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NURS 4500 > Class 2: Pregnancy (uncomplicated) > Flashcards

Class 2: Pregnancy (uncomplicated) Flashcards

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1
Q

Pregnancy length of time

A

9 calendar months
10 lunar months of 28 days
280 days total
40 weeks (from 1st day of last menstrual period)

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2
Q

Pregnancy trimesters

A

First: weeks 1 through 13
Second: weeks 14 through 26
Third: weeks 27 through to term

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3
Q

The physiological processes of pregnancy

A

Oogenesis
Spermatogenesis
Menstrual cycle and ovulation
Conception (fertilization, implantation)

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4
Q

Fertilization

A

Fertilization occurs in the outer 3rd of the uterine tube

Mitotic cell division (cleavage) occurs

Morula develops (day 3)

Early blastocyst (day 4)

Implantation (day 6-10)

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5
Q

Blastocyst

A

Inner cell mass = embryoblast
Blastocyst cavity = blastocele
Outer cells = trophoblasts

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6
Q

The corpus luteum

A

Receives a signal from the zygote (hormone: hCG human chorionic gonadotropin) to alert that fertilization has occurs

Will produce progesterone and some estrogen

Lasts for approx 12 weeks

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7
Q

Pregnancy tests

A

-detect the hormone hCG
-OTC urine pregnancy tests can detect hCG usually when level is about 25 mIU/mL
-clients should be instructed to use the first void in the morning, as levels are the highest at that time
-blood hCG is quantitative (exact amount is measured), <5 mIU/mL is normal when not pregnant

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8
Q

Pre-embryonic stage

A

Fertilization to end of 2nd week
Fertilization; cleavage; morula
Blastocyst
Implantation
The yolk sac provides nutrients and oxygen
Nutrients diffuse across the chorion from pregnant person’s circulation

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9
Q

Fetal period

A

Weeks 9 to birth

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10
Q

Embryonic period

A

Weeks 3-8

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11
Q

Embryonic stage

A

weeks 3-8
The embryonic disk, yolk sac and amniotic sac are connected to chorionic villi by connecting stalk
Week 3 blood vessels begin to supply nutrients from pregnant person’s circulation to early placental structure
End of week 3 the primitive heart starts to beat
In the 4th week the yolk sac folds into digestive tract
In the 5th week the connected stalk is compressed and forms the umbilical cord
Basic structures of major body organs andmainexternalfeatures are developed during this time (organogenesis)
Very sensitive time for malformations to occur

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12
Q

Fetal stage

A

week 9 untilbirth.
Refinement of the structure and function of organ systems

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13
Q

Chorion

A

Blends with the placenta

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14
Q

Amnion

A

Blends with the umbilical cord
Amniotic fluid: at term 700-1000ml, important functions for development of the fetus, contains genetic information from the fetus, can be sampled to determine fetal lung maturity (L/S ratio)

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15
Q

Umbilical cord

A

2 arteries
1 vein
Wharton’s jelly

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16
Q

Placental structure

A

Fetal side (chorion frondosum) & maternal side (decidua basalis)
Complete and functional at approx. 12 weeks gestation
There is no mixing of the blood between pregnant person and fetus
Location and implantation of the placenta are very important!

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17
Q

Placental function

A

Site of respiration, nutrition, excretion and storagefor the fetus – mostly using diffusion
Blood flow through uteroplacental vascular system at 40 weeks is 450-650ml/min.
Endocrine function:Hormones of theplacenta – progesterone,placentallactogen, estrogen,relaxin, B-hCGandinfant growth factors (IGFs)
**Blood pressure dependent

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18
Q

Amniotic fluid function

A

It serves as a cushion for the growing fetus, but also facilitates the exchange of nutrients, water, and biochemical products between mother and fetus
This fluid also allows the developing fetus to practice breathing, which is crucial for extra uterine life

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19
Q

Amniotic fluid content

A

Is made up of fetal urine and fluid that is transported through the placenta from maternal circulation
The fetus swallows AF and excretes urine and waste products which are then excreted by maternal kidneys

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20
Q

Normal amount of amniotic fluid at term

A

700-1000 mL

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21
Q

Which is more common: polyhydramnios or oligohydramnios?

A

Oligohydramnios

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22
Q

Fetal circulatory system

A

Optimization of transfer of O2 from parent to fetus

Fetal hgb (carries more O2 than parental hgb and higher hgb concentration

FHR is higher than parental HR

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23
Q

Fetal maturation

A

Viability - “age of viability,” 22-25 weeks

Capability of fetus to survive outside uterus

Limitations based on central nervous system function and oxygenation capability of lungs

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24
Q

What is a congenital disorder?

A

A structural or functional anomaly (“birth defect”) that happens during intrauterine life

Congenital disorders may be inherited or may be caused by environmental factors

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25
Factors to developing congenital disorder
1. Genetic factors – single gene disorders, chromosomal abnormalities 2. Nongenetic factors - Teratogens - Drugs and chemicals; alcohol, oral isotretinoin - Infections: rubella, varicella - Radiation: xrays/CT scans  - Maternal health conditions: e.g. Diabetes – hyperglycemia  - Maternal Nutrition
26
Hormones in pregnancy
- Human chorionic gonadotropin (hCG or BhCG) - Biochemical marker of pregnancy (urine or serum) - Can be false pos or neg  - Estrogen (E) - vascularization - Progesterone (P) – smooth muscle relaxation - Relaxin - Human placental lactogen (hPL)  - Oxytocin - Prolactin
27
Zygote and hormones
Zygote → corpus luteum → estrogen and progesterone
28
Placenta and hormones
hCG estrogen progesterone relaxin hPL
29
Presumptive signs of pregnancy
Patient’s subjective symptoms that may be associated with pregnancy amenorrhea, breast tenderness, nausea/vomiting, urinary frequency
30
Probable signs of pregnancy
Objective signs that can be assessed by the provider, physical assessment findings Positive pregnancy test, uterine enlargement, Hegar’s sign, Goodell’s sign, Chadwick’s sign
31
Positive signs of pregnancy
Signs of pregnancy that can only be present if there is a fetus present FHR auscultation, fetal movement palpated by provider, U/S of fetus
32
Uterus change in pregnancy
enlarges, becomes an abdominal organ, ++↑ blood flow
33
CVS change in pregnancy
↑CO, HR, & blood volume, ↓BP (DBP more than SBP) ↓PVR
34
RESP change in pregnancy
↑ O2 consumption, elevated diaphragm, ↑ minute ventilation ↓ CO2
35
GU change in pregnancy
↑CO leads to ↑ renal flow to kidneys, dilation, stasis 
36
GI change in pregnancy
↑ intra-abdominal pressure, relaxed lower esophageal sphincter, delayed gastric emptying
37
Hematologic change in pregnancy
↓ HGB ↑ clotting factors
38
Nutrition in pregnancy
Calories from carbohydrates, protein and fat RDA is 340kcal above prepregnancy caloric needs in T2 RDA is 452kcal above prepregnancy caloric needs in T3 Fluid intake is recommended to be 9 cups per day
39
Anemia in Pregnancy
N HGB in pregnancy is > 110 g/L (N nonpreg 120-160 g/L), HCT > 0.33 (N nonpreg 0.37 to 0.47) = Physiologic anemia OR Dilutional anemia (considered normal in pregnancy) HGB ≤ 110g/L or HCT ≤ 0.32 then we consider true anemia that requires further investigation and possibly treatment
40
Common cause for anemia in pregnancy
Usually nutritional - most commonly iron deficiency
41
Nonspecific symptoms of anemia in pregnancy
fatigue, weakness, dyspnea on exertion, light-headed, pruritus  Likely asymptomatic if mild 
42
Management of anemia in pregnancy
Iron supplements, iron rich foods
43
Nausea and vomiting in early pregnancy
50-90% of pregnant individuals experience 1st trimester nausea and potentially some vomiting Onset is usually weeks 4-6 gestation Improves or resolves by 13 weeks for most May be triggered by certain foods or smells
44
Signs/symptoms of Normal N&V 
VS Urine output Able to eat throughout the day without vomiting  Weight stable or increasing No symptoms of infection  No signs of dehydration 
45
Signs/symptoms Abnormal N&V
VS Urine output Excessive vomiting Weight loss Electrolyte imbalances Potential signs of dehydration  Urine ketones  Chills/fever Dysuria Abd pain Vaginal bleeding Backache/ Flank pain
46
Nursing interventions for normal N&V
Avoid triggers Increase rest Small frequent meals  Plain carbs Avoid extended period without eating (avoid empty stomach) Avoid overloaded stomach Adequate fluids 
47
Education to provide on N&V in pregnancy
When to seek care – s/sx abnormal n/v Feeling presyncopal, decreased urine output, weight loss Vaginal leaking or bleeding  Pain or fever Dysuria
48
Healthy weight BMI in pregnancy
18.5-24.9
49
Healthy weight gain in kg and lbs
11.5-16 kg or 23-35 lbs
50
During T1 and T2 most weight gain is within...
the tissues of the pregnant person
51
Average weight gain in T1
1-2kg
52
Most weight gain occurs...
In T3 within the fetal tissues
53
During T2 and T3 individuals require....
More calories for fetal growth and development
54
In T2 and T3 the mean weight gain is...
1lb/ week for those within the BMI 18.5-24.9 category
55
Inadequate nutrition can lead to an increase in...
Low-birth-weight (LBW) infants (2500 g or less) Preterm infants
56
Folic acid recommendation for low risk
0.4 daily for at least 2-3 months prior to pregnancy, throughout pregnancy, and postpartum if breastfeeding
57
Folic acid recommendation for moderate risk
Diabetes, epilepsy, obesity , or first- or second-degree relative with hx of NTD 1.0mg daily for the 3 months prior to pregnancy and during the first trimester Decrease dose to 0.4mg after first trimester
58
Folic acid recommendation for increased or high risk for NTD
4 mg/ day at least months prior to conception and through the first trimester of pregnancy, after which time can decrease intake to 0.4 to 1.0 mg daily
59
Prenatal visits
Q 4 weeks until 30 weeks  Q 2 weeks from 30-36 weeks  Q 1 week from 36 weeks to delivery 7 – 11 visits throughout pregnancy
60
Individuals at increased risk for adverse outcomes in pregnancy
Adolescent (Age 15 years or less) Advanced maternal age (Age > 35 years)
61
Pregnancy in adolescence have a higher likelihood of:
Poverty Lower education Nutritional deficiencies (anemia) Inadequate social support  Preterm birth Preeclampsia (+/- HELLP) PPH Chorioamnionitis  Less likely to attend prenatal care  More likely to smoke tobacco Less likely to have adequate weight gain 
62
If no preconception history known, an in-depth history will be taken including the following
Child and adult illness, medical conditions currently  Current medications, allergies (Rx/OTC/herbal/supplements)*folic acid, multivitamin Immunization history Medical, psychiatric, surgical history Obstetrical history: Gravida, Term, Preterm, Abortion (SA and TA), living children Family History, including partner’s personal and family history - genetic disorders/birth defects/multiple gestations/close relations Lifestyle: Nutrition, exercise Social History: screen for alcohol use, drug use, smoking, vaping Psychosocial history: Culture, socioeconomic status, sexuality, disabilities, Occupation, Travel Screen for Intimate Partner Violence   Personal history of physical, emotional or sexual abuse 
63
Initial prenatal visit ROS
particularly – any vaginal bleeding or leaking, n/v, syncope, dysuria, abdominal pain, fever Any mental health concerns, adaptation to pregnancy
64
Calculate Gestational Age
from 1st day of late menstrual period (LMP) E.g. LMP Aug 1, 2023 (Day 0)  GA currently: 5 weeks + 2 days Estimated Date of Birth (EDB): May 8 Nagele’s rule: 1st day of LMP – 3 months + 7 days (add 1 year), or pregnancy wheel
65
Initial prenatal visit - physical exam
Appearance & mental status Height, weight, BMI, BP, HR, RR, temp HEENT, CVS, RESP, breasts, ABD, pelvic (prn), extremities with other PE as required (initial) Gest age at visit will determine fetal assessment afterward
66
Initial prenatal visit - laboratory tests
Confirm probable pregnancy with urine hCG Serology for CBC, STI screening- HIV, VDRL (syphilis), & Hep B Cervical Swab for gonorrhea and chlamydia Blood type, Rh and antibody screen Titres for rubella and varicella Urinalysis + urine culture Pap if due (routine screening Q3 years)
67
Subsequent Prenatal Visits
Includes: Interview: any new symptoms, emotional wellbeing, concerns, fetal movements (after 24 + weeks), vaginal bleeding or leaking, cramping Physical exam - Weight, height, determine BMI - Look at general appearance and mental status - VS: BP, HR, RR +/- temp - Urinalysis* Fetal assessment: FHR, SFH, Leopold’s maneuvers (T3) Document on the MB Prenatal record 
68
Common first trimester symptoms
breast changes/ tenderness, amenorrhea, nausea/ vomiting, urinary frequency, fatigue, nasal stuffiness, bleeding gums, leukorrhea, mood changes
69
Common second trimester symptoms
Quickening, skin changes, pruritus, palpitations, supine hypotension, orthostatic hypotension, heartburn, constipation, flatulence, varicose veins (hemorrhoids), headaches, carpal tunnel syndrome, round ligament pain, joint pain
70
Common third trimester symptoms
dyspnea, insomnia, mood changes, urinary frequency and urgency, perineal pressure, leg cramps, edema to lower extremities
71
Potential complications in first trimester
Severe vomiting/ weight loss/ unable to keep fluids down, fever, dysuria, diarrhea, abdominal cramping, vaginal bleeding
72
Potential complications in second and third trimester
Persistent vomiting, leaking of fluid or blood from vagina, abdominal pain, fever, dysuria, diarrhea, severe backache or flank pain, change or decrease in fetal movements, uterine contractions (before week 37), visual disturbances, headaches, muscular irritability or convulsions, epigastric or abdominal pain
73
When can preterm labour occur?
Weeks 21-36 weeks + 6 days
74
Signs of preterm labour
feel uterus at fundus for contractions, empty bladder, drink water, lie down in side-lying position, monitor contractions for 1 hour (from start of one to the beginning of the next) to determine how often (e.g. every 5mins). Regular contractions, continuing for 1 hour is concerning. They may be uncomfortable but not always.
75
Interventions for preterm labour
Call provider if contractions last for 1 hour, regularly occurring every 10mins or less, pelvic pressure not resolving, vaginal bleeding or leaking, feeling that “something is not right”
76
GTPAL
G: total number of pregnancies of any gestation (twins/multiples =1) (includes non-viable) Parity (TPAL) means the number of pregnancies that reach 20 weeks TPAL: Term (T): # of births (≥ 37wks) Preterm (P): # of births (20 wks - 36 wks+6days) Abortions (A): # of abortions < 20 wks (induced or spontaneous) Living children (L): # living children
77
Estimated date of birth (EDB)
Estimated date of birth (EDB) or Estimated Due Date (EDD) Formulas for calculating EDB/EDD but none infallible Nägele's rule Determine first day of last menstrual period (LMP), subtract 3 months, and add 7 days plus 1 year. Alternatively, add 7 days to LMP and count forward 9 months. Most women give birth from 7 days before to 7 days after EDB/EDD
78
Prenatal Care - Fetal Assessment
Fetal Assessment: FHR – can start to assess at 10-12 weeks SFH –begin to measure at 20 weeks Fetal movements – starts at time when movements felt regularly (variable, by 24 weeks should be felt) Leopold’s maneuvers – start at 30-32 weeks
79
Auscultate fetal heart rate
Fetal heart can usually be heard with a Doppler at between 10-12 weeks. Once fetal heart is detectable it should be checked every prenatal visit. Count for 1 min. Fetal heart rate (FHR) is typically between 110-160 bpm and varies more than the adult heart rate.
80
Measuring fundal height
Measured in cm from the top of the pubic bone to the top of the fundus Should be determined at each prenatal visit Used as a measurement of fetal growth once the uterus leaves the pelvic cavity Measurement in cm typically corresponds to weeks of gestational age (20 cm=20 weeks); +/- 2cm Once lightening (dropping of the fetus into the pelvic cavity) occurs around 36 weeks fundal height no longer corresponds to gestational age
81
What are "off for dates"?
"off for dates" - when the SFH does not correspond to what you expect based on the gestational age of the pregnancy For example, at 25 weeks the normal range is between 23cm-27cm
82
Leopold’s Maneuvers
Typically begin @ 30-32 weeks gestation 1st palpate fetal part at the fundus (or the farthest away from the pelvic inlet) 2nd determine the location of the fetal back 3rd palpate to determine the presenting part 4th palpate for the attitude of the presenting part
83
Fetal Health (FH) surveillance
Fetal movement is a good indicator of fetal health Kick count is a formal measurement Done in cases where there is reason to suspect placental insufficiency or in other high-risk pregnancies. From 26-32 weeks, the pregnant person should be asked to set aside a time to count fetal movements each day. The baby should move 6 times in 2 hours. All people should be counseled that if they suspect decreased movements, do a kick count
84
Reasons for decreased fetal movements
Hunger/Thirst Sleep cycle of fetus Amniotic fluid decreased Death of fetus
85
Labs and diagnostics 4 weeks onward
urine or serum hCG
86
Labs and diagnostics 10-12 weeks
CBC Blood type, Rh, antibody screen MSU, C&S, urinalysis Cervical swab Gc & CT Serology: HIV, HEP B, Syphilis Titres for rubella, varicella

NURS 4500 (4 decks)

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