Nursing Management during Pregnancy Flashcards
Goals of Preconception Care
- promote the health and well being of a women and her partner before pregnancy
- Identify and modify biomedical, behavioral, and social risks to a woman’s health or pregnancy
- CDC guidelines
Risk Factors for Adverse pregnancy
- isotretinoin’s-Retina, Accutane
- alcohol/smoking
- antiepileptic drugs
- obesity/diabetes
- folic acid deficiency
- STI’s-HIV/AIDS
- hypothyroidism
What can the mother take to help prevent a miscarriage?
anticoagulants
When is the greatest environmental sensitivity and consequent risk for a developing embryo?
days 17-56 after conception
What is the number 1 cause of miscarriage in the first trimester?
UTI
What will happen at the first prenatal visit?
- establishment of trust
- focus on education of overall wellness
- detection and prevention of potential problems
- comprehensive health history, physical exam, and laboratory tests
What would be a women’s reason for seeking care?
- suspicion of pregnancy
- date of last menstrual period
- signs and symptoms of pregnancy
- urine or blood test for hCG
What will you ask the patient about her menstrual cycle?
- Age at menarche
- Days in cycle
- Flow characteristics
- Discomforts
- Use of contraception
What rule is often used to estimate the baby’s date of delivery?
Nagele’s Rule
Nagele’s Rule
subtract 3 months from her last menstrual period and then add 7 days to the first day of the last period and then correct the year by adding 1 to it when necessary
What is the best method of dating a pregnancy?
ultrasound
What are the terms for obstetric history?
G-gravida T-term births P-preterm births P-para A-abortions L-living children
Gravida
count of pregnancies; including current pregnancy
- primigravida- first pregnancy
- secundigravida-second pregnancy, etc.
Para
a woman who has produced one or more viable offspring carrying a pregnancy 20 weeks or more
Primipara
one birth after a pregnancy of at least 20 weeks
“primip”
Multipara
two or more pregnancies resulting in viable offspring
“multip”
Nullipara
no viable offspring; para 0
Term births
the number of pregnancies ending > 37 weeks gestation at term
Preterm Births
the number of preterm pregnancies ending >20 weeks or viability but before completion of 37 weeks
Abortions
number of pregnancies ending before 20 weeks or viability
elected or spontaneous
Living children
number of children currently living
What will happen during the pelvic examination?
- examine internal and external genitalia
- bimanual examination
- pelvic shape
- pelvic measurements
What are the 4 types of pelvic shapes?
gynecoid, android, anthropoid, platypelloid
What are the 3 pelvic measurements?
diagonal conjugate
true (obstetric) conjugate
ischial tuberosity
What laboratory tests will be used for pregnant women?
urinalysis, CBC, blood typing, Rh factor, Rubella titer, Hep B surface antigen, HIV/VDRL/RPR testing, cervical smears, ultrasound
How often will the mom have follow-up visits?
q 4 weeks up 28 weeks
q 2 weeks from 29-36 weeks
q week from 37 weeks to birth
What assessments are completed at each subsequent prenatal visit?
- weight and BP compared w/ baseline
- urinalysis for protein, glucose, ketones, and nitrites
- fundal height
- quickening/fetal movement
- fetal heart rate
- teaching; danger signs
If Nitrites are found during urine testing during pregnancy what will it automatically indicate?
UTI
What will ketones in the urine indicate?
dehydration
Amniocentesis
involves a transabdominal puncture of the amniotic sac to obtain a sample of amniotic fluid for analysis
- chromosomal abnormalities and hereditary metabolic defects
- women 35 years old and up
Fundal Height
the distance between the top of the pubic bone to the top of the fundus with the client lying on her back with her knees slightly flexed
-provides gross estimate of duration of pregnancy
Ultrasound
used to confirm placental location during amniocentesis and to provide visualization chorionic villus sampling
Chorionic villus sampling
a prenatal test in which a sample of chorionic villi is removed from the placenta for testing. The sample can be taken through the cervix or the abdominal wall
Doppler flow studies
- measure the velocity of blood flow via ultrasound
- can detect fetal compromise in high risk pregnancy
- evaluate the blood flow through other fetal blood vessels
Alpha-fetoprotein (AFP)
glycoprotein produced initially by the yolk sac and fetal gut, and later predominately by the fetal liver
Maternal serum screening can
help identify fetal risk for complications, chromosomal disorders and anomalies
Nuchal translucency screening
done in the 1st trimester
-allows for early detection and diagnosis of some fetal chromosomal and structural abnormalities
Increase nuchal translucency is a marker for what?
chromosomal abnormalities, structural anomalies, genetic syndromes, and high risk of abortion and fetal death
What can be identified by chorionic villus sampling?
down syndrome, cystic fibrosis, enzyme deficiencies, gender, hemophilia, sickle cell anemia, tay-sachs disease
Nonstress Test
an indirect measurement of uteroplacental function
Biophysical profile
- uses ultrasound and NST
- performed in an effort to identify infants who may be at risk of poor pregnancy outcome
First trimester discomforts
- urinary frequency/incontinence
- fatigue
- nausea/vomiting
- breast tenderness
- constipation
- nasal stuffiness, bleeding gums, epistaxis
- cravings
- leukorrhea
Second trimester discomforts
- backache
- varicosities of vulva and legs
- hemorrhoids
- flatulence w/ bloating
Third trimester discomforts
- return of 1st trimester discomforts
- shortness of breath/dyspnea
- heartburn/indigestion
- dependent edema
- Braxton hicks contractions
Important Personal Hygiene during Pregnancy
- perineal care
- dental care
- breast care
- avoid hot tubs and saunas
Why should you advise pregnant women to avoid hot tubs and saunas?
The heat can cause fetal tachycardia and raise the maternal temperature
Perineal Care
advise women to shower frequently and wear all cotton underwear to minimize effects of excess secretions
- do NOT douche, or wear panty liners
- avoid perfumed soaps, lotions, perineal sprays, and harsh laundry detergent
Breast Care
stress the need to wear a firm, supportive bra with wide straps to balance the weight
- anticipate buying a larger sized bra
- avoid using soap on the nipple area because it can by very drying
Clothing
advise to avoid wearing constricting clothes and girdles that compress the growing abdomen
- avoid knee high hose which may impede circulation
- low heeled shoes and layered clothing
Other self-care during pregnancy
exercise, sleep and rest, employment, sexual activity, travel, immunizations and medications
Reassure the women that sexual activity during pregnancy is ok as long as there is not a history of?
vaginal bleeding placenta previa risk of preterm labor cervical insufficiency premature rupture of membranes presence of infection
Traveling while pregnant:
For long car rides make sure to stop and walk every hour
For planes request and aisle seat and walk every 2 hours
What are the 3 most common types of child birthing classes?
Lamaze
Bradley
Dick-Read
Lamaze Classes
a psychoprophylactic (“mind prevention”) method of preparing for labor and birth that promotes the use of specific breathing and relaxation
Bradley Method
“partner-coached childbirth”
focuses on exercises and slow, controlled abdominal breathing
Dick-Read Method
focuses on fear reduction via knowledge and abdominal breathing techniques
Advantages of Breast-feeding
- promotes bonding
- decreases mothers risk of ovarian and breast cancer
- decreases risk of obesity and diabetes for mom and baby
- gives baby immunities for certain diseases and infections
Disadvantages of Breast-feeding
- breast discomfort
- sore nipples
- mastitis
- engorgement
- milk stasis
- vaginal dryness
- decreased libido
Disadvantages of Bottle-feeding
babies will have an increased risk of otitis media, diabetes, asthma, atopic dermatitis, reflux diarrhea, colic, constipation, and lower respiratory infections
Hospitals
delivery rooms and birthing suits
recommended for high risk pregnancies
Birth Center
good choice for a woman who wants more personalized care than in a hospital, but does not feel comfortable with a home birth
-women with low risk pregnancies
Homebirths
believed that home births increase privacy, comfort, and convenience
facilitate family involvement an a relaxed, peaceful environment
