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Mother/Infant > ANTEPARTUM #3 CARE OF CHILDBEARING FAMILY > Flashcards

ANTEPARTUM #3 CARE OF CHILDBEARING FAMILY Flashcards

1
Q

OBJECTIVE/PROBABLE

A
  • cervix increased vascularity
  • enlargement of the abdomen
  • Braxton hicks contractions
  • uterine soufflé
  • ballottement
  • fetal outline palpation after 24 weeks
  • skin pigmentation changes
  • pregnancy tests
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2
Q

SIGNS OF PREGNANCY: 3 CATEGORIES

A
  1. presumptive- changes felt by the women
  2. probable - changes observed by an examiner
  3. positive - signs that attributable only to the presence of a fetus
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3
Q

SUBJECTIVE/PRESUMPTIVE

A

-AMENORRHEA
earliest sign of pregnancy

-NAUSEA AND VOMITING
hormonal influences appears by 6weeks disappear 6-12 weeks later

  • EXCESSIVE FATIGUE
  • URINARY FREQUENCY
  • BREAST CHANGES
  • QUICKENING
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4
Q

DIAGNOSTIC/POSITIVE SIGNS OF PREGNACY

A

-FETAL HEARTBEAT
electronic Doppler: 8-12 wk

-FETAL MOVEMENTS
palpable at about 20wks

-VISUALIZATION OF THE FETUS (VAGINAL SONO)

~the gestational sac can be observed by 4-5 wks (10 days after implantation)

~cardiac activity at 6-7 weeks gestation

~fetal parts 8 weeks

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5
Q

PREGNANCY TESTS -PROBABLE

A
  • serum and urine testing for hCG levels
  • urine tests best with “first AM void” 5th week
  • 95% accurate
  • 98% in determining the absence of pregnancy
  • Eliza testing most popular for OTC home kits, earlier detection affords prompt pre natal care
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6
Q

HORMONES IN PREGNANCY

A

PROGESTERONE

  • produced by the placenta
  • maintains pregnancy
  • develops acini and lobules of the breast

RELAXIN

  • produced by the corpus luteum
  • inhibits uterine contractions
  • softenining of the cervix

PROSTAGLANDINS

  • high concentration found in the female reproductive tract and decidua
  • maintains placental vascular resistance
  • initiates labor
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7
Q

HORMONES IN PREGNANCY

A

HUMAN CHORIONIC GONADOTROPIN (HCG)

  • secreted by the trophoblast
  • stimulate progesterone and estrogen production by the corpus luteum to maintain pregnancy

HUMAN PLACENTAL LACTOGEN (HPL)

  • promotes growth of fetus by regulating glucose available to it
  • promotes breast development and lactation

ESTROGEN

  • produced by the placenta -7 weeks stimulates uterine development
  • ductal development of the breast
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8
Q

UTERUS

A

BEFORE PREGNANCY

  • small semi solid ,pear shaped organ
  • weight 60g
  • capacity 10ml

TERM PREGNANCY

  • increased in size
  • weight 1000g
  • capacity 5000ml
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9
Q

CERVIX

A
  • increases in cell number
  • secretes thick tenacious mucus
  • mucus plug

-increased vascularization

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10
Q

VAGINA

A
  • vaginal epithelial hypertrophy and hyperplasia
  • thick white discharge known as leucorrhea
  • Acid PH
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11
Q

OVARIES

A
  • ovulation ceases
  • HCG maintains corpus luteum
  • corpus luteum prduces progesterone, estrogen and HCG
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12
Q

BREAST

A
  • progesterone causes tissue hypertrophy and increased glandular size
  • colostrum production
  • straie- purplish stretch marks
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13
Q

CARDIOVASCULAR SYSTEM

A
  • heart displaced laterally upward
  • blood colume increased by 40-50%
  • HR increases 10-15bpm may have murmur
  • BP slightly decreased in 2nd trimester
  • increased femoral pressure leads to dependent edema and varicose veins
  • physiological anemia of pregnancy
  • WBC increases (15000 without infection)
  • hyper coagulation along with increased venous pressure =risks of thrombosis
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14
Q

VEBAL CAVAL SYNDROME

A
  • pressure on the vena cava by the enlarging uterus
  • pressure interferes with returning blood flow= decresed BP with dizziness, pallor, clamminess
  • lie on left side and arise slowly
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15
Q

RESPIRATORY CHANGES

A
  • the diaphragm is elevated with the sub-costal angle increased
  • thoracic breathing with increased tidal volume
  • nasal stuffiness and congestion along with epistaxis common
  • physiological dyspnea of pregnancy common
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16
Q

GENITOURINARY

A
  • 1st trimester growing uterus presses against bladder causing urinary frequency
  • better in 2nd trimester then returns in 3rd
  • pressure on the bladder results in urinary stasis and can lead to UTI
  • proteinuria (decreases 1+) and glycosuria
  • kidney -glomerular filtration rate increases
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17
Q

INTEGUMENTARY

A

-changes stimulated by increased estrogen, progesterone,melanocte stimulating hormones

  • pigmentation of skin
  • linea alba -linea nigra
  • chloasma- “mask of pregnancy”
  • striae gravidarium
  • vascular spider nevi
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18
Q

GASTROINTESTINAL SYSTEM

A
  • nausea and vomiting of pregnancy
  • hyperemesis gravidarum
  • ptyalism
  • pyrosis(heartburn)
  • constipation
  • pica
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19
Q

MUSCULOAKELETAL

A
  • hormones relaxin and progesterone causes the sacroiliac, sacrococcygeal joints to relax =waddling gait
  • change in posture due to gravity changes. center of gravity shift forward
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20
Q

METABOLISM

A
  • recommended total weight gain 11.5-16kg=25-35lbs for normal weight woman
  • weight may decrease slightly during the 1st trimester due to nausea and vomiting
  • low material weight associated with preterm labor ,SGA and IUGAR
  • increased maternal weight associated with LGA and birth complications
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21
Q

NEUROLOGICAL

A
  • lightheadedness:r/t vaso instability, postural hypotension or hypoglycemia
  • carpal tunnel syndrome: r/t edema and compression of medial nerve
  • tension HA
  • numbness and tingling of hands
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22
Q

WEIGHT GAIN

A

1st trimester- 2-4lb total
2nd- 1lb per week
3rd- 1lb per week

23
Q

WEIGHT GAIN DISTRIBUTION

A
  1. 0kg=11lb=fetus,placenta,amniotic fluid
  2. 9kg=2lb=uterus
  3. 8kg=4lb=blood volume
  4. 4kg -3lb= breast tissue
  5. 3-4.5kg=5-10lb=maternal stores
24
Q

CALORIC NEEDS

A

RDA- no caloric increase 1st trimester

increase 300cals during 2nd and 3rd trimesters

fluid 8-10 , 8oz glasses of which 4-6 glasses is water

carbohydrates 50-55%
protein 15-20%
fats 30% (decrease 10% sat)
vitamin and minerals

25
Q

PSYCHOLOGICAL VARIABLES OF PREGANCY

A
  • ambivalence
  • acceptance
  • introversion
  • mood swings
  • changes in body image /role
  • rubin’s psychologic tasks (mother)
  • response of the father/siblings
26
Q

NUTRITION PLAN FOR THE DAY

A 
protein - 6oz 
milk/products- 4 servings (low fat)
veggies- 3-5 servings
fruit- 2-4 servings 
grains - 6-11 servings

folic acid- 600mcg/day

27
Q

ANTEPARTAL NURSING HISTORY

A
  • present history and past medical history
  • family history
  • current pregnancy
  • past pregnancy
  • gynecologic history
  • psychological history (include abuse)
  • cultural history
  • paternal health history
28
Q

ACCOMODATE RELIGIOUS RITUALS AND PRACTICES

A
  • religious beliefs influence experiences and attitudes

- incorporate into plan of care by doing a history

29
Q

BIOLOGICAL INFLUENCES AMONG GENDER AND RACES

A

-BLACKS- increase BP, lactose intolerance, sickle cell thalassemia

ASIANS- sickle cell, thalassemia

MEDITERRAINIAN- sickle cell , thalassemia

INDIAN -type II diabetes , lactose intol

MEXICAN -lactose intol

30
Q

CULTURAL ASSESSMENT

A
  • who in the family must be consulted before decisions are made
  • what type of healthcare provider is most appropriate
  • what beliefs or traditions may affect the plan of care
31
Q

DOMESTIC VIOLENCE SCREENING QUESTIONS

A

are you with a partner who threatens or physically hurts you?

within the past year or in this pregnancy has anyone hit, slapped, kicked ,or otherwise hurt you?

has anyone forced you to have sexual activities that made you uncomfortable

32
Q

DEVELOP CULTURAL COMPETENCE

A
  • self awareness
  • awareness and understanding of cultural differences
  • ability to adapt clinical skills and practices as needed
  • knowledge
33
Q

ASSESSING FOR DOMESTIC ABUSE

A
  • does client have inappropriate affect
  • delay in reporting symptoms
  • serious injuries are left untreated
  • intimate partner never leaves client’s side
  • “cause” of injury is inconsistent with findings
  • missed appointments
  • cultural variables
34
Q

WHAT TO DO?

A
  • avoid judgmental comments or asking why
  • do not speak directly to suspected abuser
  • what to say: I am afraid for you , you are not alone, I am here for you
  • choose words carefully….survivor is empowering while victim is not
35
Q

DOMESTIC VIOLENCE DURING PREGNANCY

A
  • incidence from 4-20%
  • may occur for 1st time during pregnancy
  • intensifies with positive history of abuse
  • risks include miscarriage, stillbirths and pre-term delivery
36
Q

NURSING PROCESS:SUBSTANCE ABUSE

A

ASSESSMENT

  • matter of fact, non judgmental, non punitive approach
  • what are the physical /behavioral signs

-DIAGNOSIS
-PLANNING
~therapeutic relationship

-IMPLEMENTATION 
~education 
~referral
~evaluation 
~ongoing
37
Q

INTERVENTIONS SUBSTANCE ABUSE

A
  • behavioral therapy
  • recovery environment
  • support groups
  • detoxification
  • medication therapy
38
Q

LABORATORY EVALUATIONS

A
  • urine analysis
  • complete blood count
  • blood type and Rh
  • antibody titer (indirect combs)
  • VDRL/STD
  • rubella titer
  • sickle cell screen
  • HIV
  • genetic screening
  • GTT -blood sugar
  • GBS -strep
39
Q

OBSTETRIC EXAM

A
  • mcdonald’s rule
  • vaginal exam :increased vascularity hormonal influence
  • PAP
  • internal pelvic measurement
  • breast examination
40
Q

PHYSICAL ASSESSMENT

A

-vital signs
report BP > 140/90

-weight

-prenatal visits -for normal pregnancy
every 4 wks for 1st trimester
every 2wks until 36wks
every wk after 36 wks

41
Q

FUNDAL HEIGHT

A
  • measured in cm to assess gestational age of fetus
  • at 20wks fundal ht- @level of umbilicus
  • between 22-34wks fundal ht approximates fetal age in weeks +-2 cm
42
Q

TEACHING THE DANGER SIGNS OF PREGNANCY

A

report the following to practitioner promptly

  • HA, visual disturbance or dissiness
  • BP> 140/80
  • epigastric ,abdominal or severe flank pain
  • burning on urination
  • chest pain or SOB with activity
  • vaginal bleeding or leakage of fluid from vagina
  • decrease in fetal movement
  • fever>38C (100.4)
43
Q

SUBSQUENT ROUTINE ANTEPARTAL EXAM

A
  • glucose tolerance test 28wks
  • group B strep 35-37 wks
  • VS
  • BP
  • UA
  • weight gain
  • uterine size
  • fetal HR
  • psychological status
  • assess danger signs
  • education/support
44
Q

SUBSEQUENT VISITS CONTINUE TO MONITOR

A
  • course of pregnancy
  • woman’s responses
  • discomfort
  • physical changes
  • adjustment of the support person,children
45
Q

SUMMARY DISCOMFORTS:1ST TRIMESTER

A
  • nausea/vomiting
  • fatigue
  • urinary frequency
  • breast sensitivity
  • nasal stuffiness
  • leucorrhea
  • ptylism
46
Q

THE FOLLOWING DISCOMFORTS Y=TYPICALLY INTENSIFY AS THE PREGNANCY PROGRESSES

A
  • constipation
  • hemorrhoids
  • backaches
  • round ligament pain
47
Q

SUMMARY DISCOMFORTS 2ND AND 3RD TRIMESTER

A 
heartburn
flatulence
leg cramps
varicose veins
edema of feet/ankles
feeling faint 
SOB
carpal tunnel syndrome
48
Q

ALLEVIATING COMMON DISCOMFORTS

A

NAUSEA

  • small frequent meals,fluid between meals
  • crackers before arising
  • carbonated beverages

URINARY FREQUENCY
-void every 2 hrs

FATIGUE
-napping

BREAST TENDERNESS
-wear supportive bra

INCREASED VAGINAL DISCHARGE
-daily bathing, cotton underwear, avoid douching

NASAL STUFFINESS
-cool air vaporizers, normal saline nasal spray

HEARTBURN

  • non sodium antacids
  • avoid eating just before be
  • head of bed elevated

ANKLE EDEMA
-avoid prolonged sitting or standing ,keep feet and legs elevated

VARICOSE VEINS
-regular exercise, avoid prolonged sitting or standing

FLATULENCE
-regular bowel habits

HEMORRHOIDS
-avoid constipation, gently self reduce hemorrhoid

FAINTNESS
-sit down and lower head between knees avoid standing in one place too long

SOB
-good posture when sitting ,prop up in bed

DIFFICULTY SLEEPING
-avoid caffeine, maximize comfort in bed

BACKACHE
-pelvic tilt,posture,avoid fatigue, body mechanics

CONSTIPATION
-increase fluids and roughage, daily exercise, regular bowel habits

49
Q

2ND AND 3RD TRIMESTER

A

sexual activity- generally no limitations until membranes rupture unless stated by practioner but may need to try different positions

physical activity
maintain normal activity as is comfortable for individual mother

50
Q

MEDICAL RISKS FOR OLDER EXPECTANT MOTHERS

A
  • death
  • chronic medical condition
  • miscarriage
  • gestational diabetes
  • hypertension
  • placenta previa
  • difficult labor
  • newborn complications
  • low birth weight infants
  • preterm births
  • perinatal death
  • down syndrome
  • preeclampsia
51
Q

EMPLOYMENT AND TRAVEL

A
  • can work until labor starts
  • must be aware of environmental hazards
  • no restrictions unless complications
  • frequent breaks during car travel
  • use seat belt
52
Q

SPECIAL CONCERNS OF EXPECTANT COUPLES OVER AGE 35

A
  • enough energy to care for a new baby

- ability to deal with the needs of the child as they age

53
Q

ADOLESCENCE

A
  • still growing must gain her expected weight plus that expected for pregnant adult
  • support system?
  • education
  • ongoing prenatal care

Mother/Infant (8 decks)

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