Antepartum Nursing Flashcards
What is weight gain during pregnancy based on?
pre-pregnancy BMI
What are obese patients at risk for?
AP, IP, PP
What are underweight patients at risk for?
SGA/preterm delivery
When is the patter of weight gain?
first trimester (1.1-4.4 lbs)
What is important nutritional education for childbearing?
- maintain a healthy weight (appropriate weight gain)
- calorie intake of 300 cal/day
- prenatal vitamin
- minerals
- drink 8-10 glasses of water a day
What should your daily food intake include?
protein, fruit, vegetables, grains, and dairy
What should your prenatal vitamin include?
600mcg of folic acid daily
What minerals should you be consuming each day?
27 mg of iron, and 1000 mg/day of calcium
What nutritional precautions should you teach your patient?
- limit caffeine
- avoid alcohol
- avoid fish high in mercury
- avoid excess vitamin A (toxic to fetus)
- nutritional supplements consult provider
What factors influence nutrition?
- ae
- nutritional knowledge
- exercise (athletes may require diet modifiation)
- culture
What do 3rd trimester women prefer?
cold foods
What do postpartum women prefer?
hot foods
What is included in a preconception visit?
- complete history
- physical exam
- health screen
What health problems should be included in preconception?
- chronic conditions and medications
- social problems or harmful habits
How long should you be off hormonal contraception to conceive?
2-3 months
How long should you be off depo provera to conceive?
several months to one year
What is included in conception timing teaching?
fertility awareness family planning to time intercourse
What preconception behaviors should you avoid?
- alcohol
- drug (prescribed, OTC, illicit)
- excessive caffeine
- tobacco and second-hand smoke
- complementary and alternative meds
- hot tubs and saunas
What safe behaviors should you be practicing prior to conception?
- adequate ret and relaxation
- exercise
- safe sex
- seatbelts
- sunscreen
- smoke and carbon monoxide alarms
- dental health
- flu immunizations
- folic acid 400-800 mcg/day
What are presumptive signs of pregnancy?
- amenorrhea
- fatigue
- nausea and vomiting
- urinary frequency
- breast increase size and fullness
- pronounced nipples
- quickening (fetal movement)
What are probable signs of pregnancy?
- uterine enlargement
- Chadwick’s sign
- Goodell’s sign
- Hegar’s sign
- Ballottement
- Braxton Hicks contractions
- Positive pregnancy test
What are positive signs of pregnancy?
- fetal heart sounds (10-12 weeks)
- fetal movement (observed/palpated)
- ultrasound visualization of fetus
- cardiac movement at 4-8 weeks
- transvaginal ultrasound (detect sac at 4.5 to 5 weeks
What confirms pregnancy?
serum or urine hCG
When does hCG production begin?
implantation
When is hCG detected?
7-8 days after conception
What do higher than normal levels of hCG mean?
- multiples
- ectopic
- molar pregnancy
- genetic abnormality
What do lower than normal levels of hCG mean?
- miscarriage
- ectopic
What can cause a false positive or negative pregnancy test?
medications
- anticonvulsants
- diuretics
- tranquilizers
What is considered the gestational age?
number of completed weeks
How long is the gestational period?
fertilization to delivery (approximately 280 days)
How many weeks is a term baby?
38-42 weeks
How many weeks is a preterm baby?
less than 37 weeks
How many weeks is a post term baby?
more than 42 weeks
EDC
estimated date of confinement
EDD
estimated date of delivery
EDB
estimated date of birth
LMP
last menstrual period
What is the formula for Naegele’s Rule?
LMP - 3 months + 7 days = EDD
Gravida
number of pregnancies
Nulligravida
never been pregnant
Primigravida
pregnant for the first time
How are the kidneys and ureters affected by pregnancy?
renal pelvis dilates and ureters elongate and dilate
What happens to the renal plasma flow during preganancy?
increases by 50-80%
What happens to the glomerular filtration rate during pregnancy?
increases by 50%
What is the renal function dependent upon?
position
What are two common urinary issues women may have during pregnancy?
glycosuria and proteinuria
What 3 things with the bladder increase during pregnancy?
blood volume, frequency (nocturia), bladder capacity
What does progesterone cause the bladder to do? What does this cause?
decrease in tone
Causes urinary stasis
and makes women predisposed to urinary tract infections
How does pregnancy affect the skin?
increased circulation, hot flashes and facial flushing, increased perspiration, increased sebaceous glands activity
What does increased sebaceous gland activity cause?
oily skin and acne
Linea nigra
darker vertical line from umbilicus to mons pubis
What is hyperpigmentation a cause of?
increased melanin
Melasma
mask of pregnancy
What are common cutaneous vascular changes during pregnancy?
small angiomas or palmar erythema
What are common connective tissue changes during pregnancy?
Striae gavidarum (stretch marks
Where do stretch marks most commonly appear?
breast, hips, abdomen, buttocks
What are common musculoskeletal changes during pregnancy?
calcium demand increase and postural changes
Progesterone and relaxin
initiate relaxation of the ligaments and joints
altered posture
center of gravity shifts (increases fall risk)
Lordosis
shift in the center of gravity
altered gait
pregnant waddle
diastasis recti
abdominal midline muscle separates during 3rd trimester
round ligament pain
relaxation of ligament and abdominal distention (stretching and pain)
What does the increase in pituitary size cause?
secretion of prolactin and oxytocin
prolactin
preparation for lactation
oxytocin
uterine contraction and milk ejetion
What helps with fetal neurological function?
thyroid increase in size and production
parathyroid function
calcium homeostasis
pancreas function
continuously producing glucose for the fetus
What are the 3 hormones included in the corpus luteum?
progesterone, estrogen, and relaxin
progesterone
maintains uterine linin, relaxes smooth muscles
estrogen
stimulates uterine growth, increases blood supply
relaxin
inhibits uterine activity
What is secreted by the placenta?
estrogen, progesterone, human placental lactogen, and relaxin
What is the function of the placenta?
support and maintain pregnancy, fetal growth, and development
What are two common neurological issues with pregnancy?
headache and syncope
What 3 things must the maternal immune system do to maintain pregnancy?
- tolerant of foreign fetal system
- protects fetus from infection
- preserve maternal-fetal well-being
What are the goals for antepartum care?
- assess and identify potential risks
- educate to promote health and prevent diseases
- families can make informed healthcare choices
- healthier pregnancy
- best possible outcome for mom and baby
What two things should be included in family-centered maternity care?
- pregnancy and childbirth is a normal life event
- developmental life transition vs. medical event
Fundal assessment
uterine growth pattern during pregnancy
Leopold’s Maneuver
external palpation of uterus to determine:
- presenting part
- degree of descent into pelvis
- point of maximum impulse
How do you perform Leopold’s maneuver?
- identify fetal part located in fundus
- determine location of fetal back
- determine presenting part in pelvis
- determine location and attitude of fetal head
What is included in the initial prenatal visit?
H&P, reproductive exam, laboratory and diagnostic studies, risk assessment
What is the timeline for prenatal visits?
Q4 wk-conception to 28 weeks
Q2 wk-29 to 36 weeks
Q1 wk-37 to birth
How often do post date patients go to the doctor?
biweekly
What is included in subsequent prenatal visits?
- v/s
- weight
- urine dip
- fundal height
