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Maternal-Newborn > Chapter 4 > Flashcards

Chapter 4 Flashcards

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1
Q

Antepartum Period

A

Prenatal period begins with conception and ends with the onset of labor

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2
Q

Focus of Antepartum Nursing Care

A

-Regular assessment of the health of the pregnancy-Regular assessment and screening of risk factors for potential complications-Implementation of appropriate interventions based on risk status or actual complications-Inclusion of significant others/family in care and education to promote pregnancy adaptation-Education on health promotion and disease prevention

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3
Q

Preconception Care

A

Interventions that aim to identify medical, behavioral, and social risks to a woman’s health or pregnancy outcomes through prevention and management

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4
Q

Two components of Preconception Health Care Visit

A
  1. Physical examination2. Lab and diagnostic tests
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5
Q

Preconception physical exam includes:

A
  1. Comprehensive physical exam2. Breast exam3. Pelvic exam
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6
Q

Preconception lab & diagnostic tests

A

Pap smear, blood type and Rh factor, blood count, serum cholesterol, serum glucose, urinalysis, HIV, Syphilis, STD cultures

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7
Q

Anticipatory Guidance

A

Information and guidance to women and their families that enables them to be knowledgeable and prepared as the process of pregnancy and childbirth unfold.

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8
Q

Anticipatory guidance and teaching include:

A

-Nutrition-Prenatal vitamins-Exercise-Self-care-Contraception cessation-Timing of conception-Modifying behavior to reduce risk

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9
Q

Maternal obesity associated with:

A

Increased perinatal morbidity and mortality

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10
Q

Folic acid supplementation:

A

Decreases risk of neural tube defects

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11
Q

Calcium, magnesium and Vitamin D

A

Contribute to bone health and osteoporosis prevention

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12
Q

Iron Supplementation

A

Treat iron deficit anemia

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13
Q

Contraception Cessation

A

-Have two to three normal menstrual periods-Have IUD removed-Stop hormonal contraception

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14
Q

Nursing Actions in Preconception Care

A

-Provide comfort and privacy-Use therapeutic communication techniques-Obtain health history-Conduct review of systems-Assist with physical and pelvic exams-Assist with obtaining specimens-Provide teaching about procedures-{rovide antepartum guidance related to plan of care and appropriate follow up-Assess patient understanding-Provide education, recommendations, and referrals to help woman make appropriate behavioral, lifestyle, or medical changes based on history or physical exam

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15
Q

Presumptive signs of pregnancy

A

Include all subjective signs of pregnancy (i.e. physiological changes perceived by the woman herself

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16
Q

Presumptive signs of pregnancy are:

A

-Nausea or vomiting at weeks 2 to 12-Breast changes at 2-3 weeks-Fatigue-Frequent urination-Quickening (awareness of fetal movement) 18 weeks

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17
Q

Amenorrhea

A

Absence of menstruation

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18
Q

Quickening

A

A woman’s first awareness of fetal movement occurs around 18 weeks gestation -early as 16 weeks late as 22 weeks

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19
Q

Probable signs of Pregnancy

A

Are objective signs of pregnancy and include all physiological and anatomical changes that can be perceived by the health care provider.

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20
Q

Probable signs of pregnancy include

A

-Chadwick’s sign-Goodell’s sign-Hegar’s sign-Uterine / abdominal growth-Melasma-Linea Nigra-Ballottement-Positive pregnancy test results

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21
Q

Chadwick’s sign

A

Bluish-purple coloration of the vaginal mucosa, cervix, and vulva seen at 6-8 weeks

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22
Q

Goodell’s sign

A

Softening of the cervix and vagina with increased leukorrheal discharge, palpated at 8 weeks

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23
Q

Hegar’s sign

A

Softening of the lower uterine segment palpated at 6 weeks

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24
Q

Melasma (cholasma)

A

Mask of pregnancy; brownish pigmentation over the forehead, temples, cheek, and/or upper lip.

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25
Linea Negra
Dark line that runs from the umbilicus to the pubis.
26
Ballottement
Tap of the examining finger on the cervix causes fetus to rise in the amniotic fluid and then rebound to its original position, occurring between 16-18 weeks.
27
Pregnancy test looks for
hCG (human chorionic gonadotropin)
28
Positive signs of pregnancy
Objective signs of pregnancy that can only be attributed to the fetus.
29
Positive signs of pregnancy include:
-Auscultated fetal heartbeat at 10-12 weeks- Palpation of fetal movement- Sonographic visualization of fetus cardiac movement at 4-8 weeks- Gestational sac seen on sonogram at 6-7 weeks
30
Estimated Due Date (EDD)
Best estimation of when full term infant will be born
31
Naegele's Rule
Formula for determining estimated due date EDD - First day of last menstrual period LMP minus 3 months plus 7 days (LMP-3 months + 7 days)
32
Term Gestation
5 weeks from 37-42 weeks of gestation
33
Trimesters
Pregnancy divided into 3 month segments
34
First trimester
First day of last menstrual period LMP through 12 completed weeks of pregnancy
35
Second Trimester
13 weeks to 27 completed weeks of pregnancy
36
Third Trimester
28 to 40 completed weeks of pregnancy
37
Fundus
Upper portion of uterus
38
Isthmus
Lower portion of uterus
39
Cervix
The lower part or neck; the external part of the cervix that interfaces with the vagina
40
Uterus size before pregnancy
Small pear approximately 3 inches x 2 inches x 1 inch in dimension
41
Uterus size mid-pregnancy
Fundus reaches level of umbilicus in the abdomen.
42
Uterus size end of pregnancy
Fills abdominal cavity, alters placement of lungs, rib cage, and abdominal organs.
43
Leukorrhea
Vaginal discharge (whitish)
44
Endometrium
Uterine lining
45
Corpus luteum in pregnancy
Produces progesterone and some estrogen to maintain endometrium
46
Hypervolemia of Pregnancy
Blood volume increases by 1,500 mL or an increase of 40-50%
47
Changes to heart in pregnancy
-Shifts upward and laterally-Enlarges slightly-Cardiac output increases 30-50%-Heart rate 20% increase to 15-20 beats / min
48
Changes to RBC in pregnancy
-RBC count increases 30%-RBC volume increases 17-33%
49
Physiological anemia of pregnancy
Due to hemodilution. The increase in plasma volume is larger than the increase in RBCs and results in reduced hemoglobin to hematocrit values. Also called pseudoanemia of pregnancy
50
Iron deficiency anemia
Hemoglobin less than 11.0 g/dL and hematocrit less than 33%
51
Changes to WBC in pregnancy
Increases up to 15,000 in the absence of infection.
52
Hypercoagulation occurs during pregnancy to:
-Decreased risk of postpartum hemorrhage. This change puts patient at risk for thrombosis.-Plasma fibrin increases 40%-Fibrinogen increases 50%-Coagulation inhibiting factors decrease
53
Respiratory changes in pregnancy
-Pulmonary function not compromised in normal pregnancy-Tidal volume increases-Slight respiratory alkalosis-Diaphragm displaced upward-Shift from abdominal to thoracic breathing
54
Renal system changes in pregnancy
-Renal plasma flow increases-Glomerular filtration rate GFR increases-Renal tubular reabsorption increases-Shift in fluid / electrolyte balance
55
Supine and upright maternal position causes:
Blood to pool in lower body; decrease in cardiac output, GFR and urine output, causing excess sodium and fluid retention
56
Supine hypotensive syndrome
Results from lying on back in mid to late pregnancy and compressing the vena cava. causes drop in cardiac output and drop in blood pressure. Patient feels dizzy and faint.
57
Left Lateral recumbent maternal position will:
-Maximize cardiac output, renal plasma volume and urine output-Stabilize fluid and electrolyte balance-Minimize dependent edema-Maintain optimal blood pressure
58
Gastrointestinal changes of pregnancy
-Relaxation of GI tract causes heartburn and constipation-Progesterone relaxes smooth muscle of gallbladder and can cause gallstones and slow emptying of bile-Cholestasis is bile backing up into bloodstream-Pruritus (itching) is a sign of gallbladder cholestasis-Bleeding gums and periodontal disease-Ptyalism is an increase in saliva
59
Musculoskeletal changes in pregnancy
-Shift in the center of gravity forward-Altered gait "pregnant waddle" progesterone and relaxin soften joints and increase joint mobility-Joint discomfort progesterone and relaxin soften cartilage and connective tissue cause joint instability-Round ligament spasm due to increased elasticity and abdominal distension can cause spasm and pain-Lordosis -Diastasis recti-HIGH RISK FOR FALLS
60
Lordosis
Abnormal anterior curvature of the lumbar spine
61
Diastasis Recti
Benign separation of rectus abdominis in third trimester due to abdominal distention
62
Integumentary changes in pregnancy
-Linea negra-Melasma-Striae (stretch marks)-Hot flashes and facial flushing-Oily skin and acne-Sweating
63
Placenta produces hormones
- Estrogen- Progesterone- Relaxin- Human placental lactogen (hPL)
64
Prenatal period
Entire period during which woman is pregnant through the birth of the baby
65
Prenatal care
Healthcare related to pregnancy
66
Family centered maternity care
Based on model of obstetric care based on view that pregnancy and childbirth as a normal life event, a life transition that is not primarily medical but rather developmental
67
Standard number of prenatal visits
14 to 16 prenatal visits for low risk pregnancy in US
68
Goals of Prenatal Care
-maintain maternal fetal health-accurate determination of gestation age-assess risk status -implement risk intervention-build rapport with family-refer to appropriate resources
69
G/P
Two digit system to denote pregnancy and births
70
Gravida
Number of times a woman has been pregnant including current pregnancy without regard for how it ended.
71
Para
Any birth after 20 weeks gestation whether live birth or not. Does not count number of fetuses.
72
Pregnancy ending before 20 weeks is
Abortion either (spontaneous) for miscarriage or (induced) for elective or therapeutic
73
GTPAL comprehensive obstetric history
T= number of term infants born after 37 weeksP=preterm between 20-37 weeks gestationA= number of abortions either induced or spontaneous before 20 weeksL=number of children currently living
74
Nulligravida
Has never been pregnant or given birth
75
Primigravida
Woman pregnant for the first time
76
Multigravida
Woman pregnant for at least the second time
77
Prenatal care facts
- 84% of women receive prenatal care in first trimester- 4% receive late or no prenatal care
78
Fetal Heart Rate FHR can be heard...
by Doppler between 10-12 weeks
79
Normal fetal heart rate/baseline FHR
110 bpm up to 160 bpm
80
End of First Trimester fetus is:
- 3 inches in length- 1-2 ounces- All organs present- Head is large- Heartbeat audible with Doppler
81
First Trimester Danger Signs
-Abdominal cramping or pain-Vaginal spotting or bleeding-Absence of fetal heart tone-Fever or chills-Dysuria-Prolonged nausea or vomiting
82
Hyperemesis Gravidarum
Prolonged nausea or vomiting-dehydration risk
83
Fetus weight gain 2nd trimester
0.5 - 1 pound per week
84
Gestational Diabetes Screening
1 hour glucose challenge test between 24-28 weeks gestation
85
Preterm Labor (PTL) signs
- Low backache- Pelvic pressure- Lacking amniotic fluid- Rhythmic lower abdominal cramping or pain- increased vaginal discharge- Vaginal spotting or bleeding
86
Hypertensive signs
- Severe headache that does not respond to normal relief measures- Visual changes- Facial or generalized edema
87
Second Trimester Danger Signs
- Abdominal or pelvic pain- No fetal movement after feeling daily- Prolonged nausea or vomiting- Dysuria- Vaginal bleeding
88
Kick Count
Four in 1 hour or 10 in two hours is reassuring.
89
Leopold's Maneuvers
Palpation of abdomen to determine position of fetus in utero
90
Third trimester danger signs
-abdominal or pelvic pain-decreased or absent feral movement-prolonged nausea or vomiting-fever or chills-dysuria-vaginal bleeding-signs of preterm labor-hypertensive signs-absent fetal heart tones
91
The appropriate recommended weight gain during pregnancy for a woman with normal BMI is:
25-35 pounds
92
The purpose of preconception care is
Improve perinatal outcomes
93
Presumptive signs of pregnancy
Physiological changes perceived by the woman herself.
94
Physiological changes in pregnancy
Protective of the woman and/or fetus
95
Intimate partner violence
Crosses all ethnic, racial, religious, and socioeconomic levels
96
RhoGAM would be administered during pregnancy at 28 weeks gestation to women with the following:
Blood type O-
97
Blood volume increases during pregnancy by
1500 ML
98
A woman presents for prenatal care at 10 weeks gestation reporting nausea and vomiting. Self-care and relief measures include:
Small and frequent meals.

Maternal-Newborn (2 decks)

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