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N352: Practice of Nursing I > OB Module 2: Antepartum Nursing > Flashcards

OB Module 2: Antepartum Nursing Flashcards

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1
Q

Where is the female bladder located

A

anterior to the uterus and vaginal vault

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2
Q

The uterus leans ___ on top of the ____

A

forward on top of the bladder

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3
Q

In post partum, a distended bladder can do what?

A

displace the uterus and make it hared to stop a hemorrhage

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4
Q

Where is the female rectum located?

A

Immediately behind the uterus and vaginal vault

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5
Q

Retroverted

A

position of the uterus where the base of the uterus softens and can lean back toward the rectum rather than forward

this can affect when we hear Fetal heart beat or symptoms of pregnancy

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6
Q

Anteverted

A

position of the uterus where it tips forward from the cervix toward the abdomen

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7
Q

Fimbriae

A

capture the egg and have motion to move the egg along the tubes (on the side) to get it into the uterus

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8
Q

During ovulation, the ovum leaves where and enter where?

A

leaves the ovary and enters the fallopian tube

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9
Q

Fertilization generally occurs where

A

in the outer third of the fallopian tube

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10
Q

When does cell division of the ovum start>

A

Cell division starts as the ovum advances through the fallopian tube to the uterus where it will implant in the uterine wall lining

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11
Q

Ovulation

A

time each month that several eggs will move toward development with one usually being the one to become fully developed

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12
Q

Corpus Luteum

A

Once an egg is released, its ovary sac will become the corpus luteum

This will produce hormones until the placenta implants and can do it on its own

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13
Q

Pregnancy and Antepartum Care involves what things?

A

Diagnosis of the pregnancy

Signs and symptoms

General body system changes

Adaptation to pregnancy

Prenatal Care

Factors which influence pregnancy outcomes

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14
Q

Human pregnancy is designed to last for ___ weeks of “gestation.” Including the __ weeks before conception (when the last menstruation and ovulation were)

A

40 weeks; 2 weeks

(so that is 38 weeks of dev)

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15
Q

Pregnancy is described in terms of ___

A

trimesters

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16
Q

Are trimesters equal in length?

A

No - it is a 40 week period that does not split evenly

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17
Q

1st Trimester

A

1-12 Weeks

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18
Q

2nd Trimester

A

13-27 Weeks

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19
Q

3rd Trimester

A

28-40 Weeks

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20
Q

The major infant organs are formed by …

A

8 weeks (but that doesnt mean they are fully functional at 8 weeks)

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21
Q

Although the organs are formed, many essential systems are only …

A

minimally functional by week 24

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22
Q

After organ formation at 8 weeks, the rest of the pregnancy focuses on …

A

further development, growth, and maturation

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23
Q

Micro Preemies

A

Infants born between 23-27 weeks

Require considerable supportive care (their organs still needed more development time for example)

If they survive in the ICU nursery, they will have some disability in the end

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24
Q

Diagnosis of a Pregnancy Involves what kinds of signs

A

Presumptive Signs

Probable signs

Positive signs

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25
Q

What are Presumptive Signs of Pregnancy?

A

Signs the mother can perceive (subjective) that are not definitive since there are other illnesses that can mimic these symptoms

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26
Q

List the Presumptive signs of pregnancy

A

cessation of menses

N/V

Breast changes - enlargement and tenderness

Urinary frequency

fatigue

elevation of basal body temp

leakage of colostrum

excessive salivation at 4-14 weeks

quickening

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27
Q

Quickening

A

The mothers perception of fetal movement

18-20 weeks primips (first time mom)

16+ weeks multips (woman whose had babies before)_

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28
Q

What are probable signs of pregnancy

A

signs that are more objective and seen by the physician, increasing the likelihood of pregnancy, but they cannot be used to make a definitive diagnosis as other things could cause this

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29
Q

List the probable signs of pregnancy

A

Chadwick’s Sign

Hagar’s Sign

Piskacek’s Sign

McDonalds Sign

Goodells Sign

Abdomen enlargement

Uterine Soufflé

Palpation of fetal outline

Ballottement

Fetal movement witnessed

Positive pregnancy test

Skin color changes like appearance of Montgomery’s tubercles

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30
Q

Chadwick’s Sign

A

Blue or purple discoloration of the vulva and vaginal mucosae, including the vaginal portion of the cervix

begins around 8 weeks and beyond

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31
Q

Hegar’s Sign

A

The softening and compressibility of the uterine isthmus

Because of this softening the uterus may be anteflexed or retroverted

occurs at 6-12 weeks

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32
Q

Piskacek’s Sign

A

Asymmetry of the uterus with a rough, irregular contour on one side

The side that is rough is the side the placenta implanted on

Occurs at week 4-5

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33
Q

McDonald’s Sign

A

an ease in flexing the body of the uterus against the cervix

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34
Q

Goodell’s Sign

A

the softening of the cervix around 5 weeks

(after some time it will harden again to not give way)

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35
Q

Isthmus

A

area between the cervix and the upper body of the uterus

(lower uterus)

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36
Q

Why do McDonald’s Sign and Hegar’s Sign go together?

A

Because the isthmus softens so the heavier upper body of the uterus can press against the uterus

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37
Q

Mucus Plug

A

a product of the cervix made to prevent anything getting through the vaginal vault and impacting the pregnancy

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38
Q

Uterine Souffle

A

Blowing sound of increased blood flow around the uterine area

This occurs from the high pressure and increased vascularization

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39
Q

Montgomery’s Tubercles

A

small bumps emerging on the areola that secrete lubricant for the nipple

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40
Q

What are positive signs of pregnancy

A

signs that confirm a pregnancy

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41
Q

List the Positive signs of pregnancy

A
  1. Auscultation of fetal heart tones (10-12 weeks)
  2. Fetal movement perceived by the provider
  3. Visualization of the fetus through ultrasound or X ray
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42
Q

When can the fetal heart tones first be heard?

A

around 10-12 weeks

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43
Q

What can an ultrasound image confirm at 4-5 weeks and at 6 weeks?

A

4-5: Sac

6: Fetal Pole

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44
Q

We do not do what unnecessarily if we suspect a pregnancy?

A

Give an X Ray

Sometimes coincidentally we find out though when they are getting an X ray for something else

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45
Q

Pregnancy testing is done to assess levels of ___ produced by the fetus in either ___ or ___ serum to determine the presence of a viable pregnancy

A

hCG (human chorionic gonadotropin); urine; blood

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46
Q

What is the easiest to administer and least expensive method clinical pregnancy test?

A

Urine Based hCG test

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47
Q

When is a urine based hCG test done during the day, and when is the first time period it is accurate?

A

First morning voiding

10-14 days after the first missed menses

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48
Q

What can Serum hCG (blood) testing do that a Urine based test cannot?

A
  1. It is not dependent on time of day
  2. can detect a pregnancy earlier
  3. serial testing can also be used to assess the potential viability of a pregnancy
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49
Q

Ways to Date a Pregnancy

A

Naegele’s Rule

Uterine Sizing

Ultrasound

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50
Q

Naegele’s Rule

A

Dating a pregnancy based on the rule that the 1st day of the last menstrual cycle + 7 days and then - 3 months gives an estimated date of delivery

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51
Q

Uterine Sizing is a way to date a pregnancy, what is the size of the uterus at 8, 10, and 12 weeks?

A

8 - egg sized

10 - orange sized

12 - grapefruit and at the pelvic brim

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52
Q

At week 12, the uterus is grapefruit sized and now located at the pelvic brim so what can we do now?

A

Do an ultrasound to hear fetal heart tones

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53
Q

If we know the size of the uterus at week 12, but cannot hear heart tones…

A

we should be concerned about pregnancy’s viability

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54
Q

The earlier the ultrasound…

A

the more valid dating it gives and the more accurate it is

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55
Q

Why are ultrasounds less accurate later on?

A

After periods like 20 weeks of gestation, other factors begin to effect size

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56
Q

What does GPTPAL stand for when documenting a pregnancy

A

Gravida
Parity
Term
Preterm
Abortions
Living

Its either written as something like G7P6 or G7T4P2A0L6

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57
Q

(GPTPAL) Gravida

A

any pregnancy regardless of gestation including the current pregnancy (miscarriage, abortion, live, etc)

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58
Q

(GPTPAL) Parity

A

any birth after 20 weeks gestation whether born alive or dead

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59
Q

(GPTPAL) Term

A

number of infants born at or after 38 weeks gestation

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60
Q

(GPTPAL) Preterm

A

Number of infants born between 20 weeks and 38 weeks

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61
Q

(GPTPAL) Abortions

A

number of infants born before 20 weeks gestation whether born alive or dead

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62
Q

(GPTPAL) Living

A

number of children alive currently

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63
Q

Why did we switch from just using Gravida and Parity to a system where were use Gravida, Term, Preterm, Abortions, and Living?

A

GP did not give us a good feel for those who had pre term babies and who may not be having babies that survive or life, so we had a system where we added TAL and replaced Parity with preterm

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64
Q

Nulligravida

A

Woman who has never been pregnant

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65
Q

Primigravida

A

Woman pregnant for the first time

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66
Q

Multipara

A

woman who has had two or more births at more than 20 week’s gestation

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67
Q

Multigravida

A

Woman in second or any subsequent pregnancy

also called Multips

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68
Q

Normal gestation is __ weeks

A

40

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69
Q

Where does the placenta usually implant?

A

Near the fundus (top of the uterus)

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70
Q

The uterus is mostly ___

A

muscle

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71
Q

As the pregnancy occurs, the uterus gets more __ and ___

A

distended and thicker

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72
Q

How are babies typically positioned in the womb near term and before 37 weeks?

A

They are generally head down toward the cervix near term. but before 37 weeks they are small in a large pool of fluid and may change position frequently

73
Q

Uterus

A

usually pale pink organ that turns burgundy from vascularization during pregnancy

Comprised of muscle and increased in size and thickness of muscle mass during pregnancy

made up of the corpus (body), isthmus (center), fundus (top), cervix (bottom)

74
Q

Placenta

A

a disk shaped organ which starts to form at implantation

Has multiple functions

75
Q

What functions does the placenta have?

A
  1. Supplying fetus with o2 and nutrients
  2. removing CO2 and waste materials
  3. producing hormones to maintain the pregnancy
  4. producing amniotic fluid
76
Q

Based on current research as of April 2021, can COVID-19 infect a baby in the womb?

A

no it cannot cross the placenta or go into breast milk

77
Q

Do the mother and fetal blood intermix in the placenta?

A

No

78
Q

Fetal and Mother blood are separated by …

A

the placental membrane which helps to protect the fetus from many environmental factors

79
Q

Some molecules are small enough to cross the placental membrane and affect the pregnancy, what are some examples?

A

Alcohol

Some Viruses

Toxic Chemicals

80
Q

How do the fetal side and maternal side of the placenta differ?

A

Maternal Side - looks meaty and coalesced (ridges with depressions in it)

Fetal Side - shiny with membranes coming off of it to make the amniotic sac. Fetal blood vessels come centrally into the umbilical cord to provide things

81
Q

Chorion

A

outer level of the amniotic sac

82
Q

Amnion

A

inner level of the amniotic sac

83
Q

Amniotic Sack

A

a fluid filled double layer pouch which surrounds the fetus providing a protective barrier for the infant

Also allows the lungs to develop since they do not need to push off the uterine wall

Can also maintain the uterus as a dilated vessel that the infant can easily practice moving in

Fluid is made by the placenta

84
Q

Human Chorionic Gonadotropin (hCG)

A

The first placental hormone produced is hCG

Can be found in maternal blood and urine as early as the first missed menstrual period and up through the 100th day of pregnancy

This is the hormone analyzed by a pregnancy test

Present only during pregnancy since it is secreted by the placenta

85
Q

hCG is not used after __ months as an indicator

A

3

86
Q

Progesterone

A

the most significant hormone for maintaining pregnancy

It is needed to maintain the endometrial lining of the uterus during pregnancy

Levels are high during pregnancy and is made by the placenta

Sometimes given supplementally if pregnancy at risk

Prevents preterm labor by reducing myometrial contraction

87
Q

Estrogen

A

stimulates the development of secondary female sex characteristics usually

In pregnancy, it helps the woman’s mammary gland development in prep for lactation and stimulates uterine growth to accommodate the growing fetus

88
Q

Relaxin

A

hormone made by corpus luteum

during first trimester levels rise and additional amounts are made by the decidua (placenta)

peaks during the 14 weeks of the first trimester and at delivery

mediates the hemodynamic changes of pregnancy such as increased CO, renal blood flow, and arterial compliance

Relaxes other pelvic ligaments and softens the pubic symphysis

89
Q

Circulating volume in pregnancy increases __-__%

A

30-50%

90
Q

Human Placental Lactogen (hPL [Human Chorionic Somatomammotropin])

A

Lactogenic and growth promoting property hormone

promotes mammary gland growth in preparation for lactation

Also regulates maternal glucose, protein, and fat levels so that this is always available to the ftus

91
Q

Why does a pregnant woman tend to waddle?

A

Relaxin makes the pelvic muscles less stable to allow labor and delivery later

92
Q

Cardiovascular Changes in Pregnancy

A

Slight Cardiac Hypertrophy (to make up for increased volume)

Upward cardiac displacement (baby pushes diaphragm up)

Increased blood volume, cardiac output, pulse rate, and tendency toward arrhythmias

Relaxation of vascular bed tone to accommodate volume

93
Q

How many BPM can a pregnant woman increase in during pregnancy?

A

10-15 BPM

94
Q

Respiratory changes in pregnancy

A

O2 requirements increase

Increased chest expansion

Lower rib cage flares out

Upward displacement of diaphragm

upper resp tract more vascular and therefore is more congested (can cause snoring)

Increased tidal volume and capacity, but decreased reserve and residual volumes

95
Q

What does “increased tidal volume and capacity, but decreased reserve and residual volumes” mean?

A

There is increased capacity, but when resting/emptying there is lower reserve and residual air in the lungs leftover

96
Q

Renal Changes in pregnancy

A

renal pelves and ureters dilate

uterus enlargement puts pressure on bladder and ureters

urinary flow rate slower

UTIs common

glomerular filtration increased

renal blood flow increases

increased renal function in the lateral position (important to diuresing)

decreased BUN and Creatinine

glucose present in urine normally

97
Q

Integumentary changes in pregnancy

A

increased skin thickness, subdermal fat, hair and nail growth, sweat and sebaceous gland activity, circulation and vasomotor activity

Hyperpigmentation

cutaneous elastic tissues are more fragile resulting in increased tendency for stretch marks (when we need it more elastic, it is becoming more fragile!)

98
Q

What are some common skin findings in pregnant women?

A

Dependent Edema

Melasma

Spider Nevi

Striae gravidarum

Linea Nigra

99
Q

___ edema in pregnancy is not uncommon, but ___ edema is indicative of disease

A

dependent; generalized

100
Q

Linea Nigra

A

A large vertical dark line that can form down the pregnant woman’s stomach

101
Q

Melasma

A

darkening in areas like the face (sort of in a butterfly shape)

102
Q

Spider Nevi

A

tiny spider like veins and red spots of vascularization appearing on the skin

103
Q

Striae gravidarum

A

stretch marks

pink to silver in color over time

104
Q

Neuromuscular system changes in pregnancy

A

center of gravity shifts

lordosis develops

relaxation and softening of connective tissues occur

abdominal muscles weaken and separate

increased tendencies toward HA, syncope, muscle cramping and numbness

105
Q

Why is syncope very common early in pregnancy?

A

Because of the relaxation of the vasculature without the accompanying increased circulatory volume yet

106
Q

GI changes in pregnancy

A

appetite fluctuates (diminishes early on)

intestinal secretions decrease while absorption of nutrients increase

tendency toward nausea early on

colon is displaced

decreased gastric motility

food cravings and changes in food taste (can be temp or permanent)

increased salivations

107
Q

What is causing the increase in absorption of nutrients, decrease in intestinal secretions, and decreased gastric motility in pregnancy?

A

Progesterone

it is to allow there to be more time to allow for absorption

108
Q

Calorie increase of ___ calories will begin in pregnancy over a pre pregnant diet

A

(only) 200 calories

this isn’t a large jump, but this needs to be a nutrient rich 200 calories

109
Q

What should be done with a pregnant woman at risk in order to assess diet practices and allow for adjustments early in pregnancy?

A

a 24 hour recall dietary assessment

assesses for malnutrition and issues with nutrition, but has the problem of not representing normal patterns

110
Q

Pica

A

An issue that can occur in pregnancy where there is unusual non nutritive food cravings

these practices can lower a womans consumption of nutrient rich foods

ex: commonly ice eating, soap powder, dirt cravings, weird stuff

111
Q

What should a diet look like in a pregnant woman?

A
  1. 4 or more servings of fruit/vegi
  2. 4 or more servings of whole wheat or enriched breads/cereals
  3. 4 or more servings of milk products
  4. 3 or more servings of protein
  5. Folic acid - 400 mcg in diet or supplement (Folic Four)
  6. Calcium 1200-1500 mg
112
Q

A woman of average weight before pregnancy should gain __ to __ pounds during pregnancy

A

25-35 pounds

113
Q

An underweight woman before pregnancy should gain __ to __ pounds during pregnancy

A

28-40 pounds

114
Q

An overweight woman before pregnancy should gain __ to __ pounds during pregnancy

A

15-25 only

115
Q

If a woman is expecting twins she should gain __ to __ pounds during pregnancy

A

35-45

116
Q

What things contribute to the weight gain of a pregnant woman?

A

1 is the fetus, #2 is the increase in blood

We then have the uterus and breast, other tissue like fat, ECF, amniotic fluid, and the placentae

117
Q

Who are some populations at risk nutritionally during pregnancy?

A

Adolescents

Those having frequent pregnancy’s like 3 in 2 years time

Prior poor fetal outcome

Poverty

Poor diet habits with resistance to change

Use of tobacco, alcohol, or drugs

Multifetal pregnancies

Anyone underweight or overweight at conception

Anyone with problems with weight gain or weight loss

History of eating disorders

Low H&H

118
Q

Pregnancy is a major __ milestone

A

maturational

119
Q

What sort of developmental tasks must a pregnant woman master?

A

Accepting the pregnancy

Identifying with the role of mother

Reordering the relationship with her mother and her partner

establishing a relationship with her unborn child

Preparing for the birth experience

120
Q

It is not uncommon to be ___ in the first trimester

A

Ambivalent

121
Q

The relationship with the unborn child increases a lot in the first trimester after….

A

there is awareness by the mother of movement

122
Q

What are the 3 major factors influencing adaptation to a pregnancy?

A
  1. Maturation Level
  2. Supportive relationship with mother
  3. Supportive relationship with partner

can they make someone else a priority over them?

123
Q

In the second trimester, adaptive changes include what things and what developmental tasks?

A

Shifting focus from self to fetus

Developing a relationship with the fetus

Accepting the pregnancy and her changing body image

Initiating preparations for the arrival of the infant

Starting childbirth preparation classes

relative ambivalence now shifts to accepting pregnancy changes

124
Q

What trimester is the optimal time to start childbirth prep classes and why?

A

Second Trimester

This is because some pregnancies are preterm and some do not get to the third trimester, so it is important that they know the exercise and knowledge just in case

125
Q

Education in the second trimester should include information about what things?

A

nutrition and weight gain

exercise and safety

warning signs of complications

avoiding substances harmful to the pregnancy

common discomforts in pregnancy

prenatal education classes should be started late in 2nd tri

126
Q

Adaptive changes in the 3rd trimester include…

A

ongoing education and prep for labor

creating a labor plan

negotiating labor support personnel

continuing preparations for the arrival of the infant

continuing to develop a relationship with her unborn child

127
Q

What is important to consider when making the labor plan?

A

Know what to expect at birth, but do not put extreme expectations and be inflexible

Never having done labor makes it harder to anticipate

Also, the length of a labor plan correlates to C Section needs

128
Q

Labile Emotional States & Pregnancy

A

Rapid mood change from hormones surging

First trimester involves ambivalence but the second trimester involves more general feelings of well being

129
Q

Rubin’s Four Developmental Tasks of Pregnancy

A
  1. Ensuring safe passage through pregnancy, labor, and birth
  2. Seeking acceptance of the child by others
  3. Seeking commitment and acceptance of herself as a mother to the infant
  4. Learning to give oneself on behalf of one’s child
130
Q

When reordering relationship with partner, what 2 things does the pregnant woman need

A
  1. To feel loved and valued
  2. For the partner to accept the pregnancy
131
Q

When reordering relationship with mother, what 3 things does the pregnant woman need?

A
  1. Acceptance of the pregnancy
  2. Emotional Support
  3. Guidance regarding pregnancy, labor, and mothering
132
Q

If mother or partner are not present or supportive…

A

the woman will seek support and guidance from other sources

133
Q

What are the important components of prenatal care in the 1st trimester

A

Early assessment and intervention if needed

Early and accurate dating of the pregnancy

Education regarding behaviors which enhance successful pregnancy

Counseling regarding risk behaviors

Prenatal care allows for these things

134
Q

Assessments during the 1st trimester include

A

making a data base and assessing risk factors

physical examination

lab tests

135
Q

The interview is a major component of initial prenatal care and factors identified there…

A

can help to frame the care for the rest of the pregnancy

136
Q

What is important to do during the initial prenatal interview?

A

Give adequate time and a private environment

Since woman come from a wide variety of social backgrounds and situations, stay non judgmental in assessment

A woman who feels accepted is more likely to be open and honest in disclosures

137
Q

The initial prenatal interview contains…

A

demographic information

current pregnancy history

OB and gyno history

current and PMH

nutritional history

substance use history

family hx

psychosocial and experiential history including abuse

ROS

138
Q

What laboratory tests may be done in the first prenatal visit?

A

CBC

Blood type and Rh

Antibody Screen

rubella titer

urinalysis

RPR/VDRL

HIV testing

Glucose

TORCH studies (toxoplasmosis, other infections, rubella, cytomegalovirus, herpes simplex virus)

139
Q

How does Rh incompatibility develop

A

If the mom is rh- and the baby is rh + this will not impact the first pregnancy, since no blood mingled with the placental barrier in place – however the blood mingles during delivery

So, the mother will make antibodies against the rh+ blood and these antibodies can get across the placental barrier and impact future pregnancies

Need to give Rhogam to prevent this around28 weeks gestation through 12 weeks until delivery when mini placental separations can occur

140
Q

What sort of Cervical Cultures need to be done in initial prenatal visits?

A

Cultures for Gonorrhea and Chlamydia

pap smear

other testing based on findings such as tuberculin tests, cystic fibrosis tests, genetic tests, ultrasounds

141
Q

The initial prenatal visit physical exam includes what things?

A

VS and BP

Urinalysis

Height and Weight

Full systems exam

Nutritional exam

Breast exam

Bimanual exam

Pap smear and culture taking

Assessment of uterine size

Assessment of fetal heart tones (week 10+)

142
Q

Teaching in the first prenatal visit should include information on…

A

S/S of complications

smoking cessation and substance avoidance

infectious avoidance - such as toxoplasmosis in cat feces

nutrition

exercise, posture, and body mechanics

fetal growth and development

relationship changes

future testing

care during pregnancy including dental care

reliable information resources (up to date and not just wrong online sources)

143
Q

After 12 weeks gestation, the uterus does what?

A

the uterus becomes large enough to rise out of the pelvis and into the abdominal cavity. The abdomen will show signs of enlarging

144
Q

At around 5 months, the breasts start to form…

A

colostrum

145
Q

The uterus (top) tends to start rising from __ weeks and beyond and will correlate from distance between anterior pubic bone’s top to the top of the top of the uterus in ___ of height

A

20 weeks

centimeters

146
Q

Around 28 weeks there is __ cm between anterior pubic bone and uterus; at 30 weeks it is __ cm

A

28;30

147
Q

When will the uterus start to drop a bit

A

at 38 weeks it will begin to fall rather than rise

148
Q

Engagement

A

point at which the baby drops back into the pelvis (38 weeks)

149
Q

When does engagement occur?

A

in the first pregnancy it starts around week 38, but in future pregnancies it starts at onset of labor

150
Q

During the 2nd trimester, increasing blood volume causes congestion in many tissues, what may happen as a result?

A

the woman may still be experiencing fatigue if her body is not keeping pace with creating red blood cells to fill the expanding blood volume

This is physiologic anemia and may need iron supplementation

151
Q

When should prenatal visits be scheduled?

A

Every 4 weeks for the first 28 weeks, every 2 weeks until 36 weeks gestation, and every 1 week until birth after 36 weeks

This changes though if complications arise or there are additional risk factors then making visits more often

152
Q

Prenatal care in the second and third trimesters involve what?

A

routine assessments such as:

urinalysis

weight

BP

fundal height assessment

fetal heart rate assessment

153
Q

Why do we do urinalysis in the 2nd and 3rd trimesters?

A

To check for proteins and ketones

Ketones can signify nutritional issues/muscle breakdown

Proteins can signify preeclampsia

154
Q

How does the physician measure fundal height ?

A

Measures with a tape measurement from the anterior pubic bone to the top of the uterus

155
Q

Testing in the 2nd trimester include…

A

Maternal serum alpha fetal protein or Quad test

18-20 week ultrasound (2nd tri)

assessment for quickening (earlier in second time moms, later in first time moms)

156
Q

Quad Test

A

test screening for down syndrome or open neural tube defects

157
Q

What is the problem with the 18-20 week ultrasound?

A

it has a 90% false positive rate - which is significant- and can signify need for amniocentesis which is invasive and has a 1% loss rate

158
Q

Testing in the third trimester includes…

A

28 week H&H

1 degree Glucose tolerance test

Mini dose Rhogam (if Rh negative)

Screening for group B strep

additional optional testing like a nonstress test, stress test, ultrasound, BPP

159
Q

Why is the pregnant woman at a predisposition for gestational diabetes

A

because there is a strain on adequate nutritional processes

160
Q

Why is a Group B strep screen done at 36 weeks?

A

While it is normal vaginal flora in 25% of women and not an issue until labor it can cause resp infections in a newborn with 15% dying or having complications

So we do a vaginal swab and if positive we treat AT LABOR to prevent infection (we are not getting rid of it totally though on the mom)

It is NOT an STD

161
Q

Nonstress test

A

Period of fetal monitoring in absence of contractions

It can check for appropriate reaction with induced contractions to check

162
Q

BPP

A

biophysical profile

a more elaborate ultrasound check for fetal wellbeing indicators

163
Q

__% of infants born to Strep B positive women will become infected, and there is a __% mortality rate in this group

A

3;15

164
Q

The placenta is created to last and supply the infant with O2 and nutrients for __ weeks

A

40

165
Q

What may be an issue regarding the placenta in the third trimester?

A

Some factors can cause premature deterioration resulting in O2 and nutrient decreases such as smoking (and smoking can decrease placental blood flow for up to 2 hours!)

Some pregnancies go beyond 40 weeks and the placenta starts to decrease and deteriorate

Certain tests will check for fetal status or reserve though

166
Q

What sort of discomforts of pregnancy tend to increase or occur throughout the 2nd and 3rd trimesters>

A

breast changes and pain

frequency and urgency of urination

fatigue

GI upset

gingivitis

nasal stuffiness

constipation

sleep disturbances

dependent swelling

varicose veins and hemorrhoids

low back pain

carpal tunnel syndrome (from increased interstitial fluid)

167
Q

What sort of pregnancy comforts occur during the third trimester?

A
  1. increased pressure from the enlarging uterus which can cause venous stasis with edema in the legs, varicose veins, and discomfort
  2. Potential for a vagal response when lying on their back

fetus continues to grow in size and organ systems continue to mature though

168
Q

Why is a vagal response a potential discomfort that can happen starting at 20 weeks and beyond?

A

if she lays on her back the heavy uterus lays on the inferior vena cava instigating the response

It will make her feel lightheaded, nauseous, and generally feel bad

You should put her on her side, check her vitals and the heart tones of the baby

169
Q

During the third trimester of pregnancy, the uterus develops what?

A

Oxytocin receptor sites

170
Q

Oxytocin

A

the love and contraction hormone

involved in the love she has for child and aids in causing contractions in labor and delivery

it does not work earlier in the pregnancy because the uterus has not developed receptors yet

171
Q

Cervical “Ripening”

A

the cervix has been hard and unable o give way under the weight of the pregnancy, will begin to soften and take on water to become more elastic in the third trimester to prep for delivery

can palpate and feel the difference

172
Q

The great stressor in any pregnancy is

A

labor contractions

173
Q

Why is it important to do a nonstress test?

A

allows for monitoring in the absence of labor and therefore a non stress situation - done in third tri

174
Q

What occurs for normal non stress test results?

A

a woman is placed on a fetal monitor for at least 15 minutes

To be reactive, there must be 2 accelerations in the fetal heart rate of at least 15 BPM lasting for at least 15 seconds in a 20 minute period

175
Q

Contraction Stress Test (CST

A

Test done if the nonstress test raises suspicion about the status of the infant - done in 3rd tri

The woman is on a fetal monitor throughout the test, and contractions are induced to watch infant response

If there is any evidence of fetal intolerance the test is stopped and the infant must be delivered by C Section

176
Q

BPP

A

Biophysical profile

a more involved ultrasound assessment which measures for 4 criteria of fetal wellbeing

done in 3rd tri

177
Q

What are the 4 criteria of fetal wellbeing looked at in a BPP

A

Amniotic Fluid Level

Fetal Breathing

Fetal Tone

Fetal movement

178
Q

What is some PRE-conception care that should be done for a mother?

A

immunization status

underlying med issues

reproductive health care practices

sexuality and sexual practices

nutrition

lifestyle practices

psychosocial issues

medications and drug use

support system

179
Q

A woman planning a pregnancy should start with ___ mcg of folic acid supplementation ___ before she conceives

A

400 mcg; daily

N352: Practice of Nursing I (14 decks)

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