Healthy Pregnancy and Assessment of Pregnant Client Flashcards
1
Q
Gravidity
A
Number of pregnancies no matter how long
2
Q
Parity
A
Number of births of viable age (>20weeks)
3
Q
Term
A
Number of births > 37 weeks
4
Q
Preterm
A
Number of births < 37 weeks
5
Q
Abortus
A
Induced or spontaneous abortion < 20 weeks
6
Q
Living
A
Number of living children
7
Q
True or False: Twins count as one pregnancy and 2 births
A
False, twins count as one pregnancy and one birth
8
Q
Define subjective/presumptive changes that occur during pregnancy
A
symptoms experienced by the pregnant client suggestive of pregnancy; can be caused by conditions other than pregnancy
9
Q
Amenorrhea, nausea and vomiting, changes in breasts, and quickening are examples __________ changes
A
Presumptive/subjective
10
Q
Define objective/probable changes that occur during pregnancy
A
Signs perceived by examiners; could be caused by conditions other than pregnancy
11
Q
Enlargement of the abdomen, braxton hick’s contractions, uterine souffle are examples of ___________ changes
A
objective/probable
12
Q
Goodell’s sign (probable sign)
A
(probable sign)
softening of the cervix
13
Q
Hegar’s sign (probable sign)
A
softening of the lower uterine segment
14
Q
Chadwick’s sign (probable sign)
A
bluish discoloration of the vaginal mucosa and cervix
15
Q
A positive pregnancy test is an example of a _________ change
A
probable/objective
16
Q
Define diagnostic/positive changes of pregnancy and list what they are (3)
A
Signs that are completely objective & caused only by pregnancy
· Detection of a fetal heartbeat
· Fetal movements detected by a trained examiner
· Verification of a gestational sac and heartbeat through ultrasound.
17
Q
When is first trimester?
A
0 to 12 weeks
18
Q
When is second trimester?
A
13-26 weeks
19
Q
When is third trimester?
A
27 - 40 (+/- 2) weeks
20
Q
What is antepartum?
A
period of pregnancy, usually refers to last 20 weeks of the pregnancy
21
Q
What is intrapartum?
A
labour
22
Q
What is post partum?
A
period following birth, lasting approximately 6 weeks
23
Q
What is Nagele’s rule?
A
- Take the first day of the LMP
- Add a year (?)
- Subtract 3 months
- Add 7 days
24
Q
What occurs to the blood volume of a pregnant client
A
increase blood volume 30-50% (~1500 mls)
25
What occurs to the cardiac output of a pregnant client
↑ by 40% - 50%
26
What maintains normal blood pressure during pregnancy?
Peripheral vasodilation
27
Why does supine hypotension occur in pregnant clients?
Vena caval syndrome
28
True or false: pregnant clients are at increased risk for thrombus formation
True
increase in clotting factors / fibrinogen, fibrinolysis inhibition = hypercoagulable state,
29
When is an increase in WBC seen in a pregnant client
2nd and 3rd trimesters
30
What respiratory changes may you see in a pregnant client?
Increased oxygen consumption by 15-20%
SOB caused by displacement of diaphragm
31
Role of increased progesterone in pregnancy
Maintains pregnancy
32
Role on increased estrogen in pregnancy
Enlarges uterus, breasts, genitals
33
Role of oxytocin at term
contractions and let down reflex for lactation
34
How do increased hCG levels effect the GI system
Alter carb metabolism
35
What is thought to play a role in morning sickness and when is it the worst
Rapid estrogen increase at 6-12 weeks
36
What is the effect of increased abdominal size and decreased muscle tone on the musculoskeletal system of a pregnant client?
exaggeration of lumbosacral curve
37
What is the cause of low back pain in pregnant clients
compression of lumbar nerve roots
38
Define Supine Hypotensive Syndrome/(Aortocaval Compression)
Pressure from the growing fetus and gravid uterus compresses iliac veins and inferior vena cava
39
What is optimal positioning to avoid Supine Hypotensive Syndrome/(Aortocaval Compression)
left lateral
40
What are the 4 leopold's maneuvers?
1. identifies part of baby in upper pole of fundus (vertex v breech presentation)
2. identifies location of fetal back and limbs (side of abdomen)
3. identifies presenting part in pelvis and engagement (thumb and fingers above symphysis pubis)
4. Determine degree of flexion of presenting part
41
When is the preconception phase?
3 months
42
Role/amount of folic acid supplementation prenatally
0.4mg
Prevention of neural tube defects
43
Role/amount of iron supplementation prenatally
16-20mg
Pregnant women experience an increase in blood volume without an increase in RBC
44
Why is it important to assess oral health prenatally?
Gingivitis cause preterm babies and LBW
45
What is the normal weight gain for a person with a normal BMI during pregnancy?
25-35lbs
46
What is the anticipated weight gain during the 1st trimester of pregnancy?
6lbs/0.5 a week
47
What is the anticipated weight gain during the 2nd trimester of pregnancy?
12lbs/1 a week
48
What is the anticipated weight gain during the 3rd trimester of pregnancy?
12lbs/1 a week
49
Why is the recommended weight gain around 30 lbs when babies usually only weigh around 7 lbs?
o Extra fluids, blood, protein = 3.5kg
o Breasts and energy stores = 3kg
o Uterus = 1kg
o Placenta = 1kg
o Baby = 3.5kg
o Amniotic Fluid = 1kg
50
Danger signs in 1st trimester
1. bleeding (miscarriage)
2. painful urination (UTI)
3. severe persistent vomitting (hyperemesis gravidarum)
4. lower abdominal pain with dizziness accompanied by shoulder pain (ruptured ectopic)
51
Danger signs in 2nd trimester
1. regular uterine contractions (preterm)
2. pain in calf (deep vain clot)
3. sudden leakage of vaginal fluid (premature membrane rupture)
4. absence of fetal movement > 12 hours (fetal distress)
52
Danger signs in 3rd trimester
1. sudden weight gain + facial edema + severe upper abdominal pain + headache w visual changes (gestational hypertension/pre-eclampsia)
2. decrease in fetal movement > 24 hours (fetal demise)
53
Why is Rh type screened in pregnancy?
Rh - mother: baby could be Rh + if father was. If cells mixed (abruption of placenta), mother could develop antibodies
54
What infectious diseases are screened for in pregnancy?
STI, HIV, Hepatitis B&C, Rubella
55
When is a glucose tolerance test done during pregnancy?
24-28 weeks
56
When is a group b strep screening done?
35-37 weeks
57
Why is asymptomatic bacteruria screened prenatally?
UTI in pregnancy can cause preterm labour
58
What 2 ultrasounds are offered for pregnant clients and what are their purposes?
a dating ultrasound between 8-12 week
an anatomy ultrasound between 18 and 22 weeks of pregnancy. (SOGC guidelines)
59
By what week should all women be aware of fetal movement?
26-32 weeks
60
At what rate do we recommend mom's call MRP for decrease in fetal movement?
< 6 movements in 2 hours is not enough
61
If a woman is experiencing decrease is fetal movement and goes to the physician, what test would be performed?
Non-stress test
62
Why is group b strep screening and treatment done so late in pregnancy?
We wait to treat because transmission occurs during labor; bacteria could reappear if treated earlier in pregnancy
63
What are the rx factors for GBS infections?
· Preterm labor before 37 weeks gestation (poorly developed immune system)
o (with or without ruptured membranes).
· Term rupture of membranes >18 hrs
· Unexplained, mild fever during labour.
· Previous baby with a GBS infection.
· Previous or present GBS bacteriuria caused by the GBS bacteria.
o Past UTI where bacteria is GBS
64
Purpose of doppler flow study
Non Routine test to measure the velocity of blood flow via ultrasound
65
What does a non-stress test access?
Fetal heart rate patterns in response to fetal movement
Non invasive, most common method of prenatal testing
66
What is a biophysical profile and what are its 5 components
Combination of non stress test and ultrasound to monitor 1. movement
2. tone
3. breathing
4. fluid volume
5. non stress test
67
How much amniotic fluid is present at birth
800-1000ml
68
What are the 2 sources of amniotic fluid?
1. fluid from the maternal blood across amnion
2. fetal urien
69
What is oligohydraminos?
Decreased amniotic fluid
70
What is Polyhydramnios/Hydramnios
Excessive amniotic fluid
71
What is a marker screening test?
Prenatal serum screening
Blood test offred to women to determine risk of aneuploidy
NON DIAGNOSTIC
72
What does a marker screening test done in 1st trimester demonstrate
risk of chromosomal disorders and anomalies only
73
What does a marker screening test done in 2nd trimester demonstrate
o Additionally with chromosomal disorders can determine ONTD risk
74
Following marker screening tests, what further testing should be discussed in counselling?
Amniocentesis, detailed ultrasound-exclude anomalies, nuchal translucency
75
What is a Nuchal Scan for Translucency
a collection of fluid under the skin at the back of a fetus' neck
76
What is determined by a nuchal scan for translucency?
From the measured thickness of the nuchal translucency combined with maternal age, the risk of chromosomal abnormality can be calculated
77
How does Non-Invasive Prenatal Testing work?
NIPT works by taking a blood sample from a pregnant client and analyzing for abnormalities of specific chromosomes (13, 18, 21, X, Y) associated with conditions like Down syndrome and Turner syndrome
78
True or False: there is a high risk of miscarriage associated with NIPT?
carries no risk of miscarriage, because there is no need to pierce the amniotic sac. NIPT can be performed from 9 to 10 weeks in pregnancy, versus 16 weeks for amniocentesis.
79
True or false: NIPT can diagnosis chromosomal anomalies around 9-10 weeks
True
80
What is the purpose of an amniocentesis done in the 2nd trimester?
Genetic testing
81
What is the purpose of an amniocentesis done in the 3rd trimester?
Maturitu
82
What is the L/S ratio?
(Lecithin/Sphingomyelin) 2:1=>35 weeks
2 components of surfactant which line alveoli of lungs & reduces surface tension when the infant exhales
