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Nurse 2 Ante, Intra, and Post-partum > Chapter 12 Nursing Management during Pregnancy > Flashcards

Chapter 12 Nursing Management during Pregnancy Flashcards

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1
Q

Preconception care is

A

the promotion of the health and well-being of a woman and her partner before pregnancy

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2
Q

What is the goal of preconception care?

A

is to identify and modify biomedical, behavioral, and social risks to a woman’s health or pregnancy outcome through prevention and management interventions.

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3
Q

isotretinoins

A

Use of isotretinoins (e.g., Accutane) in pregnancy to treat acne can result in serious birth defects such as cleft palate, congenital heart defects, hearing loss, and microcephaly.

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4
Q

Alcohol misuse

A

No time during pregnancy is safe to drink alcohol, and harm can occur early, before a woman has realized that she is pregnant

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5
Q

antiepileptic drugs

A

Certain antiepileptic drugs are known teratogens (e.g., valproic acid). Recommendations suggest that before conception, women who are on a regimen of these drugs and who are contemplating pregnancy should be prescribed lower dosages of these drugs.

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6
Q

Diabetes preconception

A

The threefold increase in the prevalence of birth defects among infants of women with type 1 and type 2 diabetes is substantially reduced through proper management of diabetes.

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7
Q

Folic acid deficiency

A

Daily use of vitamin supplements containing folic acid (400 mcg) has been demonstrated to reduce the occurrence of neural tube defects by two thirds.

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8
Q

Hepatitis B

A

Vaccination is recommended for men and women who are at risk for acquiring hepatitis B virus (HBV) infection. Preventing HBV infection in women of childbearing age prevents transmission of infection to infants and eliminates risk to the woman of HBV infection and sequelae, including hepatic failure, liver carcinoma, cirrhosis, and death.

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9
Q

HIV/AIDS

A

f HIV infection is identified before conception, timely antiretroviral treatment can be administered, and women (or couples) can be given additional information that can help prevent mother-to-child transmission.

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10
Q

Rubella seronegativity

A

Rubella vaccination provides protective seropositivity and prevents congenital rubella syndrome.

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11
Q

Obesity

A

Adverse perinatal outcomes associated with maternal obesity include neural tube defects, preterm delivery, diabetes, cesarean section, and hypertensive and thromboembolic disease. Appropriate weight loss and nutritional intake before pregnancy reduce these risks.

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12
Q

Sexually transmitted Infections

A

hlamydia trachomatis and Neisseria gonorrhoeae have been strongly associated with ectopic pregnancy, infertility, and chronic pelvic pain. STIs during pregnancy might result in fetal death or substantial physical and developmental disabilities, including intellectual disability and blindness. Early screening and treatment prevent these adverse outcomes.

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13
Q

Smoking

A

Preterm birth, low birth weight, and other adverse perinatal outcomes associated with maternal smoking in pregnancy can be prevented if women stop smoking before or during early pregnancy. Because only 20% of women successfully control tobacco dependency during pregnancy, cessation of smoking is recommended before pregnancy.

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14
Q

Risk factors for adverse pregnancy outcomes

A

Isotretinoins; alcohol misuse; antiepileptic drugs; diabetes (preconception); folic acid deficiency; hepatitis B; HIV/AIDS; Rubella seronegativity; obesity; STI’s ;smoking

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15
Q

Preconception care key areas

A

-Immunization status
-underlying medical conditions
-Reproductive health data, such as pelvic exams, use of contraceptives, and STIs
-Sexuality and sexual practices
-Nutrition history and present status
-lifestyle practices, including occupation and recreational activities.
-Psychosocial issues such as levels of stress and exposure to abuse and violence
-Medication and drug use, including use of tobacco, alcohol, OTC and prescription meds, and illicit drugs
-Support system, inc family, friends, and community

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16
Q

Initial health history typically includes questions about three major areas:

A
  1. reason for seeking care
  2. past medical, surgical, and personal history, including that of her family and her partner
  3. the clients reproductive history
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17
Q

What are common reasons a woman would be seeking prenatal care?

A

-suspicion of pregnancy
-Date of last menstrual period
-signs and symptoms of pregnancy
-urine or blood test for hCG

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18
Q

Description of a woman’s cycle includes:

A

-age at menarche
-number of days in her cycle
-typical flow characteristics
-any discomfort experienced
-use of contraception

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19
Q

Nagele’s Rule for Calculating the Estimated Due Date (EDD)

A
  1. Use the first day of the last normal menstrual period. ex: 10/14/20
  2. Subtract 3 from the number of months. ex: 7/14/20
  3. Add 7 to the number of days. ex: 7/21/20
  4. Adjust the year by adding 1 year. ex: 7/21/21
  5. Estimated due date (+ or - 2 weeks)= July 21, 2021
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20
Q

most accurate method of dating a pregnancy

A

ultrasound

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21
Q

Gravid is

A

the state of being pregnant

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22
Q

Gravida/Gravidity

A

The total # of times a woman has been pregnant, regardless of whether the pregnancy resulted in a termination or if multiple infants were born from a pregnancy.

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23
Q

Nulligravida

A

a woman who has never experienced pregnancy

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24
Q

Primigravida

A

woman pregnant for the first time

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25
Q

Secundigravida

A

woman pregnant for the second time

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26
Q

Multigravida

A

woman pregnant for at least the third time

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27
Q

Para

A

The #of times a woman has given birth to a fetus of at least 20 gestational weeks (viable or not), counting multiple births as one birth event

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28
Q

Parity

A

to the number of pregnancies, not the number of fetuses, carried to the point of viability, regardless of the outcome

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29
Q

Nullipara (para 0)

A

woman who has not produced a viable offspring

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30
Q

Primipara

A

woman who has given birth once after a pregnancy of at least 20 weeks, commonly referred to as a “primip” in clinical practice

31
Q

Multipara

A

woman who has had two or more pregnancies of at least 20 weeks’ gestation resulting in viable offspring, commonly referred to as a “multip”

32
Q

Obstetric History Terms: GTPAL

A

G (gravida): the current pregnancy to be included in count
T (term births): the number of term gestations delivering between 38 and 42 weeks
P (preterm births): the number of preterm pregnancies ending >20 weeks or viability but before completion of 37 weeks
A (abortions): the number of pregnancies ending before 20 weeks or viability
L (living children): the number of children currently living

33
Q

what causes peripheral dilation?

A

Progesterone

34
Q

Four pelvic shape types:

A

gynecoid, android, anthropoid, and platypelloid

35
Q

Three pelvic measurements are assessed:

A

-diagonal conjugate
-true conjugate
-ischial tuberosity

36
Q

diagonal conjugate is the

A

distance between the anterior surface of the sacral prominence and the anterior surface of the inferior margin of the symphysis pubis

37
Q

the most useful measurement for estimating pelvic size because a misfit with the fetal head occurs if it is too small.

A

the diagonal conjugate

38
Q

true conjugate (obstetric conjugate) is

A

-the measurement from the anterior surface of the sacral prominence to the posterior surface of the inferior margin of the symphysis pubis.
-This diameter cannot be measured directly; rather, it is estimated by subtracting 1 to 2 cm from the diagonal conjugate measurement.
-The average true conjugate diameter is at least 11.5 cm

39
Q

ischial tuberosity diameter is

A

the transverse diameter of the pelvic outlet. This measurement is made outside the pelvis at the lowest aspect of the ischial tuberosities. A diameter of 10.5 cm or more is considered adequate for passage of the fetal head

40
Q

What is urine analyzed for during pregnancy?

A

-albumin
-glucose
-ketones
-bacteria casts

41
Q

Complete blood cell count (CBC)

A

Evaluates hemoglobin (12–14 g) and hematocrit (42% ± 5%) levels and red blood cell count (4.2–5.4 million/mm3) to detect the presence of anemia; identifies white blood cell level (5,000–10,000 mm−3), which if elevated, may indicate an infection; determines platelet count (150,000–450,000 mL3) to assess clotting ability

42
Q

Blood typing

A

Determines woman’s blood type and Rh status to rule out any blood incompatibility issues early; Rh-negative mother would likely receive RhoGAM (at 28 weeks’ gestation) and again within 72 hours after childbirth if she is Rh-sensitive

43
Q

Rubella titer

A

Detects antibodies for the virus that causes German measles; if titer is 1:8 or less, the woman is not immune; requires immunization after birth, and the woman is advised to avoid people with undiagnosed rashes

44
Q

Hepatitis B

A

Determines if the mother has hepatitis B by detecting presence of hepatitis antibody surface antigen (HbsAg) in her blood

45
Q

HIV testing

A

Detects HIV antibodies and if positive, requires more specific testing, counseling, and treatment during pregnancy with antiretroviral medications to prevent transmission to fetus

46
Q

STI screening: venereal disease research laboratory (VDRL) or rapid plasma reagin (RPR) serologic tests or by cervical smears, cultures, or visual identification of suspicious lesions

A

Detects STIs (such as syphilis, herpes, HPV, gonorrhea) so that treatment can be initiated early to prevent transmission to fetus

47
Q

Cervical Smears

A

Detects abnormalities such as cervical cancer (Pap test) or infections such as gonorrhea, chlamydia, or group B streptococcus so that treatment can be initiated if positive

48
Q

The recommended follow-up visit schedule for a healthy pregnant woman is:

A

-every 4 weeks up to 28 weeks (7 months)
-every 2 weeks from 29 to 36 weeks
-every week from 37 weeks to birth

49
Q

at each follow up visit, what assessments are completed?

A

-weight and BP, which are compared with baseline values
-urine testing for protein, glucose, ketones, and nitrites
-fundal height measurement to assess fetal growth
-assessment for quickening/fetal movement to determine fetal well-being
-assessment of fetal heart rate (110-160bpm)

50
Q

fundal height

A

tape measure from top of pubic bone to top of uterus (fundus)

51
Q

Contact health care provider if during the first trimester:

A

spotting or bleeding (miscarriage), painful urination (infection), severe persistent vomiting (hyperemesis gravidarum), fever higher than 100°F (37.7°C; indicative of infection), and lower abdominal pain with dizziness and accompanied by shoulder pain (indicative of ruptured ectopic pregnancy).

52
Q

Contact health provider if during second trimester

A

regular uterine contractions (preterm labor); pain in calf, often increased with foot flexion (indicative of DVT); sudden gush or leakage of fluid from vagina (prelabor rupture of membranes); and absence of fetal movement for more than 12 hours (indicative of possible fetal distress or demise).

53
Q

contact health provider if during the third trimester

A

sudden weight gain; periorbital or facial edema, severe upper abdominal pain, or headache with visual changes (indicative of gestational hypertension and/or preeclampsia); and a decrease in fetal daily movement for more than 24 hours (indicative of possible demise).

54
Q

early contractions can lead to

A

preterm birth

55
Q

include those that are complicated by maternal or fetal conditions (coincidental with or unique to pregnancy) that jeopardize the health status of the mother and put the fetus at risk for uteroplacental insufficiency, hypoxia, and death

A

High risk pregnancies

56
Q

Doppler ultrasonography

A

is the use of sound waves to examine the flow of blood in blood vessels

57
Q

Alpha-fetoprotein analysis

A

is a glycoprotein produced initially by the yolk sac and fetal gut, and later predominately by the fetal liver.
- If a developmental defect is present, such as failure of the neural tube to close, more AFP escapes into amniotic fluid from the fetus. AFP then enters the maternal circulation by crossing the placenta, and the level in maternal serum can be measured. The optimal time for AFP screening is 16 to 18 weeks’ gestation.
-A variety of situations can lead to elevation of maternal serum AFP, including open neural tube defects, underestimation of gestational age, the presence of multiple fetuses, gastrointestinal defects, low birth weight, oligohydramnios, maternal age, diabetes, and decreased maternal weight

58
Q

Marker screening tests

A

Using maternal serum is an effective, noninvasive method for identifying fetal risk for aneuploidy (trisomies 13, 18, and 21) and neural tube defects.

59
Q

Nuchal Translucency Screening (ultrasound)

A

This allows for early detection and diagnosis of some fetal chromosomal and structural abnormalities.
-Ultrasound is used to identify an increase in nuchal translucency, which is due to the subcutaneous accumulation of fluid behind the fetal neck. Increased nuchal translucency is associated with chromosomal abnormalities such as trisomies 21, 18, and 13.

60
Q

Amniocentesis

A

involves a transabdominal puncture of the amniotic sac to obtain a sample of amniotic fluid for analysis.
-The fluid contains fetal cells that are examined to detect chromosomal abnormalities and several hereditary metabolic defects in the fetus before birth.
-Amniocentesis is performed in the second trimester, usually between 15 and 20 weeks’ gestation.
-Amniocentesis can be performed in any of the three trimesters of pregnancy. An early amniocentesis (performed between weeks 11 and 14) is done to detect genetic anomalies.
-In the second trimester, the procedure is performed between 15 and 20 weeks to detect chromosomal abnormalities, evaluate the fetal condition when the woman is sensitized to the Rh-positive blood, diagnose intrauterine infections, and investigate amniotic fluid AFP when the MSAFP level is elevated
-In the third trimester, amniocentesis is most commonly indicated to determine fetal lung maturity after the 35th week of gestation via analysis of lecithin-to-sphingomyelin ratios and to evaluate the fetal condition with Rh isoimmunization.

61
Q

The amniocentesis procedure

A

-Amniocentesis is performed after an ultrasound examination identifies an adequate pocket of amniotic fluid free of fetal parts, the umbilical cord, or the placenta
-It is an invaluable diagnostic tool, but the risks include lower abdominal discomfort and cramping that may last up to 48 hours after the procedure, spontaneous abortion (one in 300 to 500), maternal or fetal infection, postamniocentesis chorioamnionitis that has an insidious onset, fetal–maternal hemorrhage, leakage of amniotic fluid in 2% to 3% of women after the procedure, and higher rates of fetal loss in earlier amniocentesis procedures (earlier than 15 weeks’ gestation) versus later ones (Ghidini, 2019). Obtaining the test results may take up to 3 weeks. Women today are choosing noninvasive prenatal testing rather than undergoing invasive testing such as amniocentesis despite those tests not being 100% correct.

62
Q

Chorionic Villus Sampling (CVS)

A

is an invasive procedure involving an 18-gauge needlestick through the abdomen or passage of a suction catheter through the cervix under ultrasound guidance.
-This test is used to obtain a sample of the chorionic villi from the placenta for prenatal evaluation of chromosomal disorders such as Down syndrome or cystic fibrosis, enzyme deficiencies, and fetal gender determination and to identify sex-linked disorders such as hemophilia, sickle cell anemia, and Tay–Sachs disease

63
Q

Nonstress test

A

the most common method of prenatal testing used in practice today. The NST provides an indirect measurement of uteroplacental function
-The basis for the NST is that the normal fetus produces characteristic fetal heart rate patterns in response to fetal movements.

64
Q

Biophysical profile

A

uses a real-time ultrasound and NST to allow assessment of various parameters of fetal well-being that are sensitive to hypoxia.
-A BPP is performed in an effort to identify infants who may be at risk of poor pregnancy outcome, so that additional assessments of well-being may be performed or labor may be induced or a cesarean section performed to expedite birth.
-The primary objectives of the BPP are to reduce stillbirth and to detect hypoxia early enough to allow delivery in time to avoid permanent fetal damage resulting from fetal asphyxia.

65
Q

First trimester discomforts (1-12 wks)

A

-Urinary frequency or incontinence (common in first and third, but uncommon in second)
-Fatigue
-nausea and vomiting
-Breast tenderness
-Constipation
-Nasal stuffiness, bleeding gums, and epistaxis (nosebleeds)
-Cravings
-Leukorrhea (increased vaginal discharge)

66
Q

Second trimester discomforts (13-28 wks)

A

-Backache
-Leg cramps
-varicosities of the vulva and legs
-hemorrhoids
-flatulence with bloating

67
Q

third trimester discomforts

A

-SOB and dyspnea
-Heartburn and indigestion
-dependent edema
-Braxton Hicks contractions

68
Q

Should women avoid hot tubs, saunas, whirlpools, and tanning during pregnancy?

A

yes

69
Q

contraindications to sexual activity during pregnancy:

A

-Vaginal bleeding
-placenta previa
-risk of preterm labor
-premature cervical dilation
-premature rupture of membranes
-presence of infection

70
Q

vaccines contraindicated during pregnancy

A

-Influenza (live attenuated vaccine) nasal spray
-measles
-mumps
-rubella
-varicella
-BCG (tuberculosis)
-Typhoid

71
Q

Lamaze (psychoprophylactic) method

A

“mind prevention” method of preparing for labor and birth that promotes the use of specific breathing and relaxation techniques.

72
Q

Bradley (Partner coached) method

A

uses various exercises and slow, controlled abdominal breathing to accomplish relaxation.

73
Q

Dick Read method (natural childbirth)

A

He believed that the attitude of a woman toward her birthing process had a considerable influence on the ease of her labor, and he believed that fear is the primary pain-producing agent in an otherwise normal labor.

Nurse 2 Ante, Intra, and Post-partum (3 decks)

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