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NU3 13 Final Exam With
Complete Solution
Conception - ANSWER - Union of a single egg from the female & sperm cell from the male
- Marks the beginning of pregnancy Fertilization - ANSWER Occurs when a sperm successfully penetrates the membrane surrounding the egg Implantation - ANSWER - Occurs between 6-8 days after fertilization
- Fertilized cell implants itself into the endometrial lining of the uterus Fetal Development Terms - ANSWER - Zygote: first 2 weeks
- Embryo: 2-12 weeks
- Fetus: anything after 12 weeks Umbilical Cord Anatomy - ANSWER - Contains one large vein & two small arteries (AVA)
- Wharton's jelly surrounds vein & arteries to prevent compression Human Chorionic Gonadotropin (hCG) - ANSWER - Produced by the developing embryo & placenta
- Stimulates corpus luteum to continue hormone production
- Pregnancy test hormone
Effects of Estrogen - ANSWER - Stimulates uterine growth
- Increases vascularity
- Increases Breast development & vascularity of breast tissue
- Causes hyperpigmentation in the skin Effects of Progesterone - ANSWER - Considered the major hormone of pregnancy
- Maintains lining of the uterus
- Also aides in Breast development along with estrogen
- Relaxes smooth muscle (GI, Uterine) Prescribing Meds During Pregnancy - ANSWER - Benefits to mother must outweigh risks to fetus
- Use lowest possible dose of safest drug Nagele's Rule - ANSWER - Calculates estimated due date (EDD)
- First day of last menstrual period (LMP) minus 3 months plus 7 days Crown Rump Length - ANSWER - Most accurate measurement for determining gestational age
- Done via ultrasound during first trimester Gravida - ANSWER A woman who is pregnant Para - ANSWER The number of pregnancies in which the fetus/fetuses have reached 20 weeks of gestation Multigravida (multip) - ANSWER A woman who has had two or more
- Probable pregnancy sign Goodell's Sign - ANSWER - Softening of the cervix felt upon exam at 6- weeks
- Probable pregnancy sign Chadwick's Sign - ANSWER - Vaginal mucosa discoloration (bluish)
- Probable pregnancy sign Ballotment - ANSWER - Lower uterine segment or cervix tapped by examiner's finger & left there, fetus floats upward, then sinks back & a gentle tap is felt on the finger (16 weeks)
- Probable pregnancy sign Positive Blood Pregnancy Test - ANSWER - Increase levels of HCG in blood usually at 10 days of pregnancy
- Probable pregnancy sign GTPAL - ANSWER - G=Gravity: # of times pregnant
- T=Term Births: # of babies had between 37.1- 42.0 weeks
- P=Preterm Births: # of babies had between 20.0- 37.0 weeks
- A=Abortions (spontaneous or therapeutic)
- L=Living Children Week 1 of Pregnancy - ANSWER Vascular changes influenced by progesterone prepare uterus for implantation Week 3 of Pregnancy - ANSWER First missed period
Week 4 of Pregnancy - ANSWER - Early breast changes
- Positive pregnancy test Weeks 5-7 of Pregnancy - ANSWER - Increased mucous membrane development
- Hegar's & Chadwick's signs
- Kidneys form at 5 weeks & urine is excreted into the amniotic fluid
- Heart & main blood vessels are formed, heart starts beating by 6th week
- Primitive brain & spinal cord (neural tube) also begin to form Weeks 4-11 of Pregnancy - ANSWER - Placenta & umbilical cord develop
- Amniotic fluid surrounds the baby
- Face, & limbs take shape Weeks 8-12 of Pregnancy - ANSWER - Sex can be determined
- Audible fetal heart rate (120-160bpm)
- Fetal respiratory movements at 11 weeks, these movements aid in development of chest muscles
- Maternal weight gain (0-5 lbs. in first trimester)
- Nausea, fatigue, & tenderness
2nd Trimester of Pregnancy - ANSWER - Baby will starts to show @ 14 weeks
- Fetal heart audible with doppler (120-160 bpm)
- Protective coating called vernix begins to form on baby's skin
- Hair eyelashes & eyebrows appear
- Organs keep maturing
- Fetus is very active
- The eyes can open & blink
Fetal Development at 6 Months - ANSWER - Fetus is 8-10 inches long & weighs 8 oz
- Lungs are filled with amniotic fluid, & they start with breathing motions
- If you talk or sing, they can hear you
- Fat is starting to deposit under skin
3rd Trimester of Pregnancy - ANSWER - Heartburn
- SOB
- Urinary frequency
- Alteration in maternal posture
- Abdominal wall striations: straie gravidarum & linea nigra as skin is stretched
- Lightening removes pressure from lung onto bladder
- Weight gain of 25-30 lbs
Fetal Development at 36 Weeks - ANSWER - Fetus is about 17-18 inches long & weighs 5-6 pounds
- Skin is smooth because of the increase in fat
- Baby's movement slows down due to lack of room
- Disease fighting antibodies are shared through mother's blood
Fetal Development at 40 Weeks - ANSWER - Length 18-21 inches, Weight 6 to 9 lbs
- Fetus assumes position of comfort, usually head down (vertex/cephalic)
- Well-flexed extremities and head
- Skin is pink and has smooth, polished look
- Has own body rhythms and individual style of response
Pregnancy & Nutrition - ANSWER - Add 500 calories to diet
- Lower intake of fats & cholesterol
- Increase folic acid & iron intake
- Avoid eating fish high in mercury
Folic Acid - ANSWER - Women of childbearing age need 400 mcg per day
High Risk Pregnancies - ANSWER - Under 16 or over 35 yrs old
- Poverty
- Pre-pregnancy weight: underweight or obese
- Substance use: alcohol, tobacco, illicit drugs
- Pre-existing medical conditions
- Multiple gestation: more than one fetus
- Rh sensitization
- Placental abnormalities
- Previous preterm birth
- Complications in previous pregnancies
Fundal Height Throughout Pregnancy - ANSWER - 12 Weeks: Fundus initially palpable
- 16 Weeks: Halfway between symphysis & umbilicus
- 20 Weeks: Fundus at umbilicus
- After 20 Weeks: # cm with a measuring tape should approximate # weeks gestation
Maternal Care & Screening at 24-28 Weeks - ANSWER Gestational diabetes screen
Maternal Care & Screening at 27-36 Weeks - ANSWER Tdap vaccine admin (tetanus, diphtheria & pertussis)
Maternal Care & Screening at 28 Weeks - ANSWER - Hgb/Hct
- If Rh neg, antibody screen. If antibody screen neg, administer Rhogam
Maternal Care & Screening at 36 Weeks - ANSWER - Group B strep culture
- Take culture from cervix to test
Screening vs Diagnostic Test - ANSWER - Screenings are non-invasive & low risk, used to identify need for diagnostic testing
- Include bladder palpation, self-breast exam, & Snellen eye chart
- Diagnostic tests are used to identify specific problems with a high degree of accuracy, usually involve more risks & specialized personal/equipment
- Such as ultrasounds & mammograms
Alpha fetoprotein (AFP) - ANSWER - Protein synthesized in fetus, excreted into the amniotic fluid, crosses placenta & enters maternal circulation
- Low levels: possible chromosomal abnormalities
- High levels: possible neural tube or body wall detects
- Observes fetal heart rate (FHR) in response to fetal movement or stimulation
Reactive (Reassuring) NST - ANSWER - Two FHR accelerations within a 20 min period at least 15 beats above baseline for at least 15 seconds
- Indicates adequate oxygenation in the setting of a mature & healthy neurological system
Nonreactive (nonreassuring) NST - ANSWER - FHR does not exhibit the criteria for a reactive NST within 40 minutes
- Further assessment needed
- May be caused by sleep wake cycles or neurological immaturity/defect
Biophysical Profile - ANSWER - Measures NST, fetal breathing movements, gross fetal movements, fetal tone, & amount of amniotic fluid
- Score 0 or 2 for each of 5 components
- Score of 8-10 is reassuring
- Lower scores require followup
Amniotic Fluid Index (AFI) - ANSWER - A measure of chronic hypoxia
- Hypoxic fetus shunts blood to vital organs: heart, brain, placenta, at the
expense of organs not critical during fetal life
- Since lungs & kidneys produce amniotic fluid during chronic hypoxia, their function may be compromised
- Oligohydramnios (low amniotic fluid volume) is an indicator of chronic hypoxia
Danger/Warning Signs of Pregnancy to Report Immediately - ANSWER - Vaginal bleeding
- Abdominal pain
- Fever above 101 F
- Persistent vomiting
- Persistent severe headache
- Swelling of hands and face
- Epigastric pain
- Visual disturbances
- Seizure
- Decrease in frequency or strength of fetal movement
- Dysuria
- Sudden gush of fluid from vagina
- Signs/symptoms preterm labor
- Blood Pressure: Take w/patient side lying, decreased BP could be Hypovolemic shock; increased BP could be Antepartum & Intrapartum PIH/Pre-Eclampsia
Postpartum Estimated Blood Loss (EBL) Assessment - ANSWER - <500 mL of blood lost in the first 24 hours after birth
- 800 mL blood lost during the first week postpartum
- Return to pre-pregnant levels at 3-4 weeks postpartum
- Determine lochia vs. bleeding from another source (could be uterine atony, remaining parts of placenta, or tearing)
- ABNORMAL: Loss of >500 mL of blood lost in the first 24 hours
Nursing Actions for Abnormal Blood Loss - ANSWER - FUNDAL MASSAGE
- Locate & identify the source of bleeding
- Administer medications as ordered by provider
S/S of Hemorrhage Postpartum - ANSWER - Cold
- Clammy
- Pallor
- High HR, low BP
- Excessive bleeding
Hematocrit Postpartum - ANSWER - Normal range: 36-
- Increases immediately postpartum due to decrease in blood plasma volume & dehydration
- Return to pre-pregnant value in 5 weeks
- ABNORMAL: Decrease in HCT of 10% or in low 20's
Coagulation Factors Postpartum - ANSWER - Platelets: 150,000-450,
- PT: 11-14.4 seconds
- PTT: 23-36 seconds
- Fibrinogen: 200-
- ABNORMAL RESULTS: Monitor bleeding (lacerations, uterine, needle sticks, gums), administer medications as ordered by Provider
WBC Postpartum - ANSWER - May increase to 20,000-25,000 during the first week postpartum
- Elevated levels need further assessment
Fetal Jaundice - ANSWER - Observed during the first week of life
- Serum bilirubin levels greater than 5-
hours, apply HEAT as needed, warm showers to promote milk production & flow
- If not breastfeeding: Apply ice, no heat or stimulation of breasts, tight fitting bra without underwire
- Engorgement will regress in 2-3 days if not breastfeeding
Mastitis - ANSWER - Inflammation of the breast
- Most commonly caused by staph, strep or staph Aureus
- Pain, erythema, tenderness, fever
- Treat with warm compresses & Antibiotics (amoxicillin)
- CONTINUE TO BREAST FEED
Postpartum Uterine Assessment - ANSWER - Do assessment while patient flat on back
- Give pain meds prior to assessment, especially if c-section
- Assess fundal height
- Document in relation to umbilicus
Postpartum Normal Involution of Uterus - ANSWER - Decrease in size of the uterus
- Decrease in position in the abdomen
- Fundus should be firm & contracting with palpation
- Involution occurs quicker in the primip
- Uterine atony: the inability of the uterus to contract
Subinvolution of Uterus - ANSWER - Uterus does not return to its normal size
- Predisposing factors: Grand multiparity, overdistension of uterus, C-section, uterine prolapse/fibroid, retained products of conception, & infection
Uterine Afterpains - ANSWER - More acute for multiparas due to repeated stretching of muscle fibers, leading to loss of muscle tone which causes contraction & relaxation of uterus
- Overdistention or retained blood clots can also be cause
- Severe during breastfeeding due to release of oxytocin to stimulate release of milk from milk ducts
Nursing Considerations for Uterine Afterpains - ANSWER - Analgesic frequently used
- Medicate before breastfeeding
- Enhance comfort & relaxation to facilitate letdown of milk
- Prone position may provide relief
- Educate that afterpains decrease by the 3rd day postpartum
