REP Exam 1 Flashcards by Student .

What are some prenatal care nursing interventions?

-pt history
-help with birth plan
-assessment
-labs/immunizations
-education
-fundal height
-gestational age
-genetic screening
-ultrasound
-Leopold maneuver

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Leopold maneuvers

palpation of the pregnant mother’s abdomen to determine the fetal position and presentation

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What is a RhoGam injection? When is it given?

it’s an immunity support injection given to mothers who are Rh-negative during pregnancy to prevent their bodies from making antibodies against their baby’s Rh-positive blood

Given around 28 weeks

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What is the normal TOTAL weight gain during pregnancy?

25-35 lbs total

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How many pounds should you gain in the first trimester?

1.1-4.4 lbs total

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How much weight should you gain in the second and third trimesters?

1 lb per week

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What are some maternal effects of excessive weight gain during pregnancy?

-gestational diabetes
-gestational hypertension
-preeclampsia (usually after 20 weeks, high blood pressure and high levels of protein in urine)
-worsening obesity
-more likely to be induced
-more likely to have a C-section

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What are some fetal effects of excessive weight gain during pregnancy?

-macrosomia (above the 400g weight threshold)
-stillbirth
-childhood obesity
-more likely to be pre-term
-hypoglycemia

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What are some common discomforts of pregnancy?

-N/V
-urinary frequency
-breast tenderness
-UTIs
-fatigue
-heartburn
-constipation
-hemorrhoids
-backaches
-SOB
-leg cramps
-varicose veins/lower extremity edema
-gingivitis
-nasal stuffiness
-epistaxis (nosebleed)
-Braxton hicks
-supine hypotension

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What is an ectopic pregnancy?

a pregnancy in which the fertilized ovum is implanted outside of the uterus

can cause abrupt unilateral lower quadrant abd pain with or without vaginal bleeding

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Ectopic pregnancy expected findings

-unilateral stabbing pain in lower quadrant
-delayed menses (1-2 weeks)
-lighter/irregular, dark red/brown spotting
-shoulder pain due to blood in peritoneal cavity which irritates the phrenic nerve
-shock if severe

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What is Naegale’s rule?

-Last Menstrual Period + 7 days - 3 months = Expected Due Date

*Add days first

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GTPAL

-G: # of pregnancies
P
-T: term delivery
-P: pre-term
-A: abortions/miscarriages
-L: living children

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What is the fundal height assessment?

-Measured from the pubic symphysis to the top of the uterine fundus (18-30 weeks), this approximates gestational age

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Fundal height measurement values

-16 weeks = at/slightly below umbilicus
-20 weeks = at/slightly above umbilicus
-37 weeks = xiphoid process
-38-40 weeks begins to ascend bc baby descends

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teratogen examples

-certain meds
-drugs
-infection
-alcohol
-chemicals
-anti-seizure meds
-TORCH

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TORCH

widely accepted infectious agents

T= toxoplasmosis
O= other (syphilis, varicella-zoster, parvovirus B19)
R= rubella
C= cytomegalovirus
H= herpes

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Types of internal fetal monitoring

-Internal fetal electrode/fetal scalp electrode = fetal EKG
-IUPC (intrauterine pressure catheter) = measures strength of contractions

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Amniocentesis

removes amniotic fluid for testing @ 14 weeks

tests for abnormalities, fetal blood type, assesses fetal lung maturity

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what is the range for a normal baseline fetal heart rate?

110-160

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What makes a FHR normal?

-moderate variability
-no late or variable decels
-early decels present or absent
-accelerations present or absent

-reactive NST

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what makes a FHR abnormal?

-absent or baseline variabiliy
-recurrent late/variable decels
-bradycardia

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What is variability?

-the average fluctuations of HR
-best indicator of oxygen status
-caused by cord compressions

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What is the ideal variability?

moderate, 8-25 variabilities per min

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What is minimal variability?

1-5 variabilities per min, fetal distress may be expected

what is absent variability?

flat line, medical emergency

what is marked variability?

greater than 25 variabilities per minute, not significant

What are early decelerations caused by?

head compression

What are late decelerations caused by?

placental insufficiency

suggestions for pregnancy N/V

-eat crackers/dry toast before getting out of bed -avoid an empty stomach -avoid spicy/greasy/gas forming foods -drink fluids in between meals

suggestions for pregnancy urinary frequency

-empty frequently -decrease fluid frequency before bed -perineal pads -kegel exercises

suggestions for pregnancy UTIs

-wipe front to back -avoid baths -wear cotton underwear -avoid tight fitting pants -consume lots of water -void b4 and after sex -void as soon as urge occurs

suggestions for pregnancy heartburn

-small, frequent meals -do not allow stomach to get too empty or too full -do not lie down immediately after eating

suggestions for pregnancy constipation

-drink plenty of water -eat high fiber -exercise regularly

suggestions for pregnancy hemorrhoids

-warm bath -witch hazel pads -topical ointments

suggestions for pregnancy backaches

-pelvic tilt exercises -proper body mechanics -side-lying position -counter pressure

suggestions for pregnancy SOB

-maintain good posture -sleep with extra pillows

suggestions for pregnancy leg cramps

-keep effected leg straight -dorsiflex foot -heating pad

suggestions for pregnancy varicose veins/LE edema

-elevate legs -avoid constricting clothing -wear support hose -avoid sitting or standing in one position for extended periods of time -do not sit with legs crossed at knees -sleep in left lateral position -exercise moderately

suggestions for pregnancy gingivitis

-brush teeth gently

suggestions for pregnancy epistaxis and nasal stuffiness

-use humidifier -normal saline nose drops/spray

suggestions for Braxton hicks

change position and taking walks can help subside contractions

suggestions for pregnancy supine hypotension

-lie in side lying position with knees slightly flexed (think pregnancy pillow)

where does fertilization take place?

lower 1/3 of the Fallopian tubes

At what weeks is the fetus most susceptible to teratogens?

3-8 weeks

You are a nurse in the fertility clinic and you have 4 patients to be seen today. Which one needs the most support? a. Teenage mother who is 11 weeks into her second pregnancy with an eating disorder b. 35 year old that smoked a pack of cigarettes in the first trimester c. Diabetic

a. Teenage mother who is 11 weeks into her second pregnancy with an eating disorder

VEAL CHOP

V: variable decels E: early decels A: accelerations L: late decelerations C: cord compressions H: head compressions O: oxygen = good P: placental insufficiency

Does "I need to increase calories during the first trimester" need further teaching?

Yes, you do not need to increase caloric intake in the first trimester.

What is the first action you should take when decelerations occur?

reposition the mother

Categorize the following in presumptive, probable, and positive Amenorrhea, quickening, positive pregnancy test, visualization of contraction, and visualization of baby on fetal monitor

Presumptive: amenorrhea, quickening Probable: positive pregnancy test Positive: visualization of contraction and visualization of baby on fetal monitor

Which vaccines are NOT okay during pregnancy?

-live vaccines -rubella

Which vaccines are okay during pregnancy?

-Influenza -T-dap -Covid

Your patient has a BMI of 40 and is currently in her second trimester. She has already gained 35 pounds. What do you do?

a. Nutrition consult

Pt with lower abd pain and positive pregnancy test, ultrasound showed nothing in uterine cavity. What could it be?

ectopic pregnancy

Pt in 1st trimester experiencing nausea and vomiting every other day. She is still able to do daily activities. She has not tried to do anything for her N/V. What do you expect the provider will order for this patient?

small, frequent meals is first resort

Pt does not want to take supplements. What vitamins and minerals should she include in her diet?

iron and folic acid

SATA: Which is incorrect about the placenta

It makes carbohydrates and protein

What days of the menstrual period is the fertile window?

days 9-14

What develops first in a fetus?

brain, spinal cord, heart

implantation occurs ____ days after fertilization

est. 7 days

SATA Pt's fundal height is at their belly button. What are you going to do at this prenatal appointment?

pt is around 20 weeks, so... -anatomy scan -fetal heart tones w doppler

You are performing a NST. What do you do if you you only see one acceleration of moderate variability?

well, the criteria is at least 2 accelerations and no decelerations (early decels are fine) in this situation, the criteria has not been met, so continue to watch for another 40 minutes. If the criteria has not been met after 1 hour then the NST is determined non-reactive.

Your pt comes in at 32 weeks gestation. What is a sign that you need to call the HCP?

her fundal height is 29 cm (too small) fundal height should be +/- 2 cm how many weeks they are

Where does implantation occur?

uterus

Where does ovulation occur?

ovaries

Where does fertilization occur?

Fallopian tubes

What is HCG's primary function?

stimulates the corpus luteum to produce progesterone to maintain the pregnancy & hormonal regulation

How does the fetus get oxygen?

the veins and arteries in the umbilical cord bring oxygenated blood to the baby

Why do pregnant women experience constipation?

progesterone causes decreased bowel motility

Pt is lying down in a supine position for a cervical exam. When they sit up they report dizziness and nausea. What is this a sign of?

gestational supine hypotension

What does it mean if your FHR strip is a category 3?

nonreassuring

The blastocyst implants itself into the decidua (uterine lining) at what day?

about 7 days after ovulation

When does your basal body temp increase?

after ovulation

What test can you perform after 36 weeks of gestation?

GBS culture

How can you calculate the EDD if the LMP is unknown?

measurements via ultrasound

No variability is...

very bad

What day does ovulation occur?

day 14

What supplement is essential to preventing neural tube defects?

folic acid

When is the CNA vulnerable to teratogens?

weeks 3 to full term

True or false: STI testing is done for all pregnant people

True

At what weeks is the fetus most susceptible to teratogens?

3-8

Accelerations are present on the FHR... what interventions are necessary?

None, accelerations = good