-
Quickening, a presumptive sign of pregnancy, occurs between 16 and 19 weeks’
gestation.
- Ovulation
ceases during pregnancy.
- Any
vaginal bleeding during pregnancy should be considered a complication until
proven otherwise.
- To
estimate the date of delivery using Nägele’s rule, the nurse counts backward 3
months from the first day of the last menstrual period and then adds 7 days to
this date.
- At 12
weeks’ gestation, the fundus should be at the top of the symphysis pubis- If a
patient misses two consecutive menstrual periods while taking an oral
contraceptive, she should discontinue the contraceptive and take a pregnancy
test.
- If a
patient who is taking an oral contraceptive misses a dose, she should take the
pill as soon as she remembers or take two at the next scheduled interval and
continue with the normal schedule.
- If a
patient who is taking an oral contraceptive misses two consecutive doses, she
should double the dose for 2 days and then resume her normal schedule. She also
should use an additional birth control method for 1 week.
- Eclampsia
is the occurrence of seizures that aren’t caused by a cerebral disorder in a
patient who has pregnancy-induced hypertension.
- In
placenta previa, bleeding is painless and seldom fatal on the first occasion,
but it becomes heavier with each subsequent episode.
- Treatment
for abruptio placentae is usually immediate cesarean delivery.
- Drugs used
to treat withdrawal symptoms in neonates include phenobarbital (Luminal),
camphorated opium tincture (paregoric), and diazepam (Valium).
- Infants
with Down syndrome typically have marked hypotonia, floppiness, slanted eyes,
excess skin on the back of the neck, flattened bridge of the nose, flat facial
features, spadelike hands, short and broad feet, small male genitalia, absence
of Moro’s reflex, and a simian crease on the hands.
- The
failure rate of a contraceptive is determined by the experience of 100 women
for 1 year. It’s expressed as pregnancies per 100 woman-years.
- The
narrowest diameter of the pelvic inlet is the anteroposterior (diagonal
conjugate).
- The
chorion is the outermost extraembryonic membrane that gives rise to the
placenta.
- The corpus
luteum secretes large quantities of progesterone.
- From the 8th
week of gestation through delivery, the developing cells are known as a fetus.
- In an
incomplete abortion, the fetus is expelled, but parts of the placenta and
membrane remain in the uterus.
- The
circumference of a neonate’s head is normally 2 to 3 cm greater than the
circumference of the chest.
- After
administering magnesium sulfate to a pregnant patient for hypertension or
preterm labor, the nurse should monitor the respiratory rate and deep tendon
reflexes.
- During the
first hour after birth (the period of reactivity), the neonate is alert and
awake.
- When a
pregnant patient has undiagnosed vaginal bleeding, vaginal examination should
be avoided until ultrasonography rules out placenta previa.
- After
delivery, the first nursing action is to establish the neonate’s airway.
- Nursing
interventions for a patient with placenta previa include positioning the
patient on her left side for maximum fetal perfusion, monitoring fetal heart
tones, and administering I.V. fluids and oxygen, as ordered.
- The
specific gravity of a neonate’s urine is 1.003 to 1.030. A lower specific
gravity suggests overhydration; a higher one suggests dehydration.
- The
neonatal period extends from birth to day 28. It’s also called the first 4
weeks or first month of life.
- A woman
who is breast-feeding should rub a mild emollient cream or a few drops of
breast milk (or colostrum) on the nipples after each feeding. She should let
the breasts air-dry to prevent them from cracking.
-
Breast-feeding mothers should increase their fluid intake to 2½ to 3 qt (2,500
to 3,000 ml) daily.
- After
feeding an infant with a cleft lip or palate, the nurse should rinse the
infant’s mouth with sterile water.
- The nurse
instills erythromycin in a neonate’s eyes primarily to prevent blindness caused
by gonorrhea or chlamydia.
- Human
immunodeficiency virus (HIV) has been cultured in breast milk and can be
transmitted by an HIV-positive mother who breast-feeds her infant.
- A fever in
the first 24 hours postpartum is most likely caused by dehydration rather than
infection.
- Preterm
neonates or neonates who can’t maintain a skin temperature of at least 97.6° F
(36.4° C) should receive care in an incubator (Isolette) or a radiant warmer.
In a radiant warmer, a heat-sensitive probe taped to the neonate’s skin
activates the heater unit automatically to maintain the desired temperature.
- During
labor, the resting phase between contractions is at least 30 seconds.
- Lochia
rubra is the vaginal discharge of almost pure blood that occurs during the
first few days after childbirth.
- Lochia
serosa is the serous vaginal discharge that occurs 4 to 7 days after
childbirth.
- Lochia
alba is the vaginal discharge of decreased blood and increased leukocytes
that’s the final stage of lochia. It occurs 7 to 10 days after childbirth.
- Colostrum,
the precursor of milk, is the first secretion from the breasts after delivery.
- The length
of the uterus increases from 2½" (6.3 cm) before pregnancy to 12½"
(32 cm) at term.
- To
estimate the true conjugate (the smallest inlet measurement of the pelvis),
deduct 1.5 cm from the diagonal conjugate (usually 12 cm). A true conjugate of
10.5 cm enables the fetal head (usually 10 cm) to pass.
- The
smallest outlet measurement of the pelvis is the intertuberous diameter, which
is the transverse diameter between the ischial tuberosities.
- Electronic
fetal monitoring is used to assess fetal well-being during labor. If
compromised fetal status is suspected, fetal blood pH may be evaluated by
obtaining a scalp sample.
- In an
emergency delivery, enough pressure should be applied to the emerging fetus’s
head to guide the descent and prevent a rapid change in pressure within the
molded fetal skull.
- After
delivery, a multiparous woman is more susceptible to bleeding than a
primiparous woman because her uterine muscles may be overstretched and may not
contract efficiently.
- Neonates
who are delivered by cesarean birth have a higher incidence of respiratory
distress syndrome.
- The nurse
should suggest ambulation to a postpartum patient who has gas pain and
flatulence.
- Massaging
the uterus helps to stimulate contractions after the placenta is delivered.
- When
providing phototherapy to a neonate, the nurse should cover the neonate’s eyes
and genital area.
- The narcotic
antagonist naloxone (Narcan) may be given to a neonate to correct respiratory
depression caused by narcotic administration to the mother during labor.
- In a
neonate, symptoms of respiratory distress syndrome include expiratory grunting
or whining, sandpaper breath sounds, and seesaw retractions.
- Cerebral
palsy presents as asymmetrical movement, irritability, and excessive, feeble
crying in a long, thin infant.
- The nurse
should assess a breech-birth neonate for hydrocephalus, hematomas, fractures,
and other anomalies caused by birth trauma.
- When a
patient is admitted to the unit in active labor, the nurse’s first action is to
listen for fetal heart tones.
- In a
neonate, long, brittle fingernails are a sign of postmaturity.
-
Desquamation (skin peeling) is common in postmature neonates.
- A mother
should allow her infant to breast-feed until the infant is satisfied. The time
may vary from 5 to 20 minutes.
- Nitrazine
paper is used to test the pH of vaginal discharge to determine the presence of
amniotic fluid.
- A pregnant
patient normally gains 2 to 5 lb (1 to 2.5 kg) during the first trimester and
slightly less than 1 lb (0.5 kg) per week during the last two trimesters.
- Neonatal
jaundice in the first 24 hours after birth is known as pathological jaundice
and is a sign of erythroblastosis fetalis.
- A classic
difference between abruptio placentae and placenta previa is the degree of
pain. Abruptio placentae causes pain, whereas placenta previa causes painless
bleeding.
- Because a
major role of the placenta is to function as a fetal lung, any condition that
interrupts normal blood flow to or from the placenta increases fetal partial
pressure of arterial carbon dioxide and decreases fetal pH.
-
Precipitate labor lasts for approximately 3 hours and ends with delivery of the
neonate.
-
Methylergonovine (Methergine) is an oxytocic agent used to prevent and treat
postpartum hemorrhage caused by uterine atony or subinvolution.
- As
emergency treatment for excessive uterine bleeding, 0.2 mg of methylergonovine
(Methergine) is injected I.V. over 1 minute while the patient’s blood pressure
and uterine contractions are monitored.
- Braxton
Hicks contractions are usually felt in the abdomen and don’t cause cervical
change. True labor contractions are felt in the front of the abdomen and back
and lead to progressive cervical dilation and effacement.
- The
average birth weight of neonates born to mothers who smoke is 6 oz (170 g) less
than that of neonates born to nonsmoking mothers.
- Culdoscopy
is visualization of the pelvic organs through the posterior vaginal fornix.
- The nurse
should teach a pregnant vegetarian to obtain protein from alternative sources,
such as nuts, soybeans, and legumes.
- The nurse
should instruct a pregnant patient to take only prescribed prenatal vitamins
because over-the-counter high-potency vitamins may harm the fetus.
-
High-sodium foods can cause fluid retention, especially in pregnant patients.
- A pregnant
patient can avoid constipation and hemorrhoids by adding fiber to her diet.
- If a fetus
has late decelerations (a sign of fetal hypoxia), the nurse should instruct the
mother to lie on her left side and then administer 8 to 10 L of oxygen per
minute by mask or cannula. The nurse should notify the physician. The
side-lying position removes pressure on the inferior vena cava.
- Oxytocin
(Pitocin) promotes lactation and uterine contractions.
- Lanugo
covers the fetus’s body until about 20 weeks’ gestation. Then it begins to
disappear from the face, trunk, arms, and legs, in that order.
- In a
neonate, hypoglycemia causes temperature instability, hypotonia, jitteriness,
and seizures. Premature, postmature, small-for-gestational-age, and
large-for-gestational-age neonates are susceptible to this disorder.
- Neonates
typically need to consume 50 to 55 cal per pound of body weight daily.
- Because
oxytocin (Pitocin) stimulates powerful uterine contractions during labor, it
must be administered under close observation to help prevent maternal and fetal
distress.
- During
fetal heart rate monitoring, variable decelerations indicate compression or
prolapse of the umbilical cord.
-
Cytomegalovirus is the leading cause of congenital viral infection.
- Tocolytic
therapy is indicated in premature labor, but contraindicated in fetal death, fetal
distress, or severe hemorrhage.
- Through
ultrasonography, the biophysical profile assesses fetal well-being by measuring
fetal breathing movements, gross body movements, fetal tone, reactive fetal
heart rate (nonstress test), and qualitative amniotic fluid volume.
- A neonate
whose mother has diabetes should be assessed for hyperinsulinism.
- In a
patient with preeclampsia, epigastric pain is a late symptom and requires
immediate medical intervention.
- After a
stillbirth, the mother should be allowed to hold the neonate to help her come
to terms with the death.
- Molding is
the process by which the fetal head changes shape to facilitate movement
through the birth canal.
- If a woman
receives a spinal block before delivery, the nurse should monitor the patient’s
blood pressure closely.
- If a woman
suddenly becomes hypotensive during labor, the nurse should increase the
infusion rate of I.V. fluids as prescribed.
- The best
technique for assessing jaundice in a neonate is to blanch the tip of the nose
or the area just above the umbilicus.
- During
fetal heart monitoring, early deceleration is caused by compression of the head
during labor.
- After the
placenta is delivered, the nurse may add oxytocin (Pitocin) to the patient’s
I.V. solution, as prescribed, to promote postpartum involution of the uterus
and stimulate lactation.
- Pica is a
craving to eat nonfood items, such as dirt, crayons, chalk, glue, starch, or
hair. It may occur during pregnancy and can endanger the fetus.
- A pregnant
patient should take folic acid because this nutrient is required for rapid cell
division.
- A woman
who is taking clomiphene (Clomid) to induce ovulation should be informed of the
possibility of multiple births with this drug.
- If needed,
cervical suturing is usually done between 14 and 18 weeks’ gestation to
reinforce an incompetent cervix and maintain pregnancy. The suturing is
typically removed by 35 weeks’ gestation.
- During the
first trimester, a pregnant woman should avoid all drugs unless doing so would
adversely affect her health.
- Most drugs
that a breast-feeding mother takes appear in breast milk.
- The Food
and Drug Administration has established the following five categories of drugs
based on their potential for causing birth defects: A, no evidence of risk; B,
no risk found in animals, but no studies have been done in women; C, animal
studies have shown an adverse effect, but the drug may be beneficial to women
despite the potential risk; D, evidence of risk, but its benefits may outweigh
its risks; and X, fetal anomalies noted, and the risks clearly outweigh the
potential benefits.
- A patient
with a ruptured ectopic pregnancy commonly has sharp pain in the lower abdomen,
with spotting and cramping. She may have abdominal rigidity; rapid, shallow
respirations; tachycardia; and shock.
- A patient
with a ruptured ectopic pregnancy commonly has sharp pain in the lower abdomen,
with spotting and cramping. She may have abdominal rigidity; rapid, shallow
respirations; tachycardia; and shock.
- The
mechanics of delivery are engagement, descent and flexion, internal rotation,
extension, external rotation, restitution, and expulsion.
- A probable
sign of pregnancy, McDonald’s sign is characterized by an ease in flexing the
body of the uterus against the cervix.
- Amenorrhea
is a probable sign of pregnancy.
- A pregnant
woman’s partner should avoid introducing air into the vagina during oral sex
because of the possibility of air embolism.
- The
presence of human chorionic gonadotropin in the blood or urine is a probable
sign of pregnancy.
-
Radiography isn’t usually used in a pregnant woman because it may harm the
developing fetus. If radiography is essential, it should be performed only
after 36 weeks’ gestation.
- A pregnant
patient who has had rupture of the membranes or who is experiencing vaginal
bleeding shouldn’t engage in sexual intercourse.
- Milia may
occur as pinpoint spots over a neonate’s nose.
- The
duration of a contraction is timed from the moment that the uterine muscle
begins to tense to the moment that it reaches full relaxation. It’s measured in
seconds.
- The union
of a male and a female gamete produces a zygote, which divides into the
fertilized ovum.
- The first
menstrual flow is called menarche and may be anovulatory (infertile).
-
Spermatozoa (or their fragments) remain in the vagina for 72 hours after sexual
intercourse.
- Prolactin
stimulates and sustains milk production.
- Strabismus
is a normal finding in a neonate.
- A
postpartum patient may resume sexual intercourse after the perineal or uterine
wounds heal (usually within 4 weeks after delivery).
- A pregnant
staff member shouldn’t be assigned to work with a patient who has
cytomegalovirus infection because the virus can be transmitted to the fetus.
- Fetal
demise is death of the fetus after viability.
-
Respiratory distress syndrome develops in premature neonates because their
alveoli lack surfactant.
- The most
common method of inducing labor after artificial rupture of the membranes is
oxytocin (Pitocin) infusion.
- After the
amniotic membranes rupture, the initial nursing action is to assess the fetal
heart rate.
- The most
common reasons for cesarean birth are malpresentation, fetal distress,
cephalopelvic disproportion, pregnancy-induced hypertension, previous cesarean
birth, and inadequate progress in labor.
-
Amniocentesis increases the risk of spontaneous abortion, trauma to the fetus
or placenta, premature labor, infection, and Rh sensitization of the fetus.
- After
amniocentesis, abdominal cramping or spontaneous vaginal bleeding may indicate
complications.
- To prevent
her from developing Rh antibodies, an Rh-negative primigravida should receive
Rho(D) immune globulin (RhoGAM) after delivering an Rh-positive neonate.
- If a
pregnant patient’s test results are negative for glucose but positive for
acetone, the nurse should assess the patient’s diet for inadequate caloric
intake.
- If a
pregnant patient’s test results are negative for glucose but positive for
acetone, the nurse should assess the patient’s diet for inadequate caloric
intake.
- Rubella
infection in a pregnant patient, especially during the first trimester, can
lead to spontaneous abortion or stillbirth as well as fetal cardiac and other
birth defects.
- A pregnant
patient should take an iron supplement to help prevent anemia.
- Direct
antiglobulin (direct Coombs’) test is used to detect maternal antibodies
attached to red blood cells in the neonate.
- Nausea and
vomiting during the first trimester of pregnancy are caused by rising levels of
the hormone human chorionic gonadotropin.
- Before
discharging a patient who has had an abortion, the nurse should instruct her to
report bright red clots, bleeding that lasts longer than 7 days, or signs of
infection, such as a temperature of greater than 100° F (37.8° C),
foul-smelling vaginal discharge, severe uterine cramping, nausea, or vomiting.
- When
informed that a patient’s amniotic membrane has broken, the nurse should check
fetal heart tones and then maternal vital signs.
- The
duration of pregnancy averages 280 days, 40 weeks, 9 calendar months, or 10
lunar months.
- The
initial weight loss for a healthy neonate is 5% to 10% of birth weight.
- The normal
hemoglobin value in neonates is 17 to 20 g/dl.
- Crowning
is the appearance of the fetus’s head when its largest diameter is encircled by
the vulvovaginal ring.
- A
multipara is a woman who has had two or more pregnancies that progressed to
viability, regardless of whether the offspring were alive at birth.
- In a
pregnant patient, preeclampsia may progress to eclampsia, which is characterized
by seizures and may lead to coma.
- The Apgar
score is used to assess the neonate’s vital functions. It’s obtained at 1
minute and 5 minutes after delivery. The score is based on respiratory effort,
heart rate, muscle tone, reflex irritability, and color.
- Because of
the anti-insulin effects of placental hormones, insulin requirements increase
during the third trimester.
-
Gestational age can be estimated by ultrasound measurement of maternal
abdominal circumference, fetal femur length, and fetal head size. These
measurements are most accurate between 12 and 18 weeks’ gestation.
- Skeletal
system abnormalities and ventricular septal defects are the most common
disorders of infants who are born to diabetic women. The incidence of
congenital malformation is three times higher in these infants than in those
born to nondiabetic women.
- Skeletal
system abnormalities and ventricular septal defects are the most common
disorders of infants who are born to diabetic women. The incidence of congenital
malformation is three times higher in these infants than in those born to
nondiabetic women.
- The
patient with preeclampsia usually has puffiness around the eyes or edema in the
hands (for example, “I can’t put my wedding ring on.”).
- Kegel
exercises require contraction and relaxation of the perineal muscles. These
exercises help strengthen pelvic muscles and improve urine control in
postpartum patients.
- Symptoms
of postpartum depression range from mild postpartum blues to intense, suicidal,
depressive psychosis.
- The
preterm neonate may require gavage feedings because of a weak sucking reflex,
uncoordinated sucking, or respiratory distress.
- Acrocyanosis
(blueness and coolness of the arms and legs) is normal in neonates because of
their immature peripheral circulatory system.
- To prevent
ophthalmia neonatorum (a severe eye infection caused by maternal gonorrhea),
the nurse may administer one of three drugs, as prescribed, in the neonate’s
eyes: tetracycline, silver nitrate, or erythromycin.
- Neonatal
testing for phenylketonuria is mandatory in most states.
- The nurse
should place the neonate in a 30-degree Trendelenburg position to facilitate mucus
drainage.
- The nurse
may suction the neonate’s nose and mouth as needed with a bulb syringe or
suction trap.
- To prevent
heat loss, the nurse should place the neonate under a radiant warmer during
suctioning and initial delivery-room care, and then wrap the neonate in a
warmed blanket for transport to the nursery.
- The
umbilical cord normally has two arteries and one vein.
- When
providing care, the nurse should expose only one part of an infant’s body at a
time.
- Lightening
is settling of the fetal head into the brim of the pelvis.
- If the
neonate is stable, the mother should be allowed to breast-feed within the
neonate’s first hour of life.
- The nurse
should check the neonate’s temperature every 1 to 2 hours until it’s maintained
within normal limits.
- At birth,
a neonate normally weighs 5 to 9 lb (2 to 4 kg), measures 18" to 22"
(45.5 to 56 cm) in length, has a head circumference of 13½" to 14"
(34 to 35.5 cm), and has a chest circumference that’s 1" (2.5 cm) less
than the head circumference.
- In the
neonate, temperature normally ranges from 98° to 99° F (36.7° to 37.2° C),
apical pulse rate averages 120 to 160 beats/minute, and respirations are 40 to
60 breaths/minute.
- The
diamond-shaped anterior fontanel usually closes between ages 12 and 18 months.
The triangular posterior fontanel usually closes by age 2 months.
- In the
neonate, a straight spine is normal. A tuft of hair over the spine is an
abnormal finding.
- Prostaglandin
gel may be applied to the vagina or cervix to ripen an unfavorable cervix
before labor induction with oxytocin (Pitocin).
-
Supernumerary nipples are occasionally seen on neonates. They usually appear
along a line that runs from each axilla, through the normal nipple area, and to
the groin.
- Meconium
is a material that collects in the fetus’s intestines and forms the neonate’s
first feces, which are black and tarry.
- The
presence of meconium in the amniotic fluid during labor indicates possible
fetal distress and the need to evaluate the neonate for meconium aspiration.
- To assess
a neonate’s rooting reflex, the nurse touches a finger to the cheek or the
corner of the mouth. Normally, the neonate turns his head toward the stimulus,
opens his mouth, and searches for the stimulus.
- Harlequin
sign is present when a neonate who is lying on his side appears red on the
dependent side and pale on the upper side.
- Mongolian
spots can range from brown to blue. Their color depends on how close melanocytes
are to the surface of the skin. They most commonly appear as patches across the
sacrum, buttocks, and legs.
- Mongolian
spots are common in non-white infants and usually disappear by age 2 to 3
years.
- Vernix
caseosa is a cheeselike substance that covers and protects the fetus’s skin in
utero. It may be rubbed into the neonate’s skin or washed away in one or two
baths.
- Caput
succedaneum is edema that develops in and under the fetal scalp during labor
and delivery. It resolves spontaneously and presents no danger to the neonate.
The edema doesn’t cross the suture line.
- Nevus
flammeus, or port-wine stain, is a diffuse pink to dark bluish red lesion on a
neonate’s face or neck.
- The
Guthrie test (a screening test for phenylketonuria) is most reliable if it’s
done between the second and sixth days after birth and is performed after the
neonate has ingested protein.
- To assess
coordination of sucking and swallowing, the nurse should observe the neonate’s
first breast-feeding or sterile water bottle-feeding.
- To
establish a milk supply pattern, the mother should breast-feed her infant at
least every 4 hours. During the first month, she should breast-feed 8 to 12
times daily (demand feeding).
- To avoid
contact with blood and other body fluids, the nurse should wear gloves when
handling the neonate until after the first bath is given.
- If a
breast-fed infant is content, has good skin turgor, an adequate number of wet
diapers, and normal weight gain, the mother’s milk supply is assumed to be
adequate.
- In the
supine position, a pregnant patient’s enlarged uterus impairs venous return
from the lower half of the body to the heart, resulting in supine hypotensive
syndrome, or inferior vena cava syndrome.
- Tocolytic
agents used to treat preterm labor include terbutaline (Brethine), ritodrine
(Yutopar), and magnesium sulfate.
- A pregnant
woman who has hyperemesis gravidarum may require hospitalization to treat
dehydration and starvation.
-
Diaphragmatic hernia is one of the most urgent neonatal surgical emergencies.
By compressing and displacing the lungs and heart, this disorder can cause
respiratory distress shortly after birth.
- Common
complications of early pregnancy (up to 20 weeks’ gestation) include fetal loss
and serious threats to maternal health.
- Fetal
embodiment is a maternal developmental task that occurs in the second
trimester. During this stage, the mother may complain that she never gets to
sleep because the fetus always gives her a thump when she tries.
-
Visualization in pregnancy is a process in which the mother imagines what the
child she’s carrying is like and becomes acquainted with it.
- Hemodilution
of pregnancy is the increase in blood volume that occurs during pregnancy. The
increased volume consists of plasma and causes an imbalance between the ratio
of red blood cells to plasma and a resultant decrease in hematocrit.
- Mean
arterial pressure of greater than 100 mm Hg after 20 weeks of pregnancy is
considered hypertension.
- The
treatment for supine hypotension syndrome (a condition that sometimes occurs in
pregnancy) is to have the patient lie on her left side.
- A
contributing factor in dependent edema in the pregnant patient is the increase
of femoral venous pressure from 10 mm Hg (normal) to 18 mm Hg (high).
-
Hyperpigmentation of the pregnant patient’s face, formerly called chloasma and
now referred to as melasma, fades after delivery.
- The
hormone relaxin, which is secreted first by the corpus luteum and later by the
placenta, relaxes the connective tissue and cartilage of the symphysis pubis
and the sacroiliac joint to facilitate passage of the fetus during delivery.
-
Progesterone maintains the integrity of the pregnancy by inhibiting uterine
motility.
- Ladin’s
sign, an early indication of pregnancy, causes softening of a spot on the
anterior portion of the uterus, just above the uterocervical juncture.
- During
pregnancy, the abdominal line from the symphysis pubis to the umbilicus changes
from linea alba to linea nigra.
- In
neonates, cold stress affects the circulatory, regulatory, and respiratory
systems.
- Obstetric
data can be described by using the F/TPAL system:
o F/T:
Full-term delivery at 38 weeks or longer
o P: Preterm
delivery between 20 and 37 weeks
o A:
Abortion or loss of fetus before 20 weeks
o L: Number
of children living (if a child has died, further explanation is needed to clarify
the discrepancy in numbers).
- Parity
doesn’t refer to the number of infants delivered, only the number of
deliveries.
- Women who
are carrying more than one fetus should be encouraged to gain 35 to 45 lb (15.5
to 20.5 kg) during pregnancy.
- The recommended
amount of iron supplement for the pregnant patient is 30 to 60 mg daily.
- Drinking
six alcoholic beverages a day or a single episode of binge drinking in the
first trimester can cause fetal alcohol syndrome.
- Chorionic
villus sampling is performed at 8 to 12 weeks of pregnancy for early
identification of genetic defects.
- In
percutaneous umbilical blood sampling, a blood sample is obtained from the
umbilical cord to detect anemia, genetic defects, and blood incompatibility as
well as to assess the need for blood transfusions.
- The period
between contractions is referred to as the interval, or resting phase. During
this phase, the uterus and placenta fill with blood and allow for the exchange
of oxygen, carbon dioxide, and nutrients.
- In a
patient who has hypertonic contractions, the uterus doesn’t have an opportunity
to relax and there is no interval between contractions. As a result, the fetus
may experience hypoxia or rapid delivery may occur.
- Two qualities
of the myometrium are elasticity, which allows it to stretch yet maintain its
tone, and contractility, which allows it to shorten and lengthen in a
synchronized pattern.
- During
crowning, the presenting part of the fetus remains visible during the interval
between contractions.
- Uterine
atony is failure of the uterus to remain firmly contracted.
- The major
cause of uterine atony is a full bladder.
- If the
mother wishes to breast-feed, the neonate should be nursed as soon as possible
after delivery.
- A smacking
sound, milk dripping from the side of the mouth, and sucking noises all
indicate improper placement of the infant’s mouth over the nipple.
- Before
feeding is initiated, an infant should be burped to expel air from the stomach.
- Most
authorities strongly encourage the continuation of breast-feeding on both the
affected and the unaffected breast of patients with mastitis.
- Neonates
are nearsighted and focus on items that are held 10" to 12" (25 to
30.5 cm) away.
- In a
neonate, low-set ears are associated with chromosomal abnormalities such as
Down syndrome.
- Meconium
is usually passed in the first 24 hours; however, passage may take up to 72
hours.
- Boys who
are born with hypospadias shouldn’t be circumcised at birth because the
foreskin may be needed for constructive surgery.
- In the
neonate, the normal blood glucose level is 45 to 90 mg/dl.
- Hepatitis
B vaccine is usually given within 48 hours of birth.
- Hepatitis
B immune globulin is usually given within 12 hours of birth.
- HELLP
(hemolysis, elevated liver enzymes, and low platelets) syndrome is an unusual
variation of pregnancy-induced hypertension.
- Maternal
serum alpha-fetoprotein is detectable at 7 weeks of gestation and peaks in the
third trimester. High levels detected between the 16th and 18th weeks are
associated with neural tube defects. Low levels are associated with Down
syndrome.
- An arrest
of descent occurs when the fetus doesn’t descend through the pelvic cavity
during labor. It’s commonly associated with cephalopelvic disproportion, and
cesarean delivery may be required.
- A late
sign of preeclampsia is epigastric pain as a result of severe liver edema.
- In the
patient with preeclampsia, blood pressure returns to normal during the
puerperal period.
- To obtain
an estriol level, urine is collected for 24 hours.
- An estriol
level is used to assess fetal well-being and maternal renal functioning as well
as to monitor a pregnancy that’s complicated by diabetes.
- A pregnant
patient with vaginal bleeding shouldn’t have a pelvic examination.
- In the
early stages of pregnancy, the finding of glucose in the urine may be related
to the increased shunting of glucose to the developing placenta, without a
corresponding increase in the reabsorption capability of the kidneys.
- A patient
who has premature rupture of the membranes is at significant risk for infection
if labor doesn’t begin within 24 hours.
- Infants of
diabetic mothers are susceptible to macrosomia as a result of increased insulin
production in the fetus.
- To prevent
heat loss in the neonate, the nurse should bathe one part of his body at a time
and keep the rest of the body covered.
- A patient
who has a cesarean delivery is at greater risk for infection than the patient
who gives birth vaginally.
- The
occurrence of thrush in the neonate is probably caused by contact with the
organism during delivery through the birth canal.
- The nurse
should keep the sac of meningomyelocele moist with normal saline solution.
- If fundal
height is at least 2 cm less than expected, the cause may be growth
retardation, missed abortion, transverse lie, or false pregnancy.
- Fundal
height that exceeds expectations by more than 2 cm may be caused by multiple
gestation, polyhydramnios, uterine myomata, or a large baby.
- A major
developmental task for a woman during the first trimester of pregnancy is
accepting the pregnancy.
- Unlike
formula, breast milk offers the benefit of maternal antibodies.
-
Spontaneous rupture of the membranes increases the risk of a prolapsed
umbilical cord.
- A clinical
manifestation of a prolapsed umbilical cord is variable decelerations.
- During
labor, to relieve supine hypotension manifested by nausea and vomiting and
paleness, turn the patient on her left side.
- If the
ovum is fertilized by a spermatozoon carrying a Y chromosome, a male zygote is
formed.
-
Implantation occurs when the cellular walls of the blastocyte implants itself
in the endometrium, usually 7 to 9 days after fertilization.
-
Implantation occurs when the cellular walls of the blastocyte implants itself
in the endometrium, usually 7 to 9 days after fertilization.
- Heart
development in the embryo begins at 2 to 4 weeks and is complete by the end of
the embryonic stage.
- Methergine
stimulates uterine contractions.
- The
administration of folic acid during the early stages of gestation may prevent
neural tube defects.
- With
advanced maternal age, a common genetic problem is Down syndrome.
- With early
maternal age, cephalopelvic disproportion commonly occurs.
- In the
early postpartum period, the fundus should be midline at the umbilicus.
- A rubella
vaccine shouldn’t be given to a pregnant woman. The vaccine can be administered
after delivery, but the patient should be instructed to avoid becoming pregnant
for 3 months.
- A
16-year-old girl who is pregnant is at risk for having a low-birth-weight
neonate.
- The
mother’s Rh factor should be determined before an amniocentesis is performed.
- Maternal
hypotension is a complication of spinal block.
- After
delivery, if the fundus is boggy and deviated to the right side, the patient should
empty her bladder.
- Before
providing a specimen for a sperm count, the patient should avoid ejaculation
for 48 to 72 hours.
- The
hormone human chorionic gonadotropin is a marker for pregnancy.
- Painless
vaginal bleeding during the last trimester of pregnancy may indicate placenta
previa.
- During the
transition phase of labor, the woman usually is irritable and restless.
- Because
women with diabetes have a higher incidence of birth anomalies than women
without diabetes, an alpha-fetoprotein level may be ordered at 15 to 17 weeks’
gestation.
- To avoid
puncturing the placenta, a vaginal examination shouldn’t be performed on a
pregnant patient who is bleeding.
- A patient
who has postpartum hemorrhage caused by uterine atony should be given oxytocin
as prescribed.
- Laceration
of the vagina, cervix, or perineum produces bright red bleeding that often
comes in spurts. The bleeding is continuous, even when the fundus is firm.
- Hot
compresses can help to relieve breast tenderness after breast-feeding.
- The fundus
of a postpartum patient is massaged to stimulate contraction of the uterus and
prevent hemorrhage.
- A mother
who has a positive human immunodeficiency virus test result shouldn’t breast-feed
her infant.
-
Dinoprostone (Cervidil) is used to ripen the cervix.
-
Breast-feeding of a premature neonate born at 32 weeks’ gestation can be
accomplished if the mother expresses milk and feeds the neonate by gavage.
- If a
pregnant patient’s rubella titer is less than 1:8, she should be immunized
after delivery.
- The
administration of oxytocin (Pitocin) is stopped if the contractions are 90
seconds or longer.
- For an
extramural delivery (one that takes place outside of a normal delivery center),
the priorities for care of the neonate include maintaining a patent airway,
supporting efforts to breathe, monitoring vital signs, and maintaining adequate
body temperature.
-
Subinvolution may occur if the bladder is distended after delivery.
- The nurse
must place identification bands on both the mother and the neonate before they
leave the delivery room.
-
Erythromycin is given at birth to prevent ophthalmia neonatorum.
-
Pelvic-tilt exercises can help to prevent or relieve backache during pregnancy.
- Before
performing a Leopold maneuver, the nurse should ask the patient to empty her
bladder.
- Unlike false labor, true labor produces
regular rhythmic contractions, abdominal discomfort, progressive descent of the
fetus, bloody show, and progressive effacement and dilation of the cervix.
- To help a
mother break the suction of her breast-feeding infant, the nurse should teach
her to insert a finger at the corner of the infant’s mouth.
-
Administering high levels of oxygen to a premature neonate can cause blindness
as a result of retrolental fibroplasia.
- Amniotomy
is artificial rupture of the amniotic membranes.
- During
pregnancy, weight gain averages 25 to 30 lb (11 to 13.5 kg).
- Rubella
has a teratogenic effect on the fetus during the first trimester. It produces
abnormalities in up to 40% of cases without interrupting the pregnancy.
- Immunity
to rubella can be measured by a hemagglutination inhibition test (rubella
titer). This test identifies exposure to rubella infection and determines
susceptibility in pregnant women. In a woman, a titer greater than 1:8
indicates immunity.
- When used
to describe the degree of fetal descent during labor, floating means the
presenting part isn’t engaged in the pelvic inlet, but is freely movable
(ballotable) above the pelvic inlet.
- When used
to describe the degree of fetal descent, engagement means when the largest
diameter of the presenting part has passed through the pelvic inlet.
- Fetal
station indicates the location of the presenting part in relation to the
ischial spine. It’s described as –1, –2, –3, –4, or –5 to indicate the number
of centimeters above the level of the ischial spine; station –5 is at the
pelvic inlet.
- Fetal
station also is described as +1, +2, +3, +4, or +5 to indicate the number of
centimeters it is below the level of the ischial spine; station 0 is at the
level of the ischial spine.
- During the
first stage of labor, the side-lying position usually provides the greatest
degree of comfort, although the patient may assume any comfortable position.
- During
delivery, if the umbilical cord can’t be loosened and slipped from around the
neonate’s neck, it should be clamped with two clamps and cut between the
clamps.
- An Apgar
score of 7 to 10 indicates no immediate distress, 4 to 6 indicates moderate
distress, and 0 to 3 indicates severe distress.
- To elicit
Moro’s reflex, the nurse holds the neonate in both hands and suddenly, but
gently, drops the neonate’s head backward. Normally, the neonate abducts and
extends all extremities bilaterally and symmetrically, forms a C shape with the
thumb and forefinger, and first adducts and then flexes the extremities.
-
Pregnancy-induced hypertension (preeclampsia) is an increase in blood pressure
of 30/15 mm Hg over baseline or blood pressure of 140/95 mm Hg on two occasions
at least 6 hours apart accompanied by edema and albuminuria after 20 weeks’
gestation.
- Positive
signs of pregnancy include ultrasound evidence, fetal heart tones, and fetal
movement felt by the examiner (not usually present until 4 months’ gestation
- Goodell’s
sign is softening of the cervix.
- Cow’s milk
shouldn’t be given to infants younger than age 1 because it has a low linoleic
acid content and its protein is difficult for infants to digest.
- If
jaundice is suspected in a neonate, the nurse should examine the infant under
natural window light. If natural light is unavailable, the nurse should examine
the infant under a white light.
- The three
phases of a uterine contraction are increment, acme, and decrement.
- The
intensity of a labor contraction can be assessed by the indentability of the
uterine wall at the contraction’s peak. Intensity is graded as mild (uterine
muscle is somewhat tense), moderate (uterine muscle is moderately tense), or
strong (uterine muscle is boardlike).
- Chloasma,
the mask of pregnancy, is pigmentation of a circumscribed area of skin (usually
over the bridge of the nose and cheeks) that occurs in some pregnant women.
- The
gynecoid pelvis is most ideal for delivery. Other types include platypelloid
(flat), anthropoid (apelike), and android (malelike).
- Pregnant
women should be advised that there is no safe level of alcohol intake.
- The
frequency of uterine contractions, which is measured in minutes, is the time
from the beginning of one contraction to the beginning of the next.
- Vitamin K
is administered to neonates to prevent hemorrhagic disorders because a
neonate’s intestine can’t synthesize vitamin K.
- Before
internal fetal monitoring can be performed, a pregnant patient’s cervix must be
dilated at least 2 cm, the amniotic membranes must be ruptured, and the fetus’s
presenting part (scalp or buttocks) must be at station –1 or lower, so that a
small electrode can be attached.
- Fetal
alcohol syndrome presents in the first 24 hours after birth and produces
lethargy, seizures, poor sucking reflex, abdominal distention, and respiratory
difficulty.
-
Variability is any change in the fetal heart rate (FHR) from its normal rate of
120 to 160 beats/minute. Acceleration is increased FHR; deceleration is
decreased FHR.
- In a
neonate, the symptoms of heroin withdrawal may begin several hours to 4 days
after birth.
- In a
neonate, the symptoms of methadone withdrawal may begin 7 days to several weeks
after birth.
- In a
neonate, the cardinal signs of narcotic withdrawal include coarse, flapping
tremors; sleepiness; restlessness; prolonged, persistent, high-pitched cry; and
irritability.
- The nurse
should count a neonate’s respirations for 1 full minute.
-
Chlorpromazine (Thorazine) is used to treat neonates who are addicted to
narcotics.
- The nurse
should provide a dark, quiet environment for a neonate who is experiencing
narcotic withdrawal.
- In a
premature neonate, signs of respiratory distress include nostril flaring,
substernal retractions, and inspiratory grunting.
-
Respiratory distress syndrome (hyaline membrane disease) develops in premature
infants because their pulmonary alveoli lack surfactant.
- Whenever
an infant is being put down to sleep, the parent or caregiver should position
the infant on the back. (Remember back to sleep.)
- The male
sperm contributes an X or a Y chromosome; the female ovum contributes an X
chromosome.
-
Fertilization produces a total of 46 chromosomes, including an XY combination
(male) or an XX combination (female).
- The
percentage of water in a neonate’s body is about 78% to 80%.
- To perform
nasotracheal suctioning in an infant, the nurse positions the infant with his
neck slightly hyperextended in a “sniffing” position, with his chin up and his
head tilted back slightly.
-
Organogenesis occurs during the first trimester of pregnancy, specifically,
days 14 to 56 of gestation.
- After
birth, the neonate’s umbilical cord is tied 1" (2.5 cm) from the abdominal
wall with a cotton cord, plastic clamp, or rubber band.
- Gravida is
the number of pregnancies a woman has had, regardless of outcome.
- Para is
the number of pregnancies that reached viability, regardless of whether the
fetus was delivered alive or stillborn. A fetus is considered viable at 20
weeks’ gestation.
- An ectopic
pregnancy is one that implants abnormally, outside the uterus.
- The first
stage of labor begins with the onset of labor and ends with full cervical
dilation at 10 cm.
- The second
stage of labor begins with full cervical dilation and ends with the neonate’s
birth.
- The third
stage of labor begins after the neonate’s birth and ends with expulsion of the
placenta.
- In a
full-term neonate, skin creases appear over two-thirds of the neonate’s feet.
Preterm neonates have heel creases that cover less than two-thirds of the feet.
- The fourth
stage of labor (postpartum stabilization) lasts up to 4 hours after the
placenta is delivered. This time is needed to stabilize the mother’s physical
and emotional state after the stress of childbirth.
- At 20
weeks’ gestation, the fundus is at the level of the umbilicus.
- At 36
weeks’ gestation, the fundus is at the lower border of the rib cage.
- A
premature neonate is one born before the end of the 37th week of gestation.
-
Pregnancy-induced hypertension is a leading cause of maternal death in the
United States.
- A habitual
aborter is a woman who has had three or more consecutive spontaneous abortions.
- Threatened
abortion occurs when bleeding is present without cervical dilation.
- A complete
abortion occurs when all products of conception are expelled.
- Hydramnios
(polyhydramnios) is excessive amniotic fluid (more than 2,000 ml in the third
trimester).
- Stress,
dehydration, and fatigue may reduce a breast-feeding mother’s milk supply.
- During the
transition phase of the first stage of labor, the cervix is dilated 8 to 10 cm
and contractions usually occur 2 to 3 minutes apart and last for 60 seconds.
- A
nonstress test is considered nonreactive (positive) if fewer than two fetal
heart rate accelerations of at least 15 beats/minute occur in 20 minutes.
- A
nonstress test is considered reactive (negative) if two or more fetal heart
rate accelerations of 15 beats/minute above baseline occur in 20 minutes.
- A
nonstress test is usually performed to assess fetal well-being in a pregnant
patient with a prolonged pregnancy (42 weeks or more), diabetes, a history of
poor pregnancy outcomes, or pregnancy-induced hypertension.
- A pregnant
woman should drink at least eight 8-oz glasses (about 2,000 ml) of water daily.
- When both
breasts are used for breast-feeding, the infant usually doesn’t empty the
second breast. Therefore, the second breast should be used first at the next
feeding.
- A
low-birth-weight neonate weighs 2,500 g (5 lb 8 oz) or less at birth.
- A
very-low-birth-weight neonate weighs 1,500 g (3 lb 5 oz) or less at birth.
- When
teaching parents to provide umbilical cord care, the nurse should teach them to
clean the umbilical area with a cotton ball saturated with alcohol after every
diaper change to prevent infection and promote drying.
- Teenage
mothers are more likely to have low-birth-weight neonates because they seek
prenatal care late in pregnancy (as a result of denial) and are more likely
than older mothers to have nutritional deficiencies.
- Linea
nigra, a dark line that extends from the umbilicus to the mons pubis, commonly
appears during pregnancy and disappears after pregnancy.
-
Implantation in the uterus occurs 6 to 10 days after ovum fertilization.
- Placenta
previa is abnormally low implantation of the placenta so that it encroaches on
or covers the cervical os.
- In
complete (total) placenta previa, the placenta completely covers the cervical
os.
- In partial
(incomplete or marginal) placenta previa, the placenta covers only a portion of
the cervical os.
- Abruptio
placentae is premature separation of a normally implanted placenta. It may be
partial or complete, and usually causes abdominal pain, vaginal bleeding, and a
boardlike abdomen.
- Cutis
marmorata is mottling or purple discoloration of the skin. It’s a transient
vasomotor response that occurs primarily in the arms and legs of infants who
are exposed to cold.
- The
classic triad of symptoms of preeclampsia are hypertension, edema, and
proteinuria. Additional symptoms of severe preeclampsia include hyperreflexia,
cerebral and vision disturbances, and epigastric pain.
- Ortolani’s
sign (an audible click or palpable jerk that occurs with thigh abduction)
confirms congenital hip dislocation in a neonate.
- The first
immunization for a neonate is the hepatitis B vaccine, which is administered in
the nursery shortly after birth.
- If a
patient misses a menstrual period while taking an oral contraceptive exactly as
prescribed, she should continue taking the contraceptive.
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