Maternity Flashcards
Presumptive Signs of Pregnancy
Amenorrhea
N/V
Urinary Frequency
Breast tenderness
Probable Signs of Pregnancy
A positive pregnancy test Goodell's sign Chadwicks sign Hegars Sign Uterine enlargment Braxton Hicks contractions Linea nigra ABdominal striae Facial chloasma Darkening of the areola
Goodell’s sign
Softening of the cervix; Second month
Chadwicks sign
Bluish color of vaginal mucosa and cervix; week 4
Hegars Sign
Softening of lower uterine segment/ 2nd and 3rd month
Positive signs of Pregnancy
Fetal Heart Beat Doppler - 10 - 12 weeks Fetoscope - 17 to 20 weeks Fetal Movement Ultrasound
Gravidity
of times someone has been pregnant
Parity
of pregnancies in which the fetus reaches 20 weeks
Viability
24 Weeks = infant has the ability to live outside the uterus
TPAL
Term
Preterm
Abortion
Living Children
Naegele Rule for Due Date
Add 7 days
subtract 3 months
Add one year
Nutrition Teaching
4 food groups
Increase Calories by 300 per day after the first trimester
In Adolescents, Increase calories by 500 calories after first trimester because of pt growth needs
Increase Protein to 60 grams a day
Weight Gain
Expect to gain 4 pounds in the first trimester
Prenatal Vitamin Supplements
Iron supplements cause constipation and GI upset
Take Iron with vit c to enhance absorptions
Folic acid prevents neural tube defects - 400mcg/day
Exercise Rules
No high impact; walking and swimming are best
No heavy or unaccustomed exercise program
No overheating ( no hot tubs or electric blankets)
Increased temp = birth defects
Don’t let the heart rate 140
DANGER SIGNS
Sudden gush of vaginal fluid Bleeding Persistent vomting Severe headache Abd pain Increased Temps Edema No Fetal movement
Common Discomforts
Nausea and vomiting Breast Tenderness Urinary Frequency Tender Gums Fatigue Heartburn Increased Vaginal secretion Nasal Stuffiness Varicose Veins Ankle edema Hemorrhouds Constiptation Backache Leg Cramps
What are you going to tell the preg person about taking medications?
NO
Smoking
Stop smoking or smoke outside if they don’t stop
How often should they visit the healthcare provider?
First 28 Weeks - once a month
28 - 36 weeks - every 2 weeks
36 weeks; weekly until delivery
Ultrasound
Distend bladder to push uterus to surface
Second Trimester ( week 14 to 26) SIgns and Symptoms
Weight Gain: 1 pound per week (4 pounds a month)
NO more N/V or Urinary Frequency
YES breast tenderness
Quickening - Fetal Movement
Fetal Heart Rate
Kegal excercise
Pregnancy is considered term if it advances 37 to 40 weeks
Fetal Heart Rate
120 to 160 in the seconds trimester
110 to 120 worried and watching
less than 110: panic
Kegal Exercise
Exercise to strength the pubococcygeal muscles. These muscles help stop urine flow and help prevent uterine prolapse.
Third Trimester ( Week 27 to 40) Assessment
Weight Gain: No more than a pound a week
Monitor BP and report any changes from baseline (Worried about pregnancy induced HTN)
Check for Protein
Fetal heart Rate
Use Leopolds Maneouver to discern fetal position/ presentation. Make sure Client voids first, and in between contractions.
Client Education: Signs of Labour
Lightening : When the presenting part of the fetus descends into the pelvis
Client will be able to breath easier but urinary frequency will be a problem again
Engagement : The largest presenting part is in the pelvic inlet - Hopefully its the head
Fetal station: measured in cm; measures the relationship of the presenting part of the fetus to the ischial spines of the mother
Braxton Hicks Softening of cervix Bloody show Sudden burst of energy called nesting Diarrhea Rupture of membranes Come to hospital, could prolapse cord when ROM and when contractions are 5 minutes apart
Non stress Test
Want to see two or more accelerations of 15 beats/minute with fetal movement
Acceleration
is when the fetal heart rate has an abrupt increase from the baseline. This is visualized on the fetal heart monitor. The increase is above the baseline and at least 15 seconds, but the heart rate should come back to the baseline within 2 minutes. Record for 20 minutes.
Biophysical Profile
30 minute test. 6 we are worried, 4 is an emergency.
Heart rate - Based on NST ( reactive or non-reactive)
Muscle tone - Does the baby have at least one flexion/extension movement in 30 mins?
Movement-Does the baby move at least 3 times in 30 minutes?
Breathing - does the baby have breathing movements at least once in 30 minutes?
Amniotic Fluid- Is there enough Fluid around the baby?
Contraction Stress Test/ Oxytocin Challenge test
Done when NST is non-reactive. Performed on higher risk pregnancies: preeclampsia, maternal diabetes and any condition in which placental deficiency is suspected.
Determines if bb can handle the stress of contraction.
Uterine contractions decrease blood flow to the uterus and the placenta.
If there is hypoxia, there will be a deceleration. If it is late this is indicating uterine/placental insufficiency
Performed after 28 weeks
3 Types of decelerations
Early: benign - caused by physiological hypoxia form fetal head compression
Late: caused by uterine/placental insufficiency
Variable: Caused by umbilical cord compression
True Labour
Contraction regular and increase
Discomfort in back and abdomen
Increase pain with activity
False Labour
Irregular
Abd discomfort
Change in activity decreases pain
Epidural anesthesia
Position: Lie on left side, Legs flexed
Given at 3 -4 cm dilation
Usually no headache/don’t want to get to spinal fluid
Major complication is hypotension so monitor BP
Infuse bolus fluids to fight hypotension
Put in semi-fowlers on left side to prevent vena cava compression. If compressed will decrease venous return, reduce cardiac output and BP and decrease placentral perfusion
Alternate position side to side hourly
