1
Q
what are the 4 presumptive signs of pregnancy
A
ammenorrhea
N/V
Urinary frequency
breast tenderness (excess tenderness)
2
Q
what homrone causes ammenorrhea
A
progesterone
3
Q
what are pregnancy tests based on
A
presence of hCG levels
4
Q
can other conditions cause increased hCG levels?
A
yes; hydatidiform mole; drugs
5
Q
What is Goodell’s sign and when does it happen
A
softening of cervix
second month
6
Q
What is Chadwick’s sign and when does it occur
A
bluish color of vaginal mucosa and cervix
week 4
7
Q
What is Hegar’s sign and when does it happen
A
softening of the lower uterine segment
2nd/3rd month
8
Q
what are braxton hick’s contractions
A
occur throughout pregnancy; move blood through the placenta
9
Q
what is linea nigra
A
dark line down center of abdomen during pregnancy
10
Q
what is facial chloasama
A
pregnancy mask
11
Q
do the nipples darken during pregnancy
A
yes
12
Q
at what point can the fetal heartbeat be heard with a doppler
A
fetal 10-12 weeks
13
Q
when can a fetoscope be used
A
17-20 weeks - can hear the baby heartbeat
14
Q
what does gravidity mean
A
of times women has been pregnant
15
Q
what is parity
A
of pregnancies where the baby reached 20 weeks
16
Q
what is viability and how many weeks
A
at 24 weeks the infant has the ability to live outside the uterus
17
Q
Is a 20 week old baby considered viable
A
no
18
Q
what is TPAL
A
acronym that gives further information on parity T - term P - preterm A - abortion L - living children
19
Q
what is NAegele’s rule for the due date estimation and how accurate is it
A
add 7 days and 9 months
accurate to +/- 2 weeks
20
Q
what is the daily caloric intake increase for moms after their first trimester? what about pregnant adolescents? how much protein?
A
100
500
60 g protein a day
21
Q
what is the expected weigh gain in the first trimester
A
4 lbs
22
Q
why do women not like taking iron during pregnancy
A
causes constipation and GI upset
23
Q
what should iron be taken with to enhance absorption
A
vitamin C
24
Q
what does taking folic acid prevent
A
neural tube defects such as spina bifida
25
how much folic acid should be taken per day
400 mcg/day
26
waht are the best exercises for pregnant women
swimming and walking
27
true or false; high impact exercise is necessary during pregnancy
false
28
should hot tubs and heating blankets be used during pregnancy? why or why not?
no, increases body temp and can lead to birth defects
29
what is the exercise rule for pregnancy
dont let your hear rate get above 140
30
what happens if your HR goes over 140 in pregnancy
CO and uterine perfusion will drop
31
What are 8 danger signs during pregnancy
```
sudden gush of vaginal fluid
bleeding
persisten vomiting
severe HA
abdominal pain
increased temp
edema
no fetal movement
```
32
what should you tell the pregnant person about taking medicatons
don't take unless approved by dr
33
how often should a pregnant client visit the primary HCP during the first 28 weeks
once a month
34
how often should a pregnant client visit the primary HCP during the first 28-36 weeks
twice a month
35
how often should a pregnant client visit the primary HCP after 36 weeks
once a week till delivery
36
what should a pregnant person do prior to an U/S
drink water to distend the bladder
37
why do you want to distend bladder prior to U/S
pushes uterus to abdominal surface
38
what should a pregnant person do about an U/S prior to a procedure
void
39
what is the second trimester
weeks 14-26
40
how much weight gain is expected per week druing the second trimester
1 pound a week 4 pounds a month
41
in the second trimester is N/V still occuring
no
42
does a pregnatn woman still have breast tenderness in the second semester
yes
43
is there urinary frequency in the secondary trimester? why?
no, uterus is low in first trimester but rises and enlarges in 2nd
44
what is quciening and when does it start
fetal movement 2nd trimester
45
what should the fetal heart rate be during the second trimester
120-160
46
what is normal fetal heart rate, when are we worried and watching and when are we panicing
120-160 normal
110-120 worried and watching
< 110 panic
47
when is a pregnancy considered term
37-40 weeks
48
what is considered third trimester
27-40
49
what is the expected weight gain in the third trimester
pound a week
50
when are we worried about pregnancy induced HTN
third trimester
51
what are leopold manuevuers
used to determine fetal position and presentation
52
what nursing intervention should be done prior to leopold manuevuers
put in foley
53
where is the best place to hear the babys HR
over the babys back
54
what are the 3 signs of labor
lightening
engagement
fetal stations
55
what is lightening
first stage of labor - usually occurs two weeks before term
| head descends into pelvis
56
how will the pergnant person feel during lightening
less congested and breathe easier but urinary frequency is a problem again
57
what is engagement
second stage of labor - largest presenting part is in the pelvic inlet (hopefully the head)
58
what are fetal stations
stage of labor
| measured in cm; measures the relationship of the presenting part of the fetus to the ischial spines of the mother
59
what are braxton hick's contractions
true labor more frequent and stronger
60
what is ripening
softening of cervix
61
what is bloody show
mucousy blood in labor
62
what is the sudden burst of energy called in labor
nesting
63
is diarrhea a sign of labor
yes
64
when should a client go to the hospital
when contractison are 5 mins apart or hwne ht emembranes ruptuer
65
what are we worried about when membranes rupture
prolapsed cord
66
what is the non-stress test
what to see two or more accelerations of 15 beats/minute or more with fetal movement
each increase should last for at least 51s and be recorded for 20 minutes
67
what is acceleration
when the fetal heart rate has an abrupt increase from the baseline
an increase of greater than 15 beats/minute above the baseline that lasts at least 15s but should return to bseline within 2 minutes
68
do you want the non stress test to be reactive or non reactive
reactive
69
what is the biophysical profile test BPP?
```
measures
HR
muscle tone
movmement
breathing
amniotic fluid
```
70
when is the BPP test done
last trimester but can be done at 32-34 weeks in a high risk pregnancy
71
how often will a high risk pregnancy have the BPP done
every week or twice a week in 3rd trimester
72
in the BPP what is done regarding hr
nonstress test want it reactive i.e. it increases when baby moves
73
in the bpp what is looked at to assess msucle tone
does baby have at least 1 flexion-extension movement in 30 mins
74
what is observed for regarding breathing in the BPP
does the baby have breathing movements at lesat 3x in 30 mins
75
what is obserrved for regarding movement in the biophysical profile test
does the baby move at least 3 times in 30 minutes
76
what is the observation time for BPP
30 minutes
77
what are good worrisome and ominous results in the BPP
10 good
6 worrisome
4 omnious
78
what is the contraction stress test: oxytocin challenge test
determines if a baby can handle a contraction since contractions decrease blood flow to the uterus and placenta
79
when is contraction stress test or oxytocin challente test done
if the NST is non-reavtive and it is a high risk pregnancy
80
what will be seen if the fetus becomes hypoxic during the contraction stress test or oxytocin challenge
fetal heart reate will decrese from the baseline HR (deceleration)
81
What do you not want to see in the contraction stress test
late decelerations --> means urteroplacental insufficienty
82
do you want a positive or negaitve contraction stress test
negative --> means no decelerations were seen
83
the contraction stress test is rarely seen befeore how many weeks
28
84
what are the 3 types of decelerations
```
early - benign not bad - casued by phsyiological hypoxia from fetal head compressionl
late decelerations (bad) - caused by uteroplacental insufficenty (UPI)
what is variable decelerations (bad) - caused by umbilical cord compressin
```
85
in true labor are contractions regular or irregular
regualr
86
do contractions increase or decrease in true labor
increase
87
where does discomfort in back radiate to in true labor
back
88
does pain decrease with change in activity in true labor
no; increases
89
what do contractions do in false labor
irregular
90
where is discomfort in false labor
just in abdomen
91
what happens to pain in false labor when you cahnge activities
it decrease or goes away
92
when is epidural anesthesia done for a pregnant lady6
stage 1 of labor at 3-4 cm dilation
93
what is a major complication for epidural anesthesia
hypotension
94
what should be done to combat hypotension forepidural anesthesia
bolus 1000mL NS or LR
95
what posistion should a pregger lady be put in for epidural anesthesia to prevent hypotension
semi-fowler on side to prevet vena cav compression
96
how often should a pregger lady alternate position from side to side when getting an epidural
hourly
97
what are the 3 complicatiosn we are worried about for a pt receiving oxytocin
hypertonic labor
fetal distress
uterine rupture
98
what is uterine rupture
can be partial or complete -->uterus rips open
| complete = through the uterine wall into the peritoneal cavity
99
what are S & S of complete uterine rupture
sudden sharp shooting pain
"feels liek something gave way"
pain relieved
100
what is partial or incomplete uterine rupture
through the uterine wall but doesn't tear the peritoneum peritoneal cavity is still intact
101
what are the signbs and symptoms of incomplete uterine rupture
internal bleeding
pain may or may not be present
client may vomit
102
what is ideal contraction rate
1 every 2-3 minutes, with each lasting 60 seconds
103
when should ixytocin be discontinued
if contractions are too often or too long
| if there is fetal distress
104
do you ever straight line oxytocin
no piggy back so when you discontinue oxy be sure to discontinue fluid
105
what posistion should the pt receiving oxytocin be in
any posistion but on her back
106
what posistion do we put a preggers lady if there are any unreassuring heart tones
left side to enhance uterine perfusion
107
what should be done with the oxytocin infusion if late decelerations are seen
turn it off
108
should a client push btwn contractions
hellz no
109
what cna a pt. do to decrease the urge to push
pant or blow
110
what can be done to prevent the baby from coming out to fast
push on head
111
following birth what temperature might the babys temp increase to during the first 4 horus
38 degrees celsius
112
what heart rate for a baby is common during the first 6-10 days following birth
50-70 bpm
113
when you see tachycardia in a postpartum women what should you immediately think
hemorrhage
114
how long are breasts soft before they engorge following birth
2-3 days
115
what is diastasis recti
abdominal muscles separate--> dent down abdome
116
where is the fundus found immediately following birth
midline 2-3 finger breadths below umbilicus
117
whwere should the fundus be a few hours after birth
rises to level of umbilicus or one FB above
118
what is the first thing you do if the fundus is boggy
massage the fundus until its firm and then check for bladder distension
119
when is bladder distension suspected
when the uterus is above the suspected level or is not in the midline
120
what problem does a distended bladder cause following brith
not allow the uterus to contract normally which increases the chance of hemorrhage
121
how much should fundal heigh decend per day following birth
one finger breadth/day
122
what is the proper term used when the fundus descends and the uterus returns to its pre-pregnancy size
involution
123
how long are afterpains common following birth? whta will cause them to continue to be common
2-3 days
| breastfeed
124
what color should the lochia be the first 3-4 days following birth
rubra - dark red
125
what color should the lochia be the first 4-10 days following birth
serosa - pinkish brown
126
what color should the lochia be the first 10-28 (as long as 6 weeks) days following birth
alba - whitish yellow
127
are clots ok to pass following birht?
yes; as long as they are no larger than a nickel
128
what happens to UO in the first 24 hours following brith? what are we worried about
diurese
| dehydration
129
why should the legs be closely inspected following birth
DVT
130
how long should ice packs be used for perineal edema following birth
6-12 hours
131
what are 3 things important in perineal care post-partum for patients who have an an epiosotmy, laceration or hemorrhoisd
warm water rinses
sitz baths 2-4 times a day
anaestheic sprays
132
what is the peripad rule following birth
do not want the client to saturate more than 1 peripad an hour
133
what is bonding also called? how often should it be done
kangaroo care; skin to skin
| baby should be held for 1 hour at least 4 times a week
134
how should breastfeeding mothers cleanse their breasts
with warm water after each feeding and let air dry
135
what should be done for sore breasts in breastfeeding mothers
ointment or express some colostrum and let it airdry
136
how soon should breastfeeding be initated following birth
ASAP
137
what can be done if breastfeeding is interrupted
can pump
138
how much should caloric intake be increased by when breastfeeding
500 calories
139
how mcuh fluid/milk should a mother intake that is breastfeeding
8-10 8oz glasses a day
140
what breast care should be done for non-breastfeeding mothers
ice packs
breast binders
chilled cabbage leaves
no stimulation of brest
141
why do chilled cabbage leaves help for breast care in non breast feeding mothers
decreases inflammation and decrease engorgement
142
what are 3 complications postpartum
infection
hemorrhage
mastitis
143
how many days post birth are we worried about postpartum infection
10 days
144
what are the two things you must have to define early postpartum hemorrhage
more than 500 cc blood lost in the first 24 hours and 10% drop from admission hematocrit
145
when does late postpartum haemorrhage occur
after 24 hours up to 6 weeks
146
when does mastitis usually occur following birth
2-4 weeks
147
what causes mastitis
breasts not emptying properly
148
if mom is going to continue to breastfeed after a mastitis infection what does she need to do
initate breastfeeding frequently or pump
149
is penicillin ok with breastfeeding
yes
150
can a baby be fed during mastitis? should you use the affected breast
yes baby should be fed frequently
| affected breast should be used first --> empties breast milk
151
what 3 things should be done immediately for newborn care
suction
clamp and cut cord
maintain body temperateure
152
when should apgar be done following birth
1 and 5 minutes
153
waht does apgar look at? what score do we want
looks at HR, R, muscle tone, refelc irritability, color
| want at least 8-10
154
what is given for eye prophylaxix for babies? what else does it kill
erythromycin ---> kills clamidyia too
155
what should be given to promote formation of clotting factors in new babies
IM vitamin K given IV vastus lateralis
156
how long does it take for a babies umbilical cord to dry and fall off
10-14 days
157
what should the cord be cleansed with and when should it always be cleasened
alcohol or NS and with each diaper changing
158
how should a diaper be folded when the umbilical cord has not yet fallen off
fold diaper below cord
159
why do some babies experience hypogycemia following birth
because they are not getting glucose from mo
160
what risks put a baby more at risk for hypoglycemia
large or small babies
preterm babies
babies of diabetic moms
161
when does pathological jaundice occur in newborns? why does this occur
1st 24 hours
| Rh/ABO incompatibiulity
162
when does physiological jaundice occur in newborns? why
after 24 hours
| due to normal hemolysis of excess RBCs releasing bilirubin or liver immaturity
163
how is Rh incompatibility diagnosed
indirect coombs - measures # of ab in MOMs blood
| direct coombs - measures if there are any ab stuck to RBCs for baby
164
what are the 2 things done if you have a Rh+ fetus and a sensitized mother
```
frequent U/S to watch baby growth
early birth (when baby stops growing)
```
165
when is Rho(D) given
w/in 72 hours following birth
166
true or false Rho(d) is given with any bleeding episode
true - prophylaxis
167
how does rhogam work
destroys fetal cells that got into mothers blood so mom does not make anitbiods
NCLEX
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