NURS 306 Final Exam Study Guide Complete Guide 2023

NURS 306 Final Exam Study Guide Complete Guide 2023. Overview of the transition the woman goes through into her new maternal role • Common psycho-social changes that accompany pregnancy • Special needs regarding specific patient populations o Teenagers § Specific concerns regarding teenage parents o Older mothers, lesbian mothers, single parents Chapter 6 Antepartal tests § Indications for first trimester ultrasound o Best indicator of accurate dating o Why is accurate dating of pregnancy so important? § What does nuchal translucency screen for? § Anatomy US o When is it performed? o What does it look for? § Indication for umbilical artery Doppler flow § CVS o Indication o Procedure o Timing in pregnancy o Risks o Pros and cons for parents § Amniocentesis o Indication o Procedure o Timing in pregnancy o Risks o Pros and cons for parents § PUBS o Indication o Procedure o Timing in pregnancy o Risks o Pros and cons for parents § NIPT o Indication o Procedure o Timing in pregnancy o Risks o Pros and cons for parents § California Prenatal Screening Program (Quad Screen or Multiple Markers Screen) o Indication o Procedure o Timing in pregnancy o Risks o Pros and cons for parents § Fetal Kick Counts o Patient teaching on how to perform § NST o Indications o Procedure o Interpretation-Be sure to consider normal baseline and moderate variability in addition to accels § Reactive • What does moderate variability indicate? • What do accelerations indicate? • What teaching do we give when an NST is reactive? § Nonreactive • Vibroacoustic Stimulation • Next steps for further evaluation § CST o Indications o Procedure o Interpretation § Positive § Negative § AFI o Indications o Procedure o Interpretation (normal levels) § Oligohydramnios-know definition • Possible causes • Effects of fetus § Polyhydramnios • Possible causes • Effects on fetus • Effects on mother § BPP o 5 criteria o Which scores indicate fetal well-being and which indicate need for immediate intervention o What is a modified BPP and when might you do that instead of the entire thing? Chapter 9 Fetal heart monitoring Be able to interpret strips in terms of baseline HR, variability, presence of accels, decels, tachysystole etc. • • • Intermittent auscultation (IA) VS continuous electronic fetal heart monitoring (EFM) o Which pt is a candidate for IA? **Which is NOT? § How do you perform IA? o When is continuous EFM indicated? • How often should you assess? And what are you assessing for? o Example: If mom comes in and is in active labor and is low risk … you can do IA every 30 minutes or if she is on continuous EFM you are continuously watching the monitor, but you chart on it every 30 minutes. o You are charting: § What is the baseline § What is the variability? • Absent o What may cause absent variability and what can you do to intervene? • Minimal o What may cause minimal variability and what can you do to intervene? • Moderate o **Understand this is BEST indicator for fetal well being o What does it really mean? • Marked o What may cause marked variability and what can you do to intervene? § Are there accelerations? • Yes • No o Is it ok for her not to have accelerations while in labor? o What do accelerations mean when we do an NST (what are they telling me?) § Are there decelerations? • If no, great • If yes, what kind (and then know your interventions for each and what the cause is) o Early o Late o Variable o Prolonged § Reasons for fetal tachycardia § How frequent are her contractions? § How long do her contractions last? § What is the strength of her contractions? • Mild/moderate/strong • What does “strength mean” … as in understand there is a difference between palpation (external toco) vs IUPC § What is uterine relaxation/tone? How long of a period of relaxation to we want for adequate oxygenation • Category I, II, III tracings o Know what criteria make it category I o Know what criteria make it category III (what does this indicate?) o Everything else that is not I or III is II Chapter 8 Labor • Signs/Symptoms of Labor o True vs. false labor § What kind of questions are you asking her on admission to figure out if she is in true vs false labor? o What are the main labor hormones? § Which of these hormones can we “control”? o What is the definition of labor? • 5 Ps of labor o Know how each of the Ps below may have an effect on labor progress and outcome o How do we assess the “P”s? § Powers • Contractions • Pushing § Passage and position • Pelvic Types • CPD and fetal station • Understand that the positions mom is in during labor may have an effect on her labor progress and outcomes and how that will tie into her power and the passenger and fetal position § Passenger & Fetal Positions • Cardinal Movements in Labor (you don’t need to know them in order, but you need to know their significance in the labor process and how the passenger and his/her position will have an effect on the cardinal movements in labor) • Risk with transverse lie and breech § Psyche • Vaginal Exam o Dilation o Effacement o Station o Possible risks related to frequent vaginal exams • Should be for medical (maternal or fetal) indication only • Rupture of Membranes o How to assess (testing) o Importance of color of fluid o What kind of questions are you asking her on admission if she comes in saying “I think my water broke”? o Length of SROM. How long is OK? Expectant management vs induction? o Chorioamnionitis – what is it, when does it happen, when is risk increased, what s/s will you see in mom and **on FHR, treatment o GBS – understand when we screen for it, how we screen for it, and what we are doing with that information during L&D. How and when do we treat for GBS? What if we don’t know the results? What if it’s a scheduled c-section? Review Pg. 533-534 in your textbook • Stages of Labor o Know each stage and the phases of 1st stage § Have a general understanding of how long is normal and what your nursing assessment is … do you think “she is ok, let her labor” or do you think “this is not OK, we need to go for a section” based on certain assessments. • What are you assessing for in 1st stage to determine progress? • What are you assessing for in 2nd stage to determine progress? o Know what your nursing roles/interventions are in each stage o Know how to tell if someone is in latent vs active vs transition phase (aside form a vaginal exam … what will the patient be doing/acting like)? What questions can you ask to determine? o When can meds be given? Which type of meds are you giving at what point in labor? What type of nonpharmacological interventions can you do/suggest in different phases of labor? o What is active management of labor? What is your nursing responsibility during this phase? § Meds? Fundus? Vitals? o What are signs of placental separation? o Benefits of skin to skin for both mom and baby o APGAR score § Know what the 5 things are and how to assign an APGAR score (FOLLOW YOUR BOOK’S VERBIAGE) § What is normal score? How often do you do it? o Pain Management in Labor § What are available options, Pros and cons of each? When can they be given? General administration process, Nursing actions, assessments, interventions, priorities, teaching, complications • IV • N2O2 • Epidural/Spinal o What is your priority nursing action before and after pt gets epidural? Chapter 12 (normal PP) / Chapter 14 (high risk PP)-NEW CONTENT • Postpartum o Be able to recognize normal vs. abnormal findings o BUBBLEDE § Know what you are assessing for each letter, why you are assessing that, and what normal abnormal finding are. o Changes to uterus/endometrium § Bleeding- How to assess normal vs abnormal • Uterine atony-common reasons this occurs (think overdistension) o Initial intervention • Lacerations-common reasons this occurs (think operative deliveries) o If the uterus is firm & midline, think laceration as the source of bleeding § Greatest risk for PPH is during which time in post delivery § Risk factors for PPH § S/s of PPH (vital signs)? § Causes of PPH (table 14-1, pg. 420) … which is the MAJOR cause of PPH? § PPH assessment and interventions (make sure you know your PPH meds!!! AND when certain PPH meds are contraindicated) § Definition of PPH • Know both the book definition and the ACOG definition • EBL vs QBL § Endometritis (definition, what increases risk, s/s, management/treatment) § Lochia, clots, education on this, danger signs § Proper fundal check and level of fundus • Where do you expect to find the fundus on PP day1 vs PP day3? 1 week PP? § After-pains (more painful for 2nd and 3rd time moms than G1P1. It goes away a few days later.) o Hematoma § S/s o Postpartum infection § S/s-think endometritis o Perineal Care o Breast Changes § New bra § When is colostrum formed? § Oxytocin, prolactin/placenta § Engorgement vs Mastitis - s/s, interventions o Cardiovascular changes § What are they at risk for? • Understand why pt is increased risk for thrombosis (again see pg. 64 and pg. 375) § How do you get them out of bed? § Why is there a big fluid shift? § What does this fluid shift lead to? § Fluid shift, PP chills