Summary Nurs 306 Final Exam Study Guide

Final Study guide
N306 Study Guide – Final
Menstrual Cycle
Consists of two cycles working simultaneously (ovarian and endometrial) what are levels and roles of estrogen and
*progesterone in each cycle
Ovarian Cycle
oOvulatory phase begins when estrogen levels rise
oRise in estrogen and progesterone inhibit secretion of FSH and LH (suppressing new follicular
growth) & prepares/maintains endometrium of uterus
oWhen estrogen and progesterone decrease, the endometrium breaks down and menstruation
begins
oProgesterone thickens the uterine lining- gets it ready for implanatation
o What happens at time of ovulation (typically what day during the cycle, what the ovaries are doing, the
hormone levels, and what the endometrial lining is doing)
Day 14 of the cycle Chapter 3
Surge in LH triggers ovulation
Rise in estrogen and progesterone prepare/maintain endometrium of uterus
o Where does implantation usually happen?
Implantation occurs around days 5 or 6
Trophoblast (outer cell mass) is involved in implantation
Normally occurs in the upper part of the posterior wall of the uterus
Endometrium

Chapter 4
Prenatal Care
o Most likely cause of amenorrhea? (Pregnancy)
Pregnancy
No menses
o When can mom feel quickening? (baby moving)…is there a difference b/w 1st and 2nd time
pregnancies?
14-20 weeks
Nutrition- prevention of neural tube defects- ie. spina bifida
folic acid
Schedule of prenatal visits
o Know what is done in the first trimester, 2nd trimester, 3rd trimester during visits (what
tests are done? What is screened for? What vaccines can be given, and which can’t?)
Recommended at 28 weeks for every patient=TDAP
35 Weeks= GBS for every patient
First Trimester
oHistory of current pregnancy
oOB history
oPhysical and pelvic exam
oAssessment of uterine growth
oAssessment of fetal heart tones
oLab and diagnostic studies
oPatient education & anticipatory guidance
oDental health- keep dental check ups
Second Trimester
oComponents of initial assessment
oConfirm established due date
oLab and diagnostic tests
oAdminister Rhogam (if indicated)
oPatient education and anticipatory guidance
oGlucose screening

, Third Trimester
oFocused assessment
oAssessment of fetal well-being
oPelvic examination
oLeopold's maneuver
oNutritional follow-up
oScreening for GBS
oLAB tests
oPatient education and anticipatory guidance

What happens at a first prenatal visit- procedures and work up (know all the prenatal labs that need
to be drawn)
Chorionic villus sampling and amniocentesis- not for every patient
Extensive health history
Screening tool that IDs factors that may adversely affect the pregnancy
Establish rapport & trust
Family/social profile
Hx of past illness, family illness, current medical Hx
Gynecologic history
OB history
Identify high risk factors
Laboratory Work
oCBC
oABO & Rh type
oAntibody  screen
oRubella
 titer
oVDRL  or RPR (syphillis)
oHepatitis
 B surface antigen
oGonorrhea culture
oChlamydia  culture
oAlpha-fetoprotein
 @ 14wks**
oHIV  screen
oUrine:  glucose, protein & ketones by dipstick.
oUrinalysis:  RBCs, leukocytes, bacteria
oHereditary  disease screening
oSickle  cell
oTay-sachs 
oCystic  fibrosis

Naegele’s Rule in calculating a due date (need LMP)
o What is the most accurate dating of gestational age?
First trimester ultrasound
Physiological changes of pregnancy (table 4-1, pg 58-62) & Self-Care/Relief Measures (Table 4-5, pg. 88-93)
o N/V during pregnancy, fatigue, insomnia, emotional lability, tender/enlarged breasts, Braxton
Hicks contractions, increased cervical/vaginal secretions (yeast infections), dyspareunia, supine
and orthostatic HTN, anemia, dependent edema, varicosities, hyperventilation and dyspnea, nasal
and sinus congestion, bleeding gums, flatulence, heartburn, constipation, hemorrhoids, low back
pain, round ligament spasms and pain, leg cramps, stretch marks, skin hyperpigmentation, acne,
headaches.
o Make sure you understand physiological adaptations of pregnancy especially CARDIAC
(how does the body prepare to prevent PPH, physiologically). Re-read pg. 63, 64, 65, 66 and
67.
Average blood loss of 200-500mL

, WBCs increase
Risk of thrombosis due to increase in circulation of clotting factors
Orthostatic hypotension: due to decreased vascular resistance in the pelvis
Postpartum chills: related to vascular instability
Cardiac output increases 30-50%
Heart rate increases 15 t0 20 bpm
Hypercoagulation occurs during pregnancy to decrease the risk of postpartum
hemorrhage
Increased blood volume

Chapter 6
Antepartal tests
§ Indications for first trimester ultrasound
Confirm intrauterine pregnancy
Confirm fetal cardiac activity
Detect multiple gestation
Assessment of amnionicity and chorionicity
Visualization during chorionic villus
Estimate gestation age
Elevate uterine structures
Detect missed abortions, tubal or ectopic pregnancy or hyatidiform mole
Evaluate vaginal bleeding to screen for nuchal translucency

§ Amniocentesis
o Indication
Fetal lung maturity
Detect genetic disorders
Assessment of hemolytic disease
Intrauterine infections
Therapy for polyhydramnios
§ NST
o Interpretation-Be sure to consider normal baseline and moderate variability in addition to accels
Done to assess fetal well-being
§ Reactive
FHR increases 15 beats above baseline for 15 seconds twice or more in 20 minutes
Moderate variability
2 Accelerations
What does moderate variability indicate?
Adequate oxygenation
What do accelerations indicate?
Head compression
What teaching do we give when an NST is reactive?
Send mom home and have them count kicks
Instructions on fetal kick count
AFI
§ Oligohydramnios-know definition
AFI less than 5 cm
Low AFI
Variable decels

Chapter 9
Fetal heart monitoring
Be able to interpret strips in terms of baseline HR, variability, presence of accels, decels, tachysystole etc.
http://ob-efm.com/2418.htm
https://ncc-efm.org/game/efmgame.cfm
Intermittent auscultation (IA) VS continuous electronic fetal heart monitoring (EFM)

, o Which pt is a candidate for IA? **Which is NOT?
Patient on pitocin- not a candidate for IA
Bag of water broken= not a candidate for IA
Low risk moms
Home births and birthing center

§ What is the variability?
Minimal
o What may cause minimal variability and what can you do to intervene?
Maternal related:
oSupine hypotension
oCord compression
oUterine tachysystole
oDrugs
Mag-Sulfate
Fetal related:
oFetal sleep
oPrematurity
Interventions:
oChange position
oDiscontinue oxytocin
oDeliver oxygen at 10mL
oIV bolus
Moderate
o **Understand this is BEST indicator for fetal well being
o What does it really mean?
Predicts a well-oxygenated fetus with normal acid-base
balance at a time

§ Are there decelerations?
· If no, great
· If yes, what kind (and then know your interventions for each and what the cause is)
o Early
Mirror the contractions
No interventions
Head compression
o Late
Tachysystole=Decreased blood flow
Decels occur after a contraction
POOF
Placental insufficiency
Epidural can cause it
o Variable
Cord compression
oOligo-low fluid
oBag of water is broken
Abrupt drops
Change position
Perform SVE to evaluate cord
Amnioinfusion
Administer 02
Decrease or discontinue oxytocin
Consider need for tocolytic
o Prolonged
Decelerations that last longer than 2 minutes