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NUR 102 OB Assessment #1 > Adaptations to Pregnancy > Flashcards

Adaptations to Pregnancy Flashcards

1
Q

Pregnancy challenges each body system to adapt to the increasing demands of the reproductive system & the growing fetus

A
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2
Q

Changes in the Reproductive System

Vagina & vulva

Cervix

Uterus (5000mL capacity at birth)

Ovaries

Breasts

A
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3
Q

Ovaries secrete ___ from corpus luteum in first 6-7 weeks; prevents spontaneous abortion

Breasts become highly vascular; areola become larger

___ (stretch marks)

A

progesterone

Striae gravidarum

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4
Q

By late pregnancy, blood flow 1200mL/min to uterus & placenta

Uterus grows through hyperplasia & hypertrophy

___ (top of uterus) helps to measure pregnancy

> Highest level that this reaches is the xiphoid process

Irregular uterine contractions in 1st & 2nd trimester

___ contractions ARE NOT labor contractions

A

Fundus

Braxton Hicks

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5
Q

Increase in vascularity to vaginal walls, leading to a bluish color

Increase in glycogen production leads to an increase in vaginal discharge

> Creates a favorable environment for yeast infections

Estrogen causes ___ (congestion w/blood) of cervix

A

hyperemia

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6
Q

___ sign - a softening of the cervix that can be felt

___ sign - a bluish-purple color of the cervix, labia, & vagina

A

Goodell’s

Chadwick’s

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7
Q

Respiratory Changes

Oxygen consumption increases by 20%

Hyperventilation - normal range for pregnant adult: __-__

(normal __-__)

___ PCO2

Respiratory Alkalosis

Movement of the diaphragm due to enlarging uterus

A

16-24

16-20

Lower

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8
Q

Cardiovascular Changes

Heart

Blood Volume

Blood Pressure

Blood Flow

Blood Components

A

Heart

  • Slight increase in size
  • Can be displaced in position
  • PMI site
  • Systolic murmurs common due to inc in blood volume
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9
Q

Blood Volume

  • Increases in plasma, WBC’s, RBC’s, platelets
  • Plasma increases 1200-1600 mL to transport O2 & nutrients
  • Creates a reserve for blood loss that occurs during delivery
  • RBC’s inc 20-30% above pre-pregnancy levels
  • pseudoanemia; iron supplementation in 2nd trimester

> constipation & nausea

A

Blood Pressure

  • Minimal changes d/t easier flow throughout body

> Positioning can impact BP

  • supine hypotension syndrome; DO NOT lay flat
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10
Q

Blood Flow

  • Flow to the uterus, placenta, & fetus
  • Inc flow to kidneys to remove waste products from mother & fetus
  • Inc flow to growing breasts
  • Stasis can cause venous distension, leading to varicose veins & inc clot risk
A

Blood Components

  • Iron for erythrocyte production

> Supplements increase it by 30%

  • WBC’s inc by up to 15,000; inc in labor, delivery, & postpartum
  • Platelet’s & coag factors change slightly to protect from hemorrhage (inc risk of DVT or PE)
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11
Q

Gastrointestinal Changes

  • Mouth - gingivitis, bleeding gums as sign of pregnancy & anemia
  • Esophagus - pyrosis (heartburn)
  • Stomach - slower motility –> constipation
  • Small and Large intestine
A
  • Liver & Gallbladder

> prolonged emptying; gallstone formation; retainment of bile salts

> itchy in hands & feet

> may have to undergo GB surgery

> alterations in LFT’s d/t displacement

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12
Q

Genitourinary Changes

Bladder

Ureters

Kidneys

  • Frequent urination; nocturia
  • Stress & urge incontinence (encourage Kegel exercises)
  • Bladder moves forward & upward; inc risk of infection & trauma during childbirth
A
  • Ureters compressed d/t shrinkage of abdominal cavity; stasis can occur
  • Inc risk of UTI or kidney stone development
  • Renal blood flow inc 50-80% during pregnancy
  • Tubules can’t reabsorb all components going through so you see glucose, amino acids, electrolytes & water-soluble vitamins in urine in larger amts
  • Glucosuria common in pregnancy
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13
Q

Musculoskeletal Changes

Pelvic instability - allows for fetus to descend into pelvic cavity

___ - curvature of lower back

___ - abdominal muscles end up slightly or severely separating

A

Lordosis

Diastasis Recti

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14
Q

Skin Changes

Circulation increases

Acne development - sweat & sebaceous gland accelerated activity

Hyperpigmentation

Striae gravidarum - fade but don’t disappear

Hair growth

> postpartum hair loss can occur > pregnancy

A
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15
Q

Hyperpigmentation

  • Elevated estrogen, progesterone, & melanocyte-stimulating hormone leading to hyperpigmentation; begins as early as 8th week

___ - the “mask” of pregnancy; brownish patches on cheeks, nose

___ - a dark line over longitudinal line of abdomen

A

melasma

linea nigra

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16
Q

Endocrine Changes

  • Pituitary gland
  • Thyroid gland
  • Pancreas
  • Placental hormones
  • Metabolism
A
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17
Q

?

Normally enlarges

Important in fetal brain development

Have level checked during appointments

A

Thyroid gland

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18
Q

?

Expected 25-35 lb weight gain

Body water inc 6.5-8.5L (stay hydrated) = edema

A

Metabolism

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19
Q

Pancreas

Fluctuations in ___ production & alterations in maternal blood glucose

A

insulin

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20
Q

Pituitary gland

___ secretion happens; prepares breast to produce milk

Estrogen & progesterone levels are high

After birth > breast milk production

___ stimulates uterine contractions; milk ejection reflex

A

Prolactin

Oxytocin

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21
Q

Placental Hormones

  • Cause maternal resistance to insulin; inadequate insulin production = maternal DM

___ starts developing at moment of conception & stimulates corpus luteum to make progesterone until placenta develops & takes over; also creates positive test result

A

hCG

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22
Q

?

Is a relaxant for smooth muscles; prevents spontaneous abortion; prevents tissue rejection of fetus

A

Progesterone

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23
Q

?

Stimulates uterine growth; develops ductal system in breast for breastfeeding; hyperemia; gum bleeding

A

Estrogen

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24
Q

?

Increases glucose availability for fetus

A

Human chorionic sommatomammotropin (HCS)

25
Q

?

Inhibits uterine activity; helps soften cervix; lengthens pubic ligaments

A

Relaxin

26
Q

So now that we know all the changes that occur in pregnancy, it should be easy to tell if I am pregnant…right?

A

Presumptive Signs of Pregnancy

  • Amenorrhea
  • Nausea & vomiting
  • Fatigue
  • Urinary frequency
  • Breast & skin changes
  • Vaginal & cervical color changes
  • Fetal movement (as perceived by the mother)
27
Q

Probable Signs of Pregnancy

  • Abdominal enlargement
  • Cervical softening - ___ sign
  • Uterine consistency - ___ sign
  • Braxton-Hicks contractions
  • Palpation of fetal outline

___ (a soft, blowing sound that can be auscultated over the top of the uterus)

  • Positive pregnancy test (could be from hematuria, proteinuria; certain diseases or rx’s)
A

Goodell’s

Hegar’s

uterine souffle

28
Q

Positive Indicators of Pregnancy

* Auscultation of fetal heart sounds

> handheld doppler @ 9 weeks

> US @ 8 weeks

* Fetal movements felt by the examiner

* Visualization of the fetus

> By US as early as 3 weeks gestation on transvaginal US

A

Now that we know she is pregnant, let’s look at how we can best care for her

29
Q

Preconception/Interconception Care

Because the first weeks of pregnancy are such a sensitive period of fetal development, preconception or interconception is recommended for all women of childbearing age

A

Look for comorbidities; e.g. DM, HTN

Use of alcohol, tobacco, illicit drugs

Partner violence? Taking harmful drugs?

Are overweight or obese?

Look at vaccination history

30
Q

?

Take 400-800 micrograms of ___ 1 month < conception; consider family history of neural tube defects (would increase dosage to ___)

A

folate

4 mg

31
Q

Obtaining an Obstetric History: GPTPAL

Obstetric history is reported through the acronym GPTPAL

G = ?

P = ?

T = ?

P = ?

A = ?

L = ?

A

Gravidity

Parity

Term

Preterm

Abortions

Living Children

32
Q

?

number of pregnancies, regardless of duration

A

Gravidity

33
Q

?

number of pregnancies that ended at 20 weeks or greater

> a miscarriage @ 16 weeks gestation WOULD NOT count

A

Parity

34
Q

?

deliveries between 38 and 42 weeks

A

Term

35
Q

?

deliveries between 20 and 38 weeks

A

Preterm

36
Q

?

spontaneous or therapeutic

A

Abortions

37
Q

?

number of children currently living

A

Living Children

38
Q

?

is a miscarriage

“therapeutic” is choosing to end the pregnancy; more common of what we think

A

spontaneous abortion

39
Q

Put It Into Practice

Alia gave birth to a daughter 5 years ago at 41 weeks gestation. She then had a miscarriage one year later at 9 weeks gestation. Two years ago, she birthed her son at 36 weeks gestation. She thinks she may be pregnant again after having a positive home pregnancy test, with her last menstrual period being 11/27.

What is Alia’s GPTPAL?

A

G = 4

P = 2

T = 1

P = 1

A = 1

L = 2

40
Q

Calculating Estimated Date of Delivery

Estimated Date of Delivery (EDD) is commonly done based on the first day of the last normal menstrual period (LNMP)

Nagele’s Rule

Subtract 3 months from the first day of the LNMP

Add 7 days

Correct for the year, if needed

A

* Rule only works if it’s a 28-day cycle

41
Q

Put It Into Practice

Alia gave birth to a daughter 5 years ago at 41 weeks gestation. She then had a miscarriage one year later at 9 weeks gestation. Two years ago, she birthed her son at 36 weeks gestation. She thinks she may be pregnant again after having a positive home pregnancy test, with her last menstrual period being 11/27/21.

According to Nagele’s rule, what is Alia’s EDD?

A

Answer: September 3, 2022

42
Q

Other Historical OB Information to Obtain

  • Past pregnancies & deliveries
  • Length of gestations - h/o preterm births
  • Weight of infants
  • Labor experience & type of delivery
  • Anesthesia history
A
  • Prenatal, intrapartum, & postpartum complications
  • Neonatal complications
  • Methods of newborn feeding used (e.g. breastfeed, bottle-feed)
  • Any special concerns
43
Q

More Patient History to Review

  • Gynecologic & contraceptive history

> STI’s present? infertility issues? IUD used? oral contraceptives taken?

  • Medical-surgical history
  • Family health history (patterns of congenital/genetic abnormalities)
  • Partner’s health history (assess Rh type)
  • Psychosocial history
A
44
Q

Schedule of Antepartum Visits

Conception to 28 Weeks: every 4 weeks

29 through 36 Weeks: every 2 weeks

37 Weeks until Birth: Weekly

A

Monitor mom & baby & ensure proper growth is occurring

Provide frequent touchpoints for pregnancy, L&D, & postpartum education

Centering pregnancy concept - schedule for meetings that meets at 12 weeks & into postpartum period

45
Q

?

Could experience preterm labor w/a viable baby @ this period

A

29 through 36 Weeks: Every 2 Weeks

46
Q

?

Check fetal HR

Measure fundal height

Take mother’s BP

A

Conception to 28 Weeks: Every 4 Weeks

47
Q

?

Ensure that no fetal complications occur

Make sure no maternal complications develop

A

37 Weeks until Birth: Weekly

48
Q

Ongoing Antepartum Assessments and Teaching

  • Vital signs (BP)
  • Weight
  • Urinalysis (look for protein, glucose, ketones, UTI)
  • Fundal height (centimeters correlates to week’s gestation; e.g. 20 weeks gestation = 20 cm)
  • Leopold’s maneuver’s
  • Fetal heart rate (what is the normal range ?)
A

110-160 bpm

49
Q

Ongoing Antepartum Assessments and Teaching cont’d

  • Fetal activity
  • Signs of labor
  • Ultrasound screening
  • Glucose screening (24-48 weeks gestation)
  • Isoimmunization (Rh factor)
  • Pelvic examinations
A
50
Q

Common Discomforts of Pregnancy

  • Nausea & vomiting / heartburn
  • Backache / round ligament pain
  • Urinary frequency / varicosities
  • Constipation
  • Hemorrhoids / leg cramps
A

Safety Alert! Signs of Possible Complications During Pregnancy

* Vaginal bleeding / visual disturbances / painful urination

* Fluid leaking from vagina / persistent or severe epigastric pain

* Persistent vomiting / swelling of the fingers or face

* Convulsions / decrease in frequency or strength of fetal movements

* Continuous, pounding headache

* Chills or fever / sxs of preterm labor

51
Q

Remember, we need a holistic approach…we have covered the needs of the changing pregnant body, what about the psychological responses to pregnancy?

A

Maternal Psychological Responses

* First Trimester

* Second Trimester

* Third Trimester

52
Q

?

* Vulnerability

* Increasing dependance

* Preparation for birth (“nesting”)

A

Third (Trimester)

53
Q

?

* Uncertainty

* Ambivalence

* Focus on Self

A

First (Trimester)

54
Q

?

* Physical evidence of pregnancy

* Focus on fetus

* Narcissism & introversion

* Body image

* Changes in sexuality

A

Second (Trimester)

55
Q

Factors that Influence Psychological Adaptations

  • Age (e.g. geriatric 35+)
  • Multiparity
  • Social support
  • Absence of partner
  • Socioeconomic status
  • Abnormal situations (e.g. partner violence, substance abuse)
A

Familial Adaptations

  • Paternal adaptations
  • Adaptation of grandparents
  • Adaptation of siblings (based on age; e.g. toddlers don’t understand situation)
56
Q

Cultural Influences on Childbearing

  • Health beliefs
  • Communication techniques
  • Time orientation
A
57
Q

Health Beliefs

* Healthcare maintenance practices (pregnancy thought of as an illness in the US)

* Belief in fate

* Practices for preventing illness

* Ways to restore health

* Modesty (preference for female caregivers; lack of male nurses in L&D)

* Female genital cutting (happens in childhood; pelvic exams uncomfortable & difficulty during delivery)

A

Communication Techniques

* Language

* Communication style

* Decision making

* Eye contact (can be offensive in some cultures)

* Touch (e.g. welcomed in Hispanic cultures)

58
Q

?

(is) Providing information while acknowledging that the client or family members may hold different views

Allow the family to express their beliefs, and then provide rationales for why the recommendations are made. Together, compromise to an outcome that is satisfactory for all.

A

Cultural Negotiation

59
Q

Perinatal Education

  • Preconception classes
  • Early pregnancy classes
  • Exercise classes
  • Childbirth preparation classes
  • Cesarean birth preparation classes
A
  • Breastfeeding classes
  • Parenting classes
  • Classes for partners
  • Classes for siblings
  • Postpartum classes

NUR 102 OB Assessment #1 (11 decks)

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