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Maternity - 431 > Exam 1 - Nursing Care During Pregnancy > Flashcards

Exam 1 - Nursing Care During Pregnancy Flashcards

1
Q

Human Chorionic Gonadotropin (hCG)

A
    • the earliest biochemical marker of pregnancy
    • Produced by the embryo soon after conception and later by the placenta
    • Can be found in maternal blood and urine
    • hCG level increases until it peaks at about 60-70 days of gestation
  • *** HCG – earliest predictor (but not 100% sure) of pregnancy
    • Guys who got + of pregnancy – need to be checked w cancer

– HCG number increases…… If the number is not climbing right, mom might have miscarriage…

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2
Q

Presumptive Signs of Pregnancy

A
    • Least reliable indicators
    • Subjective

– Example: Amenorrhea, N/V, fatigue, urinary frequency, breast and skin changes, fetal movement, quickening

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3
Q

Probable Signs of Pregnancy

A

– Objective findings

– Example: Abdominal enlargement, cervical softening, changes in uterine consistency, ballottement, braxton hicks, palpation of fetal outline, positive pregnancy tests, vaginal and cervical color changes

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4
Q

Positive Signs of Pregnancy

A
  1. Auscultation of fetal heart sounds
    - 100% assurance of pregnancy
    - 80 beats/min = could be MOM or dying baby
    - 160 beats/min = baby
  2. Fetal movements felt by examiner
  3. Visualization of embryo or fetus in ultra sound
    - As early as 5 wks after missed period
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5
Q

Changes in Uterus

A

Grows in a predictable pattern
o Helps to confirm EDB (expected date of birth)
o Provides info about fetal birth
– 12 weeks extends out of pelvis
– 16 weeks, midway
– 20 weeks, @ umbilicus
– 36 weeks, highest level
– Drops from fetal descent after 36 weeks (lightening)

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6
Q

change in uterus:

LIGHTENING

A

fundus is highest when baby was at 36 THEN at 40 wks comes down to 32 – means baby is ready for delivery – BABY DROPS DOWN THE CANAL

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7
Q

change in uterus:

BRAXTON HICKS (4th month)

A

o Note *** False contraction or FALSE LABOR – feels like contracting but the cervix is not opening
o tell patient to time it…
o Empty bladder
o Drink fluid
o Lay down
o If contractions of >6 in an hour then call Dr or nurse !!

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8
Q

HEGAR SIGN

A

– softening of the lower segment of the uterus

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9
Q

UTERINE SOUFFLE

FUNIC SOUFFLE

A

SOUFFLE means heartbeat

o Babies upper back is where you hear baby’s heartbeat

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10
Q

BALLOTEMENT

A

– when the cervix is tapped, the fetus floats upward in the amniotic fluid. A rebound is felt by the examiner when the fetus falls back.

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11
Q

Changes in Cervix

A 
-- Cervix becomes congested with blood (Chadwick’s sign)
o	Chadwick’s sign –TURNED BLUISH
-	Friable
-	Goodell’s sign 
-	MUCOUS PLUG
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12
Q

MUCOUS PLUG

A

– yellowish that is plugged – to protect fetus from infection; so bacteria can’t invade the baby

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13
Q

GOODELL’s sign

A

– softening of cervix

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14
Q

Chadwick’s sign

A

–TURNED BLUISH bec congested w/ blood

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15
Q

Changes in Vagina and Vulva

A

o Increased vaginal vascularity causes bluish color (Chadwick’s)
o Leukorrhea – a vaginal white, thick discharge present is NORMAL
o Vaginal mucosa thickens and rugae prominent
o Increased amounts of glycogen cause the acidic environment that protects from bacteria but a good medium for yeast – that’s why pregnant mom usually gets yeast infection!!
o Vulva and perineum more pliable due to increased vascularity

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16
Q

Leukorrhea

A

– a vaginal white, thick discharge present is NORMAL

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17
Q

Changes in OVARY

A

– Corpus luteum secretes progesterone for first 6-7 weeks, placenta secretes it thereafter
– Progesterone must be present in adequate amounts from the earliest stages of pregnancy to maintain the pregnancy
– ** When it’s time for birth, the progesterone drops which starts the contraction process**
o Helps to suppress uterine cx
o Helps to prevent tissue rejection of the fetus

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18
Q

Changes in BREASTs

A
  • Estrogen stimulates growth of mammary ductal tissue
  • Progesterone promotes growth of lobules, lobes, and alveoli
  • Become highly vascular
  • Nipples increase in size
  • Increased alveolar pigmentation
  • Montgomery Tubercles
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19
Q

How to correct Inverted/Flat Nipple

A
  • Use Breast Shells to Correct Inverted/ Flat Nipples
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20
Q

Changes in CARDIOVASCULAR:

INCREASE:
plasma vol, blood vol, clotting, CO, Kidney work, Varicose veins

Decrease: PVR

Remain: BP

A
  • Heart enlarges slightly because of increased workload
  • Heart is pushed upward as uterus enlarges
  • Splitting of heart sounds is normal
  • Total blood volume increases 40-50% bec mom will lose blood during delivery !
  • Plasma volume increases by 50% – which sometimes causes Pseudoanemia or FALSE ANEMIA because the increase in plasma dilutes the RBC w/c shows low Hct and low Hgb.
  • Physiologic anemia, pseudoanemia of pregnancy
  • Clotting factors increase
  • CO increases by 30-50%
  • PVR decreases
  • Blood pressure remains stable
  • Kidneys have to work harder to eliminate maternal and fetal wastes
  • 500-800ml/min of blood circulated to the uteroplacental circuit
  • Varicose veins common due to pressure of uterus obstructing blood return from legs
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21
Q

Supine Hypotensive Syndrome

A

o lying supine occludes the vena cava and descending aorta

o side lying position corrects supine hypotension

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22
Q

RESPIRATORY changes

A
    • O2 consumption increases by 15-20%
    • RR remains unchanged, but woman breaths deeper through mild hyperventilation
    • Tidal volume and minute volume increase by 40%
    • Progesterone & Estrogen
        • The more o2 take in the more O2 to the baby
        • bec of Progesterone and Estrogen == that’s why O2 increases

– These are 3rd trimester changes

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23
Q

GI changes:

A

• Nausea common in first trimester
– If nausea absent, increased appetite may be present
• Estrogen causes hyperemia of gums and mouth
• Ptyalism: increased salivation
• Reduced lower esophageal sphincter tone
• Progesterone decreases tone and motility of GI tract
• Decreased emptying time by small intestine
• Gall bladder hypotonic which could lead to gall stones (or right after they had the baby)
• Liver function mildly altered

** Sometimes loosing the nausea is not good,, might lose the baby too bec progesterone causes the N/V

** Gingivitis can lead to premature labor

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24
Q

Changes in Urinary: BLADDER

A

Frequency and urgency of urination 1st trimester (normal) due to:
o Hormonal influences
o Increase in uterine size

Frequency and urgency of urination 3rd trimester:
o Due to large uterus pressing on bladder

    • Bladder capacity doubles by term as the bladder relaxes –so we can hold more longer
    • Bladder more susceptible to trauma and infection
    • Pay close attention to s/s bladder infection b/c could lead to preterm labor!
    • Women who are prone to UTI needs a lot of teaching
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25
Q

Changes in Urinary: KIDNEYS and URETER

A

– Progesterone
o Dilation of renal pelvis and ureters
– Flow of urine through ureters partially obstructed by uterus
o Dilation helps flow
o Stasis can lead to bacterial growth
– Renal plasma flow and GFR increases
– Flow highest when woman in side-lying position (left side to promote blood flow)
– Glycosuria is common bec filtered load of glucose exceeds ability of renal tubules to reabsorb it

  • Mild spilling of protein is NORMAL (bleeding might see protein)
  • Note:
    o These can cause infection
    o Hydrate to flush and prevent infection
26
Q

Changes in INTERGUMENTARY

A

– Increased metabolic rate causes: sweating and the feeling of warmth

– Hyperpigmentation: estrogen, progesterone, and melanocyte-stimulating hormone (melasma, chloasma, mask of pregnancy, linea alba

– Increased vascularity may cause angiomas on face (not cancerous tumors)

    • Striae gravidarum – stretch marks
    • Hair and nail growth increases
27
Q

Changes in MUSCULOSKELETAL System

A

• Calcium stored to meet later needs of fetus
• Does not deplete mother’s stores
• Postural changes
o Due to change in center of gravity
• Widening of symphysis pubis
o Allows more room for head to deliver
o Causes pain in some
• Abdominal Wall weakens and may separate

• Note:
o Mom’s Ca level should NOT be changed !!
o Prone to fall bec of change in stature… center of gravity changes

28
Q

Changes in NEUROLOGIC System

A
  • Sensory changes in legs caused by compression of pelvic nerves
  • Dorsolumbar lordosis may cause pain related to nerve traction or compression
  • Edema may cause carpal tunnel syndrome
    o CARPAL TUNNEL SYNDROME–main s/s: pain spares the pinky
  • Numb hands caused by stooped shoulder stance
  • Light-headedness or faintness usually caused by CV changes
  • Muscle cramps may be caused by hypocalcemia or hypomagnesemia
    o Pain in legs and muscles means low Ca and Mg
29
Q

Changes in Endocrine : PITUITARY

A

o FSH and LH are suppressed
• FSH and LH are not needed bec pt is already pregnant

o Prolactin released

30
Q

Changes in Endocrine : THYROID Gland

A

o Enlarges due to increased vascularity

o Hormones increase, but level off at end of first trimester

31
Q

Changes in Endocrine : PARATHYROID

A

– Calcitonin decreased to allow for calcium needs during pregnancy

32
Q

Changes in Endocrine : PANCREAS

A

– Hypoglycemia common
• Hypoglycemia – need small freq meal

– Tissue sensitivity to insulin decreases r/t hPL

33
Q

Changes in Endocrine : ADRENALS

A

o Aldosterone and cortisol levels elevate

34
Q

Placental Hormones

A
  • hCG
  • Estrogen
  • Progesterone
  • hPL – human placental lactogen
  • Relaxin → changes cavity shape → changes gait
35
Q

Other Changes:

WEIGHT
FLUID
HEMODILUTION (dilution of RBC)

A
  • Weight gain: fetus, placenta, and fluid make up less than half of weight gain during pregnancy
  • Women with normal BMI should gain 25-35 lbs
  • Water needs increase = 3L / day
  • Hemodilution causes dependent edema
  • Carpal Tunnel Syndrome from fluid retention
  • Problems with carbohydrate metabolism
36
Q

Preconception Visit

A
    • Complete history and examination
    • Screening for rubella, varicella, and hepatitis B
    • FOLIC ACID needs before and during pregnancy

Note:
o Can’t get Rubella vaccine while pregnant – need to be immune before pregnancy – can’t give live vaccine to pregnant
o Boost folic acid before getting pregnant

37
Q

Initial Prenatal Visit

A
  • Verify pregnancy
  • Evaluate physical health
  • Assess growth of fetus
  • Establish baseline data
  • Establish trust
  • Evaluate psychosocial needs
  • Negotiate plan of care
  • Note:
    o Initial visit more entail
38
Q

HISTORY to get on 1st visit

A 
	Obstetric: GTPAL 
	Gravida, para
	Menstrual History
	EDD: Naegele’s Rule, gestational wheel
	Contraceptive History
	Medical and Surgical History
	Family History
	Partner’s Health History
	Psychosocial History
39
Q

GTPAL

A

– Gravida: # of pregnancies
– Term: at least 37 weeks gestation
– Preterm: > 20 weeks but < 37 weeks
– Abortion: < 20 weeks, either spontaneously or electively
o SAB- spontaneous abortion (no control of her own)
o EAB- elective abortion
o TAB – therapeutic abortion
– Living: number of living children

40
Q

Initial Physical Exam

A
  • Vital Signs
  • Cardiovascular
    o Venous congestion
    o Edema
  • Musculoskeletal
    o Posture and gait
    o Height and weight
    o Pelvic Measurements
    o Abdomen
  • Skin
  • Neurologic: DTR
  • Endocrine: Thyroid
  • GI: mouth, intestine
  • Urinary: protein, glucose, ketones, bacteria
  • Reproductive: breasts, internal and external reproductive
  • Laboratory
41
Q

Urinalysis

A

checks for:

Protein, gluccose , nitrates, glucosite, ketones (for dehydration)

42
Q

Fundal Height

A

o The number of weeks = the number of centimeters (normal)
o Distance from upper border of symphysis pubis and top of the fundus

– at 20 wks, right on the unbilical

43
Q

Leopold’s maneuvers

A

palpating to feel where the head, back, hands and feet

–to know where to auscultate the heart of baby

44
Q

Signs of Labor

A 
o	6 contraction/ hr
o	Pelvic pressure
o	Leakage of fluid
o	Bleeding
o	104 F – infection causes labor
45
Q

Ultrasound screen

A

at 12-20 weeks

46
Q

Glucose screen

A

at 24-28 weeks

o to check if mom has gestational DM (GDM)

How?
•	Light breakfast
•	Drink nasty syrup
•	After 1 hr, Draw blood
•	if positive for DM, will test again
•	If 2 out of 2 are positive, means MOM is diabetic
47
Q

Isoimmunization

A

???

48
Q

Pelvic exam

A

Pelvic exam during last 4 weeks of pregnancy

49
Q

Pregnancy Milestones in an Uncomplicated Pregnancy

A

5-6 wks – 1st see the heart fluttering on Ultra Sound
10-12 wks – FHR heard on fetoscope/doppler
16-20 wks – Quickening
16-18 wks – MFSFAP – Maternal Serum Alfafetal Protein
– to screen for neural tube defects & Trisomy 21
20 wks – ultrasound
20-24 wks – Viability
26-28 wks – GDM testing
34-36 wks – fetal lung maturity; w/ enough surfactant
36 wk – GBS screening

50
Q

GBS Screening

A

GBS Screening:
– Group Beta Hemolytic Streptococcus
o Normal vaginal/cervical flora in some women
o Can cause sepsis in newborn
o Can lead to infection in mother

– Screened for prenatally at 36 weeks gestation by swabbing the cervix and rectum and culturing the specimen

– Women who are GBS Positive should receive antibiotics during labor (at least 2 IV doses are required and must be given at least 4-6 hours before the baby is born to be effective)
o Penicillin or Clindamycin

      *	Once the water bag breaks (can break in months before delivery), mom gets antibiotic
51
Q

Multifetal Pregnancies

A

Multifetal Pregnancies

  • More likely in woman with personal or family history, older mothers, infertility therapy
  • Greater weight gain and more rapid uterine growth
  • Degree of maternal physiologic change greater with multiple fetuses
  • More frequent antepartum visits
  • Educate early and often about s/s of PTL (preterm labor)
52
Q

Teachings

A

– Bathing important
– No Hot tubs or saunas
– No Douching
– Breast care
– Comfortable Clothing
– Exercise/Kegels
– Sleep and Rest
– Dental Care
* periodontal disease related to Preterm Births
* LBW, and increased risk for preeclampsia
– Sexual activity – no limit
– Nutrition
– Employment
o Maternal safety
o Exposure to teratogens
– Immunizations (live vaccines contraindicated)
– Sleeping Positions – side lying is good for circulation

53
Q

Preventing UTIs

A
  • UTIs common during pregnancy and may be asymptomatic
  • A cause of Preterm Labor
    - Ask if mom is prone to UTI –
    - Need to test bec sometimes asymptomatic
54
Q

Discomforts Related to Pregnancy

A
  • NAUSEA & VOMITING – due to increased hCG and estrogen
  • HEARTBURN bec esophageal sphincter is relaxed
  • BACKACHE
    - Round Ligament Pain
    – can’t take motrin while pregnant – tylenol better
    o More common on right side
  • URINARY FREQUENCY – normal if no burning, urgency, or s/s of UTI
  • VARICOSITIES
  • HEMORRHOIDS – no sitting on the toilet for a long time bec it’s going to get worst
  • CONSTIPATION
  • LEG CRAMPS
    o Low Mg levels are cause
    o Imbalance of calcium and phosphorus
    o dorsiflex your foot to relax the muscle
55
Q

Recognizing Preterm Labor

A

– UTERINE CONTRACTIONS of 6X in an hr (every 10 min)
– Painful or Painless contractions
– Persistent or Intermittent Low Backache
– Lower abdominal cramping
– Suprapubic pain or pressure
– Pelvic pressure or heaviness
– Change in vaginal discharge
– Urinary Frequency
o UTIs
– Bloody Spotting or Leaking of fluid from vagina

56
Q

Goals of Perinatal Education

A
    • Helps parents become knowledgeable consumers
    • Helps parents take and active role in their health, pregnancy, and birth
    • Helps parents to acquire coping techniques to deal with pregnancy, childbirth, and parenting
57
Q

Providers of Education

A
    • Registered Nurses
    • Others certified to become perinatal educators
    • Doulas
58
Q

Types of Classes

A 
	Preconception
	Early Pregnancy
	Exercise
	Childbirth Preparation 
	Refresher Courses
	C-Section Preparation Classes
	VBAC Vaginal Birth After Cessarian – VBAC
	Prone to complications 
	Breastfeeding
	Parenting
	Postpartum
	Siblings
	Childbirth Preparation Classes
59
Q

Methods of Pain Management

A

 Education
 Relaxation
 Conditioning

60
Q

Methods of Childbirth Prep Classes

A

 Dick-Read Method
 Bradley Method
 LeBoyer Method
 Lamaze Method –

61
Q

Lamaze Method

A 
Lamaze Method:
	Exercises
	Relaxation Techniques
	Cutaneous Stimulation 
	Mental Stimulation
	Special Techniques
	Breathing Techniques

Maternity - 431 (4 decks)

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