Chapter 6, 7, & 8 Flashcards
ballottement
diagnostic technique using palpation; a floating fetus, when tapped or pushed, moves away and then returns to touch the examiner’s hand.
Braxton Hick’s sign
mild, intermittent, painless uterine contractions that occur during pregnancy; more frequently as pregnancy advances but not representing true labor; however, they should be distinguished from preterm labor.
carpal tunnel syndrome
Syndrome in which edema compresses the median nerve beneath the carpal of the wrist; causing tingling, burning, or numbness in the inner half of one or both hands
Chadwick sign
violet color of vaginal mucous membrane that is visible from approximately the 4th week of pregnancy; caused by increased vascularity.
cholasma
Increased pigmentation over the bridge of the nose and cheeks of pregnant women and some women taking oral contraceptives; also known as the mask of pregnancy
colostrum
fluid in the acini cells of the breasts present from early pregnancy into the early postpartal period; rich in antibodies, which provide protection to the breastfed newborn from many diseases; high in protein, which binds bilirubin; and laxative acting, which speeds the elimination of meconium and helps loosen mucous.
diastasis reci abdominis
separation of the two rectus muscles along the median line of the abdominal wall; often seen in women with repeated childbirths of with a multiple gestation
epulis
tumor-like benign lesion of the gingiva seen in pregnant woman
funic souffle
Soft, muffled, blowing sound produced by blood rushing through the umbilical vessels and synchronous with the fetal heart sounds.
Goodell sign
softening of the cervix, a probable sign of pregnancy, occuring during the second month
Hegar sign
softening of the lower uterine segment that is classified as probable sign of pregnancy, may be present during the second and third months of pregnancy, and is palpated during bimanual examination
human chorionic gonadotropin (hCG)
Hormone that is produced by the chorionic villi; the biologic marker in pregnancy tests.
leukorrhea
white or yellowish mucous discharge from the cervical canal or the vagina that may be normal physiologically or caused by pathologic state of the vagina and endocervix
lightening
sensation of decreased abdominal distention produced by uterine descent into the pelvic cavity as the fetal presenting part settles into the pelvis; usually occurs 2 weeks before the onset of labor in nulliparas.
linea nigra
line of darker pigmentation seen in some women during the latter part of pregnancy that apears on the middle of the abdomen and extends from the symphysis pubis towards the umbilicus
Montogomery tubercles
small, nodular prominences (sebaceous glands) on the areolas around the nipples of the breasts that enlarge during pregnancy and lactation.
operculum
plug of mucous that fills the cervical canal during pregnancy
palmar erythema
Rash on the surface of the palms sometimes seen in pregnancy
ptyalism
excessive salivation
pyrosis
burning sensation in the epigastric and sternal region from stomach acid (heartburn)
quickening
maternal perception of fetal movement; usually occurs between weeks 16 and 20 of gestation
striae gravidarum
“stretch marks”; shining reddish lines caused by stretching of the skin, often found on the abdomen, thighs, and breasts during pregnancy; these streaks turn to a fine pinkish white or silver tone in time in fair-skinned women and brownish in darker-skinned women
uterine souffle
soft, blowing sound made by the blood in the arteries of the pregnant uterus and synchronous with the maternal pulse
GTPAL
Gravity Term Preterm Abortions Living Children
Gravida
a woman who is pregnant
Gravidity
pregnancy
Multigravida
a woman who has had 2 of more pregnancies
multipara
a woman who has completed two or more pregnancies to 20 weeks of gestation or more
nulligravida
a woman who has never been pregnant
nullipara
a woman who has not completed a pregnancy with a fetus beyond 20 weeks of gestation
Parity
the number of pregnancies in which the fetus has reached 20 weeks of gestation when they are born. Not the number of fetuses.
Postdate or postterm
a pregnancy that goes beyond 42 weeks of gestation
preterm
a pregnancy that has reached 20 weeks of gestation but before completing 37 weeks of gestation
primigravida
a woman who is pregnant for the first time
primipara
a woman who has completed one pregnancy with a fetus or fetuses who have reached 20 weeks of gestation
Term
a pregnancy from the completion of week 37 to the end of week 42
Viability
capacity to live outside the uterus; there are no clear limits of gestational age or weight but it is rare for a fetus to survive before 22 to 24 weeks of gestation and weighing less that 500 grams.
hCG
rise and fall
- can be detected as early as 7 to 10 days after conception.
- increases until 60 -70 days of gestation
- the declines until about 80 days and remains stable til 30 weeks
- the gradually increases until term.
What is the most popular method of testing for pregnancy?
Enzyme-linked immunosorbent assay (ELISA) testing, it uses anti-hCG.
What is the most common error in performing home pregnancy tests?
Performing them too early
What medications can cause false positives?
anticonvulsants and tranquilizers can cause false-positives.
What medications can cause false negatives?
diuretics and promethazine can cause false-negatives
Presumptive signs of pregnancy
Specific changes felt by the woman
e.g. amenorrhea, fatigue, nausea, and vomiting, breast changes
Probable signs of pregnancy
changes observed by an examiner.
e.g. Hegar sign, ballottement, pregnancy tests
Positive signs of pregnancy
signs that are attributable only to the presence of the fetus
e.g. hearing fetal heart tones, visualization of the fetus, palpating fetal movement
3 P signs of pregnancy
Presumptive
Probable
Positive
When does pregnancy typically “show”
after 14th week
Normal rate of blood flow through the uterus is
500 ml/min average
3 factors known to decrease blood flow to the uterus is
- a low MAP
- contractions of the uterus
- maternal supine position
What can increase uterine blood flow?
estrogen stimulation
Conditions with increased risk of poor placental perfusion
- hypertension
- intrauterine growth restriction
- DM
- multiple gestation
Heart sound after 20 weeks
an S3 sound can be heard after 20 weeks and will go away after birth. Systolic and diastolic murmurs can be heard over the pulmonic area as well.
Blood pressure cuff size
Bladder length should be 80% and width 40% of the arm’s circumference
Normal MAP
In non-pregnant women it is 86.4 +-7.5 mmHg
pregnant women it is slightly higher
Calculating MAP
SBP + 2(DBP) divided by 3 = MAP mmHg
Blood volume increases by what %
40 - 45% of normal prepregancy levels.
1000mL of plasma and about 450 mL of RBCs
pysiologic anemia
hemodilution that can occur during pregnancy and is r/t hemodilution from increased plasma levels
iron deficiency anemia
if hemoglobin value drops below 11 g/dL it is considered iron deficiency anemia
Cardiac output
Increases from 30 - 50% over the nonpregnant rate by the 32nd week of pregancy and declines to about 20% increase by 40 weeks
Why are pregnant woman at higher risk for blood clots?
circulation time decreases by week 32 and slowly returns to normal by term. The blood also has increases in several clotting factors during pregnancy (Factors VII, VIII, IX,X, and fibrinogen)
Elevated levels of ______ cause the ligaments of the ribs to relax, permitting chest expansion
Estrogen
d/t the increased vasularity of the respiratory tract there can be the following symptoms
congestion, nasal and sinus stuffiness, epistaxis, changes in the voice and a marked inflammatory response that can develop into a mild upper respiratory infection
Normal H&H in pregnant women
Hemaglobin - >11 g/dl
Hematocrit - >33%
Acid base balance
PCO2 will decrease by about 5 mmHG by 10th week
Tidal volume is increase,
HCO3 decreases and pH increases slightly
pregnancy is a state of compensatory respiratory alkalosis
How much sodium is retained for fetal needs
500 to 900 mEq
pysiologic edema
pooling of blood in the lowers legs during pregnancy
angiomas
aka vascular spiders
they are tiny, star-shaped or branched, slightly raised and pulsating end-arterioles usually found on the neck, thorax, face, and arms
occur during 2-5 month are blue in color and don’t blanch.
Hirsutism
the excessive growth of hair, or growth of hair in unusual places.
Lordosis
an increase in the lumbosacral curve
Morning sickness
appears about 4-6 weeks and usually subsides by the end of the 3rd month
Prolactin
produced by anterior pituitary. responsible for lactation. High levels of estrogen and progesterone inhibit it by blocking binding of prolactin until after birth
Parathyroid function during pregnancy
hyperparathyroidism often occurs during pregnancy r/t an increased need for calcium for fetal bone development
Maternal Insulin crosses the placenta to the fetus for blood glucose regulation
False
First trimester
weeks 1 - 13
second trimester
weeks 14 - 26
third trimester
27 - 40
term pregnancy
37 - 42 weeks
birth plan
a tool by which parents can explore their childbirth options and choose those that are most important to them
couvade syndrome
the phnomenon of expectant fathers’ experiencing pregnancy-like symptoms
cultural prescriptions
practices that are expected or acceptable
cultural proscriptions
forbidden; taboo practices
doula
trained assistant hired to give the woman support during pregnancy, labor and birth, and postpartum
home birth
planned birth of the child at home, usually performed under the supervision of a midwife
morning sickness
N/V that affect some women during the first few months of their pregnancy; may occur at any time of the day
multifetal pregnancy
pregnancy in which more than one fetus is in the uterus at the same time; multiple gestation
Nagele’s rule
one method for calculating the estimated date of birth or due date. LMP - 3 months + 7 days + 1 year
pelvic tilt (rock)
exercise used to help relieve low back discomfort during menstruation and pregnancy.
pinch test
determines whether nipples are everted or inverted by placing thumb and forefinger on areola and pressing inward; the nipple will stand erect of will invert.
supine hypotension
drop in blood pressure caused by impaired venous return when the gravid uterus presses on the ascending vena cava, when woman is lying flat on her back; vena cava syndrome
trimesters
one of 3 periods of approximately 3 months each into which pregnancy is divided.
The mother-child relationship contains _____ phases
3
Mother-child relationship phase 1
the woman accepts the biologic fact of pregnancy. She needs to be able to say “I am pregnant” and incorporate the idea of a child into her body and self image.
Mother-child relationship phase 2
the woman accepts the growing fetus as distinct from herself, usually accomplished by the 5th month. She can now say “I’m going to have a baby”
Mother-child relationship phase 3
the woman prepares herself for the birth and parenting of the child. She expresses the thought, “I am going to be a mother” and defines the nature and characteristics of the child.
First phase of father’s reaction to pregnancy
announcement phase- last few hours to few weeks
men react with joy or sadness depending on whether pregnancy is desired or unplanned. If unwanted or unplanned some men engage is affairs, or batter wives.
Second phase of father’s reaction to pregnancy
moratorium phase
the period when he adjust to the reality of pregnancy. The developmental task is to accept the pregnancy.
Depending on man’s readiness for the pregnancy, this phase may be short, or persist until the last trimester.
Third phase of father’s reaction to pregnancy
focusing phase
begins in the last trimester and is characterized by the father’s active involvement in both the pregnancy and his relationship with his child. He concentrates on his experience of the pregnancy and begins to think of himself as a father.
3 phases of father’s reaction to pregnancy
announcement
moratorium
focusing
The partner’s main role in pregnancy is to …
nurture and respond to the pregnant woman’s feeling of vulnerability
Prenatal care facts
in 2004, almost 84% of all women received care in the first trimester.
- African-American, Hispanic, and Native American women are 2xs as likely to get late prenatal care or no care at all as compared to Caucasian women.
Prenatal visits
The initial visit usually occurs in the first trimester, with visits every 4 weeks through week 28. Thereafter, visits are every 2 weeks until 36 weeks, and then every week until birth.
Centering pregnancy
a care model in which authority shifts from the provider to the woman and other women with similar due dates. Creates an atmosphere that facilitates learning and discussion while developing mutual support
Initial prenatal assessment includes
comprehensive health history emphasizing the current pregnancy, previous pregnancies, the family, a psychosocial profile, a physical assessment, diagnostic testing, and an overall risk assessment.
What two types of data are collected at the prenatal interview
the woman’s subjective appraisal of her health status and the nurse’s objective observations
Stage 1 Hypertension
SBP 140 - 159
DBP 90 - 99
Stage 2 Hypertension
SBP 160 or greater
DBP 100 or greater
Signs of Potential Complications
1st Trimester
Severe Vomiting, chills, fever, burning with urination, diarrhea, abdominal cramping, or vaginal bleeding
Signs of potential complications
2nd or 3rd trimester
Persistent severe vomiting, sudden discharge of fluid from vagina before 37 weeks, vaginal bleeding, severe abdominal pain, chills, fever, burning on urination, diarrhea, severe backache or flank pain, change in fetal movements, uterine contractions, visual disturbances, swelling of face, fingers or over sacrum, headaches, muscular irritability or convulsions, epigastirc or abdominal pain, glycosuria
Fundal height
from approximately 18 to 32 weeks the height of the fundus in cm is approx the same as the number of weeks of gestation =/- 2GW. Example a woman 28GW should be 26 to 30 cm. Measured from symphisis pubis to top of fundus
Fetal kick count
4 or more kicks should be felt in an hours time.
When is maternal AFP or quad screen conducted
recommended between 15 and 20 weeks; ideally between 16 and 18 weeks. and screens for neural tube defects, down syndrome and other chromosomal abnormalities
When is glucose tolerance testing conducted
between 24 and 28 weeks
When is group B strep testing conducted
between 35 and 37 weeks
Smoking is associated with
increased frequency of preterm labor, PROM, abruptio placentae, placenta previa, and fetal death, possibly from decreased placental perfusion.
nurse midwives
registered nurses with advanced training in care of obstetric patients
direct-entry midwives
also called certified professional midwives
trained through self-study, apprenticeship, midwifery schools or universities as a profession distinct from nursing.
independent midwives
AKA lay midwives
nonprofessional caregivers. training ranges from formal training to self teaching.
emotional lability
Mood swings related to hormone changes and anxiety during pregnancy.
Adequate Intakes (AIs)
Recommended nutrient intakes estimated to meet the needs of almost all healthy people in the population; provided for nutrients or age-group categories for which the available information is not sufficient to warrant establishing recommended dietary allowances.
Anthropometric measurements
Body measurements, such as height and weight
Body Mass Index (BMI)
method of calculating appropriateness of weight for height (BMI = weight in kg / height in meters squared)
Dietary Reference Intakes (DRIs)
Nutritional recommendations for the United States, consisting of the recommended dietary allowances, adequate intakes, and tolerable upper intake levels; the upper limit of intake associated with low risk in almost all members of a population.
intrauterine growth restriction (IUGR)
Fetal undergrowth from any cause
kcal
Kilocalorie; unit of heat content or energy equal to 1000 small calories
lactose intolerance
Inherited absence of the enzyme lactase
physiologic anemia
Relative excess of plasma leading to a decrease in hemoglobin concentration and hematocrit; normal adaptation during pregnancy
pica
Unusual oral craving during pregnancy (e.g., for laundry starch, dirt, red clay)
pyrosis
a burning sensation in the epigastric and sternal region from stomach acid (heartburn)
Recommended Dietary Allowances (RDAs)
Recommended nutrient intakes estimated to meet the needs of almost all (97% - 98%) of the healthy people in the population.
Folic acid is recommended in what amount to prevent what condition?
400mg
neural tube defects
What is the primary role of protein in pregnancy
to provide amino acids for the synthesis of new tissues.
Nitrogen
Fiber
food sources
Whole grains, bran, vegetables, fruits, nuts and seeds
Calcium
food sources
Milk, cheese, yogurt, sardines, or other fish eaten with bones left in, deep green leafy vegetables except spinach or Swiss chard, calcium-set tofu, baked beans, tortillas
Iron
food sources
Liver, meats, whole grain or enriched breads and cereals, deep green leafy vegetables, legumes, dried fruits
Zinc
food sources
liver, shellfish, meats, whole grains, milk
Iodine
food sources
iodized salt, seafood, milk and milk products, commercial yeast breads, rolls, and donuts
Magnesium
food sources
Nuts, legumes, cocoa, meats, whole grains
Vitamin A
food sources
deep green leafy vegetables; dark yellow vegetables; and fruits, chili peppers, liver, fortified margarine and butter
Vitamin D
food sources
Fortified milk and margarine, egg yolk, butter, liver and seafood
Vitamin E
food sources
Vegetable oils, green leafy vegetables, whole grains, liver, nuts and seeds, cheese, fish
Vitamin C
food sources
citrus fruits, strawberries, melons, broccoli, tomatoes, peppers, raw deep green leafy vegetables
Folate
food sources
fortified ready-to-eat cereals and other grain products, green leafy vegetables, oranges, broccoli, asparagus, artichokes, liver
Pyridoxine (B6)
food sources
meats, liver, deep green vegetables, whole grains
B12
food sources
Milk and milk products, eggs, meats, liver, fortified soy milk
BMI classifications
underweight - less than 18.5
normal - 18.5 - 24.9
overweight - 25 - 29.9
obese - greater than 30
Amount of weight women should gain
Underweight - 28 - 40 lbs
Normal - 25 - 35 lbs
Overweight - 15 - 25 lbs
Obese - 11 - 20 lbs
Protein
food sources
milk, meat, eggs and cheese are complete-protein foods with a high biologic value. Legumes (dried beans and peas), whole grains, and nuts are also valuable sources of protein.
Fish
Avoid, Limit, & 12 oz or less
Avoid: Shark, swordfish, king mackerel and tilefish.
Limit: albacore and “white” tuna and tuna steaks
12 oz or less a week: shrimp, salmon, pollock, catfish, and canned light tuna.
What is the main substance of cells, blood, lymph, amniotic fluid, and other vital body fluids?
Water
Dehydration increases chances of….
cramping, contractions, and preterm labor
Excessive caffeine use can cause
> 300mg
higher risk of miscarriage and of giving birth to infants with IUGR
Aspartame should be avoided in patients with…
PKU because it contains phenylalanine
In general, nutrient needs of pregnant women should be met through dietary sources with the exception of what 2 things?
folate and iron
Teach patients what about Iron supplementation to facilitate better absorption
Best absorbed on an empty stomach (take between meals)
Iron absorption is promoted by a diet rich in vitamin C (take with orange juice)
Sources of calcium for women who don’t consume milk
Sardines, salmon(if bones are eaten), beans and legumes, greens (collard, kale or turnip), Baked products, fruits, sauces (pesto or cheese)
Which nutrient is most likely to be lacking in the diets of women of childbearing years?
Potassium
an AI of Potassium is associated with …
a reduced risk of hypertension.
Zinc deficiency is associated with..
malformations of the CNS in infants
Isotretinoin
vitamin A analog (accutane)
associated with increased incidence of heart malformations, facial abnormalities, cleft palate, hydrocephalus, deafness and blindness to the infant, and well as an increased risk of miscarriage.
As a general rule a woman should gain
2.2 - 4.4 lbs during the first trimester
and 1 lb a week for the 2 - 3 trimesters
How many calories should the average person increase during pregnancy
340 - during 2nd trimester
452 - during 3rd trimester
How calories additional calories should the breastfeeding mother include
330- 1st 6 months
400 - after 6 months
