Nur 125 Ob Test 1: Prenatal (Antepartal) Period

Front 1

What is the recommended amount of weight an underweight mother should gain during pregnancy?

Back 1

28-40 lb

Front 2

What is the recommended amount of weight an overweight mother should gain during pregnancy?

Back 2

15-25 lb

Front 3

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.

Back 3

2-4 lb

Front 4

What is the ideal weight gain range for a woman who is 25 weeks pregnant?

Back 4

14-16 lb

Front 5

What is the ideal weight gain range for a woman who is 31 weeks pregnant?

Back 5

20-22 lb

Front 6

True or False? A pregnant woman who is vegan may be deficient in vitamin B12

Back 6

True

Front 7

A lactoovo-vegetarian who is pregnant may need not have adequate _______ and ______.

Back 7

Zinc & Iron

Front 8

True or False? During lactation, a women needs 500 calories less than during pregnancy.

Back 8

False: Need 500cal MORE

Front 9

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.

Back 9

Iron

Front 10

True or False? There is no difference in the recommended daily intake of calcium between a non-pregnant woman and a pregnant woman.

Back 10

True

Front 11

The inability to digest milk sugar caused by the absence of the lactase enzyme in the small intestine is called ________________.

Back 11

Lactose intolerance

Front 12

True or False? Urine pregnancy tests are less expensive and provide faster results than serum pregnancy tests.

Back 12

True

Front 13

What is the biologic marker that pregnancy tests are based on (abbreviation and full name)?

Back 13

HCG Human Chorionic Gonadotropin

Front 14

A woman who is pregnant for the first time

Back 14

Primigravida

Front 15

Any pregnancy, regardless of duration, including present pregnancy

Back 15

Gravida

Front 16

A woman who has never been pregnant

Back 16

Nulligravida

Front 17

Beginning of 38th week to end of 41st week

Back 17

Term

Front 18

A woman who has had two or more births at more than 20 weeks gestation

Back 18

Multiparous

Front 19

Delivery that occurs after 20 weeks but before the completion of the 37th week

Back 19

Preterm

Front 20

Weeks 14-26 of the pregnancy

Back 20

2nd trimester

Front 21

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

Back 21

42012

Front 22

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.

Back 22

41113

Front 23

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)?

Back 23

138-90 = 48
48/3 = 16
16+90 = 106
2nd trimester Map should be < 90 so yes, Mom at risk!

Front 24

An MAP > ______ in the third trimester is an indication of PIH.

Back 24

>102

Front 25

What signs are presumptive of pregnancy?

Back 25

Presumptive = Subjective
Amenorrhea
Nausea & Vomiting
Urinary frequency
Breast tenderness
Quickening

Front 26

At which gestational age is quickening most likely to occur?

Back 26

16-20 wk

Front 27

What are the probable signs of pregnancy?

Back 27

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

Front 28

True or False? Presumptive signs of pregnancy are objective signs that are perceived by the examiner

Back 28

False: pre-s-umptive signs = subjective = said.
They are experences the woman reports (says).

Front 29

Identify the type of pregnancy sign
(presumptive, probable, positive)
Breast tenderness

Back 29

Presumptive

Front 30

Identify the type of pregnancy sign
(presumptive, probable, positive)
Fetal heart tones detected during an ultrasound

Back 30

Positive/Diagnostic

Front 31

Identify the type of pregnancy sign
(presumptive, probable, positive)
Chadwick sign

Back 31

Probable

Front 32

Identify the type of pregnancy sign (presumptive, probable, positive)
Quickening

Back 32

Presumptive

Front 33

Identify the type of pregnancy sign
(presumptive, probable, positive)
Urinary frequency

Back 33

Presumptive

Front 34

Identify the type of pregnancy sign
(presumptive, probable, positive)
Positive pregnancy test (serum)

Back 34

Probable

Front 35

Identify the type of pregnancy sign
(presumptive, probable, positive)
Fetal movements visible

Back 35

Positive/Diagnostic

Front 36

Your patient is at 22 weeks gestation. Would you expect her to be complaining of “morning sickness”?

Back 36

No: N & V occurs between weeks 4-14

Front 37

The softening of the lower uterine segment that occurs between weeks 6-12 is called _____.

Back 37

Hegar's sign

Front 38

The softening of the cervical tip that occurs about the 5th week is called _____.

Back 38

Goodell's sign

Front 39

What are the two main hormones that are responsible for uterine growth?

Back 39

Estrogen & Progesterone

Front 40

While assessing the fundal height of your patient, you palpate the fudus almost at the umbilicus. The best estimate of gestation is:

Back 40

20-22 weeks

Front 41

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?

Back 41

Lightening

Front 42

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.

Back 42

True

Front 43

_____ 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.

Back 43

Ballottement

Front 44

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?

Back 44

Yes, it is Chadwick's sign & is caused by increased vascularity.

Front 45

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?

Back 45

Tell her that increased sexual interest is normal during the second trimester

Front 46

True or False? Because the vaginal secretions become more acidic during pregnancy, the risk of yeast infections decreases during pregnancy

Back 46

False: Risk of yeast infections increase during pregnancy.

Front 47

True or False? The operculum (mucous plug) acts as a barrier against bacteria during pregnancy.

Back 47

True

Front 48

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?

Back 48

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

Front 49

Bladder tone decreases as the pregnancy progresses. Does this allow the bladder to hold more or less urine?

Back 49

The woman holds MORE urine (decreased tone = bladder stretches out and holds more)

Front 50

Which position is the worst for renal function during pregnancy?

Back 50

Supine

Front 51

Why should diuretics be avoided during pregnancy?

Back 51

Diuretics decrease perfusion of the placenta

Front 52

Is it ok to have glucosuria during pregnancy?

Back 52

Yes. Only if it is a trace amt
Occurs when maternal glucose is <160mg/dl

Front 53

Your patient has +2 proteinuria. Is this ok?

Back 53

No: proteinuria should only be present in trace to +1 levels

Front 54

Your patient is at 14 weeks gestation. Where would you expect to palpate the fundus?

Back 54

Just above pelvis/symphasis pubis (14 cm)

Front 55

What is the purpose for the changes to the body that occur during pregnancy?

Back 55

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

Front 56

During pregnancy, what changes occur to blood volume? Why is this change needed?

Back 56

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

Front 57

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?

Back 57

Center of gravity shifts forward

Front 58

What is lordosis?

Back 58

Lordosis is an increase in the normal lumbosacral curve that occurs during pregnancy to help maintain balance

Front 59

Discuss changes to blood pressure during each trimester.

Back 59

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.

Front 60

What is physiological anemia?

Back 60

Physiological anemia occurs because the increase in plasma during pregnancy exceeds the increase in RBCs which causes hemodilution.

Front 61

What hemoglobin and hematocrit levels indicate true anemia?

Back 61

True anemia occurs when hemoglobin decreases to ≤10 and hematocrit decreases to <33.(norms for pre-pregnant: HgB 12-16; Hcrt 37-47)

Front 62

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.

Back 62

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

Front 63

True or False? Both coagulants and fibrinolytic activity increase during pregnancy.

Back 63

False. Coagulants increase but fibrinolytic activity decreases. (Fibrinolytics breakdown fibrin in clots)

Front 64

True or False? Cardiac output increases by as much as 30-50% by the 32nd week.

Back 64

True

Front 65

What is the most common & permanent integumentary change?

Back 65

Striae gravidarum "stretch marks"

Front 66

Use Nagele’s rule to calculate the EDD (estimated date of delivery) for a woman whose LMP (last menstrual period) was May 20, 2004.

Back 66

LMP = May 20
Subtract 3 months (or add 9 mon)
Then add 7 days
**Feb 27, 2005**

Front 67

True or False? The first screening for gestational diabetes usually occurs at 12 weeks gestation

Back 67

False. Gestational diabetes screening is not usually done until 24-28 weeks.

Front 68

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.

Back 68

>140 mg/dl

Front 69

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.

Back 69

True

Front 70

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?

Back 70

3rd trimester

Front 71

What is the purpose of a Nonstress test (NST)? Do you want the results to be reactive or nonreactive?

Back 71

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.

Front 72

What test is ordered if a patient’s NST is read Non-reactive? When would this test be done?

Back 72

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)

Front 73

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.

Back 73

True

Front 74

True or False? A good result to a fetal kick test is at least 3 movements in one hour.

Back 74

True

Front 75

Ultrasounds can be done anytime during a pregnancy. What is the main purpose for doing an ultrasound?

Back 75

Determining fetal age and due date.

Front 76

Amniocentesis may be done after week 14. What can be determined by amniocentesis?

Back 76

Genetic disorders or genetic anomalies
pulmonary maturity
fetal hemolytic diseases

Front 77

What nursing instructions should you provide to your patient after amniocentesis?

Back 77

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.

Front 78

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?

Back 78

2:1. (L/S study is completed with amniotic fluid from amniocentesis).

Front 79

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.

Back 79

Fetal breathing movement
Gross body movement
Fetal tone
Fetal heart rate
Qualitative amniotic fluid volume

Front 80

What are some danger signs in pregnancy?

Back 80

Chills and fever, Cerebral disturbances (headaches), Abdominal pain, Blurred vision, Elevated Blood pressure, Bleeding, Swelling around the eyes, Sudden escape of fluid (ruptured membranes)

Front 81

Your patient is complaining of nausea and vomiting during the first trimester. What advise would you give her?

Back 81

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.

Front 82

Your patient is complaining of heartburn (pyrosis). What advise would you give her?

Back 82

Eat small and more frequent meals
Use low sodium antacids
Avoid overeating
Avoid fatty and fried foods
Avoid laying down after eating

Front 83

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.

Back 83

True

Front 84

Cervical and uterine contractions occurring between 20-36 weeks of pregnancy is known as ______________.

Back 84

Preterm labor
(Braxton Hicks contractions do not involve the cervix)

Front 85

A woman in her 25th week believes she is having preterm labor. What advise would you give her?

Back 85

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.

Front 86

What are Tocolytic drugs used for?

Back 86

To stop preterm labor.

Front 87

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.

Back 87

True

Front 88

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)?

Back 88

138-90 = 48
48/3 = 16
16+90 = 106
3nd Trimester MAP <102
Yes, at risk!

Front 89

Hormones that increase during pregnancy

Back 89

Estrogen, Progesterone, & Prolactin (starts to increase in 1st trimester)

Front 90

1st trimester side effects of pregnancy

Back 90

frequent urination
nausea & vomiting
decreased appetite
Chadwick's (from 4th wk)
Goodell's (from 6th wk)
Hegar's (8-12 wk)

Front 91

2nd trimester side effects of pregnancy

Back 91

decreased BP
increased sexual interest
palpitations
faintness
heartburn
constipation
round ligament pain
increased appetite
quickening (16-20 wks)

Front 92

3rd trimester side effects of pregnancy

Back 92

Blood volume reaches peak (32-34 wks)
shortness of breath
lightening

Front 93

Pregnancy weight gain is based on _____.

Back 93

BMI (body mass index)

Front 94

Which is more important, total amount of weight gained or pattern of weight gain.

Back 94

Pattern

Front 95

Poor weight gain early in pregnancy may risk ...

Back 95

SGA (small for gestational age) baby

Front 96

Increased weight gain during last half of pregnancy may risk...

Back 96

preterm birth

Front 97

Inadequate weight gain may indicate

Back 97

fetal growth retardation

Front 98

What is the rule of thumb for pregnancy weight gain?

Back 98

1st trimester: 2-4 lb total
2nd & 3rd trimesters: 1 lb per week

Front 99

What is the weight guideline for an underweight pt?

Back 99

28-40 lb

Front 100

What is the weight guideline for an overweight pt?

Back 100

15-25 lb

Front 101

What is the weight guideline for an average pt?

Back 101

25-35 lb

Front 102

Lactoovovegetarians

Back 102

Eat dairy, eggs & vegetables
Low in Zinc & Iron

Front 103

Lactovegetarians

Back 103

Eat milk & vegetables
Do not eat eggs or butter
Low in Zinc

Front 104

Vegans

Back 104

Only plant products
No dairy, eggs, honey
Low in Zinc, Iron & B12
(may be low in protein)

Front 105

Nutrient needs during Lactation

Back 105

+500 calories
"ABCZIPE"
Vit A, B, C, E, Zinc, Iodine, & protein

Front 106

Nutrient needs higher in pregnancy than during lactation

Back 106

"IM FaN"
Iron, Magnesium, Folic acid, Niacin

Front 107

S/S of lactose intolerance

Back 107

abdominal cramping
bloating
diarrhea

Front 108

Biological marker pregnancy tests are based on

Back 108

hCG

Front 109

A woman whose gestation is no greater than 20 wks

Back 109

Nulliparous

Front 110

Weeks 1-13

Back 110

1st trimester

Front 111

Weeks 27-40

Back 111

3rd trimester

Front 112

Has never been pregnant before (and not pregnant now)

Back 112

Nulligravida

Front 113

Delivery that occurs prior to the end of 20 wks gestation
No viable fetus present

Back 113

Abortion

Front 114

Number of weeks since the first day of the last menstrual period

Back 114

Gestation

Front 115

Delivery that occurs after the beginning of the 42nd week

Back 115

Postterm

Front 116

Time between the conception and the onset of labor or birth

Back 116

Antepartum or Prenatal

Front 117

Time from the onset of labor until the delivery (including baby & placenta)

Back 117

Intrapartum

Front 118

Time from birth until the body returns to pre-pregnancy state (up to 6 wks following delivery)

Back 118

Postpartum

Front 119

A fetus born dead after 20 wks gestation

Back 119

Stillborn

Front 120

The period of time from the point of viability through the neonatal period

Back 120

Perinatal

Front 121

The capacity to live outside the uterus

Back 121

Viability

Front 122

The first 28 days of life

Back 122

Neonate

Front 123

The number of pregnancies (not babies) in which the fetus(es) have reached viability

Back 123

Parity

Front 124

Changes in BP by trimester

Back 124

1st trimester: stays the same
2nd trimester: decreases (due to increased progesterone)
3rd trimester: returns to same

Front 125

An increased MAP in pregnancy may indicate ...

Back 125

PIH (pregnancy induced hypertension)

Front 126

Woman may be at risk for PIH during 2nd trimester when...

Back 126

MAP >90

Front 127

Woman may be at risk for PIH during 3nd trimester when...

Back 127

MAP >102

Front 128

Growth stimulated from estrogen and progesterone, results in
increased vascularity and dilation of blood vessels, hyperplasia and hypertrophy and deciduas

Back 128

Uterus Enlargement

Front 129

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.

Back 129

Braxton Hicks Contractions

Front 130

Diagnostic signs of Pregnancy

Back 130

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

Front 131

Discharge clear to cloudy in appearance and may turn yellow after drying; slightly slimy, is nonirritating, and has a mild inoffensive odor.

Back 131

Leukorrhea

Front 132

Location the uterus may be palpated between the 12-14 wk.

Back 132

Symphysis Pubis

Front 133

Location the uterus may be palpated between the 22-24 wk.

Back 133

Umbilicus

Front 134

Location the uterus may be palpated between the 38-40 wk.

Back 134

Xiphoid

Front 135

Why does vascular volume need to increase during pregnancy?

Back 135

For adequate placenta perfusion.

Front 136

Musculoskeletal System Changes

Back 136

-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

Front 137

Integumentary System Changes

Back 137

-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"

Front 138

Darkening around eyes: "racoon"

Back 138

Chloasma
Facial Melasma
"mask of pregnancy"

Front 139

Dark line from pelvis to top of uterus

Back 139

Linea Nigra

Front 140

Separation within the underlying connective (collagen) tissue of the skin

Back 140

Striae gravidarum

Front 141

Red palms during pregnancy

Back 141

Palmar erythema
"slapped hand"
?r/t increased estrogen lvls?

Front 142

What do pregnancy hormones do?

Back 142

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

Front 143

Hypertrophy of sebaceous glands embedded in areolae, may have a protective role in that they keep the nipples lubricated for breastfeeding

Back 143

Montgomery tubercles

Front 144

Cardiovascular System Changes

Back 144

-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

Front 145

Respitory System Changes

Back 145

-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

Front 146

Renal System Changes

Back 146

-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

Front 147

GI System Changes

Back 147

-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

Front 148

Endocrine System Changes
(list major players)

Back 148

Estrogen
Progesterone
Prolactin
Oxytocin
hCS

Front 149

Prolactin

Back 149

Responsible for initial lactation
Starts in 1st trimester
produced by anterior pituitary

Front 150

Progesterone

Back 150

Relaxes smooth muscle, results in decreased uterine contraction, so prevents miscarriage

Front 151

Estrogen

Back 151

-Responsible for enlargement of genitals, uterus, breasts
-increases vascularity, causing vascularity
-relaxes pelvic ligaments & joints
-alters metabolism
-promotes retention of Na & H20 (kidney tubules)

Front 152

Oxytocin

Back 152

-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

Front 153

hCS

Back 153

Produced by placenta
Acts as growth hormone
Contributes to breast development

Front 154

Blood Volume

Back 154

-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

Front 155

RBC's

Back 155

-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

Front 156

WBC's

Back 156

-Increases during the 2nd trimester and peaks during the 3rd trimester
-Primarily granulocytes; lymphocyte count stays same throughout pregnancy

Front 157

Coagulation Factors

Back 157

Increase

Front 158

Fibrinolytic activity

Back 158

 the splitting up or (the dissolving of a clot)
-Depressed during pregnancy and PP

Front 159

Hemodilution

Back 159

Physiologic Anemia
Plasma increase exceeds increase of RBC
Hgb <11; Hcrt <35

Front 160

Heart Rate

Back 160

Increases approx 10-15 bpm between 14-20 wks
Palpations may occur

Front 161

CO2

Back 161

-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.

Front 162

Diabetes Screen
(Glucola Screen)

Back 162

-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

Front 163

How many times should H&H be tested?

Back 163

2:
once at initial visit, and again between wks 24-28

Front 164

Rubin's Safe Passage
1st trimester

Back 164

-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

Front 165

Rubin's Safe Passage
2nd trimester

Back 165

-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

Front 166

Rubin's Safe Passage
3rd trimester

Back 166

-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

Front 167

NST

Back 167

-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

Front 168

Ultrasound (Generally)

Back 168

-Produces a three-dimensional view from which a pictorial image is obtained
-Performed either abdominally or transvaginally
-Done anytime during pregnancy

Front 169

Amniocentesis

Back 169

-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

Front 170

Ultrasound
1st trimester

Back 170

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

Front 171

Ultrasound
2nd & 3rd trimester

Back 171

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

Front 172

Amniocentesis Complications

Back 172

-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.

Front 173

Kick Count/DFMC
(daily fetal movement count)

Back 173

-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

Front 174

Danger/warning signs of pregnancy

Back 174

"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)

Front 175

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

Back 175

Abruptio placenta

Front 176

Placenta implanted in the lower uterine segment near or over the internal cervical os.

Back 176

Placenta previa

Front 177

Low birth weight

Back 177

a newborn whose wt falls within last 10%

Front 178

GBS (Group B Strep)

Back 178

often causes/associated with preterm labor
treated with Penicillin G

Front 179

Plan of Care/Interventions:
Preterm Labor

Back 179

-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

Front 180

Tocolytics

Back 180

Betamethasone
Terbutaline
Magnesium Sulfate
Nifedipine (calcium antagonistic)
Prostaglandin Synthetics (motrin/naproxen)

Front 181

Maternal contraindications to Tocolytics

Back 181

Severe PIH or Eclampsia
Intrauterine infection
Active vaginal bleeding
Cardiac disease

Front 182

Eclampsia

Back 182

Had seizure

Front 183

Fetal contraindications to Tocolytics

Back 183

> 37 wks
Dilation >4cm
Fetal demise
Lethal fetal anomaly
Chorioamnionitis
Acute fetal distress
Chronic IUGR

Front 184

Betamethasone

Back 184

Glucocorticoids
increases production of surfactant in fetal lungs
can use between 20 to 32/35 wks

Front 185

Terbutaline

Back 185

Relaxes smooth muscle
relaxes uterus (inhibits uterine contraction)
bronchodilation
vasodilation
hypotension
Makes pt jittery

Front 186

Uterus
1st trimester

Back 186

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

Front 187

Uterus
2nd & 3rd trimester

Back 187

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

Front 188

Placentap perfusion depends on what?

Back 188

Maternal blood flow

Front 189

Amount of maternal blood volume in uterine vascular system

Back 189

1/6

Front 190

Blood flow to uterus decreases when...

Back 190

MAP (mean arterial pressure) is low or high
uterus contracts (is a temporary decrease)
supine position
DM (vascular damage)
Multiple gestations (vascular issues)

Front 191

Noises from the uterus

Back 191

Uterine souffle (blood flow shuffle from placenta)
Funic souffle (blood flow from cord - lighter sound)
Fetal Heart Rate (120-160, like a horse canter)

Front 192

Changes of Vagina & Vulva

Back 192

-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

Front 193

Increased cardiac output may cause...

Back 193

varicose veins
hemorroids
labial vericosities

Front 194

Neurological System Changes

Back 194

-Compression of pelvic nerves may cause sensory changes (numbness, tingling)
-Carpal tunnel
-Vasomotor hypotensio (lightheadedness)
-Hypocalcemia (muscle cramps in legs)

Front 195

Ovum & chorionic villi produce _____ until placenta takes over.

Back 195

hCG

Front 196

Thyroid Gland

Back 196

Gland & hormone increased due to increased levels of estrogen

Front 197

Parathyroid gland

Back 197

Controls Ca & magnesium metabolism
Increased fetal needs creates slight hyperparathyroidism in mom

Front 198

Diabetic Moms

Back 198

-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

Front 199

Rh - mom

Back 199

Assume baby is + and give RhoGAM

Front 200

RhoGAM

Back 200

Blood product that prevents mom from making antibodies to baby's blood

Front 201

Rubella titer

Back 201

>1:8

Front 202

AFP test

Back 202

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

Front 203

Penicillin G

Back 203

Group B Strep

Front 204

Ambivalence

Back 204

Mixed feelings regarding pregnancy
Excited & happy one moment, unhappy & depressed the next

Front 205

Binding in

Back 205

The commitment that the pregnant woman forms to her baby by the end of pregnancy

Front 206

Emotional Liability

Back 206

Frequency &/or extremes in emotional changes experienced by a woman during pregnancy

Front 207

Maternal
Psycological Changes
1st trimester

Back 207

acceptance vs denial
shock & disbelief
ambivalence (#1 emotion)
emotional lability
self focus

Front 208

Maternal
Psycological Changes
2nd trimester

Back 208

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

Front 209

Maternal
Psycological Changes
3rd trimester

Back 209

increased anxiety
self-absorbtion
anticipation vs dread
concerns of safety
giving of self to fetus
nesting

Front 210

Paternal
Psycological Changes
1st trimester

Back 210

Joy/excitement vs anger/disappointment
pride
ambivalence

Front 211

Paternal
Psycological Changes
2nd trimester

Back 211

emotional distancing
introspection
detachment
jealousy

Front 212

Paternal
Psychological Changes
3rd trimester

Back 212

acceptance of reality
protectiveness
active involvement
increased anxiety
altered sexual desire
prenatal attachment

Front 213

Magnesium Sulfate

Back 213

Relaxes smooth muscle so decreased uterine contractions
causes CNS depression
"MS: muscle, smooth"

Front 214

Prostaglandin Synthetase Inhibitors
(Naproxen, Motrin)

Back 214

Interfers with prostaglandins
(prostaglandins cause uterus to contract)

Front 215

(Calcium Antagonistic)
Nifedipine

Back 215

"CAN"
prevents return of uterine contractions by inhibiting Ca to re-enter cell membrane
(Ca needed for muscle contraction)