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Nursing Management During Pregnancy Flashcards

1
Q

Prenatal care
First prenatal visit is when
Purpose

A

First trimester

Purpose:
Monitor physical and psychological changes
Anticipatory guidance: educate on anticipated things
Preparing for labor and post pregnancy

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2
Q

Periodic prenatal visits

A

Every 4 weeks until 28

Evey 2 week until 36 weeks

Every week until delivery 36+

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3
Q

Initial prenatal visit critieria
-thorough health hx
-psychosocial hx
-others

A

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

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4
Q

Determination of Due Date
(EDB) estimated date of birth
-Naegele rule
-ultrasound for gestational age

A

Naegele Rule: first day of the last menstrual period (LMP)
-substract 3 months, add 7 days, add a year

US: most accurate

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5
Q

high risk assessment

A

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

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6
Q

Initial prenatal visit
Physical assessment

A

VS
Weight
pelvic exam
Fetal assessment (FHT(doppler, US)

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7
Q

Pelvic exam

A

Exam external and internal structures

Bimanual examination

Pelvic shape:

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8
Q

Pelvic shapes

A

Gynecoid: best one

Anthropoid

Make vag preg difficult:
Android

Platypelloid

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9
Q

Initial lab work

A

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

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10
Q

Pap smear
UA and potentially cultures
Non-invasive prenatal testing

A

Pap smear: Gonorrhea and Chlamydia

Non-invasive: checks fetal DNA circulating in maternal blood

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11
Q

RH incompatibility
What blood type are we worried about
What test we can do
What we give the mom
When is it given prophylactic

A

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

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12
Q

When to give Rhogam before birth

When to give and why to give Rhogam after birth

A

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

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13
Q

Indirect vs direct coombs

A

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)

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14
Q

When is Rhogam also given

If women has:

A

Amniocentesis
Chorionic villi sampling
Ectopic pregnancy
Miscarriage
Trauma/accidents

(This is to prevent mixing of blood)

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15
Q

Periodic prenatal visit
-assessment of maternal vs fetal wellbeing

Also anticipatory guidance

A

Maternal:
BP
Wt
UA
Labs

Fetal:
Fundal height
FHR
Fetal movement

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16
Q

2nd trimester

How often to get visits
Screening between when
After 20 weeks ask what
US(anatomical survey)

A

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

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17
Q

2nd trimester continued

Quadruple screen (when and what it test)

Amniocentesis

A

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

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18
Q

3rd trimester
Screenings (what wks this is done)
Checking gestational diabetes
Blood test to repeat
Administer what

A

24-28wks

1hr GTT: normal <140
If abnormal=do a 3hr GTT

Repeat H/H, Rh- antibody screening

Administer Rhogam to Rh- mother

19
Q

3rd trimester

If high risk may recieve what (4)
Issues we may see (4)
Fluid level issues (2)

A

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

20
Q

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

A

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

21
Q

Danger signs to teach

S/s of preeclampsia

A

Trickle or gush of fluid
PPROM (premature prelabor ROM)

Preeclampsia s/s:
Severe HA
Epigastric pain
Swelling of hands/face
Visual disturbances/dizzy

22
Q

Common discomforts in pregnancy (1st trimester)

A

N/V: Ginger, Vit B6 & Doxylamine, Saltines
Urine freq
Fatigue
Breast tenderness: supportive bra
Leukorrhea: hygiene, loose cotton underwear
Excessive salivation
Nasal stuffiness/epistaxis

23
Q

Common discomforts of preg
2nd and 3rd trimester (6)

A

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

24
Q

Routine self-care

A

Prenatal vitamin/visits
Dental visits
Avoid xrays
Ask about meds/herbal remedies
Caffeine: limit to 200mg/day

25
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
26
Vaccines Administered Avoid
Administer: -Tday (3rd tri) for pertussis (whopping cough) -influenza -Hep B -Covid Avoid live: -MMR -Varicella -Nasal influenza
27
Tobacco use in preg
Ask Smoking cessation edu Risk of tobacco use: -miscarriage -IUGR -placental abruption -preterm delivery -Increased risk of SIDS
28
Alcohol use in pregnancy: Fetal alcohol syndrome
Depends on timing of exposure NO safe level of alcohol
29
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
30
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
31
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
32
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
33
Types of US
Transabdominal: Full bladder preferred Transvaginal: 1st trimester Maternal anatomy Cervical assessment Shortened cervical length
34
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
35
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)
36
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
37
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
38
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
39
Decel: deceleration
Decrease in FHR
40
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
41
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
42
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
43
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
44
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

N330 (17 decks)

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