• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

Card Range To Study

through

image

Play button

image

Play button

image

Progress

1/77

Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

77 Cards in this Set

  • Front
  • Back
Gravidity
the number of times a female has been pregnant
Parity
the number of times a female has given birth counting multiple births as one and usually including stillbirths
GTPAL
provides more detailed information regarding a woman's obstetric history
G stands for GTPAL
gravida. # of pregnancies
T stands for in GTPAL
number of term (completion of 37 wks) infant born
P stands for in GTPAL
number of preterm (after 20 wks but before completion of 37 wks) infant born
A stands for in GTPAL
number of pregnancies ending in either spontnaeous or therapeutic abortion
L stands for in GTPAL
number of currently living children to whom the woman has given birth
Pregnancy Tests
- Human chorionic gonadotropin (hCG)
* EARLIES BIOLOGICAL MARKER ON WHICH PREGNANCY TESTS ARE BASED
* Production begins on day of implantation.
* Detected 7-10 days after conception.
Presumptive Signs
- SUBJECTIVE SIGNS - felt by woman
* amenorrhea - no period
* Nausea & vomiting (morning sickness).
* Fatigue.
* Urinary frequency.
* Breast changes.
* Quickening (perception of movement).
What are Probable Signs of Pregnancy
- OBJECTIVE SIGNS - observable by physician
* Enlargement of the abdomen (uterus). - people can have tumor that looks like preg.
* Goodell’s Sign.
* Chadwick’s sign.
* Hegar’s sign.
* Ballottement.
* Pregnancy tests (serum-4-12 wk & urine 6-12 wk). - neg - or +
* Braxton-Hick’s contractions (16 wk). - false + or -
* Uterine souffle. - blowing sounds blood going into fetus
What happens during probable signs
- Goodell’s Sign – Softening cervix & vagina. Cause is increased vascular congestion. Which hormone is responsible? - estrogen
- Chadwick’s Sign – Purplish or bluish discoloration of vagina & vulva. 6-8 wks gestation. Which hormone is responsible? - estrogen
- Hegar’s Sign – Softening isthmus of cervix. 6-12 wks gestation.
- Ballottement – Fetal part displaced by light tap of examining finger through vagina & then quickly rebounds. 16-28 wks gestation.
estrogen does what
works with the vascular system
what does progesterone work with
relaxes smooth muscle
Positive signs of pregnancy
- FHR distinct from mother’s.
* US – 6 wks
* Doppler – 8-17 wks
* Stethoscope 17-19 wks
- Fetal movements felt by examiner – 19-22 wks.
- Identification of embryo or fetus (ultrasound) - possible as early as 5-6 WKS of gestation with 100% reliability. Method is noninvasive & is EARLIEST POSITIVE SIGN OF PREGNANCY
Fetal movements visible – late pregnancy.
Uterus
- Rapid growth in 1st trimester result of estrogen & progesterone.
- Expands during pregnancy by hypertrophy of the myometrium.
- As uterus grows & fills pelvic cavity, it is elevated out of pelvic area & may be palpated above symphysis pubis some time between 12th & 14th week.
- At level of umbilicus at 22-24 weeks’ gestation.
what is hypertrophy
getting bigger but not multiplying
- you want this because then it will go back to pre pregnancy
Uterus is what size at
7 wks
10 wks
12 wks
GOLDEN RULE FOR WHERE IT SHOULD BE
- egg
- orange
- grapefruit
Cervix
- After childbirth, cervix becomes more oval in horizontal plane, & external os appears as transverse slit.
- Endocervical glands of cervical mucosa increase in number & activity.
- Prepares for uterine effacement & cervical dilatation when baby is born.
- Increased cervical discharge of thick, tenacious mucous leads to formation of mucous plug.
Mucous plug
- Seals cervical canal.
- Prevents ascent of any organisms into uterus.
- Loosens & expelled with beginning of cervical dilatation.
- to protect fetus from infection
Vagina & vulva
- Secretions increase.
* Leukorrhea - white or slightly gray mucoid discharge with faint musty odor. Occurs in response to cervical stimulation by estrogen & progesterone.
- pH becomes more acidic - result of increased production of lactic acid in vaginal epithelium. Pregnant woman more susceptible to vaginal yeast infections. (vagina is more basic side then loose normal flora to become acidic)
- Which hormone prepares vagina for passage of newborn & causes thickening of mucosa & a loosening of connective tissue? - estrogen
Ovaries
- Cease to produce ova during pregnancy.
- Corpus luteum.
* (remember) Produces progesterone 1st 10-12 wks. Progesterone maintains uterine lining until placenta established.
- Placenta.
* Begins manufacturing progesterone at 6-7 wks. At that time involution of corpus luteum begins. Corpus luteum decreases in size & disappears by 20th week.
Breast
- Areolae of breasts usually become deeply pigmented.
- Striae may become visible.
- Hormone-induced breast changes occur early in pregnancy.
- High levels of estrogen & progesterone prepare breasts for lactation.
Cardiovascular system
- everything
- blood pressure
- systemic vascular resistance (IMPORTANT)
- Slight cardiac enlargement probably secondary to increased blood volume & cardiac output.
- Elevation of diaphragm caused by uterine growth displaces heart upward, forward, & to left.
- Makes heart appear enlarged on x-ray.
- Between 14 & 20 wks heart rate increases approximately 10-15 beats/min. (increased cardiac output)
- Palpitations may occur due to increases in thoracic pressure. (its normal) REMEMBER!
- Orthostatic hypotension is common. (its normal) REMEMBER!
- Pooling of venous blood results in dependent edema & varicosities of legs, vulva, & rectum.
- more cardiac output to take care of the fetus
- Blood pressure
* 1st Trimester - same as prepregnancy level.
* 2nd Trimester - decrease in systolic & diastolic pressure of 5-10 mm Hg.
* 3rd Trimester - should return to prepregnant levels.
- SYSTEMIC VASCULAR RESISTANCE (IMPORTANT!)
* There is decreased systemic vascular resistance in pregnancy.
* Which hormone relaxes smooth muscle, causing vessels to dilate? progesterone
* These changes allow body to accommodate increased blood volume without pressure changes.
Cardiovascular System
- blood volume
- peripheral vasodilation
- RBC
- Blood volume
* Blood volume 40%-45% more than pre-pregnant state.
* Which hormone causes tone of vasculature to relax & enables body to accommodate massive increase in blood volume? Progesterone
* Blood volume starts to increase about 10th to 12th week.
* Peaks about 32nd to 34th week.
* Decreases slightly at 40th week.
- Peripheral vasodilation
* Maintains normal blood pressure despite increased volume in pregnancy.
- RBC’s
* Physiologic Anemia of Pregnancy (also called Pseudoanemia) [false anemia]
* Occurs because plasma volume increase is greater than erythrocyte increase.
* Thus, hematocrit, which measures portion of blood composed of RBC’s, decreases slightly.
* (REMEMBER) Hgb value <11 g/dl is considered abnormal.
Leukocytes
- Normal leukocyte production equals or is slightly higher than increase in blood volume.
- Average cell count is 5,000 to 12,000/mm3.
- Occasionally woman will develop physiologic leukocytosis of 15,000 mm3. (big increase doesn't mean infection but is used ward off infection)
- Levels may rise to 25,000 mm3 during labor & early postpartum.
- Reasons are unknown.
Cardiac Output
- Cardiac output is amount of blood leaving heart.
- CO = HR X Stroke Volume.
- In early pregnancy increase in CO due to increase in stroke volume.
- CO increases 30%-50% over nonpregnant rate by 32nd wk & declines to 20% increase by 40 wk.
- As pregnancy progresses, HR INCREASES UP TO 10-15 BEATS/MIN & stroke volume returns to pre-pregnant rate.
Vena Caval Syndrome
- Supine hypotension (vena caval syndrome) may be caused by weighty uterus resting heavily on vena cava when woman is lying flat on her back.
- Woman feels dizzy & clammy & is pale
- Rapid relief occurs by having woman turn onto her side or by raising head of bed.
Blood Coagulation
- Protective functions.
* Greater tendency for blood to clot due to increases in clotting factors.
* Dissolving of clots is decreased during pregnancy & PP.
- What complication may occur as a result? - deep vein thrombosis
- When is the highest incident of this complication? - post pardon
Respitratory Changes
- CHANGES IN MECHANICAL FUNCTION
* Maternal oxygen requirements increase during pregnancy.
* Occur early in pregnancy.
* Transverse diameter of the thoracic cage increases by approximately 2 cm, & the circumference increases by 6 cm.
* Compensates for elevated diaphragm, so there is no significant loss of lung capacity.
- In the central respiratory system there is increased tidal volume & decreased blood PCO2.
- There is a decrease in airway resistance by relaxation of smooth muscle.
- Ligaments are relaxed, allowing chest cage to expand & diaphragm to move more easily.
- What hormone produces these effects? progesterone
- LUNG VOLUME & GAS EXCHANGE
* Respiratory rate unchanged or slightly increased.
*30%-40% increase in tidal volume.
*Residual capacity is decreased by 20% because of elevated diaphragm.
Rhinitis of Pregnancy
- Nasal stuffiness & congestion is common during pregnancy.
- Epistaxis (nose bleeds) may occur.
- effects everyone differently
- Which hormone induces edema & vascular congestion of the nasal mucosa? - estrogen
Metabolism
- Metabolic functions accelerate.
- Recommended weight gain 25-35 lbs.
- Water metabolism.
* Increased water retention.
* Caused by increased level of steroid sex hormones which affect sodium & fluid retention.
* Extra water needed for products of conception.
Urinary system
- Glomerular filtration rate of kidneys rises.
- Renal tubules increase reabsorption.
- Water is retained because it is needed for increased blood volume & for dissolving nutrients for fetus.
- Ureters elongate, become tortuous & form single or double curves. DILATED MORE ON RIGHT SIDE THEN LEFT. (uterus generally leans to right) Urine flow is slowed & can result in urine stasis. MORE SUSCEPTIBLE TO UTI'S.
- uti can cause preterm labor
Integumentary system
- Sweat & sebaceous glands of skin become more active.
- SPIDER NEVI, small red elevations of skin with lines radiating from the center, may occur.
- Palms of hands may become deeper red.
- Pigmentation changes reversed shortly after delivery.
- hormones goes back to normal after pregnancy
- Pruritic urticarial papules & plaques of pregnancy (PUPPP)
Abdominal Striae (stretch marks)
- Increased amounts of estrogen cause a rise in adrenal gland activity. Believed to cause breakdown & atrophy of underlying connective tissue in skin.
- Fine, pinkish-white or purplish-gray lines.
- either get them or don't
- based on adrenal
Skeletal System
- Note the LORDOSIS of lumbosacral spine & increasing curvature of thoracic area.
- Joints of pelvis relax somewhat because of hormonal changes & entry of presenting part of fetus into pelvic brim in last trimester.
- “Waddling” gait in last few weeks of pregnancy because of slight separation of pubic joint.
- These changes are reversed within 6 week postpartum period.
GI System
- Larger uterus displaces stomach & intestines toward back & sides of abdomen.
- Acidity of gastric secretions is decreased.
- Emptying of stomach & motility of intestines is slower.
- May feel bloated.
- May have increased flatus due to slowing of contents through intestinal tract.
- May experience constipation & hemorrhoids.
-Caused by which hormone? - progesterone
Mouth & Esophagus
- Gums may become tender & bleed more easily.
* Which hormone is responsible? - estrogen
- No increased incidence of dental caries or tooth loss.
- Saliva
* Becomes more acidic, but an increase is not normal change in pregnancy.
* Increased salivary secretions (PTYALISM).
- PYROSIS (HEARTBURN) frequent complaint due to relaxation of cardiac sphincter of stomach, which permits reflux. (very common)
Gallbladder
- MORE LIKELY TO DEVELOP GALLSTONES DURING PREGNANCY
- Which hormone decreases tone & motility of the GB? - progesterone
- can become constipated
Pancreas
- Pregnant woman has increased demands for insulin.
- Latent deficiency may become evident during pregnancy, producing symptoms of gestational diabetes.
- A 31-year-old woman believes that she may be pregnant. She took an OTC pregnancy test 1 week ago after missing her period; the test was positive. During her assessment interview, the nurse inquires about the woman’s last menstrual period and asks whether she is taking any medications. The woman states that she takes medicine for epilepsy. She has been under considerable stress lately at work and has not been sleeping well. She also has a history of irregular periods. Her physical examination does not indicate that she is pregnant. She has an ultrasound scan, which reveals that she is not pregnant. What is the most likely cause of the false-positive pregnancy test result?

A. She took the pregnancy test too early.
B. She takes anticonvulsants.
C. She has a fibroid tumor.
D. She has been under considerable stress and has a hormone imbalance.
B

interferes with birth control pills
The nurse is assessing the lab report of a 40 week gestation patient. Which of the following values would the nurse expect to find elevated above prepregnancy levels?

A. Glucose
B. Fibrinogen
C. Hematocrit
D. Bilirubin
B

have to due with clotting
A patient asks the nurse what was meant when the physician told her she had a positive Chadwick’s sign. Which of the following information would be appropriate for the nurse to tell the patient?

A. “It is a purplish stretch mark on your abdomen.”
B. “It means that you are having heart palpitations.”
C. “It is a bluish discoloration of your cervix or vagina.”
D. “It means the doctor heard abnormal sounds when you breathed in.”
C
Which finding would the nurse view as normal when evaluating the lab reports of a 34 week gestation patient?

A. Anemia
B. Thrombocytopenia
C. Polycythemia
D. Hyperbilirubinemia
A

peak of pseudoanamia
Terry is a primigravida who is 2 months pregnant. She is at her initial prenatal clinic.

State the purpose of the health history interview.
- get background
- ask alot of questions
- disease
- changes over pregnancy
- baseline
- potential health problems
Terry is a primigravida who is 2 months pregnant. She is at her initial prenatal clinic.

What diagnostic tests should the nurse anticipate on the 1st visit?
- urine (protein, glucose, infection)
- Hcg
- * CBC *
- * type in Rh*
- Ethic base
Terry is a primigravida who is 2 months pregnant. She is at her initial prenatal clinic.

Terry tells the nurse that she is used to being active & exercises every day. Now that she is pregnant she wonders if she should reduce or stop her exercise routine. Discuss the nurse’s response to Terry.
Yes
body will tell when to stop
swimming is very good
Terry tells you that she has limited her intake of fluids, & tries to hold her urine as long as she can because, “I just hate going to the bathroom so
frequently.”

Write a nursing diagnosis, an expected outcome, & nursing interventions for the nursing diagnosis.
- at risk of uti
• Lack of knowledge r/t changes that occur to the body during pregnancy.
• Interventions:
o Terry will attend pregnancy classes to get a better understanding of what is happening with her body and what complications can occur during pregnancy.
• Expected outcome:
o Within two weeks, Terry will have a better understanding about intake and output during pregnancy as evidence by explaining the complications of holding urine and limited intake of fluids.
Terry is accompanied by her husband, Tim, on her 2nd prenatal clinic visit. Answer each of the following questions asked by Terry & Tim:

“At the 1st visit I was told that the estimated date of birth is December 25, 2013. Can I really count on my baby being born on Christmas Day?”
No

2 wks give or take
Terry is accompanied by her husband, Tim, on her 2nd prenatal clinic visit. Answer each of the following questions asked by Terry & Tim:

Cultural beliefs & practices are important influencing factors during the prenatal period. Explain how cultural beliefs can affect a woman’s participation in prenatal care as it is defined by the Western biomedical model of care.
- sex
- doc only for illness
- prenatal vit.
- modesty
- religion
- diet
Terry is accompanied by her husband, Tim, on her 2nd prenatal clinic visit. Answer each of the following questions asked by Terry & Tim:

“Before I became pregnant my friend told me that I should be doing Kegel exercises. I was too embarrassed to ask her about them. What are they & is it safe to do them while I am pregnant?”
stop pee flow
Terry is accompanied by her husband, Tim, on her 2nd prenatal clinic visit. Answer each of the following questions asked by Terry & Tim:

“What effect will pregnancy have on our sex life? We are willing to abstain during pregnancy if we have to keep our baby safe.”
Yes
- 1st trimester down
- 2nd up
- 3rd down

female orgamism can cause feeling of contractions but you will be okay
Terry is accompanied by her husband, Tim, on her 2nd prenatal clinic visit. Answer each of the following questions asked by Terry & Tim:

“This morning sickness I am experiencing is driving me crazy. I become nauseated in the morning & again in the late afternoon. Occasionally I vomit or have dry heaves. Will this last for my entire pregnancy? Is there anything I can do to feel better?”
normally ends after 1st trimester

crackers
small meals
Tim confides in you, “I just can’t figure out Terry. One minute she is happy &
the next minute she is crying for no reason at all! I do not know how I will be
able to cope with this for 7 more months.”

Write a nursing diagnosis & expected outcome that reflects Tim’s concern.
• Ineffective coping r/t lack of understanding hormonal changes going on with Terry and lack of communication.
• Within a month, Tim will have a better understanding of the changes going on with Terry as evidence by demonstrating effective communication between the two.
Tim confides in you, “I just can’t figure out Terry. One minute she is happy &
the next minute she is crying for no reason at all! I do not know how I will be
able to cope with this for 7 more months.”

Discuss how you would respond to his concern.
normal
don't take personal
IMBEVALISE (have doubt about having a baby) very normal
Terry is in her 2nd trimester of pregnancy. Answer each of the following
questions asked by Terry during a prenatal visit.

“Why do you measure my abdomen every time I come for a check up?”
indirect assessment
determine that the baby is growing adequately
While the nurse is measuring Terry’s fundus, she becomes pale & diaphoretic.
She states that she feels dizzy & lightheaded.

State the most likely explanation for the assessment findings exhibited by Terry. Describe the nurse’s immediate action.
vena caval syndrome

turn on side or raise head up
While the nurse is measuring Terry’s fundus, she becomes pale & diaphoretic.
She states that she feels dizzy & lightheaded.

“How can you tell if my baby is doing okay?”
fetal heart rate assessment and movement

27 weeks
While the nurse is measuring Terry’s fundus, she becomes pale & diaphoretic.
She states that she feels dizzy & lightheaded.

“What can I do about gas & constipation? I never had much of a problem before I was pregnant.” (2nd trimester)
increase fiber
decrease carbohydrates
stay active
While the nurse is measuring Terry’s fundus, she becomes pale & diaphoretic.
She states that she feels dizzy & lightheaded.

“I will be flying to Chicago to visit my father in one month. Is airline travel safe for me when I am 5 months pregnant?”
Yes
take a walk qh
drink water
empty bladder

in a car walk q2h
Terry is in her third trimester of pregnancy. Answer each of the following
questions asked by Terry during a prenatal visit.

“My ankles are swollen by the time I get home from work late in the afternoon. I have been trying to drink 3 liters of fluid a day. Should I reduce the amount of liquid I am drinking or ask the doctor for a water pill?”
its normal
dont take water pill
elevate legs
****KNOW FOR TEST****
Terry is in her third trimester of pregnancy. Answer each of the following
questions asked by Terry during a prenatal visit.

“I woke up last night with a terrible cramp in my leg. It finally went away but my husband & I just did not know what to do. What if this happens again tonight?”
normal 2nd & 3rd
do dorsal flex
taking vits def calcium
Terry expresses concern about preterm birth. Her sister had a preterm baby
that died. “I am so worried that this will happen to me.”

Identify one nursing diagnosis with an expected outcome that reflects Terry’s concern.
• Anxiety r/t preserved preterm birth.
• Terry will have a decrease in her anxiety within two weeks as evidence by explaining her family history with a genetic counselor.
Terry expresses concern about preterm birth. Her sister had a preterm baby
that died. “I am so worried that this will happen to me.”

Indicate what the nurse can teach Terry about the signs of preterm labor.
contraction every 10 min
lower abdominal pain,
increase in color and amount of vaginal discharge.
lite menstrual cramp
I would explain to her that preterm delivery could occur between twenty and thirty-six weeks.
Terry expresses concern about preterm birth. Her sister had a preterm baby
that died. “I am so worried that this will happen to me.”

Describe the actions Terry should take if she experiences signs of preterm labor.
empty bladder
drink 3 glasses of water
lay down
call doc
go to hospital
Purpose of IV therapy
- treat or prevent fluid, electrolyte, or nutritional imbalances
- get in body fast
indications for iv
-pre-op., intraop, post-op
- known imbalance
- NPO
- burns - 1/3 spacing fluid need in vascular space
- need for fast acting results
volume deficit
- shock
* inadequte tissue prefusion from 2 little blood volume
* bp down, hr up, pallor, cool, dizzy, confused
- dehydration
* lose of body water
* dry skin, thirst, lack of skin turgor, less tears and perspiration
volume overload
- replace fluid to fact
- CHF
- edema
- lung congestion
- hypertension
Shock
- syndrome characterized by decreased tissue perfusion and impaired cellular metabolism
- one classification
* low blood flow
~ cardiogenic - heart cant pump out enough blood
~ hypovolemic - lost a lot of blood, not circulation around
= absolute - can see that its lost (GI bleed)
= relative - fluid shifting (burns) 3rd spacing sit out in tissue
Collaborative Care
- GOAL: stop loss of fluid and restore circulating volume
* ID those at risk - they type we give a lot of fluid
* oxygen & ventilation
* fluid resuscitation - treat underlying causes get fluid stable

ER14-16g two sites
Isotonic Solution
- expands ECF (specifically intravascular volume)
* no movement in or out of ICF
- indication: hypovolemia
- examples:
* normal saline 0.9% (NS)
* lactated ringer's solution (LR)
* 5% dextrose in water (D5W)

same consternation as cell
just fills the space won't go anywhere
Hypotonic Solutions
- fluid shift out of vascular compartment into ICF and interstitial
- indication: cellular dehydration
- examples
* 0.45% saline (1/2 NS)
* 2.5% dextrose in water (D2.5W)
* 0.33% saline (1/3 NS)

- less concentrated then cells
- when pt not drinking need to replace
- hydrate the cells
Hypertonic Solution
- more concentration
- pulls the fluid (3rd spacing to pull back into vascular space)
- fluid shifts out of ICF and interstitial campartments into intravascular compartment
- indication
* vascular dehydration
* intracellular/interstitial overload
- examples
* 5% dextrose in normal saline (D5NS)
* 5% dextrose in 0.45% saline (D5 1/2NS)
* 5% dextrose in lactated ringer's (D5LR)
* 5% dextrose in 0.33% saline
* 10% dextrose in water (D10W)
Discomforts for 1st trimester
- N/V (morning sickness)
- Urinary Frequency
- Fatigue & Malaise
- Breast Tenderness
- Vaginal Discharge
- Nasal stuffiness & epistaxis
- Ptyalism
- Gingivitis
Discomforts for 2nd trimester
- Pyrosis (heartburn)
- varicosities
- Flatulence
- Hemorrhoids
- Constipation
- Backache
- Faintness
- Round Ligament Pain
- Carpal Tunnel Syndrome
- Vascular Spider Nevi
Discomforts for 3rd trimester
- Leg Cramps
- Dyspnea
- Ankle Edema
- PUPPP
-