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Flashcards in Antepartal Period Deck (186):
0

How long is the antepartal period

9 calendar months , 40 weeks average

1

How many weeks are each trimester

13 weeks

2

What are signs called that the mother can perceive? What is an example

Presumptive signs. Absence of mensturation is most obvious sign

3

Rebound of unengaged fetus

Ballottement

4

Signs of pregnancy that can be detected by a physical exam by a health care professional. What is an example

Probable signs.
Hegar's sign, Goodells sign, Chadwick's sign

5

Softening and compressibility of lower uterus

Hegar's sign

6

Softening of the cervical tip

Goodell's sign

7

Bluish-purple coloration of vaginal mucosa and cervix

Chadwick's sign

8

What kind of signs are pregnancy test?

Probable sign

9

What are some positive signs of pregnancy

Visualizing fetus by ultrasound, palpating fir fetal movements, and hearing fetal heartbeat

10

Spontaneous, irregular, painless contractions. They are false contractions and usually relieved by walking

Braxton Hicks Contractions

11

Lower portion of the uterus

Isthmus

12

Excessive salivation

Ptyalism

13

Promotion of the health and well being of a woman and her partner before pregnancy

Preconception care

14

The state of being pregnant

Gravid

15

A pregnant woman

Gravida

16

The number of deliveries at 20 week or greater the woman has, regardless whether the newborn was born alive or dead.

Para

17

A thin brownish black pigmented line running from the umbilicus to the symphysis pubis

Linea nigra

18

When can hCG production start? When can it be detected?

Can start as early as the day of implantation and can be detected as early as 7-10 days after conception

19

What can higher levels of hCG indicate?

Multifetal pregnancy, ectopic pregnancy, or a genetic abnormality

20

What can lower levels of hCG indicate?

Miscarriage

21

What you use to look for presence of hCG

Urine or serum test

22

What is Nägele's rule

Take the first day of woman's last menstural cycle, subtract 3 months, and then add 7 days and 1 year, adjusting the year as necessary

23

How do you measure fundal height? What does fundal height tell you?

Measure in centimeters from the symphysis pubis to the top of the uterine fundus (between 18 and 32weeks of gestation). This approximates the gestational age

24

Number of pregnancies

Gravidity

25

A woman who has never been pregnant

Nulligravida

26

A woman in her first pregnancy

Primigravida

27

A woman who has had two or more pregnancies

Multigravida

28

No pregnancy beyond stage of viability

Nullipara

29

Has completed one pregnancy to stage of viability

Primipara

30

Has completed two or more pregnancies to stage of viability

Multipara

31

Stretch marks most notably found on the abdomen and thighs

Striae gravidarum

32

What are reproductive changes that occur in pregnant woman

Uterus increases in size and changes shape and position. Ovulation and menses cease during pregnancy.

33

Cardiovascular changes in pregnant woman

Cardiac output and blood volume increase (45-50% at term) to meet the greater metabolic needs. Heart rate increases during pregnancy.

34

Respiratory changes in pregnant woman

Maternal oxygen needs increase. During the last trimester, the size of the chest may enlarge, allowing for lung expansion , as the uterus pushes upward. Respiratory rate increases and total lung capacity decreases

35

What happens to pelvic joints during pregnancy

They relax

36

What can cause nausea and vomiting during pregnancy?

Hormonal changes and increase in pressure within the abdominal cavity as pregnant clients stomach and intestines are is displaced within the abdomen

37

Why may constipation occur during pregnancy

Increased transit time of food trough the gastrointestinal tract and thus increased water absorption

38

What kind of organ does placenta become? What does it produce?

Becomes an endocrine organ that produces large amounts of hCG, progesterone, estrogen, human placental lactogen, and prostaglandins

39

What does blood pressure do during the second trimester of pregnancy

Decreases 5-10 mm Hg for both diastolic and systolic

40

When should blood pressure return to baseline range after how long

Approximately 20 weeks gestation

41

When does pulse increase during pregnancy

Increases 15-20 around 20 weeks gestation and remains elevated throughout remainder of pregnancy

42

What changes occur with breasts

Increase in size and areolas darken

43

Pigmentation increases on the face

Chloasma

44

What may cause episodes of maternal hypotension

Due to the weight of the uterus on the vena cava, this decreases venous blood flow to the heart

45

When should urine pregnancy test be done

First voided morning specimen to provide most accurate results

46

When can the FHR be heard on Doppler?

10-12 weeks gestation

47

When can FHR be heard with an ultrasound stethoscope?

16-20 weeks gestation

48

Where do you listen to hear FHR

At midline, right above the symphysis pubis, by holding stethoscope firmly on the abdomen

49

When can you measure fundal height

After 12 weeks gestation

50

When can you begin assessing for fetal movement

Between 16-20 weeks gestation

51

What does CBC with differential, Hbg, and Hct detect

Detects infection and anemia

52

How much water should pregnant woman consume

2-3 L of water each day from food and beverage source

53

I'm third trimester how should you instruct mother to count fetal movement/kick counts

2-3 times a day for 60 minutes each time. Fetal movements of less than 3 per hour or movements that cease entirely for 12 hours indicate a need for further evaluation

54

Ptylism

Increased or excessive saliva

55

Least reliable signs of pregnancy

Presumptive signs

56

Why should pregnant women not use saunas

Expose women to bacteria and increase risk of fetal tachycardia and raise the maternal temperature

57

Hormone that inhibits the formation of urine via vasoconstriction

Vasopressin

58

Pregnant women may experience discomfort resulting from variocosities of the rectum that are called _____.

Hemorrhoids

59

What is a oral anticoagulant that is used for the blood clotting and it is a known teratogen?

Warfarin

60

The pituitary gland is also called the _____.

Hypophysis

61

Emptying time of the gallbladder is ______.

Prolonged

62

The pregnant woman may experience ______ is dependent areas

Edema

63

The compulsive ingestion of no food substances is referred to as _______.

Pica

64

__________ is a hormone that contributes to the development of constipation during pregnancy

Progesterone

65

Hormone released by the posterior pituitary gland and is responsible for contractions

Oxytocin

66

What is the complaint that may be caused by a decrease in unconscious swallowing during nausea

Ptyalism

67

Goodells sign is described as _______ of the cervix

Softening

68

What is increased vaginal secretions that occur during pregnancy called

Leukorrhea

69

What position do you use for pelvic exam

Lithotomy

70

A pregnant women who withdraws and becomes increasingly preoccupied with herself and her fetus is experiencing what?

Introversion

71

What hormone is called the "hormone of pregnancy"

Progesterone

72

This hormone is believed to be a contributor in nausea and vomiting

TSH

73

What is a vaccine that is contraindicated during pregnancy

Rubella

74

Leukorrhea helps decrease most infections but what type of infection does it increase?

Fungal infections

75

What is quickening?

When mother feels baby kicking. 16-20 weeks

76

Glycoproteins produced initially by the yolk sac and the fetal gut, and later predominately by the fetal liver

Alpha-fetoprotein

77

Involves transabdominal puncture of the amniotic sac to obtain a sample of amniotic fluid for analysis

Amniocentesis

78

What is a procedure obtaining a sample of the chorionic villi for prenatal evaluation of chromosomal disorders, enzyme deficiencies, and fetal gender determination and to sex linked disorders

Chronic villus sampling (CVS)

79

What uses a real-time ultrasound to allow assessment of various parameters of fetal well-being

Biophysical profile (BPP)

80

A birth without pain reliving medications

Natural birth

81

What are 6 presumptive signs of pregnancy

Amenorrhea, N/V, exercise fatigue, urinary frequency, changes in breasts, quickening

82

What should you tell a woman who is complaining of nausea?

Keep dry crackers by bed and eat before getting up, watch spicy foods, eat small amounts, and get up slowly

83

Is there a increase or decrease vascularization with cervical changes

Increase vascularization

84

What is McDonalds sign?

Ease flexing of uterus. It is moving cervix easily and then there is easily flexion of uterus

85

What is Von Braun-Fernwald's sign

clinical sign in which there is an irregular softening and enlargement of the uterine fundus during early pregnancy.

86

What are 4 probable signs of pregnancy

Cervical changes with increased vascularization, enlargement of abdomen, Braxton-Hicks Contractions , positive pregnancy test

87

What are 3 positive signs of pregnancy

Fetal heartbeat, Leopolds Maneuvers where fetal movement is palpated by caregiver, Ultrasound

88

What does a positive pregnancy test detect?

hCG

89

What does a cervix look like in a healthy woman? What about when she gets pregnant?

In healthy woman cervix looks nice and pink and during pregnancy it turns a bluish, purple

90

When can you visualize fetal parts/movement with ultrasound? When can you see gestational sac?

Fetal parts/movement @ 8 weeks
Gestational sac @ 4-5 weeks

91

What does enlargement of uterus deal primarily with early? What about after that?

Early it deals with myometrial hyperplasia (cells developed) and then hypertrophy ( cells getting bigger)

92

Does the isthmus hypertrophy?

No!

93

What are two concerns with enlarged uterus

Vena cava syndrome and supine hypotension

94

When the uterus pushes against the diaphragm what can this cause

Shortness of breath

95

What is lightening? What happens?

Uterus grows out and then sinks down into pelvic area. Breathes faster and frequency of urination.

96

What four things happen with the stretching and growth of the uterus

1. Increased circulatory requirements (80-90% blood flow to placenta)
2. Diameter of main uterine article doubles
3. Increase size and number of blood and lymphatic vessels
4. Uterus in pelvic cavity for first 3 months

97

Spontaneous, irregular, intermittent contractions; begins early in pregnancy then, throughout pregnancy

Braxton-Hicks Contractions

98

What is a mucous plug

Thick, tenacious mucus that seals the endocervical canal

99

When is the mucus plug expelled

When cervical dilation begins

100

What is white, cheesy patches in mouth of newborn

Thrush

101

What does estrogen influence with vagina

Hypertrophy and vascularization

102

How early can colostrum be expressed

Early as 12 weeks , it's the first secretion

103

What is a medication that is given to Rh negative woman at 28 weeks gestation and within 72 hours of delivery

Rhogam

104

Stretch marks that may occur with growth and connective tissue changes

Striae

105

How does corpus luteum develop

From a ruptured follicle
Corpus luteum- ova becomes fertilized by sperm and creates

106

Corpus luteum is maintained with ______. If egg is fertilized to produce _______ regress approx 6-7 weeks and _______ takes over to produce progesterone

Corpus luteum is maintained with hCG. If egg is fertilized to produce progesterone regress approx 6-7 weeks and placenta takes over to produce progesterone

107

What do progesterone and estrogen influence with mouth

Gingivitis and soft, hyperemic gum tissue=bleeding

108

Reflux of acidic secretions

Pyrosis (heartburn)

109

How much increased blood volume is there by 30 weeks?

Over 50% pre-pregnancy level

110

There is a increased plasma and erythrocytes so what does the woman need?

Iron

111

Cardiac output increases ____-_____% over pregnancy levels and peaks around _____ weeks

Increases 30-50% and peaks around 32 weeks

112

Does the pulse increase or decrease?

Increases. 10-15 BPM by 14-20 wks

113

What does blood pressure do during pregnancy?

Decreases. It is lowest at mid pregnancy and then increases to pregnant level until term

114

What can you tell a woman to do who has dependent edema and varicose vein formation?

Support hose, put feet up often, check diet for amount of sodium she is having

115

Reduced blood pressure that can occur in women who lie down on their back which causes the uterus to compress the vena cava

Supine hypotensive syndrome

116

What does increased fibrin and plasma fibrinogen cause during pregnancy

Hypercoagulable state

117

What is physiological anemia of pregnancy? Why does it occur?

Blood volume increases and the woman's RBC increases a little but not as much and blood volume which makes it look like woman has anemia. Usually you don't have to treat, but you encourage her to take a prenatal vitamin

118

Breathing changes from abdominal to ________

Thoracic (diaphragmatic) - deep;faster

119

Tidal volume / volume of inhaled air increases which causes what? What actions should you take?

Hyperventilation. Sit her down and slow her breathing down

120

Estrogen induced edema and vascular congestion of nasal mucosa puts woman at risk for? Nursing implications?

Epitaxis (nosebleeds)
Lean forward, pressure on nose, ice pack

121

Melasma of chloasma on forehead and cheeks. What is this called?

Mask of pregnancy

122

What is skin pigmentation affected by?

Estrogen, progesterone, and melanocyte-stimulating hormones

123

What are vulvular changes

It looks darker

124

What is vascular spider nevi

Veins that look broken down on dependent areas or abdomen

125

What are the changes in the musculoskeletal system influenced by

Relaxin, progesterone, fetal growth, and maternal weight

126

What does relaxation of pelvic joints cause

Waddling

127

What can softening and stretching of ligaments in pelvis cause?

Round ligament pain. Pain in the lower abdomen and legs. Get woman off her feet, use support hose

128

What postural changes occur?

Increased swayback
Center of gravity changes ( increased lordosis)

129

What is diastasis recti

Abdominal muscle separating, can happen late in pregnancy and post partum

130

What are important teaching points for woman with diastasis recti

Need to tone after, post partal exercises, help her learn to push if happens before baby is born

131

What is the process of an accurate fundal height measurement

Use non stretch tape and measure distance from top of pubic bone to top of uterus (aka fundus)

132

Usually if you get a fundal height measurement of 20 cm you can assume the gestational age is 20 weeks. When would this not apply

After 36 weeks due to lightening

For twins, too much fluid, or tumors

133

Facilitates lactogenesis

Prolactin

134

Stimulates cell hormone

GH

135

Stimulates uterine contractions; milk ejection

Oxytocin

136

FSH and LH are inhibited by ____

hCG

137

TSH is ______ in the 1st trimester

Reduced

138

Stimulating hormone that increases pigmentation

Melanocyte

139

Inhibits urine production and increases BP

ADH (vasopressin)

140

How does pancreas work to produce insulin?

Works on supply-demand mode. Maternal insulin does not cross the placenta

141

The realization of a pregnancy can lead to fluctuating responses, possibly at the opposite ends of the spectrum

Ambivalence

142

Focusing on ones self, this is common during the early part of pregnancy

Introversion

143

Emotional lability is characteristic throughout most pregnancies

Mood swings

144

What food should women avoid in pregnancy?

Fish with moderate to high mercury level
Foods that risk getting listeriosis
Cold hot dogs or lunch meat
Soft cheeses

145

How much folic acid is needed during pregnancy

800 mcg/day

146

How much ferrous iron is needed during pregnancy

30 mg/day

147

How many more calories do woman need during pregnancy

300

148

What is normal weight gain during pregnancy

25-35 pounds

149

What could lack of folic acid lead to

Neural tube defects

150

An ultrasound is the most common

Diagnostic test

151

What can an ultrasound detect

Confirm pregnancy
Assess for congenital abnormalities
Assess fetal size and growth
Assess for placental location

152

There are five different measurements for fetal growth, what are they

Crown-rump length
Biparietal diameter (BPD)
Femur length
Abdominal measurement
Head/abdominal ratio

153

BPD is the most common measurement for fetal growth, what is this

The diameter of the head between the two parietal eminences

154

What makes up the 5 fetal biophysical variables

Fetal movement
Fetal tone
Fetal breathing
Amniotic fluid volume
NST normal

155

What is the normal fetal heart rate measurment

110-160

156

Nuchal translucency screening is what

An ultrasound to assess for nuchal translucency (looking at chromosomes) due to subcutaneous fluid accumulation behind fetal neck

157

When does the pregnant women usually think she feels quickening

16-20 weeks

158

What are the two things that are considered feeling quickening

10 movements per hour

Left lateral position, after a meal, 4 movements in an hour

159

How should a women count her movements she feels per hour

At same time
Count until you feel 10
Record them

160

What is a non stress test

Indirect measurement of uteroplacental function by trained personnel

161

Amniocentesis

Transabdominal puncture of amniotic sac for amniotic fluid after ultrasound

162

If amniocentesis is done between 11-14 weeks what are they looking for

Abdominal and fluid leakage

Detect generic abnormality

163

Amniocentesis done between 15-20 weeks

Most common time

Chromosomal and biochemical determination

164

Amniocentesis during 3rd trimester

Assess lung maturity

165

Chronic villus sampling

Obtain sample of chronic villus for PN elevation disorders

Chromosomal, enzyme or sex linked, fetal gender

166

Percutaneous umbilical blood sampling (PUBS)

Allows rapid chromosomal analysis test

167

When would you do a PUBS

Coagulation study
Blood typing
CBC
Blood disorders
Women at risk for genetic abnormalities

168

Risks with PUBS

Bleeding puncture site
Cord laceration
Hematomas
Thromboembolism
Infection
Labor

169

What intervals should a pregnant women be seen

Every 4 weeks up to 28 weeks
Every 2 weeks from 29-36 weeks
Every week from 37 weeks to birth

170

Is exercise or working allowed during pregnancy

Yes, both are fine. The mother should not do more than she can handle

171

What can a women do to lessen the chance of nausea upon awakening

Eat dry crackers before getting out of bed and get up slowly

172

When it comes to washing the breast, what teaching points should you give a mother

Wash with warm water and do not use soap. Soap will dry out the nipple

173

What is increased thyroid hormone critical for?

Fetal brain and neurological growth

174

What changes happen with thyroid

Increased size and activity

175

What does a Doppler flow study show

Movement of red blood cells in vessels

176

What is alpha-fetoprotein analysis

Glycoprotein-form yolk sac and fetal gut; later fetal liver

177

What are biomarker screening tests for all pregnant women with AFP at different weeks for

10-14 weeks- amino fluid
12-14 weeks- maternal serum
16-18 weeks- optimal time to assess

178

What could AFP readings be influenced by

Number of fetuses
Gestational age
Low maternal weight
Race

179

Elevated levels of AFP usually are linked to

Neural tube defects

180

What are we worried about if we see nuchal translucency on an ultrasound

Trisomy 21,18,31
Skeletal issues
Cardiac issues
Neurological issues

181

What do we want to see when performing a non stress test

At least 2 fetal movements with increased fetal heart rate 15 bpm greater than normal for at least 15 seconds over a20 minutes period

182

Contraction stress test

Not preformed often

Mother given small dose of oxytocin

183

What do we want to see with a contraction stress test

Uterine contractions in 10 minutes without fetal heart rate decelerations

NEGATIVE TEST IS GOOD

184

Lecithin/ sphingomyelin deals with lung maturity. What must the ratio be with these to have mature lungs

2:1
2 lecithin to 1 sphingomyelin

185

Source of amniotic fluid

Fetal urine