Common Test

Question 1

Risk factor of GDM

Answer 1

Maternal obesity (90kg)

Maternal age older than 25 years

Previous unexplained stillbirth

Previous infant having congenital abnormalities

History of GDM in a previous pregnancy

Family history of DM

Large infant (>4kg)

Fasting glucose >126mg/dl or post glucose >200mg/dl

Question 2

GDM is diagnosed via

Answer 2

oral glucose tolerance test
≥ 140mg/dl (positive)
< 140mg/dl (negative)

urine for glucose

Blood glucose

Question 3

Fetal effects of GDM

Answer 3

Congenital abnormalities

Macrosomia(large size)

Intrauterine growth restriction

Birth injury

Delayed lung maturation

Neonatal hypoglycaemia

Neonatal hypocalcemia

Neonatal hyperbilirubinaemia
and jaundice

Neonatal polycythemia
(Hematocrit level>65%)

Perinatal death

Question 4

Definition of uterine fibroids

Answer 4

Benign growth of the smooth muscle in the wall of the
uterus.

Known as myomas or leiomyomas

Well-circumscribed capsulated tumor, firm to touch
with pinkish appearance

Question 5

Types of fibroids tumors

Answer 5

Intramural fibroids

• most common
• grow in the wall of the uterus.

Subserosal fibroids

• grow on the outside of the uterus.
• can cause pain due to their size or pressure on nearby organs

Submucosal fibroids

• least common
• grow just underneath the uterine lining and can crowd into the uterus cavity
• lead to urgency, heavy bleeding, infertility, back and pelvic pain with other more serious complications.

Pedunculated fibroids
-grow on small stalks inside or outside the
uterus.

Question 6

Diagnostic Evaluations of fibroids tumors

Answer 6

Health history
- Menstrual pattern
- Fertility and child bearing
desires
- Pain assessment

Pelvic examination (Bimanual examination)
- Detect for abdominal lumps

Diagnostic laparoscopy
- To visualize subserosal fibroids (perimetrium lining)

Ultrasound or MRI
- MRI will be able to detect fibroids which is not visible
during an ultrasound

Hysteroscopy ( submucosal fibroids)
- Inspection of uterus cavity

Blood test

• FBC to rule out anaemia
• TSH (thyroid problem)

Question 7

Rationale for laparoscopy for pt with fibroids tumors

Answer 7

To visualize subserosal fibroids (perimetrium lining)

Question 8

Rationale for hysterescopy for pt with fibroids tumors

Answer 8

Hysteroscopy ( submucosal fibroids)

- Inspection of uterus cavity

Question 9

Definition of endometriosis

Answer 9

Endometriosis is the presence of functioning
endometrial glands and stroma outside the uterine
cavity, most often in the pelvic peritoneal cavity

Question 10

Pathophysiology of Endometriosis

Answer 10

Metaplasia Theory:
• Endometrial tissue develops from embryonic epithelial cells due to hormonal or inflammatory changes: a layer of cells surrounding the ovaries and other cells within the pelvic region are able to change into endometrial cells.

Retrograde Menstruation Theory:
• Menstrual tissue backs up through the fallopian tubes during menses and implants on various pelvic structures due to contraction of smooth muscles.

Transplantation Theory:
• Endometrial implants spread via lymphatic or vascular channels.

Question 11

Diagnostic evaluation of endometriosis

Answer 11

Health History
• Menstrual pattern
• Fertility status & child bearing desires
• Pain assessment

2. Pelvic examination (Bimanual Examination)
   • To detect fixed tender nodules round uterus
3. Full Blood Count (FBC)
   • Rule out infection
   • Check for anemia due to heavy menses
4. Diagnostic laparoscopy
   • small incision made on the abdomen with camera
   • guided instruments inserted to view the pelvic cavity

Question 12

Definition of ovulation

Answer 12

Expulsion of an ovum from the ovary on
spontaneous rupture of a mature follicle as a
result of cyclic ovarian and pituitary function

It is usually occurs on or about the 11th to the
14th day before the next menstrual period.

Question 13

Definition of fertilization

Answer 13

Occurs when a sperm penetrates an ovum and unites
with it, each with 23 chromosomes  Produces a
zygote with 46 chromosomes

Sperm provides paternal chromosomes

Oocyte provides maternal chromosomes,

Occurs in upper third of uterine tube ( ampulla)

During transport through the fallopian tube, the zygote
undergoes rapid mitotic division or cleavage

Question 14

Definition of implantation

Answer 14

It involves the attachment,
penetration and embedding
of the blastocyst in the
lining of the uterine wall
(endometrium)

Question 15

Definition of embryonic stage

Answer 15

Development of membranes and
placenta

This stage lasts from day
15 until approximately 8
weeks after conception

End of 8 weeks, all the
organ systems and
external structures are
present

Question 16

Definition of hyperemesis gavidarum

Answer 16

It refers to persistent and severe vomiting leading to fluid
and electrolyte disturbance, marked ketonuria, nutritional
deficiency and weight loss
Persists beyond the 20th week of pregnancy
(most common in first trimester)

Question 17

Clinical manifestations of hyperemesis gavidarum

Answer 17

Persistent nausea and vomiting

Inability to retain food and fluids

Significant weight loss ( more than 5% prepregnant
weight)

Dehydration as evidenced by dry tongue and mucous
membranes, decreased turgor of the skin, scant and
concentrated urine

Electrolytes and acid-based imbalanced

Ketonuria

Question 18

Nursing diagnosis of Hyperemesis Gavidarum

Answer 18

Fluid volume deficit related to severe vomiting

Impaired nutrition, less than body requirement related
to inability to tolerate fluids and foods

Anxiety related to ineffective coping of persistent and
severe vomiting

Question 19

Nursing Intervention of Hyperemesis Gavidarum

Answer 19

Fluid and nutritional balance:

 Monitor vitals signs for dehydration such as tachycardic and hypotension.

 Assess for signs and symptoms for dehydration such as dry lips and mucosa, decreased skin turgor and sunken eyes to determine the severity of dehydration.

 Maintain Nil By Mouth (NBM) status to allow GI tract to rest.

 Administer antiemetic drugs as ordered e.g. Maxolon, IV Zofran.

 Administer IV Dextrose 5% in lactated ringer

 Monitor intake and output chart to assess fluid balance and determine fluid replacement.

 Daily weight to assess fluid balance.

 Introduce small amounts of oral fluid and food gradually when patient’s nausea and vomiting subsided for better toleration.

Comfort:

• Ensure comfort in oral cavity by providing oral hygiene, lips therapy and oral gel.
• Grouping nursing care to avoid unnecessary disturbances to provide maximum rest.

3.Emotional support
Listen to her concerns and feelings by answering all her questions
Teach the patient about therapeutic lifestyle changes like avoid stressors
and fatigue

Health teaching

Take frequent, small amounts of food and fluid, to prevent the
stomach becoming too full
Eat easily digested carbohydrates, e.g. crackers to avoid empty
stomach
Sitting upright after meals at least 2 hours after eating, to reduce
gastric reflux into the esophagus
Avoid noxious stimuli to prevent triggers that cause nausea and
vomiting

Question 20

Nursing Intervention of Hyperemesis Gavidarum ( Fluid and nutritional balance )

Answer 20

Fluid and nutritional balance
 Monitor vitals signs for dehydration such as tachycardic and hypotension.
 Assess for signs and symptoms for dehydration such as dry lips and mucosa,
decreased skin turgor and sunken eyes to determine the severity of dehydration.
 Maintain Nil By Mouth (NBM) status to allow GI tract to rest.
 Administer antiemetic drugs as ordered e.g. Maxolon, IV Zofran.
 Administer IV Dextrose 5% in lactated ringer
 Monitor intake and output chart to assess fluid balance and determine fluid
replacement.
 Daily weight to assess fluid balance.
 Introduce small amounts of oral fluid and food gradually when patient’s nausea
and vomiting subsided for better toleration.

Question 21

Nursing Intervention of Hyperemesis Gavidarum ( Health teaching)

Answer 21

Take frequent, small amounts of food and fluid, to prevent the
stomach becoming too full
Eat easily digested carbohydrates, e.g. crackers to avoid empty
stomach
Sitting upright after meals at least 2 hours after eating, to reduce
gastric reflux into the esophagus
Avoid noxious stimuli to prevent triggers that cause nausea and
vomiting

Question 22

Nursing Intervention of Hyperemesis Gavidarum ( Comfort )

Answer 22

Ensure comfort in oral cavity by providing oral hygiene, lips
therapy and oral gel.
Grouping nursing care to avoid unnecessary disturbances to
provide maximum rest.

Question 23

Nursing Intervention of Hyperemesis Gavidarum (Emotional support)

Answer 23

Listen to her concerns and feelings by answering all her questions
Teach the patient about therapeutic lifestyle changes like avoid stressors
and fatigue

Question 24

Mild pre-eclampsia

Answer 24

BP: ≥ 140/90 mmHg but less than
160mmHg; diastolic greater
than 90mmHg but less than
<110mmHg

Proteinuria: Trace to 1+

Oedema: Trace to 1+ pedal, if present

Headache: Absent

Epigastric pain: Absent

Visual problems: Absent

Reflexes: Maybe normal

Serum creatinine: Normal

Platelets: Normal

Liver enzymes: Normal or minimal

Question 25

Severe pre-eclampsia

Answer 25

BP: ≥ 160/110 mmHg and greater Proteinuria: ≥ 2+ to 3+ Oedema: Oedema ±; oedema of face or hand is significant Headache: Severe Epigastric pain: Present Visual problems :Blurred, photophobia Reflexes: Hyperreflexia >3+ possible ankle clonus Serum creatinine: elevated Platelets : Decreased Liver enzymes: Markedly elevated

Question 26

Clinical Manifestation of severe pre-eclampsia

Answer 26

Central Nervous System: Severe headache (brain edema and small cerebral haemorrhages) Hyperactive deep tendon reflexes (CNS irritability) Eyes: ``` Visual disturbances (blurred or double vision or ‘spots before the eyes’) due to arterial spasm and edema surrounding the retina ``` Urinary tract: Reduces urine production and worsens hypertension due to decrease blood flow to the kidneys Respiratory system: ▪Dyspnoea due to pulmonary edema (accumulation of fluid in the lungs) Gastrointestinal system and liver: ▪Epigastric pain or nausea due to liver edema, ischaemia and necrosis Blood clotting: ▪HELLP syndrome ▪Involves haemolysis, elevated liver enzymes and low platelets

Question 27

Nursing management of pre-eclampsia

Answer 27

PE monitoring chart Daily weight measurement – to assess for retention of fluid Strict I/O monitoring – prevent fluid overload and ensure adequate kidney function Insert Indwelling catheter – monitor output every hour (30ml / hour) - Send Urine C/S, FEME Continuous fetal monitoring with CTG/Doppler – monitor the well being of the fetus Check daily urine protein (dipstick) to measure the amount of protein in the urine Explain and reassure patients – provide emotional support Nursed in a quiet environment

Question 28

Nurse management of eclampsia

Answer 28

Activate Code Blue if patient having seizures Ensure patent airway by turning patient to left lateral and suctioning of mouth to clear secretion. Administer Oxygen at 6-8 litres/min by face mask Protect patient from injury during seizures - Note duration of seizures Administer anti-hypertensive, anti-convulsive as ordered Close monitoring of parameters as per pre-eclampsia management Observe for uterine contractions and vaginal loss after seizures Transfer to ICU and prepare for delivery after seizures

Question 29

Definition of abortion

Answer 29

Abortion: Termination of pregnancy before viability (20 weeks of gestations), either spontaneous or induced

Question 30

Definition of Miscarriage

Answer 30

Miscarriage: Spontaneous termination of pregnancy before viability (20 weeks of gestations) – Also known as spontaneous abortion

Question 31

Definition of Termination of pregnancy (TOP)

Answer 31

It is a procedure to terminate a pregnancy by using medical or surgical methods before 20 weeks of gestation – Also known as induced abortion

Question 32

Types of abortion

Answer 32

Spontaneous abortion: Threatened abortion Inevitable abortion Incomplete abortion Complete abortion Missed abortion Recurrent abortion Induced abortion: Therapeutic abortion Elective abortion

Question 33

Threatened abortion

Answer 33

REFER TO SLIDES

Question 34

Inevitable abortion

Answer 34

Refer to slides

Question 35

Incomplete abortion

Answer 35

Refer to slides

Question 36

Complete abortion

Answer 36

Refer to slides

Question 37

Missed abortion

Answer 37

Refer to slides

Question 38

Recurrent abortion

Answer 38

Refer to slides

Question 39

Therapeutic abortion

Answer 39

Refer to slides

Question 40

Elective abortion

Answer 40

Refer to slides

Question 41

Risk factors of miscarriage

Answer 41

``` - Maternal age – more than 35 years • Increased gravidity • Previous history of miscarriage • Multiple pregnancy • In-vitro fertilization • Polycystic ovarian syndrome (PCOS) ```

Question 42

Clinical manifestations of miscarriage

Answer 42

Amenorrhoea Vaginal bleeding Lower abdominal cramping/pain Positive pregnancy test (hCG) Vaginal examination – cervix closed/dilate

Question 43

Diagnostic evaluations of miscarriage

Answer 43

1. Full blood count (FBC) 2. Blood urea and serum electrolytes 3. Blood grouping and x-match 4. Urine FEME 5. Urine Pregnancy test (hCG) 6. Ultrasound of abdomen

Question 44

Nursing diagnosis of miscarriage

Answer 44

Grief related to loss of anticipated infant Risk of infections related to the retain of product of conception Risk for fluid volume deficit related to excessive bleeding IMPORTANT : LOOK AT BODY TEMPERATURE IF TEMPERATURE STILL LOW, (RISK) OF INFECTION

Question 45

Nursing interventions of miscarriage

Answer 45

Psychological care: a) Counselling referral b) Support group c) Provide adequate space and time for the couple to grief Observation: a) Monitor vital signs (hourly blood pressure, pulse, respiration rate and 4 hourly temperature -> post-operative complications such as hypovolemic shock b) Observe pad chart for the amount and characteristic of discharge -> determine amount of blood loss. c) Monitor for post-operative complications such as hypovolemic shock, pelvic infection -> to provide early intervention

Question 46

Complications of Miscarriage

Answer 46

- Hemorrhage • Infection • Sepsis • Death

Question 47

Definition of ectopic pregnancy

Answer 47

Ectopic Pregnancy occurs when the fertilized ovum (zygote) is implanted outside the uterine cavity such as fallopian tube, ovary, abdomen or the cervix Occurs at first trimester before 13 weeks of gestation

Question 48

Clinical manifestations of ruptured ectopic pregnancy

Answer 48

Cramping pain and tenderness over the pelvic region, lower back, abdomen or pelvic region • Shoulder and neck pain caused by accumulating intraperitoneal blood that irritates the diaphram • Vaginal bleeding (a large of mass clotted blood collected in the pelvis) Signs of hypovolemic shock and haemorrhage: * Pallor * Rapid, thready pulse * Decreased blood pressure * Sweating * Subnormal temperature * Restlessness

Question 49

Nursing diagnosis of ruptured ectopic pregnancy

Answer 49

Lower abdominal pain related to inflammation or ruptured of the fallopian tube Fluid volume deficit related to bleeding from a ruptured ectopic pregnancy Bleeding related to rupture of the fallopian tube Anxiety related to effect of surgery on fertility Grieving related to loss of pregnancy loss

Question 50

Immediate nursing interventions of ectopic pregnancy

Answer 50

1. Monitor the vital signs (Blood pressure, pulse rate and respiration rate) every 15 mins if actively bleeding and temperature 4 hourly (R) increase pulse rate and drop in blood pressure will indicate hypovolemic shock and infection. 2. Administer IV Normal Saline if patient is Nil by mouth (if actively bleeding due to ruptured fallopian tube) (R) To replace blood and fluid loss 3. Monitor the intake and output (Urinary catheterization - 30ml/hr) (R) to monitor renal function and hydration status 4. Monitor pad chart (R) To note the colour and amount of blood loss ( if ruptured fallopian tube) 5. Observe for signs and symptoms of hypovolemic shock (R) To prevent patient compromised 6. Administer oxygen if necessary (R) to increase the amount oxygen saturation 7. Provide emotional support (R) To allay fear and anxiety 8. Pain management - observe for presence and location (R) to promote comfort and relief pain 9. Blood transfusion if excessive bleeding ( R) to replace blood loss 10. Prepare for surgery if there is excessive bleeding due to ruptured fallopian tube (R) To prevent patient compromised

Question 51

Complications of ectopic pregnancy

Answer 51

Ruptured Ectopic Pregnancy Hypovolemic shock Recurrent of ectopic pregnancy

Question 52

First stage of labour

Answer 52

Begins from the onset of regular uterine contractions to full dilatation of the cervix Divided into 2 phases: • Latent phase • Active phase

Question 53

Nursing Intervention for 1st stage of labour

Answer 53

1. Monitor vital signs, hourly pulse rate, respiration rate, blood pressure and 4 hourly temperature (R) To detect for bleeding, dehydration and infection 2. Assess status of labour • Monitor uterine contractions by placing the entire hand lightly on the uterine fundus (R) To assess the progress of labour 3. Perform 4 hourly or PRN vaginal examination to assess for: • Cervical effacement and dilatation, of • Fetal descent • Membranes – present or absent • Colour of the amniotic fluid (liquid) (R) To monitor the progress of labour and fetal distress 4. Assessment of the perineum - perineum bulging - anus gaping (R) To observe for signs of second stage 5. Monitor of the fetal heart rate (FHR) using doppler or CTG • Normal FHR: 110 – 160 bpm • Bradycardia: below 110 bpm • Tachycardia: above 160 bpm (R) For early detection of fetal hypoxia and to provide prompt interventions

Question 54

Purpose of CTG

Answer 54

Assess and document fetal heart rate Assess and document the duration, frequency and intensity of uterine contractions

Question 55

Second stage of labour

Answer 55

Begins with full dilatation of the cervix to the birth of the baby

Question 56

Third stage of labour

Answer 56

From the birth of the baby till the expulsion of | placenta and membranes and the bleeding stop

Question 57

Fourth stage of labour

Answer 57

1 to 4 hours after birth Physiologic readjustment of mother’s body begin Haemodynamic changes occur (to observe in the woman): • Blood loss of 250 – 500ml of blood Loss of blood and removal of weight from the pregnant uterus from surrounding vessels allows redistribution of blood onto venous beds Results in moderate drop in SBP & DBP, increased pulse pressure and moderate tachycardia

Question 58

Immediate care for mother after normal vaginal behaviour

Answer 58

Monitor vital signs every hour (blood pressure, temperature, pulse rate & respiration rate) – to detect for bleeding Check the uterine contraction for the location and firmness of uterine fundus – to ensure no uterine atony Monitor the pad chart, note the amount and colour of lochia to detect for post partum haemorrhage Check condition of episiotomy wound and perineum, to note for bleeding from the laceration/episiotomy and haematoma Monitor IV infusion and medication as ordered by Dr Administer of oxytocin infusion as needed to contract the uterus Pain management, to observe for presence and location of pain – to relief pain and promote comfort Observe for bladder distension as full bladder hinder uterine contractions that may lead to post partum haemorrhage Check the level of sensation and ability to move lower extremities if epidural anaesthesia is used Promote comfort

Question 59

Description of uterine contractions

Answer 59

Descriptions of uterine contractions • Frequency: the elapsed time between the beginning of one contraction until the beginning of the next contraction (e.g contraction every 15 mins) • Duration: the elapsed timed from the beginning to the end of the same contraction (e.g lasting 45 to 50 seconds) • Intensity: approximate strength of contraction - Ranges from mild → moderate → strong • Interval: the amount of time the uterus relaxes between contractions

Question 60

Increment:

Answer 60

period of increasing of the contraction

Question 61

Acme:

Answer 61

Peak of the contraction

Question 62

Decrement:

Answer 62

decreasing strength of the contraction

Question 63

Definition of episotomy

Answer 63

A surgical incision of the perineal body to enlarge the outlet Has been thought to minimize risk of lacerations of the perineum and overstretching of the perineal tissues

Question 64

Risks of episiotomy

Answer 64

• Increase the risk of fourth-degree perineal lacerations • Major perineal trauma (extension to or through the anal sphincter) more likely to happen if midline episiotomy done • Blood loss, infection, pain and discomfort for weeks after delivery • Painful intercourse

Question 65

Metaplasia theory

Answer 65

Endometrial tissues develop from embryonic epithelial cells due to inflammatory and hormonal changes whereby a layer of cells surrounding the ovaries and other cells within the pelvic region are able to change into endometrial cells