Exam 1 - Nursing Care During Pregnancy Flashcards

(61 cards)

1
Q

Human Chorionic Gonadotropin (hCG)

A
    • the earliest biochemical marker of pregnancy
    • Produced by the embryo soon after conception and later by the placenta
    • Can be found in maternal blood and urine
    • hCG level increases until it peaks at about 60-70 days of gestation
  • *** HCG – earliest predictor (but not 100% sure) of pregnancy
    • Guys who got + of pregnancy – need to be checked w cancer

– HCG number increases…… If the number is not climbing right, mom might have miscarriage…

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2
Q

Presumptive Signs of Pregnancy

A
    • Least reliable indicators
    • Subjective

– Example: Amenorrhea, N/V, fatigue, urinary frequency, breast and skin changes, fetal movement, quickening

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3
Q

Probable Signs of Pregnancy

A

– Objective findings

– Example: Abdominal enlargement, cervical softening, changes in uterine consistency, ballottement, braxton hicks, palpation of fetal outline, positive pregnancy tests, vaginal and cervical color changes

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4
Q

Positive Signs of Pregnancy

A
  1. Auscultation of fetal heart sounds
    - 100% assurance of pregnancy
    - 80 beats/min = could be MOM or dying baby
    - 160 beats/min = baby
  2. Fetal movements felt by examiner
  3. Visualization of embryo or fetus in ultra sound
    - As early as 5 wks after missed period
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5
Q

Changes in Uterus

A

Grows in a predictable pattern
o Helps to confirm EDB (expected date of birth)
o Provides info about fetal birth
– 12 weeks extends out of pelvis
– 16 weeks, midway
– 20 weeks, @ umbilicus
– 36 weeks, highest level
– Drops from fetal descent after 36 weeks (lightening)

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6
Q

change in uterus:

LIGHTENING

A

fundus is highest when baby was at 36 THEN at 40 wks comes down to 32 – means baby is ready for delivery – BABY DROPS DOWN THE CANAL

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7
Q

change in uterus:

BRAXTON HICKS (4th month)

A

o Note *** False contraction or FALSE LABOR – feels like contracting but the cervix is not opening
o tell patient to time it…
o Empty bladder
o Drink fluid
o Lay down
o If contractions of >6 in an hour then call Dr or nurse !!

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8
Q

HEGAR SIGN

A

– softening of the lower segment of the uterus

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9
Q

UTERINE SOUFFLE

FUNIC SOUFFLE

A

SOUFFLE means heartbeat

o Babies upper back is where you hear baby’s heartbeat

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10
Q

BALLOTEMENT

A

– when the cervix is tapped, the fetus floats upward in the amniotic fluid. A rebound is felt by the examiner when the fetus falls back.

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11
Q

Changes in Cervix

A
-- Cervix becomes congested with blood (Chadwick’s sign)
o	Chadwick’s sign –TURNED BLUISH
-	Friable
-	Goodell’s sign 
-	MUCOUS PLUG
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12
Q

MUCOUS PLUG

A

– yellowish that is plugged – to protect fetus from infection; so bacteria can’t invade the baby

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13
Q

GOODELL’s sign

A

– softening of cervix

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14
Q

Chadwick’s sign

A

–TURNED BLUISH bec congested w/ blood

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15
Q

Changes in Vagina and Vulva

A

o Increased vaginal vascularity causes bluish color (Chadwick’s)
o Leukorrhea – a vaginal white, thick discharge present is NORMAL
o Vaginal mucosa thickens and rugae prominent
o Increased amounts of glycogen cause the acidic environment that protects from bacteria but a good medium for yeast – that’s why pregnant mom usually gets yeast infection!!
o Vulva and perineum more pliable due to increased vascularity

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16
Q

Leukorrhea

A

– a vaginal white, thick discharge present is NORMAL

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17
Q

Changes in OVARY

A

– Corpus luteum secretes progesterone for first 6-7 weeks, placenta secretes it thereafter
– Progesterone must be present in adequate amounts from the earliest stages of pregnancy to maintain the pregnancy
– ** When it’s time for birth, the progesterone drops which starts the contraction process**
o Helps to suppress uterine cx
o Helps to prevent tissue rejection of the fetus

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18
Q

Changes in BREASTs

A
  • Estrogen stimulates growth of mammary ductal tissue
  • Progesterone promotes growth of lobules, lobes, and alveoli
  • Become highly vascular
  • Nipples increase in size
  • Increased alveolar pigmentation
  • Montgomery Tubercles
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19
Q

How to correct Inverted/Flat Nipple

A
  • Use Breast Shells to Correct Inverted/ Flat Nipples
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20
Q

Changes in CARDIOVASCULAR:

INCREASE:
plasma vol, blood vol, clotting, CO, Kidney work, Varicose veins

Decrease: PVR

Remain: BP

A
  • Heart enlarges slightly because of increased workload
  • Heart is pushed upward as uterus enlarges
  • Splitting of heart sounds is normal
  • Total blood volume increases 40-50% bec mom will lose blood during delivery !
  • Plasma volume increases by 50% – which sometimes causes Pseudoanemia or FALSE ANEMIA because the increase in plasma dilutes the RBC w/c shows low Hct and low Hgb.
  • Physiologic anemia, pseudoanemia of pregnancy
  • Clotting factors increase
  • CO increases by 30-50%
  • PVR decreases
  • Blood pressure remains stable
  • Kidneys have to work harder to eliminate maternal and fetal wastes
  • 500-800ml/min of blood circulated to the uteroplacental circuit
  • Varicose veins common due to pressure of uterus obstructing blood return from legs
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21
Q

Supine Hypotensive Syndrome

A

o lying supine occludes the vena cava and descending aorta

o side lying position corrects supine hypotension

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22
Q

RESPIRATORY changes

A
    • O2 consumption increases by 15-20%
    • RR remains unchanged, but woman breaths deeper through mild hyperventilation
    • Tidal volume and minute volume increase by 40%
    • Progesterone & Estrogen
        • The more o2 take in the more O2 to the baby
        • bec of Progesterone and Estrogen == that’s why O2 increases

– These are 3rd trimester changes

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23
Q

GI changes:

A

• Nausea common in first trimester
– If nausea absent, increased appetite may be present
• Estrogen causes hyperemia of gums and mouth
• Ptyalism: increased salivation
• Reduced lower esophageal sphincter tone
• Progesterone decreases tone and motility of GI tract
• Decreased emptying time by small intestine
• Gall bladder hypotonic which could lead to gall stones (or right after they had the baby)
• Liver function mildly altered

** Sometimes loosing the nausea is not good,, might lose the baby too bec progesterone causes the N/V

** Gingivitis can lead to premature labor

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24
Q

Changes in Urinary: BLADDER

A

Frequency and urgency of urination 1st trimester (normal) due to:
o Hormonal influences
o Increase in uterine size

Frequency and urgency of urination 3rd trimester:
o Due to large uterus pressing on bladder

    • Bladder capacity doubles by term as the bladder relaxes –so we can hold more longer
    • Bladder more susceptible to trauma and infection
    • Pay close attention to s/s bladder infection b/c could lead to preterm labor!
    • Women who are prone to UTI needs a lot of teaching
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25
Changes in Urinary: KIDNEYS and URETER
-- Progesterone o Dilation of renal pelvis and ureters -- Flow of urine through ureters partially obstructed by uterus o Dilation helps flow o Stasis can lead to bacterial growth -- Renal plasma flow and GFR increases -- Flow highest when woman in side-lying position (left side to promote blood flow) -- Glycosuria is common bec filtered load of glucose exceeds ability of renal tubules to reabsorb it * Mild spilling of protein is NORMAL (bleeding might see protein) * Note: o These can cause infection o Hydrate to flush and prevent infection
26
Changes in INTERGUMENTARY
-- Increased metabolic rate causes: sweating and the feeling of warmth -- Hyperpigmentation: estrogen, progesterone, and melanocyte-stimulating hormone (melasma, chloasma, mask of pregnancy, linea alba -- Increased vascularity may cause angiomas on face (not cancerous tumors) - - Striae gravidarum – stretch marks - - Hair and nail growth increases
27
Changes in MUSCULOSKELETAL System
• Calcium stored to meet later needs of fetus • Does not deplete mother’s stores • Postural changes o Due to change in center of gravity • Widening of symphysis pubis o Allows more room for head to deliver o Causes pain in some • Abdominal Wall weakens and may separate • Note: o Mom’s Ca level should NOT be changed !! o Prone to fall bec of change in stature… center of gravity changes
28
Changes in NEUROLOGIC System
- Sensory changes in legs caused by compression of pelvic nerves - Dorsolumbar lordosis may cause pain related to nerve traction or compression - Edema may cause carpal tunnel syndrome o CARPAL TUNNEL SYNDROME–main s/s: pain spares the pinky - Numb hands caused by stooped shoulder stance - Light-headedness or faintness usually caused by CV changes - Muscle cramps may be caused by hypocalcemia or hypomagnesemia o Pain in legs and muscles means low Ca and Mg
29
Changes in Endocrine : PITUITARY
o FSH and LH are suppressed • FSH and LH are not needed bec pt is already pregnant o Prolactin released
30
Changes in Endocrine : THYROID Gland
o Enlarges due to increased vascularity o Hormones increase, but level off at end of first trimester
31
Changes in Endocrine : PARATHYROID
-- Calcitonin decreased to allow for calcium needs during pregnancy
32
Changes in Endocrine : PANCREAS
-- Hypoglycemia common • Hypoglycemia – need small freq meal -- Tissue sensitivity to insulin decreases r/t hPL
33
Changes in Endocrine : ADRENALS
o Aldosterone and cortisol levels elevate
34
Placental Hormones
- hCG - Estrogen - Progesterone - hPL – human placental lactogen - Relaxin → changes cavity shape → changes gait
35
Other Changes: WEIGHT FLUID HEMODILUTION (dilution of RBC)
- Weight gain: fetus, placenta, and fluid make up less than half of weight gain during pregnancy - Women with normal BMI should gain 25-35 lbs - Water needs increase = 3L / day - Hemodilution causes dependent edema - Carpal Tunnel Syndrome from fluid retention - Problems with carbohydrate metabolism
36
Preconception Visit
- - Complete history and examination - - Screening for rubella, varicella, and hepatitis B - - FOLIC ACID needs before and during pregnancy Note: o Can’t get Rubella vaccine while pregnant – need to be immune before pregnancy – can’t give live vaccine to pregnant o Boost folic acid before getting pregnant
37
Initial Prenatal Visit
- Verify pregnancy - Evaluate physical health - Assess growth of fetus - Establish baseline data - Establish trust - Evaluate psychosocial needs - Negotiate plan of care - Note: o Initial visit more entail
38
HISTORY to get on 1st visit
```  Obstetric: GTPAL  Gravida, para  Menstrual History  EDD: Naegele’s Rule, gestational wheel  Contraceptive History  Medical and Surgical History  Family History  Partner’s Health History  Psychosocial History ```
39
GTPAL
-- Gravida: # of pregnancies -- Term: at least 37 weeks gestation -- Preterm: > 20 weeks but < 37 weeks -- Abortion: < 20 weeks, either spontaneously or electively o SAB- spontaneous abortion (no control of her own) o EAB- elective abortion o TAB – therapeutic abortion -- Living: number of living children
40
Initial Physical Exam
- Vital Signs - Cardiovascular o Venous congestion o Edema - Musculoskeletal o Posture and gait o Height and weight o Pelvic Measurements o Abdomen - Skin - Neurologic: DTR - Endocrine: Thyroid - GI: mouth, intestine - Urinary: protein, glucose, ketones, bacteria - Reproductive: breasts, internal and external reproductive - Laboratory
41
Urinalysis
checks for: | Protein, gluccose , nitrates, glucosite, ketones (for dehydration)
42
Fundal Height
o The number of weeks = the number of centimeters (normal) o Distance from upper border of symphysis pubis and top of the fundus -- at 20 wks, right on the unbilical
43
Leopold’s maneuvers
palpating to feel where the head, back, hands and feet | --to know where to auscultate the heart of baby
44
Signs of Labor
``` o 6 contraction/ hr o Pelvic pressure o Leakage of fluid o Bleeding o 104 F – infection causes labor ```
45
Ultrasound screen
at 12-20 weeks
46
Glucose screen
at 24-28 weeks o to check if mom has gestational DM (GDM) ``` How? • Light breakfast • Drink nasty syrup • After 1 hr, Draw blood • if positive for DM, will test again • If 2 out of 2 are positive, means MOM is diabetic ```
47
Isoimmunization
???
48
Pelvic exam
Pelvic exam during last 4 weeks of pregnancy
49
Pregnancy Milestones in an Uncomplicated Pregnancy
5-6 wks -- 1st see the heart fluttering on Ultra Sound 10-12 wks -- FHR heard on fetoscope/doppler 16-20 wks -- Quickening 16-18 wks -- MFSFAP -- Maternal Serum Alfafetal Protein -- to screen for neural tube defects & Trisomy 21 20 wks -- ultrasound 20-24 wks -- Viability 26-28 wks -- GDM testing 34-36 wks -- fetal lung maturity; w/ enough surfactant 36 wk -- GBS screening
50
GBS Screening
GBS Screening: -- Group Beta Hemolytic Streptococcus o Normal vaginal/cervical flora in some women o Can cause sepsis in newborn o Can lead to infection in mother -- Screened for prenatally at 36 weeks gestation by swabbing the cervix and rectum and culturing the specimen -- Women who are GBS Positive should receive antibiotics during labor (at least 2 IV doses are required and must be given at least 4-6 hours before the baby is born to be effective) o Penicillin or Clindamycin * Once the water bag breaks (can break in months before delivery), mom gets antibiotic
51
Multifetal Pregnancies
Multifetal Pregnancies - More likely in woman with personal or family history, older mothers, infertility therapy - Greater weight gain and more rapid uterine growth - Degree of maternal physiologic change greater with multiple fetuses - More frequent antepartum visits - Educate early and often about s/s of PTL (preterm labor)
52
Teachings
-- Bathing important -- No Hot tubs or saunas -- No Douching -- Breast care -- Comfortable Clothing -- Exercise/Kegels -- Sleep and Rest -- Dental Care * periodontal disease related to Preterm Births * LBW, and increased risk for preeclampsia -- Sexual activity – no limit -- Nutrition -- Employment o Maternal safety o Exposure to teratogens -- Immunizations (live vaccines contraindicated) -- Sleeping Positions – side lying is good for circulation
53
Preventing UTIs
- UTIs common during pregnancy and may be asymptomatic - A cause of Preterm Labor - Ask if mom is prone to UTI – - Need to test bec sometimes asymptomatic
54
Discomforts Related to Pregnancy
- NAUSEA & VOMITING -- due to increased hCG and estrogen - HEARTBURN bec esophageal sphincter is relaxed - BACKACHE - Round Ligament Pain -- can’t take motrin while pregnant – tylenol better o More common on right side - URINARY FREQUENCY -- normal if no burning, urgency, or s/s of UTI - VARICOSITIES - HEMORRHOIDS – no sitting on the toilet for a long time bec it’s going to get worst - CONSTIPATION - LEG CRAMPS o Low Mg levels are cause o Imbalance of calcium and phosphorus o dorsiflex your foot to relax the muscle
55
Recognizing Preterm Labor
-- UTERINE CONTRACTIONS of 6X in an hr (every 10 min) -- Painful or Painless contractions -- Persistent or Intermittent Low Backache -- Lower abdominal cramping -- Suprapubic pain or pressure -- Pelvic pressure or heaviness -- Change in vaginal discharge -- Urinary Frequency o UTIs -- Bloody Spotting or Leaking of fluid from vagina
56
Goals of Perinatal Education
- - Helps parents become knowledgeable consumers - - Helps parents take and active role in their health, pregnancy, and birth - - Helps parents to acquire coping techniques to deal with pregnancy, childbirth, and parenting
57
Providers of Education
- - Registered Nurses - - Others certified to become perinatal educators - - Doulas
58
Types of Classes
```  Preconception  Early Pregnancy  Exercise  Childbirth Preparation  Refresher Courses  C-Section Preparation Classes  VBAC Vaginal Birth After Cessarian – VBAC  Prone to complications  Breastfeeding  Parenting  Postpartum  Siblings  Childbirth Preparation Classes ```
59
Methods of Pain Management
 Education  Relaxation  Conditioning
60
Methods of Childbirth Prep Classes
 Dick-Read Method  Bradley Method  LeBoyer Method  Lamaze Method --
61
Lamaze Method
``` Lamaze Method:  Exercises  Relaxation Techniques  Cutaneous Stimulation  Mental Stimulation  Special Techniques  Breathing Techniques ```