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OB Final review 2009

A nurse is working in a OB clinic and wants to implement an intervention to help with lowering infant mortality among her patients. How would she accomplish this? Stress the importance of regular prenatal care
A nurse practitioner cares for many patients that are of lower SES. She is assessing when her patients seek health care. A patient statement that would reflect how they seek health care would be: They go to ER, their actions are reactive, not preventative.
Katie is a multigravida, pregnant for the third time, (3-1-0-1-2). She is currently 18 weeks pregnant and her health has been good, as determined during regular prenatal visit. Explain the 5-digit system used to describe Kate's obstetric history GTPAL G3T1P0A1L2
Katie’s states her last menstrual period was November 13, 2008. Using Nagele’s Rule, what is her EDC? -3 +7 +1 8/20/09
Katie is in for her visit and asks why she has to urinate in a cup every time. The nurse practitioner’s response would be: Check pts sugar and for protein
What are the normal ranges for protein and glucose? trace or +1 proteins 300mg/24 hours and no sugars
Outline the components of the history/interview for routine prenatal visits. What systems would the practitioner want to know about and Why? Last Menstrual period, OB history, usage of drugs and alcohol, nutrition, and urinary system.
The Ductus Arterious bypasses lungs to liver
The Ductus Venous blood goes to inferior vena cava
The Foramen ovale Blood from fetus legs and abd go to right atrium to the left atrium
Healthy family characteristics A good support system, There is agreement about parenting strategies, Open communication.
What to do about Nausea and Vomiting Crackers in the AM before getting out of bed, 6 small meals, fluid separate from food, don’t lie down after eating
What to make sure about urinary frequency no painful urination
What to do about heartburn tums, avoid spicy foods
What to do about leg cramps increase your calcium intake, dorsiflex the foot
What you need to know about breathing during pregnancy Don’t over do it! Nasal congestion is common, nosebleeds are ok, accompanied by a headache is not ok
What to do about backaches pelvic rock, or the “cat” maneuver
What to do about constipation push the fluids and the fiber
Where do you get folic acids? Green Leafy vegs
Katie is 38 y.o. and her midwife asks her if she wants to have what test? CVS 6-8weeks Amnio 14-16 weeks
Constant lump in throat is? Heartburn
CST= contraction stress test
You have a CST when? after a negative NST
A positive CST is what? late decells, that’s bad
First Stage of Labor is where cervical effacement and dilation occur. Starts with the onset of true labor and ends with complete dilatation.
Second stage of labor is begins when the patient is 10cm.
Third stage of labor is the separation of the placenta from the uterine wall, uterus becomes globular, and cord lengthens, then expulsion.
Early Phase is up to 3 cm, mother is sociable and excited
Active phase is cervix is 4-7cm effacement is cervix is 100% serious and inward, discomfort increases
Transition phase cervix goes from 8-10cm and fetus descends further. Urge to push, leg tremors, nausea and vomiting are common, woman may be irritable and loose control
Diet allowed during labor clear liquids maybe a soft diet
Signs and symptoms that would make the nurse not give the patient her pain medication? Feeling like there is pressure, needs to be checked
How would the nurse assess the patients pushing? high fowlers, open glottis, push at the urge.
What should you check if there is increased bleeding after delivery? Uterine atony, uterus location, if it’s to the right look at bladder distention.
APGAR scoring heart rate, respiration rate, tone, reflex, color
Katie’s Blood Type is O neg and Joshua’s Blood type is B neg. What condition does this place Joshua at risk for? ABO incompatibility, and hemolytic disease
What complications can occur when hemolytic disease is not controlled? Karitonitus of the brain.
The taking in phase is all about her and the birth
The taking hold phase is learning
The letting go phase is letting go of the life before the baby goes
The Blues is normal. Found in the first 7-10 days crying, but still caring for self
PP Depression more than 10 days, needs meds
Bubble Heart- Breast, Uterus, Bladder, Bowel, Lochia, Epis, Homans, Emotion, Attach, Reflexes, Teaching
Breast assessment not breast feeding- need to have a tight bra on, no stimulation. Breastfeeding5-7 days milk comes in, check for mastitis (red warm flu like)
Uterus - location in relation of umbilicus, down one finger breath a day, if lochia increases or smells rotten go to Dr.
Bladder needs to void every couple hours, know s/s of uti
Bowel look for constipation
Lochia look for decreasing, no clots
Janice is AFA who is 20 weeks gestation and has sickle cell anemia. What would the care during the pregnancy and postpartum involve? thicker blood, more blood, stay hydrated, prevent clots in legs, wear Ted hose, and elevate feet
Pre-conceptual counseling is very important with Type I diabetics for what reason? prevent malformations of neurotubes and cardiac
Signs and symptoms of cardiac decomposition Edema weak pulses, irregular pulses, sob, crackels
OB emergency situations (10)- hemorrhage/abruption. Lates, cord prolapse, uterine rupture, eclamptic seizures, Hellp syndrom, DIC, bradycardia
CBC with diff results are what with PIH Low Platlets