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97 Cards in this Set

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A woman is 8 weeks pregnant, will she feel fetal movement? Will there be a ballottement baby?

- No
- Ballottement – rebound of unengaged fetus felt in the 4th or 5th month of pregnancy

Ballottement--a mid-pregnancy sign in which the fetus can be pushed from the mother's abdomen, and felt to bounce back, tapping an examining finger in the vagina.

No, you cannot feel ballottement on an 8 week fetus

8 weeks pregnant and you are going to teach her about the pregnancy and what to expect…
Will you teach her about breathing?
Will you teach her about infant care?
Will you teach her about nutrition of the neonate?
(Remember about gestation and what happened at each point.)
What happens in an early part of pregnancy?

-No
-No
-No
- You should teach her about nausea, vomiting and fatigue associated with the 1st trimester (as opposed to teaching her about deep breathing and labor)
- 1st trimester teaching: Physical psychosocial changes
- Discomforts of pregnancy and relief measures
- Lifestyle: exercise, stress, nutrition, sex, dental care, medication use, substance abuse, and STD’s
- Complications, choosing an obstetrician
- Fetal growth and development
- Prenatal exercise, laboratory testing
- Amenorrhea, N/V, fatigue, urinary frequency, breast changes, uterine enlargement
What do you expect to see with Placenta Previa?

- Painless bleeding, baby is fine. The mom’s abdomen is soft. Find out where the bleeding is coming from.
- Painless, baby is typically ok, abdomen is going to be soft, and ultrasound would be done to find out where the placenta is.
- S/S – Painless, bright red vaginal bleeding, relaxed, nontender uterus with normal tone, higher than expected fundal height, palpable placenta, fetus in breech, oblique, or transverse position
- Occurs when the placenta abnormally implants in the lower segment of the uterus near or over the cervical os instead of attaching to the fundus
- Results in bleeding during the 3rd trimester as cervix dilates and effaces
- Major complications associated with placenta previa are: maternal hemorrhage, and fetal prematurity or death
- Risk factors include: previous placenta previa, uterine scarring, maternal age > 35 years, multifetal gestation, multiple gestations, or closely spaced pregnancies
- Diagnosed with transabdominal or transvaginal ultralsound which shows placental placement
- Assess bleeding, leaking, or contraction
- Count pads for bleeding amount
- Examine the abdomen, and assess fundal height
- Perform Leopold’s maneuvers to determine fetal position and presentation
- Check VS and assess I&O
- Place client on bedrest, IV fluids as ordered, blood replacement as ordered
- Nothing inserted vaginally
- Corticosteroids given for fetal lung maturation
Does the placenta produce maternal antibodies?

At what point do they use the Hegar’s sign?

- No.
- The placenta produces hormones needed to maintain pregnancy
- Performs the metabolic functions of respiration nutrition, excretion, and storage
- Maternal Oxygen diffuses across the placenta into the fetal blood
- Carbon dioxide diffuses from the fetal blood across the placenta into the maternal blood

- 6-8 weeks. Not definitive signs. (Probable signs) (objective)
- Hegar’s sign – softening and compressibility of lower uterus at 6-8 weeks pregnancy
What is Chadwick’s Sign?

- Violet-blue color of vaginal mucosa
What is Goodell’s sign?

- Cervical tip softening
What is Ballottement?

- Rebound of unengaged fetus felt in the 4th or 5th month of pregnancy
What are Probable signs and symptoms of pregnancy (objective)?

- Abdominal enlargement, cervial changes
- Hegar’s sign – softening and compressibility of lower uterus at 6-8 weeks pregnancy
- Chadwick’s Sign - Violet-blue color of vaginal mucosa
- Goodell’s sign - Cervical tip softening
- Ballottement - Rebound of unengaged fetus felt in the 4th or 5th month of pregnancy
- Braxton Hicks contractions
- Positive pregnancy test, palpable fetal outline
What are the Presumptive signs and symptoms of pregnancy (usually subjective)?

- Amenorrhea, N/V, fatigue, urinary frequency, breast changes, uterine enlargement
- Quickening – fetal movement felt at 16-20 weeks gestation
- Linea Nigra - dark vertical line that appears on the abdomen during about three quarters of all pregnancies
- Chloasma (melasma) – Mask of pregnancy
- Striae Gravidarum – Stretch Marks
- Darkened areola
What are the Positive signs and symptoms of pregnancy?

- Fetal heart sounds with fetoscope or doppler
- Fetal movement palpated by an experienced examiner
- Visualization of fetus by ultrasound or through x-ray examination
Is bilateral edema (lower extremity edema) normal for someone who is 36-38 weeks preganant?

- Yes
- 3rd trimester – swelling in hands and/or feet
Will you be concerned if the pregnant woman does not have pedal pulses?

- Yes
How much weight should a pregnant woman gain?

- 25-35lb
- Recommended weight gain during pregnancy is usually 25-35 pounds
- General rule: weight gain of 3-4 pounds the first trimester, and 1 pound per week for the last 2 trimesters
- Excessive weight gain leads to macrosomia (big baby) and labor complications
- Poor weight gain leads to low birth weight
Pt with heart burn, what do you think might help her?

- eat small, frequent meals
If pt is laying on her back and feels dizzy, what would you do?

- Lay on left side or either side
- During the last months of pregnancy the woman should rest on her left side for at least 1 hour in the morning and afternoon to relieve fetal pressure
- Avoid sleeping or lying on the back due to supine hypotension syndrome due to fetal compression on the aorta and the vena cava
- If woman must remain on back, place small pillow or towel roll under one hip
When do the symptoms of pregnancy like nausea, vomiting, etc usually subside (stop)?

- After the 1st trimester
2nd trimester, how much weight should they typically gain?

- 1lb a week
- General rule: weight gain of 3-4 pounds the first trimester, and 1 pound per week for the last 2 trimesters
Where does conception happen?

- Occurs in outer third in of the fallopian tubes
If conception happens outside the fallopian tubes, what will happen?

- Ectopic pregnancy (abdominal pregnancy)
- Abnormal implantation outside the uterus
- Implantation in the fallopian tube leads to rupture causing fatal hemorrhage
- Risk factors include any factor that compromises tubal patency (PID, IUD > 2 years)
- Transvaginal ultrasound shows empty uterus
- S/S – Unilateral stabbing pain, vaginal spotting, referred shoulder pain, N/V, and shock
- Assess for unilateral pain & vaginal bleeding
- Assess VS
- Assess skin color and urine output
- Provide replacement fluid and maintenance of electrolyte balance
- Provide education and psychological support
- Prepare client for surgery: linear salpingostomy (helps to salvage fallopian tube if not ruptured) and laparoscopic salpingostomy (tube removal)
How do you figure out Nagele’s sign?

- Determine the date of the 1st day of the woman’s LMP, add 7 days, subtract 3 months, the resulting date is the EDD
- Determining the estimated date of delivery (EDD); also called the estimated date of confinement (EDC), uses Nagele’s Rule
- A full term pregnancy is approximately 280 days from the first day of the last menstrual period (LMP), or 266 days after fertilization
How do u calculate a due date?

- Date of their last period, add 7 days and subtract 3 months
What is one of the complications (or concerns) in a fetal alcohol baby? (signs would a baby have if the mom was a alcoholic)

- Learning Disabilities, Cognitive ability impairment
- Alcohol crosses the placental barrier and cause: growth deficiency, craniofacial deformity, behavioral and cognitive impairment, motor and sensory deficits, and seizures
- Baby is not addicted to alcohol
- Learning disabilities (cognative abilities)
The least (Non) invasive form of fetal surveillance? (least invasive)

- Non stress test (NST)
- Doppler transducer and tocotransducer are attached externally producing paper tracing strips during the third trimester to evaluate fetal heart rate (FHR), fetal movement, and the fetal nervous system during the third trimester
Name some signs that a patient should notify her Dr. when she has c/o?

- Blurred vision (what is blurred vision assoc. with - Preeclampsia)
- Abdomen pain
- Bleeding
Is HTN associated with preeclampsia?

- Yes
Can you have HTN without preeclampsia?

- Yes
S/S of a abruption? (Abruptio Placenta) (placenta pulls away from uterous)

- Sudden onset of intense localized uterine pain, vaginal bleeding, board-like abdomen, firm rigid uterus with contractions, fetal distress, hypovolemic shock
- Premature separation of the placenta from the uterus
- Can be partial or complete detachment
- Occurs after 20 weeks gestation, usually in the 3rd trimester
- Leading cause of maternal death
- Moderate to severe abruption can lead to disseminated intravascular coagulopathy (DIC)
- Associated with maternal hypertension
- Associated with abdominal trauma, cocaine abuse, prior Hx of abruption, smoking, premature rupture of membranes, short umbilical cord, and multifetal pregnancy
- Palpate the uterus for tenderness and tone
- Assess bleeding rate, amount, and color
- Assess fetal HR, maternal VS, maternal color and turgor, maternal capillary refill, urine output and LOC
- Place client on bedrest, refrain from vaginal exams
- Administer blood products, fluid volume replacement, corticosteroids, and immune globulin as ordered
- TX: cesarean delivery
- Hardened abdomen
Stretch marks, what are they called?

- Striae Gravidarum = Stretch Marks; Skin stretched (Presumptive)
What is Linea Nigra? (Presumptive)

- dark vertical line that appears on the abdomen during about three quarters of all pregnancies
What is Chloasma (melasma)

- Mask of pregnancy (Presumptive)
Why is it so important to diagnose ectopic pregnancy right away?

- The mom can die from bleeding to death
- S/S – Unilateral stabbing pain, vaginal spotting, referred shoulder pain, N/V, and shock, hypovolemia, hypotension, pallor
- Pain in abdoman
Teatment for ectopic pregnancy patient in shock?

- Treat her like she is in shock, start an IV (replace fluids), give o2
- ask her history, do an ultrasound, and HCG, find out whats going on
Is it normal to have SOB at 37 weeks?

- Yes
- 8th month – heartburn, indigestion, SOB, varicose veins, hemorrhoids, Braxton-Hicks contractions, orthostatic hypotension
Would you tell the pt to come in if they are 37 weeks pregnant and cannot sleep?

- No (it’s normal)
What are some S/S of Hydatidiform Mole?

- Also called Trophoblast
- Rapid Uterine growth
- Has Pregnancy signs
- Elevated HCG levels
- Benign abnormal uterine mass derived from chorionic villi that appears as a “bunch of grapes”
- Very large cystic vesicles
- U.S. incidence is 1 out of every 2000 pregnancies
- Early in the pregnancy maternal blood will present with high levels of hCG
- Associated with fertilization of the ovum by 2 or more sperm
What do the Hydatidiform Moles look like?

- Benign abnormal uterine mass derived from chronic villi that appears as “bunch of grapes”
If the pregnant woman who is due in 10 days tells you that she is fatigued, and tired and wants to be induced “NOW!!!” what would you tell her? What happens if she delivers too soon?

- Hang on Hold on, there is not much more to do. Many pregnant woman in your position go through the same thing and they do it.
- Try to relax, because they will not be induced this soon.
- What happens if you push them too deliver too soon? Baby will die or there will be major complications (Brain Dead).
At what point do you feel the baby move or kick (quickening) (presumptive sign) (usually subjective)?

- 16-20 weeks
- Quickening – fetal movement felt at 16-20 weeks gestation
- On top of Pubic symphysis
What does insulin do to the baby?

- Makes baby bigger
- Insulin acts like growth hormone on the fetus
- Increased fetal risks including: spontaneous abortion, infections, hydramnios (excess amniotic fluid), ketoacidosis, hypoglycemia, and hyperglycemia
When doing NST (Non stress test), baby is quiet, what can you do?

- Give them sugar (orange juice)
- More butter
- Instruct the mother to drink a fluid, have a snack, or to touch or rock the abdomen to move the fetus
What do you tell a patient who has abdominal bleeding or vaginal bleeding?

- Don’t tell patient: “Don’t worry; you’ll be able to continue pregnancy”
Is spinal bifida associated with down syndrome, gestational diabetes, or first trimester bleeding?

- No
Spinal bifida has familial tendency

Spinal bifida has familial tendency
AFP = blood test associated with what
AFP = blood test associated with what
- High levels associated with neural tube defects
Afp is not linked to down syndrome
Afp is not linked to down syndrome
In the clinic, what do we check for with preeclampsia?

- Proteinuria
Lack of folic acid, causes what?

- Neuro tube defect
What pregnancy hormone is elevated in pregnancy?

- hCG (Human Chorionic Gonadotropin)
What foods contain iron?

- Green Vegetables, Meats
What can happen to the baby with Hyperemesis gravidarum?

- Risk to fetus for intrauterine growth restriction or preterm birth
- Retardation
- Excessive N/V, related to elevated hCG levels, that is prolonged past 12 weeks gestation and results in 5% weight loss from nonpregnancy weight, dehydration, electrolyte imbalance, ketosis, and acetonuria
- May be accompanied by liver dysfunction
- Risk to fetus for intrauterine growth restriction or preterm birth
- Risk factors include: mother<20 years, obesity, 1st pregnancy, multifetal gestation, gestational trophoblastic disease, Hx of psychiatric disorders, transient hyperthyroidism, Vitamin B deficiencies, high stress levels
- Diagnostics include: UA for ketones and acetones, elevated specific gravity, chemistry profile, elevated liver enzymes, thyroid test, and elevated Hct
- S/S – excessive vomiting, dehydration with possible electrolyte imbalance, weight loss, decreased B/P, increased Pulse, poor turgor
- Monitor I&O, skin turgor, mucus membranes, VS, and weight
- NPO for 24-48 hours, advancing to clear liquids after 24 hours if no vomiting, advancing to diet as tolerated, TPN in severe cases
- IV fluids of lactated Ringer’s solution, vitamin B6 and other supplements, antiemetic and corticosteroids
Know the scores and what they mean for bio physical profile?

- Biophysical profile (BPP) – uses an ultrasound to visualize physical and physiological characteristics of the fetus in response to stimuli

- 2=normal, 0=abnormal, total 8-10=normal
- Fetal heart rate
- Fetal breathing movements
- Gross body movements
- Fetal muscle tone
- Amniotic fluid volume
At Each Prenatal visit, what do we check for that can be normal (Normal sign of pregnancy)?

- Edema
Assessment of pregnant woman, what do we check for?

- Edema
Hyperemesis gravidarum, what do u suggests they eat?

- No Oatmeal
- No eggs
- No milk
At 32 weeks, what is the #1 thing to worry about?

- Preeclampsia
Know when ovum is implanted during conception process?

- Ovum stage – conception to day 14
- 7-10 days
Confirmed pregnancy, low risk at 6 weeks, what will u establish with her?

- Prenatal care
- Physical and psychosocial changes
- Discomforts of pregnancy
- Lifestyle: exercise, stess, nutrition, sex, dental care, medication use, substance abuse, and STD’s
- Complications, choosing an obstetrician
- Fetal growth and development
- Prenatal exercise, laboratory testing
What do you teach a woman who just found out she is prego?

- Take vitamins & tell her what to expect the first 3 months (FATIGUE, mood swings, headache, morning sickness, urinary frequency, weight gain, BREAST SENSITIVITY and possible linea nigra and chloasma)
How long till the nausea and vomiting will stop?

- Usually after 9-12 weeks nausea & vomiting will stop
Pt getting heartburn, what can you instruct her to do?

- Eat small frequent meals
What is normal weight gain during pregnancy?

- 25-35 lbs
How do you determine estimated due date (EDD)?

- Take the first day of the last menstrual period and add 7 days and subtract 3 months (Nagele's Rule)
Its the 2nd trimester and the fundal height is 19cm, how many weeks along is
pt?

- 19 weeks
Pt takes a pregnancy test at home and it comes back false positive, what should she do?

- Go to MD and get blood test to see hcg
What else, besides vitamins should a prego take?

- Folic acid
Pt is a couple months prego and has hyperemesis, what do we need to see as
the final outcome?

- Maintain uterine growth, need to see the baby grow
Pt is in the hospital for hyperemesis, what do you give her to eat?

- clear liquids.
- Teach nutrition to later include green leafy veggies
What can you teach about nutrition?

- Spinach, meat, protein, increase iron, milk, increase calories by 300 per day, salt, folic acid and increase fluid to 10 glasses per day
When might the pt feel quickening (fetal movement)?

16-20 weeks

Pt c/o feeling very tired?

Tell her to rest!
Pt can take iron pills with what?

- Orange juice for absorption
What is AFP (Alpha fetaprotein) for?

- Genetic testing taken via amniocentesis to check for high levels which indicate neural tube defect and spinal bifida
Best place to hear fetal heart tones during 1st trimester?

- By doppler above the symphisis pubis
Pt drinking lots of wine, what is the fetus at risk for?

- Fetal alcohol syndrome, causes growth deficiency, mental retardation, cognitive & learning disabilities, seizures & deformities
When can the MD hear the first fetal heart tones?

- 10-11 weeks via doppler
Where does fertilization occur?

- In the outer 1/3 of the fallopian tube
Positive signs of pregnancy?

- fetal heart tone & movement.
- Also visual on ultrasound or Xray
When will the fertilized ovum be implanted in the endometrium?

- 6-10 days after conception
Highest priority for pt at 6 weeks prego?

- Establish prenatal visits
Pt smokes, what do you teach?

- Intrauterine growth retardation can occur, STOP SMOKING YOU MORON!!!!!
PT is diabetic, what is the risk to the fetus?

- If unmanaged, the insulin acts as a growth hormone, making the baby very big, but not healthy for the baby.
- It can also cause spontaneous abortion, infection, ketoacidosis & hypoglycemia & hyperglycemia.
Ultrasound reveals that pt is 14 weeks prego but the uterus is 18-20
weeks??

- Gestational Trophoblastic Disease.
- The ultrasound shows dense growth with characteristic vesicles but no fetus. Will do a D&C
S/S of mole pregnancy?

Elevated Hcg, rapid uterine growth, vaginal bleeding & discharge, excessive vomiting and PIH (Pregnancy Induced Hypertension).
DO an ultrasound
Pt admitted with an ectopic pregnancy, what risk factor will nurse see in
history?

- multiple pregnancies, history of PID or IUD < 2 years
S/S of ectopic pregnancy?

- Positive pregnancy test, abdominal pain, vaginal pain & spotting, NV & shock. Also referred shoulder pain
How much weight is gained in the 2nd and 3rd trimesters?

1lb per week
What do you assess for in pt who is 36 weeks?

- Urine check for glucose and protein.
- Fetal heart rate. B/P, fundal height and edema
34 weeks prego and have bright red bleeding, no pain and fetal heart rate
is normal, whats happening?

- Placenta Previa, placenta is covering the os, baby coming too soon, state c section
S/S of PIH (pregnancy induced hypertension)?

headache, edema, blurry vision, epigastric pain and rapid weight gain
What is magnesium sulfate for with pregnancy?

- Prevent seizures due PIH and preeclampsia
PIH pt comes in at 32 weeks c/o abdominal pain and bleeding?

Check fetal heart tones/rate, check how much bleeding and take VS
bpp (biophysical profile =

Ultrasound to visualize physical and physiological
response to stimuli. Detects FHR, Fetal breathing, gross body movement, fetal muscle tone and amniotic fluid volume.
2=normal and 0=abnormal.
Normal total score 8-10
Pts for above scores an 8, what do you tell her?

- fetus is healthy and well
32 weeks prego, what complications can happen in next few weeks?

proteinuria, edema and PIH
Pt comes in and asks about red streaks on her breasts, what is this?

> Stretch marks (striae gravidarum)
Line that shows down the stomach?

- Linea nigra

What does the placenta do?

- Production of estrogen & progesterone, exchange of food & gas & waste.
- detoxification of drugs and chemicals