chapter 6: nursing care during pregnancy ppt

Question 1

initial prenatal assessment

Answer 1

• begins with the suspicion of pregnancy
• diagnosis: amenorrhea usually the first sign
• use of a home pregnancy test
• abdominal ultrasonography
• transvaginal ultrasonography (TVUS)
• antepartum period: begins with conception and ends with the onset of labor

Question 2

gravida

Answer 2

numbers of times a woman has been PREGNANT

Question 3

para

Answer 3

production of a VIABLE infant regardless of whether the fetus is alive at birth

Question 4

viability

Answer 4

newborn weighing at least 500g or more than 20 wks gestation

Question 5

multiple birth

Answer 5

a single parous experience

Question 6

GTPAL system

Answer 6

g: the number pregnancies regardless of the outcome or number of fetuses

t: the number of term infants born at 37 weeks gestation and beyond

p: the number of preterm infants born after 20 weeks gestation and before 37 weeks gestation

a: the number of pregnancies that ended in a spontaneous or therapeutic abortion

l: the number of living children

Question 7

family physicians

Answer 7

qualified to manage most uncomplicated pregnancies

Question 8

obstetrician-gynecologists (OB-GYNs)

Answer 8

provide health care for all phases of pregnancy, from preconception planning to postpartum recovery

Question 9

certified nurse midwives

Answer 9

provide preconception, maternity, and postpartum care for women at low risk of complications during pregancy

Question 10

estimated date of delivery (EDD)

Answer 10

important to monitor the growth and progress of the pregnancy

Question 11

Naegele’s rule

Answer 11

subtract 3 months from the first day of the last menstrual period and then add 7 days, which will indicate the approximate date of delivery

Question 12

pregnancy wheel

Answer 12

• based on Naegele’s rule
• adding 40 weeks to the date of the last menstrual period
• provides approx conception date, gestation week, and due date

Question 13

health promotion

Answer 13

• schedule the first prenatal visit as soon as pregnancy is confirmed
• obtain a thorough past medical history and current health history
• encourage asking questions
• answer all questions honestly
• encourage to obtain all lab tests ordered
• stress subsequent prenatal visits and care throughout the pregnancy

Question 14

initial client history

Answer 14

• use therapeutic communication
• include past medical, family, gynecological, and obstetrical histories
• use a culturally sensitive approach
• include a list of medications or substances currently being used

Question 15

initial prenatal assessment

Answer 15

• should be scheduled as soon as pregnancy is confirmed
• begins with the physical exam

Question 16

physical exam

Answer 16

• perform a head to toe physical exam covering all major systems
• pelvic exam: lithotomy position is used
• information obtained: examination of the external genitalia, culture for STI may be obtained, exam of the internal genitalia to observe the cervix for the signs of pregnancy, pap smear, bimanual exam of the uterus to determine size, pelvic bones assessed to determine size and adequacy for vaginal birth

Question 17

pelvic assessment measurements

Answer 17

diagonal conjugate

obstretric conjugate

ischial tuberosity diameter

Question 18

laboratory tests

Answer 18

CBC

antibody screen

***blood typing and rh status

rubella titer

varicella titer

hepatitis b and c

HIV and STI screen

Papanicolaou (pap)

urinalysis

tuberculosis

glucose challenge test: fasting, check blood sugar, given a drink, check blood sugar again

***group B streptococci test (GBS) if a mother is positive before delivery, given IV antibiotics

Question 19

screening tests for fetal health: first trimester

Answer 19

• pregnancy associated plasma protein A: done between 1 and 13 weeks to help detect trisomy 18 and trisomy 21
• fetal ultrasonography
• chorionic villi sampling: done between 11 and 13 weeks gestation and checks for genetic disorders
• nuchal translucency testing: done between 1 and 13 works gestation to screen for chromosomal abnormalities

Question 20

screening tests for fetal health: second trimester

Answer 20

• quadruple screen: done using he mother’s serum between 15 and 20 wks to detect levels of specific serum markers
• alpha fetoprotein (neural tube defects, eg down syndrome, take folic acid)
• human chorionic gonadotropin
• unconjugated estriol
• inhibin A

Question 21

alpha-fetoprotein

Answer 21

high levels may indicate fetal neural tube defect and lower levels could indicate risk for down syndrome or trisomy 18

Question 22

human chorionic gonadotropin

Answer 22

higher levels indicate risk for down syndrome

Question 23

unconjugated estriol

Answer 23

lower levels indicate a risk for down syndrome

Question 24

inhibin A

Answer 24

higher levels indicate a risk for down syndrome

Question 25

amniocentesis

Answer 25

performed to diagnose down syndrome, cystic fibrosis, spina bifida, and other genetic disorders

Question 26

percutaneous umbilical cord sampling

Answer 26

test of cells obtained directly from the umbilical cord

Question 27

subsequent visits and care: frequency

Answer 27

• monthly for the first 28 weeks gestation
• every 2 weeks until 36 weeks gestation
• weekly after 36 weeks until childbirth

Question 28

subsequent visits and care: care

Answer 28

• evaluate any physical or psychological patient concerns and answer questions
• current weight
• vital signs
• urinalysis: glucose, ketones, protein, nitrates
• fundal height
• fetal heart rate (135-160 normal)
• psychological assessment
• provide education
• screen for intimate partner violence

Question 29

quickening

Answer 29

The mother’s sensation of fetal movement, expected between 16 and 22 weeks gestation