NUR2513 Maternal Child Nursing Concept Guide Exam 1 (100% Reviewed & Verified Guide For Excellent Grades)

Concept Guide Exam 1 Maternal Child GYN/General  Trends currently influencing maternal child care? o Accidents are a leading cause of injury/mortality in the school aged populations  What influences the changes in the types of care required to support maternal child health issues? o Mobile, single, employed moms  Review 2020 National Health Goals for pregnancy- be able to provide recommendations from this info o stop smoking/alcohol use o eat a healthy diet o take potential natural vegetation o take folic acid 800mcg, 400mcg pre pregnancy o achieve optimal nutrition prior to conception  Know the strategies for smoking cessation o Following a designated smoking plan o Getting a support system o Ask MD if any meds can help o Get a friend involved in the plan *Nicotine patch can cause side effects – do not offer  Know the phases of the menstrual cycle and what happens during each o Menses – old blood and tissue from inside the uterus is shed o Proliferative – the uterus builds up a think inner lining o Secretory/luteal – the lining of the uterus releases of help the lining break down and shed if no egg was fertilized o Ischemic – shrinkage and degeneration of the endometrium  When is conception possible? o Conception can occur 2-3 days before ovulation and up to 1 day afterwards CONTRACEPTION  Hormonal and nonhormonal contraceptive options: (COC, IUD, Depo provera, NFP)  Hormonal o Progestin only pill (pill) o Combined oral contraceptives (pill) – smoking, hypertension, thrombosis o Levonorgestril releasing IUD  Watch for IUD strng length  Preventions of implantation, induction of an inflammatory response  99% effective Contraindications include abnormalities in uterine shape such as bicornate uterus or uterus septums o Nuvaring o Nexplanon (arm insertion) o Depo provera (shot) o Transdermal patch  Nonhormonal o Natural family planning o Copper IUD o Barrier methods:  Condom  Diaphragm  It is essential the diaphragm fits snugly in the vagina  Change every 2 years  Needs to remain in place for 6 hours after intercourse  Will need to get a new one if lost or gained weight  Need further teaching if the patient says 30lbs  Cervicle cap  Pap smears: what do they test for? When are they recommended? o Pap smears test for HPV o This test will happen on your first prenatal visit INFECTION  STIs and treatments- know what teaching you may need to provide re: behavior modification during treatment o Syphilis – Penicillin G – IM injections o Chlamydia – Zithromax PO o HSV – acyclovir or Valtrex PO o Trichomonas – metronidazole PO (must abstain from alchol during tx)  Partner must also be tested o BV – metronidazole PO o Candidiasis – terconazole vaginal cream (2nd trimester)  STIs: symptoms- recognize the symptoms related to each and be able to identify what testing would be used to diagnose o HSV cause genital warts and cancer. Tx provided after delivery. HPV can cause cervicle cancer and is treated with antibiotic o HIV o Chlamydia – bacterial infection. Asymptomatic. Can lead to PID. Treat with antibitoics o Trichomonas caused by protozoan parasite. S/s – yellow/ green discharge, dysuria, itching. Can lead to PID and infertility. Can also cause preterm labor. Treat with antibiotic. o Syphilis – 1st (chancre) 2nd (skin rash) 3rd (internal organ damage), treat with antibiotic o Vesicle lesions clustered = herpes**All infants administered azithromycin after delivery within 1-2 hours to prevent opthalmia neonatorum  Benefits and importance of folic acid supplementation o Preventing the development of open neutral tube defects o Not pregnant 400mcg o Pregnant 800mcg Pregnancy  Understand positive, probabale, and presumptive signs of pregnancy o Presumptive  Missed period  Nausea and vomiting  Urinary frequency  Uterine enlargement o Probable  Positive pregnant test  Abdominal enlargement  Hegar’s sign: softening of the lower uterus  Goodell’s sign: softening of the cervicle tip  Chadwhick’s sign: violet/blush color of cervix and vaginal mucous o Positive  Fetal heart sounds  Visualization of fetus on ultrasound  Know risks faced by the post term fetus o Macrosomia o Respiratory distress o Meconium aspiration o Stillbirth increases significantly at term with advancing gestation  What is omphalocele? o The infant's intestines, liver, or other organs stick outside of the belly through the belly button. The organs are covered in a thin, nearly transparent sac that hardly ever is open or broken.  Be able to articulate appropriate communications between families regarding pregnancy and new baby o Siblings need to feel comfortable that they are not being replaced and that the family is simply growing o Avoid taking items away from the sibling to give to the new baby o Offer to take care of the baby o Offer a gift from the baby to the child  Be able to calculate EDC from LMP o First day of LMP, subtract 3 months, add 7 days  Be able to create the GTPAL statement from an OB history o Gravida = total pregnancies o Term = full term 37-40 wks o Para = preterm 20-36 wkso Abortions = less than 20 wks includes miscarriages o Living children  When do moms feel first fetal movement? o 16-20 wks o Primigravida: 18020 wks o Multipara: 15-17 wks  Amniotic fluid- functions? o Cushions the fetus and protects against mechanical injury o Helps the fetus to maintain a normal body temperature o Allows for symmetrical fetal growth o Prevents adherence of the amnion to the fetus o Aids in fetal musculoskeletal development by providing freedom of movement o Essential for normal fetal lunch development  What could variances represent? o Hydramnios (or polyhydramnios) is more than 2000mls and while the cause is unknown, it is associated with congenital abnormalities o If fetus is unable to swallow (esophageal atresia or anencephaly are the two most common reasons), excessive amniotic fluid or hydramnios will result o Oligohydramnios is less than 500-400mls o Less fluid = less room for baby to move o Fetal urine adds to quantity of the amniotic fluids disturbances of the kidney function may cause oligohydramnios or a reduction in the amount of amniotic fluid  Normal weight gain in pregnancy: Normal BMI? Obese? o underweight <18.5: 28-40lbs o normal weight 18.5-24.9: 25-35lbs o overweight 25-29.9: 7-11.5lbs o obese >30: 5-9lbs  Effects of smoking on the growing fetus o Development of smaller placenta o Placenta ages more rapidly o Small for gestational age o Intrauterine growth resection  LGA baby  Asymptomatic  Decreased fundal height TESTING IN PREGNANCY  LABS in early pregnancy o 1st trimester  Pregnancy test  Dating ultrasound  Nuchal translucency  Blood type and Rh  Antibody screen  CBC RPR – detects syphyillis  Hep B and c  HIV  GC/CT  Urine drug screen o 2nd trimester * THERE IS A DECREASE IN BP o Labs typically drawn together between 24-28 wks:  Repeat CBC  Repeat HIV  1 hour glucose tolerance test  Repeat antibody screen in Rh negative  Anatomy scan o 3rd trimester  Group beta step (rectovaginal culture at 36 wks)  Baby kick count  FHR monitoring  Growth scan  MSAFP- what does it test for o Maternal serum alpha feta protein o Taken at 15-22 weeks to screen for down syndrome and neural tube defects o Tests for:  Trisomy 13 – patau syndrome  Trisomy 18 – edward syndrome  Trisomy 21 – down syndrome  ONTD  Quad screen – low birth weight, abnormally shaped head, clenched hands  Genetic testing: SCA and CF… it is important to understand how these disorders are passed on and what situations would be necessary o Both are autosomal recessive o Each parent must be a carrier of the gene or mutation in order to produce offspring with the condition FETAL DEVELOPMENT & OXYGENATION  What is surfactant? o Liquid made by the lungs that keep the airways open o An unborn baby starts making surfactant at about 26 weeks of pregnant o Prevents alveoli from collapsing on expiration  How is the fetus is oxygenated while in utero? o Placenta/placental perfusion o Mom is asking what if my baby is drowning? – baby is breathing through placenta  Fetal development stages: o Embryonic  From 2 – 8 weeks of life. During this time, organs are mainly formed. During rapid cell division and forming organs, if exposed to viruses or drugs, this can harm the fetus o Fetal From 9th week until birth ASSESSING THE FETUS:  Know what the expected fundal height should be for a gestation… also know what deviations could imply and what action would be appropriate o We assess fetal wellbeing at each visit by assessing the following:  Fetal movement  Fetal height  FHR o Fundal height: at 12 weeks should be at symphysis, 20 weeks at umbilicus, 40 weeks xiphoid process o After 20 weeks the fundal height should be in correlation in cm to the # weeks gestation. If it is less, possible IUGR or oligohydramnios (baby not growing or there isn’t enough fluid-can lead to kidney dysfunction) if it is greater, possible macrosomia or polyhydramnios (too much fluid, could indicate a congenital malformation) o Fundal height can be inaccurate if  Mom is obese  Mom is carrying multiples  Mom has fibrioids   Normal FHR Range o 110-160  Patterns of fetal movement o Pregnant women feel their baby's movements as a kick, flutter, swish or roll. As your baby grows, both the number and type of movements will change with your baby's activity pattern. Usually, afternoon and evening periods are times of peak activity for your baby.  Nonstress test- what is it, what makes it reactive/nonreactive; what is variability? If not reactive… what are some reasons? o FHR baseline o Variability – normal o Presence of accelerations (HR rises 15 beats above baseline for a duration of at least 15 seconds) o Absence of decelerations o Why not active? Baby might be sleeping, nonplacental insufficiency, placenta perfusion, hypoglycemia, drug use  Nonreactive within 40 minutes – do a BPP and CST  Biophysical profile- what is it, what does it assess? o Fetal movement o Fetal tone o Fetal breathing o Amniotic fluid o HR *Each receives a score of –2 points for a total of 10, the ultrasound is a total max of 8 What conditions will amniocentesis detect? Be able to give examples o Amniocentesis will allow for analysis of fetal genetics – trisomy 21 o It will assess for disorders directly related to genetic alterations or chromosomal abnormalitie FETAL MONITORING  Know FHR variability o Minimal: 0-5 BPM – baby is sleeping o Moderate: 6-25 BPM – healthy o Marked: >25 BPM – baby is in distress o Absent: 0 BPM – deliver baby  Early Decelerations o Fetal head compression o Decelerations occurs simultaneously with contraction; the nadir aligns with the peak  NO INTERVENTION NEEDED  Late Decelerations o Caused by uteroplacental insufficiency o Onset of the deceleration occurs after the beguinning of the contraction, and the lowest point of the deceleration occurs after the peak of the contraction  EXPIDITE DELIVERY  Variable Decelerations o Cord compression o Intrauterine resuscitation  MOVE POSITIONS INTAUTERINE RESUSCITATION  What are the steps? o Reposition patient – usually lateral o Increase rate of IV infusion o Administer o2 via face mask  Why? o Repositioning changed the shift of weight to allow for change in distribution to facilitate blood flow o Iv bolus speeds the rate of oxygen transport o O2 – hyperoxygenation mom- moms oxygenation directly impacts baby’s oxygenations NUTRITION IN PREGNANCY  How do we assess nutritional history? o Give a recall of the foods consumed in the past week using a diary  Nutrition: restrictive diets in pregnancy (vegetarian/vegan) will they need supplementation? o Poor protein, iron, zinc, calcium, and B12  IRON supplementation- how to take it o Normal hemoglobin in pregnancy is 11-12g/dLo Make sure to take with vitamin C to help with absorption (orange juice) o No not take with food. it will decrease absorption ASSESSING AND MANAGING PHYSIOLOGIC CHANGES IN PREGNANCY  PHYSIOLOGIC CHANGES: (what happens? Why? How to manage?) o Breast tissue?  Breast enlargement in preparation for lactation, darkening of the areola, sometimes accompanied by itching  Estrogen enlarges mammary glands and darkens the areola o Urinary frequency?  As the baby grows, it is common to experience urinary frequency due to the pressure that the baby is putting on the bladder  SYMPTOMS & Pregnancy related conditions: o What is first line management/recommendation for GERD in pregnancy?  Small, frequent meals  Avoid lying down after meals o What is hyperemesis gravidarium? What are the goals in the care of this patienthow would you measure that?  Persistent vomiting unrelated to other causes, a measure of acute starvation (usually KETONRUIA), and some discrete weight loss, most often 5% of the pregnancy weight  Differs from typical nausea and vomiting that affects 70% of pregnant woman in the extent of the physiologic effects  TPN!! o What is supine hypotensive syndrome?  In the supine position, the weight of the uterus compresses the vena cava reducing the blood return to the heart and resulting in decrease in BP  This results in decrease in tissue perfusion  Symptoms may be dizziness in mom and non-reassuring FHR/late decelerations in the fetus o Which maternal positions will facilitate fetal oxygenation?  Left side lying/lateral BLEEDING  Review the causes of vaginal bleeding in pregnancy. o Potential causes:  Placenta previa = nothing into the vagina  Placental abruption = IV, bedrest, tocolytic medications o Vaginal bleeding during pregnancy is always a deviation from normal o DO NOT DO A VAGINAL EXAM o Review details that will allow you to narrow down and focus on the possible cause.  Placental abruption causes pain, rigid abdomen, contractions every 1-2 minutes, dark red bleeding, NRFHR  Placenta abruption causes painless, bright red bleeding, soft abdomen may or may not have contractions, FHR and fetal movement may be stable  First action of assessment in placenta previa? o Placenta previa is an improperly planted placenta in the lower uterine segmento Assessments include fetal monitoring, VS, fetal heart rate, and fetal activity, bed rest in a side-lying position, ultrasound, IV fluids, AVOID VAGINAL EXAMS  Assess the baby – early deceleration: no intervention necessary  Late deceleration: due to uteroplacental insufficiency. Place the patient side-lying, administer IV fluids, d/c oxytocin, administer o2, palpate uterus for tachysystole, notify provider  Variable deceleration: due to umbilical cord compression. Place patient in knee-chest position, d/c oxytocin, administer oxygen  Assess the FHR MEDICATIONS  RHOGAM o What is the purpose of RhoGAM?  Rhogam prevents the development of sensitization (antibody formation) in the Rh neg moms carrying Rh positive baby. PREVENT CREATING ANTIBODY IN MOM.  It should be given during pregnant at 28 weeks  It should be given within the first 72 hours postpartum to moms who have delivered Rh positive fetus  Rhogam is also given when mom is at risk of being exposed to the fetus blood.  Considerations and expected orders for the patient on magnesium sulfate o Remember: the patient is receiving magnesium sulfate for either pre- e or pre term labor  She is on STRICT BED REST o Always use an infusion pump for administration and run the medication piggyback, not as the main line o Monitor pulse, blood pressure, respirations, and ECG. Respirations should be at least 16/min before each dose o Monitor neurological status throughout therapy o Monitor intake and output as well as renal function o Have a 10% calcium gluconate available should toxicity occur. o Provide 1:1 nursing care for women in labor who are receiving magnesium sulfate o Watch out for deep tendon reflexes disappear, monitor respirations q1hr, and monitor contractions and be ready with calcium gluconate PRETERM LABOR  What interventions would you expect to provide to the patient in preterm labor? o 2 main goals:  stop contractions (Hydrate, bedrest, administer tocolytics)  optimize fetal status prior to delivery (administer betamethasone for fetal lung maturity)  Steps: give a tocolytic, lie on left side, monitor FHR  What medications would be given? (know the purpose for each) o For mom  Nifedipine  Terbutaline – can cause tachycardia  Magnesium sulfateo For baby  Betamethasone  Dexamethasone  Testing with preterm labor o fetal monitoring (NST) o contraction monitoring o urinalysis o fetal fibronectin  What are tocolytic medications used for? … also know what they are o We give tocolytic medications to women when we want to relax the uterus or stop it from contracting o We would give this in instance of preterm contractions with signs of a living, viable fetus o We would not give in cases of full term or fetal death o Meds include  Terbutaline  Nifedipine  Magnesium sulfate GESTATIONAL DIABETES  What is Gestational Diabetes?  What are the risks to the fetus in Gestational diabetes? o Macrosomia – it increases the risk for birth trauma (shoulder dystocia), also impact fetal blood glucose regulation following delivery  Understand nutritional counseling for the patient with gestational diabetes? o Appropriate carbohydrate and protein intake; appropriate caloric consumption  Recommendations for exercise? How would we manage energy consumption concerns? o Maintain active plan of exercise – do not initiate a new strenuous plan…stick with low impact…know that energy consumption will be increased during exercise. Eat an appropriate carbohydrate sustaining snack prior to exercise  What are the potential effects of elevated blood glucose during the first trimester? o Link to congenital abnormalities  CNS  Musculoskeletal system  Renal system  CV  GI  What is glycosuria a possible indication of? What testing would be indicated? o Glucosuria may be an indicator of gestational diabetes o Further indicated via assessment of serum HGB A1C, fasting glucose, or GTT PREECLAMPSIA/HTN  What is gestational hypertension? … how does that impact nursing care (consider nursing diagnoses and interventions) o Consider vasoconstriction associated with hypertension and ho this will impar perfusion to the tissueso Nursing care will be aimed at improving tissue perfusion  What are our goals and interventions in caring for the patient with preeclampsia? o Goals: prevention of injury  Bed rest  Reduce stimulation  Pad the side rails  Administer magnesium sulfate  Deliver the fetus  What is HELLP syndrome? o (Hemolysis, Elevated Liver enzymes and Low Platelets) syndrome is a lifethreatening pregnancy complication usually considered to be a variant of preeclampsia. Both conditions usually occur during the later stages of pregnancy, or soon after childbirth. o Hemolysis – leads to anemia o Elevated liver enzymes – epigastric pan o Low platelets – abnormal bleeding/clotting (VITAMIN K) o Contraindication with epidural EPIDURAL  What are some exclusion criteria for epidurals? o Anemia, thrombocytopenia o So, consider the patients with these conditions may not be a safe candidate for an epidural o Epidural block – eliminates sensation from umbilicus to thighs. Administer when mom is at least 4cm dilated. DO NOT GIVE IT WHEN THE PT IS HAVING HEELP SYNDOME o S/S: hypotension, fetal bradycardia  What physiologic changes might we expect with epidural placement? How do we prep the patient? o Hypotension – give IV LR o We prep for this by administering a bolus of at least 500ml of LR prior to the procedure o DO NOT GIVE IF THE PATIENT IS EXPERENCING HELLP SYNDOME LABOR  Stages/phases of labor o Patient must be actively contracting o First stage: 0-10cm  Latent phase: 0-3 cm  Active phase: cervicle changes of 0.5-1cm/hr, contractions are longer than 60 seconds and more frequent  Transition: more rapid cervicle changes 1-1.5cm/hr. contractions are longer 60-90 seconds), stronger, and more frequent. They ay start to feel pelvic or rectal pain o Second stage: fully dilated, pushing, delivery o Third stage: after delivery of the fetus through the placental delivery  Nonpharmacologic pain management in laboro Pharmacologic:  IV/IM opioid medications, epidural, pudendal block o Nonpharmacological:  Hydrotherapy  Massage  Birthing ball  Breathing technqiues  Methergine, Cytotec, oxytocin o Oxytocin – used to stimulate the uterus to contract o Cytotec - cervicle ripening, and to induce labor o Methergine - You use it for post-partum hemorrhage o **need to know when to give it and who to give tocolytic  At 32 weeks of pregnancy a woman experiences preterm labor. Although tocolytics are administered and she is place on bed rest, she continues to experience regular contractions and her cervix is beginning to dilate and efface. What additional medication should be considered to assist the development of the fetus o Bethamethasone  THIS IS TO HELP WITH FETAL LUNG MATURITY  The student nurse is learning that is recommended to screen for domestic violence in the first prenatal visit for all clients. The instructor has explained how to communicate and ask questions that are personal, so which question would be the best stated for the student nurse to ask? o “This is something that we ask everyone. Do you feel safe in your current living environment and relationships?