Chapters 4 & 6 Flashcards
(156 cards)
1
Q
antepartum period
A
begins with the last day of the LMP and ends with the onset of labor
2
Q
the antepartum period is divided into __
A
first, second, and third trimesters
3
Q
what happens during the initial visit of the first trimester?
A
- comprehensive physical exam
- current pregnancy hx
- pelvic exam
- determine EDD
- nutrition assessment
- psychosocial assessment
4
Q
what happens during the return visits in the first trimester?
A
- focused assessment
- height, weight, urine, vitals, fundal height
5
Q
1st trimester warning signs
A
-prolonged N/V
- cramps
- spotting
- absence of fetal heart tones
- fever/chills
- dysuria, frequency or urgency
6
Q
how often are second trimester visits?
A
every 4 weeks
7
Q
what is assessed during a second trimester visit?
A
- nutrition follow up
- focused assessment
- height, weight, urine (glucose), fundal height, FHR (110-160), fetal movement, leopolds maneuver, edema
- GTT/GCT done at 22-26 weeks
- internal exam if necessary
- RhoGAM given at 28 weeks to all Rh - moms
8
Q
2nd trimester warning signs
A
- abdominal/pelvic pain
- absence of fetal movement
- dysuria, frequency, or urgency
- fever/chills
- prolonged N/V
- vaginal bleeding
9
Q
how often are third trimester visits?
A
every 2 weeks: 28 to 36 weeks, then weekly until 40 weeks
10
Q
what is assessed during a third trimester visit?
A
- focused assessment
- same as before: height, weight, fundal height, urine for glucose, FHR, fetal movement, leopolds meneuver, edema
- internal exam if necessary
11
Q
what does GBS + mean?
A
the woman has group b streptococcus
- 1/4 - 1/3 of women are GBS +
12
Q
why is GBS harmful to the fetus?
A
when the fetus is born, if the mom was GBS+ and not treated, then the newborn can get the infection. GBS infections can cause neurological problems or death
13
Q
when is GBS tested vs treated?
A
vaginal and rectal swabs done at 35-37 weeks
- treated with ampicillin before/during labor because not effective if given too early
14
Q
3rd trimester warning signs
A
- s/sx of hypertensive disorder
- abdominal/pelvic pain
- decreased or absence of fetal movement
- dysuria, frequency, urgency
- fever/chills
- prolonged N/V
- vaginal bleeding
- s/sx of preterm labor
15
Q
when/how is fundal height measured?
A
- after 12 weeks
- measured in cm, cm = weeks
- “0” on symphysis pubis and extend to the top of the fundus (think low to high)
16
Q
what is the fundal height landmark at 12 weeks?
A
symphysis pubis
17
Q
what is the fundal height landmark at 20 weeks?
A
the umbilicus
18
Q
what is the recommended weight gain during pregnancy?
A
- 1-5 lbs in 1st tri
- 25-35 lbs total for normal weight person
- 15-25 for overweight person
19
Q
nutrition recommendations during antepartum period?
A
- eat a variety
- unprocessed food
- limit caffeine to 200 mg/day
- avoid fish high in mercury (sword)
- rinse fruits/veggies
- wash hands
- cook food thoroughly
- discard food left out > 2 hrs
20
Q
preterm labor: warning s/sx
A
- rhythmic lower abdominal cramping
- low backache
- pelvic pressure
- leaking fluids
- increased vaginal discharge
21
Q
hypertensive: warning s/sx
A
- severe headache that doesn’t go away
- visual changes
- facial or general edema
22
Q
what are some common discomforts during antepartum?
A
-fatigue
-emotional lability
-increased vaginal secretions
-supine hypotension
-orthostatic hypotension
- varicosities
- heartburn
- nasal/sinus congestion
- backache
23
Q
what is the difference between supine and orthostatic hypotension?
A
- supine is a drop in BP when laying down on back
- orthostatic is a drop in BP when standing up from a seated or lying position
24
Q
patient education: fatigue
A
- plan rest times
- get help with tasks
25
patient education: emotional lability
- teach that it is normal
- get adequate rest
- support groups
26
patient education: increased vaginal secretions
- panty liners
- daily bathing
- cotton underwear
- notify provider if change in color
27
patient education: supine hypotension
- side-lying position
- rise slowly
28
patient education: orthostatic hypotension
- keep feet moving when standing
- rise slowly
29
patient education: variscosities
- wear support hose
- avoid crossing legs
30
patient education: heartburn
- eat small meals frequently
- raise head of bed
31
patient education: nasal/sinus congestion
- cool air humidifier
- avoid nasal decongestants
- saline is okay to use
32
patient education: backache
pelvic rocking
33
what are the 3 main components of maternal adaptation to pregnancy?
- maturational milestones
- mastery of certain skills
- preparation for childbirth
34
what are some of the maturational milestones mom goes through?
- new level of caring and responsibility
- self-concept changes to prepare for parenthood
- moved from self-contained and independent to being committed to a lifelong concern for another person (their baby)
35
what are some of the skills that mom must master in pregnancy?
- accept the pregnancy
- identify the mother role
- reordering personal relationships between her own mom and her significant other
- establish a relationship with the fetus: mom's attachment process
36
how does dad adapt/accept the pregnancy?
- developmental tasks
- announcement, moratorium, and focusing phases
- identifying the father role
- reordering personal relationships
- establishing a relationship with the fetus
-preparing for birth
37
announcement phase
how the father reacts to the pregnancy will be determine by whether it was planned/unplanned/wanted/unwanted
-joy, distress, combination of emotions
38
moratorium phase
the man may disregard the pregnancy, even though his partner is going through physical and emotional changes
39
focusing phase
- happens in last trimester
- men become involved with pregnancy and relationship with child
40
what are some nursing interventions for education of self-management during antepartum?
- expected maternal/fetal changes
- nutrition
- personal hygiene
- prevention of UTIs
- kegel exercises
- preparation for breastfeeding
- dental health
- physical activity
- alcohol, cigarette smoking, drugs, caffeine
- normal discomforts
- recognize potential complications
- recognizing preterm labor
- psychosocial support
- sexual counseling: hx, counter misinformation, how to be safe and comfortable during sexual activity while pregnant
41
what are the physiological reproductive characteristics/body parts that change during pregnancy?
- breasts
- uterus
- cervix
- vagina
42
breast changes
- increased blood volume- fullness/heaviness/size
- montgomery tubercles
- colostrum
- heightened sensitivity
- tingling
- striae gravidarum
- increased amount of veins visible
- pigmentation of the nipples
43
what are montgomery tubercles?
bumps usually around the areola
44
what is colostrum?
"pre-milk"
- yellow to yellow/orange color
- secretion of colostrum may occur as early as 12 weeks
45
3 parts of the uterus:
-fundus: upper
-lower uterine segment
- cervix: neck (lower, closest to vagina)
46
uterus changes
- size, shape, and position
- thin uterine wall
- fundus at umbilicus by 20 weeks
- uterus fills abdominal cavity by end of pregnancy
- braxton hicks contractions
- hegar's sign
47
braxton hicks contractions
fake contractions
- get the body to prepare for labor
48
hegar's sign
softening of the uterus, happens are 6 weeks gestation
49
chadwick's sign
blue cervix
50
vaginal changes
- increased vascularity: leukorrhea
- decreased pH (acidic): more prone to yeast infection
51
leukorrhea
flow of whitish, yellowish, or greenish discharge from the vagina
- could be normal or indicate infection
52
supine hypotension is also called ___
vena cava syndrome
53
s/sx of supine hypotension
-pallor
-dizziness/faintness
-nausea
-tachycardia
-clammy skin (sweating)
54
nursing intervention for supine hypotension
-turn patient to side-lying position until sx subside and vital signs are stable
55
what causes supine hypotension during pregnancy?
compression of the vena cava causing a decrease in BP and uterine blood flow/perfusion
56
respiratory changes during pregnancy
- increased O2 needs due to increased metabolic rate and O2 consumption
- increased vascularity: leads to nasal congestion, stuffiness, nose bleeds
- slight hyperventilation late in pregnancy
-RR increases slightly or is unchanged
57
renal changes during pregnancy
- increase in GFR
- increase in urinary frequency (r/t pressure on the bladder in 1st & 3rd trimesters
- increase risk of infection r/t impairment of drainage (pressure)
- decreased bladder tone
- urinary stasis
- increased risk of UTIs
- lightening
58
what is lightening
when the fetus drops into the pelvis
59
s/sx of UTI
urinary frequency, urgency, dysuria
- sometimes pus or blood in the urine
60
GI changes during pregnancy
- 90% experience N/V that decreases as the pregnancy progresses
- increased appetite
- uterus displaces the stomach, liver and intestines
- GI system slows
- hemorrhoids develop
- gallstones due to slowing relaxation gallbladder and delayed bile emptying
- ptyalism
- bleeding gums
61
musculoskeletal system changes during pregnancy
- pelvic joints relax
- waddling gait
- joint discomforts
- postural changes r/t increased uterine weight: lordosis, fall risk
- diastasis recti: stretching of abdominal muscles
62
integumentary changes during pregnancy
- alterations r/t hormonal imbalance and mechanical stretching
- hyperpigmentation
63
hyperpigmentation is stimulated by __
the anterior pituitary hormone melantropin
64
what are examples of hyperpigmentation seen during pregnancy?
- darkening nipples/areola
- chloasma/melasma - facial mask of pregnancy
- striae gravidarum
- linea nigra
- hot flashes
-acne and oily skin
-sweating
65
striae gravidarum
stretch marks
66
linea nigra
the dark line running vertical on the mom's abdomen
67
chloasma
dark patches on mom's face
68
fetal ultrasound: timing
1st trimester to confirm pregnancy
69
fetal ultrasound: abdomen
- want full bladder
- supine position
70
nursing actions: fetal ultrasound
- explain the process
- access for latex allergy
- position patient supine
- provide comfort
- be sensitive to cultural issues
- document
71
what does a fetal ultrasound do?
uses high frequency sound waves to produce an image of organs/tissues
72
what can the fetal ultrasound tell us?
- gestational age
- fetal growth
- anatomy/presentation
- placental location
-fetal activity
- number of fetuses
- amount of amniotic fluid
- assist with some procedures
73
what is a 3D or 4D ultrasound? how does it work?
- ordered as needed for further evaluation - fetal abnormalities
- gives more detailed assessment of fetal structures
- works same as normal US
74
why is an MRI used during pregnancy?
to evaluate organs from multiple planes
-used for suspected brain anomalies
75
nursing actions: MRI
- involved in pre and post procedure
- explain procedure
- answer questions
76
what is doppler flow studies: umbilical artery doppler?
used for IUGR fetuses
-evaluates the rate and volume of blood flow through the placenta and umbilical cord
- used with higher amounts of resistance in the placenta
77
what is chorionic villus sampling?
-endoscopy placed vaginally
or
- ultrasound guides a needle aspiration through the abdomen
-1/455 chance of fetal death
78
what is an amniocentesis?
needle is inserted through abdomen to aspirate the amniotic fluid
79
why is an amniocentesis done?
- genetic testing
- fetal lung maturity
- intrauterine infection
80
risks of amniocentesis
- fetal loss 1/300
- fetal/placental trauma
- infection
- bleeding
- PTL
- Rh sensitization from fetal blood to maternal blood (Rh- mom needs Rhogam)
81
what is AFP: Alpha Fetal Protein?
glycoprotein produced by fetus
- mom's blood is drawn for the biomarker between 15-20 weeks, if its seen in her blood then we know something isn't right with fetus
- a screening tool for developmental defects
82
what developmental defects can AFP screen for?
- NTDs
- ventral abdominal wall defects
- Trisomy 21 (down syndrome)
83
what are the multiple marker screening tests?
- triple marker screen
- quad screen
84
triple marker screen can screen for __
-AFP: NTD, ventral wall abnorms, Trisomy 21
-HCG: low HCG can indicate Trisomy 21
-Estriol levels
85
quad screen can detect __ by __
trisomy 21 by adding inhibin A
86
antenatal fetal testing consists of what tests?
- fetal movement (kicks) : want 4-5 in 1 hr, 10 in 2 hrs
- NST
- AFI
87
Non-stress tests
non-invasive test using external fetal monitoring (strap around mom's belly)
- toco
- FHR monitor
88
reactive stress test
includes an increase of fetal heart of 15 beats lasting 15 seconds (should have 2 in a 20 minute strip)
89
non-reactive stress test
"straight" line, no accelerations
correlated with higher incidence of fetal distress
- need BPP done
90
nursing actions: non-stress test
leave patient on fetal monitor
- educate about fetal strip and need
91
AFI
measures volume of amniotic fluid pockets
-reflects placental function and perfusion to fetus
92
what is amniotic fluid composed of mostly?
fetal urine
93
normal AFI is __
pockets are 8 cm to 24 cm
94
abnormal AFI is ___
pockets < 5 cm
95
components of BPP
- body movement
- fetal tone
- fetal breathing
- amniotic fluid volume
- NST
96
what is the present score vs the absent score on a BPP?
- present: 2
- absent: 0
- total of 10 max
97
BPP reactive: body movement
3 movements
98
BPP reactive: fetal tone
flexion and extension 1 time
99
BPP reactive: fetal breathing
1 episode lasting 30 sec
100
BPP reactive: amniotic fluid volume
1 pocket 2x2 cm
101
BPP reactive: NST
reactive
102
what does preconception care consist of?
- risks assessment
- education and anticipatory guidance
- 2 components: physical exam and screening tools
103
physical exam during antepartum
- height
- weight
- comprehensive physical
- pelvic exam
104
lab tests during antepartum
- blood type/ Rh
- CBC, chol, glucose, rubella, HIV, Syphilis
- urinalysis
- cultures for STIs
- pap smear
- TB skin test
- others as needed
105
preconception information
- nutrition
- vitamins
- folic acid
- exercise
106
folic acid
very important for the production of RBC and hemoglobin
107
why is folic acid useful in pregnancy?
maternal ingestion can decrease the risk of NTDs
-recommended to take prior to conception
108
examples of NTDs
- spina bifida
- anencephaly
- meningomyelocele
109
diagnosis of pregnancy: presumptive
-s/sx may resemble pregnancy or could be caused by something else
110
subjective data of presumptive pregnancy
- amenorrhea
- fatigue
- breast changes
- vomiting
- urinary frequency
- quickening
111
diagnosis of pregnancy: probable
signs that indicate pregnancy the majority of the time
- still a chance that they can be false or caused by something other than pregnancy
112
objective signs of probable pregnancy
- chadwick's sign
- goodell's sign
- hegar's sign
- uterine growth
- chloasma
- ballottement
- pregnancy tests
113
goodell's sign
softening of the cervix, increased whitish discharge
114
ballottement
around 16-18 weeks, during a manual exam. lightly tap on the cervix, which causes fetus to move up and down
115
diagnosis of pregnancy: positive
signs that cannot, under any circumstance, by mistaken for other conditions.
- evidence pregnancy has occurred
116
objective signs of positive pregnancy
- doppler fetal heart tones
- ultrasound visualization
- fetal movement palpated by examiner
117
trimester 1 timeframe
1st day of LMP - week 12
118
trimester 2 timeframe
week 13 - week 27
119
trimester 3 timeframe
week 28 - week 40
120
the estimated date of delivery/confinement (EDD/EDC) can be determined by __
1. ultrasound: standard procedure
2. gestational wheels: less accurate but good for determining gestational age
3. naegale's rule: assumes woman has 28 day cycle- LMP+7 days-3 months, change year
121
early term
37.0 - 38 6/7 weeks
122
full term
39.0 - 40 6/7 weeks
123
late term
41.0 - 41 6/7 weeks
124
post term
42.0 + weeks
125
terms used to describe OB history
- 2 digit system: G&P
or
- 5 digit systen: GTPAL
126
G&P
gravida + para
127
GTPAL
gravida-term-preterm-abortion-living
128
gravida is __
the total # of pregnancies, including current
129
nulligravida
never been pregnant
130
primigravida
first pregnancy
131
multigravida
2 or more pregnancies
132
para is __
total # of pregnancies from 20 weeks onward regardless of whether born alive or stillborn
133
nullipara
woman who has NOT carried a pregnancy to 20 weeks
134
primipara
carried 1 pregnancy to 20 weeks gestation
135
multipara
carried 2 or more pregnancies to 20 weeks gestation
136
explain what each part of GTPAL stands for/means
G: gravida- total # of pregnancies (**twins/multiples count as 1)
T: term- # of term pregnancies (born between 37-42 weeks) (**twins/multiples count as 1)
P: preterm- # of preterm pregnancies (born between 20-36 6/7 weeks) (**twins/multiples count as 1)
A: abortion- # of abortions (either spontaneous or induced before 20 weeks) (**twins/multiples count as 1)
L: living- # of children living
137
a term baby can be __
37-42 weeks
- includes, early term, full term and late term (and post term if baby is just 42.0 weeks, but not over)
138
what is the difference between preterm and early term?
- early term is 37.0-38.6 weeks
- preterm is 20-36.6 weeks.
(think preterm has a wider range)
139
what does a nurse assess in a risk assessment as a part of preconception care?
- health status
- health services
- socioeconomic status
- mental health status
- nutrition
- environment
- family
- self care
- education
- personal: genetics, culture, race/ethnicity, language
140
at what time during gestation do NTD's emerge?
early in pregnancy- 1st few weeks after conception
141
quickening
feeling baby move, if not pregnant: gas bubbles
142
cervical changes
- cervical OS
- Goodell's sign
- Chadwick's sign
143
what is the cervical OS?
the opening of the cervix
144
ptyalism
excess saliva
145
BPP: 8/10 score
assuring, healthy baby
146
BPP: 6/10 score
slightly concerning
147
BPP: 4/10
not assuring, discuss next steps
148
BPP: 2/10
fetal hypoxia, prep for delivery
149
pregnancy hormone: prolactin- where does it come from/what does it do?
- secreted from the pituitary gland
- stimulates milk production and secretion
150
milk production is ____ and ____
supply and demand
151
factors that influence milk production:
- maternal fluid intake
- if mom chooses to supplement feedings with formula
- if baby isn't nursing often
152
around what day does the true milk come in?
day 2 or 4 postpartum
153
hyperemesis is ___
prolonged N/V
154
how long is it recommended that mothers breastfeed?
6 months
155
pregnancy hormone: oxytocin- what does it do?
stimulates milk let down response
156
kegel exercises are for ___
pelvic floor strengthening
