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
hyperpigmentation is stimulated by __
the anterior pituitary hormone melantropin
what are examples of hyperpigmentation seen during pregnancy?
- darkening nipples/areola
- chloasma/melasma - facial mask of pregnancy
- striae gravidarum
- linea nigra
- hot flashes
-acne and oily skin
-sweating
striae gravidarum
stretch marks
linea nigra
the dark line running vertical on the mom’s abdomen
chloasma
dark patches on mom’s face
fetal ultrasound: timing
1st trimester to confirm pregnancy
fetal ultrasound: abdomen
- want full bladder
- supine position
nursing actions: fetal ultrasound
- explain the process
- access for latex allergy
- position patient supine
- provide comfort
- be sensitive to cultural issues
- document
what does a fetal ultrasound do?
uses high frequency sound waves to produce an image of organs/tissues
what can the fetal ultrasound tell us?
- gestational age
- fetal growth
- anatomy/presentation
- placental location
-fetal activity - number of fetuses
- amount of amniotic fluid
- assist with some procedures
what is a 3D or 4D ultrasound? how does it work?
- ordered as needed for further evaluation - fetal abnormalities
- gives more detailed assessment of fetal structures
- works same as normal US
why is an MRI used during pregnancy?
to evaluate organs from multiple planes
-used for suspected brain anomalies
nursing actions: MRI
- involved in pre and post procedure
- explain procedure
- answer questions
what is doppler flow studies: umbilical artery doppler?
used for IUGR fetuses
-evaluates the rate and volume of blood flow through the placenta and umbilical cord
- used with higher amounts of resistance in the placenta
what is chorionic villus sampling?
-endoscopy placed vaginally
or
- ultrasound guides a needle aspiration through the abdomen
-1/455 chance of fetal death
what is an amniocentesis?
needle is inserted through abdomen to aspirate the amniotic fluid
why is an amniocentesis done?
- genetic testing
- fetal lung maturity
- intrauterine infection
risks of amniocentesis
- fetal loss 1/300
- fetal/placental trauma
- infection
- bleeding
- PTL
- Rh sensitization from fetal blood to maternal blood (Rh- mom needs Rhogam)
what is AFP: Alpha Fetal Protein?
glycoprotein produced by fetus
- mom’s blood is drawn for the biomarker between 15-20 weeks, if its seen in her blood then we know something isn’t right with fetus
- a screening tool for developmental defects
what developmental defects can AFP screen for?
- NTDs
- ventral abdominal wall defects
- Trisomy 21 (down syndrome)
what are the multiple marker screening tests?
- triple marker screen
- quad screen
triple marker screen can screen for __
-AFP: NTD, ventral wall abnorms, Trisomy 21
-HCG: low HCG can indicate Trisomy 21
-Estriol levels
quad screen can detect __ by __
trisomy 21 by adding inhibin A
antenatal fetal testing consists of what tests?
- fetal movement (kicks) : want 4-5 in 1 hr, 10 in 2 hrs
- NST
- AFI
Non-stress tests
non-invasive test using external fetal monitoring (strap around mom’s belly)
- toco
- FHR monitor
reactive stress test
includes an increase of fetal heart of 15 beats lasting 15 seconds (should have 2 in a 20 minute strip)
non-reactive stress test
“straight” line, no accelerations
correlated with higher incidence of fetal distress
- need BPP done
nursing actions: non-stress test
leave patient on fetal monitor
- educate about fetal strip and need
AFI
measures volume of amniotic fluid pockets
-reflects placental function and perfusion to fetus
what is amniotic fluid composed of mostly?
fetal urine
normal AFI is __
pockets are 8 cm to 24 cm
abnormal AFI is ___
pockets < 5 cm
components of BPP
- body movement
- fetal tone
- fetal breathing
- amniotic fluid volume
- NST
what is the present score vs the absent score on a BPP?
- present: 2
- absent: 0
- total of 10 max
BPP reactive: body movement
3 movements
BPP reactive: fetal tone
flexion and extension 1 time
BPP reactive: fetal breathing
1 episode lasting 30 sec
BPP reactive: amniotic fluid volume
1 pocket 2x2 cm
BPP reactive: NST
reactive
what does preconception care consist of?
- risks assessment
- education and anticipatory guidance
- 2 components: physical exam and screening tools
physical exam during antepartum
- height
- weight
- comprehensive physical
- pelvic exam
lab tests during antepartum
- blood type/ Rh
- CBC, chol, glucose, rubella, HIV, Syphilis
- urinalysis
- cultures for STIs
- pap smear
- TB skin test
- others as needed
preconception information
- nutrition
- vitamins
- folic acid
- exercise
folic acid
very important for the production of RBC and hemoglobin
why is folic acid useful in pregnancy?
maternal ingestion can decrease the risk of NTDs
-recommended to take prior to conception
examples of NTDs
- spina bifida
- anencephaly
- meningomyelocele
diagnosis of pregnancy: presumptive
-s/sx may resemble pregnancy or could be caused by something else
subjective data of presumptive pregnancy
- amenorrhea
- fatigue
- breast changes
- vomiting
- urinary frequency
- quickening
diagnosis of pregnancy: probable
signs that indicate pregnancy the majority of the time
- still a chance that they can be false or caused by something other than pregnancy
objective signs of probable pregnancy
- chadwick’s sign
- goodell’s sign
- hegar’s sign
- uterine growth
- chloasma
- ballottement
- pregnancy tests
goodell’s sign
softening of the cervix, increased whitish discharge
ballottement
around 16-18 weeks, during a manual exam. lightly tap on the cervix, which causes fetus to move up and down
diagnosis of pregnancy: positive
signs that cannot, under any circumstance, by mistaken for other conditions.
- evidence pregnancy has occurred
objective signs of positive pregnancy
- doppler fetal heart tones
- ultrasound visualization
- fetal movement palpated by examiner
trimester 1 timeframe
1st day of LMP - week 12
trimester 2 timeframe
week 13 - week 27
trimester 3 timeframe
week 28 - week 40
the estimated date of delivery/confinement (EDD/EDC) can be determined by __
- ultrasound: standard procedure
- gestational wheels: less accurate but good for determining gestational age
- naegale’s rule: assumes woman has 28 day cycle- LMP+7 days-3 months, change year
early term
37.0 - 38 6/7 weeks
full term
39.0 - 40 6/7 weeks
late term
41.0 - 41 6/7 weeks
post term
42.0 + weeks
terms used to describe OB history
- 2 digit system: G&P
or - 5 digit systen: GTPAL
G&P
gravida + para
GTPAL
gravida-term-preterm-abortion-living
gravida is __
the total # of pregnancies, including current
nulligravida
never been pregnant
primigravida
first pregnancy
multigravida
2 or more pregnancies
para is __
total # of pregnancies from 20 weeks onward regardless of whether born alive or stillborn
nullipara
woman who has NOT carried a pregnancy to 20 weeks
primipara
carried 1 pregnancy to 20 weeks gestation
multipara
carried 2 or more pregnancies to 20 weeks gestation
explain what each part of GTPAL stands for/means
G: gravida- total # of pregnancies (twins/multiples count as 1)
T: term- # of term pregnancies (born between 37-42 weeks) (twins/multiples count as 1)
P: preterm- # of preterm pregnancies (born between 20-36 6/7 weeks) (twins/multiples count as 1)
A: abortion- # of abortions (either spontaneous or induced before 20 weeks) (twins/multiples count as 1)
L: living- # of children living
a term baby can be __
37-42 weeks
- includes, early term, full term and late term (and post term if baby is just 42.0 weeks, but not over)
what is the difference between preterm and early term?
- early term is 37.0-38.6 weeks
- preterm is 20-36.6 weeks.
(think preterm has a wider range)
what does a nurse assess in a risk assessment as a part of preconception care?
- health status
- health services
- socioeconomic status
- mental health status
- nutrition
- environment
- family
- self care
- education
- personal: genetics, culture, race/ethnicity, language
at what time during gestation do NTD’s emerge?
early in pregnancy- 1st few weeks after conception
quickening
feeling baby move, if not pregnant: gas bubbles
cervical changes
- cervical OS
- Goodell’s sign
- Chadwick’s sign
what is the cervical OS?
the opening of the cervix
ptyalism
excess saliva
BPP: 8/10 score
assuring, healthy baby
BPP: 6/10 score
slightly concerning
BPP: 4/10
not assuring, discuss next steps
BPP: 2/10
fetal hypoxia, prep for delivery
pregnancy hormone: prolactin- where does it come from/what does it do?
- secreted from the pituitary gland
- stimulates milk production and secretion
milk production is ____ and ____
supply and demand
factors that influence milk production:
- maternal fluid intake
- if mom chooses to supplement feedings with formula
- if baby isn’t nursing often
around what day does the true milk come in?
day 2 or 4 postpartum
hyperemesis is ___
prolonged N/V
how long is it recommended that mothers breastfeed?
6 months
pregnancy hormone: oxytocin- what does it do?
stimulates milk let down response
kegel exercises are for ___
pelvic floor strengthening
