Pregnancy Flashcards
(92 cards)
0
Q
Presumptive signs
A
Changes a woman experiences that make her think she is pregnant.
Amenorrhea
Fatigue
N/V
Urinary frequency
Breast changes- darkened areolae, enlarged Montgomery’s glands
Quickening- slight fluttering movements of the fetus felt by woman.
1
Q
Signs of pregnancy classified into three groups:
A
Presumptive
Probable
Positive
2
Q
Probable signs
A
Abdominal enlargement- related to changes in uterine size, shape, and position.
Positive pregnancy test
Fetal outline felt by examiner
3
Q
Probable signs
Hegar’s sign
A
Softening and compressibility of lower uterus.
4
Q
Chadwick’s sign
A
Deepened violet- bluish color of cervix and vaginal mucosa.
5
Q
Goodell’s sign
A
Softening of cervical tip
6
Q
Ballottement
A
Rebound of unengaged fetus
7
Q
Braxton Hicks contractions
A
False contractions; painless, irregular, and usually relieved by walking.
8
Q
Positive signs (signs that can only be explained by pregnancy)
A
Fetal heart sounds
Visualization of fetus by ultrasound
Fetal movement palates by an experiences examiner.
9
Q
Human chorionic gonadotropin
hCG
A
Production starts as early as implantation.
Can be detected as early as 7-10 days after conception.
Peaks at about 60-70 days of gestation declines until 80 days then gradually increases until term.
10
Q
hCG
A
Higher levels can indicated multi fetal pregnancy.
Ectopic pregnancy
Hydatidiform mole
Down syndrome
Lower blood levels may indicate a miscarriage.
11
Q
Urine samples
A
First voided morning specimens.
12
Q
Nagele’s rule
A
Take first day of woman’s last menstrual cycle. Subtract 3 months, and then add 7 days and 1 year
13
Q
Gravidity- number of pregnancies
A
Nulligravida- never
Primigravida- 1st pregnancy
Multigravida- 2 or more
14
Q
Parity- number of pregnancies in which fetus or fetuses reach viability (approx. 20 weeks) regardless of whether fetus is born alive.
A
Nullipara- no pregnancy beyond the first stage of viability
Primipara- has completed one pregnancy to stage the viability.
Multipara- has completed two or more pregnancies to stage of viability.
15
Q
GTPAL
A
G- gravidity
T- term births (38 wk or more)
P- preterm births (viability up to 37 wks)
A- abortions/ miscarriages (prior to viability)
L- living children
16
Q
Assessment:
A
Current knowledge Previous pregnancies Birthing experience Medical Hx (rubella, Hep B) Family Hx Recent or current illness Current meds/ substance abuse Psych Hx Work conditions Exercise and diet habits Clients goals Discuss birthing methods/ pain control
17
Q
Routine Lab tests
A
Blood type, Rh factor and presence of irregular antibodies CBC w/ differential, Hgb, Hct. Hgb electrophoresis Rubella titer Hep B Group B streptococcus
18
Q
Routine Lab tests (continued)
A
Urinalysis w/ microscopic examination One-hour glucose tolerance Three hour glucose tolerance PAP test Vaginal/ cervical culture PPD Venereal disease research lab HIV Maternal serum alpha-fetoprotein-- used to rule out Down syndrome and neural tube defect.
19
Q
Clients who are Rh negative
A
Around 28 weeks administer RhO (D) immune globulin
(RhoGAM) IM
20
Q
Education
A
Avoid all over the counter meds without provider knowledge Flu immunization Smoking cessation Tx of infections Genetic testing Exposure to hazardous materials 30 minutes of moderate exercise daily Avoid saunas and hot tubs Consume 2-3 liters of water daily
21
Q
Rupture of amniotic fluid
A
Gush of fluid from the vagina
22
Q
Abruption or previa
A
Vaginal bleeding
23
Q
Premature labor
Abruptio placentae
Ectopic pregnancy
A
Abdominal pain
24
Changes in fetal activity
Decreased fetal movement may indicate fetal distress
25
Hyperemesis gravidarum
Persistent vomiting
26
Gestational hypertension
Severe headaches
Blurred vision
Edema of hands and face
Epigastric pain
27
Infection
Elevated temperature
| Dysuria
28
Recommended weight gain during pregnancy?
```
11.2-15.9 kg (25-35 lb)
1-2 kg (2.2-4.4 lb) 1st trimester
1 lb per week for last two trimesters
Underweight women 28-40 lbs
Overweight 15-25
```
29
Calorie increase
340/day during second tri
452/day during 3rd tri
If breasting feeding postpartum additional 330/day 1st 6mo
Additional 400/day 2nd 6mo
30
Folic acid
```
Crucial for neurological development and prevention of neural tube defect. 500-600 mcg
Leafy vegetables
Dried peas
Beans
Seeds
Orange juice
Breads and cereals
```
31
iron supplements
Increase maternal RBC mass
Best absorbed between meals and w/ vitamin c
Milk and caffeine interfere w/ iron absorption
Stool softener may be used to decrease constipation
32
Caffeine
Limit to 300 mg/day
33
Calcium
1,000 mg/ day over 19
| 1,300 mg/ day under 19
34
Risk factors for inadequate nutrition
```
Adolescent
Vegetarian (protein, calcium, zinc, B12)
Nausea vomiting
Anemia
Eating disorder
Appetite disorder pica
Excessive weight gain
Inability to gain weight
Financially unable to purchase food
WIC
```
35
Dietary complications
Nausea and constipation:
Eat dry crackers or toast-- avoid alcohol, fats, caffeine, and spices
Increase fluids and fiber
36
Maternal phenylketonuria
Maternal genetic disease: high levels of phenylalanine pose a danger to fetus.
Avoid foods high in protein: fish, poultry, meat, eggs, nuts, dairy products.
37
Ultrasound:
1-2 quarts of fluid prior to ultrasound
Fill the bladder, lift and stabilize uterus.
Displace the bowel, act as an echolucent to better reflect sound waves.
38
Biophysical profile BPP
| Score of 8-10 is normal
```
Assesses fetal well being by measuring five variables with a score of 2 or 0
Reactive FHR
Fetal breathing movements
Gross body movements
Fetal tone
Qualitative amniotic fluid volume
```
39
Alpha fetoprotein
High levels: are associated with neural tube defects such as anencephaly. Spina bifida, omphalocele.
Low levels: Down syndrome, hydatidiform mole.
40
How many weeks for a full term baby?
37 weeks
41
At 30 weeks what would a nurse expect to find assessing this preterm baby?
Lanugo, a fine hair covering the body
| Greatest between 28-30 weeks
42
Factors that increase risk for postpartal atony
```
Precipitous delivery
Distended bladder
Macrosomic delivery
Multiple fetal birth
Multi para
Polyhydramnios
```
43
Physiologic changes preceding labor:
Backache- pelvic muscle relaxation
Weight loss- 1-3 lb weight loss
Lightening- fetal head descends into true pelvis (14 d prior)easier breathing, pressure on bladder, urinary freq.
contractions- Braxton hicks
Energy burst- "nesting response"
GI changes- N/V, indigestion
Rupture of membranes- indicative of imminent labor.
44
Assessment of amniotic fluid:
Watery clear and pale-straw-yellow color.
Odor should not be foul
Volume between 500- 1,200 mL
Nitrazine paper should be used to confirm.
45
Nitrazine paper
Amniotic fluid is alkaline
Nitrazine paper should be deep blue indicating pH of 6.5-7.5
Urine is slightly acidic:
Paper will remain yellow.
46
Five "P"s that affect and define the labor and birth process
```
Passenger
Passageway
Powers
Position
Psychologic response
```
47
Passenger:
Fetus and placenta
| Size of fetal head/ presentation, lie, attitude, and position affect ability to navigate birth canal.
48
Presentation:
```
Part of the fetus that is entering the pelvic inlet first
Back of head (occiput)
Chin (mentum)
Shoulder (scapula)
Breech (sacrum or feet)
```
49
Lie:
Relationship of the maternal longitudinal axis (spine)
Fetal long. Axis (spine)
--transverse
-- parallel
50
Attitude:
Relationship of fetal body parts to one another.
Fetal flexion: chin-chest extrem.-torso
Fetal extension: chin extended extrem too.
51
Fetopelvic or fetal position:
Relationship of presenting part of fetus as it relates to one of the 4 maternal pelvic quadrants.
R or L for maternal pelvis
O S M Sc for presenting part of fetus
A P T part of maternal pelvis
Station: measure of fetal descent in CM 0 being at level of ischial spines
Minus stations superior to that an plus stations inferior to that.
52
Passageway
Birth canal: composed of bony pelvis, cervix, pelvic floor, vagina, and introitus. Size and shape of bony pelvis must allow baby to pass through and cervix must dilate in response to contractions and fetal descent.
53
Powers:
Uterine contractions: cause dilation of cervix and descent of fetus, involuntary urge to push and voluntary bear down.
54
Position:
Of woman who is in labor, client should engage in frequent position changes during labor to increase comfort, relieve fatigue, and promote circulation.
*Gravity can aid in fetal descent.
55
Psychological response:
Maternal stress, tension, anxiety, can produce physical changes that impair the progress of labor.
56
Urinalysis: clean catch urine sample
Hydration- specific gravity
Nutritional- via ketones
Proteinuria- indicative of gest. HTN
UTI- via bacterial count
57
Nitrazine paper
Used to confirm that amniotic fluid is present.
| Paper should be deep blue indicating pH of 6.5-7.5
58
Five "P"s
Passageway
Powers
Position
Psychologic response
59
Passageway
Birth canal-- bony pelvis, cervix, pelvic floor, vagina, and introitus(vaginal opening).
60
Stages of labor:
```
First stage:
Latent-irregular contraction 30-45 sec.
Active- reg. contr. 40-70 sec. 4cm
Transition-2-3 min reg. cont. 8cm
Second stage: 10cm cont 1-2 min
Third stage: delivery of neonate
Fourth stage: delivery of placenta stabilization of Maternal VS
```
61
Pain management: gate control theory
Sensory nerve pathways used by pain sensations to get to the brain will only allow a limited number of sensations to travel at any given time. By sending alternate signals using these pathways pain signals can be blocked.
62
Pain management:
| Sensory stimulation strategies
```
Aromatherapy
Breathing techniques
Imagery
Music
Use of focal points
Subdued lighting
```
63
Pain man.
| Cutaneous strategies
Back rubs and massages
Effleurage- light gentle circular stroking of client's abdomen w/ fingertips in rhythm w/ breathing during contractions.
Sacral counterpressure- consistent pressure applied using heel of hand against sacral area to counter lower back pain
Heat or cold therapy
Hydrotherapy- increases endorphin levels
Acupressure
64
Analgesic med risk
Vaginal exam evaluating uterine contractions must be done to verify that labor is well established to avoid slowing progress of labor.
65
General anesthesia nursing actions:
```
Ensure client is NPO
IV infusion in place
Apply anti embolic stockings and SCD
Premedicate with antacid
Admin. H2 receptor antagonist (Zantac)
Reglan- increase gastric emptying
```
66
Continuous internal fetal monitoring
| Advantages:
```
Early detection of abnormal FHR patterns
Accurate assess. of FHR variability
Accurate measurement if intensity
Tracing not affected by fetal activity, maternal position changes
Or obesity
```
67
Disadvantages of continuous internal fetal monitoring.
Membranes must have ruptured with presenting part having descended along with cervix being dilated 2-3cm
Potential risk to fetus if improperly placed.
Contraindicated with vaginal bleeding
Increase risk of infection
Specially trained to perform
68
Hispanic:
Prefer mother to be present
69
African American:
Prefer female family members for support.
70
Asian American:
May prefer mother, partner not active participant, labor in silence, C-Section undesirable.
71
Native American:
Female nursing personnel
Family involved in birth
Use of herbs
Squatting position for birth.
72
European American:
Birth is public concern
Focus on technology
Partner expected to be involved
Provider seen as head of health care team.
73
Single most important indicator of progress of labor?
Cervical dilation: both fetal descent and cervical dilation are caused by contractions.
74
Transition phase of labor:
Discourage pushing efforts until cervix is fully dilated.
75
Third stage of labor-
| Signs of placental separation from the uterus
Fund us firmly contracting
Swift gush of dark blood
Umbilical cord appears to lengthen
Vaginal fullness on exam
76
What is a External cephalic version and what are it's contraindications?
Attempt to manipulate the abdominal wall to direct a malpositioned fetus into normal vertex presentation after 37 weeks of gestation. (High risk of umbilical cord prolapse)
C/I: uterine anomalies, prev. C section, cephalopelvic disproportion, placenta previa, multi fetal gestation, oligohydramnios.
77
Bishop Score:
```
Cervical:
dilation
Effacement
Consistency
Position
Station of presenting part
Score of 0-3 for each one
```
78
Liver: 3rd trimester
* Alkaline phosphatase increases to 2-4X
| * Albumin and total protein decrease
79
Estrogen:
* Uterine growth
* Increasing blood supply to uterine vessels
* developing ductal system
* hyperpigmentation
* vascular changes in skin
* increased salivation (starch)
* Hyperemia of gums and nasal mucus.
80
Progesterone
```
Maintain endometrial layer
Prevent spontaneous abortion
Prevent tissue rejection of fetus
Develop lobes in breast
Facilitate deposit of maternal fat stores
Relax smooth muscle
Increase resp. Sensitivity to CO2
Stimulates ventilation
Suppresses immunologic resp. Preventing rejection of baby.
```
81
Estrogen effects:
* Increased blood supply to uterus= uterine growth
* develops ductal system
* hyperpigmentation, salivary glands, Hyperemia of gums and nasal mucous membranes.
82
Progesterone effects:
* Maintaining endometrial layer for implantation
* relaxes smooth muscle of uterus preventing spont. Abortion.
* develops lobes/lobules of breast
* deposit of maternal fat stores
* relaxing smooth muscle: uterus, lower esophageal sphincter, intestines, ureters, bladder.
* increased sens. To CO2
83
human chorionic somatomammotropin also called human placental lactogen.
Insulin antagonists that makes insulin more available to fetus.
Decreases maternal metabolism of glucose and has her rely more on free fatty acids.
84
Relaxin:
Inhibits uterine activity
Softens ct of cervix
Lengthens pubic ligaments
85
What is the third stage and what are the four signs of separation?
```
Placenta is expelled after is separated from uterine wall.
•uterus has spherical shape
•uterus rises upward
•uterine contractions
•vaginal drainage
```
86
What is Schultz in regards to placenta?
Shiny fetal side first
87
What is Duncan in regards to placenta?
Rough maternal side presenting
88
Regional pain management
•Epidural: s/e = hypotension, bladder distention, prolonged second stage, migration of epidural cath, fever, N/V, pruritus, delayed resp. Dep.
•intrathecal (subarachnoid) opioid anal.
-subarachnoid-- spinal block
89
Systemic drugs:
Opioid analgesics: Demerol, fentanyl
Opioid antagonists: reverse opioid
Adjunctive drugs
Sedatives__ for women fatigued from false labor.
90
Vaginal birth anesthesia:
Local infiltration for episiotomy or suture
| Pudendal block-- same as local infiltration.
91
General anesthesia:
For C/S when mother refuses block or is not a candidate or emergency does not allow.
