Ch 11-12 Maternal Adaptation & Nursing Mgmt in Pregnancy Flashcards
Presumptive signs of pregnancy
Fatigue Breast tenderness N/V Amenorrhea Urinary frequency
Probably signs of pregnancy
Braxton Hicks
Ballottement
Abdominal enlargement - starts low, gets higher
Pregnancy test - probably b/c of false negative
Goodell’s sign - softening of cervix
Chadwick’s sign - bluish/purplish hue r/t blood circulation
Hegar’s Sign - softening of lower uterus (isthmus)
it’s GOOD your cervix is soft
Goodell’s sign
Chad is so blue
blue/purple hue r/t blood circulation
increased vascularity
chadwick’s sign
oval sign - softening of lower uterus (isthmus)
hegar’s sign
Positive signs of pregnancy
Fetal Heart Tones - make sure rhythm isn’t the same as the mom’s fetal demise ensure there is viable fetus Ultrasound visualization of the fetus Palpable fetal movements felt by HCP mom might just feel GI distress
Early pregnancy confirmation is made through the earliest biological chemical marker for pregnancy
can be detected as early as 7-10 weeks
peak 18-20 weeks
hCG
high levels of hCG may indicate..
molar - grape cluster - requires termination & removal. don't get pregnant for 1 year b/c of meds. multiple gestation abnormal gestation (trisomy 31, neural tube defects)
low levels may indicate
Ectopic pregnancy
Impending miscarriages
nonviable pregnancies
how do you obtain hCG levels?
urine + blood
True or false:
A positive pregnancy test is a positive sign of pregnancy.
False
First trimester weeks:
Second trimester weeks:
Third trimester weeks:
1-13
14-26
27-40
late preterm:
term:
postterm:
37-38
39-42
>42
What changes occur in the uterus?
Changes in size, shape and position Changes in contractility Uteroplacental blood flow Cervical changes Ballottment Quickening
a sharp upward pushing against the uterine wall with a finger inserted into the vagina for diagnosing pregnancy by feeling the return impact of the displaced fetus
Ballottment
the first movements of the fetus felt in utero. It occurs from the eighteenth to the twentieth week of pregnancy.
quickening
not regular, go away, not long - 30-40 seconds. Don’t get closer over time
braxton hicks contractions
Interventions for braxton hix contractions
rest
hydrate
positioning
they’re normal anyway - practice contractions
what does the fundal height correlate w/?
gestational age
where is the fundal height @ 20 weeks gestation?
umbilicus
(mucus plug) - bacterial barrier for ascending infx
operculum
vaginal changes
Increased vascularity
Lengthening of vaginal vault
Acidotic - prevents infection
Leukorrhea- vag discharge
Cervical changes
- Softening (Goodell’s sign) (seems like ripening too)
- Operculum (mucus plug) - bacterial barrier for ascending infx
- Increased vascularity (Chadwick’s sign) - increased bleeding (can bleed from sex / trauma)
when is the dev of the mammary glands functionally complete?
midpregnancy
changes in breast
- Fullness
- Tenderness
- Sensitivity
- Greater pigmentation
- Erect nipples
- Hypertrophy of the Montgomery tubercles - “won’t talk about montgomery tubercles”
- Subcutaneous vessel dilation
- Striae
- Enlargement
best indication that you might get striae?
your mom had them
GI (mouth/nutrition to butt)
- Gums: hyperemic (increased blood flow), swollen, friable
- Excess salivation
- Increased oral vascularity & gingivitis
n/v
food cravings
- Decreased peristalsis & smooth msk relaxation
- hemorrhoids from constipation + increased venous pressure + uterus pressure
- slow gastric emptying, heart burn
- prolonged gallbladder emptying
what is a nonfood craving called? (crave paper, dirt, etc)
pica
how much does blood volume increase (%) above prepregnant levels?
40-50%
does BP go up or down midpregnancy?
down
what increases, cardiovascularly?
- blood volume
- CO
- venous return
- HR
- RBC
- iron demands, fibrin, plasma fibrinogen –> hypercoagulable
- -> this is why being on bedrest = VTE
Heart sound changes
Splitting S1 & S2; S3 heard maybe after 20 weeks.
Systolic & diastolic murmurs may be heard over pulmonic valve in some women
Heart complications
PVC’s, PAC’s, sinus arrhythmias
When assessing a pregnant woman, which of the following would the nurse expect to find?
a. Increase in blood pressure
b. Complaints of nausea
c. Dry mouth
d. Diarrhea
complaints of nausea
occurs when women lay flat on their backs for periods of time resulting in reflex bradycardia and decreases in systolic BP = baby on top of inferior vena cava
supine hypotensive syndrome
complications of supine hypotensive syndrome
fetus: low HR r/t low blood supply
mom: high HR, nausea, vomit, lightheaded, dizzy
When is the peak blood volume?
32-34 weeks.
When would you transfuse?
below 16-17
Respiratory changes
- Increased O2 requirements
- Transverse diameter increases
- Thoracic (diaphragmatic) breathing replaces abdominal breathing
- Increased vascular congestion - stuffy
- Lower threshold for CO2
- Compensatory respiratory alkalosis
- RR increases
Renal changes
- ureters constrict/dilate
- urine volumes in pelves/ureters smaller/larger
- urine flow increase/decrease
- stagnation leads to..
- frequency from what initially, and then later from ?
- GFR up or down
- Dilation of renal pelves and ureters
- Larger urine volumes held in the pelves and ureters
- Urine flow decreased
- Stagnation leads to bacterial accumulation
- Frequency from increased bladder sensitivity and later from compression
- increased GFR
Is proteinuria or glucosuria ever normal?
no! not even in pregnancy
MSK changes in pregnancy
- Center of gravity shifts forward
- Lordosis
- Aching, numbness and muscle weakness may be present
- Enlargement of pelvic dimension (relaxin)
- Separation of symphisis pubis - not generally delivered vaginally
- Decreased abdominal tone
- Umbilical hernias
- Hiatal hernias
- Separation of rectus abdominis
Integumentary changes in pregnancy
- Cholasma
- Linea Nigra
- Striae Gravidarium
- Angiomas
- Palmar Erythema
- Epulis - inflamed gums
- Increased nail growth
- Increased hair growth
does thyroid gland enlarge or shrink? what does it cause? cause?
what should you do? what would it cause in the fetus?
increased activity; increase in BMR
monitor hypo & hyperthyroidism closely
can cause cognitive delays
does pituitary gland enlarge or shrink? what does it cause?
enlargement;
decrease in TSH, GH; inhibition of FSH & LH; increase in prolactin, MSH; gradual increase in oxytocin with fetal maturation
what happens w/ the pancreas?
insulin resistance due to hPL and other hormones in 2nd half of pregnancy
what happens with the adrenal glands?
increase in cortisol and aldosterone secretion
neuro changes
- compression of nerves & vascular stasis = sensory changes
- dorsolumbar lordosis = nerve root pain
- edema in peripheral nerves = parasthesia
- opioid use - physical dependency in newborn, resp distress
- acroesthesia - carpal tunnel r/t swollen nerves in unlar
- lightheadedness, faint, syncope
- hypocalcemia - msk cramp, tetany – drink dairy, no soft cheese, eat banana
how many more calories from the baseline should mom eat for 1 baby? 2 babies?
500
700
how many more calories should mom eat if lactating?
400+
how much weight gain is healthy in 1st and 2nd/3rd trimesters in a healthy person?
Total weight gain
3.5-5 for 1st
1 for 2nd/3rd
total weight gain: 25-35 lbs
Emotional Responses
Ambivalence
pregnancy loss
rape/abuse
not the right time
Introversion - focusing on oneself, withdrawn
Acceptance - when you get bigger, you hear heart beat
Mood swings - bipolar
Changes in body image
high risk: teenage, athletes, bulimic/anorexics
Can you give MMR, TDAP, Flu during pregnancy?
Yes - unattenuated, NOT LIVE
What happens in the 1st prenatal visit?
- Establishment of trusting relationship
- Focus on education for overall wellness, not a state of dz
- Detection and prevention of potential problems
- UTI, urinary frequency, pain, blurred vision, excessive N/V, weight loss,
- Comprehensive health history (reason for seeking care (suspicion of pregnancy? Date of LMP, s/s of preg, urine or blood test for hCG), past med, surg, personal hx, reproductive hx), physical examination, and laboratory tests
How to calculate nagele’s rule?
LMP
- 3 months
+ 1 year
+ 7 days
= EDD/EDC
Gravida
Primigravida
Multigravida
Nulligravida
Gravida: a woman who is pregnant
Primigravida: a woman who is pregnant for the first time
Multigravida: a woman who has had two or more pregnancies
Nulligravida: a woman who has never been pregnant
Parity
Primipara
Multipara
Nullipara
Parity: the number of pregnancies in which the fetus or fetuses have reached 20 weeks of gestation when they are born, not the number of fetuses (e.g., twins) born. Whether the fetus is born alive or is stillborn (fetus who shows no signs of life at birth) does not affect parity
Primipara: a woman who has completed one pregnancy with a fetus or fetuses who have reached 20 weeks of gestation
Multipara: a woman who has completed two or more pregnancies to 20 or more weeks of gestation
Nullipara: a woman who has not completed a pregnancy with a fetus or fetuses who have reached 20 weeks of gestation
a pregnancy that has reached 20 weeks of gestation but ends before completion of 37 weeks of gestation
preterm
a pregnancy that goes beyond 42 weeks of gestation
postdate
a pregnancy from the completion of 37 weeks of gestation to the end of week 42 of gestation
term
capacity to live outside the uterus; there are no clear limits of gestational age or weight. (24 wks) Infants born at 22 to 25 weeks of gestation are considered to be at the threshold
viability
G T P A L
# of pregnancies (gravida) # of term # of preterm # of abortions # of living children
Physical Exam for pregnancy
Vital signs
Head-to-toe assessment - nurse
Head and neck
Chest
Abdomen, including fundal height if appropriate
top of symphysis pubis to top of the fundus
start @ 20 wks - size should be equivalent to gestational age
too big: too much fluid, diabetes (big baby)
Extremities
Pelvic examination - nurse in inpatient setting
Examination of external and internal genitalia
Look for STIs
Bimanual examination - internal vag exam & rectal
vag wall intact, no fistula, assess ovaries & uterus
Pelvic shape: gynecoid, android, anthropoid, platypelloid
Pelvic measurements: diagonal conjugate, true (obstetric) conjugate, and ischial tuberosity
Lab tests during pregnancy
- Urinalysis
- Complete blood count
- Blood typing
- Rh factor
- Rubella titer
- Hepatitis B surface antigen
- HIV, VDRL, and RPR testing
- Cervical smears - vag culture
- Ultrasound
- confirm baby and confirm EDD
Visit schedule
Every 4 weeks until __ weeks
Every 2 weeks from __ to __ weeks
Every week from __ weeks until _____
up to 28 weeks
29 - 36
37 until birth
What to assess and look for changes in over time?
Weight & BP compared to baseline values
Urine testing for protein, glucose, ketones (dehydration), and nitrites (UTI)
Fundal height
Quickening/fetal movement
Fetal heart rate- should be 110 & 160 - higher earlier in gestation
done btw 15-22 wks, screens for downs in early pregnancy through maternal blood
alpha-fetoprotein analysis
done between 11-14 wks, for fetal chromosomal and structural anomalies
nuchal transluscency screening
prenatal diagnosis of chromosomal abnormalities & fetal infections – sampled from amniotic sac and DNA is examined
amniocentesis
diagnosis for identifying chromosomal abnormalities and other inherited dz – can be transcervical (US + thin cath through cervical to placenta) or transabdominal (US + long thin needle through abdomen to placenta)
CVS
collection of blood specimen from fetal umbilical vein for chromosomal analysis for women @ risk for genetic anomalies
percutaneous umbilical blood sampling
assessment of fetal wellbeing main thing
US
Discomforts of pregnancy
1st trimester
- Urinary frequency or incontinence
- Fatigue
- Nausea and vomiting
- EAT BRAT - Breast tenderness
- ice - Constipation
- leafy green veggies - Nasal stuffiness, bleeding gums, epistaxis
- Cravings
- Leukorrhea
Discomforts of pregnancy
2nd trimester
- Backache
- Varicosities of the vulva and legs
- spider veins in lower extremities
- if vulval - be careful for bleeding - Hemorrhoids
- tucks
- tylenol
- don’t sit on toilet for long period of time - Flatulence with bloating
NO urinary frequency!
Discomforts of pregnancy
3rd trimester
- Return of 1st trimester discomforts
- Shortness of breath and dyspnea
- Heartburn and indigestion
- Dependent edema
- swelling in hands and feet - Braxton Hicks contractions
While assessing a woman at 18 weeks gestation, which of the following would the nurse report as unusual?
a. Urinary frequency b. Backache c. Leukorrhea d. Flatulence with bloating
urinary frequency
not common in 2nd trimester
(psychoprophylactic) method: focus on breathing and relaxation techniques
lamaze
(partner-coached childbirth) method: focus on exercises and slow, controlled abdominal breathing
(courtney)
bradley
(natural childbirth) method: - focus on empowerment, focus on fear reduction via knowledge and abdominal breathing techniques
dick-read
Can you get hypobirthing on the fly?
no, requires preparation
if woman wants a natural childbirth and is committed, should you offer epidural?
no
decision to incision
30 minutes
you can hemorrhage to death in how many minutes?
10 min w/ significant bleed
