Module 4 - Antepartal Considerations (Exam 2) 1 Flashcards Preview

Semester Three - Half Two - Nursing 212 > Module 4 - Antepartal Considerations (Exam 2) 1 > Flashcards

Flashcards in Module 4 - Antepartal Considerations (Exam 2) 1 Deck (52):
1

Holistic Nursing Care General Considerations

  1. Age
  2. History
  3. Medications
  4. Emotional Health
  5. Medical Concerns
  6. Nutrition and Exercise
  7. Lifestyle and cultural influences

2

Subjective (presumptive) signs of pregnancy

Symptoms experienced and reported

3

Objective (probable) signs of pregnancy

Signs that suggest pregnancy

4

Diagnositc (positive) signs of pregnancy

  1. Indications percieved by CNM, NP, physician
  2. Attributable only to pregnancy

5

When does quickening happen?

16-18 weeks, for sure by 20 weeks

6

Subjective Signs of Pregnancy

  1. Fatigue
  2. Quickening
  3. Amenorrhea (no period)
  4. Breast tenderness
  5. Urinary frequency
  6. Nausea and vomiting

7

Quickening

Sensation of movement of the fetus

8

Objective Signs of Pregnancy

  1. Ballottment
  2. Skin changes
  3. Uterine enlargement
  4. Positive pregnancy test
  5. Changes in reproductive organs

9

Diagnositc Signs of Pregnancy

  1. Fetal Heart Sounds
  2. Fetal movement felt by examiner
  3. Ultrasonography

10

Diagnostic - Fetal Heart Sounds

  1. At 8-12 weeks by electronic doppler
  2. At 17-20 weeks by fetoscope

11

Diagnositc - Fetal movement felt by examiner

At approximately 20 weeks

12

Diagnostic - Ultrasonography

Fetal heart activity at ~8 weeks

13

Menstrual History

  1. Dating the pregnancy
  2. Conception ~ 2 weeks AFTER menses (28 day cycle)

14

Previous Pregnancy (Gravida) History

  1. Prenatal Course
  2. Outcomes

15

Previous Delivery (Para) History

  1. Intrapartal course
  2. Neonatal status

16

Gravida

The number of times a woman has been pregnant, regardless of duration or outcome

17

Para

The number of pregnancies that have ended at 20 or more weeks. Multifetal gestations are considered one birth.

18

G TPAL

  1. T=Term
    1. 38-42 weeks gestation
  2. P=Preterm
    1. 20-37 weeks gestation
  3. A=Abortion
    1. Either sponaneous (SAB) or elective (TAB)
  4. L=Living Children
    1. At time of assessment

19

TPAL

May describe pregnancies delivered. Multiple gestationscounted as one parous experience

OR

May describe infants born. Multple gestations are counted individually.

20

Gestational Age

Approximately 280 days or 40 weeks following the last menstrual period

21

Fertilization Age

Approximately 266 days or 38 weeks following fertilization

22

Ways to date a pregnancy

  1. Nagele's Rule
  2. Quickening
  3. Fetal Heart Tones
  4. Fundal Height
  5. Ultrasonography

23

Nagele's Rule

  1. Determine the first day of thelast normal menstrual period
  2. Subtract 3 months
  3. Add seven days

24

Demographic Risk Factors

  1. <16 or >35 years of age
  2. Low socioeconomic status

25

Social and/or personal Risk Factors

  1. Tabacco
  2. ETOH/Social illegal drug use
  3. Low pre-pregnancy weight
  4. Obesity

26

Obstetrical Risk Factors

  1. Greater than or equal to 6 deliveries of viable infants
  2. Rh sensitization
  3. Previous Fetal/neonatal death

27

Medical Risk Factors

  1. Diabetes
  2. Concurrent infections
  3. Hypertension

28

Uterine Fundal Height 10-12 weeks

Above symphysis (out of pelvis, abdominal organ)

29

Uterine Fundal Height at 16 weeks

1/2 way between symphysis and umbilicus

30

Uterine Fundal Height at 20-22 weeks

At umbilicus

31

Uterine Fundal Height at 36 weeks

Below xiphoid process

32

If 16-38 weeks gestation than..

Funal height in cms ~ gestational age (within 3 cms)

33

Chadwick's Sign

  1. Reproductive Adaptation
  2. Bluish coloration of vagina, cervix, labia
  3. R/t vascular congestion

34

Goodell's Sign

  1. Reproductive System Adaptation
  2. Softening of the cervix
  3. Due to progesterone

35

Hegar's Sign

  1. Reproductive System Adaptation
  2. Softening of the lower uerine segment

36

Increased blood volume

  1. Cardiovascular System Adaptation
  2. 40-50% increase

37

Physiologic Anemia

  1. Cardiovascular System Adaptation
  2. Plasma volume increases by ~50%
  3. RBC increase by ~25%
  4. Resolves in early PP

38

Respiratory System Adaptations

  • Volume of air breathed increased
    • Oxygen consumption increases
  • Airway resistance decreases
    • Progesterone relaxes respiratory structures
  • Displacement of diaphragm
    • Respiratory symptoms decrease close to term with lightening(lightening reduces pressure on diaphragm but replaces that pressure with pressure on the bladder)

39

Urinary Frequency

  1. Renal System Adaptation
  2. 1st and 3rd Trimesters

40

Renal System Adaptations

  1. Urinary Frequency
  2. Increased glomerular filtration r/t kidneys working harder
  3. Glycosuria (excessive glucose load)
  4. Increased risk of UTI
    1. r/t urine stasis, correlates with preterm labor

41

Gastrointestinal System Adaptations

  1. Nausea/vomiting of pregnancy (NVP)
    1. Hormonal Changes
    2. Altered carbohydrate metabolism
    3. Generally resolves by early second trimester
  2. Smooth muscle relaxation
    1. Delayed gastric emptying
    2. Decreased peristalsis

42

Straie gravidarum

  • Skin Adaptation
  • Stetch marks

43

Linea nigra

  • Skin Adaptation
  • Pigmentation from umbilicus to publis

44

Chloasma

  • Skin Adaptation
  • Mask of pregnancy

45

What does a maternal physical exam include?

  1. Baseline VS
  2. Height and Weight
  3. Thyroid
  4. Heart and lung sounds

46

What does a maternal gynecologic exam include?

  1. Pelvic measurements
  2. Uterine size

47

Complete Maternal Physical Assessment

  1. Complete maternal physical exam
  2. Gynecologic exam
  3. Fetal Heart Tones

48

Maternal Laboratory Testing

  • Serologic Testing
    • Blood Type and Rh
    • CBC and Hgb
    • Syphilis testing
      • Venereal Disease Research Lab
      • Rapid Plasma Reagin
    • Rubella titre
    • HIV screen
    • Hep. B screen
    • Genetic Testing
  • Urinalysis
    • Glucose
    • Protein
      • Trace is acceptable
    • Ketones
      • Suggests inadequate nutrition
    • Bacteria, WBCs, nitrites, casts
      • Suggests UTI
  • Pap smear
  • Cultures
    • Gonorrhea
    • Chlamydia
  • Wet prep
    • Monilia (yeast)
    • Bacterial vaginosis
  • Illicit drug screen (if history indicates)

49

Warning Signs of Pregnancy

  1. Dysuria
  2. Vaginal bleeding
  3. Persistent vomiting
  4. Presistent headache
  5. Preterm labor
  6. Decreased fetal movement
  7. Abdominal or epigastric pain
  8. Rupture of membranes (ROM)

50

Prenatal Visits

  1. Every 4 weeks until 28 weeks (first and second trimesters)
  2. Every two week between 28 and 36 weeks (third trimester)
  3. Every week until delivery

51

Routine Assessments for Prenatal Visits

  1. Vital signs
  2. U/A
  3. Weight
  4. Uterine Height
  5. Fetal Heart Rate and Fetal Activity

52

Trimester Specific Screening Prenatal Visits

  1. U/S
  2. Glucose tolerance Test (GTT)
  3. Multiple Marker Screen
  4. Group B Strep (GBS)

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