NURS 210 OB Maternal Newborn ATI Proctored Notes ALL ANSWERS 100% CORRECT FALL-2021 SOLUTION GUARANTEED GRADE A+

Video #1: Contraception & Infertility  Diaphragms: client must be refitted for a diaphragm for the following conditions: 1.) Its been 2 years since she’s been fitted 2.) Gained more than 15 pounds (7kg) 3.) Had a full term pregnancy 4.) Had a second term abortion o When you use a diaphragm, you need to use spermicide with every act of coitus (withdrawal of penis from vagina prior to ejaculation). Every time you withdrawl, instill more spermicide o Diaphragm must stay inserted for 6hrs after act of coitus  Hormonal Contraceptives (Oral) o Side effects: Chest pain, SOB, Leg pain (from a possible clot), headache or eye problems (from a stroke or hypertension) o Contraindications: Women with a history of blood clots, stroke, cardiac problems, smoker, breast or estrogen related cancers (pill contains estrogen)  Depo-Provera/Medroxyprogesterone o Injectable progestin o Can cause decreased bone mineral density or loss of calcium  Nursing action: Ensure patient has adequate intake of calcium and vitamin D  IUD o Increase risk for PID o Can cause uterine perforation or ectopic pregnancy (increases risk for ectopic pregnancy) o Look out for/Notify PCP:  Change in string length  IUD is moving and not in the right place  Foul smelling vaginal discharge  Pain with intercourse  Fever/Chills (infection) Infertility is defined as an inability to conceive desire engaging in unprotected sexual intercourse for a prolonged period of time or at least 12 months.  Common factors associated with infertility include: o Decreased sperm production (Sperm analysis) o Endometriosis o Ovulation disorders o Tubal occlusions  If you test and use DYE (used in the fallopian tubes), make sure the woman is not allergic to iodine or shellfish/seafood Video #2: Signs of Pregnancy Presumptive: Can be defined by things/reasons other than pregnancy  Amenorrhea  Can be anorexic or exercising too much  Fatigue  Didn’t sleep well  Nausea/Vomiting  Sick  Urinary Frequency  UTI  Quickening/Fluttering in stomach  Gas Probable: Changes that make the examiner suspect a woman is pregnant (primarily related to physical changes of the uterus).  Abdominal enlargement: Related to changes in uterine size, shape, and position  Hegar’s Sign: Softening and compressibility of the lower uterus  Chadwick’s Sign: Deepend violet bluish color of cervix and vaginal mucosa  Goodell’s Sign: Softening of cervical tip  Ballottement: Rebound of unengaged uterus  Braxton Hicks Contractions: False contractions that are painless, irregular, and usually relieved by walking  Positive Pregnancy Test: Woman’s hormonal level may not be normal  Fetal Outline: Positive: Very distinct things.  Fetal Heart Sounds  Fetal Heart Beat can be heard  Can see the baby with ultrasound  Can feel movement in the uterus Naegele’s Rule: LMP – 3 months + 7 days + 1 year Cathy’s Rule: + 9 months + 1 week Know how to find out GTPAL numbers G= Gravidity (# of times a woman has been pregnant PLUS current pregnancy) T= Term Births (How many baby’s were delievered at term 38 WEEKS OR MORE) P= Preterm Births (Below 38 weeks) A= Abortion (spontaneous or not) or miscarriages L= Living children Video #3: Weight Gain & Nutrition During Pregnancy AND Diagnostic Tests During Pregnancy Weight Gain & Nutrition  Normal weight gain = 25- 35 pounds  Overweight person weight gain = 15- 25 pounds  Underweight person weight gain = 28-40 pounds  During 1st trimester  A woman should only gain 1-2 kg (2-4 pounds); A woman should not gain 1 pound per week.  During 2nd trimester  1 pound per week is normal; increase caloric intake by 340 calories per day  During 3rd trimester  1 pound per week is normal ; increase caloric intake by 450 calories per day  If you are breastfeeding after pregnancy  You still need to eat an extra 300-400 calories per day  Intake of FOLIC ACID  Helps prevent Neural Tube Defects (NTD)  Sources: dark green leafy veggies; orange juice  Women should increase their fluid intake to 2-3L per day  Women should limit their caffeine intake to  300 mg per day  No amount of alcohol is okay Diagnostic Tests During Pregnancy Noninvasive = Full Bladder Invasive = Empty Bladder Ultrasound  Bladder should be full to help sound waves resonate better Amniocentesis  Bladder should be empty Biophysical Profile (BPP): Scored from 0-10  Score between 8-10  Healthy Baby  Tests Measures 5 things o Reactive HR (0/2) o Breathing (0/2) o Body Movement (0/2) o Fetal Tone (0/2) o Amniotic Fluid Volume (0/2) Non-Stress Test (NST)  Non-invasive  Measures fetal well being within the last trimester of pregnancy  Measures response of FHR to Fetal Movement o Reactive: FHR accelerates during movement (normal; positive) o Nonreactive: No accelerations during movement (not normal; negative)  If non-reactive, the DR will perform another test called: Contraction Stress Test (CST) or a BPP Video #4: Diagnostic Tests Contraction Stress Test (CST)  Induce contraction with administration of Pitocin/oxytocin or nipple stimulation  During the contraction, monitor FHR for late decelerations  Negative CST Response (no late decels; which is what you want)  Positive CST (late decels happen; not a good thing)  Risk o Can send woman into PTL Amniocentesis  You want an empty bladder b/c you will poke into amniotic sac to test for genetic abnormalities (levels of AFP aka alphafeto-protein) o High AFP = NTD o Low AFP = Chromosomal disorders such as down syndrome  LS Ratio (Lecithin Sphingomyelin)  tests for fetal lung maturity o Ratio of 2:1 = fetal lung maturity o Ratio of 2.5:1 or 3:1 = fetal lung maturity for client with DM  Done around 14 weeks  Risks/Complications o Amniotic Fluid Emboli (AFE) o Hemorrhaging o Infection o Leaking of AF o ROM o Miscarriage Chorionic Villus Samping (CVS)  Alternative to Amniocentesis  Can be done between 10-12 weeks  Also tests for genetic abnormalities by testing the placenta instead of the amniotic fluid  Advantage  Can be done earlier Bleeding and Complications During Pregnancy Video #5  Ectopic Pregnancy  Ovum is planted outside of the uterus, often in the fallopian tube. Need to know the symptom of unilateral stabbing pain in the lower abdominal quadrant o If it burst the fallopian tube, it can be life threatening to the mom  Gestational Trophoblasic Disease (GTD)  the proliferation and degeneration of trophoblastic billi in the placenta that becomes swollen, fluid-filled, and takes on the appearance of grape-like clusters or prune juice.