PPN 301 FINAL REVIEW PACK – QUESTIONS ANSWERED AND EXPLAINED FOR BETTER UNDERSTANDING

1. Define term - ANSWER 37w-40w6d 2. define early term - ANSWER 37w - 38w6d 3. Define full term - ANSWER 39w - 40w6d 4. Define later term - ANSWER 41st week 5. Post term - ANSWER after 42w 6. What are some presumptive signs of pregnancy? - ANSWER No period N/V Fatigue Increased urination Breast changes Quickening skin changes 7. What are some probably signs of pregnancy? - ANSWER -enlarged abdo -braxton hicks end of 1st trim -skin changes like striae and increased pigment -pos preg test (can be preg, ectopic, or miscarriage) -hegar's sign (softening lower uterine segment at 6 w) -Goodell's sign (softening of cervix) -chadwick's sign (blue-violet hue on vulva, vagina, cervix) 8. What are positive signs of pregnancy? - ANSWER fetal heart tones (u/s 4 - 8 w after conception; doppler 10-12wk) 9. fetal movement felt by examiner 18-20w 10. u/s visualization of fetus 5-6w 11. What is hegar's sign? - ANSWER Uterine softening at 6w 12. What is ballottement? - ANSWER Light tap of examining finger on cervix causes fetus to rise in amniotic fluid & then rebound to original position (16-18 wks) 13. probably sign of pregnancy 14. What is Goodell sign? - ANSWER Cervical tip softening 6w probably sign of pregnancy 15. What is Chadwick's sign? - ANSWER blue-tint to cervix, vagina, and vulva 16. What respiratory system changes would you expect as an adaptation to pregnancy? - ANSWER - increase o2 consumptions -change from abdominal breathing to thoracic breathing -increased vascularization in upper resp tract d/t estrogen -nasal and sinus stuffiness, nosebleeds, and voice changes 17. What is vena cava syndrome? - ANSWER -supine hypotension due to lack of collateral circulation, note systolic fall of up to 30mmHg, reflex bradycardia, CO reduced by half, pt feels faint -can occur when pt lays down flat, fix by moving positions 18. What changes do you expect in a pregnant person's hemoglobin levels? - ANSWER decreased 19. What changes do you expect in a pregnant person's hematocrit levels? - ANSWER decrease 20. Why are pregnant people prone to gallstones? - ANSWER increased hormones during pregnancy can cause higher cholesterol levels and delayed gallbladder emptying which can lead to gallstones 21. What is Naegele's rule? - ANSWER Add 7 days to the first day of the LMP and subtract 3 months to determine EDB 22. What is the McDondald method? - ANSWER to measure fundal height + estimate gestational age 23. use tape measure; CM from top of symphysis pubis to top of uterine fundus 24. What is quickening? - ANSWER the awareness of fetal movement; usually between 16-22 weeks gestation 25. definition of low birth weight infant? - ANSWER 2500g or less 26. What is the recommended additional caloric intake for 1st trimester pregnancy? - ANSWER same as non-pregnant 27. What is the recommended additional caloric intake for 2nd trimester pregnancy? - ANSWER 340 kcal 28. What is the recommended additional caloric intake for 3rd trimester pregnancy? - ANSWER 452 kcal 29. What is the recommended weight gain for someone whose BMI is < 18.5 (underweight) - ANSWER 12.5 - 18 kg 28-40lb 30. What is the recommended weight gain for someone whose BMI is 18.5 - 24.9? - ANSWER 11.5 - 16 kg 25-35 lb 31. What is the recommended weight gain for someone whose BMI is 35 - 29.9? - ANSWER 7 - 11.5 kg 15-25 lb 32. What is the recommended weight gain for someone whose BMI is > 30? - ANSWER 5 - 9 kg 11-20 lb 33. How frequently should a patient go for prenatal visits until 28w gestation aka end of 2nd trim? - ANSWER q1mo 34. How frequently should a patient go for prenatal visits from 28w-36 wk? - ANSWER Q2w 35. How frequently should a patient go for prenatal visits from 37w 40w? - ANSWER Q1w however a high-risk pregnancy will require more frequent visits. 36. what are the NI for PROM/PPROM? - ANSWER observation + mgmt if low r/f infection NST BPP (monitor fetal health antibiotics mag sulph if < 34w emotional support ax fetal movement (6/2hr; if not further antenatal testing NST, BPP or both req) introduce nothing to vagina 37. what are complications of PROM? - ANSWER chorioamniotis (dx w fever, mat + fet tachycardia, uterine tenderness, foul odour from amniotic fluid) cord prolapse and umbilical cord compression associated with oligohydramnios 38. Late term vs post term pregnancy - ANSWER late term 41w post term 42w 39. What are the risks for post term pregnancies? - ANSWER primigravida male fetus genetic predisposition 40. What are NI for post term pregnancies? - ANSWER fet ax beginning at 41w daily fet mvmt, NST, AFV ax, CST, BPP, and dopper flow pt teaching >daily fet mvmt count >signs of labour >call PCP if membranes rupture or decrease fet counts 41. what are NI for labour dystocia - ANSWER supportive care positional change induction/augmentation of labour promote ripening of cervix caesarean external-cephalic manoeuvre forceps/vacuum 42. complications of labour dystocia - ANSWER hemorrhage fetal distress infection uterine rupture perineal trauma pelvic trauma obstrical fistual dislocate pelvis 43. What are some latent phase abnormal uterine activity leading to dystocia? - ANSWER hypertonic uterine dysfunction exhaustion 44. What are some active phase disorders related to abnormal uterine activity? - ANSWER no progress in labour; hypotonic uterine dysfunction labouring patient initially makes normal progress into active stage of labour then contractions become weak and inefficient or stop altogether 45. What are some causes of active phase disorders leading to dystocia? - ANSWER cephalopelvic disproportion 46. fetal malposition (extension of fetal head) 47. What are some alterations in pelvic structure leading to dystocia? - ANSWER congenital abnormalities immature pelvic size placenta previa uterine fibroids ovaraian tumours 48. What are some alterations in passenger leading to dystocia? - ANSWER neural tube defects cephalopelvic disproportion (macrosomia) malpositino mal-presentation (breech or transverse) multifetal pregnancy 49. Why might you see obstetrical fistual? - ANSWER labour dystocia pressure > decreased blood perfusion to areas > eventual no flow > necrotic tissue > fistula 50. What are some post-partum outcomes after fetal hypoxia d/t cord compression? - ANSWER neonatal hypoxic-ischemia encephalopathy cerebral palsy neonatal death 51. what complications can occur from cord prolapse - ANSWER temperature of cord: vasospasm >> impacts oxygenation and nutrients 52. What is McRobert's Maneuver? - ANSWER Used to manage shoulder dystocia during delivery of the infant. Maternal legs are removed from stirrups and sharply flexed upon the abdomen. 53. What are s/s of amniotic fluid embolism? - ANSWER respiratory distress (restless, dypnea, cyanosis, pulmonary edema, respiratory arrest) circulatory collapse (hypotension, tachycardia, shock, cardiac arrest) heorrhage (coagulation failure, uterine atony) 54. What are the NI for amniotic fluid embolism? - ANSWER O2 (10L/min) BVM at 100% o2 prepare for intubation and mechanical ventilation initiate or assist with CPR Tile pregnant patient 30 degrees to side to displace uterus Maintain CO + replace fluids (place pt on side, IV fluid, blood, measure I & O) Monitor fetus Prepare emergency birth once patient's condition stabilized 55. How is preterm labour predicted? - ANSWER fetal fibronectin test cervical length < 30mm 56. What are some contraindications of tocolytics - ANSWER -severe pre-eclampsia or severe gestational hypertension -sign vag bleeding -intrauterine infection (chorioamnionitis) -cardiac disease -medical or obstetrical condition that contraindicates continuation of pregnancy -gest age > 37 - fetal demise -lethal fetal anomaly -evidence of acute or chronic fetal compromise 57. What is used to manage inevitable preterm birth - ANSWER mag sulph to reduce or prevent neborn neuro morbidity 58. Nursing care for tocolytic therapy - ANSWER - education -reposition lateral position to enhance placental perfusion - montior VS, lung sounds, resp effort, FHR and pattern, and labour status - assess pt and fetus for s/s adverse reactions -fluid balance -psychosocial support to pt and fam -encourage diversional activities and relaxation techniques 59. PROM vs PPROM - ANSWER PROM: after 37 weeks PPROM: before 37 weeks 60. What are the risks for (P)PROM? - ANSWER >hx prior preterm birth/prom >hx cervical surgery or cerglage >infection >short (<25mm) cervical length in 2nd trim >Preterm labour or symptomatic contractions in the current pregnancy >uterine overdistension >low BMI + SES >connective tissue disorders >pulmonary disease >copper and ascorbic acid deficiency >cig 61. When is the uterus expected to return to normal postion postpartum? - ANSWER 6 weeks 62. How long is lochia rubra expected? - ANSWER 3-4 days 63. How long is lochia serosa expected? - ANSWER 2-4 weeks 64. How long is lochia alba expected? - ANSWER 4 - 6weeks 65. What are potential signs of post partum hemorrhage? - ANSWER soaking pads 1-2 hrs passing clots > golf ball SOB lighteheaded chest pains palpitation 66. What is primary PPH? - ANSWER within 24 hours of delivery 67. What can cause primary PPH? - ANSWER uterine atony genital laceration retained products of conception uterine rupture uterine inversion DIC 68. What is secondary PPH? - ANSWER occurs more than 24h but less than 12w postpartum 69. What causes secondary PPH? - ANSWER subinvolution of uterus (not shrinking back to size) retained products of conception infeciton coagulopathy (like DIC) 70. When is Rhogam given? - ANSWER 28 weeks and within 72 hours of delivery 71. How can a nurse assess the intensity of a contraction? - ANSWER Uterus can be indented with gentle pressure at the peak of contraction Mild: like tip of nose Moderate: tip of chin Strong: cannot be indented, like forehead 72. How is the frequency of uterine contractions measured? - ANSWER number of contractions in a 10-minute period averaged over 30 mins 73. What is the RADAR tool? - ANSWER IPV screening tool Routinely ask about IPV Ask directly Document Assess safety Review options 74. What is the HITS tool? What does a score of 10 mean? - ANSWER IPV screening tool 75. Total score 10 or > suggestive of IPV 76. What are birth alerts - ANSWER Controversial practice of sharing a pregnant person's personal information between social workers and HCW without consent diproportionately affected Indigenous and Black families Stopped in ontario in 2020 77. When is early loss? - ANSWER before 12 weeks 80% of early pregnancy loss occurs before 12 weeks gestation 78. When is late loss? - ANSWER 12 - 20w 79. risks: advanced mat age, premature dilation of cervix, chronic infection, drug use 80. How long should pregnancy be postponed after pregnancy loss? - ANSWER 2 months 81. What are the 3 types of placenta previa? - ANSWER Marginal: low lying in the uterus, 3cm from the internal cervical os 82. Partial/marginal: < 3cm away from internal cervical os, but does not cover it completely 83. Total: placenta completely covers the cervical os 84. What are the clinical presentations of placental previa in late pregnancy? - ANSWER bright red bleeding pain absent uterine normal normal FHR diagnosis made with transabdominal or vaginal ultrasound 85. What does the BPP score? - ANSWER Fetal breathing, movements, and tone AFI NST 86. How do you score a BPP? - ANSWER Normal score = 2 Abnormal score = 2 87. How do you get a full score on fetal breathing for BPP? - ANSWER One or more episodes in 30min each lasting 30 or more seconds 88. How do you get a full score on fetal movements for BPP? - ANSWER At least 3 trunk or limb movements in 30 mins 89. How do you get a full score on fetal tone for BPP? - ANSWER At least one episode of active extension with return to flexion of fetal limb or trunk; opening and closing of hand is considered normal tone 90. How do you get a full score on amniotic fluid index for BPP? - ANSWER at leas tone cord and limb-free fluid pocket that is 2cm x 2cm at right angles 91. How do you get a full score on nonstress test for BPP? - ANSWER May or may not be done looking for normal 92. What are expectant managements for placenta previa? - ANSWER no vaginal or rectal exams U/s exam may be done q2w bleeding ax by bleeds on perineal pads (weigh pad; 1g = 1mL blood) 93. Fetal surveillance (may include NST and/or BPP) q1-2w 94. Betamethasone 95. What is the classification system for placental abruption? - ANSWER Grade 1: mild Grade 2: moderate Grade 3: severe 96. Based on clinical presentation: vaginal bleeding, abdominal pain, unterine tenderness, and contractions 97. How much blood loss is anticipated in class 1 placenta abruption? - ANSWER minimal < 500mL 98. How much blood loss is anticipated in class 2 placenta abruption? - ANSWER absent or moderate mL 99. How much blood loss is anticipated in class 3 placenta abruption? - ANSWER Absent to heavy >1500mL 100. Couvelair uterus - ANSWER life-threatening condition 101. loosening of placental causes bleeding that penetrates into the uterine myometrium forcing its way into the peritoneal cavity 102. o/e uterus tense and rigid 103. Gestational hypertension - ANSWER develops after 20w 104. Proteinuria concentration for pre-eclampsia and eclampsia - ANSWER 0.3g/L per 24h 105. What is the main pathogenic factor in pre-eclampsia? - ANSWER poor perfusion resulting from vasospasm (not increase in BP) arteriolar vasospasm diminishes the diameter of blood vessels, which impedes blood flow to all organs and increases BP 106. When is universal screening for GDM? - ANSWER 24-28w 107. What is the normal range for 50g 1 hr glucose challenge test - ANSWER < 7.8 mmol/L 108. What is the range for glucose tests for GDM? - ANSWER FPG: >5.3 75g 1 hPG > 10.6mmol/L Or 50g 1 hPG > 11.1 mmol/L 2 hPG >9 mmol/L 109. Is a pregnant person expected to have a higher or lower plasma glucose compared to non-pregnant people? - ANSWER lower < 7.8 mmol/L in pregnant people < 11.1 mmol/L in non pregnant 110. this is d/t expected physiological changes in pregnancy r/t hyperinsulemia 111. Where is the narrowest point in the pelvic cavity? - ANSWER Midplane 112. What are the four basic types of pelves classification? - ANSWER gynecoid android anthropoid platypelloid 113. When is the bony pelvis assessed? - ANSWER during first prenantal evaluation by HCP; need not be repeated if pelvis is of adequate size and suitable shape 114. 3rd trim may do again is there is increased relaxation and mobility 115. Term for involuntary contractions where effacement and dilation are occuring - ANSWER Primary powers 116. Term for presenting part reaching pelvic floor where contractions are now voluntary and gestating parent uses bearing-down efforts; experience may feel involuntary urge to push. - ANSWER Secondary powers 117. You are intermittently auscultating and the FHR has an irregular heart rate (fetal arrhythmia), what should the nurse next initiate? - ANSWER -EFM 118. -communicate with primary cary provider to initiate further fetal testing 119. -consider causative factors (maternal positional for example) - auscultate FHR immediately after next contraction 120. If the client is in latent phase of labour and hospitalized, how frequent should IA be performed? - ANSWER Done at admission time then Q1H 121. If the client is in active phase of Stage 1 of labour, how frequent should IA be performed? - ANSWER Q15min - Q30min 122. If the client is in active phase of stage 2 of labour (pushing) how frequent should IA be performed? - ANSWER q5min or immediately following each contraction 123. Why shouldn't EFM be used routinely? - ANSWER -tracing can be inaccurate and anbiguous causing needless anxiety 124. -risk of false alarms and legal vulnerability of ambiguous patterns may contribute to increased caesareans 125. Why isn't external electronic fetal monitoring not ideal in preterm UA? - ANSWER tocotransducers of most electronic fetal monitors are designed for assessing UA in term pregnancy 126. In preterm, fundus amy be located below the level of the umbilicus and nurse may need to rely on labouring pt to indicate when UA is occuring and to use palpation as additiona sessment 127. What anatomical factors of the client do you need in order to use continuous internal electronic FHR or UA? - ANSWER -membranes must be ruptured 128. -cervix sufficiently dilated (2 - 3 cm) 129. -presenting part low enough to allow placement of the spiral electrode, IUPC, or both 130. Define gravida - ANSWER a person who is pregnant 131. Define Gravidity - ANSWER pregnancy 132. nulligravida - ANSWER never been pregnant and currently not pregnant 133. primigravida - ANSWER pregnant for the first time 134. multigravida - ANSWER hx two or more pregnancies 135. parity - ANSWER number of pregnancies in which the fetus or fetuses have reached 20 weeks gestations, not number of fetuses born (e.g. twins) 136. Parity not affected by whther fetus is born alive or is stillborn 137. nullipara - ANSWER person who has not completed a pregnancy with a fetus or fetuses beyond 20 weeks of gestation 138. Primipara - ANSWER a person who has completed one pregnancy with a fetus or fetuses who have reached 20 weeks gestation 139. Multipara - ANSWER person who has completed 2 or more pregnancies to 20 weeks gestation or more 140. Viability - ANSWER capacity to live outside the uterus 141. infants born 22 - 25 weeks are considered on threshold of viable 142. GTPAL - ANSWER Gravidity: number of all pregnancies 143. Term: Total term births (> 37w) 144. Preterm: total preterm births (20w-37w gestation) 145. Abortions: miscarriage or elective 146. Living children 147. What can be taught regarding number of drinks in preconception care? - ANSWER no more than 2 drinks a day on most days, no more than 10 / week 148. If someone has a regular 28 day cycle, which day is ovulation? - ANSWER 14 149. What is the role of the zona pellucida? - ANSWER offer more protection and play a crucial role in fertilisation by sperm 150. What is the precursor to the placenta? - ANSWER trophoblast 151. What are the 6 functions of the placenta? - ANSWER respiration 152. nutrition 153. excretion 154. protection/barrier 155. storage 156. hormonal production (hCG, estrogen, progesterone, human pacental lactogen) 157. At what week gestation can you start to identify the sex of a fetus? - ANSWER 15 w 158. VEAL CHOP: V + C and nursing interventions - ANSWER Variable FHR 159. Cord compression 160. reposition patient 161. VEAL CHOP: E + H - ANSWER Early decelerations + Head compression 162. Usually benign; continue to monitor; vaginal exams to determine if fetus is descending alt if not contact pcp 163. VEAL CHOP: A + O - ANSWER Accelerations + OK 164. VEAL CHOP: L + P - ANSWER Late decelerations + Problem 165. address oxygenation or fetal resuscitation- turn pt to left, if that doesn't help turn to right; O2 @ 10L, turn up plain IV to hydrate, turn off oxytocin, call PCP 166. 3 periods of pregnancy? - ANSWER antepartum (prenatal; between conception and onset of labour aka prenatal or antenatal) 167. intrapartum: period from onset of true labour to delivery of baby and placenta 168. Postpartum: 6w period between delivery of placenta and membranes 169. What are the trimesters? - ANSWER 1st trim: 1 - 14 170. 2nd trim: 14 - 28 171. 3rd trim: 28 - 40 172. define parity - ANSWER number of pregnacies in which fetus/es have reached 20w gest NOT number of fetuses born 173. Define preterm - ANSWER 20w - 36w6d 174. Definte late preterm - ANSWER 34w - 36w6d