102-Antepartum Flashcards
HR with pregnancy
Increases 15-20 bpm
WBC with pregnancy
Increase to about 15,000 sometimes (normal 5-10,000) due to hormones, stress, exercise
Hyper coagulation
Fibrinogen increases by 50% with pregnancy to decrease risk for PP hemorrhage but increase DVT risk
Ptyalism
Increased saliva
Optimal positivism for urinary function and circulation
Left lateral recumbent
Chloasma
Hyper pigmentation on darker skinned pregnant women
Linea nigra
Darkened (hyper pigmentation) through umbilicus
Striae gravidarum
Stretch marks
Presumptive diagnosis
Woman perceives own pregnancy (subjective)
Nausea/vomiting, amenorrhea, fatigue, urinary freq, breast changes, quickening
Probable diagnosis
Provider perceived (objective)
Chadwick’s sign, goodells sign, uterine and abdominal growths skin hyper pigmentation, positive pregnancy tests
Positive diagnosis
Objective but ONLY attributed to fetus
FH auscultation (fetus HR), fetal movement and palpation noted by provider, ultrasound visitation
Fetal heart rate can be felt when? (Positive diagnosis)
4-8 weeks
Chadwick’s sign
Bluish color of vaginal mucosa (probable sign of pregnancy)
Goodells sign
Softening of cervix (probably sign of pregnancy)
Nageles rule
How to calculate estimated due date:
Last noted monthly period (LNMP) - 3 months + 1 week
1st trimester
First day LMP-12 weeks
2nd trimester
13-27 weeks
3rd trimester
28-40 weeks
Term gestation
37-42 weeks
Most babies born either 3 weeks before or 2 weeks after due date
Gravida
times pregnant
Para
pre term births
T
term births
A
abortions (including miscarriages under 20 weeks)
L
living children
GTPAL
Way to identify patients gravida and para (jargon)
Nullgravida
Never pregnant before
Primigravida
First time ever pregnant
Multigravida
Pregnant 2+ times
Why is folic acid important before and during pregnancy
Prevents neural tube defect
Prenatal visits conception-28 weeks
Every 4 weeks
Prenatal visits 29-36 weeks
Every 2 weeks
Prenatal visits 37 weeks- birth
Every week
Normal pregnancy weight gain
25-35 lbs
Transnational ultrasound
Used in 1st trimester to confirm pregnancy and calculate age (probe into vagina)
Transabdominal ultrasound
2 & 3 trimesters
Anatomical survey of fetus, further evaluation
When is maternal blood drawn
15-20 weeks gestation
Quad screen
At 15-20 weeks gestation this screens for Down syndrome (low AFP) and neural tube defects (high AFP)
Kick counts
Daily fetal movement count after 28 weeks
4 movements in one hour or 10 in 2 hours
Nonstress test
Assess fetal well being, FH accelerates in respect to movement= adequate oxygenation
Vibroacoustic stim test
Confirm non-reactive NST (nonstress test)
What is the biophysical profile
Assessment of 5 parameters for fetal well being (NST and US)
What are the 5 parameters for fetal well being in the biophysical profile
- NST
- Fetal breathing movements
- Gross body movements
- Fetal tone
- Amniotic fluid (fluid around baby)
Iron deficiency hgb/hct ranges
Hgb
Gestational trophoblastic disease
Aka hydatiform mole
Benign proliferating growth placenta trophoblasts; nonviable pregnancy
Gestational trophoblastic disease assessments
Vaginal bleeding, hyperemesis due to EXCESSIVE HCG levels
**can develop into cancer
How to prevent antibodies in Rh- women
Rhogam injections at 28 weeks or abdominal trauma/procedures
What does practitioner do for incompetent cervix?
Cerclage placement
-pursued string suture to reinforce cervix
Nursing care after cerclage placement for incompetent cervix
Monitor: uterine activity, vaginal bleeding/leaking fluid, infection, and administer tocolytics
What does it mean when a mom is sensitized
Develops antibodies against Rh
Placenta previa
Placenta implanted in low segment of uterus over cervix- requires c-section, 20 weeks found usually and usually migrates to correct spot as uterus grows
Clinical mani placenta previa
Painless, BRIGHT RED uterine bleeding
Mom at risk for: hemorrhage and hypovolemic shock
Fetus at risk for: anemia, hypoxia, death
Main nursing actions for placenta previa
Insert large bore IV cath to anticipate blood transfusion, corticosteroids as ordered for fetal lung maturation, monitor CBC (h/h), clotting
Abruptio placenta
Partial or total separation of placenta after 20 weeks and before delivery (3 trimester); leading cause of maternal and fetal death
Clinical manifestations abruptio placenta
DARK RED bleeding, severe abdominal pain, contractions, uterine tenderness
Nursing actions for abruptio placenta
Mom must deliver, palpate uterus (tenderness, distention), hypotension-tachycardia-administer O2 (hypovolemic shock), CBC &clotting
Main clinical mani of preeclampsia
BP, edema, quiet environment, bed rest in recumbent position, anticonvulsant (mag sulfate), anti hypertensive
HELLP syndrome
Complication of severe preeclampsia
H- hemolysis (anemia/jaundice)
E- elevated L- liver enzyme (epigastric pain, nausea/vomiting)
L- low P- platelets (abnormal bleeding and clotting)
Syncope
fainting
Polyhydroamnios
Increased amniotic fluid
Oligohydramnios
Decreased amniotic fluid
Newborn macrosomia
Large birth weight- common morbidity of GDM (gestational diabetes mellitus)
Infections that complicate pregnancy
TORCH
T- toxoplasmosis (cat litter) O- other (hep B) R- rubella C- cytomegalovirus H- herpes simplex
(* can all cross placenta and have teratogenic to fetus)
Group B streptococcus (GBS)
A symptomatic bacteria colonizing rectum vagina cervix and urethra.
35-37 weeks gestation
Penicillin
Chorionic villus sampling (CVS)
Tests placental tissue for fetal abnormalities (cyst. fibrosis, down);
10-12 weeks
Low risk for fetal loss/bleeding from procedure
Amniocentesis
Diagnose genetic disorders, lung maturity, hemolytic disease fetus, intrauterine infection
Needle through abdomen to get amniotic fluid
2/3 trimester
Less favorable than CVS (expensive, risk, later term)
