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OB Maternal Newborn ATI Exam Study Guide 4
V
Video #1: Contraception & Infertility
Diaphragms: client must be refitted for a diaphragm for the following conditions:
It’s been 2 years since she has been fitted
Gained more than 15 pounds (7kg)
Had a full-term pregnancy
Had a second term abortion
When you use a diaphragm, you need to use spermicide with every act of coitus (withdrawal of penis from
vagina prior to ejaculation). Every time you withdrawal, instillmore spermicide.
Diaphragm must stay inserted for 6hrs after act of coitus.
Hormonal Contraceptives (Oral)
Side effects: Chest pain, SOB, Leg pain (from a possible clot), headache or eye problems(from a stroke or
hypertension)
Contraindications: Women with a history of blood clots, stroke, cardiac problems,smoker, breast or
estrogen related cancers (pill contains estrogen)
Depo-Provera/Medroxyprogesterone
Injectable progestin
Can cause decreased bone mineral density or loss of calcium
Nursing action: Ensure patient has adequate intake of calcium and vitamin D
IUD
Increase risk for PID
Can cause uterine perforation or ectopic pregnancy (increases risk for ectopic pregnancy)
Look out for/Notify PCP:
Change in string length IUD is moving and not in the right place
Foul smelling vaginal discharge
Pain with intercourse
Fever/Chills (infection)
Infertility is defined as an inability to conceive desire engaging in unprotected sexual intercourse for a
prolonged period of time or at least 12 months.
Common factors associated with infertility include:
Decreased sperm production (Sperm analysis)
Endometriosis
Ovulation disorders
Tubal occlusions If you test and use DYE (used in the fallopian tubes), make sure thewoman is not
allergic to iodine or shellfish/seafood
Video #2: Signs of Pregnancy
Presumptive: Can be defined by things/reasons other than pregnancy
Amenorrhea Can be anorexic or exercising too much
Fatigue Didn’t sleep well
Nausea/Vomiting Sick
1
, Page 2
Urinary Frequency UTI
Quickening/Fluttering in stomach Gas
2
, Page 3
Probable: Changes that make the examiner suspect a woman is pregnant (primarily related to physical
changes of the uterus).
Abdominal enlargement: Related to changes in uterine size, shape, and position
Hegar’s Sign: Softening and compressibility of the lower uterus Chadwick’s Sign:
Deepend violet bluish color of cervix and vaginal mucosaGoodell’s Sign: Softening
of cervical tip
Ballottement: Rebound of unengaged uterus
Braxton Hicks Contractions: False contractions that are painless, irregular, and usually relievedby
walking
Positive Pregnancy Test: Woman’s hormonal level may not be normal
Fetal Outline: Positive: Very
distinct things.
Fetal Heart Sounds
Fetal Heartbeat can be heard
Can see the baby with ultrasound
Can feel movement in the uterus
Naegele’s Rule: Last menstrual period minus (– ) 3 months + 7 days + 1-year ;Cathy’s Rule: + 9
months + 1 week
Gravidity and Parity:
Gravida: a woman who is pregnant
Gravidity: number of pregnancies
Nulligravida: a woman who has never been pregnant
Primigravida: a woman who is pregnant for the first time
Multigravida: a woman in at least her second pregnancy.
Parity: the number of births (not the number of fetuses [ex: twins]) carried pat 20 weeks
gestation, whether or not the fetus was born alive.
Nullipara: a woman who has not had a birth at more than 20 weeks of gestation.
Primipara: a woman who has had one birth that occurred after 20 weeks of gestation.
Multipara: a woman who has had two or more pregnancies to the stage of fetal viability.
Know how to find out GTPAL numbers:
G= Gravidity (# of times a woman has been pregnant PLUS current pregnancy)
T= Term Births (How many babies were delivered at term 38 WEEKS OR MORE)
P= Preterm Births (Below 38 weeks)
A= Abortion (spontaneous or not) or miscarriages L= Living children
Fundal height:
Measured to evaluate the gestational age of the fetus.
During the second and third trimesters (weeks 18-30), the fundal height in centimeters
approximately equals the fetus’s age in weeks, plus or minus 2 cm.
At 16 weeks, the fundus can be found approximately halfway between the symphysis pubis andthe
umbilicus.
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, Page 4
At 20 to 22 weeks, the fundus is
approximately at the location of the
umbilicus.
At 36 weeks, the fundus is at the xiphoid
process.
When assessing fundal height, monitor the
clientclosely for supine hypotension when
place in the supine position.
Measuring fundal height:
Place the client in a supine position
Place the end of the tape measureat the
level of symphysis pubis
Stretch the tape to the tope of theuterine
fundus
Note and record the measurement.
Physiological Maternal Changes:
Cardiovascular system:
Circulating blood volume increases by approximately 40 – 50%; physiological anemia may occuras the
plasma increase exceeds the increase in the production of red blood cells.
Heart size is increased, and the heart is elevated upward and to the left because of displacement ofthe
diaphragm as the uterus enlarges.
There is an increase in the body’s demand for iron.
Sodium and water retention may occur, which can lead to weight gain.
Respiratory system:
Oxygen consumption increases by approximately 15% to 20%
Diaphragm is elevated as a result of the enlarged uterus
Shortness of breath may be experienced.
During pregnancy, a woman’s pulse rate may increase about 10 to 15 beats/minute, the blood pressure
slightly decreases in the second trimester, then increases in the third trimester but not above the
pregnancy level; and the respiratory rate remains unchangedor slightly increases.
Gastrointestinal System:
Nausea and vomiting, which usually subsides by the 3rd month, may occur as a result of the secretion of
human chorionic gonadotropin (hCG); hCG stabilizes or decreases around week 12
Poor appetite may occur because of decreased gastric motility.
Alterations in taste and smell may occur.
Constipation may occur because of an increase in progesterone production or pressure of theuterus,
resulting in decreased GI motility.
4
OB Maternal Newborn ATI Exam Study Guide 4
V
Video #1: Contraception & Infertility
Diaphragms: client must be refitted for a diaphragm for the following conditions:
It’s been 2 years since she has been fitted
Gained more than 15 pounds (7kg)
Had a full-term pregnancy
Had a second term abortion
When you use a diaphragm, you need to use spermicide with every act of coitus (withdrawal of penis from
vagina prior to ejaculation). Every time you withdrawal, instillmore spermicide.
Diaphragm must stay inserted for 6hrs after act of coitus.
Hormonal Contraceptives (Oral)
Side effects: Chest pain, SOB, Leg pain (from a possible clot), headache or eye problems(from a stroke or
hypertension)
Contraindications: Women with a history of blood clots, stroke, cardiac problems,smoker, breast or
estrogen related cancers (pill contains estrogen)
Depo-Provera/Medroxyprogesterone
Injectable progestin
Can cause decreased bone mineral density or loss of calcium
Nursing action: Ensure patient has adequate intake of calcium and vitamin D
IUD
Increase risk for PID
Can cause uterine perforation or ectopic pregnancy (increases risk for ectopic pregnancy)
Look out for/Notify PCP:
Change in string length IUD is moving and not in the right place
Foul smelling vaginal discharge
Pain with intercourse
Fever/Chills (infection)
Infertility is defined as an inability to conceive desire engaging in unprotected sexual intercourse for a
prolonged period of time or at least 12 months.
Common factors associated with infertility include:
Decreased sperm production (Sperm analysis)
Endometriosis
Ovulation disorders
Tubal occlusions If you test and use DYE (used in the fallopian tubes), make sure thewoman is not
allergic to iodine or shellfish/seafood
Video #2: Signs of Pregnancy
Presumptive: Can be defined by things/reasons other than pregnancy
Amenorrhea Can be anorexic or exercising too much
Fatigue Didn’t sleep well
Nausea/Vomiting Sick
1
, Page 2
Urinary Frequency UTI
Quickening/Fluttering in stomach Gas
2
, Page 3
Probable: Changes that make the examiner suspect a woman is pregnant (primarily related to physical
changes of the uterus).
Abdominal enlargement: Related to changes in uterine size, shape, and position
Hegar’s Sign: Softening and compressibility of the lower uterus Chadwick’s Sign:
Deepend violet bluish color of cervix and vaginal mucosaGoodell’s Sign: Softening
of cervical tip
Ballottement: Rebound of unengaged uterus
Braxton Hicks Contractions: False contractions that are painless, irregular, and usually relievedby
walking
Positive Pregnancy Test: Woman’s hormonal level may not be normal
Fetal Outline: Positive: Very
distinct things.
Fetal Heart Sounds
Fetal Heartbeat can be heard
Can see the baby with ultrasound
Can feel movement in the uterus
Naegele’s Rule: Last menstrual period minus (– ) 3 months + 7 days + 1-year ;Cathy’s Rule: + 9
months + 1 week
Gravidity and Parity:
Gravida: a woman who is pregnant
Gravidity: number of pregnancies
Nulligravida: a woman who has never been pregnant
Primigravida: a woman who is pregnant for the first time
Multigravida: a woman in at least her second pregnancy.
Parity: the number of births (not the number of fetuses [ex: twins]) carried pat 20 weeks
gestation, whether or not the fetus was born alive.
Nullipara: a woman who has not had a birth at more than 20 weeks of gestation.
Primipara: a woman who has had one birth that occurred after 20 weeks of gestation.
Multipara: a woman who has had two or more pregnancies to the stage of fetal viability.
Know how to find out GTPAL numbers:
G= Gravidity (# of times a woman has been pregnant PLUS current pregnancy)
T= Term Births (How many babies were delivered at term 38 WEEKS OR MORE)
P= Preterm Births (Below 38 weeks)
A= Abortion (spontaneous or not) or miscarriages L= Living children
Fundal height:
Measured to evaluate the gestational age of the fetus.
During the second and third trimesters (weeks 18-30), the fundal height in centimeters
approximately equals the fetus’s age in weeks, plus or minus 2 cm.
At 16 weeks, the fundus can be found approximately halfway between the symphysis pubis andthe
umbilicus.
3
, Page 4
At 20 to 22 weeks, the fundus is
approximately at the location of the
umbilicus.
At 36 weeks, the fundus is at the xiphoid
process.
When assessing fundal height, monitor the
clientclosely for supine hypotension when
place in the supine position.
Measuring fundal height:
Place the client in a supine position
Place the end of the tape measureat the
level of symphysis pubis
Stretch the tape to the tope of theuterine
fundus
Note and record the measurement.
Physiological Maternal Changes:
Cardiovascular system:
Circulating blood volume increases by approximately 40 – 50%; physiological anemia may occuras the
plasma increase exceeds the increase in the production of red blood cells.
Heart size is increased, and the heart is elevated upward and to the left because of displacement ofthe
diaphragm as the uterus enlarges.
There is an increase in the body’s demand for iron.
Sodium and water retention may occur, which can lead to weight gain.
Respiratory system:
Oxygen consumption increases by approximately 15% to 20%
Diaphragm is elevated as a result of the enlarged uterus
Shortness of breath may be experienced.
During pregnancy, a woman’s pulse rate may increase about 10 to 15 beats/minute, the blood pressure
slightly decreases in the second trimester, then increases in the third trimester but not above the
pregnancy level; and the respiratory rate remains unchangedor slightly increases.
Gastrointestinal System:
Nausea and vomiting, which usually subsides by the 3rd month, may occur as a result of the secretion of
human chorionic gonadotropin (hCG); hCG stabilizes or decreases around week 12
Poor appetite may occur because of decreased gastric motility.
Alterations in taste and smell may occur.
Constipation may occur because of an increase in progesterone production or pressure of theuterus,
resulting in decreased GI motility.
4
