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Chamberlain College of Nursing NR321 SME Study Guide

Instructions: The contents on this guide are intended to help you organize your preparation for the Subject Matter Exam (SME) for NR321. This is NOT intended to serve as a direct reflection of the exact questions which will be presented in the exam. As you review the topics listed below, be sure that you can 1. Understand the Pathophysiology 2. Identify the appropriate assessment skills 3. Interpret the appropriate lab or other diagnostic findings 4. Develop a safe and competent plan of care with rationale 5. Associate the nursing implications with the appropriate medications or other treatments 6. Teach the RATIONALE for all the above. 7. Prioritize especially r/t interventions and use of the nursing process Medication calculations (IM, mg & ml; IV-gtt/min) Maternal Physiologic Changes Fetal development and Maternal changes Relate key development milestones and maternal changes to teaching for the client Antepartum Nursing Care Psychosocial responses Prenatal visits Nutrition Fetal and Maternal Assessment Techniques Types Ultrasonography Chorionic villi sampling (CVS) Amniocentesis Electronic fetal monitoring Nonreassuring warning signs with rationale (Know causes!) Nonreassuring (Ominous) signs with rationale Non-stress test Contraction stress test (CST) Biophysical profile (BPP) Used in which trimester with rationale Interpretation of findings with rationale Nursing care pre and post procedure including teaching Possible complications with rationale Spontaneous abortion Controversy r/t fetal anomalies Fetal injury Infection

Intrapartum Nursing Care Stages of labor MUST KNOW START AND END OF EACH STAGE TO CHOOSE SAFE ACTIONS!!!!!!!!!!! Stage I Starts with onset of true labor and ends with cervical dilation reaching 10cm Nursing Assessment: including, but not limited to: Prodromal labor signs Gravidity and parity Gestational age FHR Contraction frequency, intensity, and duration Status of membranes Vaginal examination including, but not limited to: Fetal station Fetal presentation Fetal position Nursing plans and interventions with rationale Stage II Starts with need to push, cervical dilation reaching 10 cm, rapid fetal descent, and ending with birth Nursing Assessment Nursing plans and interventions with rationale Stage III From expulsion of baby to complete expulsion of placenta Nursing assessment Nursing plans and interventions with rationale Stage IV First four hours after delivery of placenta Nursing assessment Nursing plans and interventions with rationale Newborn care (delivery room) Nursing assessment including, but not limited to: Apgar assessment X2 Gestational age assessment Exam cord for AVA and document Nursing plans and interventions with rationale including, but not limited to: ID bands Footprints with maternal thumb print Prophylactic eye care Labor with analgesia or anesthesia Timing of administration Nursing assessment Nursing plans and interventions Normal Puerperium (Postpartum) Definition Normal puerperium changes Nursing assessment

Nursing plans and interventions (concentrate on teaching aspects with application of rationale) Include methods of contraception

The Normal Newborn Nursing assessment Consider implications for variances from normal VS for newborn Consider implications for variances from normal physical exam for newborn Nursing care Aspiration Infection The 4-Hs (hypothermia, hypoglycemia, hemorrhagic disorders, hyperbiliruminemia) Nursing plans and interventions High-Risk Disorders Types Spontaneous abortion Ectopic pregnancy Abruptio Placentae Placenta Previa Infections Preterm labor PIH Maternal & infant cardiac disease Congenital heart disease in newborn Hyperemesis gravidarum Diabetes mellitus Emergency delivery Effect on underlying pathology for each Nursing assessment of each Nursing plans and interventions (with focus on teaching, prevention, decision making) for each TEACHING, TEACHING, TEACHING!!!!!!!!!!!!!!!!!!!!!!!!! Postpartum High-Risk Disorders Types Infections Hemorrhage Nursing assessment of each Nursing plans and interventions (with focus on teaching, prevention, decision making) for each TEACHING, TEACHING, TEACHING!!!!!!!!!!!!!!!!!!!

Post Full bladder distention (what are actions, rationals Med admin Mag and Pit Calculation Mech of action Adverse effects Hyperstimulation or hypertonic same thing, uterine atony (Pitocin) Antepartum Hemo dilution at 28 weeks, what are phys adaptation Alcohol and pregnancy Before and after amniocen Colostrum, when does it leak, is it ok? CST Cyktoec and preg HVA1C results Infertility Drugs 869-870, Clomid drug of choice Pre clamp, Edema Trip screen Intra Anesthesia Pre op for c-section, atrophine Back labor relief, sacral pressure Delivery- in the parking lot (give baby to mom to carry it) Hellp Labor progression Magsulfate Output Meconium stain, What happens, decreased FHR Pitocin Prolapse cord Trendelenburh, true prolapse cord S/s shock Srom, confirm by nytrazine, or ufern? V decels, what causes them Heart and vena cava, valsalva maneuver Newborn Adrenal hyperplasia APGAR Diaper changer Hyperglycemia IDM, IDDM Jaundice, supplies. Lights blanket Mora reflex Shoulder dystocia Assessment, respiratory distress Weight loss, 10% TSH and T4 test Vitamin K thigh 1 hour

Crack baby Post Birth Control Cardiac output Fundal Massage Hemorrhage Mastitis Assessment Refuse rhogam, you document it Sore titty, reposition baby Thrombophlebitis Antepartum Thyroid scan PKU Prenatal history Cultural spiritual Diaphragm, Has to be fitted Post Partum Parenting transition, Anxiety