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51 Cards in this Set
- Front
- Back
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Preconception Care |
Care of female before conception. Consider nutrition, folic acid, drinking, drugs, emotional stress, finances. Encourage client to participate and learn. |
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Amenorrhea |
Cessation of menstrual cycle for more than 3 months |
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Quickening |
A woman's first awareness of fetal movement. 18-20 wks |
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Presumptive signs |
Only felt by mother. Includes: amenorrhea, nausea/vomitting, fatigue, urinary frequency, swelling/tenderness of the breast, quickening |
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Probable signs |
Objective signs: enlarged/softened uterine body (8-10 weeks); goodell's sign (softening of uterus); chadwick's sign (bluish purplish mucous membranes) ; hegar's sign (6-8wks softening of isthmus; ballottement; pregnancy tests (hCG) |
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Positive signs |
Fetal heart sounds; Fetal movement; visualization of fetus during ultrasound |
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Ballottement |
During fourth or fifth month, floating fetus rebounds against examiners fingers |
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Uterine souffle |
Sound made by increased blood perfusing the uters and mimics matrrnal pulse |
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Funic souffle |
The sound of blood floeing through umbilical cord |
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When can a fetus hb be heard by doppler? Fetoscope? Rate? |
Doppler: 10-12 wks Fetoscope: 18-20 wks Bpm: 110-160 |
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Naegele's rule |
+7 days -3 months; adjust year |
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Uterus adaptation |
Enlargment, mostly mechanical distention. @12 wks fundus rises above symphysis and displaces intestines; broad and round ligaments anchor uterus; increased blood flow (20-25%) by term |
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hCG |
Human chorionic gonadotropin Secreted by tissue around embyro, is used to detect pregnancy. Maintains corpus luteum until placenta is developed. After placenta is working, hCG helps with immunological functions of mom v fetus |
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Human placentsl lactogen |
hPL Levels gradually risr and peak round 36wks. Alters mother's metanolism of carbs, fat, protein by lowering the materna sensitivity to insulin and improves bodys ability to use fattu acids for energy. Frees glucose for fetal development |
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Estrogen |
Levels increase rapidly early in pregnancy then slow 24-32wks then increase again til term. Promotes vasodilation, increasing blood flow to uterus. Changes sensitivity of respiratory system to carbon dioxide. Softens cervix, initiates iterine activity, maintains labor, develops breasts in prep for lactation and secretion of prolactin by pituitary gland |
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Progesterone |
Produced by corpus luteum for first 5wks then by placenta til term. Readys uterus for implantation. Relax smooth muscle of uterus to prevent spontaneous abortion. Suppression of immune response of mom v fetus. Relaxes gi smooth muscle decreasing motility and increasing absorption of nutrients. Gu tract smoothv muscle relaxation enlarges ureters and bladder. Prepares alveoli and duct of breast for lactation. |
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How can you tell it is true labor? |
True labor: Pain beginsnin lower back and radiates across lower abdomen. Contractions intensify and do not cease. Become progressively more regular frequent and painful. Bloody show. 15% of time membranes rupture and water gushes out. Durin peak of contraction, fundus should be firm as forehesd |
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Uterine contractility |
Uterus (even non pregnant) contracts all the time. Mom can start to feel contractions in late second trimester. Usually called braxton hicks and irregular and painless. Closer to term they become regular and painful. |
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Cervix adaptations |
Prepregnant: firm like top of ear. As early as 4wks, increased fluid and blood causes cervix to soften. Mucus plug forms to protect fetus and membranes from bactetia that may ascend through vagina during pregnancy. As cervix dilates, small arteries burstbandn mix with mucus causing bloody show |
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Vaginal adaptation |
Increased vascularizaton; softening of connective tissue. Rugae enlarges. Mucus increases. Vagina cells contain glycogen and slough off , being broekn down by Lactobacillus acidophilus, increasing discharge. Yeast infections are common |
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Ovary adaptation |
Follicle releases ceases. Corpus luteum forms. Production of progesterone peaks at 8days. 6-7wks placenta takes over |
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Breast adaptation |
Estrogen and progesterone driven. Early: full and tender. Veiny. Striae. Areola darken and enlarge. Colostrum is a protein rich yellowish fluid. Tubercles of montgomery become more visible and secrete to keep nipples supple. |
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Hemotalogic system adaptation |
Blood volume: 40-50% increase. Red blood cells: 33% (450ml) with iron and 18% (200ml) without iron supplements. Wbcs: 4500-16000 Blood coagulation: increased platelets; fibrinogin increasr |
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Physiologic anemia of pregnancy |
Plasma increases to rapidly and dilutes rbcs causing the ratio to be off |
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Cardio vascular adaptation |
Heart: pushed upward and left. Systolic heart murmur is normal at 20wks. Diastolic murmurs are rare. Mammary souffle: increased blood flow to breasts cardiac output: increasr as early as ten weeks and peaking at 20-24 wks. Nonprego: co @ 4.5 l/min with 2% to uterus. Prego: co @ 6 l/min with 20% to uterus. |
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Maternal positioning concerns |
Movement from supine to left side increases cardiac output by 20% and fetal oxygen sat by 10%. Supine, gravid uterus occludes inferior vena cava causing dizzyness called supine hypotension |
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Blood pressure adaptation |
First trimester: decreases 5-10 s and 10-15 d mmHg @ 22-24 wks rises |
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Venous return stuff |
Increased pressure below the uterus causes blood to pool and varicosities to form. Increased plasma causes blood congestion and edema. Decrease on peripheral vascular resistance. |
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Respiratory system adaptation |
Mechanical: uterus changes and grows raising diaphragm up by 4cm. Chest circumference increases by 7 cm. Diaphragmatic exursion increases Progesterone: increase tidal volume; decrease PCO2; decreases airway resistance by relaxing smooth muscle Gas exchange: 35-50% increase in tidal volume; func'l residual capacity decreased by 20%. |
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Respiratory alkalosis |
Pregnant mom is always in a state of respiratory alkalosis due to progesterone and the changes in lung volume. Specifically increase of PaO2 and decrease of PCO2. This is to facilitate removal of CO2 from fetus. Alkalosis is compensated by renal secretion of bicarb. |
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Gastrointestinal adaptation |
Mouth: estrogen causes increased proliferation of blood vessels causing gums to become soft and edematous. Saliva is more acidic Esophagus: progesterone lessens peristalsis and decreases effect of lower esophageal sphincter. Stomach/intestines: displacement due to uterus; delayed stomach emptying; acid production decreased during 1&2 then increases back to baseline towards term; slowing of peristalsis causes constipation but increases absorption of nutrients. Intake should be monitored for 6 hours before labor to decrease risk of aspiration. Gallbladder: increased risk of gallstone formation Liver: physically displaced; decreased: serum albumin by 30%; increased: serum cholesterol by 2x normal; serum alkaline phosphatase by 2-3x normal. |
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Pituitary adaptation |
Pituitary: enlarges; prolactin (preps breasts for milk) increases; oxytocin increases (uterine contractions and ejection of milk) oxytocin is formed in hypothalamus and secreted from post pituitary. |
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Thyroid adaptation |
Enlarges some; doesn't change a lot. Alterations req further investigation |
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Parathyroid adaptation |
Parathyroid hormone increases which increases calcium and phosphorus to meet the demands of the fetus |
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Adrenal gland circulation |
Cortisol: promotes metabolism of carbs, fats, and protein. Triggers gluconeogenesis when body needs more energy. Aldosterone: increases, also renin and angiotensin increases to decrease amount of sodium lost |
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Pancreas adaptation |
Beta cells increases in number, producing more insulin. |
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Changes in metabolism/ gestational diabetes |
Carbs produce more glucose for the fetus. Ketoacidosis occurs faster. G diabetes is when moms pancreas cannot keepup with insulin demands. Water retention is to be expected due to low plasma osmolarity. Water retained can be up to 6.5 l often presenting as edema. |
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GU adaptation |
Dilated kidneys and ureters. @ 20wks ureters are compressed by uterus. Ureters are elongated increasing urine volume up to 25fold. By end of 2 mechanical displacement causes incontinence. Bloodflow to kidneys increases by 50-80% increasing gfr (glomular filtration rate). Leads to incresed urine volume, decreased bun and uric acid level, more nutrients to kidneys, increased filtration and excretion of water and solutes. Altered renal secretion of drugs. Proteinuria (lower than 300mg) and glycosuria (inconsistent) are normal |
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Integumentary adaptation |
Spider anginomas: 8-20wks in 75% women usually disapear after delivery Palmar erythemia: familial tendency Linea nigra: midline of abdomen Chloasma: mask of pregnancy. May not disapear completely Striae gravidarum: stretch marks Beu's lines: lines in nails Hair may increase and become thicker |
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Musculoskeletal adaptation |
Lordosis; ligaments in symphasis pubis and sacroiliac joints soften due to relaxin. Center of gravity lowers |
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Hyperemesis gravidarum and morning sickness |
Speculated bc of high levels of hCG and estrogen. Eat crackers, small meals, make a list of bothetsome foods/smells. Drink plenty of fluids |
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Heartburn |
Monitor foods, avoid drinking liquids with meals, sit upright for 30 minutes after eating. Don't bend at waist. Lie on right side. Tums. |
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Constipation |
Don't stop taking supplements. Increase fiber and fluids ingested. Exercise regularly. |
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Fatigue |
Try meditation jeez wtf |
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Kegal exercises |
Use same muscles to stop urination. Hold for 5 seconds then repeat. Do 25-50 per day. |
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Urinary frequency |
Make sure its not a uti. Teach kegel exercises. |
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Epitaxis |
Cool mist humidifier at night, saline spray |
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Variscocities |
Don't stand too long. Don't sit too long. Maternity hose. Loosley fitting clothes. |
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Hemorrhoids |
Relieve constipation. Don't sit too long or strain. Sitz bath. Witch hazel. Push them back into rectum. |
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Back pain |
Fix posture Bend at knees. Low heeled shoes. Elevate one foot when standing for a while. Don't sit or stand too long. Massages |
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Leg cramps |
Thought to be problems balancong calcium and phosphorus. Try walking about. Sit with legs and knees straight, grab toes and pull back to flex her foot. |
