Midterm 1 Material Flashcards
What are the 4 main hormones produced by the placenta?
- hCG
- hPL
- Estrogen
- Progesterone
hCG (drops after the first trimester),
hPL (human placental lactose) - helps regulate sugar for baby,
Estrogen & progesterone (sustains endometrial lining to nourish blood supply to baby, prepares mammary glands for production)
When does increased urinary frequency occur to mom, what drives this change? Provide Nursing Interventions
1st trimester, d/t vascular engorgement and pressure on the bladder.
Nursing: empty bladder frequently, Kegel exercises, report painful urination
When does N&V typically occur in pregnancy and what drives it?
Provide Nursing interventions
1st trimester d/t increased HcG levels.
Nursing: small frequent meals, low fat content, crackers at the bedside & citrus scents
Which trimester does Heartburn start and what drives it?
Heartburn: typically second trimester and d/t increased progesterone and reduced intestinal mobility
What are Montgomery’s tubercules?
Found around the nipples as a result of increased hormones; lead to increased lubrication for the nipples while breastfeeding
What is the corpus luteum (C.L)? What hormones does it produce?
Remnants of the follicle after ovulation.
hCG produced by the inital cells of fetus signal for the CL to remain viable.
CL produces estrogen and progesterone to sustain endometrial lining and produce a habitable enviro for implantation and growth.
CL also produced relaxin ( to relax joints of the symphysis pubis) & inhibin to limit contractions
C.L will produce hormones for about 3-4 months until the placenta can take over
What drives nasal stuffiness & epistaxis in pregnant mom?
estrogen levels, occurs in 1st trimester resolves after delivery
Nursing: humidifier, NS nasal drops
What changes occur to BP during pregnancy?
diastolic: decreases 1st trimester until 24-32 weeks»_space; increases to pre-pregnancy levels
systolic: remains the same or slowly lower as pre-pregnancy levels
What are the physiological changes that occur to the body during pregnancy?
- Fatigue»_space; d/t hormone changes
- Urinary frequency»_space; vascular engorgement & fluid changes
- N&V»_space; increased hCG
- Heartburn»_space; progesterone & decreased intestinal motility
- Breast Tenderness»_space; Hypertrophy of tissue
- Montgomery’s tubercles»_space; hormone driven
- Back pain»_space; Relaxin and changes in center of gravity
- Faintness»_space; Postural hypotension
- Epistaxis»_space; Estrogen levels
- Ankle edema»_space; increased fluid, decreased circulation
- Varicose veins»_space; heredity, enlarging uterus, relaxed smooth muscle walls in veins
- Hemorrhoids»_space; smoot muscle walls relax in veins & congestion in pelvis
- Constipation» low GI motility
- Difficulty sleeping»_space; discomforts, baby moving
- round ligament pain»_space; stretching of ligaments
- BP»_space; diastolic: increase 1st trimester until 24-32wks / systolic: remains the same, may lower slightly
- Respirations» change in respiratory center results in lowered threshold of Co2. increased tidal volume and increased O2 consumption by 20-40%
When does the fetal heart beat at a regular rhythm
when is the fetal heart fully developed
when can the fetal heart be detected by doppler
4weeks
8weeks
10-12 weeks
When do the neural tubes begin to develop?
When does ultrasound verification of the embryo occur
3 - 8 weeks
between the 6 - 8 weeks
when do maternal antibodies begin transferring to the baby?
8- 10weeks
Timeline of key fetal developments in the first trimester:
- Neural tubes begin developing between weeks ____ to _____
- Fetal Heart beats at a regular rhythm @ _____weeks
- Heart of the fetus is fully developed by _____ weeks
- The embryo becomes a fetus at the end of the _____ week
- Maternal antibodies begin to transfer to the baby at about ___to ____ weeks
- The first trimester last from ____________ to _________
- Fetal heart rate can be detected on doppler @ ___ to ___ weeks
- sex of the baby is determined at ____ weeks
- Urine begins to be produced and excreted at ____ weeks
- by the end of the _____ trimester all organs are formed
- by the end of 12 weeks the fetus
- resembles a ______
- ______ is secreted
- kidneys are _____________
- _________ is present
- earliest _______ _______ are present
- ______ recognizable
- 3 - 8weeks
- 4 weeks
- 8 weeks
- 8 week
- 8 -10 weeks
- 1st day of last period to 12 weeks
- 10-12 weeks
- 12 weeks
- 12 weeks
- 1st trimester
- human, bile, able to secrete urine, suckling, taste buds, sex is recognizable
Timeline of key fetal developments in 2nd trimester:
- 2nd trimester last from _____ week to ______ week
- Fetal movements are felt by the mom (quickening) at ____ to ____ wks
- Lanugo begins to grow on the fetus and Vernix begins to protect the baby at about _____ weeks
- Alveolar ducts and sacs are present at _____ weeks
- Brown fat deposits are developed beneath the skin @ ____ to ___ weeks
- Lecithin begins to appear in amniotic fluid at about ____ weeks
- 13 week to 28th week
- 14 to 18 weeks
- 20 weeks
- 24 weeks
- 26 - 30 weeks
- 21 weeks
Why are some fish and shellfish detrimental to the developing NS of the fetus?
How many servings of and what types of fish are recommended while pregnant?
high levels of mercury
2-3 servings per week of salmon, sardines and trout. Canned light tuna. All of these are low in mercury
Foods such as hot dogs, lunch meats, bologna, deli meats, soft cheeses, raw and unpasteurized dairy products are recommended to be avoiding by pregnant women because they pose a risk of:
listeriosis
rare serious infection caused by consuming listeria monocytogenes bacterium
if infection developed in 1st trimester: risk of miscarriage
if infection developed later in pregnancy»_space; infection can be passed to the fetus: risk of premature or still birth
What is a safe dose of daily caffeine while pregnant?
300 mg/day (equivalent to 2 8oz cups of coffee a day)
* fetal growth restriction can occur with high caffeine intake
Pregnant women handling cat feces and eating undercooked meat can lead to infection of
toxoplasma gondis»_space; protozoan parasite»_space; toxoplasmosis
Pregnant women with periodontal disease may have increased risk of:
delivering preterm or having a low birth weight
It is best to seek dental care between the _____ & _____ month of pregnancy
4th - 6th month
during the 2nd trimester
Risk associated with hot tubs and pregnancy
Breeding ground for bacterial infections
* can cause fetal tachycardia
* high temps can cause discomfort to the fetus
avoid temps above 38.9C
* hypotension»_space; dizzy and faint. do not enter hot tub alone
Risks of smoking while pregnant
- single greatest modifiable cause of poor pregnancy outcomes
- low birth weight
- preterm birth
- premature rupture of the membranes
- SIDS (higher incidence of babies who are born to mothers who smoke)
- Smoking is associated with IUGD
What is IUGR, what modifiable actions increase the risks o IUGR
Intrauterine growth restriction
smoking / chronic exposure to secondhand smoke
Multiparous
gravid
para
primiparous
- two or more births
- state of being pregnant
- having given birth (live or stillborn) after 20weeks gestation
- 1 birth at more than 20weeks gestation (live or stillborn)
G T P A L
G: total # of pregnancies, including the current one
T: total number of term infants; (>37weeks) twins count as 2
P: total # of children born prematurely ( 20 - 37 weeks) twins count as 2
A: total # of pregnancies that ended in either therapeutic abortion or spontaneous abortion before 20 weeks gestation
L: Total # of children currently alive
Nageles rule
determine the ____ day of the last menstrual period
Subtract ______ months, and 7 days
Add ___ year
FIRST
3 months
1 year
*** this rule is an estimate assuming the woman has a regular 28 day cycle & and that pregnancy occurred on the 14th day of the cycle
What are the primary components of an antenatal assessment?
Interview Health history Physical exam Lab tests Fetal wellbeing >> fundal height, gest age, health status
Importance of the RH protein lab evaluation ?
Rh factor protein found on RBC
If it is present»_space; Rh positive / if not Rh negative
If the mother is Rh negative and baby is Rh positive»_space; Rh incompatibility.
if fetal blood (from Rh +’ve baby) transfers to mom (Rh -‘ve) the mothers body will begin producing antibodies. This will become an problem for the second baby, where the mothers blood (which now has antibodies for Rh) will attack fetal RBC
What is Win Rho?
When and why is it given?
Injection given at 28 weeks gestation for ALL Rh mothers and then within 72 hours of delivery. IM or IV injection
Designed to prevent Rh antibodies from developing.
What are the increased caloric demands on the pregnant mom at each trimester?
1st trimester: synthesis of fetal tissue few demands for maternal nutrition
What is the average total weight gain of the baby at 40 weeks?
13kg (29 lbs)
What assessments should be conducted at the first prenatal visit?
Vitals Height & weight H2T Head and Neck inspection chest inspection abdomen inspection Extremities Pelvic exam
What is fundal height and what does it measure
fundal height is the measurement of the uterus above the pubis symphysis»_space; used as an indicator of fetal growth
fundal height» provides a rough estimate of the duration of pregnancy.
use measurement of fundal height (+/- 2cm) to estimate gestational weeks
ie. fundal height of a women @ 28 weeks gestation w/ empty bladder should measure around (26 - 30 cm)
What is the fundus
Top of the uterus
Fundus is slightly above the pubis symphysis: _____to _______ weeks
Fundus is halfway between the pubis symphysis and the umbilicus: _______ weeks
Fundus is at the umbilicus: ____ to____ weeks ** think halfway
Fundus is three fingerbreadths above the umbilics _____ weeks
Fundus is at the xiphoid process: ______ weeks
12- 14 weeks 16 weeks 20 weeks 28 weeks 28 weeks
What is a normal fetal heart rate
110 - 160bpm
We want baby’s HR to ________ moms contractions
mirror. This is called early deceleration
The fetal HR should decelerate with moms contractions. Not substantial decrease still within normal (120-160bpm) but slight dip
Compression of baby’s head on pelvis/soft tissue of cervix
this is normal no interventions necessary
When fetal HR deceleration follows the contraction it is known as
late deceleration
Appears as a “u” pattern when compared with contractions
Causes: uteroplacental insufficiency»_space; not enough nutrients and oxygen when mom is having a contraction. uterus and placenta aren’t meeting their nutrient / requirements
Needs intervention
The cause of variable fetal HR deceleration is
cord compression (prolapsed, wrapped around the baby) Needs intervention
What are Leopold’s Maneuvers
what is their purpose
4 maneuvers of palpating the maternal abdomen to determine:
- the number of fetuses
- fetal presentation, lie and attitude
- Determine the degree of decent into the pelvis
- Determine the point of maximal intensity of the FHR on maternal abdomen
When can Leopold’s Maneuvers be done
as early as 20-24 weeks. At this point the uterine wall has become thin enough to palpate.
Can also be performed antenatally in labor and during contractions
When thinking about Leopold’s maneuvers the fetus is referred to as the ____________, while the maternal pelvis is referred to as the _____________
passenger
passageway
4 sutures in the fetuses skull
Frontal
Lambdoid
Coronal
sagittal
Fetal attitude refers to
the fetal body parts in relation to one another
deviations from normal fetal attitude can cause issues for labor and birth process
Normal: general flexion, head and chin tucked in
Fetal lie refers to:
name the 3 types
position of the baby’s spine in relation to moms
longitudinal (99% fall in this category) - lines up with moms spine
Oblique
transverse
Fetal presentation refers to:
name the 3 types:
presentation or presenting part indicates the portion of the fetus that overlies the pelvic inlet.
the passageway refers to the mothers pelvis.
name the 3 bones that make up the pelvis
Ilium
ischium
Pubis
When discussing the fetus in the womb and how it sits we consider these 3 terms
Fetal attitude ( how its body parts are arranged; normal >> general flexion. head and chin tucked) Fetal lie ( baby's spine in relation to moms) Fetal presentation (cephalic, breech, shoulder)
The true pelvis is divided into 3 sections
inlet
midpelvis
pelvic outlet
Three notations to describe fetal position:
_____ _______ _______
the middle notation is viewed first. It refers to:
the first notation is viewed next and refers to:
the third notation refers to:
Look at the middle blank first. This refers to the landmark. What is the landmark of the
presenting part? Occiput (O)? Mentum (M)? Sacrum (S)? Scapula (Sc)?
Middle notation refers to left or right in relation to the mothers pelvis (L) or (R).
Third notation refers to whether the landmark is in the front, back or side of maternal pelvis. Anterior (A), Posterior (P) or transverse (T).
_________________________________________
- Is the landmark towards the left or the right
L - left
R - right
Determine middle blank first! 2. Determine Landmark: Position of fetus in mother O - occiput (flexed head) M - mentum (un flexed head, straight up) S - sacrum (sacrum first)
- Is the landmark facing anterior, posterior or transverse (in regard to mom)
A - anterior
P - posterior
T - transverse
Ex. LOA = left, occiput, anterior
How many extra calories should mom intake at each stage to maintain proper nutrition?
1st trimester: Synthesis of fetal tissue occurs, there are few demands on maternal nutrition.
2nd trimester: 340 extra calories a day, (for women with normal bodyweight before pregnancy).
3rd trimester: 452 extra calories per day (for women with normal bodyweight before pregnancy).
What is the total weight gain for a 40 week pregnancy?
13 kg (25 - 30lbs)
In the 1st & 2nd trimester growth primarily takes place in _________ __________
In the 3rd trimester growth primarily occurs in the ________ _________
Maternal Tissues
Fetal tissues
Fetal __________ condition where the baby is born larger than 8lbs 13 ounces
What are the primary drivers of this conditon
fetal macrosomia
diabetes & obesity of the mother during pregnancy
Mom reports “I’ve gained SOOOO much weight” during the pregnancy and has visible fluid retention.
What are your thoughts upon assessment, what causes large babies? is it an underlying condition?
modifiable factors: is she eating more than necessary, are her dietary choices nutrient dense, is she a diabetic, is she experiencing gestational diabetes.
Does she have hypertension or HF that could be causing fluid retention?
These nutrients play an important role in growth and development of the infant
Omega-3 fatty acids
- remember safe sources of fish to avoid listeria
- no sushi or uncooked fish.
Mom requires additional ______ to permit expansion of maternal RBC mass
iron
red meats, eggs, poultry, whole grains, enriched breads & cereals
The practice of consuming nonfood substances or excessive amounts of food stuffs low in nutritional values.
Related to iron deficiency anemia
Pica
What are the primary nutrients that require daily increases in pregnancu
Iodine [150»220mcg] ( iodized salt, seafood & milk products)
Iron 18mg»_space; 27mg
Magnesium[360» 400mg] (nuts legumes cocoas meats whole grains)
Zinc [ 9»_space; 12mg] (shellfish, meats, whole grains)
Vit A [700»_space; 750mcg] (deep green leafy and dark yellow veg)
Vit B6 1.2»_space; 1.9mg
Vit C[65mg»_space; 80] (citrus fruits, strawberries, tomatoes peppers).
Family is ____ or ____ individuals who depend on each other for ______, ________, and ______ support
2 or more
physical, emotional, financial
Family as _______ refers to family-centered or family focused. Individual as the foreground. traditional nursing approach.
Family as CONTEXT
Family as _________ refers to family as foreground . All members of the family are assessed. Assessing how the family is affected by illness/wellness of the individual
Family as CLIENT
Family as ________, believes that the whole is more than the sum of it’s parts. Interactions are the targets for interactions
Family as SYSTEM
Family as _________ of _______ is used in community health nursing. and believes the family is an institution within ________
component of society
institution within society
Three primary concepts essential to understanding family:
- _______ : individuals that comprise the family.
- ________: large purposes or roles of families. The way families serve of benefit each other.
- _________: Family coping skills, roles
Structure
Function
Process
An individuals health affects the entire _________ functioning
family’s
A theory is ways of thinking about and explaining _________
phenomena
name the 3 primary family theory’s
family systems theory
Family development & life cycle theory
biological system theory
4 major concepts of family systems theory:
- All parts of the system are ________
- The ______ is more than the sum of its ______
- All systems have ______ & _____ between the system and the enviro
- ______ can be further organized into _________
* Subsystems consider 3 dimensions of families:
- interconnected
- whole, parts
- borders and boundaries
- systems, subsystems
structure, function and processes.
What is the goal of nursing in the family systems thoery
To help maintain/restore stability of family to help members achieve highest level of functioning they can.
Assessment questions in the family systems theory relate to interaction between _________ & __________. And interaction between ________ & _________ in which they live
individual & family
Family & community
What are some strengths and weaknesses of family systems theory
Strengths:
- It focuses on family as a whole, its subsystems or both
- it is generally understood and accepted theory in society
Weaknesses:
- too broad and general
- Does not give definitive and prescriptive interventions
The following questions support which assessment theory?
- How does the event impact various family members
- who is affected most by this event?
- what kind of boundaries exist between the family and the enviro?
- Has there been a similar event in the past? what helped?
Family systems theory
This assessment theory believes:
- the family is a system
- family has a life cycle
- the family follow common and predictable stages & changes
Family development & life cycle theory
name strengths and weaknesses of family development & life cycle theory
strengths:
- focuses on the family as a whole
- provides a framework for predicting family events at any given stage in the family life cycle
- can offer anticipatory guidance
weaknesses:
- traditional, linear family life cycle is NOT the norm
- modern families vary widely in structure & roles
- developmental milestones shift with shifting structure of modern families
The following assessment questions belong to which family theory?
- what stage of the family life cycle is the family at?
- What are the typical stressors at this stage?
- is the family experiencing normative or non-normative events?
Family development & life cycle theory
This assessment theory believes:
- combines children’s biological deposition & environmental forces
biological systems theory
You would evaluate these 5 systems when using the biological systems theory
microsystem mesosystem exosystem macrosystem chronosystem
Provide some strengths and weaknesses of the biological systems theory
strengths
- holistic
- bio/psycho/social/cultural/spiritual approach
weaknesses:
- not specific enough to define contextual changes over time
- time consuming
- larger context in which the family is embedded can’t be controlled
The following assessment questions support which systems theory?
- Which social structure does the family interact with?
- assessment consists of looking at all levels of the system
biological systems theory
________ is a pictorial display of a persons family relationship and medical history
genogram
________ is a graphical representation that shows all the systems at play in an individuals life
ecomap
What are the primary principles of family centered care
- respect and dignity
- information sharing
- participation
- Collaboration
Family as structure
- Individuals that comprise the family
- Interactions with other social systems
- Ordered set of relationships within the family
- Does not include roles or functions
- Does not indicate health of family or how it function
Family as system
-Interactions in a system
-Whole is more than the sum of its
Parts, more than each individual alone
Family Function
-The way families serve or benefit each other Reproductive Socialization Affective Economic Health care
Family process
Family coping skills, roles, communication, decision making, rituals and routines
Interactions between members of a family including :
-relationships
-communication patterns
-time spent together
-satisfaction with family life.
Family process
Family coping skills, roles, communication, decision making, rituals and routines
Interactions between members of a family including :
-relationships
-communication patterns
-time spent together
-satisfaction with family life.
What are the three concepts essential to understanding family interactions that affect health, illness and well-being?
Structure
function
process
family structure: who is the family?
Who is in family:
- Relationships between family members
- Interactions between family members
Family nursing process
- Assessment
- Analysis
- Design
- Intervention
- Evaluation
- Analysis
Nurses role to engaging families in care
- Background and first contact
- Making Community-Based appointments
- Family assessments in Acute Care settings
- Using interpreters with families
Genograms include at least ______ generations
3
How are children organized in a genogram
oldest to youngest
What is the purpose of a genogram
highlights disease and conditions the family might be at risk for
maps out all family members in an organized ‘tree-like’ fashion
What will the nurse assess in biological systems theory
Assess: social structures (environmental systems) this family interacts with.
-Assessment includes looking at all levels of the system: micro, meso, macro and chronosystems.
Define preconception health
Preconception care is the promotion of the health and well-being of a woman and her partner before pregnancy
Preconception health refers to the positive health practices that youths/adults of reproductive age can make to improve their health before pregnancy
What is the role of estrogen produced by the placenta
increases prostaglandin production when labour to start; increases blood flow to baby; increases secretion of prolactin
What is the role of progesterone produced by the placenta
decreases uterine contractions; decreases immunologic response preventing rejection of fetus; gradually rises to term then drops and labour starts
When is side-lying a more appropriate position over supine in those who are pregnant
side-lying takes pressure off the vena cava
Why is preconception health important?
The health of parents, their lifestyle choices, and the environment in which they live before and during pregnancy have lifelong implications for their children’s health, learning, and behaviour.
Definition of preterm births
The preterm birth rate is defined as the
number of live births with a gestational age at birth of less than 37 completed weeks (<259 days),
expressed as a proportion of all live births
Definition of SGA birth rate
The number of live births for which birth weight is below the 10th percentile of the sex and gestation-specific birth weight, expressed as a proportion of all singleton live births.
The period of greatest sensitivity of the developing fetus to maternal conditions and environmental exposures is between _____ days and ____ weeks after conception.
** the sensitive period occurs between the woman’s ___ and ____ periods.
15 days & 8 weeks
between the 1st & 2nd periods
Organogenesis begins ____days after conception
17 days
What are the 4 Components of Preconception Health
- safe guarding fertility
- preparing for pregnancy
- modifying risk factors
- optimizing the early fetal environment
Why is FA recommended during preconception care
Taking FA before you get pregnant substantially reduces the risk of occurrence of neural tube defects (NTDs)
What is preconception care?
Provides health promotion, screening, and interventions for women of reproductive age to reduce risk factors that might affect future pregnancies
Primary factors that influence preconception health
individual factors
environmental factors
SDOH
______are associated with mortality in the immediate perinatal period
NDTs
Dietary sources of FA
Leafy greens
Citrus fruits
Enriched breads and cereals
Beans
If a mother has NO known NTDs/ no risk factors prior to pregnancy, how much folic acid is recommended daily
0.4 mg/day folic acid 3 months prior to pregnancy and continuing throughout pregnancy is recommended
If a mother is at risk for NTDs OR had a prior pregnancy affected with folate sensitive anomalies: what is the recommended daily dose
4 mg/day folic acid 3 months prior to pregnancy and through the first trimester,
Then 0.4 mg/day folic acid for the remainder of pregnancy.
OR 5mg per day
Individual factors affects preconception health
Folic acid consumption Alcohol use Obesity Smoking Underlying infections; Hepatitis B vaccination HIV/Aids screening and treatment Rubella vaccination Varicella vaccination Sexually Transmitted Infections (STIs) screening and treatment
T or F
Obesity is an individual risk factor for preconception health. Once pregnant weight loss of 10lbs is recommended
False
weight loss once pregnant is not recommended
AVOID CONCEPTION FOR ___ ______ AFTER RECEIVING LIVE-ATTENUATED VACCINES
4 Weeks
Advanced maternal age is a risk factor for:
trisomy 21 , Down syndrome
____________ Canadians have higher risks of adverse pregnancy and infant health outcomes independent of socio-economic status and neighbourhoods
Indigenous
Pregnancy last for _____ lunar months
10 lunar months (28 days in 1 lunar month)
So… 280 days/ 40 weeks
How many weeks is the first trimester
The first trimester begins on the first day of your last period and lasts until the end of week 12.
0-13 weeks
How many weeks is the second trimester
14-26 weeks
How many weeks is the third trimester
27-40 weeks
T or F
A couple has decided to start trying to get pregnant. The first visit to the physician should be scheduled as soon as the woman suspects she is pregnant.
False
ideally she would visit prior to conception
** taking FA 3 months before conception has proven to be effective for reducing the risk of NTD
T or F
All baby’s organs and body systems have fully
formed by 8 weeks from conception.
False not fully
T or F Women with diabetes are more likely to have a baby born heavier than normal at birth.
True
macrosomia
T or F
Obese, pregnant women are more likely to have a baby born with a birth defect than a pregnant woman of normal weight
True
T or F
Women of normal weight prior to becoming pregnant are advised to gain 11.5 - 16 kg (25-35 lbs) during pregnancy.
False weight gain is dependent on BMI
T or F
Women who smoke in pregnancy are more likely to deliver an infant with a low birth weight.
True
SGA
T or F
Women could transmit sexually transmitted
infections, like syphilis, to their baby
Women could transmit sexually transmitted
infections, like syphilis, to their baby
T or F
During the last 3 months of pregnancy, the developing baby is at greatest risk from exposure to harmful substances or environmental toxins
False: it is the first 3 months of pregnancy. Between the first and second missed periods
High levels of ______ and _______ stimulate uterine growth in the first trimester.
Progesterone & estrogen
Kelsey is pregnant for the third time. She gave birth to a single baby at 42 weeks and twins at 35 weeks gestation, all of whom are currently alive.
What is here GTPAL?
What will the GTPAL be after
her baby is born at 39 weeks?
Gravidity – 3 number of all pregnancies
Term birth – 1 single baby at 42 weeks
Preterm births –2 twins at 35 weeks (preterm is after 20 weeks to 37 weeks)
Abortions and miscarriages – 0
Living children – 3
____________________
G3 – 3 pregnancies
T2 - 2 single babies at 37 weeks or more gestation
P2 - 2 babies at 35 weeks gestation (Textbook says to count twins as 2 here)
A0 – no abortions or miscarriages
L4 – twins plus 2 single birth babies
Kelly reports her menstrual cycle is 28 days long and periods have been regular prior to pregnancy.
the first day of kelly’s last menstrual period (LMP) was September 19, 2018 and lasted 5 days, ending on September 24, 2018.
When is Kelly’s baby due?
Using Nagele’s rule:
September 19 2018
Subtract 3 months – June
Add 7 days - 26
Adjust year - 2019
What are the components of an antenatal assessment?
Interview>> health hx Physical examination Lab tests Fetal well being (beginning end of 1st trimester) Fundal height gest age health status
When is the woman screened for Group B streptococci? GBS
35 -37 weeks
How can fetal blood impact the mother, at which points can fetal blood interact with mom?
amniocentesis
chorionic villi sampling
bleeding during pregnancy
trauma to the abdomen during pregnancy
___________ is the earliest biological marker for pregnancy.
Human chorionic gonadotropin (HCG)
Production of HCG begins as early as the day of implantation and can be detected as early as 7-10 days after conception.
Main action of progesterone during pregnancy
Effects smooth muscles = relaxes
Ex. relaxed veins in legs → varicose veins
Main action of estrogen during pregnancy
Increases vascularity of the breasts and uterus (hypertrophy of cells)
In which trimester does frequent urination tend to stop? When is frequent urination most commonly going to occur?
Frequent urination stops during 2nd trimester, as the uterus rises higher into the abdomen, relieving the pressure. Then at the end of the term, there is more pressure in the 3rd trimester due to the immense growth
1st trim: increased pressure and voiding
2nd trim: back to normal
3rd trim: increased pressure and voiding
What hormone relaxes the esophageal sphincter, causing acid reflux
progesterone
In the first 12 weeks of pregnancy where do the pregnancy hormones secrete from?
corpus luteum creates hormones for the first 12 weeks, after which the placenta takes over
Define primigravida
first pregnancy
Define antepartum
Time between conception and the onset of labour; often used to describe the period during which a woman is pregnant; used interchangeably with prenatal
Define intrapartum
Time from the onset of regular contractions until the birth of the baby and placenta
Define multiparous
has gone through labour more than once
What are 3 methods to determine an estimated date of birth
EDB wheel
Ultrasound
Nagele’s rule
Define Rh incompatibility
When mom is Rh - and Dad is Rh +
What is hemolytic disease of the newborn?
AKA erythroblastosis fetalis
If the fetus is Rh positive, antibodies from the mother cross the placenta, attach to fetal RBCs and begin to hemolyze them. This breaks down the RBC way too fast.
Indirect vs Direct Coombs test
indirect coombs test: checking for sensitization, more of a screening out of precaution (indirectly checking sensitization through mom)
direct coombs test: it is done on the infant’s blood to detect antibody-coated Rh-positive red blood cells. (directly checking sensitization on baby)
What is the role of iron supplementation in pregnancy
allows transfer of iron to the fetus. Permits expansion of maternal hemoglobin (important for brain development too)
pica is often related to
iron deficiency anemia
Why may systolic murmurs occur during pregnancy
due to increased blood volumes
Do resps increase or decrease during pregnancy
Increased demands on the body causes INCREASED respirations
A slight dip in BP is most noticeable in which trimester
2nd
Peripheral vasodilation can cause a drop in BP
What 4 physical changes happen to the uterus over the course of pregnancy
Hyperplasia
Increased vascularity
Hypertrophy
Change in shape and position (pear shaped) due to pressure exerted by growing fetus
Fundal height correlates with gestational weeks around ______ weeks
Starting around 22-24 weeks
Ex. At 22 weeks, fundal height will be 22 cm
At what week, does fundal height NOT correlate with gestational weeks?
why?
34 weeks
at this point the baby has usually dropped down into the pelvis
Why would fundal height be measuring larger than expected?
Polyhydramnios → Too much amniotic fluid
Macrosomia → excessive tissue growth (big baby)
Twins?! Maybe it is not a singleton pregnancy: more than one child
Define polyhydramnios
too much amniotic fluid
Fundal height may be measuring smaller than expected due to ??
Intrauterine growth restriction (IUGR) → fetus isn’t growing at the rate it should be.
- Mother is a smoker: interferes with oxygen to fetus
- Lack of nutrition
Oligohydramnios → Too little amniotic fluid
pulsations under the fontanelles could indicate_______
dehydration
longitudinal fetal lie looks like…..
Baby is in line with mom’s spine; HEAD FIRST pointing towards the vagina
Transverse fetal lie looks like
Baby is horizontally sideways; head pointing left or right
Oblique fetal lie looks like…
Baby is transverse but at an angle
Define fetal presentation. what are the 3 fetal presentations
The part of the fetus that enters the pelvic inlet first
Three presentations are:
- cephalic (head first)
- breech (butt/feet first)
- shoulder presentation
Explain: cephalic vertex presentation. is this an ideal positon?
Head first
Chin tucked into chest
BEST for labour. The most common presentation and associated with the fewest complications
What are the 4 cephalic presentations?
- Vertex - complete flexion
- Military- moderate flexion
- Brow - poor flexion
- Face - full extension (literally face first out the birth canal)
What are SOGC Recommendations for fetal movement?
Count 6 distinctive fetal movements; if less than 6 movements in 2 hours, further assessment is indicated.
Tell her to contact primary caregiver OR go to the hospital
What factors affect fetal activity?
Decreased fetal movement:
- Due to decreased placental perfusion (lack of O2)
- Mother’s BG levels
- Smoking and drug use
the ________ stage of labour begins with onset of regular contractions and ends with complete cervical effacement and dilation
first stage of labour
what are the 2 phases of the 1st stage of labour
Latent (early) phase: 0-3 cm dilated in primiparous and
cervical length < 1 cm or
75% effaced
Active (about 3-6 hours): Beginning at 4 cm dilated in a nulliparous woman; 4-5 cm in multiparous woman
What are the 5 P’s that affect the process of labour
- Passenger (fetus and placenta)
- fetal head
- fetal attitude
- fetal lie
- fetal presentation
- fetal position
engagement
station - Passageway (birth canal)
3.Powers (contractions) - Position of the mother
5.Psychological Response
