Exam One Flashcards
If BMI weight is less than 18.5, what is the total weight gain range during pregnancy?
28-40 lb
If BMI weight is 18.5-24.9, what is the total weight gain range during pregnancy?
25-35 lb
If BMI weight is 25-29.9, what is the total weight gain range during pregnancy?
15-25
If BMI weight is 30 or higher, what is the total weight gain range during pregnancy?
11-20 lb
What are presumptive signs of pregnancy? List 3
Fatigue (12 weeks) Breast tenderness (3–4 weeks) Nausea and vomiting (4–14 weeks) Amenorrhea (4 weeks) Urinary frequency (6–12 weeks) Hyperpigmentation of the skin (16 weeks) Fetal movements known as quickening (16–20 weeks) Uterine enlargement (7–12 weeks) Breast enlargement (6 weeks)
what are probable signs of pregnancy? list 3
Braxton Hicks contractions (16–28 weeks) Positive pregnancy test (4–12 weeks) Abdominal enlargement (14 weeks) Ballottement (16–28 weeks) Goodell sign (5 weeks) Chadwick sign (6–8 weeks) Hegar sign (6–12 weeks)
What are positive times of pregnancy? list 3
Ultrasound verification of embryo or fetus (4–6 weeks)
Fetal movement felt by experienced clinician (20 weeks)
Auscultation of fetal heart tones via Doppler (10–12 weeks)
T/F: an at home positive pregnancy test 100% confirms the patient is pregnant
FALSE
What does lightening mean?
Baby drops
If the patient is 38 weeks pregnant, what is an expected fundal height? 30cm 40cm 28cm 34cm
40cm
What does goodell sign mean?
cervix begins to soften at 6-8 weeks
What is chadwick’s sign?
Increased vascularity causes color change, purple-blue
White, thick discharge is called what? Is this a normal finding?
Leukorrhea. Yes, this is a normal finding.
List some GI changes during pregnancy
Gums are swollen
Decreased lower esophageal sphincter
Stomach decreased tone and mobility with deleted gastric emptying, which increases the risk of gastroesophageal reflux and vomiting
List 3 cardiovascular changes during pregnancy?
Lower hemoglobin and hematocrit Cardiac output increases Diastolic pressure decreases by 10-15 RBC increases throughout pregnancy Heart rate increases by 10-15 bpm between 14-20 weeks
List 3 changes of respiratory system during pregnancy
enlargement of the uterus shifts the diaphragm up to 4 cm above its usual position. As muscles and cartilage in the thoracic region relax, the chest broadens with conversion from abdominal breathing to thoracic breathing. This leads to a 50% increase in air volume per minute. Tidal volume, or the volume of air inhaled, increases gradually by 30–40% (from 500 to 700 mL) as the pregnancy progresses.
list 3 renal/urinary changes during pregnancy
renal pelvis becomes dilated
bladder tone decreases
blood flow to kidney increases due to increased cardiac output
List 3 musculoskeletal system changes during pregnancy
Distention of the abdomen with growth of the fetus tilts the pelvis forward, shifting the center of gravity. The woman compensates by developing an increased curvature (lordosis) of the spine.
Relaxation and increased mobility of joints occur because of the hormones progesterone and relaxin, which lead to the characteristic “waddle gait” that pregnant women demonstrate toward term.
list 3 changes in the intergumentary system
Hyperpigmentation
Striae gravidarum
linea nigra
melasma (mask of pregnancy)
List 3 changes in endorcine system during pregnancy
Controls the integrity and duration of gestation by maintaining the corpus luteum via hCG secretion; production of estrogen, progesterone, hPL, and other hormones and growth factors via the placenta; release of oxytocin (by the posterior pituitary gland), prolactin (by the anterior pituitary), and relaxin (by the ovary, uterus, and placenta).
List 3 changes in the immune system during pregnancy
A general enhancement of innate immunity (inflammatory response and phagocytosis) and suppression of adaptive immunity (protective response to a specific foreign antigen) take place during pregnancy. These immunologic alterations help prevent the mother’s immune system from rejecting the fetus (foreign body), increase her risk of developing certain infections, and influence the course of chronic disorders such as autoimmune diseases.
For a pregnant women, what is the caloric recommendation?
2,500
For a pregnant women, what is the protein recommendation?
80 g
For a pregnant women, what is the water intake recommendation?
8 glasses daily
For a pregnant women, what is the vit. a recommendation?
770 mcg
For a pregnant women, what is the vit. c recommendation?
85 mg
For a pregnant women, what is the vitamin D recommendation?
5 mcg
For a pregnant women, what is the calcium recommendation?
1,000 mcg
For a pregnant women, what is the iron recommendation?
27 mg
What are some examples of maternal emotional response?
Ambivalence (doubting, second guessing)
Acceptance
Mood swings
Change in body image
Definition of infertility
Inability to concieve a child AFTER a year
Primary infertiility and secondary interfility
Primary- means that they have never been able to conceive
Secondary- conceived once but at having problems conceiving again
Things to know for infertility
Treatment depends on cause
Medication or surgery is possible for treatment
Preconception care definition
promition of the health and well-being of a woman and her partner BEFORE pregnancy. Attempting to get into a healthy state
What is the gestational age time frame for pre-term births?
20-36.6
What is the gestational age time range for term births?
37-41.6
What type of laboratory tests are done during prenatal and follow up visits?
UA
blood studies (CBC, blood type, RH factor, glucose screening, rubells titer)
Cervical smear for STD detection
Ultrasound
How often should follow up visits be if you are anywhere between 4-28 weeks pregnant?
Every 4 weeks
How often should follow up visits be if you are 29-36 weeks preggo
every 2 weeks
How often should follow up visits be if you are 37+ weeks preggo
every week
What assessments, tests, or labs are done during subsequent/follow up visits
Assessment and vital signs Checking urine (backteria, protein) Graph weight gain fundal height fetal heart rate fetal movement teaching danger signs of pregnancy
Why is a pregnant women who is Rh negative given Rhogam at around 28 weeks?
keeps mom from building antibodies that can attack the baby who may be Rh positive
When is group b strep culture done
28-36 weeks
1 hour GCT’s are done how often?
every 24-28 weeks
Effects chlamydia may have on mom or fetus
mom- may be asymptomatic. posisble dysuria, urinary frequency, cervical discharge
Fetus- stillborn, preterm, opthalmia neonatorum
TREAT PARTNER TOO
Complications and treatment for chlamydia
complications- ectopic pregnancy, PID, sterility/infertility
Treatment- erythromycin or axithromycin
effects gonorrhea has on mom and fetus
mom- asymptomatic to dysuria, purlent vaginal discharge, PID
fetus- opthalmia neonatroum, sepsis
Definition of threatened abortions
have spotting, cramping with no passage of tissue or cervical dilation. Bedrest and pelvic rest are management
Definition of inevitable abortions
has moderate bleeding with cramping and cervical dilatation. Watch bleeding and infection if ROM. May need a vacuum curettage (dilatation and curettage); prostaglandins to empty uterus.
Definition of incomplete abortion
- heavy bleeding with severe cramping. Part of the fetal contents are expelled and there is some cervical dilatation. A D&C is performed to remove the rest of the fetal contents.
definition of complete abortion
History of bleeding and cramping. Passage of tissue, now has decrease in pain and bleeding. No medical or surgical intervention necessary.
Definition of missed abortion
when the fetus is dead but the contents are not expelled. Maybe some spotting, no cramping or passage of tissue and cervical dilatation. The fetal contents must be expelled via medication or surgery.
are 3 or more consecutive spontaneous abortions of previable pregnancies. Treatment depends on the cause such as cerclage for incompetent cervix.
recurrent abortions
Pregnancy in which the fertilized ovum implants outside the uterine cavity…
Can cause maternal infertility or death
ectopic pregnancy
- What are some diagnostic testing for ectopic pregnancy?
- T/F Ruptered and nonrputured ectopic pregnancies are a nonmedical emergency
- Signs and symptoms?
- hcg, US, laparoscopy
- FALSE
- abdominal pain, amenorrhea and vaginal bleeding, tender abdomen, painful vaginal exam, cervical motion tenderness and possible adnexal mass.
Disorder of placental development (hydatidiform mole) and neoplasms of the trophoblast ( choriocarcinoma.)…
Gestational trophoblastic disease
T/F: If the patient has gestational trophoblastic disease, this means the patient was never truly pregnant and does not have a fetus however experienced signs of pregnancy due to the disorder
TRUE. Hcg is present which gives false positive, no viable fetus in womb
Looks liek a snowstorm or white grapes on ultrasound..
gestational trophoblastic disease
Long-term follow up to detect any trophoblastic tissue that may become malignant. Serial hCG levels are taken for ____. (Should start to drop within ____ weeks)
Chest xray Q ___ months, Regular pelvic exams
Strong recommendations to avoid pregnancy for ____.
Long-term follow up to detect any trophoblastic tissue that may become malignant. Serial hCG levels are taken for 1 year. (Should start to drop within 8-12 weeks)
Chest xray Q 6 months, Regular pelvic exams
Strong recommendations to avoid pregnancy for 1 year
T/F: management of gestational trophoblastic disease consists of immediate evacuation of the uterine contents
TRUE
Nursing management for gestational trophoblastic disease
focus on preparing for D&C, providing support, education on risks and strict adherence for follow up program
Premature dilation of cervix…
Cause unknown but can related to things such as cervical length or less collagen production
Cervical insufficiency
- treatment for cervical insufficiency are?
- how is it diagnosed ?
- nurses monitor patient for signs of pre-term labor such as?
- May have the placement of ___ or ___ to hold cervix closed
- bedrest, pelvic rest, no heavy liftening, progesterone supplementation for women at risk
- via transvaginal ultrasound around 16-24 weeks
- backache, increased vaginal discharge, ROM, and uterine contractions
- May have the placement of a pessary or cerclage to hold the cervix closed.
Low, dull backache Cramping UTI symptoms Pelvic pressure or fullness More than 6 contractions in an hour Regular contractions and increasing in pain ARE ALL SIGNS OF WHAT?
Preterm labor
The placenta is inserted wholly or partially into the lower uterine segment of the uterus – partially or completely covering the internal cervical opening
Placenta previa
- what are causes for placenta previa?
- what is a KEY symptom?
- How is it diagnosed?
- RF?
- uterine scarring or damage to the upper uterine segment.
- PAINLESS vaginal BRIGHT RED bleeding
- ultrasound or MRI
- > 35 years of age, previous c/s, multiparity, uterine injury, cocaine use, previous uterine surgery, multiple gestation, smoking, HTN or DM.
Nursing management for Placentra previa?
Monitoring maternal-fetal status – vaginal bleeding, VS, uterine contractions. Fetal – heart rate
Administer pharmacologic agents as necessary (tocolytics), give Rhogam if client is Rh-negative (at 28 weeks but immediately if actively bleeding)
Provide Support and education
Do Not perform vaginal or cervical examinations
Premature separation of the implanted placenta after the 20th week of gestation prior to birth
Placental abruption
- what is a key symptom of placental abruption?
- risk factors ?
- placental abruption may affect the fetus how?
- Suddent onset of abdominal pain with vaginal bleeding. DARK RED BLOOD
- obstetric hemorrhage, need for blood transfusion, emergency hysterectomy, disseminated intravascular coagulopathy (DIC).
- fetal hypoxia and possible fetal death
Which disorder has a classification range of Grade 0- Grade 3? Placenta Previa Placental abruption Gestational trophoblastic disease Cervical insufficiency
Placental abruption
As a nurse what do you prepare the patient for if placental abruption is possible or occurs?
Blood transfusions so placing large bore IV’s
Risk factors for placental abruption?
> 35 yoa, poor nutrition, multiple parity, excessive intrauterine pressure (hydramnios, twins, triplets), trauma, HTN, fetal growth restriction, smoker, history of abruption, drug abuse, thrombocytopenia, alcohol.
severe form of nausea and vomiting associated with pregnancy
hyperemesis gravidarum
- When does hyperemesis gravidarum begin?
- What can It cause?
- risk factors?
- Can also be caused by ?
- 9 weeeks gestation
- causes dehydration, nutritional deficiencies, ketosis, electrolyte imbalances, and weight loss of more than 5% of prepregnancy body weight.
- history of hyperemesis, molar pregnancy, history of H. pylori, multiple gestations, hyperthyroid disorder, and prepregnancy psychiatric diagnosis.
- by high levels of hCG and estrogen, vit B6 deficiency, genetic factors, psychological stress
What is the first choice of management for hyperemesis gravidarum?
fluid replacement, oral foods and fluids are withheld for 24-36 hours
One of the leading causes of death and severe maternal morbidity worldwide.
New onset hypertension with proteinuria and/or maternal organ dysfunction. Can target CV, hepatic, renal and CNS.
Can present with features or it may not
preeclampsia/ecclampsia
Two stages of ______:
1st: vasospasm and hypoproperfusion
2nd: woman’s response to abnormal placentation (placement of the placenta), symptoms occur such as HTN, proteinuria, headache, N/V, blurred vision and hyperreflexia
Preclampsia
- Reduced kidney perfusion can cause what?
- Decreased perfusion to placenta can cause what?
- decreased perfusion to brain can cause what?
- protein in urine, oliguria
- IUGR
- seizures
- N/V, Increased liver enzymes, epigastric pain, RUQ pain in preeclampsia are signs or indicative of what?
- Visual changes in preeclampsia are signs or indicative of what?
- Hemolysis, platelet adhesion-low platelets and DIC are signs or indicative of what?
- Decreased liver perfusion
- decreased perfusion to eyes
- intravascular coagulation
THE ONLY CURE for preeclampsia when experiecing decreased liver perfusion, etc., would be?
DELIVERY OF FETUS
What are some nursing managements, consideration, or assessment for patients with preeclampsia?
If hospitalized, monitored closely for S&S of severe preeclampsia or impending eclampsia (HA, hyperreflexia)
Frequent VS and fetal surveillance – kick counts, NST and serial US to evaluate fetal growth and amniotic fluid levels.
Expectant management until 37 weeks’ gestation and fetal lung maturity is documented, or complications develop.
During labor, (magnesium sulfate is not recommended for Preeclampsia w/o SF) BP is monitored frequently, quiet environment, close monitoring of neurologic status, foley catheter to accurately measure urine output.
While in labor, she will receive oxytocin, antihypertensive drugs and magnesium sulfate.
Must evaluate for magnesium toxicity.
May use PGE2 gel to ripen the cervix.
Vaginal delivery is preferred but C/S if necessary
What are some risk factors for preeclampsia?
Primigravida Multiple gestations Hx of Preeclampsia In vitro fertilization Lupus Lower socioeconomic status Hx of DM, HTN, or renal disease Poor nutrition African American Younger than 20 and older than 35 Obesity
What does the accronym HELLP stand for? What is HELLP syndrome?
Hemolysis, Elevated Liver enzymes, and Low Platelet count. Variant of preeclampsia/eclampsia syndrome.
Increased risk of cerebral hemorrhage, retinal detachment, hematoma/liver rupture, DIC, acute renal failure, pulmonary edema and maternal death.
What is the main treatment for patients with HELLP syndrome
lowering high BP using antihypertensives, prevention of convulsions and seizures with mag sulfate and use of steroids (Betamethasone) for fetal lung maturity.
What are some instances that fetal blood may enter mom’s blood?
amniocentesis, ectopic pregnancy, placenta previa, abruption, in utero fetal demise, spontaneous abortion, or abdominal trauma
What is an indirect Coomb’s test used for? What is results are negative? What if results are positive?
Indirect Coomb’s test will determine if the mother has developed isoimmunity to the Rh antigen. Tests to find antibodies in mom’s blood.
negative = give Rhogam; if positive, isoimmunization has occurred = monitor for fetus for hemolytic disease.
If mother is Rh negative, when will rhogam be given?
at 28-32 weeks’ gestation and before 72 hours postpartum and if there is a chance that fetal blood has entered the maternal system.
What is a prostaglandin synthesis inhibitor you can use to decrease the amniotic fluid volume in a patient who has polyhydramnios?
Indomethacin
Spontaneous rupture of the amniotic sac before onset of true labor in a woman greater than 37 weeks’ gestation. Associated conditions and complications include: infection, prolapsed cord, placental abruption and preterm labor…
Prelabor Rupture of Membranes (PROM)
What are some of the care a patient may receive if they are experiencing prelabor rupture of membranes?
Sterile technique Antibiotics and Corticosteroids Labs Pelvic rest Monitor for infection Teaching Observe amniotic fluid for blood and meconium
- What disorder: Glucose intolerance with onset during pregnancy usually diagnosed n the second or third trimester of pregnancy.
- What disorder: : Identified before pregnancy. Includes type 1 or type 2.
- gestational diabetes
2. pregestational diabetes
List some maternal and fetal complications related to diabetes
Maternal : Increased miscarriage Increased C/S Preeclampsia Preterm labor Hydramnios Infection
Fetal: Macrosomia Shoulder dystocia IUGR Fetal distress Stillbirth Respiratory Distress Syndrome (RDS) Metabolic abnormalities
1, How frequently will pregestational diabetes be monitor in the first trimester?
- What is the fasting target plasma control range for a patient who has pregestational diabetes?
- Insulin needs increase the first __ weeks of pregnancy and decreased at __-__ weeks for patients with pregestational dm.
- Insuling resistance occurs in __ and __ trimester requiring more insulin
- every 1-2 weeks
- 60-90
- 6 weeks, 7-15 weeks
- 2nd and 3rd trimester
T/F There is no increase of fetal risk in gestational diabetes mellitus
TRUE
What are S&S of cardiac decompensation in a pregnant women?
fatigue, cough, dyspnea, SOB, edema, diastolic heart murmurs, palpitations, tachycardia, adventitious breath sounds and weight gain.
T/F: We can use Coumdain, an anticoagulant, as a treatment for a pregnant women who has cardiac issues
FALSE, we CAN use anticoagulants but NOT coumadin specifically
The patient is at an increased risk for spontaneous abortion, Gestational diabetes, Preeclampsia and have an increase in the morbidity and mortality for both mother and fetus if they are what or show signs of what?
Obese/obesity
What are the 4 P’s used for screening in maternal substance abusers?
Parents, Partners, Past, Pregnancy
How many kick counts do you need every 1-2 hour? What happens if it takes longer to achieve said kick count?
Need 10 per 1-2 hours
If it takes longer – notify your doctor
T/F: In an ultrasound being done early in pregnancy, the pregnant patient needs an empty bladder
FALSE, needs to be full
What is Alpha-Fetopreotein Analysis used for ?
Used to detect neural tube defects
Low levels may indicate downs syndrome, molar pregnancy.
Must have correct due date and correct weight
What is the marker screening tests used for? What do the triple and quad screen look for?
Used to identify fetal risk for trisomes 13, 18, 21 and neural tube defects.
Triple Screen – AFP, hCG, and estriol
Quad Screen – adds inhibin A with the above
What are some nursing care that is needed to be done to a patient who is planned to have an amniocentesis?
Baseline vital signs and Fetal Heart Rate
Support
Proper specimen care- bili (low lights, cover with foil)
Monitoring FHR
Teaching
Rhogam
Which testing has removal of a small piece of the villi done between 8-13 weeks and is
Used for genetic testing
Monitoring
Rhogam if indicated
Chorionic villi sampling
What does it mean if the patient had a reactive tracing result for the non-stress test?
has 2 or more accelerations 15 beats X 15 seconds in 20 minutes occured
What is biophysical profile used for?
Used as a Physical exam of the fetus (ultrasound)
Can assess wellbeing
Accurate indicator of impending death
What does TORCH stand for?
Toxoplasmosis Other such as (hepatitis, syphillis, HIV, gonorrhea, and chlamydia GBS Rubella Cytomeglovirus Herpes
What are the effects that can occur to mother and baby if toxoplasmosis occurs? What is treatment?
Mother- mild to preterm labor
Fetal-stillbirth, microcephaly, blind, or deaf
Treat with pyrimethamine and sulfadiazine
What are some complications that can occur for the fetus if the mother has Rubella?
Fetal-Congenital heart defects, IUGR, Blind, or Deaf
T/F: No treatment for mother is given and recommended therapeutic abortion in the 1st trimester is advanced in mother who is pregnant currently has Rubella infection
TRUE
Does mother with herpes received vaginal or c-section if herpes is active?
c-section
Which infection causes cheesy vaginal discharge with severe itching to mom and can also cause thrush to fetus?
Candidasis
What is the drug treatment for a pregnant women who has HIV
Zidovudine. Can use triple antiretroviral therapy or ART drug therapies.
Which disorder will patient receive a guardasil vaccine for as a form of protection
HPV
What are the Primary Secondary Latent and Tertiary outcomes of maternal syphilis
Primary: Chancre
Secondary: Flu-like symptoms
Latent: No symptoms
Tertiary: CNS, tumors CV issues
What is the Zygotic Blastocyst Embryonic and Fetal stage?
Zygotic Stage – Fertilization of sperm and egg through the second week.
Blastocyst Stage – Zygote divides into a solid ball of cells which attaches to the uterus.
Embryonic Stage – Major organs and structures begin to emerge by end of the second week through the 8th week.
Fetal Stage – Differentiation and structures specialize by the end of the 8th week until birth.
When does the zygotic stage occur?
around 2 weeks after the last normal period in a 28-day cycle.
What does the amniotic fluid help the fetus with
helps to maintain body temperature; permit symmetric growth and development; cushion the fetus from trauma; allow the umbilical cord to remain free from compression; promote fetal movement.
What contains wharton jelly to prevent compression? Umbilical cord or amniotic fluid
umbilical cord
In what fetal growth stage are all major systems present in their basic form
fetal stage
