NUR 2513 Maternal Child Final Exam with

NUR 2513 / Maternal Child Final Exam with NCLEX questions Dysmenorrhea - a common complaint with women - what are the non- pharmacological and pharmacological treatments.(ANS - Painful periods. Heating pad, rest, birth control, increase fluids, decrease red meats, increase calcium, decrease drug or alcohol, Nsaids (taken consistently), folic acid increase Affects the menstrual cycle (ANS - STRESS, drug use, overweight, pregnancy, medications, hormones Naegele's rule (ANS - The rule estimates the expected date of delivery (EDD) by adding a year, subtracting three months, and adding seven days to the origin of gestational age.Risks to pregnancy (ANS - smoking, alcohol, obesity, diabetes, drug use, HTN, poor nutrition Pregnancy risks that lead to poor perfusion may cause (ANS - small baby IUGR (identified by smaller fundus) Diabetics/Uncontrolled sugars may have (ANS - macrocosmic babies, large fundal height, hypoglycemic baby after birth, shoulder dystocia, non-mature lungs from insulin resistance Fetal Assessment (ANS - heart tones, movement, fundal height Heart tones audible by Doppler at (ANS - 10-12 weeks 1 / 4

Fundal height palpable at 12-14 weeks (ANS - pubis symphysis Fundal height palpable at 20 weeks (ANS - umbilicus Fetal movement to mother is felt at (ANS - 16-18 weeks for multi or 18-20 for prima What is responsible for providing gas exchange to a fetus (ANS - the placenta Anemia becomes a problem in pregnancy - can you discuss the maternal and fetal risks (ANS - Low hem = low oxygen = poor perfusion = smaller babies Iron supplement = constipation = fix with increase fluids and fibers and exercise Hyper emesis gravid (ANS - excessive vomiting that leads to electrolyte imbalances. HYDRATION is vital. IV fluids and antiemetic if can't keep anything down.Hypertension = preeclampsia

(ANS –

Subjective = headache, epigastric pain, visual changes, bloated

• Objective = edema, high BP, proteinuria
• Interventions = bed rest, dim lights, mag sulfate 4gm bolus and 2gm

maintenance, fetal heart monitoring, laying on left side, monitor for respiratory depression/check urine (increased urine with mag bc relaxes vessels to organs), monitor LOC, hourly vitals

• 32 week delivery = give steroids (betamethasone) for lungs in fetus

Pre term labor - define it, signs and symptoms, treatment modalities and nursing interventions.

(ANS 2 / 4

• S+S = pelvic pressure, baby dropped, cramps or contractions, lower back pain,

increased discharge, increased urine output Interventions = Fundal check. Fetal heart monitoring. GIVE FLUIDS. Still contracting = possible infection/uti so get UA and treat with IV antibiotics. FFN = test to determine preterm labor test. Check these 3 things before a vaginal exam.No cervical change = NOT labor Has cervical change = 2cm/80% effaced = aggressively treat by terbutaline (maternal tachycardia), then mag sulfate (4gm bolus/2 gm maintenance), no seizure precautions Diabetes Mellitus - Type 1, Type 2 and Gestational DM all have issues that are common to all and specific to each. Note the concerns specific to each, management and fetal surveillance

(ANS –

Type 1.) patient on insulin coming into pregnancy (a vascular disease) so we are concerned with circulation. on insulin in the first stage of pregnancy = multiple ANOMALIES. baby may not grow, CARDIAC problems, CNS problems, skeletal problems.will do a lot of ultrasounds and FETAL ECHO'S to monitor.most common defect for baby of someone with IDDM in pregnancy is a ventricular septal defect (hole between the 2 ventricles), and poor lung maturity Type 2.) Surveillance- Manage with diet only! Mom must keep sugars under control, then risks are minimal

Risks to baby: Minimal risks to baby unless insulin comes on board. As long as

sugars are under control and macrosomia isn't an issue then baby should be healthy! 3 / 4

Gestational.) *Optimal glycemic goals for GDM include a fasting venous plasma glucose concentration less than or equal to 95 mg/dL and a one-hour postprandial plasma glucose of less than or equal to 140 mg/dL. Blood glucose self-monitoring is recommended. Although diet and exercise are the mainstays of care for the woman with GDM, up to 20% will require insulin during pregnancy to maintain euglycemia. If fasting blood glucose levels exceed 105 mg/dL, insulin therapy is initiated.

*Risks to baby: As long as sugars are controlled, risks are minimal. Fetal

macrosomia and hypoglycemia are possible outcomes if mom doesn't control sugars. If insulin comes on board, then perfusion will be an issue and all concerns form IDDM will come in to play.Does a diabetic woman require more or less insulin in the first trimester?(ANS - less but needs increase over second and thrid trimester. *** daily kick counts are important to watch for fetal demise becuase this could happen very fast*** pregnant type 2 diabetics that aren't using insulin (ANS - there are no fetal abnormalities seen, try to control by diet Define Macrosomia - and what are the risks (ANS - A baby diagnosed with fetal macrosomia has a birth weight of more than 8 pounds, 13 ounces.Labor problems. Fetal macrosomia can cause a baby to become wedged in the birth canal, sustain birth injuries, or require the use of forceps or a vacuum device during delivery (operative vaginal delivery). Sometimes a C-section is needed.Genital tract lacerations. During childbirth, fetal macrosomia can cause a baby to injure the birth canal — such as by tearing vaginal tissues and the muscles between the vagina and the anus (perineal muscles).

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