- Comprehensive Review for the
N (oD €121\
EXAMINATION
Anatomy and Physiology of
Reproduction
--------------------------------------------
The Menstrual Cycle
HESI Hint + The menstrual phase varies in length in
most women.
HESI Hint « Ovulation occurs approximately 14 days
before the next menstrual cycle.
HESI Hint * To avoid pregnancy a woman should abstain
from unprotected sexual intercourse during her fertile
days. The most fertile days for pregnancy are the day before
ovulation and the day of ovulation. The fertile period begins
4.5 days prior to ovulation and ends 24-48 hours after
ovulation.A couple must avoid unprotected intercourse for
several days before an anticipated ovulation and for 3 days
after ovulation to prevent pregnancy because sperm can
live in a woman's body approximately 4 to 5 days and eggs
live approximately 24-48 hours after being released.
HESI Hint * Some women do not realize they are
preghant because they experience implantation bleeding
or spotting.
Antepartum Nursing Care
A AA P AT AARAT AR AARAT AR AAR AT AARAT AR AAR AT AR AR AT AAN AT A
, HESI Hint « Signs of healthy psychosocial maternal-
fetal bonding include massaging the abdomen, nicknaming
the fetus, and talking to the fetus in utero.
HESI Hint + Practice determining gravidity and parity.
A woman who is 6 weeks pregnant has the following
maternal history:
* She has healthy 2-year-old male fraternal twins
* She had a miscarriage at 22 weeks
* She had an elective abortion at 6 weeks, 5 years earlier.
* With this pregnancy she is gravida 4 para 2, only 2
deliveries after 20 weeks' gestation, and twins are two
living
» GTPALis 4 |-1-1-2] (G-4 pregnancies (twins, miscar-
riage, electrive abortion, current pregnancy;T-1 (twins
count as one birth); P-1 (22 week miscarriage); A-|
(elective abortion at 6 weeks); L-2 (twins).
HESI Hint * For many women, battering (emotional or
physical abuse) begins during pregnancy.Women should
be assessed for abuse in private, away from the partner,
by a nurse who is familiar with local resources and knows
how to determine the safety of the client.
Five digits: GTPAL (Gravidity, Term Births, Pre-
term Births, Abortions and Miscarriages, Living
Children) provides information of the client’s ob-
stetrical history.
(1) Gravidity — number of pregnancies
(2) Term — term births or pregnancies deliv-
ered (full term is a fetus at 38-40 weeks’
gestation).
(3) Preterm — pregnancy that has reached 20
weeks of gestation but ends before comple-
tion of 37 weeks of gestation
(4) Abortions and Miscarriages — pregnancy that
does not reach 20 weeks of gestation.
(5) Living children — infants that have survived
birth
//
,Calculate gestational age: estimated date of birth
(EDB) using the Nigele rule:
1. Count back 3 months from the first day of the last
normal menstrual period, and add 7 days.
2. For example: If the LMP was March 23, the EDB
would be December 30.
HESI Hint * Practice calculating EDB. If the first day of
a woman's last normal menstrual period was December
9, what is her EDB, using the Nagele rule? Answer:
September |6. Count back 3 months and add 7 days
(always give February 28 days).
HESI Hint « At approximately 28 to 32 weeks' gestation,
a plasma volume increase of 25% to 40% occurs, resulting
in normal hemodilution of pregnancy and Hct values.
above 38% or hemoglobin levels above |3g/dL are
associated with gestational hypertension. High Hct values
may look good, but in reality they represent a gestational
hypertension disorder and a depleted vascular space.
HESI Hint « Hgb and Hct data can be used to evaluate
nutritional status. Example:A 22-year-old primigravida at
|2 weeks’ gestation has an Hgb of 9.6 g/dL and an Hct of
31%. She has gained 3 pounds during the first trimester.
A weight gain of 907.18 to 1814.4 g. (2 to 4 Ib) during the
first trimester is recommended. Since this client is anemic
supplemental iron and a diet higher in iron are needed.
Foods high in iron:
* Fish and red meats
* Cereals and yellow vegetables
* Green leafy vegetables and citrus fruits
» Egg yolks and dried fruits
, HESI Hint * As pregnancy advances, the uterus presses
on abdominal vessels (vena cava and aorta). Teach the
woman that a left side-lying position relieves supine
hypotension and increases perfusion to uterus, placenta,
and fetus.
HESI Hint * The normal FHR is |10 to 160 bpm.
Changes in FHR are the first and most important
indicators of compromised blood flow to the fetus; these
changes require action! Fetal well-being is determined by
assessing fundal height, fetal heart tones and rate, fetal
movement, and uterine activity (contractions).
HESI Hint + Early intervention can optimize maternal
and fetal outcome. Teach clients to report immediately
any of the following danger signs. Possible indications of
preeclampsia and eclampsia are:
* Visual disturbances
» Swelling of face, fingers, or sacrum
» Severe, continuous headache
* Persistent vomiting
» Epigastric pain
* Infection:
« Chills
* Temperature over 38° C
* Dysuria
* Pain in abdomen
* Fluid discharge or bleeding from vagina (anything
other than normal leukorrhea)
* Change in fetal movement or increased FHR
HESI Hint + Most providers prescribe prenatal
vitamins to ensure that the client receives an adequate
intake of vitamins. However, only the health care
provider can prescribe prenatal vitamins. It is the nurse’s
responsibility to teach about proper diet and about taking
prescribed vitamins as they have been prescribed by the
health care provider.
HESI Hint * It is recommended that pregnant women
consume the equivalent of 3 cups of milk or yogurt per
day. This will ensure that the daily calcium needs are met
and help alleviate the occurrence of leg cramps.
N (oD €121\
EXAMINATION
Anatomy and Physiology of
Reproduction
--------------------------------------------
The Menstrual Cycle
HESI Hint + The menstrual phase varies in length in
most women.
HESI Hint « Ovulation occurs approximately 14 days
before the next menstrual cycle.
HESI Hint * To avoid pregnancy a woman should abstain
from unprotected sexual intercourse during her fertile
days. The most fertile days for pregnancy are the day before
ovulation and the day of ovulation. The fertile period begins
4.5 days prior to ovulation and ends 24-48 hours after
ovulation.A couple must avoid unprotected intercourse for
several days before an anticipated ovulation and for 3 days
after ovulation to prevent pregnancy because sperm can
live in a woman's body approximately 4 to 5 days and eggs
live approximately 24-48 hours after being released.
HESI Hint * Some women do not realize they are
preghant because they experience implantation bleeding
or spotting.
Antepartum Nursing Care
A AA P AT AARAT AR AARAT AR AAR AT AARAT AR AAR AT AR AR AT AAN AT A
, HESI Hint « Signs of healthy psychosocial maternal-
fetal bonding include massaging the abdomen, nicknaming
the fetus, and talking to the fetus in utero.
HESI Hint + Practice determining gravidity and parity.
A woman who is 6 weeks pregnant has the following
maternal history:
* She has healthy 2-year-old male fraternal twins
* She had a miscarriage at 22 weeks
* She had an elective abortion at 6 weeks, 5 years earlier.
* With this pregnancy she is gravida 4 para 2, only 2
deliveries after 20 weeks' gestation, and twins are two
living
» GTPALis 4 |-1-1-2] (G-4 pregnancies (twins, miscar-
riage, electrive abortion, current pregnancy;T-1 (twins
count as one birth); P-1 (22 week miscarriage); A-|
(elective abortion at 6 weeks); L-2 (twins).
HESI Hint * For many women, battering (emotional or
physical abuse) begins during pregnancy.Women should
be assessed for abuse in private, away from the partner,
by a nurse who is familiar with local resources and knows
how to determine the safety of the client.
Five digits: GTPAL (Gravidity, Term Births, Pre-
term Births, Abortions and Miscarriages, Living
Children) provides information of the client’s ob-
stetrical history.
(1) Gravidity — number of pregnancies
(2) Term — term births or pregnancies deliv-
ered (full term is a fetus at 38-40 weeks’
gestation).
(3) Preterm — pregnancy that has reached 20
weeks of gestation but ends before comple-
tion of 37 weeks of gestation
(4) Abortions and Miscarriages — pregnancy that
does not reach 20 weeks of gestation.
(5) Living children — infants that have survived
birth
//
,Calculate gestational age: estimated date of birth
(EDB) using the Nigele rule:
1. Count back 3 months from the first day of the last
normal menstrual period, and add 7 days.
2. For example: If the LMP was March 23, the EDB
would be December 30.
HESI Hint * Practice calculating EDB. If the first day of
a woman's last normal menstrual period was December
9, what is her EDB, using the Nagele rule? Answer:
September |6. Count back 3 months and add 7 days
(always give February 28 days).
HESI Hint « At approximately 28 to 32 weeks' gestation,
a plasma volume increase of 25% to 40% occurs, resulting
in normal hemodilution of pregnancy and Hct values.
above 38% or hemoglobin levels above |3g/dL are
associated with gestational hypertension. High Hct values
may look good, but in reality they represent a gestational
hypertension disorder and a depleted vascular space.
HESI Hint « Hgb and Hct data can be used to evaluate
nutritional status. Example:A 22-year-old primigravida at
|2 weeks’ gestation has an Hgb of 9.6 g/dL and an Hct of
31%. She has gained 3 pounds during the first trimester.
A weight gain of 907.18 to 1814.4 g. (2 to 4 Ib) during the
first trimester is recommended. Since this client is anemic
supplemental iron and a diet higher in iron are needed.
Foods high in iron:
* Fish and red meats
* Cereals and yellow vegetables
* Green leafy vegetables and citrus fruits
» Egg yolks and dried fruits
, HESI Hint * As pregnancy advances, the uterus presses
on abdominal vessels (vena cava and aorta). Teach the
woman that a left side-lying position relieves supine
hypotension and increases perfusion to uterus, placenta,
and fetus.
HESI Hint * The normal FHR is |10 to 160 bpm.
Changes in FHR are the first and most important
indicators of compromised blood flow to the fetus; these
changes require action! Fetal well-being is determined by
assessing fundal height, fetal heart tones and rate, fetal
movement, and uterine activity (contractions).
HESI Hint + Early intervention can optimize maternal
and fetal outcome. Teach clients to report immediately
any of the following danger signs. Possible indications of
preeclampsia and eclampsia are:
* Visual disturbances
» Swelling of face, fingers, or sacrum
» Severe, continuous headache
* Persistent vomiting
» Epigastric pain
* Infection:
« Chills
* Temperature over 38° C
* Dysuria
* Pain in abdomen
* Fluid discharge or bleeding from vagina (anything
other than normal leukorrhea)
* Change in fetal movement or increased FHR
HESI Hint + Most providers prescribe prenatal
vitamins to ensure that the client receives an adequate
intake of vitamins. However, only the health care
provider can prescribe prenatal vitamins. It is the nurse’s
responsibility to teach about proper diet and about taking
prescribed vitamins as they have been prescribed by the
health care provider.
HESI Hint * It is recommended that pregnant women
consume the equivalent of 3 cups of milk or yogurt per
day. This will ensure that the daily calcium needs are met
and help alleviate the occurrence of leg cramps.
