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92 Cards in this Set
- Front
- Back
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1st Trimester Psychosocial Responses
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Ambivalence; financial worries; career concern
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-2nd Trimester Psychosocial Responses
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Quickening; pregnancy becomes real; pregnant woman accepts pregnancy; ambivalence wanes
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-3rd Trimester Psychosocial Responses
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Introverted and self absorbed; begins to ignore partner
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Throughout Pregnancy Psychosocial Responses
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Mood swings; ultrasensitive; strained relationship
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hesi hint
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Look for signs of maternal-fetal bonding during pregnancy (talking to baby, nicknames, massaging)
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hesi hint
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Abuse begins during pregnancy; assess for abuse in private, away from partner
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V/S During Pregnancy
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BP - average 90-140/60-90
HR - 60-90 RR - 16-24 T - 97-100 |
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Labs to check in prenatal visit
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HIV, Hep B, CMV, Toxoplasmosis, Rubella, Syphillis, TB, Rh and blood type, Urinalysis
Rubella >1:10 = immunity |
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Foods Rich in Iron
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fish, red meat, green leafy vegetables, cereals, yellow vegetables, citrus fruits, egg yolks, dried fruits
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Urine
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Albumin & Glucose Albumin - no more than trace amount (r/t preeclampsia)Glucose - no more than +1 (r/t gestational diabetes)
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Fundal Height
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12-13 wks - fundus rises out of symphysis;
20 wks - at umbilicus; 24 wks - fundal height is measured in cm with the number of cm = to # wks gestation |
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fhr
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10-12 weeks detectable using doppler;
15-20 weeks detectable using fetoscope; 110-160 bpm is normal range |
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Fetal well being
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is detected by fetal tone, FHR, UCs, fundal height, fetal movement; changes in FHR are first and more important indicator of compromised blood flow
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Teach clients to report immediately
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visual changes, swelling of face, fingers, sacrum, severe HA, persistent vomiting, infection, fluid discharge, change in fetal movement
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Nutrition Interventions
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Iron 30+mg/day;
folic acid 800-1000mcg/day; increase vit A, C, and calcium |
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HESI Hint
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Only healthcare provider can prescribe prenatal vitamins but it is the RN's responsibility to teach about proper diet and taking vitamins
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HESI Hint
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It is recommended that pregnant women consume 1 qt/day of milk or yogurt to ensure adequate calcium (dec. leg cramps)
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Position recommended for optimal perfusion to uterus, placenta, fetus
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Knee-Chest Position
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Maternal Risk Factors
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Age <17 or >34; high parity; HTN; anemia; multiple gestation; Rh incompatibility; Hx of dystocia Malnutrition; Infection; Medical disease during pregnancy; abuse
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HESI Hint
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In some states, screening for neural tube defects by AFP or amniotic fluid AFP levels is mandated by state law; this test is highly associated with false positives and false negatives
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Ultrasound
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High frequency sound waves are beamed into the abdomen;
echoes are returned to a machine that records the fetus' location and size; |
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Ultrasound in 1st trimester
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Used for # of fetuses, presence of cardiac movement and rhythm, uterine abnormalities, gestational age
full bladder |
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Ultrasound in 2nd/3rd Trimester
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fetal viability, gestational age, amniotic fluid vol, placental location and maturity, uterine abnormalities, results of amniocentesis
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BPP 5 variables assessed
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FHR, Fetal tone, fetal breathing movements, body movements, amniotic fluid volume; score can go up to 10 = good
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Chorionic Villi Sampling
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Removes small piece of villi between 8-12 wks to test for genetic dx; informed consent. better due to get results in 1 wk so still in frst tri abortion
detects ntd |
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Amniocentesis
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Removal of amniotic fluid sample from uterus between 14-16 weeks; used for genetic dx, fetal maturity, fetal well-being; meconium in fluid may indicate stress
in 3rd tri deteect L/S Ratio Should be 2:1, indicates fetal lung maturity which is best predictor of extrauterine survival HESI Hint When an amniocentesis is done in early pregnancy, bladder must be full. In late pregnancy bladder must be empty |
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Nursing Care during amniocentesis
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Obtain Mom V/S and FHR, supine position, scrub with Betadine, emotional support, assist to void after
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Contractions Duration, Frequency, Intensity
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30mmHg is weak, 70mmHg is strong
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What is the most important indicator of health of the fetal CNS?
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FHR
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Accelerations of FHR
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caused by sympathetic response, occur in response to movement, indicative of a reactive/healthy fetus
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Early Decels
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Due to head compression, HR decels at beginning of contraction and returns to baseline at end
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Variability
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Absent or minimal;
Short term is absent, l ong term is minimal; Causes - hypoxia, acidosis, maternal drug ingestion, fetal sleep |
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Bradycardia
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Baseline is below 110 bpm for 10 min;
causes - LATE manifestation of hypoxia, maternal hypotension, med induced, fetal heart block, cord compression |
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Tachycardia
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baseline is about 160 bpm;
causes: early sign of hypoxia, fetal anemia, dehydration, maternal infection, maternal hyperthyroid disease, med induced |
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Variable Decels
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Caused by cord compression
Variable Decels Nursing Interventions Change mom position, stimulate fetus, d/c Oxytocin, Administer O2, perform vaginal exam, report to MD |
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Late Decels
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uteroplacental insufficiency
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What is the rate of uterine growth during pregnancy
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1 cm per week after 20 weeks gestation
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what is lightening
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descent of the uterus into the pelvic cavity that occurs late in pregnancy; the fetus is said to have dropped
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Hegar's sign
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Hegar's sign is an indication of pregnancy in a woman, specifically the compressibility and softening of the cervical isthmus It is a "probable" sign of pregnancy
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chadwick's sign
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Chadwick's sign is a bluish discoloration of the cervix, (cyanotic cervix) vagina, and labia caused by the hormone estrogen which results in venous congestion.
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Goodell's sign?
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a softening of the vaginal cervix. another probable sign of pregnancy
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a presumptive sign of pregnancy
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the changes felt by the woman that may indicate pregnancy like:amenorrhea fatigue nausea vomiting breast changes quickening
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probable sign
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these changes in a woman observed by the examiner that indicate pregnancyhegars sign, pregnancy test, ballotement
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a positive sign of pregnancy
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those signs that are attributed only to the presence of a fetus like: fetal heart sounds visualization of the fetuspalpating fetal movements
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braxton hicks contractions
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light, usually painless, irregular uterine contractions during pregnancy, gradually increasing in intensity and frequency and becoming more rhythmic during the third trimester.they begin around the 4th month of pregnancy
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Ballotement
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vaginal finger displaces the fetus upward and a tap is felt on the finger as the fetus returns
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leukorrhea
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a normal whitish or grayish discharge from the vagina in a pregnant woman.
there is no associated itching |
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an important vaginal change in a pregnant woman
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Vaginal pH decreases, which protects against infection , but also makes the woman more prone to yeast infections
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what is an anemia dx in a pregnant woman
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hemoglobin less than 10 and a hematocrit less than 35%
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circulation changes in the pregnant woman
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Increased tendency for blood coagulation Heart rate increases 10-15 beats/minBP declines in mid-pregnancy and then increases to first timester levelsBMR increases 25 %
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chloasma
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the "mask" of pregnancy.
it is a hyperpigmentation of the cheek; s, nose and forehead |
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diastasis recti
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it is a separation of the rectus abdominal muscles than can occur in pregnancy.
normally the rectus abdominal muscles are held together by the linea alba |
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ptyalism
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excessive drooling;
occurs in women who are experiencing hyperemesis gravidum, excessive nausea and vomiting far worse than normal morning sickness |
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what are come cat X drugs
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Accutane, Coumadin, Cancer radiation Therapy, Tegison or Soriatane for psoriasis, streptomycin for tuberculosis, thalidomide for insomnia, diethylstilbestrol (DES) for menstrual disorders and mercury from contaminated food
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how many calories should a pregnant woman consume
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Increase 300 calories over intake of 1800 to 2200 per day
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fetal accelerations
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Indicate fetal well being
Rise over BL of FHR 15 bpm for 15 seconds or longer (15 by 15)In preterm fetus, 10 by 10 Can occur as a result of fetal scalp stimulation |
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interventions for a nonreassuring FHR?
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Pitocin off Position changes, LL or RLOxygen 10L via NRFMIV fluid bolusPlacement of FSE if unable to maintain continuous monitoringDetermine underlying cause and correct, ex. hypotension, maternal tempInform CNM or MD
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what are the components of a post partum assessment BUBBLE-HEB
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BreastsUterusBladder- should be able to void by 6-8 hours post delivery
Bowel Lochia Episiotomy Homan's sign Emotional statusBonding |
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the focus of midwifery?
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to be with woman through out the pregnancy and assist the family in childbirth. she can care for any low risk pregnancy
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10 ethical principles used in clinical practice
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1.respect2.autonomy3.beneficence4.nonmaleficence5.veracity6.fidelity7.justice8.confidentiality9.informed consent10. universality: same principles apply to everyone, everytime
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the 4 elements of informed consent
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disclosure of information (teaching)comprehensionvoluntary agreementcompetency to make decisions
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hysterosalpingogram (hsg)
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a diagnostic test in which radiopaque dye is instilled into the uterus and fallopian tubes via a catheter inserted through the cervix;
used to detect uterine or tubal anomalies*** Ask if the woman is allergic to shellfish! ***Ask when her LMP was- dont want to inturrupt and early pregnancy |
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estrogen responsible for
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development of secondary sex characteristics at puberty, and peaks at the follicular phase in the menstrual cycle.it also inhibits FSH and LH production
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corpus luteum
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it is the ovum once its released from the ovaried in the fallopian tubes. it disintigrates if fertilization doesnt take place in 24 hours, or creates progesterone if it becomes fertilized.
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what changes occur in cervical mucus during ovulation?
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becomes thinner, more plentiful, and has a more stretchy consistency (spinbarkket) this is to help the sperm move into the uterus
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what is a septate uterus
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a heart shaped uterus (a dividing membrane down the middle that can be mild or completely separate the uterus into 2 pieces) if fertilization occurs it makes it harder for this baby to be carried to term
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what is a bicornate uterus?
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what problems does this pose to a pregnancy? two banana shaped uteri, side by side, curving away from eachother. they may end at one cervix, or each have their own cervix and own vagina. the woman may have a normal mesntrual cycle if both horns are fully developed.***getting pregnant isnt really a problem but carrying the baby to term is an issue
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if a woman is following a BBT method for tracking fertility, how will she know when she is ovulating?
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when her temp drops slightly THEN rises 0.5-1.0 F this temperature spike rises with 24 hours of ovulation.
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what is mittelschmerz
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old term for midcycle pain experienced at the time of ovulation; may last 1-2 days, and may be accompanied by pressure, aching felt into the rectum, or distention
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what chemical is typically used in spermicide
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nonoxynol-9 and oxynol-9
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what components should you teach when counseling about contraceptives
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(BRAIDED) Benefits RisksAlternativesInquiries (let her ask questions)Decisions (let her decide or change her mind)Explanations = how to use the selected methodDocumentation
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what are the goals of family planning?
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assist with reproductive decision making, enabling the person to prevent pregnancy, limiting the number of children, spacing time between pregnancies, and voluntary interrupting pregnancy as desired. **has NOTHING to do with fertility treatments, or dx procedures
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why is informed consent with contraceptives?
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because of the potentially serious complications associated with so many contraceptive methods
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what should you teach to a patient that wants to follow the cervical mucus method effects its consistency?
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douchessemenblood and discharge from vaginal infectionscontraceptive gels, foams, films, or suppositoriesantihistamines
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what should a couple using a diaphragm, a male or female condom, or a cervical cap all avoid?
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oil based lubricants!! breaks down the material = increases chances of contraceptive failur
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What are the warning signs and symptoms associated with an IUD?
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(PAINS) Period late (pregnancy), abnormal spotting and bleedingAbdominal pain, pain with intercourseInfection exposure (STD), abnormal vaginal dischargeNot feeling well, fever>100.4, chillsString missing, or shorter or longer than usually felt
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what are the warning signs and symptoms associated with oral contraceptives?
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ACHES) Abdominal pain Chest pain, cough, and/or shortness breathHeadaches, dizziness, weakness or numbnessEye problems (blur or change in vision) and speech problemsSevere
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what are the warning signs and symptoms associated with a diaphragm, cervical cap and the sponge
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Toxic shock syndrome: -elevated temp>101.4F-diarrhea and vomiting-weakness and fainting-muscle aches-sore throat-sunburn type rashdifficulty urinatingabdominal or pelvic fullnessfoul-smelling vaginal discharge
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what are some contraindications to a diaphragm
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a hx of UTIsa hx of toxic shock syndrome
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who is a candidate for an IUD
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parous woman in stable monogamous relationships (low risk for STDs) with NO hx of PID, and normal uterine anatomy
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what kind of twins run in the family
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Dizygotic/fraternal/non identical twinsthe pregnancy results from the fertilization of two separate eggs by two separate sperm cellsthe zygotes develop separately and do not share placentas or amniotic sacs.
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what is the optimal time to have intercourse in relationship to ovulation is a couple desires to get pregnant?
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sex can take place no earlier than 24 hours before ovulation, and no later than 12 hours after to achieve fertilization.
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what is a morula
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what a fertilized egg is called by the time it reaches the uterus and is ready to implant.
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oligohydramnios?
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a condition of diminished amniotic fluid often related to renal system mlfunction, intrauterine growth restrictions, and post maturity.it can cause skin and skeletal abnormalities, pulmonary hypoplasia, and cord compression
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what hormones are produced during pregnancy and what functions do they serve?
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progesterone: maintains pregnancyestirol: stimulates uterine growth and mammary glandshoman chorionic gonadotropin (hCG): siminlar to luteinizing hormonehoman plancental lactogen (hPL): causes decreased insulin sensitivity = diabetogenic effect in the mother = stimulates breast development
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what is significant in the 4th week of gestation?
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fetal heart begins to beat
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what is significant in the 8th week of gestation
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all body organs are fully formed
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what is significant in the 16th week of gestation?
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baby's sex can be seen, although thin, the fetus looks like a baby
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what is significant in the 20th week of gestation?
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heartbeat can be heard with fetoscope. mother feels quickening/movementsbaby develops a regular schedule of sleeping, sucking, and kicking (!!!)
hands can graspbaby assumes a favorite position in uterovernix protects the body and lanugo keeps oil on the skinhead hair, eyebrows and eyelashes are present |
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what is significant in the 24th week
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activity is increasing, respiratory movements begin
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what is significant in the 28th week gestation
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eyes begin to open and close, baby can breathe, surficant needed for breathing is formed, baby is 2/3 full size
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what is significant in the 32th week
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baby has fingernails and toenails, SQ fat is being made, baby appears less red and wrinkled
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