PREGNANCY Flashcards
Refers to the medical and nursing care given to the pregnant woman between conception and the onset labor
Consideration is given to the physical, emotional, and social needs of the woman, the unborn child, her partner, and other family members
Pregnancy-antepartum
The process of carrying or being carried in the womb between conception and birth
Gestation
Is the ability of a fetus to survive outside of the womb at the end of 20 weeks
Viability
Is the number of times pregnant, regardless of duration and outcome, including the present pregnancy
Gravida
Is a woman who has not and never has been pregnant
Nulligravida
Is a woman pregnant for the first time
primigravida
Is the number of pregnancies that lasted more than 20 weeks, regardless of outcome
Para
Is a pregnant for second or subsequent time
Multigravida
is a woman who has not given birth to a baby beyond 20 weeks gestation
Nullipara
Is a woman who has given birth to one baby more than 20 weeks gestation
Primipara
Para is subdivided to reflect births that went to Term, Premature births, abortions, and living children
TPAL
A newbord born before 37 weeks of gestation
Preterm
Is a newborn born after 37 weeks to 40 weeks of gestation
Term
Is a newborn born after 40 weeks
Post term
LMP
Last Menstrual Period
EDC
Expected date of delivery/confinement
AOG
Age of Gestation
CIL
Cephalic in Labor
Duration of pregnancy
266-280 days, 38-42 weeks, 9 calendar months, 10 lunar months (28 days)
Periods of pregnancy
First trimester, 2nd, 3rd
Period organogenesis; teratogens are highly damaging
First trimester
Most comfortable period for mother, fetal growth continues
Second trimester
rapid deposition of fats, thus period of most rapid growth, with rapid iron and calcium deposition
Third Trimester
CONDITIONS FOR FERTILIZATION
- live, motile, normal sperm present in cervical mucus
- Fallopian tubes paten
- endometrial biopsy indicates adequate progesterone and secretory endometrium
- Semen is supportive to pregnancy at least 2 ml semen and contain at least 200 million sperm/ml >60% normal and >50% motile (moving forward)
The production of offspring; in general humans copulate purely for the purpose of procreation
Procreation
TWO RELATED THEORIES FOR PROCREATION
CREATION AND EVOLUTION
God created the world and all that’s in it, including humans, and they reproduce through sexual intercourse
Creation
Darwin’s theory that humans evolved over the years through natural occurrences and from the growth and development of monkeys and other creatures
Evolution
This happened during sexual intercourse
some sperm ejaculated from the male penis swim up through the female vagina and uterus toward an oocyte (Egg cell) floating in one of the uterine tubes
Fertilization takes place where
ampula (outer 1/3) portion of the fallopian tube
The sperm and egg are ___
gametes
the sperm and egg contain half the ____ necessary for production. When a sperm cell penetrates and fertilizes an egg, that genetic information combines
genetic information
The 23 chromosomes from the sperm pair with 23 chromosomes in the egg, forming a 46- chromosome cell called a
zygote
___ Starts to divide and multiply. As it travels toward the uterus it divides to become a ___, which will burrow into the uterine wall
zygote ; blastocyst
A fertilized egg, or zygote takes about how many days to reach the uterus from the uterine tube
Five days
As the zygote moves, the zygote divides and develops into a ___, with an inner mass of cells and a protective outer ring
blastocyst
attaches to the wall of the uterus and gradually implants itself into the uterine lining
blastocyst
During implantation, its cells differentiate further. At day 15 after conception, the cells that will form the embryo become an
embryonic disc
the___, on one side of the disc, will become part of the digestive tract
yolk sac
As the cells multiply, they will also separate into two distinctive masses:
- the OUTER CELLS will eventually become the placenta and umbilical cord, which will bring in nutrients and eliminate waste and
- the inner cells from the embryo
On the other side, the ___ fills with fluid and will surround the embryo as it develops
amnion
By week 4, the embryo ____
the embryo has a distinct head and tail and a beating heart
Over the next six weeks, _________ form. Primitive versions of all body systems appear
limbs, eyes, brain region, and vertebrae form
In eight weeks, the embryo develops
contains a flat embryonic disc that now differentiates into three layers:
endoderm, mesoderm, ectoderm
skin and nervous system
ectoderm
digestive and respiratory system
Endoderm
Muscle and skeletal systems
Mesoderm
All organs of the human body derive from these three tissues called___. They begin to curve and fold and to form an oblong body
Ectoderm, Endoderm, Mesoderm
10th week of pregnancy
your baby will change names from an embryo to a fetus. There are about 40 weeks to a typical pregnancy. These weeks are divided into three trimesters
Pregnancy is often measured in terms
gestational age
age of the fetus starting with the first day of a woman’s last menstrual period
gestational age
actual age of the growing fetus.
embryonic or fetal stage
STAGES OF FETAL DEVELOPMENT
Ovum- from ovulation to fertilization
Zygote - (12-14 days after fertilization) from the time the ovum is fertilized until is is implanted in the uterus
Embryo- from implantation to 5-8 weeks. During this period, embryo is most vulnerable to teratogens: viruses drugs radiation or infection can cause major congenital anomalies
Fetus- 8-10 weeks until term(38-41 weeks)
from ovulation to fertilization
Ovum-
(12-14 days after fertilization) from the time the ovum is fertilized until is is implanted in the uterus
Zygote -
from implantation to 5-8 weeks. During this period, embryo is most vulnerable to teratogens: viruses drugs radiation or infection can cause major congenital anomalies
Embryo-
8-10 weeks until term(38-41 weeks)
Fetus-
is the developing embryo or fetus and placental structures throughout pregnancy
Conceptus
the earliest age at which fetuses could survive if they were born at that time, generally accepted as 24 weeks, or fetuses
Age of viability
During intra uterine life the fetus derives _______, not from O2 exchange in the lungs but from the ____
O2 and excrete carbon dioxide ; placenta
is connected by the umbilical cord to the placenta, the organ that develops and implants in the mother’s uterus during pregnancy
fetus
How does fetus receive all the necessary nutrition, oxygen, and life support from the mother through the placenta
through the blood vessels in the umbilical cord
Where the gas exchange takes place during fetal life
Placenta
carry unoxygenated blood from the fetus to the placenta
Umbilical arteries
Brings oxygenated blood coming from the placenta to the fetus
Umbilical vein
Connects the left and the right atrium. It pushes blood from the right atrium to the left atrium so that blood can be supplied to brain, kidney, and heart.
Foramen ovale
Carry oxygenated blood from umbilical vein to inferior venacava, by passing fetal liver
ductus venosus (vein to vein)
carry unoxygenated blood from the pulmonary artery to aorta, by passing
Ductus arteriosus (artery to artery)
FETAL CIRCULATION
The oxygenated blood enters the umbilical vein from the placenta -> enters ductus venosus that connects the umbilical vein to the inferior venacava, w/c allows oxygenated blood to be supplied directly to the fetal liver -> it passes through inferior venacava -> enters the right atriums (heart) -> enters the foramen ovale (opening bet. rt. atrium and left atrium)
-> goes to the left atrium -> passes through the left ventricle -> flows to ascending aorta to supply nourishment to the brain and upper extremities -> it enters superior venacava (return to the heart) goes to the right atrium -> enters the right ventricle -> enters pulmonary artery with some blood going to the lungs to supply oxygen and nourishment -> it flows to ductus arteriosus (channel bet. aorta and main pulmonary artery) Allows blood to bypass the fetal lung. It closes during normal respiration -> It enters descending aorta (some blood going to the lower exteremities) -> and enters hypogastric arteries that return the blood to the placenta (unoxygenated blood because it is away from the fetal heart) -> and goes back to the placenta
During pregnancy, the pregnant mother undergoes significant anatomical and physiological changes in order to:Wh
nurture and accomodate the developing fetus
When do maternal changes start?
after conception. and it affects every system in the body. These changes resolve after pregnancy with minimal residual effects
Maternal changes 8 weeks AOG
- Nausea persists up to 12 weeks
- Uterus changes from pear to globular shape
- hegar’s sign: softening of the isthmus cervix
-goodell’s sign: softening of the cervix
-leukorrhea increases
-ambivalence about pregnancy may occur
-no noticeable wieght gain
-chadwick’s sign appears (dark bluish or purplish) appears as early as 4 weeks’ gestation
Fetal development 8 weeks AOG
-Rapid development
- heart begins to pump blood
-limb buds are well developed
-facial features discernible
-major divisions of brain discernible
-ears develop from skin folds
-tiny muscles are formed beneath this skin
-embryo weighs 2 grams
Nursing intervention 8 WEEKS AOG
- Teach prevention of nausea
*Eat dry crackers before getting out of bed in the morning
*Eat small, frequent meals and avoid fatty foods
*increase fluid intake to 3L/day
-Teach safety
*Avoid hot tubs, saunas, and steam rooms throughout pregnancy (hypotension may cause fainting)
-Prepare for pregnancy
*Discuss attitudes toward pregnancy
*discuss value of early pregnancy classes that focus on what to expect during pregnancy
*provide information about childbirth preparation classes
*include father/family in preparation for childbirth (expectant fathers experience many of the same feeling/conflicts experienced by the expectant mother)
Maternal changes (28 weeks aog)
-Fundus halfway between umbilicus and xiphoid process
-thoracic breathing replaces abdominal breathing
-fetal outline palpable
- woman becomes tired of pregnancy and eager for delivery
-heartburn may begin
-hemorrhoids may develop
Fetal Development 28 weeks (AOG)
Fetus can breathe, shallow, regulate temperature
-surfactant forms in lungs
-fetus is 2/3 birth size
-baby can hear
-eyelids open
-period of greatest fetal weight gain begins
-fetus weighs 1100 gms (21/2 lbs)
Nursing intervention 28 WEEKS AOG
- Treatment for hemorrhoids
*Sit’z bath
*gentle reinsertion of hemorrhoids with lubricated fingertips
*suppositories as ordered
*topical anesthetic agents
*stool softeners as ordered - Teach comfort measures
*elevate legs when sitting
*assume side-lying position when resting
-Teach measures to avoid heartburn
*eat small frequent meals
*avoid fatty foods
*avoid lying down after meals
*Maalox or Mylanta may be helpful
*avoid sodium bicarbonate
-Prepare for delivery and parenthood
*discuss mother’s/father’s/family expectations of labor and delivery
*discuss mother’s/father’s/family expectations caring for infant
*start childbirth preparation classes
Maternal changes ( 32 weeks AOG)
-fundus reaches xiphoid process
-breast full and tender
-urinary frequency returns
-swollen ankles may occur
- sleeping problems may develop
- dyspnea may develop
Fetal development (32 weeks AOG)
-brown fat develop beneath skin to insulate baby following birth
-fetus is 15-17 inches in length
- begins storing iron, calcium and phosphorous
-fetus weighs 1800-2200 gms (4-5 lbs)
Maternal Changes 38 WEEKS AOG
Lightening occurs
-placenta weighs approximately 20oz
Mother eager for birth, may have burst of energy
-backaches increase
-urinary frequency increases
-braxton hick’s contractions intensify (cervix and lower uterine segment prepare for labor)
Fetal Development (38 weeks AOG)
Fetus occupies entire uterus; activity is restricted
-maternal antibodies are transferred to fetus (provides immunity for approximately 6 months, until infant’s own immune system can take over)
-fetus weighs 3200 grams and more (7lbs)
Nursing interventions 38 weeks AOG
-Teach safety measures
*wear low heeled shoes or flats
*avoid heavy lifting
*sleep on side to relieve bladder pressure; urinate frequently
-prepare for delivery
*continue pelvic tilt exercises
*pack a suitcase for delivery
*fundus reaches xiphoid process
*breast full and tender
*urinary frequency returns
*swollen ankles may occur
*sleeping problems may develop
*dyspnea may develop
Is probably caused by reduced blood circulation due to uterine pressure and gen fluid retention
Ankle edema
Management for Ankle Edema
-sitting with your feet elevated
-resting in left side lying position
-avoid standing for long period of time
-avoid using restrictive garments on the lower half of your body.
To maintain the balance that may lead to backache (lumbar lordosis) or the pride of pregnancy
Backache
Management for backache
-Apply local heat
-Avoid long periods of standing
-Advise to squat rather than bent to pick up objects
-Wear low-heeled shoes
-maintain correct posture
-used of firm mattress
-tailor sitting, pelving rocking and shoulder circling exercises to strengthen back
-Acetaminophen (tylenol) in usual adult dose may help
Breast tenderness Management
- wear a supportive bra with a wide shoulder strap
-decrease the amount of caffeine and carbonated beverages ingested
As the weight of the growing uterus presses against the bowel that slows down the peristalsis and also due to increase progesterone level
Constipation
Management constipation
-increase fiber in your diet
-drink additional fluids
-have inhibits gastric motility a regular time for bowel movements
-exercise and use stool softener as prescribed. Enema is contraindicated
A pregnant women experiencing difficulty in sleeping due to enlarged abdomen that compresses the diaphragm
Difficulty sleeping
Difficulty sleeping management
Drink a warm caffeine-free drink before bedtime
-practice relaxation techniques
Is a feeling of constant tiredness or weakness and can be physical mental or combination of both
Fatigue
Management for fatigue
-Schedule rest periods daily
-Have a regular bedtime routine
-use extra pillow for comfort
Management for faintness
-move slowly
-avoid crowds
-remain in a cool environment
-always lie on your left side when at rest
Is due to expanding blood volume which put pressure on cerebral arteries
Headache
Management for headache
-avoid eye strain. Visit your eye doctor
-Rest with a cool cloth on your forehead
-and report immediately on persistent headaches to your primary care provider
is due to increase progesterone that slows gastric motility
Heartburn
Management for heartburn
-eat small, frequent meals each day
-avoid overeating as well as spicy, fatty, and fried foods
Is a condition that causes the overproduction of saliva
- due to hyperacidity that increases salivation
Ptyalism
Management of ptyalism
-Use mouthwash as needed
-chew gum or suck on hard candy
-brush and floss daily, watch your diet
is an uncomfortable sensation in the abdomen near the hips or into the groin area
Round ligament pain/abdominal discomfort
Round ligament pain/ abdominal discomfort management
-avoid twisting motions
-rise to a standing position slowly and use your hands to support the abdomen
-bend forward to relieve discomfort
-rest and yoga exercises may help, and you may want to avoid sudden movements.
Due to to compression in the diaphgram related to growing fetus
Shortness of breath
Shortness of breath management
-use proper posture
-use pillows behind the head and shoulders at night
-adequate rest period
URINARY FREQUENCY
1st trimester - increase urination due to increase blood supply to kidney
2nd trimester - decrease urination
3rd urination- increase urination due to pressure
Management urinary frequency
- Void as necessary at least every 2 hours
- increase fluid intake
- avoid caffeine
- practice kegel exercises (contracting and relaxing perineal muscles) to decrease urinary incontinence
Due to increase progesterone level
Vaginal discharge/ Leukorrhea
Management for Vaginal discharge/ Leukorrhea
Wear cotton underwear and bathe daily
-avoid tight pantyhose and
-use of perineal pad
Due to pressure on the veins returning blood from the lower extremities. This causing blood pool
Varicose veins
Management for varicose veins
-walks regularly
- rest with feet elevated for 15-20 minutes
-avoid long periods of standing
-do not cross your legs when sitting
-avoid knee-high stockings
-wear support hosiery and take vitamin c or fresh fruits
Varicosities of rectal veins due to gravid uterus
Hemorrhoids
Management for hemorrhoids
- avoid constipation and straining with a bowel movement
-practice regular bowel movement
-knee chest position for 10 to 15 mins to relieve pressure and replacing hemorrhoids with gentle finger can be helpful
=take a sitz bath
-use of stool softener as prescribed
Is due to increased calcium levels and decrease phosphorous level and interference with circulation due to increase pressure due to gravid uterus
Leg cramps
Management for leg cramps
-avoid pointing your toes
- Lie on her back, straighten your leg and dorsiflex your ankle
-lowering milk intake and supplementing this with calcium lactate
-stretching
See your doctor, If you’re pregnant or have any of these conditions and are experiencing more leg crams than usual
- addison’s disease
- alcohol use disorder
- kidney failure
- thyroid issues’
- parkinson’s disease
- type 2 diabetes
- sarcoidosis
- cirrhosis
- vascular disease
Medications that contribute to leg cramp
- birth control pills
-diuretics - naproxen (aleve)
-albuterol, an asthma medication - statins
Due to increase HCG resulting to increase gastric acid
Nausea
Management for nausea
-eat 6 small meals/day rather than three
- eat a piece of dry toast or some crackers before getting out of bed
- avoid foods or situations that worsen the nausea if it persists, report this problem toyour primary care provider
- drink fluid seperately rather than with your meals and avoid fried, greasy gas producing or spicy foods and foods with strong odors
This causes nasal congestion. Increased blood flow to the nasal passages and enlargement of the nasal veins also play a role
Nasal stuffiness
Management for nasal stuffiness
Use cool air vaporized or humidifier
- increase fluid intake
- place moist towel on the sinuses and massage the sinuses
