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Mark K NCLEX Review > Maternal Newborn > Flashcards

Maternal Newborn Flashcards

1
Q

Due date calculation

A

Take the first day of the last period, add 7 days, subtract 3 months
NOTE: leveluprn says take first day of last period, add 9 months, add 7 days

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2
Q

Total weight gain for average pregnancy

A

28 lbs +/- 3

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3
Q

Weight gain during first trimester

A

1 lb each month
NOTE: first trimester is 3 months long. Weight gain should be about 3 lbs

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4
Q

Weight gain during second and third trimester

A

1 lb per week

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5
Q

Pregnancy weight gain chart

A

Week 12: 3 lbs
Week 13: 4 lbs
Week 14: 5 lbs
Week 15: 6 lbs
Week 16: 7 lbs
Week 18: 9 lbs
NOTE: week of gestation - 9 lbs = expected weight gain

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6
Q

Fundus cannot be palpated until ___ weeks gestation

A

12

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7
Q

When is the fundus at the level of the umbilicus?

A

20-22 weeks gestation

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8
Q

What are the four positive signs of pregnancy?

A

1) fetal skeleton on X-Ray
2) fetal presence on ultrasound
3) auscultation of a fetal heart rate
4) examiner palpates fetal movement

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9
Q

When would you first auscultate a fetal HR?

A

8 weeks

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10
Q

When would you most likely auscultate a fetal HR?

A

10 weeks

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11
Q

When should you auscultate fetal HR?

A

12 weeks

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12
Q

When does quickening occur?

A

Between 16-20 weeks

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13
Q

Probable/presumptive signs of pregnancy

A
  • positive urine and blood tests
  • Chadwick’s sign: cervical color change to cyanosis
  • Goodell’s sign: cervical softening
  • Hegar’s sign: uterine softening
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14
Q

How often should a pregnant client come in for prenatal care?

A
  • Once a month until week 28
  • week 28: once every two weeks until week 36
  • week 36: every week until delivery or until 42 weeks where you would schedule C section/induction
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15
Q

Throughout pregnancy, hemoglobin levels may _________

A

Decrease

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16
Q

Morning sickness is a discomfort experienced during the _____ trimester of pregnancy

A

First

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17
Q

Morning sickness interventions

A

Dry carbohydrates (crackers) before getting out of bed

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18
Q

Urinary incontinence may be experienced during which trimesters of pregnancy?

A

First and third

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19
Q

Urinary incontinence interventions

A

Void every 2 hours throughout pregnancy until 6 weeks after delivery

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20
Q

Difficulty breathing and back pain may occur during which trimesters of pregnancy?

A

Second and third

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21
Q

Interventions to address difficulty breathing

A

Tripod position (feet flat, arms on the table leaning forward)

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22
Q

Back pain interventions

A

Pelvic tilt exercises (tilt pelvis forward — can be achieved by putting foot on stool

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23
Q

Most valid sign a woman is in labor

A

Onset of regular and progressive contractions

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24
Q

The relationship of the fetal presenting part to moms ischial spine

A

Station

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25
Q

_________ stations are above the ischial spine

A

Negative

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26
Q

__________ stations are below ischial spine

A

Positive

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27
Q

Engagement is station ___ in which the presenting part is at the ischial spine

A

0

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28
Q

The relationship between the spine of the mother and the spine of the baby

A

Lie

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29
Q

The part of the baby that enters the birth canal first

A

Presentation

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30
Q

Most common presentations

A

ROA or LOA
NOTE: pick R before L

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31
Q

Stage 1 of labor

A

LABOR (three phases — LAT): Latent, Active, and Transition

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32
Q

Stage 2 of labor

A

Delivery of the baby

33
Q

Stage 3 of labor

A

Delivery of the placenta

34
Q

Stage 4 of labor

A

Recovery (lasts for 2 hrs)

35
Q

What is the purpose of uterine contractions in the first stage of labor?

A

To dilate and efface the cervix

36
Q

What is the purpose of uterine contractions in the second stage of labor?

A

To push the baby out

37
Q

What is the purpose of uterine contractions in the third stage of labor?

A

To push the placenta out

38
Q

What is the purpose of uterine contractions in the fourth stage of labor?

A

To contract the uterus to stop bleeding

39
Q

When does “postpartum” technically begin?

A

Hours after delivery of the placenta

40
Q

Priority in the second PHASE of labor

A

Pain management

41
Q

Priority in the second STAGE of labor

A

Clearing baby’s airway

42
Q

Major nursing action in the third PHASE of labor

A

Checking dilation, assisting with pain

43
Q

Major nursing action in third STAGE of labor

A

Monitor for blood loss and placental parts

44
Q

Labor chart (3 phases)

A

Latent: 0-4 cm dilated; contractions every 5-30 min apart, contraction duration 15-30 seconds, intensity described as mild

Active: 5-7 cm dilated; contractions every 3-5 min apart, contraction duration 30-45 seconds, intensity described as moderate

Transition: 8-10 cm dilated; contractions every 2-3 min apart, contraction duration 60-90 seconds, intensity is described as moderate

45
Q

Contractions should not be longer than ___ seconds or closer than every ___ minutes

A

90; 2
NOTE: this indicates uterine tentany. STOP Pitocin!

46
Q

The beginning of one contraction to the beginning of the next measures _________

A

Frequency

47
Q

The beginning to the end oof one contraction measures _________

A

Duration

48
Q

Strength of contraction that is purely subjective

A

Intensity

49
Q

How should the nurse teach the pregnancy client to palpate?

A

one hand over the fundus with the pads of the finger

50
Q

Interventions for occiput posterior

A
  • position mom knee to chest
  • push into mom’s sacrum with fist
51
Q

Interventions for prolapsed cord

A
  • push head off cord
  • position mom in knee to chest
  • stay that way until they pull it out during C-Section
52
Q

Interventions for all other complications in labor and birth

A

LIONS
L - turn on left side
I - increase IV
O - oxygenate
N - Notify physician
S - if running, STOP Pitocin followed by LION

53
Q

Do NOT administer a pain medication to a woman in labor if

A

The baby is likely to be born when the med peaks

54
Q

FHR patterns that are concerning

A

Low FHR (< 110 bpm), Low baseline variability, late decelerations,

55
Q

Interventions for concerning FHR patterns

A

LIONS

56
Q

FHR patterns that are okay/normal/expected

A

High FHR ( > 160 bpm, take mom’s temp. May have fever), high baseline variability, early decelerations

57
Q

Most unique and concerning FHR pattern

A

Variable decelerations
NOTE: VERY BAD — placental insufficiency — treat with push and position

58
Q

VEAL CHOP

A

Variable decels — Cord compression
Early decels — Head compression
Accelerations — Okay!
Late decels — Placental insufficiency

59
Q

Order of events during the second stage of labor (delivery of baby)

A

1) deliver the head (cephalic)
2) suction mouth THEN nose (alphabetical)
3) check for nuchal (around neck) cord
4) deliver shoulders and body
5) baby MUST have ID band on before leaving delivery area

60
Q

How many arteries and veins make up the placenta?

A

Two arteries, one vein
NOTE: remember AVA

61
Q

What are the 4 things the nurse does 4 times/hour during the 4th stage of labor (recovery)?

A

1) asses VITALS and for S/S of shock
2) assess the FUNDUS (massage if boggy)
3) assess perineal PADS for bleeding (excessive bleeding = saturating pad in 15 min or less)
5) ROLL mom over to assess for bleeding beneath her

62
Q

Postpartum assessment should be performed every ___-___ hrs

A

4-8

63
Q

Important factors of postpartum assessment

A
  • uterine fundus and height
  • lochia
  • extremities (assessing for thrombophlebitis and bilateral calf circumference)
64
Q

Height of the fundus related to the umbilicus postpartum

A

Fundal height = day postpartum
EX) 4th day postpartum = 4 below the umbilicus, BUT STILL midline

65
Q

Different types of lochia

A

Rubra (red), serosa (pink), and alba (white)

66
Q

Normal amount of lochia

A

4-6 inches on pad/hour

67
Q

Normal variations in the newborn

A

Erythema, caput succedaneum (crosses sutures, symmetrical), cephalohematoma (does not cross sutures), hyperbilirubinemia (normal physiologic jaundice appears after 24 hrs)

68
Q

Action of tocolytics

A

Stop labor

69
Q

Examples of tocolytics

A

Terbutaline, Magnesium Sulfate

70
Q

Key side effect of terbutaline

A

Maternal tachycardia

71
Q

Side effects of magnesium sulfate

A

Hypermagnesemia — decreases HR, BP, RR, DTRs, and LOC
NOTE: if respirations are below 12 and reflexes are 1+ — slow DOWN mag infusion; if reflexes are above 3 — speed infusion UP

72
Q

Action of Oxytoxics

A

Stimulate and strengthen labor

73
Q

Examples of Oxytoxics

A

Pitocin, Methergine

74
Q

Key side effect of Pitocin

A

Uterine hyperstimulation (contractions longer than 90 sec and closer than every 2 min)

75
Q

Key side effect of Methergine

A

Maternal hypertension

76
Q

Fetal lung maturing medications

A

Betamethasone (steroid), surfactant

77
Q

Betamethasone characteristics

A
  • given to mom IM
  • given before baby is born
  • may repeat as long as baby is in-utero
78
Q

Surfactant characteristics

A
  • given to neonate
  • administered transtracheal (blown into trachea)
  • given after baby is born

Mark K NCLEX Review (12 decks)

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