ATI Capstone Maternal Newborn Assessment CORRECT ANSWERS

What hormone is the basis for pregnancy testing? - ANSWER ==Human chorionic gonadotropin Excreted by the placenta and promotes the excretion of progesterone and estrogen. Uterine fibroid - ANSWER ==Can increase the risk for postpartum hemorrhage due to the increase in blood supply to the uterus, which supports the fibroid. Will undergo serial US examinations during pregnancy to monitor because they are likely to grow during pregnancy in response to the increased circulating estrogen. Can have a vaginal delivery if it is small and not near the cervical os. Hydatidiform mole - ANSWER ==AKA a molar pregnancy. A benign proliferative growth of the chorionic villi, which gives rise to multiple cysts. The products of conception transform into a large number of edematous, fluid-filled vesicles. As cells slough off the uterine wall, vaginal discharge is usually dark brown and can contain grape-like clusters. Alleviating lower back pain during the latent phase of labor - ANSWER ==Counterpressure applied to the client's sacral area during contractions. This lifts the fetal head away from the sacral nerves, which decreases pain. Preterm labor - which medication should the nurse plan to administer? - ANSWER ==Betamethasone IM A glucocorticoid that stimulates fetal lung maturity and thereby prevents respiratory depression. Methylergonovine - ANSWER ==An ergot alkaloid. For patients experiencing postpartum hemorrhage. Stimulates uterine contractions. Poractant alfa - ANSWER ==A synthetic lung surfactant. Administer to a preterm newborn who is experiencing respiratory distress. Misoprostol - ANSWER ==Stimulates uterine contractions for a client who is undergoing labor induction. Oligohydramnios - ANSWER ==A volume of amniotic fluid less than 300 mL during the third trimester. Occurs when there is a renal system dysfunction or obstructive uropathy. Absence of fetal kidneys will cause this. What causes late decelerations? - ANSWER ==Fetal hypoxemia due to insufficient placental perfusion. Treatment of late decelerations - ANSWER ==Reposition the client, initiate oxygen, and increase the infusion rate of IVF to enhance placental perfusion. What causes early decelerations? - ANSWER ==Fetal head compression. What causes variable decelerations? - ANSWER ==Compression of the umbilical cord. Often occurs after ROM. Nagele's rule - ANSWER ==Count back 3 months from the first day of the LMP, then add 7 days. Most accurate means of obtaining client's F&E status? - ANSWER ==Daily weights! Placenta previa - ANSWER ==The placenta implants in the lower part of uterus and obstructs the cervical os. Avoid vaginal examinations, which can cause tearing of the placenta and increased bleeding. What should you do if a client that is in labor has moderate bright red vaginal bleeding? - ANSWER ==Obtain blood samples for baseline laboratory values (Hgb and Hct). The patient should be on strict pelvic rest (no vaginal exams or ultrasounds). Early manifestation of gestation HTN or pre-eclampsia - ANSWER ==Blurred or double vision Swollen face Decreased urinary output Proteinuria Decreased fetal activity Should a pregnant patient be concerned about increased white vaginal discharge? - ANSWER ==No. An increase in vaginal discharge can occur due to the cervix becoming hyper-stimulated from an increase in hormones. Probable signs of pregnancy - ANSWER ==- Chadwick's sign - Positive pregnancy test Presumptive signs of pregnancy - ANSWER ==Amenorrhea Can also occur due to stress, endocrine disorders, and significant weight loss Quickening (client's report of fetal movement) Chadwick's sign - ANSWER ==A bluish discoloration in the cervix, vagina, and vulva that occurs at 6-8 weeks. Probable sign of pregnancy. After first pregnancy, the discoloration can remain, making it of little value as an indicator in subsequent pregnancies. Positive signs of pregnancy - ANSWER ==- Palpable fetal movements Other causes of positive pregnancy test - ANSWER ==- Menopause - Choriocarcinoma - Hydatidiform mole HIV positive mother - ANSWER ==Continue to take zidovudine throughout pregnancy to decrease the risk of transmission to the newborn. Use a condom during sexual intercourse. NO BREASTFEEDING! Bladder during abdominal US? - ANSWER ==Needs to be full to help lift the gravid uterus out of the pelvis during the exam. Determining the length of the cervix? - ANSWER ==Transvaginal US. Second and third trimesters to assess for preterm labor. Non-stress test: FHR = 130/min No accelerations for 10 mins Nursing action? - ANSWER ==Use vibroacoustic stimulation on the client's abdomen for 3 seconds to elicit fetal activity because the fetus is most likely sleeping. Fetal movement should cause accelerations in the FHR. When is a non-stress test determined to be non-reactive? - ANSWER ==After 40 minutes of continuous monitoring without accelerations in the FHR despite vibroacoustic stimulation. Pre-eclampsia treatment - ANSWER ==Magnesium sulfate Can expect feeling warmth all over body and sedation while infusing. Have calcium gluconate at bedside!! When should the nurse report BP in a patient with pre-eclampsia? - ANSWER == 160/110 Signs of magnesium toxicity - ANSWER ==Loss of deep tendon reflexes Respiratory rate 12 breaths/minute Muscle weakness Urine output and pre-eclampsia... - ANSWER ==If output is 20 mL/hr, it can indicate inadequate renal perfusion. If patient is receiving magnesium sulfate, this increases the risk for toxicity developing. A decreased urinary output can also indicate a decrease in renal perfusion s/t worsening of the client's pre-eclampsia. How often should the client feel the fetus move each hour? - ANSWER ==At least 3 times per hour Nursing instruction for client reporting constipation - ANSWER ==Moderate physical activity, such as walking at least 30 minutes every day or swimming. Increases intestinal peristalsis, which can help alleviate constipation. DO NOT consume mineral oil because it can lead to severe cramping, diarrhea, fluid loss, and preterm contractions. Decrease red meat consumption because it is high in iron and contributes to constipation. Cervical cerclage - ANSWER ==Used for incompetent cervix Prevents premature opening of the cervix during pregnancy. Can expect spotting for 1-2 days after placement. Do not resume sexual intercourse until provider gives approval at postop visit. Immediately go to a facility for evaluation if experience any manifestations of labor while in place. Administration of Rho(D) immune globulin - ANSWER ==At 28 weeks of gestation and again within 72h if the newborn is Rh-positive. Mother is not immune against rubella... - ANSWER ==Receive immunization after delivery Polyhydramnios - ANSWER ==The presence of excessive amniotic fluid surrounding the unborn fetus. Expected findings: GI malformations and neurologic disorders in the fetus. Can be detected by a fundal height greater than expected for gestational a