lp4 stuff Flashcards
Gravida
para term
parapre term
abortion
living children
primapara
multipara
Gravida: # of preg including current
Para Term: # of births that reached 37 weeks (born alive or dead)
Para Pre-term: # of births that reached 20 weeks, but before 36 weeks (born alive or dead)
Abortion: # of preg that end (spontaneous or elective-before 20 weeks)
Living children: # of children currently alive
Primipara – first birth; Multipara – second or subsequent birth
Pregnancy Effect on Body Systems
due to
perceived
increased
increased
Mostly due to hormonal influences needed to maintain pregnancy
May be perceived negatively
↑ vascularity r/t estrogen-inc blood
↑ muscle relaxation r/t progesterone & relaxin
Primigravida
Multigravida
P – woman pregnant with her first child
M– woman pregnant for the second or subsequent time
Presumptive (Subjective) signs of pregnancy
week+s/s
2
3
12
18
24
2 Breast changes /NV/ amenorrhea
3 frequent urination
12 fatigue/uterine involvement
18 quickening
24 linea nigra /melasma /straia gravidarum
probable signs of pregnancy weeks
1
6
16
20
1-HCG//pregnacny test
6-chadwick, hager, goodell, sonogragy
16-ballotmetn
20-braxton hicks contractions, fetal outline felt
Probable (Objective Signs of pregnancy
Lab tests
how accurate
24-48
7-9
60-80
hcg/if non-pregnant=no hcg
//95-98% accurate.
24-48hrs-trace amounts
7-9days-5MIU
60-80days=100,000 miu after this will decline 2000-50000 miu/ml
Probable (Objective Signs of pregnancy
pregnancy tests
how accurate
read
if negative
do
97-99% accurate
check exp date/ read instruction including time to read/ concentrated urine works best-do in morning/read results at exa t time//
//if negative wait one week and try again, if neg again check for amenorrhea/
/do prenatal care asap
Positive signs of pregnancy
Demonstration of fetal heart separate from pregnact parents
Stethoscope can hear in 18-20 weeks
Ecocardiography can hear in 5 weeks
Doppler in 10-12 weeks
Fetal HR= 120-160 bpm
Positive signs of pregnancy
fetal movements
can be felt as early as 16-20 weeks in person
examiner can feel in 20-24 weeks
positive signs of pregnancy
visualization
ultrasound-as early as 4-6 weeks of pregnancy can see charactertic ring and site of impantation/
by 8th week fetal outline can be measured and determine age-clear proof
ultrasound generally at 20 weeks as well-for abnormalities in genetics/working organs
Uterus in pregnancy
increase
blood flow
↑ in size, weight, capacity
↑ in blood flow-15-20 ml/min and ends at 500-750 ml/min—75% going to placenta–needs to be circulatory system for placenta
Lightening
12
20
36
38
Uterus in pregnancy
– fetus settles into mid pelvis-
12wk ut is lg enough to be felt in abdomen
/20wk level of umbilicus
36 wk- touches xiphoiod
38 wks settles into pelvis
Hegar sign
Uterus in pregnancy
–walls of uterus feel thin as tissue paper-
extreme softenin of lower uterine segment
Ballottement
rise in
Uterus in pregnancy
-16-20 wks-uterus is tapped sharply and fetus will bounce/\
rise on amniotic fluid agants when the hand placed on abdomen
Braxton Hicks contractions
manifestations
who can see
do not cause
Uterus in pregnancy
-uterine contractions as early as 12th week. Present throughout rest of pregnancy.
Waves of hardness/tightening accros abdomen/”practice contractions”
/examiner or electric monitor can see
not causing cervix change
amenorrhea
why occur
why only presumptive sign
could be
occurs because of suppression of FSH by rising estrogen levels/
/could be result of things like uterine infection, anxiety, athletes or chronic illness so only presumptive sign
could be spotting
Cervix changes in pregnancy
hyperactivity
mucus plug
Hyperactivity of tissue ==mucorrhea
Mucus plug (operculum)-seal out bacteria and help prevent infection in fetus/membranes
Vasculatiry changes in cervix in pregnancy
↑ vascularity-inc in fluid between cells can soften consistency from pale pink to violet hue
Vagina changes in pregnancy
thickening
relaxing
Thickening of mucosa,
relaxation of connective tissue
increase in
causes a decrease/inc in
vaginal changes in pregnancy
↑ in amt & acidity of secretions-
↓ in bacterial infections but ↑ yeast infections
Chadwick’s sign-
vagina changes in pregnancy
color of vaginal wall will turn violet hue
Ovaries
reproductive changes in pregnancy
Ovulation ends
Corpus luteum (shell of discharged ova) produces necessary hormones @ the beginning of pregnancy-after 16 weeks placenta will take over
goodels sign
softening of cervix
Breast changes in pregnancy
may be
colostrum
montogmery
May be one of first changes- may notice @6 weeks a feeling of sublt fullness, tingling, ot tenderness that’s caused by high estrogen levels
Colostrum -3rd trimester-“pre milk”-thin watery high protein fluid can be exctreted
Montogmetry tubercles-elargne to stop cracking of nips
changes visual on breast
increase in
str
blue
darkening
Enlargement- –dt mammory alveoli and fat deposits-making milk
↑ in size & number of glands
straie-stretch mark
blue veins
Darkening of areola-from3-5 cm
endocrine system changes in pregnancy
placenta
Placenta – produces estrogen and progesterone, HCG
endocrine system changes in pregnancy
Pituitary gland
Prolactin-milk production
Oxytocin-labor contraction
endocrine system changes in pregnancy
Thyroid
↑ BMR by 20%-
emotional liability perspiration and tachycardia
endocrine system changes in pregnancy
Adrenal gland
Inhibit Immune response-
inc levels of corticosteroids and aldosterone to prevent rejection of pregnacy
endocrine system changes in pregnancy
Pancreas
-inc insulin production but inslin doesn’t work as well d/t estrogen and progest
progesterone
when present
inc in progesterone
present in as early as 4 weeks
inc in progesterone reduces contracibiltiy of uterus which prevents premature labor
estrogen
contributes
stimulates
contributes to memory gladn development in prep for lactation
stimulates uterine growth to account for developing fetus
human placental lactogen
growth
present
expanding
regulates
growth-promoting and lactogenic
present in 6th week
expanding breast growth=lactation
regulates parental glucose, protein , fat levels for adequate nutrients for fetus
hcg
blood serum
failsafe
role
8th week
blood serum will be completely negative 1-2 weeks after birth
failsafe measure to ensure that corpus lutetium of ovaries continues to produce progesterone and estrogen
plays role in suppressing maternal immunological response so placental tissue is not detected as foreign object
8th week outer layer of placenta begin developing progesterone, producing corpus lutem
what is N/v caused by
what is increased mucus caused by
HCG
estrogen
Gestational diabetes
inc risk
monitor for
lab when
inc risk of diabetes and size of baby
monitor bs in baby after birth
lab values @25-28 weeks
what vaccine to never give pregnant women
rubella
Integumentary & Hair changes in pregnancy
linea nigra
hyperactive glands
hair changes
Linea nigra-narrow brown line on abdomen-fades away
Hyperactive sweat & sebaceous glands-inc perspiration and sweat
Hair thickening, then loss post-partum
Straie gravidarum-
Integumentary & Hair changes in pregnancy
see streaks on sides of abdomen and sometomes on thighs
are permanent-will fade
Chloasma(melasma)
Integumentary & Hair changes in pregnancy
“mask of pregnancy”- darkened/reddened areas on face across cheeks and nose
fades away
Diastasis
Integumentary & Hair changes in pregnancy
-rectus muscles underneath skin will painlessly separate
vascular spiders
small fiery red branching spots on skin
thighs/hands//palms
musculoskeletal system changes
softens
changes
possible
inc
Pelvic/ligaments + Joints soften
(Helps baby move through pelvis during Childbirf)
Changes to center of gravity.
Possible back/ girdle pain.
inc risk of restless leg syndrome + Carpal tunnel Syndrome
respiratory system in pregnancy
wha looks like
may be
tidal volume
02 consumption
increase
BPM
Dyspnea/SOB-d/t fetus on lungs
May be congestion
↑ in tidal volume of air
↑ in O2 consumption causing mild hyperventilation
↑ in thoracic circumference
↑ depth & rate of respiration
18-20 breaths per minute
what side to sleep on for resp
left sided sims position
temperature changes in pregnancy
due to
Early pregnancy temp will increase– after 16 weeks temp goes back to nomral
due to progestogen
Cardiovascular System in Pregnancy
blood flow
peripheral
postural
supine hypotensive
↑ blood flow to uterus & kidneys
peripheral blood flow dec causing edema-goes away at night
postural hypotension
Supine hypotensive syndrome-laying supine compresses vena cava and blood return to heart decreses
Cardiac output
Heart rate
Blood presure
Blood volume
changes in Pregnancy
↑ in cardiac output,
↑ in HR,
slight ↓ in BP,
25 to 50 % ↑ blood volume
Cardiovascular System in Pregnancy
need what for blood
plasma
physiologic anemia
inc
need ↑ of Fe and folic acid for inc rBC
50% ↑ in plasma volume
Physiologic Anemia - not having enough healthy red blood cells or hemoglobin to carry oxygen to the body’s tissue-SOB
increase in fibrinogen
WBC changes
Clotting changes
Pregnancy changes in heart
Slight ↑ of WBC’s until delivery then significant ↑
↑ in clotting factors- ↑ risk of thrombosis
what to teach for cardiovascular system
elevate legs and use compression sock helps vascolarities and blood flow
folic acid and iron helps enhance pregnancy and getting pregnant
Gastrointestinal System in Pregnancy
s/e
peristalsis
gallstone
N & V-can be noticed at same time of hcg and progesterone increase- subsides after 3 months
↓ in peristalsis constipation heartburn and flatulence
↑ risk of gallstone formation-may need emergency removal
Hemorrhoids
Heartburn
Gi system in pregnancy
pressure from uterus on veins and consitpation Hemorrhoids
Relaxation of cardiac sphincter heartburn
Hyper-ptyalism
Gums
Teeth
GI system in pregnancy
Hyper-ptyalism-excessive production of saliva
Bleeding gums-estrogen
Increased tooth decay
Urinary Tract in Pregnancy
ureters
glom filt rate
Elongation & dilation of ureters
↑ in glomerular filtration rate (2nd trimester) and renal function
urinary frequency in 1/2/3 trimester
Urinary Tract in Pregnancy
Pelvic organ- urinary frequency (1st & 3rd trimester)
Abdominal organ - ↓ urinary frequency (2nd trim)
retention
capacity
decrease
reabsorb
bladderchanges in pregnancy
increase in fluid retention
increase in bladder capacity
decrease in BUN and creating
sometimes body cant reabsorb all glucose= glycosuria
glycosuruia
can lead
inc what
Urinary Tract in Pregnancy
Sometimes body can’t reabsorb all glucose filtered
can lead to yeast infection
inc fluids and urination
relaxation
Musculoskeletal System in Pregnancy
Relaxation of joints waddling gait- walking can be difficult and painful
Progressive lordosis
Musculoskeletal System in Pregnancy
–shoulders back and abdomen forward
Diastasis recti
Musculoskeletal System in Pregnancy
separation of rectus abdominis muscl
will not go back to same shape
1st trimester changes in mother/father
accept reality of pregnacy, feel less pleasure and more anxiety-can be confusing/ once patients know gender they can be more accepting/hearing about prenatal can make feel “more pregnant” and help accepting
can be forgotten, but highly important to be apart of emotional/supportive role. Also feeling of ambivalence. Happy but overwhelmed, takes a lot of thought. May not have anyone to support them
2nd trimester changes in mother and father
trimester-accept reality of baby-feeling a kick can give sense of a person inside. After quickening(first movement), refer to baby as its own entity. can pinpoint when they wanted the child
Trimester-can be felt left out. some will work more. can have difficulty enjoying pregnancy
3rd trimester changes in mother father
”nest building activates” – prenatal classes and preparing for childbirth. Childbirth education. Happy time for most parents, but unwanted pregnancy, financial difficulties,
sibling changes in pregnancy
The emotional upset and disruptive behavior of firstborn children to the arrival of a new sibling is often viewed assibling jealousy
routine is key for toddlers
school age needs reassurance
age appropriate teaching–also sibling classes
make it family affair
grandprent changes in pregnancy
don’t know their role
can try to step in unnecessarily
can often overstep
tell parents to set boundaries
grandparents can be pushy
Determination of due date
1st day of LMP
EDB
Subtract 3 months, and add 7 days
ultrasounds can help
initial prenatal assessment
determine high risk factors
High risk = possible negative outcome
Social and personal
Preexisting medical-diabetes or thyroid may be high risk
Obstetric/GYN considerations
—-previous pregnancys what look like
Full Physical assessment including VS
Labs
Laboratory tests
initial prenatal assessment
Hgb, Hct, and RBCs
ABO and Rh
WBC and differential
Glucose
Protein
Rubella
Hepatitis B and HIV (if desired)
STDs
Pelvic and Pap
Pelvic exam answer
gyneocloid
initial prenatal assessment
factors
Family and support systems-whats going on
Economic and living conditions-resources if needed
Educational needs-what help may need
=any home issues to be aware of
Initial Assessment-Cultural Factors
Respect and professionalism-integrate practices if possible
Don’t stereotype
Ask, don’t assume
Break down language barriers
Handouts and translation services
Subsequent Prenatal Assessments
how often
what looking at
fetal development
q 4 wks to week 28
q 2 wks to week 36, then weekly until birth
Health Interview
Weight Gain/VS
Edema
Urine sample
Uterine size-Fundal height
Fetal development
Quickening
Doppler
Ultrasound
Special tests
first triemester
nuchal translucency testing
looking at neck folds on baby
Special tests
2nd trimester
Amniocentesis
check for gender or genetic disorder
Special tests
15-20 weeks
Quad or Pentascreen-
Down syndrome /neural tube defect or any risk
Special tests
24-48 weeks
glucose tolerance test
and H&H (Glucose test may be done sooner if diabetes suspected)
looking for anemia
Special tests
35-37 weeks
GBS (Group B streptococcus) screen
if positive given antibotcs during delivery
prenatal danger signs
Vaginal bleeding
Persistent vomiting
Temp and chills
Gush of fluid
Abdominal pain
Dizziness, blurred vision, spots before eyes
Severe headache
Edema
Muscular irritability or convulsions
Epigastric pain
Oliguria
Dysuria
Absence of fetal movement
Fetal activity monitoring
influences on fetal activity
mom will track activity-10 an hr
Cigarettes and drugs
Blood glucose
Time of day
Sleep/wake cycles
Sounds
discomforts of 1st trimester pregnancy
Urinary Frequency
Nausea and vomiting
Fatigue
Breast tenderness
Increased vaginal discharge
Nasal stuffiness
discomforts of second/third trimesters
Heartburn
Ankle edema
Varicose veins
Flatulence
Hemorrhoids
Constipation
Backache
Leg cramps
Faintness
SOB
Difficulty sleeping
—-Left sided Sims - optimal
Round ligament pain
Carpal tunnel syndrom
Breast and Nipple Care
Support the breasts with nice bra
Comfort
Prevent back strain
Nipple Care
, don’t wash with soaps or put oil or lotion on the nipples
Promotion of Self-care Environmental Factors
Employment-some jobs cant do
Travel- dont recommend later in trimester
Clothing and Bathing-loose fitting clothing
Activity and Rest
Teratogenic Substances and Medications-chemicals
Environmental Factors-ETOH
increases the risk of miscarriage,
premature birth and your baby having a low birthweight
no ridge on nose
can cause neurological damage
NO ACLOHOL
Environmental Factors-Tobacco
Effects of tobacco use –
increased incidence of:
Fetal growth restriction
Low birth weight - SGA
Stillborn and SIDS risk
Pregnancy Nutrition
weight gain
Wt gain- 25-35 lbs if normal BMI
11 lb fetus, placenta, fluid
2.5lb uterus
4lb increased blood volume
1.5-3lb breast tissue
7 lb maternal stores-backup
Nutritional requirements
pregnancy
Calories: 300 extra calories daily in 2&3 trimester.
Carbohydrates-
Proteins-meat, poultry, eggs
Fat-vegetable oils-
Minerals-calcium, Iodine, iron, fluoride, zinc-
Vitamins-CAD, folic acid//fresh fruit, vegtables, milk eggs
Fluid- 8-10 glasses fluid daily
4-6 should be water-2500-3000ml
pregnacy nutrition
what to watch for
supplements
Watch raw foods and fish sources
Prenatal vitamin-can be taken-wont hurt
Supplements
-Iron: Iron helps make hemoglobin.
-Folic Acid- helps prevent neural tube defects AND helps make red blood cells.
Factors affecting nutrition
Don’t restrict calories, but make them count = nutritious
Lactose intolerance
Eating disorders
Pica-eat non food items
Discomforts
Cultural, ethnic, and religious
Psychosocial
Socioeconomic
ADOLEctents need even more cals
what to teach a new pt that comes in with N/v
small frequent meals
increase fluids to 2-3 l
8-10 fluids per day
why is calcium so vital
calcium makes the baby bones!
if you dont eat calcium, baby will steal the calcium from your bones to create its bones
milk/dairy/leafy greens
what occurs in metabolism in pregnancy
goes up-300 cals a day
underweight should gain over 35 lbs
normal should gain 25-30
overwiehgt should gain 15-20
why no raw fish/deli meats
fish-mercury
meats-listeria-can cause still birth
supplements
prenatal vits can always be taken
iron and folic acid are important to take during
when to notify a provider in pregnancy
if any bleeding
what teaching for urinatiom
go to bathroom as often as possible
go on first urge
empty bladder fast
pain meds during pregnancy
ACETAMINOPHEN only
nothing else
back pain help
soft shoes
massages
ice
positioning
pillows
prevention of varicose veins
elevate legs
teds compressions stocking
what do if mom is RH negative
ROGAM
shot at 28 weeks and 72 hrs after labor
help not trasnfering blood
best sleeping position
left sided sims
helps dizziness
what to do if severe fatigue
iron testing and H&H for anemia
severe headache and blurred vision help
contract provider
NO ER
what causes gums to bleed
estrogen
what helps a baby move
ice water
sugary food
move around
call if nothing after 2 hrs
when to get strep test
NO SOONER THEN 35 WEEKS
why do babies kick at random times
not on same schedule as mother
kick when they feel like it
what do you not take in pregnancy
NO mental health drugs
no lithium
antiserzires meds no
