Nursing212

MaternityNursing

FinalExamReview
Fall2017

Preparedby:M.LaBarbera
fromnotesandclassoutline.
ALWAYSCONFIRMDATAONYOUROWN
 Nursing212FinalExamReview

Fall2017

Periodicbreathing:

pausesofnomorethan10sec.followedbyrapid,shallowbreathing(maybeaccompaniedbyminor
desatsandbradycardia)

Apnea:

pauseinrespirations>20sec.and/oraccompaniedbyhypoxiaorbradycardia

Gonorrhea:

maycauseophthalmianeonatorum(eyesiteisGoneo.)

Chlamydia:

producesneonatalconjunctivitis,TxwithErythromycinopth.

Fetaldevelopment:

Firsttrimester:Weeks113

Organogenesis

(weeks28,greatestriskofinfectionsandteratogens)

Secondtrimester:weeks1427

Dramaticgrowth

refinementoforgansystems

Thirdtrimester:28weekstobirth/term

nutrientandfatstores

Positivesignsofpregnancy:

Fetalheartsounds:

912weeksdopplerscope

1820weeksfetoscope

Fetalmovementfeltbyexaminer

~20weeks

Ultrasound:
 embryodiscernable~6weeks

Bloodvolumeincreasesby4050%

Plasmaincreasesby~50%

RBCsincreaseby~25%

Weightgainpatterns:

1sttrimester~1.14.4lbs

2nd,3rdtrimesters~1/21lbsperweek

**weightgaincorrelateswithhealthyinfantoutcome

Iron:

**IronpillsarebesttakenwithOrangejuice(Theenhancementofironabsorptionfromvegetablemealsisdirectlyproportionaltothequantityof
ascorbicacidpresent.)(enhancementisviaachelationroute).

**Animalfoodsourcesinclude:

Meat,Fish,Poultry,Eggs

Multiplemarkertest:

Triplemarkertest:

AlphaFetoprotein Producedbythefetus

hCG Producedbytheplacenta

Esterol Producedbyfetusandplacenta

Quadruplemarkertest:

InhibinA Producedbytheplacenta

Amniocentesis:

genetictesting,usuallypreformedinthesecondtrimesterbetween15and20weeks

Kickcounts:

lieonyoursideandcountmovements(10movementsin2hoursisnormal)

Nonstresstest:

eatbeforethetesttopromotefetalmovement,emptybladderforcomfort.Fetalheartrateshould
increasewithfetalmovement.Apositivetestis2increasesinHRassociatedwithmovementwithin20
minutes.Ifthefetusisnotactivethemothermaydrinkjuiceorwater.

Biophysicalprofile(BPP):

preformedinNSTfails.BPPcombinesacontinuedNSTcombinedwithultrasoundtodetectfetal
positionandmovement,measurementofamnioticfluid(amnioticfluidindexshouldbe2)anddetect
intrauterinefetalbreathing.Isscoredona1to10scale,cantakeupto30minutestocollectdata.

Fundalheightlandmarks:

1012weeks Justabovethepubicsymphysis

16weeks waybetweenthepubicsymphysisandumbilicus

2022weeks Attheumbilicus

36weeks Belowthexiphoidprocess

Letcithin/Sphynogmyelinratio:

Obtainedfromamnioticfluid(amniocentesis)in3rdtrimester(about35weeks).Ratiosshouldbe2:1.
AlongwithPosphatidylglycerol(PG)(present)indicateslungmaturity.

**DiabeticwomenshouldhaveaL/Sratioof3:1

TOLAC:

Trialoflaboraftercesarean(mayleadtoVBACisvaginaldeliveryissuccessful)

Bishopsscore:

Determinesthelikelihoodofsuccessfulvaginaldelivery

Multipara 5

Primapara 7

Prostaglandins:

DinoprostoneIntravaginal

MisoprostoneIntravaginalororal

PitocinIV(fastandadjustable)**AHIGHALERTMEDICATION**(aftercervixchangesopenthegarage
doorbeforestartingyourcar)

 Tocolytics:

Indomethacin(aprostaglandininhibiter),decreaseseffacement,givenorally

Nifedipine(aCalciumchannelblocker),inhibitscontractions,givenorally

Magnesiumsulfate(asmoothmusclerelaxant),givenIV**AHIGHALERTMEDICATION**

Tachysystole: (contractions<2minapart,5contractionsin10minutes,contractions>90120seconds,
restinginterval<30seconds,increasedrestingtone)

FIRST!StopPitocin

IVfluids,Oxygen,sidelying,callprovider

Jaundice:(*clinicallyevidentONLYAFTER1st24h.oflife*)

Jaundice<24h.ISPATHOLOGIC!

Day1:(2448h.)

facial(5mg/dl)

Day2:(2872h.)

tochest(10mg/dl)

Day3:(>72h.+)

toabdomen(15mg/dl)


**Thenumber1interventionifacesareansectionisrequiredISANIV**

Normalhead:chestcircumference:

Head3238

Chest3036

Normalbirthweight25004000grams

NormalneonatalvitalsT.36.537.5,HR120160,RR3060

Breastfeeding:

1.53h.(avgover24h.)

Formulafeeding:

34h.

dayofdelivery1530ml

day13045ml

day24560ml

(graduallyincreaseover1stweek)

Voiding:

Initial:

Void:withinfirst12to24hours Stool:withinfirst12to24hours

Day2:

Void:2 Stool:2

Bydischarge:

6voids/24h. 12stools/24h.

VEALCHOP:

V variabledeceleration C cordcompression

E earlydeceleration H headcompression

A acceleration O OK

L *latedeceleration! P *Placentalinsufficiency!

StagesofLabor:

Stage1:

Phase1Latentlabor:

03cmdilation Frequency57minutes Duration3040sec.

Phase2Activephase: **PAINCONTROL

47cmdilation Frequency25minutes Duration4060sec.

Phase3Transitionalphase:

810cmdilation Frequency1.52minutes Duration6090sec.

Stage2:

10cmdilated, Frequency23minutes Duration4060sec.

cervixhasslippedoverthefetalhead,**baredownthroughcontractions**

Stage3:

Fromimmediatelyafterneonateisborntoplacentaldelivery

skintoskin,OxytocinIVorIM

monitorforbleedingQ15m.X1h.,thenevery1h.x

**ontest,assumeyouarecaringforbothmotherandneonate**


Transienttachypneaoftheneonate(TTN) inadequateabsorption/expulsionofamnioticfluid

Meconiumaspirationsyndrome(MAS) meconiumaspiration/chemicalpneumonia

NeonatalVoidandExcretion:

Initial Voidwithin1224h.oflife Stoolwithin1224h.,thick,greenblack,mech.

Day2 Void2voidsin2nd24hours Stool2stoolswithinthesecond24h.,brgreen

Discharge Void6voidsin24h. Stool12stoolsin24h.

Athome Expectmorewetdiapersperday Stoollarge/loose(breastfeeding)

Yellow,formed,pasty(Formula)

Birthweightloss:

Ballardscoreof3940isnormal(term)

TACO(COAT):

Time(<24h.)

Amount

Color

Odor

Categoryoffetalheartrates:

1 110160(reassuring)

2,3*notneededtoknow.

Beforeestablishingepidural:(give1000mlNaCl)

monitormaternalvitalsigns

fetalmonitor

levelofsensation

mayneedFoley(lackofsensation/urgetovoid)

(mayprolong..butmayalsohelpmovealong)

Baselinetachycardia>160:

poorplacentalperfusion

mostcommonlymaternaldehydration,fever,infection=IVfluids,Oxygen,infection?

**Afterepiduralfetalmonitoringisthetoppriority**

placeFoleyafterepidural

Normalfetalsleepperiodis3040minutes

VariabledecelerationmayhaveaVorWpattern(consider:contractions,dec.amnioticfluid)

Circumcisionsshouldurinatewithin6hoursofprocedureorsuspectswelling

Postpartumfundalheight:

12hourspost. ~atumbilicus

Fundalheightdecreasesabout1fingerbreadthperday

Fundusshouldbeintothepelviccavitybyday1012

Lochia:

DODday3 L.Rubra(moderate,red,earthy)

Day410 L.Serosa(pink/brown)

46weeks L.Alba(light,scant,creamywhite)

babyblues

NORMALupto2weeksPP

6080%incidence

Mayprogresstopostpartumdepression

HyperemesisGravidarum:

Lossof5%ormoreofprepregnancyweight

electrolyteimbalance

blood/urinekeytones

LossofHCl(vomiting)

K+

temp.

Vit.K

Thiamine(B1deficiency)

LFTs

Riskfactorsfor:Abruptioplacenta:

Cocaine,HTN,tobacco,multigravid,shortumbilicalcord,abd.Trauma,prematureROM,

Previousabruptioplacenta,maternalage,hypercoagulopathies,autoimmunedisorders.

Riskfactorsfor:Placentaprevia:

maternalage,previousD/C,AfricanAmerican,Asian,Cocaine,Tobacco.

CervicalCerclage:

preformedaround812weeks

RX:Indomethacin,nifedipine

Cerclageremovedaround3738weeks

Ectopicpregnancy:

**HallmarkSx:suddendeeppelvicpainbetween812weeks

mayhavereferredrightshoulderpain

Preeclampsia:

BP >160/110

Cr

LFT

HR

**Thrombocytopenia(<100,000)(normalis150400thou.)

Eclampsia:

Seizuresinapreeclampticwomanwithnootheridentifiablecause

Sx:cerebralirritability,confusion,headache,visionchanges,hyperreflexia(+3+4)**notifyprovider!*

Preeclampsiawithseverefeatures:

adiseaseofvasoconstriction

Tx:

bedrest,sidelying,MgSO4,IVfluid,measureI/O,(dailyweights,FetalNST/BPP)

Magnesium(MgSO4):

1effectraisetheseizurethreshold(stopsseizures)

2effectdecreasedbloodpressureisasecondaryeffect

Assmoothmusclesrelaxbleedingmayincrease

**CalciumgluconateistheantidoteforMgSO4overdose**(haveintheroom)

**MgSO4crossestheplacentalbarrier**

IVfluidtoclearMgSO4

Diabetesinpregnancy:

earlypregnancy insulinsensitive=hypoglycemia

latepregnancy insulinresistance=hyperglycemia

Humanplacentallactogen(hPL)secretedbyplacentawhichsparesglucoseforthefetus

Glucosechallengetest:(thisisascreeningonly,notdiagnosticlikeOGTT)

screeningat2428weeks

50Goralglucosesolution(*nonfasting)

1h.postprandialblooddraw

shouldbe<140mg/dl

if>140mg/dlproceedtotheOGTT

OralGlucoseToleranceTest(OGTT):

Fasting812h.

100Goralglucosesolution

postprandialdrawseveryhourx3

1fasting>95mg/dl(>95isadiagnosisofdiabetes)

21hour:>180mg/dl(thisisaboutdoubletheprevious95)

32hours:>155mg/dl

43hours:>140mg/dl

(2postprandialeventsduringtest=Diabetes)

Neonatalrespiratorydistress:

Indicationsevidentshortlyafterbirth:

tachypnea,GFR(Grunting,Fairing,Retractions),cyanosis,heartmurmur(PDA)

HElLPsyndrome:
HHemolysis
ElLElevatedLiverenzymes
Pplatelets