typical: week 1 Flashcards
(35 cards)
1
Q
pregnancy: duration
A
- 40 weeks
- 10 lunar months
- 280 days
3 trimesters:
– 1st: 1-13 weeks
– 2nd: 14-26 weeks
– 3rd: 27-40 weeks
Nagel’s rule - LMP- 3 months + 7 days and 1 year
- LMP + 7 days + 9 months
2
Q
Gravida & Para
A
Gravida - pregnant/ prior number of pregnancies - prima-gravida: 1st pregnancy - multi-gravida: 2nd or more pregnancies Para - description of pregnancy outcome - single number: pregnancies that have reached viability - 4 number system: specific outcomes of all pregnancies - pregnancies not infants
3
Q
TPAL
A
Parity: TPAL system
T: number of pregnancies that have reached term
P: preterm
A: abortions: voluntarily or spontaneousl
L: living children
4
Q
Term terminology
A
term: beginning of week 38 of gestation to end of week 42 of gestation
preterm: 20 weeks to 37 6/7 weeks
- very preterm
- late preterm
postterm/postdate: 42+ weeks
viability: capacity to live outside uterus; about 22-24 weeks since LMP, or fetal weight greater than 500g
5
Q
Pregnancy tests
A
- human chorionic gonadotropin (hCG) is earliest biochemical marker of pregnancy
- pregnancy tests based on recognition of hCG or B subunit of hCG
- urine pregnancy test may be positive as early as 7-10 days after conception. Uses ELISA marker method
- blood test for hCG provides “numerical” analysis or pregnancy. used most often to verify “growth” w/spotting or risk of “problem”
6
Q
signs and symptoms of pregnancy
A
Presumptive - missed period, breast tenderness, nausea Probably - goodell/chadwick/hegar sign: chadwick looks blueish upon speculum inspection - + urine hCG (some cancers mimic hCG) Positive - visualization of fetus - sonogram of heartbeat
7
Q
adaptations to pregnancy: uterus
A
Changes in size, shape, and position
- @12 weeks size of grapefruit and anterior
- increases in size w/ growing fetus
- 22-24 wks @ umbilicus
- measure in cms from symphysis pubis: should correspond to weeks of gestation
Uteroplacental blood flow
Cervical changes
- increased vascularity: softening and “blue”
- increased vaginal discharge
Ballotment: examiner feels “floating fetus”
Quickening:
- maternal perception of movement
- 18 weeks appx (usually earlier with 2nd baby)
8
Q
adaptations to pregnancy: breasts
A
- fullness, heaviness
- heightened sensitivity from tingling to sharp pain
- areolae become more pigmented (estrogen)
- Montgomery’s tubercles: bumps around nipple
- colostrum by 16 weeks (early milk. esp if lactated before).
9
Q
adaptations to pregnancy: cardiovascular
A
blood volume - increases by 50% - mostly plasma increase (drink water) increased cardiac output (increased workload) blood pressure - decrease in 2nd trimester - returns to normal at term pulse - increase in pulse 2nd trimester until term (10-15bpm above norm) coagulation - increased coag times hypercoagulable
10
Q
adaptations to pregnancy: respiratory
A
- increased metabolic rate
- increased o2 demand and consumption
- relaxation of cartilage
- greater expansion
- congestion
11
Q
adaptations to pregnancy: renal
A
- increased GFR from increased CO
- dilation of ureters/increased pressure
- increased resorption of Ha
- some glucose spills at serum levels less than 160
12
Q
adaptations to pregnancy: integumentary
A
hyperpigmentation
- chloasma: mask of pregnancy
- linea nigra: line of pregnancy
- areeola
striae: stretch marks
angioma: spider veins. congestion in vascular space
13
Q
adaptations to pregnancy: musculoskeletal and neuro
A
- change in center of gravity
- increased relaxin- relaxes connective tissue
- diastasis recti abdominis: muscle buckles out
- lumbar lordosis
neuro: mild numbness and tingling
14
Q
adaptations to pregnancy: gastrointestinal
A
altered metabolism - changes in carbohydrate metabolism - increasing resistance to insulin n/v - worse in first trimester - should get better after 12 weeks - heartburn constipation/hemorrhoids (dilated rectal vessel) PICA - craving for non-food substances - starch, clay, dirt - not common - assess for iron deficiency anemia
15
Q
adaptations to pregnancy: hormones of pregnancy
A
- progesterone: high from corpus luteum. inhibits uterine activity
- hCG: human chorionic gonadotropin
- Estrogen: promotes growth of uterine tissues
- hPL: insulin antagonist. triggers milk production
- Prostaglandin: stimulates labor
16
Q
adaptations to pregnancy: maternal adaptation
A
- accepting pregnancy
- identifying with mother role
- reordering personal relationships
- establishing relationship with fetus
- preparing for childbirth
17
Q
Rubin’s tasks
A
- ensuring safe passage through pregnancy, labor, and birth
- seeking acceptance of the child by others
- seeking commitment and acceptance of herself as mother to infant
- learning to give of oneself on behalf of one’s child
- 1st trimester: ambivalence. “not real”
- 2nd trimester: self-absorbed, pregnancy becomes real
- 3rd trimester: fears about baby’s well being, delivery
18
Q
adaptations to pregnancy: paternal adaptation
A
- accepting pregnancy
- identifying with father role
- reordering personal relationships
- establishing r/s w/ fetus: emotional attachment
- Couvade syndrome
- preparing for childbirth
19
Q
nursing care management
A
- purpose of prenatal care is to identify existing risk factors and other deviations from normal
- emphasis on preventative care and optimal self-care
- prenatal care is sought routinely by women of middle or high socioeconomic status
- women in poverty or lacking health insurance may not have access to public or private care- poor outcomes associated with no prenatal care
20
Q
nursing care management: initial intervew
A
- reason for seeking care
- current pregnancy (GP designation)
- ob/gyn history
- medical history (general)
- genetic history (babies with problems?)
- nutrition history
- risk factor assessment
- history of drug use and herbal preparations
- family history
- social, experiential, occupational hx
- review of systems
physical exam, laboratory tests
21
Q
routine pregnancy lab tests
A
- CBC
- Blood type, Rh, Antibody screen (hemoglobin: sickle cell, thalassemia)
- TB screen
- Genetic panel (CF, Tay-Sachs)
- Rubella Titer (immune v. non-immune)
- Syphilis Screen (VDRL)
- HIV
- Hepatitis B screen
- Varicella screen
- Pap
- GC/Chlamydia
22
Q
Identification of risk
A
- preexisting medical conditions
- genetic factors
- age
- environment
- risk for pregnancy complications
23
Q
tests during pregnancy
A
Nuchal Translucency Screening - sonogram of back of neck at 10-14 weeks - blood test AFP/Quad screen - neural tube defects - 15-22 wks: increased: risk of NTD; decreased: risk of Down's Amnio - 14+ weeks - chromosome karyotype CVS - 10-12 weeks - merging of 2 layers of tissue
24
Q
testing by weeks: additional
A
18-20 wks: second trimester sonogram
26-28 wks: glucose tolerance testing
28-30 wks: RhoGam if indicated
34+ wks: rpt CBC (thrombocytopenia, anemia)
36+ wks: GBS. if positive, must give AB within 4 hours of giving birth
25
First trimester common discomforts
- nausea and vomiting
- urinary frequency
- fatigue
- breast tenderness
- increased vaginal discharge (leukaria)
- nasal stuffiness and nosebleeds
- ptyalism (spitting)
26
first trimester management of symptoms
- most symptoms resolve by end of first trimester
- dry crackers for nausea
- Vitamin B6
- rest when tired
- ginger? gingerale? peppermint?
27
Second trimester common discomforts
- heartburn
- ankle edema (elevate feet)
- varicose veins
- hemorrhoids
28
Third trimester common discomforts
- constipation
- backache
- leg cramps (very acute- if lying down, try to stand up)
- faintness
- dyspnea
- carpal tunnel syndrome
- Braxton-Hicks contractions ("practice contractions". r/t hydration status)
29
Management of symptoms: second and third trimesters
- supportive shoes
- supportive stockings
- back support
- exercise: talk test. swimming is best.
- diet modification: extra 500cal/day
- stool softener
- avoid supine positioning if possible
- monitor for PTL (not ok to have 5+ contractions in an hour)
30
visit schedule
1st trimester: monthly
2nd trimester: q3-q4 weeks
3rd trimester: q2 weeks/weekly
31
warning signs
- pressure
- gush of fluid from vagina
- abdominal pain
- fever
- dizziness, blurred vision, spots before eyes
- persistent headache
- persistent vomiting or persistent abdominal pain
- edema: facial
- significant weight gain (2kg 1 week)
- muscular irritability or convulsions
- epigastric pain
- oliguria
- dysuria
- absence of fetal movement (drink a cold sugary drink. if less than 9 movements in an hour, call PCP.
32
Maternal and Fetal nutrition
good nutrition before and during pregnancy an important preventive measure
- low birth weight
- preterm infants
- neonatal death rates for moderate LBW are 5x higher than babies >2500g
- the risk for VLBW is 100 times higher
33
nutrient needs before conception
- first trimester crucial for embryonic and fetal organ development
- healthful diet before conception ensures that adequate nutrients are available for developing fetus.
- folic acid intake important in periconceptual period: neural tube defects are more common in infants of women with poor folic acid intake. need 400mcg/day
34
Nutrient needs during pregnancy
Energy needs
- weight gain: 10lbs by 20 weeks. 1lb per week after
- pattern for weight gain: 25-35 lbs TL
- normal weight gain: 1.6-2.3kg (3.5-5lb) during first trimester
- hazards of restricting adequate weight gain
Protein, Vitamins, Minerals
Fluids: 8-10 glasses per day
35
substances to avoid during pregancy
- mercury
- tuna, mackerel, swordfish, shark, tilefish
- soft cheeses: non-pasteurized cheese (brie, feta, mozarella)- risk of listeria
- sushi
- undercooked foods
- moderation with other foods: cold cuts, hot dogs
- alcohol/drugs/tobacco
- caffeine
- medications
- rx and OTC must be cleared by OB/MD
- herbal supplements
