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215 Cards in this Set

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What is the recommended amount of weight an underweight mother should gain during pregnancy?
28-40 lb
What is the recommended amount of weight an overweight mother should gain during pregnancy?
15-25 lb
The recommended amount of weight for a normal weight mother should gain during pregnancy is 25-35 pounds, with ____ to _____ pounds gained in the first trimester and one pound a week thereafter.
2-4 lb
What is the ideal weight gain range for a woman who is 25 weeks pregnant?
14-16 lb
What is the ideal weight gain range for a woman who is 31 weeks pregnant?
20-22 lb
True or False? A pregnant woman who is vegan may be deficient in vitamin B12
True
A lactoovo-vegetarian who is pregnant may need not have adequate _______ and ______.
Zinc & Iron
True or False? During lactation, a women needs 500 calories less than during pregnancy.
False: Need 500cal MORE
Many Recommended Dietary Allowances (RDAs) increase during lactation or stay the same as the pregnancy amount. Name one element whose intake is recommended to be less than the pregnancy amount.
Iron
True or False? There is no difference in the recommended daily intake of calcium between a non-pregnant woman and a pregnant woman.
True
The inability to digest milk sugar caused by the absence of the lactase enzyme in the small intestine is called ________________.
Lactose intolerance
True or False? Urine pregnancy tests are less expensive and provide faster results than serum pregnancy tests.
True
What is the biologic marker that pregnancy tests are based on (abbreviation and full name)?
HCG Human Chorionic Gonadotropin
A woman who is pregnant for the first time
Primigravida
Any pregnancy, regardless of duration, including present pregnancy
Gravida
A woman who has never been pregnant
Nulligravida
Beginning of 38th week to end of 41st week
Term
A woman who has had two or more births at more than 20 weeks gestation
Multiparous
Delivery that occurs after 20 weeks but before the completion of the 37th week
Preterm
Weeks 14-26 of the pregnancy
2nd trimester
Use the 5 digit system to describe the obstetric history for Angela who is 6 weeks pregnant. Her previous pregnancies resulted in the live birth of a daughter at 40 weeks of gestation, the live birth of a son at 38 weeks of gestation, and a miscarriage at 10 weeks of gestation
42012
Use the 5 digit system to describe the obstetric history for Constance who is pregnant for the fourth time. Her first pregnancy ended in a miscarriage at 12 weeks, the second resulted in the live birth of twin boys at 32 weeks, and the third resulted in the live birth of a daughter at 39 weeks.
41113
Your patient is at 28 weeks gestation, and her BP is 138/90 what is her Mean Arterial Pressure (MAP)? Is she at risk for PIH (pregnancy-induced hypertension)?
138-90 = 48
48/3 = 16
16+90 = 106
2nd trimester Map should be < 90 so yes, Mom at risk!
An MAP > ______ in the third trimester is an indication of PIH.
>102
What signs are presumptive of pregnancy?
Presumptive = Subjective
Amenorrhea
Nausea & Vomiting
Urinary frequency
Breast tenderness
Quickening
At which gestational age is quickening most likely to occur?
16-20 wk
What are the probable signs of pregnancy?
Probable = Objective
Palpation for fetal outline
Pregnancy test
Ballottement
Braxton Hicks contractions
Enlargement of abdomen
Changes in pelvic organs:
- Chadwick's sign
- Goodell's sign
- Hegars's sign
- Uterine enlargement
True or False? Presumptive signs of pregnancy are objective signs that are perceived by the examiner
False: pre-s-umptive signs = subjective = said.
They are experences the woman reports (says).
Identify the type of pregnancy sign
(presumptive, probable, positive)
Breast tenderness
Presumptive
Identify the type of pregnancy sign
(presumptive, probable, positive)
Fetal heart tones detected during an ultrasound
Positive/Diagnostic
Identify the type of pregnancy sign
(presumptive, probable, positive)
Chadwick sign
Probable
Identify the type of pregnancy sign (presumptive, probable, positive)
Quickening
Presumptive
Identify the type of pregnancy sign
(presumptive, probable, positive)
Urinary frequency
Presumptive
Identify the type of pregnancy sign
(presumptive, probable, positive)
Positive pregnancy test (serum)
Probable
Identify the type of pregnancy sign
(presumptive, probable, positive)
Fetal movements visible
Positive/Diagnostic
Your patient is at 22 weeks gestation. Would you expect her to be complaining of “morning sickness”?
No: N & V occurs between weeks 4-14
The softening of the lower uterine segment that occurs between weeks 6-12 is called _____.
Hegar's sign
The softening of the cervical tip that occurs about the 5th week is called _____.
Goodell's sign
What are the two main hormones that are responsible for uterine growth?
Estrogen & Progesterone
While assessing the fundal height of your patient, you palpate the fudus almost at the umbilicus. The best estimate of gestation is:
20-22 weeks
Your pregnant patient has been complaining of difficulty breathing for weeks. Today she says she is able to breathe much easier, but now she has some pelvic pain. She is 38 weeks gestation. What is she most likely causing these changes?
Lightening
True or False? Low or high maternal MAP, contractions of the uterus, and the mother lying in the supine position can decrease blood to the uterus and decrease placental perfusion.
True
_____ is a diagnostic technique using internal palpation that can be done between wks 16 - 18. The floating fetus moves away when tapped or pushed and then returns to touch the examiner’s hand.
Ballottement
While examining your patient who is at 8 weeks gestation, you observe a violet-bluish color of the vaginal mucosa and cervix. Is this a normal finding?
Yes, it is Chadwick's sign & is caused by increased vascularity.
Your patient is 16 weeks pregnant and she tells you she is as “horny as a hound dog in heat”. What is the most appropriate response?
Tell her that increased sexual interest is normal during the second trimester
True or False? Because the vaginal secretions become more acidic during pregnancy, the risk of yeast infections decreases during pregnancy
False: Risk of yeast infections increase during pregnancy.
True or False? The operculum (mucous plug) acts as a barrier against bacteria during pregnancy.
True
Your primigravida patient calls and is upset about a whitish-gray mucoid discharge she is having. Is this normal? What is this called? What teaching would you do?
Yes, this is normal. It is called Leukorrhea. Teach:
it is not preventable
do not douche (ever)
wear perineal pads
wipe front to back
call Dr. if accompanied by pruitus, foul odor or change in color or character
Bladder tone decreases as the pregnancy progresses. Does this allow the bladder to hold more or less urine?
The woman holds MORE urine (decreased tone = bladder stretches out and holds more)
Which position is the worst for renal function during pregnancy?
Supine
Why should diuretics be avoided during pregnancy?
Diuretics decrease perfusion of the placenta
Is it ok to have glucosuria during pregnancy?
Yes. Only if it is a trace amt
Occurs when maternal glucose is <160mg/dl
Your patient has +2 proteinuria. Is this ok?
No: proteinuria should only be present in trace to +1 levels
Your patient is at 14 weeks gestation. Where would you expect to palpate the fundus?
Just above pelvis/symphasis pubis (14 cm)
What is the purpose for the changes to the body that occur during pregnancy?
Changes protect the woman’s normal physiologic functions
Changes are required to meet metabolic demands
Changes provide a nurturing environment for fetal growth and development
During pregnancy, what changes occur to blood volume? Why is this change needed?
Blood volume increases 40-45 % (about 1500 mL).
1. To protect the mother by giving a reserve for delivery and postpartum (300-500 mL of blood is lost during delivery), and
2. to provide placental perfusion
Changes to the musculoskeletal system include loss of muscle tone due to the stretching of the abdominal muscles. What change occurs related to the center of gravity?
Center of gravity shifts forward
What is lordosis?
Lordosis is an increase in the normal lumbosacral curve that occurs during pregnancy to help maintain balance
Discuss changes to blood pressure during each trimester.
Blood pressure usually stays at the pre-pregnancy level in the 1st trimester, drops during 2nd trimester due to vasodilation, and in the 3rd trimester returns to the same as the 1st trimester.
What is physiological anemia?
Physiological anemia occurs because the increase in plasma during pregnancy exceeds the increase in RBCs which causes hemodilution.
What hemoglobin and hematocrit levels indicate true anemia?
True anemia occurs when hemoglobin decreases to ≤10 and hematocrit decreases to <33.(norms for pre-pregnant: HgB 12-16; Hcrt 37-47)
True or False? The reason for increased WBC production during the 2nd and 3rd trimester is to meet the increased oxygen demands of the fetus.
False. White blood cells increase to build up protection against the risk of infection during delivery. Red blood cells increase to provide increased oxygen to the fetus
True or False? Both coagulants and fibrinolytic activity increase during pregnancy.
False. Coagulants increase but fibrinolytic activity decreases. (Fibrinolytics breakdown fibrin in clots)
True or False? Cardiac output increases by as much as 30-50% by the 32nd week.
True
What is the most common & permanent integumentary change?
Striae gravidarum "stretch marks"
Use Nagele’s rule to calculate the EDD (estimated date of delivery) for a woman whose LMP (last menstrual period) was May 20, 2004.
LMP = May 20
Subtract 3 months (or add 9 mon)
Then add 7 days
**Feb 27, 2005**
True or False? The first screening for gestational diabetes usually occurs at 12 weeks gestation
False. Gestational diabetes screening is not usually done until 24-28 weeks.
A glucose level above _________ mg/dl from the Glucola screening (O”Sullivan Lab) is considered positive and should be followed by a 3-hour oral glucose tolerance test.
>140 mg/dl
True or False? According to Rubin’s Safe Passage, a woman demonstrates Safe Passage in the first trimester by being concerned more for herself than the baby.
True
According to Rubin’s Safe Passage, in what trimester would you want to educate your patient about the signs of true labor vs. false labor?
3rd trimester
What is the purpose of a Nonstress test (NST)? Do you want the results to be reactive or nonreactive?
A Nonstress test is done to observe the response of the fetal heart rate to activity (heart rate should increase when the baby is moving). You want results to be REACTIVE.
What test is ordered if a patient’s NST is read Non-reactive? When would this test be done?
Contraction Stress Test (CST). The same day as the NST.***(this is outdated, Dr.s now would do a biophysical profile but we need to know CST for NCLEX)
True or False? You want the results of a CST to be negative which is indicated by 3 contractions in 10 minutes without late decelerations.
True
True or False? A good result to a fetal kick test is at least 3 movements in one hour.
True
Ultrasounds can be done anytime during a pregnancy. What is the main purpose for doing an ultrasound?
Determining fetal age and due date.
Amniocentesis may be done after week 14. What can be determined by amniocentesis?
Genetic disorders or genetic anomalies
pulmonary maturity
fetal hemolytic diseases
What nursing instructions should you provide to your patient after amniocentesis?
Instruct patient to call if leaking, fever, or cramping occurs to rule out preterm labor, or if fetal movement decreases or is absent after test.
An L/S ratio test may be done after the 35th week and is used to determine fetal lung maturity and if the infant can be safely delivered. What L/S ratio indicates lung maturity?
2:1. (L/S study is completed with amniotic fluid from amniocentesis).
A biophysical profile is usually done the same day as a nonreactive NST and gives more information about the fetus. List the 5 elements of a biophysical profile.
Fetal breathing movement
Gross body movement
Fetal tone
Fetal heart rate
Qualitative amniotic fluid volume
What are some danger signs in pregnancy?
Chills and fever, Cerebral disturbances (headaches), Abdominal pain, Blurred vision, Elevated Blood pressure, Bleeding, Swelling around the eyes, Sudden escape of fluid (ruptured membranes)
Your patient is complaining of nausea and vomiting during the first trimester. What advise would you give her?
Have small frequent meals (every 2-3 h)
Take meals dry (don’t drink with meals, drink between meals)
Eat dry crackers or toast before getting up in the morning
Avoid greasy & highly seasoned foods
Drink carbonated beverages.
Your patient is complaining of heartburn (pyrosis). What advise would you give her?
Eat small and more frequent meals
Use low sodium antacids
Avoid overeating
Avoid fatty and fried foods
Avoid laying down after eating
True or False? Your patient is complaining of varicose veins. You should advise her to elevate her legs frequently, wear supportive hose (full length not knee highs), avoid standing for long periods, and to increase walking.
True
Cervical and uterine contractions occurring between 20-36 weeks of pregnancy is known as ______________.
Preterm labor
(Braxton Hicks contractions do not involve the cervix)
A woman in her 25th week believes she is having preterm labor. What advise would you give her?
Drink 2-3 glasses of water or juice (dehydration can cause uterus to contract)
Lie down on left side for an hour
If signs don’t go away or if fluid begins to leak from vagina call doctor immediately.
What are Tocolytic drugs used for?
To stop preterm labor.
True or False? Risk factors for preterm labor include age (under 17 or over 35), low socioeconomic status, smoking and substance abuse, but the single most risk factor associated with preterm labor is a previous history of preterm labor.
True
Your patient is at 28 weeks gestation and her BP is 138/90. What is her Mean Arterial Pressure (MAP)? Is she at risk for HIH (pregnancy-induced hypertension)?
138-90 = 48
48/3 = 16
16+90 = 106
3nd Trimester MAP <102
Yes, at risk!
Hormones that increase during pregnancy
Estrogen, Progesterone, & Prolactin (starts to increase in 1st trimester)
1st trimester side effects of pregnancy
frequent urination
nausea & vomiting
decreased appetite
Chadwick's (from 4th wk)
Goodell's (from 6th wk)
Hegar's (8-12 wk)
2nd trimester side effects of pregnancy
decreased BP
increased sexual interest
palpitations
faintness
heartburn
constipation
round ligament pain
increased appetite
quickening (16-20 wks)
3rd trimester side effects of pregnancy
Blood volume reaches peak (32-34 wks)
shortness of breath
lightening
Pregnancy weight gain is based on _____.
BMI (body mass index)
Which is more important, total amount of weight gained or pattern of weight gain.
Pattern
Poor weight gain early in pregnancy may risk ...
SGA (small for gestational age) baby
Increased weight gain during last half of pregnancy may risk...
preterm birth
Inadequate weight gain may indicate
fetal growth retardation
What is the rule of thumb for pregnancy weight gain?
1st trimester: 2-4 lb total
2nd & 3rd trimesters: 1 lb per week
What is the weight guideline for an underweight pt?
28-40 lb
What is the weight guideline for an overweight pt?
15-25 lb
What is the weight guideline for an average pt?
25-35 lb
Lactoovovegetarians
Eat dairy, eggs & vegetables
Low in Zinc & Iron
Lactovegetarians
Eat milk & vegetables
Do not eat eggs or butter
Low in Zinc
Vegans
Only plant products
No dairy, eggs, honey
Low in Zinc, Iron & B12
(may be low in protein)
Nutrient needs during Lactation
+500 calories
"ABCZIPE"
Vit A, B, C, E, Zinc, Iodine, & protein
Nutrient needs higher in pregnancy than during lactation
"IM FaN"
Iron, Magnesium, Folic acid, Niacin
S/S of lactose intolerance
abdominal cramping
bloating
diarrhea
Biological marker pregnancy tests are based on
hCG
A woman whose gestation is no greater than 20 wks
Nulliparous
Weeks 1-13
1st trimester
Weeks 27-40
3rd trimester
Has never been pregnant before (and not pregnant now)
Nulligravida
Delivery that occurs prior to the end of 20 wks gestation
No viable fetus present
Abortion
Number of weeks since the first day of the last menstrual period
Gestation
Delivery that occurs after the beginning of the 42nd week
Postterm
Time between the conception and the onset of labor or birth
Antepartum or Prenatal
Time from the onset of labor until the delivery (including baby & placenta)
Intrapartum
Time from birth until the body returns to pre-pregnancy state (up to 6 wks following delivery)
Postpartum
A fetus born dead after 20 wks gestation
Stillborn
The period of time from the point of viability through the neonatal period
Perinatal
The capacity to live outside the uterus
Viability
The first 28 days of life
Neonate
The number of pregnancies (not babies) in which the fetus(es) have reached viability
Parity
Changes in BP by trimester
1st trimester: stays the same
2nd trimester: decreases (due to increased progesterone)
3rd trimester: returns to same
An increased MAP in pregnancy may indicate ...
PIH (pregnancy induced hypertension)
Woman may be at risk for PIH during 2nd trimester when...
MAP >90
Woman may be at risk for PIH during 3nd trimester when...
MAP >102
Growth stimulated from estrogen and progesterone, results in
increased vascularity and dilation of blood vessels, hyperplasia and hypertrophy and deciduas
Uterus Enlargement
Irregular, painless, intermittent contractions that occur
after the 4th month and become definite after 28 weeks but usually cease with walking or exercise and cause no change in the cervix.
Braxton Hicks Contractions
Diagnostic signs of Pregnancy
Diagnostic = Postive
(basically, visualization, fetal heart beat, fetal movement)
Visualization of fetus by ultrasound or x-ray
Fetal heart tones detected by ultrasound – around wk 6
Fetal heart tones detected by Doppler - around 10-12 wks
Fetal heart tones detected by fetoscope – around 17-20 wks
Fetal movements palpated by examiner
Fetal movements visible to examiner
Discharge clear to cloudy in appearance and may turn yellow after drying; slightly slimy, is nonirritating, and has a mild inoffensive odor.
Leukorrhea
Location the uterus may be palpated between the 12-14 wk.
Symphysis Pubis
Location the uterus may be palpated between the 22-24 wk.
Umbilicus
Location the uterus may be palpated between the 38-40 wk.
Xiphoid
Why does vascular volume need to increase during pregnancy?
For adequate placenta perfusion.
Musculoskeletal System Changes
-Center of gravity shifts forward
-Lordosis develops to help maintain balance
-Slight relaxation & >mobility of the pelvic joints (Relaxin, estrogen) permit enlargement of pelvic dimensions to facilitate labor & birth
-waddling gait
-separation of rectus abdominis muscles
Integumentary System Changes
-Hyperpigmentation
-Facial melasma/chloasma/“mask of pregnancy”
-Linea nigra
-Striae gravidarum
-Palmar erythema
-Pruritus
-Increased hair/nail/sweat/sebaceous gland
-Increased circulation/vasomotor activity = "glow"
Darkening around eyes: "racoon"
Chloasma
Facial Melasma
"mask of pregnancy"
Dark line from pelvis to top of uterus
Linea Nigra
Separation within the underlying connective (collagen) tissue of the skin
Striae gravidarum
Red palms during pregnancy
Palmar erythema
"slapped hand"
?r/t increased estrogen lvls?
What do pregnancy hormones do?
Adequate levels needed to support pregnancy
Prepare the vagina for stretching during L&D by causing the vaginal mucosa to thicken
Connective tissue to loosen
Smooth muscle to hypertrophy
Vaginal vault to lengthen
Hypertrophy of sebaceous glands embedded in areolae, may have a protective role in that they keep the nipples lubricated for breastfeeding
Montgomery tubercles
Cardiovascular System Changes
-hypertrophy of heart muscle (gets larger)
-enlarged uterus displaces heart up & to the left
-pulse increases 10-15 bpm
-BP decreased in 2nd trimester
-hypotension occurs in supine position
-Blood volume gradually increases by 40-45%
-clotting activity increased
-fibrinolytic activity decreased
Respitory System Changes
-Increase in tidal volume (amt breathed in)
-Increase in respiratory rate (need more O2 to perfuse placenta for baby)
-Rib cage relaxes & expands (caused by estrogen)
-BMR increases up to 15-20%
-Mom becomes slighly alkalotic to facilitate O2 to baby & release CO2 from baby
Renal System Changes
-Enlarging uterus presses on renal system
-Urine rate slows (ureters & urethra lengthen)
-Blatter irritated (nocturia, frequency, urgency)
-Decreased bladder tone
-Mom goes from normal 350ml to 500ml bladder capacity
-Risk for UTI (urine stasis)
-Renal function best in left side lying position
GI System Changes
-Appetite increases (b/c BMR increases)
-May have non-food cravings: PICA
-Pregnancy gingivitis may occur
-Ptyalism (excess saliva) occurs
-Pyrosis (heartburn) may occur due to decreased tone & motility of smooth muscle
-Increased water absorbtion in colon leads to constipation
-gallstones may occur
Endocrine System Changes
(list major players)
Estrogen
Progesterone
Prolactin
Oxytocin
hCS
Prolactin
Responsible for initial lactation
Starts in 1st trimester
produced by anterior pituitary
Progesterone
Relaxes smooth muscle, results in decreased uterine contraction, so prevents miscarriage
Estrogen
-Responsible for enlargement of genitals, uterus, breasts
-increases vascularity, causing vascularity
-relaxes pelvic ligaments & joints
-alters metabolism
-promotes retention of Na & H20 (kidney tubules)
Oxytocin
-Stimulates uterine contractions (high levels of progesterone keep at bay until near term)
-stimulates let-down/milk ejection reflex after birth in response to infant sucking
-produced by posterior pituitary as fetus matures
hCS
Produced by placenta
Acts as growth hormone
Contributes to breast development
Blood Volume
-Increases approx. 1500 ml, or 40% to 45% above non-pregnancy levels
-Starts to increase at approx. 10th –12th wk, peaks at approx. 32nd-34th wk
-Peripheral vasodilatation maintains a normal blood pressure despite the increased blood volume in pregnancy
RBC's
-There’s an accelerated production of RBC
-% of increase depends on the amount of iron available
-increased by 30-33% with iron supplement
-only 18% without iron supplement
WBC's
-Increases during the 2nd trimester and peaks during the 3rd trimester
-Primarily granulocytes; lymphocyte count stays same throughout pregnancy
Coagulation Factors
Increase
Fibrinolytic activity
 the splitting up or (the dissolving of a clot)
-Depressed during pregnancy and PP
Hemodilution
Physiologic Anemia
Plasma increase exceeds increase of RBC
Hgb <11; Hcrt <35
Heart Rate
Increases approx 10-15 bpm between 14-20 wks
Palpations may occur
CO2
-Increases from 30% to 50% over the nonpregnant rate by 32nd wk
-Declines to approximately 20 % at 40 wks gestation
-This elevated CO2 is a result of > stroke volume & heart rate and occurs in response to > tissue demands for oxygen
-CO2 is higher when on lateral recumbent position (side lying) than when supine.
Diabetes Screen
(Glucola Screen)
-Usually done at 24 to 28 weeks of gestation
-1st, do 1-hour glucose tolerance: drink 50 mgs glucose, after 1 hour check the blood glucose level. If the result over 140 mg/dl, then order 3-hour glucose tolerance
-3-hour glucose tolerance: Drink 100 mgs glucose under NPO situation, then check blood glucose level after 1h, 2h, and 3h. If there are two readings over the normal range, consider this Mom has gestational diabetes
How many times should H&H be tested?
2:
once at initial visit, and again between wks 24-28
Rubin's Safe Passage
1st trimester
-Concern about self.
-Alerted, something is “not there.”
-“Am I sick or am I pregnant?”
-Seeks competent maternity care to provide a sense of control
-Keeps all prenatal appointments
Rubin's Safe Passage
2nd trimester
-Concern about baby
-Care of and for baby. “Is my baby all right?”
-Engages in self care activities related to diet, exercise, alcohol consumption and so forth
Rubin's Safe Passage
3rd trimester
-Concern about self and baby. Seeking delivery care. “Will my baby and I safely go through labor and delivery.”
-Nurse discusses signs of labor and when to go to hospital/doctor
-Reassure pt. regarding her fears
-Have her ventilate her concerns
NST
-Purpose is to observe the response of the fetal heart rate to the stress of activity
-A normal fetus will increase heart rate in response to fetal movement
-In a healthy fetus with an intact CNS, 90% of gross fetal body movements are associated with accelerations of the FHR
-You want it to be read reactive
-Usually this test is ordered after 27th week of pregnancy
-Procedure requires approximately 20-30 minutes
-Mother is in semi-fowler’s position or positioned in a supine position with a wedge under her right hip
-External monitor is applied to document fetal activity
-Mother activates the “mark” button on electronic fetal monitor when she feels fetal movement
Ultrasound (Generally)
-Produces a three-dimensional view from which a pictorial image is obtained
-Performed either abdominally or transvaginally
-Done anytime during pregnancy
Amniocentesis
-Possible after 14 wk
-performed to obtain amniotic fluid
-Under direct ultrasonographic visualization, a needle is inserted transabdominally into uterus, amniotic fld is withdrawn into a syringe, & various assessments are performed
-Indications for the procedure include prenatal dx of
Genetic disorders or congenital anomalies (neural tube defects in particular)
Assessment of pulmonary maturity
Diagnosis of fetal hemolytic disease
Ultrasound
1st trimester
Information obtained on:
-Number, size & location of gestational sacs
-Presence/absence of fetal cardiac & body movements
-Presence/absence of uterine abnormalities (i.e.: ectopic pregnancy)
-Date of pregnancy - by measuring crown rump length & biparietal diameter of fetus
Ultrasound
2nd & 3rd trimester
Info on the following is sought:
-Fetal viability, number, position, gestational age, growth pattern, & anomalies
-Amniotic fluid volume
-Placental location & maturity
-Uterine fibroids & anomalies
-Adnexal masses
-Cervical length
Amniocentesis Complications
-occur in fewer than 1%
-Maternal hemorrhage
-Fetomaternal hemorrhage w/ possible maternal Rh isoimmunization
-Infection, labor, abruptio placentae, inadvertent damage to the intestines or bladder, and amniotic fluid embolism
-fetal-leakage of amniotic fluid
-direct injury from the needle, miscarriage or preterm labor, and death.
Kick Count/DFMC
(daily fetal movement count)
-Usually starts 24-28 wk gestation (after quickening)
-presence of fetal movements is generally a reassuring sign of fetal health
-Mom is reliable
-YOU WANT 3 fetal movements/hr
-Generally, a count of less than three fetal mvts w/n 1 hr warrants further evaluation by NST or CST, BPP or a combination of these
-Nursing Alert: Fetal movement is usually not present during the fetal sleep cycle and are temporarily reduced if the woman is taking depressant med., drinking alcohol, or smoking a cigarette; and do not decrease as woman nears term
Danger/warning signs of pregnancy
"CABS"
CHILLS AND FEVER (infection)
CEREBRAL DISTURBANCES (Headache during pregnancy=severe preeclampsia)
ABDOMINAL PAIN (may be due to edema of the liver capsule & may indicate a convulsion is impending. A rigid, board-like abdomen during the last trimester usually indicates abruptio placenta)
BLURRED VISION (high BP or complication w/severe preeclampsia)
BLEEDING (miscarriage, abortion, ectopic pregnancy or hydatiform mole, placenta previa or abruptio placenta)
SWELLING (edema: periorbital & digital areas - mild preeclampsia)
SUDDEN ESCAPE OF FLUID (rupture of membranes)
premature separation of the placenta and occurs in the area of the decidua basalis after the 20th wk of pregnancy and before the birth of the baby
Abruptio placenta
Placenta implanted in the lower uterine segment near or over the internal cervical os.
Placenta previa
Low birth weight
a newborn whose wt falls within last 10%
GBS (Group B Strep)
often causes/associated with preterm labor
treated with Penicillin G
Plan of Care/Interventions:
Preterm Labor
-early recognition & diagnosis
-bed rest
-home uterine activity monitoring
-lifestyle changes:
decrease sexual activity (may stimulate labor)
long trips (not close to resourses)
Heavy lifting or carrying
Climbing stairs
Hard physical work
Tocolytics
Betamethasone
Terbutaline
Magnesium Sulfate
Nifedipine (calcium antagonistic)
Prostaglandin Synthetics (motrin/naproxen)
Maternal contraindications to Tocolytics
Severe PIH or Eclampsia
Intrauterine infection
Active vaginal bleeding
Cardiac disease
Eclampsia
Had seizure
Fetal contraindications to Tocolytics
> 37 wks
Dilation >4cm
Fetal demise
Lethal fetal anomaly
Chorioamnionitis
Acute fetal distress
Chronic IUGR
Betamethasone
Glucocorticoids
increases production of surfactant in fetal lungs
can use between 20 to 32/35 wks
Terbutaline
Relaxes smooth muscle
relaxes uterus (inhibits uterine contraction)
bronchodilation
vasodilation
hypotension
Makes pt jittery
Uterus
1st trimester
Hyperplasia (new muscle fibers)
Hypertrophy (enlargment of existing fibers)
Increase vascularity and dilation of vessels
Decidua developes
12 wks: size of grapefruit & rises out of pelvis
Uterus
2nd & 3rd trimester
20th week: at umbilicys
dextorated (lies more to the right side b/c of shape of colon)
In contact abdominal wall (anterior wall provides support)
38-40wks: reaches xyphoid process
lightening at 38-40 wks
Placentap perfusion depends on what?
Maternal blood flow
Amount of maternal blood volume in uterine vascular system
1/6
Blood flow to uterus decreases when...
MAP (mean arterial pressure) is low or high
uterus contracts (is a temporary decrease)
supine position
DM (vascular damage)
Multiple gestations (vascular issues)
Noises from the uterus
Uterine souffle (blood flow shuffle from placenta)
Funic souffle (blood flow from cord - lighter sound)
Fetal Heart Rate (120-160, like a horse canter)
Changes of Vagina & Vulva
-Influenced by estrogen & progesterone
-vaginal mucosa thickens
-connective tissue loosens
-smooth muscles hypertrophy
-vaginal vault lengthens (making room for baby to position)
-mucous plug/operculum formation
-leukorrhea
-Chadwick's sign
-estrogen causes vagina to become more acidic (increasing yeast infections)
-increased sensitivity (sexual interests)
-external structures enlarge
Increased cardiac output may cause...
varicose veins
hemorroids
labial vericosities
Neurological System Changes
-Compression of pelvic nerves may cause sensory changes (numbness, tingling)
-Carpal tunnel
-Vasomotor hypotensio (lightheadedness)
-Hypocalcemia (muscle cramps in legs)
Ovum & chorionic villi produce _____ until placenta takes over.
hCG
Thyroid Gland
Gland & hormone increased due to increased levels of estrogen
Parathyroid gland
Controls Ca & magnesium metabolism
Increased fetal needs creates slight hyperparathyroidism in mom
Diabetic Moms
-Fetus depletes mom's glucose = less need for insulin (in beginning of pregnancy)
-very unstable
Gestational diabetes: risk of developing type II later in life
Rh - mom
Assume baby is + and give RhoGAM
RhoGAM
Blood product that prevents mom from making antibodies to baby's blood
Rubella titer
>1:8
AFP test
detects chromosome defects & neural tube defects
at 15-22 wks
unreliable if don't have correct hisory/information
increase may indicate NT defects
decrease may indicate downs syndrome
Penicillin G
Group B Strep
Ambivalence
Mixed feelings regarding pregnancy
Excited & happy one moment, unhappy & depressed the next
Binding in
The commitment that the pregnant woman forms to her baby by the end of pregnancy
Emotional Liability
Frequency &/or extremes in emotional changes experienced by a woman during pregnancy
Maternal
Psycological Changes
1st trimester
acceptance vs denial
shock & disbelief
ambivalence (#1 emotion)
emotional lability
self focus
Maternal
Psycological Changes
2nd trimester
introverted in latent period
increased dependence
altered body image
dreams & fantasies
alterations in sexual responsiveness
increased awareness of fetus
prenatal attachment (binding in)
seeking acceptance of fetus by others
beginning to give of self to fetus
Maternal
Psycological Changes
3rd trimester
increased anxiety
self-absorbtion
anticipation vs dread
concerns of safety
giving of self to fetus
nesting
Paternal
Psycological Changes
1st trimester
Joy/excitement vs anger/disappointment
pride
ambivalence
Paternal
Psycological Changes
2nd trimester
emotional distancing
introspection
detachment
jealousy
Paternal
Psychological Changes
3rd trimester
acceptance of reality
protectiveness
active involvement
increased anxiety
altered sexual desire
prenatal attachment
Magnesium Sulfate
Relaxes smooth muscle so decreased uterine contractions
causes CNS depression
"MS: muscle, smooth"
Prostaglandin Synthetase Inhibitors
(Naproxen, Motrin)
Interfers with prostaglandins
(prostaglandins cause uterus to contract)
(Calcium Antagonistic)
Nifedipine
"CAN"
prevents return of uterine contractions by inhibiting Ca to re-enter cell membrane
(Ca needed for muscle contraction)