HESI Maternity and Pediatrics

HESI Maternity and Pediatrics How is EDD calculated using Nagele's rule? Ans- 1. Determine the first day of the LMP 2. Subtract 3 months 3. Add 7 days 4. Adjust the year What is gravidity? Ans- the number of pregnancies including current pregnancy. includes miscarriages, ectopic pregnancies, stillbirths. What is parity? Ans- number of births in which the fetus is carried past 20 weeks gestation(not number of fetuses [e.g., twins] GTPAL Ans- Gravida, Term, Preterm, Abortions, Living What are presumptive signs of pregnancy? Ans- Subjective signs perceived by the woman - Signs: amenorrhea, breast changes & tenderness, nausea - Symptoms: N/V, urinary freq, weight gain, fatigue, quickening (fetal movement), discoloration of vaginal mucosa Probable signs of pregnancy Ans- Uterine enlargement, Goodell's sign, Chadwick's sign, Hegar's sign, Ballottement, + Pregnancy test, Braxton Hicks contractions Goodell's sign Ans- softening of the cervix Chadwick's sign Ans- Bluish purple discoloration of the cervix, vagina, and labia during pregnancy as a result of increased vascular congestion. Hegar's sign Ans- softening of the lower uterine segment Ballottement Ans- The rebounding of the fetus against the examiner's fingers on palpation Positive signs of pregnancy Ans- audible fetal heartbeat, fetal movement felt by examiner, ultrasound visualization of fetus How to measure Fundal Height Ans- Symphysis pubis to top of uterine fundus. # of cm is usually equivalent to gestation age, give or take 1-2 cm --At 36 weeks fetus moves down into the pelvis, measurement not as reliable Smoking tobacco during pregnancy can lead to Ans- low birth weight, a higher incidence of birth defects, and still births Cholasma Ans- Pigmented area of the face (mask of pregnancy) "Linea Nigra" of pregnancy Ans- Dark line of hyperpigmentation down the midline of the abdomen stiae gravidarum Ans- stretch marks What are some interventions that the nurse can teach the patient for nausea and vomiting in pregnancy(occurs during 1st trimester)? Ans- Eat crackers before rising in the morning, eat small, frequent and low fat meals, drink liquids between meals rather than at meals, avoid fried and spicy foods. Ask HCP if vit. B6 would be helpful. What are some interventions for syncope during pregnancy? Ans- sit with feet elevated and change positions slowly. Instruct the pregnant client to avoid lying in the supine position. What are some interventions for urinary frequency occurring during pregnancy? Ans- Limit fluid intake during the evening, void at regular intervals, kegal exercises, avoid caffeine What are some interventions of ptyalism during pregnancy? Ans- Small, frequent meals, gum chewing and oral lozenges Dilution of RBC mass causing a decline in maternal hemoglobin and hematocrit Ans- physiologic anemia or pseudoanemia Iron deficiency anemia occurs when the Hgb and Hct are? Ans- Hgb less than 11 g/dL or Hct less than 33% in 1st or 3rd trimester & Hgb less than 10.5 g/dL or Hct less than 32% in 2nd trimester What is prescribed in pregnancy to prevent iron deficiency anemia? Ans- Ferrous Sulfate(iron supplement) What happens to the heart rate during pregnancy? Ans- heart rate increases by 15-20 BPM. Interventions for heartburn during pregnancy? Ans- Eat small meals Q2-3H and avoid fatty, acidic, or spicy foods. Eliminate or curtail smoking and drinking coffee and carbonated beverages. Try chewing gum. Do not eat or drink before bedtime and sleep with extra pillow. Walk or sit upright 1-2 hours after meals. May take liquid antacids. Avoid bending over. What is round ligament pain? Ans- Sharp pain in the side or inguinal area, usually on the right side. Interventions for round ligament pain? Ans- Use good body mechanics, do not make sudden position changes or sudden movements. Avoid stretching and twisting at the same time. Bend toward pain, squat or bring knees up to chest. Apply heat and lie on right side. Interventions for hemorrhoids during pregnancy? Ans- Avoid constipation, take frequent tepid backs. Apply cool witch hazel compresses or anesthetic ointments. Eat high fiber foods. Interventions for constipation during pregnancy? Ans- Drink 8 glasses of liquids each day. Add foods high in fiber. Restrict cheese consumption. Consult HCP about stool softeners. Try swimming, riding a bicycle, or take a brisk walk to stimulate peristalsis Normal fetal heart rate Ans- 110-160 When is fetal movement first noted by expectant mother? Ans- 16-20 weeks. If unsensitized when should an Rh negative mother receive Rh (D) immune globulin prophylactically? Ans- 28 weeks Should rubella vaccine be given during pregnancy? Ans- No Women should be counseled to not become pregnant for how long after receiving the rubella vaccine? Ans- 1-3 months. Plane travel is safe up to how many weeks gestation in an uncomplicated pregnancy? Ans- 36 weeks 4 maternal tasks of pregnancy Ans- 1. Seeking safe passage for herself and the baby through pregnancy, labor, and childbirth. 2. Securing acceptance of the baby and herself by her partner and family. 3. Learning to give of herself 4. Developing attachment and interconnection with the unknown child. Normal weight gain for women who begin pregnancy with a normal BMI Ans- 25-35lbs Weight gain for an underweight mother during pregnancy? Ans- 28-40lbs Recommended weigh gain of an overweight woman during pregnancy? Ans- 15-25lbs Recommended weight gain for obese women during pregnancy? Ans- 11-20lbs Daily caloric intake during pregnancy Ans- 1st trimester: calories/day 2nd trimester: Increase intake by 340 calories/day = calories/day 3rd trimester: Increase intake by 452 calories/day = calories/day Foods likely to be contaminated with listheria? Ans- luncheon meats & hot dogs unless reheated to steaming hot. Soft cheeses, unpasteurized milk, and raw or undercooked meats and poultry. How many calories a day above prepregnancy requirements are needed to meet the requirements of lactation? Ans- 500 calories each day When the mother drinks alcohol she should not breastfeed for how long? Ans- 2 hours What is the main protein in fetal plasma? Ans- Alpha-fetoprotein (AFP) how often is a low risk pregnancy seen? Ans- Every 4 weeks until 28 weeks Every 2 weeks from 28 weeks until 36 weeks Every week from 36 weeks until delivery Possible indications of eclampsia and pre eclampsia Ans- visual disturbances, swelling of face, fingers, or sacrum, severe and continuous headache, persistent vomiting, epigastric pain, infection, fluid discharge or bleeding from the vagina, change in fetal movement or increased FHR. How many lbs per week should the pregnant women gain in the 2nd and 3rd trimester? Ans- 1lb/week. Low levels of MSAFP are associated with? Ans- Chromosomal abnormalities such as trisomy 21 High levels of MSAFP indicate Ans- failure of the embryonic neural tube or anterior body wall to close properly. What does Chorionic Villi Sampling determine? Ans- genetic diagnosis early in the first trimester What is the removal of amniotic fluid sample from the uterus? Ans- Amniocentesis What is an amniocentesis used to determine? Ans- fetal genetic diagnosis(usually in the 1st trimester), diagnose amnionitis, Fetal lung maturity (last trimester), fetal well being What is the L/S ratio that generally determines fetal lung maturity? Ans- An L/S ratio greater than 2:1 generally indicates that surfactant is adequate and lungs are mature In early pregnancy should the bladder be full or empty during an amniocentesis? Ans- full in early pregnancy and empty in later pregnancy What results indicate a Reactive or reassuring Nonstress test? Ans- At least 2 FHR accelerations. with or without fetal movement, occurring within any 20 minute period and peaking at least 15 BPM above baseline and lasting 15 seconds What can be used during a non stress test to reduce false positive results? Ans- Vibroacoustic stimulation How are contractions generated during a contraction stress test? Ans- oxytocin infusion or nipple stimulation What is measured with a BPP? Ans- FHR activity is interpreted from NST. Four additional parameters are determined by ultrasound How is the BPP scored? Ans- A scoring technique is used to interpret the data, with each parameter contributing either 0 or 2 points. A score of 10 (8 for BPPs without the NST) is perfect. A score of 0 is the worst score. A total score of 8 to 10 out of 10 is reassuring. What is an early deceleration? Ans- (1) Benign pattern caused by parasympathetic response (head compression) (2) Heart rate slowly and smoothly decelerates at beginning of contraction and returns to baseline at end of contraction What is the nursing intervention for early decelerations? Ans- 1. No nursing interventions are required except to monitor the progress of labor. 2. Document the processes of labo