UNIT 1 HEALTH ASSESSMENT CHAPTER 7, 8, Flashcards
(126 cards)
1
Q
What is Gestation
A
age in weeks of pregnancy
2
Q
What is Trimester
A
segments (13 1/3 weeks)
3
Q
What his Antepartum
A
time before birth
4
Q
What is Intrapartum?
A
time during labor and birth
5
Q
What is Post Partum
A
return to pre-pregnant
state (about 6 weeks)
6
Q
Which of the following weeks of Gestation is in accordance with a full-term pregnancy?
A. 37 weeks
B. 19 weeks
C. 49 weeks
D. 12 weeks
A
A. 37 weeks
7
Q
What is the range of a Full Term Pregnancy
A
37-42 weeks
8
Q
What is the range of a Preterm pregnancy
A
20-36 weeks
9
Q
What amount of weeks would the fetus NOT be viable to live outside of the mothers womb?
A. 15 weeks
B. 21 weeks
C. 37 weeks
D. 25 weeks
A
A. 15 weeks
Viability-20 or more weeks gestation
10
Q
FILL IN THE BLANK
The total number of pregnancies is….
A.Gravidity
B.Nullgravida
C.Primigravida
D.Multigravida
A
A.Gravidity
number of pregnancies
11
Q
What is Paravididty
A
number of viable pregnancies (> 20
weeks)
Parity: The number of pregnancies in which the fetus or fetuses have reached
20 weeks of gestation or more, not the number of fetuses (e.g., twins) born. Parity is not affected by whether the fetus is born alive or is stillborn (i.e., showing no signs of life at birth).
Nullipara: A woman who has not completed a pregnancy with a fetus or fetuses who have reached at least 20 weeks of gestation
Primipara: A woman who has completed one pregnancy with a fetus or fetuses who have reached 20 weeks of gestation or more
Multipara: A woman who has completed two or more pregnancies to 20 weeks of gestation or more
12
Q
What is Gravida
A
pregnant (been pregnant)
13
Q
What is Nullgravida
A
never pregnant
14
Q
What is Primigravida
A
Primigravida-pregnant or one child
15
Q
What is Multigravida
A
pregnant second or
more times
16
Q
Drugs used during Pregnancy -process
A
- Terbutaline (Brethine)- pt goes into preterm labor and drug is used to slow down labor, stop them from having contraction
- Nifedipine (Procardia)- to treat hypertension
- Magnesium Sulfate- used for pts with preeclampsia, magnesium relaxes the body systems
- Betamethasone (Celestone)/Dexamethasone- steriod decreases inflammation(used to mature babies lungs due to preterm labor
- Oxytocin (Pitocin)- Causes contactions , induce uterine contractions
- Dinoprostone (Cervidil)- soften cervix
- Misoprostol (Cytotec)- used for uterine contraction, can cause an abortion when not used on pt in labor
- Methylergonovine maleate (Methergine)- helps with decreasing excessive bleeding after labor
- Carboprost tromethamine (Hemabate)- helps with decreasing excessive bleeding after labor
- Fentanyl- opiod analgesic - PAIN
- Morphine Sulfate- opiod analgesic - PAIN
- Butorphanol Tartrate (Stadol)
17
Q
What is Naegeles rule?
A
it is the expected date of birth
18
Q
How do you calculate the Expected Date of Birth?
A
+7 days +9 months from the first day of her last menstrual cycle
19
Q
The pregnant patient reports that THE START or first day of her period was on February 3. What would be her expected due date due to Naegeles Rule?
A. November 10
B. April 10
C. December 21
D. October 3
A
A. November 10
Most women give birth from 7 days before to 7 days after EDB
20
Q
What consists of the Gravida Calculation?
SELECT ALL THAT APPLY
A.GRAVIDA
B.SEX
C.TERM
D.GENETIC CODE
E.PRETERM
F.ABORTION
G.LIVING
A
GTPAL
GRAVIDA - NUMBER OF PREGNANCY
TERM- 37-42 WEEKS OF PREGANCY
PRETERM- 20-36 WEEKS OF PREGNANCY
ABORTION- delivery before 20 weeks
LIVING- BABIES AT HOME living
21
Q
Hormones of Pregnancy
A
Human Chorionic Gonadotropin (hCG)
* Maintain corpus luteum
* In urine & serum 10-14 days after conception
- Human Placental Lactogen (hPL)
- Insulin antagonist by placenta increase blood glucose
- Estrogen
- Increase blood flow to uterus (vasodilation).
- Change sensitivity of respiratory system to carbon dioxide.
- Soften cervix, initiate uterine activity, maintain labor.
- Develop breasts for lactation, secretion of prolactin
22
Q
What would be a subjective sign of pregnancy
A
SHE SAID
*My breasts are bigger, sore, tingling…”
* “My bowels don’t work as well.”
(constipation)
* “I have urinary frequency”
* “I am soooo tired all of the time.”
(fatigue)
* “I missed my period!” (amenorrhea)
* “I have to throw up EVERY
morning.”(N/V)
* “I think I am feeling the baby kick.”
(quickening
23
Q
What would be a probable sign of pregnancy.
A
- Goodell’s sign- softening of the cervical tip. This probable sign of pregnancy, the Goodell sign, is due to increased vascularity, slight hypertrophy, and hyperplasia (increase in the number of cells).
- Chadwick’s sign- Increased vascularity results in the violet-blue color of the vaginal mucosa and cervix, known as the Chadwick sign. This is evident at 6 to 8 weeks of pregnancy.
- Hegar’s sign- At approximately 6 weeks of gestation, softening and compressibility of the lower uterine segment (uterine isthmus) occurs (Hegar sign)
- Enlarging Uterus
- Positive pregnancy test
- Stria Gravidarum- stetch mark
- Braxton Hick’s contractions- Soon after the 4th month of pregnancy, intermittent uterine contractions may be felt through the abdominal wall. These are referred to as Braxton Hicks contractions and are thought to enhance blood flow through the intervillous spaces. Braxton Hicks contractions are irregular and painless, although some women complain that they are annoying- ing.
- Ballottement- Passive movement of the unengaged fetus is called ballottement and can be identified by the examiner generally between the 16th and 18th weeks. Ballottement is a technique of palpating a floating structure by bouncing it gently and feeling it rebound. To palpate the fetus, the examiner places a finger within the vagina and taps gently upward on the cervix, causing the fetus to rise. The fetus then sinks, and a gentle tap is felt on the finger
24
Q
What Is Leukorrhea
A
Vaginal discharge increases during pregnancy. Leukorrhea is a white or slightly gray mucoid vaginal discharge with a faint musty odor. This copious mucoid fluid occurs in response to cervical stimula- tion by estrogen and progesterone.
25
What drug can cause a false positive pregnancy test?
Blood hCG 2 days after implantation- MOST PRECISE IN PREGNANCY TESTING
Fertility drugs-Methadone: false
positive
26
What drug can cause a false negative pregnancy test?
Urine 42 days after first day of last
menstrual period
Promethazine: false negative
27
1. A 30 year old female is 25 weeks pregnant with twins. She has 5 living children. Four of the 5 children were born at 39 weeks gestation and one child was born at 27 weeks gestation. Two years ago she had a miscarriage at 10 weeks gestation. What is her GTPAL?*
A. G=7, T=4, P=0, A=1, L=5
B. G=7, T=4, P=1, A=1, L=5
C. G=6, T=4, P=0, A=1, L=5
D. G=6, T=2, P=2, A=1, L=5
B. G=7, T=4, P=1, A=1, L=5
28
2. A 27 year old female is currently 16 weeks pregnant. She has 2 year-old twins that were born at 39 weeks gestation and a 5 year-old who was born at 40 weeks gestation. She had no history of miscarriage or abortion. What is her GTPAL?*
A. G=3, T=1, P=0, A=1, L=3
B. G=3, T=1, P=1, A=0, L=3
C. G=3, T=2, P=0, A=1, L=1
D. G=3, T=2, P=0, A=0, L=3
D. G=3, T=2, P=0, A=0, L=3
29
3. A 20 year old female is currently 8 weeks pregnant. She had a miscarriage at 12 weeks gestation two years ago. She has no living children. What is her GTPAL?*
A. G=2, T=0, P=0, A=1, L=0
B. G=3, T=1, P=1, A=0, L=3
C. G=2, T=2, P=0, A=1, L=2
D. G=1, T=1, P=1, A=0, L=1
A. G=2, T=0, P=0, A=1, L=0
30
4. A 26 year old female is currently 26 weeks pregnant. She had a miscarriage at 10 weeks gestation five years ago. She has a three year old who was born at 39 weeks. What is her GTPAL?*
A. G=3, T=1, P=0, A=1, L=1
B. G=3, T=1, P=1, A=0, L=3
C. G=3, T=2, P=0, A=2, L=2
D. G=2, T=1, P=0, A=1, L=1
A. G=3, T=1, P=0, A=1, L=1
31
5. A 35 year old female is currently pregnant with twins. She has 10 year old triplets who were born at 32 weeks gestation, and a 16 year old who was born at 41 week gestation. Twelve years ago she had a miscarriage at 19 weeks gestation. What is her GTPAL?*
A. G=4, T=1, P=2, A=1, L=4
B. G=3, T=1, P=1, A=0, L=4
C. G=4, T=1, P=1, A=1, L=4
D. G=4, T=1, P=1, A=1, L=1
C. G=4, T=1, P=1, A=1, L=4
32
A patient presents to the clinic for her first prenatal appointment. She states that she has 2 living children, both born at 39 weeks, and she has had one miscarriage. Which of the following would be her correct GTPAL?
A, 3-2-0-1-2
B. 4-2-0-0-2
C. 4-2-0-1-2
D. 3-2-0-1-2
C. 4-2-0-1-2
33
Function of Progesterone?
Progesterone
* Prepare uterus for implantation.
* Prevent immunologic response to fetus.
* Relaxes smooth muscle
* GI decrease motility & improve
absorption of nutrients.
* Enlarges ureters & bladder to increase
capacity.
* Develop alveoli (milk secretion) & ductal
system for lactation
34
Function of Relaxin
Relaxin: Relaxes pelvic muscles & joints
35
Breast Function
Lactation
* Progesterone (glands)/Estrogen
(ducts)/Prolactin (milk secretion)
* Lactogenesis-breast development
to secrete milk in pregnancy
* Physiologic changes with
menstruation; self-examination
best 5-7 days after end of period(do mot palpate or self exam during period due to hormonal changes)
* Organs for sexual arousal
36
What would be a possible breast change during pregnancy?
Increase size, fullness, heaviness, tingling
Darkening of areola
Hypertrophy: alveolus hyperplasia epithelial
cell lining
Breast can secrete milk 18 weeks gestation
37
What sign is the softening of the cervix?
Goodell
38
What signs is the softening of the lower segment of the uterus?
Hegars
39
What sign is the change of the cervix (bluish color)
Chadwick sign
40
What sign causes intermittent contractions that start after the 4th month of pregnancy?
Braxton hicks
41
What could be a positive sign of pregnancy?
1. Fetal heart rate detected by electronic device
(Doppler transducer) at 10 to 12 weeks and by nonelectronic device (fetoscope) at 20 weeks of gestation
2. Active fetal movements palpable by examiner
3. Outline of fetus via radiography or ultrasonogra-
phy
42
What sign is the tapping of the cervix to so the fetus can rise?
Ballotment
43
Is this a positive sign of pregnancy?
"my stomach has gotten bigger in the last month and I missed my period"
NO
this is a presumptive sign, "she said"
44
What changes to the uterus during pregnancy?
* Almost solid organ to thin-
walled, hollow organ; can hold
15-20 liters. or 15000ml to 20000 ml
* Position moves up in pelvis
* Braxton Hicks contractions- intermittent contarations HARMLESS
* Mucous plug-Cervix moves behind uterus.
* Impending labor: cervix moves forward, softens,
opens.
45
What is the function of the Placenta?
Nutrition oxygenation for the baby , the baby's life line
* Transport oxygen & nutrients
* Removes metabolic wastes
* Barrier separating maternal & fetal structures
* Secretes Human Chorionic Gonadotropin (hCG),
progesterone, estrogen, human placental lactogen (hPL)
The placenta provides for exchange of nutrients
and waste products between the fetus and birth-
ing parent.
2. The placenta begins to form at implantation; the
structure is complete by week 12.
3. It produces hormones to maintain pregnancy
and assumes full responsibility for the produc- tion of these hormones by the 12th week of ges- tation.
4. In the third trimester, transfer of maternal im- munoglobulin provides the fetus with passive immunity to certain diseases for the rst few months after birth.
5. By week 10 to 12, genetic testing can be done via chorionic villus sampling (CVS).
46
What is quickening?
Quickening is the first recognition of fetal movements, or “feeling life.” It can be detected by the multiparous woman as early as 14 to 16 weeks of gestation.
47
What occurs during Placenta Previa
low lying placenta;
covers os
PAINLESS BRIGHT RED BLOOD
MANADATORY C SECTION
48
What occurs during Placenta Accreta
Placenta accreta: chorionic villi extend
into myometrium; separate @ delivery
difficult
PLACENTA ATTACHES TO THE UTERINE WALL
49
What occurs during Abruptio Placenta
Abruptio placenta: premature
separation placenta prior to delivery, form
retroplacental blood clot; oxygen &
nutrients to fetus compromised
PREMATURELY DETACHES TO UTERINE WALL MEDICAL EMERGENCY
baby is missing its nutrients when its nutrients and oxygen
50
How do you measure fundus height
START AT PUBIC BONES
by the gestation age of the baby, there is a range -2/+2 from gestation age is a proper fungus height
51
Where would the fundus be in the gestation age if the fetus is 12 weeks?
at publical synthesis
10centimeters - 14 centimeters
52
Where would the fundus be in the gestation age if the fetus is 20 weeks?
at the umbilicus
18 centimeters - 22 centimeters
53
Where would the fundus be in the gestation age if the fetus is 36 weeks?
Xiphoid process
34centimeters- 38 centimeters
54
What is the function of "Lightening" ?
Between weeks 38 and 40, the fundal height decreases as the fetus begins to descend into the pelvis (lightening) in preparation for birth (see Fig. 7.1, dashed line). In general, lightening occurs in the nullipara ap- proximately 2 weeks before the onset of labor and in the multipara at the start of labor.
THE FUNDUS HEIGHT DECREASES TO PREPARE FOR BIRTH
55
Is having increased vaginal discharge normal in pregnancy?
Yes
56
A client calls the physician's office to schedule an appointment because a home pregnancy test was performed and the results were positive. The nurse determines that the home pregnancy test identified the presence of which of the following in the urine?
A. Human chorionic gonadotropin (hCG)
B. Progesterone
C. Estrogen
D. Follicle-stimulating hormone (FSH)
A. Human chorionic gonadotropin (hCG)
57
1. The rubella titer comes back on a pregnant client as non-immune. What is the best plan for this client?
A. Counsel the client to avoid people with signs of rubella.
B. Vaccinate the client at her next prenatal visit.
C. Have the client return to the clinic immediately for vaccination.
D. Plan to have the patient vaccinated after delivery.
D. Plan to have the patient vaccinated after delivery.
58
The nurse is reviewing the record of a client who has just been told that her pregnancy test is positive. The physician has documented the presence of Goodell's sign. The nurse determines that this sign is indicative of:
A. The presence of human chorionic gonadotropin (hCG) in the urine
B softening of the cervix
C. A soft blowing sound that corresponds to the maternal pulse while auscultating the uterus
D. The presence of fetal movement
B softening of the cervix
59
Which of the following hormones are found in urine or blood to report pregnancy?
A. Human Chorionic Gonadotropin (hCG)
B.Estrogen
C. Oxytocin
D. Prostaglandins
A. Human Chorionic Gonadotropin (hCG)
Maintain corpus luteum
* In urine & serum 10-14 days after conception
60
Which of the following statements would mean that the female patient is positive for being pregnant?
A. positive Goodells sign
B. Amenorhea'
C. fetus is shown in ultrasound
D. Positive Hegars sign
C. fetus is shown in ultrasound
61
. Your patient is 48 hours post-delivery. While assessing fundal height, you would expect the fundal height to be?
A. 1 cm above the umbilicus
B. 2 cm above the umbilicus
C. 1 cm below the umbilicus
D. 2 cm below the umbilicus
The answer is D. The fundal height will decrease by 1 cm per day below the umbilicus. Therefore, if the woman is 48 hours postpartum (2 days) the fundal height will be 2 cm BELOW the umbilicus.
62
2. You’re providing discharge teaching to a new mother who is going home after a vaginal delivery. The woman asks when the uterus will return to its pre-pregnancy size. Your response is?
A. At about 14 days
B. At about 6 months
C. At about 6 weeks
D. At about 7 days
The answer is C. The uterus will return to its pre-pregnancy state at about 6 weeks.
63
3. During a prenatal visit, you are assessing the fundal height. You find the fundus of the uterus to be right above the symphysis pubis. Based on this finding the patient is about how far along in her pregnancy?
A. 20 weeks
B. 12 weeks
C. 16 weeks
D. 24 weeks
The answer is B. At about 12 weeks of pregnancy, the fundal height can be found right above the symphysis pubis.
64
4. You’re assessing a patient’s chart and find that the patient is 36 weeks pregnant. Where should you find the fundus of the uterus during your assessment of fundal height?
A. midway between the umbilicus and xiphoid process
B. about 4 cm below the xiphoid process
C. at the xiphoid process
D. 5 cm above the umbilicus
The answer is C. At 36 weeks of pregnancy, the fundal height should be at the xiphoid process.
65
5. Your patient is 24 weeks pregnant, and you’re measuring the fundal height. Which finding below is a normal measurement for this patient?
A. 16 cm
B. 28 cm
C. 26 cm
D. 12 cm
The answer is C. The patient should be + or – 2 cm of their week of pregnancy. Remember that after 20 weeks of pregnancy the number of weeks the patient is pregnant will match the fundal height measurement plus or minus 2 cm. Therefore, if the patient is 24 weeks, a normal measurement would be either 22 cm to 26 cm.
66
What hormone induces uterine growth
Increased production
of estrogen &
progesterone initiates
uterine growth.
67
One hour after delivery where do you expect to find the fundus of the uterus?
A. 4 cm below the xiphoid process
B. right above the symphysis pubis
C. At the umbilicus
D. 2 cm below the umbilicus
The answer is C.
68
1. During a prenatal visit a patient tells you her last menstrual period was May 21, 2016. Based on the Naegele's Rule, when is the estimated due date of her baby?*
A. February 27, 2016
B. March 19. 2017
C. February 28, 2017
D. April 16, 2016
C. February 28, 2017
69
2. During a prenatal visit a patient tells you her last menstrual period was November 25, 2016. Based on the Naegele's Rule, when is the estimated due date of her baby?*
A. October 1, 2017
B. September 10, 2017
C. August 28, 2016
D. September 1, 2017
D. September 1, 2017
70
3. During a prenatal visit a patient tells you her last menstrual period was January 20, 2016. Based on the Naegele's Rule, when is the estimated due date of her baby?*
A. October 27, 2016
B. September 5, 2017
C. October 28, 2016
D. November 1, 2016
A. October 27, 2016
71
2. Parity or "Para" is defined as ______________________________.
A. the number of babies born at 20 weeks or greater.
B. the number of pregnancies greater than 36 weeks.
C. the number of births at 20 weeks or less.
D. the number of completed pregnancies at 20 weeks or greater.
D. the number of completed pregnancies at 20 weeks or greater.
72
Gravidity is defined as _______________________________.*
A. the number of completed pregnancies at 20 weeks or greater.
B. the number of pregnancies greater than 20 weeks.
C. the number of times a woman has been pregnant regardless of the outcome.
D. the number of births regardless of the outcome.
C. the number of times a woman has been pregnant regardless of the outcome.
73
3. A woman who has never given birth or completed a pregnancy at 20 weeks gestation or greater is termed as?*
A. Primigravida
B. Nullipara
C. Nulligravida
D. Primipara
B. Nullipara
The answer is B. Nullipara means that the woman has never given birth or completed a pregnancy at greater than 20 weeks or greater.
74
4. A patient says she has never been pregnant before. You would chart this as?
A. Nullipara
B. Primigravida
C. Nulligravida
D. Multigravida
The answer is C. Nulligravida means that a woman has never been pregnant before.
75
How many cm does the fundus under the umbilicus after 72hours of giving birth?
A. 3 cm
B. 5 cm
C. 6 cm
D. 22cm
A. 3 cm
each day the fundus drops 1 cm under the umbilicus after giving birth
76
Immune system pregnancy
The maternal immune system functions during pregnancy to protect the mother against infection while also preventing rejection of the ge- netically foreign fetus. Pregnancy is not a state of immunosuppression; instead, there is both activation and dampening of aspects of the mater- nal immune system. There is evidence that the placenta has an active role in regulating the differentiation and function of the immune cells of the mother to support the pregnancy while also protecting the fetus.
77
Which of the following musculoskeletal changes would you suspect to see in a pregnancy women is at 36weeks gestation?
a. boy-his
b. scoliosis
c. kyphosis
d. lordosis
d. lordosis
78
Your pregnant patient has recently undergone an ultrasound at 34 weeks and her amniotic fluid had dramatically declined out of normal range (abnormal finding). What term would you define this as?
A. Placenta previa
B. Oligohydramnios
C. Abruptio Placenta
D. Polyhydramnios
B. Oligohydramnios
Functions
* Characteristics
* 98% water 2% salts
* Average at 34 weeks peaks @ 800
mL, @ term about 600 mL
* Polyhydramnios
* Oligohydramnios
79
What would be some vaginal or perineal changes during pregnancy?
Mucosa thicken, rugae pronounced
Increase discharge(Luekhorea), acidic environment
(prevent infections).
Superficial muscles-vaginal opening back
past rectum; deeper muscle across
perineum (sling)
Cervix, vaginal, abdominal tissue never
return to pre-pregnant statu
80
What is the importance of having your pregnancy patient empty their bladder before diagnostic test?
A. so she does not wet the bed
B. so the fetus has room to move without pressing down on the mother's fetus
C. so the uterus is midline during the diagnostic test
D. to ensure that her bladder will always remain the same prepregancy size
C. so the uterus is midline during the diagnostic test
81
GI changes in pregnancy?
Decreased gastrointestinal motility
* Nausea/vomiting
* Constipation/hemorrhoids
* Delayed gallbladder emptying
* Increased vascularity of gums, saliva
* Heartburn
* Hiatal hernia
The gums can become hyperemic, spongy, and swollen during pregnancy. They tend to bleed easily because the increasing levels of estrogen cause selectively increased vascularity and connective tissue proliferation (a nonspecific gingivitis).
Some pregnant women complain of ptyalism (excessive saliva- tion), often due to the unconscious decrease in swallowing by the woman when nauseated.
82
Your pregnant patient reports of morning sickness and nausea and vomtting? What would you as a nurse recommend to lessen these symptoms?
eat a small snack or cracker before getting out of bed
83
Kidney changes in pregnancy?
glomerular filtration is increased
84
Is Bun and Creatnine increased during pregnancy?
A. No
B. Yes
A. No
The glomerular filtration rate (GFR) in- creases by 50% during the first trimester and remains elevated through- out pregnancy. These changes are caused by pregnancy hormones; an increase in blood volume; and the woman’s posture, physical activity, and nutritional intake. The woman’s kidneys must manage the increased metabolic and circulatory demands of the maternal body, as well as the excretion of fetal waste products. The increase in GFR results in in- creased creatinine clearance and a reduction or decrease in serum creatinine, blood urea nitrogen (BUN), and uric acid levels
85
Is it a normal finding for Protein to be in the urine
A. No
B. Yes
A. No
the glomerular filters are not filtering properly
During normal pregnancy, there is an increase in the urinary excre- tion of protein and albumin, most notable after 20 weeks of gestation. This is due to increased GFR and impaired proximal tubular function. It is considered abnormal when proteinuria exceeds 300 mg/24 hours or when albuminuria is greater than 30 mg/24 hours. The amount of protein excreted is not an indication of the severity of renal disease, nor does an increase in protein excretion in a pregnant woman with known renal disease necessarily indicate a progression in her disease. However, a pregnant woman with hypertension and proteinuria must be evaluated carefully because she may be at greater risk for adverse pregnancy outcomes (Cunningham et al., 2018).
86
Does the pregnant woman's bladder become displaced during preganancy?
A. No
B. Yes
B. Yes
87
Is urinary frequency an abnormal finding in pregnancy?
A. Yes
B. No
B. No
88
Is there an increase in Urine production in pregnant women?
A. No
B. Yes
B. Yes
Yes due to the increase in blood volume the kidneys have more blood to filter which results in more production of urine
89
What is the best position for a pregnant women to lie in to in crease renal function?
A. right side lying
B. left side lying
C. Supine
D. Prone
B. left side lying
Renal function is most efficient when the woman lies in the lateral recumbent position and least efficient when the woman assumes a supine position. A side-lying position increases renal perfusion, which increases urine output and decreases edema. When the pregnant woman is lying supine, the heavy uterus compresses the vena cava and the aorta and CO decreases. As a result, blood flow to the brain and heart is continued at the expense of other organs, including the kid- neys and uterus.
90
What are some cardiovascular changes in pregnancy?
* Slight hypertrophy; placement up & forward
* Pulse increase-palpitations
* Increased blood volume: Physiologic anemia
* Increased cardiac output
* Pulse rate
* Stroke volume
* Hypercoagulable state
* Thrombosis risk
91
Respiratory Changes during pregnancy
* Changes compensate to maternal need
* Increased oxygen consumption;
efficiency of oxygen utilization
* Estrogen relaxes intracoastal ligaments
* Increase vascularity; nasal & sinus
congestion; epistaxis
* Diaphragm elevated (4 cm into thorax
at 36 weeks); 3rd trimester Shortness of Breathe
common
92
What is Vena Cava Syndrome?
In pregnant women laying supine fetus presses on vena cava disrupts circulation, can cause light-headedness to pregnant women, repositioning can prevent vena cava syndrome
93
What are some musckulosksteal changes in Preganancy?
*Center gravity shifts
forward; Lordosis
* Relaxation of joints;
pelvic joint mobility:
Gait more unsteady
* Abdominal muscles
stretch & lose tone/may
separate
The muscles of the abdominal wall stretch and ultimately lose some tone. During the third trimester, the rectus abdominis muscles can separate (diastasis recti abdominis), allowing abdominal contents to protrude at the midline. The umbilicus flattens or protrudes. After birth, the muscles gradually regain tone. However, separation of the muscles can persist.
94
What diagnostic can cause carpal tunnel in pregnancy women?
Edema involving the peripheral nerves can result in carpal tunnel syndrome during the last trimester.
95
Neurological changes in pregnancy
* Sensory changes in legs
* Sciatica
* Restless leg
syndrome
* Carpal tunnel;
Acroesthesia
* Tension headaches
* Syncope
* Muscle cramps
The olfactory sense is altered during pregnancy. Many women report an enhanced sense of smell and sensitivity to certain odors that previ- ously were benign.
96
Should a pregnant women reports of a headache be disregarded?
A. No
B. Yes
A. No\
Headache during pregnancy can be a symptom of a complication such as pre- eclampsia. Therefore, all pregnant women complaining of headaches should be carefully evaluated to rule out complications.
97
Integumentary changes in pregnancy?
Melasma (also called chloasma or mask of preg- nancy) is a blotchy, brownish hyperpigmentation of the skin over the cheeks, nose, and forehead, especially in pregnant women with dark
Striae gravidarum, or stretch marks (see Fig. 7.9), appear in 50% to 80% of pregnant women during the second half of pregnancy.
The linea nigra (Fig. 7.9) is a pigmented line extending from the symphysis pubis to the top of the fundus in the midline.
Angiomatas, commonly known as vascular spiders, are tiny star- shaped or branched, slightly raised, and pulsating end-arterioles usu- ally found on the neck, thorax, face, and arms.
Pinkish red, diffusely mottled, or well-defined blotches are seen over the palmar surfaces of the hands in the majority of women during pregnancy. These color changes, called palmar erythema, are related to increased estrogen levels.
Nail and hair growth may be accelerated. Some women notice thin- ning and softening of the nails. Hirsutism, the excessive growth of hair or growth of hair in unusual places, is commonly reported.
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Adolescent pregnancy
*Higher risk for anemia,
preeclampsia, preterm birth
* Possible impulsive behaviors &
lack life experience to make
informed, complex decisions
* Additional nutrition to provide for
own growth
* Possibly lack resources to support
education or provide care for self
or newborn
* Self-esteem issues
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Advanced Maternal Age
* Possible preexisting conditions
(diabetes & hypertension)
* Increased risk vaginal bleeding,
preeclampsia, multiple gestation,
gestational diabetes, preterm labor,
dysfunctional labor, cesarean birth
* Fetus at greater risk for low birth
weight, macrosomia, chromosomal
abnormalities & congenital
malformations
* Long identification as adult with
mature relationships/communicatio
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Goal for pregnant pt care
* Promote health, well-being;
preventative care
* Provide resources: poverty, lack
health insurance
* Culturally sensitive care,
communication
* Prenatal care of marginalized
women
* Inadequate prenatal care = increased
infant mortality, maternal/fetal
complications
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Things to ask your pregnant pt in first visit
* Childbearing, reproductive
history/current pregnancy
* Health history; Review of systems
* Mental health history
* Nutrition history
* History drug, herbal preparations
use
* Family history
* Social, experiential, occupational
history
* History physical abuse
* Physical examination; laboratory
tests
Biographic data
* Reason for seeking care
* Present health or history of
present illness
* Past health
* Family history
* Screen for abuse
* Review of systems
* Functional assessment
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What occurs when a pregnant woman lays on her back
Signs and Symptoms
* Pallor
* Dizziness,faintness,breathlessness
* Tachycardia
* Nausea
* Clammy(damp,cool)skin;sweating
Interventions
* Position woman on her side until he r signs and symptoms subside and vital signs stabilize to within normal limits.
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Violence during pregnancy
* Intimate partner
violence (IPV)
* Physical, emotional
or sexual abuse
* Isolation
* Controlling all aspects of the woman’s life
* Money
* Shelter
* Time
* Food
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Battering during pregnancy
Rates range 4% to 8%; (20% in some
populations)
Incidence intimate partner violence
may escalate
Often first incident during pregnancy
Risk to fetus: increased miscarriage,
preterm birth, and stillbirth
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Rh- and Rh+ pregnant women and fetus
Women with the Rh-negative (D-negative) blood type who are carrying an Rh-positive (D-positive) fetus can develop antibodies against the D antigen on the fetal red blood cell, causing lysis of the fetal red blood cells. This can lead to life-threatening hemolytic disease of the fetus and newborn (see Chapter 25).
A dose of 300 mg of Rh immune globulin is routinely administered at 26 to 30 weeks to all Rh-negative women without evidence of anti-D alloimmunization. If she gives birth to an Rh-positive infant, the dose of Rh immune globulin is repeated within 72 hours after birth (see the Medication Guide in Chapter 19).
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UTI symptoms
Although UTIs can be asymptomatic, typical symptoms include frequency, urgency, dysuria, dribbling, and hesitancy; gross hematuria can occur.
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Spiritual
Approaches
to Women’s
Health
Helpful in maintaining wellness, coping
with illness
Refers to efforts of our being, humanity
Holistic approach to women’s wellness
Spiritual assessment
Spirituality more basic to humanity than
religion
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Physical Exam &
Cultural
Considerations
In many
cultures a female
examiner is
preferred
* General appearance/objective
data/describe findings
* Vital signs
* Cultural considerations,
communication variations
* Literacy
* Woman expert on her life,
culture, experiences
* Respect, genuine desire to learn
encourage self disclosure
* Appropriate to disrobe
completely for physical exam?
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Lab test
* CBC- anemia, infection, or clotting disorders
* Blood type-blood group A, B, AB, or O
* Rh status-mom Rh (-); if fetus Rh (+) risk
isoimmunization
* Coombs-screen antibodies to Rh (+) proteins
* Rubella/Varicella- not immune? postpartum
vaccination offered
* STIs-mainly syphilis, gonorrhea, chlamydia
* HIV-screen for HIV, positive? further testing
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Lifestyle &
Hygiene
* More perspiration, body odor & acne may
shower more
* Leukorrhea thin, white, scant vaginal
discharge, no douching
* Cotton underwear, wipe front to back
* Sexual activity-sex until due date for most
healthy women, try different positions as
fetus grows
* Travel-safe to 36 weeks, ambulate every 1-2
hours fluids
* Work:-avoid heavy lifting, chemicals, fumes
exposure, radiation, diseases, rest & brief
walks to promote circulation
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Warning signs of pregnancy
* Any fluid from vagina-not leukorrhea
* Abdominal or pelvic pain
* Epigastric pain; severe heartburn
* Sudden or severe edema in face, hands
* Severe or unusual continuous headache
* Dizziness, blurred vision, seeing spots
* Persistent vomiting
* Temperature 100.4 F or higher
* Dysuria, oliguria
* No fetal movement for 12 hours
* Leg edema with pain or redness
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Preeclampsia
a condition in pregnancy characterized by high blood pressure, sometimes with fluid retention and proteinuria.
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Discomforts during preganancy
Gastrointestinal
* Nausea and vomiting
* Ptyalism
* Dyspepsia
* Flatulence
* Constipation; hemorrhoids
Respiratory
* Nasal Congestion
* Shortness of breath/hyperventilation
Musculoskeletal
* Backache; leg cramps
* Dependent edema
* Varicosities
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Should you give a live vaccine to a pregnant woman?
A. No
B. Yes
A. No
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your pregnant patient is currently in her third trimester at 36 weeks gestation, how often should her visits to the clinic be?
A. Biweekly
B. Weekly
C. Daily
D. Monthly
Monthly first 28 weeks
* Every 2 weeks from 28-35 weeks
* Weekly 36 weeks-delivery
* Visits added with unusual symptoms.
Schedule adjusted as needed if high-
risk complications
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What does the Maternal Multiple Marker test is used to find and what is the age of gestation this lab is taken?
15-18 weeks-
Maternal multiple Marker
Quad screening
1. Assesses for the presence of four specic sub- stances
2. Screens for other chromosomal defects, includ- ing Down’s syndrome and neural tube and ab- dominal wall defects
3. Interventions
a. a-Fetoprotein level is determined by a blood
sample drawn between 16 and 18 weeks of
gestation. NTD
b. If the level is abnormal and the gestation is
less than 18 weeks, a second sample is drawn
and screened.
c. An ultrasound is performed for elevated lev-
els to rule out fetal abnormalities or multiple
gestation.
d. Amniocentesis is performed to diagnose and
conirm chromosomal defect and/or neural
tube conditions.
This diagnostic test is used to test for any chromosomal abnormalities and neural tube defects in the fetus through a blood test
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When is an ultrasound screening or amniocentesis taken around what age of gestation?
15-26weeks
Ultrasound screening to measure the head and anatomical parts of the fetus and to see if the fetus is growing correctly
d. Amniocentesis is performed to diagnose and
conirm chromosomal defect and/or neural
tube conditions.
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When is Gestational Diabetes tested?
24-28 weeks
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The nurse is providing instructions to a pregnant cli- ent who is scheduled for an amniocentesis. What instruction would the nurse provide?
1. Strict bed rest is required after the procedure.
2. Hospitalization is necessary for 24 hours after the procedure.
3. An informed consent needs to be signed before the procedure.
4. A fever is expected after the procedure because of the trauma to the abdomen.
ANSWER 3
Rationale: Because amniocentesis is an invasive procedure, informed consent needs to be obtained before the procedure. After the procedure, the client is instructed to rest, but may resume light activity after the cramping subsides. The client is instructed to keep the puncture site clean and to report any complications, such as chills, fever, bleeding, leakage of fluid at the needle insertion site, decreased fetal movement, uter- ine contractions, or cramping. Amniocentesis is an outpatient procedure and may be done in the obstetrician’s office or in a special prenatal testing unit. Hospitalization is not necessary after the procedure.
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2. A pregnant client in the rst trimester calls the nurse at a health care clinic and reports noticing a thin, colorless vaginal drainage. The nurse would make which statement to the client?
1. “Come to the clinic immediately.”
2. “The vaginal discharge may be bothersome, but
is a normal occurrence.”
3. “Report to the emergency department at the ma-
ternity center immediately.”
4. “Use tampons if the discharge is bothersome, but
be sure to change the tampons every 2 hours.”
2. “The vaginal discharge may be bothersome, but
is a normal occurrence.”
Rationale: Leukorrhea begins during the first trimester. Many clients notice a thin, colorless, or yellow vaginal discharge throughout pregnancy. Some clients become distressed about this condition, but it does not require that the client report to the health care clinic or emergency department immediately. If vaginal discharge is profuse, the client may use panty liners, but should not wear tampons because of the risk of infection. If the client uses panty liners, the client needs to change them frequently.
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The nurse is performing an assessment on a client who suspects being pregnant and is checking the client for probable signs of pregnancy. The nurse would assess for which probable signs of pregnancy? Select all that apply.
1. Ballottement
2. Chadwick’s sign
3. Uterine enlargement
4. Positive pregnancy test
5. Fetal heart rate detected by a nonelectronic de-
vice
6. Outline of fetus via radiography or ultrasonog-
raphy
1, 2, 3, 4
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When is the mom's Rh factor tested
24-28 weeks
give the first dose and then the next dose within 72 hours of post delivery protect pregnancy
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Is Group Beta B life-threatening to the fetus? When is it tested?
at 35-37 gestation
- swab around mothers vagina and rectum to test for the bacteria
The test will either be positive or negative
if the test is positive you are required to give antibiotics 4 hours before delivery ton protect the baby from infection
This bacteria is teratogenic to the fetus and a=can kill the baby if not managed properly
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Can a patient have a vaginal delivery if there is an active herpes lesion?
No
always culture herpes lesion
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Risk factors for Prreclampsia
*Family history
* Multiple fetal pregnancy
* African-American race
* Obesity
* Before 19 & after 40 years old
* Pre-existing medical or genetic
conditions
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What is AVA according to the placenta?
You can find 2**arteries** and 1 vein in the placenta
**A-Artery**
**V-Vein**
**A-Artery**
