Review for Maternity Test
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| Does blood pressure increase or decrease during pregnancy? | Decrease
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| Does erythrocyte volume increase or decrease during pregnancy? | Increase
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| Does cardiac output increase or decrease during pregnancy? | Increase
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| Does hematocrit increase or decrease during pregnancy? | Decrease
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| Does the pulse increase or decrease during pregnancy? | Increase
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| What causes heartburn during pregnancy? | The baby presses upwards and the cardiac sphincter is ineffective to stop acid.
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| What causes hemorrhoids in pregnancy? | Strain and the lack of blood flow R/T the baby pressing on the vena cava.
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| When and what causes urinary frequency during pregnancy? | Hormones cause frequent urination in the first trimester and the baby presses on the bladder during the third trimester.
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| What is chloasma? | The "mask of pregnancy".
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| What is striae gravidarum? | Wavy irregular streaks appearing on the abdomen. Stretch marks.
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| What is spider nevi? | Small, bright red, vascular elevations of the skin.
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| What is the linea nigra? | Line of darker pigmentation extending from the pubic area to the umbilicus.
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| What is the average weight gain during the first trimester? | 3.5-5 lbs
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| What is the average weight gain during the second trimester? | 12-15 lbs; 1 lb a week
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| What is the average weight gain during the third trimester? | 12-15 lbs; 1 lb a week
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| List some subjective/presumptive signs of pregnancy. | Amenorrhea, urinary frequency, NV, quickening.
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| List some objective/probable signs of pregnancy. | Goodell's sign, positive pregnancy test, enlargement of abd, Braxton Hicks contractions.
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| List some diagnostic/positive signs of pregnancy. | Fetal heart sounds, palpable fetal movements.
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| What is McDonalds rule for calculating fetal age in months? Weeks? | Months: # of cm. X2/7 =preg. in months
Weeks: # of cm. X8/7 =preg. In weeks
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| What are three changes to the mother's blood constitution during pregnancy? | Physiological anemia, increased leukocytes, increased fibrinogen and fibrin
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| What two endocrine organs become enlarged during pregnancy? | Thyroid and pituitary.
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| How is the secretion of gonadotropin, prolactin, and oxytocin modified during pregnancy. | Gonadotropin suppressed, Prolactin secreted, Oxytocin secreted
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| What are 8 danger signs of pregnancy? | Vaginal gush, vaginal bleeding, persistent vomiting, severe H/A, abdominal pain, increased temp., edema, absence of fetal movement
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| What are high-risk factors to be considered in the pregnant mother? | Socioeconomic, age, weight, maternal habits, maternal disease, previous pregnancy abnormalities.
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| What are 6 uses for an ultrasound during pregnancy? | Validates pregnancy, predicts due dates, identifies fetal growth, detects congenital anomalies, localizes placenta for amniocentesis, identifies multiple pregnancies.
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| What 5 criteria are examined during a biophysical profile? | Fetal movement, fetal tone, fetal breathing movements, amniotic fluid volume, non stress test
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| A biophysical profile has three possible outcomes corresponding to the score of the test. What are the categories and their ranges? | 8-10 –normal infant, relatively low risk for asphysia
4-6 –chronic suspected asphyxia
A score of less than 4 after 120 minutes of testing, regardless of gestational age is indication for delivery.
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| What can an MRI be used for during pregnancy? | It can evaluate fetal structure, placenta, amniotic fluid quantity, maternal structures, biochemical status, metabolic, or functional malformations.
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| During what week of pregnancy can an amniocentesis possibly be done? | Week 14 and on. Ideally between the 16-18 week for most accurate results.
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| What are the 4 uses of an amniocentesis? | Prenatal dx, assessment of pulmonary maturity, dx of fetal hemolytic disease, AFP testing
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| When a pt is undergoing an amniocentesis, what are 4 nursing priorities? | Explain procedure and give support to back, woman should empty bladder, aseptic technique must be maintained, observe client for next 2 hours for bleeding or contractions.
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| When can chorionic villi sampling be done? | Between 8-12 weeks of pregnancy.
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| Why would chorionic villi sampling be done? | Used for genetic studies, sex determination, and fetal anomalies.
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| At what week is the mother instructed to begin kick counts? | Week 27
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| How much movement in what time frame is considered healthy during a kick count. | 10 movements in 12 hours.
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| For a NST, there are 3 possible outcomes. What are the outcomes and the criteria for each? | Unsatisfactory NST (baby doesn’t move)
Reactive NST=at least 2 accels of at least 15 beats lasting 15 seconds.
Nonreactive NST = indicates further testing
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| When is a contraction stress test useful? | 32 weeks and later.
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| What are some indications that will likely mean that the mother will undergo a contraction stress test? | Preeclampsia, eclampsia, sickle cell anemia, postmaturity, *Hx of still birth *, RH sensitization, Nonreactive NST.
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| List some contraindications to performing a contraction stress test. | 3rd trimester bleeding, previous c section with classical incision, PTL, incompetent cervix, multiple gestation, or anytime the risk outweighs the advantage of cst
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| What are the possible outcomes of a contraction stress test and the criteria for each. | Negative: 3 contractions without late decels
Positive: Persistent late decels in 50% of contractions. *stop after 3 decels.*
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| What is the peak of the contraction? | Acme
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| What is the letting up of the contraction? | Decrement
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| How do you measure the duration of a contraction? | The time from the beginning to the end of a contraction.
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| How do we measure the frequency of contractions? | From the beginning of to the beginning of another.
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| What is the intensity of a contraction? | The strength of the contraction.
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| There are 4 essential factors for a successful labor are the 4 Ps. What are they? | Passageway, passenger, powers, psych
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| What is the diagonal conjugate? | Distance between the sacrum and the pubis.
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| What are the 4 pelvis types? | Gynecoid, Android, Anthropoid, Platypelloid
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| What is the fetal attitude? | The relation of fetal parts to one another. The problems come with deviation from the normal fetal attitude.
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| What is the fetal lie? | The relationship of the long axis of the fetus to that of the mother.
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| What is the fetal presentation? | This is the portion of the baby’s body that lies nearest to the external os of the cervix.
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| What are the 6 parts of the fetal skull? | Sinciput, Bregma, Vertix, Occiput, Posterior fontanelle, Mentum.
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| What are the 4 variations of a cephalic presentation? | Vertex, Military, Brow, Face
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| What are the 3 variations of a breech presentation? | Complete, Frank, Footling
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| What is engagement? | Occurs when the largest diameter of the presenting part reaches or passes through the pelvic inlet.
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| What is the station? | Refers to the relationship of the presenting part to the imaginary line between the ischial spines.
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| What is fetal position? | The exact relationship of the presenting part to the maternal pelvis.
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| What do each of the three letters of fetal presentation stand for (like ROA)? | The first letter is left or right(related to maternal pelvis), the second letter is the fetal part, the third letter is A or P for Anterior/Posterior.
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| What is the primary power of labor? | Uterine contractions.
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| What is the secondary power of labor? | Pushing.
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| Anatomically, what is the best position to give birth and why? | Squatting because of the help of gravity.
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| List the 6 theories of why labor begins. | Oxytocin, Estrogen stimulation, Progesterone withdrawal, Fetal Cortisol, Prostaglandin, Uterine distension.
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| What are some prodromal signs of labor? | Lightening, Braxton Hicks Contractions, Cervical Changes-softening, bloody show, ROM, Sudden burst of energy, Slight weight loss.
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| What are the 7 mechanisms of labor? | Engagement, Descent, Flexion, Internal Rotation, Extension,
External rotation, Expulsion.
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| What causes early fetal decelerations during labor? | Response to compression of the fetal head.
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| What causes late fetal decelerations during labor? | Caused by uteroplacental insufficiency. Decels begin after the cx is well established and persists after cx ends.
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| What causes variables in the fetal heart rate that do not mirror contractions? | Cord compression
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| What are the 4 characteristics of fetal heart rate during labor that are reassuring? | Baseline FHR in the normal range of 110-160 with average variability, accelerations, early decelerations, mild variables.
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| What are some characteristics of the fetal heart rate that are not reassuring during labor? | Progressive increase or decrease in baseline FHR, tachycardia above 160, progressive decrease in baseline variability, severe variable decelerations, repetitive late decels, total absence of variability, prolonged decel of any kind, severe bradycardia.
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| What is included in the first stage of labor? | From the onset of true labor to fully effaced and dilated.
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| What is included in the second stage of labor? | Pushing-Birth
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| What is included in the third stage of labor? | Delivery of the placenta
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| What is the fourth stage of labor? | Recovery and bonding
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| Stage 1 is divided into 3 phases. What criteria indicates Phase 1? | Early stage with dilation of 0-3cm. Contractions 5-30 minutes,
Last 20-30 seconds, Mild in intensity.
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| What criteria is needed for phase 2 of stage 1 of labor? | The active phase of labor is when the cervix is dilated 4-7 cm. Contractions 2-5 minutes, Last 45-60 seconds, Stronger in intensity.
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| What criteria is needed for phase 3 of stage 1 of labor? | The late stage of labor begins when the cervix is dilated 8-10 cm. Contractions 90 sec-2 min.,
Very strong in intensity, Lasts 60-90 seconds.
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| What are 6 sources of pain during labor? | Dilation of cervix, Emotional tension, Hypoxia of uterine muscles, Stretching of uterus, Pressure, Distension of perineum.
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| What are 4 non-pharm measures of controlling the pain of labor? | Effleurage, Distraction, Controlled breathing, Relaxation.
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| What are 5 causes of dystocia? | Dysfunctional labor, Alterations in pelvic structure, Fetal Causes, Maternal Position, Psychological Responses.
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| When is dystocia suspected? | There is a lack of progress in the rate of cervical dilation, lack of progress in fetal descent, or problems with uterine contractions.
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| What is primary dysfunctional labor? | Hypertonic uterus
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| What is secondary dysfunctional labor? | Hypotonic contractions, these contractions decrease in strength and uterine tone drops below normal between contractions. This usually occurs in the active phase.
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| What is stage 2 dystocia? | Ineffective expulsive force. Inability to push related to too much anesthesia, fatigue or pain.
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| What is precipitous labor? | Labor of 3 hours or less. It is usually related to a lack of resistance in maternal pelvis.
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| What are fetal causes of dystocia? | Related to anomalies, fetal size, presentation, and position.
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| What are high risk conditions associated with multiple pregnancies? | Premature labor, PIH, Abnormal presentation, hydramnios, uterine dysfunction.
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| How is a Bishop score determined? | 5 items are compared including cervical dilation, effacement , position, and consistency, and the station of the fetal head.
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| Explain Bishop test scoring. | A score of 13 is possible.
9 or more is good for nullipara
5 or more for multip
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| What is used for cervical ripening? | Prostaglandin gel (cervidil)
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| What is the goal of oxytocin administration? | Achieve contractions that are 2-3 minutes apart, lasting 45 seconds.
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| When should Pitocin be discontinued? | Contraction longer than 90 seconds, abnormal FHR patterns, significant maternal BP changes.
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| What is the puerperium? | The postpartal period, traditionally considered to last 6 weeks after the birth of the baby. The woman adjusts physically and psychologically to the birth and the body returns to the prepregnant state.
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| What is involution? | The return of the uterus in size and location to the prepregnant state.
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| What are 2 postpartum signs of hemorrhage? | A boggy and/or deviated uterus.
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| Describe the evolution of lochia after the birth process. Specify color and amount of time considered normal. | Rubra-dark red, days 1-3, contains epithelial cells, erythrocytes, leukocytes, shreds of decidua.
Serosa-pinkish, days 3-10, more serous
Alba-creamy, yellowish, lasts 1-2 weeks
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| Describe the evolution of breast milk after the birth process. | Colostrum in breasts at delivery and for the first 2-4 days postpartum.
Transitional milk: Replaces colostrum, and is in the breasts 1st 2 weeks of life.
Mature Milk: Thin looking appearance, high % of water.
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| When is there enough surfactant is in the alveoli of lungs to prevent collapse? | 35 weeks
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| What is surfectant composed of? | Phospholipids
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| Why is lecithin important? | Stability
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| At what ratio are the lungs developed enough to function properly at birth? | 2:1 - the ratio is higher if the mom is a gestational diabetic
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| What 4 types of stimuli are needed to result in the baby's first breath? | 1. Chem Events-The PCO2 +, PH & PO2 -; stim the resp center of the medulla.
2. Thermal Stimuli- - in temp causes some cold stress
3. Physical Stimuli- Drying stims resprs and prevents heat loss.
4. Mech Events- air replaces fluids.
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| What are 3 S/S of respiratory distress? | retractions, grunting, and nasal flaring.
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| When does the foramen ovale close? | Functional closure of the foramen ovale from changing atrial pressures(total closure takes from several weeks to one year)
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| What is the ductus arteriousis? What causes it to close and when does it close? | The Ductus is the chanel between main pulmonary artery and the aorta of the fetus. Constriction of ductus arteriosus as a result of increased PO2 after air enters the lungs. ( Functional closure within 15 hours)
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| What is the reason infants get acrocyanosis? | Peripheral circulation of the newborn is sluggish.
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| What is the regular BP for a newborn? HR? HGB and HCT? RBC and WBC? Blood sugar? | BP of newborn is 78/42
HR=120-160
HGB=14-22
HCT=44-72
RBC’s=5-7.5
WBC’s=18,000
Blood sugar=40-60
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| In utero, when does the fetus begin producing urine? | urine forms in the kidneys by the 4th month gestation and is excreted into the amniotic fluid.
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| When is mature kidney function established in a child? | Mature kidney function not established until 2nd year of life. It has a narrow margin of safety in chemical balance.
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| Why would there be a pinkish dust in an infants diaper? | “Brick dust” or pinkish stains on diaper caused by urate crystals formed by newborn kidney is normal.
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| What macronutrients can an infant digest? | Newborn is capable of swallowing, digesting, metabolizing and absorbing proteins, simple carbohydrates and limited ability to digest fats.
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| What is the stomach capacity of an infant? | 30-60 mL
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| Why doesn't meconium stink? | Bacteria not in bowel at birth. Normal intestinal flora synthsize vitamin K, folic acid, and biotin.
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| What is the Caput succedaneum? | edematous area of the scalp, crosses suture lines
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| What is a cephalohematoma? | a collection of blood between a skull bone and its periostem, does not cross suture lines.
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| What is erythema toxicum? | Normal newborn rash
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| What are some reflexes to check for in an infant? | stepping, Babinski, rooting, sucking, grasp, moro
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| Why is it important for an infant to be kept in a warm environment? What is their most important source of heat? | They are at risk for heat transfer, because they have a limited supply of body fat and large surface area in relation to body weight. The most important source of heat in a cold-stressed newborn is brown fat.
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| What are 4 routes of heat loss? | conduction, convection,evaporation, and radiation.
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| When do infants need to receive immunizations? | 2 months
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| What are the 6 stages of newborn consciousness? | 1. Quiet Alert
2. Active Alert
3. Crying State
4. Drowsy
5. Active Sleep
6. Deep Sleep
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| What are 4 priorities in the birthing suite? | APGAR scoring
ID bands
Clamp
Bonding
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| What is milia? | pinpoint, white spots on nose
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| What are the 2 possible abnormalities with the meatus of the male genetalia? | if on underside it is called hypospadias, if on dorsum is called epispadius.
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| What is special about the first feeding if the infant is bottle fed? | the first feeding is done in a few hours after birth. Sometimes the first feeding is sterile water, to establish a patent esophagus.
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| What are caloric, fluid, and protein requirements for a newborn? | Caloric requirements-50-55 kilocalories per lb. of body weight
Fluid req-2-3 oz/lb. of body weight
Protein req-2.2gm/kg/24 hours
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