NURSING NU265 NUR2 Maternal Child Health Exam 2 Review condensed
NURSING NU265 NUR2
Maternal Child Health Exam 2
Review condensed
Symptoms of Early
... [Show More] Labor: (Term Birth = 39 weeks)
* Excited Mother, irritable related to answering multiple questions & about contractions.
* Mothers pulse will be 100 BPM (choose answer TWICE in the select all that apply question)
Corticosteroid Therapy: only treatment shown to improve fetal survival (during preterm labor 24-34)
Benefits: decrease in intraventricular hemorrhage, respiratory distress syndrome and mortality
* betamethasone - 12 mg IM every 24 hours for two days
* dexamethasone -6 mg IM every 12 hours for two days.
** BOTH Meds help Baby’s Lungs Mature (watch for distractions in question)
Assessment of the preterm client : Obtain UA & Culture and sensitivity if indicated by leukocytosis
Preterm Rupture of Membranes (PROM): Rupture of membranes b4 37 weeks.
What to do: Doctor should perform a speculum exam and check for dilation/effacement
AVOID: digital exams bcuz they have been proven to increase morbidity & mortality
* avoid prolonging delivery when PROM occurs between 34+ weeks
Unborn baby w/pulmonary maturity (32-34 weeks) - go to hospital where care for pre-mature neonates is good and
induce labor & perform an amniocentesis. Prolonging pregnancy increases risk for: maternal amnionitis, umbilical cord
compression, prolonged hospitalization and neonatal infection.
* Delivery prior to 32 weeks has a high mortality rate.
* PROM occurring before 24 weeks = 6-7 days till delivery & many long term effects on the infant.
Antibiotics during PROM: reduces neonatal infections & prolong the latent period.
Exam question: (exam question will be what you WON’T do)
You are reviewing orders for a PROM, and you understand that you ARE going to do the following:
* Monitor fetal heartrate
* administer antibiotics
* monitor vital signs
* SPECULUM exam
* Nurse will NOT use Hands (only done in a vaginal exam)
Determine if able to complete a fetal fibronectin test (FFN)
1. NO SEX in the last 24 hours
2. No rupture of membranes.
3. The fetal fibronectin test is a predictor test of delivery in the next two weeks.
* Sperm contains fetal fibronectin and would give a false positive result.
* Do this test from the weeks 24 to 34 weeks of pregnancy.
* A negative test is desired- no fetal fibronectin is found and pregnancy will continue for two more weeks.
Determine if amniosure test should be done - checks for ruptured membranes.
* Negative means no rupture of membranes.
* Positive result means the bag of water is not intact.
Rule out bleeding: Place on continuous fetal monitoring.
* A non-stress test -the determination of the fetal heart rate over a 20-40 minute period.
* The fetal heart rate should accelerate by 15 beats and this acceleration should last 15 seconds, at least two
times in a 20 minute time frame.2
NON REACTIVE test is no acceleration of 15X15 in 40 minutes-(40 min. is considered babies normal sleep cycle)
If delivery is obvious, contractions are present and strong, membranes ruptured or cervix dilating the use of steroids
may be needed for the fetus.
Preeclampsia (BLOOD PRESSURE Disorder) symptoms: occurs after 20 weeks (3rd trimester).
* If it occurs prior to 32 weeks, it is called early-onset preeclampsia
* visual changes, epigastric pain, nausea and vomiting
* Proteinuria (abnormal amount of protein in the urine)
* Worsening condition of the mother = “severe features” - #1 problem is LOW PLATELETS
Severe Preeclampsia Management:
* Corticosteroids - helps baby’s lungs mature
* Magnesium sulfate - reduces blood pressure & prevents seizures.
Exam Question: A pregnant mother is receiving Magnesium Sulfate for her BP and is in labor. She now wants an
epideral. What would you need to think about when a patient wants an epidural?
* Know platelets (bcuz epidurals can cause bleeding) – if platelets are low, DO NOT give epidural
* platelets < 90,000 are LOW (100,000 is considered a low normal)
Risks for MOM w/Preeclampsia: increased risk later in life for cardiovascular disease, kidney disease, HA, Stroke, HTN,
seizures in a condition called E-clampsia, which can also lead to HELLP syndrome.
HELLP Syndrome: Hemolysis – elevated liver enzymes & low platelet count. RBCs are damaged/destroyed, clotting is
impaired & internal bleeding from liver causing chest and abdominal pain. Can cause death in to Mom or have lifelong
health problems.
Blood test for preeclampsia would include: liver functions studies, uric acid level, UA - protein.
Possible causes of Preeclampsia: diabetes mellitus, thrombophilia, lupus, had invitro-fertilization
Chronic Hypertension: High BP present b4 pregnancy or occurs in the first half of pregnancy - <20 weeks.
How its managed: Ultrasound exams - in the 3d trimester
Gestational Hypertension: High BP that occurs in the 2nd half - >20 weeks (usually goes away after pregnancy)
Problems from Hypertension in pregnancy: (Hyperventilating is NOT an emergency)
* Fetal growth restriction
* Preeclampsia
* Preterm delivery
* Placental Abruption – detachment of placenta from the wall of uterus (medical emergency)
* C-Section delivery
Place on continuous fetal monitoring. A non-stress test to determine fetal heart rate over a 20-40 minute period. The
fetal heart rate should accelerate by 15 beats and this acceleration should last 15 seconds
Tachysystole contractions - too many contractions (Most common from PITOCIN/OXYTOCIN admin)
* > 5 contractions in a 10 minutes, painful contractions.
HYPER-TONIC –Too strong a [Show Less]