Maternity Part 1 Flashcards
1st Trimester presumptive signs of pregnancy (AKA you MIGHT be pregnant..)
Amenorrhea
N/V
Urinary frequency* often 1st
Breast tenderness d/t excess hormones
What hormone causes Amenorrhea?
Progesterone (NOT hCG)
What does progesterone cause the body to do?
Increase temperature after ovulation
How long is a released egg good for?
How to try and plan pregnancy?
24 hours
Record and predict when you get increased temperature indicating ovulation and then try to have sex BEFORE this increased temperature
Probably pregnancy signs (You are PROBABLY pregnant)
Positive pregnancy test Goodells, Chadwick's, Hegar's sign Uterine enlargement Braxton Hicks contractions Pigmentation changes of the skin
How does a pregnancy test determine a positive result?
Can anything else induce this?
Presence of hCG levels
Yes: Hydatiform mole; anti-convulsants/anxiety/Parkinson’s drugs
DIFFERENCES
Chadwick’s sign
Goodall’s sign
Hagar’s sign
When they occur?
What happens?
Chadwick’s sign: Bluish cervix/vagina, 4th week
Goodell’s: cervix softens, 2nd month
Hagar’s: Uterus softens; 2-3 months
Why Braxton Hicks contractions?
When do they occur?
They occur all throughout pregnancy
They move blood through the placenta
What probable pregnancy pigmentation skin changes occur in the first trimester?
Linea Nigra
Abdominal Striae
Facial Chloasma (Mask of freckle lookingness)
Areola darkens
What are the positive signs of pregnancy?
Fetal heartbeat
Fetoscope
Fetal movement
US
When do you do listen for the fetal heartbeat?
When can you hear with a fetoscope?
Doppler: 10-12 weeks
Fetoscope: 17-20 weeks
What is Gravidity?
of pregnancies; completed or not
*This includes her CURRENT pregnancy
What is Parity?
of pregnancies where the fetus reached 20 weeks
What is Viability?
24 weeks; This is when the infant has the ability to live OUTSIDE the uterus
A baby at 20 weeks is not considered viable!!!
When is a fetus term?
When is a fetus preterm?
37 weeks
Before 37 weeks
What acronym is going to be obtained by the doctor to figure out pregnancy history?
What does each letter stand for?
GTPAL
Gravida - # pregnancies Term - 37 weeks Preterm - before 37 weeks Abortion - spontaneous or elective Living children
What is the Naegele’s Rule?
Due date estimation
First dat of LMP
Add 7 days
Subtract 3 months
Add 1 year
Nutrition in the 1st Trimester
Teaching?
Calories?
Calories for adolescent?
How much protein do they need to increase?
Teach the 4 Food groups
Increased calories to 300 /day
Adolescent: 500 /day
Protein: 60g/day (Normally 40-45)
How much weight should be gained in the 1st trimester?
4 pounds
What are the side effects of iron?
How do we prevent these SE?
What should women take it with to enhance absorption?
Constipation, GI upset
Take with food!
Vitamin C
*Best absorption is truly when the stomach is empty, but with all the GI upset and taking it with food, this Vitamin C is going to help us
What does Folic Acid prevent?
How many mcg do we need?
Neural tube defects, like Spina Bifida
400 mcg/day
What is the best way to exercise?
What do we want to avoid? Why?
What else might cause this adverse affect?
Walking or swimming are best
Avoid high intensity exercises because we don’t want ANY overheating!!! This means no hot tubs or electric blankets
What happens when mom has an increased body temperature?
Birth defects
What is the PREGNANCY EXERCISE RULE???
Why?
DON’T LET YOUR HEART RATE GET ABOVE 140
HR>140 causes CO and uterine perfusion will drop
What are DANGER signs in pregnancy?
Sudden gush of vaginal fluid Bleeding Persistent vomiting Severe HA Abdominal pain Increased Temp Edema Absent fetal movement
What if a patient calls and complains of just a bit less than normal fetal movement?
CALL 911!!!!
ASSUME THE WORST!!!!!! Never pick a “don’t worry about it” answer
What are some common discomforts?
N/A, breast tender, frequency, fatigue, ankle edema, backache Heartburn Increased vaginal secretions Stuffy nose Varicose veins Hemorrhoids Constipation Leg cramps
Things we can do for
Stuffy nose:
Ankle edema:
Constipation:
** KEY THING TO REMEMBER
Stuffy nose: nasal spray, steam
Ankle edema: elevate feet
Constipation: Increase fiber, ambulation, more fluids
WE DON’T WANT TO GIVE THESE PEOPLE MEDS!
We need a physician ORDER for meds
Patient teaching regarding smoking
What does this increase risk for?
STOP
But if they refuse, at least pick an answer that involves them going outside
Risk: SGA baby
How often to visit the physician
First 28 weeks: Once a month
28-36 weeks: Twice a month
36 weeks: Weekly
What should you have the patient do before an US?
Why?
When wouldn’t you need to do this?
What if they are having an US before a procedure?
DRINK! A distended bladder pushes the uterus close to the abdominal surface
No need to drink for a transverse US
VOID if they are having a procedure
Ex: Amniocentesis
When is the first Trimester?
Second?
Third?
1st: Week 1-13
2nd: Week 14-26
3rd: 27 - birth
Expected weight gain in the 2nd trimester?
1 pound a WEEK
2nd TRIMESTER
Should mom have N/V?
Urine frequency?
Breast tenderness?
N/V - NO
Frequency - NO: Uterus rises back off the bladder
Breast tenderness - YES
What should FHR be in the 2nd trimester?
***NCLEX When to worry?
120-160 - normal
110-120 - worried and watching
Below 110 - PANIC
What do kegels help prevent?
Uterine Prolapse
Expected weight gain in 3rd trimester?
No MORE than 1 lb/week
3RD Trimester
What do we REALLY need to keep an eye on?
BP
Report ANY increase from the baseline
What does pregnancy induced HTN cause?
What might we do?
Pre-eclampsia / eclampsia
HTN hurts our kidneys so they can’t filter out our protein so the protein builds up and pours into the urine
We want them to drink plenty of fluids, but we might restrict their salt intake
Normal FHR in the 3rd trimester
120-160
How is fetal presentation/position determined?
What should the patient do before?
What if they are having contractions?
Leopold Maneuver
VOID
Do them between contractions - unless ya wanna feel a hard ass uterus
What are signs of labor?
Lightening, Engagement, Fetal stations Faster, stronger Braxton Hicks Softened cervix Bloody show Nesting - burst of energy Diarrhea Rupture of membranes
What is lightening?
When does it occur?
What problem returns?
Part of the fetus (usually head) descends into the pelvis causing mom to feel less congested and breathing easier
Usually occurs 2 weeks before term
Urinary frequency
How do we want the fetus when ROM occurs?
Head well engaged!! If not, the cord could come out first (prolapsed cord)
What is engagement?
The largest presenting part (hopefully the head) is in the pelvic inlet
What are fetal stations?
Measurement?
Cm measurement of the relationship of the presenting part of the fetus to the ischial spines of the mom
*Picture the pelvis and the 2 points where the pelvis slightly curves - ischial spine
-3, -2, -1, +1, +2, +3
More negative = the more the head is inside mom
More positive = the more baby is through the pelvis
“Im at zero, from here on out it’s all positive!”
When do we worry bloody show vs hemorrhage?
Bloody show: small amount
Hemorrhage: Continuous slow trickle
When should mom go to the hospital?
What do we worry about with ROM?
When contractions are 5 min apart or ROM
PROLAPSED CORD - Think killer answer!
What are 3 Diagnostic tests before labor?
- Non-Stress Test (NST)
- Biophysical Profile Test (BPP)
- Contraction Stress Test (CST)
Non-Stress Test
When is it done? What do we want to see? How should the accells be? How long is the test recorded? What response do we want?
3rd Trimester
Want to see: 2 or more accelerations of 15 bpm with fetal movement
Acelleration: Increase 15 bpm lasting 15 seconds, with HR returning to baseline within 2 minutes
20 minutes
We want REACTIVE
Biophysical Profile
When is it done?
What about high-risk mom?
How is it done? What does it look at?
Good/Bad score?
Third trimester
@ risk: May be done at 32-34 weeks or as much as weekly
US measurements during an NST
Looks at HR, muscles tone, movement, breathing, amniotic fluid
8/10 - good
6/10 - worry
Biophysical Profile
How long is it?
What is needed in these parameters to earn 2 points?
HR: Muscles Tone: Movement: Breathing: Amniotic Fluid:
30 MINUTES
HR: Reactive NST
Muscles Tone: At least 1 flexion-extension movement
Movement: Move 3 times
Breathing: Breathing movements at least once
Amniotic Fluid: Is there enough?
What is another name for Contraction Stress Test
When is it done? After what test?
What does it determine?
What result do we want?
What are @risk women that would get this?
Oxytocin Challenge Test
Rarely done before 28 weeks, but is done with a NONreactive NST
Determines if baby can handle the stress of a contraction
Want a NEGATIVE result
Preeclampsia, maternal DM, condition causing placental insufficiency
What do contractions do to baby?
What terms a deceleration?
Decrease blood flow to baby and placenta
If blood flow decreases enough to cause hypoxia, and the FHR goes below baseline
What does a late decel mean?
Uteroplacental insufficiency aka the placenta is wearing out - It has more difficulty delivering nutrients and oxygen to baby
How long are Contraction Stress Test results good for??????
ONE WEEK!!!!! WE WANT ACCELERATIONS!
What do we worry about when giving oxytocin before wanted birth?
Preterm labor!!!! Oxytocin challenge patients need strict observations because it is a HIGH RISK DRUG
Differences between decelerations
Early
Late
Variable
Early - not bad, cause by fetal hypoxia from fetal head compression
Late - caused by uteroplacental insufficiency
Variable - Caused by umbilical cord compression
