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Flashcards in MatAdap, PregComp Deck (52):

Indications of pregnancy but no definite diagnosis can be made.

Presumptive/subjective signs
Amenorrhea, nausea, vomiting, frequent urination, fatigue, fetal movement, breast changes.


Strong evidence of pregnancy but no definite diagnosis can be made.

Probable/objective signs
Hager's sign, Chadwick sign, ballottement of head, home pregnancy test


Signs only caused by the developing fetus

Positive signs.
Hearing the fetal heart rate, palpation of the fetus, ultrasounds.


Changes in the uterus during pregnancy?

Braxton hick's contractions, hager's sign. Increases in strength and elasticity. Gradual growth (enters the abdomen at about 13 weeks). Reaches the xyphoid process at term.


Changes in the cervix during pregnancy?

Softens to allow expulsion of the uterus. Goodell's and Chadwick's signs. Mucus plug prevents entry of pathogens.


GI changes?

Appetire increase due to increased metabolic demands. Relaxation and slower emptying of the stomach and intestines. Gums are hyperemic with increased dental plaque. Constipation.


Cardio changes?

50% increase over pre-pregnancy blood volume (the plasma). Physiologic anemia of pregnancy. Supine and orthostatic hypotension. Increased clotting factors.


Respiratory changes?

Pressure on the diaphragm with the growing uterus. History of asthma and there respiratory problems can decompensated more quickly. Increased cardio congestion (nasal congestion-epistaxis)


Urinary changes?

Increased glomerular filtration rate (more blood flow and volume, accumulation of glucose and protein). Increased risk for UTI's.


Musculoskeletal changes?

Lordosis. Pressure on the ligaments that support the uterus. Release of relaxin.


Expected weight gain during pregnancy?

1st trimester gains 5 pounds total. Then, 1 pound per week. Based on BMI. Needs to gain different amounts of weight based on starting BMI.
Under: 28-40 pounds
Normal: 25-30 pounds
Overweight: 15-25 pounds


Calories, protein, iron, and folic acid while pregnant? Vitamins?

Additional 300 calories. Protein intake needs to increase by 30%. Iron by 30%. Folic acid 25%. Vitamins A and C have smaller required doses, with a prenatal vitamin daily.


What can cause bleeding during pregnancy?

Abortion, ectopic pregnancy, cervical insufficient, placenta previa, abrupto placentae


What should be done in a nursing assessment for an abortion?

Description and duration of bleeding and clots. Evaluate the intensity of abdominal pain. Vital signs and the level of pain. Support in the grieving process with reassurance. Possible medications.


Fertilized ovum implants outside the uterine cavity. Possibly cause by the zygote being unable to travel along the Fallopian tube.

Ectopic pregnancy. Ad it grows, it draws blood supply from the site. No site other than the uterus can support placental implantation or growth of the embryo. A ruptured pregnancy is a medical emergency.


Nursing assessment for an ectopic pregnancy?

Health history. 6-8 weeks after missed period, spotting, ab pain. Risk factors. S/s of internal bleeding if ruptured. Diagnostic testing: beta-hCG levels are too low for the length of the pregnancy, visualization of a mass outside the uterus. Education.


Non-painful, rapid dilation and effacement, minimal bleeding. Structurally defective cervix.

Cervical insufficiency (CI). 2nd or 3rd trimester of pregnancy. Management includes bed rest or pelvic rest. Avoidance of heavy lifting. Placement of a cerclage as late as 28 weeks,


Nursing assessment for CI?

History of cervical trauma or surgery, preterm labor, fetal loss in the second trimester, often around 20 weeks. Complaints of pelvic pressure or pink tinged discharge to bleeding. Loss of amniotic fluid.


Implantation of the placenta in the lower uterus.

Placenta previa. "Afterbirth first"
Total, partial, marginal, low-lying. Bleeding in the 2 or 3 trimester. Painless, bright red, comes and goes. Secondary to thinning of the uterus for labor. Lower uterus cannot contract well to stop the bleeding.


Nursing assessment and management of placenta previa?

Health history, risks, education. May be treated with bed rest.
When actively bleeding: pad count, V/S, FHTs, abdomen. No vaginal exams. Oxygen at the bed side.


Separation of the normally located placenta at greater than 20 weeks. Bleeding behind the placenta causes this.

Abruptio placentae.
Fetal blood supply is compromised which leads to fetal distress.
History: 80% have vaginal bleeding that is dark red. 20% have no overt signs of bleeding. "Knife-like" abdominal pain that can be rigid.


Assessment and management of abruptio placentae?

Bed rest on the left lateral position. Frequent vitals, fundal height checks, peri pad count. Foley and large-bore IV insertion. Fetal and contraction monitoring. Watch for unusual bleeding and report gums, oozing from the IV site.


Persistent, uncontrollable nausea and vomiting.

Hyperemesis gravidarum.
Dehydration, greater than or equal to 5% of body weight loss. Electrolyte imbalance. Hospitalization.


History, labs, diagnostic for hyperemesis gravidarum?

History of risk factors. Physical exam. Liver enzymes, CBC, TSH/T4, urine specific gravity, electrolytes, ultrasound


Nursing management of hyperemesis gravidarum?

NPO 24-36 hours. IV fluids with normal saline with electrolytes and vitamins added. IV or IM anti-emetics until able to eat. G-tube if oral intake is unsuccessful.


140/90 prior to the 20th week of pregnancy?

Chronic HTN. No proteinuria. Increased risk for the development of preeclampsia.


Systolic is greater than 140 and/or diastolic is greater than 90.

Gestational HTN. At least twice, taken at least 6 hours apart after the 20th week in a woman known to be normotensive prior to that. No proteinuria. Increased risk for the development of preeclampsia.


Nursing assessment of preeclampsia?

Accurate measurement of maternal BP, with same device and same position. Frequent weights. Subjective complaints: visual changes, worsening headaches, bleeding or nursing, epigastric pain, rings feeling small


What can be used to prevent seizures in preeclampsia? It also blocks neuromuscular transmutation and is a vasodilator. Management?

Magnesium sulfate.
Monitor magnesium levels closely. Assess DTRs and check ankle clonus. Calcium gluconate available to toxicity (CNS depression, hypotension, decreased DTRs and RR)


Nursing considerations for magnesium sulfate?

Loading dose, then 1-4gm/hr. Continuous monitoring of fetal heart tones. Monitor and report: hypotension and/or dperessed DTRs, LOC, blurred vision, headache. U/o less than 30mL/hr, I/O hourly. RR less than 12 breaths per minute.


Nursing management of eclampsia?

Generalized, begin with facial twitching.
Alternating contraction and relaxation of the muscles. Turn to side lying and stay with pt. Raise bed rails with padding. Dim lights and quiet environment. Document time of seizure, oxygen after cessation of seizure. Continue mag sulf and electronic fetal monitoring. Prepare for delivery


HELLP for severe pre-eclampsia signs?

Liver function tests
Platelet count


Occurs when a pregnant woman's blood type is O, which contains naturally occurring antibodies against type A and B blood (anti-A and anti-B).

ABO incompatibility.
If pregnant with a fetus with non-O blood (A, B, or AB), her anti-A or anti-B antibodies can cross the placenta and cause hemolysis of fetal red blood cells.


Pregnant women with Rh(-) factor becomes pregnant with a fetus that has an Rh(+) factor. Mother has no symptoms but it adversely affects fetal health.

Rh incompatibility. Erythrocytes from the fetal circulation leak into the maternal circulation causing maternal antibodies to be made against the fetus' Rh(-) anti-D antigen. They cross the placenta and destroy fetal RBCs resulting in hemolytic disease of the newborn.


Risks for Rh incompatibility?

Being pregnant, invasive procedures, trauma.


Rh(-) mothers who are pregnant with an Rh(+) infant get what medication at 28 weeks?

Rhogam (blood product). Within 72 hours post part, after miscarriage or abortion, after amniocentesis or chorionic villi sampling to prevent sensitization to the D antigen of the Rh(+) fetus.


Binds fetal red blood cells with the D antigen before the mother is able to produce an immune response and form anti-D antibodies.

Rhogam (blood product)


Dominance and recessiveness of blood types?

Type A and B are dominant over O.
Type A and B are considered co-dominant.
Type O is recessive.


Which blood types come together to make what other ones?

AO=type A
BO=type B
OO=type O
AB=type AB


Greater than 2000mL of amniotic fluid between 32-36 weeks. Causes, risk, and signs?

Amniotic fluid imbalance, or hydramnios.
Causes: gestational diabetes and upper GI problems of the fetus, fetal anomalies.
Risks: PROM, preterm delivery, prolapsed cord
Signs: dyspnea, fundal height greater than dates


Less than 500mL amniotic fluid between 32-36 weeks. Causes and signs?

Amniotic fluid imbalance, or oligohydramnios.
Causes: conditions that do not allow the fetus to make to excrete urine.
Signs: fundal height < dates. May be unaware of PROM.


Rupture of membranes before labor begins in term pregnancy, greater than or equal to 38 weeks.
Rupture before labor beings in preterm pregnancy, less than 38 weeks.

Alkalinity of fluid on special "nitrazine" paper, fern appearance on microscope slide or speculum visualization


Concerns for the premature rupture of membranes?

Infection, fetal lung maturity, cord compression or prolapse, closely observe in the hospital but some women are managed at home


Promotes fetal lung maturity by increasing surfactant. Improvement in lung maturity can be seen after 24 hours.

betamethasone (Celestone)
2 doses Im 24 hours apart. Repeat in 7 days until the lungs are mature or delivery.
Monitor mother for infection, especially in the lungs.


What is involved in insulin resistance due to placental hormones?

Gestational diabetes. Remember the importance of preconception counseling. Blood glucose is gone at first prenatal visit if at risk. Normal is fasting <126 mg/dL
Blood glucose challenge at 24-28 weeks. 1 hour test abnormal is >140 mg/dL. If abnormal a 3 hour challenge is done at a later time.


What are risks for gestational diabetes?

HTN early pregnancy, recurrent candida infections, BMI>30, infant with congenital abnormality. Infant > or equal to 4,000 grams. Unexplained fetal demise or neonatal death. Age >25 years. Family history of diabetes.


What maternal things should be monitored with diabetes?

Urinary protein, ketones, nitrates. Kidney function, creatine clearance and protein levels. Eye exams and HbA1c.


What fetal things should be monitored with diabetes?

U/s for growth, activity, and amniotic fluid levels. AFP for congenital anomalies. Weekly NSTs, BPP as needed. Amniocentesis for fetal lung maturity.


Medical providers often don't care for pregnant women with this disease. Disproportionate affect on services for people living with it.

HIV. Pregnant women may not know they have it. 8500 give birth annually. No breastfeeding or pre-chewing infants food if they are HIV+. Vulnerable populations include adolescents, women greater than 35 years of age, and women who abuse substances.


These medications before and during pregnancy reduce the risk of the child contracting HIV from 28% to <2%.

Antiretroviral (ART). Taken at the same time every day, missing doses can be very detrimental. Infant must be treated for 4-6 weeks after birth to reduce risk.


What effects can smoking and alcohol have on the baby?

Smoking: heart, cleft and placental problems, preterm births, LBW
Fetal alcohol syndrome


What effects can caffeine and tobacco, marijuana, stimulants have on the baby>

Caffeine: LBW, irritability in large amounts
T,M,S: Can double or triple the rate of the stillborn