HESI PN MATERNAL NEWBORN PROCTORED EXAM
VERSION 12
Prenatal Lab Tests and Discomforts During Pregnancy
IMPORTANT: Rh Factor of mother and baby through indirect Coombs test. If mom is Rh negative and baby is Rh positive, causes mom to build up antibodies that may not affect this pregnancy but WILL attack the next baby’s RBC’s causing them to lyse.If mom is Rh negative and baby Rh positive: Repeat Coombs test at 24-28 weeks. Rhogam will be administered at 28 weeks gestation, which prevents the development of antibodies.Group B Streptococcus: will be checked by taking a vaginal and anal culture around 35-37 weeks gestation.One-hour glucose tolerance test done at 24-28 weeks gestation. No fasting required, if results come back over 140, requires a follow-up 3-hour glucose tolerance test: fasting is required.Maternal serum alpha-fetoprotein: Taken at 15-22 weeks gestation, screens for Down Syndrome of neural tube defects. If LOW: could mean down syndrome. If HIGH: Neural tube defect.Other: CBC, Rubella titer, HIV, Hepatitis B, HPV, STI’s (gonorrhea, chlamydia, syphilis), PPV (check for TB), TORCH infections, and urinalysis
Expected Discomforts:
- N/V: usually in first trimester. Eat dry toast or crackers in the morning before getting
up
- Urinary frequency: Empty bladder frequently, use Kegel exercises if stress
incontinence’
- UTI’s: Notify if foul smelling or cloudy urine
- Heartburn: Advice to eat small, frequent meals, sit up for at least 30 minutes after
eating
- Fatigue and difficulty breathing: Take frequent rest periods
- Constipation: Increase intake of fluid and fiber
- Hemorrhoids: Use warm Sitz baths, witch hazel pads
- Varicose veins: elevate legs, were compression hose, walk frequently, and avoid
- Gingivitis, indigestion, and epistaxis (nose bleed): Good oral hygiene, NS spray
standing
Nutrition, Weight Gain, and PKU 1 / 2
Weight Gain:
- Normal weight: total 25-35 pounds. 1
st
: 2-4lbs. 2
nd and 3 rd
: 1lb per week
- Obese: 15-25lbs.
- Underweight: 28-40lbs.
Calories: No additional calories needed during first trimester.
2 nd
trimester: extra 340 calories per day
3 rd
trimester: extra 460 calories per day
Breastfeeding: extra 450-500 calories per day
Nutrition:
FOLIC ACID (IMPORTANT): Prevents neural tube defects. Recommended: 600mcg per day.Increase protein intake, possibly iron supplements (vitamin C increases absorption), calcium 1000mg per day (bone and teeth formation, vitamin D increases absorption). Fluid intake (2-3L per day). Caffeine reduced (200mg per day). NO alcohol.Phenylketonuria (PKU): A genetic disease that causes amino acid Phenylalanine to build up in body which can cause a risk for birth defects in the fetus.IMPORTANT teaching: Adhere to PKU diet 3 months prior to pregnancy and throughout pregnancy. Needs frequent blood Phenylalanine drawn.PKU diet: Very low in protein. Avoid: No meat, fish, poultry, nuts, eggs, or dairy.
Ultrasound, BPP, NST, and CST
Ultrasound: Noninvasive: Confirm pregnancy, site of implantation, assess baby growth and development and movement.Teaching: Have mom drink a full quart of water prior to procedure to better reflect sound waves.
Biophysical Profile: Uses real time ultrasound technology to assess for fetal well-being. Score of 0-10. 8-10 = normal; less than 8 = fetal asphyxia due to insufficient oxygen. FIVE areas: reactive fetal heart rate, fetal breathing movements, gross body movements, fetal tone, and amniotic fluid volume.Non-Stress Test: Non-invasive test that measures fetal HR response to fetal movement. Done in 3 rd trimester, acoustic vibration device may help awaken fetus or orange juice. Mom pushes button when she feels movement, provider assesses HR during movement to see if increasing when moving. Preformed when mom reports decreased fetal movement, diabetes, gestational HTN, or post-maturity.Results (IMPORTANT): Reactive: normal finding (HR normal rate, moderate variability, and accelerates at least 2 times in a 20-minute time period). Non-reactive: Abnormal finding, fetal
- / 2