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64 Cards in this Set
- Front
- Back
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Trends in the 20th Century |
family-centered care: focus on the needs of the family family as the constant evidence-based, case-managed care: use of research or evidence for planning and implementing care; interdisciplinary, collab approach |
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Effects of cost containment |
early discharge insufficient teaching Current practice: complex with increased technology, threats of litigation, care under time and economic restraints |
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mortality |
number who have died over a specific period rates for African American woman higher than any other ethnic group U.S ranking: 50th Health promotion and prevention better sanitation increased medical knowledge widespread availability of antibiotics |
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health status |
fetal mortality rate: number of fetal deaths (20 weeks or older)/1000 live births exact cause unkown maternal factors: malnutrition, disease, preterm cervical dialation fetal factors: chromosomal abnormalities, poor placental attachment |
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morbidity |
measures prevalence of specific illness in a population over a given time; rates per 1000 pop. difficult to define due to wide variations in definition (physician visits or diagnosis for hospital admission) difficult to obtain data women's health indicators |
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healthy people 2020 & pregnancy |
goal-improve health/well-being of woman, infants, children, and families decrease fetal, infant, and child deaths decrease maternal death and illness increase prenatal care and obstetric care decrease risk factors mom and baby decrease prenatal substance exposure increase rates of breastfeeding |
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cultural aspects of pregnancy |
cultural group-share a community changing cultural demographics-Hispanic fast growing, followed by asian immigration and globalization increased emphasis on culturally competent care cultural aspects and beliefs about health care practices |
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stages of fetal development |
preembryonic - fertilization through 2nd week fertilization; cleavage; morula blastocyst and trophoblast implantation embryonic stage: end of week 2 through 8th week basic structures of major body organs and external features fetal stage- end of 8 week til birth |
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placenta |
serves as the interface between mother and fetus makes hormones to contrl the physiology of mother protects fetus from immune attack by mother removes waste products from fetus induces the mother to bring more food to placenta produces hormones that mature fetal organs |
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umbilical cord |
formed from the amnion lifeline from the mother to growing embryo one large vein and 2 small arteries whartons jelly surrounds the vein and arteries to prevent compression at term, average uc is 22 inches long and 1 inch wide |
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role of amniotic fluid |
helps maintain a constant body temp for fetus permits symmetric growth and development cushions the fetus from trauma allows the umbilical cord to be relatively free of compression promotes fetal movement to enhance musculoskeletal development |
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fetal circulation |
blood from placenta to and through fetus then back to placenta 3 shunts during fetal life ductus venosus- umbilical vein to inferior vena cava ductus arteriosus - mian pulmonary artery to aorta foramen ovale- anatomical opening between right and left atrium |
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assessment of fetal well-being |
ultrasonography Doppler flow studies biophysical profile alpha-fetoprotein analysis marker screening test amniocentesis cvs pubs nonstress test; contraction stress test maternal report of fetal movements |
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ultrasound |
ultrasonography best method of dating- if done early in pregnancy cost effective non-invasive painless biophysical profile bpp dopler flow studies-us for blood flow |
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ultrasound |
a way of looking inside mom and baby can visualize fetal abnormalities is used to determine the need for further invasive testing no special prep is needed early pregnancy might need full bladder for abdominal ultrasound |
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bpp- biophysical profile |
uses ultrasound to visual fetus to identify possible/problems well-being scoring of 5 items: body movements fetal tone fetal breathing amniotic fluid volume nst-non stress test |
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nst- non stress test |
performed by electronic fetal monitoring EFM non-invasive, quick and fast look for accelerations in the fetal heart rate reactive/non-reactive reactive-2 acceraltions in 20 mins nonreactive- if does not meet criteria in 40 min if non-reactive, may perform bpp |
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amniocentesis |
performed with ultrasound transabdominal needle puncture 15-18/20 weeks for problems with fetus third trimester-done for fetal lung maturity empty bladder, informed consent, efm before and after, rhogam if rh neg many risk to mom and baby |
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cvs- chorionic villus sampling |
for obtaining a sample of chorionic villus earlier (than amniocentesis) detection of chromosomal problems with fetus performed at 10-13 weeks after LMP ultrasound for dates,and viability and continuous during the test full bladder to help with testing informed consent and many risks |
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pubs- percutaneous umbilical blood sampling |
same as amniocentesis and cvs only obtaining blood from umbilical cord (cordocentesis) continuous ultrasound, informed consent, major risks performed after 16 weeks gestation |
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Embryonic state |
week 1-2 pre-embryonic week 3-7 |
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fetal development |
week 8 becomes a fetus week 16 quickening week 17-20 vernix, lanugo week 20 |
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fetal period |
week 21-24 surfactant production begins week 24 - viable? week 28 eyes open week 32 week 36 week 40 |
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signs n symptoms of pregnancy |
presumptive signs- subjective breast tenderness- 3-4 weeks amenorrhea - 4 weeks nausea and vommting - 4-14 weeks breast enlargement - 7-12 weeks urinary frequency - 6-12 weeks fatigue -12 weeks hyperpigmentation of skin (chloasma) - 16 weeks fetal movements (quickening)- 16-20 weeks |
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probable (objective) signs |
Braxton hicks contractions- 16-28 weeks positive pregnancy test-serum/urine - 4-12 weeks abdominal enlargement 14 weeks ballottement 16-28 weeks goodells sign - 5 weeks - softening cervix chadwicks sign 6-8 weeks- bluish cervix hegars sign - 6-12 weeks softening lower segment of uterus |
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positive signs |
ultrasound verification of embryo or fetus fetal movement felt *palpated by expierenced clinical 20 weeks fetal heartbeat : by Doppler 8-12 weeks fetal movements visible *late preg. |
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reproductive system adaptation uterus |
increase in size, weight, length, width, depth, volume, and overall capacity pear shaped to ovoid shape; positive hegars sign enhanced uterine contractility; Braxton hicks contractions ascent into abdomen after 1st 3 months fundal height by 20 weeks gestation at level of umbilicus, 20cm, reliable determination of gestation age until 36 weeks gestation |
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cervix |
softening - goodells sign mucous plug formation increased vascularization - chadwicks sign ripening about 4 weeks before birth |
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vagina |
increased vascularity with thickening lengthening of vaginal vault secretions more acidic, white, and thick; leukorrhea |
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ovaries |
enlargement until 12th to 14th week of gestation cessation of ovulation |
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breast |
increase in size and nodularity to prepare for lactation; increase in nipple size, becoming more erect and pigmented production of colostruml antibody-rich, yellow fluid that can be expressed after 12th week; conversion to mature milk after delivery |
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gi system adap. |
gums- hyperemic, swollen, friable ptyalism dental problems- gingivitis decreased peristalsis and smooth muscle relaxation; constipation constipation + increased venous pressure + pressure from uterus= hemmoroids slowed gastric emptying; heart burn prolonged gallbladder emptying nausea and vomitting gallbladder |
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cardiovascular system |
increase in blood volume -50% above prepreg levels increase in cardiac output; increased venous return; increase hr slight decline in bp until mid preg, then returning to prepreg levels increased in number of rbcs, plasma volume > rbc leading to hemodilution (physiologic anemia) preg as a hypercoagulable state |
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respirtatory system |
breathing more diaphragmatic than abdmonial due to increase in diaphragmantic excursion, chest circumference, tidal volume increase in 02 consumption congestion secondary to increased vascularity |
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renal/urinary system |
dilation of renal pelvis; elongation; widening, and increase of curve of ureters increase in length and weight of kidneys increase in gfr; urine flow accumulates and slows increase in kidney activity with woman lying down; greater increase later in pregnancy with woman lying on side |
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musculoskeletal system |
softening an stretching of ligaments holding sacroiliac joints and pubis symphysis postural changes: increased swayback and upper spine extension forward shifting of center gravity increase in lumbosacral curve(lordosis) compensatory curve in cervicosdorsal area waddle gait |
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integumentary system |
hyperpigmentation; mask of pregnancy (facial melisma) linea nigra striae gravidarum varicosities vascular spiders palmar erythema decline in hair growth; increase in nail growth |
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endocrine system |
thyroid gland: slight enlargement: increased activity: increase in bmr pituitary gland: enlargement: decrease is tsh, gh, inhibition of fsh and lh, increase in prolactic, msh, gradual increase in oxytocin with fetal maturation pancreas: insulin resistance due to hPL and other hormones in 2nd half of preg adrenal glands: increase in cortisol and aldosterone secretion prostaglandin secretion placental secretion: hcg, hpl, relaxin, progesterone, estrogen |
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nutritional needs |
direct effect of nutritional intake on fetal well-being and birth outcome need for vitamin amd mineral supplement daily dietary recommendation- increase protein, iron, folate, and calories, use of USDA's food guide pyramid, avoidance of some fish due to mercury content |
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maternal emotional responses |
ambivalence introversion acceptance mood swings changes in body image family-centerd emphasis - partners rxn to preg and changes couvade syndrome, ambivilance acceptance of roles- 2nd trimester preparation for reality of new role - 3rd trimester |
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nursing management during pregnancy 1st visit |
estabilish of trusting relationship focus on education for overall wellness detection and prevention of potential problems comprehensive health history, physical exam, lab test. |
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menstrual history |
date of last menstrual period LMP calc of estimated or expected date of birth (EDB) or delivery (EDD) negales rule- use first day of LNMP, subtract 3 months add 7 days, add 1 year gestation or birth calc or wheel ultrasound |
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obestric history |
gravida- number of times woman is pregnant gravida 1- first preg, gravida 2- second preg para- number of pregnancies delivered after the age of vaibility primapara- one birth after a preg of at least 20 weeks (primip) multipara: 2 or more pregnancies resulting in viable offspring (multip) nullipara: no viable offspring; para 0 |
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obstetric history |
g= gravida- the number of times pregnant t= term births- the number of preg after completion of 37th weeks gestation p= preterm births- then umber of preterm preg ending >20 weeks or viability but before 37 weeks a= abortions- number of pregnancies ending b4 20 weeks or viability l= living children- number of children currently living |
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physical exam |
pelvic exam - exam of external and internal genitalia, bimanual exam. pelvic shape- gyencoid, android, anthropoid, platypelloid pelvic measurements- diagonal conjugate, true obestric conjugate, ischial tuberosity lab test- urinalysis, cbc, blood typing, rh factor, ultrasound, rubella titer, hep b suface antigen, hiv, vdrl, rpr testing, cervical smears |
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follow up visit |
assessments weight and bp compared to baseline urine testin for protein, glucose, ketones, nitrites fundal height quickening/fetal movement fetal heartrate teaching: danger signs |
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1st trimester discomforts |
urinary freq or incontinence fatigue nausea and vomitting breast tenderness constipation nasal stuffiness, bleeding gums, epistaxis cravings leukorrhea |
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2nd trimester discomforts |
backache varicosities of vulva and legs hemorrhoids flatulence with bleeding
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3rd trimester discomfort |
return of 1st discomforts SOB and dypsnea heart burn n indigestion dependent edema Braxton hicks contractions |
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danger signs of pregnancy |
during first- spotting or bleeding(miscarriage), painful urination (infection), severe persistent vomiting (hyperemesis gradiarum), fever higher than 100 F (infection) 2nd- regular uterine contractions (preterm labor); pain in calf, often increased with foot flexion (blood clot in deep vein) 3rd- sudden weight gain; periorbital or facial edema, severe upper abd pain, headache with visual changes (preg induced htn), decrease in fetal daily movement more then 24 hours (possible demise) |
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prep for birth |
perinatal education childbirth education Lamaze (psychoprophylactic) method; focus on breathing and relaxtion techs Bradley (partner-coached childbirth) method; focus on exercises and slow, controlled abd breathing dick-read (natural childbirth)method: focus on fear reduction via knowledge and abdominal breathing techs |
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prep for labor , birth, parenthood contd |
options for birth setting- hospitals- delivery room, birthing suite, birth centers, home birth options for care providers- obstetrician, midwife, doula-support only, and not liscenced feeding choices- breastfeeding, bottle, teaching final prep for siblings. |
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nclex bullet pts |
gravida is number of pregnancies a woman has had regardless of the outcome para is number of preg that reached viability, regardless of whether fetus was delivered alive or still born - a fetus is considered viable at 20 weeks from the completion of the 8th week of gestation the developing cells are known as a fetus. |
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ptyalism |
excessive flow of saliva |
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chorion |
outermost membrane around the embryo |
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amnion |
inner most membrane around embryo |
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chloasma |
pregnancy mask |
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couvade syndrome |
sympathy pregnancy. when a partner experiences symptoms and behavior of an expectant mother. weight gain, altered hormone levels, nausea, disturbed sleep patterns. |
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chromosome |
in the nucleus of each cell, the dna is packed into threadlike structures called chromosomes. They are made up of dna tightly coiled many times around proteins called histones that support its structure |
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macrosomia |
newborn with excessive birth weight. - larger then normal. |
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antenatal |
before birth; prenatal |
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gestation |
the process of carrying being carried in the womb between conception and birth |
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antepartum |
occurring not too long before childbirth |
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sentinel event |
unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. |
