NUR 2633: Maternal Child Health Final Exam Study Guide (latest version)

NUR 2633: Maternal Child Health 1. Dysmenorrhea – a common complaint with women – what are the non-pharmacological and pharmacological treatments. NSAID’s (Motrin, Naproxen, Alive), heating pad, rest, increase calcium, increase fluids, decrease red meat, alcohol, smoking drugs, exercise. 2. Obstetrical issues – pregnancy risks - Know Naegle’s Rule – to establish gestational age ovulation occurs in the middle of the cycle, stress can affect cycle, as well as high exercise, pregnancy, medications, drugs, hormones, obesity. Add 1 year, subtract 3 months, add 7 days. Pregnancy risks smoking, alcohol drinking, obesity, diabetes, drug use, hypertension, poor nutrition, eating disorders ALL affect pregnancy. EDD can also be measured by fundal height (Ex. Fundal height is measuring at umbilicus = 20 weeks) 3. Fetal assessment 3 things baby is okay – fetal heart tones (audible at 10-12 weeks), movement (16-18 weeks for multiparis, 18-20 for prima gravida), fundal height (12-14 weeks, at the symphysis pubis, umbilicus is 20 weeks) 4. Poor nutrition, drugs, HTN, DM are all issues of placental perfusion – what will the fetal result be – IUGR is the result, how do we identify IUGR? Smaller fundus. Uncontrolled diabetes = large baby, larger fundal height, baby can have hypoglycemia after birth, birth injuries and respiratory immaturity 5. Does the placenta provide nutrition? – no it provides for gas exchange, baby gets oxygen. 6. Anemia becomes a problem in pregnancy – can you discuss the maternal and fetal risks – low hemoglobin = low oxygen, baby with low oxygen means less movement. Iron ingestion can cause GI upset, tarry stools, constipation (increase fluids, fiber, stool softeners and exercise) 7. Hyperemesis – excessive vomiting that exceeds more than 3 months, at risk for fluid and electrolyte imbalance, manage by IV fluids and antiemetics (Zofran), small frequent meals, avoid trigger foods, carb snack 8. Hypertension – preeclampsia has specific symptoms – please know these as well as treatment modalities and nursing interventions – keep in mind Magnesium Sulfate nursing interventions – headaches, blurry vision, epigastric pain, bloated, edema, high BP, protein in the urine. Manage by bed rest, dim the lights, Mag sulfate 4g maintenance over 20-30 minutes’ bolus, maintenance 2g. Seizure precautions, and monitor baby, left side lying. For Mag watch for mag toxicity and respiratory depression, check for urine output, and deep tendon reflexes, vitals every hour. Lungs if have to deliver baby, use Betamethasone to help with lung maturity. No bolus fluids in preeclampsia. 9. Pre- term labor – define it; signs and symptoms, treatment modalities and nursing interventions – pelvic pressure, cramping, contractions, baby drop, lower back pain, increase urine output and vaginal discharge. Can be caused by dehydration or infection. Put on monitor, GIVE FLUIDS (Bolus Lactated ringers), FFN test before vaginal exam, LABOR IS NOT LABOR WITHOUT CERVICAL CHANGE. 2CM OR 80% effaced, start aggressively managing pre term labor with terbutaline (Causes maternal tachycardia, watch heart rate), if unsuccessful go to mag sulfate and use betamethasone. 10. Diabetes Mellitus – Type 1, Type 2 and Gestational DM all have issues that are common to all and specific to each. Note the concerns specific to each, management and fetal surveillance – type 1 concerned with cardiac, skeletal and CNS in baby, woman requires less insulin 1st trimester because of basal metabolic rate is increased, then needs progress over 2nd/3rd trimester. Monitor closely, babies at risk for sudden fetal demise, have mom monitor # of fetal movements. Type 2 concerned with controlling sugars, control by diet, and hypoglycemic/macrosomic baby. Gestational DM, same interventions as type 2 DM. 11. Define Macrosomia – and what are the risks – large baby, larger funda