Summary ATI PROCTORED MATERNAL NEWBORN-Study Guide, (Set-6), Best document for preparation, Verified And Correct Answers, Secure Bettergrade

ATI PROCTORED MATERNAL-NEWBORN NOTES bleeding in the third trimester and the cervix begins to dilate
and efface.
Risk factors
 Previous placenta previa
SPONTANEOUS ABORTION: terminated before 20 weeks  Previous C/S (uterine scarring)
or weighs less than 500 grams  > 35
Risk factors  multifetal gestation
 Chromosomal anomalies  multiple gestations or close pregnancies
 Maternal illness, infection  smoking
 AMA Expected findings
 Trauma/injuries  painless
 Anomalies of the fetus or placenta  bright red bleeding (2nd or 3rd trimester)
 Antiphospholipid syndrome  fundal height bigger than normal
Expected findings  fetus in breech, transverse, or oblique
 Tenderness and backache  reassuring FHR
 ROM  VS WNL
 Dilation of cervix  Decreasing urine output
 Fever Labs
 Signs and symptoms of hemorrhage  Hb/Hct
Diagnostics/therapeutic procedures  CBC
 Ultrasound  Kleihauer-Betke test (detects fetal blood in maternal
 Cervical exam circulation)
 D&E DX
 D&C  US
 Prostaglandins and oxytocin  Fetal monitoring and assessment
Patient education Nursing
 Some vaginal discharge OK for 1-2 wk  No vaginal exams
 NO baths, tampons, or intercourse for 2 wk  IV fluids
 O2 nearby
ECTOPIC PREGNANCY Patient ED
Risk factors  Bed rest
 Anything that compromises tubal patency  Nothing in vagina
 STIs
 IVF PLACENTA ABRUPTION: premature separation of
 Tubal surgery placenta from uterus (>20 wk)
 IUDs  DIC is associated with moderate or severe abruption
Expected findings Risk Factors
 Unilateral pain  Maternal HPT
 Light period that is late  Trauma
 Scant, dark red, brown vaginal spotting  Cocaine
 6-8 wks after last normal menses  Previous
 referred shoulder pain  Cigarette
 SHOCK  PROM
Labs  Multifetal preg
 Elevated hCG and progesterone will rule out ectopic Expected findings
preg  Severe pain
DX/therapeutic procedures  Sudden onset of dark red bleeding
 Transvaginal US  Uterine tenderness that can be diffuse
 CAUTION W/ VAGINAL EXAMS  Hypertonicity
TX – rapid treatment necessary  Fetal distress
 Medical management  Hypovolemic shock S/SX
 If rupture has not occurred and tube LABS
preservation is desired  Hb/Hct decreased
 Methotrexate  Coags decreased
 Inhibits cell division, dissolves pregnancy  Clotting defects (DIC)
 Salpingostomy  Cross and type match
 Fixes the tube  Kleihauer-Betke
 Laproscopic salpingectomy  US
 Removes the tube  BPP
Nursing
PLACENTA PREVIA: abnormal implantation of placenta in  Immediate birth is the management
the lower uterine segment, near or over the cervix. Results in  IV fluids

,  O2 8-10 liters  US
 Assess urinary output  Short cervix
 Cervical funneling
VASA PREVIA: fetal umbilical vessels implant into the fetal  Effacement
membranes rather than the placenta  Prophylactic cervical cerclage
 12-14 weeks
CHAPTER 8 – INFECTIONS  removed at 37 weeks
HIV/AIDS Medications
 Passed from mother to fetus through placenta and  Tocolytics
breastmilk D/C Education
Expected findings  Activity restriction
 Flu like symptoms  Hydration
 Fever  Avoid intercourse
 Lymphadenopathy  Nothing into vagina
 Diarrhea  Bed rest
 Weight loss
 Anemia HYPEREMESIS GRAVIDARUM: excessive N/V past 12
Medications weeks prob r/t increase hCG
 Retrovir  5% weight loss from prepreg weight
 14 wk  electrolyte imbalance
 throughout preg  acetonuria
 before labor  ketosis
 delivery Risk factors
 6 wk after delivery  younger than 30
Patient Education  history of migraines
 no breastfeeding  first preg
 report to health department (provider)  obese
 gestational trophoblastic disease
TORCH Infections  high levels of emotional stress
 toxoplasmosis  hyperthyroid
 raw or uncooked meat  DM
 other (hepatitis)  GI Dx
 rubella  HX of hyperemesis Gravidarum
 cytomegalovirus LABS
 droplet  UA: ketones acetones (breakdown of protein/fat)
 HSV  Elevated urine specific gravity
 Passage through birth canal  Chem-7
Expected findings  Sodium, potassium, chloride decreased
 T – similar to flu  Metabolic acidosis
 R – rash, lymphedema, fever, fetal consequences  Metabolic alkalosis
 HSV – lesions and tender lymph nodes  Elevated liver enzymes
Medications  Bilirubin
 Antibiotics as RX  Thyroid
 Toxoplasmosis TX  CBC
 Sulfonamides Nursing
 NPO for 24-48 hr
CERVICAL INSUFFICIENCY: expulsion of the products Medications
of conception occurs  IV LR
 Tissue changes  Vitamin b6
 Alteration in length of cervis  Zofran
Risk factors  Metoclopramide
 Cervical trauma HX  Corticosteroids
 Short labors
 Pregnancy loss early weeks IRON DEFICIENCY ANEMIA
 Advanced cervical dilation at early weeks Risk factors
 DES exposure  Less than 2 yr between preg
 Congenital structure deformities  Heavy menses
Expected findings  Multifetal preg
 Pink stained vaginal D/C  Vomiting
 ROM Expected findings
 Uterine contractions w/ expulsion of fetus  Fatigue
DX/therapeutic procedures  Irritability