Maternal and Newborn ATI Final Exam
nosebleeds are common in pregnancy d/t elevated progesterone levels
chorionic villi secrete human chorionic gonadotropin which stimulates production of
estrogen and progesterone from the corpus luteum
production of HCG begins on the day of implantation (which takes 7-10 days) and can be detected
by day 6
amnion inner membrane
chorion outer membrane
umbilical cord two arteries carry deoxygenated blood to the placenta
one vein carries oxygenated blood to the fetus
encased in wharton's jelly (prevents pressure on the vein and arteries)
no pain receptors
covered by chorionic membrane
amniotic fluid replaced every 3 hr
800-1200 mL at the end of pregnancy
functions: temperature regulation, protection, and promotes musculoskeletal
development of the fetus
ambivalence 1st trimester
assess meaning of pregnancy to the client/partner and socioeconomic
supports; refer if needed
accepting 2nd trimester
assess if ambivalence is increased and how the client views the fetus
preparing for birth 3rd trimester
teach manifestations of onset of labor, newborn care, feeding methods, birth
control, and home preparation for baby, as well as birthing plan
skin changes 2nd and 3rd trimester
striae, linea negra, cholasma
pigmentation disappears after pregnancy and straie may fade
breast changes 1st trimester
fullness and sensitivity is hormone related
instruct about supportive bra and that OTCs do not reduce stretch marks
colostrum may be expressed as early as 16 weeks
, Maternal and Newborn ATI Final Exam
dyspena 2nd and 3rd
sleep propped or sitting up
lightening (fetus descends into pelvis) between 38 and 40 weeks; can breathe
easier
faintness and syncope 2nd
encourage moderate exercise, deep breathing, side-lying position; avoid
sudden changes in position
varicose veins and leg cramping 2nd and 3rd
assess activity: sitting/standing, constrictive clothing, crossing legs (try to avoid
this)
teach leg elevation, position changes, support hose (but no tight fitting socks),
exercise
N/V 1st
teach diet: dry crackers, 5-6 small meals
assess wt, urine output, and signs of hyperemesis
teach importance of calling if pt cannot eat/drink for 24 hrs, urine becomes
scant or dark, heart counts, or client becomes dizzy
constipation 2nd, 3rd
teach about activity, fluids, fiber
heartburn 2nd, 3rd
encourage small meals; sit upright for 30 minutes or more after eating; avoid
spicy, fatty foods
BP may decrease slightly at first
GI frequency 1st and 3rd
assess for UTI
teach not for decrease fluids
leukorrhea 2nd, 3rd
white discharge from the vagina; completely normal
Braxton Hicks 2nd, 3rd
false labor
backache during pregnancy - how to relieve perform pelvic rock exercises every day
use proper body mechanics
1st trimester issues breast tenderness
urinary frequency
epitaxis
, Maternal and Newborn ATI Final Exam
nutrition all trimesters
average wt gain 25 to 35 lb
caloric increase 300 to 400 kcal/day
protein increase by 25 g/day
iron intake increase by 30 mg/day (double what is usually is)
foalte increase by 600 mcg/day
if preg mom does not like milk, what are other good dark green leafy vegetables
sources of calcium
1st trimester wt gain 3-4 lb
presumptive signs and symptoms subjective
amenorreha
fatigue
N/V
urinary frequency
breast changes: darkened areola, enlarged Montgomery tubules
quickening: slight fluttering movements of the fetus felt by client, usually
between 16-20 weeks of gestation
probable signs objective
cervical changes
Hegar's: softening of lower uterus
Chadwick's sign: violet-bluish color of vaginal mucosa
Goodell's: softening of cervical tip
Ballottement: rebound of unengaged fetus
Braxton Hicks: painless, irregular, and usually relieved by walking
positive pregnancy test
positive signs signs related to presence of fetus
fetal heart tones
visualization of fetus by u/s
fetal movement palpated by examiner
HCG detection 6-11 days in serum and 26 days in urine
-higher levels can indicate multifetal pregnancy, ectopic pregnancy,
hydatidform mole, or a genetic abnormality
-lower levels suggest miscarriage, ectopic pregnancy
Nagel's rule add 7 days then count back 3 month
McDonald's rule Fundal height =GA
umbilicus at 18-36 weeks
, Maternal and Newborn ATI Final Exam
ultrasound confirm pregnancy and location
evaluate fetus: number, heartbeat, gestational age, abnormalities, growth and
development, activity
evaluate placenta
NI: full bladder
non-stress test monitors response of FHR to fetal movement
uses: assess for fetal well-being and intact CNS during the third trimester and
assess fetus of clients with high-fetus pregnancies (maternal DM, HTN, heart
disease, IUGR, postdates, history of previous stillbirth, or decreased fetal
movement)
tell the mom to press the provided button each time fetal movement is
detected; offer client orange juice to stimulate fetus during procedure
may need to use acoustic vibration device to awaken baby
reactive NST two or more fetal heart rate accelerations
-increase in FHR of at least 15/min above the baseline and last 15 seconds
within a 20 minute period
before 32 weeks gestation acceleration is an increase of at least 10 beats/min lasting at least 10 seconds
non-reactive stress test ABNORMAL
does not produce two or more qualifying accelerations in 20 minutes
if does not meet criteria in 40 min, additional testing is indicated (CST or BPP)
NST NI seat the client in reclining chair, semi-Fowler's, or left lateral position
apply two belts and transducers to the client's abdomen
reactive NST
non-reactive NST
contraction stress test method: nipple stimulation
oxytocin (pitocin) IV
contraction stress test indications non-reactive NST
high risk pregnancies; same as indications for NSTs
-decreased fetal movement, IUGR, postmaturity (babies after 42 weeks)
nosebleeds are common in pregnancy d/t elevated progesterone levels
chorionic villi secrete human chorionic gonadotropin which stimulates production of
estrogen and progesterone from the corpus luteum
production of HCG begins on the day of implantation (which takes 7-10 days) and can be detected
by day 6
amnion inner membrane
chorion outer membrane
umbilical cord two arteries carry deoxygenated blood to the placenta
one vein carries oxygenated blood to the fetus
encased in wharton's jelly (prevents pressure on the vein and arteries)
no pain receptors
covered by chorionic membrane
amniotic fluid replaced every 3 hr
800-1200 mL at the end of pregnancy
functions: temperature regulation, protection, and promotes musculoskeletal
development of the fetus
ambivalence 1st trimester
assess meaning of pregnancy to the client/partner and socioeconomic
supports; refer if needed
accepting 2nd trimester
assess if ambivalence is increased and how the client views the fetus
preparing for birth 3rd trimester
teach manifestations of onset of labor, newborn care, feeding methods, birth
control, and home preparation for baby, as well as birthing plan
skin changes 2nd and 3rd trimester
striae, linea negra, cholasma
pigmentation disappears after pregnancy and straie may fade
breast changes 1st trimester
fullness and sensitivity is hormone related
instruct about supportive bra and that OTCs do not reduce stretch marks
colostrum may be expressed as early as 16 weeks
, Maternal and Newborn ATI Final Exam
dyspena 2nd and 3rd
sleep propped or sitting up
lightening (fetus descends into pelvis) between 38 and 40 weeks; can breathe
easier
faintness and syncope 2nd
encourage moderate exercise, deep breathing, side-lying position; avoid
sudden changes in position
varicose veins and leg cramping 2nd and 3rd
assess activity: sitting/standing, constrictive clothing, crossing legs (try to avoid
this)
teach leg elevation, position changes, support hose (but no tight fitting socks),
exercise
N/V 1st
teach diet: dry crackers, 5-6 small meals
assess wt, urine output, and signs of hyperemesis
teach importance of calling if pt cannot eat/drink for 24 hrs, urine becomes
scant or dark, heart counts, or client becomes dizzy
constipation 2nd, 3rd
teach about activity, fluids, fiber
heartburn 2nd, 3rd
encourage small meals; sit upright for 30 minutes or more after eating; avoid
spicy, fatty foods
BP may decrease slightly at first
GI frequency 1st and 3rd
assess for UTI
teach not for decrease fluids
leukorrhea 2nd, 3rd
white discharge from the vagina; completely normal
Braxton Hicks 2nd, 3rd
false labor
backache during pregnancy - how to relieve perform pelvic rock exercises every day
use proper body mechanics
1st trimester issues breast tenderness
urinary frequency
epitaxis
, Maternal and Newborn ATI Final Exam
nutrition all trimesters
average wt gain 25 to 35 lb
caloric increase 300 to 400 kcal/day
protein increase by 25 g/day
iron intake increase by 30 mg/day (double what is usually is)
foalte increase by 600 mcg/day
if preg mom does not like milk, what are other good dark green leafy vegetables
sources of calcium
1st trimester wt gain 3-4 lb
presumptive signs and symptoms subjective
amenorreha
fatigue
N/V
urinary frequency
breast changes: darkened areola, enlarged Montgomery tubules
quickening: slight fluttering movements of the fetus felt by client, usually
between 16-20 weeks of gestation
probable signs objective
cervical changes
Hegar's: softening of lower uterus
Chadwick's sign: violet-bluish color of vaginal mucosa
Goodell's: softening of cervical tip
Ballottement: rebound of unengaged fetus
Braxton Hicks: painless, irregular, and usually relieved by walking
positive pregnancy test
positive signs signs related to presence of fetus
fetal heart tones
visualization of fetus by u/s
fetal movement palpated by examiner
HCG detection 6-11 days in serum and 26 days in urine
-higher levels can indicate multifetal pregnancy, ectopic pregnancy,
hydatidform mole, or a genetic abnormality
-lower levels suggest miscarriage, ectopic pregnancy
Nagel's rule add 7 days then count back 3 month
McDonald's rule Fundal height =GA
umbilicus at 18-36 weeks
, Maternal and Newborn ATI Final Exam
ultrasound confirm pregnancy and location
evaluate fetus: number, heartbeat, gestational age, abnormalities, growth and
development, activity
evaluate placenta
NI: full bladder
non-stress test monitors response of FHR to fetal movement
uses: assess for fetal well-being and intact CNS during the third trimester and
assess fetus of clients with high-fetus pregnancies (maternal DM, HTN, heart
disease, IUGR, postdates, history of previous stillbirth, or decreased fetal
movement)
tell the mom to press the provided button each time fetal movement is
detected; offer client orange juice to stimulate fetus during procedure
may need to use acoustic vibration device to awaken baby
reactive NST two or more fetal heart rate accelerations
-increase in FHR of at least 15/min above the baseline and last 15 seconds
within a 20 minute period
before 32 weeks gestation acceleration is an increase of at least 10 beats/min lasting at least 10 seconds
non-reactive stress test ABNORMAL
does not produce two or more qualifying accelerations in 20 minutes
if does not meet criteria in 40 min, additional testing is indicated (CST or BPP)
NST NI seat the client in reclining chair, semi-Fowler's, or left lateral position
apply two belts and transducers to the client's abdomen
reactive NST
non-reactive NST
contraction stress test method: nipple stimulation
oxytocin (pitocin) IV
contraction stress test indications non-reactive NST
high risk pregnancies; same as indications for NSTs
-decreased fetal movement, IUGR, postmaturity (babies after 42 weeks)
