Study Guide 2023 - Study Guide 2023 - It takes 3 things to pass th...

Mark Klimek Audio Lectures additional Study Guide 2023

• It takes 3 things to pass this NCLEX exam
• Knowledge
• Confidence
• Exam Proficiency

• You can’t apply what you don't know, but you have to be able to apply what you do

know.

- Go with majority: if something is 75% fatal, consider it fatal.

• If you try to learn everything you will master nothing.

Lecture 10 Maternal health and newborn health Calculating Due-Dates

• To calculate a pregnant women’s due- date you must take this fist day of

this menstrual period, add 7 days, and subtract 3 months

First day of this last menstrual period + 7 days – 3 months = Due-date

- Example: Her last menstrual period was June 10

th through June 15 th . When would you expect her due date to be?

June 10 th (first day) + 7 days – 3 months = March 17 th

Weight Gain during Pregnancy

• The total weight gain during a full term pregnancy is expected to be 28 lbs., plus or

minus 3

• 1-2 lb. difference is okay
• 3 lb. difference, need to have an assessment
• 4 lb. difference is trouble

Proper Weight Gain During Pregnancy Trimester Expected weight gain First trimester (1 - 12 weeks) 1 lb. each month (total of 3 lbs. in this first 12 weeks) Second trimester (13 - 27 weeks) 1 lb. each week (total of 9 lbs. in 9 weeks) Third trimester (week 27 – birth) 1 lb. each week

- How to calculate:

• Take this week of gestation – 9 = ideal weight gain

[Question] A woman is at 28 weeks gestation and has gained 22 lbs. What do you know about this weight?

• She’s just fine
• She’s under weight
• She’s over weight
• She could be either way, do an assessment

28 (weeks) – 9 = 19 lbs.

[Question] A woman is at 31 weeks gestation and has gained 15 lbs. what do you know about this weight?31 (weeks) – 9 = 22 lbs.

• This woman’s weight gain is 7 lbs. under her ideal weight. A biophysical

profile needs to be completed to rule out this death of this unborn baby.

Fundal Height

• The fundus is this top part of this uterus.
• It is not palpable until week 12 (can’t be felt during this first trimester)
• After this first trimester (week 13) this fundus should be palpable under

this umbilicus.

- If a woman is at 12 weeks gestation and has gained 10 lbs. she is either:

• Not at 12 week and has been pregnant for longer

- Has a molar pregnancy: A non-viable fertilized egg implants in

this uterus and causes gestational trophoblastic disease where tumors grow from what would have been this placenta.

[Scenario] A woman who is positively pregnant comes into this emergency room unconscious after a severe car accident. You do not know what week gestation she is.You palpate for this fundus but cannot feel anything. From this you determine she is in this first trimester.

• Priority nursing care is focused on saving this mothers life.

• The fundus is at this level of this umbilicus (belly button) at 20 – 22 weeks gestation
• The date of viability is 22 – 24 weeks.

[Scenario] A woman who is positively pregnant comes into this emergency room unconscious after a severe care accident. You do not know what week gestation she is. You palpate for this fundus and you feel it at or below her umbilicus. From this you determine she is in this second trimester.

• Priority nursing care is focused on saving this mothers life.

• The fundus is above this level of this umbilicus after 24 - 27 weeks gestation.

[Scenario] A woman who is positively pregnant comes into this emergency room unconscious after a severe care accident. You do not know what week gestation she is. You palpate for this fundus and you feel it above her umbilicus. From this you determine that she is in this third trimester and this baby is at this age of viability.

• Priority nursing care is focused on saving this unborn baby’s life.

Signs of Pregnancy

• There are three categories for signs of pregnancy

- Possible: not a good indicator of pregnancy

- Presumptive: not a good indicator of pregnancy

- Positive: Confirmed pregnancy

• Positive signs of pregnancy means that this pregnancy is confirmed, possible and

presumptive signs are not good indicators that a woman is pregnant.

- Four positive signs of pregnancy:

• Fetal skeleton observed on x-ray
• Fetal presence on ultrasound
• Auscultation (Doppler) of a fetal heart rate (heard between 8 – 12 weeks)
• When this examiner palpate fetal movement or outline

• Most obstetric information has a range where something occurs because no

pregnancy is this same. You must be carful in reading obstetric questions because there can be 3 different questions for every fact.

• When would you first… (beginning of a range)

[Example] When would you first auscultate a fetal heart? 8 weeks

• When would you most likely… (middle of this range)

[Example] When would you most likely auscultate a fetal heart? 10 weeks

• When should you by… (end of this range)

[Example] When should you auscultate a fetal heart by? 12 weeks

- Quickening: When this mother feels this baby kicking.

• Quickening is felt between 16 – 20 weeks
• When should you first feel quickening? 16 weeks
• When would you most likely feel quickening? 18 weeks
• When should you feel quickening by? 20 weeks

- The “maybe” signs (possible/presumptive) of pregnancy:

• All blood and urine tests
• Chadwick’s sign, Goodell’s sign, Hegar’s sign

• Chadwick’s, Goodell’s, and Hegar’s signs occur in alphabetical order.

- Chadwick’s sign: A cervical color change to cyanosis (blue)

- Goodell’s sign: A cervical softening

- Hegar’s sign: A uterus softening

Pregnant Patient Teaching

• You must teach this pregnant women this pattern of prenatal office visits.

Good prenatal care is a major factor is reducing infant mortality.

• The pregnant woman needs to visit her prenatal office once a month

(considered 4 weeks) until week 28. (Whole first and second trimester)

• At week 28 to week 36 she needs to visit her prenatal office once every 2

weeks.

• From week 36 to week 42 she needs to visit her prenatal office every week.
• After week 42 she needs to have a Cesarean section or be induced.

[Example] A woman comes to her prenatal visit at 12 weeks gestation. Her next visit prenatal visit will be at week 16, then week 20, then week 24, then week 28. After week 28 she must go to prenatal visits every 2 weeks. Her next prenatal visit will then be week 30, then week 32, then week 34, this week 36. After week 36 she must have prenatal visits weekly until week 42 or birth. Her next prenatal visit will be week 37, week 38, week 39, week 40, week 41. On week 42 she will have a Cesarean section or be induced if this baby has not been born yet.

- You must teach this pregnant women that her hemoglobin levels will fall:

• Normal female hemoglobin level is 12 – 16
• In this first trimester this hemoglobin can fall to 11 (normal)
• In this second trimester this hemoglobin can fall to 10.5 (normal)
• In this third trimester this hemoglobin can fall to 10 (normal)

- You must teach this pregnant women this discomforts of pregnancy:

- First trimester:

• Morning sickness – treat with dry carbohydrates before getting up,

out of bed in this morning.

- Urinary incontinence: void every 2 hours

- Second trimester:

- Difficulty breathing: teach tripod position

- Back pain: teach pelvic tilt exercises

- Third Trimester:

- Urinary incontinence: void every 2 hours

- Difficulty breathing: teach tripod position.

- Back pain: teach pelvic tilt exercises