Competency Appraisal

• What is the definition of fetal death in utero?

  : Fetal death in utero refers to the death of a fetus after the twentieth week of gestation and before birth.
• What potential complication can arise if the dead fetus is retained in the uterus for an extended period?

  A: The client can develop DIC if the dead fetus is retained in the uterus for 3 to 4 weeks or longer.
• signs of fetal death that may be observed during assessment.

  Absence of fetal movement and absence of fetal heart tones, Maternal weight loss is an indicator of fetal death in utero, Lack of fetal growth or decrease in fundal height
• What is the primary action to be taken in terms of interventions when fetal death in utero is confirmed?

  Prepare for the birth of the fetus.
• What is the cause of hematoma in the postpartum period?

  Hematoma occurs following the escape of blood into the maternal tissue after birth.
• What are the predisposing conditions for hematoma?

  Predisposing conditions include operative delivery with forceps or injury to a blood vessel.
• What are some recommended interventions for managing a hematoma?

  Apply ice to the hematoma site, administer analgesics as prescribed(+abdominal pain), and monitor intake and output.
• Why is monitoring for signs of infection crucial in clients with a hematoma?

  Infection is common after hematoma formation; monitoring helps detect early signs such as increased temperature, pulse rate, and white blood cell count.
• What is the causative agent of AIDS?

  HIV (Human Immunodeficiency Virus) is the causative agent of AIDS.
• Why are women infected with HIV considered vulnerable to life-threatening infections during pregnancy?

  Normal pregnancy involves some suppression of the maternal immune system.
• What is the recommended preventive measure for maternal-to-fetal HIV transmission?

  Zidovudine is recommended for the prevention of maternal-to-fetal HIV transmission, administered orally after 14 weeks of gestation, intravenously during labor, and in syrup form to the newborn for 6 weeks after birth.
• List three modes of HIV transmission.

  Sexual exposure to genital secretions, parenteral exposure to infected blood and tissue, and perinatal exposure of an infant to infected maternal secretions through birth or breastfeeding.
• What tests are used to determine the presence of antibodies to HIV?

  Tests include enzyme-linked immunosorbent assay (ELISA), Western blot, and immunofluorescence assay (IFA).
• Why is a single reactive ELISA test not sufficient for diagnosing HIV?

  A single reactive ELISA test should be confirmed by follow-up tests using Western blot or IFA.
• is a positive Western blot or IFA considered confirmatory for HIV?

  yes
• What are the recommended intrapartum interventions for reducing the risk of HIV transmission to the fetus during delivery?

  Avoid internal scalp electrodes, episiotomy, oxytocin administration; place absorbent pads, minimize neonate's exposure, and suction fluids promptly.
• What precautions should be taken during the postpartum period for a mother with HIV?

  Monitor for signs of infection, place the mother in protective isolation if immunosuppressed, restrict breastfeeding, and instruct the mother to monitor for signs of infection.
• Why may neonates born to HIV-positive clients test positive for HIV antibodies?


  Neonates may test positive because antibodies received from the mother may persist for 18 months after birth; all neonates acquire maternal antibody to HIV infection, but not all acquire the infection.
• What precautions should be taken before invasive procedures for a neonate born to an HIV-positive mother?


  Bathe the neonate carefully before any invasive procedure and clean the umbilical cord stump meticulously every day until healed.
• What is the recommended duration of administering zidovudine to the newborn?

  Administer zidovudine to the newborn as prescribed for the first 6 weeks of life.
• What is the recommended schedule for HIV culture testing in infants at risk for HIV infection?

  IV culture is recommended at 1 and 4 months after birth, and infants at risk should be seen by the healthcare provider at specific intervals up to 4 months of age.
• Why is monitoring for early signs of immunodeficiency important in HIV-exposed infants?

  The child may be asymptomatic for the first several years of life, and monitoring helps detect early signs of immunodeficiency.
• What is the recommendation regarding immunizations for infants at risk for HIV infection?
• What is the recommendation regarding immunizations for infants at risk for HIV infection?

  Infants at risk for HIV infection need to receive all recommended immunizations on the regular schedule; however, no live vaccines should be administered.
• What is hydatidiform mole, and what causes its occurrence?

  Hydatidiform mole is a form of gestational trophoblastic disease that occurs when the trophoblasts develop abnormally.
• How does hydatidiform mole manifest, and what are the potential outcomes?

  The mole manifests as an edematous grape-like cluster that may be nonmalignant or may develop into choriocarcinoma.
• What is a key sign in the assessment of hydatidiform mole related to fetal health?

  Fetal heart rate is not detectable.
• What signs of preeclampsia may be observed before the twentieth week of gestation in a client with hydatidiform mole?

  Elevated blood pressure and proteinuria.
• What is the primary intervention for hydatidiform mole, and what diagnostic tests are performed before evacuation?

  Prepare the client for uterine evacuation; diagnostic tests are done to detect metastatic disease.
• how is the evacuation of the mole typically done, and what medication is administered afterward?

  Evacuation is done by vacuum aspiration, and oxytocin is administered after evacuation to contract the uterus.
• What should be monitored postprocedure for a client who underwent uterine evacuation for hydatidiform mole?

  Monitor for postprocedure hemorrhage and infection.
• Why is follow-up important after uterine evacuation, and what changes are monitored in laboratory evaluations?

  Follow-up is important to detect changes suggestive of malignancy; tissue is sent to the laboratory for evaluation.
• How often are human chorionic gonadotropin levels monitored after hydatidiform mole evacuation, and for how long?

  Levels are monitored every 1 to 2 weeks until normal prepregnancy levels are attained; then, they are checked every 1 to 2 months for 1 year.
• What is the importance of instructing the client and her partner about birth control measures during the 1-year follow-up period?

  To prevent pregnancy and allow for thorough monitoring during the follow-up period.
• What is hyperemesis gravidarum, and when does it typically occur during pregnancy?

  Hyperemesis gravidarum is intractable nausea and vomiting during the first trimester that causes disturbances in nutrition and fluid and electrolyte balance.
• When is nausea most pronounced in hyperemesis gravidarum?

  Nausea is most pronounced on arising and may occur at other times during the day (first trimester)
• What dietary recommendations can be given to a client experiencing hyperemesis gravidarum?

  Encourage intake of small portions of food (low-fat, easily digestible carbohydrates) such as cereals, rice, and pasta.
• Why is it advised to encourage the intake of liquids between meals for a client with hyperemesis gravidarum?

  To avoid distending the stomach and triggering vomiting.
• What postural recommendation can be given to a client after meals to manage hyperemesis gravidarum?

  Encourage the client to sit upright after meals.
• What are the potential outcomes of gestational hypertension, and how can it progress?

  Gestational hypertension can be mild or severe, leading to preeclampsia and then eclampsia (seizures).