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38 Cards in this Set
- Front
- Back
3 trimesters
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1st trimester: weeks 1-12
2nd trimester: weeks 13-27 3rd trimester: weeks 28-42 |
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Naegles rule
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1ST DAY OF LAST MENSTRUAL PERIOD MINUS 3 MONTHS AND THEN ADD 7 DAYS and ONE YEAR WILL GIVE YOU THE
ESTIMATED DATE OF DELIVERY (EDD) |
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Gravida
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# of pregnancies
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Para
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# of pregnancies that end after 20 weeks
(regardless of alive or still birth) |
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Frequency of Antenatal Visits
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Every 4 weeks for the first 28-32 weeks of
gestation Every 2 weeks until 32-36 weeks gestation After 36 weeks, every week until childbirth |
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Nursing Care - First Trimester
Education for Self care |
exercise- 30 minutes (abdominal, perineal, inner thigh)
sexuaity- no limit Diet-decrease caffeine, increase fluids Sleep-do not sleep flat on back. |
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Nursing Care - First Trimester
Education for Self care (cont) |
Safety - correct seat belt, proper body mechanics.
Smoking give until week 20 to stop. Drugs, ETOH, abuse |
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Discomforts during first trimester
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-Nausea and vomiting
Eat dry crackers before getting out of bed Small frequent meals Drink carbonated beverages Need to stay hydrated -Increased vaginal discharge Proper hygiene Cotton underpants |
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Nursing Care During the 2nd
Trimester |
-Assess for risk factors
-Fundal ht - used to indicate uterine size and correlates well with gestation 22-34 -Quickening - mothers perception of fetal movement 18-20 weeks |
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Nursing Care During the 3rd
Trimester |
-Assess for risk factors
-Fetal well being Fetal movement NST -Prepare for breast feeding Breast shells -Signs of preterm labor Braxton Hicks -Signs of labor |
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Nutrition During Pregnancy
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„ Requires 340/462 kcal/day above
usual intake during the 2nd and 3rd trimester, respectively „ Underweight or has a physically strenuous lifestyle may require more Kcal/day. „ Inadequate weight gain can cause Intrauterine Growth Restriction (IUGR) |
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Causes of Excessive Weight Gain
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multiple gestation
PIH - associated with edema Overeating |
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Problems Associated with Excessive Weight gain
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-Increased risk of developing PIH and gestational
diabetes - Macrosomia- “Big Baby” |
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Macrosomia- “Big Baby”
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„ 4000 grams or greater
„ Increased rate of c-sections „ Birth trauma Shoulder dystocia Asphyxia at birth „ Intrauterine fetal death „ Infant mortality „ Risk of congenital defects doubles |
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Nutrition - Adolescents
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Need extra calcium/iron
Increase risk of complications during preg/birth support moms growth as well as baby |
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Nutrition - Short stature
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-less than 62 in
-HR for fetal-pelvic disposition (birth trauma/inc. incidence of c-section |
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Nutrition during pregnancy
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-body image crisis
-educate about weight distribution -emphasize benefits of good nutrition vs. # of kcal |
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Fluid needs
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2000 ml/day
avoid caffeine - assoc w/ IUGR r/t vasoconstriction in placenta; acts as diuretic |
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Physiologic anemia
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plasma volume increases more than RBC mass during pregnancy which decreases hgb concentration and hct
-greatest during 2nd trimester -Fe supplements |
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Pica
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assoc with low levels of hgb
cultural |
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HR Pregnancy
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-substance abuse
-STIs - (trichomoniasis, chlamydia, syphilis, herpes, HPV) |
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TORCH
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T-toxoplasmosis
O- Other (gonorrhea, syphilis, varicella, HBV, HIV) R- Rubella C- cytomegalovirus H- Herpes |
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HIV
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AZT during pregnancy, labor and birth. Also given to newborn for 1st 6 weeks.
-c/s reduces transmission to 2% |
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Group Beta Streptococcus (GBS)
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-normal flora of non pregnant
- common cause of neonatal sepsis and meningitis in US -screened at 35-37 weeks -IV Abx prophylaxis (IAP) given who test positive |
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Iron deficiency anemia
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recommended supplementation 60-120 mg/day
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Genetic blood dyscrasias
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pregnancy can worsen sickle cell disease crisis
complications- pylonephritis, strokes, CHF, PIH, leg ulcers, fetal demise due to placental infarcts |
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Heredity anemias
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thalassemia major - low birth wt, fetal distress due to hypoxia, PIH/preeclampsia
thalassemia minor - doesnt respond to Fe therapy, uncomplicated pregnancy |
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Asthma
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-effect on pregnancy unpredictable. Some improve, stay the same or worsen
-goal - prevent attacks, relieve bronchospasm; reduce allergen exposure |
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Cholecystitis
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pressure of uterus interferes w/ normal circulation and drainage of gall bladder
delay surgery |
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choletithiasis (gallstones)
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increase progesterone levels increase cholesterol
reduce dietary fat to 40-50 kcal/day avoid fried foods |
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Appendicitis
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appendix is pushed upward and to the right of its usual location and inc. risk of rupture
Dx is often delayed in pregnancy |
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Maternal heart disease
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-leading cause of maternal death from non-OB sources
-4th leading cause of maternal deaths overall -miscarriage, preterm labor, premature delivery, IUGR, congenital heart disease |
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Cardiovascular changes of pregnancy
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„ Increased intravascular volume
„ Decreased peripheral vascular resistance „ Increases cardiac output If the heart can not tolerate the increased workload than cardiac failure results |
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Peripartum cardiomyopathy
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-development of CHF in last month of pregnancy or within the first 5 PP months
-assoc w/ twin gestation, preeclampsia, Gest. HTN, AA race |
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Signs of cardiac decompensation
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„ Increasing Fatigue even at rest
„ Orthopnea; Increasing dyspnea „ Sensation of smothering „ Moist, Frequent Cough „ Palpitations „ Progressive, Generalized Edema „ Pulse 100 or more, RR 25 or more „ Crackles „ Cyanosis |
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Cardiac Decompensation Nursing mgmt
Antepartum care |
-goal is to maintain cardiac function by minimizing stress on the heart
-prevent fetal hypoxia -Antepartum adequate nutrition rest prevent emotional stress monitor drug therapy vaccinate against flu and pneumococcus |
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Cardiac Decompensation Nursing mgmt
(cont) Intrapartum care |
routine assessment for all laboring women
ekg proper positioning-head and shoulder elevated or side lying -Interventions- con't BP and pulse Ox pain relief (epidura) psycho support monitor drug therapy |
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Cardiac Decompensation Nursing mgmt
(cont) Postpartum care |
essential to monitor
hemorrhage or infection can worsen the condition bedrest stool softeners education on self care |