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NURS 4500 > Class 2: Pregnancy (uncomplicated) > Flashcards

Class 2: Pregnancy (uncomplicated) Flashcards

1
Q

Pregnancy length of time

A

9 calendar months
10 lunar months of 28 days
280 days total
40 weeks (from 1st day of last menstrual period)

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2
Q

Pregnancy trimesters

A

First: weeks 1 through 13
Second: weeks 14 through 26
Third: weeks 27 through to term

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3
Q

The physiological processes of pregnancy

A

Oogenesis
Spermatogenesis
Menstrual cycle and ovulation
Conception (fertilization, implantation)

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4
Q

Fertilization

A

Fertilization occurs in the outer 3rd of the uterine tube

Mitotic cell division (cleavage) occurs

Morula develops (day 3)

Early blastocyst (day 4)

Implantation (day 6-10)

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5
Q

Blastocyst

A

Inner cell mass = embryoblast
Blastocyst cavity = blastocele
Outer cells = trophoblasts

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6
Q

The corpus luteum

A

Receives a signal from the zygote (hormone: hCG human chorionic gonadotropin) to alert that fertilization has occurs

Will produce progesterone and some estrogen

Lasts for approx 12 weeks

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7
Q

Pregnancy tests

A

-detect the hormone hCG
-OTC urine pregnancy tests can detect hCG usually when level is about 25 mIU/mL
-clients should be instructed to use the first void in the morning, as levels are the highest at that time
-blood hCG is quantitative (exact amount is measured), <5 mIU/mL is normal when not pregnant

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8
Q

Pre-embryonic stage

A

Fertilization to end of 2nd week
Fertilization; cleavage; morula
Blastocyst
Implantation
The yolk sac provides nutrients and oxygen
Nutrients diffuse across the chorion from pregnant person’s circulation

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9
Q

Fetal period

A

Weeks 9 to birth

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10
Q

Embryonic period

A

Weeks 3-8

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11
Q

Embryonic stage

A

weeks 3-8
The embryonic disk, yolk sac and amniotic sac are connected to chorionic villi by connecting stalk
Week 3 blood vessels begin to supply nutrients from pregnant person’s circulation to early placental structure
End of week 3 the primitive heart starts to beat
In the 4th week the yolk sac folds into digestive tract
In the 5th week the connected stalk is compressed and forms the umbilical cord
Basic structures of major body organs andmainexternalfeatures are developed during this time (organogenesis)
Very sensitive time for malformations to occur

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12
Q

Fetal stage

A

week 9 untilbirth.
Refinement of the structure and function of organ systems

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13
Q

Chorion

A

Blends with the placenta

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14
Q

Amnion

A

Blends with the umbilical cord
Amniotic fluid: at term 700-1000ml, important functions for development of the fetus, contains genetic information from the fetus, can be sampled to determine fetal lung maturity (L/S ratio)

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15
Q

Umbilical cord

A

2 arteries
1 vein
Wharton’s jelly

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16
Q

Placental structure

A

Fetal side (chorion frondosum) & maternal side (decidua basalis)
Complete and functional at approx. 12 weeks gestation
There is no mixing of the blood between pregnant person and fetus
Location and implantation of the placenta are very important!

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17
Q

Placental function

A

Site of respiration, nutrition, excretion and storagefor the fetus – mostly using diffusion
Blood flow through uteroplacental vascular system at 40 weeks is 450-650ml/min.
Endocrine function:Hormones of theplacenta – progesterone,placentallactogen, estrogen,relaxin, B-hCGandinfant growth factors (IGFs)
**Blood pressure dependent

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18
Q

Amniotic fluid function

A

It serves as a cushion for the growing fetus, but also facilitates the exchange of nutrients, water, and biochemical products between mother and fetus
This fluid also allows the developing fetus to practice breathing, which is crucial for extra uterine life

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19
Q

Amniotic fluid content

A

Is made up of fetal urine and fluid that is transported through the placenta from maternal circulation
The fetus swallows AF and excretes urine and waste products which are then excreted by maternal kidneys

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20
Q

Normal amount of amniotic fluid at term

A

700-1000 mL

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21
Q

Which is more common: polyhydramnios or oligohydramnios?

A

Oligohydramnios

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22
Q

Fetal circulatory system

A

Optimization of transfer of O2 from parent to fetus

Fetal hgb (carries more O2 than parental hgb and higher hgb concentration

FHR is higher than parental HR

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23
Q

Fetal maturation

A

Viability - “age of viability,” 22-25 weeks

Capability of fetus to survive outside uterus

Limitations based on central nervous system function and oxygenation capability of lungs

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24
Q

What is a congenital disorder?

A

A structural or functional anomaly (“birth defect”) that happens during intrauterine life

Congenital disorders may be inherited or may be caused by environmental factors

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25
Q

Factors to developing congenital disorder

A
  1. Genetic factors – single gene disorders, chromosomal abnormalities
  2. Nongenetic factors
    - Teratogens
    • Drugs and chemicals; alcohol, oral isotretinoin
    • Infections: rubella, varicella
    • Radiation: xrays/CT scans
    • Maternal health conditions: e.g. Diabetes – hyperglycemia
      - Maternal Nutrition
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26
Q

Hormones in pregnancy

A
  • Human chorionic gonadotropin (hCGorBhCG)
    • Biochemical marker of pregnancy (urine or serum)
    • Can be false pos or neg
  • Estrogen (E) - vascularization
  • Progesterone (P) – smooth muscle relaxation
  • Relaxin
  • Human placental lactogen (hPL)
  • Oxytocin
  • Prolactin
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27
Q

Zygote and hormones

A

Zygote → corpus luteum → estrogen and progesterone

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28
Q

Placenta and hormones

A

hCG
estrogen
progesterone
relaxin
hPL

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29
Q

Presumptive signs of pregnancy

A

Patient’s subjective symptomsthat may be associated with pregnancy
amenorrhea, breast tenderness, nausea/vomiting, urinary frequency

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30
Q

Probable signs of pregnancy

A

Objective signs that can be assessed by the provider, physical assessment findings
Positive pregnancy test, uterine enlargement,Hegar’ssign, Goodell’s sign, Chadwick’s sign

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31
Q

Positive signs of pregnancy

A

Signs of pregnancy that can only be present if there is a fetus present
FHR auscultation, fetal movement palpated by provider, U/S of fetus

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32
Q

Uterus change in pregnancy

A

enlarges, becomes an abdominal organ, ++↑ blood flow

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33
Q

CVS change in pregnancy

A

↑CO, HR, & blood volume, ↓BP (DBP morethan SBP)↓PVR

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34
Q

RESP change in pregnancy

A

↑ O2 consumption,elevated diaphragm, ↑ minuteventilation ↓ CO2

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35
Q

GU change in pregnancy

A

↑CO leads to ↑ renal flow to kidneys, dilation, stasis

36
Q

GI change in pregnancy

A

↑ intra-abdominal pressure, relaxed lower esophagealsphincter, delayed gastric emptying

37
Q

Hematologic change in pregnancy

A

↓HGB↑ clotting factors

38
Q

Nutrition in pregnancy

A

Calories from carbohydrates, protein and fat
RDA is 340kcal above prepregnancy caloric needs in T2
RDA is 452kcal above prepregnancy caloric needs in T3
Fluid intake is recommended to be 9 cups per day

39
Q

Anemia in Pregnancy

A

N HGB in pregnancy is > 110 g/L (Nnonpreg120-160 g/L), HCT > 0.33 (Nnonpreg0.37 to 0.47) = Physiologic anemia OR Dilutional anemia (considered normal in pregnancy)

HGB ≤ 110g/L or HCT ≤ 0.32 then we consider true anemia that requires further investigation and possiblytreatment

40
Q

Common cause for anemia in pregnancy

A

Usually nutritional - most commonly iron deficiency

41
Q

Nonspecific symptoms of anemia in pregnancy

A

fatigue, weakness, dyspnea on exertion, light-headed, pruritus

Likely asymptomatic if mild

42
Q

Management of anemia in pregnancy

A

Iron supplements, iron rich foods

43
Q

Nausea and vomiting in early pregnancy

A

50-90% of pregnant individuals experience 1sttrimester nausea and potentially some vomiting
Onset is usually weeks 4-6 gestation
Improves or resolves by 13 weeks for most
May be triggered by certain foods or smells

44
Q

Signs/symptoms of Normal N&V

A

VS
Urine output
Able to eat throughout the day without vomiting
Weight stable or increasing
No symptoms of infection
No signs of dehydration

45
Q

Signs/symptoms Abnormal N&V

A

VS
Urine output
Excessive vomiting
Weight loss
Electrolyte imbalances
Potential signs of dehydration
Urine ketones
Chills/fever
Dysuria
Abd pain
Vaginal bleeding
Backache/ Flank pain

46
Q

Nursing interventions for normal N&V

A

Avoid triggers
Increase rest
Small frequent meals
Plain carbs
Avoid extended period without eating (avoid empty stomach)
Avoid overloaded stomach
Adequate fluids

47
Q

Education to provide on N&V in pregnancy

A

When to seek care – s/sx abnormal n/v
Feeling presyncopal, decreased urine output, weight loss
Vaginal leaking or bleeding
Pain or fever
Dysuria

48
Q

Healthy weight BMI in pregnancy

A

18.5-24.9

49
Q

Healthy weight gain in kg and lbs

A

11.5-16 kg or 23-35 lbs

50
Q

During T1 and T2 most weight gain is within…

A

the tissues of the pregnant person

51
Q

Average weight gain in T1

A

1-2kg

52
Q

Most weight gain occurs…

A

In T3 within the fetal tissues

53
Q

During T2 and T3 individuals require….

A

More calories for fetal growth and development

54
Q

In T2 and T3 the mean weight gain is…

A

1lb/ week for those within the BMI 18.5-24.9 category

55
Q

Inadequate nutrition can lead to an increase in…

A

Low-birth-weight (LBW) infants (2500 g or less)
Preterm infants

56
Q

Folic acid recommendation for low risk

A

0.4 daily for at least 2-3 months prior to pregnancy, throughout pregnancy, and postpartum if breastfeeding

57
Q

Folic acid recommendation for moderate risk

A

Diabetes, epilepsy, obesity , or first- or second-degree relative with hx of NTD

1.0mg daily for the 3 months prior to pregnancy and during the first trimester
Decrease dose to 0.4mg after first trimester

58
Q

Folic acid recommendation for increased or high risk for NTD

A

4 mg/ day at least months prior to conception and through the first trimester of pregnancy, after which time can decrease intake to 0.4 to 1.0 mg daily

59
Q

Prenatal visits

A

Q 4 weeks until 30 weeks
Q 2 weeks from 30-36 weeks
Q 1 week from 36 weeks to delivery
7 – 11 visits throughout pregnancy

60
Q

Individuals at increased risk for adverse outcomes inpregnancy

A

Adolescent (Age 15 years or less)
Advanced maternal age (Age > 35 years)

61
Q

Pregnancy in adolescence have a higher likelihood of:

A

Poverty
Lower education
Nutritional deficiencies (anemia)
Inadequate social support
Preterm birth
Preeclampsia (+/- HELLP)
PPH
Chorioamnionitis

Less likely to attend prenatal care
More likely to smoke tobacco
Less likely to have adequate weight gain

62
Q

If no preconception history known, an in-depth history will be taken including the following

A

Child and adult illness, medical conditions currently
Current medications, allergies (Rx/OTC/herbal/supplements)*folic acid, multivitamin
Immunization history
Medical, psychiatric, surgical history
Obstetrical history: Gravida, Term, Preterm, Abortion (SA and TA), living children
Family History, including partner’s personal and family history - genetic disorders/birth defects/multiple gestations/close relations
Lifestyle: Nutrition, exercise
Social History: screen for alcohol use, drug use, smoking, vaping
Psychosocial history: Culture, socioeconomic status, sexuality,disabilities, Occupation, Travel
Screen for Intimate Partner Violence
Personal history of physical, emotional or sexual abuse

63
Q

Initial prenatal visit ROS

A

particularly – any vaginal bleeding or leaking, n/v, syncope, dysuria, abdominal pain, fever
Any mental health concerns, adaptation to pregnancy

64
Q

Calculate Gestational Age

A

from 1stday of late menstrual period (LMP)
E.g. LMP Aug 1, 2023 (Day 0)  GA currently: 5 weeks + 2 days
Estimated Date of Birth (EDB): May 8
Nagele’s rule: 1stday of LMP – 3 months + 7 days (add 1 year), or pregnancy wheel

65
Q

Initial prenatal visit - physical exam

A

Appearance & mental status
Height, weight, BMI, BP, HR, RR, temp
HEENT, CVS, RESP, breasts, ABD, pelvic (prn), extremities with other PE as required (initial)
Gest age at visit will determine fetal assessment afterward

66
Q

Initial prenatal visit - laboratory tests

A

Confirm probable pregnancy with urine hCG
Serology for CBC, STI screening- HIV, VDRL (syphilis), & Hep B
Cervical Swab for gonorrhea and chlamydia
Blood type, Rh and antibody screen
Titres for rubella and varicella
Urinalysis + urine culture
Pap if due (routine screening Q3 years)

67
Q

Subsequent Prenatal Visits

A

Includes:
Interview: any new symptoms,emotional wellbeing, concerns,fetal movements (after 24 + weeks), vaginal bleeding or leaking, cramping
Physical exam
- Weight, height, determine BMI
- Look at general appearance and mental status
- VS: BP, HR, RR +/- temp
- Urinalysis*
Fetal assessment: FHR, SFH, Leopold’s maneuvers (T3)
Document on the MB Prenatal record

68
Q

Common first trimester symptoms

A

breast changes/ tenderness, amenorrhea, nausea/ vomiting, urinary frequency, fatigue, nasal stuffiness, bleeding gums, leukorrhea, mood changes

69
Q

Common second trimester symptoms

A

Quickening, skin changes, pruritus, palpitations, supine hypotension, orthostatic hypotension, heartburn, constipation, flatulence, varicose veins (hemorrhoids), headaches, carpal tunnel syndrome, round ligament pain, joint pain

70
Q

Common third trimester symptoms

A

dyspnea, insomnia, mood changes, urinary frequency and urgency, perineal pressure, leg cramps, edema to lower extremities

71
Q

Potential complications in first trimester

A

Severe vomiting/ weight loss/ unable to keep fluids down, fever, dysuria, diarrhea, abdominal cramping, vaginal bleeding

72
Q

Potential complications in second and third trimester

A

Persistent vomiting, leaking of fluid or blood from vagina, abdominal pain, fever, dysuria, diarrhea, severe backache or flank pain, change or decrease in fetal movements, uterine contractions (before week 37), visual disturbances, headaches, muscular irritability or convulsions, epigastric or abdominal pain

73
Q

When can preterm labour occur?

A

Weeks 21-36 weeks + 6 days

74
Q

Signs of preterm labour

A

feel uterus at fundus for contractions, empty bladder, drink water, lie down in side-lying position, monitor contractions for 1 hour (from start of one to the beginning of the next) to determine how often (e.g. every 5mins). Regular contractions, continuing for 1 hour is concerning. They may be uncomfortable but not always.

75
Q

Interventions for preterm labour

A

Call provider if contractions last for 1 hour, regularly occurring every 10mins or less, pelvic pressure not resolving, vaginal bleeding or leaking, feeling that “something is not right”

76
Q

GTPAL

A

G: total number of pregnancies of any gestation (twins/multiples =1) (includes non-viable)
Parity (TPAL) means the number of pregnancies that reach 20 weeks

TPAL:
Term (T): # of births (≥ 37wks)
Preterm (P): # of births (20 wks - 36 wks+6days)
Abortions (A): # of abortions < 20 wks (induced or spontaneous)
Living children (L): # living children

77
Q

Estimated date of birth (EDB)

A

Estimated date of birth (EDB) or Estimated Due Date (EDD)
Formulas for calculating EDB/EDD but none infallible
Nägele’s rule
Determine first day of last menstrual period (LMP), subtract 3 months, and add 7 days plus 1 year.
Alternatively, add 7 days to LMP and count forward 9 months.
Most women give birth from 7 days before to 7 days after EDB/EDD

78
Q

Prenatal Care - Fetal Assessment

A

Fetal Assessment:
FHR – can start to assess at 10-12 weeks
SFH–begin to measure at 20 weeks
Fetal movements – starts at time when movements felt regularly (variable, by 24 weeks should be felt)
Leopold’s maneuvers– start at 30-32 weeks

79
Q

Auscultate fetal heart rate

A

Fetal heart can usually be heard with a Doppler at between 10-12 weeks.
Once fetal heart is detectable it should be checked every prenatal visit. Count for 1 min.
Fetal heart rate (FHR) is typically between 110-160 bpm and varies more than the adult heart rate.

80
Q

Measuring fundal height

A

Measured in cm from the top of the pubic bone to the top of the fundus
Should be determined at each prenatal visit
Used as a measurement of fetal growth once the uterus leaves the pelvic cavity
Measurement in cm typically corresponds to weeks of gestational age (20 cm=20 weeks); +/- 2cm
Once lightening (dropping of the fetus into the pelvic cavity) occurs around 36 weeks fundal height no longer corresponds to gestational age

81
Q

What are “off for dates”?

A

“off for dates” - when the SFH does not correspond to what you expect based on the gestational age of the pregnancy
For example, at 25 weeks the normal range is between 23cm-27cm

82
Q

Leopold’s Maneuvers

A

Typically begin @ 30-32 weeks gestation
1st palpate fetal part at the fundus (or the farthest away from the pelvic inlet)
2nd determine the location of the fetal back
3rd palpate to determine the presenting part
4th palpate for the attitude of the presenting part

83
Q

Fetal Health (FH) surveillance

A

Fetal movement is a good indicator of fetal health

Kick count is a formal measurement
Done in cases where there is reason to suspect placental insufficiency or in other high-risk pregnancies. From 26-32 weeks, the pregnant person should be asked to set aside a time to count fetal movements each day.
The baby should move 6 times in 2 hours.
All people should be counseled that if they suspect decreased movements, do a kick count

84
Q

Reasons for decreased fetal movements

A

Hunger/Thirst
Sleep cycle of fetus
Amniotic fluid decreased
Death of fetus

85
Q

Labs and diagnostics 4 weeks onward

A

urine or serum hCG

86
Q

Labs and diagnostics 10-12 weeks

A

CBC
Blood type, Rh, antibody screen
MSU, C&S, urinalysis
Cervical swab Gc & CT
Serology: HIV, HEP B, Syphilis
Titres for rubella, varicella

NURS 4500 (4 decks)

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