Summary ATI Maternal Newborn 2020 fully covered

Main topics covered on proctored & need to know information* PLUS PROCTORED EXAM 2020 QUESTIONS Contraception: à Diaphragms o Must be refit every 2 years, if client has gained more than 15 lbs, and if becomes pregnant o You must use spermicide with every act of coitus interruptus; every time you withdrawal, more spermicide should be instilled o Do not remove diaphragm for 6 hours following sexual intercourse à Oral contraceptives o Side effects: chest pain, SOB, leg pain, increased risk for DVT, headache, vision problems, stroke, hypertension o Contraindicated in women with histories of blood clots, stroke, cardiac conditions, smoking, breast or estrogen related cancers à Depo-Provera AKA Medroxyprogesterone o Injectable progestin; key piece of information to know – can cause decreased bone mineral density and/or loss of calcium ****** Presumptive signs of pregnancy: other conditions may cause these signs to occur © Amenorrhea © Fatigue © Nausea, vomiting © Urinary frequency © Quickening (“stomach flutter”) Probable signs of pregnancy: © Hegar’s sign © Chadwick’s sign © Ballottement © Braxton hicks contractions © Positive pregnancy test Positive signs of pregnancy: © Fetal heart sounds heard © Baby seen via ultrasound © Fetal movement felt GTPAL: G = gravidity: number of times a woman has been pregnant, including current pregnancy* (don’t forget) T = Term births: numbers of babies delivered at 37 weeks+ P = Preterm births: number of babies born before 37 weeks A = Abortion: spontaneous or miscarriages L = Living children Routine lab tests: © Blood type, Rh factor, © CBC with differential, hgb, and hbt - anemia © Rubella titer © Hep B screening © Group B strep – 35-37 weeks gestation © Urinalysis – identifies pregnancy, DM, gestational HTN, renal disease, infection © 1 hr glucose tolerance test! o 24-28 weeks o > 140 mg/dl = follow up with 3 hr glucose tolerance test © 3 hr glucose tolerance test o Screening tool for DM; diagnosis is based on two elevated glucose readings © MSAFP – between 15 and 22 weeks o Used to rule out down syndrome (low levels) and neural tube defects (high) Biophysical Profile (BPP): à (5) variables o Reactive FHR o Fetal breathing movements o Gross body movements o Fetal tone o Qualitative amniotic fluid volume (2 = adequate, 0 = not) à Score of 8-10 = normal; low risk for chronic fetal asphyxia Amniocentesis: à Aspiration of amniotic fluid w/ needle into client’s uterus & amniotic sac with use of an ultrasound à May be performed after 14 weeks gestation** à Alfa-fetoprotein (AFP): 16-18 weeks gestation – neural tube defects or chromosomal disorders o High levels = neural o Low levels = down syndrome à Fetal lung maturity: 37 weeks gestation; obtains lecithin/sphingomyelin (L/S) Ratio (normal = 2:1) Chorionic villus sampling: à Assessing portion of developing placenta; 1st trimester, 10-12 weeks à Determines genetic chromosome abnormalities Quad marker and alpha-fetoprotein screening: à Likelihood of fetal birth defects; 16-18 weeks gestation Vaginal bleeding during pregnancy = ALWAYS ABNORMAL!! Occurring in 1st trimester: spontaneous abortion, ectopic pregnancy Occurring in 2nd trimester: gestational trophoblastic disease Occurring in 3rd trimester: placenta previa, abruptio placentae Preterm labor: © Uterine contractions & cervical changes occurring between 20-37 weeks © Diagnosis: fetal fibronectin between 24-24 weeks*** © Medications o Nifedipine – monitor for ortho hypotension © Magnesium sulfate (#1!!!) o Tocolytic that relaxes smooth muscle, thus inhibiting uterine activity o Discontinue if signs of pulmonary edema present © Betamethasone (another really important one!!) o Administered IM in two injections 24 hours apart; given to increase fetal lung maturity