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NURS 4500: Midterm Material > Class 2: Uncomplicated Pregnancy > Flashcards

Class 2: Uncomplicated Pregnancy Flashcards

1
Q

appropriate preconception care leads to…

A
  • improved health outcomes for pregnant persons and fetus/newborns
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2
Q

what are the components of preconception care (2)

A
  • health promotion –> optimize health of person prior to pregnancy
  • risk assessment and interventions –> identify individuals at increased risk
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3
Q

reproduction encompassess… (4)

A
  • the reproductive cells from males and females
  • the female menstrual cycle
  • the process of conception
  • the process of pregnancy
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4
Q

define: oogenesis

A
  • the process of egg formation (ovum)
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5
Q

define ovum

A
  • mature female reproductive cell, especially of a human or other animal, which can divide to give rise to an embryo usually only after fertilization by a male cell
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6
Q

define spermatogenesis; when does it begin?

A
  • the formation of a germ cell to a sperm cell
  • begins at puberty under the influence of testosterone and continues throughout adult life
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7
Q

define: menstrual cycle, describe the four stages

A
  • physiological preparation for conception
  • four stages that occur every 28 days
  • involves shedding of the endometrium (stage 1 = menstrual phase), ovary and follicle preparing for release of an ovum (stage 2 = follicular phase), ovulation (stage 3 = ovulation phase), propellation of the ovum towards the uterus (stage 4 = luteal phase)
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8
Q

define: ovulation

A
  • process by which the ovum is expelled from the follicle and is drawn into the fallopian tube
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9
Q

define: conception

A

same as fertilization?

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10
Q

define: fertilizization

A
  • fertilization of an ovum by sperm when a sperm penetrates the ovum membrane
  • results in a zygote, with half the genetic material from the ovum and half from the sperm
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11
Q

define: implantation and when does this occur

A
  • the embedding of a blastocyst in the endometrium of the uterus
  • begins about the seventh day after fertilisation of the ovum
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12
Q

define embryonic period; what occurs during this time?

A
  • stage between weeks 3 and 8 after fertilization
  • during this time, differentiation of body systems and organs occurs
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13
Q

what is a major concern during the embryonic period

A
  • teratogenicity because all external and internal structures are developing
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14
Q

define: fetal period

A
  • the final stage of development beginnig on the 9th week after fertilization until birth
  • period of signif fetal growth
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15
Q

at the time of implantation, two fetal membranes that will surround the developing embryo begins to form. what are they

A
  • chorion
  • amnion
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16
Q

the chorion forms from?

A
  • from trophoblast cells
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17
Q

define the chorion membrane, what does it contain, what does it blend with?

A
  • outermost fetal membrane
  • blends w placenta, lines fetal side of placenta
  • contains the major umbilicial blood vessels
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18
Q

describe the amnion membrane, what does it become and help form

A
  • inner fetal membrane
  • becomes the covering of/blends w the umbilical cord and helps form the amniotic cavity filled w amniotic fluid
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19
Q

the amnion forms from?

A
  • inner cells of blastocyst
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20
Q

describe amniotic fluid and what it’s derived from

A
  • fluid inside the amniotic cavity which is derived from maternal blood thru diffusion, fluids secreted by the GI/GU and resp tract of the fetus
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21
Q

what are the function of amniotic fluid (7)

A
  • thermoregulation
  • prevent embryo from tangling w membranes, facilitating symmetrical growth
  • barrier to infection
  • allows freedom of movement for MSK development
  • cushion to protect fetus and umbilical cord from trauma
  • source of oral fluid and a repository for waste
  • enhance fetal lung development
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22
Q

what 2 tests can be done using amniotic fluid

A
  • amniocentesis
  • LS ratio
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23
Q

what can an amniocentesis tell you

A
  • identify chromosomal abnormalities
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24
Q

what does LS ratio tell you? when is this test done

A
  • used to measure lung surfactant
  • tells us if there is sufficient surfactant to breathe on their own
  • done if worried about pregnant person going into pre-term labor
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25
Q

what is a normal amount of amniotic fluid? abnormal?

A
  • normal: 700-1000 mL
  • abnormal: <300, >2L
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26
Q

what is a concern w an abnormal amt of amniotic fluid

A
  • can cause abnormalities w fetus
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27
Q

describe the umbilical cord

A
  • cord that provides the embryo w maternal nutrients, oxygen, contains blood vessels,
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28
Q

the umbilical cord is surrounded by? what is the function of this?

A
  • warton’s jelly
  • protects umbilical cord from compression
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29
Q

describe the placement of the umbilical cord

A
  • should be in center of placenta
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30
Q

what is the diameter of the umbilical cord at term? average length?

A
  • diameter: 2cm
  • length: 30-90cm
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31
Q

at what week does the connecting stalk to the embryo become the umbilical cord

A
  • week 5
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32
Q

how long is pregnancy in calendar months? lunar months? days? weeks?

A
  • spans 9 calendar months
  • 10 lunar months of 28 days (280 days total)
  • 40 weeks from the 1st day of the last menstrual period
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33
Q

what is the length of each of the 3 trimesters of pregnancy?

A
  • 1st: weeks 1-13
  • 2nd: weeks 14-26
  • 3rd: weeks 27 through to term
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34
Q

how many stages of fetal development are there? what is each one called?

A
  1. pre-embryonic stage
  2. embryonic stage
  3. fetal stage
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35
Q

how long is the pre-embryonic stage

A
  • fertilization to end of 2nd week
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36
Q

what occurs in the pre-embryonic stage of fetal development (6)

A
  • fertilization
  • cleavage
  • morula
  • blastocysts
  • trophoblast
  • implantation
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37
Q

where does fertilization occur?

A
  • in the outer 1/3 of the fallopian tube
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38
Q

after fertilization occurs, what happens?

A
  • cleavage = cells rapidly divide but don’t get bigger
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39
Q

by day 3, the cells become known as?

A
  • morula
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40
Q

by day 4, what occurs?

A
  • cells have organized into an early blastocyst
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41
Q

by day 6-10, what occurs?

A
  • blastocyst implants into endometrium
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42
Q

what are the outer cells of a blastocyst called? what is the function of these cells?

A
  • trophoblast cells
  • fnxn: secrete enzymes which allow blastocyst to invade and attach to endometrium
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43
Q

after ovulation, a piece is leftover. what is this called and what kind of structure is it

A

= corpus luteum
- endocrine structure which is imp if pregnancy occurs

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44
Q

if fertilization occurs, what happens r/t corpus luteum

A
  • fertilized eggs secretes the hormone hCG
  • hCG tells corpus luteum it needs to stick around and produce estrogen and progesterone
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45
Q

what role does estrogen and progesterone have when produced by corpus luteum? (4)

A
  • helps prep for pregnancy
  • increases blood flow
  • increases vascularity
  • produce nutrients
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46
Q

how long does the corpus luteum produce estrogen and progesterone

A
  • until ~12 weeks when the placenta takes over
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47
Q

after implantation, the endometrium (lining of uterus) becomes..

A
  • decidua
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48
Q

how long is the embryonic stage of fetal development

A
  • end of 2nd week through 8th week
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49
Q

what occurs in the embryonic stage of fetal development, what is this called

A
  • basic structures of major body organs and main external features are developed = organogenesis
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50
Q

when is organogenesis complete

A
  • by end of the 8th week
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51
Q

what stage of fetal development is the fetus most susceptible to malformations

A
  • embryonic stage
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52
Q

when is the fetal stage of fetal development

A
  • end of 8th week until birth
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53
Q

congenital disorders may be.. (2)

A
  • inherited
  • or caused by enviro factors
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54
Q

what are 4 categories of nongenetic factors that influence fetal development

A
  • teratogens
  • maternal nutrition (ex. low FA)
  • SDoH (ex. income –> poor nutrition)
  • advanced maternal age
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55
Q

what are examples of teratogens that influence fetal development (5)

A
  • drugs and chemicals, alcohol
  • oral isotretinoin (acne med)
  • infections: rubella, varicella
  • radiation: xrays, CT scans
  • maternal health consitions: ex. diabetes –> hyperglycemia (esp. in embryonic period)
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56
Q

what is the placenta

A
  • the site of “respiration, nutrition, excretion, and storage” for the fetus
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57
Q

what are the 2 sides of the placenta?

A
  • fetal side (chorion frondosum)
  • maternal side (decidua basalis) which is dividided into lobules (cotyledons) on the uterine side
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58
Q

how do substances transfer across the placenta? what substances will transfer

A
  • thru diffusion
  • not only substances we want (ex. glucose) and ones we dont want (ex. teratogens)
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59
Q

the placenta has an endocrine function. what are the hormones of the placenta? (6)

A
  • progesterone
  • placental lactogen
  • estrogen
  • relaxin
  • B-hCG
  • infant growth factors (IGFs)
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60
Q

describe the mixing of blood between the pregnant person and fetus

A
  • there is no mixing of blood
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61
Q

by the 5th month of pregnancy, what is between the pregnant person and fetus

A
  • only a single cell layer between them
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62
Q

what are the functions of the placenta (5)

A
  • endocrine function
  • site of disposal
  • transfer of substances
  • store nutrients
  • site of excretion
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63
Q

what hormones does the placenta produce? (6)

A

produces hormones:
- progesterone
- placental lactogen
- estrogen
- relaxin
- B-hCG
- infant growth factors

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64
Q

if the placenta doesn’t implant properly, what can happen?

A
  • spontaneous abortion
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65
Q

describe the role of the placenta and umbilical cord in fetal circulation

A
  • The placenta accepts the blood without oxygen from the fetus through blood vessels that leave the fetus through the umbilical cord (umbilical arteries, there are two of them)
  • When blood goes through the placenta it picks up oxygen.
  • The oxygen rich blood then returns to the fetus via the third vessel in the umbilical cord (umbilical vein).
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66
Q

what are 3 important structures in fetal circulation

A
  • ductus venosis
  • foramen ovale
  • ductus arteriosis
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67
Q

what is the role of ductus venosis in fetal circulation

A
  • shunt that allows oxygenated blood from the umbilical vein to partially bypass the liver and connect to inferior vena cava
  • closes after birth
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68
Q

where is the foramen ovale located

A
  • openning between the RA and LA of the heart
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69
Q

what is the role of foramen ovale in fetal circulation

A
  • allows the oxygen rich blood to go from the right atrium to left atrium , without going into the lungs first (since fetus isn’t using own lungs to oxygenate blood)
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70
Q

where is the ductus arteriosis located?

A
  • opening from the pulmonary artery to aorta
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71
Q

what is the role of ductus arteriosis in fetal circulation

A
  • sends the oxygen poor blood to the organs in the lower half of the fetal body.
  • helps shunt mixed (oxygenate and deoxygenated) blood directly into the aorta where it will eventually travel to the umbilical arteries and back to the placenta.
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72
Q

what occurs during fetal maturation (3)

A
  • viability
  • resp system
  • fetal circulation
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73
Q

what is fetal viability

A
  • the capability of fetus to survive outside uterus
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74
Q

what is the threshold for fetal viability

A
  • 22-25 weeks
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75
Q

fetal viability has limitations based on…

A
  • CNS function and oxygenation capability of lungs
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76
Q

what occurs during fetal maturation r/t resp system

A
  • pulmonary surfactants in fetal lung
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77
Q

at what point is there a sufficient quntity of pulmonary surfactants? what happens before then?

A
  • at 35 weeks there is sufficient quantity
  • before then, will not be able to breathe on its own
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78
Q

what occurs during fetal maturation r/t fetal circulatory system (3)

A

optimization of transfer of O2 from parent to fetus by:
- fetal HGB carriers more O2 than parental HGB and high HGB concentration
- fetal HR is higher than parental HR

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79
Q

what hormones are present during pregnancy (7)

A
  • human chorionic gonadotropin (hCG or BhCG)
  • estrogen
  • progestrone
  • relaxin
  • human placental lactogen
  • oxytocin
  • prolactin
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80
Q

what is hCG

A
  • biochemical marker of pregnancy (not definitive)
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81
Q

what role does estrogen have in pregnancy (4)

A
  • increases blood flow
  • increases uterine mass
  • vascularization
  • prep breast tissue for lactation
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82
Q

what role does progesterone have in pregnancy (4)

A
  • SM relaxation
  • stimulates growth of blood vessels
  • helps w implantation process
  • stimulates glands to secrete nutrients
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83
Q

what role does relaxin have in pregnancy (3)? When is it highest?

A
  • relax walls of uterus to prevent contractions
  • relaxes maternal blood vessels
  • relax ligaments in pelvis
  • highest in 1st trimester
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84
Q

what role does human placental lactogen have in pregnancy

A
  • insulin antagonist = increases BG for fetus
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85
Q

what role does oxytocin have in pregnancy (2), what is it produced and secreted by?

A
  • produced by hypothalamus
  • secreted by posterior pituitary
  • acts in contractions
  • stimulates milk let down
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86
Q

what role does prolactin play in pregnancy (2)? What is it secreted by

A
  • promote growth of breast tissue & mammary gland development
  • milk production
  • secreted by anterior pituitary
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87
Q

what are the 3 categories of signs of pregnancy

A
  • presumptive
  • probably
  • positive
88
Q

what are presumptive signs of pregnancy? examples of them? (4)

A

pt’s subjective symptoms that may be associated w pregnancy
- amenorrhea
- breast tenderness
- NV
- urinary frequency

89
Q

what are probable symptoms of pregnancy? what are examples? (5)

A

signs that can be assessed by the providers, physical assessment findings
- positive pregnancy test
- uterine enlargement
- Hegar’s sign
- Goodell’s sign
- Chadwick’s sign

90
Q

what is Hegar’s sign

A
  • softening of the uterus
91
Q

what is Goodell’s sign

A
  • softening of the vaginal portion of the cervix
92
Q

what is Chadwick’s sign

A
  • bluish discoloration of the vagina, vulva, and cervix
93
Q

what are positive signs of pregnancy? what are examples? (3)

A

signs of pregnancy that can only be present if there is a fetus pregnant
- fetal heart rate (FHR) auscultation
- fetal movement palpated by provider
- US of fetus

94
Q

what contributes to changes in uterus during pregnancy

A
  • estrogen
  • progesterone
  • then d/t growing fetus
95
Q

what physiological changes r/t uterus occur during pregnancy (7)

A
  • enlarges
  • decidua developments
  • uterus elongates
    -rises out of pelvis into abdomen
  • changes in contractility –> Braxton hicks contractions
  • uteroplacental blood flow increases ++
  • changes related to fetal presence –> Ballottement
96
Q

what are Braxton hicks contraction

A
  • tightening in your abdomen that comes and goes
  • painless, irregular, stop with exercise
  • occurs at 16 weeks
97
Q

what is Ballottement

A
  • a palpatory technique, in which the uterus is pushed with a finger to feel whether a fetus moves away and returns again
98
Q

what physiological changes r/t cervix occur during pregnancy (3)

A
  • hypertrophy
  • hyperplasia
  • increased vascularity
99
Q

what physiological changes r/t vagine and vuvla occur in pregnancy? (5)

A
  • chadwick sign
  • leukorrhea
  • increased thickness of mucous
  • increased vascularity and sensitivity
  • relaxation of CT
100
Q

what physiological changes to the breasts occur during pregnancy (6)

A
  • growth and development of mammary glands by mid pregnancy = fullness, heaviness, breasts more lobular
  • heightened sensitivity from tingling to sharp pain
  • areolae become more pigmented
  • dilation of blood vessels in breasts visible
  • colostrum may be present and expressed at 16 weeks or later
  • lactation does not occur until after birth (due to drop in estrogen)
101
Q

what physiological changes r/t CVS occur during pregnancy (7)

A
  • increased CO and blood volume (by 1500mL or 40-50%, peak at 32-34 weeks)
  • increased HR (by 15-20 beats/min)
  • decreased PVR (d/t progesterone) = decreased venous return
  • decreased BP (DBP>SBP) in 1st and 2nd trimester, increases but in normal range at 3rd trimester
  • varicose veins & lower leg & feet edema
  • heart sounds change (d/t increased CO, ex. heart murmur, split S1/S2, audible S3)
  • heart position moves up, rotated forward, and left
102
Q

describe supine hypotension, how to avoid?

A
  • compression of superior vena cava = hypotension
  • after 4th months of pregnancy, do not lay directly on back –> tilt to hip
103
Q

what physiological changes r/t resp system occur during pregnancy (10)

A
  • increased O2 consumption
  • increased and tidal volume minute ventilation
  • more O2 available to diffuse across placenta to fetus, decreased CO2 due to efficient exchange of CO2 from fetus to pregnant person
  • no change or slight increase in RR
  • some dyspnea w normal SPO2 common
  • nasal congestion and nosebleeds common
  • increased BMR
  • change in acid-base balance (decreased CO2 and increased O2, decreased HCO3, blood pH increased)
  • elevated diaphragm
  • increased vascularity of mucus membranes
  • ligaments of chest relax
104
Q

decreased CO2 in the pregnant person allows for?

A
  • easier diffusion of fetal CO2 back to mom
105
Q

what physiological changes r/t GU system occur during pregnancy (5)

A
  • increased CO = increased renal flow to kidneys
  • ureters and renal pelvis relax & dilate = slow urine flow, larger volume urine retained
  • urinary freq and urgency (but should be no burning)
  • increased risk of UTIs and pyelonephritis (due to stasis of urine)
  • urine dip should be clean w no leukocytes, glucose, ketones, blood, or protein
106
Q

what is the best position to promote optimal renal flow

A
  • side lying
107
Q

what physiological changes r/t GI system occur during pregnancy (8)

A
  • increased intra-abdominal pressure
  • relaxed lower esophageal sphincter (r/o heartburn)
  • delayed gastric emptying (d/t decreased smooth muscle tone)
  • increased incidence of gallstones, gallbladder stasis, and cholecystitis
  • decreased GI motility = risk of constipation
  • reflux symptoms
  • hemorrhoids common
  • NV in first trimester (associated w high lvls of hCG)
108
Q

what physiological changes r/t integ system occur during pregnancy (6)

A
  • increased pigmentation (nipples, areolae, axillae, vulva, melasma, linea nigra)
  • stretching of skin (stretch marks, palmar itching)
  • increased hypertrophy and vascularity –> gums may bleed
  • hair and nail changes (vary by person)
  • increased perspiration
  • acne may worsen
109
Q

what physiological changes r/t hematologic system occurs in pregnancy (7)

A
  • decreased HGB = anemia (dilutional effect d/t more increased plasma than RBCs)
  • increased blood volume = increased RBCs
  • increased clotting factors = increased risk of DVT and PE
  • increased leukocytes, but decreased function
  • humoral immunity increases antibodies available to be transferred across placenta = pregnant person more susceptible to viruses and pathogens
  • spleen enlargment
  • may have less symptoms from autoimmune disease
110
Q

what is normal hemoglobin in pregnancy vs non-pregnancy? what lvl makes us consider true anemia that requires further investigation and possibly treatment?

A
  • normal hgb in pregnancy: > 110 g/L
  • normal hgb in nonpregnancy: 120-160
  • possible anemia: < 110
111
Q

what is normal hct lvl in pregnancy? nonpregnancy? what lvl makes us consider true anemia?

A
  • normal in pregnancy: >0.33
  • normal in non-pregnancy: 0.37-0.47
  • consider anemia: <0.32
112
Q

what are S&S of anemia

A
  • pale
  • fatigue
  • SOB
  • increased HR
  • weakness
113
Q

what is the most common form of anemia in pregnancy

A
  • iron deficiency anemia
114
Q

what is the concern of going into birth with low hgb

A
  • have low reserves for blood loss
115
Q

what are risk factors for anemia? (4)

A
  • poverty
  • short span between pregnancy
  • eating disorder
  • adolescents
116
Q

what can be included in mngmt of anemia (5)

A
  • iron supplement
  • diet (meat –> heme)
  • blood transfusion
  • orange juice, vitamin C (increased absorption of iron)
  • education
117
Q

what physiological changes occur r/t MSK system in pregnancy (7)

A
  • increased weight
  • change in posture
  • pelvis tilt forwards (shifts center of gravity)
  • ligament laxity, joint laxity
  • ligaments and muscles of mid and low back strained
  • abdominal wall muscles stretch
  • feet may enlarge and/or become flatter
118
Q

what are S&S of normal NV (7)

A
  • not projectile vomitting
  • not signs of shock (tachycardia, no decreased BP)
  • normal VS
  • no blood/coffe emesis
  • no electrolyte imbalances
  • weight stable
  • no pain
119
Q

what are S&S of abnormal NV (10)

A
  • protracted vomiting
  • requires IV fluid rehydration
  • constant nausea
  • electrolyte imbalance
  • changed VS (increased HR, low BP)
  • signs of dehydration
  • weight loss
  • pain
  • fever
  • hyperemesis gravidum
120
Q

what is included in nursing interventions for NV in pregnancy (11)

A
  • assessment oif NV –> OPQRSTU
  • color of emesis
  • weight
  • VS
  • signs of dehydration
  • pain
  • fever
  • order labs to assess for electrolyte imbalance
  • assess emotional wellbeing
  • how NV impacting ability to function
  • meds
121
Q

describe education for NV in pregnancy (5)

A
  • NV common in 1st trimester
  • small, freq, bland meals
  • avoid nausea triggers
  • teach about what is not normal
  • rest
122
Q

expected weight gain in pregnancy depends on…

A
  • your start BMI
123
Q

when is most of pregnancy weight gained?

A
  • during 2nd and 3rd trimester
124
Q

for a BMI of 18.5-24.9 “normal weight”, what is the expected weight gain>

A
  • 11.5-16 kg or 25-35 lbs
125
Q

where are different places weight goes during weight gain in pregnancy? (6)

A
  • extra blood, fluids, and protein
  • breasts and energy stores
  • uterus
  • placenta
  • baby
  • amniotic fluid
126
Q

what social determinants of health can impact prenatal care (4)

A
  • income and socioeconomic status
  • culture
  • education and literacy
  • access to health services
127
Q

describe the importance of nutrition during pregnancy (2)

A
  • good nutrition before and during pregnancy is an important preventive measure
  • a pregnant person’s nutrition and lifestyle affect the long-term health of their children
128
Q

inadequate nutrition can lead to an increase in: (2)

A
  • low birth weight infants (2500g or less)
  • preterm infants
129
Q

what are barriers to obtaining prenatal care (8)

A
  • inadequate number of providers
  • unpleasant facilities or procedures
  • inconvenient clinic hours
  • distance to facilities
  • lack of transportation
  • fragmentation of services
  • inadequate finances
  • personal attitudes
130
Q

which individuals are at an increased risk for adverse outcomes in pregnancy? (2)

A
  • adolescents (15 or younger)
  • advanced maternal age (>35 years)
131
Q

describe the frequency of prenatal visits until 30 weeks, from 30-36 weeks, from 36 weeks to delivery

A
  • q4-6 weeks until 30 weeks
  • q2-3 weeks from 30-36 weeks
  • q1 week from 36 weeks to delivery

=~12 visits

132
Q

when is the initial prenatal visit recommended

A
  • just after first missed period and confirmation of pregnancy w urine test
133
Q

what 3 main things happen at the initial prenatal visit

A
  • interview
  • physical exam
  • lab tests
134
Q

what info is collected during the interview portion of the initial prenatal visit (9)

A
  • past medical and surgical history
  • prescription and non-prescription meds (OTC, herbal, supp)
  • family history (genetic disorders, birth defects, multiple gestations, close relations)
  • social history (smoking, drugs, IPV, nutrition)
  • obstetrical history (prior pregnancies, GTPAL)
  • history present pregnancy (bleeding, leaking, NV, syncope, dysuria)
  • review of systems
  • occupational and experientatial history
  • history of physical or sexual abuse
  • EDD
135
Q

what does GTPAL stand for

A
  • Gravida (total # of pregnancies of any gestation, includes non viables, twins/multiples=1)
  • Term births (# of deliveries >37 weeks)
  • Preterm births (20 weeks - 36 weeks + 6 days)
  • Abortion (# deliveries < 20 weeks, induced or spontaneous)
  • Living Children
136
Q

what is assessed during the physical examination of the initial prenatal visit (8)

A
  • appearance
  • mental status
  • height
  • weight
  • BMI
  • BP, HR, RR, temp
  • HEENT, CVS, RESP, ABD, other PE as required
  • gestational age will determine fetal assessment required
137
Q

what is gestational age?

A
  • from 1st day of late menstrual period (LMP
138
Q

how is estimated due date calculated

A
  • Naegele’s rule: 1st day of LMP - 3months + 7 days + 1 year
  • or LMP + 7 days + 9 months
  • most give birth from 7 days before to 7 days after EDD
139
Q

what is assessed r/t lab tests during the initial prenatal visit (7)

A
  • confirm probable pregnancy with hCG
  • serology for CBC
  • STI screening (GC/CT swab and serology) –> everyone
  • blood type
  • Rh and antibody screen
  • titres for rubella and varicella (check if any immunity)
  • UA and C&S
140
Q

subsequent prenatal visits include: (4)

A
  • interview for new symptoms, emotional wellbeing or concerns
  • fetal movements (after 24+ weeks)
  • physical exam
  • fetal assessment
  • document on MB health record
141
Q

what is assessed in the physical exam at subsequent prenatal visits? (5)

A
  • weight, height, BMI
  • general appearance and mental status
  • VS
  • urine dip for glucose, protein, leukocytes
  • midstream urine (MSU) for culture
142
Q

what is assessed in a prenatal care fetal assessment (4)

A
  • FHR
  • SFH (symphysial fundal height)
  • fetal movements
  • leopold’s maneuvers
143
Q

when can FHR start to be assessed? how often should it be assessed?

A
  • at 10-12 weeks with a Doppler
  • once detectable, should be checked every prenatal visit
144
Q

what is a regular FHR? how does it differ from adult HR? how long should you count it?

A
  • between 110-160
  • varies more than the adult heart rate
  • count for 1 full min
145
Q

when can SFH begin to be measured

A

at 20 weeks

146
Q

how is SFH measured? what does its measurement typically correspond to?

A
  • in cm from top of the pubic bone to top of the fundus
  • corresponds typically to weeks of gestational age +/- 2 cm
    ex. 20 cm = 20 weeks
147
Q

when should SFH be measured

A
  • at every prenatal visit
148
Q

why is it important to measure SFH

A

-used as a measurement of fetal growth once the uterus leaves the pelvic cavitiy

149
Q

at what point does fundal height no longer correspond to gestational age?

A
  • once lightening (dropping of the fetus into the pelvic cavity) occurs at around 36 weeks
150
Q

when do we start to assess fetal movements

A
  • starts at time when movements felt regularly
  • variable, by 24 weeks should be felt
151
Q

what are leopold’s maneuvers? what is it used for? when can this be started?

A
  • series of four maneuvers used to determine the position and presentation of your baby in-utero
  • used to locate back of fetus & we know where to put doppler for HR
  • start at 30-32 weeks
152
Q

what are 4 parts of leopold’s maneuvers

A
  1. palpate fetal part at the fundus (or the farthest away from the pelvic inlet) –> head or bum?
  2. determine the location of the fetal back
  3. palpate to determine the presenting part
  4. palpate for the attitude of the presenting part (flexed or extended?
153
Q

what is a good indicator of fetal health? what is a form measurement of this?

A
  • fetal movement
  • kick count is a formal measurement
154
Q

when is kick count done?

A
  • in cases where there is reason to suspect placental insufficient or in other high-risk pregnancies
  • from 26-32 weeks, mom should be asked to set aside a time to count fetal movements each day
155
Q

how often should the fetus move?

A
  • 6 times in 2 hours
156
Q

what should the pregnant person be counseled to do if she suspects decreased movements

A
  • do a kick count
157
Q

what are some reasons for decreased fetal movements? (4)

A
  • hunger/thirst
  • sleep cycle of fetus
  • amniotic fluid decreased
  • death of fetus
158
Q

what imaging test is often used in pregnancy?

A
  • ultrasound
159
Q

what is US used for in pregnancy (11)

A
  • confirm & date pregnancy
  • verify intrauterine pregnancy
  • verify # of fetuses
  • detect fetal cardiac activity
  • measure fetal growth
  • assess fetal anatomy/detect fetal anomalies
  • measure amniotic fluid volume
  • determine fetal position
  • determine placental position
  • assess placental functioning
  • measure cervical length
  • measure nuchal translucency
  • adjust to invasive procedures
  • confirm if in uterus (rule out ectopic)
160
Q

describe the nursing role in use of US in pregnancy (2)

A
  • educate pregnant person on rationale/purpose of test
  • position w towel or wedge under right hip to avoid supine hypotension
161
Q

4 weeks and onward, what labs/diagnostics are done and why?

A
  • urine or serum hCG to confirm probable pregnancy
162
Q

from 10-12 weeks, which labs and diagnostics are done and why (6)

A
  • CBC –> check for anemia
  • blood type, Rh, antibody screen –> document blood type, Rh status, presence of antibodies
  • MSU C&S, UA –> r/o UTI, and glucose or protein in urine
  • cervical swab Gc & CT–> r/o gonorrhea and chlamydia infection
  • serology: HIV, HEP B, syphilis –> r/o bloodborne infection
  • titres for rubella and varicella –> determine if immunity to rubella and varicella
163
Q

which optional labs & diagnostic testing is done in the prenatal period?

A
  • TB testing
  • other infections
164
Q

what labs/diagnostic is done from 10-14 weeks of pregnancy and why?

A
  • US for nuchal translucency –> imaging that detects fluid at back of fetal neck (increased risk for chromosomal abnormality)
165
Q

what labs/diagnostics are done during 10-16 weeks of pregnancy and why?

A
  • US –> dating of pregnancy
166
Q

what labs/diagnostics are dnoe during 15-20 weeks + 6 days of pregnancy and why

A
  • maternal serum screening (AFP, hCG, estriol, inhibin A) –> screening test to determine if increased risk for neural tube defects/chromosomal abnormalities
167
Q

what lab/diagnostic is done from 18-22 weeks? why?

A
  • US –> placental placement, fetal anatomy, fetal growth, gestational age, # of fetusus
168
Q

what labs/diagnostics are done at 28 weeks (4) and why?

A
  • OGTT 50 gm –> screen for GDM
  • repeat CBC –> screen for anemia
  • repeat STBBI –> screen for STBBI
  • repeat Rh and antibody screen (if Rh negative) –> screen for antibodies, prophylaxis to be provided to Rh neg
169
Q

what labs/diagnostic are done from 35-37 weeks

A
  • GBS vaginal/perianal swab –> screen for presence of GBS
170
Q

when is screening for gestational diabetes completed (2)

A
  • for all pregnant people between 24-28 weeks’ gestation
  • if there is a high risk of GDM based on clinical factors, screening should be offered at any stage in pregnancy
171
Q

describe the preferred approach to screen for GDM

A
  • 50 g glucose challenge test with PG (plasma glucose) 1 hr later
172
Q

what PG after 50g glucose challenge is normal? what should you do after finding this lab value?

A
  • <7.8
  • reassess at 24-28 weeks if tested earlier
173
Q

what should be done with a PG of 7.8-11 mmol after a 50g glucose challenge?

A
  • 75g OGTT measure FPG, 1hPg, 2hPG
174
Q

what FPG, 1hPG, and 2hPG values indicate GDM?

A
  • FPG: >5.3
  • 1hPG: >10.6
  • 2hPG: >9
175
Q

what does a PG of >11.1 after a 50g glucose challenge mean?

176
Q

what is isoimmunization

A
  • normally, a pregnant person’s & fetal circulation is seperated –> if if a pregnant person’s circulation is exposed to fetal circulation, they can develop antibodies against the antigen on fetal RBC = an issue in future pregnancy
  • condition that happens when a pregnant woman’s blood protein is incompatible with the baby’s, causing her immune system to react and destroy the baby’s blood cells.
177
Q

isoimmunization is a concern for…

A
  • Rh negative pregnant person carrying Rh positive fetus
178
Q

what can isoimmunization result in

A
  • fetal hemolytic anemia
179
Q

how do we prevent isoimmunization

A
  • giving the pregnant person Rh IgG 300 mcg (if antibody screen is negative) routinely at 28 week and within 72 hours of the birth of Rh POS infant
180
Q

what is amniocentesis? when and how it it done?

A
  • A procedure performed during pregnancy to obtain amniotic fluid to test for chromosomal abnormalities and fetal infections.
  • done at 15 weeks on
  • US guided transabdominal extraction of amnitoic fluid
181
Q

when is Chorionic Villus Sampling done? how?

A
  • at 10-12 weeks
  • US guided biopsy of chorion (transabdominal or transcervical)
182
Q

when should pregnant people be screen for syphilis?

A
  • at initial prenatal visit
  • 28 weeks
  • at delivery
183
Q

how can syphilis be transmitted to the fetus? (2)

A
  • thru the placenta blood supply to the fetus in utero
  • or from contact w a lesion during birth
184
Q

what can syphilis in the fetus cause? (8)

A
  • still birth
  • premature birth
  • issues w placenta structure
  • hepatomegaly
  • rhinitis
  • rash
  • generalized lymphadenopathy
  • bone abnormalities
185
Q

what is included in treatment of syphilis

A
  • penicillin
186
Q

what prenatal education should be given (9)

A
  • vitamins (FA, prenatal vitamins)
  • exercise
  • nutrition
  • encourage abstitence from drugs, alcohol, smoking
  • childbirth and breastfeeding prep classes
  • upcoming diagnostic tests
  • to attend all prenatal appointments
  • safe food prep, foods to avoid, dental health
  • common physical changes and discomforts relevant to trimester
187
Q

what foods should be avoided during pregnancy (5)

A
  • sushi
  • deli meat
  • raw meat
  • unpasteruized food
  • some teas
188
Q

what signs should a pregnant person be educated on for when to seek help? (*8)

A
  • vaginal bleeding or leaking
  • abdominal cramping
    -fever
  • dysuria
  • headaches
  • visual distrubance
  • persistent vomiting
  • decreased fetal movements
189
Q

which vaccines are safe in pregnancy

A
  • influenza recommended
  • tdap between 27 and 36 weeks
190
Q

which vaccines are not safe during pregnancy

A
  • live vaccines
191
Q

define gravida

A
  • person who is pregnant
192
Q

define gravidity

193
Q

define multigravida

A
  • person who has had two or more pregnancies
194
Q

define multipara

A

person who has completed two or more pregnancies to 20 weeks gestation or more

195
Q

define nulligravida

A
  • person who has never been pregnant
196
Q

define nullipara

A

person who has not completed a pregnancy with fetus or fetuses beyond 20 weeks gestation

197
Q

define parity

A

number of pregnancies in which fetus or fetuses have reached 20 weeks of gestation, not number of fetuses (ex. twins) born
- not affected by whether the fetus is born alive or stillborn

198
Q

define post-date or post-term

A
  • pregnancy that goes beyond 41 weeks of gestation
199
Q

define preterm

A
  • pregnancy that has reached 20 weeks of gestation but before completion of 36 weeks of gestation
200
Q

define primigravida

A
  • person who is pregnant for the first time
201
Q

define primipara

A

person who has completed one pregnancy w fetus or fetuses who have reached 20 weeks of gestation

202
Q

define term

A
  • pregnancy from beginning of week 37 of gestation to end of week 40 + 6 days of gestation
203
Q

define viability, what point is considered viable

A
  • capacity to live outside the uterus
  • about 22 to 25 weeks of gestation
204
Q

what is Ballottement

A
  • a palpatory technique, in which the uterus is pushed with a finger to feel whether a fetus moves away and returns again
205
Q

when is CBC done (2) and why?

A
  • initial visit
  • 28 weeks
  • screen for anemia
206
Q

when is Rh, blood type, and antibody screen done (2)?

A
  • intial
  • 28 weeks
207
Q

when is STBBI serology done (3)? why?

A
  • initial
  • 28 weeks
  • at delivery
  • screen for HIV, Hep B, syphilis
208
Q

when is gonorrhea and chalmydia swab/urine done? (3)

A
  • initial
  • 28 weeks
  • delivery
209
Q

when is rubella and varicella titres done? why>

A
  • initial
  • determine if immune to rubella and varicella?
210
Q

when is UA done (2)? why?

A
  • initial
  • each prenatal visit
  • screen for bacteria, glucose, protein
211
Q

when is C&S done? why?

A
  • initial
  • screen for bacteria
212
Q

when is urine for hCG done?

213
Q

when is maternal serum screening done? why>

A
  • 15-20 + 6 weeks
  • screen for neural tube defects, chromosomal abnormalities
214
Q

when is US done? why (3)?

A
  • 18-22 weeks

determine:
- placenta placement
- fetal anatomy & growth
- fetal cardiac activity

215
Q

when is OGTT 50g done?

216
Q

when is GBS done

A
  • 35-37 weeks

NURS 4500: Midterm Material (19 decks)

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