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112 Cards in this Set
- Front
- Back
Normal changes are influenced by which
hormones during pregnancy? |
ESTROGEN and PROGESTERONE
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the UTERUS Increases its volume carrying ability from what to what?
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10 ml to 5000 ml
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The enlargement of the uterus is a result of an increase in?
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size (hypertrophy) of the preexisting
myometrial cells. • Only a limited increase in cell number (hyperplasia) occurs |
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In general, the uterus enlarges more around which area?
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the placental insertion site and in the upper portion of the uterus which is the fundus.
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Braxton Hicks Contractions
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Irregular •Palpated bimanually about 4th month •Stimulate the movement of blood through
the intervillous spaces of the placenta •In late pregnancy, may be uncomfortable and Confused with true labor |
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Mucous plug in the cervix
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-seals the endocervical canal
and prevents the ascent of bacteria into the uterus |
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Goodell’s sign
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softening of the cervix
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Chadwick’s sign
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blue-purple discoloration
of the cervix |
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Ovaries
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Cease ovum production during pregnancy •Follicles develop temporarily •Thecal cells lining these follicles become active in hormone production
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During early pregnancy, hCG-human chorionic gonadotropin maintains what organ?
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the corpus luteum which produces hormones
until about weeks 6-8 of pregnancy |
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Corpus Luteum
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Engulfs approximately a third of the ovary. •secretes progesterone to maintain the endometrium until the
placenta produces enough progesterone to maintain the pregnancy. • Then it disintegrates slowly. |
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Vagina
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Hypertrophy and hyperplasia during pregnancy •These changes are estrogen induced
• Result in a thickening of the mucosa •Increase in vaginal secretions-thick-white and acidic |
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Moniliasis
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common vaginal infection
during pregnancy |
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BREASTS
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Estrogen and Progesterone
• Increases in size and nodularity •Tenderness • By end of the second month, superficial veins are prominent and hyperpigmentation of the areola and Striae |
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Colostrum
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expressed manually by 12th week and may leak during the last trimester
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THORAX and LUNGS
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progesterone influences the relaxation of the ligaments and
joints which allows the ribcage to flare,thus increasing the anteroposterior and transverse diameters. |
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increase in the anteroposterior and transverse diameters is because of what?
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• This accommodation is necessary as pregnancy
progresses and the enlarging uterus pushes up on the diaphragm. |
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Respiratory system
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30%-40% rise from non pregnant values • Between weeks 16 and 40, oxygen
consumption increases 15%-20% to meet the needs of the mother as well as the fetus and the placenta |
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LUNGS
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Shortness of breath is a common complaint during last trimester •Deep respirations
• More frequent sighing • Pulmonary requirements increase |
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why do Oxygen requirements increase during pregnancy?
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because of the additional cellular growth of the body
and the fetus |
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Epistaxis
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(nosebleeds)-result of estrogen induced edema and vascular congestion of the
nasal mucosa |
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what happens to the Circumference of the chest during pregnancy?
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it may increase
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what do Measurements of airway resistance show during pregnancy?
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a marked decrease in response to elevated progesterone levels.
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Pulmonary function during pregnancy?
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is not impaired by
pregnancy |
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HEART
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is required to pump much harder •Actually increases in size •Heart rate may increase by 10-15 bpm •Systolic murmers may be heard
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Blood volume
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increases to 40-45% above
nonpregnant levels near term- |
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Cardiac Output
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begins to increase early and
peaks at 20-24 weeks at 30-50% prepregnant levels |
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Femoral venous pressure
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slowly rises as the uterus exerts increasing pressure on return blood flow.
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BLOOD PRESSURE
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Decreases slightly during pregnancy
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when does blood pressure Reach its lowest point during pregnancy?
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the second trimester
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what happens to blood pressure during the third trimester/
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increases during the
third trimester |
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What happens to the blood pressure of a pregnant woman at term?
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it is near prepregnant
levels |
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Femoral venous pressure during pregnancy
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slowly rises as the uterus exerts increasing pressure on
return blood flow. |
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Postural Hypotension
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Increased blood volume in lower extremities Resulting dependent edema and tendency toward varicose vein formation in the legs,
vulva, and rectum late in pregnancy |
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Supine Hypotensive Syndrome
• Vena Caval Syndrome • Aortocaval Compression |
Enlarging uterus puts pressure on Vena Cava when woman is supine interfering
with maternal blood flow • Produces ↓ B/P, dizziness • Have woman lie on her left side |
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what is a PHYSIOLOGIC ANEMIA during pregnancy?
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Incr in maternal bld vol but not a proportionate incr in RBC production •Psuedoanemia plasma vol incr • RBC vol incr This changes occur by 30-34 wks gestation
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Pulse Rate
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Frequently incr's
Varies from almost no incr to an incr of 10-15 beats per min |
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PLASMA BLOOD VOLUME
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AS PBV increases, blood vesselsaccommodate for this vol. • 2nd trimester-clients feel light-headed and dizzy
• Peak 32-34 weeks |
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what does Progesterone do to lood vessles during pregnancy?
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acts on the vessels to make them relax and dilate
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what happens to the ABDOMEN during pregnancy?
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Abdominal muscles stretches as the
uterus enlarges. Expanding uterus exerts pressure on the bladder,kidneys,and ureters |
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Rectus abdominis muscles
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stretch to the point that permanent separation occurs
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what is Lower pelvic discomfort during pregnancy?
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stretching of the round ligaments
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what causesDECREASED GASTRIC MOTILITY during pregnancy
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Enlarging uterus puts pressure and displaces the sm int •This pressure along w/ the secretion of progesterone decr gastric motility •Gastric tone is decr •Emptying time of stomach is decr
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FIRST TRIMESTER-GI
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n & v are assoc w/ the hCG secreted by the implanted blastocyst and w/ a change in carbohydrate metabolism that occurs in early pregnancy
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Second half of pregnancy- GI
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Pressure of growing uterus
Heartburn-pyrosis-reflux of acidic secretions •Hemorrhoids • Prolonged emptying of the gallbladder |
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how does progesterone change smooth muscles during pregnancy?
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it relaxes them
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Basal metabolic rate
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Increases up to 30%
Thyroxine increases BMR, heart rate, heat intolerance, cardiac output, vasodilation |
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what happens to the Gums during pregnancy?
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Gingival bleeding when brushing, best time to go to the dentist is the 2nd trimester
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What causes Nasal stuffiness-epistaxis during pregnancy
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estrogen induced edema and vascular congestion of the nasal mucosa and sinuses
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what causes Vocal changes during pregnancy?
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edema of the larynx
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Urinary Frequency
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common complaint of
the 1st and 3rd trimesters |
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bladdar pressure During the 2nd trimester
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subsides and urinary frequency is relieved by the uterus enlarging and being lifted out of the pelvic area
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linea nigra
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a dark line extending from the umbilicus to the mons pubis
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cholasma
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a darkening of the skin on the
face-Women who take contraceptives have this because of the hormones in the medicine |
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what are some SKIN CHANGES during pregnancy?
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Darkening of the aerola and
nipples,axillae,umbilicus, and perineum, Scars and moles • Vascular changes-spider nevi-elevate estrogen levels •Palmar erythema •Hair and nail growth incr |
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what are some MUSCULOSKELETAL changes during pregnancy?
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Lordosis •Uterine growth pulls the pelvis forward •Spine curvesforward
•Progesterone and relaxin influence then pelvic joints and ligament to relax |
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PERIPHERAL VASCULAR
SYSTEM |
Swelling of lower extremities in the third trimester
• Pregnant women are more prone to thrombophlebitis because of the hypercoagulabe state of pregnancy |
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NEUROLOGICAL
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Pain and tingling in the thigh
• Carpal tunnel syndrome • Leg Cramps • Supine Hypotensive Syndrome |
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what happens to the Thyroid during pregnancy?
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pregnancy influences size &
activity |
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Total serum Thyroxin
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increases in early pregnancy
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Thyroid Stimulating Hormone
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decreases
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hCG
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stimulates progesterone and
estrogen production till placenta develops |
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Estrogen
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stimulates uterine development
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Progesterone
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inhibits spontaneous uterine
contractility, & maintains pregnancy |
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Relaxin
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aids in softening of cervix and
inhibits uterine activity |
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Human Placental Lactogen
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Antagonist of insulin – Decr maternal metabolism of glucose to favor fetal growth
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when is Estrogen produced during pregnancy?
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produced at 7th week of
pregnancy |
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Subjective (Presumptive) Changes
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Amenorrhea, N&V
Excessive Fatigue, Urinary Frequency, Changes in the breasts, Quickening |
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Objective (Probable Signs)
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Changes in Pelvic organs, Enlargement of the Abdomen, Braxton Hicks contractions, Uterine Souffle, Changes in pigmentation of the skin, Clinical pregnancy tests, Over the counter pregnancy tests
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Diagnostic (Positive) Changes
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Fetal heartbeat, Fetal movement, Visualization of the fetus
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Psychologic Response
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Ambivalence,Acceptance-develops self-confidence
• Rubin-4 tasks |
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Rubin-4 tasks
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Safe Passage, Seeking of Acceptance, Binding-In, Giving of oneself
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Gravida and para
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term refers to pregnancies
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Gravida
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any pregnancy regardless of
duration including present pregnancy |
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Para
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Birth after 20 weeks’ gestation
regardless if infant is born alive or dead. |
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Term
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38-42 weeks of gestation
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Preterm
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after 20 weeks and before 37
weeks of gestation |
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Postterm
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after 42 weeks of gestation
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TPAL
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Term, Preterm, Abort,Living Child
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1st trimester
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1-12 wks
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2nd trimester
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13-24 wks
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3rd trimester
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25-37 wks
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normal recommended weight gain during pregnacy?/ if over weight?/ and if underweight?
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20-25 lbs. if over weight- 15 lbs if under weight gain ideal weight and add 11.5-16 lbs
*3.5-5lbs then 1lb per week |
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normal weight gain during 1st trimester?
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3.5-5 lbs.
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normal weight gain during 2nd trimester?
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12-15 lbs
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normal weight gain during 3rd trimester?
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12-15 lbs
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CBC; H&H?
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Hemoglobin 12-16g/dl;Hematocrit-38-47%
– RBCs ; WBCs |
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Fundal Height assessment
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Centimeters & weeks of gestation correlate, Woman must empty her bladder, Maternal position
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Quickening
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fetal movements-approx 20
wks |
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when is Fetal heartbeat assessed?
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10-12 weeks gestation
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Common Discomforts of Pregnancy
• 1st Trimester |
N&V,Urinary Frequency,
Fatigue, Breast tenderness, Incr vaginal dc, Nasal stuffiness and nosebleeds, Ptyalism |
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Common Discomforts of Pregnancy
• 2nd and 3rd Trimesters |
Heartburn, Faintness, Ankle Edema, Dyspnea, Varicose Veins, Flatulence, Hemorrhoids, Carpel Tunnel Syndrome, Constipation, Backache, Leg Cramps
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Inactivated Virus Vaccines
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Influenza, Hepatitis A&B
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Toxoids
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Tetanus
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Live Virus Vaccines-Contraindicated
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Measles, Mumps, Rubella, Varicella Zoster, Smallpox
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Expectant Couple over 35
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Financial concerns, Planned vs.unexpected •Amniocentesis •Medical Risks
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Amniocentesis
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14 weeks for
chromosomal studies |
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Medical Risks Couple over 35
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Cesarean Birth Rate is incr, Down Syndrome/congenital malformations, Placenta previa, Placenta abruptio, Low-birth weight, Preterm, Spontaneous abortion
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Adolescent Pregnancy
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Puberty, Psychosocial Development, Peer pressure, Lack of knowledge about sexuality, Lack of knowledge about contraception, Socioeconomic factors
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Physiologic Risks-
Adolescent Pregnancy |
Preterm births, LBW infants, Preeclampsia/eclampsia, Iron deficiency anemia, CPD (cephalopelvic disproportion), Prenatal care-critical factor, Psychological & Sociologic Risks
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Substance Abuse Cocaine
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Feeding difficulties, extreme irritability in Breastfeeding NB
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Substance Abuse Heroin
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IUGR; shrill high pitch cry, Withdrawal-72 hours, Methadone
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Placenta previa
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Painless vaginal bleeding after 20 wks
gestation |
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Abruptio placentae
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Painful, may or may not be accompanied by bleeding, occurs before birth usually during labor process
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Hyperemesis Gravidarium
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Severe nausea, affects hydration and nutritional status
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Hypovolemia during pregnancy leads to:
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hypertension, incr pulse rate, hematocrit, and BUN, decr urine output, Weight loss of 5% of prepregnancy weight
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PROM
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After 37 weeks but before the onset of labor
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Prolonged ROM-
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more than 24 hours before
birth |
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Betamethasone
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Celestone Soluspan
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Preterm Labor-
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Occurs between 20-37 weeks of pregnancy
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RH incompatibility
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Screening at 28 weeks gestation
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ABO incompatability
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Type O mothers with Type A or B fetus, Hyperbilirubinemia
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