Chapters 4 & 6 Flashcards

1
Q

antepartum period

A

begins with the last day of the LMP and ends with the onset of labor

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2
Q

the antepartum period is divided into __

A

first, second, and third trimesters

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3
Q

what happens during the initial visit of the first trimester?

A
  • comprehensive physical exam
  • current pregnancy hx
  • pelvic exam
  • determine EDD
  • nutrition assessment
  • psychosocial assessment
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4
Q

what happens during the return visits in the first trimester?

A
  • focused assessment
  • height, weight, urine, vitals, fundal height
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5
Q

1st trimester warning signs

A

-prolonged N/V
- cramps
- spotting
- absence of fetal heart tones
- fever/chills
- dysuria, frequency or urgency

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6
Q

how often are second trimester visits?

A

every 4 weeks

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7
Q

what is assessed during a second trimester visit?

A
  • 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
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8
Q

2nd trimester warning signs

A
  • abdominal/pelvic pain
  • absence of fetal movement
  • dysuria, frequency, or urgency
  • fever/chills
  • prolonged N/V
  • vaginal bleeding
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9
Q

how often are third trimester visits?

A

every 2 weeks: 28 to 36 weeks, then weekly until 40 weeks

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10
Q

what is assessed during a third trimester visit?

A
  • focused assessment
  • same as before: height, weight, fundal height, urine for glucose, FHR, fetal movement, leopolds meneuver, edema
  • internal exam if necessary
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11
Q

what does GBS + mean?

A

the woman has group b streptococcus
- 1/4 - 1/3 of women are GBS +

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12
Q

why is GBS harmful to the fetus?

A

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

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13
Q

when is GBS tested vs treated?

A

vaginal and rectal swabs done at 35-37 weeks
- treated with ampicillin before/during labor because not effective if given too early

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14
Q

3rd trimester warning signs

A
  • 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
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15
Q

when/how is fundal height measured?

A
  • after 12 weeks
  • measured in cm, cm = weeks
  • “0” on symphysis pubis and extend to the top of the fundus (think low to high)
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16
Q

what is the fundal height landmark at 12 weeks?

A

symphysis pubis

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17
Q

what is the fundal height landmark at 20 weeks?

A

the umbilicus

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18
Q

what is the recommended weight gain during pregnancy?

A
  • 1-5 lbs in 1st tri
  • 25-35 lbs total for normal weight person
  • 15-25 for overweight person
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19
Q

nutrition recommendations during antepartum period?

A
  • 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
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20
Q

preterm labor: warning s/sx

A
  • rhythmic lower abdominal cramping
  • low backache
  • pelvic pressure
  • leaking fluids
  • increased vaginal discharge
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21
Q

hypertensive: warning s/sx

A
  • severe headache that doesn’t go away
  • visual changes
  • facial or general edema
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22
Q

what are some common discomforts during antepartum?

A

-fatigue
-emotional lability
-increased vaginal secretions
-supine hypotension
-orthostatic hypotension
- varicosities
- heartburn
- nasal/sinus congestion
- backache

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23
Q

what is the difference between supine and orthostatic hypotension?

A
  • 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
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24
Q

patient education: fatigue

A
  • plan rest times
  • get help with tasks
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25
Q

patient education: emotional lability

A
  • teach that it is normal
  • get adequate rest
  • support groups
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26
Q

patient education: increased vaginal secretions

A
  • panty liners
  • daily bathing
  • cotton underwear
  • notify provider if change in color
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27
Q

patient education: supine hypotension

A
  • side-lying position
  • rise slowly
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28
Q

patient education: orthostatic hypotension

A
  • keep feet moving when standing
  • rise slowly
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29
Q

patient education: variscosities

A
  • wear support hose
  • avoid crossing legs
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30
Q

patient education: heartburn

A
  • eat small meals frequently
  • raise head of bed
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31
Q

patient education: nasal/sinus congestion

A
  • cool air humidifier
  • avoid nasal decongestants
  • saline is okay to use
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32
Q

patient education: backache

A

pelvic rocking

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33
Q

what are the 3 main components of maternal adaptation to pregnancy?

A
  • maturational milestones
  • mastery of certain skills
  • preparation for childbirth
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34
Q

what are some of the maturational milestones mom goes through?

A
  • 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)
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35
Q

what are some of the skills that mom must master in pregnancy?

A
  • 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
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36
Q

how does dad adapt/accept the pregnancy?

A
  • developmental tasks
    • announcement, moratorium, and focusing phases
  • identifying the father role
  • reordering personal relationships
  • establishing a relationship with the fetus
    -preparing for birth
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37
Q

announcement phase

A

how the father reacts to the pregnancy will be determine by whether it was planned/unplanned/wanted/unwanted

-joy, distress, combination of emotions

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38
Q

moratorium phase

A

the man may disregard the pregnancy, even though his partner is going through physical and emotional changes

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39
Q

focusing phase

A
  • happens in last trimester
  • men become involved with pregnancy and relationship with child
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40
Q

what are some nursing interventions for education of self-management during antepartum?

A
  • 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
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41
Q

what are the physiological reproductive characteristics/body parts that change during pregnancy?

A
  • breasts
  • uterus
  • cervix
  • vagina
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42
Q

breast changes

A
  • increased blood volume- fullness/heaviness/size
  • montgomery tubercles
  • colostrum
  • heightened sensitivity
  • tingling
  • striae gravidarum
  • increased amount of veins visible
  • pigmentation of the nipples
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43
Q

what are montgomery tubercles?

A

bumps usually around the areola

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44
Q

what is colostrum?

A

“pre-milk”
- yellow to yellow/orange color
- secretion of colostrum may occur as early as 12 weeks

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45
Q

3 parts of the uterus:

A

-fundus: upper
-lower uterine segment
- cervix: neck (lower, closest to vagina)

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46
Q

uterus changes

A
  • 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
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47
Q

braxton hicks contractions

A

fake contractions
- get the body to prepare for labor

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48
Q

hegar’s sign

A

softening of the uterus, happens are 6 weeks gestation

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49
Q

chadwick’s sign

A

blue cervix

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50
Q

vaginal changes

A
  • increased vascularity: leukorrhea
  • decreased pH (acidic): more prone to yeast infection
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51
Q

leukorrhea

A

flow of whitish, yellowish, or greenish discharge from the vagina
- could be normal or indicate infection

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52
Q

supine hypotension is also called ___

A

vena cava syndrome

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53
Q

s/sx of supine hypotension

A

-pallor
-dizziness/faintness
-nausea
-tachycardia
-clammy skin (sweating)

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54
Q

nursing intervention for supine hypotension

A

-turn patient to side-lying position until sx subside and vital signs are stable

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55
Q

what causes supine hypotension during pregnancy?

A

compression of the vena cava causing a decrease in BP and uterine blood flow/perfusion

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56
Q

respiratory changes during pregnancy

A
  • 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
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57
Q

renal changes during pregnancy

A
  • 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
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58
Q

what is lightening

A

when the fetus drops into the pelvis

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59
Q

s/sx of UTI

A

urinary frequency, urgency, dysuria
- sometimes pus or blood in the urine

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60
Q

GI changes during pregnancy

A
  • 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
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61
Q

musculoskeletal system changes during pregnancy

A
  • pelvic joints relax
  • waddling gait
  • joint discomforts
  • postural changes r/t increased uterine weight: lordosis, fall risk
  • diastasis recti: stretching of abdominal muscles
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62
Q

integumentary changes during pregnancy

A
  • alterations r/t hormonal imbalance and mechanical stretching
  • hyperpigmentation
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63
Q

hyperpigmentation is stimulated by __

A

the anterior pituitary hormone melantropin

64
Q

what are examples of hyperpigmentation seen during pregnancy?

A
  • darkening nipples/areola
  • chloasma/melasma - facial mask of pregnancy
  • striae gravidarum
  • linea nigra
  • hot flashes
    -acne and oily skin
    -sweating
65
Q

striae gravidarum

A

stretch marks

66
Q

linea nigra

A

the dark line running vertical on the mom’s abdomen

67
Q

chloasma

A

dark patches on mom’s face

68
Q

fetal ultrasound: timing

A

1st trimester to confirm pregnancy

69
Q

fetal ultrasound: abdomen

A
  • want full bladder
  • supine position
70
Q

nursing actions: fetal ultrasound

A
  • explain the process
  • access for latex allergy
  • position patient supine
  • provide comfort
  • be sensitive to cultural issues
  • document
71
Q

what does a fetal ultrasound do?

A

uses high frequency sound waves to produce an image of organs/tissues

72
Q

what can the fetal ultrasound tell us?

A
  • gestational age
  • fetal growth
  • anatomy/presentation
  • placental location
    -fetal activity
  • number of fetuses
  • amount of amniotic fluid
  • assist with some procedures
73
Q

what is a 3D or 4D ultrasound? how does it work?

A
  • ordered as needed for further evaluation - fetal abnormalities
  • gives more detailed assessment of fetal structures
  • works same as normal US
74
Q

why is an MRI used during pregnancy?

A

to evaluate organs from multiple planes
-used for suspected brain anomalies

75
Q

nursing actions: MRI

A
  • involved in pre and post procedure
  • explain procedure
  • answer questions
76
Q

what is doppler flow studies: umbilical artery doppler?

A

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

77
Q

what is chorionic villus sampling?

A

-endoscopy placed vaginally
or
- ultrasound guides a needle aspiration through the abdomen

-1/455 chance of fetal death

78
Q

what is an amniocentesis?

A

needle is inserted through abdomen to aspirate the amniotic fluid

79
Q

why is an amniocentesis done?

A
  • genetic testing
  • fetal lung maturity
  • intrauterine infection
80
Q

risks of amniocentesis

A
  • fetal loss 1/300
  • fetal/placental trauma
  • infection
  • bleeding
  • PTL
  • Rh sensitization from fetal blood to maternal blood (Rh- mom needs Rhogam)
81
Q

what is AFP: Alpha Fetal Protein?

A

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

82
Q

what developmental defects can AFP screen for?

A
  • NTDs
  • ventral abdominal wall defects
  • Trisomy 21 (down syndrome)
83
Q

what are the multiple marker screening tests?

A
  • triple marker screen
  • quad screen
84
Q

triple marker screen can screen for __

A

-AFP: NTD, ventral wall abnorms, Trisomy 21
-HCG: low HCG can indicate Trisomy 21
-Estriol levels

85
Q

quad screen can detect __ by __

A

trisomy 21 by adding inhibin A

86
Q

antenatal fetal testing consists of what tests?

A
  • fetal movement (kicks) : want 4-5 in 1 hr, 10 in 2 hrs
  • NST
  • AFI
87
Q

Non-stress tests

A

non-invasive test using external fetal monitoring (strap around mom’s belly)
- toco
- FHR monitor

88
Q

reactive stress test

A

includes an increase of fetal heart of 15 beats lasting 15 seconds (should have 2 in a 20 minute strip)

89
Q

non-reactive stress test

A

“straight” line, no accelerations
correlated with higher incidence of fetal distress
- need BPP done

90
Q

nursing actions: non-stress test

A

leave patient on fetal monitor
- educate about fetal strip and need

91
Q

AFI

A

measures volume of amniotic fluid pockets
-reflects placental function and perfusion to fetus

92
Q

what is amniotic fluid composed of mostly?

A

fetal urine

93
Q

normal AFI is __

A

pockets are 8 cm to 24 cm

94
Q

abnormal AFI is ___

A

pockets < 5 cm

95
Q

components of BPP

A
  • body movement
  • fetal tone
  • fetal breathing
  • amniotic fluid volume
  • NST
96
Q

what is the present score vs the absent score on a BPP?

A
  • present: 2
  • absent: 0
  • total of 10 max
97
Q

BPP reactive: body movement

A

3 movements

98
Q

BPP reactive: fetal tone

A

flexion and extension 1 time

99
Q

BPP reactive: fetal breathing

A

1 episode lasting 30 sec

100
Q

BPP reactive: amniotic fluid volume

A

1 pocket 2x2 cm

101
Q

BPP reactive: NST

A

reactive

102
Q

what does preconception care consist of?

A
  • risks assessment
  • education and anticipatory guidance
  • 2 components: physical exam and screening tools
103
Q

physical exam during antepartum

A
  • height
  • weight
  • comprehensive physical
  • pelvic exam
104
Q

lab tests during antepartum

A
  • blood type/ Rh
  • CBC, chol, glucose, rubella, HIV, Syphilis
  • urinalysis
  • cultures for STIs
  • pap smear
  • TB skin test
  • others as needed
105
Q

preconception information

A
  • nutrition
  • vitamins
  • folic acid
  • exercise
106
Q

folic acid

A

very important for the production of RBC and hemoglobin

107
Q

why is folic acid useful in pregnancy?

A

maternal ingestion can decrease the risk of NTDs
-recommended to take prior to conception

108
Q

examples of NTDs

A
  • spina bifida
  • anencephaly
  • meningomyelocele
109
Q

diagnosis of pregnancy: presumptive

A

-s/sx may resemble pregnancy or could be caused by something else

110
Q

subjective data of presumptive pregnancy

A
  • amenorrhea
  • fatigue
  • breast changes
  • vomiting
  • urinary frequency
  • quickening
111
Q

diagnosis of pregnancy: probable

A

signs that indicate pregnancy the majority of the time
- still a chance that they can be false or caused by something other than pregnancy

112
Q

objective signs of probable pregnancy

A
  • chadwick’s sign
  • goodell’s sign
  • hegar’s sign
  • uterine growth
  • chloasma
  • ballottement
  • pregnancy tests
113
Q

goodell’s sign

A

softening of the cervix, increased whitish discharge

114
Q

ballottement

A

around 16-18 weeks, during a manual exam. lightly tap on the cervix, which causes fetus to move up and down

115
Q

diagnosis of pregnancy: positive

A

signs that cannot, under any circumstance, by mistaken for other conditions.
- evidence pregnancy has occurred

116
Q

objective signs of positive pregnancy

A
  • doppler fetal heart tones
  • ultrasound visualization
  • fetal movement palpated by examiner
117
Q

trimester 1 timeframe

A

1st day of LMP - week 12

118
Q

trimester 2 timeframe

A

week 13 - week 27

119
Q

trimester 3 timeframe

A

week 28 - week 40

120
Q

the estimated date of delivery/confinement (EDD/EDC) can be determined by __

A
  1. ultrasound: standard procedure
  2. gestational wheels: less accurate but good for determining gestational age
  3. naegale’s rule: assumes woman has 28 day cycle- LMP+7 days-3 months, change year
121
Q

early term

A

37.0 - 38 6/7 weeks

122
Q

full term

A

39.0 - 40 6/7 weeks

123
Q

late term

A

41.0 - 41 6/7 weeks

124
Q

post term

A

42.0 + weeks

125
Q

terms used to describe OB history

A
  • 2 digit system: G&P
    or
  • 5 digit systen: GTPAL
126
Q

G&P

A

gravida + para

127
Q

GTPAL

A

gravida-term-preterm-abortion-living

128
Q

gravida is __

A

the total # of pregnancies, including current

129
Q

nulligravida

A

never been pregnant

130
Q

primigravida

A

first pregnancy

131
Q

multigravida

A

2 or more pregnancies

132
Q

para is __

A

total # of pregnancies from 20 weeks onward regardless of whether born alive or stillborn

133
Q

nullipara

A

woman who has NOT carried a pregnancy to 20 weeks

134
Q

primipara

A

carried 1 pregnancy to 20 weeks gestation

135
Q

multipara

A

carried 2 or more pregnancies to 20 weeks gestation

136
Q

explain what each part of GTPAL stands for/means

A

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

137
Q

a term baby can be __

A

37-42 weeks
- includes, early term, full term and late term (and post term if baby is just 42.0 weeks, but not over)

138
Q

what is the difference between preterm and early term?

A
  • early term is 37.0-38.6 weeks
  • preterm is 20-36.6 weeks.
    (think preterm has a wider range)
139
Q

what does a nurse assess in a risk assessment as a part of preconception care?

A
  • health status
  • health services
  • socioeconomic status
  • mental health status
  • nutrition
  • environment
  • family
  • self care
  • education
  • personal: genetics, culture, race/ethnicity, language
140
Q

at what time during gestation do NTD’s emerge?

A

early in pregnancy- 1st few weeks after conception

141
Q

quickening

A

feeling baby move, if not pregnant: gas bubbles

142
Q

cervical changes

A
  • cervical OS
  • Goodell’s sign
  • Chadwick’s sign
143
Q

what is the cervical OS?

A

the opening of the cervix

144
Q

ptyalism

A

excess saliva

145
Q

BPP: 8/10 score

A

assuring, healthy baby

146
Q

BPP: 6/10 score

A

slightly concerning

147
Q

BPP: 4/10

A

not assuring, discuss next steps

148
Q

BPP: 2/10

A

fetal hypoxia, prep for delivery

149
Q

pregnancy hormone: prolactin- where does it come from/what does it do?

A
  • secreted from the pituitary gland
  • stimulates milk production and secretion
150
Q

milk production is ____ and ____

A

supply and demand

151
Q

factors that influence milk production:

A
  • maternal fluid intake
  • if mom chooses to supplement feedings with formula
  • if baby isn’t nursing often
152
Q

around what day does the true milk come in?

A

day 2 or 4 postpartum

153
Q

hyperemesis is ___

A

prolonged N/V

154
Q

how long is it recommended that mothers breastfeed?

A

6 months

155
Q

pregnancy hormone: oxytocin- what does it do?

A

stimulates milk let down response

156
Q

kegel exercises are for ___

A

pelvic floor strengthening