anatomy and physiology of pregnancy

Question 1

Parity?

Answer 1

number of pregnancies carried past 20 weeks – not number of fetuses born & regardless of alive or stillborn

Question 2

Gravida?

Answer 2

a woman who has been pregnant

Question 3

Primigravida?

Answer 3

a woman pregnant for the first time

Question 4

Primipara?

Answer 4

a woman who has delivered one child past gestation of 20 weeks

Question 5

multigravida?

Answer 5

a pregnant woman who has been pregnant before

Question 6

multipara?

Answer 6

a woman who has carried two or more pregnancies to 20 weeks or more

Question 7

Nulligravida

Answer 7

a woman who has never been and is not currently pregnant

Question 8

Nullipara?

Answer 8

a woman who has not completed a pregnancy with a fetus or fetuses who have reached 20 weeks or more

Question 9

Preterm?

Answer 9

pregnancy that has reached 20 weeks of gestation but before completion of 37 weeks of gestation (20- 26.6 wks)

Question 10

Viability

Answer 10

capacity to live outside uterus; about 22 to 25 weeks gestation are on the threshold of viability
These very premature infants are vulnerable to brain injury

Question 11

Name the term weeks

early term
full term
late term
post term

Answer 11

Early Term- 37 0/7wk- 38 6/7wks
Full Term- 39 0/7wks- 40 6/7wks
Late Term-41 0/7wks- 41 6/7wks
Post Term- 42 0/7wks and beyond Term: pregnancy from beginning of week 38 of gestation to end of week 42 of gestation

Question 12

Two digits. define

G
P

Answer 12

G – gravida – number of pregnancy

P – para- over 20 weeks

Question 13

what is

GTPAL stand for ?

Answer 13

5 digits
GTPAL
Gravidity (# pregnancies)
Term (deliveries >37 wk)
Preterm (deliveries >20wk but <37wk)
Abortions (deliveries <20wks spontaneous or induced)
Living children

Question 14

Tell me about pregnancy tests

Answer 14

Human chorionic gonadotropin (hCG) is earliest biochemical marker of pregnancy

Pregnancy tests based on recognition of hCG or β subunit of hCG

Can be detected in serum or urine as early as 7 to 8 days after ovulation

Enzyme-linked immunosorbent assay (ELISA)
testing is most popular method of testing for pregnancy
ELISA technology is the basis for most over-the-counter home pregnancy tests
Medication use, hormone based tumors, or improper collection may cause inaccurate results

Question 15

Presumptive signs of pregnancy

Answer 15

Least indicative of pregnancy
Amenorrhea
N/V
Breast changes
Quickening 
Skin changes
Linea nigra
Melasma
Striae gravidarum

Question 16

Probable signs of pregnancy?

Answer 16

More reliable & more diagnostic, but not true diagnosis
Positive lab tests
Chadwick’s sign
Goodell’s sign
Hegar’s sign
Ballottement
Fetal outline felt by examiner

Question 17

Positive signs of pregnancy

Answer 17

Ultrasound of fetus
Fetal heart tones by Doppler or ultrasound
Fetal movement felt by examiner

Question 18

Cervix characteristics when uterine growth in pregnancy occurs

Answer 18

it becomes vascular and edematous

Question 19

define

goodells sign

chadwick sign

hegar sign

Answer 19

Goodell’s sign -Softening of cervix- throughout pregnancy to prepare for delivery

Chadwick sign- bluish hue of the cervix and vagina

Hegar Sign- Softening of the area between the cervix and body of the uterus

Question 20

what secretes progesterone and estrogen during the first 12 weeks? and why

Answer 20

Corpus luteum

Maintains pregnancy until placenta formed & functioning

Question 21

What happens to the vagina during the growth of the uterine during pregnancy?

Answer 21

Chadwick’s sign
Vagina purplish (and cervix)Increased vascularity of vagina
Increased acidity to resist bacteria
Increased sensitivity
increased vaginal discharge - leukorrhea

Question 22

What happens to the breast during the growth of the uterine during pregnancy?

and what do you educate?

Answer 22

Increase in size, vascularity
Feelings of fullness & tenderness as early as 6 weeks
Colostrum as early as 16 weeks

*** Education- Supportive bra;
Discuss value of breastfeeding
early; Reinforce self breast exam

Question 23

What happens to the respiratory system during the growth of the uterine during pregnancy?

and what do you educate?

Answer 23

Shortness of breath
Diaphragm displaced upward
Lungs expand horizontally
Nasal congestion
Elevated estrogen
Capillary engorgement

** Education:
Warm compresses, humidifier, position changes

Question 24

What happens to the cardiovascular system during the growth of the uterine during pregnancy in regards to just blood volume?

Answer 24

Blood volume increases 1500 ml
1000 ml plasma
450 ml RBCs

Blood volume 25-40% greater than nonpregnant levels

Physiologic anemia: apparent decrease in hemoglobin & hematocrit

RBC production increases 30-33%

Question 25

What happens to the cardiovascular system during the growth of the uterine during pregnancy in regards to blood cells? and what do you educate?

Answer 25

Hemoglobin- less than 11.5 g/Dl or hematocrit less than 30% is considered anemia WBCs -increase to 5000-12000/cubic mm. Cardiac output increases – 30 – 50% Increased Pulse (14-20-wk) Increased Cardiac output Decreased Blood Pressure (slight)- 1st trimester- 32wks Back to baseline in 3rd trimester Supine hypotension syndrome Lying supine obstructs blood return from extremities, decreases cardiac output, hypotension ** Education- Tilt; change positions slowly

Question 26

What happens to the renal system with urinary output? what about specific gravity?

Answer 26

urine output increases sg decreases

Question 27

What renal test do you do in pregnancies?

Answer 27

Creatinine clearance best test of renal function Done on 24-hour urine sample *** Education: Empty bladder completely; limit fluid intake in evening; avoid caffeine

Question 28

What happens to gastrointestinal system during pregnancy?

Answer 28

``` Nausea/vomiting: Causes HCG & progesterone increase Estrogen increase Glucose levels decrease Heartburn due to displacement of stomach by uterus - pyrosis Slowing of GI tract leads to constipation, flatulence, heartburnDecreased tone and motility GI- incr P4 Reflux; Heartburn (pyrosis) Hemorrhoids common Pica – cravings for non-food items such as clay, laundry starch, and ice Gallstones Cholestasis Ptyalism – excessive salivation ```

Question 29

What do you want to educate in pregnancy in regards to gastrointestinal systems?

Answer 29

``` *** Education*** Small frequent meals; Separate liquids from solids Ginger; B6 Eat crackers before getting out of bed Avoid greasy, spicy foods or triggers Stool Softeners ```

Question 30

What happens to the musculoskeletal system in pregnancy?

Answer 30

``` Pelvic ligaments soften Excessive mobility of joints Lordosis - pride of pregnancy Diastasis recti *** Education- Maternity Belts Posture & mobility ```

Question 31

What happens to the integumentary system during pregnancy?

Answer 31

Chloasma - “mask of pregnancy” Linea nigra - dark pigmentation down center of abdomen Striae gravidarum - stretch marks

Question 32

Neurological changes during pregnancy?

Answer 32

Compression pelvic nerves Carpal Tunnel Syndrome- 3rd trimester Tension Headache

Question 33

Psychological changes during pregnancy?

Answer 33

Maternal adaptation Emotional Lability Fatigue (hemodynamic & metoblic changes) * ** Education- discuss normalcy of emotional mood swings and mixed feeling early in the pregnancy; * s/sx depression review; * encourage naps; * exercise and healthy diet

Question 34

Nursing management for Nausea and Vomitting?

Answer 34

N/V - usually between 4-5 week until 12th week High hCG and progesterone levels & changes in carbohydrate metabolism Avoid empty and overloaded stomach – eat more frequent smaller meals Dry toast 30 minutes before getting out of bed Hot drinks Get up slowly Avoid greasy foods Sweet lemonade may help Diclegis: Formerly Bendectin – off the market for 30 years, just returned to use in 2013 by FDA approval. It is composed of Vitamin B6 and an antihistamine-doxylamine.

Question 35

Nursing management for heartburn?

Answer 35

Heartburn Pressure of fetus on stomach and decreased GI tract motility lead to reflux Low fat diet Pat of butter before meals to inhibit excretion of acid in stomach Eat several small meals rather than 3 large ones Aluminum or magnesium based antacids Sit upright after meals Avoid coffee & cigarettes (stimulate acid secretion)

Question 36

What do you want to do to help with flatulence in pregnancy?

Answer 36

Due to undesirable bacterial action Eat small amounts of well-chewed foods Avoid constipation Avoid gas forming foods

Question 37

How can you help with frequent urination during pregnancy?

Answer 37

Frequent Urination Early & Late pregnancy Encourage to drink fluids in morning & afternoons, decreasing fluids in evening

Question 38

What can you do to help backache in pregnancies?

Answer 38

Backache Teach good posture & body mechanics Teach to bend from knees rather than back Teach to wear shoes appropriate for activity Exercises to strengthen back muscles

Question 39

Nursing management for dyspnea in pregnancy?

Answer 39

Dyspnea Encourage mom to prop up with pillows when in bed Teach to sit & stand erect to lift diaphragm up

Question 40

Nursing management of varicose veins in pregnancy?

Answer 40

Weight of fetus on saphenous veins of legs leads to increased pressure in veins Can occur in legs & vulva Prevention is easier than treatment Avoid restricting clothing, knee-highs Teach to elevate legs periodically Good fitting elastic stockings are useful

Question 41

Nursing management of leg cramps in pregnancy?

Answer 41

Pressure of enlarged uterus/fetus on nerves of lower extremities, fatigue, chilling Decreased serum calcium, increased serum phosphorus Decrease milk intake and supplement with calcium supplements (Milk increases phosphorus) Aluminum hydroxide gel removes some phosphorus Regular exercise Immediate relief: dorsiflex foot & put pressure on knee to straighten leg

Question 42

What are the potential complications during the first trimester?

Answer 42

``` First Trimester: Severe vomiting Chills, fever Burning on urination Diarrhea Abdominal cramping Vaginal bleeding ```

Question 43

What are the potential complications during the second and third trimester?

Answer 43

Persistent, severe vomiting Sudden discharge of fluid from vagina before 37 weeks Vaginal bleeding, severe abdominal pain Chills, fever, burring on urination, diarrhea Severe backache or flank pain Change in fetal movement Uterine contractions; pressure; cramping before 37 weeksVisual disturbances: blurring; double vision, spots Swelling of face or fingers and over sacrum Headaches; sever, frequent, or continuous Muscular irritability or convulsions Epigastric or abdominal pain (perceived as heartburn or severe stomachache) Glycosuria, positive glucose tolerance test reaction

Question 44

What to avoid during pregnancy?

Answer 44

Avoid cat litter boxes – toxoplasmosis Avoid exposure to infectious diseases Avoid all drugs not prescribed during pregnancy No alcohol Avoid cigarettes – causes growth retardation