Antepartum Niii

Front 1

Embryonic period conception-8 weeks
Fetal period 9-40 weeks

Back 1

Name the periods of antepartum

Front 2

List the blood tests done throughout the pregnancy

Back 2

*CBC w/Hgb/Hct
*Blood type/Rh factor
*Rubeller titer (german measles
*Urinalysis
*HIV/Hepatitis/GC/VDRL
*28 Week glucose Tolerence test

Front 3

What are the frequency of Dr. visits?

Back 3

1-6 months 1xmth
7-8 months 2xmth
9th 3xmth

Front 4

Assessment during visit

Back 4

Fundal height/Mcdonalds method
quickening
Fetal heart rate (FHR-110-160)
Cervical Group B Streptococcus

Front 5

SUBJECTIVE/PRESUMPTIVE
S/S OF PREGNANCY

Back 5

Amenorrhea
-Endocrine factors, Metabolic factors, psychoogic

2)N/V

3)Urinary Frequency

4)Breast tendernes

5)Quickening

Front 6

OBJECIVE/PROBABLE
S/S OF PREGNANCY

Back 6

1)Change in pelvic organs

2)Goodell's sign-estrogen-progestern oral conctraceptives

3)Chadwicks sign-vulvar, vaginal, cervical hyperemia

4)Hegar's sign-excessively soft walls of nonpregnant uterus

5)Uterine enlargement-uterine tumor

6)Braun Von Fernwald's sign-Uterine tumor

7)Piskalek's sign-Uterine tumor

8)Enlargement of abdomen-obesity, ascites, pelvic tumor

9)Braxton hicks contractions-hematometra. Pedunculated, submucous and soft momas

10)Uterine souffle-large uterine myomas, large ovarian tumors, or any condition with greatly increased uterine blood flow

11)Pigmentation of skin-estrogen-progestin oral contraceptives

12)Melasma, Linea nigra, Nipples/areola-melanocyte hormaonal stimulation

13)Abdominal striae-obesity, pelvic tumor

14)Ballottement-uterine tumors/polyps, ascites

15)Pregnancy tests-increasedpituitary gonadotropins at menopause, choriocarcinoma, hydatidiform mole.

16)Palpatiod of fetal outline-uterine myomas

Front 7

POSITIVE S/S OF Pregnancy

Back 7

1)Fetal movement-at 17-20wk, as early as 10-12wk,rate 120-160

2)Fetal movement-can see, hear, and feel, done by the examiner at 20 wks

3)Visualization of fetus-ultrasound can see the fetal sac by 4-5 wks

Front 8

ID physiological changes in the cardiac are and give SELF CARE measures

Back 8

CARDIOVASCULAR
-Supine hypotension/vena caval syndrome
SELF CARE: lay Left side or wedge under Right hip

2)Palpitations-be aware

3)Faintness(potural hypotension)r/t-anemia, standing too long in warm areas, sudden change in posture.
SELF CARE:avoid prologning standing in warm areas, evalute Hmt,Hgb

4)Ankle Edema (non-pitting)-prolonged standing or sitting, increased levels of Na due to hormonal influence, circul. congestion of lower extremites, increased capilary permeability, varicose veins
SELF CARE:practice frequent dorsiflexion of feet when prolonged sitting/standing, elevate legs, avoid tight garters or restrictive garters or restrictive bands around legs

Front 9

ID physiological changes in Respiratory system and give SELF CARE measures

Back 9

RESPIRATORY
1)Dyspnea-decreased vital capacity form pressure of enlarged uterus on diaphram
SELF CARE: use proper positioning/posure when sitting/standing, sleep propped up w/ pillos for reief if problems occur during the night

2)Nasal stuffiness-elevated estrogen levels may produce edema of nasal mucosa
SELF CARE:Cool air vaporizers an NS nose drops. OTC's can cause an increase in the problem and all medications should be avoided during pregnancy

3)Epistaxis-nose bleeds
SELF CARE:S/A

Front 10

ID physiological changes in GI system and give SELF CARE measures

Back 10

Gastrointestinal
1)Ptyalism-excessive bitter saliva
SELF CARE:uses of mouthwash, shewing gum, hard candy, reduce starch intake

2)Pyrosis(heartburn)-regurgitation of acid back into the esophagus
SELF CARE:do not overeat, ingest fatty, fried foods or lying down after eating, drink 8-10 8oz H2O daily, eat small more frequent meals
practice good posture

3)Hemorrhoids-r/t constipation
SELF CARE:avoid constipation, apply ice packs, topical itment anesthetic agents, warm soaks

4)N/V-increased levels of human chorionic gonadotropin, change in carb. metab., emotional factors, fatigue
SELF CARE:avoid odors or causative factors, eat dry crackers/toast before arising in morning, small frequent meals, avoid greasy/seasoned foods, dry meals w/ fluid beween meals, drink carbonated beverages

5)Constipation-r/tincreased levels of progestrone, cause bowel sluggishness, pressure of enlarging uterus on intestines , iron supplements, diet, lack of exercise, decresed fluid
SELF CAE:develop regular bowel habits, stool sofners via physician

6)Flatulence-decrease gastrointestinal motility leading to delaying emtying time, pressure of growing uterus on large intestines, air swallowing
SELF CARE:avoid gas-forming foods, chew food thouroghly, regular daily exercise, maintain normal bowel habits

Front 11

ID physiological changes in the Reproductive system and give SELF CARE measures

Back 11

Reproductive
1)Amenorrhea-is the earliest symptomof pregnancy when women's regular menstrual cycle is missed

2)Goodell's sign-sofening of the cervix and vagina as being usually indicative of pregnancy

3)Chadwick's sign-a bluish discoloration of the cervix and vagina, a sign of pregnancy

4)Hegar's sign-softening and compressibility of the lower segment of the uterus in early pregnancy (about the 7th week) which, on bimanual examination, is felt by the finger in the vagina as though the neck and body of the uterus were separated, or connected by only a thin band of tissue.

5)Uterin suffle-may be heard when auscultating the abdomen over the uterus. it is a soft blowing sound at the same rate as the maternal pulse and is due to the increase uterine vascularization and blood pusating through the placenta

6)Funic souffle-is a soft blowing sound of blood pulsating through the umbilical arteries. It is at the same rate as the FHR.

7)Ballottement-is the passive fetal movement elicited by pushing up against the cervix w/ 2 fingers

8)Braxton Hicks Contractions-irregular contractions of the wonb occuuring towards the middle of pregnancy in the first pregnancy and , earlier and more intensely, in subsequent pregnancies. also called false labor. They are painless.

Front 12

ID physiological changes in the Integumentary system and give SELF CARE measure

Back 12

Integumentary
1)Striae gravidarum-a fine pinkish-white or gray line, usually 14cm long, seen in parts of the body where skin has been stretched; commonly seen on thighs, abd, and breasts of women who are or have been pregnant; in persons whose skin has been stretched by obesity, tumor, or edema; or in persons who have taken adrenocortical homones for a prolonged period.

2)Chloasma-tan to brown, sharply, defined patches of skin pigment, usually found symmetrically on the forehead, temples, cheeks, or upper lip. The excess pigmentation often occurs inpregnant women, in women using oral contraceptives, or in pt. w/ underlying liver disease. Women are affected more often than men. Sun exposure tends to worsen the condition

3)Linea nigra-a dark line or discoloration of the abd that may be seen in pregnant women during the later part of term. It runs from above the mbilicus to the pubes.

4)Telangiectasis-a vascular lession formed by dilatation of agroup of small blood vessels. It may appear as a birhtmark or become apparent in young children. It may also be caused by long-term sun exposure. Although the lesion may occur anywhere on the skin, it is seen most frequently on the face and thighs

5)Palmear erythema-mottling of the hand

6)Epulis-a nonpathological softening and swelling of the gums due to hyperemia that begins during midtrimester pregnancy and subsides after delivery. In susceptivle women, this condition tends to recur during subsequent pregnancies. (Swelling of the gums)

Front 13

ID physiological changes in Renal system and give SELF CARE measures

Back 13

Renal
1)Urinary frequency-urinary frequency is a common discomfort of pregnancy. It occur early in prenancy and the third trimester because of the pressure of the enlarging uterus on the bladder. Coughing and sneezing in the last month may even cause leakage of urine. Although frequence rate increases the urine output does not. Contact physician if painful urinatin or burning or blood in urine occurs
SELF CARE:there is no method for decreasing the frequence of urination. decreasing fluid intake is not recommended, pads can be worn if leakage occurs and night lights and clear passage to the bathroom for frequent night trips.

Front 14

ID physiological changes in the musculoskeletal system and give SELF CARE measures

Back 14

Musculoskeletal
1)Diastasis recti abdominis-a separation of the two halves of the rectus abd muscles in the midline at the lenea alba. This condition is benign when it occurs in pregnant women.

2)Lordosis-abnormal anterior convexity of the lumbar spine; center of gravity is off
SELF CARE:Pelvic tilt exercises.

3)Gastrocnemius spasm-a involuntary sudden movement or muscular contraction that occurs in the large muscle of the posterior portion of the lower leg. r/t-increase in P and not enough Ca and a decrease in Mg

Front 15

ID physiological changes in the musculoskeletal system and give SELF CARE measures

Back 15

Musculoskeletal
1)Diastasis recti abdominis-a separation of the two halves of the rectus abd muscles in the midline at the lenea alba. This condition is benign when it occurs in pregnant women.

2)Lordosis-abnormal anterior convexity of the lumbar spine; center of gravity is off
SELF CARE:Pelvic tilt exercises.

3)Gastrocnemius spasm-a involuntary sudden movement or muscular contraction that occurs in the large muscle of the posterior portion of the lower leg. r/t-increase in P and not enough Ca and a decrease in Mg

Front 16

ID physiological changes in the Endocrine system and give SELF CARE measures

Back 16

Endocrine
1)(HCG)-pregnancy tests and home pregnancy(based on the concentration of HCG in the urine-best sample taken in the morning.

Human Placental lactogen (HPL)-stimulats breast develpment, can cause insulin resistance

3)Relaxin-relaxes everything for delivery

4)Prostaglandin (PG)- labor, preechlampsia, surfactant?

5)Progesterone-the hormone decreases tone-keeps everything quiet
-main source throughout pregnancy is the placenta
-prepares the endometrium for the reception and develpment of the fertilized ovum. Increses supply of glycogen to arterial blood.
-Causes cervical mucus to become scanty, thick-tacky and sticky once again-no longer reeptive to sper.
-Brings about increased uterine growth and causes the cervix to secrete thick mucus to seal off the uterin cavity.
-Inhibits the activity or contractility-or a quiting of the uterine muscle(keeps uterus quit).
-Stimulates development of lobules and alveoli in the maternal breast.
-Effects maternal metabolism. Pregnant mother feels very tired in early pregnancy.
-Causes a reduction or relaxtion of vascular tone in blood vessels so that with increase blood volume there is no concurrent rise in blood pressure.
-Inceases skin pigmentation-linea nigra, chloasma
-Decreases gastric mobility which can lead to constipation
-Reduces bladder tone which can result in urinary retention that can lead to urinary tract infection
-Reduces tone of gall bladder-gall stones
-Increases aldosterone secetion which can result in retention of water and electrolytes

6)Estrogen-increases tone
-principal source is the placenta
-Enhances the growth and matuation of the graafian follicle
-Builds up the endometrium during the ploliferative phase of the menstrual cycle
-Causes cervical mucus to become very copious, thin, watery, alkaline and clear before ovulation occurs
-Increases the size of the duct system in the breast during pregnancy as ell as the size of the nipple and areola
-Increases skin and muzcle elasticity and bone strength during pregnancy
-Stimulates te amount of uterine muscle fibers and its contractility as well as increase in blood supply
-Causes increased pigmentaion in the skin
during prenancy
-Rising Estriol levels (by product) of estrogen indicate fetal well being. There is an interplay between the fetal adrenals, fetal liver and the placenta-assess fetoplacental function.
-Causes body to retain glycogen, amino acids and electrolytes
-90% of estrogen is excreted in maternal urine as astriol
-May stimulate prostaglandin Production (labor)-abortion

Front 17

ID physiological changes in the Neurologic system and give SELF CARE measures

Back 17

Neurologic
1)Carpal tunnel syndrome-Pain or numbness that affects some part of the median nerve distribution of the hand. Pt. may have a history of cumulative trauma to the wrist, for example, in carpenters, rowers, typists, computer users, or those who regularly use vibrating tools or machinery. In addition, the condition may occur after wrist fracture, in pregnancy, or as a consequence of systemic or meabolic disorders such as diabetes mellitus, hypothyrodidsm, acromegaly, and amyloidosis