Nursing care of the childbearing family Flashcards
Gravida
a woman who is pregnant
Nulligravida
a woman who has never been pregnant and is currently not pregnant
Primigravida
a woman who is pregnant for the first time
Multigravida
a woman who has had two or more pregnancies
Nullipara
a woman who has not completed a pregnancy with a fetus or fetuses who have reached at least 20 weeks of gestation
Primipara
a woman who has completed one pregnancy with a fetus or fetuses who have reached 20 weeks of gestation or more
Multipara
a woman who has completed two or more pregnancies to 20 weeks of gestation or more
Preterm
a pregnancy that has reached 20 weeks of gestation but ends before 37 weeks 0 days of gestation
Late preterm
a pregnancy that has reached between 34 weeks 0 days of gestation and ends before 36 weeks 6 days gestation
Full term
a pregnancy that has reached between 37 weeks 0 days and 41 weeks 6 days gestation
Post-term
a pregnancy that has reached 42 weeks and 0 days beyond gestation
Viability
the capacity to live outside the uterus; there are no clear limits of gestational age or weight
What age is considered to be the threshold of viability and vulnerable to brain injury
22 to 25 weeks of gestation
What skin problems do post-term babies usually have
dry and peeling skin
Amenorrhea
no period
Quickening
fetal movement between 10-12 weeks
EDC
estimated date of confinement, the due date
What is the common method for collecting EDC
determine the first day of the LMP, subtract 3 calendar months and add 7 days, then change the year
What does the EDC assume
that the woman has a 28-day cycle and that fertilization occurred on the 14th day
5 digit obstetric history
GTPAL
2 digit obstetric history
GP
What does the G stand for in obstetric history
gravida: number of pregnancies (current pregnancy is included)
What does the T stand for in obstetric history
term births: number of term gestations delivering between 37 and 42 weeks
What does the P stand for in obstetric history
pre-term births: number of preterm pregnancies ending greater than 20 weeks but before completion of 37 weeks
What does the A stand for in obstetric history
abortions/miscarriages: number of pregnancies ending before 20 weeks of viability
What does the L stand for in obstetric history
living children: number of children currently living
What is the best way to ensure a healthy outcome for both the mother and child
early and regular prenatal care
What is inadequate antepartum care closely associated with
low birth weight and increased premature birth, increasing neonatal mortality
What are the subjective/presumptive changes during pregnancy
amenorrhea, nausea/vomiting, excessive fatigue, urinary frequency, breast tenderness/enlargement, and quickening
What is the definition of subjective/presumptive changes
these changes are not definitive and could be caused by something other than pregnancy
What are the objective/probable changes during pregnancy
enlargement of the abdomen, cervical changes, uterine changes, pregnancy tests
What is the definition of objective/probable changes
changes that are observed by an examiner but may have other causes and do not confirm pregnancy
Goodell’s sign
softening of the cervix from the consistency of the tip of your nose to the consistency of your earlobe
Hegar’s sign
6th week of pregnancy, the lower uterine segment is so soft that it can be compressed to the thinness of paper, allowing the uterine segment to be flexed against the cervix
Chadwick’s sign
bluish, purple discoloration of the mucous membranes of the cervix/vagina; caused by increased vascularity of the pelvic organs, one of the earliest signs of pregnancy
Fetal outline
can be palpated by an experienced practitioner by the 2nd half of pregnancy
Ballottment
when a sudden tap on the cervix during vaginal examination near mid-pregnancy causes the fetus to rise in amniotic fluid and rebound to its original position
Braxton hicks
contractions that occur throughout pregnancy and are usually irregular and painless, most women do not notice until the 3rd trimester
Pregnancy tests
based on the presence of hCG in maternal urine and may be used as early as 3 days after a missed period (home kits are 97% accurate if used correctly)
Radioimmunoassay tests
use radioactive markers to detect antibodies against hCG in the blood or urine, done in a lab and are accurate as early as 1 week after ovulation
ELISA enzyme
linked immunosorbent assay uses antibodies to detect hCG in the blood and urine, positive 5 days before a missed period, certain drugs may affect accuracy
What is the definition of positive/diagnostic changes
conclusive proof of pregnancy
What are the positive/diagnostic changes during pregnancy
fetal heartbeat, fetal movement, visualization of the fetus
When can you hear a fetal heartbeat with an electronic doppler
10-12 weeks
When can you hear a fetal heartbeat with a fetoscope
18-20 weeks
What should the fetal heart rate be
160-170 bpm
Transvaginal ultrasound
visual examination of the fetus 4-6 weeks after LMP (identify the fetus and the heartbeat)
When are women screened for glucose levels
average: 24-28 weeks of gestation
high-risk: early 1st trimester
When is further glucose testing required
fasting: >126 mg/dl
challenge test: >140 mg/dl
What is given if the antibody tier for Rh is negative
RhoGAM is given
Group B streptococcus
normal for the mom, harmful for the baby, vaginal/rectal cultures are obtained at 35-37 weeks gestation, treated during active labor with antibiotics in an IV
Rubella
prevent the possibility of contracting rubella in future pregnancies through the MMR vaccine
Hepatitis B screen
important if the mother is positive because the infant must be given immune globulin after birth
Varicella
a vaccine is given postpartum and during follow up visit in women that have no immunity
What blood draws are done during pregnancy
alpha-fetoprotein (AFP), triple/quad screen, cell-free
Alpha-fetoprotein (AFP)
screens for neural tube defects and multiple pregnancies, done 15-18 weeks
Triple/quad screen
determines the risk of neural tube defects and down syndrome, done 15-18 weeks
Cell-free (DNA) screen
tests for trisomies 13/18/21, fetal rH status, fetal sex, gene disorders, done at 10 weeks
Nuchal translucency ultrasound
measures fluid, nasal bone, nuchal fold, trisomy 13/18/21 abnormalities, 10-14 weeks
Ultrasounds
fetal heart activity, gestational age, fetal growth, fetal anatomy, placental position/appearance, fetal well-being
Amniocentesis test (biochemical)
fetal sex, 40 different genetic abnormalities, inborn errors of metabolism, neural tube defects, 15-20 weeks
Chronic villus sampling (biochemical)
obtains a sample of the chorionic villi for prenatal evaluation of chromosomal disorders, enzyme deficiencies, fetal sex determination, sex-linked disorders, 10-12 weeks
What should weeks gestation equal
uterine centimeters measured
20 cm = 20 weeks
When is the embryonic period
3rd week until 8th week
Embryonic disc layers (3)
ectoderm, mesoderm, endoderm
When are all major organ systems in place
the end of the 8th week
What do teratogens do during the embryonic period
cause major structural and functional damage to developing organs
When is the fetal period
9 weeks after conception until birth
What happens during the fetal period
dramatic growth and refinement of established organ systems
When do neural tube defects occur
3-16 weeks
When do heart malformations occur
end of 6 weeks to end of 8 weeks
When does the cleft lip palate occur
late 6 weeks to early 9 weeks
What growth occurs at 4 weeks
developing structures that will form into the face and neck, home pregnancy test is positive
What growth occurs at 5 weeks
neural tube, fetal spine
What growth occurs at 9 weeks
umbilical vessels, ribs, ear buds, placental attachment, neural tube closes, called a fetus
What growth occurs at 14 weeks
can see all 3 umbilical cord vessels
What growth occurs at 20 weeks
weighs about 20 ounces, 6 inches long, the uterus is at belly button level, the fetus can yawn/suck a thumb/stretch/make faces
What are the fetal membranes (2)
Amnion (inner), chorion (outer)
Amnion
inner membrane, the developing embryo draws amnion around itself to form a fluid-filled sac, becomes the covering of the umbilical cord and covers the chorion on the fetal surface of the placenta
Chorion
outer membrane, becomes the covering of the fetal side of the placenta, contains major umbilical blood vessels
Amniotic fluid
protects the fetus and promotes development, derived from fetal urine (cause of kidney problems), fetus breaths in amniotic fluid while in utero
Umbilical cord veins and arteries
2 arteries that carry non-oxygenated blood to the placenta from the fetus, 1 vein that carries oxygenated blood to the fetus
What is involved in the 5 adaptions made during fetal circulation
umbilical vein, ductus venosus, foramen ovale, ducts arteriosus, umbilical arteries
What does the umbilical vein turn into
the ligamentum teres after the cord is clamped because it is functionally closed
Ductus venosus
Most of the blood passes through here into the inferior vena cava. There mixing with deoxygenated blood from the fetal legs and abdomen on its way to the right atrium
What does the ductus venosus turn into
the ligamentum venosum after the cord is clamped because it is functionally closed
Foramen ovale
most of the blood passes straight through the right atrium and through the foramen ovale, an opening into the left atrium. There mixing with the small amount of deoxygenated blood returning it from the fetal lungs through the pulmonary veins
What happens to the foramen ovale
closes at birth because there is an increased pulmonary blood flow from the left side, causing increased pressure in the left atrium
Ductus arteriosus
fetal lungs do not function for respiratory gas exchange, so the pathway bypasses the lungs, blood flows from the pulmonary artery to the aorta
What does the ductus arteriosus turn into
the ligamentum arteriosum after the cord is clamped because it is functionally closed
What happens to the PO2 level when the ductus arteriosus closes
increases
What has an important role in closing the ductus arteriosus
circulating prostaglandin E
What does the umbilical artery turn into
medial umbilical ligament after the cord is clamped because it is functionally closed
What does clamping of the umbilical cord cause
a rise in blood pressure which increases circulation and lung perfusion
Vena cava syndrome
when the gravid uterus rests on top of the vena cava, maternal blood flow is diminished or cut off, causing maternal hypotension and dizziness
Human chorionic gonadotropnin (hCG)
early pregnancy hormone that stimulates the corpus lutem to produce progesterone and estrogen to maintain pregnancy, causes a positive pregnancy test
Human placental lactogen (hPL)
antagonist to insulin, freeing fatty acids for energy so glucose becomes available for fetal growth
Estrogen
stimulates uterine and breast (duct) development, produced by the placenta after the 7th week
Progesterone
maintains uterine lining for implantation, relaxes all smooth muscles preventing contractions, develop breasts (lobules) for lactation, facilitates deposits of maternal fat stores for energy, inhibits oxytocin
Relaxin
inhibits uterine activity diminishing the strength of uterine contractions, aids in softening of the cervix, relaxes muscles and joints in the body
Prolactin
prepares the breasts to produce milk
Oxytocin
stimulates contractions of the uterus to help birth occur, helps to keep the uterus contracted to prevent hemorrhage after birth
First trimester discomforts of pregnancy (7)
nausea/vomiting, urinary frequency, fatigue, breast tenderness, increased vaginal discharge, nasal stuffiness and epistaxis
What is the cause of nausea and vomiting in the first trimester
unknown but believed to be elevated hCG/estrogen levels, decreased blood sugar
What is the cause of urinary frequency in the first trimester
the bladder is being squeezed by an enlarging uterus
What is the treatment for urinary frequency
urinate frequently, Kegel exercises
What is the cause of fatigue in the first trimester
effects of relaxin, hypoglycemia, anemia
What is the cause of breast tenderness in the first trimester
effects of estrogen and progesterone
What is the cause of increased vaginal discharge in the first trimester
increased production of mucus due to increased estrogen levels
What is the cause of nasal stuffiness and epistaxis in the first trimester
elevated estrogen levels
Second-trimester discomforts of pregnancy (7)
heartburn (pyrosis), constipation, hemorrhoids, varicose veins, leg cramps, ankle edema, backache
What is the cause of heartburn in the second trimester
diminished gastric motility, displacement of the stomach by the enlarging uterus, relaxation of the cardiac sphincter
What is the cause of hemorrhoids in the second trimester
vascular engorgement of the pelvis, constipation, prolonged standing, straining during stool
What is the cause of constipation in the second trimester
decreased bowel motility due to increased progesterone levels, diet, decreased fluids, lack of exercise
What is the cause of varicose veins in the second trimester
family history, obesity, the weight of the uterus compresses venous return causing stasis, prolonged standing
What is the cause of leg cramps in the second trimester
imbalance of calcium/phosphorus ratio, low magnesium levels, increased pressure of the uterus on nerves
What is the cause of ankle edema
prolonged sitting/standing, increased levels of sodium due to hormonal influences, circulatory congestion
What is the cause of backaches in the second trimester
increased curvature of the lumbosacral spine as the uterus enlarges, softening of cartilage from increased hormone levels, poor body mechanics, preterm contractions
How does a doppler transducer work
high frequency sound waves reflect the mechanical movement of the fetal heart, need to use gel
Tocotransducer (toco)
pressure-sensitive device that detects changes in abdominal contour to measure uterine activity (non-invasive), assess the frequency and duration of contractions and relative intensity and uterine resting tone
Baseline variability
evaluates the function of the fetal autonomic nervous system, especially the parasympathetic branch
Absent variability
amplitude range is undetectable
Minimal variability
detectable but less than 5 bpm amplitude
Moderate variability
6-25 bpm
adequate oxygenation
want to be here
Marked variability
greater than 25 bpm
Decelerations
periodic decreases in FHR from the normal baseline (early, late, variable)
Warning signs during all trimesters (9)
spotting/bleeding, painful urination (infection), severe persistent vomiting (hyperemesis gravidarum), fever higher than 100, pain in the calf (deep vein thrombosis), sudden gush or leakage of fluid from the vagina, periorbital/facial edema, severe upper abdominal pain, headache with visual changes
Warning signs during the first trimester (3)
lower abdominal pain, dizziness, shoulder pain (ectopic pregnancy)
Warning signs during the second trimester (2)
regular uterine contractions, absence of fetal movement for more than 12 hours
Warnings signs during the third trimester (2)
sudden weight gain, decrease in fetal movement for more than 24 hours
When does a hypercoagulative state occur
during pregnancy
What is the most effective way to dilate the cervix
the fetal head
Attitude
the relation of fetal parts to one another
Normal attitude
head is flexed forward, arms and legs are flexed onto the trunk, efficient use of space
What is the easiest way to deliver
complete flexion
What position is a sunny side up baby in
occiput posterior position
What are the most common and easiest positions to deliver in
left occipital anterior and right occipital anterior
What does station have to do with
the ischial spine
Effacement
thinning of the cervix
Dilation
opening of the cervix
What does maternal position do during labor
affects anatomic and physiologic responses
What can position changes during labor do
relieve fatigue, improve circulation, enhance comfort
