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NUR 220 > Antepartum > Flashcards

Antepartum Flashcards

1
Q
A
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2
Q

what is antepartum

A

before delivery

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3
Q

diagnosis of pregnancy

A

Presumptive- subjective: how pt is feeling “i missed my period”
* Probable
– Chadwick: blue discoloration of cervix
– Goodelle: softening of cervix
– Hegar: softening of lower uterine segment
* Positive: diagnostics like us, fetal movement, heartbeat

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4
Q

naegele’s rule

A

LMP (- 3 months + 7 days +
adjust year)
LMP: December 22nd, 2020
Convert December to 12
12 – 3 = 9 (September)
Date/Days: 22 + 7 = 29
Adjust year:
September 29th, 2021

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5
Q

what is primigravida

A

1st pregoo

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6
Q

what is multigravida

A

multiple preggo

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7
Q

what is nulligravida

A

never preggo

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8
Q

what does “para” mean

A

births that occurred after 20 weeks gestation

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9
Q

labs taken initially

A

Blood type ABO and RH
* CBC
* Rubella/ varicella titers
* Venereal Disease Research Laboratory (VDRL) , or rapid plasma (RPR):
screen for syphilis
* Hepatitis B
* HIV
* Papanicolaou test (Pap) screen for cervical cancer
* hCG
* Gonorrhea and Chlamydia cultures
* Transvaginal ultrasound (confirms EDC and/or viability)
* Genetic screening

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10
Q

torch infections

A

Toxoplasmosis
Other (Hepatitis)
Rubella
Cytomegalovirus
Herpes simplex virus

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11
Q

what is chorionic villus sampling

A

assesses placenta
usually done with HIGH risk pregnancies
Can be performed at 10-12 weeks
(advantage to amniocentesis)
*Done with ultrasound
*Cannot determine spina bifida or
anencephaly
Instruct patient to drink plenty
of fluid to fill bladder
Risks: Spontaneous abortion (> amniocentesis); fetal limb
loss; chorioamnionitis; rupture of membranes (ROM)

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12
Q

immunizations recommened during pregnancy

A

Tdap
* Given between 27- 36
weeks gestation
* Administered with each
pregnancy
* Influenza (inactivated)
* Recommended seasonally
during pregnancy
* Hepatitis B
* Based on 1st trimester labs

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13
Q

vaccines contraindicated during pregnancies

A

MMR (attenuated)
* (German) Measles, Mumps and Rubella
* Varicella (attenuated)
* Chickenpox
* Rubeola
* Form of measles

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14
Q

nutrition for pregnancy

A

Caloric need increases in
2nd trimester, then slightly
more in 3rd trimester
* Protein increase essential
for growth
* Increase Fe to help with
RBC supply
Prenatal vitamin with Folic
Acid (Folate):
CRUCIAL! Start before
getting pregnant
Pica
* Non-food eating
* Cultural

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15
Q

weight gain reccomendations

A

Single pregnancy total = 25 – 35 lbs
* Underweight/Overweight variances

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16
Q

exercise recommendations

A

At least 150 minutes of moderate
intensity aerobic exercise/week
* Women who are currently active can
continue their routine

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17
Q

gi symptoms adaptions

A

saliva production increases, gastric emptying delayed,
decreased intestinal motility

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18
Q

cardiovascular systemp adaptionsq

A

50% increase in plasma, 30-50% increase in cardiac output

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19
Q

resp system adaptions

A

enlargement of uterus shift diaphragm higher

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20
Q

urinary system adaptions

A

bladder tone decreases, bladder capacity doubles

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21
Q

musculoskeletal system adaptations

A

pelvis tilts forward, increases curvature of spine,
relaxation of joints

22
Q

integumentary system adaptions

A

hyperpigmentation of skin

23
Q

immune system adaptions

A

enhancement of innate immunity, suppression of adaptive
immunity

24
Q

WARNING SIGNS

A

hreatened AB or placenta previa
~ UTI  pyelonephritis  PTL
Vaginal
Bleeding or
spotting
* ~ infection  PTL
Dysuria,
frequency,
urgency
* ~ lead to dehydration PTL
Fever or chills
* ~ could indicate SAB
Prolonged
nausea and
vomiting
Abdominal
Cramping or
pain

25
Q

second trimester maternal assessment

A

Vital Signs (pay
particular attention to
BP)
* Weight
* Fundal Height

26
Q

fetal assessment 2nd tri

A

Fundal height
* FHR
* Fetal activity

27
Q

maternal labs second tri

A

Quad Screen and Alpha
-Fetoprotein Analysis
* CBC, GTT
* Antibody screening if
Rh negative
* External ultrasound –
anatomy screening,
placental attachment,
amniotic fluid volume
* STI screening if
applicable

28
Q

anticipatory guidance second tri

A

Common
Discomforts
* S/S of PTL
* S/S of HTN
disorder
* General warning
signs

29
Q

normal fetal hr

A

110-160 bpm (ATI)
* 120-160 bpm (Davis)

30
Q

indication for rhogam

A

Give to Rh-negative women at 28
weeks prophylactically
– Also administered to women who had a
pregnancy loss, amniocentesis or
abdominal trauma

31
Q

action of rhogam

A

Prevents production of anti-Rho (D)
antibodies in Rho(D) negative women
exposed to Rho (D) positive blood.
– Prevents hemolytic diseases of the
newborn in future pregnancies of
women who have conceived an Rho (D)
positive fetus.

32
Q

amniocentesis

A

Aspiration of amniotic fluid for analysis. Needle inserted via
abdominal wall
*Performed after 14 weeks
gestation
*Done with ultrasound
*Patient should EMPTY bladder before test (reduces size and prevents puncture)
*Patient must notify MD if experiences: Fever, chills, leaking of fluid, decrease fetal
movement, uterine contractions

33
Q

additional warning signs for second tri

A

decreased fetal movement
increased bp

34
Q

maternal assessment thrid tri

A

Weight
* Vital Signs
* Compare fundal
height with
gestational age
* Fetal movement
* Psychosocial review

35
Q

fetal assessment thrid tri

A

Fetal lie
* Leopold’s
Maneuvers
* Kick Count

36
Q

maternal labs thrid tri

A

GBS culture
* Clotting
factors/Fibrinogen
levels
* STI cultures
(repeating if
necessary)
* Ultrasound as
indicated

37
Q

anticipatory guidance thrid tri

A

Caloric intake
* Review
Discomforts
* Review Warning
signs
* Signs of Labor
* Discuss Feeding
preference
* Discuss
preparedness for
newborn

38
Q

maternal pshyical exam thrid tri

A

Baseline vital signs
– Pelvimetry
Uterine growth is related to fetal
size and gestational age.
Pelvimetry: measuring the
diameters of the pelvis

39
Q

how to do leopolds maneuvers

A

Fetal Assessment: Leopold’s
Maneuvers
Third maneuver:
Presenting part
First maneuver:
Determine part
located in the
fundus
Second maneuver:
Location of back
Fourth maneuver:
Cephalic
prominence

40
Q

fetal assessment kick count

A

indicates fetal wellbeing

41
Q

non stress test thrid tri

A

Non invasive monitoring of FHR
and the FHR response to movement
* Assess for intact fetal CNS in
3rd trimester
* R/o risk of death for high risk
patients
* If Reactive, associated w/ fetal
survival of 1 week
Reactive = good! Means the FHR accelerated two or more times during a 20 – 40 minute period
NonReactive = bad! Means that the FHR did not accelerate over a 40 minute period
*Send patient for CST, BPP

42
Q

contraction stress test 3rd tri

A

Nipple  Oxytocin
Done after a nonreactive non -
stress test (there was no FHR
acceleration with fetal
movement)
Also done if there is decreased
fetal movement, IUGR, post
dates, GDM, GHTN, maternal
chronic HTN, hx of fetal demise,
AMA, sickle cell dz
NEGATIVE = NORMAL – no
decelerations with contractions
POSITIVE = PROBLEMS – decelerations
that denote issues with placenta, cord,
or head compression

43
Q

what is biophysical profile third tri

A

Real time ultrasound;
Visualizes physical and physiological characteristics of
fetus – response to stimuli
Criterion Present (2 points) Absent (o points)
NST (if used) Reactive (positive = good) Nonreactive (negative = bad)
Fetal breathing 1 or more of rhythmic FBM of 30
seconds or more within 30 minutes
Absent FBM
Gross body movements 3 or more trunk movements in 30
minutes
Two of fewer trunk movements
Fetal Tone 1 or more episodes of fetal
extremity extension with return to
flexion, opening closing hand
Extension with return to partial flexion,
absence of flexion
Amniotic Fluid Volume At least 2 pockets of fluid that
measure at least 2 cm in two planes
perpendicular to each other
Does not meet the criteria

44
Q

what is gbs

A

Group B Streptococcus
– naturally occurring bacteria
* Carried in the rectum or vagina
* Life-threatening to newborns
* Administer antibiotics during
labor (Penicillin G)

45
Q

maternal breastfeeding benefits

A

Decreased incidence of breast and ovarian
cancer
* Decreased risk of Type 2 diabetes
* Cost effective
* Bonding
* Promotes gradual weight loss

46
Q

infant breastfeeding benefits

A

decreased childhood and adult obesity
* Decreased risk of type 1 and type 2
diabetes
* Decreased risk of SIDS
* Decreased food allergies
* Bonding
* Immunologic properties help prevent
infections

47
Q

prenatal breast assessment

A

Assess for:
* Flat or inverted nipples
* Abnormal shape
* Past breast/nipple surgeries
* Small, firm nodules
* Tenderness
* Heat

48
Q

postpartum breast assessment

A

First 24 hours - soft and non-tender
* Day 2 - slightly firm and non-tender
* Day 3 - firm, tender and warm to
touch
Assess for:
* Flat or inverted nipples
* Small, firm nodules
* Tenderness
* Heat
* Sore nipples
* Cracked or bleeding nipples

49
Q

breastmilk production

A

3 steps
suckling…stimulates pituitary gland
pituitary gland releases prolactin and oxytocin
these cause synthesis and release of breast milk and contraction of the smooth muscle in the uterus and around the alveoli cells in the breast

50
Q
A

NUR 220 (6 decks)

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