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NCLEX® - RN & PN Review
Conductedby:
GeorgeMataMontausMSN/Ed,RN&WalterUrdasDonatoBSN,RN [email protected]
Telephone#714-679-9320Fax#909-247-2721
Conductedby:
GeorgeMataMontausRN,MSN/Ed&WalterUrdasDonatoBSN,RN
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§ Reproductive Development Secondary Sex Characteristics
InFemale• GrowthSpurt• Increaseinthetransverse
diameterofthepelvis• Breastdevelopment• Growthofpubichair• Onsetofmenstrua;on• Growthofaxillaryhair• Vaginalsecre;ons
InMales • Increaseinweight• Growthoftestes• Growthoffacial,axillary,
andpubichair• Voicechanges• Penilegrowth• Increaseinheight• Spermatogenesis
Reproduc?veSystem
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ANATOMY OF THE BREASTS
TheMenstrualCyclePhasesofMenstrualCycle Descrip?ons
MenstrualPhase:Days1-5cycle
Sheddingofendometriumoccursintheformofuterinebleeding
Prolifera;on/follicularPhase:Day5-ovula;on
Increasedestrogen,releasedofFSHandLHandaffectsovula;ons
Secretory/LutealPhase:ovula;on–3daysbeforemenstrualcycle
Estrogenlevelsleveloff;increaseprogesterone
IschemicPhase:3days–beforetheonsetofmenstrua;on
Iffer;liza;ondidnotoccur:corpusluteumdegenerates;estrogen&progesteronelevelsdrop;onsetofmenstrua;on
NOTE:ThemenstrualphasevariesinlengthinmostwomenBetweenovula;onandthebeginningofthenextmenstrualcyclethereareusually14days,therefore,ovula;onoccurs14daysbeforethenextmenstrualperiod.
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Fer?liza?onDevelopment Descrip?ons
Indica;onsofOvula;ons Slightriseintemp.,duringovula;on(10-12days);clear,abundantmorealkalinecervicalmucus;Spinbarkeitispresent
Condi;onsforFer;liza;on
Postcoital:+live,mo;le,normalsperm;occursinampullaoffallopiantube.
Implanta;on Zygotetakes3-4daystoentertheuterus;takes7–10daystocompletetheprocess
FetalDevelopment Zygote–12-14daysa`erfer;liza;on;Embryo–3-8weeksa`erfer;liza;on;mostvulnerabletoteratogens(viruses,drugs,radia;on,orinfec;ons,
Note:Spermliveapproximately3daysandsomeare5days,andeggsliveabout24hours.
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Placenta� Providesexchangeofnutrientsandwastebetweenfetusandmother.
� Developsby3rdmonth.� Bacteria–donotpass:virus-passthroughtheplacenta.
� During3rdtrimester,transferofmaternalimmunoglobulinoccurs. Thefetusdevelopspassiveimmunitytocertaindiseasesforthe1stfewmonthsa`erbirth.
� Byweek8,gene;ctes;ngcanbedone.
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Fetalcircula?on
UmbilicalCord
2arteries,1vein(AVA)
Arteries carrydeoxygenatedblood,wasteproductsVein–
carryoxygenatedblood,nutrients
Ductusarteriosus connectspulmonaryarterytotheaorta;bypassesthelungs.
Ductusvenosus.
connectstheumbilicalveinandinferiorvenacava;bypassestheliver
Foramenovale
openingbetweenrightandleXatriaofheart;bypassesthelungs
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MaternalChanges&FetalDevelopment
AGEOFGESTATIONS(WEEKS)
MATERNALCHANGES FETALDEVELOPMENT
1–3weeks Fer;liza;on,embryonicgrowthanddevelopment,implanta;on,amnio;ccavityappearance;spinalcordclosesby4thweek.
8weeks Nausea,uteruschanges,Hegarsigns,Goodellsign,feelingofambivalence,Chadwickssign
Heartpumps,(+l)imbbuds,(+)facialfeatures,(+)earbuds,Braindivision,(+);nymuscles.
12weeks Uterusrisesabovepelvicbrim;(+)BraxtonHicks;Placentaisfullyfunc;oningandproducinghormones.
Heartbeat(utz),lowerbodydevelops,sexisdeterminable,(+)urine
20weeks Fundusisinthelevelofumbilicus;lacta;on(colostrum)begins;areolaedarken;hypotension,nasalstuffiness,cons;pa;on,legcrampsorvaricosemaydevelop.
Vernix,lanugo,eyebrows,eyelashes,headhair;fetussleeps,sucks,andkicks(quickening14-18weeks)Heartbeatcanbedeterminedbyfetoscope
AGEOFGESTATIONS(WEEKS)
MATERNALCHANGES FETALDEVELOPMENT
28weeks Fundusbetweenumbilicusandxiphoid,Abdominalbreathing,heartburn,hemorrhoids.
Breathe,swallow,regulatetemp;+surfactant,eyelids,open,canhearwell
32weeks Fundusreachesxiphoid;full/tenderbreasts;frequenturina;on;swollenankle;dyspnea.
Storingiron,calcium,phosphorusbegins;fetusweigh4–5lbs.
38weeks Lightening;mayburstenergy;backaches;increaseurinaryfrequency;Braxtonhicksintensify
Fetusoccupiesen;reuterusL/S(lecithin/sphingomyelin)is2:1.
NOTE:Psychosocialmaternal-fetalbondingduringpregnancyisnecessary,example:talkingtofetus,massagingtheabdomen,ornicknamingfetus.
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LINEANIGRA
OBSTETRICALASSESSMENTDiagnos?c/Laboratorytests
Ultrasonography RhFactor
ChorionicVilliSampling NonStressTest-Reac;ve-Non-Reac;ve
Amniocentesise.g.AFP OxytocinChallenge
Ultrasound,Doppler FernTest
Urinalysis NitrazineTest
Hemoglobin&Hematocrit ABOTyping
Infec;ons:VD,Gonorrhea,Herpes,Chlamydia,Hep.B,HIV,Rubella;ter,TBTest,SicleCellScreening.
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SYPHILIS
HERPESGENITALIS
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Nagele’sRule
ForEDD(expecteddateofdelivery)1stdayofLMP(lastmenstrualperiod)Countback3monthsfromthefirstLMPandadd7days.
Example:IfLMPwasMarch23,EDDwouldbeDecember30.Ques?on:Ifthefirstdayofawoman’slastnormalmenstrualperiodwasOctober172008.whatisherEDD,usingNageleRule?
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Gravida:no.ofpregnancies,Para:no.ofdeliveriesa`erageofviability
G=gravida,T=terminfants,P=preterm,A=abor?ons,L=living Prac?ce:Awomanwhois6weekspregnanthasthefollowingmaternalhistory:
• Shehasa2yearoldhealthydaughter• Shehadamiscarriageat10weeks,3yearsearlier• Shehadelec;veabor;onat6weeks,5yearsearlier.Whatisthepa?ent’sGTPAL?
SignsofPregnancyManifesta?ons Presump?ve Probable Posi?ve
amenorrhea
Hegar’ssigns
Fetalhearttone(UTZ)
(+)HCG
Nausea/vomi;ng
Leopold’sManeuver
Fullnessofbreasts
Dyspnea
Urinaryfrequency
OutlineofFetus
Chadwickssigns
Fa;gue
Quickening
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MaternalRiskFactors1. Germanmeasles2. STD’s(Sexually-transmiiedDiseases)
(Syphilis,Genitalherpes,Gonorrhea)3. HIV4. SubstanceAbuse5. CardiovascularSystem6. RespiratorySystem7. GISystem8. RenalSystem9. EndocrineSystem10. Skin
11. Breasts12. SkeletalSystem13. Metabolism
RiskCondi?onsinRela?ontoPregnancy
Abor?on
Hyda?diformMole
AIDS/Hepa??sB
HyperemesisGravidarum
Anemia
Tuberculosis
CardiacDisease
FetalDeathinUtero(FDIU)
ChronicHPN
DiabetesMellitus(DM)
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Infec?ons:
Toxoplasmosis(protozoon)– Signsandsymptomsareflu-like.– Sources:Rawmeat,handlingcatliiers.– Transmikedacrossplacenta.– Causesspontaneousabor;on.
Rubella:– Transmikedacrossplacenta.– Teratogenicespecially1sttrimester.
• Eyes,heart,ears,brainareaffected.– Womenwithlowrubella;ters–vaccinatedatleast3monthsbeforepregnancyorfollowingadelivery.
LaborandDelivery FactorsAffec?ngLabor
Passage PelvicDimension
Passenger FetalDimension
Power UterineContrac?on
Psyche Maternal/Fetalbehavior
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Contrac?onsTrueLabor FalseLabor
Progressivecervicaldilata?on/effacement
Nocervicaldilata?onoreffacement
Occursinregularintervals Occursonirregularintervals
Decreasecontrac?onsbetweenintervals
Contrac?onsthesamebetweenintervals
Increasefrequencyofdura?onandintensity
Intensitydecreasesorremainthesame
Locatedmainlyinbackandabdomen Locatedmainlyonlowerabdomenandgroin
Intensifiedbywalking Willnotbeaffectedbywalking
Noteasilydisruptedbymedica?ons Relievedbymildsead?on
StagesoflaborFirstStage–CervicalComple;on/Dila;on/
Effacement
Latentphase cervicaldilata?on0-3cm.;uterinecontrac?onq15-30mins.;10-30secs.indura?on;mothertalka?ve/eager.
Ac?vephase:
cervicaldilata?on4-7cm.;uterinecontrac?onq3-5mins.;30-60secs.indura?onignoresinstruc?ons;restlessandanxiousascontrac?onsbecome stronger.
Transi?onPhase: cervicaldilata?on8-10cm.;uterinecontrac?onq2-3mins.,50to90secsindura?onmotheris?red,restless,irritable,feelsoutofcontrol.
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SecondStage–StageofDeliveryü Completecervicaldilata;on.ü Uterinecontrac;onq2-3mins.;ü Increaseinbloodyshow.ü Motherfeelsurgetobeardown;pain,helplessness,panicking,fearof
losingcontrolü Monitor(crowning).ü Prepareforbirth.
ThirdStage–PlacentalDeliveryü Contrac;onsun;lplacentaisborn.ü Placentalsepara;on/expulsionoccur(contracteduterus,globular
inshape).ü Umbilicalcordlengthens,spurtofbloodfromvaginaappears.ü Occurs5-30mins.a`erbirthofbaby.
D. Stage4–StageofRecovery– 1-4hoursa`erdelivery.– Fundus:contracted,midline,1-2finger-
breadthsbelowtheumbilicus.– Lochia:red;scanttomoderate.– Monitormother:q15mins–10
q30mins–1
q10 -20
Massageuterustopromotecontrac?onandpreventbleeding.
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ProblemswithLaborandDeliveryPROBLEMS Manifesta?onsDystocia
difficult labor that is prolonged or more painful
Fetal Distress
FHR above 160 bpm or below 120 bpm. Meconium – stained amniotic fluid. Fetal hyperactivity. Variable deceleration pattern. Late deceleration.
Precipitous Labor and Delivery
Labor lasts less than 3 hours.
Preterm Labor
Labor occurring after 20th week but before the 37th week of gestation.
PROM
May cause maternal and fetal infection, and fetal trauma
Rupture of Uterus
excessive fundal pressure, forceps delivery, violent bearing down effort
Vena Cava Syndrome
Impaired venous return to the heart due to the weight of uterus.
ComparisonsPlacentaPrevia Abrup?oPlacenta
Improperlyimplantedplacenta Prematuresepara?onofplacentafromtheuterinewallaXerthe20thweekofgesta?onandbeforethefetusisdelivered.
Characteris?cmanifesta?on:Painlessbleeding(mildtomoderate)
Painfulvaginalbleeding.
Board-likerigidityofabdomen
Management:Bedrest,leXlateralposi?on.Novaginalexamina?onPrepareforprematurebirthorC-Sec?on.
Management:Prepareforimmediatedelivery–vaginaldeliveryiffetusishealthyorstable;CSdeliveryifwithfetaldistress.
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MANAGEMENT OF PROLAPSED CORD
ThePostpartumPeriod• Startsimmediatelya`erdeliveryuptoweek6
followingdelivery.• Involu;onoccursNursingAssessment:BreastsUterusBowelBladderLochiaEpisiotomy
Homan’sEmo?onal
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PostpartumBluesThisiscausedbyphysiologicalandemo;onalstressesa`er
delivery.Experiencedon5thdaya`erdelivery.Iflastsformorethanaweekto10days,no;fyMDManic-depressivebehavior;Delusions,hallucina;ons.Psychosis:Starts4weekspostpartum;Withpasthistory
ofpsychiatricdisorder;Suicide,infan;cidearecommon.
Management:– Encourageverbaliza;on.– Avoidpostpartumdepression(moodswings).
Facts about HUMAN MILK
• Humanmilkincreasesthechild’sintelligence
• Itaffordsprotec?onagainstseveralbacterialandviraldiseases(e.g.respiratoryandgastrointes?nalsystems).
• Itprotectsaninfantagainstdevelopmentoffoodallergiesandenhances
ac?veimmuneresponsetoHaemophilusinfluenzaetypeBvaccine.
• Wholecow’smilkisnotrecommendedforinfantslessthan12monthsofage.
• Donotusemicrowavingtodefrostfrozenhumanmilkortoheatformula.
High-temperaturesignificantlydestroysthean?infec?vefactors.
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Maternity and Newborn MedicationsOxytocin(pitocin)
ErgotAlkaloids:ergonovine(ergotrate),methylergonovine(methergine)
UterineRelaxants:Ritodrine(yutopar),Terbutaline(Bricanyl)
Prostaglandins:Abor;facients:Carboprost(hemabate)IM,Dinoprostone(cervidil)/vaginaMagnesiumSulfateMeperidineHCL(Demerol)Rho(D)ImmuneGlobulinBetamethasone(Celestone)Increasesurfactantproduc;onErythromycin.5%;Tetracycline1%VitaminK
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