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Maternity Flashcards

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1
Q

Cardiovascular system

A

Pulse may increase 10b/minutes

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2
Q

Blood pressure

A

May decrease in second trimester

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3
Q

 Endocrine system

A

BMI raises, body weight increases

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4
Q

Respiratory system

A

Oxygen consumption increases by 15% to 20%

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5
Q

Gastro intestine system

A

Nausea, vomiting, constipation,and hemorrhoids

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6
Q

renal system

A

Frequency of urination increases in first and third Trimester

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7
Q

Reproductive system

A

Uterus enlarges, cervix changes.
Leukorrhea is normal- White milky discharge PV-due to hormonal changes (if foul smelling /itching/ burning-need to report)

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8
Q

Skin

A

Linea Negra /striae(stretch marks)/chloasma(blackish color on the face)vascular spider Navi (very very small and tiny-blood vessels)

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9
Q

Skeletal system

A

Center of gravity changes -lordosis

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10
Q

Weight gain during pregnancy

A 
Weight gain 11.2 to 15.9kg KG  (25 to 35 LB)
1st trimester 1 to 2kg(2.2to4.4lb)
2nd to3trimester 0.4 KG (1 lb)
under weight woman total 28 to 40 gain
Overweight woman 15 to 25 Lb
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11
Q

Pica

A

Pica is the abnormal, compulsive craving for and consumption of substances normally not considered nutrionally not valuable or edible
Common substance include ice,corn starch, chalk,clay,dirt,and paper
associated with iron identification anemia.so monitor the Hb and Hct.

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12
Q

Laboratory tests Blood type and Rh factor

A

mother is Rh negative and it has negative antibody screen should be given Rho(D)immune globulin (RhoGAM) within 72 hours of birth of first baby when detected
With every other pregnancy, should be given RhoGAM at 28 week ago gestational and within 72 hours of birth of baby

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13
Q

Other pregnancy tests

A

Tuberculin-skin test (if needed) positive test indicates need for chest x-ray to rule out active disease. In Pregnant client, x-ray cannot be performed until after 20th week of gestation
urine glucose-?Diabetes, protein-? Preeclampsia,nitrates and WBC? Infection
May be decreased and a specific gravity may be increased (vomiting )
blood:hCG levels (human chorionic gonadotrophin)
diagnostic test: ultrasonography
outline define identifies fetal and maternal structures.
Assist in confirming gestational age and estimated date of confinement.
Avoid supine position-reduced venous return -hypotension dizziness,fall

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14
Q

Chorionic villus sampling (high risk)genetic problem

A

Assessment of portion of the developing placenta (chronic villi) which is aspirated through a thin sterile catheter accident or syringe (10 to 12 weeks)
detects genetic abnormalities by sampling chronic villus tissue at 8 to 12 week of gestation
kick counts (fetal movement counting)- 10 times into 2hrs.

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15
Q

amniocentesis

A

Aspiration of amniotic fluid may be done from 13 to 14 weeks of gestation
Used to determine genetic disorders, metabolic defects , fetal lung maturity.
Risks maternal hemorrhage,infection,abruptio placenta, premature rupture of membranes.
(AFP)alpha-fetoprotein can be measured from the amniotic fluid
high levels of AFP are associated with neural tube defects,anencephaly (incomplete development of fetal skull and brain), Omphalocele(abdominal wall defect)

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16
Q

Amniosynthesis:high levels of AFP.

A

High levels of AFP also May be present with a normal multi fetal pregnancies
Low levels of AFP are associated with chromosomal disorder (down syndrome) or gestational trophoblastic disease (hydatidiform mole)

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17
Q

fetal lung test

A

Lecithin/Sphingomyelin(L/S)ratio is 2:1ratio indicating

fetal lung maturity (2.5:1or 3:1for a client who has diabetes mellitus)

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18
Q

Present of phosphatidylglycerol(PG)



A

Absence of PG is associated with respiratory distress
after amniocentesis:administer Rho(D)immune globulin RhoGAM to the client if she’s Rh negative
advise the client to report to her provider if she’s experience fever, chills, leakage of fluid, or bleedingfrom the incision site, decreased fetal movement, vaginal bleeding,or uterine contractions after the procedure

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19
Q

Fern test

A

Microscopic slide to determine in presence of amniotic fluid leakage

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20
Q

Nitrazine test

A

Determines present of amniotic fluid in vagina secretions; shades of blue indicate that membranes probably ruptured. blue green/ blue gray/ deep blue = positive

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21
Q

Quad marker screening

A

A blood test that ascertain information about fetal birth defects,it does not diagnose the actual defect. Check HCG,AFP, Estriol,inhibin-all proteins from fetus and placenta

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22
Q

Sustained Fetal Tachycardia

A

> 160/min for>10mts is concerning finding that requires further follow up

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23
Q

Nonstress test positive - reactive it’s normal

A

Performed to assess placenta function and oxygenation
Assesses fetal well-being-FHR-vs fatal moment
Normal increased the fetal heart rate with fetal movement
outpatient clinic external monitor
the non stress test is reactive- (normal) when 2 or more fhr acceleration of at least 15 beats/mts (each with a duration of at least 15 seconds ) occur in a 20 minuets Period Test
(wait at least for 40 minutes if no fetal heart rate acceleration, before saying it it’s abnormal)

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24
Q

contractions stress test(positive is abnormal)

A

Performed to access placental function, oxygenation and baby tolerated labor ?
Fetal heart rate versus contractions -nipple stimulation/ oxytocin(Oct)
Normal-no late deceleration, no variable deceleration
early decerlaration is OK -due to head compression to maternal pelvis
assess fetal ability to tolerate labor,fetal well-being

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25
Q

late deceleration and variable decelerations: not OK uteroplacental insufficiency

A

A variable decelerations- maybe due to cord compression, cord prolapse, uterine tachysystole ( first constructions) chorioamnionitis, Pleasant abruption, nactual cord , PROM with the fetal distress,maternal pushing during labor.
Late decelerations:due to decreased cardiac output from mother/ decreased blood to the placenta :
common causes maternal dehydration, anemia, hypoxia, hypertension epidural analgesia , uterine tachysystole, placental abruption.

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26
Q

Fetal monitoring

A

External fetal monitoring: non-invasive, performed using transducer or Doppler
Transducer,fastened with belt,should be placed on side of mother where fetal back is located (find using Leopold’s maneuvers)
Internal fetal monitoring invasive , requires rupturing of membranes,
attachment of electrode to presenting part of fetus, mother must be dilated 2 to 3 cm to perform this procedure
contraindications-closed cervix, placenta previa,STD, breach, AIDS, hepatitis B.

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27
Q

fetal assessment biophysical profile BPP

A

Check fightings on score 0 to 20 by Dr. with the help of ultrasound
1-fetal heart rate/NST
2-fetal breathing moment
3-fetal body movements
4-Fetal muscle tone
5-amount of amniotic fluid
score 8 to 10=reassuring=good
6-Equivocal (suspicious)need another BPP With in the next 12 to 24hrs
4 or less non-reassuring- may needed immediate attention/delivery

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28
Q

Nagele’s Rule

A

to estimate date of confinement,delivery date:
1-subtract 3 months from the first day of the last menstrual period,
2-add 7 days,and
3-Adjust the year

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29
Q

McDonalds Method-

A

Fundal height-correlate with you gestational age until 3rd trimester. Consistency (same person same measurement) is important

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30
Q

GTPAL acronym: Gravidity number of pregnancies

A

Nulligravida woman has never been pregnant.

primigravida: a woman in her first pregnancy,
multigravida: a woman who has had two or more pregnancies

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31
Q

GTPAL acronym

A 
G= gravida
T- term baby 
P-preterm Baby
A-abortion 
L- living
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32
Q

Gravida

A

The number of times the woman has been pregnant, regardless of pregnancy outcome

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33
Q

Term term

A

The number of pregnancies delivered at 37 weeks zero days and beyond

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34
Q

Preterm 

A

The number of pregnancy delivered from 20 weeks zero days gestation through 36 weeks six days risk gestation

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35
Q

Abortion

A

The number of pregnancy sending before 20 weeks zero days gestation this may be spontaneous miscarriages are induced abortions

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36
Q

Living

A

The number of currently living children

37
Q

Torch: malformations, fetal death

A

Toxoplasmosis:uncooked meals, cat litter- avoid backyard gardens/soil food
cats and kittens prefer litter boxes, garden soil and sand boxes for elimination

38
Q

toxoplasmosis other infections(TORCH) Malformation, fetal death

A

Other infections( usually hepatitis): poor hand washing, blood and body fluids contamination, rubella:: droplet spread-rubella virus,
cytomegalovirus:droplet, body fluids (including Tears , saliva breast milk),Handwashing.
herpes simplex STI

39
Q

Presumptive signs(subjective) Change that the woman experiences that make her think that she may be pregnant

A

 amenorrhea, fatigue , nausea and vomiting, urinary frequency
Breast changes-darkened areolae,Montgomery ‘s glands around the breast
quickening - slight fluttering movements of the fetus felt by a woman between 16 to 20 weeks of the gestation
uterine enlargement, probable signs

40
Q

Probable signs : (objective )

A

Change that make the examiner suspect a woman is pregnant (primarily related to physical changes of the uterus)
abdominal enlargement related to changes in uterine size,shape,and position

41
Q

Braxton hicks Contractions – false contractions

A

painless, irregular, and usually relieved by walking.

positive pregnancy test, fetal outline felt by examiner

42
Q

Hegar sign:

A

Softening and thinning of lower uterine segment at about sixth week of gestation 

43
Q

Goodells sign:

A

Softening of cervix, beginning at second month of gestation

44
Q

Chadwick’s signs:

A

Bluish coloration of mucous membrane’s of cervix, vagina,vulva at about sixth week of gestation

45
Q

Ballottement:

A

Rebounding of fetus against examiner’s fingers on palpation

46
Q

Positive sign

A

fetal heart rate; 120 to 160 per minute, active fetal movement
outline of fetus on x-ray or ultrasonogram

47
Q

Common discomforts of pregnancy

A

Urinary frequency, avoid UTI. Encourage the client to wipe the perineal area from front to back after voiding; avoid bubblebaths,wear cotton underpants, avoid tight fitting pants, consume plenty of water (eight glasses of water per day). Avoid urinary stasis

48
Q

Other common problem in pregnancy :nausea and vomiting

A

Nausea and vomiting;: eat crackers or dry roast dry toast 30 minutes to 1 hour rising in the morning to relieve discomfort
small frequent meals,
high-protein snacks.
Instruct the client to avoid heaving empty stomach and ingesting spicy ,greasy, And gas forming foods.
Encourage the client to drink fluids between meals,
consume food high in vitamin B6 (example nuts ,seeds, legumes)

49
Q

Other symptoms in pregnancy Heartburn

A

Eat more small frequent meals, not allow the stomach to get empty or to full ,
sit up for 30 minutes after meals, check with her provider to using any over-the-counter antacids

50
Q

Other common problems in pregnancy period

A

Fatigue: may occur during the first and third trimester -frequent rest periods
Beckache: exercise regularly, perform pelvic tilt exercises (alternately arching and straightening the back). Use proper body mechanics by using the legs to lift rather than the back, and use the side lying position

51
Q

Common discomfortable pregnancies

A

Constipation: the client is encouraged to drink plenty of fluids, Eat a diet high in fiber, and exercise regularly
bulk forming fiber supplements:Psyllium methylcellulose, wheat dextrin.
Hemorrhoids: A warm sitz bath and application of topical ointments will help relieve discomfort

52
Q

Ectopic pregnancy

A

Abnormal implantation of a fertilized ovum outside of the uterine cavity. Usually in the fallopian tube, which can result in a Tubal rupture causing a fatal hemorrhage.

53
Q

Ectopic pregnancy symptoms

A

Unilateral stabbing pain and tenderness in the lower abdominal quadrant,
Reffered shoulder pain and due to blood in the peritoneal cavity irritating the diaphragm or phrenic nerve after tubal rupture
nursing action: replace fluids and maintain electrolyte balance to
avoid shock
provide medical and educational psychological support. Rh negative mom -give Rh immunoglobulin.

54
Q

Hyperemesis gravidarum

A

Excessive nausea and vomiting past 12 weeks and result in a 5% weight loss,
electrolyte in balance and ketosis
nursing care:monitor the client intake output (urine specific gravity - increase if dehydration)
give the client IV fluids. Assess the clients a skin turgor, and mucous membrane’s.
monitor the client Vital signs (hypotension,Tachycardia)
monitor the client’s wait. Have the client remain NPO for 24 to 48 hours
med/easily digestible foods (low fat/simple carbs like cereal rice pasta.)

55
Q

Gestational diabetes

A

Screen all pregnant woman’s between 24th to 28th week of gestation.
can be treated by diet alone;some may need insulin
during second and third trimester, maternal insulin needs increased (placental hormones- increase insulin resistance).
Fetus produces own insulin and pulls glucose from mother, predisposing mother to hypoglycemia.

56
Q

Risk for polyhydramnios :(excessive accumulation of amniotic fluid,(>1200to 2000ml ) clumsy eclampsia,dystocia, infections (yeast)

A

Newborn infant of diabetic mother at risk for hypoglycemia, hyperbilirubinemia, respiratory distress syndrome, hypocalcemia, congenital anomalies

57
Q

polyhydramnios assessment

A

Signs similar to those of diabeties Mellitus in nonpregnant woman. polyuria, polydipsia polyphagia monitor the client blood glucose, monitor the fetus, administer insulin.

58
Q

Polyhydramnios client education

A

Instruct the client to perform daily kicks counts.
Educate the client about diet and exercise
Educate the client about self administration of insulin

59
Q

Hypoglycemia signs



A

Nervousness, headache,weakness, irritability, hunger,blurred vision, tingling of mouth or extremities

60
Q

Hyperglycemia signs

A

Thirst,nausea, abdominal pain, frequent urination, flushed dry skin, fruity breath)

61
Q

Gestational trophoblastic pregnancy,molar pregnancy

A

No fetus, but uterus swollen, fluid filled, and takes on the appearance of grape like clusters.
excessive vomiting (hyperemesis gravidarum)due to elevated hCG levels
in rapid uterine growth more than expected for the duration of the pregnancy due to the over proliferation of cells.
An Ultrasound reveals a dense growth with characteristics vesicles , but no Fetus in Uterus 

62
Q

Gestational trophoblastic disease,Hydatidiform mole,Molar pregnancy:

A

nursing actions: Measure fundal height.
Symptoms of preeclampsia may be present
Assess vaginal bleeding and discharge.
Rho(D)immunoglobin RhoGAM to the client who is Rh negative

63
Q

Preterm labor

A

Occurs after 20th week, but before 37 the week of gestation.
risk factor:H/O preterm delivery or cervical surgery (cone biopsy), mother age (< 17 or>35)current infection, (Dental/ UTI),substance-abuse, malnutrition.
Contractions occur more frequently than every 10 minutes, last 30 seconds or longer persist. (Patient may complain of low back pain/ pelvic pressure or heaviness /abdominal cramps) assessment:Rapture of amniotic membranes

64
Q

Preterm interventions/med

A

Maintain left lateral position, monitor fetal status.
Betamethasone:to hasten surfactant production. Administer tocolytics.to stop Contractions,
Retrodrine, Turbutaline,mag sulphate,Nefidipine,Indomethacine.

65
Q

Preterm labor client education

A

Give me the attention immediate action for patient experiencing suspected preterm labor at home 1- empty bladder,
2-left laying position,
3drink 3 to 4 cups of water,
4-palpate abdomen to assist contractions, 10 minutes apart or closer contact doctor
5-rest for 30 minutes and slowly resuming activity if symptoms disappear. If symptoms persist up to one hour,contact doctor 

66
Q

Contraction for tocolytics

A

active vagina bleeding , dilation of the cervix greater than 6 cm,chorioamnitis,greater than 34 weeks of gestation, and acute fetal distress.
betamethasone:pulmonary edema and hyperglycemia
indomethacin:PP hemorrhage, blood tinged sputum,
magnesium sulfate toxicity blood BLURP

67
Q

Premature rupture of membranes(PROM)

A

rupture of the amniotic sac before Onset of the labor, regardless of length of gestation.
assessment: nitrazine test,Fern test positive, presence of pool of fluid near cervix.

68
Q

rupture of membranes interventions

A

May remain in hospital or at home on bedrest/activity limitations
no PV ( unless absolutely necessary, sterile technique), temperature 2hrs,Hydration.
If home:Educate to avoid sexual intercourse, insertion of anything into a vagina.
Avoid breast stimulation if gestation is preterm,
monitor temperature report temperature;of 100° immediately, admission antibiotics to mother as prescribed

69
Q

placenta previa

A

improperly implanted placenta into lower uterine segment, near are over the Internal cervical os.Maybe total, marginal,or or low- lying depending on how much is covered
assessment: sudden onset of painless, bright red vagina bleeding.

70
Q

Placenta previa mads:

A

Corticosteroids, such as betamethasone (Celestone),promote fetal lung maturation if delivery is anticipated (cesarean birth).
Have oxygen equipment available in case of fetal distress.

71
Q

Placenta previa interventions

A

Monitor maternal and fetal status, assess for bleeding, leakage or contractions.
Maintain mother inside lying position as prescribed,
monitor amount of bleeding; assess for development of shock
refrain from the performing vaginal exam (may exacerbate bleeding)
Administer IV fluids, blood products,and medications as prescribed
mother -OK to be home if no bleeding and baby’s status is good.
pelvic rest-no P/V,No sexual activity -injury to placenta
Plan for C-section. Additional ultrasounds will be needed to assess progress

72
Q

Abruptio placenta

A

Premature separation of the placenta from the uterine wall after 20th week of gestation , before fetus is delivered
A complication associated with gestational hypertension

73
Q

Abruptio Placenta assessment

A

Assessment:dark red, painful vaginalbleeding ,intra uterine rigidity(uterine muscle contraction,tenderness and stiffness)

74
Q

Abruptio placenta interventions

A

interventions: monitor maternal fetal status, maintain bedrest, administer oxygen.
Risk factor:gestation hypertension, fall accident.
Prepare for delivery of fetus as  Quickly as possible; vaginal delivery preferred but, because of emergency, cesarean section may be done.
palpate the uterus for tenderness and tone. Assess fetal heart rate pattern.
Administer IV fluids,blood products and medication‘s :corticosteroids to promote fetal lung maturity
administer oxygen 8 to 10 L per minute via facemask
assess urinary output and monitor fluid balance
Prepare for delivery as quickly as possible; vaginal delivery preffered but,because of emergency cesarean section may be done

75
Q

placenta accreta

A

The placenta implantation in the myometrium normal implantation is in the endometrium.
During delivery,placenta accreta is suspected if the placenta has not been delivered within 30 minutes of the infants delivery/attempts at manual removal cannot create a plan of separation/placental traction causes large volume hemorrhage.
during labor and delivery, placenta accreta can results in life-threatening hemorrhage and retained placental fragments.
The client should have a type and cross match on the chart in case an immediate blood transfusion is needed
they also required two large board IV sites

76
Q

Supine hypotensive syndrome(vena cava syndrome)

A

Occurs whenVenous returns to heart is impaired by weight of uterus; results in partial occlusion of vena cava and descending aorta and in reduced cardiac return,cardiac output, blood pressure Assessments:Faintness,lightheadedness,vertigo, hypertension, fetal distress
interventions: position client in a lateral recumbent position to shift weight of fetus off inferior vena cava
monitor maternal and fetal vital signs

77
Q

HIV aids

A

Routine laboratory testing in the early prenatal period

Procedures,such as amniocenteses and Episiotomy, should be avoided due to the risk of maternal blood exposure

78
Q

HIV aids

A

Avoid internal fetal monitors, vacuum extraction, and forceps during labor. No oxytocin induction-to avoid strong uterine contractions and vaginal tear

79
Q

How to take care the infection HIV AIDS internal fetal monitoring 

A

Administration of injections and blood testing should not be place until the first bath given to newborn
Instruct the client not to breast feed.
postpartum Period: if mother immune compromised, placed in protective isolation
Antiviral prophylaxis (Retrovir-zidovudine)may be given to the mother,
administer Retrovir at 14 weeks of gestation, throughout the pregnancy, and before the onset of labor Cesarean birth
Administer Retrovir to the infant at delivery and for 6weeks following birth 

80
Q

Group B, streptococcus B– hemolytic 

A

GBS is a bacterial infection that can be passed to a fetus during labor and delivery 

81
Q

Positive GBS (Group B streptococcus B hemolytic

A

positive GPS may have maternal and fetal effects, including premature rupture of membranes, preterm labor and delivery, Choreoamnionitis infections of the urinary track, and maternal sepsis. vaginal and Rectal cultures are performed at 36 to 37 weeks of gestation 
Administer intrapartum antibiotics prophylaxis(IAP) penicillin .

82
Q

Group B streptococcus B-hemolytic

A

Client who delivered previous infant with GBS infection/GBS bacteria during current GBS-positive screening during current pregnancy.
Client who has unknownGBS status who is delivering it less than 37 weeks of gestation,client who has maternal fever of 38°C (100.4°F),client who has rupture of membranes 18 hours or longer

83
Q

Bleeding during pregnancy

A

Vaginal bleeding during pregnancy is always abnormal.
Spontaneous abortion:when a pregnancies terminated before 20 weeks of the gestation (the point of fetal viability)are fetal weight less than 500 g.
Abortion: pregnancy that ends before 20thweek of gestation, spontaneously or electively.
Spontaneous: pregnancy ends because of natural causes. Reduced
induced: Therapeutic or elective reasons for terminating pregnancy.
Threatened: developing spontaneous abortion.
inevitable: Threatened’s loss that cannot be prevented.

84
Q

oligohydramnios: Amnioinfusion

A

Aminoinfusion-increasing isotonic saline to add volume-through intrauterine pressure catheter- transvaginal ( monitor for over a fluid – uterine tone >20 MM of Hg).
Decrease fundal height, irregular contour of metal abdomen.
Major complication: pulmonary hypoplasia,due to the lack of normal alveolar distention by amniotic fluid- baby might needed resuscitation. umbilical cord compression-monitor for variable decelerations.

85
Q

Anemia

A

Predisposes Client to postpartum infection

assessment: fatigue, headache,pallor,, tachycardia, hemoglobin level lower than 10mg/dl hematocrit level lower than 30mg/dl.
interventions: monitor hemoglobin levels every two weeks. Instruct client to take iron and folic acid supplements.
medications: Ferrous sulfate(325mg)iron supplements twice daily. instruct the client to take supplements on an empty stomach. Encourage a diet rich in vitamin C-containing foods to increase absorption

86
Q

Anemia a

about food

A 
Suggest that the client increased roughage and fluid intake diet to assist with the discomfort of constipation.  
Iron dextran (Imferon):used in the treatment of iron deficiency anemia when oral iron supplements cannot be tolerated by the client who is pregnant.
 Ferrous sulfate iron supplements may also cause constipation. High-fiber diet, fluids, exercise and bulk forming fiber supplements will help
87
Q

Gestational hypertension

A

Acute hypertensive state the develops after 20th week of gestation.
Hypertensive disorder of pregnancy where by the woman has elevated blood pressure at 140/90 MM of Hg or greater recorded at least twice, 4 to 6 hours apart, with in 1-week Period, after 20thweek of pregnancy

88
Q

Gestational hypertension condition

A

Condition can be mild or severe: can progress to eclampsia, characterized by presence of seizures associated with placental abruption, kidney failure, hepatic rapture, preterm birth, fetal and maternal death.
Predisposing conditions: chronic conditions, such as renal disease, hypertension, diabetes mellitus, primigravida, especially woman younger than 19 years or older than 40 years of age

89
Q

Gestational hypertension assessment

A

Mildelevated blood pressure, usually 15 to 30 MM of Hg above baseline;
Weight gain of 1 Lb/week or more in last trimester,; mild generalized even though edema; proteinuria of 1+to 2+
severe:severe hypertension, systolic blood pressure at least 160 MM of Hg or diastolic at least 110 MM of Hg; massive,generalized edema; weight gain;proteinuria 3+to 4+;visual disturbances; headache; HELLP syndrome of laboratory findings – hemolysis, elevated liver enzymes, low platelets .
eclampsia: characterized by generalized Seizures,

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