NUR 113 Test 1 FC's Flashcards
antipartum
the time between conception and the onset of labor or birth. Is used interchangable with prenatal.
gestation
the number of weeks since the first day of the LMP
abortion
delivery that occurs prior to 20 weeks gestation. Miscariage is a spontanous abortion
term
normal duration of pregnancy, beginning of 38th week to the end of 41st week
preterm
delivery that occurs after 20 weeks but before 38th week. Before is an abortion, after is a full term baby
postterm
delivery that occurs after the 41st week of gestation
intrapartum
time from the onset of labor until the delivery of the products of conception (infant and placenta)
postpartum
time from birth until the wonan’s body returns to an essentially prepregnancy state, the first 6 weeks following delivery
gravida
any pregnancy, regardless of duration, including present preg
nulligravida
a woman who has never been preg
multigravida
woman who has been preg more than once (multiv)
primigravida
a woman who is preg for first time (primiv) most dangerous type
stillborn
a fetus born dead after 20 weeks
perinatal
the period of time from the point of viability through the neonatal period
viability
22-24 wks, the capacity to live outside the uterus, fetal weight greater than 500gm
neonate
the first 28 days of life
5-Digit System
GTPAL (Great to play and laugh) Gravida, Term, Preterm, Abortions, Living children
first change that usually occurs in preg
enlargement of breasts
what is the biological marker for preg
Hcg
ways to tell if your preg (types)
subjective (presumptive), objective (probable signs), diagnostic (positive)
size of uterus
prepreg-golf ball, 10wks-orange, 12wks-grapefruit, rises up out of pelvis at 12 weeks
what happens to uterus during preg
grows in size d/t inc estrogen and progesterone, inc in vascularity and dilation of blood vessels, hyperplasia-prod of new fibers, hypertrophy-enlargement of existing fibers, thinning caused by growing fetus, development of decidua (endometrium)
subjective signs/presumptive signs woman is preg
amenorrhea, N/V, urinary freq, breast tenderness, quickening
objective/probable signs woman is preg
Hegar’s sign, Chadwick’s Sign, Goodell’s sign (6-8 weeks), uterine enlargement, Braxton Hicks contractions, enlargement of abdomen (HCG UBE)
Diagnostic/positive changes that confirm pregnancy
fetal heartbeat, visualization of fetus by ultrasound, fetal movement palpated by examiner
heights of fundus
at half way point (20wks) it will be at belly button
Hegar’s sign
practitioner puts 2 fingers into vag past cervix and feels for softening of lower uterine segment. This allows it to fall forward to carry baby in front, if not preg it will be very hard. Will cause woman to pee a lot since uterus sits on bladder. “Hey girl what are you doing”
dextorated uterus
uterus tilts to the right since on L side is the colon, so they will tilt to the right
lightening
when uterus drops back down into pelvis, this signals baby is coming out soon (within 2 weeks), allows them to breath easy again, but they will start peeing a lot again
round ligament pain
lower back pain d/t uterus pushing on things
how do you relieve round ligament pain***
pelvic rocking, getting onto all fours and rocking pelvis
Braxton Hicks
aka false labor-practice shocks for uterus, they do not change cervix, they do not get stronger, they usually stop with walking, occur after 28wks, they facilitate blood flow and oxygen delivery to fetus
what predicts health of baby?
the placenta, healthy placenta=healthy baby
what restricts blood flow to placenta
smoking, HTN, type 1 DM, drugs, sickle cell, hemorrhage, BP too high or low, contractions of the uterus, supine position, multiple gestations
what causes inc in uterine blood flow
estrogen
what dilates vessels in uterus
progesterone. When it drops it starts your period (when not preg)
Niphedipine (procardia)
Ca Channel blocker-dec BP, dec contractions to uterus since it is smooth musc.
positioning in preg women*****
don’t lay supine-dec perf to placenta b/c they are laying on the aorta/vena cava. They should lay on their left side. NEVER lay on their back in 2&3 trimester
Ballottement
occurs after 16-18th wks, when practitioner takes finger and tap on tip of cervix and fetus will move up and them come back down and tap their finger. This tests for content of fluid in uterus
Quickening
feeling of life, occurs in 16-20wks, can base gestational age on this. Multivs are more accurate and can feel them sooner. It bonds mom to child. It inc in intensity as preg goes on
Goodell’s Sign
practitioner puts finger into vag and feels the cervix. If positive they will have a softening of cervix. If not preg it will be firm like a nose. Press the doorbell, goodday
changes to cervix during preg
inc vascularity, hypertrophy, hyperplasia, softening (Goodell’s sign), bluish color, friability (bleeds easy, esp after sex), ballottement, quickening
Vaginal changes during preg
mucosa thickens (strengthens musc for delivery), conn tess loosens (allows for joints to stretch), SM hypertrophy, Vag vault lengthens, formation of the operculum (mucus plug), secretions are more acidic d/t inc lactic acid prod, inc risk for yeast inf (itiching), leukorrhea-whiteish discharge clensing of vag and washing of epithelial cells, inc sensitivity of genitalia, inc sexual interest, enlargement of genitalia
Chadwick’s Sign
bluish coloring of labia manora and inside vag. Chad choked and turned blue. Well estrogenized women have bluish tint to vag normally
Breast changes during preg
fullness, sensitivity, tingling, heaviness, inc pigmentation of nipples and areola-so baby can see it, more erect nipples, hypertrophy of sebaceous glands, venous congestion-more veins present on breasts, proliferation of lactiferous ducts and lobule alveolar tiss, colostrum appears in acini cells of the breast (3rd month of preg)
cardiac changes during preg
hypertrophy, inc CO, inc blood volume, displacement up and to the left, pulse inc by 10-15beats, possible cardiac rhythm changes-fluttering
BP changes during preg
affected by anxiety, positioning, size of cuff. During first tri BP same, 2nd dec, 3rd inc back to pre preg level. Watch for ORTHOSTATIC HYPOTENSION
what causes BP to dec
vasodilation d/t progesterone
trimesters
1-weeks 1-13 2-weeks 14-26 3-weeks 27-40
what trimester are tertogenic agents most harmful
first
Leukorrhea
is norm as long as it doesn’t have a fowl odor or itch
changes in blood vol during preg
increases 40-45% or 1500ml, starts at wks 10-12, peaks at 32-34wks (important for moms on cardiac meds) max workload of heart is after 32-34wks. Perif vasodilation occurs d/t progesterone.
blood contents change during preg
inc RBC, dec Iron, inc WBC, inc Chol, hemodilution-hgb 11, hct 35.
true anemia
hgb 10 or less, Hct 33 or less. Norm is 12-16 and 37-47
most at risk for anemia
teens, b/c their diet sucks
why do WBCs inc in preg
to inc defenses during birth 18-20 is ok. Norm is 5-10
clotting changes during preg
inc clotting, inc in factors 7-10, dec in fibrinolytic activity (breaking up of clots), inc risk for dvt. This is so mom doesn’t beed out during birth. After birth they will shed clots fot a while
coagualtion changes during preg
inc clotting, inc in factors 7-10
respiratory changes during preg
nasal congestion-d/t inc blood vol, may get epistaxis (nose bleeds), inc in BMR d/t inc need for oxygen, resp alk, relaxation of ribcage d/t estrogen, expansion of thoracic chage, thoracic breathing occurs, inc in tidal vol, inc in RR, inc in inspiratory capacity, asthma will be worsened
renal/urinary system during preg
inc press on kidneys, ureters dilate and lengthen, urine flow rate slows, inc vascularity-will have blood in pee from small accidents, nocturia, freq and urgency, dec in bladder tone-holds more, inc GFR, inc risk for UTI
why is inf bad for preg woman
b/c it causes inflam response, which may start preterm labor or try and attack fetus.
if having renal problems what should woman do?
bedrest, lie lateral recumbent-best for renal function
Fluid and Electrolyte changes during preg
Na and water reabsorption. Estrogen conserves Na, progesterone excretes Na. Do NOT give lasix to them, glucosuria-small amounts are ok, if BG is 160+ spilling will occur, proteinuria-trace or +1 are ok as long as mom doesn’t have HTN
Integumentary changes during preg
hyperpigmentation is stimulated by the anterior pituitary releasing melanotropin (can get a better tan), inc in hair and nail growth, sebaceous gland growth-sweat more, inc circulation causes rosy cheeks, striae gravidarum-stretch marks d/t inc in adrenocorticoisteriods stretching conn tiss, chlosoma-mask of pregnancy (across nose and cheeks), darkening of nipples and underarms, palmar erythema, linea nigra
what type of swelling should preg women not have?
periorbital edema
what things in preg do not go away afterwards
striae gravidarum, and expansion of rib cage
Musculoskeletal system changes during preg
lordosis, waddling gait, inc mobility of joints (can cause falls), seperation of rectus abdominis musc.
neurological system changes during preg
compression of pelvic nerves, lordosis, carpal tunnel syn, traction of brachial plexus (due to weight of belly pulling down on shoulder nerves), lightheadedness d/t vasomotor hypotension, hypoCa
gastrointestinal system changes during preg
appetite-dec in 1st tri d/t N/V, inc in 2nd tri, PICA, ptyalism, gingivitis, herniation of stom, pyrosis, constipation, gallstones, Ab discomfort, pelvic heaviness, flatulence and distention
what makes preg woman naseous
high levels of Hcg
PICA
cravings for non food items like starch, dirt or ice. More common in teen moms b/c their diet sucks
ptyalism
excess saliva during preg, may inc N/V, can accelerate gingivitis
what causes constipation in preg women
inc progesterone results in inc water resorption from colon (dries out poop), and being on Iron pills
endocrine changes in preg women
inc estrogen, progesterone, hCG,hCS serum prolactin, oxytocin, suppression of FSH and LH, thyroid gland gets bigger d/t to estrogen, parathyroid can’t keep up, pancreas-fetus steals glucose and AAs
why can’t you get preg on top of a preg
suppression of FSH by progesterone stops the release of eggs
what does oxytocin do?
produced in post pituitary. Infant sucking releases oxytocin which causes contractions that shrink the uterus. It also causes labor to begin.
what does parathyroid do?
regulates Ca and Mg, this is why people may lose a tooth while preg from not enough Ca.
does glucose cross placenta?
yes
does insulin cross placenta?
no, placenta creates it also
where is insulin created in mom
beta cells of pancreas
how does glucose work with fetus
baby steals glucose and dec mothers ability to produce glucose by stealing amino acids (AA) from mom also, this dec mom’s BG. When too much insulin is produced and cells can’t reuptake it all you get gestational DM?
RBC
inc
Blood vol
inc
muscle tone
dec
WBC
inc
BP in 1st tri
same
BP in 2nd tri
dec (d/t vasodilation from progesterone)
BP in 3rd tri
inc bac to first tri level
HR
inc
CO
inc
fibrolytic activity (ability to break up clots)
dec
why do we have inc blood vol during preg
to inc perfusion to placenta
where does uterus shift to during preg
up and to the right
what is the expected reaction from a woman when she finds out she is preg
ambivilance- b/c that is the point of no return. Is a norm reaction for first few weeks
Rubin’s Psychological changes of preg
Safe Passage- 1st tri-mom seeks out medical care. 2nd tri-concerned for baby. 3rd tri-worried about labor and delivery
most important tri for fetal well being
first
father’s role during preg
support
Nagele’s rule or EDC (estimated date of confinement)
take first day of LMP and subtract 3 months and add 7 days
first MD appointment
pelvic exam, intense health Hx, Chadwicks, Goodell’s, Hegars, drug use, menstrual Hx, preg Hx, violence, STIs, get prepreg weight
MD appointments
first at 8-10 weeks, then monthly till 26weeks, bimonthly till 36weeks, then every week till delivery
best indicator of how preg is going
weight gain
can you drug test preg woman?
only if they give permission, you can however test baby when it is born (through their diaper)
what drug causes preterm labor
cocaine, it vasoconstricts vessels and can cause detachmenet from uterine wall, preterm
what drug can we give addicts to help them during preg
methadone, to maintain their levels so they don’t go through withdrawls
fetal alcohol syn
causes low birth weight, microcephaly, MR, unusual facial features, cardiac defects
greatest preventalbe cause of MR
alcohol
cigarettes
dec perf to baby, preterm, small babies
caffeine
limit to 3 cups per day, inc risk for miscariage
babies with withdrawls are
irritable, diarrhea, need quiet envt, skin is very sensitive, are given morphine for withdrawls b/c once cord is cut they stop getting drugs
when do we screen mom for DM
24-28 wks
SGA
small for gestitaional age
IUGR
intrauterine growth restriction, 10th percentile baby, very small, little musc, very wrinkly, leathery skin, due to dec perfusion
*** 1 hour glucose test (O’Sullivan’s or 1ogt)
no fasting, maybe carb load prior. Have mom drink 50gm of glucola wait an hr and then draw blood, if 140+ she fails. Then we need to follow up and do 3hr test
***3Hr Oral Glucose Challenge Test **
NPO after midnight prior to test (or carb load), draw fasting BG, then drink 100gm glucola, then draw blood at 1,2,3hrs. 4 blood draws total. 2 or more abnormal results = gestational diabetic
GBS screening
group B strep, normal flora in many people, can cause death in newborns they become septic, and can cause preterm labor, penicilin G is given either to cure mom or to prep baby so it can fight it, try to get 3 doses into mom prior to birth. If unsure of mom’s GBS we keep baby 48hrs
Diabetes I vs II
type one can cause birth defects, gest DM doesn’t affect baby till late-it affects size of baby and possible hypoglycemia when born
relationship of gest DM vs type II
women what have gest DM are 70% more likely to get Type II DM in the future, usually several years later
S/S of infection in neonate
dec in temp, don’t eat
toxoplasmosis
bacterial inf found in litter boxes, can cause birth defects
blood type and match
group- A,B,AB,O, types -,+
why is Rh factor important in preg
if baby is + and mom is -, mom will try and attack baby, or will build antibodies and attack next baby. You will be given Rhogam-is a type of blood product. IM inj given profalactically. When baby is born we check blood if baby is born - then mom will not need more Rhogam, if + she will get another shot within 72hrs, also given for abortions or anytime fetal and maternal blood mixes. MUST GIVE before they go HOME.
Rhubella titer
drawn on mom, if immune they don’t need anything, if not give her vaccine right after birth. Do NOT give during preg, not supposed to get preg within 1 month of getting rhubella vaccine. If baby gets it causes-Hearing, cardiac, MR
fundal height measurements
should be within +- 2cm of gestation age charts
each visit
always assess for violence, calculate EDC, learning needs, assess knowledge level
weight gain in preg
for average women 25-35lbs, if malnurished may be more, if obese may be less. Wt gain indicates health of baby, adequate weight gain reduces risk of small baby, inadeq wt gain may inc risk for IUGR. Too much wt gain (macrosomia) or too little