1
Q
discuss common techniques used to assess fetal well-being
A
- Ultrasound
- Biophysical profile
- Nonstress Test
- Contraction Stress Test
- Aminocentesis
2
Q
list and explain one noninvasive way to assess fatal well-being
A
external abdominal ultrasound: safe, noninvasive, painless procedure whereby an ultrasound transducer is moved over a client’s abdomen to obtain an image. More useful after the 1st trimester when the gravid uterus is larger.
3
Q
discuss what to teach the pregnant client with heartburn; hemorrhoids; constipation
A
- Heartburn: Client should eat small frequent meals, not allow the stomach to get to empty or too full, sit up for 30 min after meals and check with provider prior to using OTC antacids
- Constipation: Encourage fluids, eat a diet high in fiber and exercise regularly
- Hemorrhoids: Warm sitz bath, witch hazel pads and application of topical ointments
4
Q
how is the sex/gender of the baby determined
A
- DNA determines baby’s gender.
- XX- female
- XY- male
- Father determines baby’s gender.
5
Q
discuss common maternal discomforts during pregnancy and their treatment
A
- nausea/vomiting: should eat crackers (dry food) 30min to 1 hour prior to getting up in the morning to prevent feelings.
- breast tenderness: client should wear a comfortable bra with room to breath.
- urinary frequency: client should void full and often. don’t drink right before bed. practice kegal exercises. wear pads.
- UTI: avoid bubble baths, wipe front to back, cotton panties, loose underwear/pants
- fatigue: simple solution –> rest often!
- constipation: eat fiber. drink plenty of fluids. exercise 30 minutes 3x/week.
6
Q
discuss the signs and symptoms of hyperemesis gravidarum
A
- excessive vomiting/diarrhea
- dehydration
- weight loss
- increased pulse
- decreased BP
- poor skin turgor and dry mucous membranes
7
Q
discuss the client teaching following a vasectomy
A
following the procedure:
- scrotal support and moderate activity for a couple of days to reduce discomfort
- sterility is delayed until the proximal portion of vas deferent is clears of all remaining sperm (approx. 20 ejaculations)
- follow up for a sperm count
- no lifting heavy objects
8
Q
identify vital signs in the pregnant client that should be reported to the charge nurse or provider
A
dizziness, lightheadedness, and cool/clammy skin should be reported
9
Q
discuss the use of basal body temperature method of birth control
A
temperature can drop slightly at the time of ovulation. this can be used to facilitate conception, or be used as a natural contraceptive.
woman is instructed to measure oral temperature before getting out of bed in the morning.
advantage: inexpensive, convenient, no s/e
disadvantages: BBT is influenced by many factors
risk: pregnancy
10
Q
list the hormone(s) measured by a pregnancy test
A
hCG
11
Q
list expected symptoms in the early weeks of pregnancy
A
- Breast tenderness
- Missed period
- Nausea/vomiting
- Feeling of bloating
- Dizziness
12
Q
what causes the sensation of quickening
A
fetal movement
13
Q
discuss the care of the pregnant client in third trimester who is having vaginal bleeding
A
Placenta Previa:
- Monitor for bleeding, leakage or contractions
- Monitor fundal height
- Perform Leopold maneuvers (fetal position and presentation)
- Refrain from performing vaginal exams (can exacerbate bleeding)
- Assist with administration of IV fluids, blood products and medications
- Have O2 equipment available in case of fetal distress
Abruptio Placenta:
- Palpate the uterus for tenderness and tone
- Monitor FHR pattern
- Assist with the administration of IV fluids, blood products and meds as prescribed
- Adminiset O2 8-10 L via face mask
- Monitor urinary output and monitor fluid balance
14
Q
list the best places to detect fetal heart tones in the first trimester, second and third trimesters
A
- 1st trimester: just above the pubis at the midline
- 2nd and 3rd: upper right of left quadrant
15
Q
list the client instructions for taking oral contraceptives
A
requires a prescription and follow-up appt.
medication must be used consistently
if one dose is missed, take one pill immediately when remembered, then take next dose at scheduled time. If missing 2+ doses, see manufacturer’s instructions and use alternative form of contraceptive to prevent pregnancy.
16
Q
what would the nurse expect to assess in the client who is 8 weeks? 12 weeks? 20 weeks?
A
8 weeks:
- At 5 weeks the embryo is ¼ inch long
- All major organ systems develop
- The placenta and umbilical cord develop
- Amniotic fluid surrounds the baby
- Face and limbs take shape
12 weeks:
- Fetus is about 1 inch long
- Nostrils, mouth, lips, teeth buds and eyelids form
- Fingers and toes are almost complete
- Eyelids are fused shut
- Arms, legs, fingers and toes have developed
- All internal organs are present- but aren’t ready to function
- The genital organs can be recognized as male of female
20 weeks:
- The fetus is about 6 inches long and weights 4-5 oz
- A protective coating called vernix begins to form on baby’s skin
- Hair eyelashes and eyebrows appear
- Organs keep maturing
- Fetus is very active
- The eyes can open and blink
17
Q
explain the difference between complete, incomplete, and threatened abortion
A
- Complete- Mild cramps; minimal bleeding; complete expulsion of uterine contents; cervical opening is closed with no tissue in cervical canal
- Incomplete- Severe cramps; continuous and severe bleeding; partial fetal tissue or placenta; cervical opening is dilated with tissue in cervical canal or passage of tissue
- Threatened- With or without mild cramps; slight to spotted bleeding; no tissue passed; cervical opening is closed
18
Q
list the risk factors for developing abrupt placenta
A
- maternal HTN
- blunt external trauma
- cocaine use resulting in vasoconstriction
- previous incidents of abruptio placenta
- premature rupture of membranes
- multifetal pregnancy
19
Q
when should the provider be able to hear fatal heart tones using a doppler
A
by the 10th week
20
Q
list 4 presumptive, 4 probable, and 4 positive signs of pregnancy
A
Presumptive:
- Amenorrhea
- Fatigue
- Nausea and vomiting
- Urinary frequency
- Breast changes- darkened areolae, enlarged Montgomery’s glands
- Quickening- slight fluttering movements of the fetus felt by a woman, usually between 16-20 weeks of gestation
Probable:
- Abd enlargement related to changes in uterine size, shape and position
- Hegar’s sign- softening and compressibility of lower uterus
- Chadwick’s sign- deepened violet- bluish color of cervix and vaginal mucosa
- Goodell’s sign- softening of cervical tip
- Ballottement- rebound of unengaged fetus
- Braxton Hick’s contractions- false contractions; painless, irregular and usually relieved by walking
- Positive pregnancy test
- Fetal outline felt by examiner
Positive:
- Fetal heart sounds
- Visualization of fetus by ultrasound
- Fetal movement palpated by an experienced examiner
21
Q
discuss how to prepare a client for a pelvic exam
A
- empty bladder before exam
- no sex a few days before
- lithotomy position
- provide pads if bleeding
- don’t schedule on menses
22
Q
describe the position the client should assume for a pelvic exam
A
lithotomy
23
Q
list the s/e of an intrauterine device (IUD)
A
- irregular periods
- abdominal pain
- pain with intercourse
- fever/chills
- dislocation of IUD
24
Q
define linea nigra, chloasma, and striae gravidarum
A
skin changes:
linea nigra: dark line of pigmentation from the umbilicus to the pubic area
chloasma: pigmentation increases on the face
striae gravidarum: stretch marks around abd., breasts, and thighs
25
define and describe hydatidiform mole
A hydatidiform mole is a growing mass of tissue inside your womb (uterus) that will not develop into a baby. It is the result of abnormal conception. It may cause bleeding in early pregnancy
26
discuss ways for the pregnant client to prevent UTI
- wipe front to back
- drink lots of fluids
- avoid bubble baths
- cotton undies
- lose fitting clothing
- urinate before and after intercourse
- urinate when you feel like you have to go
27
what vitals signs would you expect in the hemorrhaging client who is pregnant
hypotension and tachycardia
28
list and describe the test for fetal lung maturity
Amniotic fluid is tested to determine whether the fetal lungs are mature enough to adapt a extrauterine life.
- Lecithin/sphingomyelin (L/S) ratio
- Presence of phosphatidylgylcerol (PG)
29
discuss the danger signs of pregnancy
- gush of fluid from the vagina
- vaginal bleeding
- abdominal pain
- changes in fetal activity (decreased)
- persistent vomiting
- severe headaches
- elevated temperature
- dysuria
- blurred vision
- edema of face and hands
- epigastric pain
- hyperglycemia (fruity breath, flushed dry skin, rapid breathing, increased thirst)
- hypoglycemia (clammy pale skin, tremors,, irritability, lightheadedness)
30
explain the functions of the placenta
- protect and nourish the baby.
- provide oxygen
- attaches to the uterine wall
- allows fetus to transfer waste products to the mother via bloodstream
31
list 5 food sources for iron
beef liver
fish
red meats
32
describe 2 medical conditions that are complicated by pregnancy
HTM
| DM
33
explain the GTPAL system of scoring a woman's OB history
- Gravidity
- Term births (38 weeks or more)
- Preterm births (from viability up to 37 weeks)
- Abortions/miscarriages (prior to viability)
- Living children
34
discuss the proper use of an IUD
IUD will stay in place in the upper uterus, strings will hang down through the cervix and the client must feel for them on occasion.
35
list the signs and symptoms of an ectopic pregnancy
- unilateral abd. pain that begins as a dull, lower quadrant pain. progress to dull pain, to colicky, sharp, stabbing pain.
- delayed 1 to 2 weeks menses
- scant, dark red, or brown vaginal spotting occurs 6-8 weeks after last menses
- referred shoulder pain due to blood in the peritoneal cavity
- faitness/dizziness r/t bleeding
- shock: hypotension, tachycardia, pallor
36
list the normal ranges for hemoglobin
12-16. 10 is danger
37
describe general function of each major organ of the male and female reproductive system
- Ovaries- produces eggs and sex hormones. Monthly prepares for a possible pregnancy by producing an ovum
- Fallopian tubes- Cilia sweep ovum into the fallopian tube; smooth contractions move ovum towards the uterus
- Uterus- If ovum is fertilized, implants in wall of uterus leading to pregnancy
- Cervix- Provides opening to uterus from vagina
- Vagina- Birth canal through which infant passes
- Testes/testicles- Sperm is produced
- Scrotum- Regulates temperature for sperm production
- Epididymis- Site where sperm are stored
- Vas deferens- Long tube that connects the epididymis to the urethra
- Penis- Deposits sperm in the female
38
discuss the purpose of non-stress test and explain how it's done
Most widely used technique for antepartum evaluation of fetal well-being performed during the 3rd semester. It is a noninvasive procedure that monitors response of the FHR to fetal movement. A Doppler transducer and a tocotransducer (used to monitor uterine contractions) are attached externally to a client’s abd to obtain tracing strips. The client pushes a button attached to the monitor whenever she feels a fetal movement, which is then noted on the tracing. This allows a nurse to monitor the FHR in relationship to the fetal movement.
39
list 3 food sources for folic acid
leafy veggies
peas
seeds
40
when should the pregnant client first feel fetal movement
by the 16th week
41
give examples of primary, secondary, and tertiary prevention
Primary- Education, teaching abstinence, effective birth control measures
Secondary- Encourage client to use contraceptives consistently and to detect early pregnancy
Tertiary- Counsel client about available options such as keeping the baby, adoption and abortion
42
list the equipment needed to perform a biophysical profile
ultrasound with transducer
43
list 6 common discomforts of pregnancy and client teaching for each
1. nausea/vomiting: should eat crackers (dry food) 30min to 1 hour prior to getting up in the morning to prevent feelings.
2. breast tenderness: client should wear a comfortable bra with room to breath.
3. urinary frequency: client should void full and often. don't drink right before bed. practice kegal exercises. wear pads.
4. UTI: avoid bubble baths, wipe front to back, cotton panties, loose underwear/pants
5. fatigue: simple solution --> rest often!
6. constipation: eat fiber. drink plenty of fluids. exercise 30 minutes 3x/week.
44
list the expected findings in a client who has had a ruptured ectopic pregnancy
- unilateral abd. pain that begins as a dull, lower quadrant pain. progress to dull pain, to colicky, sharp, stabbing pain.
- delayed 1 to 2 weeks menses
- scant, dark red, or brown vaginal spotting occurs 6-8 weeks after last menses
- referred shoulder pain due to blood in the peritoneal cavity
- faitness/dizziness r/t bleeding
- shock: hypotension, tachycardia, pallor
45
discuss normal weight for the pregnant client
general rule is 25-30 pounds total in pregnancy.
46
explain how fundal heigh relates to gestational age
After the first 16 weeks of pregnancy, your fundal height measurement often matches the number of weeks you've been pregnant.
47
list the questions to ask a client presenting with abnormal bleeding
how many pads have been saturated?
48
list the s/e of oral contraceptives
- chest pain
- sob
- leg pain from possible clot
- headache/eye problems
- stroke
- HTN
49
discuss the instructions for the client being discharged following an abortion
- Provide instructions on perineal care after each voiding and bowel movement and to change perineal pads often
- Encourage eating foods high in iron and protein to promote tissue repair and RBC replacement
- Recommend grief counseling/support groups
- Notify provider of heavy, bright red vaginal bleeding; elevated temperature or foul smelling vaginal discharge
- A small amount of discharge is normal for 1-2 weeks
- Take prescribed antibiotics
- Refrain from tub baths, sex or placing anything into the vagina for 2 weeks
- Avoid becoming pregnant for 2 months
50
calculate due date using Nagele's rule
first day of the woman's last menstrual cycle, subtract 3 months, and then add 7 days and 1 year.
ex: last period of April 1, 2013 --> due date is January 8, 2014
51
explain the variables in the biophysical profile (BPP). How are the scores interpreted.
Assesses fetal well being by measuring the following 5 variables with a score of 2 for each normal finding and a score of 0 for each abnormal finding:
- Reactive FHR (reactive nonstress test)- 2; nonreactive- 0
- Fetal breathing movements (at least 1 episode of greater than 30 seconds duration in 30 min)- 2; absent or less than 30 seconds duration- 0
- Gross body movements (at least 3 body or limb extensions with return to flexion in 30 minutes)- 2; less than 3- 0
- Fetal tone (at least 1 episode of extension with return to flexion)- 2; slow extension and flexion, lack of flexion or absent movement- 0
- Qualitative amniotic fluid volume (at least one pocket of fluid that measures at least 2 cm in two perpendicular planes)- 2; pockets absent or less than 2 cm- 0
52
explain the pros and cons of having a vasectomy
Pros:
- great conception form
- quick and simple
- sexual function is not impaired
Cons:
- requires surgery
- irreversible
53
explain TPAL scoring
- T- Term births (38 weeks or more)
- P- Premature births
- A- Abortions/miscarriages
- L- Living children
Term 4
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