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N330 > Nursing Management During Pregnancy > Flashcards

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
Q

Health promotion education during pregnancy

fetal activity check
Avoid what
Car limit
Exercises for birth

A

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
Q

Vaccines
Administered
Avoid

A

Administer:
-Tday (3rd tri) for pertussis (whopping cough)
-influenza
-Hep B
-Covid

Avoid live:
-MMR
-Varicella
-Nasal influenza

27
Q

Tobacco use in preg

A

Ask
Smoking cessation edu

Risk of tobacco use:
-miscarriage
-IUGR
-placental abruption
-preterm delivery
-Increased risk of SIDS

28
Q

Alcohol use in pregnancy:

Fetal alcohol syndrome

A

Depends on timing of exposure

NO safe level of alcohol

29
Q

Preventing infections
TORCH

A

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
Q

Sexual activity

Is it okay

What causes restriction

What can cause contraction

A

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
Q

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

A

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
Q

Ultrasound:
Confirms what
Can identify what 7 things

A

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
Q

Types of US

A

Transabdominal:
Full bladder preferred

Transvaginal:
1st trimester
Maternal anatomy
Cervical assessment
Shortened cervical length

34
Q

Biophysical profile (BPP)

Predicts what
What is it
Measures what 5 things
Scores

A

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
Q

Nonstress test (NST)
What it test
Advantages
Disadvantages

A

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
Q

Nonstress test (NST)
Procedure
What to do
Position
What it measures
The button
How long it takes
What to do after

A

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
Q

NST interpretation

Reactive vs nonreactive tracing

A

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
Q

Contraction stress test (CST)
Stress is put on baby

Position
Records what
Contractions are what 3 things

Interpretation: neg vs pos vs equivocal

A

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
Q

Decel: deceleration

A

Decrease in FHR

40
Q

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

A

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
Q

Chorionic villi sampling

Use what to aspirate/ get what
Done when to diagnose what
Done where
Give what post
Monitor what

A

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
Q

Percutaneous umbilical blood sampling (PUBS)

Done when
Aspiration of what from where
Test what things (5)

A

Done 2nd or 3rd tri

Aspiration of cord blood

Test:
Genetic conditions
Fetal infection
Fetal anemia
Gemolytix disease
Thrombocytopenia

43
Q

Choices for birth experience
Who you want
Feeding choice
Location
Birth plan
Classes

A

Pysician or OB
Midwife
Doulas (birth support)

Hospital, birth center, home

Breast or bottle feeding

44
Q

Premonitory signs of labor(6)

A

-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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