Chapter 12. Nursing Management During Nursing

Question 1

Isotretinoins/accutane

Answer 1

Used to treat acne. Can result in miscarriage and birth defects.

Question 2

Alcohol misuse

Answer 2

Feel alcohol syndrome and other birth defects. Should cease intake before conception

Question 3

Antiepileptic drugs

Answer 3

Women who are on these drugs should be prescribed a lower dose before conception.

Question 4

Diabetes preconception

Answer 4

There’s a threefold increase in birth defects among infants of women with type I and type II diabetes. This is reduced if Properly managed

Question 5

Folic acid deficiency

Answer 5

A supplement at least 400 mcg reduces the occurrence of neural tube defects by two thirds

Question 6

Hepatitis B

Answer 6

Preventing infection and women of childbearing age prevents transmission to the infants and eliminates the risk to the woman. This could include hepatic failure, liver carcinoma, cirrhosis, and death.

Question 7

HIV/AIDS

Answer 7

If known before conception, antiretrovirals treatment can be given along with information that can help prevent mother to child transmission.

Question 8

Hypothyroidism

Answer 8

The dosages of levothyroxine for treatment increase during early pregnancy. It needs to be adjusted for proper neurological development of the fetus.

Question 9

PKU/maternal phenylketonuria

Answer 9

Women diagnosed with PKU as infants have increased risk for delivery neonates with intellectual disability. This can be prevented when mothers adhere to a low phenylalanine diet before conception and continuing throughout the pregnancy

Question 10

Rubella seronegativity

Answer 10

Rubella vaccination helps prevent congenital rubella syndrome

Question 11

Period of greatest risk to embryo

Answer 11

Between day 17 and 56 after conception.

Question 12

Obesity

Answer 12

Neural tube defects, preterm delivery, diabetes, c-section, hypertensive and thromboembolic disease. Weight-loss and nutritional intake before pregnancy reduces these risks

Question 13

Oral anticoagulant

Answer 13

Warfarin is teratogen. They should be changed to a different anticoagulant before pregnant

Question 14

STIs

Answer 14

Chlamydia and gonorrhea are associated with ectopic pregnancy, infertility, chronic pelvic pain. They could result in fetal death or substantial physical and developmental disabilities, including intellectual disability and blindness. Women’s be screened early

Question 15

Smoking

Answer 15

Preterm birth, low birth weight, and other adverse outcomes is associated with smoking. They can be prevented if they stop smoking before or during early pregnancy.

Question 16

Diabetes testing

Answer 16

Should be tested at the first prenatal visit if high risk which includes women over 25, overweight, have polycystic ovarian syndrome, history of gestational diabetes, and a positive history of family diabetes. High risk populations include Hispanic, black, Asian, Arab, Afro Caribbean, Mediterranean, and native American.

Fasting plasma glucose 126 mg/dL
Hemoglobin A-1C at least 6.5%
Random plasma glucose 200 mg/dL
Normally tested from 24 to 28 weeks

Question 17

Nageles rule

Answer 17

Subtract three months from the first day of her last menstrual period and then add seven days.

Margin of error is plus or -2 weeks

Less accurate if the cycles are irregular, if the woman conceived while breast-feeding, before her regular cycle is established after childbirth, or after discontinuing oral contraceptives

Ultrasound is the most accurate method of dating a pregnancy

Question 18

Gravid

Answer 18

The state of being pregnant

Question 19

Gravida

Answer 19

A pregnant woman. Gravidarum I/primigravida is the first pregnancy, gravida II/secundigravida is the second pregnancy. Nulligravida never pregnant. Multigravida pregnant at least third time

Question 20

Para

Answer 20

The number of deliveries at 20 weeks or greater that a Woman has, regardless of whether it was born alive or dead.

Nullipara never offspring after 20 weeks
Multipara a woman 2 or more

Question 21

Gravidity

Answer 21

The number of times that a woman has been pregnant, irrespective of the outcome

Question 22

GTPAL

Answer 22

G-gravida, including current pregnancy
T-term gestations 38-42
P-preterm 20-37
A-#ending before 20 weeks
L-children currently living

If an extra p, it is the same as L

Question 23

Appointment schedule

Answer 23

Every four weeks up to 28 weeks
Every two weeks from 29 to 36 weeks
Every week from 37 weeks to birth

Weight and blood pressure compared to the baseline. Urine testing for protein, glucose, ketones, and nitrates. Fundal height to assess fetal growth. Assessment for quickening/fetal movement. Assessment of fetal heart rate.

Question 24

Fundal height measurement

Answer 24

From the top of the pubic bone to the top of the uterus/fundus with the client lying on her back and knees slightly flexed. This is termed McDonald’s method.

Question 25

Fetal movements

Answer 25

While sitting or lying record mmovvements. Notified Dr. if there’s not at least 10 within one hour. This needs to be done around the same time everyday

The second option is to lie on the left side for one hour after meals, Count how many movements she felt in one hour, needs to be at least 4, if not wait one more hour to see if you can feel 4 more movements

Question 26

Danger during the first trimester

Answer 26

Spotting or bleeding, painful urination, persistent vomiting, fever abovve100, lower abdominal pain with dizziness and shoulder pain, which could indicate ruptured ectopic pregnancy

Question 27

Danger during the second trimester

Answer 27

Regular contractions, pain in calf, rupture of membranes, absence of fetal movement for more than 12 hours.

Question 28

Dangers during the third trimester

Answer 28

sudden weight gain, periorbital or facial edema, severe abdominal pain, headache with visual changes, decreases in fetal movement, any of the other warning signs

Question 29

Preterm labor

Answer 29

If experiencing cramps occurring every 10 minutes accompanied by a low backache, just stop what she is doing and lie down on her left side for one hour and drink 2 to 3 glasses of water. If they do not stop she needs to go into the doctor

Question 30

Amniocentesis

Answer 30

Detects chromosomal abnormalities and hereditary metabolic defects in the fetus. Performed in the second trimester, usually between 15 and 18.

While under ultrasound a 5 inch needle is inserted to withdraw fluid. Empty bladder prior to procedure. Fetal heart rate monitoring is done for 20 minutes. RhoGAM maybe given if the woman is Rh negative. Assess maternal vital signs and fetal heart rate every 15 minutes for an hour. Observe for bleeding and drainage. Report fever, leaking fluid, vaginal bleeding, uterine contractions, or change in fetal activity.

Question 31

chorionic villus sampling

Answer 31

Detect chromosomal disorders, enzyme deficiency, fetal gender determination, and sex linked disorders such as hemophilia, sickle cell anemia, and Taysachs disease. 10 to 13 weeks after the last menstrual period. The ultrasound confirms gestational age, and then under ultrasound guidance transcervical or transabdominal is done. The client must have a full bladder. RhoGAM is given to Rh negative women. Report fever, cramping, vaginal bleeding, no strenuous activity for 48 hours.

Question 32

Nonstress test

Answer 32

Recommended twice-weekly after 28 weeks for clients with diabetes and preeclampsia, postterm pregnancy, renal disease, and multi fetal pregnancy. It is to determine fetal heart rate patterns in response to movement. The mother eats a meal, lays in the left lateral position, monitoring devices are placed, the client is given a button to push every time she feels feel movement. That marks the fetal monitor strip. Usually lasts 20 to 30 minutes. a reactive test includes two accelerations of at least 15 beats for at least 15 seconds with in the 20 minute period. If it does not meet this after 40 minutes it is considered nonreactive.

Question 33

Vaccinations to get

Answer 33

Hepatitis B, influenza, tetanus/diphtheria., Meningococcal, Rabies

Question 34

Vaccinations to avoid

Answer 34

Live influenza, measles, mumps, rubella, varicella, tuberculosis, typhoid