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NCLEX > Maternity Part 1 > Flashcards

Maternity Part 1 Flashcards

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1
Q

1st Trimester presumptive signs of pregnancy (AKA you MIGHT be pregnant..)

A

Amenorrhea
N/V
Urinary frequency* often 1st
Breast tenderness d/t excess hormones

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2
Q

What hormone causes Amenorrhea?

A

Progesterone (NOT hCG)

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3
Q

What does progesterone cause the body to do?

A

Increase temperature after ovulation

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4
Q

How long is a released egg good for?

How to try and plan pregnancy?

A

24 hours
Record and predict when you get increased temperature indicating ovulation and then try to have sex BEFORE this increased temperature

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5
Q

Probably pregnancy signs (You are PROBABLY pregnant)

A 
Positive pregnancy test
Goodells, Chadwick's, Hegar's sign
Uterine enlargement
Braxton Hicks contractions
Pigmentation changes of the skin
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6
Q

How does a pregnancy test determine a positive result?

Can anything else induce this?

A

Presence of hCG levels

Yes: Hydatiform mole; anti-convulsants/anxiety/Parkinson’s drugs

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7
Q

DIFFERENCES

Chadwick’s sign
Goodall’s sign
Hagar’s sign

When they occur?
What happens?

A

Chadwick’s sign: Bluish cervix/vagina, 4th week

Goodell’s: cervix softens, 2nd month

Hagar’s: Uterus softens; 2-3 months

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8
Q

Why Braxton Hicks contractions?

When do they occur?

A

They occur all throughout pregnancy

They move blood through the placenta

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9
Q

What probable pregnancy pigmentation skin changes occur in the first trimester?

A

Linea Nigra
Abdominal Striae
Facial Chloasma (Mask of freckle lookingness)
Areola darkens

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10
Q

What are the positive signs of pregnancy?

A

Fetal heartbeat
Fetoscope
Fetal movement
US

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11
Q

When do you do listen for the fetal heartbeat?

When can you hear with a fetoscope?

A

Doppler: 10-12 weeks
Fetoscope: 17-20 weeks

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12
Q

What is Gravidity?

A

of pregnancies; completed or not

*This includes her CURRENT pregnancy

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13
Q

What is Parity?

A

of pregnancies where the fetus reached 20 weeks

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14
Q

What is Viability?

A

24 weeks; This is when the infant has the ability to live OUTSIDE the uterus

A baby at 20 weeks is not considered viable!!!

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15
Q

When is a fetus term?

When is a fetus preterm?

A

37 weeks

Before 37 weeks

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16
Q

What acronym is going to be obtained by the doctor to figure out pregnancy history?

What does each letter stand for?

A

GTPAL

Gravida - # pregnancies
Term - 37 weeks
Preterm - before 37 weeks
Abortion - spontaneous or elective
Living children
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17
Q

What is the Naegele’s Rule?

A

Due date estimation

First dat of LMP
Add 7 days
Subtract 3 months
Add 1 year

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18
Q

Nutrition in the 1st Trimester

Teaching?
Calories?
Calories for adolescent?

How much protein do they need to increase?

A

Teach the 4 Food groups
Increased calories to 300 /day
Adolescent: 500 /day

Protein: 60g/day (Normally 40-45)

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19
Q

How much weight should be gained in the 1st trimester?

A

4 pounds

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20
Q

What are the side effects of iron?
How do we prevent these SE?

What should women take it with to enhance absorption?

A

Constipation, GI upset
Take with food!

Vitamin C
*Best absorption is truly when the stomach is empty, but with all the GI upset and taking it with food, this Vitamin C is going to help us

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21
Q

What does Folic Acid prevent?

How many mcg do we need?

A

Neural tube defects, like Spina Bifida

400 mcg/day

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22
Q

What is the best way to exercise?

What do we want to avoid? Why?
What else might cause this adverse affect?

A

Walking or swimming are best

Avoid high intensity exercises because we don’t want ANY overheating!!! This means no hot tubs or electric blankets

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23
Q

What happens when mom has an increased body temperature?

A

Birth defects

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24
Q

What is the PREGNANCY EXERCISE RULE???

Why?

A

DON’T LET YOUR HEART RATE GET ABOVE 140

HR>140 causes CO and uterine perfusion will drop

25
Q

What are DANGER signs in pregnancy?

A 
Sudden gush of vaginal fluid
Bleeding
Persistent vomiting
Severe HA
Abdominal pain
Increased Temp
Edema
Absent fetal movement
26
Q

What if a patient calls and complains of just a bit less than normal fetal movement?

A

CALL 911!!!!

ASSUME THE WORST!!!!!! Never pick a “don’t worry about it” answer

27
Q

What are some common discomforts?

A 
N/A, breast tender, frequency, fatigue, ankle edema, backache
Heartburn
Increased vaginal secretions
Stuffy nose
Varicose veins
Hemorrhoids
Constipation
Leg cramps
28
Q

Things we can do for

Stuffy nose:
Ankle edema:
Constipation:

** KEY THING TO REMEMBER

A

Stuffy nose: nasal spray, steam
Ankle edema: elevate feet
Constipation: Increase fiber, ambulation, more fluids

WE DON’T WANT TO GIVE THESE PEOPLE MEDS!
We need a physician ORDER for meds

29
Q

Patient teaching regarding smoking

What does this increase risk for?

A

STOP
But if they refuse, at least pick an answer that involves them going outside

Risk: SGA baby

30
Q

How often to visit the physician

A

First 28 weeks: Once a month
28-36 weeks: Twice a month
36 weeks: Weekly

31
Q

What should you have the patient do before an US?
Why?
When wouldn’t you need to do this?

What if they are having an US before a procedure?

A

DRINK! A distended bladder pushes the uterus close to the abdominal surface
No need to drink for a transverse US

VOID if they are having a procedure
Ex: Amniocentesis

32
Q

When is the first Trimester?
Second?
Third?

A

1st: Week 1-13
2nd: Week 14-26
3rd: 27 - birth

33
Q

Expected weight gain in the 2nd trimester?

A

1 pound a WEEK

34
Q

2nd TRIMESTER

Should mom have N/V?
Urine frequency?
Breast tenderness?

A

N/V - NO
Frequency - NO: Uterus rises back off the bladder
Breast tenderness - YES

35
Q

What should FHR be in the 2nd trimester?

***NCLEX When to worry?

A

120-160 - normal
110-120 - worried and watching
Below 110 - PANIC

36
Q

What do kegels help prevent?

A

Uterine Prolapse

37
Q

Expected weight gain in 3rd trimester?

A

No MORE than 1 lb/week

38
Q

3RD Trimester

What do we REALLY need to keep an eye on?

A

BP

Report ANY increase from the baseline

39
Q

What does pregnancy induced HTN cause?

What might we do?

A

Pre-eclampsia / eclampsia

HTN hurts our kidneys so they can’t filter out our protein so the protein builds up and pours into the urine

We want them to drink plenty of fluids, but we might restrict their salt intake

40
Q

Normal FHR in the 3rd trimester

A

120-160

41
Q

How is fetal presentation/position determined?
What should the patient do before?
What if they are having contractions?

A

Leopold Maneuver
VOID
Do them between contractions - unless ya wanna feel a hard ass uterus

42
Q

What are signs of labor?

A 
Lightening, Engagement, Fetal stations
Faster, stronger Braxton Hicks
Softened cervix
Bloody show
Nesting - burst of energy
Diarrhea
Rupture of membranes
43
Q

What is lightening?
When does it occur?
What problem returns?

A

Part of the fetus (usually head) descends into the pelvis causing mom to feel less congested and breathing easier

Usually occurs 2 weeks before term

Urinary frequency

44
Q

How do we want the fetus when ROM occurs?

A

Head well engaged!! If not, the cord could come out first (prolapsed cord)

45
Q

What is engagement?

A

The largest presenting part (hopefully the head) is in the pelvic inlet

46
Q

What are fetal stations?

Measurement?

A

Cm measurement of the relationship of the presenting part of the fetus to the ischial spines of the mom

*Picture the pelvis and the 2 points where the pelvis slightly curves - ischial spine

-3, -2, -1, +1, +2, +3
More negative = the more the head is inside mom
More positive = the more baby is through the pelvis

“Im at zero, from here on out it’s all positive!”

47
Q

When do we worry bloody show vs hemorrhage?

A

Bloody show: small amount

Hemorrhage: Continuous slow trickle

48
Q

When should mom go to the hospital?

What do we worry about with ROM?

A

When contractions are 5 min apart or ROM

PROLAPSED CORD - Think killer answer!

49
Q

What are 3 Diagnostic tests before labor?

A
  1. Non-Stress Test (NST)
  2. Biophysical Profile Test (BPP)
  3. Contraction Stress Test (CST)
50
Q

Non-Stress Test

When is it done?
What do we want to see?
How should the accells be?
How long is the test recorded?
What response do we want?
A

3rd Trimester
Want to see: 2 or more accelerations of 15 bpm with fetal movement
Acelleration: Increase 15 bpm lasting 15 seconds, with HR returning to baseline within 2 minutes

20 minutes

We want REACTIVE

51
Q

Biophysical Profile

When is it done?
What about high-risk mom?
How is it done? What does it look at?

Good/Bad score?

A

Third trimester
@ risk: May be done at 32-34 weeks or as much as weekly

US measurements during an NST
Looks at HR, muscles tone, movement, breathing, amniotic fluid

8/10 - good
6/10 - worry

52
Q

Biophysical Profile

How long is it?
What is needed in these parameters to earn 2 points?

HR: 
Muscles Tone: 
Movement: 
Breathing: 
Amniotic Fluid:
A

30 MINUTES

HR: Reactive NST
Muscles Tone: At least 1 flexion-extension movement
Movement: Move 3 times
Breathing: Breathing movements at least once
Amniotic Fluid: Is there enough?

53
Q

What is another name for Contraction Stress Test
When is it done? After what test?

What does it determine?

What result do we want?

What are @risk women that would get this?

A

Oxytocin Challenge Test
Rarely done before 28 weeks, but is done with a NONreactive NST

Determines if baby can handle the stress of a contraction

Want a NEGATIVE result

Preeclampsia, maternal DM, condition causing placental insufficiency

54
Q

What do contractions do to baby?

What terms a deceleration?

A

Decrease blood flow to baby and placenta

If blood flow decreases enough to cause hypoxia, and the FHR goes below baseline

55
Q

What does a late decel mean?

A

Uteroplacental insufficiency aka the placenta is wearing out - It has more difficulty delivering nutrients and oxygen to baby

56
Q

How long are Contraction Stress Test results good for??????

A

ONE WEEK!!!!! WE WANT ACCELERATIONS!

57
Q

What do we worry about when giving oxytocin before wanted birth?

A

Preterm labor!!!! Oxytocin challenge patients need strict observations because it is a HIGH RISK DRUG

58
Q

Differences between decelerations

Early
Late
Variable

A

Early - not bad, cause by fetal hypoxia from fetal head compression
Late - caused by uteroplacental insufficiency
Variable - Caused by umbilical cord compression

NCLEX (23 decks)

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