NCLEX: Maternity Nursing Flashcards

Terms Definitions
What are the ovarian hormones?
Follicle-stimulating hormone (FSH) and luteninizing hormone (LH).
-These hormones are released by the anterior pituitary gland
-They produce changes in the ovaries, causing the menstrual cycle.
What pelvis shape is most ideal for a successful labor and birth?
Gynecoid. It is considered the normal female pelvis. It is transversely rounded or blunt.
What pelvic shape is unfavorable for labor?
Android. More often seen in males, it is wedge-shaped or angulated.
Where does fertilization occur?
Occurs in the upper region of the fallopian tubes.
-It occurs within 12 hours of ovulation and within 2 to 3 days of insemination, the average duration of viability for the ovum and sperm.
Define the preembryonic period.
First 2 weeks after conception.
Define the embryonic period.
Beginning of the third through the the eighth week after conception.
Define the fetal period.
Beginning of the ninth week after conception and ending with birth.
What can and cannot pass through the placenta?
-Large particles such as bacteria cannot pass through the placenta.
-Nutrients, drugs, antibodies, and viruses can pass through the placenta.
How many blood vessels are in a normal umbilical cord?
It contains TWO arteries, and ONE vein. The umbilical arteries take blood away from the fetus. The vein brings oxygenated blood back to the fetus.
What is the normal fetal heart rate?
-First trimester: 160-170 beats/min.
FHR will slow with fetal growth to 120-160 beats/min near or at term.
What is the function of the ductus arteriosus and foramen ovale in the fetal heart?
They allow for the fetal circulation bypass because of the nonfunctioning lungs
-The ductus arteriosus connects the pulmonary artery to the aorta, bypassing the lungs.
-The foramen ovale is the opening between the right and left atria of the heart, bypassing the lungs.
In what form can the status of a women's pregnancy outcomes be described?
GTPAL
G=gravidity (number of pregnancies)
T= term births (the number born at term, longer than 37 weeks)
P= preterm births, the number born before 37 weeks gestation.
A=Abortions and/or miscarriages (including gravida before 20 weeks)
L-the number of currently living children
What are the presumptive signs of pregnancy?
Amenorrhea, N/V, increased size and increased feeling of fullness in breasts, Pronounced nipples, urinary frequency. Fatigue, discoloration of vaginal mucosa.
Quickening (the first perception of fetal movement may occur as early as the sixteenth to twentieth week of gestation).
What are the probable signs of pregnancy?
-Uterine enlargement
-Hegar's Sign
-Goodell's sign
-Chadwick's sign
-Ballottement
-Braxton Hicks contractions
-Positive pregnancy test for the determination of the presence of human chorionic gonadotropin.
What are the positive signs of pregnancy?
-Fetal heart rate detected by electronic device (Doppler transducer) at 10 to 12 weeks and by nonelectronic device (fetoscope) at 20 weeks of gestation.
-Active fetal movements palpable by examiner
-Outline of fetus via radiography or ultrasonography.
What sexually transmitted diseases can affect the fetus?
-Syphilis (can lead to spontaneous abortions, mental subnormality and physical deformites)
-Genital Herpes (fetus is contaminated after membranes rupture or with vaginal delivery).
-Gonorrhea (may result in postapartum infection of the neonate, risk inclue opthalmia, neonatorum, pneumonia, and sepsis)
Where should the fundus be during different phases of pregnancy?
-2nd and 3rd trimesters (weeks 18-30)= fetus's age in wks plus or minus 2 cm.
-16 weeks=halfway b/w the symphysis pubis and the umbilicus
-20-22 weeks= umbilicus
-36 weeks=xiphoid process
At what point during pregnancy can quickening first begin?
Quickening occurs as early as 16-20 weeks.
What are the main cardiovascular changes that occur when a women gets pregnant?
-Blood volume increase, increased RBC volume
-Anemia (plasma increase exceeds RBC production)
-Iron requirements increase
-Heart size increase
-Heart pushed upward and to the left as uterus enlarges
-Pulse may increase 10 bpm
-Slight decrease in BP in 2nd trimester
-Retention of sodium and water
What changes occur in the respiratory system during pregnancy?
-Increased O2 consumption (15-20%)
-Elevated diaphragm (due to uterus enlargement)
-SOB may be experienced
What changes occur in the GI system during pregnancy?
-N/V may occur (due to the secretion of human chorionic gonadotropid, should subside by THIRD month)
-Decreased motility, may lead to poor appetite
-Changes in taste and smell
-Constipation (result of progesterone production)
-Flatulence and heartburn
-Hemorrhoids (due to increased venous presure)
-Swollen gum tissue
What changes occur in the renal system during pregnancy?
-Frequency in urination (uterus enlargement)
-Decreased bladder tone
-Renal threshold for glucose may be reduced
What are the changes that occur in the Endocrine system during pregnancy?
-Basal metabolic rate rises
-Thyroid activity increase
-Aldosterone levels gradually increase
-Anterior lobe of the pituitary gland, parathyroid and throid enlarges slightly
How does the cervix change during pregnancy?
-It becomes shorter, more elastic and larger in diameter.
-Endocervical gland secrete a thick mucous plug (it is expelled from the canal when dilation begins)
-Increased vascularization and estrogen causes softening and a blue-purple discoloration (Chadwick's Sign-at about 6 weeks)
What function do the ovaries play during pregnancy?
-Secretes progesterone for teh first 6 to 7 weeks
What occurs the the vagina during pregnancy?
-Hypertrophy of the muscle
-increase in vaginal secretions, they are usually thick, white and acidic.
What happens to the breast during pregnancy?
<>Changes occur b/c of the increasing effects of estrogen and progesterone
-Increase size
-Nipples become more pronounced
-Areola becomes darker
-Superficial veins become prominent
-Colostrum may leak
What is linea nigra?
A dark streak down the midline of the abdomen that may occur during pregnancy.
What is chloasma?
aka Mask of Pregnancy
-a blotchy brownish hyperpigmentation, over the forehead, cheeks, and nose.
What are striae?
Reddish-purple stretch marks on teh abdomen, breast, thighs and upper arms.
When is N/V a problem during pregnancy?
Occurs in first trimester
What interventions are used for a women who are experiencing N/V during pregnancy?
-Eat dry crackers before arising
-Avoid brushing teeth immediately after arising
-Small frequent, low fat meals
-Drink liquids inbetween meals rather than at meals
-Avoid fired and spicy foods
-Acupressure
What blood tests are done on a pregnant woman?
-ABO typing: determines the woman's blood time in the ABO antigen system
-RH typing: done to determine blood type in the rhesus antigen system. If the client is Rh negative she should receive Rh immune globulin at 28 weeks' gestation.
How do hemoglobin and hematocrit levels change during pregnancy?
-Levels will drop during gestation due to an increase in plasma level.
-A decrease in hemoglobin level to lower than 1-g/dL or hematocrit level lower than 30% indicates anemia.
What is the Alpha-fetoprotein screening done to determine.
-Elevated levles of protein are associated with open neural tube and abdominal wall defects
-Can detect spina bifida and Down syndrome.
When is an alpha-fetoprotien screening performed?
Maternal blood sample can be drawn at 15 to 18 weeks' gestation.
What is Chorionic villus sampling done for?
-The physician aspirates a small sample of chorionic villus tissue at 8-12 weeks
-it is used to detect genetic abnormalities.
What is the use of a Kick count test?
-Mother sits/lies quietly and counts fetal kicks for a period of time
-Should notify the physician if there are fewer than 10 kicks in a 12-hour period.
What is the use of an amniocentesis.
-Aspiration of amniotic fluid, may be done after 13 to 14 weeks of pregnancy
-It is performed to determine genetic disorders, metabolic defects and fetal lung maturity.
What are the risks of amniocentesis?
Maternal hemorrhage, infection, Rh isoimmunization, abruptio placentae, amniotic fluid emboli, premature rupture of the membrames
What is the fern test?
Microscopic slide test to determine the presence of amniotic fluid leakage.
-A specimen is obtained from the external os of the cervix and vaginal pool and is examined on a slide under a microscope
-A fern-like pattern produced by the effects of salts of the amniotic fluid indicates the presence of amniotic fluid.
What is the Nitrazine test used for?
-It is a test strip used to detect the presence of amniotic fluid in vaginal secretions.
-It uses pH. Vag secretions have pH of 4.5-5.5, amniotic fliuid has a pH of 7.0-7.5 and turns nitrazine string or swab blue.
What is the nonstress test?
-The test is preformed to assess placental function and oxygenation
-Determines fetal well-being
-The test evaluates fetal heart rate response to fetal movements
What is a reactive nonstress test?
-Normal, negative
-This indicates a healthy fetus.
<>This occurs when two or more FHR accelerations of at least 15 bpm, lasting at least 15 secods from the beginning of the acceleration to the end., in association with fetal movement, during a 20 minutes period
What is a nonreactive nonstress test?
-No accelerations of accelerations of less than 15 bpm or lasting less than 15 seconds in duration occur during a 40 minute observation.
What weight gain is expected during pregnancy?
25-35 lbs
How many calories a day should a pregnant woman consume over the normal consumption?
300 calorie increase
What is the extra calorie intake needed during lactation?
500 cal/day extra
Why is an increase in folic acid important in pregnant women?
It is necessary for all women of childbearing age to prevent neural tube defects in the fetus during the first trimester of pregnancy.
What is the definition of an abortion?
-A pregnancy that ends before 20 weeks gestation, spontaneously or electively.
What medication is administered to a pregnant woman who is HIV positive?
Zidovudine (ZDV) is recommended for the prevention of the maternal-fetal HIV transmission and is administered orally beginning after 14 weeks' gestation, IV during labor an din the form of syrup to the neonate for 6 weeks after birth.
What complication may a women experience if she is anemic during pregnancy?
-Predisposes the client to postpartum infection.
Why are patients with various cardiac disease issues considered a high risk pregnancy population?
-They may be unalbe to physiologically cope with the added plasma volume and increased cardiac output that occur during pregnancy. Blood volume is at a maximum during the last weeks of the second trimester.
What is chorioamnionitis?
a bacterial infection of the amniotic cavity; can result from premature rupture of the membrane, vaginitis, amniocentesis, or intrauterine procedures.
How does diabetes mellitus complicate pregnancy?
-Causes insulin requirements to change (first trimester, decrease. 2nd and 3rd increase dose needed)
-After placental delivery, placental hormone levels drop abruptly and insulin requirements decrease.
How is the fetus affected or how does it affects the mother with diabetes?
-Maternal glucose crosses the placenta but insulin does not
-The fetus produces its own insulin and pulls glocose from the mother, which predisposes the other to hypoglycemic reactions.
What are the risks of a newborn infant of a mother with diabetes?
At risk for hypoglycemia, hyperbilirubinemia, respiratory distress syndrome, hypocalcemia, and congenital anomalies.
What is gestational diabetes mellitus?
-Diabetes that occurs only in pregnancy (during 2nd or 3rd trimester). The pancreas cannot respond to the demand for more insulin.
-Pregnant women should be screened between 24 and 28 weeks of pregnancy.
What WBC value should be expected postpartum?
For 10-12 days postpartum the WBC will be elevated.
What may occur to a woman's hematocrit postpartum?
The Hct level may be high due to fluid losses that occur as part of the normal postpartum process (high Hct indicating a greater amount of volume in proportion to loss of RBCs). The client should be encouraged to increase fluid intake if this occurs.
What are the conditions for a reactive nonstress test?
Reactive if two or more FHR accelerations of 15 bpm that last 15 sec or longer are noted and are associated with fetal movement in a 20 minute period.
How is fetal lung development determined?
Fetal lung maturity can be determined in one of two ways. First, the amniotic fluid from the vaginal pool can be tested for phosphatidylglycerol (PG); if PG is PRESENT, fetal lung maturity is probable. Second, fetal lung maturity can be determined by collecting amniotic fluid through amniocentesis and evaluating for lecithin/sphingomyelin (L/S) ratio. An L/S ratio of 1:8 to 2:1 indicates probable lung maturity.
What is the most common complication following a circumcision?
Bleeding. The site should be monitored hourly to observe for bleeding in the first 12 hours following the procedure.
When a patient's labor is not progressing due to shoulder dystonia, what action should the nurse take?
Suptrapubic pressure can be used to attempt to push the shoulder to go under the symphysis pubis and thus pass through the birth canal.
What does a new mother focus on during the taking-hold phase?
The mother is focusing on care of the newborn and acquiring parenting skills. This is a good time for teaching the mother about new skills for caring for the newborn.
What are normal bilirubin levels for a newborn?
LOOK UP ANSWER
How should counterpressure be used as a non-pharmaceutical method for pain relief during pregnancy?
Pressure should be applied to the lower back continuously for back pain.
If a nurse observes decelerations beginning and ending with contractions, what action should the nurse take?
The nurse should just continue fetal heart monitoring, these are early decelerations, which are a normal finding during the transition phase of labor progression.
What are some possible reasons for jitteriness in a newborn?
It may be an indication of infection, hypoglycemia or hypoxia.
What is a possible risk for a pregnant mother that has a high maternal serum alpha-fetoprotein level?
Anencephaly
Spina bifida
What is a possible risk for a pregnant mother that has a low maternal serum alpha-fetoprotein level?
Down Syndrome
How should a newborn be suctioned using a bulb syringe?
-Suction the mouth before the nose (otherwise the newborn may gasp and inhale pharyngeal secreations)
-Suction until gurgling subsides
-Insert the bulb syringe on the sides of the mouth
-Compress the bulb syringe before insertion
What should the nurse do to avoid hypotension in the pregnant client who is receiving an epidural?
-Give IV lactated Ringer's bolus before hand. This will help maintain adequate fluid volume to prevent hypotension resulting from epidural-related vasodiation.
How many weight a week should a pregnant woman gain in the second and third trimesters?
0.4 kg (.88 lb) per week.
What is the cause of variable decelerations?
Umbilical cord compression, which can be caused by short cord, prolapsed cord, and cord wrapped around fetal body part.
How soon after conception can Human chorionic gonadotropin (hCG) be detected in the blood.
6 to 11 days after conception.
Why is assessing lochia a priority assessment for a woman who is post-cesarean section?
During the immediate postpartum period, the greatest risk to the client is bleeding. The amount of lochia can assist the nurse in determining if excessive bleeding is occuring. pooledblood under the buttocks or a perineal pad that is saturated in 15 min or less is a sign that require immediate attention.
What is the priority assessment for a client undergoing an amniotomy?
Checking temperature because the greatest risk for the client is infection.
What is the pattern of lochia changes after delivery?
-Lochia rubra=Bright Red lasts 3-4 days
-Lochia serosa=pale pink or brown, lasts 22 to 27 days
-Loachia alba= white, may persist longer than 6 weeks.
What are the main assessment findings that indicate fetal distress?
-Fetal Heart rate less than 120 or greater than 160 bpm
-Meconium stained amniotic fluid
-Fetal hyperactivity
-Progressive decrease in baseline variability
-Severe variable decelerations
-Late decelerations
When is a pregnant/delivering mother given Methylergonovine (Methergine)?
Causes the uterus to contract, can be used when the uterus is hypotonic, postpartum.
When is ibuprofen used in a delivering mother?
Used for postpartum pain.
When is magnesium sulfate used in a delivering mother?
It is used to prevent postpartum seizures.
When is Terbutaline (Brethine) used in a delivering mother?
Used to suppress uterine activity in preterm labor.
When performing a heel stick for a blood glucose check of a newborn, what should the nurse do?
-The nurse can apply a warm cloth to the heel to dilate blood vessels
-The area should be cleansed with alcohol
-The nurse should use a spring-loaded puncture device
-The puncture shoulbe be made at the lateral aspect of the heel. This decreases the risk of puncturing the bone and causing trauma to the heel.
When should the car seat change from rear facing to front facing (age/weight)?
20lbs and one year of age.
What is the cause of late decelerations? Of variable decelerations.
Late: Uteroplacental insuffiency
Variable: Cord compression
What is a consequence to a newborn whose mother is exposed to rubella during pregnancy?
The infant may experience hearing loss.
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