Pregnancy Flashcards
Positive (definitive) signs of pregnancy
Fetal heart sounds, seeing fetus on ultrasound, fetal movement felt by healthcare provider
T or F: a positive pregnancy test is a positive (definitive) sign of pregnancy
FALSE; it is probable but not definitive. A pregnancy test detects the presence of human gonadotropic hormone (HCG), but there are other reasons HCG may be present in the body aside from pregnancy!
A pregnant patient’s blood volume may increase by almost ___% leading to side effects such as
50%; edema, tachycardia, low Hgb and Hct (diluted)
A pregnant patient is not considered to be anemic UNLESS the Hgb is less than ___ g/dL in the first and third trimesters or less than ___ g/dL in the second trimester
11; 10.5
Prevention of supine hypotension syndrome
Avoid laying on back (heavy uterus puts pressure on vena cava); OR place pillow under one hip
Expected integumentary findings of pregnancy
Chloasma (mask of pregnancy; facial discoloration), striae gravidarum (stretch marks), linea nigra (darkening of abdomen; verticals line running down the belly)
First trimester of pregnancy visit
Fetal HR ultrasound, CBC, STI testing, PAP, blood typing (including Rh factor), test for HBV
Second trimester visits
Maternal serum alpha fetoprotein (MSAFP), gestational diabetes screening for high risk patients, anatomy scans (fetal anatomy), fundal height assessment
Fundal height is measured in centimeters from
The pubic symphysis up to the fundus (topmost part of uterus)
The gestational age of the pregnancy should correlate to the fundal height in centimeters plus or minus _________
2 weeks
Third trimester visits
Patient receives Rhogam (if Rh negative), TdaP vaccine to pregnant patient, Non-stress tests if indicated, vaginal and rectal swab for group B strep
GTPAL
G- gravidy (how many times has patient been pregnant no matter the outcome?)
T- term (how many term deliveries (past 38 wks) has patient had?)
P - preterm (how many preterm (from 20ish weeks to 37 wks) has patient had?)
A- abortion (how many lost pregnancies, whether elective or spontaneous?)
L - how many children are living now?
Nulligravida
Never been pregnant
Primigravida
First pregnancy
Multigravida
Multiple pregnancies
Easy way to calculate pregnancy term
Add 9 months and 1 week to first day of last menstrual period
Naegele’s rule
Subtract three months from first day of last menses, add one week, add one year
RhoGAM is administered at ___ weeks, within ___ hours of delivery, and any time there is pelvic/abdominal trauma or vaginal bleeding
28; 72
Increased MSAFP is indicative of __________, and a decreased MSAFP is indicative of _________
Neural tube defects; Down syndrome
One hour glucose tolerance test (gestational diabetes screening)
No fasting required; patient consumes 50 g glucose solution, wait and hour, draw blood
A 1 hour glucose tolerance test above ____ requires moving forward to
140; 3 hour glucose testing
3 hour glucose testing
Must have been fasting except for water; draw fasted blood level, administer 100 g glucose solution, take blood test at 1 hr, 2 hr, and 3 hr.
___ abnormal results in 3 hour glucose test is diagnostic for gestational diabetes
2
The nurse should educate a pregnant client to increase intake of what three dietary components?
Folic acid, iron, protein
A pregnant patient should increase their folic acid intake to ___ mcg/day to prevent neural tube defects
600
How many grams of protein should the nurse advise a pregnant patient to consume per day?
60
Iron should be increased to ___ mg/day in pregnant patients
27 (take with vitamin C if supplement)
A patient with average weight should gain roughly ___ to ___ lbs throughout pregnancy
25-35
Warning signs of potential pregnancy complications
Diarrhea, fever, chills, severe abdominal cramping, severe vomiting, decreased fetal activity
Interventions for hemorrhoids
Witch hazel, warm sitz baths
Interventions of N/V associated with pregnancy
Eat crackers or a carb-heavy snack before getting out of bed; eat smaller, frequent meals and bland foods (or anything the patient prefers/can stomach)
Abdominal ultrasound patient education
Encourage having a full bladder as this helps to better reflect sound waves
Chorionic villus sampling is an invasive diagnostic that helps to diagnose
Genetic conditions
Chorionic villus sampling complications
Bleeding, Infection, miscarriage
Because of the risk for bleeding, an Rh negative pregnant patient should receive __________ after chorionic villus sampling to prevent complications should there be mixing of maternal and fetal blood
RhoGAM
Removal of fluid from amnion for genetic testing
Amniocentesis
Amniocentesis complications
Infection, fetal harm, rupture of membranes leading to amniotic fluid leakage/loss which can cause miscarriage or fetal death
An amniocentesis is completed along with an _________ to prevent fetal harm
Ultrasound
Nonstress test (NST) patient education
Press the button any time you feel the baby move
A reactive NST is ideal and consists of acceleration of fetal heart rate (FHR) by ___ bpm for at least ___ seconds in duration ___ times during the NST (20 min)
15; 15; 2
What does a NST assess?
Fetal wellbeing and oxygenation
A score below ___ on a biophysical profile (BPP) is indicative of fetal hypoxia
8
Contraction Stress Tests (CST) can lead to
Preterm labor (d/t release/administration of oxytocin)
The loss of a pregnancy for any reason
Spontaneous abortion (AKA miscarriage)
A miscarriage is the loss of a pregnancy before ___ weeks gestation
20
Procedures that cleanses of the uterus of a miscarriage
Dilation and curettage (D&C)
Medication used for miscarriage that allows the cervix to soften and dilate on its own to allow for easier passage of pregnancy contents
Misoprostol
Abnormal growth of the trophoblastic villi in the placenta which prevents normal embryo maturity
Hydatidiform mole
A hydatidiform mole may look like
Grape-like clusters
S/S of hydatidiform mole
Dark vaginal bleeding (prune juice consistency or color), rapid growth of pregnancy hormone levels
Hydatidiform mole treatment
D&C, HCG monitoring for 6 months to ensure levels return back to 0
Hydatidiform mole patient education
Avoid pregnancy for 1 whole year to accurately monitor for choriocarcinoma
Pregnancy that grows outside of the uterine cavity
Ectopic pregnancy
S/S of ectopic pregnancy
Unilateral stabbing pain in early pregnancy (5-9 weeks)
Treatment for ectopic pregnancy
Methotrexate, surgery
Mnemonic to help remember infections that are teratogenic
TORCH: toxoplasmosis, other, rubella, cytomegalovirus, HIV
A parasitic infection found in cat feces, dirt, and some foods
Toxoplasmosis (this is why pregnancy patients are advised to avoid handling cat litter and gardening, and ensure that foods are cooked thoroughly)
What infections fall in the “other” component of TORCH?
Varicella, syphilis, parvovirus
T or F: herpes can be transmitted to the baby during childbirth if the patient has active lesions
True
Interventions for herpes during pregnancy
Antivirals, C-section (especially if active lesions)
T or F: gonorrhea and chlamydia are often asymptomatic
True!
Untreated gonorrhea and chlamydia can cause ophthalmia neonatorum, which is
An infection of the baby’s eyes
Ophthalmia neonatorum prophylaxis
Erythromycin eye ointment at birth
Syphilis is easily treatable with a shot of
Penicillin G
S/S of trichomoniasis
Yellow-green discharge, intense itching, painful urination
Trichomoniasis treatment
Antibiotics
HIV can be passed through body fluids such as
Blood, semen, vaginal secretions, and breast milk
Breastfeeding is contraindicated for patients with
HIV
Plan for C-section around 38 weeks of gestation if maternal HIV viral load is greater than _____ copies/mL
1000
Throwing up more than usually during pregnancy
Hyperemesis gravidarum
Complications of hyperemesis gravidarum
Clinical dehydration, electrolyte imbalances, weight loss
Hallmark of hyperemesis gravidarum
Ketones in urine
Yeast infection
Candidiasis
Hallmark symptom of candidiasis
Thick, white discharge (cottage cheese-like in consistency); other symptoms include intense itching (pruritis), burning with urination, vaginal inflammation
Candidiasis patient education
Avoid tight and damp clothing, NO douching or scented products, wear COTTON underwear
S/S of iron-deficiency anemia
Fatigue, pallor, SOB upon exertion, pika (the craving or eating on non-food substances such as dirt, clay, laundry detergents), decreased H&H
Iron supplement education
Take in morning with orange juice (vitamin C increases absorption of iron); increase fluid intake to help combat constipation
Risk factors for gestational diabetes
Obesity, GDM in previous pregnancy, family hx, HTN
Complications of gestational diabetes
Fetal macrosomia, fetal hypoglycemia, maternal pre-eclampsia, birth trauma, diabetes following pregnancy
Premature dilation of the cervix
Cervical insufficiency (incompetent cervix)
S/S of cervical insufficiency
Increased pelvic pressure, vaginal bleeding, pink-tinged discharge, gush of fluid from vagina, cervical dilation
Treatment for cervical insufficiency
Cervical cerclage (suture placed in cervix allowing it to be closed); bed rest and pelvic rest (avoiding any penetrative sexual activity)
Cervical cerclage is placed around ___ to ___ weeks and removed at ___ to ___ weeks gestation
12; 14; 36; 38
Complication of pregnancy by which the placenta itself implanted near or over the opening of the cervix (cervical OS)
Placenta previa
S/S of placenta previa
Painless, bright red vaginal bleeding
Vaginal bleeding nursing consideration
Do NOT perform a cervical check
What class of medications is administered to improve lung maturation of infants that are anticipated to be born preterm?
Corticosteroids
The separation of the placenta from the uterine wall prematurely
Placental abruption (abruptio placenta)
Placental abruptions places fetus at risk for _________ and mom at risk for __________
Hypoxia; hemorrhage/shock
S/S of placental abruption
Dark red vaginal bleeding, severe abdominal pain, rigid board-like abdomen (d/t accumulation of blood in abdominal space), S/S of hypovolemic shock (tachycardia, hypotension, tachypnea, pallor)
Placental abruption risk factors
Smokers, maternal hypertension, trauma (MVA, fall down stairs), multiparity (twin pregnancy, etc.), use of cocaine or other stimulants
Placental abruption treatment
Emergency treatment, O2, IV fluids, blood products, avoid vaginal exams!
Hypertension (BP > 140/90) after 20 weeks of gestation
Gestational hypertension
Gestational hypertension is diagnosed through ___ abnormal blood pressures taken ___ hours apart
2; 4
T or F: gestational hypertension is characterized by proteinuria
False
Mild preeclampsia
BP > 140/90 with 1+ proteinuria
Severe preeclampsia
BP > 160/100 and 3+ proteinuria; Other possible symptoms: severe headache that will not go away, blurred vision, epigastric pain, thrombocytopenia, impaired liver and kidney function, edema, hyperreflexia
For a patient to be diagnosed with eclampsia, they must have had a
Seizure
What does HELLP syndrome stand for?
Hemolysis, elevated liver enzymes, low platelets
S/S of HELLP syndrome
Epigastric or RUQ pain (d/t liver involvement), elevated liver enzymes (AST, ALP), thrombocytopenia
HELLP syndrome treatment
Antihypertensives (hydralazine, labetalol), magnesium
Nursing care for the pregnant client receiving magnesium
Monitor respiratory status and quality
Antidote for magnesium toxicity (decreased DTRs, RR < 12/min, oliguria)
Calcium gluconate
Patient education for hypertensive disorders of pregnancy (gestational hypertension, preeclampsia, eclampsia, HELLP syndrome)
Low sodium diet, limit caffeine, maintain quiet environment to prevent seizures, bed rest
Group B Strep (GBS) is treated with _________ during birth
Antibiotics (penicillin G, ampicillin)
Maternal complications related to GBS AFTER birth
Sepsis, chorioamnionitis
Newborn complications related to GBS
Meningitis, pneumonia, sepsis
GBS is diagnosed through a perineal and rectal swab between ___ to ___ weeks gestation
35-37
Excess amniotic fluid
Polyhydramnios
Polyhydramnios risk factors
Gestational diabetes, fetal congenital abnormalities
Polyhydramnios treatment
Amniocentesis (to remove amniotic fluid from uterus)
Decreased amniotic fluid volume
Oligohydramnios
Oligohydramnios risk factors
Premature rupture of membranes, uretoplacental insufficiency, abnormalities of fetal genitourinary tract
Infection or inflammation of the amniotic sac (chorion and amnion)
Chorioamnionitis
Chorioamnionitis risk factors
Genitourinary infections like UTIs, infection affecting reproductive or urinary tract
S/S of chorioamnionitis
Elevated WBCs, malodorous vaginal discharge, fever, uterine pain
Chorioamnionitis treatment
Antibiotics
