Chapter 7 Flashcards
Exam 1
What are the goals of preconception?
To promote the health and well-being of a woman and her partner BEFORE pregnancy.
Identify and modify biomedical, behavioral, and social risks to a woman’s health or pregnancy outcome through prevention and management intervention.
Preconception Care- Immunization status
up to date
Preconception Care- Underlying medical conditions
DM; Asthma (controlled or uncontrolled)
Preconception Care- Reproductive Health Care Practices
Contraceptive habits
Preconception Care- Sexuality and Sexual Practices
At risk for STIs
Preconception Care- Nutrition
Prenatal vitamin usage
Preconception Care- Environment Health Assessment
Environmental hazards
Preconception Care- Psychosocial Issues
Stress level
Preconception Care- Medication and Drug Use
OTC and Prescription
Preconception Care- Support System
Partner, spouse, family member, friend
1st Prenatal Visit
-Establishment of trusting relationship
-Verify or rule out pregnancy
-Establish baseline data for comparison with future visits
*Testing- labs, pregnancy test
-Evaluate psychosocial needs
*do they want a baby?
Comprehensive Health History
-Reason for seeking care
*Suspicion of pregnancy
*Date of last menstrual period
*Signs and symptoms of pregnancy
*Urine or blood test for hCG
-Past medical, surgical, and personal history
-Woman’s reproductive history: menstrual, obstetric, and gynecologic history
Obstetric History
Gravida
-Gravida 1 (primigravida): first pregnancy
-Multigravida: pregnant more than once
Para
-Primapara: Given birth once after at least 20 wks gestation (“primip”)
-Multipara: Two or more pregnancies of at least 20 wks gestation (“multip”)
Gravida
the total number of times a woman has been pregnant
Term Births
the number of pregnancies ending >37 wks gestation, at term
Preterm Births
the number of preterm pregnancies ending >20 wks or viability but before completion of 37 wks
Abortions
the number of pregnancies ending before 20 wks or viability
Living Children
number of children currently living
GTPAL
G- Gravida
T- Term births
P- Preterm births
A- Abortions
L- Living Children
Menstrual History
-Date of LAST MENSTRUAL PERIOD (LMP)
-Calculation of estimated or EXPECTED DATE OF BIRTH (EDB) OR ESTABLISHED DUE DATE (EDD)
-Nagele’s Rule
*Use first day of LMP
*Subtract 3 months
*Add 7 days
*Add 1 year
Gestational or birth calculator or wheel
Ultrasound is best method of dating a pregnanct
LMP
Last Menstrual Period
EDB
Expected Date of Birth
EDD
Expected Due Date
Nagele’s Rule
*Use first day of LMOP
*Subtract 3 months
*Add 7 days
*Add 1 year
Murmur
Can be a normal occurrence during pregnancy
Physical Examination: Abdomen
-Fundal height if approp. and FHR (@10-12 wks)- Uterine measurements include the distance between the upper border of the symphysis pubis and the top of the fundus- in centimeters
Physical Examination- Pelvic Exam
-Examination of external and internal genitalia
-Pelvic shape: gynecoid, android, anthropoid, platypelloid
-Pelvic measurements: done to determine whether the shape and size of the bony pelvis are adequate for a normal birth
Lab Tests (table 7.1)
-Urinalysis
-CBC
-Blood typing
-Rh factor
-Rubella titer
-Hep B surface antigen (HbsAg)
-HIV, VDRL, and RPR testing
-Cervical smears
-Ultrasound (abd & transvag)
F/U Visit Schedule
*Conception to 28 wks: Every 4 wks
*29 to 36 wks: every 2 wks
*37 wks to birth: weekly
fundal height
Uterine measurements include the distance between the upper border of the symphysis pubis and the top of the fundus (in cm)
F/U appt: Assessment
-Weight and BP- compare to baseline
-Urine testing for protein, glucose, ketones, and nitrites
-Fundal height
-Quickening/ fetal movement: 16- 20 wks
-Fetal Heart rate (FHR): 110-160 bpm
-Teaching: danger signs
-Screening for Gestational Diabetes: 24- 28 wks
Signs of Possible Pregnancy Complications
*Vaginal bleeding with or without discomfort: Spontaneous abortion, placenta previa, placental abruption, lesions of the cervix or vagina, “bloody show”
*Escape of fluid from the vagina: Rupture of membranes
*Swelling of the fingers (rings become tight) or puffiness of the face or around the eyes: Excessive edema, preeclampsia
*Continuous pounding headache: Chronic hypertension or preeclampsia
*Visual disturbances (such as blurred vision, dimness, flashing lights, spots before the eyes): Worsening preeclampsia
*Seizures: Eclampsia
*Persistent or severe abdominal or epigastric pain: Ectopic pregnancy (if early), worsening preeclampsia, placental abruption
*Chills or fever: Infection
*Painful urination: Urinary tract infection, pyelonephritis
*Persistent vomiting: Hyperemesis gravidarum
*Change in frequency or strength of fetal movements: Fetal compromise or death
*Signs or symptoms of preterm labor: Uterine contractions, cramps, constant or irregular low backache, pelvic pressure, watery vaginal discharge: Labor onset
Table 7.3 Factors and the Associated Problems
read over
1st Trimester Discomforts
*Nausea and vomiting
*Heartburn
*Fatigue
*Breast tenderness
*Constipation
*Nasal stuffiness, bleeding gums, epistaxis (nose bleed)
*Urinary frequency
*Leukorrhea (white discharge- normal)
2nd Trimester Discomforts
*Backache
*Varicosities of the vulva and legs
*Hemorrhoids
*Flatulence with bloating
3rd Trimester Discomforts
*Return of 1st trimester discomforts
*Shortness of breath and dyspnea
*Heartburn and indigestion
*Dependent edema
*Braxton Hicks contractions
Nursing Management to Promote Self-Care
*Personal hygiene
*Avoidance of saunas and hot tubs
*Perineal care
*Dental Care
*Breast care
*Clothing
*Exercise
*Sleep and rest
*Sexual activity and sexuality
*Employment
* Travel
*Exposure to teratogens
*Immunizations and medications
Prep for Labor, Birth, and Parenthood-
Education Classes
*Perinatal education: goal is to reduce fear of unknown and help parents make informed decisions
*Parenting or Sibling Classes
*Childbirth Education
-Lamaze (pyschoprophylatic) method: focus on breathing and relaxation techniques to block pain
-Labor partner or coach
-Birth plan (Box 7.3) (Box 7.4)
*Options for birth setting
-Hospitals: delivery room, birthing suite
-Birth centers
-Home birth
*Options for care providers
-Obstetrician
-Midwife
-Doula
*Feeding choices
-breast-feeding: advantages and disadvantages
-bottle feeding: advantages and disadvantages
-Teaching
*Final Prep for labor and birth
