Chapters 4 & 6 Flashcards
antepartum period
begins with the last day of the LMP and ends with the onset of labor
the antepartum period is divided into __
first, second, and third trimesters
what happens during the initial visit of the first trimester?
- comprehensive physical exam
- current pregnancy hx
- pelvic exam
- determine EDD
- nutrition assessment
- psychosocial assessment
what happens during the return visits in the first trimester?
- focused assessment
- height, weight, urine, vitals, fundal height
1st trimester warning signs
-prolonged N/V
- cramps
- spotting
- absence of fetal heart tones
- fever/chills
- dysuria, frequency or urgency
how often are second trimester visits?
every 4 weeks
what is assessed during a second trimester visit?
- nutrition follow up
- focused assessment
- height, weight, urine (glucose), fundal height, FHR (110-160), fetal movement, leopolds maneuver, edema
- GTT/GCT done at 22-26 weeks
- internal exam if necessary
- RhoGAM given at 28 weeks to all Rh - moms
2nd trimester warning signs
- abdominal/pelvic pain
- absence of fetal movement
- dysuria, frequency, or urgency
- fever/chills
- prolonged N/V
- vaginal bleeding
how often are third trimester visits?
every 2 weeks: 28 to 36 weeks, then weekly until 40 weeks
what is assessed during a third trimester visit?
- focused assessment
- same as before: height, weight, fundal height, urine for glucose, FHR, fetal movement, leopolds meneuver, edema
- internal exam if necessary
what does GBS + mean?
the woman has group b streptococcus
- 1/4 - 1/3 of women are GBS +
why is GBS harmful to the fetus?
when the fetus is born, if the mom was GBS+ and not treated, then the newborn can get the infection. GBS infections can cause neurological problems or death
when is GBS tested vs treated?
vaginal and rectal swabs done at 35-37 weeks
- treated with ampicillin before/during labor because not effective if given too early
3rd trimester warning signs
- s/sx of hypertensive disorder
- abdominal/pelvic pain
- decreased or absence of fetal movement
- dysuria, frequency, urgency
- fever/chills
- prolonged N/V
- vaginal bleeding
- s/sx of preterm labor
when/how is fundal height measured?
- after 12 weeks
- measured in cm, cm = weeks
- “0” on symphysis pubis and extend to the top of the fundus (think low to high)
what is the fundal height landmark at 12 weeks?
symphysis pubis
what is the fundal height landmark at 20 weeks?
the umbilicus
what is the recommended weight gain during pregnancy?
- 1-5 lbs in 1st tri
- 25-35 lbs total for normal weight person
- 15-25 for overweight person
nutrition recommendations during antepartum period?
- eat a variety
- unprocessed food
- limit caffeine to 200 mg/day
- avoid fish high in mercury (sword)
- rinse fruits/veggies
- wash hands
- cook food thoroughly
- discard food left out > 2 hrs
preterm labor: warning s/sx
- rhythmic lower abdominal cramping
- low backache
- pelvic pressure
- leaking fluids
- increased vaginal discharge
hypertensive: warning s/sx
- severe headache that doesn’t go away
- visual changes
- facial or general edema
what are some common discomforts during antepartum?
-fatigue
-emotional lability
-increased vaginal secretions
-supine hypotension
-orthostatic hypotension
- varicosities
- heartburn
- nasal/sinus congestion
- backache
what is the difference between supine and orthostatic hypotension?
- supine is a drop in BP when laying down on back
- orthostatic is a drop in BP when standing up from a seated or lying position
patient education: fatigue
- plan rest times
- get help with tasks
patient education: emotional lability
- teach that it is normal
- get adequate rest
- support groups
patient education: increased vaginal secretions
- panty liners
- daily bathing
- cotton underwear
- notify provider if change in color
patient education: supine hypotension
- side-lying position
- rise slowly
patient education: orthostatic hypotension
- keep feet moving when standing
- rise slowly
patient education: variscosities
- wear support hose
- avoid crossing legs
patient education: heartburn
- eat small meals frequently
- raise head of bed
patient education: nasal/sinus congestion
- cool air humidifier
- avoid nasal decongestants
- saline is okay to use
patient education: backache
pelvic rocking
what are the 3 main components of maternal adaptation to pregnancy?
- maturational milestones
- mastery of certain skills
- preparation for childbirth
what are some of the maturational milestones mom goes through?
- new level of caring and responsibility
- self-concept changes to prepare for parenthood
- moved from self-contained and independent to being committed to a lifelong concern for another person (their baby)
what are some of the skills that mom must master in pregnancy?
- accept the pregnancy
- identify the mother role
- reordering personal relationships between her own mom and her significant other
- establish a relationship with the fetus: mom’s attachment process
how does dad adapt/accept the pregnancy?
- developmental tasks
- announcement, moratorium, and focusing phases
- identifying the father role
- reordering personal relationships
- establishing a relationship with the fetus
-preparing for birth
announcement phase
how the father reacts to the pregnancy will be determine by whether it was planned/unplanned/wanted/unwanted
-joy, distress, combination of emotions
moratorium phase
the man may disregard the pregnancy, even though his partner is going through physical and emotional changes
focusing phase
- happens in last trimester
- men become involved with pregnancy and relationship with child
what are some nursing interventions for education of self-management during antepartum?
- expected maternal/fetal changes
- nutrition
- personal hygiene
- prevention of UTIs
- kegel exercises
- preparation for breastfeeding
- dental health
- physical activity
- alcohol, cigarette smoking, drugs, caffeine
- normal discomforts
- recognize potential complications
- recognizing preterm labor
- psychosocial support
- sexual counseling: hx, counter misinformation, how to be safe and comfortable during sexual activity while pregnant
what are the physiological reproductive characteristics/body parts that change during pregnancy?
- breasts
- uterus
- cervix
- vagina
breast changes
- increased blood volume- fullness/heaviness/size
- montgomery tubercles
- colostrum
- heightened sensitivity
- tingling
- striae gravidarum
- increased amount of veins visible
- pigmentation of the nipples
what are montgomery tubercles?
bumps usually around the areola
what is colostrum?
“pre-milk”
- yellow to yellow/orange color
- secretion of colostrum may occur as early as 12 weeks
3 parts of the uterus:
-fundus: upper
-lower uterine segment
- cervix: neck (lower, closest to vagina)
uterus changes
- size, shape, and position
- thin uterine wall
- fundus at umbilicus by 20 weeks
- uterus fills abdominal cavity by end of pregnancy
- braxton hicks contractions
- hegar’s sign
braxton hicks contractions
fake contractions
- get the body to prepare for labor
hegar’s sign
softening of the uterus, happens are 6 weeks gestation
chadwick’s sign
blue cervix
vaginal changes
- increased vascularity: leukorrhea
- decreased pH (acidic): more prone to yeast infection
leukorrhea
flow of whitish, yellowish, or greenish discharge from the vagina
- could be normal or indicate infection
supine hypotension is also called ___
vena cava syndrome
s/sx of supine hypotension
-pallor
-dizziness/faintness
-nausea
-tachycardia
-clammy skin (sweating)
nursing intervention for supine hypotension
-turn patient to side-lying position until sx subside and vital signs are stable
what causes supine hypotension during pregnancy?
compression of the vena cava causing a decrease in BP and uterine blood flow/perfusion
respiratory changes during pregnancy
- increased O2 needs due to increased metabolic rate and O2 consumption
- increased vascularity: leads to nasal congestion, stuffiness, nose bleeds
- slight hyperventilation late in pregnancy
-RR increases slightly or is unchanged
renal changes during pregnancy
- increase in GFR
- increase in urinary frequency (r/t pressure on the bladder in 1st & 3rd trimesters
- increase risk of infection r/t impairment of drainage (pressure)
- decreased bladder tone
- urinary stasis
- increased risk of UTIs
- lightening
what is lightening
when the fetus drops into the pelvis
s/sx of UTI
urinary frequency, urgency, dysuria
- sometimes pus or blood in the urine
GI changes during pregnancy
- 90% experience N/V that decreases as the pregnancy progresses
- increased appetite
- uterus displaces the stomach, liver and intestines
- GI system slows
- hemorrhoids develop
- gallstones due to slowing relaxation gallbladder and delayed bile emptying
- ptyalism
- bleeding gums
musculoskeletal system changes during pregnancy
- pelvic joints relax
- waddling gait
- joint discomforts
- postural changes r/t increased uterine weight: lordosis, fall risk
- diastasis recti: stretching of abdominal muscles
integumentary changes during pregnancy
- alterations r/t hormonal imbalance and mechanical stretching
- hyperpigmentation