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NUR2633 Final Exam Study Guide Maternal Child Health Nursing, Exams of Cell Biology

DeVry University - ArizonaCell Biology

A study guide for the final exam of the Maternal Child Health Nursing course. It covers topics related to pregnancy, including trimesters, tests, obstetrical issues, anemia, hypertension, preeclampsia, pre-term labor, and stages of labor. The guide provides definitions, signs and symptoms, treatment modalities, and nursing interventions for each topic. It also includes non-pharmacological and pharmacological methods for dysmenorrhea. useful for students preparing for the final exam or studying maternal child health nursing.

Typology: Exams

2023/2024

Available from 10/07/2023

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NUR2633 Final Exam Study Guide Maternal Child Health Nursing
1st Trimester: 0-13 weeks
2nd Trimester: 14-26 weeks
3rd Trimester: 27-40 weeks
Test GBS (group B strep) @ 36 weeks
Non-stress test measures HR baseline, variability, accelerations, decelerations, and cervical activity
Biophysical Profile for anybody with poor non-stress test results: amniotic fluid index, fetal movement, reflexes, and
breathing activity.
Amniocentesis is part of quad screening. Performed at 16 weeks
1. Dysmenorrhea
a. Dysmenorrhea – painful menses or painful cramps during period; common complaint among women
b. Non-pharmacological methods
i. No caffeine, improve diet, exercise, increase calcium, no alcohol
ii. Rest, deep breathing, relaxation, heat, increase fluids
c. Pharmacological – NSAIDS (are antiprostaglandins)
i. Motrin, naproxen, Aleve, Ibuprofen, Advil
2. Obstetrical issues – pregnancy risks - Know Naegle’s Rule – to establish gestational age
a. Pregnancy Risks
i. Old Age; obesity; smoking; alcohol use; drug use
ii. Diabetes
1. Perfusion issues
2. Large babies – polyhydramnios?
iii. Hypertension
1. Perfusion issues
b. Obstetrical Issues
i. IUGR
1. IUGR baby is small and fundal height not meeting gestational age; oligohydramnios? If
so, check renal function
ii. Macrosomia
1. Baby has large trunk; could lead to birth injuries such as shoulder dystocia
iii. Polyhydramnios
1. Is mom diabetic? If there is not enough fluid, look at fetal renal issues
iv. Placenta Previa
v. Abruption placenta
vi. Gestational diabetes
vii. Placental separation
c. Naegele’s Rule
i. Plus 7 days minus 3 months from LMP
ii. If early and not measuring properly, may be wrong date
d. Once baby is conceived, critical period is 15-60 days; 8 weeks most critical up to 12 weeks
e. Do not worry about bleeding before 20 weeks, it’s not viable and no meds
f. At 16 weeks, heart tones 110-160
g. Earliest heart tones with Doppler 10-12 months
3. Poor nutrition, drugs, HTN, DM are all issues of perfusion – what will the fetal result be.
a. Normal fundal heigh is plus or minus 2 cm
4. Anemia becomes a problem in pregnancy – can you discuss the maternal and fetal risks
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NUR2633 Final Exam Study Guide Maternal Child Health Nursing

1 st^ Trimester: 0-13 weeks 2 nd^ Trimester: 14 - 26 weeks 3 rd^ Trimester: 27 - 40 weeks Test GBS (group B strep) @ 36 weeks Non-stress test measures HR baseline, variability, accelerations, decelerations, and cervical activity Biophysical Profile for anybody with poor non-stress test results: amniotic fluid index, fetal movement, reflexes, and breathing activity. Amniocentesis is part of quad screening. Performed at 16 weeks

  1. Dysmenorrhea a. Dysmenorrhea – painful menses or painful cramps during period; common complaint among women b. Non-pharmacological methods i. No caffeine, improve diet, exercise, increase calcium, no alcohol ii. Rest, deep breathing, relaxation, heat, increase fluids c. Pharmacological – NSAIDS (are antiprostaglandins) i. Motrin, naproxen, Aleve, Ibuprofen, Advil
  2. Obstetrical issues – pregnancy risks - Know Naegle’s Rule – to establish gestational age a. Pregnancy Risks i. Old Age; obesity; smoking; alcohol use; drug use ii. Diabetes
  3. Perfusion issues
  4. Large babies – polyhydramnios? iii. Hypertension
  5. Perfusion issues b. Obstetrical Issues i. IUGR 1. IUGR baby is small and fundal height not meeting gestational age; oligohydramnios? If so, check renal function ii. Macrosomia
  6. Baby has large trunk; could lead to birth injuries such as shoulder dystocia iii. Polyhydramnios
  7. Is mom diabetic? If there is not enough fluid, look at fetal renal issues iv. Placenta Previa v. Abruption placenta vi. Gestational diabetes vii. Placental separation c. Naegele’s Rule i. Plus 7 days minus 3 months from LMP ii. If early and not measuring properly, may be wrong date d. Once baby is conceived, critical period is 15 - 60 days; 8 weeks most critical up to 12 weeks e. Do not worry about bleeding before 20 weeks, it’s not viable and no meds f. At 16 weeks, heart tones 110 - 160 g. Earliest heart tones with Doppler 10 - 12 months
  8. Poor nutrition, drugs, HTN, DM are all issues of perfusion – what will the fetal result be. a. Normal fundal heigh is plus or minus 2 cm
  9. Anemia becomes a problem in pregnancy – can you discuss the maternal and fetal risks

a. Iron deficiency anemia i. Prenatal vitamins, iron supplements, folic acids ii. Most prenatal vitamins have everthing but do nutrition assessment on pt; some patients don’t eat a well-balanced diet; explain caloric need to patient (300+ calories per day during pregnancy) due to BMR increasing b. Physiological anemia starts to become problem around 2 - 3 trimester because fluid increases and RBCs cannot keep up with production (they are being diluted) i. Mom is anemic baby poor oxygenation ii. Hgb levels at 10 to intervene iii. Change diet, encourage greens and raisins; nutritional means are better than supplements

  1. Hypertension – preeclampsia has specific symptoms – please know these as well as treatment modalities and nursing interventions – keep In mind Magnesium Sulfate, nursing interventions a. Preeclampsia – only happens in pregnancy, systemic tension, protein in urine makes preeclampsia different from hypertension; HTN is byproduct of preeclampsia b. Biggest risk is seizures; if mom is seizing hypoxia to fetus; 20% of HTN women have preeclampsia i. Clinical Manifestations 1. Symptoms appear after 20 weeks of gestation 2. Proteinuria , headache, visual changes after 24 weeks, edema in hands and face, epigastric pain, bleeding gums ii. Interventions
  2. Fetal monitor, bedrest left side, IV fluids, seizure precautions, DTRs, strict I&O with foley, vital signs hourly
  3. Prepare for delivery of fetus
  4. Pay attention to kidneys, lungs, heart (fluid in heart cause poor gas exchange), and brain
  5. Medications a. Magnesium Sulfate i. 4 g loading dose, 2 g maintenance dose ii. Relaxes muscles and prevents seizures iii. Smooth muscle relaxed to help with better perfusion; blood pressure comes down; vasodilation iv. Listen to lungs q 1 hr b. Betamethasone i. Helps baby’s lungs develop; 24 - 34 weeks
  6. Pre- term labor – define it; signs and symptoms, treatment modalities and nursing interventions. a. Definitions i. Labor = regular uterine contractions that causes cervical change ii. Pre-term Labor = regular uterine contractions between 20 - 37 weeks causing cervical change b. S/S i. Gestation of 20 - 37 weeks ii. 4 contractions every 20 minutes or 8 in 1 hr iii. Cervical effacement of 80% or more iv. Cervical dilation more than 1 cm or change in dilation c. Screening i. Ultrasound for cervical length; check for infection; UA; Look at anything that could make uterus contract such as full bladder, infection, or sex d. Interventions i. Position on left side; frequently assess vitals; assess for chest pain & SOB; assess for DTR; assess output q 1 hr; limit fluids to 2500 mL per day; provide psychosocial support ii. Medications
  7. Magnesium Sulfate – stops contractions by relaxing muscle in uterus

syndrome and or elevated AFP is 2.5 times greater than average for the number of gestational weeks

  1. Amniotic fluid surrounds the baby and has 5 functions – oligiohydramnios means? Polyhydramnios- what are you thinking? a. Amniotic fluid – cushions baby, cushions chord, temp control, keep lungs from sticking together i. Oligohydramnios decreased amniotic fluid ii. Polyhydramnios increased amniotic fluid
  2. Gestational diabetes iii. Amniotic fluid function
  3. Protection
  4. Cushions
  5. Thermoregulation
  6. Free movement
  7. Essential for fetal lung development
  8. Essential for renal development
  9. It is all about the placenta and perfusion – how do promote perfusion to the placenta, and what can interfere? (any disease or substance that interferes with vascular perfusion: HTN, DM, smoking, drugs, poor nutrition, etc.) a. Promote perfusion i. Rest ii. Fluid iii. Nutrition iv. Left side b. What can interfere? i. Drugs ii. Alcohol iii. Smoking iv. Diabetes v. Poor nutrition
  10. Know fetal heart rate monitoring – 5 parts and what does each tell you.(ie: accelerations are always positive, healthy babies) a. Variable cord compression b. Early head compression c. Acceleration okay d. Late poor placental perfusion e. Minimal variability may be dehydrated, meconium i. Give fluids, place on left side, and administer O f. On fetal monitor and pt having variable and prolong decal – turn to left side, O2 fluids, stop Pitocin, document
  11. know Normal Fetal heart rate, when movement occurs, and when you can palpate fundal height and begin measuring with a tape measure. a. Normal fetal heart rate 110 - 160 bpm b. Palpate fundal height 12 weeks c. Measure with tape measure 20 weeks and +
  12. If there is a non reassuring Fetal Heart rate – what are the nursing interventions? a. Place patient on left side b. Give 8 - 10 L O2 via face mask c. IV fluids d. Discontinue Pitocin
  13. Epidural anesthesia is common place, what needs to be completed before an epidural can be placed? What are the risks to mother and then to baby with epidural. a. Risks i. Mom hypotension
  1. Reposition mom, turn off Pitocin, IV fluids ii. Baby bradycardia & decal b. Needs i. Order ii. Consent iii. IV in place for fluid bolus iv. CBC; platelets v. 1 liter of fluids vi. Correct position vii. Tell her she has to sit quietly viii. Becomes fall risk and safety risk – watch her legs ix. Make sure bladder is empty during labor because it displaces uterus and may hold baby’s head up – failure to distend x. Once anesthesia is in place, put her supine with bump under left hip
  2. Labor is a progression – we recognize change with behavioral and physiological changes. Vaginal exams are means to measure progress – do you understand what you are examining and what it means? Example – 3cm, 90%, - 2 ( what does this mean) a. Dilation b. Effacement c. Station
  3. Know the Stages and phases of labor – recognize some of the characteristics and what we would know with a vaginal exam. What nursing interventions should occur? a. Phases of Labor i. Latent-contractions
  4. No time frame
  5. Mom is excited, scared, chatty
  6. Lightening
  7. 0 - 3 cm dilation
  8. Longest phase
  9. Bloody show ii. Active 4 - 7 cm
  10. 4 - 6 hour timeframe
  11. 1cm per hour
  12. Mom is feeling fear
  13. Best time for pain management
  14. Hyperventilation breath with them, paper bag, deep breathing
  15. Give STADOL at peak of contractions
  16. Antidote for Demerol
  17. Cord compression reposition mom iii. Transition – 8 - 10 cm
  18. 30 min – 2 hr timeframe
  19. I need to push
  20. Pressure early decels iv. Stages of Labor v. Recovery
  21. Risk for hemorrhage open Pitocin up, fundal massage a. 2 hours b. Assess closely for bleeding c. Massage uterus d. Not firm, add Pitocin i. Do not titrate Pitocin after baby is born, just open it up so that uterus

g. Cytotex can also be given rectal medication h. Uterus should be at umbilicus and rock hard i. Assessing post delivery – manage bleeding and lochia, pain , can she void, comfort support, check fundus- should be at umbilicus, LOC, vitals, make sure she is responding; be sure she can ambulate; allow anesthesia to wear off and get to bathroom and void vi. Uterine atony – fundal massage

  1. Full bladder
  2. Infection
  3. Over distended uterus
  4. polyhydramnios
  5. When labor is not progressing what are some of the non – pharmacological and pharmacological means to make a difference. a. Non-pharmacological i. Position changes ii. Get up and move iii. Birthing ball iv. Hydration v. Break the water – amniotomy b. Pharmacological i. Pitocin – titrate very carefully c. If unable to progress, C-section is option
  6. Delivery of the baby and delivery of the placenta – what are the risks? a. Delivery of placenta i. Hemorrhage
  7. Fundal massage, Pitocin ii. Delivery of baby
  8. Shoulder dystocia
  9. IUGR, causes, risks, how do you recognize this in the antepartum period? a. First seen with fundal measurements i. Less than fundal height for gestational age b. Risks i. Low birth weight c. How to recognize? i. Small fundal height
  10. What are the signs of placental separation - risks and nursing interventions? a. Signs i. Gush of blood ii. Cord lengthening iii. Urge to push iv. Globular uterus (contracted) b. Risks i. Hypoxia (baby) ii. Hemorrhage c. Interventions i. Fundal massage
  11. Postpartum risks – how do we intervene if a patient has a postpartum hemorrhage – the initial response? a. Fundal massage
  12. Newborn assessment – what is the first assessment? Then? Know APGAR…. And thermoregulation and the prevention of cold stress. a. First assessment respirations- AIRWAY b. APGAR

c. Thermoregulation 2 nd^ thing to check i. Cover babies head with a hat to keep warm ii. Trying to prevent hypothermia and cold stress – could cause hypoxia

  1. How do we keep babies safe in the hospital setting? a. ID anklets and on arms b. Compare ID on baby to ID on mom c. Security on alarm tags d. Make sure if baby is transported, use a crib e. Do not give away baby to anyone without the ID tag
  2. Physiological jaundice is common – how do you recognize this, the most common cause, and how do we handle Hyperbilirubinemia? What are the treatment modalities and risks of the treatment? a. Causes i. Immature livers ii. Trauma, bruising iii. Breastfeeding b. Clinical manifestations i. Do not occur until after the first 24 hours of life 1. Total serum bilirubin level is greater than 5 mg to 7 mg/dL 2. Yellowing of skin and sclera c. Treatment – if baby’s bilirubin is rising i. Feeding baby more often, increae fluid intake because bilirubin is excreted in bowel and urine ii. Phototherapy
  3. Protect EYES & GENITALS
  4. No oils or lotions
  5. Thermoregulation d. Circumcision i. Look out for bleeding, pain, make sure baby can void before leaving ii. Breast feeding, swaddling, distraction, non-nutritive sucking, sugar, sucrose
  6. NAS – neonatal abstinence syndrome – that which a baby endures during withdrawal – what are the signs of NAS? What is the management of the NAS? a. Signs i. Irritability, tremors, wakefulness, loose stools, poor weight gain, hypertonia, seizures, tachypnea, poor feeding pattern b. Management i. Chlorpromazine (thorazine) ii. Diazepam (Valium) iii. Paregoric (camphorated tincture of opium) iv. Phenobarbital (Luminal) v. Clonidine (Catapres) vi. Methadone treatment

c. Use simple terms d. Demonstrate if possible e. Use transitional objects f. Have parents bring something familiar from home

  1. Pain management for children – both pharm and non- pharm management
  2. Know Erikson’s theory and some of the characteristics of each group. Provide education regarding the unique characteristics that you find at each age. Keep in mind the challenges of hospitalization on the pediatric patient.
  3. Discipline and limit setting – what is appropriate. Know families – and how they cope with stress – how do children cope with stress?
  4. Medication administration to children – lets discuss oral meds, IM, IV, Subq. Otic, ophthalmic,
  5. What is the role of the child life specialist?
  6. Neurological – seizures and LOC – using Glascow coma scare – remember airway is always first. Care of the child during and after seizure.
  7. Autism
  8. ICP signs and some causes?
  9. Respiratory – croup syndromes, risks, how do we manage? Use only cool mist vaporizers due to risk of burns. Rest is promoted, some medications? Know these. Surgical interventions and sign to observe for?
  10. Why do children have more Respiratory infections?
  11. Cardiac – nursing interventions? Rest? And circulation – know the care of cardiac Catheter. Children admitted with Congestive heart failure – nursing interventions, management.
  12. Know Drugs usually seen in cardiac care – digoxin, Lasix, also steroids, as well as all obstetrical drugs for antepartum care, postpartum issues.
  13. Endocrine system – diabetes what is some of the symptoms? How is it managed?
  14. GI system – diarrhea, dehydration, constipation – recognize symptoms of each and management
  15. Renal – concern failure – what type of dialysis? Common urinary issues, presentations, causes, treatment.
  16. MS system: recognize care of a sprain vs fracture – then think through all the needs of the immobilized child. And why, and what are the nursing interventions? Difference between sprains/ fractures and education for both.
  17. Immunocompromised or suppressed children – what are the risks? How do we prevent risks?
  18. Blood issues – sickle cell anemia, iron deficiency anemia, hemophilia – know symptoms and priority needs and management.
  19. Know how to manage blood administration –
  20. Cancer care – we move from curative to palliative care – what are some of the goals of palliative care? These children may be immunocompromised – or immunosuppressed – how do we manage?
  21. Chemo therapy has risks and side effects – name them and note nursing management of each
  22. Grieving families – stages of grieve and how do we respond to family needs?
  23. Pre and post-operative care of the child with any surgery and then specific signs to watch for in respiratory issues, throat surgery, abdominal surgery, extremities, head. There are some similarities and specific needs of each.
  24. Forms of child abuse – and your Legal responses of a child maltreatment.
  25. Skin – each age has unique skin challenges – know them, how to treat and the risks. Burns are specifically difficult for children - think holistic approach.
  26. You are managed to learn more than you think…see what you know before opening a book.