N303 - Ch 16 Ob

Front 1

How are the trimesters of pregnancy divided?

Back 1

1. First trimester = weeks 1 through 13

2. Second trimester = weeks 14 through 26

3. Third trimester = weeks 27 through 40

Front 2

When is a pregnancy considered at term?

Back 2

If it advances to 38 to 40 weeks of gestation

Front 3

What is Nagele's rule for estimating date of birth?

Back 3

1. Determine date of LMP
2. Subtract 3 calendar months
3. Add 7 days and 1 year
4. The result is the EDB

OR

1. Add 7 days to the LMP
2. Count forward 9 months
3. The result is the EDB

Front 4

What are the assumptions of Nagele's rule?

Back 4

1. That the woman has a 28-day menstrual cycle
2. That pregnancy commenced on the fourteenth day

Front 5

How does pregnancy affect a woman's self-concept?

Back 5

Pregnancy is a maturational milestone that can be stressful but also rewarding as the woman prepares for a new level of caring and responsibility

Front 6

How does a woman's role change during pregnancy?

Back 6

She moves gradually from being self-contained and independent to being committed to a lifelong concern for another human being

Front 7

What developmental tasks require mastery in order to adapt to the maternal role?

Back 7

1. Accepting the pregnancy

2. Identifying with the role of mother

3. Reordering the relationships between herself and her mother and between herself and her partner

4. Establishing a relationship with the unborn child

5. Preparing for the birth experience

Front 8

What is the first step in adapting to the maternal role?

Back 8

Accepting the idea of pregnancy and assimilating the pregnant state into one's life

Front 9

How does Mercer describe the first step in adapting to the maternal role?

Back 9

Cognitive restructuring

Front 10

What is ambivalence?

Back 10

Having conflicting feeling simultaneously, for example, some pregnant women feel great pleasure that they are fulfilling a lifelong dream, but also may feel great regret that life as they now know it is ending

Front 11

When does the process of identifying with the mother role begin?

Back 11

Early in a woman's life, when she was being mothered as a child

Front 12

How are personal relationships reordered during pregnancy?

Back 12

1. The relationship with her mother becomes significant to the pregnant woman

2. Pregnant women also reorder their sexual relationship with their partner

Front 13

What sexual position is not recommended during the later stages pregnancy?

Back 13

Man-on-top because it may apply too much pressure on the woman's abdomen

Front 14

What is emotional attachment?

Back 14

Feelings of being tied by affection or love

Front 15

When does emotional attachment with the fetus begin?

Back 15

During the prenatal period as women use fantasizing and daydreaming to prepare themselves for motherhood

Front 16

What is the attachment process?

Back 16

Phases in which the woman establishes a relationship with the fetus

Front 17

What are the phases of the attachment process?

Back 17

1. Phase 1 - Biologic fact of pregnancy ("I am pregnant")

2. Phase 2 - Acceptance of the growing fetus as distinct from herself, usually accomplished by the fifth month ("I am going to have a baby")

3. Phase 3 - Realistic preparation for the birth and parenting of the child ("I am going to be a mother")

Front 18

What is paternal adaptation?

Back 18

The father's beliefs and feelings about the ideal mother and father and his cultural expectation of appropriate behavior during pregnancy affect his response to his partner's need for him

Front 19

What is couvade syndrome?

Back 19

The phenomenon in which some men experience pregnancy-like symptoms: nausea, weight gain, and other physical symptoms

Front 20

What are the phases characterizing the developmental tasks experienced by the expectant father?

Back 20

1. Announcement phase
2. Moratorium phase
3. Focusing phase

Front 21

What is the announcement phase?

Back 21

May last few hours to few weeks. Developmental task is to accept the biologic fact of pregnancy. Men may react with joy or dismay, depending on whether the pregnancy was planned or unplanned. Ambivalence is common.

Front 22

What is the moratorium phase?

Back 22

Period of adjustment. Men appear to put conscious thought of pregnancy aside for a time. Become more introspective about life, childbearing, childrearing, and relationships (especially with their fathers).

Front 23

What is the focusing phase?

Back 23

Begins in the last trimester and is characterized by the father's active involvement in both the pregnancy and his relationship with the child. Negotiation with his partner for his role during labor and prepares for parenthood. Thinks of himself as a father.

Front 24

What is the partner's main role in pregnancy?

Back 24

To nurture and respond to the pregnant woman's feelings or vulnerability

Front 25

How do fathers establish relationships with the fetus?

Back 25

He may rub or kiss the maternal abdomen, try to listen, talk, or sing to the fetus, or play with the fetus as he notes movement. Calling the unborn child by name or nickname helps to confirm the reality of pregnancy and promote attachment

Front 26

Which age group has the most difficulty with sibling adaptation?

Back 26

Early and middle adolescents because they are preoccupied with the establishment of their own sexual identity and may have difficulty accepting the overwhelming evidence of the sexual activities of their parents. They reason that if they are too young for such activity, certainly their parents are too old.

Front 27

When is the therapeutic relationship between the nurse and the woman established?

Back 27

During the initial assessment interview

Front 28

What data is collected during the initial assessment interview?

Back 28

1. The woman's subjective appraisal of her health status and the nurse's objective observations

2. The nurse observes for the woman's affect, posture, body language, skin color, and other physical and emotional signs

Front 29

What data are gathered during the obstetric and gynecologic history?

Back 29

1. Woman's age at menarche, menstrual history, and contraceptive history

2. The nature of any fertility or gynecological conditions

3. History of STIs

4. Sexual history

5. A detailed history of all her pregnancies, including present pregnancy, and their outcomes

6. Date of last Pap smear and the result

7. Date of LMP is obtained to establish the EDB

Front 30

What data are gathered during the medical history?

Back 30

1. DM, HTN, epilepsy

2. If she has undergone uterine surgery or extensive repair of the pelvic floor, cesarean birth may be necessary

Front 31

What surgical procedures should be noted in the chart?

Back 31

1. Uterine surgery or extensive repair of the pelvic floor may require cesarean birth

2. Appendectomy rules out appendicitis as a cause of RLQ pain in pregnancy

3. Spinal surgery may contraindicate the use of spinal or epidural anesthesia

Front 32

What should the nurse be alert for throughout the interview?

Back 32

The appearance of potential parenting problems, such as depression, lack of family support, and inadequate living conditions

Front 33

What areas of the woman's knowledge should be assessed?

Back 33

1. Pregnancy
2. Maternal changes
3. Fetal growth
4. Self-care
5. Care of the newborn, including feeding

Front 34

What are some common stressors during childbirth?

Back 34

1. Baby's welfare
2. Labor and birth process
3. Behaviors of the newborn
4. The woman's relationship with the baby's father and her family
5. Changes in body image
6. Physical symptoms

Front 35

What may adversely affect maternal and fetal health?

Back 35

Past and present occupation, especially if heavy lifting or exposure to chemicals and radiation were part of daily work

Front 36

What must be noted during the history of any physical abuse?

Back 36

1. Any physical signs of blows directed at the woman's head, breasts, abdomen, or genitalia

2. Sexual assault

Front 37

What is assessed during the review of body systems?

Back 37

1. Shortness of breath
2. Pain

Front 38

What must be assessed about pain?

Back 38

1. Body location
2. Quality
3. Quantity
4. Chronology
5. Aggravating or alleviating factors
6. Associated manifestations (onset, character, course)

Front 39

What is supine hypotension?

Back 39

Low BP that occurs while the woman is lying on her back, causing feelings of faintness

Front 40

What is the purpose of the Hgb, HCT, WBC, differential lab test?

Back 40

Detects anemia and/or infection

Front 41

What is the purpose of the Hgb electrophoresis lab test?

Back 41

Identifies women with hemoglobinopathies (e.g. sickle cell anemia, thalassemia)

Front 42

What is the purpose of the blood type, Rh, and irregular antibody lab test?

Back 42

Identify those fetuses at risk for developing erythroblastosis fetalis or hyperbilirubinemia in neonatal period

Front 43

What is the purpose of the rubella titer?

Back 43

Determines immunity to rubella

Front 44

What is the purpose of the TB skin testing (chest screen after 20 weeks of gestation in women with reactive TB tests)?

Back 44

Screens for exposure to TB

Front 45

What is the purpose of a urinalysis, including microscopic examination of urinary sediment; pH, specific gravity, color, glucose, albumin, protein, RBCs, WBCs, casts, acetone, hCG?

Back 45

Identifies women with unsuspected DM, renal disease, hypertensive disease of pregnancy; infection; occult hematuria

Front 46

What is the purpose of a urine culture?

Back 46

Identifies women with asymptomatic bacteriuria

Front 47

What is the purpose of renal function tests: BUN, creatinine, electrolytes, creatinine clearance, total protein excretion?

Back 47

Evaluates level of possible renal compromise in women with a history of DM, HTN, or renal disease

Front 48

What is the purpose of a Pap test/smear?

Back 48

Screens for cervical intraepithelial neoplasia, herpes simplex type 2, and HPV

Front 49

What is the purpose of vaginal or rectal smear for Neisseria gonorrhoeae, Chlamydia, HPV, GBS?

Back 49

Screens high risk population for asymptomatic infection; GBS done at 35-37 weeks

Front 50

What is the purpose of RPR, VDRL, or FTA-ABS?

Back 50

Identifies women with untreated syphilis

Front 51

What is the purpose of HIV antibody, hepatitis B surface antigen, toxoplasmosis testing?

Back 51

Screens for specific infections

Front 52

What is the purpose of the 1-hr glucose tolerance test?

Back 52

Screens for gestational DM; done at initial visit for women with risk factors; done at 24-28 weeks for all pregnant women

Front 53

What is the purpose of the 3-hr glucose tolerance test?

Back 53

Screens for DM in women with elevated glucose level after 1-hr test; must have two elevated readings for diagnosis

Front 54

What is the purpose of the cardiac evaluation: ECG, chest x-ray film, and echocardiogram?

Back 54

Evaluates cardiac function in women with a history of HTN or cardiac disease

Front 55

What are the signs and symptoms of supine hypotension?

Back 55

1. Pallor
2. Dizziness, faintness, breathlessness
3. Tachycardia
4. Nausea
5. Clammy (damp, cool) skin; sweating

Front 56

What are the interventions for supine hypotension?

Back 56

Position woman on her side until her signs and symptoms subside and until vital signs stabilize within normal limits (WNL)

Front 57

What are the signs and symptoms of potential complications during the first trimester?

Back 57

1. Severe vomiting
2. Chills, fever
3. Burning on urination
4. Diarrhea
5. Abdominal cramping; vaginal bleeding

Front 58

What are the possible causes of the potential complications during the first trimester?

Back 58

1. Hyperemesis gravidarum
2. Infection
3. Miscarriage, ectopic pregnancy

Front 59

What are the signs and symptoms of potential complications during the second and third trimesters?

Back 59

1. Persistent, severe vomiting
2. Sudden discharge of fluid from vagina before 37 wk
3. Vaginal bleeding, severe abdominal pain
4. Chills, fever, burning on urination, diarrhea
5. Severe back ache or flank pain
6. Change in fetal movements: absence or fetal movements after quickening, any unusual change in pattern or amount
7. Uterine contractions; pressure; cramping before 37 wk
8. Visual disturbance: blurring, double vision, or spots
9. Swelling of face or fingers and over sacrum
10. Headaches: severe, frequent, or continuous
11. Muscular irritability or convulsions
12. Epigastric or abdominal pain (perceived as severe stomachache)
13. Glycosuria, positive glucose tolerance test reaction

Front 60

What are the possible causes of the potential complications during the second and third trimesters?

Back 60

1. Hyperemesis gravidarum, HTN, preeclampsia
2. Premature rupture of membranes (PROM)
3. Miscarriage, placenta previa, abruptio placentae
4. Infection
5. Kidney infection or stones; preterm labor
6. Fetal jeopardy or intrauterine fetal death
7. Preterm labor
8. Hypertensive conditions, preeclampsia
9. Gestational DM

Front 61

What are the risk factors indicating the need for group B streptococcus (GBS) prophylaxis?

Back 61

1. Previous infant with a group B streptococcus infection
2. GBS bacteriuria during current pregnancy
3. Membranes ruptures or onset of labor before 37 wk of gestation

Front 62

What is quickening?

Back 62

"Feeling of life" that refers to the mother's first perception of fetal movement. Usually occurs between 16 and 20 weeks of gestation and is initially experienced as a fluttering sensation

Front 63

What are Kegel exercises?

Back 63

Deliberate contraction and relaxation of the pubococcygeus muscle to strengthen the muscles around the reproductive organs and improve muscle tone

Front 64

What test is done to determine if the nipple is everted (normal) or inverted?

Back 64

Pinch test

Front 65

What exercises can be done to help relieve low backache (as well as menstrual cramps)?

Back 65

Pelvic rocking

Front 66

What are the benefits of abdominal breathing?

Back 66

Aids in relaxation and lifts abdominal wall off uterus

Front 67

What is conscious relaxation?

Back 67

The process of releasing tension from the mind and body through deliberate effort and practice

Front 68

When can preterm labor occur?

Back 68

Usually after 20 wk but before 37 wk and consists of uterine contractions that, if untreated, cause the cervix to open earlier than normal and result in preterm birth

Front 69

What is the exact etiology of preterm labor?

Back 69

Unknown

Front 70

What is associated with preterm labor?

Back 70

1. Poverty
2. Low educational level
3. Lack of societal support
4. Smoking
5. Domestic violence
6. Stress
7. Previous preterm labor
8. Current multifetal gestation
9. Some uterine and cervical variations

Front 71

What are the signs and symptoms of preterm labor?

Back 71

1. Abdominal tightening and hardening
2. Frequent uterine contractions (every 10 minutes or more for 1 hour)
3. Bloody spotting or leaking fluid from the vagina
4. Pain

Front 72

What are the recommended sexual positions during pregnancy?

Back 72

1. Female superior (woman on top)
2. Side by side (spooning)
3. Rear entry
4. Side-lying facing each other

Front 73

What are cultural prescriptions?

Back 73

Cultural practices that tell women what to do

Front 74

What are cultural proscriptions?

Back 74

Cultural practices that are TABOOS

Front 75

How is the mean arterial pressure (MAP) calculated?

Back 75

MAP = [systolic BP + 2(diastolic BP)]/3

i.e. BP = 130/70

MAP = [130 + 2(70)]/3
MAP = [130 + 140]/3
MAP = [270]/3 ====> 90mmHg