Preconception Flashcards
Importance of PRECONCEPTION?
critical pd. of human development
Whats the PURPOSE of preconception care?
improve pregnancy outcome by addressing modifiable risk factors & planning for non modifiable risk factors
What teachings is recommended for ALL women of childbearing age?
ALL women should obtain preconception care expecially if they have hx of : spontaneous abortion, preterm birth, congenital birth defect or chronic illness.
Whats included in Preconception Care?
It consist of health promotion activities & risk assessments prior to pregnancy.
What vaccines are contraindicated during pregnancy?
MMR, Varicella
3 Health promotions included in preconception care
Adopting healthy behaviors, Avoid unintended pregnancies, Immunization & protection of other infectious disease
Risk Assesments done during Preconception Care (6)
Medical Hx, Physical Exam, Lab Tests, Teratogen Exposure, Psychosocial Issues, Nutrition
When are genetic screenings performed?
They are done prior to conception to discover Non-modifiable risks to pregnancy.
Examples of Genetic Screenings
Neural Tube Defect (NTD)
Cardiac defect
Down Syndrome
Tay-Sachs (Jewish, Cajun, or French-Canadian)
Sickle Cell Disease or trait (African)
Hemophilia
Muscular Dystrophy
Cystic Fibrosis
Huntington Chorea
Mental Retardation
Autism
Thalassemia (if Italian, Greek, Mediterranean or Asian)
Hx of genetic or congenital abnormalities
Whats the science of genetics?
Explain underlying causes of inherited congenital disorders and patterns which are passed from generation to generation.
TRUE or FALSE: Not all congenital disorders are inherited; some result from a prenatal event.
TRUE
Can genetic screening identify congenital disorders inherited from prenatal events?
NO
When is Genetic Counseling provided?
Once genetic testing is complete to discuss risks.
When is genetic testing performed?
Its recommended if a positive screen occurs but ideally done prior to pregnancy to allow individuals and families to identify, understand, and sometimes control their inherited health risks, in order to make informed reproductive decisions
Is genetic testing a choice?
YES
What does a genetic counselor provide?
With results of testing, assists to interpret the results and informs of potential options.
Whats ‘Nondirectiveness’?
Respects the right of individuals and families to make autonomous decisions.
*nurse’s primary function during this process is to provide emotional support
When is the baby the most vulnerable to teratogenic substances?
First half of the pregnancy; 1st trimester
What are some examples of modifiable risk factors to pregnancy outcomes?
unhealthy BMI, unhealthy diet, smoking, alcohol intake, nonuse of folic acid supplements, and older maternal age.
What are some examples of non-modifiable risk factors to pregnancy outcomes?
age & family history
Reproductive changes w/ pregnancy
Uterus increases in size changes shape & position. Ovulation & mensus ceases during pregnancy.
Cardiovascular changes w/ pregnancy
CO increases by 30-50%, BV increases by 30-45% at term to meet metabolic needs. HR increases beginning week 5
Respiration changes w/ pregnancy
O2 needs increase. During last (3rd) trimester; size of chest enlarges allows lung expansion as uterus pushes upwards
Musculoskeletal changes w/ pregnancy
Body alterations & weight increases
adjustment in posture pelvic joint relax
GI changes w/ pregnancy
N & V d/t hormonal changes & increase in pressure w/in the abdominal cavity
Constipation d/t increase transit time of food through GI tract & thus increased water absorption
Renal changes w/ pregnancy
Filtration Rate increases secondary to influence of pregnancy hormones & increase in BV and metabolic demands
Urine frequency increases (diuresis)
Endocrine changes w/ pregnancy
Placenta becomes an endocrine organ that produces large amounts of HcG, progesterone, estrogen, human placental lactogen & prostaglandins. Hormones are very active function to maintain pragnancy & prepare body for delivery.
What does GTPAL stand for
Gravidity, Term birth, Preterm birth, Abortions/miscarriage, Living children
Whats Nageles Rule
1st day of last menstrual cycle - 3mo + 1yr & 7days
Hemoglobin lab values
12-16 g/dL
Women residing in high altitudes may show higher hgb
Rhesus (Rh)
The Rh factor is either positive (meaning the person has the antigen) or negative (meaning the person does not have the antigen)
TORCH
identify toxoplasmosis, rubella, cytomegalovirus, and herpes
HepB screen
Surface antigen HBsAg negative. Women w/ risk factors are aslso tested for hepC (spread w/ direct contact w/ blood)
Rubella titer
Hemagglutination-inhibition (HAI) test–1:10 or above indicates woman is immune
HIV screen
Negative
Syphilis & Gonorrhea
Serologic tests for syphilis (STS), complement fixation test, Venereal Disease Research Laboratory (VDRL) test—nonreactive. Negative.
Urinalysis/Urine culture
Normal color, specific gravity; pH 4.6–8. Negative for bacteria.
Quadruple screen:
detect aneuploidy and neural tube defects; may be used in areas in which NT testing is not available.
1 Hour glucose
(done between 24 and 28 weeks’ gestation) Plasma glucose level greater than 140 mg/dL (gestational diabetes mellitus [GDM])
Prenatal vitamins
give body minerals & vitamins needed for a healthy pregnancy
Common discomforts during pregnancy
Nasal congestions (epistaxis)
bleeding gums
SOB
Fatigue
Supine hypotension syndrome
Backache
N &V
Heartburn/reflux
Urinary frequency
Constipation
Hemorrhoids & varicose veins
Braxton Hicks contractions
Skin changes & leg cramps
Supine hypotension syndrome teachings
Lie in side-lying or semi-fowlers position with knees flexed slightly.
Heartburn/ Reflux teachings
Eat small frequent meals, do not let your stomach to get too empty or too full, contact HCP before taking anti-acids. Do not lie down immediately after eating, as this can exacerbate reflux
N & V teachings
Eat crackers or dry toast before rising in the morning, avoid having an empty stomach and ingesting spicy, greasy or gas forming foods. Encourage fluids between meals.
Normal Changes
N & V
Breast tenderness
Urinary Frequency
UTI’s
Fatigue
Heartburn
Constipation
Backaches
SOB
Lef Cramps
Varicrose in lower extremities
Gingivitis, nasal stiffness, epistaxis
Braxton Hicks contractions
Supine hypotension
Hemorrhoids
1st Trimesters Warning Signs
Severe monitoring (hyperemesis gravidarum)
Burning during urination
diarrhea (infection)
fever or chills
abdominal cramping/vaginal bleeding
2nd & 3rd Trimesters Warning Signs
Gush or fluid from vagina
abruption or pevia from placenta (ab pain)
changes in fetal activity ( decrease movement= fetal distress)
severe headache
elevated temp.
Dysuria
blurred vision
clammy pale skin, weakness, tremor, lightheadedness (hypoglycemia)
Flushed dry skin, fruity breath, increased thirst and urination (hyperglycemia)
Whats the recommended weight gain during pregnancy ?
25-35 lbs
1.1-4.4 lbs during the 1st Trimester & after that 1lb every wk for the other two trimesters
What are Non-Meat iron sources ?
lentils, chickpeas, beans, kale, raisins, fortified cereals & bread, dried apricots & figs, pumpkin seeds, cashew nuts
What interferes with the absorption of Iron?
milk, caffeine, tea, colas, meat
Non-Dairy source of Calcium
fortified orange juice
fortified soy milk
nuts
legumes
dark leafy veggies
Why is Folic acid in pregnancy important?
crucial for neurologic development and prevention of fetal NTD
Vegan diet during pregnancy should include:
bread, cereal, rice, pasta, fruits, vegetables, legumes, tofu, nuts, nut butter
Pregnant/ breastfeeding mothers & young children SHOULD NOT eat what?
swordfish, shark, tilefish, or king mackerel
they contains high levels of methylmercury
To promote good nutrition and avoid the risks of mercury:
eat at least 8 oz and up to 12 oz/week (two average meals) of shellfish and fish that are lower in mercury
What fish are lower in mercury
canned light tuna, shrimp, salmon, herring, sardines, pollack, and trout
*Albacore (white) tuna has more. Only 6 oz/week is recommended
Whats Prenatal testing?
Testing to identify a fetus with a genetic disease or condition. Some prenatal testing is offered routinely; other testing may be initiated due to family history or maternal factors
What does VEAL CHOP stand for?
Variable decels Cord compress
Eearly decels Head compress
Aaccelerations Ok
Late decels Placenta
