NUR2513 Maternal Child Nursing Exam 1 Concept Guide. (100% Reviewed & Verified Guide For Excellent Grades)

NUR2513 Exam 1 Concept Guide 1) Trends that influence Maternal and Child Health a) An expansion of community-based services b) Families are smaller, with higher number of single parents c) More moms are working outside the home d) When planning care, consider these structural shifts. 2) How nurses can support the 2020 National Health goals for pregnancy a) smoking cessation, folic acid supplementation, alcohol, and drug use… b) Importance of folic acid in reducing neural tube defects. c) The normal mean of hemoglobin is 11-12 d) Encourage 6-8 glasses of water each day e) If vegan, consider B12 supplementation 3) Mortality incidence for differing age groups. a) Accidents are the leading cause of injury/mortality in the school aged population and therefore education focused on this topic would be considered high priority. 4) Calculation of due dates (EDD, EDC) Naegele’s rule a) Take away three months b) Add seven days c) Add one year 5) Differing types of contraception a) IUDs should not go into a bicornate or oddly shaped uterus. b) Natural family planning c) Diaphragm is changed as weight changes 30lbs. d) Diaphragm should remain in place for 6hrs. after intercourse 6) GTPAL system and what does each mean a) Gravida – how many times have you been pregnant? b) Term – how many babies have you delivered to term 37 weeks c) Preterm – how many babies delivered before 37 weeks? d) Abortions – how many abortions less than 20 weeks? e) Living – How many living children? (a) 4-3-1-1-3 (me) 7) Stages of fetal development a) Embryonic stage is from 2 weeks until 8 weeks of life. During this time, organs are mainly formed. If exposed to viruses or drugs, this can cause harm to the fetus. b) Fetal Development stage is from 9 weeks until birth. This study source was downloaded by from CourseH on :18:13 GMT -05:00 8) Amniotic fluid’s function: Cushions the fetus and protects against mechanical injury. Regulates temperature, allows for growth, prevents adherence of the amnion to the fetus. Provides freedom of movement, essential for normal fetal lung development. a) Fetal well-being. i) Provides temperature control, fetal movement, fundal height, FHR b) Oligohydramnios i) Not enough fluid baby can have SGA and renal functions. Less than 500 c) Polyhydramnios i) Too much fluid causing gestational diabetes More than 2000 9) Umbilical cord function? a) Protection, cushion, etc.… b) Made up of c) AVA (Artery, Artery, Vein). d) Usual insertion site 10) Placenta’s function a) Transfers nutrients to baby b) Transfers oxygen to baby c) Removes the waste products from the fetus 11) Nonstress test a) NST is non-reactive over 20 minutes. Patient may need juice or a snack. b) When performing a NST, we are assessing and documenting i) FHR baseline ii) Variability iii) Presence of accelerations 15↑ iv) Absence of decelerations 2 accelerations that meet criteria within 20 minutes of each other. 12) Biophysical Profile If NST is not reactive after 40 minutes. a) Fetal movement b) Fetal tone c) Fetal breathing d) Amniotic fluid e) NST f) Each is a 2 point with a max of 8 13) Positive signs of pregnancy a) Fetal heart sounds b) Fetal movements c) Visualization of fetus on ultrasound 14) Probable signs of pregnancy a) Abdominal enlargement This study source was downloaded by from CourseH on :18:13 GMT -05:00 b) Hagar’s sign – softening of the lower uterus c) Chadwick’s sign – violet/bluish color of cervix and vaginal mucous d) Goodell’s sign: softening of the cervical tip a) Braxton Hicks – contractions b) Positive HcG test 15) Body changes in pregnancy a) Breast – darkening of the areola, itching, enlarged b) Frequent urination – enlarged uterus is putting pressure on bladder c) BP increases 16) Fundal height a) 12 weeks → symphysis b) 20 weeks → umbilicus (correlate in cm to the number of weeks gestation.) 17) Nutrition and safe medication use in pregnancy. a) Vegans need a B12 supplementation b) Pyrosis (heartburn) management. 1. small frequent meals. 2. Do not lie down after meals 18) Bleeding in Pregnancy – What are some potential causes? If unsure do and ultrasound. a) Placenta Previa 1. Painless 2. Bright red blood 3. Soft abdomen 4. No contractions. 5. FHR are stable b) Placental Abruption 1. Painful 2. Dark red blood 3. Rigid abdomen 4. Contractions 1-2 minutes 5. NRFHR c) Cervical Dilation d) Infection related to hormones that increase the friability of the cervix and cervicitis. e) Bleeding after delivery, medications given misoprostol (Cytotec), oxytocin given to help uterus contract to control bleeding. 19) Nursing Interventions for Placenta Previa a) Monitor vital sings b) Monitor FHR and fetal activity c) Ultrasound d) Avoid vaginal exams e) Bed-rest side lying position f) Monitor amount of bleeding g) Treat signs of shock h) IV fluids – Medications (tocolytics) i) Plan for a cesarean if heavy bleeding 20) Variable deceleration: a) Place patient in knee-chest position, discontinue Oxytocin, Administer oxygen. 21) Early Decelerations: a) No interventions 22) Late Deceleration: This study source was downloaded by from CourseH on :18:13 GMT -05:00 a) Place patient in side-lying position, administer IV fluids, discontinue Oxytocin, administer oxygen, Palpate uterus for tachysystole, notify provider. 23) Hypertensive disorder in pregnancy: a) Chronic Hypertension, Gestational Hypertension, Preeclampsia superimposed on chronic hypertension, or Preeclampsia-eclampsia. i) Diet for gestational diabetes high in complex carbs and protein. 300 additional calories a day. b) Know and understand each of the disorders above and when they occur/symptoms/management of them. 24) Understand RH incompatibility, Rhogam and when you would give this to a mom and baby. a) Mom is 0- and baby is A+ b) Note you would give this even after a miscarriage. c) Purpose of Rhogam to prevent maternal D antibody formation for further pregnancies. d) Given at 28 weeks 25) Uteroplacental insufficiency a) If you were to see this on a strip, what would it look like? 26) Macrosomia a) Yellow-stained fluid suggests a blood incompatibility between mother and fetus b) Green-stained suggests meconium staining c) Causes – past due date over 40 weeks, long labor, HTN or DM, infection 27) Labs done while pregnant 1) 1st – blood type, CBD, RPR, HIV, Urine drug test 2) 2nd CBC, HIV, 1 hour glucose, Rh negative 3) 3rd – group beta strep 36 weeks 28) Surfactant liquid made by the lungs that keep the airways open. An unborn baby starts to make surfactant at about 26 weeks of pregnancy. 29) Surfactant actions on the fetus. a) Prevents alveoli from collapsing on expiration. 30) Maternal positions to facilitate oxygen. a) Left side This study source was downloaded by from CourseH on :18:13 GMT -05:00 b) Never supine 31) Variable decelerations → Cord compression. Intrauterine resuscitation. Transitory or abrupt slowing of the FHR 15bpm below baseline for at least 15 second or more. 32) Early Decals → Head compression. Deceleration occurs simultaneously. Slowing of the FHR with onset of a contraction and returns to baseline at the end of the contraction. 33) Accelerations → OK This study source was downloaded by from CourseH on :18:13 GMT -05:00 34) Late Decelerations → uteroplacental insufficiency. Onset of deceleration occurs after the beginning of the contraction 35) FHR Variability a) Absent = 0 bpm b) Minimal = 0-5 bpm c) Moderate (normal) = 6-25 bpm d) Marked = 25 bpm 36) Potential causes for nonreactive NST’s can include: a) Hypoglycemia b) Uteroplacental insufficiency c) Decreased placental perfusion d) Maternal medications/ drug use 37) What action to take with each fetal heart rate deceleration a) Variable decelerations: 1. Change maternal position 2. Proceed with the steps of intrauterine resuscitation. b) Early Decelerations: baby is descending, nurse should check the cervix c) Accelerations: Continue to monitor d) Late Decelerations: follows steps for intrauterine resuscitation and stop Pitocin. 38) Intrauterine Resuscitation. a) Reposition Patient Later position, shifts weight to facilitate blood flow. b) IV Bolus Increased rate of IV infusion speeds up the rate of oxygen transport. c) Administer Oxygen impacts baby 39) What interventions would you expect to provide to the patient in preterm labor? a) Stop contractions by hydrating, bedrest, and administering tocolytics. b) Optimize fetal status by administering Betamethasone for fetal lung maturity. 40) What medications would you expect to provide in preterm labor? a) For mom: Nifedipine, Terbutaline, Magnesium Sulfate b) For baby: Betamethasone or Dexamethasone This study source was downloaded by from CourseH on :18:13 GMT -05:00 50) What are Tocolytics used for? Relax uterus and stop from contracting. 60) We would give this in the instance of preterm labor/contractions. We would NOT give once they reach term, or it can cause death. 61) What physiologic changes might we expect with epidural placement? How do we prep the patient? a) Hypotension b) We prep by administering a bolus of 500 mL LR prior to procedure. 62) Risks faced by the post term fetus: a) Macrosomia b) Respiratory Distress c) Meconium aspiration 63) What is Omphalocele? Birth defect of the abdominal wall. The infants’ intestines stick outside the belly though the belly button. WHY? Intestines fail to return to the abdominal cavity after maturation/development. 64) What is the greatest risk to the fetus in Gestational Diabetes? a) Macrosomia → increases the risk of shoulder dystocia and can cause hypotension. 65) What are potential effects of high blood glucose during the first trimester? a) Congenital abnormalities 66) What condition will amniocentesis detect? b) Trisomy 18 – Edwards syndrome c) Trisomy 21 – Down Syndrome 67) What are goals and interventions in caring for patient with preeclampsia? a) Goal – is to prevent injury b) Intervention – bedrest, ↓ simulation, protect from injury, administer mag sulfate, deliver fetus 68) Magnesium Sulfate considerations – a) Always use an infusion pump and run-on piggyback, NOT as main line b) Respirations should be at least 16/min before each dose c) Have calcium gluconate available should toxicity occur. 69) What is HELLP? a) Hemolysis – leads to anemia b) Elevated Liver enzymes leads to epigastric pain c) Low Platelets leads to abnormal bleeding/clotting 70) Fetal Presentation: Vertex presentation is optimal for vaginal delivery. 80) What are some exclusion criteria for epidurals? This study source was downloaded by from CourseH on :18:13 GMT -05:00 a) Anemia or Thrombocytopenia (HINT) recognize diagnosis that are characterized by these conditions. 71) Epidural block – eliminates sensation form the umbilicus to thighs. Administer when mom is 4cm dilated (at least) 72) Signs and Symptoms of Epidural = hypotension and fetal bradycardia 73) Nursing care: b) Administer IV fluids to offset maternal hypotension c) Position mom on left side to prevent supine hypotension syndrome d) Monitor maternal vital signs and FHR continually. 74) Fetal medications a) Vitamin K – given in the vastus lateralis and promotes clotting for baby b) Betamethasone – helps increase lung maturity, given for preterm labor babies This study source was downloaded by from CourseH on :18:13 GMT -05:00 Objectives Modules 1-3  Describe the roles of the professional nurse in the maternal-child healthcare environment.  Describe the evolution and trends of maternal child healthcare.  Explain how cultural and social diversity plays a role in maternal child healthcare.  Identify legal and ethical considerations related to maternal child healthcare.  Compare methods of reproductive planning and contraception.  Describe the psychological and physiologic changes of pregnancy.  Recognize the signs and symptoms of pregnancy.  Apply strategies that promote nutritional health during pregnancy.  Select nursing care strategies to address the common discomforts of pregnancy.  Identify essential components and standards of prenatal care.  Describe fetal growth and development stages.  Identify patterns of maternal and neonatal response to pregnancy, labor, and delivery.  Explain potential antepartum and intrapartum complications.  Integrate multidimensional care strategies for clients during pregnancy, labor, and birth. 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