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nur 112 > anterpartal > Flashcards

anterpartal Flashcards

1
Q

Antepartal Care

A

Purpose: to have mother arrive at end of pregnancy
in good health and to deliver healthy baby

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2
Q

PRESUMPTIVE signs

A

subjective information/Reported by patient

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3
Q

examples of presumptive (6)

A
  • AMENORRHEA (absence of menstruation)
    ◦ d/t increased estrogen

-NAUSEA / VOMITING
◦ Common week 2-12

-FATIGUE

-BREAST CHANGES (tenderness, tingling,
increase vascularity, enlargement)
◦ d/t increased prolactin, week 2-3

-FREQUENT URINATION
◦ Pressure of enlarging uterus on
bladder

-Quickening
– feeling of life – mother thinks
she feels baby move, feels like a flutter
Primipara – felt @ 18-20 weeks
Multipara – felt @ 14-16 weeks

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4
Q

PROBABLE SIGNS ( who determines ..)

A

objective signs of pregnancy (physiological and anatomical) perceived by HCP

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5
Q

PROBABLE SIGNS examples (9)

A

Vaginal :
- Chadwick sign
blueish-purple coloration of vaginal mucosa, cervix and vulva seen at 6 to 8 weeks

  • Goodell signs
    softening of cervix with increased leukorrheal

Uterine :
Hegars Signs
softening of uterine segment

BRAXTON / HICKS
CONTRACTIONS
◦ 16 weeks/Uterus contracting, tightening
Intermittent, painless,
irregular

-BALLOTMENT
◦ Palpation with rebound
(16-18wks)

-PREGNANCY TESTS Depend on HCG
-Linea Nigra -dark
line from umbilicus to
pubis
-Nipple and areola -
darker in color
-Melasma
o “mask of pregnancy”
brownish pigmentation
on foreh

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6
Q

Chadwick sign

A

blueish-purple coloration of vaginal mucosa, cervix and vulva seen at 6 to 8 weeks

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7
Q

Goodell signs

increased _____

A

softening of cervix with increased leukorrheal

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8
Q

Hegars Signs

A

softening of uterine segment

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9
Q

BRAXTON / HICKS
CONTRACTIONS

A

16 weeks/Uterus contracting, tightening
Intermittent, painless,
irregular

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10
Q

BALLOTMENT

A

◦ Palpation with rebound
(16-18wks)/ technique of feeling for a movable object in the body, esp confirmation of pregnancy by feeling the rebound of the fetus following a quick digital tap on the wall of the uterus.

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11
Q

-Linea Nigra -dark

A

line from umbilicus to
pubis

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12
Q

Melasma

A

o “mask of pregnancy”
brownish pigmentation
on forehead

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13
Q

PREGNANCY TESTS
1. HUMAN CHORIONIC GONADOTROPIN
(HCG)
Urine becomes positive _____wks after
conception

  1. ______________ = Highest concentration level of HCG
  2. INACCURATE RESULTS (4)
A

PREGNANCY TESTS
HUMAN CHORIONIC GONADOTROPIN
(HCG)(found in blood or urine)
◦ Produced by chorionic villi
◦ Urine becomes positive 4wks after
conception

FIRST AM URINE
◦ Highest concentration level of HCG

INACCURATE RESULTS (not 100% accurate)
◦ Improper specimen collection
◦ Medications
◦ Hormone-producing tumors
◦ False-positive, false-negative makes it a
probable sign

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14
Q

POSITIVE SIGNS

A

FETAL HEART TONES (audible by 10wks
with doppler)

Observation and palpation of fetal
movement (20wks)

ULTRASONIC VISUALIZATION (presence
of fetus)(cardiac movement at 4-8wks)

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15
Q

NAGELE’S RULE for expected date
of delivery
USED TO CALCULATE
EXPECTED DATE OF Delivery
(EDD)

A

First Day of LMP – 3 months + 7
days

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16
Q

factors influence accuracy of nagele

A
  • regularity of cycle
  • length
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17
Q

1st trimester:

when

A

1st day of last menstrual period through 14th completed weeks

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18
Q

2nd trimester: __wks – ___completed weeks

____ testing for and adminstration of _______

A

Urine testing for glycosuria and proteinuria (screen for
gestational diabetes at 24-28wks

@20wks at umbilicus

  • administration of RHOGAM
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19
Q

3rd trimester:

what test is being done

A

29wks – 40 completed weeks

Group B streptococcus

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20
Q

Warning signs in first trimester ( 7)

when to notify hcp

A
  • abdominal cramping
  • vaginal spotting/bleeding ( can be abortion)

-absence of fetal heart rate

  • dysuria, frequency, urgency = UTI
  • fever/chills
  • prolonged nausea and vomiting (hyperemesis)
  • Pre-eclampsia: severe continuous headache, edema
    of face, hands and legs in the morning, scanty
    concentrated urine, visual disturbances – flashes of light or
    dots, dimness, blurring
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21
Q

Blood work and cultures

A

CBC –Hgb, Hct, RBC, WBC, Platelets

Sickle cell trait (prn), genetic screening

Rubella titer, Hepatitis B

Blood group – Rh factor, Coombs’ test, Blood type

 Rh incompatibility

 Detects other antibodies for incompatibility with
maternal antigens

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22
Q

Glucose screening

A

1 hr GTT if ≥130 mg/dl  will do 3 hr GTT
◦ HRF: screen @ 1st prenatal visit
◦ Lower risk: 24 – 28 wks

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23
Q

*Chorionic villus sampling (CVS)- Chorionic villus sampling (CVS)

A

aspiration
of sm. amt placental tissue (chorion) for
chromosomal analysis. Done at 10-13wks. Fetal
abnormalities d/t genetic disorders.

◦ Removal of small tissue specimen
from fetal portion of placenta
Tissue reflects. genetic makeup of fetus

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24
Q

Percutaneous Umbilical Blood Sampling
(PUBS) –

A

removal of sample fetal blood from
umbilical cord. Test for metabolic and
hematological disorders, fetal infection. Done
after 18wks.

  • Direct
    access to fetal circulation
    Insertion of needle directly into a fetal umbilical
    vessel under ultrasound guidance
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25
Q

Amniocentesis

A

Needle inserted thru abdominal wall to obtain
sample of amniotic fluid. Used for genetic testing,
hemolytic fetal disease, and assessment of fetal
lung maturity.

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26
Q

Amniotic fluid
Produced from amniotic membrane the ____
trimester, then produced by _______ 2nd
and 3rd trimester.

Fluid volume peaks at 34 weeks _________ml
then decreases to ____________

A

 Clear, composed of water, proteins, CHO,
lipids, electrolytes, fetal cells, lanugo & vernix
caseosa.
 Produced from amniotic membrane the 1st
trimester, then produced by fetal kidneys 2nd
and 3rd trimester.
 Fluid volume peaks at 34 weeks 800-1000ml
then decreases to 500-600m

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27
Q

OLIGOHYDRAMNIOS= ____ ml

Renal agenesis DEFINE..think about fetal function organs

A

Amniotic fluid less than 300 ml leading to fetal
anomalies/ renal agenesis

Renal agenesis- meaning failure of the
part/system to form

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28
Q

Polyhydramnios

A

 Amniotic fluid excess amount 1500-2000ml

 Increase risk of chromosomal disorders,
gastrointestinal, cardiac and/or neural tube
disorders.

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29
Q

vitamin b6 purpose

A

helps process certain amino acids to reduce nausea

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30
Q

Non-electronic fetal monitoring
 Daily fetal movement count (DFMC) –

A

maternal assessment of fetal movement by
counting movement/period of time:
4movements/1hour = positive

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31
Q

Ultrasonography

A

◦ Indications for use
◦Maternal uterine structure/placenta
location
◦Fetal heart activity, blood flow

◦Gestational age
◦Fetal growth, anatomy, congenital
anomalies
◦Amt of amniotic fluid
◦Assistive with other invasive tests –CVS,
PUB,amniocentesi

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32
Q

Magnetic resonance imaging (MRI)

A

◦ Examiner evaluates:
 Maternal structures (uterus, cervix, adnexa,
and pelvis)
Biochemical status of tissues and organs
Soft tissue, metabolic, or functional
anomalies
 Most common performed for suspected brain
abnormality
 Further evaluate abnormal placentat

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33
Q

Electronic Fetal Monitoring

Non-stress test (assess fetal condition/well being) fetal HR

Vibroacoustic stimulation-

Contraction stress test (CST)-

A

Non-stress test (assess fetal condition/well being) fetal HR
increases in response to movement (normal)
- Procedure-use external monitor for 20-40mins assessing
FHR with each movement on a contraction strip
◦ Interpretation: reactive vs. nonreactive

Vibroacoustic stimulation- used with nonreactive NST, use
auditory stimulation to assess fetal well-being. Create artificial
sound on maternal abd.

Contraction stress test (CST)- assessment of fetal
response to intermittent reduction in utero
placental blood flow r/t stimulated uterine contraction

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34
Q

Reactive Nonstress Test (NST)

A

n NST is reassuring or reactive when the fetus’ heart rate accelerates (increases) when it moves or when you have a contraction

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35
Q

1st trimester discomforts cont’

A

Breast changes -tenderness, enlargement; wear
well-fitting supportive bra

Emotional changes –fluctuation in emotions r/t
hormones; communicate with family and friends, TCT

Fatigue –plan for extra rest time, adequate calorie
intake, iron-rich foods, prenatal vitamins

Faintness/dizziness –hydration, avoid standing for
long periods, rise slowly from sitting to stan

36
Q

Discomforts 2nd Trimester

think about the burn…. AND LOWER HALF

A

Heartburn – eat small freq. meals, remain
upright for 30-45 after eating,
Constipation /flatulence –adequate fluid
intake, fiber, exercise as tolerated
Muscle cramps /leg spasms –Dorsiflex foot
to stretch calf muscles.
Vaginal discharge –encourage daily bathing,
use cotton underwear, wear panty liners, notify
MD if change in color or odor may indicate
infection

37
Q

chorionic villus sampling

A

(CVS) prenatal test checks cells from the placenta (which are identical to cells from the fetus) to see if they have a chromosomal abnormality (such as Down syndrome

38
Q

2nd trimester…

issues

A

Nosebleeds (Epistaxis) –Use cool air
humidifier, nasal saline gtts

Headaches –maintain adequate hydration

Increased salivation –use gum or hard candy

Heart pounding –cardiac output increases 30-
50%, HR increases 15-20 beats/min

Pelvic discomfort –Side lying, maternity girdle,
firm mattress with pillows, supportive shoes,
pelvic rock/tilt exercises

Emotional changes – adequate rest and
nutrition, pregnancy support group

39
Q

Supine hypotension.

A

Note relationship of gravid uterus
to ascending vena cava in standing posture (A) and in
supine posture

. C, Compression of aorta and
inferior vena cava with woman in supine position. D,
Relieved by use of a wedge pillow placed under woman’s
side

40
Q

3rd Trimester

notify hcp

A

Braxton Hicks Contractions – call MD if
contractions become regular and persist before
37wks. Ensure adequate fluid intake, maternity
girdle for uterus support

 Varicosities –legs, vagina/vulva,
hemorrhoids – result of increase venous
pressure. Girdle to support uterus and thus
reduce venous pressure,
support hose, avoid prolong sitting or
standing, elevate legs, position on side
when lying down, avoid crossing legs,
Avoid straining with BM, witch hazel pads

Bleeding gums – soft toothbrush, oral care
Fatigue – rest periods
Insomnia –relaxing bedtime routine, naps
Emotional changes –communication with S.O.,
prenatal classes, support group

41
Q

Lower extremity edema –

what to do

A

elevate legs, sidelying, dorsiflex periodically when standing or
sitting, maternity girdle

42
Q

Lamaze:

A

*Introduced early 60’s
*highly structured system includes conditioning,
discipline and concentration
*Having a coach to assist with system

43
Q

1st trimester:

what does this signfies” “

A

acceptance of pregnancy “I am
pregnant”

44
Q

 2nd trimester:

“. “

A

growing fetus distinct from
mother “ I am going to have a baby”

45
Q

 3rd trimester:

A

preparing for baby “ I am going
to be a Mom”

46
Q

Takes ___________________calories to support growth and
development of the fetus –translates to ___________ extra
calories/day throughout pregnancy

A

80,000

300

47
Q

Pica:

A

abnormal craving for non-food items (clay, laundry starch,
cornstarch)

48
Q

Pagophia:

A

excessive ice eating (may be related to iron deficiency)

49
Q

Underweight:

A

anemic, fatigue, poor eating habits, depression

50
Q

Overweight:

A

may need to reduce calorie intake, HT healthy choices

51
Q

Teenage pregnancy:

A

general diet usually inadequate (low in iron,
calcium, vit A and C), low birth weights, nutritional needs also r/t
growth and maturation of mother, need 2400 – 2700 calories daily

52
Q

Risks associated with GDM

mother and baby

A
  • 2x risk of HTN disorders, Preeclampsia, Preterm labor,
    Spontaneous abortion, C-section delivery, Post partum
    hemorrhage\

Fetal macrosomia  lacerations, episiotomies, c/s,
shoulder dystocia and birth trauma

  • Neonate @ risk of hypoglycemia, hypocalcemia,
    hyperbilirubinemia, thrombocytopenia, polycythemia, and
    RDS
53
Q

1st Trimester -

LEVELS

A

 estrogen & progesterone  
insulin production

Mom prone to hypoglycemia

54
Q

2nd & 3rd Trimester -

A

 placental lactogen, estrogen,
progesterone  insulin resistance in Mom
Allows glucose supply for fetus

55
Q

Mom’s insulin requirement increases ___________
gest. wks

A

18 – 24 wks

56
Q

Testing –

A

GTT (glucose tolerance test)
Blood sugar measurements –daily am fasting, 3
pre/postprandial checks/day
HBG A1C –want to keep it < 7%
Urine ketones when BS >200 mg/dL

57
Q

_______________ agents used in Type 2
stable diabetics and gestational diabetics

A

Oral hypoglycemic

58
Q

Preeclampsia

DEFINE/RISK FACTORS/S &S

A

 Hypertension, multisystem disorder in pregnancy
 Cause unknown, possible placental issue
 Risk factors: nulliparity, age <19 or >35, obesity, multiple
gestation, DM, dx of hypertension or renal disease
 Reduced organ perfusion d/t vasospasm affects hepatic
system, renal system, coagulation, central nervous system,
eyes, fluid/electrolytes, pulmonary system
 S/S: elevated BP (>140/>90), persistent headache, visual
disturbances, right upper quadrant or epigastric pain,
elevated liver function test, diminished kidney functioning,
altered clotting, facial edema

59
Q

Treatment of Preeclampsia

MEDICATIONS (2) / ASSESS FOR WHAT/ MONITOR

A

Monitor weekly - VS
 Administer antihypertensives: Hydralazine, Labetalol
 Administer Magnesium sulfate IV or IM (reduce seizure
activity in labor and delivery)
 Assess lung sounds, RR, SOB, chest tightness, cough,
POX
Monitor for CNS changes (headache, visual changes,
deep tendon reflexes), keep quiet environment
Activity restrictions (bedrest), monitor urinary output

60
Q

Abortion:

A

Spontaneous or elective termination of pregnancy prior
to 20 weeks

61
Q

Referred to as induced abortion

A

(medical/surgical termination before fetal viability)

62
Q

elective abortion

ELECTIVE… WHEN WE VOTE…

A

(at the request of the woman)

 Elective abortion: early termination of pregnancy at
request of the woman

63
Q

therapeutic abortion

A

serious maternal medical issues
or fetal anomalies)

Therapeutic abortion: performed to save the mother’s
life or serious fetal anomalies

64
Q

spontaneous abortion

A

(occurs without
medical or mechanical means-miscarriage)

65
Q

Abortion procedures:
* First trimester: Medication
procedure

  • Second trimester:
A

(mifepristonemisoprostol) or Suction curettage/vacuum aspiration

Dilation and Evacuation surgery

66
Q

Cerclage correction in Threatened
abortion

A

cervical cerclage is a treatment that involves temporarily sewing the cervix closed with stitches. This may help the cervix hold a pregnancy in the uterus. A cerclage is done in the second trimester of pregnancy to prevent preterm birth

67
Q

Ectopic Pregnancy

A

S/S: missed 1 menses, Prior to tubal rupture: pelvic or
abdominal pain, abnormal bleeding. After tubal
rupture: sever lower abdominal pain ( usually onesided), sharp pelvic pain, stabbing, tearing, unstable

VS, referred shoulder or neck pain
 Diagnosis: rule-out (r/o) ovarian cyst, appendicitis, +
pregnancy test, endovaginal ultrasound

68
Q

LAPAROTOMY:

A

Salpingectomy
◦ Removal of tube and remainder of products of
conception

69
Q

LAPROSCOPY:

A

Salpingostomy
◦ Tube opened and embryo removed;
◦ tube left to heal
◦ (HRF more scar tissues)

70
Q

Non-surgical: ectopic preggy

medication

A

administer
Methotrexate (folic acid antagonist
and type of chemotherapy agent)
cause dissolution of the ectopic mass

71
Q

Gestational Trophoblastic Neoplasms – rare
complication

A

Benign or malignant tumors that arise from the
trophoblast of human pregnancy (no fetus, no
amniotic sac, no placenta)

72
Q

Types: of neoplsmas

A

Hydatidiform mole (benign-most common),
Chorioadenoma destruens, Choriscarcinoma

73
Q

Hydatidiform Mole:

A

grape-like clusters, early s/s of
pregnancy, partial involvement= limited due to some
chorionic (fetal) tissue, complete involvement = no
embryonic tissue or membrane

74
Q

 Complete Hydatidiform Mole:

A

dark brown-bright red
vaginal bleeding, occurs 6-8 weeks post missed
menstrual cycle, large uterine size, ovarian
enlargement, abdominal cramping, Hyperemesis
Gravidarum, Gestational Hypertension

75
Q

Treatment for Hydatidiform Mole

howlong to wait till next preggy

A

Suction curettage to evacuate a molar pregnancy
 Hospitalized to monitor closely for hemorrhage (observing
for DIC and HELLP syndrome)
 Pitocin infusion for 24 hours after surgery to control
bleeding
 hCG levels monitored
 Contraceptives for one year or if complicated hysterectomy
recommended –
Oral or diaphragm recommend

76
Q

Placenta Previa

A

= implanted in the lower segment close to
cervical os/ When the placenta covers the opening in the mother’s cervix.

77
Q

Placenta Previa cont’
 Risk factors:

A

Endometrial scarring (hx of placenta
previa, previous c-section, suction/curettage for
miscarriages or induced abortions, multiple
gestation), maternal age >35, hypertension,
smoking, diabetes, uterine anomalies

78
Q

Symptoms: of Placenta Previa

A

painless bright red bleeding after 7th
month, suspected if bleeding after 20 weeks,
 Diagnosis: ultrasound to locate placenta

79
Q

Treatment of Placenta Previa :

Early pregnancy:
vs
Late pregnancy:

A

Early pregnancy: bed rest to allow for fetal lung maturity, no
intercourse, monitor VS and FHR, daily Hgb and Hct, have
blood available, may do vaginal delivery if less than 30% of
os is covered

 Late pregnancy: C-section delivery

80
Q

Abruptio Placenta

Separates prematurely ( after_____ wks)
 Biggest risk factor-

A

Separates prematurely ( after 20 wks)
 Biggest risk factor- hypertension
 Other risk factors: cocaine/methamphetamine use,
blunt abdominal trauma, smoking

81
Q

Diagnosis made by s/s: Abruptio Placenta

A

severe sudden onset of
intense uterine/abdominal pain, severe bleeding
(dark, almost purple), board-like abdomen(hypertonic
uterine contractions), FHR low or absent

82
Q

Abruptio Placenta complications

A

 C-section delivery
 Severe bruising of uterine muscle that leads to
impossible contraction = hysterectomy
 Hemorrhage
 DIC
 Hypovolemic shock > pituitary necrosis > renal failure
 Fetal hypoxia, preterm delivery, stillbirth or anoxia or
death

83
Q

Nursing care of placenta previa and abruptio
placenta

A

Comprehensive history of onset
Last vaginal exam, ultrasound results
Vital signs ( hypotension, tachycardia)
Lab tests: Hgb, Hct, CBC, clotting factors, chemistry
(CMP)
Monitor fetal heart rate, apply oxygen on Mom (8-
10L/min via mask)
Assess uterine tone/contractions, vaginal bleeding,
abdominal pain

84
Q

pt care for abruptio

A

NPO ( nothing by mouth),
insert foley
catheter( decreased renal output)
IV insertion (large needle 18 gauge)
Semi-fowler’s position
Prepare for C-section
Support parents

85
Q

HELLP syndrome

A

With hemolysis of RBC: fatigue, pallor, anorexia,
weakness, lassitude, dyspnea, edema, Hgb less
than 6, decrease O2 to the baby, increase risk of
fetal stillborn and premature newborns

  • With elevated liver enzymes: nausea/vomiting,
    malaise, right upper quadrant pain from liver
    distention, hyperbilirubinemia
  • Unexplained bruising & petechiae
86
Q

Infections
 STI/STD
 TORCH infections
 Group Beta Streptococcus (GBS) p
 Zika virus p. 212-
 Coronavirus (Covid-19)
 Human Immunodeficiency Virus (HIV)

A

Infections
 STI/STD p.206 –Chlamydia & Gonorrhea cause ophthalmia
neonatorum in birth canal during delivery
 TORCH infections p.209 (Toxoplasmosis, Other, Rubella,
Cytomegalovirus & HSV) cross placenta and affect developing
fetus.
 Group Beta Streptococcus (GBS) p.211- risk of premature labor,
newborn neurological issues
 Zika virus p. 212- mosquito bites, foreign travel, cause birth
defects, IUGR, miscarriage or stillbirth
 Coronavirus (Covid-19) p.212- pregnant increases risk for severe
respiratory manifestations, preterm delivery,
 Human Immunodeficiency Virus (HIV) p.204-destruction of CD4
T cells in immune system, Transmitted transplacental, intrapartal
& breast milk. Risk preterm delivery, preterm ROM, IUGR

nur 112 (23 decks)

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