VN 34 Mat/OB/Peds-DONE

Question 1

1.Describe what is obtained on the first prenatal visit including the lab tests. (pg.121)

Answer 1

-confirmation of pregnancy, history taking, a physical examination, laboratory work

Lab tests:
-CBC
-blood type & antibody screen
-Hep B, HIV, syphilis, gonorrhea & chlamydia, MMR titer
-Urine culture
-Thyroid screening
-pap smear, breast exam, uterus exam
-obstetric assessment
-risk assessment
-estimaded due date

Question 2

2. What does the acronym GTPAL stand for? (pg.121)

Answer 2

Gravida : total # of pregnancies
Term deliveries: # of pregnancies that went to term (@ or beyond 38 weeks gestation)
Preterm deliveries: # of pregnancies that delivered 20 weeks & before the end of 37 weeks gestation
Abortions: # of pregnancies that ended before 20 weeks gestation
Living children: # of children delivered who are alive at the time of hx collection

Question 3

3. What do the terms EDC and EDD mean? What is the “Naegele Rule” and what does it calculate? (pg.123)

Answer 3

EDC: Estimated date of confinement
EDD: Estimated date of delivery
Naegele Rule: add 7 days to the date of the first day of the LMP, then subtract 3 months.

Question 4

4. Describe the difference between an amniocentesis and chorionic villus sampling? What is an advantage of chorionic villus sampling? (pg.128 & 129)

Answer 4

Amniocentesis: is a diagnostic procedure where a needle is inserted into the amniotic sac and a small amount of amniotic fluid is obtained
Chorionic villus sampling: can provide chromosomal studies of fetal cells.
-chorionic villus sampling testing is that it is done earlier in the pregnancy than amniocentesis. Chorionic villus sampling is typically performed at 8 to 12 weeks’ gestation.

Question 5

5.What is a reactive nonstress test? (pg.129)

Answer 5

Noninvasive way to monitor fetal well-being.
-a reactive test is reassuring
-fetal heart rate acceleration pattern

Question 6

6.What should a Rh-negative woman receive after an invasive procedure?(pg.253)

Answer 6

-Rho(D) immune globulin injection

Question 7

7.Describe what should be assessed on subsequent prenatal visits and what complications should the pregnant woman be encouraged to report?(pg.124)

Answer 7

-Weight
-Glucose
-BP
-Urine protein
-Fundal height
-Fetal heart rate (FHR)

Complications to report
-Fever or severe vomiting
-Headache, unrelieved by acetaminophen or other relief measures
-Blurred vision or spots before the eyes
-Pain in the epigastric region
-Sudden weight gain or sudden onset of edema in the hands and face
-Vaginal bleeding
-Painful urination
-Sudden gush or constant, uncontrollable leaking of fluid from the vagina
-Decreased fetal movement
-Signs of preterm labor
> Lower, dull backache
> Uterine contractions (four or more per hour)
>Menstrual-like cramps
>Pelvic pressure
>Increase in vaginal discharge
>A feeling that something is not right

Question 8

8.List the types of tests that can be done to determine fetal well-being during pregnancy.(pg.125,126,129,130)

Answer 8

-Fetal movement (kick) count : 10 times in 2hrs is normal fetal movement
-Chorionic villus sampling
-Contraction stress test
-Biophysical profile
-Ultrasonography
-Maternal Serum Alpha-Fetoprotein screening
-Amniocentesis
-Nonstress test (NST)
-Percutaneous umbilical blood sampling (PUBS)/ cordocentesis

Question 9

9.What is an AFP, and what could abnormal levels indicate?(pp slide 16)

Answer 9

Alpha-fetoprotein is a protein manufactured by the fetus.
-Abnormal levels (high or low) may indicate a problem and the need for additional testing.
-Low levels may indicate down syndrome
-Higher than expected levels of MSAFP are seen when the woman is carrying multiple fetuses, or if the fetus has died in utero, or in the presence of neural tube defects.

Question 10

10.Describe involution. (pg.240)

Answer 10

The process through which the uterus, cervix, and vagina return to the nonpregnant size and function.

Question 11

11.Describe the three stages of lochia and what the client should expect over the next 6 weeks including reasons to call the Dr’s office. (pg.241)

Answer 11

Lochia rubra: Occurs during the first 3 to 4 days; is of small to moderate amount; is composed mostly of blood; is dark red in color; has a fleshy odor.
Lochia serosa: Occurs during days 4 to 10; decreases to a small amount; takes on a brownish or pinkish color.
Lochia alba: Occurs after day 10; becomes white or pale yellow because the bleeding has stopped, and the discharge is now composed mostly of white blood cells.

-Lochia may persist for the entire 6 weeks after delivery but often subsides by the end of the second or third week.
-Lochia should never contain large clots
-reversal of the pattern (e.g., the lochia has been serosa, then goes back to rubra), lochia that fails to decrease in amount or actually increases versus gradually decreasing or is malodorous

Question 12

12.When is it necessary for the postpartum woman to begin using birth control?(pg.241)

Answer 12

6-8 weeks after giving birth

Question 13

13.Describe the changes that occur to the cardiovascular system, vital signs, and the integumentary system in the postpartum period. (pg.242,243)

Answer 13

Cardiovascular changes:
-The woman who experiences a normal vaginal delivery loses approximately 300 to 500 mL of blood during delivery. If she has a cesarean delivery, normal blood loss is between 500 and 1,000 mL.
-an increase in the hematocrit
-plasma fibrinogen levels & other coagulation factors are elevated to protect the woman against hemorrhage but can put woman at risk to develop blood clots in the legs (DVT)
-WBC is elevated (protection from infection)
-Immediately or very soon after delivery, the woman may experience shaking postpartum chills.

Vital Sign changes:
-slight elevation in temperature
-slow pulse in the first week after delivery
-HR can be as low as 50 bpm

Integumentary system changes:
-Diaphoresis occurs in the first few days after childbirth as the body rids itself of excess water and waste via the skin. (particularly at night)
-striae on abdomen & sometimes on the breasts
-The nipples and areolas often darken in color during pregnancy and this color tends to lighten during the postpartum period.
-Darkening of linea nigra and then lightening in color during the postpartum period

Question 14

14.Describe healthy bonding. Describe the warning signals of poor attachment. (pg.246)

Answer 14

-naming the newborn & calling the newborn by name.
-making eye contact & talking to the newborn
-spending more time holding newborn in en face position (newborns face in direct line of vision, making full eye contact w/the newborn)
-talking to newborn in high pitched tones

Warning signs of poor attachment: (pg.253)
-making negative statements about the newborn
-turning away from the newborn
- refusing or neglecting to provide care for the newborn
- withdrawing
- Verbalizing disappointment with the sex of the newborn
- Failing to touch the newborn
- Limited handling of the newborn

Question 15

15.Describe the signs and symptoms of post-partum blues. (pg.246)

Answer 15

-Anxiety
-Difficulty sleeping or eating
-May have decreased concentration
-Irritability
-Tearfullness for no reason
-Sadness

Question 16

16.What are the issues with respiratory adaptation when an infant is born by Cesarean section?(pg.267)

Answer 16

A newborn delivered by cesarean does not always have the benefit of the pressure squeezing the chest from the birth canal. This newborn often has more fluid in their lungs, making respiratory adaptation more challenging.
-Closely monitor this newborn’s respiratory rate, lung sounds, and oxygen saturation levels.

Question 17

17.List the newborn assessment findings that would indicate the newborn is adapting to extra-uterine life. (pg.270)

Answer 17

-heart rate : greater than 100 bpm
-respiratory effort: strong vigorous cry
-muscle tone: maintains a position of flexion w/brisk movements
-reflex irritability: cries or sneezes when stimulated
-color: body & extremities pink

Apgar scores of 7 to 10 at 5 minutes of life are indicative of a newborn who is adapting well to the extrauterine environment.

Question 18

18. List the signs and symptoms of respiratory distress. (pg.267)

Answer 18

-Tachypnea (respiratory rate greater than 60 breaths per minute)
-Central cyanosis
-Unequal movements of the chest & abdomen during breathing efforts
-Intercostal or xiphoid retractions
-Nasal flaring
-Grunting

Question 19

19. Describe conduction, convection, radiation, and evaporation. (pg.269)

Answer 19

Conduction: when the newborns skin touches a cold surface causing body heat to transfer to the colder object.

Convection: when air currents blow over the newborn’s body.

Evaporation: happens when the newborn’s skin is wet. As the moisture evaporates from the body surface, the newborn loses body heat along with the moisture.

Radiation: a cold object that is close to but not touching the newborn.

Question 20

20. Describe the signs and symptoms of hypoglycemia in the newborn. (pg.271)

Answer 20

-High pitched cry
-Exaggerated Moro reflex
-Lethargy
-Listlessness (lack of interest or energy)
-Apnea or respiratory distress including tachypnea
-Jitteriness or tremors (main sign)
-Irritability
-Poor feeding

Question 21

21. Compare the differences between physiologic jaundice and pathologic jaundice and list the actions of the LVN. (pg.269)

Answer 21

Physiologic jaundice: is characterized by jaundice that occurs after the first 24 hours of life (usually on days 2 or 3 after birth); bilirubin levels that peak between days 3 and 5; and bilirubin levels that do not rise rapidly (no greater than 5 mg/dL/day)

Pathologic jaundice: Jaundice that occurs within the first 24 hours

LVN action: document and report jaundice

Question 22

22.List the normal rates for respirations, pulse, and temperature for a newborn. (pg.272)

Answer 22

HR : 110-160 bpm , during sleep as low as 100bpm, as high as 180bpm when crying

Respiratory Rate: 30–60 breaths per minute

Axillary Temp: 97.7°F–98.6°F (36.5°C–37°C)

BP: 60–80/40–45 mm Hg

Question 23

23.What is Erythema toxicum also known as newborn rash, and what is the treatment?(pg. 274)

Answer 23

This rash appears commonly on the chest, abdomen, back, and buttocks of the newborn.
The rash is harmless and will disappear without treatment.

Question 24

24.Define Mottling (pg.274):

Answer 24

is a red and white lacy pattern sometimes seen on the skin of newborns who have fair complexions.

Question 25

Milia (pg.274):

Answer 25

tiny white papules found on the face.

Question 26

Lanugo (pg.273):

Answer 26

fine downy hair that is present in abundance on the preterm infant but is found in thinning patches on the shoulders, arms, and back of the term newborn.

Question 27

Vernix(pg.273):

Answer 27

a white cheeselike substance that covers the body of the fetus during the second trimester, is normally found only in creases of the term newborn

Question 28

25.What is Harlequin sign and what could provoke this? (pg.274)

Answer 28

characterized by a clown-suit–like appearance of the newborn. Dilation of blood vessels causes the dark red color, whereas constriction of blood vessels causes the pallor.
- This harmless condition occurs most frequently w/vigorous crying or w/the infant side lying.

Question 29

26.Describe Mongolian spots and explain risk factors. (pg.274)

Answer 29

Mongolian spots are bluish-grey macular areas on the sacrum or buttocks. They usually fade over the first year.

Question 30

27.What are Epstein pearls and where would you assess them?(pg.278)

Answer 30

Small white cysts found on the midline portion of the hard palate of some newborns.
They feel hard to the touch and are harmless.

Question 31

28.Define Epispadias(pg.279):

Answer 31

If the urinary meatus opening is located abnormally on the dorsal (upper) surface of the glans penis

Question 32

Hypospadias(pg.279):

Answer 32

If the opening to the urethra is on the ventral (under) surface of the glans

Question 33

Phimosis(pg.279):

Answer 33

tightly adherent foreskin, is a normal condition in the term newborn.

Question 34

Pseudo menstruation(pg.279):

Answer 34

A blood-tinged mucous discharge from the vagina results from the sudden withdrawal of maternal hormones

Question 35

29.Describe a hydrocele and how to make the diagnosis.(pg.280)

Answer 35

Fluid within the scrotal sac, may be present and should be noted.

• Take a penlight and hold it against the scrotal sac. If fluid is present (hydrocele), the light will transilluminate the scrotum. If there is no hydrocele, the light will not shine through solid structures.

Question 36

Rooting Reflex (pg.281):

Answer 36

The newborn demonstrates this reflex by turning toward the touch with an open mouth.

Question 37

Sucking Reflex (pg.281):

Answer 37

placing a gloved finger in newborns mouth, suck should be strong

Question 38

Stepping Reflex (pg.281):

Answer 38

The newborn will lift the legs up and down in a stepping motion.

Question 39

Moro reflex(pg.281):

Answer 39

is also known as the startle reflex. When the newborn is startled, they extend the arms and legs away from the body and to the side

Question 40

Babinski reflex(pg.281):

Answer 40

the newborn’s toes fan out and hyperextend and the foot dorsiflexes when a firm object (such as the blunt end of a writing pen) is traced from the heel along the lateral aspect of the foot up and across the ball of the foot.

Question 41

31.Describe Ortolani maneuver and Barlow sign.(pg.280)

Answer 41

Ortolani maneuver: Sign is positive if a clicking or clunking sound is felt or heard. A positive sign indicates possible dislocation of the hip.

Barlow sign: Sign is positive if the head of the femur is felt to slip out of the acetabulum indicating an unstable joint.