Normal Pregnancy Part 2 Flashcards
What positioning can help with venous stasis?
Since venous stasis is due to pressure from the the uterus
- side lying
- put feet up
What type of muscular skeletal changes occur with PG?
Waddling gait Pelvic presure Lordosis Gravity shift Diastasis recti
What happens that creates the waddling gait in PG women?
Pelvic joints relax to prepare for labor and delivery.
What hormones give you the waddling gait in PG? What else?
Which of too much hormone can cause your symphis to separate? Who is it more common in: small weighted women or big weighted?
Progesterone & Relaxin but also weight gain
Too much relaxin due to it only being collagen.
Women with bigger babies have separation occur more.
Why is waddling called the pride of PG walk?
The hip change will make you walk with shoulders back with your head up and feet far apart. It just makes you look prideful. Really it just keeps you from falling over.
- altered center of gravity
What actions cause pain with the separated symphis?
What do we recommend to help relieve pain?
When will the pain go away?
Actions like walking and stepping hurt it.
A tummy hugger; has lots of straps to help support your belly
Pain will only go away after your deliver
Why would pelvic pressure increase to causes musculature changes?
The growing uterus will put pressure on the nerves making it feel like more pressure
What is Lordosis & why does it occur in PG?
What does this feel like?
Lordosis is the increased lumbar curve
Feels like backache
What is Diastasis Recti? Treatment?
What is the risk with this?
Diastasis Recti is when the rectal band splits into two. Need surgery
Risk of umbilical hernia & your abdomen may protrude after PG
Explain the rib cage change
What causes dyspnea?
The rib cage will flare
Dyspnea caused by diaphragm shifting up
What happens to oxygen consumption in PG?
You will consume more bc you are breathing for two now
Where will you breath in PG?
Thoracic breathing
Will PG causes respiratory acidosis or respiratory alkalosis?
How much should mom be breathing while in labor?
Respiratory alkalosis due to hyperventilation that you might have to do to get the oxygen
Labor should be 20-22 times
- if goes into alkalosis will be pale and tingled
What happens to your voice in PG? And why?
The voice changes due to vascular congestion
Epistaxis increases in PG. What does it mean
Why might you want a soft bristle tooth brush?
Nose bleeding
So your gums dont bleed either
Does PG help or hurt hearing? Why?
Hurts hearing. Due to membrane swelling
What hormone is responsible for the n/v that occurs with pregnancy?
HCG
- starts 6 weeks, peaks 12 weeks and then goes away
Pytalism meaning
What can help?
Increased saliva gland activity that causes you to have to swallow more or chew gum
Why does constipation occur in PG?
How to manage this?
Med?
Constipation occurs due to decreased peristalsis due to Progesterone hormone
Need to drink fluids, take in more fiber, and more activity
Colace med/stool softener
What happens to the cardiac sphincter in PG?
How to manage the pyrosis?
Cardiac sphincter will relax and cause pyrosis.
Manage with eating small, frequent meals and staying sat up instead of laying down. Don’t eat close to bed time
What does increased venous pressure do to the anal region?
Causes hemorrhoids. Try to avoid constipation
Pica?
Only really happens in PG
herbivores and noncaucasian women have highest risk but can happen for any any age group
How does PG affect the gallbladder?
Why?
Can cause more gallstones due to progesterone. Can even occur after PG.
Lack of muscle tone
Prolonged emptying time
Increased cholesterol in bile
Retention of bile salts - causes itching
If you have a history of gastric ulcers will PG make them worse?
Actually no! The acidity of the stomach decreases in PG and it may help
Why does mom have delayed gastric emptying in PG?
It is so her intestines have more time to absorb stuff
What does the relaxation of the cardiac sphincter cause
n/v
heartburn
bloating
How can the appendix be affecte by PG?
Become displaced much higher than normal - and if you have appendix, it will be way higher than other people having appendix.
Why does GFR and renal plasma flow of kidneys increase?
How is BUN when pregnant?
And creatine?
What if you see these as normal?
To keep up with demands of PG and the increased waste products
Bun lowered
Creatine lowered
If either of these are seen as normal , it actually means they are elevated technically due to lower in PG
What do serum sodium levels look like?
Does this mean we should eat or avoid sodium?
decrease - which causes the edema
Depends on the person. it is very individualized
What happens to glucose in PG?
May see spilling of glucose in last month of PG but only a trace amount.
- should never be more than 1+
Why is there an increased risk of UTI in PG?
What happens to kidneys ?
Due to pressure
Kidneys and uterers enlarge and dialate . May see hydronephrosis on right (but depends where baby is)
What happens to ureters in pregnancy?
Dilate as well but then become compressed due to uterus pressure
What happens to to pH in pregnancy?
Increases - which puts you at higher risk of uti
How does urinary present?
It comes on , leaves, and then comes back due to lightening
- early & late. no sign of infection or anythign either
Neuro
headache
cramps
Acrothesia
Fainting concern?
Tension headache
Muscle cramps due to imbalance of calcium and phosphors and circulatory stasis
- do get moving to prevent and elevate legs
Acrothesia: numbness of stooped shoulders due to weight of breasts that puts pressure on brachial plexus
- get them in a better bra & improve postuer. no guarantee of improvement
If a young woman says she fainted at work, they will do a PG test. But first need to rule out..
- vasomator instability
- hypotension
- hypoglycema
Carpal tunnel syndrome cause
Symptoms
What can exaggerates symptoms
After PG - will it go away?
Median nerve pressure from fluid/edema
Pain, tingling, weakness in hand to elbow in dominant hand usually (but can affect both)
Smoking and alcohol
Can persist after delivery in some. will need to have procedures
What does the pancreas need to do in PG? And what if it can’t do this?
Increase insulin demand to meet needs of PG
Diabetes mellitus
How much does the thyroid enlarge?
25% due to metabolism going up in PG
What does anterior pituitary release?
FSH, LH, and Prolactin hormones for PG
What does posterior pituitary release?
Oxytocin and vasopressin (ADH)
Adrenal gland releases?
estrogen increases cortisol
Aldosterone sodium retention
Initial visit history check?
Review of all systems
Family Hx
Personal health hx (so her) - wt, meds, allergies, diseases, illnesses, surgeries
Psychosocial hx - depression, anxiety
Gyn hx - menarche, infections, BC
Pregnancy hx - LMP, GTLA
Religious preference - jewish circumcision done by rabbi
Ethnicity & cultural practices - men not involved example. Ask them what they want!!!
Occupational hx
Person - education, housing, insurance, support
Birth plan
Feeding plans
Circumcision
Does everyone have a birth plan?
Do we welcome birth plan?
No - but some do. It allows for mothers to choose what they want to happen. It is a sign they are committed and educated
What is involved in physical exam?
Baseline vitals
Systems assessment
Fundal height - need empty bladder
FHR - at appropriate time
When will they do the risk assessment?
Will do it first and every visit too. It is just checking on the mom’s subjective symptoms.
How often should a mom get a urine analysis?
If there is a concern?
Every visit . Can take it home and bring it with them right before she leaves home due to shy bladder
pH, SG, glucose, protein, leukocytes, blood
If there is a concern with the UA will order a renal function test (BUN, creatinine, electrolytes)
Why does everyone receive a CBC
HGB levels that indicate anemia?
HCT?
To get a read on H&H and check for anemia
hemoglobin anemia- less than 11
hematrocrit anemia - less than 30
Why do we want her blood type ?
Check for rh factor
- done twice tho. once now and once upon admission to hospital for delivery
What do we check for immunizations
Rubella titer
Heb B screening or C depending on hx
HIV
TB if not done within last 6 motns
What stds will they check for?
Syphillis screening Gonorrhea Chlamydia HPV if not done in 6 months Herpes - only if hx or lesions HIV
What if mom doesn’t report her drug using?
Some people will call and report
Or if she triggers protocol checking like missing appt, not doing prenatal care, etc
When is Penta Marker done?
15-17 weeks
When do they do glucose screening?
First visit
And then do it 24-28 weeks
When will they do GBS screening?
36 weeks or late pregnancy but treated in labor
Formula used for calculation of due date?
Naegele’s rule where you take first day of LMP & write out its date. Subtract 3 months. Then add 7 days.
- based off lunar months
What if they have no idea when the last period was?
Check ultrasound . Earlier it is, more accurate
Pregnancy wheel on last period & go around 40 weeks
Web apps
When do mom and baby need to have first visit?
Miss 2 periods ideally. Between 8-12 weeks in first trimester
How often does mom need to come in during second trimester?
How often does she need to come back in third trimester?
Every 2 weeks in second trimester
Every week in third trimester
.. in normal pregnancies
Red flag for drug screening?
Late prenatal care
Missing appointmens
Who assesses moms anatomy?
pelvic inlet
midpelvis
pelvic outlet
Physician
first plane of pelvis
mid plane
outlet plane
you only have 3. They can tell pretty early on if you can delivery vaginally
Danger signs of Pregnancy
Gush of fluid
bleeding where?
pain where?
fever of what?
Pre-eclampsia symptoms
vomiting?
severe headache?
edema?
muscle behavior?
epigastric pain?
Oliguria
Dysuria
change in fetal movement
Gush means rupture
Vaginal bleeding
abdominal pain
101 or 104.. call doctor
BP going up causing dizzy and blurry vision, spots, headache
vomiting persistently tho. Not just morning sickness
headache that isn’t going away with Tylenol
edema above the knee is not normal
muscle irritability - jerking, seizures (eclamptic)
epigastric pain could mean liver issue
no pee - oliguria , preeclampsia
more pee - dysuria. UTI or gestational diabetes
typically decreased . people will come in for a check
Can you give a live virus in PG?
Which live vaccinations should we never give?
No do not give a live virus.
MMR Varicella Polio Yellow fever Smallpox
Can you give flu, rabies, hep a, enhanced polio?
Yes because they are inactivated
Can you give immunoglobulins to PG mom?
Yes - but they are weight based.
First Trimester Complaints
N/V
Urinary frequency
Fatigue
Breast tenderness
Increased vaginal discharge
Nasal stuffiness & nose bleeding
Pytelism (excessive salivation)
N/V - due to increased HCG and metabolism. Avoid causative factors. Eat crackers. Small frequent meals. Avoid greasy or seasoned food. Eat dry meals with fluids in between. Drink carbonated beverages
Urinary frequency - due to pressure. Void often, drink plenty still in day but decrease in evening only
Fatigue - plan time for your nap or go to bed sooner. ask family to help you out sometimes w responsibilities
Breast tenderness - increased estrogen and progesterone is the cause. wear a well fitting bra
increases vaginal discharge - due to estrogen. bathe daily . wear cotton
Pytelism - chew gum or candy. astringent mouthwashes
Second Trimester complaints
fainting
dyspnea
flatulence
carpal tunnel
fainting - changing position so avoid prolonged standing in warm or stuffy environments
dyspnea - pressure on diaphragm . use proper posture and sleep propped up w pillow
flatulence - avoid gassy foods. chew food. daily exercise. normal bowel habits
carpal tunnel - avoid aggravating hands. use splint. elevate arm
Second and Third trimester
heartburn
anke edema
varicose veins
hemorrhoids
constipation
backache
leg cramps
heartburn f- rom cardiac sphincter relaxing . eat small frequent meals. no fatty or fried foods. don’t lay down after eating
ankle edema - dorsiflexion, prolonged sitting or standing. elevate legs when sitting. avoid tight stuff
varicose veins - elevate legs , wear hose, avoid crossing legs,
hemorrhoids- avoid constipation, apply ice, ointments, do warm soaks
constipation - increase fluids if possible. fiber in diet. develop regular bowel habits.
backache - avoid uncomfortable working heights, high heeled shoes, lifting heavy loads, and fatigue
leg cramps - imbalance of phosphorus and calcium. so do dorsiflexion to stretch. and evaluate diet . maybe apply heat or start getting up slowly.
Breast Care
What should your bra be like?
How should you clean your breasts?
How to avoid cracking of breasts/nipples?
What are breast shields?
What if you see your nipples are flat?
What should clothing be like?
A well fitted bra for your changing body.
Hygiene is important with but no soap when you breast feed. It can dry you out and get rid of natural emollient.
You can moisturize with lotion and colostrum.
Erects flat nipple. Influences collagen.
If nipples are flat - you need to treat before delivery if you want to breast feed.
Clothing should be loose but still supportive bra
Cleanliness
How often should mom bathe?
Temp?
Bathe daily but not tub baths!!! DUe to vaginal bleeding or ROM
Hyperthermia risk if too hot of water
Can pregnant women be employed?
Yes employment is fine. May be at risk of preterm tho if standing for more than 3 hrs
Is it ok for PG women to travel?
No restrictions unless there are complications . But ask physicians really
Some reasons not to go would be if near preterm labor, bleeding, preeclampsia, or multiple births
What should be done when traveling in the car?
Take breaks, no caffeine, drink fluids, wear seat belt
Can you fly in PG?
Depends on the airline .
pregnancy exercises (4)
pelvic tilt to promote flexibility and reduce back pain
abdominal exercises
kegels for pelvic floor
tailer sit stretch for inner thigh muscles
Trimester responses to getting PG in mom
1st - im pregnant (self centered)
2nd - I am gong to have a baby (fetus is seperate frmo baby)
3rd - I am going to be a mother
PG response of father?
What is it called when men experience a set of behaviors specific to the mom being PG?
By 3rd trimester - should be feeling like the father
Couvade
- weight gain
- headaches
- tend to be very involved tho
How to prepare siblings?
Let them know they’re still loved
Involve them based on their age
Reassure them
Gift to the baby for acceptance
If they aren’t handling it well, a toddler may regress. Potty accidents, sucking on thumb or pacifier ,etc.
- if you give positive reinforcement , this should pass
