ATI Exam Study Guide Maternity

Maternity Diagnostic Tests & Reproductive System Human chorionic gonadotropin (HCG) Test for the presence of human chorionic gonadotropin, a hormone secreted by the placenta Indicates a positive pregnancy test, increases in a woman's blood and urine until the 15th week of pregnancy Urine test kit from the pharmacy will also test for HCG in the urine Radio immunoassay Will be positive up until 8 days after ovulation, or 6 days before scheduled menses, results are obtained in 1 hour Doppler Auscultation of fetal heart rate is usually done at 10 weeks to 12 weeks of gestation Can also help to rule out fetal abnormalities Pelvic sonogram Ensure that the patient has a full bladder Fetoscope Used to auscultate fetal heart rate at 18 to 20 weeks of gestation Heart rate is best heard at the center of the pubic hairline Normal fetal heart rate during this time is between 120 and 160 beats per minute Ultrasound Will confirm gestational Sac by week 6 Can provide Imaging of fetal heart motion by week 7 The patient should drink 1-2 L of water prior to the procedure and avoid urinating until the procedure has been completed Daily fetal movement count Assesses feel activity and reported by the pregnant mother Normal includes three movements per hour Amniocentesis Used to detect the presence of biochemical or chromosomal abnormalities such as fetal lung maturity and genetic studies Usually performed between 14 and 16 weeks of gestation Ensure that the client has voided before the procedure Chorionic villi sampling Cervical sampling Similar to an amniocentesis, however, this can be done earlier in pregnancy and it reflects fetal chromosomes, enzymes, and DNA Lecithin/sphingomyelin ratio (L/S) Diagnostic test of the amniotic fluid to determine if the fetus is likely to develop respiratory distress Non stress test Evaluate the response of the fetal heart rate to fetal movement The monitor records fetal heart rate when the mother senses fetal movement, used to assess fetal oxygen In a healthy fetus, the fetal heart rate will accelerate with each movement Patient teaching Prior to the procedure, the patient should eat, empty their bladder, and lie in a SIMs position The patient may drink orange juice or rock her abdomen to stimulate feel move Contraction stress test and oxytocin challenge test Used to induce uterine contractions to correlate fetal movement to the contractions Leopold maneuvers Determines presentation and position of the fetus Alpha-fetoprotein levels Elevated indicate neural tube defects such as spina bifida and hydrocephalus Completed at 16 to 18 weeks Will draw the mother's blood to analyze the amount of AFP that the liver normally releases, and how much it's really saying during pregnancy This can also be completed from amniotic fluid extracted from an amniocentesis Ovulation Occurs approximately 14 days after the start of the menstrual period The fertilized ovum will stay in the fallopian tube for 4 days before implants in the uterine wall There are seven days between conception and implantation Fetal heart rate monitoring Late decelerations Reposition and the mother and notify physician This can indicate placental insufficiency Folic acid An expecting mother should take folic acid at least two months before conception and throughout early pregnancy to prevent neural tube defects GTPAL Gravida- how many times a woman has been pregnant Para-actual pregnancies that have been born full-term T-how many children have been born premature A-how many abortion or miscarriages L- how many living children the mother has Signs of Pregnancy Presumptive sign Always considered subjective, the patient will tell you Menses more than 10 days late, morning nausea, quickening, skin pigmentation changes Probable and positive signs Always considered objective, will be tested with diagnostic instruments HCG in urine, Goodell's sign, ultrasound and fetal heart tones Hegar's sign When the uterus becomes globular in shape, softens, and flexes over the cervix, considered a probable sign of pregnancy Goodell's sign Erythroblastosis fetalis Treatment includes a combination of phototherapy and transfusions Rhogam will be given to women at risk for this disease within 72 hours after birth Kernicterus Severe jaundice may cause this, which is an accumulation of bilirubin in the brain If left untreated, the newborn is at risk for mental retardation and death PKU Phenylketonuria The newborn should be tested within 48 to 72 hours after birth The newborn should be drinking breast milk or formula for 2 to 3 days before the test Is positive, they will avoid aspartame, because it is converted to phenylalanine in the body A synthetic food providing enough protein for growth and tissue repair must be substituted for phenylalanine Down syndrome Decrease muscle tension and strength, called hypotonia Hallmark sign at Birth Newborn will also have a deep, straight line across the palm called a SIMIAN crease The newborn will also have slanting eyes and low-set ears Physiological jaundice Appears between the 3rd and 5th day of life, last for a week Denver developmental screening test Evaluate the development of social, motor, and language skills from 1 months to 6 years of age Infant responses should be quiet-alert Infant demonstrating the rooting reflex should be positive Moro reflex should be positive Prancing movements of the legs while the child is held upright should be positive Cervical softening do to increase vascularity, congestion, and edema, considered a probable sign of pregnancy Chadwick's sign Bluish discoloration of the cervix, considered a probable sign of pregnancy Quickening The first time fetal movement is felt by the mother, around 16 to 20 weeks for a multipara and about 18 weeks for a primipara Legal point of viability Around 22 weeks Nagele's rule Used to determine the due date of the child The first day of the last menstrual., then count backwards 3 months and add 7 days Weight gain during pregnancy 3-4lb during the first trimester 1lb per week for a total of 25 to 35 lb Fetal weight increases the most during the third trimester Supine hypotensive syndrome Lie the patient on their left side to promote fetal perfusion Varicose veins Constipation contributes to this condition Ballottement Techniques that involves the palpating of the uterus in such a way that the rebound of the floating fetus is felt by the examining finger Done during month 4 or 5 Complications During Pregnancy Pre-existing diseases Hypertension and diabetes place the mother and an increased risk of developing complications during pregnancy Women who have had more than four pregnancies are also at risk for higher complications Gestational hypertension Development of hypertension in a normotensive client without proteinuria Blood pressure returns to normal by postpartum day 10 Preeclampsia Pregnancy induced hypertension that includes proteinuria and edema of the face, hands, and ankles. More serious symptoms include blurred vision Mild 30mmHg rise in Baseline systolic blood pressure or 15mmHg rise in Baseline diastolic blood pressure Risks Can progress to eclampsia when seizures occur African American and Young primiparous Treatment Magnesium sulfate, given to lower blood pressure and work as an anticonvulsant