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NURS509 - Maternity > Care of the Pregnant Patient > Flashcards

Care of the Pregnant Patient Flashcards

1
Q

1st Trimester

A

1-13 weeks

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2
Q

2nd Trimester

A

14-26 weeks

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3
Q

3rd Trimester

A

27-42 weeks

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4
Q

Length of average menstrual cycle

A

28 days

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5
Q

How to find day of ovulation

A

take length of cycle and subtract 14 days (If their cycle is 32 days, ovulation occurred on day 18)

**Luteal phase is ALWAYS 14 days (due to life span of the luteum)

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6
Q

Follicular Phase of Menstrual Cycle

A
  • Gets the follicle ready
  • Rise of estrogen due to supporting cells of the follicle
  • Rise in estrogen makes uterine lining thick
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7
Q

Luteal Phase of Menstrual Cycle

A
  • Luteinizing hormone rises during ovulation
  • Early corpus luteum makes huge amounts of progesterone
  • Progesterone maintains uterine environment (endometrial lining)
  • Without progesterone, someone will have withdrawal bleeding
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8
Q

PreEmbryonic stage

A
  • Days 1-14
  • Starts with conception, aka fertilization
  • Formation of a zygote (egg that is fertilized with the sperm) > morula (big ball of cells) > blastocyst (hollow cell filled with fluid)
  • Fertilization occurs in the arm
  • Implantation into endometrium
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9
Q

Embryonic Stage

A
  • Day 15 – 8 weeks
  • Completion of major body organs
  • Where congenital defects occur
  • Embryo is most susceptible to damage from external sources, including teratogens (substances that cause birth defects, such as alcohol and drugs), infections (such as rubella or cytomegalovirus), radiation, and nutritional deficiencies
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10
Q

Placenta

A
  • Derived from trophoblastic cells
  • Interface between mother and fetus
  • Develops by 12 weeks gestation
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11
Q

Umbilical cord

A
  • Connects mother to growing embryo
  • One vein (Coming to the fetus / Oxygenated)
  • Two arteries (Go away from the fetus back to the mom / Deoxygenated with CO2 waste product)
  • Wharton’s jelly protects the cord from compression and prevents the cord from being kinked
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12
Q

Amniotic fluid

A
  • Increases throughout pregnancy
  • ~1 L at term
  • Low amounts can mean a dysfunction of placenta
  • Fetal urine and fluid transport
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13
Q

Functions of Amniotic Fluid

A
  • Maintains body temperature
  • Permits symmetric growth and development
  • Cushions fetus from trauma
  • Prevents compression of umbilical cord
  • Promotes fetal movement
  • Lung formation (Stretches the alveoli)
  • Repository for waste
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14
Q

Function of the Placenta

A
  • Protects fetus from immune attack (Hides the pregnancy from the maternal immune system)
  • Prevents mixing of maternal/fetal blood
  • Exchange of nutrients and waste
  • Hormonal function
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15
Q

hCG

A
  • Preserves the corpus luteum and its progesterone production so that the endometrial lining of the uterus is maintained
  • This is the basis for pregnancy tests
  • Once the placenta is formed, the corpus luteum is not needed
  • Can cause morning sickness (causes you to be in a hypermetabolic state and your GI system doesn’t like that)
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16
Q

Human placental lactogen (hPL)

A
  • Modulates fetal and maternal metabolism, participates in the development of maternal breasts for lactation, and decreases maternal insulin sensitivity to increase its availability for fetal nutrition
  • Causes insulin resistance (makes sure that there is always some glucose available for the fetus)
  • Allows the mobilization of insulin through the placenta
  • Responsible for gestational diabetes
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17
Q

Estrogen (estriol)

A
  • Causes enlargement of a woman’s breasts, uterus, and external genitalia
  • Stimulates myometrial contractility
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18
Q

Progesterone (progestin)

A
  • Maintains the endometrium, decreases the contractility of the uterus, stimulates maternal metabolism and breast development, provides nourishment for the early conceptus
  • Without progesterone, there can be no pregnancy
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19
Q

Relaxin

A
  • Acts synergistically with progesterone to maintain pregnancy, causes relaxation of the pelvic ligaments, softens the cervix in preparation for birth
  • Causes the “wobble” in pregnancy
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20
Q

Fetal Stage

A
  • 8th week until birth
  • Growth and refinement of organ systems
  • Fetal circulation
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21
Q

Ductus venosus

A
  • Shunt because the liver doesn’t need as much blood because it has the mom’s placenta and liver
  • A shunt that allows oxygenated blood in the umbilical vein to bypass the liver and is essential for normal fetal circulation. Blood becomes oxygenated in the placenta and travels to the right atrium via umbilical veins through the ductus venosus, then to the inferior vena cava
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22
Q

Patent formamen ovale

A
  • Shunt because fetal lungs don’t breathe
  • It allows blood to go to the left side of the heart without going to the lungs
  • A hole between the left and right atria (upper chambers) of the heart
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23
Q

Fetal hemoglobin & hematocrit

A

Higher

24
Q

Normal Fetal Heart Rate

A

110-160 bpm

25
Q

Prenatal Care

A
  • Assess maternal and fetal health
  • Identify social, behavioral, environmental, and biomedical risks
  • Reduce risks through identification, educations, and intervention
  • Health promotion
26
Q

Antenatal Care Visit Schedule

A

Monthly until 28 weeks

Every other week from 28 weeks

Weekly from 36 weeks

27
Q

Initial OB Visit

A
  • Reason for seeking care
  • Confirmation of Pregnancy
  • Identification of risk factors
  • Get a full health history (medical, surgical, GYN, career information, social history)
  • Education/Anticipatory guidance
28
Q

Presumptive Indicators of Pregnancy

A

What the patient reports (i.e., late period and tiredness

29
Q

Probable Indicators of Pregnancy

A

What the examiner can appreciate (i.e., pelvic exam shows some physical changes)

Maybe you’re pregnant, maybe you’re not

30
Q

Positive Indicators of Pregnancy

A

Fetal only (i.e., ultrasound shows a fetus)

31
Q

Nägele’s Rule

A
  • Used to estimate date of delivery
  • Add 7 days to 1st day of last menstrual period
  • Subtract 3 months or add 9 months
  • Use actual # of days in month when crossing over to another month
32
Q

Gravidity

A
  • How many times have you been pregnant (including this one)
  • First = G1
  • Tenth = G10
33
Q

Parity - Term

A

37 weeks 0 days and above (37 0/7 and above)

34
Q

Parity - Preterm

A

20 weeks 0 days to 36 weeks 6 days (20 0/7 – 36 6/7)

35
Q

Parity - Abortion

A
  • Any pregnancy that ends before 20 weeks regardless of how it ended
  • SAB = spontaneous abortion (miscarriage)
  • EAB = elective abortion
  • TAB = therapeutic abortion
  • Also includes ectopic pregnancy (occurs outside the uterine cavity)
36
Q

Parity - Living

A

All the live births

37
Q

A client presents for care. This is their first pregnancy. G__P__

A

G1 P0
Prima gravida

38
Q

The client delivers a male newborn at 41 weeks gestation. G__P__

A

G1 P1001

39
Q

Client presents for care in the next pregnancy at 10 weeks gestation. G__P__

A

G2 P1001

40
Q

Client delivers a male newborn at 38 weeks gestation. G__P__

A

G2 P2002

41
Q

Client delivers a male newborn at 38 weeks gestation. Next pregnancy, client presents for care at 9 weeks with cramping and vaginal bleeding, and subsequent pregnancy loss at 10 weeks. G__P__

A

G3 P2012

42
Q

Client delivers a male newborn at 38 weeks gestation. Next pregnancy, client presents for care at 9 weeks with cramping and vaginal bleeding, and subsequent pregnancy loss at 10 weeks. The client is now pregnant again with twins. G__P__

A

G4 P2012

43
Q

Client delivers a male newborn at 38 weeks gestation. Next pregnancy, client presents for care at 9 weeks with cramping and vaginal bleeding, and subsequent pregnancy loss at 10 weeks. The client is now pregnant again with twins. The twins are delivered by cesarean section at 34 weeks. G__P__

A

G4 P2114
If one came out, had a severe heart defect and died: G4 P2113

44
Q

Nutrition in Pregnancy: Calories

A

Additional 300 calories per day in the second and third trimester

45
Q

Nutrition in Pregnancy: Folic Acid

A

400 to 800 mcg/day
Should be given pre-conception
Important for the neural tube

46
Q

Nutrition in Pregnancy: Iron

A

27 g/d

47
Q

Nutrition in Pregnancy: Protein

A

80g/d

48
Q

Total Weight Gain Range (lbs) in Normal pregnancy BMI

A

25-35

49
Q

Rates of Weight Gain in 2nd and 3rd Trimester (Mean range in lbs/week)

A

1 (0.8-1)

50
Q

Food concerns in pregnancy

A
  • Artificial Sweetener (can have in moderation)
  • Seafood (can have in moderation because it has Mercury but it also has healthy fats)
  • Listeriosis
51
Q

First Trimester Prenatal Labs

A
  • ABO/Rh, RBC antibody screen
  • CBC
  • Syphilis (RPR/VDRL)
  • Hepatitis B/C
  • Rubella
  • Varicella
  • HIV
  • STIs
  • Urine (Culture, UA)
  • Aneuploidy
52
Q

Second Trimester Prenatal Labs

A
  • Maternal Serum AFP
  • Gestational diabetes screen
  • Repeat CBC, Ab Screen, HIV/RPR
  • STIs
53
Q

Third Trimester Prenatal Labs

A
  • Group beta strep
  • STIs
  • HIV/RPR
54
Q

Optional Prenatal Labs

A
  • Pap smear
  • Hg Electrophoresis, CF, SMA, Fragile X
  • Carrier screen
  • Thyroid
  • A1C
  • Lead
55
Q

Aneuploidy screening

A
  • Abnormal number of (entire) chromosomes
  • Screen ALL pregnant persons to identify those at high risk every pregnancy
  • Down syndrome (1/800)
  • Trisomy 18 (1/3-5000)
  • Trisomy 13 (1/8000)
56
Q

Rh D Immunoglobulin

A

Administered at 24-28 weeks antepartum to any patient Rh negative, within 72 hours postpartum if neonate is Rh positive, or if antenatal vaginal bleeding (trauma) to non-sensitized Rh-negative clients

NURS509 - Maternity (3 decks)

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