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CSL Maternity > CSL Day 1 Antepartum > Flashcards

CSL Day 1 Antepartum Flashcards

1
Q

Signs of pregnancy are classified into which three groups

A
  • Presumptive
  • Probable
  • Positive
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2
Q

What do we mean by Presumptive signs of pregnancy?

A

Changes that the client experiences that make them think they might be pregnant
(Subjective/Objective)

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3
Q

Name some of the Presumptive signs of pregnancy

A
  • Amenorrea
  • Fatigue
  • Nausea/vomiting
  • Urinary frequency
  • Breast Changes
  • Quickening
  • Uterine Enlargement
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4
Q

What do we mean by Probable signs of pregnancy?

A

Changes that make the examiner suspect the client is pregnant

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5
Q

Name some of the Probable signs of pregnancy

A
  • Abdominal enlargement
  • Hegar’s sign
  • Chadwick’s sign
  • Goodell’s sign
  • Ballottement
  • Braxton Hicks contractions
  • Positive pregnancy test
  • Fetal outline felt by examiner
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6
Q

What do we mean by positive signs of pregnancy?

A

Signs that can only be explained by pregnancy

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7
Q

What are the positive signs of pregnancy?

A
  • Fetal heart sounds
  • Visualization of fetus by ultrasound
  • Fetal movement
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8
Q

What methods can be used to verify pregnancy?

A

HCG levels in blood tests are most accurate
urine tests can also be used

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9
Q

What is Nageles rule?

A

A method of calculating the due date of an expectant mother.
Take the first day of the clients last menstrual cycle, subtract 3 months, and then add 7 days and 1 year. Adjusting for the year as necessary

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10
Q

What do we use measurement of fundal height for?

A

fundal height in centimeters from the symphysis pubis to the top of the uterine fundus approximates gestational age, plus or minus 2 weeks. (usually used between 18 and 30 weeks)

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11
Q

What is the term Gravidity ?

A

Number of pregnancies

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12
Q

What is Nulligravida?

A

A client who has never been pregnant

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13
Q

What is Primigravida

A

A client in their first pregnancy

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14
Q

What is Multigravida?

A

A client who has had two or more pregnancies

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15
Q

What does the term Parity mean?

A

Number of pregnancies in which the fetus or fetuses reach 20 weeks of pregnancy. Irregardless of whether they are stillborn or livebirth

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16
Q

What does Nullipara mean?

A

No pregnancies beyond point of viability

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17
Q

What does Primipara mean?

A

One pregnancy past point of viability

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18
Q

What is Multipara?

A

Two or more pregnancies to stage of viability

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19
Q

What do we mean by Viability of a fetus?

A

The point at which the infant has the ability to survive outside the uterus. There is not a specific week but 22-25 weeks are considered within the threshold

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20
Q

What does the GTPAL acronym stand for?

A

Gravidity
Term births
Preterm births
Abortions/miscarriages
Living children

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21
Q

How much does a woman’s cardiac output increase by during pregnancy?

A

30-50%

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22
Q

How much does a woman’s blood volume increase by during pregnancy?

A

30-50%

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23
Q

A woman’s pulse is expected to increase during pregnancy, peaking at around 32 weeks pregnant. By roughly how much should she expect?

A

10-15 bpm

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24
Q

How often should a pregnant woman receive prenatal care?

A

initial assessment within 12 weeks if aware of pregnancy
Monthly from weeks 16-28
Every two weeks from weeks 29-36
Weekly from week 37 to birth

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25
Q

What is Hagar’s sign?

A

softening and compressability of lower uterus

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26
Q

what is chadwick’s sign?

A

deepened violet bluish color of cervix and vaginal mucosa

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27
Q

What is Ballottement?

A

rebound of unengaged fetus

28
Q

What is considered Early preterm according to ACOG?

A

37 weeks to 38 6/7 weeks

29
Q

What is considered Full term according to ACOG?

A

39 weeks to 40 6/7 weeks

30
Q

What is considered Late term according to ACOG?

A

41 weeks to 41 6/7 weeks

31
Q

What is considered Post-term according to ACOG ?

A

42 weeks and beyond

32
Q

What type of medications can pose a risk to pregnancy?

A

retinoic acid (acne meds)
anti-epileptic drugs

33
Q

What Medical factors pose a risk to a pregnancy?

A
  • Previous Obstetric difficulties
  • Genetic disorders in mother/father/family
  • Pre-existing medical disorders such as diabetes in mother
  • recurrent illnesses or infections in mother
  • Multiple pregnancy
  • HIV/AIDS/STI
  • Autoimmune disorders
34
Q

What socioeconomic factors can pose a risk to a pregnancy?

A
  • Substance abuse
  • Hazardous working conditions
  • Domestic abuse
  • Food insecurity
  • Homelessness
  • Maternal age (Under 19 or over 40)
35
Q

What nutritional factors can pose a risk to a pregnancy?

A
  • PICA
  • Folic acid deficiency
  • Food allergies
  • Poor diet/ access to food
36
Q

Expected reproductive changes during pregnancy

A
  • Uterus increases in size and changes shape and position.
  • Ovulation and menses cease during pregnancy.
  • Hegar’s sign: softening and compressibility of lower uterus
  • Chadwick’s sign: deepened violet-bluish color of cervix and vaginal mucosa
  • Goodell’s sign: softening of cervical tip
  • Breast changes occur due to hormones of pregnancy, with the breasts increasing in size and the areolas darkening.
37
Q

Expected Endocrine changes in pregnancy

A
  • The placenta becomes an endocrine organ that produces large amounts of hCG, progesterone, estrogen, human placental lactogen, and prostaglandins.
  • Hormones are very active during pregnancy and function to maintain pregnancy and prepare the body for delivery.
38
Q

Expected cardiovascular changes in pregnancy

A
  • Cardiac output increases (30% to 50%) and blood volume increases (30% to 45% at term) to meet the greater metabolic needs.
  • Heart rate increases during pregnancy beginning around week 5 and reaches a peak (10 to 15/min above pre-pregnancy rate) around 32 weeks of pregnancy.
  • The client’s heart changes in size and shape with resulting cardiac hypertrophy to accommodate increased blood volume and increased cardiac output.
  • Pulse increases 10 to 15/min around 32 weeks of gestation and remains elevated throughout the pregnancy.
  • Blood pressure measurements are within the pre-pregnancy range during the first trimester.
  • Systolic: slight or no increase from pre-pregnancy levels
  • Diastolic: slight decreases around 24 to 32 weeks; will gradually return to pre-pregnancy level by the end of the pregnancy.
39
Q

What is Supine Hypotensive Syndrome?

A

Hypotension in the mother caused by pressure of the growing fetus on the Vena Cava when in the supine position. Usually resolved by repositioning mother to the Left lateral lie

40
Q

Expected respiratory changes during pregnancy

A
  • Maternal oxygen needs increase.
  • During the last trimester, the size of the chest might enlarge, allowing for lung expansion, as the uterus pushes upward.
  • Respiratory rate increases and total lung capacity decreases.
  • Respirations are unchanged or slightly increased. Respiratory changes in pregnancy are attributed to the elevation of the diaphragm by as much as 4 cm, as well as changes to the chest wall to facilitate increased maternal oxygen demands. Some shortness of breath might be noted.
41
Q

Expected Musculoskeletal changes during pregnancy

A
  • Body alterations and weight increase necessitate an adjustment in posture.
  • Pelvic joints relax.
42
Q

Expected GI changes during pregnancy

A
  • Nausea and vomiting might occur due to hormonal changes and/or an increase of pressure within the abdominal cavity as the pregnant client’s stomach and intestines are displaced within the abdomen.
  • Constipation might occur due to increased transit time of food through the gastrointestinal tract and, thus, increased water absorption.

* Important to avoid GI stimulants during pregnancy *

43
Q

Expected Renal changes during pregnancy

A
  • Filtration rate increases secondary to the influence of pregnancy hormones and an increase in blood volume and metabolic demands.
  • The amount of urine produced remains the same.
  • Urinary frequency is common during pregnancy.
44
Q

Expected skin changes during pregnancy

A
  • Chloasma: an increase of pigmentation on the face
  • Linea nigra: dark line of pigmentation from the umbilicus extending to the pubic area.
  • Striae gravidarum: stretch marks most notably found on the abdomen and thighs.
45
Q

What is the purpose of CBC test at initial prenatal assessment?

A

Detecting infection and anemia

46
Q

What is the purpose of Blood type nd RH test at initial prenatal assessment?

A

Determines the risk for maternal-fetal blood incompatibility (erythroblastosis fetalis) or neonatal hyperbilirubinemia. Indirect Coombs’ test identifies clients sensitized to Rh-positive blood.

47
Q

If it is determined a mother is RH negative and not sensitized, the indirect Coombes test is repeated at which weeks of gestation?

A

24 and 28

48
Q

Why do we test for rubella immunity during the initial prenatal assessment?

A

Rubella contracted during pregnancy is associated with congenital abnormalities.

49
Q

What education would we provide to a pregnant mother who is not rubela immune?

A
  • Avoid large crowds and people with symptoms of rubella
  • Vaccination should occur post partum
  • Patients should avoid pregnancy for 3 months post vaccination as it is a live vaccine
50
Q

What is the Purpose of UA screening at the initial Prenatal appointment

A

Identifies pregnancy, diabetes mellitus, gestational hypertension, renal disease, and infection.

51
Q

What is the Purpose of pap test screening at the initial Prenatal appointment

A

Used as a screening tool for cervical cancer, herpes simplex type 2, and/or human papillomavirus

52
Q

What is the Purpose of vaginal and cervical cultures at the initial Prenatal appointment

A

Detects streptococcus beta-hemolytic, bacterial vaginosis, or sexually transmitted infections (gonorrhea and chlamydia). Infections are highly associated with preterm labor.

53
Q

Why do we Screen for HIV at the initial antenatal appointment?

A

Can be transmitted from mother to fetus. Transmission prevention is possible through antiretroviral drug therapy.

54
Q

Why do we screen for the Hepatitis B surface antigen at the initital antinatal appointment?

A

can be transmitted from mom to fetus. Can decrease or prevent transmission by giving the Hep B vaccine within the first 12 hours following birth and immunoglobulins.

55
Q

what are TORCH infections and why are we screening for them at the initial antenatal appointment?

A

Screening for a group of infections capable of crossing the placenta and adversely affecting fetal development. Toxoplasmosis, other (syphilis), Rubella, Cytomegalovirus, and Herpes

56
Q

What is RPR or VDL testing and why are we doing this at the initial antenatal appointment?

A

test for syphilis. Syphilis during pregnancy is associated with congenital anomalies.

57
Q

What are the danger signs in the first trimester?

A
  • Hyperemesis gravidarum (excessive vomiting)
  • Fever
  • Abdominal cramping and or vaginal bleeding
  • Burning on urination
  • Diarrhea
  • Anything that can cause dehydration and braxton hicks
58
Q

Where do we listen with doppler for fetal Heartbeat?

A

Midline, right above symphsis pubis by holding doppler firmly on the abdomen. As pregnancy progresses past 8-10 weeks use leopold first to determine best position

59
Q

Which trimester do we begin measuring fundal height?

A

Second

60
Q

When do we begin assessing for fetal movement

A

Between 16 and 20 weeks of gestation

61
Q

what is the Maternal serum alpha-fetoprotein (MSAFP) test and which trimester do we do it in?

A

Screening occurs between 15 to 22 weeks of gestation. (second trimester)
Used to rule out Down syndrome (low level) and neural tube defects (high level).

62
Q

How many weeks of gestation do we administer RhO(D) immune globulin IM

A

28 weeks (second trimester)

63
Q

When is the one hour glucose tolerance test used?

A

At initial prenatal visit for at rist patients and 24-28 weeks for all pregnant patients

64
Q

What is the procedure for the one-hour glucose tolerance?

A
  • oral ingestion with venous sample taken 1 hr later
  • fasting not necessary
  • Identifies hyperglycemia
  • greater than 140 mg/dL requires follow up
65
Q

When is the three-hour glucose tolerance test used?

A

Used in clients who have elevated 1-hr glucose test as a screening tool for diabetes mellitus.

66
Q

What is the procedure for the three hour glucose test?

A
  • fasting overnight prior to oral ingestion or IV administration of concentrated glucose
  • venous sample taken 1, 2, and 3 hr later
  • A diagnosis of gestational diabetes requires two or more elevated blood-glucose readings on the 3-hour glucose tolerance test.

CSL Maternity (14 decks)

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