Mark k lecture 10\ Flashcards
Determining the estimated date of delivery
Use the Naegele rule—take first day of last menstrual period (LMP), add 7 days and subtract
3 months from it
o For instance, if the last menstrual period of a pt was between June 10 and 15
o The estimated date of delivery = March 17
Weight gained during pregnancy
* 1st trimester (12 weeks)
o 1 lb per month = Total of 3 lbs
Weight gained during pregnancy 2nd and 3rd trimesters
o Add 1 lb every week
The ideal weight gained during pregnancy
o 28 lbs, plus or minus 3
o Between 25 to 31 lbs
If weight gained during pregnancy is within +/–1 to 2 lbs of the ideal weight for the
gestational week
Pt is WNL
If weight gained is within +/–3 lbs , +/–4 lbs
- +/–3 lbs … Assess her
- +/–4 lbs or more… There is trouble
o perform a BPP on the fetus
A woman is in her 28th week gestation. She gained 22 lbs, what is your impression?
- Using the long method
o First trimester (12 weeks) … She gained 3 lbs
o 28 weeks minus 12 weeks = 16 weeks
o Therefore, she would add an extra 16 lbs on her weight
o 3 + 16 = 19 lbs … She has 3 lbs extra than her ideal weight
o Therefore, assess the pt
A pregnant woman at 31 weeks gestation gained 15 lbs. what is your impression?
- Using the short method, this pt ideal weight should be
o 31 – 9 = 22 lbs
o However, 22 – 15 = 7 lbs less than the ideal
o Therefore, the nurse needs to assess the biophysical profile (BPP) on the fetus
Fundal Height 1st trimester
- Fundal height cannot be palpated until week 12
o That when the fundus is midway between the umbilicus and the pubic symphysis - The fundus can be palpated at the umbilicus between 20 and 22 weeks
What is the significance of being able to palpable fundal height?
- The examiner should be able to determine in what trimester the pregnancy is
o In case pt is unconscious, for instance
o It has diagnostic significance as well … A much bigger than normal fundus may indicate
molar pregnancy
For instance, the fetal HR can be heard first between
8 to 12 weeks gestation
Quickening (baby Qicks) may be first felt between
16 to 20 weeks gestation
Maybe Signs of Pregnancy
- Positive urine/blood hCG tests
* A positive pregnancy test may result from other conditions
* For instance, cancer - Chadwick sign—cervical color change to cyanosis (Cs)
* Bluish discoloration of the vulva, vagina and cervix
Goodell sign—good and soft
* Softening of the cervix
Hegar sign—uterine softening
- Softening of lower uterine segment
Chadwich ! Goodells ! Hegar - All 3 signs are in alphabetical order and
- Move up from the vulva, vagina, cervix to the uterus
During pregnancy, pt is advised to go for prenatal visits as
- Once a Month until week 28
- Every other week between 28 and 36
- Once a week after week 36 until delivery or week 42, whichever comes first
o At week 42, delivery can be induced or by C-section
If a woman comes in for her 12th week prenatal checkup, when is her next prenatal visit?
- Her next visit is at 16 weeks
Hemoglobin (Hb) during pregancy
- Normally Hb in female = 12 – 16
- A pregnant woman can tolerate lower levels of Hb
- First Trimester: Hb can fall to 11 and be perfectly normal
- Second Trimester: Hb can fall to 10.5 and be perfectly normal
- Third Trimester: Hb can fall to 10 and be perfectly normal
How do you treat morning sickness?
- Morning sickness is usually seen during the 1st trimester
- Treatment: Dry carbohydrates—not before breakfast but—before pt gets out of bed
How do you deal with urinary incontinence?
- Urinary incontinence is seen in the 1st and 3rd trimesters
- Pt needs to void every 2 hours from the day she gets pregnant until 6
weeks postpartum
A pregnant pt complains of difficulty breathing. What should you advise her to
do?
- Difficulty breathing is a problem during the 2nd and 3rd trimesters
- Advise pt to assume to tripod position
o Tripod position is a physical stance often assumed by people
experiencing respiratory distress
o The pt will be leaning forward with hands on knees or the surface of a desk or table
A pregnant pt complains of back pain. What
should you advise her to do?
Back Pain is seen during the 2nd and 3rd
trimester
* Advise pelvic tilt exercises to pt
What is the truest most valid sign that she is in
labor?
- The truest most valid sign of labor is the
onset of regular/progressive contractions
Dilation
is opening cervix from 0 to 10 cm
Effacement
Effacement is thinning of the cervix. It goes from thick to 100% efface (thin like paper)
Station
is the relation between fetal presenting part and the mother’s ischial spines (know
this)—the narrowest part of the pelvis
o Positive numbers mean the baby has made it through this tight squeeze—good to go
o Positive numbers = Positive news
o If a baby stays at a –3, –2, –1, it can’t get through vaginally. It needs C-section for delivery
