antepartum 2 Flashcards
n/v
increased hcg
only concerned if dehyd and weight loss
crackers/toast before sitting up, small and freq, no crease or spicy or trigger, carbonated good, antiemetic, meds if necessary
urinary freq
P on bladder and hormones
q2 hr during day, avoid night time drinking, completely empty
fatigue
hormone and life
nap
breast tenderness
hormones
supportive bra
vaginal discharge
leukorrhea - no odor,
natural - lubricate and prevent infection
daily bathing, cotton, dont douche
nasal stuffy
estrogen
cool air vapor, NS nasal spray
heart burn
uterus push on stomach, sphincter relax, progesterone
combo, non Na antacid, no spicy, dont lay down after eating, avoid trigger
ankle edema
decreased venous return
concern if high BP, wont resolve with rest, generalized
avoid prolonged sit or stand, keep feet and legs elevated, exercise, hydrate
varicose veins
exercise, avoid sit or stand
flatulence
P
reg bowel habit
hemorrhoids
avoid C, gently self reduce, topical ointment, warm soak, sitz bath
constipation
hormones (progesterone)
concern if abd pain (contractions)
increase fluid, no roughage, daily exercise, reg bowel habits, laxative, fiber
backache
baby weight, lordosis
pelvic title, posture, avoid fatigue, good body mechanics when lifting, no heels
concern if reg intervals or UTI
leg cramps
unknown cause
massage, warm soak, stretch, dorsiflex
faint
sit and lower head btw knees, avoid standing in 1 place too long
SOB
P of uterus on diaphragm
posture, prop up in bed
concern if at rest, doesnt go away, with pain, cough, heart palpitations
difficulty sleeping
avoid caffeine, max comfort in bed
round ligament pain
weight of uterus stretching round ligaments
warmth to abd, slow change of position
concern if not transient
carpal tunnel
avoid repetitive hand movements, may disappear after delivery, Sx
fetal movement counts
16-22 wk, same time daily, 1 hr after meal, side lying, call if <10/2hr, eat/drink, quiet room
breast
supportive bra, clean, no soap on nipples, breast shield for inverted
clothes
no high heels or restrictive
cleanliness
bathe daily
avoid hyperthermia 1T (hot tub)
employment
work till labor, env hazards
travel
no restriction unless complication
car = stop q2 hr and walk for 10 min, seat belt - shoulder and hips
exercise
nothing new, +300 kcal/day, dont overheat, walking great!
contraindications: ROM, htn, competent cervix, bleeding, preterm labor or hx of placenta previa after 26th week
benefits: self image, energy, sleep, relieve tension, control weight gain, bowel function, help with recovery PP
kegels!
sexual activity
1T: fatigue, n/v
2T: fewer discomforts, vascular congestion increase libido
3T: fatigue, SOB, decreased mobility
fathers feelings: previous relationship, acceptance, change in appearance, pain
dental
regular, brush after n/v, avoid x ray
immunization
no live (mmr), flu and Tdap good, U2D before if possible
meds
highest risk 1T -> organs, nothing 100% safe
pregnancy (dev), lactation, reproductive potential
tobacco
lbw babies, preterm, prom, fetal demise, placental previa, abruptive placenta, sids
OH
FAS = growth retardation, facial anomalies, retardation
increased risk of miscarriage, IUFD, lbw
caffeine
no clear evidence, limit to 200 mg/day, hypersensitive
marijuana
low research, strength and composition unreliable, other drugs
cocaine
maternal MI, cardiac arrhythmias, ruptured aorta, seizure, stroke
abruptio placenta, PROM, lbw, sids, heart defect, limb defect
cord sampling -> detect use, best method
urine sampling (- in 24-48 hr, metabolize rapidly)
advanced maternal age
35+
high risk, well educated, $ secure
miscarriage, high r/o GDM, GHTN, placenta previa, hard labor; c/s multiple births, down (screen, amniocentesis), infertile (meds)
E levels, deal with child when older, peer group
adolescent - socioeconomic
poverty, AA and H, low edu and community involvement
adolescent - behavior
multiple partners, low contraceptive use, low knowledge, invulnerability
adolescent - psychosocial
fam, slef esteem, abuse, punish parents, escape, attention, love
adolescent - phys
preterm and lbw, preeclampsia-eclampsia, Fe anemia, CPD, OH and drug use, STI
adolescent - interventions
prenatal: assess and counsel nutrition, assess for high risk, test and educate STD, edu about substance, promote fam adap, prenatal edu
labor: sustained presence, educate choices, help support people
postpartum: contraception, resources, parenting
nutrition
increase folic acid, Fe, Ca
weight distribution
fetus, placenta, amniotic fluid = 11 lbs
uterus = 2lbs
blood volume = 4 lbs
breast = 31 lbs
maternal storage = 5-10 lbs
gain: 1-5 in 1T; 1lb/week after
obesity
abortion, gestational DM, preeclampdia, labor induction, c/s, anomalies
fluid
rxns, lubricate, transport, temp (8-10, 8 oz (4-6 = h2o))
pica
cravings (non nutritive) - Fe anemia
clay, soil, powdered laundry starch, soap, baking powder
i guess they are allowed to have some - dont interfere with nutrition and not harmful
ultra sound
sound waves, abd = invasive, can be done at any time
benefits: tons
non radiating, neural tube defects, skeletal malformations, anomalies
nuchal testing
screen, NOT diagnostic, done with US
11 -14 wk -> trisomy disorders, >3mm back on fetal neck = at risk
non invasive, 70-80% downs
transV US
clearer, predict preterm (short cerv or funnel (cone shaped))
need empty bladder
doppler blood flow
unbilical velocimetry
blood flow changes (mom and baby)
elevations >95% = abn
2T and 3T
non stress test
fetal and contraction monitor
acceleration of fetal HR with movement or contractions = adequate o2 and CNS intact
<32 wk = 2 FHR, 10 beats above, 10 sec
>32 wk = 2 FHR, 15 beats above, 15 seconds
nonreactive = BPP
fetal accoustic stim
sound and vibrate to stimulate infant, show accelerations
BPP
fetal breathing movement, gross body movement, fetal tone, amniotic fluid volume (/8), non stress test (/10)
2 = normal for each category
contraction stress test
eval O2 and CO2 exchange with placenta
bad = late decels
- = good
+ = bad, maybe prep for c/s
equivocal = uncertain, continue to monitor
amniotic fluid analysis
diagnostic, genetic abn, invasive, 15-20 wk or 3T
amniocentesis -> lung maturity with L/S (2:1 = mature)
chorionic villus sampling
10-13 week, invasive
diagnostic = chrom abn
risk = ROM, bleed, intrauterine infection, possible limb reduction and birth defects with early CVS
US benefits
early identification of pregnancy, FRB and breathing, multigestational, estimate BW, nuchal translucency in 1T, check heart structures, length of nasal bone, check AFI, location of placenta, detection of fetal death, fetal position and presentation, help with amniocentesis, chorionic villus sampling
danger zone - fetal movement
one of most reliable indicators of fetal wellbeing
16-20 wk
once it starts, it shouldnt stop, feeling will change
danger zone - contract/cramp
preterm: ok if - rare/occasional, know cause, normal FM and no bleeding or leaking; not ok if - regular, no cause, change in FM, bleeding or leaking
term: hopefully labor! hx if 5 min apart and getting stronger or if water breaks; not ok if - heavy bleeding, change in FM
danger zone - leaking fluid
preterm: identify source - leukorrhea and urine ok; not ok - foul odor, change in color, itchy/irritate, amniotic fluid
term: source = same; not ok if UTI s/s; amniotic fluid is ok but go to hospital (bacteria)
danger zone - bleeding
preterm: cause, amount, FM, spotting = activity, sex, exam, if cant identify not okay, more than spotting is not ok
term: cause, amount, FM, spotting = same, with contractions = ok, persistent with no cause = not ok
genetic screening - carrier
maternal and/or paternal serum or buccal swab
can be done anytime before or during
other danger s of pregnancy
abd pain, fever, persistent v, dysuria, dizzy, blurred vision, spots before eyes, persistent HA, edema (generalized), muscular irritability or convulsions, epigastric pain, oliguria
genetic screening - MSAFP
quad screening
maternal serum, 15-22 wk
measures 4 substances
screen for down, edwards, and NTD, not diagnostic
genetic screening - NIPT
maternal serum, done anytime after 10 wk
screen for down, pataue, edward, and problems with # of sex chromosomes
not diagnostic
