Maternity Hesi 16 To 40 Weeks Gestation

Front 1

16 weeks: fetal development:

Back 1

1.head still dominant, but face looks human and arm/leg ratio is proportionate
2.scalp hair appears
3.meconium in bowel, and anus open
4.most bones and joint cavities seen on ultrasound, and muscular movements detected
5.heart muscle well developed, and blood formation active in spleen
6.elastic fibers appear in lungs and terminal; respiratory bronchioles appear
7.kidneys in position
8.cerebral loves delineated, and cerebellum assumes some prominence
9.general sense organs differentiated
10.testes in position for descent into scrotum, or vagina open

Front 2

16 weeks: maternal changes

Back 2

1.quickening, the mother's first perception of fetal movement, may be noted between weeks 16 and 20.
2.colostrum, the creamy white to yellowish premilk, may be expressed from the nipples as early as 16 weeks gestation.
3.serum cholesterol increases from 16 to 32 weeks of pregnancy and remains at this level until after birth
4. by 14 to 16 weeks, the placenta is clearly defined
5. insulin resistance begins as early as 14 to 16 weeks of gestation and continues to rise until it stabilizes during the last few weeks of pregnancy
6.approximately weight gain of 1lb per week beginning in the second trimester and continuing until delivery

Front 3

16 weeks: Nursing Interventions to consider

Back 3

1. explain the screening test, and obtain blood sample for maternal serum alpha-fetoprotein (MSAFP) between 15 and 22 weeks of gestation, ideally between 16 and 18 weeks of gestation.
a. elevated levels are associated with open neural tube defects and multiple gestations
b. low levels are associated with down syndrome. abnormal levels are followed by second-trimester ultrasonography for more in-depth investigation

Front 4

16 weeks: nursing interventions to consider

Back 4

explain the multiple-marker, or triple screen blood test, and obtain a specimen for screening between 16 and 18 weeks of gestation, to measure the MSAFP, human chorionic gonadotropin (hCG), and unconjugated estriol, the levels of which are combined to yield one value
a. low levels may be associated with Down syndrome and other chromosomal abnormalities

Front 5

20 weeks: fetal development

Back 5

1.vernix protects the body
2.lanugo (fine hair) covers the body and protects body
3.eyebrows, eyelashes, and head hair develop
4.fetus sleeps, sucks, and kicks
5.fetus weighs 200 to 400g (11 to 14 oz)

Front 6

20 weeks: maternal changes

Back 6

1.fundus reaches level of umbilicus
2.breasts begin secreting colostrum; areolae darken
3.amniotic sac holds approximately 400 ml of fluid
4.postural hypotension may occur
5.fetal movement felt (quickening); pregnancy becomes "real"
6.nasal stuffiness may begin
7.leg cramps may begin
8. varicose veins may develop
9.constipation may develop

Front 7

20 weeks: nursing interventions:

Back 7

1. teach comfort measures
a. encourage to remain active
b. encourage to sit with feet elevated when possible
c. teach to avoid pressure on lower thighs
d. teach that use of support stockings may be helpful
e. teach to dorsiflex foot to relieve leg cramps
f. suggest applying heat to muscles affected by cramps
g. suggest that cool-air vaporizer or saline nasal spray may help with nasal stuffiness

Front 8

20 weeks: nursing interventions:

Back 8

teach measures to avoid constipation
a. encourage to eat raw fruits, vegetables, cereals with bran
b. encourage to drink 3L of fluid per day
c. encourage to exercise frequently

Front 9

24 weeks: fetal development

Back 9

1.body fairly well proportioned; skin red and wrinkled; sweat glands forming
2.blood formation increases in bone marrow and decreases in liver
3.alveolar ducts and sacs present, and lecithin begins to appear in amniotic fluid (weeks 26 to 27)
4. neuronal proliferation in cerebral cortex ends
5.can hear
6.testes at inguinal ring in descent to scrotum

Front 10

24 weeks: maternal changes

Back 10

1.uterus rises to the level of the umbilicus
2.diastolic BP gradually increase at 24 to 32 weeks, after having decreased in the first trimester, and returns to pre-pregnancy levels by term. systolic BP usually remains the same as the pre-pregnancy level

Front 11

24 weeks: nursing interventions

Back 11

1.explain and obtain a blood sample for a glucose challenge that is usually done between 24 and 28 weeks gestation
2. at between 24 and 32 weeks gestation, two or three ultrasound measurements may be taken 2 weeks apart to compare against standard fetal growth curves

Front 12

28 weeks: fetal development:

Back 12

1.fetus can breathe, swallow, and regulate temperature
2.surfactant forms in lungs
3.fetus can hear
4. fetus's eyelid's open
5.period of greatest fetal weight gain begins
6.fetus weighs 1100g (2 and1/2 lb)

Front 13

28 weeks: maternal changes

Back 13

1.fundus is halfway between umbilicus and xiphoid process
2.thoracic breathing replaces abdominal breathing
3.fetal outline is palpable
4.woman becomes more introspective and concentrates interest on the unborn child
5.heartburn may begin
6.hemorrhoids may develop

Front 14

28 weeks: nursing interventions:

Back 14

1. teach treatment of hemorrhoids.
a. suggest sitz baths
b. suggest topical anesthetic agents
c. suggest taking stool softeners as prescribed
2. teach comfort measures
a. encourage woman to elevate legs when sitting
b. suggest that woman assume side-lying position when resting

Front 15

28 weeks: nursing interventions

Back 15

3. teach measures to avoid heartburn
a. teach woman to eat small, frequent meals
b. teach avoidance of fatty foods
c. encourage woman to avoid lying down after meals
d. teach that antacids may be prescribed
e. teach woman to avoid sodium bicarbonate
4.prepare woman for delivery and parenthood
a. discuss mother's, father's, and family's expectations of labor and delivery
b. discuss mother's, father's, and family's expectations about caring for infant
c. encourage woman to start childbirth preparation classes

Front 16

32 weeks: fetal development

Back 16

1.brown fat deposits develop beneath skin to insulate baby following birth
2.fetus is 15 to 17 inches in length
3. fetus begins storing iron, calcium, and phosphorus
4. fetus weighs 1800 to 2200g (4 to 5 lb)

Front 17

32 weeks: maternal changes

Back 17

1.fundus reaches xiphoid process
2.berasts are full and tender
3.urinary frequency returns
4.swollen ankles may occur
5.sleeping problems may develop
6.dyspnea may develop

Front 18

32 weeks: nursing interventions

Back 18

1.teach measures to decrease edema.
a.encourage woman to elevate legs one or two times per day for approximately 1 hour
2. teach comfort measures.
a. encourage woman to wear well fitting supportive bra
b. encourage woman to maintain proper posture
c. teach woman to use semi-fowler position at night for dyspnea
3.prepare woman for childbirth
a. review signs of labor
b. discuss plans for other children (if any)
c. discuss plans for transportation to agency
d.assess father's (family member's) role during childbirth

Front 19

36 to 40 weeks: fetal development

Back 19

1.fetus occupies entire uterus; activity is restricted
2.maternal antibodies are transferred to fetus (provide immunity for approximately 6 months, until infant's own immune system can take over).
3. L/S (Lecithin/sphingyomyelin) ratio is 2:1 and phosphatidylglycerol (PG) is present
4.fetus weighs 3200 +g (7+ lb)

Front 20

36 to 40 weeks: maternal changes

Back 20

1.lightning occurs
2.placenta weighs approximately 20 oz
3.mother is eager for birth, may have burst of energy
4.backaches increase
5.urinary frequency increases
6.braxton hicks contractions intensify cervix and lower uterine segment prepare for labor).

Front 21

36 to 40 weeks: nursing interventions:

Back 21

1.teach safety measures
a. teach to wear low-heeled shoes or flats
b. instruct to avoid heavy lifting
c. encourage sleeping on side to relieve bladder pressure and urinating frequently
2.encourage preparation for delivery
a. teach woman to do pelvic tilt exercises
b. encourage packing a suitcase
c.encourage couple to tour labor and delivery area
d. discuss postpartum circumstances; circumcision, rooming-in, possibility of postpartum blues, birth control, need for adequate rest, father's role