NURS 306 PREGNANCY AND LABOR (WEEK 2+PCA) ACTUAL EXAM QUESTIONS AND ANSWERS.

Assessment for Risk Factors 1-Biophysical -from mother or fetus >genetic >medical 2-Psychosocial >smoking >drugs 3-Sociodemographic >age >ethnicity >marital >income 4-Environmental >chemical >radiation Nurse's Role in Antepartal Test ‐Provide information ‐Provide comfort ‐Provide reassurance ‐Documentation +consent +resources/referals Ultrasonography (General) Ultrasound use varies based on trimester and is used to obtain vital info such as: -Presence of gestational sac -Gestational age -Fetal growth -Fetal anatomy and presentation when performed in the *2nd & 3rd trimesters -Placental location & possible abnormalities -Fetal activity -# of fetuses -Viability -Amount of amniotic fluid -Visual assistance for some invasive procedures, such as amniocentesis Onset of Labor (Bloody show) blood-tinged mucus created by extrusion and passage of the mucous plug that filled the cervical canal during pregnancy Ultrasonography (Types) Standard Limited obstetric Specialized 3D & 4D Mechanism of Labor (Cardinal movements) Engagement 2 -greatest diameter of the head passes the pelvic inlet Descent 2 -fetus through the birth cannal Flexion 2 -Chin moves to the chest Internal rotation 3 -head aligns to the long axis Extension 4-5 -resistance of the pelvic floor, pubic symphysis, & head External rotation 6 -head angles (& exits) -shoulders rotate Expulsion 7 -head and anterior shoulder exit followed by the rest of the body Ultrasonography (Types-Standard) -fetal presentaiton -placental position -amniotic fluid volume -cardiac activity -gestational age -measurements -fetal # -fetal anatomy Labor Labor is the process in which the fetus, placenta, and membranes are expelled through the uterus. MD = 92.1% CNM= 8.1% -certified nurse midwife Ultrasonography (Types-Limited obstetric) Performed when focused/fetal ultrasound indicates need for further evaluation -amniotic fluid volume -interval growth -cervix -crown rump length -confirm fetal cardiac activity -fetal presentation -embryonic # -confirm yolk sac or uterine sac Labor Stages Divided into 4 stages 1st stage -Latent -Active -Transition 2nd stage 3rd stage 4th stage Ultrasonography (Types-Specialized) is used for targeted or detailed anatomic examination when an anomaly is suspected via other tests Labor Stage (1st) Divided in to 3 stages ‐Latent ‐Active ‐Transition Assess ‐V/S ‐FHR/UCs ‐Cervical changes (SVE) ‐Fetal position and descent >by cm -3 behind the pelivs >+3 cm ahead of the pelvis >O= the pelivs Gensation? Ultrasonography (Types-3D & 4D) Similar to fetal ultrasound in purpose & function Finds Complications: -vaginal bleeding -ventriculomegaly -hydrocephaly -congenital brain defects Diagnosis of: -uterine or pelvic abnormalities -hypoxic ischemic brain injury -inflammatory disorders 3D-presentation of placental blood flow 4D-allows for evaluation of brain morphology & ID of brain lessions Labor Stage (1st-Latent Phase) Dilation ATI-0-3 cm Book‐0-4cm Effacement ‐0-40% ATI- UCs q 5-30 min lasting 30-45 sec UCs q 5-10 min, mild intensity, lasting 30-45 sec Mild discomfort (strong cramps) Ultrasonography (Procedure) Transvaginal ultrasound -generally performed as 1st trimester for early visualization >woman in lithotomy position -sterile covered probe/transducer inserted into the vagina Abdominal ultrasound -full bladder elevates the uterus to be examined in the 1st half of pregnancy -supine position -gel is applied and abdomen is examined Ultrasonography (Inications) Use changes varies on trimester Commonly used to obtain vital information: -Presence of gestational sac -Gestational age -Fetal growth -Fetal anatomy & presentation (2nd & 3rd) -Placental location -Possible abnoramilites