NURS 306 OB Final Exam Study Guide | Complete to Score A+ 2023

NURS 306 OB Final Exam Study Guide | Complete to Score A+ 2023. Abortions are not accounted for in this system ! GTPAL o G: # times pregnancy o T: # of term infants born after 37 weeks o P: # of preterm infants between 20 and 37 weeks o A: # of abortions either spontaneous or induced before 20 weeks o L: # of living children ! Nulligravida: woman who has never been pregnant or given birth ! Primigravida: woman who is pregnant for the first time ! Multigravida: someone who is pregnant for at least the second time ! Prenatal period " entire time period during which a woman is pregnant through birth of baby ! Nurse places emphasis on health education and health promotion ! Family-centered maternity care is a model of obstetrical care based on a view of pregnancy and childbirth as a normal life event, a life transition that is not primarily medical but rather developmental ! Low-risk population should have approximately 14-16 prenatal visits per pregnancy ! First trimester o Woman learns frequency of follow-up visits and what to expect from pregnancy visits as pregnancy progresses during initial visit o Comprehensive health and risk assessment; currently pregnancy history; complete physical and pelvic examination; nutrition assessment; psychosocial assessment; assessment for intimate partner violence o Fetal heart tones are auscultated with US Doppler, initially by 10 and 12 weeks o At end of first trimester, fetus is 3 inches in length and weights 1-2 ounces, all organ systems are present o Assessment of uterine growth after 10-12 weeks is measured by height of fundus with centimeter measuring tape; zero point of tape is placed on the symphysis pubis and tape is extended to top of fundus; MEASUREMENT SHOULD EQUAL # OF WEEKS PREGNANT o Certain types of fish (king mackerel, shark, swordfish, tilefish) should be avoided due to high levels of methylmercury ! Second trimester o Chart review; interval history; focused physical assessment; pelvic exam/sterile vaginal exam if indicated; confirm EDD o Triple/quad screen (neural tube defect); US; screening for gestational diabetes; hemoglobin and hematocrit; antibody screen if Rh-negative (Administration of RhoGAM if Rh-negative and anti-body screen negative) # Administered prophylactically at 28 weeks to prevent isoimmunization from potential exposure to Rhpositive fetal blood during normal course of pregnancy # Adverse reaction " pain at IM site; fever o Slight decrease in blood pressure toward end of second trimester o Assess for quickening " when the woman feels baby move for first time o Leopold’s maneuvers to identify position of fetus o Slight lower body edema is normal due to decreased venous return o At 20 weeks, fetus is 8 inches long and weights 1 pound o Increase in calorie intake by 340 kcal/day ! Third trimester o Chart review; interval history; nutrition follow-up; focused physical assessment; pelvic exam/sterile vaginal exam if indicated o Group B Strept at 35-37 weeks; H&H if not done in second trimester; repeat GC, chlamydia, RPR, HIV HbSAg; 1- hour glucose challenge test at 24-28 weeks o Record fetal movement count " 10 distinct fetal movements within 2 hours is considered reassuring OR 4 movements in 1 hour o At term, fetus is 17-20 inches long, 6-8 pounds o Increase in calorie intake by 452 kcal/day Chapter 6 Antepartal Tests ! Chorionic villus sampling " aspiration of a small amount of placental tissue for chromosomal, metabolic, or DNA testing o Between 10 and 12 weeks to detect fetal abnormalities caused by genetic disorders o Tests for cystic fibrosis but not neural tube defects o Supine position for transabdominal aspiration with US to guide placement o Lithotomy for transvaginal aspiration with US to guide placement o Small biopsy of chorionic (placental) tissue is removed o Assess fetal and maternal well-being post-procedure; FHR is auscultated twice in 30 minutes ! 3! o Instruct woman to report abdominal pain/cramps, leaking of fluid, bleeding, fever, chills o Results within 1 week ! Amniocentesis o Needle is inserted through maternal abdominal wall into uterine cavity to obtain amniotic fluid o Genetic testing, fetal lung maturity, assessment of hemolytic disease in fetus or for intrauterine disease # Fetal lung maturity, monitor for L/S RATIO, PG, LBC o Usually performed 14-20 weeks gestation o Results within 2 weeks o FULL BLADDER MAY BE REQUIRED FOR ULTRASOUND VISULIZATION IF WOMAN IS LESS THAN 20 WEEKS ! Delta OD 450 o Evaluation of amniotic fluid obtained via amniocentesis to predict life-threatening anemia in fetus during second and third trimester o Used in a lab to determine if there is a deviation of optical density at 45 nm ! Fetal blood sampling/percutaneous umbilical blood sampling (CORDOCENTESIS) o Removal of fetal blood from umbilical cord " used to test for metabolic and hematological disorders, fetal infection, fetal karyotyping o may be done as early as 11 weeks but usually done in second trimester o results within 48 hours