Exam 1: Chapter 11 and 12 Flashcards
Divide the weeks of pregnancy into their corresponding trimesters
first: week 1 through 13
second: week 14 through 26
third: week 27 through 40
Presumptive signs and symptoms of pregnancy
Amenorrhea (4 weeks)
Fatigue (12 weeks)
Breast tenderness (3 to 4 weeks)
N/V (4 to 14 weeks)
Urinary frequency (6 to 12 weeks)
Hyperpigmentation of skin
Fetal movements (quickening) –> could be gas
Uterine enlargement
Breast enlargement
Probable signs and symptoms of pregnancy
Braxton hicks contractions
Abdominal uterine enlargement
positive pregnancy test
Ballotement
Hegar’s signs: softening of the lower uterine segment or isthmus
chadwicks
Goodell’s sign
Pregnancy test: HCG can be detected as early as ___ to ___ days after conception
7 to 10
Positive signs and symptoms of pregnancy
ultrasound verification
fetal movement felt by experience clinician
auscultation of fetal heart with doppler
What is hegar’s sign
softening of the lower uterine segment or isthmus
What is chadwicks sign
bluish purple coloration of the vaginal mucosa and cervix
Purpose of ultrasound during the first trimester
confirm pregnancy, FHR, date
Purpose of ultrasound during the second trimester
congenital malformation, exclude multifetal pregnancies, verify date and growth, gender
Purpose of ultrasound during the third trimester
fetal size, fetal growth, placenttal position
_______ is the best method of dating a pregnancy
ultrasound
Define term
pregnancy from beginning of week 37 of gestation to end of week 42 of gestation
Define pre-term
less than 37 weeks gestation
Define post-term
more than 42 weeks of gestation
Viability
capacity to live outside uterus
about 22 to 24 weeks since LMP or fetal weight greater than 500 grams
G ?
T
P
A
L
Gravida: number of total pregnancies
G
T ?
P
A
L
term birth: term deliveries that are over 37 weeks gestation
T and P= multiple pregnancies (twins, triplets, etc) count as 1. This is the same for A.
G
T
P ?
A
L
pre term births: pre term deliveries over 20 weeks or viability but before 37 weeks
T and P= multiple pregnancies (twins, triplets, etc) count as 1. This is the same for A.
G
T
P
A ?
L
abortions/miscarriage: the number of pregnancies ending before 20 weeks or viability
T and P= multiple pregnancies (twins, triplets, etc) count as 1. This is the same for A.
G
T
P
A
L ?
Living children
How does the uterus change during the course of pregnancy
pear shape to ovoid shape
increase in size, weight, length
(fundal height by 20 weeks’ gestation at level of umbilicus (20cm))
What is Vena Cava Syndrome
The heavy gravid uterus in the last trimester can fall back against the inferiorvenacavain the supine position, resulting invenacavacompression, which reduces venous return and decreases cardiac output and blood pressure, with increasing orthostatic stress.
What do we tell expecting mothers to do to combat vena cava syndrome
Sleep on their sides never supine
What is colostrum
antibody rich yellow fluid that can be expressed after the 12th week; conversion to mature milk after delivery
GI system adaptations: ptyalism
excessive salivation
GI system adaptations: dental problems
gingivitis
GI system adaptations: gums
hyperemic, swollen, friable
GI system adaptations: ______ peristalsis and smooth muscle relaxation
decreased
_____ + _______ +________ = hemorrhoids
constipation, increased venous pressure, pressure from uterus
______ + ______ = reflux/heartburn
slowed gastric emptying, relaxed cardiac sphincter
Cardiac system adaptations: ______ in CO, venous return, heart rate
increased
Cardiac system adaptations: BP during the different trimesters
1st: remain at pre pregnancy level
2nd: decreases (5 to 10 mmhg)
3rd: returns to the first trimester level
Cardiac system adaptations: _________ in number of RBC
increase by about 30%
plasma volume is still greater than RBC leading to hemodilution and anemia
Cardiac system adaptations: ________ demandes in iron, fibrin and plasma, fibrinogen levels, and some CF leading to…
increase
hypercoagulable state
Cardiac system adaptations: WBC count is
increased –> leukocytosis
Respiratory adaptations: breathing
more diaphragmatic than abdominal
Respiratory adaptations: _____ in O2 consumption
increase
Respiratory adaptations: Congestion secondary to increased vascularity (estrogen) =
epistaxis and rhinitis
Renal/ Urinary system adaptations: _________ in GFR, urine flow, and volume
increase
Renal/ Urinary system adaptations: ______ in kidney activity when a woman lies down, ______ on standing; greater _______ in later pregnancy when the woman lies on her side
increase; decrease; increase
Musculoskeletal system adaptations: Ligaments and joint
soften and stretch
Musculoskeletal system adaptations: posture
increased swayback and upper spine extension
Musculoskeletal system adaptations: center of gravity
shifts forward
Musculoskeletal system adaptations: _____ in lumbarsacral curve
increase
lordosis
Musculoskeletal system adaptations: _____ gait
waddle
Musculoskeletal system adaptations: what can happen to the muscles in our abdomen?
diastasis recti become flaccid and with time the hormones decrease and they strengthen again
Integumentary system adaptations: hyperpigmentation
preogresterone, estrogen, melanocyte stimulating hormone levels
Integumentary system adaptations:
what is the mask of prenancy
facial melasma or cholasma
Integumentary system adaptations:
linae nigra
umbilicus
Integumentary system adaptations:
striae gravidorum
stretch marks reduce connective tissue strenth
Integumentary system adaptations:
varicosities
poor circulation, uterus compression
Endocrine system adaptations: Thyroid
slight enlargement
increased activity
increased vascularity and hyperplasia
maternal thyroid hormone is transferred to the fetus beginning soon after the conception, this is critical for fetal brain development
Endocrine system adaptations: Pituitary gland
decrease in TSH and GH
inhibition of FSH and LH
increase in prolactin, MSH
oxytoxin prodution increass as the fetus matures
Maternal emotional responses: Ambivalence
conflicting feelings is the most common in the first trimester
Maternal emotional responses: introversion
mother become increasingly preoccupied with herself and her fetus
Maternal emotional responses: acceptance
physical changes of the growing fetus, enlarging abdomen and fetal movement bring reality and validity to the pregnancy (2nd trimester)
Sexuality with pregnancy
sexual behavior modifies as pregnancy progresses
during second trimester your labido is up
When are prenatal visits scheduled
every 4 weeks up to week 28
every 2 weeks from week 29 to 36
every week from 37 weeks to birth
What are the main discomforts during the 1st trimester
urinary frequency: decrease fluid in before bedtime, reduce caffeine, kegels
fatigue: attempt full night sleep, side lying position
N/V: eat small frequent meals, bland and low fat
Breast tenderness
Constipation
Nasal stuffiness, bleeding gums, epistaxis
Cravings
Leukorrhea
What are the main discomforts during the 2nd trimester
Backache
Varicosities of the vulva and legs
Hemorrhoids
Flatulence with bloating
What are the main discomforts during the 3rd trimester
Return of the 1st trimester discomforts plus…
SOB
Heartburn and indigestion
Dependent edema
Braxton hicks contractions
Childbirth education: Lamaze (psychoprophylactic) method
focus on breathing and relaxation techniques.
Bradley (partner-coached childbirth) method:
focus on exercises and slow, controlled abdominal breathing.
Dick-Read (natural childbirth) method:
focus on fear reduction via knowledge and abdominal breathing techniques.
Micronutrients:
For fetus…
Iron is essential for
folic acid essential for
fetal growth and brain development
prevention of neural tube defects
Pregnant women intake of
protein
calories
water
80 g/d
2500 cal/d
8 glasses/d
lactating women intake of
protein
calories
water
80 g/d
2700 cal/day
8 glasses/day
What fish do we avoid because they are high in mercury
shark
swordfish
king mackerel
orange roughy
ahi tuna
titlefish
What fish can we eat because they are low in mercury level
shrimp
canned light tuna
pollock
catfish
tilapia
salmon
cod
Maternal weight gain BMI
Below 18.5: underweight
25.0-29.9 overweight
Over 3.0 is obese
