Module 4 - Antepartal Considerations (Exam 2) Objectives 1

Question 1

Gravida

Answer 1

Number of pregnancies, including current

Question 2

Para

Answer 2

Birth after 20 weeks or more gestation, regardless of outcome

Question 3

Viability

Answer 3

Ability of the fetus to live outside the womb

Question 4

T

Answer 4

Number of term infants born OR pregnacies delivered

Question 5

P

Answer 5

Number of preterm infants born/ pregnancies delivered

Question 6

A

Answer 6

Number of pregnancies ending in spontaneous or therapeutic abortion

Question 7

L

Answer 7

Number of currently living children

Question 8

Identify essential components of comprehensive prenatal assessment

Answer 8

1. First Visit
   
   1. Find out why the woman is seeking care and should include a complete health history and physical exam
      
      1. Weight
      2. Nutrition
      3. Exercise pattern
      4. Over the counter drugs
      5. Prescription drugs
      6. illicit drug use
      7. Allergies
      8. POtential teratogens
      9. H/o sugery or present disease states
      10. Gynecologic hisotry including date and results of last pap smear
      11. Previous infections
      12. Age at menarche
      13. Menstrual, contraceptive, obstetric histories
      14. FHT
      15. Fundal height
      16. Complete maternal physical exam
      17. Labs: hematocrit, hemoglobin, WBC differential analysis, blood group and typing, Rh typing, rubella titer, blood glucose level, urinalysis and culture, serum syphillis test, chlamydia, pap smear, HIV and illicit drug screen
      18. Assess empotional state
      19. Discuss cultural preferences
      20. Discuss circumcision and breastfeeding
   2. Follow-up prenatal Visits
      
      1. Every 4 weeks during the first 28 weeks gestation
      2. Every 2 weeks until 36 weeks
      3. Every week until delivery
      4. Visits should include teaching as well as assessment of maternal and fetal well-being
      5. Instruct on danger signs, colostrum, and quickening
      6. Assess for acceptance of pregnancy
      7. Look for changes from baseline (VS, urine, weight)
      8. Quad screen assessed at 15-20 weeks, maternal blood glucose levels should be assessed at 24-28 weeks
      9. Fundal height, movement, HR

Question 9

Discuss presumptive, probable, and diagnostic signs and symptoms of pregnancy

Answer 9

• Presumptive
  
  • Amenorrhea
  • Nausea and vomiting
  • Fatigue
  • Urinary frequency
  • Breast changes
  • Quickening
• Probable Signs
  
  • Heger’s Sign
  • Enlargement of abdomen
  • Pigmentation Changes
  • Abdominal Striae
  • Ballottment
  • Positive pregnancy test
  • Palpation of fetal outline
• Positive Signs
  
  • Fetal Heartbeat
  • Fetal movement palpable by examiner
  • Visualization of fetus by ultrasound

Question 10

Nagele’s Rule

Answer 10

A commonly used method for determining estimated date of birth

Date of last menstrual period - 3 months + 7 days = Estimated date of birth

May 20th (-3mo) = Feb 20th (+7days) = February 27th

Question 11

Purpose and nursing responsibilites of blood type, Rh, and Indirect Coombs testing

Answer 11

Purpose is to determine blood type to screen for maternal-fetal blood incompatibility

• Identifies possible causes of incompatibility that may result in jaundice in the neonate
• If father is Rh positive and mother is Rh negative and unsensitized, Rhogam (immune globulin) will be given to the mother at 28 weeks.

Question 12

Purpose and nursing responsibilites of complete blood count (CBC) and platelets

Answer 12

Pupose is to detect infection, anemia, or cell abnormalities

• More than 15,000mm^3 WBC or decreased platelets require follow-up

Question 13

Purpose and nursing responsibilites of urinalysis and culture

Answer 13

Purpose is to detect renal disease or infection

• Requires further assessment if positive for more than trace portein, ketones, or bacteria

Question 14

Purpose and nursing responsibilites of PAP smear

Answer 14

To screen for cervical cancer

• Refer for treatment if abnormal cells are present

Question 15

Purpose and nursing responsibilites associated with rubella screening

Answer 15

Purpose is to determine immunity

• If titer is 1:8 or less, the woman is not immune
• Immunize PP if not immune

Question 16

Purpose and nursing responsibilites associated with hepatitis B screening

Answer 16

Purpose is to detect the presence of antigens in maternal blood

• If present, infants should be given hep immune globulin and vaccine soon after birth

Question 17

Purpose and nursing responsibilities associated with sexually transmitted infections screening

Answer 17

To screen for syphillis and other STIs

• Treat if results are positive; restest if indicated

Question 18

Guidelines for screening for Group B stretococcus (GBS) during the prenatal period

Answer 18

1. GBS carrier status should be obtained by vaginal and rectal culture between 35-37 weeks pregnant
2. Women who have had a previous infant with GBS or GBS in their urine at any trimester will be considered GBS positive at birth
3. A woman who delivers at or before 37 weeks, has ROM for 18 hours or more, or has a T of 100.4F is considered positive for GBS and should receive antibiotic therapy
4. C-section before membrane rupture does not require GBS antibiotic therapy
5. Penicillin is used, cephazolin is the alternative, clindamycin is used for high risk anaphylaxis
6. Group B strep treated during labor

Question 19

Normal fundal height correlations with anatomical landmarks during pregnancy

Answer 19

1. 5-8 weeks
   
   1. In pelvic cavity, size of lemon
2. 9-12 weeks
   
   1. Palpable above symphysis pubis, size of orange
3. 13-16 weeks
   
   1. Midway between symphysis pubis and umbilicus and has risen into the abdomen
4. 17-20 weeks
   
   1. At umbilicus (20 weeks)
5. 21-24 weeks
   
   1. Above umbilicus
6. 25-28 weeks
   
   1. Above umbilicus
7. 29-32 weeks
   
   1. Above umbilicus
8. 33-36 weeks
   
   1. uterus pushing on diaphram
9. 37-40 weeks
   
   1. Uterus pushing on diaphram until lightening
10. 37-40 weeks

Question 20

Discuss supine hypotensive syndrome

Answer 20

Weight of pregnant uterus partially occludes the vena sava and the aorta which diminishes return of blood from the lower extremeties and reduces cardiac return.

Question 21

Danger signs in pregnancy

Answer 21

1. Vaginal Bleeding with or without discomfort
2. Escape of fluids from the vagina
3. Swelling of fingers or puffiness of the face or around the eyes
4. Continuous pounding headache
5. Visual Disturbances
6. Convulsions
7. Persistent or severe abdominal or epigastric pain
8. Chills or fever
9. Painful urination
10. Persistent vomiting
11. Change in frequency or strength of fetal movements
12. Signs or symptoms of preterm labor: uterine contractions, cramps, constant or irregular low backache, pelvic pressure, watery vaginal discharge

Question 22

Teaching plan 1st Trimester

Answer 22

1. Physical and psychosocial changes of pregnancy
2. Self-care in pregnancy
3. Protecting and nuturing the fetus
4. Choosing a care provider and birth setting
5. Prenatal exercise
6. Relief of common early pregnancy discomforts

Question 23

Teaching Plan 2nd Trimester

Answer 23

1. Planning for breastfeeding
2. Sexuality in pregnancy
3. Relief of common later-pregnancy discomforts

Question 24

Teaching Plan 3rd Trimester

Answer 24

1. Preparation for childbirth
2. Development of a birth plan
3. Relaxation techniques
4. Postpartum self-care
5. Infant stimulation
6. Infant care and safety

Question 25

Advising the pregnant woman regarding management of common discomforts of pregnancy

Answer 25

1. Nausea/Vomiting
   
   1. Avoid strong odors
   2. Drink carbonated beverages
   3. Avoid drinking while eating
   4. EAt crackers or toast before getting out of bed
   5. Eat small, freqent meals
   6. Avoid spicy or greasy foods
2. Breast Tenderness
   
   1. Wear a well-fitting, supportive bra
3. Urinary Frequency
   
   1. Increase daytime fluid intake
   2. Decrease evening fluid intake
   3. Empty bladder as soon as urge is felt
4. Fatigue
   
   1. Plan a rest period or nap during day
   2. Go to bed as early as possible
5. Ptyalism (excessive saliva)
   
   1. Use gum, mints, hard candy, or mouthwash
6. Nasal Stuffiness/Bleeding
   
   1. Use cool air vaporizer
7. Heartburn
   
   1. Eat small, frequent meals
   2. Avoid spicy or greasy foods
   3. Refrain from lying down immediately after eating
   4. Use low-sodium antacids
8. Constipation
   
   1. Increase fluid and fiber intake
   2. Excercise
   3. Develop regular bowel habits
   4. Use a stool softeners per health care provider
9. Hemorrhoids
   
   1. Avoid constipation
   2. Apply topical anesthetics, ointments, or ice packs
   3. Use sitz baths or warm soaks
   4. Reinsert into rectum, if necessary
10. Backache
    
    1. Practice good body mechanics
    2. Practice pelvic tilt exercise
    3. Avoid high heels, heavy lifting, overfatigue, and excessive bending or reaching
11. Leg Cramps
    
    1. Dorsiflex feet
    2. Apply heat to affected muscle
    3. Evaluate calcium to phosphorus ratio in diet
12. Varicose Veins
    
    1. Elevate legs
    2. Wear support hose
    3. Avoid crossing legs at the knee, restrictive clothing, and standing for long periods of time
13. Ankle Edema
    
    1. Practice frequent dorsiflexion of feet
    2. Avoid standing for long periods of time
    3. Elevate legs when sitting or resting
14. Faintness
    
    1. Arise slowly
    2. Avoid prolonged standing
    3. Maintain hematocrit and hemoglobin
15. Flatulence
    
    1. Avoid gas-forming foods
    2. Chew food thoroughly
    3. Establish regular bowel habits

Question 26

Use of medications during pregnancy

Answer 26

Refer to doctor

Question 27

Use of herbal preparations during pregnancy

Answer 27

None. Refer to doctor if pt. thinks it is necessary

Question 28

Use of tabacco during pregnancy

Answer 28

NO

Question 29

Use of alcohol during pregancy

Answer 29

NO

Question 30

Demographic Risk Factors

Answer 30

1. Less than 16 years of age
   
   1. Preterm birth
   2. Low birth weight
   3. Preinatal Mortability
   4. Anemia
   5. HIV
   6. STDs
2. Greater than 35 years of age
   
   1. Gestational diabetes
   2. Hypertension
   3. Prolonged labor
   4. C-sections
   5. Congenital abnormalities
   6. Infant mortality
   7. Placenta previa
3. Low socioeconomic status or dependence on public assistance
   
   1. Preterm labor
   2. Maternal perinatal mortality
   3. Low birth weight
   4. Chormosomal disorders
   5. Fetal growth disorders
4. Non-white Race
   
   1. Low birth weight
   2. Preterm birth
   3. Infant mortality for some groups
5. Multiparity
   
   1. Abnormal fetal presentation
   2. Antepartum or postpartum hemorrhage
   3. C-section

Question 31

Social and Personal Risk Factors

Answer 31

1. Low prepregnancy Weight
   
   1. Low birth weight
2. Obesity
   
   1. Hypertension, gestational diabetes, failure to progress in labor, c-section, anesthesia complications, high birth weight, wound infections, postpartum hemorrhage, thromboembolism
3. Height less than 5 feet
   
   1. C-section because of cephalopelvic disproportion
4. Smoking
   
   1. Spontaneous abortion
   2. Low birth weight
   3. Abruptio placentae
   4. Placenta previa
   5. Preterm birth
   6. Perinatal mortality
   7. Sudden infant death syndrome
5. Alcohol or Illicit Drug Use
   
   1. Congenital anomalies
   2. Neonatal withdrawal syndrome
   3. Fetal alcohol spectrum disorder

Question 32

Obstetric Risk Ractors

Answer 32

1. Birth of previous infant weighing more than 4000g
   
   1. maternal gestatinal diabetes
   2. c-section
   3. birth injury
   4. neonatal hypoglycemia
2. Previous fetal or neonatal death
   
   1. maternal psychological distress
3. Rh sensitization
   
   1. jaundice
   2. fetal anemia
   3. erythromblastosis fetalis
   4. kernicterus
4. Previous preterm birth
   
   1. repeated preterm birth

Question 33

Medical Risk Factors

Answer 33

1. Diabetes mellitus
   
   1. Preeclampsia
   2. c-section
   3. preterm birth
   4. infant small or large for gestational age
   5. neonatal hypoglycemia
   6. congential anomalies
2. Hypothyroidism
   
   1. gestational hypertension
   2. low birth weight
   3. mental and motor developmental delay
3. Hyperthyroidism
   
   1. spontaneous abortion
   2. heart failure
   3. thyroid storm
   4. preeclampsia
   5. growth restriction
   6. fetal or neonatal thyrotoxicosis
4. Cardiac Disease
   
   1. congestive heart failure
   2. arrhythmias
   3. stroke
   4. maternal mortality
   5. growth restriction
   6. preterm birth
5. Renal Disease
   
   1. Maternal renal failure
   2. preeclampsia
   3. preterm delivery
   4. perinatal mortality
   5. growth restriction
6. Concurrent Infection
   
   1. severe fetal implications if maternal disease occured in first trimester
   2. increased incidence of spontaneous abortion or congenital anomalies assocaited with some infections