Review patient positioning.

Medication Math

For the entire course:

Disorders, diseases- definition, treatment, prevention, education, “what do they look like?”,
who’s at risk, etc
Study guide for quizzes and OB Mid-Exam

Chapter 1
 What impacts infant mortality?
o Low birth weight
o Premature birth
 List common maternal medical risk factors (in pregnancy).
o Obesity
 HTN and diabetes
o Amniotic fluid embolism
o Eclamspia
o Pulmonary embolism
 What is Evidenced based care, uses?
 Procedure for performing a new patient care procedure.
o Procedure manual at the hospital. Following guidelines
 SBARR
 Health Literacy (English as a second language)
o Use common words
o Avoid jargon
o Assess understanding
 Use of social media as a nurse

Chapter2
 Types of family structures: risks, benefits,
o Family is important because the child affects everyone, and some may or may
not be supportive.
o Single parents
 Economic vulnerability
 Unstable deprived environment
o Multigenerational family
 Can cause stress due to amount of people
 Culture and provision of care
o Can provide insight
o Patterns of human interaction and emotions
o Dress, language, patterns, food choices, and health practices

Chapter 3
 Vulvar self- examination
o Preformed monthly
 Between menses
o Performed by physician or women with mirror
o Moist lesion, warts, cysts, malignance
 Menstrual Cycle- average length, duration
o Menstrual cycle last about 28 days
o First day on bleeding is day 1 of the menstrual cycle
o Average bleeding flow is 5 days
o Average 50 mL of blood loss
 Pelvic floor exercises
o Kegels –“ trying to stop pee”
o everyone
 Intimate partner violence
o Most common form
o Frequent routine assessment of violence
o Emotional abuse, sexual assault, isolation physical abuse, controlling all aspect of
partners life
 Money, shelter, time and food.
 Assessing abuse, what to say, what not to say
o Get client alone for assessment
o Do not judge or question the patient on this
o Do you feel safe at home?
o Does your partner threaten or physically harm you?
o Does your partner emotionally harm you?
o In the past or present pregnancy has anyone slapped, hit, and kicked you?
o Has anyone forced you into sexually activities that made you uncomfortable
o Are you afraid of your partner?
 Pelvic exams- procedures, cultural considerations
o External insepection and palpation
o Internal exam
o Women may feel uncomfortable
 Nurse assist in relaxation techniques
 Allows the patient to express feelings and concerns
 Lithotomy position
 Explain procedure
 Pap smear: procedure, why is it done
o Examination of the cervix and cells
 Looks for abnormal cell growth
 HPV and cancers
o Test specimens for diseases or cancers
 Drug use in pregnancy
Chapter 4
 STI’s- what do they look like, symptoms, treatment, cure, prevention, risky behaviors,
and how to identify them. What they look like
o Which ones have treatments and which ones do not.
o Risk factors:
 Unprotected sex, multiple sex partners.
o Characteristics:
 Lesion
 Flu like symptoms
 Warts
 Abnormal discharge
 Pain
 Bleeding
o Chlamydia
 Usually asymptomatic
 May expeience spotting, postcoital bleeding, mucoid or purulent cervical
discharge, or dysuria.
 Diagnosis is by cultur and expensive
o Gonorrhea
 Often asymptomatic
 Cultures
o Syphilis
 Painless moist lesions
o Pelvic inflammatory disease
o HPV
o Herpes
o Hepatitis
o HIV
o Zika virus
o Bacterial vaginosis
o Candidiasis
o Trichomoniasis
 Endometriosis- definition, symptoms, treatment
o Growth of endometrial tissue outside of the uterus
o Onset in 20s-30s
o Pelvic pain, painful menses, pelvic heaviness, bowel issues,
o Impair fertility
 Scar tissue – endometrium on the tubes.
o Suppress endogenous hormones
o Leuprolide
o Danazol
 o Surgical intervention – laprascope (burn off and get rid of areas)
 Amenorrhea
o absence of menses
o primary – has not gotten period yet (hit puberty)
o Secondary – happens when they’ve had period but it has disappeared
 Dysmenorhea
o Painful or difficult menses
o interventions
 Breast cancer risks – more estrogen
o Age
o Hx
o Family hx
o High breast density
o Race
o First pregnancy after 30
o Not breastfeeding
o Hormone therapy
o Alcohol
o Sedentary lifestyle
o Period later in life.

Chapter 5
 Care of infertility patients
o Fertility specialist
o Embrologyist
o Genetic counselor
o Mental health professional
o Obtain and monitor test results
o Show compassion.
o Be aware of the treatment plans.
o Be mindful of patient’s culture and choices
 Types of contraception: Barrier methods, IUD’s, fertility awareness, etc-
advantages/disadvantages
o Condoms
o Diaphragm
 Larger failure rate
 Messy
 Not a good option for women with poor muscle tone
o Cervical cap
 Toxic shock
o Contraceptive sponge
o Oral contraceptive
  Progesterone
 Impairs infertility
o Transdermal
o Vaginal ring
o Intrauterine
 Pelvic inflammatory disease
 Emergency contraception
o Plan b
o
 Sterilization

Chapter 6

Normal human somatic cells: # of chromosomes and where they come from
 All normal human somatic cells contain 46 chromosomes arranged in 23 pairs of
homologous (matched) chromosomes. One chromosome of each pair of each pair is
inherited from each parent.
Karyotype, genotype, and phenotype
 Genotype
o Refers to genetic makeup
 Phenotype
o Observable expression of an individuals’s genotype
o Physical features
 Karyotype
o Pictorial analysis of the number, form, and size of individual’s chromosomes.
Risk factors for genetic disorders
 Being age 35 or older when your baby is due, baby’s father being age 50 years or older,
family history of neural tube defects, and family history of cystic fibrosis are all risk
factors for genetic disorders.
What produces amniotic fluid
 The amniotic cavity initially derives its fluid by diffusion from maternal blood. Fluid
secreted by the respiratory and GI tracts of the fetus and enters the amniotic cavity.
Beginning in week 11, the fetus urinates into the fluid, increasing its volume.
What is Wharton’s jelly, a true knot, nuchal cord, 2 vessel cord
 A true knot is a knot that forms in the umbilical cord. Wharton’s jelly prevents
compression of the blood vessels and ensures continued nourishment of the embryo/fetus.
Type and # of vessels within an umbilical cord
 2 vessels. 2 arteries and one vein
What does Progesterone do during pregnancy
 Progesterone maintains the endometrium, decreases the contractility of the uterus, and
stimulates maternal metabolism and development of breast alveoli.
What does HCG do during pregnancy
  Persevres the function of the ovarian corpus luteum, ensuring a continued supply of
estrogen and progesterone needed to maintain pregnancy.
Substances that are toxic developmentally in humans?
 Cocaine
 Rubella
 Smoking
 Lead
 Hyperthermia
 Ethanol
Parts of the special fetal circulatory, how does baby receive oxygen?
 The ductus arteriosus bypasses the lungs. Most of the blood passes though the ductus
venous into the inferior vena cava. Most of this blood passes straight through the right
atrium and through the foramen ovale.
Surfactant

Causes of meconium to be passed during pregnancy?
 The meconium will be passed prior to delivery due to frank breech position and fetal
hypoxia.
Pseudomenstruation & Witch’s milk
 Pseudomenstruation may occur at birth. The high level of maternal estrogen also
stimulates mammary engorgement and secretion and secretion of fluid (witch’s milk) in
newborn infants of both sexes.
Lanugo
 Very fine hair
Difference between monozygotic & dizygotic twins (# of placentas, membranes & cords)
 Dizygotic twins each have their own placenta, bag of fluid, and umbilical cord.

Chapter 7
Common prenatal discomforts and treatments
Calculate GTPAL- WILL NOT BE on QUIZ
Calculate due date- WILL NOT BE on QUIZ
Difference between presumptive, probable and positive signs of pregnancy
Braxton Hicks contractions
 Braxton Hicks are irregular and painless contractions that occur intermittently throughout
pregnancy.
Leukorrhea
 White or slightly gray mucoid vaginal discharge with a faint musty odor.
Chadwick sign
 Increased vascularity results in in a violet-blue vaginal mucosa and cervix.
Ballottement
 Passive movement of the unengaged fetus.
Striae graviadrum
 Stretch marks
Fundal height measurements
 From gestational weeks 18-30, the height of the fundus in centimeters is approximately
the same number of weeks of gestation.
CBC changes in pregnancy, why?
 Increase in plasma and WBC
 Decrease in hematocrit and hemoglobin.
Melasma (cholasma), linea nigra, angiomatas, palmar erythema
 Melasma (cholasma)
o Blotchy, brownish hyperpigmentation of the skin over cheeks, nose, and
forehead, especially in pregnant women with dark complexions.
 Linea Nigra
o Pigmented line extending from the symphasis pubis to the top of the fundus in
the midline.
 Angiomatas
o Commonly known as vascular spiders, tiny star shaped or branched, slightly
raised, and pulsating end-arterioles usually found on the neck, thorax, face, and
arms.
 Palmar erythema
o Pinkish red, diffusely mottled, or well-defined blotches are seen over the palmar
surfaces of the hand.
Ptyalism, Epulis, PICA, Pyrosis
 Ptyalism
o Excessive salivation
o Can be caused by the unconscious decrease in swallowing by women when
nauseated
o Or can be caused by stimulation of salivary glands by eating starch.
 Epulis
o Red, raised nodule on the gums that bleed easily.
o Develops around the third month and often continues to enlarge as pregnancy
progresses.
o Managed by avoiding trauma to the gums.
o Regresses after birth.
 PICA
o Nonfood cravings
o Ice, clay, laundry starch
 Pyrosis
o heartburn
Causes of second trimester bleeding
 Miscarriage, placenta previa, and abruptio placentae.
Exercise tips for women
A. Avoid risky activities such as surfing.
B. Stay hydrated.
C. Increase your caloric intake
 D. Recognize signs of danger: blurred vision, fainting and breathlessness.

How varicella and Tdap are related to pregnancy?

Who gets Rhogam?
Lordosis
 The woman’s center of gravity shifts forward. An increase of the normal lumbosacral
curve (Lordosis)
Systematic changes that occur in pregnancy
Supine hypotension, pregnancy (prevention, treatment)

Chapter 8

 Importance of prenatal care. Why?

o Promote health and well-being of the women, her fetus, her newborn, and the
family

o Education about healthy lifestyle behaviors such as nutrition and physical activity,
self-care, information about changes in the mother, identifying risk factors,

o Routine screening

o Promote safe birth for the mother and infant and to promote satisfaction of the
mother and family with the pregnancy and birth experience

 Common concerns for expecting parents, warning signs abnormal adjustment

 Understand integrative healthcare

 Alternative medicine
o Yoga
o Meditation
o Massage
o Acupuncture
o Reiki

 Fundal height

o Measurement of the height of the uterus above the symphysis pubis

o Indicator of fetal growth

o Gross estimate of the duration of pregnancy

 o From 18-30 week, the height of the fundus in centimeters is approx. the same as
the number of weeks of gestations

 Exercise tips for women

o Kegels

o Pelvic rocking

o 30 min of moderate exercise is recommended

o Take your pulse every 10-15 min

o Stay hydrated

 Supine hypotension

o Potential threatening condition

o Low blood pressure that occurs when the women is lying on her back.

o Causing a feeling of faint

o Pallor

o Dizziness

o Tachycardia

o Nausea

o Clammy

o Position women on her side until her signs and symptoms subside and vital signs
stabilize within normal limits

 40 weeks, trimesters
o 1st trimester
 0-12 weeks
nd
o 2 trimester
 13-26 weeks
rd
o 3 trimester
 27 weeks until end of pregnancy or 40 weeks
 Nageles rule
 o Estimated due date
o Subtract 3 from the month of LMP
o Add 7 to the day of LMP
 Measuring abdomen/pregnancy
 Body mechanics of pregnancy

Chapter 9
Folic acid recommendations, prevention
 Pregnant women should consume 0.4 mg (400mcg) of folic acid daily. All woman of
childbearing potential need careful counseling about including good sources of folate in
their diets. Supplemental folic acid is usually prescribed to ensure that intake is
adequate. Neural tube defects.
PICA
 The nurse can suggest choosing healthy alternatives for cravings, eating small amounts
of craved food (buying single servings), eating regularly and including healthy snacks to
avoid drops in blood glucose levels, and using distraction to curb the craving.
Alcohol consumption
 Because alcohol is a teratogen, it can cause birth defect, impaired cognitive and
psychomotor development, and emotional and behavioral problems. Fetal alcohol
syndrome can result from maternal alcohol consumption; this severe disorder involves
growth restriction, CNS abnormalities, and facial dysmorphia.
Nausea and vomiting
 Most common during first trimester. Antiemetic meds vitamin b6, ginger, and p6
acupressure for nausea.
 Hyperemesis gravidarum, or severe and persistent vomiting causing weight loss,
dehydration, and electrolyte abnormalities, occurs in up to 1% of pregnant women.
o IV fluid and electrolyte replacement, enteral tube feedings, and rarely TPN have
been used to nourish women.
Pyrosis
 Heartburn
 Can be minimized by eating small frequent meals, rather than 2 or 3 larger meals daily.
 Fluids should not be consumed with food because of distention of the stomach. Drink
adequate amount of fluids between meals.
 Avoid spicy foods.
 Can be exacerbated by laying down immediately after eating and wearing clothing that is
tight across the abdomen.

Chapter 10
Daily kick counts, benefits
 Fetus health
  Record for 60 minutes a day.
 Record 2-3 times daily for 2 hours or until 10 movements.
 Fetal alarm signal with ceased movement for 12 hours – emergency
 A count fewer than 3 within an hour requires further evaluation by nonstress test or
cintraction stress test and a complete or modified biophysical profile.
 Teach mothers significance of fetal movement and absence
Use of ultrasound
 Fetal heart rate activity
 Gestational age
 Fetal growth
 Fetal anatomy
 Fetal genetic disorders physical anomalies
 Placental position and function
 Adjunct to other invasive tests
 Fetal well-being
o Doppler blood flow analysis
o BPP
o Modified BPP
Biophysical profile
CST
 GO OVER THIS
 Which result needs to be reported.
Nonstress test
Amniocentesis
 Maternal complications

o Hemorrhage

o Fetomaternal hemorrhage

o Infection

o Labor

o Abruptio placentae

o Damage to intestines or bladder

o Amniotic fluid embolism

 Fetal complications

o Death
 o Hemorrhage

o Infection (amnionitis)

o Injury from needle

o Risks may be minimized by using ultrasound to direct the procedure

 Genetic concerns

o Women over 35 years old

o Family history of chromosomal abnormalities
 Fetal maturity
o L/S and S/A ratios
 L/S ration – how well the lungs function – comes from amniocentesis
 Fetal hemolytic disease
 LS ratio
o Lung maturity
o PG
 Alpha-fetoprotein (AFP)
o Collected through bloodwork
o Assessed through amniocentesis
o High AFP help confirm the diagnosis of an NTD (nerual tube defects) such as
spina bifida, anencephaly, or an abdominal wall defect such as omphalocele.
o Folic acid, diabetes, epileptic pt – anticonvulsants.
VAS

 Chapter 11
 Heart disease- warning signs
o Edema, cough, sinus, headache, rapid pulse
 Egrieved edema
 Diabetes risk factors – who will get tested for gestational diabetes early?
 Hyperglycemia
o The kidneys function to excrete large volumes of urine (polyuria) in an attempt to
regulate excess vascular volume and excrete the unusable glucose (glycosuria).
Polyuria, along with cellular dehydration, causes excessive thirst (polydipsia)
 Complication associated with diabetes and pregnancy
o Fetal weight >4000-5000grams
o Increased risk of preeclampsia
o More infections
o Shoulder dystocia
 Fetal/neonatal risks from maternal diabetes
o 30% miscarriage rate
o Congenital Malformations
o Stillbirth
o RDS
 Diabetic needs of mom’s in labor
o Women will need dextrose during labor to meet the energy needs.
o Scheduled cesarean sections should be in the early morning.
o Glucose should be maintained between 80-110 .
o Insulin can be given IV during labor
o Dextrose should be on infusion pump to avoid direct bolus
 Screening measures/results for gestational diabetes
 Medications for pregnant diabetics
o Insulin and oral glburide and metformin
 Cardiac decompensation in pregnancy
o Subjective:
 Increasing fatigue or difficulty breathing, or both, with her usual activities.
 Feeling of smothering
 Frequent cough
 Palpitations; feeling that her heart is racing.
 Generalized edema: swelling of face, feet, legs, fingers (ring may no
longer fit)

o Objective:
 Irregular, weak, rapid pulse
 Progressive, generalized edema
 Crackles at base of lungs after two inspirations and exhalations that do not
clear coughing.
 Orthopnea; increasing dyspnea
 Rapid respirations
 Moist, frequent cough.
 Cyanosis of lips and nail beds.
 Asthma in pregnancy
 Skin Medications to avoid
o Accutane
 Pruritus gravidarum
o Increased itching without rash
 PUPPP
o Lesions prestn on abdomen and spread to arms, thighs, back, and buttocks.
o Causes itching – severe in 80% of cases
o Associated with weight gain, and increased risk of twins.
 ICP
o Most common liver disease of pregnancy affects palms and soles.
o Usually worse at night.
 o No skin lesions are present
 Palmar erythema
o
 Substance use in pregnancy, lactation

Chapter 12
 Magnesium Sulfate indication, assessment, side effects
o Assessment to determine effectiveness: BP, reflexes,?
o Common side effects are warmth, flushin, diaphoresis, and burning at IV site.
o Symptoms of toxicity include absent deep tendon reflexes, respiratory
depression, blurred vision, slurred speech, severe muscle weakness, and cardiac
arrest. Draw blood to check for toxicity.
 HTN – 140/90. Severe range – 160/110
 Gestational HTN
o Onset of HTN without presence of proteinuria or other systemic findings
diagnostic for preeclampsia after 20 weeks gestation.
 Preeclampsia- definition, warning signs, treatment, education
o HTN and proteinuria, develops after 20 weeks gestation
o Aspirin decreases risk of preeeclampsia and adverse outcomes
o Quiet environment
o Subdued lighting
o Magnesium Sulfate
o Suction equipment
o Oxygen equipment
o Padded side rails
 Eclampsia- definition, treatment, side effects, education
o Onset of seizure activity or coma
o Headache, photophobia, right upper quadrant pain and altered mental status
o Although elcamptic seizures can occur before, during, or after birth,
approximately 50% of cases occur during antepartum period.
 Super-imposed preeclampsia
o Chronic HTN in association with preeclampsia.
 HELLP
o HELLP syndrome is a laboratory diagnosis for a variant of preeclampsia that
involves hepatic dysfunction characterized by hemolysis (H), Elevated liver
enzymes (EL), and low platelet count (LP).
o HELLP patients are at risk for:
 Pulmonary edema, DIC, liver hemorrhage or failure, abruption
 Acute renal failure, ARDS, sepsis, stroke, fetal and maternal death.
 24 hour urine-definition, results
o Proteinuria is definied as a concentration at or greater than 300 mg on the 24
hour urine specimen.
 Placenta Previa- definition, treatment, sign and symptoms, education
 o Painless bright red bleeding!!
o Nothing in the vagina!!
o Placenta is implanted in lower uterine segment; close enough to the cervix to
cause bleeding when cervix dilates or the lower uterine segment effaces.
 Cervical insufficiency
o Passive and painless dilation of the cervix leadin to preterm births during the
second trimesteer in the absence of other causes.
 Cerclage
o Treatment of choice for cervical insufficiency due to cervical weakness.
o Suture is placed around the cervix
 Ectopic
o Pregnancy in which the fertilized ovum is planted outisde of the uterine cavity.
o Tubal pregnancies – 90% are located in fallopian tube.
o First line treatment – methotrexate. (related to chemo)
 Hyperemesis gravidarum
 Molar pregnancy
 Abruptio placentae / Placental Abruption
o Understanding risk factors – what causes this?
 Maternal HTN, cocaine use, and blunt external abdominal trauma (falls?).
 Other risk factors include: smoking, history of abruption, and preterm
premature rupture of membranes.
o Reasons for this being seen?
 Many complications for mother and fetus.
o Detachment of part or all of normally implanted placenta from the uterus.
o Vaginal bleeding
o There is pain involved.
o Belly will be hard
o Contracting a lot
o Pain in their stomach and back.
 Vasa Previa
o Vessels are implanted into the fetal membranes rather than into the placenta
 Asymptomatic Bacteriuria
o Persistent presence of bacteria within the urinary tract of women who have no
symptoms.
o Treatment: antibiotics
 Spontaneous abortions- different types
o Threatened
o Inevitable
o Complete
o Incomplete
o Missed
 Know abbreviations
 Know meds – just ones from lab
o Why we give them, major side effects, and routes.