Nursing Management

Question 1

Prenatal Visits

Answer 1

Positive pregnancy test – 28 weeks
* Every 4 weeks
29 weeks – 36 weeks
* Every 2 weeks
37 weeks – delivery
* Weekly

Question 2

Prenatal Interview

Answer 2

● Reason for seeking care
● Verification of current pregnancy
● Past pregnancies
● Health history
● Nutritional history
● Family medical history
● Religious, spiritual, & cultural history
● Occupational, social, & experiential
history
● Mental health screening and
reactions to the pregnancy
● Screening for intimate partner
violence/human trafficking
● Partner’s history

Question 3

Verification of Pregnancy

Answer 3

Signs and symptoms
* Presumptive
* Probable
* Positive
Blood & urine tests
* hCG
* Peaks 60-70 days of gestation
Estimating the date of birth
* Nagële’s rule
* 1st day of LMP +7 days – 3 months
* Measurement of fundal height
* Ultrasound (US)

Question 4

Five-digit system

Answer 4

• G: total number of pregnancies
• T: number of pregnancies that ended in term births
• P: number of pregnancies that ended in preterm births
• A: number of pregnancies that ended before 20 weeks
• L: number of living children

Question 5

Physical Exam

Answer 5

● Uterine Assessment
○ Fundal height (McDonald’s Method)
○ Correlates with gestational age
○ Normal = + 2cm
● Assessment of Fetal Well-Being
○ Ultrasound
○ Fetal heartbeat
○ Quickening

Question 6

Laboratory Testing/Measurements

Answer 6

all visits
Urinalysis
Weight
Blood pressure
Fundal height after 20 weeks

1st trimester
CBC
Blood type & Rh factor
Rh (-) receive RhoGAM @ 28w
Rubella titer
RPR
Hepatitis B
HIV
Blood tests for genetic screening

2nd trimester
Screening for gestational diabetes @ 24-28 weeks
1hr GTT (>130-140mg/dl)
Blood tests for genetic screening

3rd trimester
H&H
Repeat STI screening if indicated
Group B strep (GBS) screening

Question 7

Assessment of Fetal Well-Being (1st Trimester)

Answer 7

Transvaginal ultrasound
-Gestational sac as early as 4-5wks
-Cardiac activity detected by 6-7 weeks
-Fetal breathing movements by 11-12 weeks
-Nuchal Translucency Screening
-Associated with Trisomy 21, 18 & 13 (11-14 weeks)

Doppler for FHTs

Maternal Serum Testing
-Cell-free DNA screening
-Serum Analytes
-Pregnancy-associated -plasma protein A
-Human chorionic gonadotropin
-Alpha-fetoprotein

Chorionic Villus Sampling
-Detects genetic disorders btw 10-13 weeks
-Risks
-RhoGAM if Rh (-)

Question 8

Assessment of Fetal Well-Being (2nd Trimester)

Answer 8

Ultrasound (US)
Fetal anatomy survey
Gestational age & growth
Amniotic fluid volume
Placental location

Quadruple marker screen
Done btw 15-22 weeks
Elevated with Neural Tube Defects (NTDs)
Trisomy 18 & 21

IMPORTANT TO COUNSELTHAT THIS TEST IS FOR SCREENING ONLY, NOT DIAGNOSTIC!

Amniocentesis
Performed btw 1 -18 weeks for genetic DIAGNOSIS
3rd trimester for fetal lung maturity

Risks
Fetal loss
Spotting
Hemorrhage
Infection
ROM

Nursing Care
Empty bladder prior
Pre & post FHTs
RhoGAM if Rh (-)

Question 9

Assessment of Fetal Well-Being (3rd Trimester)

Answer 9

Fetal Movement Assessment

Indirect measurement of fetal central nervous system integrity & function

Fetal movement record used to record fetal activity

Generally, expect 10 movements in 2 hours
Normal to have up to 40-minute sleep cycles

Non-stress Test (NST)

Reactive (normal) NST
Normal baseline
Moderate variability
TWO or more accelerations (15 x15)
in 20 min
Absence of decelerations

Non-reactive (abnormal) NST
Absence of accelerations in 40 min
Abnormal baseline OR variability
Presence of decelerations

Biophysical Profile (BPP)
Uses NST result & ultrasound
Five criteria with a max score of 10
-Fetal breathing movements
-Fetal movement
-Fetal tone
-Amniotic fluid index (AFI)
-NST

Vibroacoustic stimulation
-Performed with an NST
-Sound & vibration to stimulate fetus

Contraction Stress Test (CST)

Nipple stimulation or oxytocin challenge

ALSO BY ULTRASOUND:

Doppler flow studies

Evaluation of placental maturity

Estimation of Fetal Weight
Intrauterine growth restriction (IUGR)
Macrosomia

BY AMNIOCENTESIS:

Evaluation of fetal lung maturity (FLM)
Alveoli of lungs lined by substance called surfactant

FLM assessed by determining ratio of two components of surfactant & presence of another
Lecithin/Sphingomyelin Ratio
Phosphatidylglycerol (PG)

Question 10

Promoting Self-Care during Pregnancy

Answer 10

Nutrition
1,000 days campaign https://thousanddays.org/
Food safety

Personal Hygiene
Perineal care
Hot tubs & saunas

Physical activity

Sleep & rest

Sexual activity

Employment

Travel

Immunizations

Managing discomforts of pregnancy