urinalysis and what does it mean? Any further test
Maternal Child EXAM 1 Study Guide
Course: Maternal Child Health Nursing (NUR 2633)
University: Rasmussen University
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