Nursing Management During Pregnancy Flashcards
Prenatal care
First prenatal visit is when
Purpose
First trimester
Purpose:
Monitor physical and psychological changes
Anticipatory guidance: educate on anticipated things
Preparing for labor and post pregnancy
Periodic prenatal visits
Every 4 weeks until 28
Evey 2 week until 36 weeks
Every week until delivery 36+
Initial prenatal visit critieria
-thorough health hx
-psychosocial hx
-others
Health hx: PMH/FH/Reproductive/nutrition/current meds/Reproductive/obstetrical hx
Psych: mental health screening
Risk assessment for pregnancy
Teaching
Labs/diagnostics
Determination of due date
Physical exam: pelvic exam, baseline weight, VS
Determination of Due Date
(EDB) estimated date of birth
-Naegele rule
-ultrasound for gestational age
Naegele Rule: first day of the last menstrual period (LMP)
-substract 3 months, add 7 days, add a year
US: most accurate
high risk assessment
Ages <16 or >35
<100lbs or >200lbs
Recurrent abortion
5th or subsequent preg/delivery
Previous stillborn or fetal demise (death)
Substance use
Physical abuse
Hx of preterm births or anomalies
Low socioeconomic level
Medical conditions: cardiac, diabetes, thyroid, renal, epilepsy
Initial prenatal visit
Physical assessment
VS
Weight
pelvic exam
Fetal assessment (FHT(doppler, US)
Pelvic exam
Exam external and internal structures
Bimanual examination
Pelvic shape:
Pelvic shapes
Gynecoid: best one
Anthropoid
Make vag preg difficult:
Android
Platypelloid
Initial lab work
Blood type: Rh Factor
Antibody screen
CBC
RFP
Rubella titers <1:10 non-immune (less then)
HIV screening
Hep B Surface Antigen
RPR (VDRL): Syphilis (want to be nonreactive)
Toxoplasmosis
Pap smear
UA and potentially cultures
Non-invasive prenatal testing
Pap smear: Gonorrhea and Chlamydia
Non-invasive: checks fetal DNA circulating in maternal blood
RH incompatibility
What blood type are we worried about
What test we can do
What we give the mom
When is it given prophylactic
Worried about negative
Test:
Antibody screen of all RH- women (indirect coombs)
Direct coombs
We give Rh- moms Rhogam between 26-30 wks as prophylaxis to prevent developing antibodies
When to give Rhogam before birth
When to give and why to give Rhogam after birth
Rhogam given between 26-30 wks as prhylaxis
After birth if the baby blood type is Rh + then mother will. Be given Rhogam within 72 hours of delivery
If mom is + then dont have to give anything
If baby and mom are both - then dont have to give anything after birth
Indirect vs direct coombs
Indirect:
Antibody screen on all Rh- women
(Mom being tested for antibodies)
Direct:
Prevention of hemolytic disease of the NB
(Testing baby to see if moms cells attached to babies)
When is Rhogam also given
If women has:
Amniocentesis
Chorionic villi sampling
Ectopic pregnancy
Miscarriage
Trauma/accidents
(This is to prevent mixing of blood)
Periodic prenatal visit
-assessment of maternal vs fetal wellbeing
Also anticipatory guidance
Maternal:
BP
Wt
UA
Labs
Fetal:
Fundal height
FHR
Fetal movement
2nd trimester
How often to get visits
Screening between when
After 20 weeks ask what
US(anatomical survey)
Visit every 4 wks
Screening between 16-22wks
After20wks: ask about fetal movements, measure fundal, height
US (anatomical survey): looking at body and measuring it and organs) get gender also
2nd trimester continued
Quadruple screen (when and what it test)
Amniocentesis
Quadruple screen:
16-18wks
Tests: hCG, estriol, inhibin A, Maternal Alpha fetoprotein
MAF:test chromosomal issues
Amniocentesis :
If abnormal US or quad screen
Diagnose genetic info
if mom is Rh- will need Rhogam after procedure
3rd trimester
Screenings (what wks this is done)
Checking gestational diabetes
Blood test to repeat
Administer what
24-28wks
1hr GTT: normal <140
If abnormal=do a 3hr GTT
Repeat H/H, Rh- antibody screening
Administer Rhogam to Rh- mother
3rd trimester
If high risk may recieve what (4)
Issues we may see (4)
Fluid level issues (2)
US
NST (nonstress test)
BPP (biophysical profile)
Fetal surveilance
Issues:
Pre-term labor
Gestational diabetes (this is when we diagnose it)
Pre-eclampsia
IUGR (intrauterine growth restriction)
Oligohydramnios
Polyhydramnios
3rd trimester final month of pregnancy:
GBS (obtain what and where from)
If + how to tx (mainly what med, also what if not sure if +)
What labs (what if one is too low)
High risk may recieve what
When to get tested
GBS: obtain group B strep culture (vaginal/rectal)
If + mother tx with antibiotics during labor (PCN)
if not sure we will tx just in case
Labs: CBC: H/H, plt count prior to L/D
*if plt too low they cant get epidural
High Risk: US, NST, BPP
36-40 wk bc it could change
Danger signs to teach
S/s of preeclampsia
Trickle or gush of fluid
PPROM (premature prelabor ROM)
Preeclampsia s/s:
Severe HA
Epigastric pain
Swelling of hands/face
Visual disturbances/dizzy
Common discomforts in pregnancy (1st trimester)
N/V: Ginger, Vit B6 & Doxylamine, Saltines
Urine freq
Fatigue
Breast tenderness: supportive bra
Leukorrhea: hygiene, loose cotton underwear
Excessive salivation
Nasal stuffiness/epistaxis
Common discomforts of preg
2nd and 3rd trimester (6)
Heartburn: small freq meals, avoid fatty/greasy food, stay upright after eating, antiacids
Constipation: fluids, fiber
Hemorrhoids: ice pack, topical ointment, sitz bath
Back ache: pelvic tilt exercise
Leg cramps/varicosities: avoid siting w/ leggs crossed, dorsiflexion of foot and support hose can help
Difficulty sleeping
Routine self-care
Prenatal vitamin/visits
Dental visits
Avoid xrays
Ask about meds/herbal remedies
Caffeine: limit to 200mg/day
Health promotion education during pregnancy
fetal activity check
Avoid what
Car limit
Exercises for birth
How to do fetal activity monitoring after 24hrs:
10 movements in one hour
Less than 10 movements in 2 hours should be reported
Avoid excessive hot bath/hot tubs or if ROM/bleeding
Car limit to 6 hrs/day, flying, train
Employment risks for exposure to infection
Excercise for birth: pelvic tilt, kegel exercises
Vaccines
Administered
Avoid
Administer:
-Tday (3rd tri) for pertussis (whopping cough)
-influenza
-Hep B
-Covid
Avoid live:
-MMR
-Varicella
-Nasal influenza
Tobacco use in preg
Ask
Smoking cessation edu
Risk of tobacco use:
-miscarriage
-IUGR
-placental abruption
-preterm delivery
-Increased risk of SIDS
Alcohol use in pregnancy:
Fetal alcohol syndrome
Depends on timing of exposure
NO safe level of alcohol
Preventing infections
TORCH
Can cross placenta or ascend to fetus after ROM
T: toxoplasmosis(protozoa): discourage eating undercooked meat and handling cat litter
O: other: syphilis, Varicella, GBS, Hep B, HIV
R: rubella (MMR not given during preg)
C: cytomegalovirus (CMV): transmitted i body fluids
H: herpes type II: cesarean delivery if active lesions
Sexual activity
Is it okay
What causes restriction
What can cause contraction
No medical reason to limit sex
Health conditions that may cause restriction:
PTL(preterm labor)
Placenta previa: need pelvic rest
Threatened miscarriage/abortion: need pelvic rest
Can cause contractions:
Breast stimulation
Orgasm
Fetal movement counts
Where can it be done
How to do it
What number would be concerning
How long with no movement is a fetal alarm
Fetal sleep cycle
Can be done at home
Lay down for one hour to count
Do at same time everyday
<3 movements in an hour warrant test (BPP, NST, CST)
No fetal movement in 12 hours=fetal alarm
Fetal sleep cycle=40 mins
Ultrasound:
Confirms what
Can identify what 7 things
Confirms pregnancy, viability, FHR, gestational age
Identify:
-Fetal growth (IUGR)
Anatomy
Movement/position
-Genetic anomalies
Placenta position and function
Amniotic fluid/guide for amniocentesis
-Doppler blood flow analysis
Types of US
Transabdominal:
Full bladder preferred
Transvaginal:
1st trimester
Maternal anatomy
Cervical assessment
Shortened cervical length
Biophysical profile (BPP)
Predicts what
What is it
Measures what 5 things
Scores
Predicts fetal well being in 2nd and 3rd trimester
Its an US plus a non-stress test
Measures:
Fetal breathing movements
Movement
Fetal tone
Amniotic fluid volume
Non-stress test
0-2 points per category
8-10 low risk for chronic asphyxia, repeat weekly
Score <6 possible compromised fetus
Nonstress test (NST)
What it test
Advantages
Disadvantages
Observe accelerations of FHR to determine adequate fetal oxygenation and CNS
Advantages:
-quick/easy
-inexpensive
-performed in outpatient
Disadvantages:
Difficult to obtain suitable tracing
Maternal obesity
Excessive FM
Extended fetal sleep cycles
Polyhydramnios(difficult to perform)
Nonstress test (NST)
Procedure
What to do
Position
What it measures
The button
How long it takes
What to do after
Explain procedure
Have patient voided
Position semifowler or left lateral
Apply external fetal monitor:
record baseline FHR, maternal VS, uterine activity
Women will press button to record movement
Takes at least 40 mins
Interpret/document/notify provider
NST interpretation
Reactive vs nonreactive tracing
Reactive:(GOOD)
2 or more FHR accelerations of 15 beatsx15 secs within 20 minutes
Nonreactive tracing: (BAD)
Does not meet reactive criteria within 20 mins
DONT PANIC: may need to repeat
Contraction stress test (CST)
Stress is put on baby
Position
Records what
Contractions are what 3 things
Interpretation: neg vs pos vs equivocal
Semi-fowler or lateral
Record FHR and UCs, maternal VS
Contractions can be:
Spontaneous
Induced exogenous (oxytocin)
Induced endogenous (breast self-stimulation)
Interpretation:
Neg: no late decels with at least 3 contractions present within 10 mins
Pos: late decels with at least 50% contractions
(D/t placental insufficiency)
Equivocal: unsure/poor test
Decel: deceleration
Decrease in FHR
Amniocentesis:
What is aspirated and contains
Uses what to guide needle
Used for what in 2nd vs 3rd trimenter
What must be given
Monitor for what
Aspirated amniotic fluid (contains fetal cells)
US guides needle and locate placenta
Used for genetic test in 2nd tri
Used for lund maturity in 3rd tri
Given Rhogam to RH- after procedure
Monitor:
Fetal distress
Onset of labor
Bleeding
S/s of infection
Chorionic villi sampling
Use what to aspirate/ get what
Done when to diagnose what
Done where
Give what post
Monitor what
Needle aspiration/biopsy
Done in 1st trimester to diagnose gentic issues
Done transcervical or transabdominal
Given Rhogam to Rh- mother post procedure
Monitor: infection/bleeding
Percutaneous umbilical blood sampling (PUBS)
Done when
Aspiration of what from where
Test what things (5)
Done 2nd or 3rd tri
Aspiration of cord blood
Test:
Genetic conditions
Fetal infection
Fetal anemia
Gemolytix disease
Thrombocytopenia
Choices for birth experience
Who you want
Feeding choice
Location
Birth plan
Classes
Pysician or OB
Midwife
Doulas (birth support)
Hospital, birth center, home
Breast or bottle feeding
Premonitory signs of labor(6)
-Backache
-Wt loss (1-3lbs)
-Energy burst (nesting)
-Lightening (dropped) baby dropped into pelvis (easier to breath)
-increase braxton hicks (contractions)
-change in vaginal charge
