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nn maternal nursing > L2 > Flashcards

L2 Flashcards

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1
Q

Uterine fundus (top of uterus) will be palpable from ____ months of
gestation

A

3

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2
Q

Level of fundus is a key indication for determination of fetal size
and gestational age

near heart/lung ~ ___ months

A

9

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3
Q
  • Infrequent, irregular, and painless uterine contraction
  • Causes:
  • Activities of toning the uterine muscle cause promoting the flow of
    blood to the placenta
  • Begin as early as the second trimester
  • Most commonly experienced in the third trimester
  • Do not increase in intensity or frequency
  • Pregnant woman need to be educated of differentiate it from true labour
A

Braxton Hicks Contractions

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4
Q

General body System adaptations (1)
1. Gastrointestinal (GI)system

Physiology:
* Influenced by
increasing _____

then cause: ____________

A

progesterone &
estrogen,

➢ causes smooth
muscle relaxation
➢ decrease motility
➢ increase
proliferation of
blood vessels

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5
Q

General body System adaptations (1)
1. Gastrointestinal (GI)system

A

Mouth & pharynx:
* Gums become swollen and tend to bleed easily
* Saliva production increases → Food cravings

Esophagus
* Decreased lower esophageal sphincter tone
* Increase the risk of heartburn

Stomach
* Decreased mobility with delayed gastric emptying time
* Increases the risk of gastroesophageal reflux and vomiting

Intestines
* Decreased intestinal tone motility
* Increases risk of constipation and flatus

Gallbladder
* Decreased tone and motility
* Increased risk of gallstone formation

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6
Q

General body System adaptations (2)
2. Cardiovascular system

Blood volume:
* Increased by ~1500 mL
➢ provide a reserve to compensate for blood loss at birth
➢ adequate hydration and blood to fetus and enlarging uterus
➢ Cause haemodilution with decreased haemoglobin level →_______

A

physiological anaemia

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7
Q

Supine position at term can lower the cardiac output by 25-30% is called: ____

Causes: Heavy gravid uterus cause_______ (blood vessel) compression in supine position

A

Supine Hypotensive Syndrome,
inferior vena cava

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8
Q

epistaxis

A

鼻出血

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9
Q

General body system adaptations (5)
5. Musculoskeletal system

Progesterone and relaxin cause relaxation and increased
mobility of joints
* Aims at soften, stretch, widen the ligaments and joints to
increase the size of pelvic cavity
* make delivery easier
* Distension of fetus tilts the pelvis forward
* Results in an increased curvature of spine to compensate the
weight
* walk in “waddle gait”
* Prolonged posture gait with relaxed joints will result in ____

A

lower back pain

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10
Q

General body system adaptations (6)
6. Integumentary system

  • Hyperpigmentation of the skin due to the progesterone, estrogen
  • Darkened of skin includes areola, genital skin, axilla, inner thighs
  • ______(pigmented line from umbilicus to pubic area)
  • _______(mask of pregnancy) on the face
  • Striae gravidarum on abdomen, breasts and buttocks due
    to rapid growth and extension of skin
  • Formation of vascular spider and
    palmer erythema
A

Linea nigra
Melasma

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11
Q

General body system adaptations
7. Endocrine system

  • Slightly enlarged ____gland and increase its activity leading to increase in basal metabolic
    rate
  • Maintaining ____ secretion to control the duration of gestation
  • Produce more ____to overcome the increasing blood glucose from the mother to the growing fetus
  • Enlarged _____ to secrete hormone for fetal maturation.
  • Release of oxytocin and prolactin for birth and lactation.
A

thyroid
Human chorionic gonadotrophin (hCG)
insulin
pituitary gland

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12
Q

Endocrine System
Production of different hormone via _____: -
o Human chorionic gonadotrophin (HCG)-to prevent involution of corpus luteum and cause
spontaneous abortion
o Human placental lactogen (HPL)-to stimulate the mother’
s metabolic processes to ensure
more protein, glucose and minerals are available for the fetus
o Relaxin –to prepare for delivery by loosening the muscles, joints and ligaments
o Progesterone -to prevent the uterus from contracting
o Estrogen -to proliferate uterine lining, to enlarge uterus and breasts.

A

placenta

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13
Q

General body system adaptations (8)
8. Immune system
* Enhancement of inflammatory response
* prevent getting risk of developing certain infection and disease
* Suppression of ____ (protective response to foreign antigen)
* prevent the mother’s immune system from rejecting the fetus (foreign body)

A

adaptive immunity

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14
Q

Caloric intake during pregnancy
* Pregnant (Singleton) woman of normal weight should have caloric intake of:
* ____kcal during the first trimester
* _____ kcal during second trimester
* _____ during third trimester
* Caloric intake increases for multiple pregnancy with adding ___kcal for each baby for a day

A

1800
2200-2500
2400-2500
300

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15
Q

Low birth weight

A

<2.5 kg

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16
Q

Fetal macrosomia

A

> 4 kg

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17
Q

Nutritional needs during pregnancy

A

folic acid
vitamin a
iodine
iron
calcium
vitamin d
omega-3/ fatty acids

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18
Q

functions of folic acid during pregnancy

A

prevents fetus from neural tube defect. e.g. spinal bifida
prevent mother from anemia

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19
Q

functions of iodine during pregnancy

A

baby growth, brain development

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20
Q

WHO recommends ____ iodine intake during pregnancy

A

250 mg daily

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21
Q

Inadequate ____ intake may increase risk of preterm labor and gestational hypertension

A

Calcium

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22
Q

Education for Breast tingling, tenderness &
enlargement

A
  • Wear supportive maternity bras
  • Avoid breast message
  • Self hygiene with warm water and keep dry
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23
Q

Education for Urine urgency and frequency

A
  • Empty bladder regularly
  • Limit fluid before bedtime
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24
Q

Education for Fatigue and malaise (most
common)

A
  • Rest as needed
  • Well balanced die
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25
Education for Nausea and Vomiting; Morning sickness
* Avoid empty or overloaded stomach * Small frequent meals * Maintain good posture after meal * Eat dry carbohydrate
26
Education for Gingivitis
* Well balanced diet * Brush teeth gently * Good dental hygiene and avoid infection
27
Education for Nasal stuffiness; epistaxis
* Use humidifier * Avoid trauma or pricking nose
28
Education for Increased vaginal discharge
* Do not douche * Wear pads and change regularly * Regular perineal hygiene
29
Education on self management : Pigmentation spots, acne, oil skin
* Use mild skin care products * Avoid phototherapy
30
Education on Palpitations
* Seek medical advice if accompanied by cardiac symptoms (SOB, cynosis)
31
Education for Constipation
* Increased fluid and fiber intake * Exercise moderately * Advise do not take laxatives unless prescribed by health care provider
32
Nurse interview and history taking in First Antenatal Visit
1. Interview and record the pregnant history in terms of Gravida and Parity 2. Calculation of Estimated date of confinement (EDC) and Maturity 3. Assessment and interview: age, race, religion, occupation, marital status, past health history, drugs, nicotine using, LMP, Menstrual history, age at which menstruation began, number of days and regularity in the cycle, previous abortions, previous birth and conditions
33
By Nägele’s rule, calculate Estimated date of confinement (EDC)
Calculation Steps- – Step 1: take the LMP – Step 2: + 7 days – Step 3: - 3 months – Step 4: Adjust the year
34
Method 3 of Estimated date of confinement (EDC): By ultrasound To measure the____ length, head and abdominal circumferences, femur length to estimate the gestational age. * Used when the woman’s LMP are uncertain or irregular menstruation period
crown rump
35
Physical examination Head to toe examination: * Body height and weight measurement * Body height <____cm – short stature → at risk of inadequate pelvic capacity * Short stature is NOT contraindicated to vaginal delivery if no other complication * Case of overweight or underweight * Watch for any pallor, dyspnea, palpitation, arrhythmia, edema, spine deformity. Breast examination: * Symmetric in size and contour, erect nipples, pigmentation of areolas and nipples, axillary nodes, breast lumps or discharge. Abdominal examination : * Most important examination to determine fetal well being (Discussed in next section) +/-Pelvic and vaginal examination
150
36
Abdominal Examination 2. Palpation ____ to determine: o Uterine size o Fetal lie, presentation, and engagement o Amount of liquor o Uterine shape and irregularity
Leopold’s Maneuvers
37
Most common fetal presentation in term:
Cephalic presentation
38
Normal Inspection findings Gravid uterus is usually ____ oval in shape
longitudinal
39
Engagement of fetal head _____ above brim means fetal head are engaged * If the head is high, an _____ may be performed to exclude cephalopelvic disproportion (CPD)
2/5 or 1/5 high (4/5, 5/5) ultrasound scan
40
Abdominal Examination 3. Measurement of symphysio-fundal height * Distance measured with a tape from top of the pubic bone to top of the uterus (fundus) * Fundal height normally equal to the number of gestation * Affected by fat tissue layer, maternal body build and fetal presentation o By ___weeks gestation, the fundus is at level of the umbilicus and measures about ___cm. o By ____weeks gestation, fundus is at level of the xyphoid process (xiphisternum) o By 40weeks, fundus will lower under xyphoid process due to engagement of fetal head
24, 24 36
41
Abdominal Examination 4. Auscultation * From about 16 weeks fetal heart sounds may be heard via: o Electronic doppler monitor (Doptone) o Pinard monaural fetal stethoscope or the binaural stethoscope * Fetal heart sound are heard best at fetal shoulder of the fetal ____ * A uterine souffle (uterine arteries blood flow), may also be heard * Fetal heart beat will be heard for one full minute for the most accurate result o Normal range of FHR : ___bpm o Out of the range may considered changes in fetal oxygenation
back lies (fetal back) 110-160
42
Any irregular heartbeat found in fetal should
compare with the maternal pulse first
43
Cardiotocography (most reliable) * Recording the fetal heartbeat and the uterine contractions with mother’s subjective fetal movement by using the external electronic machine * Widely used to assess fetal wellbeing by reviewing the sympathetic nervous system of the fetus Indications:
* Decreased fetal movement * Onset of / In labour (most common) * Suspected fetal asphyxia * Risk of labour or any obstetric complications
44
3. Fetal movement kick count (FKC) * Maternal perception of fetal movement * Simplest, cost effective way for fetal well-being but may not be reliable * Used at least after __weeks when woman feels the fetal movements well
24
45
Fetal movement kick count (FKC) Indications:
Indications: * Decreased fetal movement * Intra-uterine Growth Retardation * Oligohydramnios * History or suspected of intrauterine death
46
Obstetric Ultrasound * Imaging uses low-energy, high-frequency sound waves * Fetal heartbeat, malformation can be measured accurately * Non-invasive, safe and accurate * May not be effectively to assess the fetal wellbeing in continuous interval Indications:
* Pregnancy location & viability, gestational age dating * Multiple gestation * Amniotic fluid volume (oligohydramnios, polyhydramnios) * Fetal growth (IUGR, macrosomia) * Fetal morphology, anomalies, fetal well-being * Pregnancy bleeding * Uterine and fetal blood flow * Prenatal diagnosis
47
Indications of offering prenatal diagnosis and counselling:
* Advanced maternal age: women ≥35 years of age o at increased risk of fetal trisomy (e.g., Trisomy 21 and 18) * Multiple fetal losses * Previous child: o neonatal death, mental retardation, aneuploidy, known genetic disorder * Family history: o genetic diseases, birth defects, mental retardation * Abnormal prenatal blood test or ultrasound scan result * Parental aneuploidy
48
Invasive Diagnostic Tests:
Amniocentesis Chorionic Villus Sampling (CVS)
49
Non-invasive Screening Tests:
Nuchal Translucency (NT) OSCAR, NT+Biochemical screening (BS) T21 (SafeT21): Nifty Test: Panorama: Another NIPT option for assessing genetic conditions.
50
Oral Glucose tolerance test Procedures: * Fasting for at least 8 hours before the test * Take fasting blood for glucose * Drink __g glucose water * Take blood again after 2 hours * Require to remain quiet and calm during the test results: <___ mmol/L - normal ___ - ___ mmol/L - impaired glucose tolerance ___ mmol/L - diabetes
75, 7.8 7.8-11.0 >11.1
51
Management for positive Group B Streptococcus screening test:
o Mother with positive GBS will be given intrapartum prophylactic IV antibiotics at their onset of labour or membrane ruptured o The newborn will also give with IV antibiotics, depends on the course and length of IV antibiotics the mother was received intrapartum o Babies born to all these mothers will be observed for signs of infection before discharge.
52
Severe form of vomiting during pregnancy
Hyperemesis gravidarum
53
Causes of Hyperemesis gravidarum
* Elevated and excessive hCG level and estrogen during through pregnancy (normally decline after 12 weeks) * Vitamin B6 deficiency
54
Medical management for Hyperemesis gravidarum:
* Mild: o Give Vitamin B6 supplement as prescribed o Antihistamines such as Maxolon or avomine to control vomiting * Severe and uncontrollable vomiting: o Hospitalization with intravenous infusion for fluid balance * In life-threatening cases: o Enteral feeding and total parenteral nutrition (TPN)
55
Hypertensive disorder of pregnancy: ————— * Blood pressure of ≥140/90 mmHg after 20 weeks’ gestation for more than one occasion * May prescribed anti-hypertensive drugs if BP not controlled_
Pregnancy-induced hypertension (PIH)
56
Hypertensive disorder of pregnancy: ______ * High blood pressure with proteinuria for more than one occasion, and may be accompanied with the following: * General Malaise * Dizziness * Headache * Vision disturbance * Epigastric pain * Abdominal pain * Generalized edema and limbs edema * Oliguria
Pre-eclampsia
57
Causes of pre-eclampsia
* Generalized vasospasm during pregnancy * Vasospasm in kidney cause increase in capillary permeability and escape of protein in urine * Elevated of blood pressure and reduced blood flow to the main organ and placenta * Cause inadequate nutrients supply to the fetus
58
Consequences of severe or uncontrolled PET
* Eclampsia: The onset of seizures (fits) in pregnancy * HELLP syndrome: “Heomolysis, elevated liver enzymes, low platelet count” → life threatening to mother and fetus
59
Management for pre-eclampsia
* Delivery is the only way to cure pre-eclampsia * Antihypertensive drugs to control BP if prematurity * For uncontrolled BP, delivery is needed despite of the maturity
60
______ * Disorder of the endocrine system (Lack of insulin) that affects the metabolism of carbohydrates, fats and protein * During pregnancy, the hormones secreted by the placenta inhibits the action of insulin causes GDM
Gestational diabetes Mellitus
61
Management of GDM during antenatal period:
* Refer dietician for diet control (GDM 1600-2000 diet) * Need insulin/oral antidiabetic agent if poor glycemic control * Mode of delivery: May need earlier induced delivery (Induction of labour) at term
62
Fetal complications to Gestational diabetes Mellitus
* Macrosomia (Big baby) * Neonatal death * Birth trauma * Intrauterine death * Shoulder dystocia * Risk of develop DM in late life * Unstable blood glucose contro
63
Maternal Complications to Gestational diabetes Mellitus
Risk of instrumental delivery Risk of caesarian delivery Pre-eclampsia Preterm labour
64
____ Vaginal bleeding from 24 weeks to delivery of the baby
Antepartum Haemorrhage
65
placenta completely covering cervix
Placenta Previa
66
dettached placenta cause bleeding
Placenta abruptio
67
Initial evaluation of Antepartum Haemorrhage
- Assess blood loss by pad inspection or USG monitoring - Assess maternal well being (vital signs) - Assess fetal well being (Abdominal examination, Doptone and CTG monitoring) - Set up intravenous line, prepare cross match for blood replacement
68
Management for Antepartum Haemorrhage (APH)
If term or nearly term >35 week → Delivery If preterm or severe preterm → Expectant management with dexamethasone injection to mother to hasten the lung surfactant maturity of the fetus
69
Nursing care to Antepartum Haemorrhage
* Psychological support to mother. * Monitor the vital signs and SpO2 to detect shock. * Save pads to monitor the vaginal bleeding. * Assess fetal movement and auscultate the fetal heart rate to monitor the fetal well being. * Advise bed rest and avoid strenuous exercise and heavy lifting. * Advise to inform nurses for any increase vaginal bleeding &uterine contraction. * Administer IV infusion and advise not to take any food in case of heavy bleeding * Prepare for delivery is required in case of heavy bleeding, regular uterine contraction or fetal distress
70
Regular uterine contractions accompanied by dilatation of cervix after 20 weeks and before 37 weeks. *Very preterm –delivery before 28 weeks of delivery *Incidence rate:6-10% *Prediction of preterm labor is difficult
preterm labour
71
Treatment for preterm labour
* Tocolytic therapy to stop uterine contraction. * Corticosteroid to facilitate fetal lung maturity. * Antibiotics to reduce the fetal infection. * Continuous / intermittent CTG for fetal and uterine activity. * Decided the optimal time of delivery (elective delivery).

nn maternal nursing (4 decks)

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