BIOL 36019/ OB HESI STUDY GUIDE LATEST
OB HESI STUDY GUIDE
Version 1
1. Basic nursing skills/safety/newborn – radiant warmer – temperature probe
• If the infant does not remain w/the mother during the 1st 1-2 hours after birth, the
infant is placed under a radiant warmer or incubator until body temperature stabilizes
• Skin temperature is used as the point of control – maintained b/t 36 ̊ and 37 ̊
• A thermistor probe (automatic sensor) is placed on the upper quadrant of the
abdomen immediately below the right or left costal margin
o Probe ensures detection of minor temperature changes before a dramatic
change in temperature develops
o Probe needs to be checked periodically to make sure it is in contact w/infants
skin
2. Med administration – math
3. Med administration – math
4. Antepartum – contractions – action
• Frequent position changes
• Encourage voiding minimum q2 hours
• Encourage deep cleansing breaths
• Provide pharmacological and non-pharmacological comfort measures
• Provide maternal/fetal monitoring
• Discourage pushing until fully dilated
5. Antepartum – CST
• Contraction stress test (CST) – purpose is to identify the jeopardized fetus that is
stable at rest but showed evidence of compromise after stress. Woman is seated and
reclined (semi-Fowler). She is monitored electronically w/fetal ultrasound transducer
and uterine tocodynamometer. Tracing is observed for 10-20 minutes for baseline rate.
Two methods of the CST are the nipple-stimulation contraction test and the more
common oxytocin stimulated contraction test. If no late decelerations are observed w/
contractions, the findings are considered negative. Repetitive late decelerations (50%
or more of contractions) render a positive result
6. Antepartum – fundal height – action
• Used as one indicator of fetal growth
• Provides a gross estimate of the duration of pregnancy
o The height of the fundus in cm is approximately the same as the number of
weeks of gestation
• Measurement is made from the upper border of the symphysis pubis to the upper
border of the fundus
, • Woman should have emptied her bladder and be lying supine with knees in flexed
position
7. Antepartum – gestational HTN
• Gestational HTN - the onset of HTN w/out proteinuria after week 20 of pregnancy
o Systolic > 140, diastolic > 90
• HTN should be recorded on at least two separate occasions at least 4-6 hours apart
and within a 1-week period
• Occurs more frequently in women w/multifetal pregnancies
• Women w/gestational HTN have no evidence of preexisting HTN, and their BPs return
to normal levels within 6 weeks after giving birth
8. Antepartum – indigestion – third trimester
• It is common for indigestion to start in the 3rd trimester d/t the growing baby pushing
the stomach upward toward the esophagus
o Relief measures
! Wait at least an hour after meals before lying down
! Eat several small meals, take your time
! Avoid foods that cause indigestion (fried/greasy foods)
! Avoid caffeine/alcohol b/c they can aggravate indigestion
! Don’t smoke
9. Antepartum - infertility – drug therapy
• Action is often directed at stimulating ovulation or enhancing ovulation so more
oocytes mature
• M/C medications include: clomiphene citrate, hMG, FSH, hCG, and GnRH
o Prevalence of multiple pregnancies w/use of these meds is > 25%
10. Antepartum – pregnancy – weight gain
• Maternal and fetal risks increase when mom is severely over or under weight
• Underweight women are more likely to have preterm labor and to give birth to LBW
infants
• Obesity – increases likelihood of preeclampsia and gestational diabetes
• Appropriate measure of evaluating weight gain is BMI
o <18.5 = underweight
o 18.5-24.9 = normal
o 25-29.9 = overweight
o 30 or > = obese
• Pattern of weight gain
o 1st trimester – average weight gain is 1-2kg
o Thereafter the recommended weight gain increases to about 0.5 kg/week for
an underweight woman and 0.4 kg/week for a woman of normal weight
, o The recommended weekly weight gain for overweight women during the 2nd
and 3rd trimester is 0.3 kg/week, and 0.2 kg for obese women
11. Antepartum – smoking in pregnancy
• Smoking is associated w/an increased frequency of preterm labor, PROM, abruption
placentae, Placenta Previa, and fetal death
• Encourage women to quit or cut down if they smoke and to avoid second hand smoke
12. Antepartum – supine hypotension
• Supine hypotensive syndrome – when lying flat, a decrease in systolic of >30mmHg d/
t suppression of the vena cava, causes faintness
o Common in the 2nd and 3rd trimester b/c of the increasing weight of the baby;
lying in the supine position can cause compression of the inferior vena cava
o Instruct client to use a side lying position with knees slightly flexed, and
change positions slowly
13. Antepartum – triple screen
• In the 2nd trimester, triple screening is available for fetuses w/Trisomy 21 and Trisomy
18
• Screen is performed at 16-18 weeks
• Measures the levels of 3 maternal serum markers; MSAFP, unconjugated estriol, and
hCG
o Fetus w/Trisomy 21 – MSAFP and unconjugated estriol levels are low
o Low levels of in all 3 markers are associated w/Trisomy 18 (Edward’s
syndrome)
14. Antepartum – ultrasound at 20 weeks
• Uses
o Establish/confirm dates
o Confirm viability
o Detect polyhdraminos/oligohydraminos
o Detect congenital anomalies
o Detect intrauterine growth restriction
o Assess placental placement
o Used for visualization during amniocentesis
15. Antepartum – vaginal discharge – pregnancy
• Leukorrhea
o Hormonally stimulated cervix becomes hypertrophic and hyperactive,
producing abundant amount of mucus
, ! Not preventable, do not douche, wear perineal pads, wipe from front to
back, report to PCP if accompanied by pruritus, foul odor, or change in
character or color
16. Antepartum – Intrapartum – UTI
• UTIs are a common medical complication of pregnancy; about 20% of all pregnancies
• Instruct women taking ABX to finish the entire course of meds, take meds on time and
around the clock so the medication levels remain constant
o Many women will develop a yeast infection while taking ABX b/c the ABX kills
normal flora. We should encourage them to include yogurt, cheese, or milk
containing active acidophilus while on their ABX regimen
• UTI prevention
o Wipe from front to back
o Cotton crotch underwear
o Avoid tight-fitting clothes
o Limit time spent in damp exercise clothes
o Avoid bath salts/bubble baths
o Avoid colored/scented toilet tissue
o Don’t wait to void
o Void before and after intercourse and before going to bed at night
o Drink at least 8 glasses of water daily
17. Intrapartum – back labor – relief
• Physiology
o Exaggerated lumbar and cervicothoracic curves caused by change in center of
gravity d/t enlarging abdomen
• Relief
o Maintain good posture and body mechanics
o Avoid fatigue
o Wear low heeled shoes
o Abdominal support may be useful
o Conscious relaxation
o Sleep on firm mattress
o Apply local heat/ice
o Get back rubs
o Do pelvic tilt exercises
OB HESI STUDY GUIDE
Version 1
1. Basic nursing skills/safety/newborn – radiant warmer – temperature probe
• If the infant does not remain w/the mother during the 1st 1-2 hours after birth, the
infant is placed under a radiant warmer or incubator until body temperature stabilizes
• Skin temperature is used as the point of control – maintained b/t 36 ̊ and 37 ̊
• A thermistor probe (automatic sensor) is placed on the upper quadrant of the
abdomen immediately below the right or left costal margin
o Probe ensures detection of minor temperature changes before a dramatic
change in temperature develops
o Probe needs to be checked periodically to make sure it is in contact w/infants
skin
2. Med administration – math
3. Med administration – math
4. Antepartum – contractions – action
• Frequent position changes
• Encourage voiding minimum q2 hours
• Encourage deep cleansing breaths
• Provide pharmacological and non-pharmacological comfort measures
• Provide maternal/fetal monitoring
• Discourage pushing until fully dilated
5. Antepartum – CST
• Contraction stress test (CST) – purpose is to identify the jeopardized fetus that is
stable at rest but showed evidence of compromise after stress. Woman is seated and
reclined (semi-Fowler). She is monitored electronically w/fetal ultrasound transducer
and uterine tocodynamometer. Tracing is observed for 10-20 minutes for baseline rate.
Two methods of the CST are the nipple-stimulation contraction test and the more
common oxytocin stimulated contraction test. If no late decelerations are observed w/
contractions, the findings are considered negative. Repetitive late decelerations (50%
or more of contractions) render a positive result
6. Antepartum – fundal height – action
• Used as one indicator of fetal growth
• Provides a gross estimate of the duration of pregnancy
o The height of the fundus in cm is approximately the same as the number of
weeks of gestation
• Measurement is made from the upper border of the symphysis pubis to the upper
border of the fundus
, • Woman should have emptied her bladder and be lying supine with knees in flexed
position
7. Antepartum – gestational HTN
• Gestational HTN - the onset of HTN w/out proteinuria after week 20 of pregnancy
o Systolic > 140, diastolic > 90
• HTN should be recorded on at least two separate occasions at least 4-6 hours apart
and within a 1-week period
• Occurs more frequently in women w/multifetal pregnancies
• Women w/gestational HTN have no evidence of preexisting HTN, and their BPs return
to normal levels within 6 weeks after giving birth
8. Antepartum – indigestion – third trimester
• It is common for indigestion to start in the 3rd trimester d/t the growing baby pushing
the stomach upward toward the esophagus
o Relief measures
! Wait at least an hour after meals before lying down
! Eat several small meals, take your time
! Avoid foods that cause indigestion (fried/greasy foods)
! Avoid caffeine/alcohol b/c they can aggravate indigestion
! Don’t smoke
9. Antepartum - infertility – drug therapy
• Action is often directed at stimulating ovulation or enhancing ovulation so more
oocytes mature
• M/C medications include: clomiphene citrate, hMG, FSH, hCG, and GnRH
o Prevalence of multiple pregnancies w/use of these meds is > 25%
10. Antepartum – pregnancy – weight gain
• Maternal and fetal risks increase when mom is severely over or under weight
• Underweight women are more likely to have preterm labor and to give birth to LBW
infants
• Obesity – increases likelihood of preeclampsia and gestational diabetes
• Appropriate measure of evaluating weight gain is BMI
o <18.5 = underweight
o 18.5-24.9 = normal
o 25-29.9 = overweight
o 30 or > = obese
• Pattern of weight gain
o 1st trimester – average weight gain is 1-2kg
o Thereafter the recommended weight gain increases to about 0.5 kg/week for
an underweight woman and 0.4 kg/week for a woman of normal weight
, o The recommended weekly weight gain for overweight women during the 2nd
and 3rd trimester is 0.3 kg/week, and 0.2 kg for obese women
11. Antepartum – smoking in pregnancy
• Smoking is associated w/an increased frequency of preterm labor, PROM, abruption
placentae, Placenta Previa, and fetal death
• Encourage women to quit or cut down if they smoke and to avoid second hand smoke
12. Antepartum – supine hypotension
• Supine hypotensive syndrome – when lying flat, a decrease in systolic of >30mmHg d/
t suppression of the vena cava, causes faintness
o Common in the 2nd and 3rd trimester b/c of the increasing weight of the baby;
lying in the supine position can cause compression of the inferior vena cava
o Instruct client to use a side lying position with knees slightly flexed, and
change positions slowly
13. Antepartum – triple screen
• In the 2nd trimester, triple screening is available for fetuses w/Trisomy 21 and Trisomy
18
• Screen is performed at 16-18 weeks
• Measures the levels of 3 maternal serum markers; MSAFP, unconjugated estriol, and
hCG
o Fetus w/Trisomy 21 – MSAFP and unconjugated estriol levels are low
o Low levels of in all 3 markers are associated w/Trisomy 18 (Edward’s
syndrome)
14. Antepartum – ultrasound at 20 weeks
• Uses
o Establish/confirm dates
o Confirm viability
o Detect polyhdraminos/oligohydraminos
o Detect congenital anomalies
o Detect intrauterine growth restriction
o Assess placental placement
o Used for visualization during amniocentesis
15. Antepartum – vaginal discharge – pregnancy
• Leukorrhea
o Hormonally stimulated cervix becomes hypertrophic and hyperactive,
producing abundant amount of mucus
, ! Not preventable, do not douche, wear perineal pads, wipe from front to
back, report to PCP if accompanied by pruritus, foul odor, or change in
character or color
16. Antepartum – Intrapartum – UTI
• UTIs are a common medical complication of pregnancy; about 20% of all pregnancies
• Instruct women taking ABX to finish the entire course of meds, take meds on time and
around the clock so the medication levels remain constant
o Many women will develop a yeast infection while taking ABX b/c the ABX kills
normal flora. We should encourage them to include yogurt, cheese, or milk
containing active acidophilus while on their ABX regimen
• UTI prevention
o Wipe from front to back
o Cotton crotch underwear
o Avoid tight-fitting clothes
o Limit time spent in damp exercise clothes
o Avoid bath salts/bubble baths
o Avoid colored/scented toilet tissue
o Don’t wait to void
o Void before and after intercourse and before going to bed at night
o Drink at least 8 glasses of water daily
17. Intrapartum – back labor – relief
• Physiology
o Exaggerated lumbar and cervicothoracic curves caused by change in center of
gravity d/t enlarging abdomen
• Relief
o Maintain good posture and body mechanics
o Avoid fatigue
o Wear low heeled shoes
o Abdominal support may be useful
o Conscious relaxation
o Sleep on firm mattress
o Apply local heat/ice
o Get back rubs
o Do pelvic tilt exercises
