Presumptive Signs of Pregnancy
◯ Amenorrhea
◯ Fatigue
◯ Nausea and vomiting
◯ Urinary frequency
◯ Breast changes – darkened areolae, enlarged Montgomery’s glands
◯ Quickening – slight fluttering movements of the fetus felt by a woman, usually between 16to20weeks of gestation
◯ Uterine enlargement
Probably signs of Pregnancy
◯ Abdominal enlargement related to changes in uterine size, shape, and position
◯ Hegar’s sign – softening and compressibility of lower uterus
◯ Chadwick’s sign – deepened violet-bluish color of cervix and vaginal mucosa
◯ Goodell’s sign – softening of cervical tip
◯ Ballottement – rebound of unengaged fetus
◯ Braxton Hicks contractions – false contractions; painless, irregular, and usually relieved by walking
◯ Positive pregnancy test
◯ Fetal outline felt by examiner
When does hCG production start?
day of implantation
When can hCG be detected?
7-10 days after conception
When does hCG peak?
60-70 days of gestation
declines around 80 days
gradually increases from there
What can high levels of hCG indicate?
multifetal pregnancy
ectopic preg
hydatidiform mole
Downs Syndrome
What can low levels of hCG indicate?
miscarriage
When do we start taking measurements of fundal height?
~ 18 weeks
GPTAL
Gravidity
Term births (38 wks or more)
Preterm births (viability up to 37 wks)
Abortions / Miscarriages (prior to viability)
Living Children
Cardiac output and volume increase by — during pregnancy.
45-50%
*** heart rate also increases
During first trimester, what to BP measurements look like?
normal range during prepragnancy
During the second trimester, what can happen to BP?
decreases by 5-10 mmHg for both diastole and systolic
After 20 weeks gestation, what happens to BP?
returns to normal prepregnancy baseline
When mother is supine, what could happen to BP?
may appear low due to pressure lying on IVC, decreasing vascular return
Around 20 weeks gestation, what happens to pulse?
increases 10-15 / min
***remains elevated throughout remainder of pregnancy
What happens to Respiratory Rate during pregnancy?
increases by 1-2 / min
***attributed to elevation of diaphragm by as much as 4 cm
***some SOB may be noted
What happens to pregnant mom’s heart sounds?
splitting of S1 and S2 with S3 more easily heard following 20 weeks gestation
murmurs
By 36 weeks, where will the top of the uterus (fundal height) be?
the xiphoid process
— is pigmentation of the face.
Chloasma
— is a dark line from the umbilicus to the pubic area.
Linea nigra
— are stretch marks found on the abdomen and thighs.
Striae gravidarum
1A nurse is caring for a client who is pregnant and states that her last menstrual period was April 1, 2013. Which of the following is the client’s estimated date of delivery?
A. Jan. 8, 2014
B. Jan. 15, 2014
C. Feb. 8, 2014
D. Feb. 15, 2014
A. Jan. 8, 2014
A nurse in a prenatal clinic is caring for a client who is in the first trimester of pregnancy. The client’s health record includes this data: G3 T1 P0 A1 L1. How should the nurse interpret this information? (Select all that apply.)
A. Client has delivered one newborn at term.
B. Client has experienced no preterm labor.
C. Client has been through active labor.
D. Client has had two prior pregnancies.
E. Client has one living child.
A. Client has delivered one newborn at term.
D. Client has had two prior pregnancies.
E. Client has one living child.
A nurse is reviewing the health record of a client who is pregnant. The provider indicated the client exhibits probable signs of pregnancy. Which of the following would be included? (Select all that apply.)
A. Montgomery’s glands B. Goodell’s sign C. Ballottement D. Chadwick’s sign E. Quickening
B. Goodell’s sign
C. Ballottement
D. Chadwick’s sign
A nurse in a prenatal clinic is caring for a client who is pregnant and experiencing episodes of maternal hypotension. The client asks the nurse what causes these episodes. Which of the following is an appropriate response by the nurse?
A. “This is due to an increase in blood volume.”
B. “This is due to pressure from the uterus on the diaphragm.”
C. “This is due to the weight of the uterus on the vena cava.”
D. “This is due to increased cardiac output.”
C. “This is due to the weight of the uterus on the vena cava.”
A nurse in a clinic receives a phone call from a client who believes she is pregnant and would like to be tested in the clinic to confirm her pregnancy. Which of the following information should the nurse provide to the client?
A. “You should wait until 4 weeks after conception to be tested.”
B. “You should be off any medications for 24 hours prior to the test.”
C. “You should be NPO for at least 8 hours prior to the test.”
D. “You should collect urine from the first morning void.”
D. “You should collect urine from the first morning void.”
