OB exam 1 - Antepartum 2 Flashcards
how to alleviate N/v
-eat crackers/toast before getting up
-SFM
-avoid greasy or spicy foods
-drink carbonated bevs
how to alleviate urinary frequency
void every 2 hrs during the day
how to alleviate fatigue
nap
how to alleviate breast tenderness
wear a supportive bra
how to alleviate increased discharge
-bath dialy
-wear cotton underwear
-avoid douching
how to alleviate nasal stuffiness
-cool air
-normal saline spray
how to alleviate heart burn
take combination non sodium antacid
how to alleviate ankle edema
-avoid prolonged sitting or standing
-keep feet & legs elevated
-hydrate
-socks above knees
when are we concerned about ankle edema
it is caused by decreased venous return and we are concerned if it is not relieved by rest or if it spreads to generalized edema
how to alleviate varicose veins
-regular exercise
-avoid prolonged sitting or standing
how to alleviate flatulence
-keep regular bowel habits
-avoid gas producing foods
how to alleviate hemorrhoids
-avoid constipation
-gentle self reduce them
-topical ointments
-warm soaks/sitz baths
how to alleviate constipation
-increase fluids & roughage
-daily exercise
-regular bowel habits
how to alleviate backache
-pelvic tilt exercise
-good posture
-avoid fatigue
-good body mechanics when lifting
when are we concerned about backaches
when it comes and goes regularity
how to alleviate faintness
-sit down and lower head between knees
-avoid standing in one place too long
how to alleviate SOB
-good posture when sitting
-prop up in bed
how to alleviate difficulty sleeping
-avoid caffeine
-maximize comfort in bed
how to alleviate round ligament pain
warmth to abdomen
how to alleviate carpal tunnel syndrome
-avoid repetitive hand movements
-wear splints
-may disappear after delivery but if not then surgery
when are we concerned of SOB
when it the timing doesn’t make sense -> SOB after doing stairs is normal and not concerning, if the SOB doesn’t go away with rest tho after stairs or just at rest then it is concerning
what do we do if a pregnant women is having difficulty breathing
-apply pulse ox
-listen to lungs
-resp assessment
how to alleviate leg cramps
-massage
-warm soaks
-stretching exercises
-dorsiflex the foot
when is fetal movement usually noted
between 16-22 wks 20
how to check fetal movement counts
take same time every day (suggest 1 hr after eating or when in a side lying position) and count the # of times baby moves within 1 hour+
when to contact HCP in regards to concerns of fetal movement
if the baby has less than 10 movements in 2 hours
a patient calls you saying she has low fetal movement, what is our initial response
ask the patient if they have eaten, laid down, and did you have an empty bladder
if the answer to all of these is yes then contact HCP
breast care
-supportive bra
-cleanliness
-no soap on nipples
-breast shields for inverted nipples during last 3-4 wks of preg
what type of clothing should be avoided during pregnancy
-restrictive clothing
-no high heeled shoes
how to avoid hyperthermia
esp during first trimester
no hot tubes or staying in too warm of water
do you have to stop working if you’re pregnant
no but you may have to modify you role depending on your job and the demands
stop working if put on bedrest or if there are environmental hazards that can not be avoided
what are the travel restrictions during pregnancy
usually none
-might need to stop or modify if there is a complication w/ the pregnancy
-airlines can restrict you from flying to reduce risk of person going into labor on plane
car safety during pregnancy
-if long trip stop every 2 hrs and walk for 10 mins
-use shoulder and lab portion of the seatbelt
lap belt goes under abd.
rules of exercise & pregnancy
-do not pick up a new activity/sport unless walking or healthful practices
-avoid overheating
-ensure nutrient & hydration needs are met
contraindications of exercise in pregnancy
-water broke/ROM
-cervical insufficiency
-vaginal bleeding
-high BP
-preterm labor
-placenta previa after 26th wk
what decreases sexual activity during 1st trimester
fatigue
nausea
vomiting
what decreases sexual activity during 2nd trimester
vascular congestion
least amount of discomfort, highest sex drive
what decreases sexual activity during 3rdtrimester
fatigue
SOB
decreased mobility
what needs to be avoided during pregnancy at dental check up
X rays
goals for immunization
be up to date before pregnancy bc live vaccines cannot be given during pregnancy
what vaccine is always given in the 3rd trimester
Tdap bc newborns cannot get it so vaccinated the mother provides protection to the baby after birth
also encourage flu vaccine
teratogenic substances
-meds **(no med is 100% safe)
-tobacco
-alcohol
-caffeine
-marijuana
-cocaine
when do medications pose the greatest to the fetus
1st trimester d/t organ development
affects of tobacco during pregnancy
-low birth wt
-preterm birth
-prom
-fetal demise
-placenta previa
-abruptio placenta
most mothers will go back to smoking so try best to get them to fully stop or reduce
affects of alcohol during pregnancy
-fetal alcohol syndrome
-increased risk of miscarriage
-IUFD (stillbirth)
-lower birth wt
fetal alcohol syndrome characteristics
-growth retardation
-facial anomalies
-mental retardation
affects of caffeine during pregnancy
hypersensitivity in newborn phase jittery baby w/ caffeine w/draw
what should you limit your caffeine to in pregnancy
200mg/d
-cup of coffee = 100
-12oz soda or tea = 50
affects of marijuana during pregnancy
little to no research but gateway drug
affects of cocaine during pregnancy
-potential for maternal MI, cardiac arrhythmias, ruptured aorta, seizure, stroke
-abruptio placenta, PROM, low birth wt, SIDS, CHD, limb defects
how can you test for cocaine uses during pregnancy
after birth sample the cord
urine screening can only detect for 24-48hrs after use
what is women concerned advanced maternal age
35
special concerns of expectant couples over age of 35
-do they have enough energy to care for the baby
-ability to deal w/ needs of child as they age
-social: only couple having first baby
ways to help avoid adolescent pregnancy
provide education and resources
keep them busy & enroll in after school activities
physiologic risks w/ adolescent pregnancy
-preterm & LBW
-pre eclampsia
-iron def anemia
-cephalopelvic disproportion
-use of alc & drugs during
-STIs
role of L&D nurse during adolescent labor
-sustain a presence w/ them and create trust
-education about choices
-help people find their roles
make teen aware they have full medical attorney of power
risks associated w/ obesity in pregnancy
-spontaneous abortion
-GDM
-PreEclamp
-labor induction
-C section
-fetal anomalies
child is at greater risk for becoming obese
how much fluid per day and of that how much water
8-10 8oz glasses of fluid (4-6 being water)
total 64-80 oz/d
what can an ultrasound show us
anomalies, neural tube deficits, skeletal malformations
nuchal translucency testing
-can do starting at 11wks to test for trisomy disorders by ultrasound
-measurements of 33mm+ are at risk
-detects 70-80% of downs does not dx
transvaginal ultrasound
clearer images d/t proximity and can be a great predictor of preterm birth since it can measure cervical length (short = preterm) and funneling (cone = preterm)
ultrasound doppler blood flow studies
noninvasive US test which measures blood flow changes in maternal and fetal circulation during 2nd & 3rd tri
>95%ile for GA are abnormal
nonstress test
fetal monitor to assess contractions, fetal heartbeat, and uterine activity
what does accelerations with movement or contractions show
adequate oxygenation and intact fetal CNS
when do we conclude a nonstress test is reactive
when we have at least two accelerations in a 20 minute time period if the baby is 32 wks or greater
if <32 then acels need to be 10 beats above baseline for 10 secs vs the 15 & 15 for >32
what could cause a nonreactive non stress test
-baby in sleep cycle
-affect of medication given
unsatisfactory nonstress test
data cannot be interpreted or there was inadequate fetal activity
what are the categories in a BPP
1) fetal breathing movements
2) gross body movements
3)fetal tone
4)amniotic fluid volume
either normal and get 2pts per category or abnormal and get 0pts
+non stress: if normal can get an additional 2 pts
if a baby does not score an 8/8 on the BPP, what is the follow up care
perform a non stress test to determine if baby is having good fetal movement & has an intact CNS
what does a contraction stress test evaluate
oxygenation and CO2 exchange of placenta
-w/ contractions, intrauterine pressure increases and blood flow (+ O2) decreases to fetal
if placental insufficiency, a decrease in FHR will occur (late decels)
desires results of a contraction test
negative
in a 10 minute period, we should see there is no drops in the heart rate of late decels meaning baby had good O2 reserve for that time of stress
what does a positive contraction test mean
during the contractions in a 10 minute time, baby was having late decels
amniocentesis
test amniotic fluid for fetal abnormalities and fetal lung maturity
L/S ratio of 2:1 = mature lungs
chorionic villus sampling considerations
it is done early but has risks for bleeding, ROM, infection, limb reduction & birth defect and the results won’t be conclusive and they will take awhile to obtain
