Nur 113 Ch 11 Assessing Fetal & Maternal Health: Prenatal Care

Front 1

Nursing diagnoses appropriate to prenatal care include:

Back 1

-Health-seeking behaviors related to guidelines for nutrition and activity during pregnancy
-Deficient knowledge regarding exposure to teratogens during pregnancy
-Risk for injury to fetus related to current lifestyle behaviors

Front 2

Immunizations that can be received during pregancy?

Back 2

-influenza
-poliomyelitis w/ Salk(killed virus)

Front 3

Meds to avoid during pregnancy?

Back 3

oral diabetic meds (use insulin injections instead
-accutane
-ASA (anti-coagaulants
-

Front 4

*Terms Related to Pregnancy Status*
1. para
2. Gravida
3. Primigravida
4. Primipara
5. Multigravida
6. Multipara
7. Nulligravida

Back 4

Para
Number of pregnancies that have reached viability, regardless of whether the infants were born alive
Gravida
Woman who is or has been pregnant
Primigravida
Woman who is pregnant for the first time
Primipara
Woman who has given birth to one child past age of viability
Multigravida
Woman who has been pregnant previously
Multipara
Woman who has carried two or more pregnancies to viability
Nulligravida
Woman who has never been and is not currently pregnant

Front 5

a woman who has had two previous pregnancies, has given birth to two term children, and is again pregnant is ?

Back 5

gravida 3, para 2

Front 6

A woman who has had two miscarriages at 12 weeks (under the age of viability) and is again pregnant is ?

Back 6

a gravida 3, para 0.

Front 7

GTPAL OR GTPALM?

Back 7

T: Number of full-term infants born (infants born at 37 weeks or after)
P: Number of preterm infants born (infants born before 37 weeks)
A: Number of spontaneous miscarriages or therapeutic abortions
L: Number of living children
M: Multiple pregnancies

Front 8

Age of viaibilty?
Preterm?
Full term?

Back 8

-20 wks
-20-36 wks
-37-40 wks

Front 9

a woman who has had two previous pregnancies, has given birth to two term children, and is again pregnant is gravida 3, para 2.
What would be her GTPAL & GTPALM?

Back 9

2002 (GTPAL) or 320020 (GTPALM).

Front 10

A multigestation pregnancy is considered as one para. For example, a woman who had term twins, then one preterm infant, and is now pregnant again would be a gravida 3, para. What is her GTPALM?

Back 10

21031 (GTPALM).

Front 11

A pregnant woman who had the following past history—a boy born at 39 weeks' gestation, now alive and well; a girl born at 40 weeks' gestation, now alive and well; a girl born at 33 weeks' gestation, now alive and well—would have her pregnancy information summarized as ?

Back 11

gravida 4; para 21030 (GTPALM).

Front 12

"weight gain is Healthy"
how many lbs are gained?

Back 12

30 to 35 lbs
40 lbs is needed for many adolescents

Front 13

A sudden increase in Pulse or Respirations suggest?

Back 13

-Bleeding

Front 14

A sudden increase in B/P or weight is a danger sign of ?

Back 14

Hypertension of pregnancy

Front 15

CHloasma:

Back 15

(extra pigment on the face that occurs from melanocyte-stimulating hormone), which may accompany pregnancy

Front 16

Dryness or sparseness of the hair suggest?

Back 16

poor nutrition

Front 17

Lack of cleanliness of hair suggest?

Back 17

Fatigue,
urge to save energy for self-care
(dandruff shampoos may be used)

Front 18

Edema of the eyelids combined with a swollen optic disk (identified on ophthalmoscopic examination) suggests ?

Back 18

edema from pregnancy-induced hypertension, a potentially dangerous condition in pregnancy

Front 19

What causes nasal congestion or swollen nasal membranes during pregnancy?

Back 19

increased levels of estrogen
(avoid nasal sprays & drops)

Front 20

Why is the date of the LMP needed?

Back 20

-to get the age of the fetus or expected date of Birth (EDB)

Front 21

**Nagele's Rule?
ie. LMP 12-2-2010
- 3 mths and + 7 days=

Back 21

9-9-2011 (EDB)

Front 22

HR for pregnant woment?

Back 22

70-80

Front 23

What are the Breast changes during pregnancy?

Back 23

-Areolae darken.
-Secondary areolae develop.
-Montgomery tubercles (sebaceous glands in the areolae) become prominent.
-Overall breast size increases.
-Breast consistency firms.
-Blue streaking of veins becomes prominent.
-Colostrum may be expelled as early as the 16th week of pregnancy.
-Any supernumerary nipple also may become darker and enlarge in size.

Front 24

Fundal Height (McDonald's Measurements)
1. What week does the uterus reach the Umbilicus?
2. What week does the uterus reach the Xiphoid Process

Back 24

1. 20-22 wks
2. 36 wks
then uterus often returns to about 4 cm below the xiphoid because of “lightening” at 40 weeks

Front 25

1. For a baby to be born vaginally, he or she must be able to pass through, what 3 parts of the pelvis?.
2. When could this be a problem?

Back 25

1. the inlet,
the cavity, and
the outlet of the pelvic bone.
2. if the mother is a young adolescent girl who has not yet achieved full pelvic growth (girls < than 14 years, most prone to this difficulty) or a woman who has had a pelvic injury (e.g., MVA)

Front 26

appears as clustered, pinpoint vesicles on an erythematous (reddened) base on the vulva. These feel painful when touched or irritated.?

Back 26

-Herpes simplex 2
-presence of herpes lesions on the vulva or vagina at the time of birth may necessitate cesarean birth to prevent exposing the fetus to the virus during passage through the birth canal.

Front 27

What is the best Pelvis shape for childbirth?

Back 27

Gynecoid

Front 28

What are the diff types and shapes of the Pelvis?

Back 28

1. android,
2. anthropoid,
3. gynecoid, and
4. platypelloid

Front 29

“female,” pelvis has an inlet that is well rounded forward and backward and a wide pubic arch?

Back 29

Gynecoid

Front 30

“male,” pelvis, the pubic arch forms an acute angle, making the lower dimensions of the pelvis extremely narrow. A fetus may have difficulty exiting from this type of pelvis?

Back 30

Android

Front 31

“ape-like,” pelvis, the transverse diameter is narrow, and the anteroposterior diameter of the inlet is larger than normal. This structure does not accommodate a fetal head as well as a gynecoid pelvis.?

Back 31

-anthropoid

Front 32

“flattened,” pelvis has a smoothly curved oval inlet but the anteroposterior diameter is shallow. A fetal head might not be able to rotate to match the curves of the pelvic cavity in this type of pelvis.

Back 32

platypelloid

Front 33

Internal pelvic measurements give the actual diameters of the inlet and outlet through which the fetus must pass. The following measurements are made most commonly:

Back 33

1. The Diagonal conjugate
2. The true conjugate or conjugate vera
3. The Ischial Tuberosity diameter.

Front 34

Diagonal conjugate:
If the measurement obtained is more than __cm, the pelvic inlet is rated as adequate for childbirth

Back 34

12.5 cm

Front 35

The diameter of the fetal head that must pass that point averages __ cm in diameter

Back 35

9 cm

Front 36

How is the diagonal conjugate measured?

Back 36

2 fingers are introduced vaginally & pressed inward & upward until the middle finger touches the sacral prominence. With the other hand, the part of the examining hand where it touches the symphysis pubis is marked
-Most useful measurement for pelvic size

Front 37

Measurement estimated from the diagonal conjugate
- To do this, the usual depth of the symphysis pubis (assumed to be 1.5-2 cm) is subtracted from the diagonal conjugate measurement. The distance remaining will be the?

Back 37

True Conjugate or the actual diameter of the pelvic inlet through which the fetal head must pass

Front 38

The average true conjugate diameter is?

Back 38

12.5(DC) cm minus 1.5 or 2 cm, or 10.5 (DC) to 11(DC) cm.

Front 39

measurement is the distance b/w the ischial tuberosities, or the transverse diameter of the outlet.
It is made at the medial and lowermost aspect of the ischial tuberosities at the level of the anus

Back 39

Ischial Tuberosity

Front 40

A diameter of ___ cm is considered adequate b/c it will allow the diameter of the fetal head, or 9 cm, to pass freely through the outlet.

Back 40

11 cm

Front 41

Cephalopelvic Disproportion:

Back 41

pelvic size is too small to have a vaginal delivery
-Should have a Cesarean Section
-(If pelvic is < 12.5 cm the baby will not be able to come through the vaginal canal

Front 42

-CBC-
H&H determines:
WBC:
PLT:

Back 42

-presence of Anemia
-infection
-clotting ability

Front 43

Genetic screen for ethnically inherited diseases
1. African Amer
2. Asian & Mediterranean
3. Jewish
4. Caucasian

Back 43

1. sickle cell trait & G6PD (glucose-6-phosphate dehydrogenase)
2. beta-thalassemia
3. Tay-sachs disease
4. cystic fibrosis

Front 44

Test for syphilis & gonorrhea?

Back 44

-serologic test (VDRL or rapid plasma reagin test)
-

Front 45

Blood type:
what mother needs a Rhogam shot?

Back 45

Rh - mother

Front 46

At what week is the Maternal serum for alpha-fetoprotein (AFP) MSAFP test done?

Back 46

16 -18 wk
-level will be elevated if a Neural tube or abnormal defect
is present in the The level in serum is expressed as “multiples of the mean” (MOM). A normal value is 2.5 MOM. If this is elevated or decreased, an ultrasound or amniocentesis will be ordered

Front 47

This test is generally repeated at 28 wk of pregnancy. If the titers are not elevated, an Rh-negative woman will receive RhIG (RhoGAM) at 28 wk & after any procedure that might cause placental bleeding, such as amniocentesis or external version.

Back 47

indirect Coombs' test (determination if Rh antibodies are present in an Rh-negative woman)

Front 48

These tests determine whether a woman is protected against rubella if exposure should occur during pregnancy and whether a newborn will have a chance of developing hepatitis
-Antibodies for varicella (chickenpox) may also be assessed

Back 48

Antibody titers for rubella and hepatitis B (HBsAg).
-may repeat at 36 wks

Front 49

High-risk criteria for HIV includes:

Back 49

-used or are using IV drugs;
-engaged in sex with multiple partners;
-sexual partners who are infected or are at risk b/c they are bisexual, intravenous drug abusers, or hemophiliacs; or
-women who received a blood transfusion between 1977 and 1985.

Front 50

A urinalysis is performed to test for?

Back 50

proteinuria,
glycosuria, and
pyuria.

Front 51

TB skin test:

Back 51

-if + : requires a chest x-ray
-If a woman has a hx of tb or has received a bacillus Calmette-Guérin (bCG) vaccine for tuberculosis, a tb skin test should not be given b/c the reaction would be extreme
-bCG is not given in US

Front 52

What are some Demographic factors/Lifestyle that categorize a Preganancy as "at Risk"?

Back 52

Maternal age < 16 or > 35
Education < 11 years
Cigarette smoking > 10 cigarettes a day or living with a person who smokes this much
Substance abuse
Long amounts of time spent commuting
Nonuse of seatbelts
Alcohol intake
Heavy lifting or long periods of standing
Unusual stress
No in-home smoke detectors

Front 53

What are some Psychosocial factors that categorize a Preganancy as "at Risk"?

Back 53

Inadequate finances
Lack of support person
Adolescent
Poor nutrition
More than two children at home; no help
Lack of acceptance of pregnancy
Attempt or ideation of suicide
Inadequate or poor housing Father of baby uninvolved
Minority status
Dangerous occupation Dysfunctional grieving
Psychiatric history

Front 54

Test that rules out Gestional Diabetes?

Back 54

-50 g 1 hr Glucose Loading or Glucose Tolerance test
-eat a high carb diet 3 days prior to GTT

Front 55

What 3 tests are used to rule out Gestional Diabetes?

Back 55

1. FBS: 65-110mg/dL
2. 1 hr GTT (50g oral glucose
3. if 140mg/dL or > do a 3 hr GTT
-glucose level should not exceed 140mg/dL
-if 1 test is +, boarder line for gestional diabetes
-if 2 out of 3 are elevated= Gestional Diabetes

Front 56

What if:
1. Indirect Coombs test is +?
2. Rubella titer is < 1:10
3. MSAFP is abnormal
4. + smears=

Back 56

1-Do NOT give Rhogam shot
2. vaccinate post-partum for future prevention(MMR live)
3. need further test
4. antibiotics (casue still birth/preterm labor)

Front 57

What are the 7 signs indicating complications of pregancy?

Back 57

1. vaginal bleeding: report no matter how slight, blood on toilet paper after BM is probably from hemorrhoids but report anyways
2. Persistent Vomiting: 1-2 x's is not uncommon in 1st trim
3. chills & fever: sx of benign gastroenteritis or intrauterine infection
4. Sudden escape of clear fluid from the vagina:
5. abd or chest pain:
6. Pregnancy-induced hypertension
7. increase or decrease in fetal mvmt

Front 58

Persisntent or extended Vomiting past the 12 th wk leads to :

Back 58

-dehydration
-depletes the nutrional supply to the fetus

Front 59

Hyperemesis Gravidarum:

Back 59

persistent vomiting

Front 60

What does it mean when a gush of clear fluid is discharged suddenly from the vagina?

Back 60

it means the membranes have ruptured and mother and fetus are now both threatened, because the uterine cavity is no longer sealed against infection.

Front 61

Abdominal pain at anytime is a signal that something is abnormal, a problem such as: a tubal (ectopic) pregnancy, separation of the placenta, preterm labor, or something unrelated to the pregnancy but perhaps equally as serious, such as appendicitis, ulcer, or pancreatitis

Back 61

a tubal (ectopic) pregnancy, separation of the placenta, preterm labor,
appendicitis, ulcer, or pancreatitis (possible problems unrelated to pregnancy)

Front 62

What are 6 sx that signal PIH (pregnancy induced hypertension) is developing?

Back 62

1. Rapid weight gain (over 2 lb per week in the 2nd trimester, 1 lb per week in the 3rd trim)
2. Swelling of the face / fingers
3. Flashes of light or dots before the eyes
4. Dimness or blurring of vision
5. Severe, continuous HA (cerebral edema or acute hypertension)
6. Decreased urine output

Front 63

Because a fetus normally moves more or less the same amt every day, what would an unusual increase or decrease in movement suggests?

Back 63

that a fetus is responding to a need for oxygen

Front 64

What is the purpose of Prenatal care?

Back 64

establish a baseline of present health,
determine the gestational age of the fetus,
monitor fetal development, identify women at risk for complications,
minimize the risk of possible complications by anticipating and preventing problems before they occur, and
provide time for education about pregnancy and possible dangers

Front 65

For a pelvic examination, pregnant women should remain in a lithotomy position for as short a time as possible to help prevent ?

Back 65

thromboembolism and
supine hypotension syndrome.

Front 66

Confims a pregnancy?

Back 66

-1st prenatal visit