NURS 2111 OB and Peds Final Exam Study Guide 2023
Maternal Study Guide
1. Condoms health promotion patient teaching
• Male condom – Unroll
... [Show More] before putting on penis. Penis has to be erect before placing on. Pinch top of condom to make sure there is a space between the head of the penis and the condom for the semen. Make sure it is not too tight or too loose. Protects against STIs.
2. Chlamydia
• Bacterial infection caused by CHLAMYDIA TRACHOMATIS and it is the MOST reported STI.
• Majority of women are ASYMPOTMATIC, but if S/S are present, it includes: mucopurulent GRAY-WHITE discharge, vulvar itching, dysuria, urinary frequency, endometritis, and Male S/S – penile discharge, dysuria, and testicular pain or edema (swelling).
• If left untreated, it can lead to pelvic inflammatory disease (PID), which can cause
infertility and ectopic pregnancy.
• If not treated during pregnancy, it can cause PROM, preterm labor, and postpartum endometritis.
• If transmitted to the neonate, it can cause conjunctivitis and pneumonia after delivery.
• MEDS – Doxycycline [Vibramycin] (used as a tx for 7 days, but contraindicated during pregnancy). Azithromycin [Zithromax in a single dose] or Amoxicillin (prescribed during pregnancy). Erythromycin (ophthalmic eye drops/ointment given to neonate following delivery) within 2 hours.
• At a higher risk for gonorrhea and HIV.
3. Gonorrhea
• Bacterial infection caused by NEISSERIA GONORRHOEAE and is the SECOND most commonly reported STI.
• Similar to Chlamydia, most women are ASYMPTOMATIC. If S/S are present, it includes: YELLOWISH-GREEN vaginal discharge, dysuria, dysmenorrhea, vaginal bleeding between periods. Male S/S – dysuria, testicular pain or edema (swelling), and penile discharge (white, green, yellow, or clear), sometimes profuse.
• In pregnancy, gonorrhea is associated with chorioamnionitis, premature labor,
spontaneous abortion, PROM, and postpartum endometritis.
• If transmitted to the neonate, ophthalmia neonatorum occurs which can lead to blindness; hence, the importance of ERYTHROMYCIN.
• Meds -
4. Syphilis
• Caused by a spirochete bacterium TREPONEMA PALLIDUM.
• Primarily affects Blacks, Hispanics, and racial/ethnic minority groups.
• Has 5 stages: Primary, Secondary, Early Latency, Late Latency, and Tertiary (LATE).
- Primary
➢ A chancre (painless ulcer) at the site of bacterial entry that will disappear within 3 to 6 weeks without intervention. This period is highly contagious especially whenever chancres are present.
- Secondary
➢ Appears 2 to 6 months after initial exposure and is manifested by flu-like symptoms and a maculopapular rash of the trunk, palms, and soles.
➢ Alopecia and adenopathy are both common during this stage.
➢ Lasts about 2 years.
- Early/Late Latency (Hidden Stages)
➢ Characterized by the absence of any clinical manifestations of disease, though the serology is positive. This stage can last as long as 20 years.
- Tertiary (Late)
➢ Damage to internal organs occurs.
• Meds – Penicillin G in a single dose. Doxycycline or tetracycline orally, if allergic to penicillin. Do not administer if pregnant.
• If left untreated or undiagnosed, can be transmitted to the neonate and cause stillborn birth or congenital abnormalities.
5. Trichomoniasis
• Caused by a protozoan parasite called TRICHOMONAS VAGINALIS.
• Can be sexually transmitted OR can be transmitted from wet surfaces like a hot tub.
• S/S in women: FROTHY, GREENISH-YELLOW, FOUL SMELLING DISCHARGE and vulvar itching, edema, and redness. Men are asymptomatic.
• Although this infection is localized, there is increasing evidence of preterm birth, premature rupture of membranes, low-birth-weight infants, postpartum endometritis, and infertility in women with this type of vaginitis.
• Meds - A single 2-g dose of oral metronidazole (Flagyl) or tinidazole (Tindamax) for both partners is a common treatment for this infection. Metronidazole is not given during the first trimester of pregnancy due to the teratogenic effects on the fetus.
6. IUD
• Active T-shaped device inserted through the cervix and placed in the uterus. Most effective contraceptive methods.
• Must be monitored monthly by clients after menstruation to ensure the presence of the small string that hangs from the device into the upper part of the vagina to rule out migration or expulsion of the device.
• Advantage: IUD can maintain effectiveness for 3 to 10 years (hormonal IUD 3 to 5 years; copper IUD 10 years)
• Disadvantage: This method can increase the risk of pelvic inflammatory disease, uterine perforation, or ectopic pregnancy and can be expelled.
• Warnings for Potential Complications for Intrauterine System Users:
P = Period late, pregnancy, abnormal spotting or bleeding A = Abdominal pain, pain with intercourse
I = Infection exposure, abnormal vaginal discharge N = Not feeling well, fever, chills
S = String length shorter or longer or missing
• Contraindications: Active pelvic infection, abnormal uterine bleeding, and severe uterine distortion
• Complications – bacterial vaginosis which can lead to PID.
• No douching when IUD because it pushes the bacteria up and it’ll get trapped in the IUD.
7. Pelvic inflammatory disease
• An infectious condition of the pelvic cavity that may involve the fallopian tubes, ovaries, and peritoneum.
• Major cause of female infertility
• Higher in young adolescent girls and young adults
• S/S – lower abdominal pain, spotting after intercourse, fever and chills, irregular bleeding
• Complications – fibrosis, scarring, loss of tubal function, ectopic pregnancy, pelvic abscess, infertility, recurrent or chronic episodes, chronic abd pain, pelvic adhesions, and depression
8. Infertility
• Primary: Defined as an inability to conceive despite engaging in unprotected sexual intercourse for at least 12 months.
• Secondary: You have a child and now unable to get pregnant after that child.
• RF: overweight or under weight and PID
• Common factors associated with infertility can include decreased sperm production, endometriosis, ovulation disorders, and tubal occlusions.
• Nonmedical, lifestyle changes, and alternative measures – nutritional and dietary changes, exercise and stress mgmt, herbal meds if prescribed, acupuncture, and avoid high scrotal temperatures
• Medical therapy – Ovarian stimulation: Clomiphene citrate and Letrozole
• Assisted Reproductive Technologies
- Intrauterine insemination
- In vitro fertilization-embryo transfer
- Gamete intrafallopian transfer
- Donor oocyte
- Donor embryo
- Gestational carrier
- Surrogate mother
- Therapeutic donor insemination
9. Teratogens
• Substance, organism, physical agent, or deficiency state present during gestation that can cause abnormal postnatal structure or function of fetal development
• 4 types: physical agents, metabolic conditions, infection, and drugs or chemical agents
• Ionizing radiation—leads to abnormal brain development, mental impairment, and leukemia.
• Organic mercury—leads to damage of the neural system, mental impairment, behavioral and cognitive problems, and blindness.
• Lead exposure—can cause spontaneous abortions, delayed fetal development, increased risk of fetal death, or abnormal mental or physical development.
• Toxoplasma—leads to spontaneous abortion or stillbirth, underdeveloped fetal brain, blindness, and seizures.
• Syphilis bacteria—can cause fetal death, spontaneous abortion, liver and spleen enlargement, and congenital syphilis.
• Rubella virus—leads to abnormal brain development.
• Cytomegalovirus—leads to underdevelopment of the fetal brain, blindness, deafness, jaundice, and liver and spleen dysfunction.
• Varicella zoster—leads to underdeveloped limbs, and brain or eye malformations.
• Herpes virus—causes fetal death, microcephaly, herpetic pneumonia, and meningoencephalitis.
• Maternal conditions—obesity, diabetes, hypothyroidism, hyperthyroidism, and phenylketonuria (PKU).
• Drugs—include thalidomide (limb malformations); alcohol (fetal alcohol spectrum disorder); angiotensin-converting enzyme (ACE) inhibitors (antihypertensive agents) (prematurity, intrauterine growth restriction [IUGR]); cocaine (placental abruption, prematurity, microcephaly); and tetracycline (yellow-brown teeth discoloration)
10. Endometriosis
• A complex syndrome characterized by an estrogen-dominant chronic inflammatory process that affects primarily pelvic tissues, including the ovaries.
• Commonly found attached to the ovaries, fallopian tubes, the outer surface of the uterus, the bowels, the area between the vagina and rectum, and the pelvic side wall.
• RF – the aging process, family hx of endometriosis, lean body size, infertility
• Mgmt – Pain relief, hormonal suppression, and surgery
• Tx – Removal of lesions or hysterectomy
• NC – Educate!!!
11. PMS
• Recurrent physical, emotional, and behavioral symptoms that occur during the luteal phase or last half of the menstrual cycle and resolve with the onset of menstruation.
• Can lead to serious depression
• Peak time for PMS is 4 to 7 days PRIOR to menses
• Women spend up to 10 years of their life in a compromised physical functioning and psychological well-being.
12. Nägele’s Rule
• Subtract 3 months from LMP and add 7 days
13. Non-stress test
• Non-invasive test done in the third trimester to measure FHR response to fetal movement.
• Give mom orange juice prior to test to energize baby.
• Mom pushes a button when she feels fetal movement.
• If fetus is sleeping, a vibroacoustic device may be used to awaken them.
• Results reactive or non-reactive. Reactive is normal: 2 fetal heart accelerations from the baseline of the heart rate higher than at least 15 bpm lasting at least 15 seconds within a 20 mins recording period! Non-reactive is abnormal!! Further testing is recommended (biophysical profile or contraction stress test).
14. Signs of pregnancy
• Presumptive: Can be defined by things/reasons other than pregnancy
- Amenorrhea
- Fatigue
- Nausea/Vomiting
- Urinary Frequency
- Quickening/Fluttering in stomach
• Probable (Objective): Changes that make the examiner suspect a woman is pregnant (primarily related to physical changes of the uterus).
- Abdominal enlargement: Related to changes in uterine size, shape, and position
- Hegar’s Sign: Softening and compressibility of the lower uterus
- Chadwick’s Sign: Deepend violet bluish color of cervix and vaginal mucosa
- Goodell’s Sign: Softening of cervical tip
- Ballottement: Rebound of unengaged uterus
- Braxton Hicks Contractions: False contractions that are painless, irregular, and usually relieved by walking
Positive Pregnancy Test: Woman’s hormonal level may not be normal
• Positive: Very distinct things.
- Fetal Heart Sounds
- Fetal Heartbeat can be heard
- Can see the baby with ultrasound
- Can feel movement in the uterus
15. Group B Streptococcus
• Culture is obtained from screening at 35 to 37 weeks by swabbing vaginal and rectal area. If positive, an IV prophylactic antibiotic is given during labor.
• Maternal effects (sepsis, chorioamnionitis, and endometritis after delivery) and fetal effects (meningitis, pneumonia, and sepsis).
• Natural occurring bacteria found in 50% of healthy adults in the gastrointestinal and urinary tract.
16. Fetal circulation
• Umbilical cord contains 2 arteries and 1 vein (AVA).
• Three shunts also are present during fetal life and will close once baby takes first breath:
- Ductus venosus—connects the umbilical vein to the inferior vena cava.
- Ductus arteriosus—connects the main pulmonary artery to the aorta.
- Foramen ovale—anatomic opening between the right and left atria.
17. Betamethasone
• A glucocorticoid administered deep IM (ventral gluteal or vastus lateralis muscle) in two injections 24hr apart to enhance fetal lung maturity and surfactant production for fetuses between 24 to 34 weeks. Requires 24hr to be effective.
18. Gravida
• GTPAL (G = # of pregnancies including current pregnancy even if baby did not make it, T
= Term births [over 37 weeks], P = Pre-term [20 to 36.6 weeks], A = Abortions, L = Living)
• Nulligravida – Never been pregnant
• Primigravida – First pregnancy.
• Multigravida – Multiple pregnancies.
19. Pregnancy induced hypertension (PIH) – GESTATIONAL HYPERTENSION
• Begins after 20th week of pregnancy
• 2 blood pressures greater than 140/90 at 2 different times, at least 4 to 6 hours apart.
• Blood pressure returns to baseline by 12 weeks postpartum. No proteinuria.
• Anti-hypertensive meds – Methyldopa, nifedipine, hydralazine, and labetalol
20. Preeclampsia
• Hypertension and +1 protein will be present in urine.
• Low dose aspirin therapy will be initiated.
• Edema can be present.
• Severe Preeclampsia – BP > 160/100, proteinuria > 3+, headache, blurred vision, edema, hepatic dysfunction
• Possible complication is seizures.
21. Magnesium sulfate
• Given as prophylactic treatment to prevent seizures in patients with eclampsia and severe preeclampsia.
• KEEP CALCIUM GLUCONATE BEDSIDE.
• Monitor for signs of magnesium toxicity (vomiting, respirations less than 12/min, urinary output less than 30/min, absence of patellar deep tendon reflexes.
• PATIENTS SHOULD BE ON FLUID RESTRICTION OF 25 ML TO 125 ML/HR.
22. Abruptio placenta
• Premature separation of placenta from uterus, which can be a partial or complete detachment. Separation occurs after 20 weeks of gestation.
• S/S – Sudden onset of intense localized abdominal pain with dark red vaginal bleeding, fetal distress, findings of hypovolemic shock, uterine tenderness, and contractions with hypertonicity
• NC
- Place mom on strict bed rest and in a left lateral position to prevent pressure on vena cava.
- Administer oxygen to ensure adequate tissue perfusion.
- Obtain maternal vs q 15 mins as indicated.
- Observe for signs of hypovolemic shock.
- Insert an indwelling urinary (Foley) catheter to assess hourly urine output.
- Initiate an IV infusion for fluid replacement using a large-bore catheter.
- Assess fundal height for changes.
- Monitor amount and characteristics of bleeding q 15 to 30 mins.
- Institute continuous electronic fetal monitoring.
- Assess contractions and report any increased uterine tenseness or rigidity.
- Also observe the tracing for tetanic uterine contractions or changes in fetal heart rate patterns suggesting that the fetus has been compromised.
- Be alert for signs and symptoms of DIC, such as bleeding gums, tachycardia, oozing from the IV insertion site, and petechiae, and administer blood products as ordered if DIC occurs.
23. Ectopic pregnancy
• Ovum implants in the Fallopian tubes or abdominal cavity due to the presence of endometrial tissue. S/S – Unilateral stabbing pain in abdomen, and signs/symptoms of hemorrhage (tachycardia, hypotension, pallor)
• Can lead to fallopian rupture and extensive bleeding, which leads to surgical removal of damaged tube if pregnancy is not dissolved.
• Methotrexate will be administered to dissolve pregnancy if identified prior to rupture.
• Salpingostomy is done to remove ectopic pregnancy and salvage the fallopian tube, if not ruptured. Salpingectomy is the removal of the fallopian tube.
24. Placenta previa
• Placenta is implanted in the lower uterine segment near or over the internal cervical os. May be total or partial. Low-lying placenta refers to the placenta implanted in the lower uterine segment but does not reach the os.
• S/S – Painless bright red bleeding during the second half of pregnancy.
• Complications associated with placenta previa include PROM, preterm labor and birth, surgery-related trauma to the structures adjacent to the uterus, anesthesia complications, blood transfusion reactions, over-infusion of fluids, abnormal placental attachments, postpartum hemorrhage, anemia, thrombophlebitis and infection.
• Mgmt - Depends on gestation. Usually observation and bed rest. If woman is bleeding,
may be placed in LDR and monitored. Usually prefer to wait until >34 weeks for delivery. Delivery is usually by cesarean. Active management for a woman who is term (37 weeks or more) having minimal bleeding, vaginal birth may be attempted. If the woman is <36 weeks, not in labor, and the bleeding is mild or stopped, expectant management (observation )is best. Antepartum steroids (betamethasone) may be ordered to promote fetal lung maturity. No vaginal exams and pelvic rest. A cevical length <3mm increases the risk for postpartum hemorrhage.
25. HELLP syndrome
• H = Hemolysis (resulting in anemia and jaundice).
• EL = Elevated Liver enzymes
• LP = Low platelets (less than 100,000/mm)
• Stabilize BP (rapid acting antihypertensive meds will be used) and assessment of fetal well-being. Magnesium sulfate will be given behind antihypertensive meds to prevent seizures. Betamethasone will be given if necessary if baby is between 24 to 34 weeks.
• High risk of bleeding out and maternal death.
26. Stages of labor
• 1st stage of labor
- 0 to 10 cm
- Cervical effacement and dilation occurs
- Early Phase (latent) – 0 to 3 cm: Mother is talkative and eager
- Active Phase – 4 to 7 cm: Mother is restless, anxious, and may feel helpless
- Transition Phase – 8 to 10 cm: Mother is experiencing a lot of pain, has the urge to push, and may feel like she is having a bowel movement due to increased rectal pressure
• 2nd stage of labor
- 10 cm to birth
- Contractions intensify in duration
- Pushing efforts begin with contractions
- ROM may occur if haven’t already (note color, amount, and if it has meconium or not)
• 3rd stage of labor
- Birth to delivery of placenta
- Can last from a few mins to 30 mins
- Signs of placental separation:
➢ Gush of blood
➢ Lengthening of umbilical cord
- Shiny Schultz (fetal side) vs Dirty Duncan (maternal side)
• 4th stage of labor
- Recovery phase
- Lasts about 2 hours
- NC: Monitor VS q 15mins, encourage breastfeeding, massage fundus q 15mins, skin to skin for at least 1 hour, monitor for bleeding, perform perineal care, monitor urinary output, oxytocin given fast after delivery to help uterus contract
27. Umbilical cord prolapsed
• The umbilical cord is displaced, preceding the presenting part of the fetus, or protruding through the cervix. This results in cord compression and compromised fetal circulation.
• NC – 1st, IMMEDIATELY CALL FOR HELP/NOTIFY PROVIDER. Next, use a sterile-gloved hand and insert two fingers into the vagina, applying finger pressure on either side of the cord to the fetal presenting part to elevate it off of the cord. Reposition in a knee- chest position, Trendelenburg, or a side-lying position. Administer oxygen at 8 to 10 mL via a face mask to improve fetal oxygenation. Provide continuous fetal monitoring.
28. True/False labor
• True Labor – cervical change and fetal descent, increase in bloody show, regular and strong contractions that are intensified by walking, and felt in lower back and goes all the way around to the lower abdomen
• False Labor – Braxton Hicks (uterine contractions irregular), no cervical change or bloody show, felt in back or abdomen, contractions stop/go away with walking or position change
29. Care of the laboring client
• Includes the fetus, mother, and support person.
• Fetus – Perform LEOPOLD MANEUVERS to aid in probable location where FHT can be best auscultated on mom’s abdomen. Once found, tocotransducer will be applied to mom’s abdomen over the fundus to measure contractions and external fetal monitoring will be placed on abdomen where fetus is located to assess FHR patterns.
• Mother – Assess contractions (frequency, intensity, duration, and resting tone of UC),
perform vaginal exams to assess for cervical change, descent/station, fetal position, presenting part and lie, and check membrane status. If IUPC is needed, make sure membranes are ruptures and cervix is fully dilated. Also, provide quiet, dim lights; minimal distractions; speak in low tones; ice chips; dry, clean gown and bed sheets;
medications, if necessary; pillows; cool wash cloths. Always inform of labor progress, procedures, etc.
• The support person – give frequent and appropriate feedback. Give specific tasks. Encourage to eat and drink fluids.
30. Oxytocin
• Given to induce labor or for post-partum hemorrhage
• Promotes uterine contractions
• Administered fast after delivery to help uterus contract
• Assess uterine tone and vaginal bleeding
• NC – Monitor FHR and contractions. Administer terbutaline to decrease uterine activity if needed.
*Discontinue oxytocin if contractions occur MORE THAN EVERY 2 MINS, LAST LONGER THAN 90 SECS, INTENSITY > 90mmHg W/ IUPC, or RESTING TONE > 20mmHg BETWEEN CONTRACTIONS
31. Shoulder dystocia
• Difficulty delivering the shoulders after the head is delivered.
• Maternal risk include vaginal or perineal trauma.
• Fetal risks include asphyxia, brachial nerve injury from over stretching the neck, clavicle fractures, and cervical nerve damage.
• Tx is to anticipate, perform Mc Robert’s maneuver (explain everything to patient), suprapubic pressure, DO NOT APPLY fundal pressure, and sometimes fracturing clavicle is necessary.
32. Uterine rupture
• Complete rupture involves the uterine wall, peritoneal cavity, and/or broad ligament. Internal bleeding is present.
• Incomplete rupture occurs with dehiscence at the site of a prior scar. Internal bleeding might not be present.
• RF – Overdistention of the uterus from a fetus who is LGA, a multifetal gestation, or polyhydramnios and forceps-assisted birth.
• Expected Findings – Clients report sensation of “ripping,” “tearing,” or sharp pain, abd pain, or uterine tenderness.
• NC – Administer IV fluids. Administer oxygen. Administer blood products if prescribed. Prepare client for immediate c-section, which can involve laparotomy and/or hysterectomy, and inform the client and their partner about the treatment.
33. Fetal position (Longitudinal, transverse, oblique)
• Longitudinal lie – Position that we want baby in (head first); however, if butt is presenting, this baby will require a c-section.
• Transverse lie – Shoulder is presenting part. Patient will require a c-section.
• Oblique lie – Baby’s head is in mother’s hips. If baby does not rotate itself before the laboring process, c-section may be necessary.
34. Amniotic fluid
• Assessment completed after ROM.
• Should be watery, clear, and have a slightly yellow tinge.
• Odor should not be foul.
• Volume is between 700 to 1000 mL
• Use nitrazine paper to confirm that amniotic fluid is present.
35. Five essential factors of labor (passenger, etc...)
• Passageway
- Size and shape must be adequate to allow fetus to pass. Cervix must dilate and efface in response to contractions and fetal descent.
• Passenger
- Consists of the fetus and the placenta. The size of the fetal head, fetal presentation, fetal lie, fetal attitude, and fetal position affect the ability of the fetus to navigate the birth canal. The placenta falls under this category because it also must pass through the canal.
• Powers
- Uterine contractions cause effacement. Involuntary urge to push and voluntary bearing down helps in the expulsion of the fetus.
• Position
- GRAVITY!!! Frequent changes increases comfort, relieves fatigue, and promotes circulation.
• Psyche
- Very important that there is no tension, anxiety, or stress. KEEP PATIENT AS CALM AS POSSIBLE!!!
36. Neutral thermal environment in newborn
• Thermoregulation - NBs keep warm by metabolizing brown fat. Very unique to babies. Brown fat is going to activate by stimulation of the sympathetic nervous system. Baby converts it into energy. Once a baby is using it to keep warm, it can’t get it back. You do not want baby to use up brown fat reserve.
• 4 types of Heat Loss:
- Conduction: caused by putting a baby directly on a cold surface
- Convection: flow of heat from body surface to a colder surface (placed in bassinet close to ac or fan)
- Evaporation: Loss of heat as surface liquid (having cold blankets stay on them, sweating
- Radiation- loss of heat from body surface to a colder surface (keep away from cold window)
37. Care of the postpartum client
• Monitor physiologic and psychologic adaptations
• Restore maternal physiologic function
• Support neonate’s physical adaptation
• Promote rest and comfort
• Promote family/newborn bonding
• Provide education on self and newborn care which encourages assumption of parental, caretaking role
• Monitor emotional state of woman and her sleep [Show Less]