Maternal Exam 2 Flashcards
Changing body system during pregnancy
reproductive Gastrointestinal muskelosketal cardiovasular respiratory renal/urinary endocrine
Changes to the abdomen
- Uterus enlarges and muscle of abdomen stretch and lose tone.
- In 3rd tri the rectus muscle may separate
- Line of pigmentation down belly=Linea Negra
- Stretch marks=Striae
- Umbillical flatten or sticks out
Probelms with stomach
- delayed emptying from pregetrone on smooth muscule motility
- Galbladder may becaome distended, galstones are common in 2nd and 3rd tri.
- Kidneys are enlarged
- Colon is shifted upward and peristalticactivity decreases= constipation/gas
How to help the GI and stomch keep going?
Lots of water, fiber and exercise
Hyperplasia
New cell formation
Hypertrophy
Stretching in 2nd and 3rd tri.
Uterus grows from 10mls to ?
5000mls in 40 wks
contractions of the uterus when in practice?
Braxton hicks are
Chadwicks sign?
When the cervix turns a purplish/ blue color
Goodell’s sign?
Connective tissue that is softened
what holds everything into the uterus?
Cervix
What changes about the uterus?
hyperplasia/hypertrophy
moves from pelvis to abdomen
contractility
cervix- chadwicks and goodell’s sign
Uterus changes in size from…
2oz- 2.5lbs
What does estrogen do to the vagina and vulva?
increases vascularity, softening and thickening of mucosa
Leukorrhea?
increased vaginal secretions which are thick , white and acidic, the acidic environment discourages bacterial growth but can make some people more prone to yeast infections
Why is ovulation interupted during pregnancy?
B/c of the elevated levels of estrogen and progesterone, blocking the secrection of FSH and LH.
Corpus luteum produces?
hormons and disintegrate slowly.
The ovaries produce?
Progesterone until placenta takes over at 6-7 wks
the cervix is used to?
Keep baby in and keep bacteria out.
Endocervical gland secret?
thick, sticky mucous that forms a mucous plug and seals the endocervical canal
Increase vascularization in cervix causes?
Purple/ blue color and softening
What stimulates the glandular tissue of the cervix?
Estrogen
Colostrum is? When does is produced?
Thick, sticky yellow discharge from nipples that come before milk at the end of pregnancy
Changes effecting breasts?
Increased vascularity, and in response to luteal and placental hormones the lactiferous ducts proliferate increasesing in size and number ( bigger by 2-3 times)
Why do boobs get saggy after baby?
Increased glandular tissues displaces connective tissue and as a result the tissue becomes softer and looser
Areola of the nipple looks like?
Becomes dark in color and bigger in diameter, more erectile and montgomery tubercles develop on them as small white pimples, these secret oil to keep nipples drying out so dont pick or pop them.
Visably breast will have what on them?
Blue veins due to mammary vascularization that has increased and the veins are engorged and visible through skin( some striae may appear)
What happens to your cardiovascular system?
Increased blood volume
Increased Blood components
Increased cardiac output and hear rate
Decreased BP
Cardiac output is increased when?
In the early pregnancy and peaks at 25-30wks and is 30-50% high then normal.
Blood volume increases due to?
increased erythrocytes and plasma, it is solo important to drink plenty of water!
Changes to heart?
- rate may increase by 10-15 bpm at term
- Heart works harder to accomadate the increased HR and stroke volume required for the extra volume.
Blood pressure should be?
Slightly lower in pregnancy( from the peripheral vasodilation from the progesterone)( porgeterone relaxes muscles so BP is lower) and go back to normal in 3rd tri.
What is supine hypotension syndrome?
Uterus putting pressure on inferior vena cava, and causes dizziness, pallor, and clamminess, correct this by NOT laying on back and if you must for surgery place wedge or towel under back.
Blood components increase by?
RBC’s by 30% and Blood volume by 50% which cause anemia which we need iron to form hemoglobin for transporting oxygen, Hmg and Hct levels will be lower because they are diluted.(Iron supplement and lots of H2O.
Why is pregnacy a hypercoagulable state?
Increased vascularity makes person hemorage risk but the body produces increased amounts of fibrin and plasma fibrinogen but that causes risks for clotting
How to prevent a dot while pregnant?
Walking, stretching, flexing feet, and riding a train so you can walking round often.
Changes to respiratory system?
- Increased volume respirations
- decreased airway resistance( become a chest breather)
- the estrogen producing vasucularity will bring blood to the nose area and cause congestion and nose bleeds
Changes to the GI? begins at mouth and ends at rectum
- gums bleed(hyperemic)
- delayed gatric emptying and decrease peristalsis from relaxation of smooth muscles related to the progeterone levels=constipation, bloating and gas
N/V is due to?
The HCG hormone, thats a good sign because thats a good hormone.
Delayed emptying of gallbladder increase the?
Cholesteral so your at an ncreased risk for gallstones.
Why does GFR increase?
Increased blood volume so GFR increases from the water.( increase by 50%)
what causes Glycosuria?
The kidney’s are working over load and they can’t filter as well, which could lead to bacteria from the sugar build up in bladder and cause infection.(kidney’s work harder)
Urenery frequentcy changes in 1st and 3rd tri because?
First because of the uterus expading and putting pressure on bladder and 3rd because baby weight is pushing down on bladder.
Integumentary system changes
- Cirulation-sweating, increased metabolism and sebaceous glands
- Hyperpigmentation- pregnancy mask
- Dialation of blood vessels from increased estrogen(spider veins)
- connective tissue changes-stretch marks( that dont go away)
What is chloasma?
pregnacy mask( hyperpigmentation)
Musculoskeletal changes
increased levels of hormones make ligament soft around the cartilage and muscels in the pelvis and lower back making them move out of the ordinary movement causing back pain, and pregnancy waddle.Also causes leg cramps, and makes sleeping very uncomfortable.
Adjusting the pregnancy muscles and skeleton?
No heels,flex foot for leg cramp(toes to nose), extra pillow to sleep on side, bend at the knees to pick up another child
The hormone relaxin is responsible for?
Softening pelvic cartilage, remodeling of collogin in joints, long term effects on pelvis.
The hormone progeterone is reponsible for ?
Softening and stretching ligaments
Endocrine changes
These hormones play a major role in controlling the supplies to the fetus,glucose, amino acids, and lipids
The Thyroid gland enlarges and increase hormone out put, which increase BMR, what else does it do?
BMR increase hunger, warmth (sweeting). People who have a preivious thyroid preoblem need to be monitor carefully.
The pituitary gland is responsable for?
- Secreting vasopressin(antidiuretic hormone) and oxytocin.(Vasopressin causes vasoconstriction and helps regulate water balance)
- Oxytocin- causes uterus to contract and stimulates the let down reflex for milk
The pancreas is responsible for?
- Insulin decreases blood glucose by increasing the rate at which glucose is uptaken and used by the cells.
- Growing fetus has large needs for glucose,amino acids, and lipids.
Does maternal insulin cross the placenta?
No! the fetus must produce its own insulin
Prolactin is responsible for what and who makes it?
Responsible for lactation and is made by the pituitary gland.
Prostoglandins are responsible for?
softening cervix, initating labor,maintaining placental vascular resistance, decerase hypertension
Placental hormones
HCG, HPL,( causes a getational diabetic) Estrogen, Pregesterone, Relaxin
HCG is responsibe for?
stimulating pregeterone and estrogen by the corpus luteum to maintain pregnancy until placenta takes over, can be detected as early as 8 days after fertilization and peaks at 9-10 wks. also cause the N/V
Greatest hormone in maintaining a pregnancy?
Progeterone, maintains the endometrium and inhibts spontaneous contractions and helps develope the breasts for lactation.
Changes in metabolism
weight gain of 25-35 lbs, less than half the weight is fetus, placenta and amniotic fluid and the greater portion comes from, blood volume,breasts, uterus size and maternal fat.
What is dependent edema?
Pregnacy causes swelling but is it too much and are we looking at preclampsia. Swelling in the wrist leads to carpal tunnel and then goes away when pregnancy is over.
Carbohydrate metabolism changes due to ?
Increased insulin needs but the protective mechanism allows the fetus to have enough glucose, but decreases the mothers ability to use insulin, must prevent hyperglycemia.( Gestational diabetes)
Gravida
number of pregnancies
Para
number of pregnancies past 20wks
Term
38-42wks
Pre-term
After 20wks but before 37wks
Post-term
After 42wks
Abortion
Pregnancy ending before 20wks
Presumptive indicators of pregnancy
Subjective changes the PATIENT tells you about
Probable indicators of pregnancy
Objective findings that the PRACTITIONER documents
Positive indicator of pregnancy
Confirmed pregnancy, ultrasound, hearing the fetal HB or palpating the fetal body.
What is Utiran Souflee?
Hearing the blood gush in stomach in stead of hearing baby
bulotinin means?
The rebound bounce of the cervix
RPR test is for?
Syphillis
PPD test is for?
TB
Rubella is a live virus can you give it?
Not to a pregnant women causes death of baby.
Check up schedule?
Every 4 wks until 28wks, then every 2wks until 36wks and the every week until delivery( based on risk factors)
LNMP means?
Last normal menstral period
Due date?
LNMP minus 3 months plus 7 days=Due date
First time moms will feel quickening at?
20wks
Leopolds maneuver is?
Pushing on belly to feel each leg, arm and head
Fundal hieght should be? Supra pubic to top of funds
At the umbilical at 20wks, after that 1 cm for every wk, if 2-3 cm off we need an ultra sound, may be having twins or something may be wrong
Scheduled testings?
- Quad screening- down syndrome at 15-20wks
- FKC-fetal kick count-26wks
- Glucose 26-28wks, 1hr blood test greater than 135 need a 3hr fast
- Repeat CBC- looking for anemia
- GBS- testing for strep B at 36wks
Nutritional recommendations?
- Vitamin and mineral supplements: prenatal, Iron, folic acid
- Increase calories by 300 a day
- increase protien to 60 g/day, which is 14g over regular( protien and carb need to be increase esspecailly in 2nd tri.
- 8-10 glasses of fluids a day,4-6 of those should be water
- at least 2 servings of fish a week
What kinds of fish can you eat?
Low consumption of fish deuring pregnancy can lead to problems, w, communication,fine motor skills, and developmental stages.
Fish is a high quality protien and low in satruated fat, contain healthy omega 3’s, BUT contains trace amounts of mercury, AVIOD shark,Swordfish, Mackerel, and Tilefish. EAT light tuna,shrimp, salmon, catfish and Pollack
Where does Listeriosis come from?
- Bacteria found in UNPASTURIZED milk, dairy,meat cheese, poultry and seafood
- No hotdogs, or deli meats unless reheated to steaming hot
- CHeck labels for pasteurization
Where does Samonella come from?
Raw or under cooked eggs.Such as cake batter, eggnog,caesar dressing, home made ice-cream
Nutrition after birth while lactating?
Continue prenatal vitamins(PNV), fluids 8-10 serving s a day, increased protein by 5g( 65g/day)
Nutrition after birth with out breast feeding?
Return to prepregnant levels of nutrients and decrease diet by 300 calls and take multivitamin (MV)
