Mark Klimek Audio Lectures Lecture 10 Maternal health and newborn health: Calculating Due-Dates.

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Mark Klimek Audio Lectures Lecture 10 Maternal health and newborn health Calculating Due-Dates - It takes 3 things to pass the NCLEX exam - Knowledge - Confidence - Exam Proficiency - You ca... n’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 the fist day of the menstrual period, add 7 days, and subtract 3 months First day of the last menstrual period + 7 days – 3 months = Due-date - Example: Her last menstrual period was June 10th through June 15th. When would you expect her due date to be? June 10th (first day) + 7 days – 3 months = March 17th 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 the 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 the 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 the death of the unborn baby. Fundal Height - The fundus is the top part of the uterus. - It is not palpable until week 12 (can’t be felt during the first trimester) - After the first trimester (week 13) the fundus should be palpable under the 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 the uterus and causes gestational trophoblastic disease where tumors grow from what would have been the placenta. [Scenario] A woman who is positively pregnant comes into the emergency room unconscious after a severe car accident. You do not know what week gestation she is. You palpate for the fundus but cannot feel anything. From this you determine she is in the first trimester. - Priority nursing care is focused on saving the mothers life. - The fundus is at the level of the 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 the emergency room unconscious after a severe care accident. You do not know what week gestation she is. You palpate for the fundus and you feel it at or below her umbilicus. From this you determine she is in the second trimester. - Priority nursing care is focused on saving the mothers life. - The fundus is above the level of the umbilicus after 24 - 27 weeks gestation. [Scenario] A woman who is positively pregnant comes into the emergency room unconscious after a severe care accident. You do not know what week gestation she is. You palpate for the fundus and you feel it above her umbilicus. From this you determine that she is in the third trimester and the baby is at the age of viability. - Priority nursing care is focused on saving the 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 the pregnancy is confirmed, possible and presumptive signs are not good indicators that a woman is pregnant. - Four positive signs of pregnancy: 1. Fetal skeleton observed on x-ray 2. Fetal presence on ultrasound 3. Auscultation (Doppler) of a fetal heart rate (heard between 8 – 12 weeks) 4. When the examiner palpate fetal movement or outline - Most obstetric information has a range where something occurs because no pregnancy is the 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 the range) [Example] When would you most likely auscultate a fetal heart? 10 weeks - When should you by… (end of the range) [Example] When should you auscultate a fetal heart by? 12 weeks - Quickening: When the mother feels the 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 [Show More]

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