OB Boot Camp: Antepartum Flashcards
Presumptive Signs
-you “think pregnant”
-subjective (patient says)
-symptoms that accompany other disorders
>amenorrhea (missing period)
>fatigue
>nausea/vomiting
>breast changes
>quickening (could feel fetal movement)
>uterine enlargement
Probable Signs
-“objective”
-body is changing and we can measure
>abdominal enlargement
>Hegar’s sign (softening of the uterus)
>Chadwick’s sign (bluing of the cervix and the vulva due to blood engorgement)
>Goodells sign (softening of the cervix)
>Braxton hicks contractions
>positive pregnancy test (she can have a false +)
>fetal outline (trained professional would tell)
Positive Signs of Pregnancy
-“explained by pregnancy”
>fetal heart sounds
>visualization by ultrasound
>fetal movement (palpation by trained professional)
How to Calculate Estimated Date of Delivery (EDD)
Nagele's Rule Gather first day of last menstrual period (LMP) -subtract 3 months -add 7 days -add 1 year
GTPAL
- Gravidity (number of pregnancies)
- Term Birth (38 weeks + on)
- Preterm (viability-37 weeks, or < 38 weeks)
- Abortions/ miscarriages (electoral or natural)
- Living
GTPAL Example:
28 y.o female is 28 weeks pregnant. Had miscarriage at 10 weeks five years ago. Has a 3 y.o. born at 39 weeks. GTPAL?
G= 3 T= 1 P= 0 A= 1 L= 1
also G3 P2 (3 pregnancies, “para” 2= past 20 weeks including now)
Patient Education: What to Avoid
- OTC medications (call healthcare provider)
- drugs, alcohol, and smoking (cause premature birth weight)
- dehydration (can cause early contractions)
Patient Education: Promote
Exercise
Patient Education: Nutrition
- healthy weight gain (25-35lb.); if obese may want to gain less, if underweight may want to gain more)
- calories, protein, and iron
- fluid (8-10 glasses)
- folic acid (for neural development)
- limit caffeine
What the Nurses Initial Assessment Should Include
- weight
- vital signs (baseline)
- pelvic exam
- ask for last menstrual period (LMP)
- history (hx)
- medical history
- medications
- social support
- cultural/ emotional/ hx of abuse (high-risk for physical abuse)
- labs (CBC, WBC, Blood Type, Rh, Rubella Titer, Urinalysis, Renal function, Pap smear, HIV, Hep B, toxoplasmosis)
What Labs should be Assessed for Pregnancy?
- CBC
- WBC (infection), hemoglobin/ hematocrit; anemic?
- Blood type
- Rh (Rhogam IM if Rh-)
- Rubella Titer (immunizations up to date?)
- Urinalysis (Urine, Glucosuria, WBC in urine?)
- Renal function (BUN, Creatinine, GFR)
- Pap Smear
- HIV, Hep B
- Toxoplasmosis
What Does the Nurse’s Ongoing Assessment Include for the Pregnant Patient?
- weight, edema (feet can be normal; elevate legs); edema in hands/face = abnormal)
- vital signs (BP)
- urine
- protein (in urine?)
- glucose–> 1 hr. glucose test (> 140 = 3 hr. test)
- leukocytes (WBC)
- fetal development
- fundal height (2nd trimester measure from symphysis pubis to the top of the fundus; correlates with # of weeks of gestation)
ex: 34 weeks, fundal height = 33-36 cm - Leopold maneuver (tells where the fetus is)
True Labor Contractions
regular contractions
- increase in intensity, increase with activity
- goes from the lower back radiating to the front
- bloody show (a discharge of mucus that’s tinged pink or brown with blood. It means the blood vessels in the cervix are rupturing as it begins to efface and dilate)
- dilation + effacement
- fetus is engaged
False Labor Contractions
- irregular contractions
- stop with activity
- its focus is in the abdominal and umbilical area
- no change in cervix
- fetus is ballotable (there is bounce back when palpated)
Can Pregnant Patients get Vaccinated?
yes
- usually the flu vaccine
- no live vaccines
