Antepartum Flashcards
1
Q
What are the goals of antepartum nursing?
A
- assess and id potential factors
- edu promotion health and prevent disease
- informed choices for families
- healthier pregnancy
- best outcome of mother and baby
- family-centered (pregnancy and childbirth is normal
- developmental life transition vs medical event
2
Q
Barriers of Antepartum
A
Health disparities (consequences)
no access to healthcare, transportation, or income
teen pregnancy (contraception, STIs, herpes)
- HTN, preeclampsia
- dropping out of school
LQBTQ (no support and fear of discrimination)
Drug abuse (risk factors - smoking)
Obesity (larger, higher Csections, mom HTN)
3
Q
If a pregnant mother has substance abuse, what could happen to the baby?
A
low birth weight
premature
SIDs
miscarriage
respiratory illness
IUGR
developmental delay
fetal alcohol syndrome
withdrawal
4
Q
IUGR means
A
Intrauterine growth restrictions
5
Q
If a pregnant mother has obesity, what could happen to the baby?
A
larger than gestational age
higher incidence of C-sections
6
Q
Preconception/Conception Visit consists of
A
pregnancy and family hx
physical exam
- Chronic illnesses and medications (Rx, OTC, illicit)
social and harmful habits (intimate partner violence)
Contraception (when fertility will return)
Fertility Awareness
7
Q
IPV means
A
Intimate Partner Violence
8
Q
How long does the antepartum last?
A
1st day of last menstrual period (LMP)
TO
9
Q
What are the lengths of an average pregnancy?
A
280 days
40 weeks
10 lunar months
9 calendar months
10
Q
How long are pregnancy trimesters?
A
13 weeks
1st (LMP through 13 weeks
2nd (14-26)
3rd (27-40)
11
Q
Gestational age is
A
the number of completed weeks
12
Q
Term baby is in gestation for how many weeks?
A
38-42 weeks
13
Q
Pre-term baby is in gestation for how many weeks?
A
before 37 weeks
14
Q
post-term baby is in gestation for how many weeks?
A
after 42 weeks
15
Q
The fundus is the
A
the top portion of the uterus
16
Q
Fundal Height is how many cm based on
A
fetal growth in weeks till lightening drop near labor
Ex) Fundal is 28 cm if 28 weeks gestation
17
Q
What are the 6 key hormones in pregnancy?
A
Human Chorionic Gonadotropin
Progesterone
Oestrogen
Prolactin
Relaxin
Oxytocin
18
Q
Lightening is
A
when the fundal height drops when the baby is ready for birth
19
Q
Human Chorionic Gonadotropin (hCG)
A
detected by pregnancy tests from the placenta after implantation
- essential in early pregnancy
20
Q
Progesterone
A
maintain uterine lining
relax smooth muscles
help uterus as baby grows
21
Q
(O)Estrogen
A
stimulates uterine growth
increases blood supply and helps fetal organs develop
22
Q
Prolactin
A
prepare for lactation
- enlargement of mammary glands preps for milk production
23
Q
Relaxin
A
inhibits uterine activity preventing premature birth
-softens and lengthens cervix and relaxes joints
24
Q
What are the 2 biggest hormones that help the body to change for pregnancy?
A
estrogen
Progesterone
25
Oxytocin
causes uterine muscle contraction
-triggers prostaglandins to increase contractions further
-induction
- stimulates milk ejection
26
Maternal changes at 8 weeks cause what hormones to increase
Increase of estrogen and glycogen
27
Maternal Changes at 8 weeks
- Increase of estrogen leads to
**blood congestion and increased vascularity**(prominent veins in cervix, vagina, and vulva)
**hypertrophy of uterine muscle stretching** in prep for delivery
- round ligament pain
- **N/V for 12 weeks**
28
Why does a pregnant woman have N/V?
increase of estrogen and hCG?
29
How long does the Nausea and vomiting in the 1st trimester last?
up to 12 weeks
30
What signs show blood congestion and increased vascularity in the 1st trimester?
Hegar's
Goodwell
Chadwick
31
Hegar's sign
softening of isthmus cervix (top)
32
Goodwell sign
softening of cervix
33
Chadwick sign
bluish-purple color of the vagina
- prominent veins
34
During the 1st trimester, the vagina is expelling extra white discharge, what should the nurse do?
continue to monitor as this is normal and called leukorrhea
- this is the forming of the mucus plug
**Report if different smell and change of color**
35
What does the increase of glycogen cause at 8 weeks?
vaginal yeast = infections
**acid pH of the vagina helps to lower bacteria
- leukorrhea increases
36
In the 1st 8 weeks, the fetus weighs
1-2 g (no noticeable gain)
- ears and tiny muscles
- heart pumps blood
37
What are the nursing interventions for a pregnant mother at 8 weeks?
Nausea Prevention
**AVOID hot tubs, sauna, and steam rooms**
Prepare for pregnancy
Periodontal Care
38
What nursing interventions would you use for nausea prevention in the pregnant mother at 8 weeks?
eating **crackers** before getting up in the **morning**
- **small frequent meals**
- **avoid fatty meals**
39
Hyperemesis Gravidarum is
intractable vomiting during pregnancy, leading to weight loss and volume depletion, resulting in ketonuria and/or ketonemia
40
At 8 weeks,
What are the nursing interventions for hyperemesis gravidarum?
**IV hydration**
need for dehydration and electrolyte imbalance
41
At 8 weeks,
What should the nurse discuss avoiding during pregnancy?
Avoid hot tubs, sauna, and steam rooms (any heat)
- increases the **risk for neural tube defects** in 1st trimester
- **hypotension and fainting**
42
Why should a pregnant mom avoid hot tubs, saunas, steam rooms?
increases the risk of neural tube defects
hypotension
fainting
43
At 8 weeks,
How should the nurse educate the mother to prepare for pregnancy?
include the partner and family
discuss attitude towards pregnancy (excited or sad)
**Provide info on childbirth classes and doula**
44
At 8 weeks, the pregnant mother should get a referral for what?
What could happen?
periodontal care due to N/V
- bleeding gums
- increase saliva
- increase cavities and plaque
- Pica
45
Maternal Changes at 12 weeks
uterus rises **above pelvic brim**
placenta is fully functioning and hormones
Increase thyroid and progesterone
gains 2-4 lbs
46
At what point are you able to check the gender?
12-16 weeks
47
The uterus is where at 12 weeks?
above pelvic brim
48
At 12 weeks gestation, the placenta is
fully functioning and producing hormones
**uterus blood flow increase due to O2, nutrients, and waste exchange with mom**
49
At 12 weeks gestation, what happens to the thyroid?
increases in size
- increase hormone production
- fetal growth and development
50
At 12 weeks gestation, progesterone
increases
- bladder tone decreases and bigger capacity
51
At 12 weeks, it is easier for a mother to get a UTI due to
increase in capacity (+ baby's kidneys start to produce urne and possible urinary stasis
52
In the 1st trimester the baby will only weight
14 g
- heart is visible
53
Nursing Interventions for 12 weeks gestation
Prevent UTIs **(3L/day of fluid, front to back wipe, and void every 2 hours while awake and before and after intercourse)
Exercise
54
At 12 week gestation, the mother should have a conversation about
effects of pregnancy on sexual relationships
- sex is relaxing
- alternate position (later on no pressure)
Other forms of intimacy
**increase of sexual desire - soft and pliable)**
55
Maternal Changes at 16 weeks
Fundus between symphysis and umbilicus
**Braxton Hicks
Quickening
Weight gain**
Increase in cholesterol and hormones
Placeta is defined
56
Where is the fundus at 16 weeks gestation?
between symphysis and umbilicus
57
Quickening means
1st perception of fetal mvmt
58
The pregnant woman should gain how much weight per week from 16 weeks to delivery?
1 lb per week
59
The placenta is considered what at 16 weeks gestation
clearly defined
-**starts producing estrogen, progesterone, and prolactin**
60
An increase of estrogen causes
blood supply to increase 2x
61
An increase of estrogen causes
prepares breasts for lactation
- colostrum may be expressed
-causes the breast to be sore, large, growing, and darker and larger areolas
62
An increase of progesterone causes
"hormone of pregnancy"
- maintain lining of uterus and relax smooth muscles
63
What does the baby look like at 16 weeks?
leg and arm ratio
- bronchioles start to appear
- bones and joints
64
Nursing Interventions for 16 weeks of gestation
Edu. true vs. false labor
Maternal serum **alpha-fetoprotein test (15-22 weeks)**
Purpose of additional testings (genetic, CVS/amniocentesis, and ultrasounds)
65
The alpha-fetoprotein test shows what
high level =
low level =
high level = neural tube defects
low level = down syndrome
followed up with 2nd-trimester in-depth ultrasound
66
At the 20-week gestation, what are the maternal changes?
Breasts secrete colostrum/areola darken
Amniotic sac 400mL of urine
Enlarged uterus
increase blood vol and progesterone
67
Where is the fundus at 20 weeks?
at the umbilicus
68
At 20 weeks, how many mL are inside the amniotic sac and what does it consist of?
400mL of urine
69
The uterus enlargement at 20 weeks can cause what to the mother?
postural hypotension
70
How can a pregnant woman get postural hypotension?
laying supine
**compression of the vena cava**
71
The mother should be positioned on how to prevent postural hypotension?
lay left lateral or on their side
72
The blood volume increase can cause what to occur in the mother as side effects at 20 weeks?
sinus congestion
HA
stuffy nose
leg cramps
varicosities (legs, vulva, and rectum)
73
The side effects of progesterone increasing causes
the gut to work less = constipation
74
At 20 weeks, the fetus weighs how much?
200-400 g
- vernix
- sucks and kicks
75
Vernix
white sticky substance for the warmth of the fetus inside the womb
76
What are nursing interventions at 2 weeks including educating on what comfort measures?
- remain active
- feet elevated (limit edema)
- avoid pressure on lower thighs
- support stockings
- dorsiflex foot to relieve cramps
- apply heat to cramps
- cool air vaporizer/slaine spray for stuffiness
77
How should a 20-week pregnant mom avoid constipation?
increase fiber, fruits, veggies
- 3L of fluid/day
- exercise frequently
78
If a pregnant mom is sitting at a desk all day for her job, what is she most a risk for?
blood clots/DVTs
- due to her hypercoagulable state increasing BP and volume to prevent hemorrhage at birth
79
What maternal changes occur at 24 weeks?
fundus above umbilicus
Diastolic BP increases to pre-pregnant levels with systolic as the same
- possible murmur (normal)
Blood volume increase
80
Where is the fundus at 24 weeks?
above the umbilicus
81
What does the BP do at 24 weeks in the mother?
Systolic is the same
Diastolic increase to pre-pregnancy level
82
The normal change in maternal BP can lead to what being discovered
systolic murmur
- moving the heart up and lateral due to the uterus expanding
83
In early pregnancy is a drop in BP normal?
yes due to the sudden start of hormones and slowly going back to normal
84
The blood volume increase in a pregnancy is required due to the
- transport of nutrients & O2 to placenta
- Meet demands of expanded maternal tissue in the uterus & breasts**
- reserve to protect from **adverse effects of blood loss from childbirth**
85
At 24 weeks, the fetus look like
600 g
- alveolar sacs and ducts
- lung maturity can be detected by a lipid test for surfactant
86
Nursing Interventions of 24 weeks
Glucose challenge
Ultrasound measurements (24-32 weeks)
Antibody screening on Rh-negative patients
CBC, HIV, RPR reassess in 3rd trimeser
87
What is the 1 hour glucose screening abnormal number?
140+
88
The ultrasound at 24 weeks is used for
standard fetal growth curve
89
If the Antibody screening is negative, what do you give the pt?
Rhogam at around 28 weeks
90
If the mother is low on hemoglobin and hematocrit, then they will take
diet modifications
iron pills or need infusion for iron (anemia)
91
If the mother does have an STI/STD, then who should be treated?
mother and father (+ for syphilis)
92
If the mother has a + blood type and the baby has a - blood type, then should you give Rhogam
no
93
If the mother has a - blood type and the baby is +, then should you give Rhogam
yes
94
When should you give Rhogam?
1st pregnancy at 24 weeks and after birth
95
Where is the fundus at 28 weeks gestation?
halfway between the umbilicus and xiphoid process
96
What are the maternal changes at 28 weeks?
Fundus raised to halfway btw umbilicus and xiphoid
- Thoracic breathing
- increase chest and RR
Increase vascular engorgement (stuffy, URT edema)
muscle relaxation and opens the airway
outline of fetus
Introspective
uterus displaces the liver and intestines
97
When does the breathing change from abdominal to thoracic?
28 weeks
- chest circumference and RR increases
98
At 28 weeks, estrogen and progesterone increase to change what in the mother?
estrogen = increase upper respiratory edema and stuffiness
progesterone = relax and open airway
99
The mother becomes introspective during the 28th week. What is her mindset?
concentrate on the unborn baby
100
What are the Maternal GI changes that occur at 28 weeks of gestation and what is the cause?
uterus displaces the organs
- heartburn
- hemorrhoids
- constipation, flatulence, and bloating
- gallbladder stones and distension
101
The fetus at 28 weeks is
1005 g
Surfactants forms in the lungs
102
Nursing Interventions at 28 weeks
Treat hemorrhoids
**Sitz bath** and stool softeners
topical anesthetic
**witch-hazel OR preparation H**
103
Nursing Interventions at 28 weeks
Avoid heartburn
no fatty foods
small, frequent meals
Avoid lying down after meals (upright for digestion)
Take antacids as prescribed
Avoid sodium bicarbonate
104
Nursing Interventions at 28 weeks
Comfort measures
elevate legs when sitting
side lying when resting (prevent vena cava compression)
105
Nursing Interventions at 28 weeks
Discuss what with the parents
expectations for delivery and how to care for an infant
Nipple discomfort and stimuli
- pleasure with breast sensitivity = preterm delivery
**no nipple stimuli**
106
Maternal changes at 32 weeks
fundus at xiphoid process
Increase progesterone = **renal system**
swollen ankles
**sleep problems - dyspnea and nocturia**
Breasts are full and tender
107
The fundus is where at 32 weeks?
xiphoid process
108
The increased levels of progesterone at 32 weeks do what to the maternal body?
increase blood flow
**increase GFR**
frequency
bladder tone down and capacity high (pressure on the bladder)
renal pelvis dilates
urinary stasis = UTI
109
Nursing Interventions at 32 weeks
Educate
- Lower edema (swollen ankles)
- comfort
- Prepare for delivery
110
A nurse should educate the patient on what measures to decrease edema?
elevate legs 1-2x /day for 1 hour
**left lateral position**
111
Why should a pregnant mom lay in the left lateral position?
increase cardiac output and urine output
112
A nurse should educate the patient on what comfort measures are in the 32-week milestone?
wear a **well-fitting support bra** plan on nursing
semi-fowler
113
A nurse should educate the patient on how to prepare for delivery?
Review **signs of labor** - not Braxton hicks
Discussion **plans** for **other children (if any) and transportation**
Assess **partner’s role** in childbirth
114
Maternal changes at 36-40 weeks
fundus below xiphoid process **(Lightening)**
Increase progesterone and relaxin
**Musculoskeletal discomfort**
Mother is eager for birth
Braxton Hicks' = intense and frequent
115
At 32+ weeks, what electrolyte is in high demand due to storage for the baby?
Calcium and iron
116
Where is the fundus at 36-40 weeks?
below the xiphoid
- Lightening = baby drops
117
When lightening occurs, what happens to the urinary system?
increase frequency
- baby is directly in the bladder
- **but breathing improves**
118
What happens to the baby in weeks 36-40?
maternal antibodies transferred
lipids increase
119
Week 36-40
Increase progesterone and relaxin for
relaxing ligaments and joints
**Diastasis recti**
120
Diastasis recti
abdominal midline muscle separates in 3rs trimester
121
What musculoskeletal discomforts would a maternal feel at 36+ weeks?
Postural changes progress
Increased **backaches**
Altered posture – **the center of gravity shifts - ↑ fall risk**
**Lordosis** - a shift in the center of gravity
Altered gait - **“Pregnant Waddle"**
122
What is the mindset of a mom in 36+ weeks?
burst of energy and eager = nesting
123
Nursing Interventions at 36+ weeks
Safety = fall risk
Prepare for delivery
Educate on Group B Strep Screening at 35-36 weeks
124
What safety measures should the nurse give at 36-40 weeks?
low heels to **flats**
**no heavy lifting**
**sleep on left side to relive bladder**
125
Nursing interventions to prepare for delivery at 36+ weeks
pelvic tilt exercises
suitcase
tour L&D
postpartum circumstances (circumcision, breast-feeding, postpartum blues, adequate rest, rooming in)
126
How do you educate on the Group B strep Screening?
35-36 weeks
will infect baby and give meningitis to death
- baby stays for 48 hours after
- Postpartum delivery 2 days
- Csection 3 days
127
Group B strep Screening
If +
required antibiotics (Pen G) during labor and every 4 hours until delivery
128
Group B strep Screening
status is unknown
assume + and treat
129
Group B strep Screening
scheduled Csection with **intact membranes**
no treatment necessary
130
Presumptive Signs of Pregnancy
- patient thinks they might be pregnant
Period absent (Amenorrhea)
Really tired (Fatigue)
Enlarged Brest (size and fullness)
Sore breast (areola dark and pronounced nipples)
Urination frequency increase
Mvmt perceived (Quickening)
Emesis and nausea
Linea nigrea
Melasma
*PRESUME LM*
131
Probable signs of Pregnancy
- physician suspicious
Positive pregnancy test - hCG
Return of fetus when uterus palpated (ballottement)
Outline of fetus
Braxton-Hicks contractions
A softening of the uterus (Goodell's sign)
Bluish color vulva, vagina, cervix (Chadwick's)
Lower uterine segment soft (Hegar's)
Enlarged uterus
*PROBABLE*
132
Positive Signs of Pregnancy
Fetal mvmt felt/observed by doctor/nurse
Electronic fetal heart sounds (10-12 weeks)
The delivery of the baby
Ultrasound and Transvaginal (sac)
See visible mvmt
*FETUS*
133
Quickening is
fetal mvmt or fluttering in the stomach
134
What is Chadwick's sign?
bluing of the vagina
135
What is Goodell's sign?
softening of the cervix
136
What is Hegar's sign?
softening of the cervical isthmus
137
Ballottement
bouncing back of the fetus when pushed down on the amniotic fluid
138
When does Chadwick's sign occur?
4 weeks
139
When does Goodell's sign occur?
6-8 weeks
140
When does Hegar's sign occur?
6-12 weeks
141
When can you hear the fetal heart sounds?
10-12 weeks
142
Fetal cardiac mvmt is detected at
4-8 weeks
143
With multigravida patient, the signs of pregnancy appear quicker or later than a primigravida patient.
quicker 14-16 weeks
144
In the presumptive sign of pregnancy, the increased circulation to the skin does what to the maternal body?
hot flashes and facial flushing
increase perspiration
oily skin and acne (increased sebaceous gland activity)
145
In the presumptive sign of pregnancy, the increased estrogen and progesterone do what to the maternal body?
Melasma (mask of pregnancy glow)
146
In the presumptive sign of pregnancy, what happens to the maternal skin?
Linea nigra - darker vertical line umbilicus to mons pubis
striae gravidarum - stretch marks to breasts, hip, abd, and butt (moisture and massage)
Rapid growth of hair and nails
dry skin and itchy
147
In the probable sign of pregnancy, when does hCG production begin
at implantation
- 7-8 days after conception
148
If hCG levels are higher than normal, what does this mean?
multiple fetuses
ectopic
molar pregnancy
genetic abnormality
149
If hCG levels are lower than normal, what does this mean?
miscarriage
150
What medications can affect the hCG and give the woman a false positive or negative?
anticonvulsants
diuretics
tranquilizers
151
What is Qualitative hCG based on?
present hCG in the blood or urine
152
What is Quantitative hCG based on?
based on weeks (length) - CERTAIN LEVELS
153
What is the normal fetal heart rate?
110-160
154
When is the fetal heart rate detectable by Dopplers?
10-12 weeks
155
When is the fetal heart rate detectable by fetoscope?
15-20 weeks
156
What does the UT transvaginal or transabdominal show?
high-frequency sound waves obtain images of maternal structures, placenta, amniotic fluid, and fetus
157
Leopold's Maneuver
external palpation of uterus to determine
id presenting parts and outline of fetus
point of max impulse
158
What is assessed during the 1st prenatal visit?
Med hx (psychosocial, OB/GYN, and contraceptive)
Head to Toe
- reproductive (inverted nipples, external genital)
- breast and pelvic exam
EBD and fundal ht
VS (ht, wt, and BMI)
Fetal heart tones
Future visits (every month)
159
Gravida
- # of pregnancies, regardless of duration, including a pregnancy in progress
160
G/P records
gravida and para
161
Nulligravida
never been pregnant
162
Primigravida
pregnant for the first time
163
Multipgravida
has been pregnant more than once
164
Para
- # of pregnancies that have reached 20 weeks or more, multiple birth counts as 1 Para
165
In the para, multiple births count as
1
166
Nullipara
never completed a pregnancy @ 20 weeks or greater
167
Primipara
has only completed 1 pregnancy @ or > 20 weeks
168
Multipara
has completed a pregnancy > 20 weeks more than once
169
Age of VIABILITY
20 weeks - fetal lungs mature enough for fetal survival outside the uterus
170
Ab means
any pregnancy loss occurring < 20 weeks is counted as an abortion
171
GTPALM
Gravida - # pregnancies
Term - # pregnancies delivered between 38-40 weeks
Pre-term - # pregnancies delivered prior to completion of the 37 week
Abortions - # miscarriages, spontaneous or induced abortions (<20wk)
Living - # children surviving birth (twins/multiples count individually)
172
Term
pregnancies delivered between 38-40 weeks
173
Pre-Term
pregnancies delivered prior to completion of the 37 week
174
Abortions
- # miscarriages, spontaneous or induced abortions (<20wk)
175
Living
- # children surviving birth (twins/multiples count individually)
176
Multiples
of multiple gestational pregnancies
177
When do twins or multiples count individually?
Living on GTPAL
178
1st Visit Pregnancy VS - Pulse
MOM = 60-90 (increase 10-20 around 32 weeks)
179
1st Visit Pregnancy VS - RR
MOM 16-24 breaths/min
180
1st Visit Pregnancy VS - BP
increased fue to peripheral vascular resistance
- Systolic up slightly <30
- Diastolic lower 24-32 weeks 10-20
- Term gradual return
90-140/60-90
181
Maternal Position means what
Supine -
Left lateral -
Supine - Vena cava compression
Left lateral - position of choice
182
Initial Labwork of the pregnant woman include
CBC with diff
Pap smear
Blood type , with Rh and antibody
HIV, Hep B, RPR/VDRL (Syphillis)
Rubella titer
TB screening
UA and drug screen
Progesterone level
TORCH
183
The CBC monitors what in maternal figures
Hgb and Hct - monitor anemia (proper foods)
WBCs increase normally
184
Why is a pap smear done for Initial pregnancy labwork?
screening tool for cervical cancer
cultures for Chlamydia & Gonorrhea
Assess for herpes, human papillomavirus
185
If the mother is not immune to Rubella then when do you give the MMR vaccine?
after birth
186
What is considered normal on a UA and drug screening initial lab work?
Albumin - Trace
Glucose - 1 +
Protein - Trace
187
What does a large amount of albumin in a maternal woman mean?
preeclampsia
188
What does a 2+ glucose in a maternal woman mean?
gestational diabetes
189
What does a <1+ protein in a maternal woman mean?
mild preeclampsia
2+ - severe
190
Low levels of progesterone mean what
spontaneous abortions and ectopic pregnancy
191
What id TORCH
**Toxoplasma**- concern is with cats; parasitic disease (gloves in garden and with cat litter, heat meat all the way through)
**Rubella**- rare but can lead to birth defects for future pregnancies if not vaccinated
**CMV**- type of herpes spread through saliva & body fluids – baby is unable to fight
**Herpes**- assess for outbreaks present and need for treatment
192
Toxoplasma is
concern is with cats; parasitic disease (gloves in garden and with cat litter, heat meat all the way through)
193
What is the relationship chnage in RBC and plasma volume in pregnancy?
INcrease of plasma volume exceeds the increase in RBCs (blood is dilutes)
194
The recommended weight gain in pregnancy is based on what
prepregnancy BMI
195
If the pregnant woman is obese, what is the baby at risk for?
AP to PP complications
196
If the pregnant woman is underwt, what is the baby at risk for?
risk for SGA and preterm delivery
197
I f the mom and baby have incompatible blood, what could the baby develop?
jaundice
198
What is the pattern of wt gain in the trimester and total wt gained overall?
1st Trimester - 2 to 4 lbs.
2nd & 3rd Trimester - average 1 lb. per week weight gain
Total weight gain during pregnancy 25-35 lbs.
199
Calculate the date of birth using Nagaele's rule
LMP - 3 months + 7 days = EDD
200
EDC =
estimated date of confinement
201
EDD
estimated date of delivery
202
EDB
estimated date of birth
203
LMP
last menstrual period
204
In subsequent prenatal visits, what is assessed?
VS
Urine dip
Fundal cm ht = # of gestation weeks
Fetal assessment (heart and activity)
educate prenatal care and anticipatory guidance
pelvic exam for cervical change at 36 weeks
205
What symptoms of malnutrition?
white on the tongue (clasidis)
chapped lips
brittle hair and nails
206
What should a pregnant woman eat for prenatal care?
Calcium 1000 mg / day5 servings/day –Protein - meats, eggs, and legumes
5 servings/day –Vegetables - green, deep yellow good source of Vitamin C
6 servings/day – Grains - bread and cereal
4 servings/day – Fruit
207
What prenatal vitamin nees to be taken daily?
folic acid 60 mcg
208
How many glasses of water should a pregnant mother drink
8-10 glassess
209
Protein ingested helps with fetal
development
210
Ca ingested helps with fetal
bones
211
Iron ingested helps with fetal
absorption and hemoglobin
212
What are warning/danger signs to call for a physician for in a pregnant woman?
- UTI
Fever, chills, dysuria, frequency, and urgency
Odorous discharge
213
What are warning/danger signs to call for a physician for in a pregnant woman?
- prom/srom/preterm delivery
Fluid, or bleeding from the vagina
Abdominal pain, cramping or backache
214
What are warning/danger signs to call for a physician for in a pregnant woman?
- placenta previa/abruption
vaginal bleeding
215
What are warning/danger signs to call for a physician for in a pregnant woman?
- pre-eclampsia
Visual disturbances & severe headache**
Swelling of the face**, fingers, or sacrum
Epigastric Pain
Severe hypertension**
216
What are warning/danger signs to call for a physician for in a pregnant woman?
- hyperemesis gravidirum/dehydration
Prolonged nausea and vomiting
Diarrhea
217
What are warning/danger signs to call for a physician for in a pregnant woman?
- fetal distress or death
Change in fetal movement or FHR
218
What are warning/danger signs to call for a physician for in a pregnant woman?
- pyelonephritis, appendicitis
Abdominal back or pelvic pain
219
When assessing a fetus, remeber to tell the client what before allowing consent for testing
voluntary and can be refused
220
What does an Ultrasound do?
Specialized or target-
When specific target or organ requires more detailed imaging
Confirm fetal heart rate activity - + of pregnancy
Verify gestational dates
Locate and/or grade the placenta
Determine fetal presentation
Estimate amniotic fluid volume (AFI)
Diagnose multiple gestation
Evaluate interval fetal growth
Evaluate the cervix
Guide amniocentesis/CVS
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Transvaginal Ultrasound
Usually done 1st trimester
Useful in obese patients
Does not require the woman to have full bladder
Woman placed in lithotomy position an
Sterile covered probe/transducer inserted into vagina
Can also be used to evaluate cervical status
222
Transabdominal Ultrasound
Transducer is moved over maternal abdomen to create an image
Warm gel to at least room temperature
Remove gel from abdomen when procedure is complete
Document teaching and toleration
No complications
223
The transabdominal Ultrasound requires what in the first 20 weeks?
Requires full bladder to help support uterus for imaging:
Allow patient to empty bladder when scan complete
Place pillows under neck & knees for uterus placement
224
The transabdominal Ultrasound requires what in the 3rd trimester?
supine with hip wedge to displace uterus to left
225
CHORIONIC VILLUS SAMPLING
Aspiration of small amount of placental tissue (chorion) -Thin sterile catheter/syringe inserted through abdominal wall or cervix under US guidance for chromosomal, metabolic or DNA testing
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Complications of CHORIONIC VILLUS SAMPLING
Limb reduction defects
Culture failure rate in growing chromosomes
Subchorionic hematomas
Infections
Spontaneous rupture of membranes
227
Advantages of CHORIONIC VILLUS SAMPLING
earlier than amniocentesis (normally performed between 10-13 weeks)
228
The nurse is responsible for what in a CHORIONIC VILLUS SAMPLING
Obtain consent
If patient is **Rh negative-give Rho (D) Immune Globulin**
Place patient in lithotomy position
**Warn patient of sharp pain with catheter insertion**
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What should a nurse teach the patient po-op of a CHORIONIC VILLUS SAMPLING
report cramping, heavy bleeding, clot or tissue passage, leakage of fluid
Notify if temperature greater than 100.4
Rest for 24 hours
avoid exercise, heavy lifting and sexual intercourse for several days
230
Amniocentesis
Needle inserted into uterine cavity to obtain amniotic fluid; guided by US
231
Amniocentesis in the early stages of pregnancy
bladder should be full to push the uterus up in the abdomen for easier access
232
Amniocentesis in the late stages of pregnancy
bladder should be empty so it will not be punctured
233
Amniocentesis risk
1% spontaneous abortion
fetal injury
Infection
234
Amniocentesis purpose
Genetic testing (15-20)
hemolytic disease
intrauterine infection
down syndrome
**Fetal Lung maturity primary method**
235
What indicates fetal hemolytic disease?
elevated bilirubin levels
236
What in the amniotic fluid can cause infection?
meconium
237
How do you determine down syndrome
10-14 days for cultures to develop for
Pt could be well into 2nd trimester so choice for abortion is dangerous
238
How do you determine Fetal Lung Maturity?
Lecithin-to-Sphingomyelin (L/S) ratio-2:1 or greater indicates adequate surfactant and mature fetal lungs
Lamellar Bodies (storage form of surfactant)
IDM have delayed fetal lung maturation
239
Amniocentesis nurse responsibility
Obtain baseline VS & FHR
Only to be performed when the uterus **rises above the symphysis (12-13 weeks) and when amniotic fluid is formed
Administer Rho (D**) Immune Globulin (RhoGAM) for Rh neg patients
Provide emotional **support**
Monitor FHR for 1 hr.
240
Amniocentesis post-op teaching
Report cramping, heavy bleeding, clot or tissue passage, leakage of fluid or temperature greater than 100.
**Rest for 24 hours** and avoid exercise, heavy lifting and sexual intercourse for several days
Report a change in fetal movements
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Who needs testing in third trimester?
Anyone with a viable gestation experiencing a high-risk pregnancy
Give extra support from you and groups
242
Examples of high risk pregnancies
Hypertensive disorders
Diabetes
Multiple Gestations
Lupus
Renal or Heart Disease
Interruption of oxygen pathways (placenta interruption
243
Fetal Kick Counts
method to evaluate fetal well-being
244
Hypotoxic fetus
activity is reduced to conserve oxygen and
eventually stillbirth may occur
245
Fetal Kick counts steps
**Rest in a quiet location and count** distinct fetal movements such as **kicks or rolls**
Maternal perception of **10 distinct movements in a 1-2-hour **
period is reflective of nonhypoxic fetus** at that moment in time**
Count is discontinued once 10 movements are perceived
Fetal movement is then recorded
246
When should you report to the doctor about fetal kick counts?
decreased fetal mvmt after 2 hours
- remember the baby does sleep
- 1 hour after with no mvmt: don’t notify physician
- drink water,
2 hours then physician
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Non-stress Test
ability of the fetal heart to accelerate either spontaneously or in association with fetal movement.
248
Non-stress Test nurse responsibility
Place patient in comfortable position with **lateral tilt - left**
Place ultrasound and tocodynamometer
Advise Pt to push button when she feels baby move so fetus response can be observed
Monitor fetus for **minimum of 20 minutes;** can be extended for another 20 minutes to account for **normal fetal sleep-wake cycles**
249
Non-stress Test stimulation may require provoking the fetus by
Patient can eat a **snack, drink water/juice or gently palpate abdomen**
**Artificial larynx** placed near fetal head
Stimulation applied for **1 to 2 seconds-can be repeated up to 3 times**
250
Reactive results for Non-stress test
FHR increases 15 beats above baseline for 15 seconds 2-3 times in 20 minutes for fetus over 32 weeks (15 x15)
FHR increases 10 beats above baseline for 10 seconds 2-3 times in 20 minutes for fetus less than 32 weeks (10 x10)
251
Non- Reactive results for Non-stress test
Fewer than two accelerations during 40-minute period
Decelerations that persist for 1 minute or longer during an NST have been associated with increased cesarean birth rates and stillbirth
252
Contraction Stress-test
assess fetal well-being and uteroplacental function by monitoring fetal heart rate in response to contractions
253
Contraction Stress test
- late decelerations mean
Brief interruptions of oxygen transfer during contractions in compromised fetus
254
Contraction Stress test
If adequate contractions are not present,
oxytocin or nipple stimulation (warm washcloth over nipple) is required = no control of oxytocin amount so monitor
255
Contraction Stress test nurse responsibility
Explain procedure and obtain informed consent
Monitor FHR and fetal activity for 20 minutes
A recording of **at least 3 contractions in 10 minutes must be obtained
Duration of each contraction should be 40 seconds or longer and palpable to nurse**
256
Negative Contraction Stress test
Negative-No late decelerations - no trouble with mom to baby O2 exchange
- good thing
257
Positive Contraction Stress test
Late decelerations are present with a minimum of 50% of the contractions, even when fewer than 3 contractions occur in 10 minutes
258
Positive Contraction Stress test means or linked to
increased incidence of fetal growth restriction, late decelerations in labor, meconium-stained fluid, low 5-minute Apgar scores and stillbirth
Discuss further testing or expedited delivery
259
Biophysical Profile shows what
**Fetal movement- 3+** discrete body or limb movements
**Fetal tone**- 1+ fetal flexion and extension or opening and closing of the hand
**Fetal breathing** movement
**Amniotic fluid amount**- Pocket of amniotic fluid measuring at least 2 cm in two planes perpendicular to each other
**NST-reactive**
260
Biophysical Profile gives what scores for each parameter
2 normal
0 for abnormal/absent
261
Biophysical Score of 8-10/10
reassuring
262
Biophysical Score of 6/10
equivocal and may indicate the need for delivery depending on gestational age
263
Biophysical Score of 4/10
means delivery is recommended because of a **strong correlation with chronic asphyxia**
264
Biophysical Score of 2/10
immediate delivery
265
Family Adaptation to Pregnancy
Acquire skills related to pregnancy, childbirth, newborn, & parenthood
Realign finances, responsibilities, & relationships preparing for newborn’s arrival
Adjust sexual expression to accommodate pregnancy **(infidelity and violence in late stages)**
Expand communication to meet emotional needs
266
Factors Influencing Family Adaptation
Age- Adolescent vs Adult
Primigravida vs Multigravida
Social support
Socioeconomic
Pregnancy complications
Psychosocial issues/ Mental health
Substance abuse
IPV – Intimate Partner Violence
267
1st Trimester Maternal Mental Response
uncertain (no chnage, seek confirm, and look forward)
vague
Ambivalence (conflicting feelings about pregnancy)
finance worry
career concerns
268
1st Trimester Maternal Mental Response
- 1st pregnancy
worries about added responsibilities, being a good parent
269
1st Trimester Maternal Mental Response
- 2nd pregnancy
how will this pregnancy affect the other children & partner
- Worry will “I love this baby as much as my first baby”
270
1st Trimester Maternal Task
Role Play- hold, feed other infants, practice
271
2nd Trimester Maternal Task
Fantasy- daydream about infant and behaviors
272
2nd Trimester Maternal Mental Response
physcial evidence (growth and mvmt, quickening and reality
**Fetus becomes the primary focus
-nickname, talk, rub, and ambivalence wanes**
body image perception
273
3rd Trimester Maternal Mental Response
negative body image - resentment
introverted and vulnerable
**self-absorbed**
- worries about baby and nightmares
- trouble concentrating or making decisions
- anxious
**Nesting - sudden burst of energy**
**ignore partner**
**increase dependence**
**ambivalence resolved**
274
3rd Trimester Maternal Task
Role Fit- sets role expected to be a “Good Mother”
275
Paternal Response to Pregnancy
Announcement phase
= accepts biological fact of pregnancy
Confirmation of pregnancy - joy or dismay depending on planned or unplanned
Ambivalence is common in the early stages of pregnancy
Couvade syndrome
276
Couvade syndrome
dad experience pregnancy-like symptoms for days or weeks
277
Paternal Response to Pregnancy
Moratorium phase
= period of adjustment to the reality of the pregnancy
Accepts pregnancy
Introspective - puts pregnancy thoughts aside & engages in discussions about parenting
Phase can be short or last into the 3rd trimester depending on the father’s readiness
278
Paternal Response to Pregnancy
Focusing phase
= active involvement
Negotiates the role he will play in labor and delivery and parenthood
Concentrate on the pregnancy experience and sees himself as a father
279
Sibling Adaptation
Child
Young
Older
Adolescent
**Influenced** by the sibling's age & developmental level & **Parent’s attitude**
- Child experiences loss, jealousy, feels “replaced”
- Younger - loss of “baby” role
- Older - increased responsibility
- Adolescents - embarrassed
280
How do you prepare a sibling for a birth
Talk about expected baby arrival
Hear heartbeat
Feel baby move
Sibling classes
Attend birth
281
Culture decisions in the childbearing family
Spirituality influences sexual attitudes, behaviors, **modesty, and touch**
Who makes decisions for the family?
282
Barriers to a culture-sensitive care in childbearing
Obstetrical care can be confusing to other ethnic backgrounds
Verbal/non-verbal communication - language barrier, avoiding eye contact out of respect or dishonesty
Acknowledge how racial difference affect the quality of healthcare (pain control)
Worldview- How is human life/illness perceived?
Decision Making- Who decides?
283
Adolescent Pregnancy risk complications
**Pregnancy Induced hypertension
Poor nutrition – anemia**
Preterm labor & birth
Depression
Substance abuse
Intimate partner violence
Death
Preterm / LBW infant
284
Risk Factors associated with teenage pregnancy
Homelessness, juvenile justice system, foster care
Maintain relationship
Means to Independence
High-risk sexual behaviors (STD or pregnancy)
Economic burden- government programs
Increase in high school dropout rate
Child is at higher risk for abuse and cognitive delays
285
Adolescent Fathers
May accept responsibility
“Phantom father” - absent or rarely involved
Conflicting roles of adolescent and fatherhood
Large number live in poverty and lack job skills
Education may be interrupted to find a job
Transition between childhood and adulthood
Lack patience to parent well
286
Intimate Partner Violence can be
actual/threatening
- Physical- slapping, punching, kicking, & pushing escalate
- Sexual- Rape
- Emotional- continuous mental abuse, threat, coercion, isolation
- Reproductive Coercion- interfere with choice of contraception/pregnancy
Homicide
Reporting of only 20%
287
Intimate Partner Violence serious impact to mom and baby
Maternal - Uterine Ruptured, Placental Abruption
Fetal - Prematurity, Low birth weight
288
ABC’S VICTIM OF ABUSE GUIDELINES
3 Questions
Have you been hit, slapped, kicked or physically hurt during the last year?
Have you been hit, slapped, kicked or physically hurt during this pregnancy?
Has anyone forced you to have sexual activities?
289
ABC’S VICTIM OF ABUSE GUIDELINES
A – Alone- Interview alone, reassure not alone
B – Belief- Let them know you believe them, Abuse not her fault
C – Confidentiality- Explain mandatory reporting laws if applicable
D – Documentation- verbatim, descriptive injuries, photos
E – Education- community resources, restraining orders
S – Safety- most dangerous time is when women decide to leave, danger plan
