Maternal health test 1 Flashcards
Cheap torches - congenital and perinatal infections
Can cause congenital conditions (present at birth) at birth if fetus is exposed to them in the uterus
Chicken, shingles
Hepatitis B, C, D, E
Enteroviruses, polio
Aids
Parvovirus B19
Toxoplasmosis
Other infections such as group b streptococcus, listeria, candida
Rubella
Cytomegalovirus
Everything else such as gonorrhea and chlamydia
Syphilis
Torch is the acronym of the 5 infections covered in the screening for infections at birth.
What is the screening called?
Toxoplasmosis
When and how to go about Abuse screening in pregnancy
what is it called?
Who to screen?
What to ask?
What to do if she says yes?
IPV screening
Ask patient in private, make it a safe process, nonjudgmental, have a safety plan in place
Screen all women and new patients, during new problems, annually, when pregnant in each trimester, GTT/PP visit
Keep it simple. Have you been injured by a partner in the last year?
Is there anyone that made you have axe against your will?
Is there anyone that made you feel unsafe? If yes? By whom? Number of times?
If yes.. inform that people are here to help she is not alone
Offer options but do not tell her what to do
Believe her and listen to her emphatically
Make a plan and offer resources
The practice of controlling the number of children in a family between births
Family planning
No drugs, devices, or surgical procedures are used to avoid pregnancy.
May be used by rhythm method(don’t have sexy during ovulation), calendar method, basal body temp/avoiding sex during fertile periods of the month based on body temperatures, hormone free, identifying fertile period, abstinence
Natural family planning
Different contraceptives?
Oral
Transdermal -estrogen and progrestone
Rings vaginal -
Implants subdermally -elective for 3 years
IUD device 3-5 years
Depo shot- every 3 months
Permanent - tubal ligation- snip Fallopian tubes (high risk for ectopic pregnancy) and vasectomy- vas deferens
Termination- has to be before 20-24 weeks
Drug use during pregnancy risk is higher when?
If homeless, poverty, partner uses drugs, preconception use
What does using drugs during pregnancy do to the fetus
Causes adverse catastrophic effects to fetus
What does using opioids during pregnancy do to the fetus
Risk of fetal growth restriction, abruptio placentae, fetal death, PTL, intrauterine passage meconium
What does using meth during pregnancy do to the fetus
What to do?
Small fetus for age
Low birth weight
Neurodevelopmental abnormalties
-encourage treatment stat
What does smoking during pregnancy do to the fetus
Premature labor
Premature rupture of membranes
Placenta previa
Fetus small for age
Resp issues in baby
Healthy people 2020 pregnant goals
Reduce HPV and cervical cancer by nurses educating patient with safer sex or abstinence and self examinations
Reduce breast cancer
Safety of LGBT people
Decrease teen sexual activity
What is involved in fetal circulation
Blood travels through the umbilical vein from the placenta to the fetus
Some blood circulated through the liver but most bypasses it through the ductus venosus and enters the inferior vena cava
It then enters the right atrium, passes through the foremen ovals, through the right ventricle , and into the aorta and suppling to upper and lower extremities and head
Then blood from head enters to the right atrium through the the right ventricle and into the the pulmonary artery. Most bypasses the lungs through the ductus arteriosus. Then to the pulmonary circulation, back to the right atrium, right ventricle, and aorta.
The umbilical cord contains how many vesicles?
Blood flows through what?
3 vessels: two arteries and one vein
Blood flows through the vein from placenta to the fetus
How blood flows through the vein and arteries to/from fetus
The umbilical vein carries oxygenated, nutrient-rich blood from the placenta to the fetus,
The umbilical arteries carry deoxygenated, nutrient-depleted blood from the fetus to the placenta
Reasoning for fundal measurements ?
To evaluate the gestational age of fetus
When to measure fundal height?
At first visit and every visit after 12 weeks
How should the fundal height measure?
The height should match the women’s gestational age.
Example- 12 weeks= 12 cm
Fundus to be where at 12 weeks?
16 weeks?
20 weeks?
22 weeks?
36 weeks?
40 weeks?
Just above pubis
16- between pubis and belly button
20- belly button
22- right above belly button
36-xiohoid process- pressure on lungs and GI
40-drop slightly into pelvis 4cm
Where should fundus be after birth?
1 hour-
1 day-
2 days-
7 days-
14 days-
Non-pregnant state is when?
1hour- at belly button (if slightly above have her urinate)
1 day- 1cm below belly button (umbilicus)
2 days- 2cm below belly
7 days- pubis
14- impalpable - onside pelvic cavity
6 weeks- non pregnant state uterus
GTPAL
Gravida
Term pregnancies
Preterm
Abortions
Living children
Gravida means?
The number of times a woman has been pregnant including abortions miscarriages pregnancy etc.
Term pregnancies
Born at 37 weeks or after
Preterm delivery’s ?
Born at 20-37 weeks (includes stillborn or alive)
Abortions/miscarriages
Both spontaneous and induced
Living children
Includes twins/triplets add two or three
Used to calculate the child’s Expected date of birth or EDD (expected date of delivery)
Nagels rule
How to calculate nagels rule
Based on the first day of last period
Add 7 days
Subtract 3 months
Plus one year?
Or LMP Add 7 days Add 9 months Plus a year
Dietary recommendations for pregnancy
How many calories a day
No alcohol
Supplements
Foods high in vitamins and minerals
(vitamin C, iron, folic acid, protein, increase water, calcium, vitaminD and omega 3)
Need more iron after 12 weeks
300 more calories a day
1 year to 6 months before pregnancy should intake folic acid (b9) to reduce chances of neural tube defects
(Calcium and folic acid - dark leafy greens)
Weight gain during pregnancy?
Weight gain of 35 pounds is acceptable depending on weight
Folic acid reduces the chance of deformities how ?
Helps regulate RBC development and Oxygen carrying - capacity in the blood
Procedures DNA and RNA to help maintain normal brain function and stabilize mental health
Purpose of preconception care?
Encourage healthy lifestyles for families that desire pregnancy
Identify and reduce risks during pregnancy or before
(Taking folic acid, exercising, at regulation, no drugs or alcohol, maintaining healthy weight)
Absence of mentsturation most often due to pregnancy,
but can be due to cycle issues or hormonal reasons
Amenorrhea
Painful mensuration that interferes with daily activities
One of the most OBGYN complaints
Dysmenorrhea
What helps treat Dysmenorrhea
What causes it?
Relaxation, using heat to increase blood flow, exercise or rest, NSAIDs/analgesics/diuretic Myron, Motrin
Heating pad, diet changes, increase activity, I limit alcohol and chocolate
Causes it - prostaglandins in menstural blood
Emergency contraceptives
What to know
Plan b - take before 72 hours after sex
Will not work if already pregnant
Does not cause miscarriage or abortion
Self breast exams
How often?
When to do? Why?
What to educate ?
Monthly
(In the shower, 7-10 days after period ends because you want progesterone out of your system because it causes breast to become lumpy)
Educate if you feel a lump see doctor immediately. The sooner it’s treated the better survival rate you have.
Contraception- both non hormonal
Abstinence Condoms Contraceptive sponge Copper IUD Tube tying
Hormonal contraceptives
Oral (synthetic estrogen)
Transdermal patch
Vaginal ring
IUD
Depo shot
Sub-dermal Implant
HPV treatment
Warts- topical agents , green tea extract
- cryotherapy (freezing),
- CO2 laser surgery
- electrotherapy
- surgical removal
Depending on severity and resistance to tx
Gardicil prevents HPV-age 11-12 yo
Can have cancerous strand
Presumptive s/s of pregnancy
Nausea and vomiting No period Breast tenderness Tired Quickening Weight gain Polyuria
Ptyalism (increase saliva) Fatigue Nasal congestion Backache Leukorrhea- (thick white yellow vag discharge) Increased urination-polyuria Dyspepsia (indigestion) Gas Constipation Hemorrhoids Dental problems Leg cramps
Probable s/s of pregnancy
Hegars sign- softening of cervix-between uterus and vaginal portion of cervix
Chadwick’s sign- bluish vagina and cervix
Goodells sign- softening of cervix
Ballottement- easy flexion or uterus when the examiners fingers pushes against the uterus and detects the presence of the fetus by return impact
Positive pregnancy test- rising Hcg levels prompts a positive pregnancy test
McDonald’s sign-indicates uterine enlargement
Uterine enlargement-occurs as the fetus grows
Mask of pregnancy- rash appears on the face due to hormonal influences
- softening of cervix-between uterus and vaginal portion of cervix
- bluish vagina and cervix
softening of cervix
- easy flexion or uterus when the examiners fingers pushes against the uterus and detects the presence of the fetus by return impact
- rising Hcg levels prompts a positive pregnancy test
indicates uterine enlargement
-occurs as the fetus grows
rash appears on the face due to hormonal influences
Hegars sign- softening of cervix-between uterus and vaginal portion of cervix
Chadwick’s sign- bluish vagina and cervix
Goodells sign- softening of cervix
Ballottement- easy flexion or uterus when the examiners fingers pushes against the uterus and detects the presence of the fetus by return impact
Positive pregnancy test- rising Hcg levels prompts a positive pregnancy test
McDonald’s sign-indicates uterine enlargement
Uterine enlargement-occurs as the fetus grows
Mask of pregnancy- rash appears on the face due to hormonal influences
Positive signs of pregnancy
Fetal heart tones
Leopolds maneuver (manual external palpation of the fetal outline)
Ultrasound of the fetal outline
When can you hear a fetus with a Doppler?
12 weeks
Purpose of amniotic fluid?
For growth and development
It cushions the fetus and protects against mechanical injury , helps fetus maintain normal body temp and helps musculoskeletal development and lung development
Decreased amniotic fluid
Oligohydraminos
Increased amniotic fluid
Increased amniotic fluid
What is the umbilical cord used for ?
Used for blood flow to and from baby
Common and systemic way to determine the position of the fetus inside the uterus
Determines presentation, lye, and fetal weight
Leopold’s
Swab testing of vagina and rectum of mother
Used to detect the risk that they will
Pass this bacteria to their newborns during birth, possibly causing a serious infection- GBS
When is it checked?
Group B strep screening
At 32-36 weeks
When to give rhogam ?
and At how many weeks ?
Give to Rh(D) negative women-
Check for Rh antibodies and if negative, rhogam is prescribed at 28-32 weeks pregnant
A problem of extreme nausea and vomiting causing electrolyte imbalance, severe dehydration and weight loss
Nursing intervention
When it usually occurs?
Hyperemesis gravidarium
——————-
IV therapy
Small more frequent meals
Antiemetic for n/v
———————
During the first trimester
What is one at risk for if they don’t gain enough weight during pregnancy?
Risk for preterm labor.
Increase calories by 300 every day for the 2nd and 3rd trimester
Week 1 in fetal growth and development
Fertilization occurs and the cyst is implanted by the end of the week
Weeks 2 in fetal growth and development
Yolk sac develops and amniotic cavity appears. Implantation is complete
Week 3 in fetal growth and development
Characteristics by the appearance of a primitive streak, skin teeth, mouth glands, nervous system, GU Tract, respiratory, digestive tract
Week 4 in fetal growth and development
Central nervous system, Brian and spinal cord
Week 8 in fetal growth and development
Upper and lower limbs
Genitals
Main organ systems
Week 9-12 in fetal growth and development
The fetal head is half the length of the crown
Face
Intestines
Genitalia is distinguished
Week 13-16 in fetal growth and development
Skeleton and bones
Weeks 17-20 in fetal growth and development
Quickening
Vernix
Eyebrows and head
Lanugo
Testies and ovaries
Week 21-25 in fetal growth and development
Gains majority of weight
Lungs
Fingernails
Eye movement
Week 26-29 in fetal growth and development
Can breath air
Eyelids
Toenails
Spleen
Bone marrow
Week 30-34 in fetal growth and development
Pupillary light reflex is present
Week 35-40 in fetal growth and development
The fetus has a strong hand grasp and orientation to light
Antepartum assessment
Testing involves use of EFM (electric fetal monitoring) or ultrasound to assess fetal well being or fetal heart rate and other characteristics during during this period from conception to labor
Leopolds maneuver position
Place her in supine position and stand behind her
Leopolds maneuvers 4 steps
- Presentation (which body part is on top or bottom) head is smooth and round
- Position (kicking, heart sounds, beat heard, hard and smooth head)
- Presentation -move hands down abdomen and grasp lower uterine
4- attitude- head flexed and engaged in pelvis
Impairment in carbohydrate metabolism that first manifests during pregnancy
Gestational diabetes
Gestational diabetes - women that are at risk
Older than 25
Obese
Polycystic ovaries
Hx of GD
Ethnicity
Family hx of type 2
Stillbirth or miscarriage
GD infant at risk for ?
Large body size
Congenital abnormalities
Low bs
Resp distress
Jaundice
Heart issues
Low calcium
GD mother at risk for?
C-section
Preeclampsia
Preterm birth
Maternal
Organ damage
Altered ABGs
When insulin is given in pregnancy-?
Watch fetus carefully with a a non-stress test
Dont want baby to delivery early due to being so big
Check for lung maturity with l/s ratio
Watch blood sugar for baby post delivery (low bs)
What is placenta perfusion ?
Any time blood flow
Is comprised to the fetus:
Preeclampsia Placenta previa Infarction Placenta hematoma Tumors Umbilical cord abnormalties Septal cysts Certain positions
Pregnancy issues of concern
Bleeding is not normal-painful/painless
Placenta previa (placenta is lying over cervix) -ultrasound but not vaginal
Placenta abruption
(placenta is lying over cervix) -painless bleeding
Interventions
Placenta previa
Bedrest,ultrasound but not vagina/c-section
placenta tears away from the uterus which causes this
S/s?
What may cause?
Placenta abruption
Painful bleeding , distended rigid and hard abdomen
Car accident, cocaine or HTN crisis
Consist of healthcare services that include:
check-ups
Patient counseling
Screening to prevent illness, disease and other health related problems
Preventative care
Consists of applying specific measures with the aids of increasing oxygen delivery to the placenta and umbilical flow
To reverse hypoxia (low oxygen) and acidosis
Intrauterine resuscitation
What to do for placental perfusion heart
Position upward lay lateral to
Left side
