Final Exam plus all above exam objectives
Final Exam plus all above exam objectives NUR 315
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This 16 page Test Prep (MCAT, SAT...) was uploaded by Pablo Garcia on Monday February 2, 2015. The Test Prep (MCAT, SAT...) belongs to NUR 315 at Purdue University taught by Dr. Shafer in Fall. Since its upload, it has received 157 views. For similar materials see OBGYN nursing in Nursing and Health Sciences at Purdue University.
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Date Created: 02/02/15
Final Exam plus all above exam objectives Diabetes in Pregnancy and Other Medical Problems Diabetes 0 If controlled then it should not add any more problems to pg 0 Effects on pg Increases rates of infection PIH Anemia Polyhydramnios l PROM PPROM PTL Nephropathy IUGR Microvascular changes to the placenta 0 Effects on fetus Congenital malformations Midline defect heart neural tube defects Macrosomia Use of forceps etc Hypoglycemia after the chord is cut dt increase normal amount ofinsan Prematurity Respiratory distress syndrome Placental failure LS ratio should be 31 0 Metabolic changes during pregnancy 1St trimester increase glucose use in the peripheries increase insulin production D decrease glucose serum levels in the mom NampV D decreased food intake 0 Increase glucose going to fetus SO INSULIN USE SHOULD BE DECREASED IN 1ST TRIMESTER 2nCI trimester amp 3rCI trimester Increase hormones estrogen progesterone which are insulin antagonist creates more blood glucose INSULIN LEVELS SHOULD BE INCREASED Labor monitor glucose levels closely due to exercise 0 Obtain glucose level from arm opposite to IV med After labor stay decreased w breastfeeding Glucose levels 0 Should be between 65 and 95 0 After eating they can be elevated 120140 HgbA1C should be under 6 Diabetic insulin needs 0 We test for gestational diabetes during 2428 weeks of gestation If no need for screening then it does not have to be done Need for screening if HTN Strong family hx of diabetes Obesity BMI gt27 Previous GDM Large infant gt4000 g or 9bs Over 45 yo 0 High cholesterol indicating poor diet lf1hr 61139 test is lt130140 D negative Dnormal prenatal care lf 1 hr 61139 test is gt140 l positive Gestational diabetes 0 Start glucose monitoring 0 Refer to a nutrionist counselor 0 Try adjusting diet rst it it doesn39t work add insulin therapy Fetal Testing 0 GDM non insulin US every 4 weeks Fetal movement count Pretty much do an US amp NST with every 0 Looks for FHR as response to fetal mo emlt Clinical ViSit Every two weeks until 3236 weeks Weekly after 36 weeks Twice a weeks after 40 weeks 0 GDM insulin Fetal movement counts beginning at 28 weeks US every 46 weeks Fetal echo at 2022 weeks and then at 34 weeks Doppler US of the umbilical artery NST BPP test weekly or biweekly after 28 weeks o GDM insulin and noninsulint Check for renal status 0 24 hr creatinine clearance Clean catch urinary analysis monthly HgbA1c FBS q visit 0 Long term implications of GDM 2050 of developing diabetes 510 years later Test at 6 weeks after PP to evaluate GDM Infant risk for obesity diabetes amp glucose intolerance Hyperemesis gravidarum o 5 weight loss accompanied by NV electrolyte imbalance dehydration o 1 hospitalized needs IV uids electrolyte balance ketonuria Hallmark not being able to kee p down anything for 2 hrs Risk f actrs fer mo m Phsy cologiical problems Obesity Twin pg Hx of migraines Increase hormones Hyperthyrof id ism Hydatiform mole 0 0 Moles that grow on the placenta Non cancerous usually Hormone levels need to remain low for not cancerous H ea rt D fi sea 595 a n d Pregna ncy 0 00000 0 00 0 Increase in by 50 Heart rate increases and blood pressure decreases more strain to the heart Pulmonary and vascular resistance decreases Increase in plasma volume and RBC mass Changes are greater during the 2nd and 3rd trimester Changes may continue 12 weeks PP If the heart had any previous prolems it won t be able to compensate for increase workload 39 Heart problems during pg account to of maternal mortality Risk factors Twin pregnancy Preeclampsia Anemia Moms heart problems should continue to see their cardiologist up to weeks PP 5amp5 SOB Edema Pink frothy mucus Cough Sings 0f uid ov erload Classi catiiions of heart disease Class I 0 Heart is working properly Class II Slight limit Class le 0 Greater limits Class IV Very limited a ctiivity 0 Only batrhooom privileges Nu rsi n 9 care Diet low in sodium high in iron and protein Frequent clinical visits DecreaSe weig ht gain Combine rest with activity 810 hrs of sleep 0 La or nursing ca re be fatal for moms wl hea problems Side lying elevate head shoulders elevate Class land II c Tell mom to blow out as she pushes Birth can be one vaginally Class III and Iv Probably a ctrseCtion instead of vaginally Continuous 02 Tertiary location preferable Earlier delivery Invasive hemodynamic monitoring 0 PPquot nursing ca re lncrea sled risk for decompensation dt return of vascular fluids to the bloodstrea Prevent nfection hemorrhage anemia clotting Anemia Present in of all pg moms Very common among pts gastric bypass due to Fe deficiency lthgb 104 hct Sickle cell anemia Increase risk forjaunice pressure ulcers decreased placental prefuision EXTREME PAIN renal injury IUG bone deformities in fetus Ma need exchange transu qn take out blood out in plasma 0 NOT USE ESTROGEN BASED ORAL CONTRACEPT IVES Keep pt h rated 00000 Asthma 0 Usually a better idea to use medications suffering from an asthma attack to prevent strokes The load side about this is that asthma medications terbutaliine may cause PP hemorrhage 0 Nursing care Prevent triggers Regulate O12 There is no cure for preeclam psi a EXCEDt the delivery of babY WE also don39t know the cause of preeclampsia or eclampsia Mag sulfate given preeclam psia to prevent seizu res Eclamtpsia seizure Describe the screening and diagnostic procedures used to identify gestational diabetes One hour glucose test 0 If less than 120130 D normal care Blood sugar levels should be between 6595 for pg moms Outline the major nursing care for a woman who is diabetic during the childbearing cycle includes symptoms of hyper and hypoglycemia and accepted range of blood glucose levels for the pregnant diabetic Need for insulin treatment if necessary Artery cord US Fetal movement count US NST BPP w every appointment If levels of glucose increase after 20 weeks D GDM Diet low on glucose 6595 Check renal status 24 hr creatinine test Suggest nutritionist Change diet rst then consider insuin tx LS ratio amniocintesis Hgb 1AC State the trends for insulin requirements in each trimester of pregnancy and the postpartum period Insulin requirements decreases for rst trimester Insulin requirements increases during 2nCI and 3rd trimester hormone increase Insulin requirements decreases PP if breastfeeding Check for glucose levels again 6 weeks after PP if GDM Discuss the physiology and related nursing care of the following medical conditions as it effects pregnancy labor and postpartum Diabetes Placental insuf ciency Risk for other complications Infection Amniohydrosis Microvascular changes to placenta Anemias Placental insuf ciency Decreased 02 consumption for fetus Increase cardiac output Asthma Placental insuf ciency Effects of terbutaline on fetus includes resp depression PP hemorrhage Hyperemesis Dehydration Electrolyte imbalance Increased NN Cardiac conditions Problems specially during labor when heart is under added stress Fluid overload o Edma o SOB Nursing In 0 Diet low in sodium high in Fe amp protein 0 810 hrs sleep 0 Elevate head of shoulders 0 Side lying Anemia including sicklecell anemia Placental insuf ciency PlH IUGR etc NoOC May need placental perfusion Maintain hydrated Hypertensive Disorders in Pregnancy Differentiate between chronic hypertension gestational hypertension preeclampsia mild and severe eclampsia and preeclampsia superimposed on chronic hypertension Chronic HTN mom has had it before pg Gestational HTN increase in BP after 20 weeks w no proteinuria Preeclampsia increase in BP after 20 weeks w proteinuria or increase in proteinuria o Mild Proteinuria 2 or gt300 mg in 24 hrs on at least in2 occasions 6 hrs apart No edema No change in re exes Elevation in BP 14090 No oliguria Occasional headache 0 Severe BP 160110 on at least in 2 occasions 6 hrs apart Edema 2 Constant headache Proteinuria 34 Oliguria Clonus Liver pain Gain of 12 lbs per week Increase in AST ALT Increase in creatinine BUN Increase in Hgb Preeclampsia w chronic HTN increase in BP before 20 weeks w protenuria Discuss maternal fetal and newborn morbidity and mortality attributable to the hypertensive disorders of pregnancy 10 of all pregnancies are affected by HTN 15 of them are affected by preeclampsia Describe the pathophysiology of preeclampsia Arteriolar vasospasm Proteins leak Platelets aggregate along damaged epithelium protein D DIC thrombocytopenia Severe pre eclampsia Seizure precaution Mag sulfate Eclampsia Elevated temperature amp re exes precede seizure Stay w pt during seizure Provide 02 if necessary Mag sulfate First priority is to stabilize the mother and to monitor fetus HELLP syndrome Hemolysis elevated liver enzymes low platelets o Abnormal blood smear hemolysis AST gt70 ALTAST gt1 Platelets under 150000 SampS Flulike symptoms NN Flank pain Sings of preeclampsia not 100 present 0000 DIC Describe the requirements route contraindications side effects and nursing considerations medications used for pre eclamptic and eclamptic clients speci cally Magnesium Sulfate and Hydralazine Mag sulfate 0 4 re ex clonus 0 Route IV 0 Contraindications 0 Side effects u know it o Antidote calcium gluconate have it readily available Hydralazine Not FDA approved for PTL Main side effect is decrease in BP IV 0000 Preterm Labor Discuss the physiology and related nursing care for clients experiencing Preterm birth A birth that is 3 weeks before due date or anywhere between 3037 weeks Preterm labor Primary cause of neonatal death Labor between 2037 weeks 1 out of 8 babies are born prematurely in the US Increasing rate due to O O O 0 Rise in obesity Multiple gestations ART Older women giving birth Current campaign focuses on O O 0 Increasing PNC w Hispanics and blacks Putting a limit on reproductive technologies to stop implanting multiple embryos Insurance companies putting a restriction on stopping deliveries before 3738 weeks Causes Me OOOOmOOOOOQOOOOOOOOOOOOO O 0 Most common cause is genital tract infectionUTI Multiple pregnancies Pprom Gestational HTN Uterine malformation Antepartum hemorrhage IUGR Moms with low prepregnancy weigth Moms with age extremes lt17 gt35 Low socioeconomic status Late PNC Drug use Long periods standing nurses ical conditions attributing to PTL Infections uti HTN Diabetes Clotting disorders Short term between pregnancies Pelvic pressurecramping Increased vaginal discharge Feel abnormalbad Contractions lasting 30 sec or more occurring every 10 min OR 56 cxhr Cervical changes shortening of cervical length PROM no daahh Predictors of PTL O O FFF present w vaginal discharge indicates that the quotgluequot that holds the placenta together is coming off shorteningfunneling of cervix determined by a US cerclage is the snitching of the cervix incase baby is to heavy and just slips out no contiraCtions Nursing intervention 0 Tell pit to take a lass of water and to lay on her left side for 1 hr 0 If39contract ions don t decrease call the MD 0 Medications NifepidinelProcardial 0 Calcium channel blocker 0 Side effects 0 Hypotenstion maternal Indometh acin Prostagilandin synthase inhibitor Nausea heart burn mother c Bleeding HTN narrowing ductus arerousus fetus sulfate 039 Warmth blurry fatigue seizure mother Decrased muscle tone bradypnea fetus Hyd roprog esterone ca proate Only drug approved by FDA for PTL Hormone drug that promotes relaxatiOn systems Only used for single fetus pregnancies Re ucjeS incidences of fintraventricular hemorrhage nee for supplemental oxygen or necrotizing enterocolitis Promotion of lung maturity o Steroids Beta met hasonte celestone 2 oses of IM injections 24 hrs aart Given fetus 24 34 weeks ROM 0 Should be sponta neus and should occur during labor P R0 M 0 After weeks but n0t during labor PPROM 0 Before 37 weeks Prolonged ROM 0 More than 24 hrs and prior to the onset of ab0r If membranes intact performa digital exam if PT L suspected If membranes ruptured perform a sterile exam If Cervix dialated 4 cm then hard to stop PTL Regioni lzation 0 Level 1 Primary basic care 0 Level NIZCU 0 Level 3 NIZCU and intensive care for mom Indiana perinatal network 0 Improve health all pg mothers and babies Identify the status of Indiana in meeting the Healthy People 2020 goals for low birth weight preterm birth and infant mortality 0 114 Goal 0 Indiana is at 132 infant mortality is really high in Indiana Discuss nursing responsibilities in the care of clients experiencing abuse 0 Teach about symptoms of batterer Teach phases of abuse Always assume violence Ask about history of violence in a private area Ask client if she has a speci c way she wants to be helped Assess bruises carefully Teach safety plan during violence Community resources Make sure client has an escape amp safety plan Describe how to assess for potential abuse in pregnancy physical and psychosocial indicators 0 Partner batterer 0 Over protective 0 Bad temper 0 Low self esteem o Insecure Bruises w vague explanations Pt avoids eye contact Explain the responsibility of the nurse who identi es a woman in an abusive situation 0 Document thoroughly w pt s words 0 Give phone numbers of organizations 0 Make sure she has a safety plan during violence amp escape route Prioritize and describe nursing interventions for facilitating care with women who are abused Discuss ethical issues surrounding abuse in pregnancy 0 60 of teens say they have been abused during pg 0 25 of all women say they have been abused Abuse can be done to men or women Oxytocin used after birth to prevent hemorrhage Recommended folic intake of folic acid is 600 mcgday Depression is not usually diagnosed until after 2 months after loss Repeat what they are saying active listening Average newborn weight 2500 3900 g Alveoli present at 24 weeks gestation baby could breath at this point Abnormalities in neonatal respirations o Grunting o Retractions Compliant chest walls 0 Nasal aring 0 Absent or diminished breath sounds Crackles Transient tachypnea of the newborn 0 Increased RR 80120 0 dt delayed clearance of lung uid 0 no eating nor breastfeeding Hyaline membrane disease 0 PTL neonates that lack surfactant D alveoli collapse D accumulation of dead cells in respiratory tract hyaline membrane D further respiratory complications 0 Tx Celestone 12 mg 24 hrs apart Respiratory support Synthetic surfactant Decreases tension and increases compliance 0 Pneumothorax Collapsed lung dt liquid in ltrating plural space Tx Needle aspiration 100 oxygen Fi02 Chest tube High frequency oscillating ventilator o Improves oxygenation High frequency Jet ventilator o Improves ventilator Chronic lung disease 0 Due to increased oxygen exposure and barotrauma o Ventilator dependency gt28 days after birth 0 1020 mortality in 1St year 0 Tx Decrease uids diuretics uid restriction Oxygen support Minimize ventilating pressure Infections 0 Group B strep E coli Risk factors Prolonged ROM gt 18 hrs Prematurity skin does not defend Necrotizing enterocolitis NEC 0 Air trapping of gas inside bowel walls 0 Tx Antibiotics TPN Report changes in metabolism ROP retinopathy of prematurity o Retina is damage bc it is too young lt30 weeks and is exposed to air To be discharged 0 feed 0 Temperature regulation 0 No bad events 0 Be in NICU until due date Signs of respiratory distress o Retractions nasal aring apnea grunting Before 34 weeks gestation most fetuses don39t produce enough surfactant to be able to live Low birth weight babies LBW lt 2500 g Infection is the only factor de nitely shown to cause PTL Dx of PTL o Contractrions o Cervical changes 0 2037 weeks Contraindications for tocoysis includes hypertension and cardiac problems 0 Tocolytics should not be given after 36 weeks 0 The goal of using tocolytics is not to delay birth to allow baby to grow more in the uterus but to delay birth just long enough so appropriate interventions can be made to facilitate birth Procardia calcium channel blocker lndomethacin NSAID stops production of prostaglandin Celestone should be given 2434 weeks Chorioamnionitis is the rst cause of preterm PROM Fever precedes PTL Pitocin increases strength and frequency of contractions 0 Side effect NN Oxytocin is given to speed up delivery of placenta stage 3 labor Conjugated bilirubin is non toxic dissolves in water Unconjugated bilirubin can be potentially toxic dissolves in fat binds to albumin Free bilirubin unbound unconjugated D TOXIC 0 Not bound to albumin cand cross BBB Total serum albumin should be less than 21 Physiologic process NORMAL D around day 3 and may peak around day 68 w1215 mgdL Pathologic nonphysiologic NOT NORMAL l before day 1 0 Need for phototherapy no need for liver for conjugation Also breastfeeding helps Watch for decreasaed platelet count Monitor ampOs Cover eyes and gonads Trunk should be right under light Avoid lotions ointments OOOOOO Milk jaundice D poor breastfeeding Heat production 0 Shivering 0 Non shivering brown tissue Main mechanism Requires glucose 0 Voluntary muscle activity Rubella equivocal D give titer shot Tdap given IM Prolactin triggers milk production Oxytocin triggers let down re ex milk release Breast feed for about 1520 mins in each breast 812 breasfeedsday on demand What to check during breastfeeding 0 Proper latching Express a few drops of colostrummilk right before Thumb above nipple four ngers below nipple Tickle baby s lip w nipple 23 cm of areolar in baby s mouth Break suction Air dry nipples Infant39s head neck and spine should all be aligned Baby39s hand around breast 1530 ccfeeding 34 hrs 0 2500 kg 3999 kg is normal 49 lbs lntrinsic IUGR l symmetric Extrinsic IUGR D assmetric head growth is spared First reactivity period rst 30 min 2nCI reacitivity period 28 hrs Erythromycin administer to both eyes within an hour of birth Under 50 glucose neonatal level is abnormal Barlow39s maneuver to rule out hip dylspacia Caput succedaneum DOES cross the suture Cephalohematoma DOES NOT cross the suture Erythema D newborn rash selfresolved Kernicterus deposition of unconjugated bilirubin in the brain leading to permanent neurological changes Lanugohau Petechial red spots may be normal First 24 hrs colostrum 34 days pp D breast engorgement Uterus 2 cm below umbilicus right after birth within 12 hrs uterus will be 6 cm under umbilicus after week one it should be halfway between umbilicus and symphysis pubis Bladder tone is restored 57 days after birth Spontaneous BM may not occur 23 days after birth OOOOOOOOO Lochia check q 15 0 Red rubra D pinkrosa serosa D White alba o Ambulation amp breastfeeding increase ochia Patient should void every 23 hrs PP Bilirubin o 24 hrs l 5 o 48 hrs D 10 o 72 hrs l 15 Tongue thrust is bad 0 Have mom pull down on baby s chin Stools green may indicate bilirubin Rhogam shot given 28 weeks amp 72 hrs after birth Ovulation starts again 6 months after birth w breastfeeding moms Neonate o 68 wet diapersday o 23 bowel movements Daily fetal counts 0 Count 10 movements within an hour 23xday If less than 4 movementshr recheck after eating NST o Reactive 2 movements in 20 min 0 Non reactive l 2 movements in 20 min BPP o If 8 then normal exing acceleartions movement amniotic uid volume breathing Presumptive probable chadwick godde pg test positive signs of pg Quad screen 1620 weeks Diet stuff Paras 0 Number of pgs where fetus is 20 weeks BMI lt18 0 Weigth gain of 2840 BMI 1824 0 Weight gain 2535 BMI gt24 0 Weight gain 1525 Protein 0 60gday Calorie 0 Increase of 300 kcal in 2nCI and 3ml 0 1 rbreast feeding 22 2900 o 25002700day Calcium 0 1200 mg Iron 0 30 mg Folic acid o 600 mg Water 0 68 oz Grains 0 9 servings Fruits vegetables dairy protein 0 3 Avoid unpasterauzed milk hot dog deli meat soft cheese sea food Nicotine addiction 0 Delay do something drink water deep breath Normal weight 2500 3999 Breasts feel weird right before mensturation don39t do self exam during this time Acculturation friendlier way than assimilation which involves loosing cultural identity Leading cause of maternal mortality in hypertension Amniocintesis l LS ratio Accelerations increase of FHR of at least 15 bpm in at least 15 secs FHR monitoring 0 Low risk Asses q 30 min in active phase q 15 min in stage 2 0 High risk Asses q 15 in active phase Q 5 in stage 2 Category II 0 One one thing wron Category Ill 0 Two things wrong absent variability Variabilities 0 Absent 0 Minimal 05 0 Moderate 525 0 Marked 25 Anterior fontanel diamnond is bigger than posterior fontanel Posterior fontanel triangle should be felt rst during occipital birth 0 Occiput back of head 0 Sacrium breech o Sinciput shoulder Cardinal movements of labor EDFIEREE 0 Engagement descent Flexion Internal rotation Extension Restitution External rotation Expulsion OOOOOOO Anesthesia D numbs sensation Analgesia D relieves pain sensation Active stage of labor is the optimal stage to apply medications Stage I o Latent 0 Active 0 Transition Passenger position 0 occipital sacrum 0 right or left based on which way the back is pointing o anterior postierion transverse based on which way back is pointing 0A is the most preferable way Epidural is associated w headaches 0 Also allows for longer treatment but has a slower onset than spinal
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