1229 Exam 2: Antepartum Flashcards
Cardiovascular
Slight enlargement
Murmur
Pulse increase up to 10-15 bpm
Palpitations
Increase CO
Decrease in BP
Pumps 1500 mL of blood
Decrease in Hgb & Hct values
-anemic=10 Hgb g/dL or < (12-16)
35% Hct or < (40%-48%)
If laying on back Uterus on Vena Cava--slows blood flowRespiratory
O2 requirements increase
Diaphragm displaced as much as 4 cm–Shortness of breath
Increased vascularization causes nasal & sinus stuffiness, epistaxis
Bluish discoloration of the cervix–Cadminsign
Respiratory rate may increase slightly by apprx. 2 br./min
During last trimester the size of the chest may enlarge to allow for lung expansion as the uterus pushes up ward
Renal System
Renal pelvis & ureters dilate
Pelvis gets loose
bladder irritability, nocturia, urinary frequency & urgency without dysuria
increase UTI’s, physiological edema
Glycosuria–occurs at varying times & to varying degrees (1+-4+)–spills at 160 mg/dL, proteinuria
Filtration rate increases during pregnancy secondary to the influence of pregnancy hormones and increase in blood volume and metabolic demands
Integumentary
Pigmentation
Mask of Pregnancy–Chloasma-pigmentation increases on face (melatonin spots)
Linea nigra (a dark line of pigmentation from the umbilicus extending to the pubic area–fundus)
Striae gravidarum (stretch marks)
Musculoskeletal
Pelvis tilts forward Waddling gait Umbilicus flatten or protrudes Carpal tunnel Lordosis (swayback) Pelvic joints relax Body alterations and Weight increase necessitate and adjustment in posture
Neuro
Sensory changes in legs (pressure on nerves)
Lightheadednes
Cramps in legs (hypocalcemia)
Headaches
Carpal Tunnel syndrome has edema in nerves to hands
Gastrointestinal
N/V-may be due to hormonal changes and pressure to the abdominal cavity–dry crackers and water when wake up, posture is erect goes away, 5-6 small meals a day
Constipation
Hemorrhoids (late in pregnancy)
Gums bleed easily
Indigestion (pressure from the uterus)
Development of gallstones (posture from gravid uterus)
Adaptations to Pregnancy
Naegle Rule–take the 1st day of the last menstrual cycle, subtract 3 months, add 7 days and 1 year
Chadwick’s sign–cervix takes on bluish
Goodell’s sign–cervical softening
McDonald’s sign–easy flexion of fundus on cervix
Heger’s sign–7-8 weeks isthmic softening
Braun von Fernwald’s sign–softening & slight fullness of the fundus near the area of implantation
Braxton Hicks–early contractions and false labor
Ballottement–rebound of unengaged fetus
Adaptations to Pregnancy
Uterus enlarges & elevates out of pelvis
Cervical friability
Leukorrhea–flow of whitish yellowish or greenish discharge from the vagina
Quickening: fetal movements as early as 14-16 weeks in multigravida-(two or more pregnancies) as late as 16-20 weeks in nulliparous-no pregnancy beyond the stage of viability (multipara-has completed two or more pregnancies to the stage of viability)
Presumptive Signs of Pregnancy
Amenorrhea--the absence of menstruation N/V Breast changes & Tenderness Urinary frequency Fatigue Quickening Uterine enlargement Linea Nigra Chloasma Striae Gravidarum Darkened areolas --observations of the expectant--
Probable Signs of Pregnancy
Abdominal enlargement Cervical changes Ballottement Quickening \+ home pregnancy test Goodell's Chadwick's Hegar's Braxton-Hicks --usually findings of the health provider--
Positive Signs of Pregnancy
FHR: Doppler 8-12 weeks; Fetoscope 16-20 weeks
Fetal heart sounds
Fetal movement
Ultrasound–visualization of the fetus
Measure Human Chorionic Gonadotropin (HCG)–earliest biochemical mark for pregnancy
Gravidity
–number of pregnancies
Nulligravaida–a woman who has never been pregnant
Primigravida–a woman who is in first pregnancy
Multigravida–a woman who has had two or more pregnancies
Parity
–number of pregnancies in which the fetus or fetuses reach viability (approx. 20-24 weeks or fetal weight of more than 500g or 2 lbs regardless of whether the fetus is born alive or not)
Nullipara–no pregnancy beyond the stage of viability
Primipara–has completed one pregnancy to the stage of viability
Multipara–has completed two or more pregnancies to the stage of viability
Para–0000
-first number is number of full term babies
-second number is preterm (less than 38 weeks)
-third number is miscarriage/abortions
-fourth number is living children
Psychosocial changes for the family
Mother & Father–acceptance of the pregnancy, identification/changes in roles, relationship with fetus, preparation for childbirth
Discomforts of Pregnancy
Breast-tenderness, supportive bra, uncomfortable during sex
Urinary frequency-kegel exercises, void regularly, pad, limit fluid intake before bed
Fatique- rest, balanced diet
N/V-erect posture, don’t over eat, stop smoking, dry crackers before getting up, 5-6 meals/day, careful with food choices
Nasal stuffiness-saline nose drops, humidifier
Leukorrhea-no douching, wear pad, wipe front to back, if itching notify HCP
Mood swings-communication, support group, partner
Pigment changes, acne-resolves after delivery
Pruritus(itching)- nails short, tepid(lukewarm) bath with Aveeno or Alphakeri
Palpitations-notify HCP if s/s cardiac decompensation
Supine Hypotension-to stop recline or lay on side
Discomfort of Pregnancy
Food cravings-careful if nonnutritive, interferes with balanced diet
Heartburn-avoid spicy, gas forming, fatty foods, erect posture, avoid large meals
Constipation-water, roughage, exercise, no stool softeners, laxatives
Flatulence-chew slowly, avoid foods that cause, exercise
Varicosities (peripheral)-avoid gaining a lot of weight, no constrictive clothing, rest, elevate legs, support hose..(hemorrhoids)-sitz bath, astringent compresses, avoid constipation
Headaches-try relaxation
Carpal Tunnel-elevate or splint
Round ligament-rest, body mechanics
Joint pain-correct posture, body mechanics, low shoes, abdominal supports
Childbirth preparation methods
Need to provide info about choices for birth provided at the hosp
May choose a birthing plan
Prenatal education materials may not reflect cultural, educational, or language
Pregnancy Dr Visits
Every month for 7 months
Every 2 weeks during 8th month
Every week during 9th month
Diagnostic Test (ATI Maternal Newborn p33 Becca p82)
Blood type, RH factor and presence of irregular antibodies CBC with differential, Hgb and Hct Hgb electrophoresis Urinalysis One Hour Glucose tolerance Three hour Glucose tolerance PAP test Cervical culture Rubella titer PPD(tuberculosis screening) Hep B Venereal disease(syphilis) HIV TORCH-Toxoplasmosis,other infections,rubella,cytomegalovirus,and herpes Maternal serum alpha-fetoprotein
Potential Complications (Read Ch.11 p51)
Fever Visual disturbances Leakage of fluid Swelling of face, fingers, sacrum Severe headache Epigastric pain Persistent vomiting Abdominal cramping Change in fetal movement Vaginal spotting or bleeding Painful urination
DFMC AF AFV AFI LBW PUBS CVS NTDs
Daily Fetal Movement Count Amniotic Fluid Amniotic Fluid Volume Amniotic Fluid Index Low Birth Weight Percutaneous Umbilical Blood Sampling Chorionic Villus Sampling Neural Tube Defect
FHR IUGR AFP EFM NST CST ROM PROM
Fetal Heart Rate Intrauterine Growth Retardation Alpha-Fetoprotein External Fetal Monitoring Non-Stress Test Contraction Stress Testing Rupture of Membranes Premature Rupture of Membranes
DFMC
Kick count: Mother counts fetal movements for 2 hours 2-3 times/day or until 10 movements are felt.
ALARM no fetal movements X 12 hrs*
If less than 10 in specified time, or fewer than previous day, notify MD
Done at home, simple, inexpensive, doesn’t interfere with normal routine
May have false positives due to fetal sleep cycle, maternal medications, ext.
