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RN Spring 2021 > Maternity Ch. 4 > Flashcards

Maternity Ch. 4 Flashcards

1
Q

What does increased estrogen and progesterone levels do to the breast?

A
  • Tenderness, feeling of fullness, and tingling sensation
  • Enlargement of breasts, nipples, areola, and Montgomery follicles (small glands on the areola around the nipple)
  • Striae
  • Increase blood flow
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2
Q

Striae

A

Due to stretching of skin to accommodate enlarging breast tissue

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3
Q

Colostrum

A

Yellow secretion rich in antibodies and begins to be produced as early as 16 weeks

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4
Q

How big can the uterus stretch?

And the purpose of the enlargement?

A
  • 20x of pre=pregnant uterus

- To accommodate developing fetus and placenta

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5
Q

pH of vagina

And can lead to?

A

Acidic environment inhibits growth of bacteria

-Acidic environment allows growth of Candida albicans, leading to increased risk of candidiasis (yeast infection)

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6
Q

Cardiac changes with pregnancy. What happens with:

  • Peripheral vascular resistance
  • Blood volume
  • Cardiac output
  • Position of heart
A
  • Decrease PRV = decrease BP
  • Increase blood volume = hypervolemia of pregnancy
  • Increase cardiac output = increase heart rate
  • Heart moves up and lateral due to uterus getting bigger and places the diaphragm
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7
Q

Supine Hypotension

A

In supine position the enlarged uterus compresses the inferior vena cava, causing reduced blood flow back to the right atrium and a drop in cardiac output and blood pressure

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8
Q

S/S of supine hypotension

A
  • Dizzy
  • Faint
  • Shallow and fast respirations
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9
Q

3 parts of the uterus

A

Fundus (upper)
Isthmus (lower segment)
Cervix (lower narrow part)

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10
Q

Estrogen, progesterone, and prostaglandins cause vascular engorgement and smooth muscle relaxation which leads to

A

Dyspnea

Nasal and sinus congestion Epistaxis

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11
Q

Renal changes during pregnancy

A

Urinary frequency and incontinence and increased risk of UTI

-Urine amount stays the same

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12
Q

What causes n/v during early pregnancy?

A

Increased levels of hCG and altered carb metabolism

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13
Q

What causes bloating, flatulence, and constipation?

A

Increased progesterone levels relax smooth muscle to slow the digestive process and movement of stool

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14
Q

What causes heartburn?

A

Increased progesterone levels slow stomach emptying and relax the esophageal sphincter

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15
Q

Pica

A

Abnormal; craving for and ingestion of nonfood substances such as clay or starch

  • *Know what pt is eating
  • **Leads to malnutrition
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16
Q

What happens to the musculoskeletal system with increases progesterone and relaxin levels?

A

lead to softening of joints and increased joint mobility, resulting in widening and increased mobility of the sacroiliac and symphysis pubis.

***Leads to increase risk of falls

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17
Q

S/S of pregnancy’s effect on musculoskeletal system

A

Altered gait: “Waddle” gait

Low back pain or pelvic discomfort

Increased risk of falls due to shift in center of gravity and change in gait and posture

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18
Q

Effects of integumentary system

A

Estrogen and progesterone levels stimulate increased melanin deposition, causing light brown to dark brown pigmentation.

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19
Q

Linea Nigra

A

pregnancy line, is a linear hyperpigmentation that commonly appears on the abdomen

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20
Q

Melasma (chloasma)

A

“mask of pregnancy”
darker pigments on cheeks, nose, and forehead
Happens mostly to darker pigmented moms

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21
Q

Fxn of endocrine system during pregancy

A

Makes hormones until placenta is ready

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22
Q

What must immune system do?

A

adaptive process involves the maternal immune system becoming tolerant of the “foreign” fetal system so that the fetus is not rejected and is protected from infection

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23
Q

Presumptive Signs of Pregnancy

A

(Subjective - could happen outside of pregnancy and are not considered diagnostic)

● Amenorrhea: Absence of menstruation
● Nausea and vomiting: Common from week 2 through 12
● Breast changes: Changes begin to appear at 2 to 3 weeks
-Enlargement, tenderness, and tingling
-Increased vascularity
● Fatigue: Common during the first trimester
● Urination frequency: Related to pressure of enlarging uterus on bladder; decreases as uterus moves upward and out of pelvis
● Quickening (does not happen right away like a missed period does!) : A woman’s first awareness of fetal movement; occurs around 18 to 20 weeks’ gestation in primigravidas (between 14 and 16 weeks in multigravidas)

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24
Q

Probable Signs of Pregnancy

A

(Objective signs - these changes can have other causes and are not diagnostic)

● Chadwick’s sign: Bluish-purple coloration of the vaginal mucosa, cervix, and vulva seen at 6 to 8 weeks ● Goodell’s sign: Softening of the cervix and vagina with increased leukorrheal discharge; palpated at 8 weeks
● Hegar’s sign: Softening of the lower uterine segment; palpated at 6 weeks
● Uterine growth and abdominal growth
● Skin hyperpigmentation
-Melasma (chloasma), also referred to as the mask of pregnancy: Brownish pigmentation over the forehead, temples, cheek, and/or upper lip
-Linea nigra: Dark line that runs from the umbilicus to the pubis
-Nipples and areola: Become darker; more evident in primigravidas and dark-haired women
● Ballottement: A light tap of the examining finger on the cervix causes fetus to rise in the amniotic fluid and then rebound to its original position; occurs at 16 to 18 weeks
● Positive pregnancy test results
-Laboratory tests are based on detection of the presence of hCG in maternal urine or blood.
-The tests are extremely accurate but not 100%. There can be both false-positive and false-negative results. Because of this, a positive pregnancy test is considered a probable rather than a positive sign of pregnancy.
-A maternal blood pregnancy test can detect hCG levels before a missed period.
-A urine pregnancy test is best performed using a first morning urine specimen, which has the highest concentration of hCG and becomes positive about 4 weeks after conception.
-Home pregnancy tests are also accurate (but not 100%) and are simple to perform.

25
Q

Positive Signs of Pregnancy

A

The positive signs of pregnancy are the objective signs of pregnancy (noted by the examiner) that can only be attributed to the fetus:

● Auscultation of the fetal heart, by 10 to 12 weeks’ gestation with a Doppler
● Observation and palpation of fetal movement by the examiner after about 20 weeks’ gestation
● Sonographic visualization of the fetus: Cardiac movement noted at 4 to 8 weeks

26
Q

Antepartum period (prenatal period)

A

begins with the first day of the last menstrual period (LMP) and ends with the onset of labor

27
Q

Intrapartal Period

A

Labor

28
Q

Naegele’s Rule

A

LPM - 3 months + 7 days = estimated date of delivery

29
Q

How to calculate EDD if LPM is unknown?

A

● Physical examination to determine uterine size (Fundal height)
● First auscultation of fetal heart rate with a Doppler and/or a fetoscope (stethoscope for auscultation of fetal heart tones)
• Date of quickening
● Ultrasound examination (***best way!!)
● History of assisted reproduction

30
Q

Two factors influence the accuracy of Naegele’s rule:

A

● Regularity of a woman’s menstrual cycles
● Length of a woman’s menstrual cycles
-Results may not be accurate if menstrual cycles are not regular or are greater than 28 days apart.

31
Q

Gravida

A

refers to the total number of times a woman has been pregnant, without reference to how many fetuses there were with each pregnancy or when the pregnancy ended. It is simply how many times a woman has been pregnant, including the current pregnancy (**)

32
Q

Para

A

refers to the number of births after 20 weeks’ gestation whether live births or stillbirths. There is no reference to number of fetuses delivered with this system, so twins count as one delivery, just like a singleton birth. A pregnancy that ends before the end of 20 weeks’ gestation is considered an abortion, whether it is spontaneous (miscarriage) or induced (elective or therapeutic), and is not counted using the G/P system.

33
Q

GTPAL

A

● G = total number of times pregnant (same as G/P system) (twins count as one here)
● T = number of term infants born (between 38 and 42 weeks’ gestation)
● P = number of preterm infants born (between 20 and 37 6/7 weeks)
● A = number of abortions (either spontaneous or induced) before 20 weeks’ gestation (or less than 500 grams at birth)
● L = the number of children currently living (count all babies here; twins = 2; triplets = 3)

34
Q

What are some hormonal changes that happen to a women who just got pregnant?

A

Hormonal influences to the breasts and reproductive system will cause discomfort and change, such as breast tenderness, a darkening of the areola and nipple, and increased leukorrhea, or vaginal discharge.

35
Q

How often are MD appts in first trimester?

A

Monthly

36
Q

What should first prenatal visit include?

A

education on expected physical and emotional changes, as well as signs and symptoms to report

complete gynecological and obstetric history will also be taken, along with fundal measurements, baseline laboratory work and an ultrasound Doppler of the fetal heart rate

37
Q

What kind of food should be avoided?

A

Raw eggs
Seafood
Unpasteurized food
Deli meat

38
Q

Second trimester education?

A

Information on preterm labor, along with signs and symptoms of other complications such as hypertensive disorders

39
Q

Second trimester warning signs?

A 
Visual changes
Sudden edema 
Vaginal spotting
Pelvic pressure
Severe headaches
40
Q

Which is the most challenging trimester?

A

3rd

41
Q

Discomforts in 3rd trimester

A

Discomforts are amplified, with fatigue, insomnia, aches, pains, and emotional lability all impacting Mom daily

42
Q

Encouraging positive coping mechanisms for third trimester?

A

daytime naps, eliminating caffeine, and enlisting help from family and friends is an important nursing responsibility during these visits

43
Q

How often are MD appointments in second trimester?

A

Every month

44
Q

How often are MD appts in third trimester?

A

every 2 weeks; then weekly at 36 weeks

45
Q

Education for third trimester?

A

excellent times to discuss birthing and parenting classes, as well as breastfeeding classes. Education on signs of impending labor and when to contact the provider are also important in these last few weeks.

46
Q

Nursing education for fatigue

A
  • Encourage rest

- Enlist support of family and friends

47
Q

Nursing education for insomnia

A
  • Routine for bedtime

- Eliminate caffeine

48
Q

Nursing education for breast discharge

A
  • Reassure mom it is normal

- Recommend soft cotton breast pads

49
Q

Braxton-Hicks

  • How they go away?
  • When to call MD?
A
  • Go away with relaxation, hydration, and side laying
  • Educate that as uterus grows occasional contractions are normal
  • Call MD if contractions become regular and persist before 37 weeks
50
Q

Nursing education for orthostatic hypotension

A

Advise women to keep moving feet when standing and avoid standing for long periods of time

51
Q

Nursing education for edema

A

Instruct:

  • Wear loose clothing
  • Avoid prolonged standing or sitting
  • Elevate legs
52
Q

Nursing education for SOB

A
  • Encourage good posture
  • Instruct the woman to stand and stretch
  • Suggest sleeping semi-sitting with pillows for support
53
Q

Nursing education for nasal and sinus congestion/ epitaxis

A
  • Cool air humidifier

- Avoid use of decongestants and nasal spray; use normal saline drops

54
Q

Nursing education of urinary frequency/urgency

A
  • Reassure it is normal
  • Encourage to empty bladder and wipe from front to back
  • Main proper hydration
55
Q

Nursing education for N/V

A
  • Avoid spicy/greasy foods, large meals, stuffy rooms, hot or loud places
  • Avoid fluid intake with meals
  • Eat dry toast or crackers when nauseous
56
Q

Nursing education for bleeding gums

A

-Maintain good oral hygiene (brush gently with soft toothbrush, daily flossing)

57
Q

Nursing education for heart burn

A
  • Small, frequent meals
  • Maintain hydration and avoid fluids with meals
  • Avoid fatty/fried foods
  • Remain upright for 30-45 mins after eating
  • Do not eat at least 3 hours prior to bedtime
58
Q

Nursing education for low back pain/joint discomfort/ difficulty walking

A
  • Maintain healthy weight gain
  • Use good body mechanics
  • Good posture
59
Q

Nursing education for striae

A
  • No method to prevent them
  • Lotions, oatmeal baths, nonbinding clothing
  • Good weight control

RN Spring 2021 (7 decks)

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