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NUR 4020 > ch. 14: nursing care of the family during pregnanct > Flashcards

ch. 14: nursing care of the family during pregnanct Flashcards

1
Q

prenatal period

A

a time of physical and psychologic preparation for birth and parenthood

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2
Q

duration of pregnancy

A

gestation
- spans 9 months, 40 weeks, or 280 days
- 3 trimesters

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3
Q

weeks first trimester

A

1-13

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4
Q

weeks second trimester

A

14-26

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5
Q

weeks third trimester

A

27-40

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6
Q

maternal adaptation (5 phases)

A

1) accepting pregnancy (joy/ambivalence)
2) identifying with the mother role
3) reordering personal relationships
4) establishing relationship with fetus: attachment process of the mother (maternal infant attachment)
- phase 1: she accepts biologic fact of pregnancy
- phase 2: she accepts the growing fetus as distinct from herself
- phase 3: she prepares realistically for the birth and parenting of the child
5) preparing for birth

TIP:
- is mother cautious for joy?
- no B/C = planned pregnancy
- potential self image issues d/t body changes

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7
Q

partner adaptation (5)

A

1) accepting the pregnancy
- announcement phase: accept sbiological fact of pregnancy
- moratorium phase: accept reality of pregnancy (men become more INTROVERTED and engage in discussions about life)
- focusing phase: negotiate with his partner the role he is to play in labor and in preparing for parenthood, men concentrate on his experience of the pregnancy and begins to think of himself as the father
2) identifying with the parent role
3) reordering personal relationships
4) establishing relationship with the fetus
5) preparing for birth

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8
Q

what other adaptations to pregnancy are important?

A

1) LGBTQIA individuals

2) sibling adaptation

3) grandparent adaptation

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9
Q

prenantal care

A

goal of prenatal care is to promote the health and wellbeing of the pregnant women, her fetus, the newborn, and the family
- women’s choise of maternity health care providers depends on the availability of providers, services, and facilities in the geographic region, health care insurance coverage, preferences for care, and health status
- providers for prenatal care/interprofessional teams -> need to be culturally sensitive
- models for prenatal care: traditional (physician, nurse, midwife), group prenatal care (led by midwife, group of women who get together + manage care under their own guidelines)

TIP:
“women providing care amongst themselves”

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10
Q

prenatal history

A
  • any difficulties with pregnancy so far? due date?
  • assessment of current and past pregnancies (GTPAL)
  • gynecologic history: abnormal PAPs, hx. STD/STI, using BC?
  • current and past medical history (ax., meds., herbs, immunizations): vitamins d/t possible excessive intake that could be toxic for mother and baby
  • social history/nutritional intake
  • family medical history: genetics?
  • religious, cultural, and occupational history
  • partner history: environmental hazards, heat, etc.?
  • mental health: depression, anxiety, mental health ds.
  • abuse: safety of relationship/home?
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11
Q

gravid

A
  • the state of being pregnancy
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12
Q

gravida

A

a pregnant women

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13
Q

gravidity

A

relates to the number of times that woman has been pregnancy, irrespective of the outcome

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14
Q

nulligravida

A

a women who has never experienced pregnancy

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15
Q

primigravida

A

a woman pregnant for the first time

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16
Q

multigravida

A

a woman pregnancy for the second time and beyond

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17
Q

para

A

number of births at 20 weeks or greater

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18
Q

parity

A

refers to the number of pregnancies, not the number of fetuses, carried to the point of viability, regardless of outcome
- 20 weeks viabile

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19
Q

nullipara

A

a woman who has not produced a viable offspring
- pregnancy not beyond 20 weeks

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20
Q

multipara

A

a woman who has had two or more pregnancies resulting in viable offspring

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21
Q

stillbirth

A

a fetus born dead after 20 weeks gestation
- abortion

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22
Q

antepartum

A

time between conception & onset of labor

23
Q

intrapartum

A

time from onset of labor to birth of baby & placenta

24
Q

postpartum

A

from birth to 6 weeks after

25
Q

term pregnancy

A

1) early term: 37 0/7 - 38 6/7
2) full term: 39 0/7 - 40 6/7
3) late term: 41 0/7 - 41 6/7

26
Q

post term pregnancy

A

> 42 weeks gestation
- providers recommend induction @ 40-41 weekss

27
Q

stillborn

A

baby born dead after 20 weeks gestation (not viable)

28
Q

GTPAL

A

G- number of pregnancies including current pregnancy
T- the number of pregnancies that were birthed at 37 completed weeks or later
P- the number of pregnancies that were birthed between 20-37 weeks
A- the number of pregnancies ending in spontaneous or therapeutic abortion
L- the number of currently living children

29
Q

prenatal high risk factors: social personal

A
  • low SES (socioeconomic status)
  • low education achievement
  • poor diet (homeless, teens, abused)
  • more than 3 pregnancies (high risk complications)
  • weight <100 Ibs or >200 Ibs
  • age <16 or >35
  • smoking 1 pack/day or more: tobacco, vapes, marijuana
  • use of illicit drugs
  • ETOH
30
Q

prenatal high risk factors: preexisting medical disorders

A
  • diabetes
  • cardiac disease
  • anemia: HgB <11 g/dL OR Hct <32% (iron deficient anemia vs. physiologic anemia)
  • HTN
  • thyroid disorders
  • renal disease
  • DES exposure (rare): diethyl stilbestrol (used to stop lactation, affects future female offspring -> abnormal shaped cervix, coxlomb cervix)
31
Q

prenatal high risk factors: obstetric considerations

A
  • stillbirth
  • recurrent abortion
  • previous cesarean birth
  • Rh or blood group (ABO) sensitization (mom Rh negative)
  • LGA baby
  • gestational diabetes (dx. after 20 weeks)
  • preeclampsia/eclampsia
  • abruptio placenta/placenta previa
  • (+) viruses/bacteria: rubella, toxoplasmosis, cytomegalovirus, herpes, syphilis
  • UTI
  • multiple gestation (twin, more)
  • history of preterm labor/birth (after 20 weeks)
32
Q

factors related to father’s health

A
  • family history of genetic conditions
  • age
  • significant health problems
  • previous or present alcohol intake
  • drug and tobacco use
  • blood type and Rh factor
  • occupation
  • feelings toward pregnancy, support of mother
33
Q

skin changes in pregnancy

A
  • spider nevi common
  • pigmentation changes: linea nigra, striae gravidum, melasma
34
Q

nose changes in pregnancy

A
  • may be edematous
  • nasal congestion
35
Q

mouth changes in pregnancy

A
  • hypertrophy of gingival tissue
  • benign granulomas

TIP: ask about last dental visits!

36
Q

thyroid changes in pregnancy

A

slight hyperplasia by third month

37
Q

breast changes in pregnancy

A
  • size increase noted in first 20 weeks
  • become nodular
  • tingling sensation in first and third trimesters
  • pigmentation of nipples and areolae darken
  • superficial veins dilate and become more prominent
  • striae in multiparas
  • tubercles of montgomery enlarge
  • colostrum may be present after 12 weeks (clear fluid that has high protein, amino acids, precurser to milk)
38
Q

montogmery tubercles

A

non pigmented nodules (12-20) around the areola in 2nd month (enlarged sebaceous glands or rudimentary lactiderous ducts)

39
Q

heart changes in pregnancy

A
  • palpitations may occur
  • short systolic murmurs (grade 2)

TIP:
PAC/PVCs

40
Q

lungs changes in pregnancy

A

SOB
- d/t baby pressing against diaphragm
- INCREASED TIDAL VOLUME

41
Q

abdomen changes in pregnancy

A
  • reddish or purple or silver straie may be present (lighter complexion)
  • linea nigra
  • diastasis of the rectus muscle
  • progressive enlargement
  • ballottement: palpate fetus
42
Q

spine changes in pregnancy

A

lumbar spinal curve may be accentuated (lordosis)

43
Q

pelvic changes in pregnancy

A
  • enlargement in anteroposterior diameter
  • uterus is pear shaped, mobile, and smooth
  • chadwick, goodell, hegar
44
Q

cervix: chadwick’s sign

A
  • dark bluish or purplish red color of the vaginal or cervical mucosa as a result of increased blood supply to the area
  • appears by 6-8 weeks
  • MUCUS PLUG
45
Q

cervix: goodell’s sign

A
  • softening of the cervix
  • collagen fibers in the connective tissue of the cervix decrease, causing it to soften
  • occurs at 5-6 weeks
46
Q

carvic: hegar’s sign

A
  • softening of the isthmus of the lower uterine segment
  • occurs by 6-10 weeks
47
Q

naegle’s rule

A

1) first day of LMP
2) subtract 3 months, add 7 days, and a year = estimated DOB or date of conception

48
Q

psychosocial assessment

A
  • history of emotional or physical abuse
  • history of emotional problems: depression/anxiety, ppd, traumatic life experiences, bipolar disorder
  • support systems
  • overuse or underuse of healthcare system: not having regular prenatal care
  • acceptance of pregnancy, intended or unintended
  • personal preferences about the birth
  • plans for care of child following birth
  • feeding preferences for the baby (breastfeed, bottlefeed?)

TIP:
- ask “how can i support you?”
- 1/4 RN experience abuse

49
Q

first prenatal visit 12 weeks gestation labs

A
  • CBC
  • blood type (Rh)
  • RPR. VDLR, or FTA-ABS (syphilis tests, rhogam)
  • rubella titer
  • hepatitis: need blood consent
  • HIV: need blood consent
  • gonorrhea/chlamydia cultures (PAP smear)
  • urinalysis/urine drug screen
  • first screen ultrasound: confirm viable fetus/gestational age
50
Q

assessment of fetal development

A

1) quickening (fetal movement): 16-22 weeks
2) fetal heartbeat: 110-160 bpm
- first heard between 10-12 weeks
3) ultrasound (2-3 week u/s for sac/viable embryo)
- gestation sac seen at 4-5 weeks
- fetal breathing movements by 10-11 weeks
- crown to rump measurement: made to assess fetal age from 4 days - 12 weeks (MOST ACCURATE IN DETERMINING EDD, first trimester)
- biparietal diameter: most accurate between 14-26 weeks (second trimester)

TIP:
1st trimester: crown to rump
2nd trimester: dating due date + anatomy

51
Q

other screening test

A

1) genetic testing:
- first screen, DNA assay, choriovilli sampling (baseline genetic, extract chorion villi from vagina BUT big risk of miscarriage) -> can determine sex of baby, suspects of chromosome ds.
- MSAFP: done at 15-18 weeks (most accurate for genetics)
- amniocentesis: performed after 20 weeks (20-30cc amniotic fluid)

2) diabetes screening between 24-26 weeks
3) GBS screened between 36-37 weeks (need to be diagnosed before labor)
4) gonorrhea/chlamydia screened at first visit & 36-37 weeks (repeat w/ GBS)
5) urine drug screen
6) ultrasound
- first screen: 10-12 weeks -> crown to rump, heart beats
- dating & anatomy: 18-22 weeks (2nd trimester) -> reconfirms DD, fetal anatomy normal or not?

52
Q

nursing interventions: education for self mgmt

A
  • expected maternal and fetal changes
  • nutrition
  • physical activity
  • posture and body mechanisms
  • rest and relaxation (sleep?)
  • medications and herbal preparations
  • substance use
  • immunizations
  • Rh immune globulin (Rh(-): receive rhogam 28 weeks + after birth to protect subsequent babies, trauma/bleed during pregnancy)
  • personal hygiene
  • prevention of UTI
  • kegel exercises
  • oral health
  • clothing
  • employment
  • travel: planes until last 4 weeks d/t altitude changes, rest Q1H car rides)
  • preparation for breast feeding
  • sexuality
  • normal discomforts
  • recognizing potential complications
  • psychosocial support

TIP:
- mom(-), dad(+): fetus (+) -> mom body fights baby and can cause harm

53
Q

variations in prenatal care: maternal age

A
  • majority of pregnancies in US occur in women between ages 20-35
  • for MOST women, pregnancy is uncomplicated and results in birth of a healthy infant
  • age differences: adolescents, less likely than older women to receive adequate prenatal care, women older than 35 years, multigravidas women, primigravidas women
54
Q

danger signs of pregnancy

A
  • gush of fluid (amniotic) from the vagina (PPROM) (premature preterum ruptum of membrane before 37 weeks)
  • vaginal bleeding
  • abdominal pain/cramping
  • lower backache (contractions)
  • fever
  • dizziness, blurred vision, spots before eyes (preeclampsia)
  • persistent vomiting
  • edema
  • muscular irritability or convulsions
  • epigastric pain: confused with heart burn
  • oliguria
  • dysuria
  • absence of fetal movement after 16-20 weeks (or no fetal movement felt in 24 hours)

TIP:
- beware of weight gain 5 Ibs/week

NUR 4020 (6 decks)

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