Exam 3 CH 11-16 Flashcards
Chadwick Signs
bluish-purple coloration of the vaginal mucosa and cervix
Goodell Sign
Softening of the cervix
Hegar Sign
softening of the lower uterine segment
or isthmus
Presumptive Signs (subjective)
- fatigue
- breast tenderness/ enlargement
- nausea/vomiting
- amenorrhea
- urinary frequency
- uterine enlargement
- quickening
- hyperpigmentation of skin
Probable Signs (objective)
- Braxton hicks
- positive pregnancy test
- abdominal enlargement
- ballottement ( press the cervix and you can feel the baby go up and down)
- Goodell, Chadwick, Hegar signs
Types of pregnancy test
- stick (yes or no)
- blood (quantitative/ numbered)
3 positive signs of pregnancy
- ultrasound (seeing embryo)
- Auscultation of fetal heart via doppler ( hearing)
- Fetal movement by clinician ( feeling)
T/F
A positive pregnancy test is a positive sign of
pregnancy.
False
Reproductive Adaptations
UTERUS: estrogen causes the uterus to grow, increasing oxytocin receptors and contractions. Hegar sign. 20 weeks fundal height at the umbilicus can determin gestational age until 36 weeks
CERVIX: Goodell sign, mucus plug, Chadwick sign, ripening 4wks before birth
VAGINA: lengthen vagina, secrete leukorrhea, increase vascularity
OVARIES: enlargement until 12-14wk gestation, stop ovulation
BREAST: increase size, nipple size (erect and darker), colostrum production
Lightning (mothers belly drop)
Primate: 1st baby ( 2 weeks before due)
Multip: more than 1 baby. (4 weeks before due)
Orthostatic Hypotension
(mother shouldn’t lay on her back)
The pressure of the uterus on the inferior vena cava.
- light headiness
- dizziness
- getting up too fast
- blurry vision
- fainting
Gastrointestinal System adaptions
- Gums: swollen, friable, hyperemic
- ptyalism: excessive spitting
- dental problems: gingivitis
- constipation, hemorrhoids
- heartburn
- nausea/vomiting (diclegis drug for 1st trimester)
Cardiovascular Adaptations
- increase blood supply ( 50%more prepreg level)
- increased output, venous return, HR
- Increase in number of RBCs; plasma volume > RBC
leading to HEMODILUTION (physiologic anemia) MORE PLASMA THAN RBC (PEPSI & ICE) - Increased clotting factors (hypercoagulable state) due to iron, fibrin, and plasma levels.
When assessing a pregnant woman, which of
the following would the nurse expect to find?
complaints of nausea
Respiratory Adaptations
- Diaphragmatic breathing
- increase oxygen
Renal/ Urinary adaptations
Increase in glomerular filtration rate; increased
urine flow and volume
Musculoskeletal system Adaptations
- Shifting balance
- waddle gait
- lordosis
- relaxing joints and pubis symphysis
Integumentary Adaptions
- hyperpigmentation
- linea nigra ( line on the belly)
- Striae Gravidarum ( stretch marks)
- varicose veins/ spider veins
- increase nail growth , decline in hair growth
- palmar erythema (red hands)
Endocrine system adaptations
- Thyroid gland: slight enlargement; increased activity;
increase in BMR. Pregnancy induced hyperthyroidism
-Pituitary gland: enlargement; decrease in TSH, GH;
inhibition of FSH and LH; increase in prolactin, MSH;
gradual increase in oxytocin with fetal maturation - Pancreas: insulin resistance due to hPL and other
hormones in second half of pregnancy (see Box 11.2) - Adrenal glands: increase in cortisol and aldosterone
secretion - Prostaglandin secretion
- Placental secretion: hCG, hPL, relaxin, progesterone,
estrogen (see Table 11.3)
T/F
Oxytocin is a hormone secreted by the anterior
pituitary gland.
False
Nutrition while pregnant
- not eating for two (only need 300 more calories) breast feeding moms need 500 calories more)
- vitamins/ folic acid
- dietary considerations, like vegetarian, vegan, gluten-free, pica, lactose intolerance.
weight gain
Healthy weight BMI: 25 to 35 lb
o First trimester: 3.5 to 5 lb
o Second and third trimesters: 1 lb/wk
- BMI <19.8: 28 to 40 lb
o First trimester: 5 lb
o Second and third trimesters: +1 lb/wk
- BMI >25: 15 to 25 lb
o First trimester: 2 lb
o Second and third trimesters: 2/3 lb/wk
Maternal Emotional Respinses
- Ambivalence: mixed feelings
- Introversion: focusing only her own body and baby
- Acceptance
- Mood swings
- Changes in body image: embrace or dislike
T/F
Ambivalence is a normal response during the
first trimester of pregnancy.
True
Couvade Syndrome
Dad has pregnancy symptoms
Risk factors for Pregnancy Box 12.2
- Isotretinoins (like Accutane for acne)
- Alcohol misuse
- Antiepileptic drugs (valproic acid): prevent seizures
- Diabetes (preconception)
- Folic acid deficiency
- HIV/AIDS
- Hypothyroidism
- Maternal phenylketonuria
- Rubella seronegative
- Obesity
- Oral anticoagulant
- STI
- Smoking
Healthy mom =
Healthy baby
Obstetric History Terms
GTPAL or TPAL
G, gravida; T, term births; P, preterm births; A, abortions; L, living children
Parity — after 20 weeks
G—the current pregnancy to be included in count
P- Preterm
T—the number of term gestations delivering between 38 and 42 weeks
Para—the number of preterm pregnancies ending >20 weeks or viability but before completion of 37 weeks
A—the number of pregnancies ending before 20 weeks or viability
L—the number of children currently living
First Prenatal Visit
Establishment of trusting relationship
Focus on education for overall wellness
Detection and prevention of potential
problems
Comprehensive health history, physical
examination, and laboratory tests
Comprehensive Health History
Reason for seeking care
o Suspicion of pregnancy
o Date of last menstrual period
o Signs and symptoms of pregnancy
o Urine or blood test for hCG
Past medical, surgical, and personal history
Woman’s reproductive history: menstrual, obstetric,
and gynecologic history
Nagele ‘s rule for calculating due date
- Use the first day of the last normal menstrual period. 10/14/20
- Subtract 3 from the number of months. 7/14/20
- Add 7 to the number of days. 7/21/20
- Adjust the year by adding 1 year. 7/21/21
- Estimated due date (+ or − 2 weeks) = July 21, 2020.
A multipara refers to a woman who is pregnant for
the first time.
False
Gravid
State of being pregnant
Gravida/ Gravidity
The total number of times a woman has been pregnant, regardless of whether the pregnancy resulted in a termination or if multiple infants were born from a pregnancy
Nulligravida
A woman who has never experienced pregnancy
Primigravida
A woman pregnant for the first time
Secundigravida
A woman pregnant for the second time
Multigravida
A woman pregnant for at least the third time
Para
The number of times a woman has given birth to a fetus of at least 20 gestational weeks (viable or not), counting multiple births as one birth event
Parity
Refers to the number of pregnancies, not the number of fetuses, carried to the point of viability, regardless of the outcome
Nullipara (para 0)
A woman who has not produced a viable offspring
Primipara
A woman who has given birth once after a pregnancy of at least 20 weeks, commonly referred to as a “primip” in clinical practice
Multipara
A woman who has had two or more pregnancies of at least 20 weeks’ gestation resulting in viable offspring, commonly referred to as a “multip
T/F
A multipara refers to a woman who is pregnant for
the first time.
False
Physical Exam
- head to toe/ vitals
- chest, abdomen, extremities
- Pelvic examination
o Examination of external and internal genitalia
o Bimanual examination
o Pelvic shape: gynecoid, android, anthropoid,
platypelloid
o Pelvic measurements: diagonal conjugate, true
(obstetric) conjugate, and ischial tuberosity
Pelvic Shapes Figure 13.2 Page 423
o Gynecoid: favorable for vaginal delivery
o Android: male shaped, not favorable
o Anthropoid: usually adequate
o Platypelloid: not favorable
Gynecoid Pelvis
Best pelvis for a vaginal delivery
Lab tests
- Urinalysis
- Complete blood count
- Blood typing
- Rh factor
- Rubella titer
- Hepatitis B surface antigen
- HIV, VDRL, and RPR testing
- Cervical smears
- Ultrasound
Follow up visits
- Every 4 weeks up to 28 weeks
- Every 2 weeks from 29 to 36 weeks
- Every week from 37 weeks to birth
Assessments
o Weight and BP compared to baseline values
o Urine testing for protein, glucose, ketones, and
nitrites
o Fundal height (see Figure 12.5)
o Quickening/fetal movement (see Box 12.4)
o Fetal heart rate (see Nursing Procedure 12.1)
T/F
A woman who is 24 weeks’ pregnant would arrange
for a follow-up visit every 2 weeks.
False
Doppler flow ultrasound
Colored picture to see the blood flow between the baby and the heart.
- 2nd and 3rd trimester, and done abdominally
normal amount of amniotic fluid full term
1 L/ 1000 ML
Polyhydramnios
Too much amniotic fluid
Oligohydramnios
Too little amniotic fluid
L/S Ration
over 2: adequate fetal lung maturity
less than 2:
Coombs test
given to every pregnant person to see if they have antibodies against Rh-positive blood
Lab and diagnostic tests
Table 10.1
While assessing a woman at 18 weeks’ gestation,
which of the following would the nurse report as
unusual?
urinary frequency
Saunas and Hottubs
increases body temperature. can be dangerous for the baby.
Rubella and Varicella vaccine
Cannot get while pregnant
Cervical soffening
Effacement
Lightening
when baby drops
Molding
the elongated shape of the fetus skull at birth
Fetal attitude
the posturing (flexion or extension) of the joints and the relationship of fetal parts to one another
- transverse lie (shoulder presentation)
- longitudinal lie
SROM (RUPTURE OF MEMBRANES)
AROM
PROM
PPROM
S: spontaneous
A: Artificial
P: premature: 37+ no contractions
PPROM: preterm premature: 20-36.6
Fetal Lie
relationship of the long axis (spine) of the fetus to the long axis (spine ) of the mother
Fetal Presentation
body part of the fetus that enters the pelvic inlet first. (the presenting part)
Fetal station
relationship of presenting part to the level of the mothers pelvic ischial spine
Fetal engagement
entrance of the largest diameter of the fetal presenting part (usually the head) to the smallest diameter of the mothers pelvis
Uterine Contraction terms
- Frequency: how often
- Duration: how long it lasts
- Intensity: strength of contraction
Doula
emotional support
Difference between true and false labor
Table 13.1 page 421
5 Ps that effect labor and birth
- Passageway (birth canal: pelvis and soft tissues)
- Passenger (fetus and placenta)
- Powers (contractions)
- Position (maternal)
- Psychological response
T/F
The true pelvis lies below the linea
terminalis
TRUE
Cephalic (head first) presentation
figure 13.7
o Military
o Brow
o Fac
Breech positions
o Frank(feet up)
o Full or complete: c ball butt down
o Footling or incomplete: single or double footing
Cephalic presentation refers to a fetus whose head enters the pelvic inlet first.
True
stations -4 to +4
relationship of the head to bony projections in the pelvis (ischial spines).
0 station is engaged
Above: negative: higher baby is to the abdomin
Below: positive: closer baby is to exit
T/F
The second stage of labor is the longest stage.
False
Anterior Fontanel
baby soft spot
Fetal Landmarks
Left or Right (L/R) Anterior or posterior (A/P)
o Occipital bone (O): vertex presentation back of the baby’s head
o Chin (mentum [M]): face presentation
o Buttocks (sacrum [S]): breech presentation
o Scapula (acromion process [A]): shoulder presentation
3 stages of labor table 13.2
1st stage: Longest stag. 0-10cm dilation
- Latent : 0-3 cm
- Active: 4-7 cm
- Transition: 8-10cm
2nd Stage: deliver the baby
3rd stage: deliver the placenta
Leopold Maeuvers
determines presentation, position, and lie of fetus.
- First maneuver: fundal grip. While facing the woman, palpate the woman’s upper abdomen with both hands. …
- Second maneuver: lateral grip. …
- Third maneuver: second pelvic grip or Pawlik’s grip. …
- Fourth maneuver: Leopold’s first pelvic grip.
Fetal Assessment during Labor
- Amniotic Fluid
-FHR
Categories of fetal HR pattern
- Category 1: NORMAL
- Category 2: Indeterminate
- Category 3: Abnormal
Comfort and Pain Management. Nonpharmacological methods
- Continuous labor support
- Hydrotherapy
- Ambulation and position changes
- Acupuncture and Acupressure
- Heat and cold packs
- focus imagery
- breathing techniques
- effleurage and massage
Comfort and pain management
Pharmacological Methods
- opioids: morphine, meperidine,
butorphanol, nalbuphine, fentanyl - Antiemetics: Hydroxyzine, promethazine, prochlorperazine
- Benzodiazepines: Diazepam, Midazolam
- Epidural analgesia, combined spinal epidural or patient controlled epidural
- Local infiltration (lidocaine)
- Pudendal Nerve block or spinal (intrathecal) anesthesia
- General Anesthesia: c section
Assessment during first stage of labor
LATENT PHASE
- vitals: 30-60 mins
- Temp: Q4H, more if membranes ruptures
- Contractions: 30-60 mins palpate or EFM
- FHR: every hours by doppler ot EFM
- Vaginal Exam: initial admission, as needed on mothers cues
- Behavior: with every client encounter. talkative, excited, anxious
Assessment during first stage of labor
ACTIVE PHASE
- vitals: 15-30 mins
- Temp: Q4H, more if membranes ruptures
- Contractions: 15-30 mins palpate or EFM
- FHR: 15-30 by doppler ot EFM
- Vaginal Exam: as needed on mothers cues
- Behavior: with every client encounter. self absorbed, intense, and quiet
Episiotomy
incision made in the perineum to enlarge the vaginal outlet.
Reading FHR
- Normal HR 110-160
- Variability: Absent, Minimal (5 or less), Moderate (6-25), Marked (26 and higher)
- acceleration: 15 in 15 mins
- deceleration
- Contractions: Normal or tachysystole.
Lochia
Vaginal discharge after birth. can last up to 4-8 weeks after birth.
- Lochia Rubra: deep red
- Lochia serosa: pink brown
- Lochia alba: white light brown
Degree of lacerations
1 degree: Vagina and vulva
2 degree: perineal muscles
3 degree: anal sphincter
4degree: anal sphincter and rectal mucosa.
Lactation
secretion of milk by the breast.
-breast stimulation causes the pituitary gland to secrete.
- oxytocin to help with contracting the uterus and let-downs
- prolactin helps with the synthesis and release of breast milk.
ENGORGEMENT: swollen, hard, tender to touch breast
Phases of Maternal Adaption
- taking in phase: immediately after birth
- taking hold phase: 2nd to 3rd day postpartum. Her and the baby.
- Letting go phase: reestablish relationships with other people.
Engrossment
Partner spending time with their newborn. ex. father and their newborn.
Partners 3 stage role development process
stage 1: expectations
stage 2: reality
stage 3: transition to mastery
Puerperium Period
begins after delivery of the placenta and lasts up to 6 weeks
3 processes of Involution
- Contraction of muscle fibers to reduce stretched ones
- Catabolism reduce enlarged individual cells
- Regeneration of uterine epithelium
sitz bath
warm, shallow bath you sit in to relieve pain, burning or itching in your perineum.
peri bottle
plastic squeeze bottle filled with warm tap water to spray over the perineal area after voiding and before applying a new pad.
Postpartum Assessment
BUBBLE-EE
- Breast
- Uterus
- Bowel
- Bladder
- Lochia
- episiotomy/ perineum/ epidural site/ extremeties/ emotions
AAP breastfeeding recommendations
breastfeed for the first 6 months and continued with foods until 12 months of life or longer.
Lochia amounts
- scant: 1-2 in stain 10ml or less
- light or small: about 4 in stain 10-25 ml loss
- Moderate: 4-6in stain 25-50ml loss
- Large or heavy: pad saturated within an hour
en face position of attachment
face to face
factors for postpartum infection
- operative procedures
- diabetes
- prolonged labor
- indwelling catheter
- anemia
- multiple vaginal exams during labor
- prolonged rupture of membranes
- manual extraction of the placenta
- HIV
factors of postpartum hemorrhage
- precipitous labor
- uterine atony
- placenta previa or abruptio placenta
- labor induction or augmentation
- operative procedure
- retained placental fragments
- prolonged third stage of labor
- multiparity spaced closely
- uterine overdistension.
DANGER SIGNS postpartum
- fever 100.4 or greater
- foul-smelling lochia or unexpected change in amount
- large blood clots, or saturated peripad in an hour
- severe headaches
- vision changes
- calf pain with dorsiflexion of the foot
- swelling redness or discharge at episiotomy site
- dysuria, burning or incomplete emptying of the bladder
- shortness of breath, difficulty breathing
- mood swings or depression
bottle feeding newborn teaching
infants need 2-4oz of milk and about 6 feeding a day. milk will increase and feeding will decrease as the child gets older.
baby blues
postpartum depression
