Download NURSING 306 N306 Exam 1 Final Study Guide and more Study Guides, Projects, Research Nursing in PDF only on Docsity!
* Test 1
* Final
N306 Exam 1 Study Guide
(40 questions) Antepartum Assessments & Care
- Reproductive Cycle & Fertilization https://www.youtube.com/watch?v=MLJTLAKFM3k A nurse is teaching a woman about her menstrual cycle. The nurse states that Proliferation of the endometrium is the most important change that happens before the secretory phase of the menstrual cycle. The clinic nurse knows that the part of the endometrial cycle occurring from ovulation to just prior to menses is known as the secretory phases occurs from the time of ovulation to the period just prior to menses, or approximately days 15 to 26. The secretory phases occurs from the time of ovulation to the period just prior to menses, or approximately days 15 to 26. Amniotic fluid first appears at about 3 weeks.
There are approximately 30 mL of amniotic fluid present at 10 weeks’
Reproductive Cycle: Menstrual Cycle 28 days MENSTRUAL CYCLE ● Ovarian Cycle: the maturation of the ova consisting of Follicular Phase - ( from the 1st day of menstruation to 12-14 days) LH & FSH cause graafian follicle to mature producing Estrogen Ovulatory Phase - (begins when estrogen levels peak until oocyte released from graafian follicle) = OVULATION ^LH Luteal Phase - (begins after ovulation and lasts 14 days) ^ estrogen & progesterone If pregnant, know that the corpus luteum secretes estrogen & progesterone until placenta matures and assumes this function _> If pregnant, corpus luteum will continue to secrete estrogen & progesterone until placenta matures
If NOT pregnant, corpus luteum degenerates = < in progesterone and beginning of menstruation ●_ Endometrial “Uterine” Cycle: changes in the endometrium of the uterus in response to the ovarian cycle Proliferative Phase - (occurs following menstruation ending with ovulation) endometrium preparing for implantation =more THICK & VASCULAR Secretory Phase - (after ovulation and ends with onset menstruation) = continues to THICKEN ^progesterone Menstrual Phase - sloughing off of the endometrium = PERIOD. Fertilization: “Conception” occurs when the sperm nucleus enters the nucleus of the oocyte within the outer third of the fallopian tube. ● The fertilized egg is then called a ZYGOTE and contains a diploid number of chromosomes = 46
gestation, and this amount increases to approximately 800 mL at 24 weeks’ gestation. After that time, the total fluid volume remains fairly stable until it begins to decrease slightly as the pregnancy reaches term.
TX:
● Males: ○ Hormonal Therapy ○ Lifestyle changes ■ Stress reduction, improved nutrition, smoking cessation, eliminating drugs ■ Corticosteroids to TX antibodies ■ Antibiotics to TX infection ■ Repair of inguinal hernia or obstruction A client is to take Clomiphene Citrate for infertility. Which of the following is the expected action of this medication? Stimulate release of FSH and LH A couple who has sought infertility counseling has been told that the man’s sperm count is very low. The nurse advises the couple that spermatogenesis is impaired when which of the following occur? The testes are overheated. A nurse working with an infertile couple has made the following nursing diagnosis: Sexual dysfunction related to decreased libido. Which of the following assessments is the likely reason for this diagnosis? The couple has established a set schedule for their sexual encounters. Couples who “schedule” intercourse often complain that their sexual relationship is unsatisfying. A couple is undergoing an infertility workup. The semen analysis indicates a decreased number of sperm and immature sperm. Which of the following factors can have a potential effect on sperm maturity? The man rides a bike to and from work each day. The man takes a calcium channel blocker for the treatment of hypertension The daily riding of a bike can be the cause of prolonged heat exposure to the testicles. Prolonged heat exposure is a gonadotoxin. A number of medications, such as calcium channel blockers, can have an effect on sperm production
- Physiological changes pregnancy by system (pg 54) CHADWICKS SIGN: BLUISH DISCOLORATION OF THE CERVIX Cardiovascular system: 10-15bmp increase heart rate (Woman feels palpitations at second trimester, assessed low blood pressure) NORMAL
● Ductus Venosus connects Umbilical Vein to Inferior Vena Cava ● Foramen Ovale (opening between L & R atrium) ○ after delivery shunt closes within 3 months from blood returning to the L atrium ● Ductus Arteriosus (connects Pulm Artery to Descending Aorta) ○ after delivery it constricts in response to ^ blood oxygen levels and prostaglandins Placenta Development: formed from both fetal and mother tissue ● Chorionic Membrane (trophoblast & chorionic villi) ○ Form fetal blood vessels of the placenta ● Endometrium (decidua) = 3 layers ○ Decidua Basalis : forms maternal side of the placenta
Placenta is divided into lobes “cotyledons” Placental membrane separates maternal/fetal blood from mixing but allows for exchange of nutrients, gases and electrolytes through diffusion and active transport Major Hormones of the Placenta ● Progesterone : < in uterine contractility & facilitates implantation ● Estrogen : “enlargement” breasts and uterus ● hCG : + preg test, ^ in 1st trimester as it stimulates corpus luteum to keep secreting estrogen and progesterone until placenta is able to secrete it (6-7wks) ● hPL : promotes fetal growth by regulating glucose and stimulates breasts to lactate Umbilical Cord = 1 vein (oxygenated blood) and 2 arteries (deoxygenated blood) A.V.A
- Teratogens - The nurse is interviewing a gravid woman during the first prenatal visit. The woman confides to the nurse that she lives with a number of pets. The nurse should advise the woman to be especially careful to refrain from coming in contact with the stool of which of the pets? The patient should refrain from coming in direct contact with cat feces. Cats often harbor toxoplasmosis, a teratogenic illness. During preconception counseling, the clinic nurse explains that the time period when the fetus is most vulnerable to the effects of teratogens occurs from 2- 8wks
Any drugs, viruses, infections or other exposures that can cause embryonic/fetal development abnormality The developing human is most vulnerable to the effects of teratogens during the period of organogenesis, THE FIRST 8 WEEKS OF GESTATION
● Hemorrhoids ○ Take warm sitz bath ○ Use witch hazel pads ○ Apply topical ointments to relieve discomfort ● Backaches ○ Exercise regularly ○ Perform pelvic tilt exercises ■ Arching & straightening back ○ Use proper body mechanics -use legs to lift ○ Use side-lying position ● SOB or Dyspnea ○ Maintain good posture ○ Sleep with extra pillows ○ Contact HCP if symptoms worsen ● Leg Cramps ○ Extend the affected leg ○ Keep knee straight ○ Dorsiflex the foot (toes towards head) ○ Apply heat while extended ○ Contact HCP if persists ● Varicose Veins & Lower Extremity Edema ○ Rest with legs elevated ○ Avoid tight/constricting clothing ○ Wear support hose ○ Avoid sitting & standing in one position for long periods of time ○ Do not sit with legs crossed at the knees ○ Sleep in the left-lateral position ○ Exercise moderately with frequent walking to stimulate venous return ● Gingivitis, Nasal Stuffiness, Epistaxis ○ Gently brush teeth/Good dental hygiene ○ Use a humidifier ○ Use normal saline drops or Spray ● Braxton Hicks contractions ○ Instruct client to change position & walking should cause contractions to subside ○ If contractions increase in intensity and become frequent with regularity - Notify HCP ● Supine Hypotension ○ Lie in a side-lying or semi-sitting position with her knees slightly flexed
- Anticipatory Teaching & Health Promotion >>>>>>
- Danger Signs & Interventions during pregnancy True anemia, or iron-deficiency anemia, occurs when the hemoglobin level drops below 10 g/dL. The blood’s decreased oxygen-carrying capacity causes a reduction in oxygen transport to the developing fetus. Decreased fetal oxygen transport has been associated with intrauterine growth restriction (IUGR) and preterm birth. Warning/Danger Signs ● First Trimester ○ Abd Cramping/Pain: poss threatened abortion, UTI, appendicitis ○ Vaginal Spotting/Bleeding: “ “ ○ Absent Fetal Heart Sound : poss missed abortion ○ Dysuria, Freq, Urgency : poss UTI ○ Fever/Chills: poss infection ○ Prolonged N/V : hyperemesis gravidarum, ^ risk for dehydration ● Second Trimester ○ Abd/Pelvic Pain: poss appendicitis, UTI, PTL or pyelonephritis ○ Vaginal Bleeding: poss infection, friable cervix from preg changes, placenta previa, abruption placenta or PTL ○ Absent Fetal Heart Sound : poss missed abortion ○ Dysuria, Freq, Urgency : poss UTI ○ Fever/Chills: poss infection
○ Prolonged N/V : hyperemesis gravidarum, ^ risk for dehydration ● Third Trimester ○ S/S of PTL (abruptio placenta: placenta detaches from womb) ■ rhythmic lower abd cramping, lower backache, pelvic pressure, leaking of amniotic fluid, ^ vaginal dc ○ S/S of HTN disorder ■ severe headache (not relieved), visual changes, facial or generalized edema ○ “ “ 10. Maternal Screening & Fetal Surveillance ● Tests & Labs ● Genetic Counseling A diagnostic test commonly used to assess problems of the fallopian tubes is: Hysterosalpingogram provides information on the endocervical canal, uterine cavity, and fallopian tubes. The nurse takes the history of a client, G2 P1, at her first prenatal visit. The client is referred to a genetic counselor, due to her previous child having a diagnosis of sickle cell anemia (autosomal recessive illness) Maternal Screening ● Risk Factors ○ Biophysical Factors: genetic, nutritional, medical or obstetric issues ○ Psychosocial Factors: negative maternal behaviors affecting fetus ■ Smoking ■ Caffeine use ■ Alcohol/drug use ■ Psychological status ○ Sociodemographic Factors ■ Age, prenatal care, parity, marital status, income and ethnicity ○ Environmental Factors: hazards in workplace or home External & Internal Electronic Fetal and Uterine Monitoring Influences on FHM
11. Utero-Placental pg. 238 Utero-Placental Unit ● Oxygenated blood from mother is delivered to the intervillous space in the placenta via uterine arteries ● Nutrients, gas exchange, O2, CO2, water and wastes products are also exchanged in the intervillous space across the membranes ★ Effective O2 & CO2 transfer are dependent on ○ Adequate uterine flow ○ Sufficient placental area
★ Decreased O2 & Increased CO2 cause the peripheral chemoreceptors to stimulate the Vagal Nerve & SLOW HR ★ Central Chemoreceptors respond to Increased HR and Increased BP
15. Hormonal Regulation pg. 240 Fetal Hypoxia causes release of → epinephrine and norepinephrine increases FHR and BP → vasopressin increases HR in response to hypoxia Hypovolemia → Renin-angiotensin (secreted by the kidneys) produces vasoconstriction 16. Fetal Reserves pg. 240 Fetal Reserves : the reserve of O2 available to the fetus to withstand the transient changes in blood flow and O2 during labor ● When O2 is decreased, blood flow is deferred to fetal vital organs to compensate BUT when the placental reserves of O2 are decrease or depleting, the fetus may not be able to compensate or adapt to the decreased O2 during contractions ● Homeostatic Mechanism ★ 3 Types of Fetal Responses - FHR Data NON Hypoxic Reflex ○ FRH Accelerations Compensatory to Hypoxemia ○ Variable Decelerations Impending Decompensation **○ Late Decelerations
- Fetal Monitoring >>>>>
- NICHD Criteria for Interpretation of FHR patterns:** pg. 241 ● Baseline variability pg. 245 ● Bradycardia & Tachycardia ● Accels ● Decels Clinical conditions that impact FHR include ● Gestational age ● Prior results of fetal assessment ● Medications ● Maternal medical conditions
VEAL CHOP
Variable (common) Cord compression
Early Head compression
Accelerations Oxygenation okay
Late Placental insufficiency
● Fetal conditions Assessing FRH Pattern: Baseline FHR (rate/variability) ○ Mean FRH rounded to increments of 5 BPM during a 10 min window ○ There MUST be 2 min of identifiable baseline segments ○ NORMAL 110-160bpm Periodic/Episodic Changes (accelerations/decelerations) Uterine Activity ○ Frequency ○ Duration ○ Intensity ○ Resting tone ○ Relaxation time between UC’s ★ Baseline Variability : the fluctuations in the baseline of the FHR ○ Irregular in amplitude & frequency ○ Most Important predictor to adequate fetal oxygenation cerebral cortex > midbrain (medulla oblongata) > vagus nerve > heart ● accels/decels not included
ABSENT : amplitude range is undetectable = Can occur if the baby is sleeping, meds S/E Maternal: supine hypo, cord compression, uterine tachysystole, drugs = May also be a sign of hypoxia/acidosis if persistent for 60min with interventions
MINIMAL : amplitude range is undetectable < 5 bpm = Can occur if the baby is sleeping, meds S/E Maternal: supine hypo, cord compression, uterine tachysystole, drugs = May also be a sign of hypoxia/acidosis if persistent for 60min with interventions
MODERATE: amplitude 6 -25 bpm
■ Assess fetal movement ■ Fetal scalp stimulation ■ Perform vaginal exam - assess for prolapsed cord ■ Maternal VS ■ Have mother change in position ■ Discontinue oxytocin to < UC’s ■ Give O2 10L/min via non-breather mask ■ Stop < pushing ■ support family ■ contact HCP ★ Fetal Tachycardia: FHR >160 bpm for at least 10 min ○ May be a sign of fetal hypoxemia, especially with decreased variability and decelerations ○ If tachy = 200-220 bpm, fetal demise ○ Causes: ■ Maternal fever/related causes ● Infection ■ Exposure to meds ( Terbutaline ) ○ TX: treat underlying cause & consider delivery ○ Nursing Actions: ■ Assess maternal VS ■ Give meds as ordered ■ Use ice packs, if fever ■ Assess for dehydration - IV fluids ■ Change the mother’s position ■ Decrease/Stop Pitocin (Oxytocin) ■ Notify HCP ★ Periodic v. Episodic Changes ○ Periodic = accelerations/decelerations in FHR due to UC & persist ○ Episodic = accelerations/decelerations in FRH not associated with UC (accelerations common) ★ FHR Accelerations = predictive of adequate central fetal oxygenation and absence of fetal acidemia ○ Visually abrupt transient increases above the FHR baseline ○ 15 beats above the baseline (15 sec-2 min) ○ Prolonged accelerations >2 min but < 10 min
VEAL CHOP
Variable (common Cord compression
Early Head compression
Accelerations Oxygenation okay
Late Placental insufficiency
★ FHR Decelerations = transitory decreases in the FHR baseline ○ Classified according to shape, timing & duration in relationship with the contraction ○ RECURRENT if occur in at least 50% of UC’s within 20 min ○ INTERMITTENT if occur fewer that 50% of UC’s within 20 min ○ Nadir : lowest point of the deceleration (occurs at the peak of the contraction)
- EARLY Decelerations: visibly apparent & symmetrical ● Mirrors the UC’s ● Normal VARIABLE Decelerations : visibly apparent, abrupt decrease in FHR ● Most common during labor ● Decrease FHR is > 15 bpm for > 15 sec and <2min in duration ● Can be a V, W or U shaped ● May be due to umbilical cord occlusion/ cord compression REPOSITION THE PATIENT
Consider Amnioinfusion, tocolytics, delivery
LATE Decelerations : visibly apparent, symmetrical gradual decrease of FHR due to UC’s ● May be a sign of fetal intolerance to labor ● Nadir occurs after peak of contraction
19. Category system – 1 2 3 pg. 241 Know category 1 and 3 Q: a doctor tells the nurse that the pt is able to discharge when she meets the criteria of category 1 20. Intrauterine Resuscitation Interventions pg. 249 These interventions maximize uterine blood flow, umbilical circulation and maternal fetal oxygenation by ● Shifting maternal position to the L or R ● Administer 500 mL of lactic ringers IV Bolus -maximize intravascular volume =improved uteroplacental perfusion ● Correct hypotension by change in position, Ephedrine and proper hydration ● Adm O2 10L/min on non-rebreather face mask ● Reduce UC’s by ○ Stopping Oxytocin ○ Removing the cervical ripening agent ○ Use Terbutaline to Relax the uterus ○ Amnioinfusion - resolving variable decelerations ○ Encourage pushing techniques ○ Obtain fetal acid-base status if possible by fetus scalp sample ○ Be supportive to mother & fam bam ● If fetus has fetal acidemia = ○ Notify HCP to initiate bedside eval for cesarean ○ Notify anesthesia & peds team
○ Move pt to OR
- Amnioinfusion pg. 251 Amnioinfusion : room temp normal saline is infused into the uterus transcervically via an intrauterine pressure catheter to increase intra amniotic fluid cushioning the umbilical cord and reducing cord compression.
Used when there are Variable Decelerations in the first stage of labor due to a decrease in amniotic fluid Also know the functions of the amniotic fluid: provides cushion for the fetus and prevents the fetus from getting contractures when bending arms and legs > mother is able to exercise, encouraged to walk daily Antenatal Assessments
- Biophysical assessments (US) pg. 116 ● Ultrasonography : high frequency sound waves producing an image or an organ or tissue ○ Gestational Age ○ Fetal Growth ○ Fetal Anatomy ○ Placental Abnormalities & location ○ Fetal Activity ○ Amount of Amniotic Fluid ○ Visual Assistance for invasive procedures -> amniocentesis > Standard Ultrasounds are typically done in 1st trimester to confirm preggo & calculate gestational age ● Transvaginal Ultrasound - done at 1st trimester ● Abdominal Ultrasound - supine position ★ To calculate gestational age = measurements of ○ Fetal-crown rump length ○ Biparietal Diameter ○ Femur Length ○ Most accurate <20 wks
- Biochemical assessments pg. 121 ● Amniocentesis ○ meconium fetal feces ● CVS Amniocentesis: less than 1% fetal loss rate after 15 weeks gestation Chorionic Villus Sampling (CVS) : the aspiration of a small amount of placental tissue for chromosomal, DNA and metabolic testing ● Done within 10-12 weeks for chromosomal analysis to detect fetal abnormalities caused by genetic disorders ● It tests for Cystic Fibrosis but NOT for Neural Tube Defects ● Performed ideally at 10-13 wks - NOT recommended before 10 weeks ● Procedure ○ Supine/Lithotomy position ○ A catheter/needle is inserted transvaginally with ultrasound guiding it (teaching) ○ Sample of chorionic “placental” tissue is removed ● Risks
