1229 Exam 2: Antepartum

Question 1

Cardiovascular

Answer 1

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 flow

Question 2

Respiratory

Answer 2

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

Question 3

Renal System

Answer 3

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

Question 4

Integumentary

Answer 4

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)

Question 5

Musculoskeletal

Answer 5

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

Question 6

Neuro

Answer 6

Sensory changes in legs (pressure on nerves)
Lightheadednes
Cramps in legs (hypocalcemia)
Headaches
Carpal Tunnel syndrome has edema in nerves to hands

Question 7

Gastrointestinal

Answer 7

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)

Question 8

Adaptations to Pregnancy

Answer 8

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

Question 9

Adaptations to Pregnancy

Answer 9

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)

Question 10

Presumptive Signs of Pregnancy

Answer 10

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--

Question 11

Probable Signs of Pregnancy

Answer 11

Abdominal enlargement
Cervical changes
Ballottement
Quickening
\+ home pregnancy test
Goodell's
Chadwick's
Hegar's
Braxton-Hicks
--usually findings of the health provider--

Question 12

Positive Signs of Pregnancy

Answer 12

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

Question 13

Gravidity

Answer 13

–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

Question 14

Parity

Answer 14

–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

Question 15

Psychosocial changes for the family

Answer 15

Mother & Father–acceptance of the pregnancy, identification/changes in roles, relationship with fetus, preparation for childbirth

Question 16

Discomforts of Pregnancy

Answer 16

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

Question 17

Discomfort of Pregnancy

Answer 17

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

Question 18

Childbirth preparation methods

Answer 18

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

Question 19

Pregnancy Dr Visits

Answer 19

Every month for 7 months
Every 2 weeks during 8th month
Every week during 9th month

Question 20

Diagnostic Test (ATI Maternal Newborn p33 Becca p82)

Answer 20

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

Question 21

Potential Complications (Read Ch.11 p51)

Answer 21

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

Question 22

DFMC
AF
AFV
AFI
LBW
PUBS
CVS
NTDs

Answer 22

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

Question 23

FHR
IUGR
AFP
EFM
NST
CST
ROM
PROM

Answer 23

Fetal Heart Rate
Intrauterine Growth Retardation
Alpha-Fetoprotein
External Fetal Monitoring
Non-Stress Test
Contraction Stress Testing
Rupture of Membranes
Premature Rupture of Membranes

Question 24

DFMC

Answer 24

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.

Question 25

Prenatal Testing

Answer 25

Ultrasound used commonly to identify # of fetuses, dates, IUP.
Transvaginal done in 1st trimester, does not require full bladder
Abdominal: Limited viability, fetal presentation, gestational age, placenta, amount of amniotic fluid.
-Targeted anomaly suspected, placenta position, growth of baby, amniotic fluid, blood flow,
-Need full bladder, but should not be uncomfortable.
-Gel maybe cold

Question 26

Ultrasound

Answer 26

used to estimate amount of AF
AFI < 5 cm oligohyramnios
5-19 cm normal
> 20 cm polyhyramnios
Evaluate fetal nuchal translucency at nape of neck @ 10-14 weeks, if > 3mm, diagnostic genetic testing recommended

Question 27

Biophysical Profile

Answer 27

Combination of studies to evaluate the pregnancy
Ultrasound for monitoring fetal breathing movements, fetal body/limb movements, fetal muscle tone, AFV
NST
Scores are all even numbers
SEE TABLE 9-1 Page 200

Question 28

MRI

Answer 28

Non-invasisve
Used for fetal structures, placenta, AF
Biochemical status of tissues
Malformation
Mother positioned supine, may take as long as 60 minutes
Because fetus may move, mother may have to be sedated

Question 29

Amniocentesis

Answer 29

Done after the 14th week
Need sufficient AF
Check for congenital anomalies, lung development, Dx of fetal hemolytic disease
Need ultrasound to identify position of placenta
Sterile Technique
Risk of leaking AF, preterm labor, infection, hemorrhage, or fetal death
Rh negative mother needs Rho (D) immune globulin (RhoGam, Rhophylac)

Question 30

PUBS

Answer 30

Guided by ultrasound
Used for genetic analysis
May cause infection
May need Intrauterine Transfusion
Need fetal monitoring
Ultrasound to check for bleeding
Need 1-4 mL blood

Question 31

CVS

Answer 31

Done at 10-12 weeks
Ultrasound guided
Can do transbdominal or transcervical
Amniocentesis safer if in 2nd trimester
If mom Rh negative, RhoGam

Question 32

AFP

Answer 32

Blood test
Drawn at 15-22 weeks
Done primarily to check for NTDs
One of 3 makers used Down Syndrome screening

Question 33

Non-Stress Test

Answer 33

Non-invasive
High rate of false positives due to fetal sleep cycle
Done in Semi-Fowler’s (tilt slightly to left)
Doppler/transducer records fetal movements
Compare FHR and fetal activity
Reactive tracing if:
-2 or more accelerations of 15 beats/min lasting 15 seconds over 20 minutes
-normal baseline
-Long-term variability of 10 or more BPM
Non-reactive if these criteria not met after 40 minutes

Question 34

Contraction Stress Test

Answer 34

used to detect fetal compromise with stress (tests if fetoplacental unit healthy)
Provides earlier warning that NST with fewer false positives
More time consuming
More invasive (if Pitocin used)
Reclining position (tilt)
Monitor strip X 10 minutes

Question 35

CST continued…

Answer 35

Nipple stimulation
-Warm, moist wash clothes to both breasts
-Massage one nipple X 10 minutes (or massage X 2 min, rest X 5 min)
If no adequate contractions (3 in 10 min), try stimulating both (oxytocin release from pituitary)

Question 36

Recommended weight gain in pregnancy

Answer 36

Unerweight: 20-40 lbs
Normal weight: 20-30 lbs
Over weight: 15 lbs

General rule mother should gain 3-4 lbs during 1st trimester, 1 lb per week for the last two trimesters

Question 36

CST continued…

Answer 36

Oxytocin stimulation
Pitocin infused IV to achieve 3 contractions in 10 min. (mix 10 units in 1000 mL of IV fluid, give with pump only, give 0.5 milliunits/minute to begin0
If no late decals = negative
Repetitive decels = positive
Late decel occurs at beginning of contraction peak and continues after conclusion of contraction