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OB FIRST WEEK > Pregnancy > Flashcards

Pregnancy Flashcards

0
Q

Presumptive signs

A

Changes a woman experiences that make her think she is pregnant.
Amenorrhea
Fatigue
N/V
Urinary frequency
Breast changes- darkened areolae, enlarged Montgomery’s glands
Quickening- slight fluttering movements of the fetus felt by woman.

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1
Q

Signs of pregnancy classified into three groups:

A

Presumptive
Probable
Positive

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2
Q

Probable signs

A

Abdominal enlargement- related to changes in uterine size, shape, and position.
Positive pregnancy test
Fetal outline felt by examiner

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3
Q

Probable signs

Hegar’s sign

A

Softening and compressibility of lower uterus.

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4
Q

Chadwick’s sign

A

Deepened violet- bluish color of cervix and vaginal mucosa.

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5
Q

Goodell’s sign

A

Softening of cervical tip

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6
Q

Ballottement

A

Rebound of unengaged fetus

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7
Q

Braxton Hicks contractions

A

False contractions; painless, irregular, and usually relieved by walking.

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8
Q

Positive signs (signs that can only be explained by pregnancy)

A

Fetal heart sounds
Visualization of fetus by ultrasound
Fetal movement palates by an experiences examiner.

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9
Q

Human chorionic gonadotropin

hCG

A

Production starts as early as implantation.
Can be detected as early as 7-10 days after conception.
Peaks at about 60-70 days of gestation declines until 80 days then gradually increases until term.

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10
Q

hCG

A

Higher levels can indicated multi fetal pregnancy.
Ectopic pregnancy
Hydatidiform mole
Down syndrome
Lower blood levels may indicate a miscarriage.

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11
Q

Urine samples

A

First voided morning specimens.

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12
Q

Nagele’s rule

A

Take first day of woman’s last menstrual cycle. Subtract 3 months, and then add 7 days and 1 year

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13
Q

Gravidity- number of pregnancies

A

Nulligravida- never
Primigravida- 1st pregnancy
Multigravida- 2 or more

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14
Q

Parity- number of pregnancies in which fetus or fetuses reach viability (approx. 20 weeks) regardless of whether fetus is born alive.

A

Nullipara- no pregnancy beyond the first stage of viability
Primipara- has completed one pregnancy to stage the viability.
Multipara- has completed two or more pregnancies to stage of viability.

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15
Q

GTPAL

A

G- gravidity
T- term births (38 wk or more)
P- preterm births (viability up to 37 wks)
A- abortions/ miscarriages (prior to viability)
L- living children

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16
Q

Assessment:

A 
Current knowledge
Previous pregnancies
Birthing experience
Medical Hx (rubella, Hep B) 
Family Hx
Recent or current illness
Current meds/ substance abuse
Psych Hx
Work conditions
Exercise and diet habits
Clients goals
Discuss birthing methods/ pain control
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17
Q

Routine Lab tests

A 
Blood type, Rh factor and presence of irregular antibodies
CBC w/ differential, Hgb, Hct.
Hgb electrophoresis
Rubella titer
Hep B
Group B streptococcus
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18
Q

Routine Lab tests (continued)

A 
Urinalysis w/ microscopic examination
One-hour glucose tolerance 
Three hour glucose tolerance 
PAP test 
Vaginal/ cervical culture
PPD 
Venereal disease research lab 
HIV
Maternal serum alpha-fetoprotein-- used to rule out Down syndrome and neural tube defect.
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19
Q

Clients who are Rh negative

A

Around 28 weeks administer RhO (D) immune globulin

(RhoGAM) IM

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20
Q

Education

A 
Avoid all over the counter meds without provider knowledge
Flu immunization
Smoking cessation
Tx of infections
Genetic testing
Exposure to hazardous materials
30 minutes of moderate exercise daily
Avoid saunas and hot tubs
Consume 2-3 liters of water daily
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21
Q

Rupture of amniotic fluid

A

Gush of fluid from the vagina

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22
Q

Abruption or previa

A

Vaginal bleeding

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23
Q

Premature labor
Abruptio placentae
Ectopic pregnancy

A

Abdominal pain

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24
Q

Changes in fetal activity

A

Decreased fetal movement may indicate fetal distress

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25
Q

Hyperemesis gravidarum

A

Persistent vomiting

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26
Q

Gestational hypertension

A

Severe headaches
Blurred vision
Edema of hands and face
Epigastric pain

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27
Q

Infection

A

Elevated temperature

Dysuria

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28
Q

Recommended weight gain during pregnancy?

A 
11.2-15.9 kg (25-35 lb)
1-2 kg (2.2-4.4 lb) 1st trimester
1 lb per week for last two trimesters
Underweight women 28-40 lbs
Overweight 15-25
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29
Q

Calorie increase

A

340/day during second tri
452/day during 3rd tri
If breasting feeding postpartum additional 330/day 1st 6mo
Additional 400/day 2nd 6mo

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30
Q

Folic acid

A 
Crucial for neurological development and prevention of neural tube defect. 500-600 mcg
Leafy vegetables
Dried peas
Beans
Seeds 
Orange juice 
Breads and cereals
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31
Q

iron supplements

A

Increase maternal RBC mass
Best absorbed between meals and w/ vitamin c
Milk and caffeine interfere w/ iron absorption
Stool softener may be used to decrease constipation

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32
Q

Caffeine

A

Limit to 300 mg/day

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33
Q

Calcium

A

1,000 mg/ day over 19

1,300 mg/ day under 19

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34
Q

Risk factors for inadequate nutrition

A 
Adolescent
Vegetarian (protein, calcium, zinc, B12)
Nausea vomiting
Anemia
Eating disorder
Appetite disorder pica
Excessive weight gain
Inability to gain weight
Financially unable to purchase food
WIC
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35
Q

Dietary complications

A

Nausea and constipation:
Eat dry crackers or toast– avoid alcohol, fats, caffeine, and spices

Increase fluids and fiber

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36
Q

Maternal phenylketonuria

A

Maternal genetic disease: high levels of phenylalanine pose a danger to fetus.
Avoid foods high in protein: fish, poultry, meat, eggs, nuts, dairy products.

37
Q

Ultrasound:

A

1-2 quarts of fluid prior to ultrasound
Fill the bladder, lift and stabilize uterus.
Displace the bowel, act as an echolucent to better reflect sound waves.

38
Q

Biophysical profile BPP

Score of 8-10 is normal

A 
Assesses fetal well being by measuring five variables with a score of 2 or 0
Reactive FHR
Fetal breathing movements
Gross body movements
Fetal tone
Qualitative amniotic fluid volume
39
Q

Alpha fetoprotein

A

High levels: are associated with neural tube defects such as anencephaly. Spina bifida, omphalocele.

Low levels: Down syndrome, hydatidiform mole.

40
Q

How many weeks for a full term baby?

A

37 weeks

41
Q

At 30 weeks what would a nurse expect to find assessing this preterm baby?

A

Lanugo, a fine hair covering the body

Greatest between 28-30 weeks

42
Q

Factors that increase risk for postpartal atony

A 
Precipitous delivery
Distended bladder
Macrosomic delivery
Multiple fetal birth
Multi para
Polyhydramnios
43
Q

Physiologic changes preceding labor:

A

Backache- pelvic muscle relaxation
Weight loss- 1-3 lb weight loss
Lightening- fetal head descends into true pelvis (14 d prior)easier breathing, pressure on bladder, urinary freq.
contractions- Braxton hicks
Energy burst- “nesting response”
GI changes- N/V, indigestion
Rupture of membranes- indicative of imminent labor.

44
Q

Assessment of amniotic fluid:

A

Watery clear and pale-straw-yellow color.
Odor should not be foul
Volume between 500- 1,200 mL
Nitrazine paper should be used to confirm.

45
Q

Nitrazine paper

A

Amniotic fluid is alkaline
Nitrazine paper should be deep blue indicating pH of 6.5-7.5
Urine is slightly acidic:
Paper will remain yellow.

46
Q

Five “P”s that affect and define the labor and birth process

A 
Passenger
Passageway 
Powers
Position
Psychologic response
47
Q

Passenger:

A

Fetus and placenta

Size of fetal head/ presentation, lie, attitude, and position affect ability to navigate birth canal.

48
Q

Presentation:

A 
Part of the fetus that is entering the pelvic inlet first
Back of head (occiput)
Chin (mentum) 
Shoulder (scapula)
Breech (sacrum or feet)
49
Q

Lie:

A

Relationship of the maternal longitudinal axis (spine)
Fetal long. Axis (spine)
–transverse
– parallel

50
Q

Attitude:

A

Relationship of fetal body parts to one another.
Fetal flexion: chin-chest extrem.-torso
Fetal extension: chin extended extrem too.

51
Q

Fetopelvic or fetal position:

A

Relationship of presenting part of fetus as it relates to one of the 4 maternal pelvic quadrants.
R or L for maternal pelvis
O S M Sc for presenting part of fetus
A P T part of maternal pelvis
Station: measure of fetal descent in CM 0 being at level of ischial spines
Minus stations superior to that an plus stations inferior to that.

52
Q

Passageway

A

Birth canal: composed of bony pelvis, cervix, pelvic floor, vagina, and introitus. Size and shape of bony pelvis must allow baby to pass through and cervix must dilate in response to contractions and fetal descent.

53
Q

Powers:

A

Uterine contractions: cause dilation of cervix and descent of fetus, involuntary urge to push and voluntary bear down.

54
Q

Position:

A

Of woman who is in labor, client should engage in frequent position changes during labor to increase comfort, relieve fatigue, and promote circulation.
*Gravity can aid in fetal descent.

55
Q

Psychological response:

A

Maternal stress, tension, anxiety, can produce physical changes that impair the progress of labor.

56
Q

Urinalysis: clean catch urine sample

A

Hydration- specific gravity
Nutritional- via ketones
Proteinuria- indicative of gest. HTN
UTI- via bacterial count

57
Q

Nitrazine paper

A

Used to confirm that amniotic fluid is present.

Paper should be deep blue indicating pH of 6.5-7.5

58
Q

Five “P”s

A

Passageway
Powers
Position
Psychologic response

59
Q

Passageway

A

Birth canal– bony pelvis, cervix, pelvic floor, vagina, and introitus(vaginal opening).

60
Q

Stages of labor:

A 
First stage:
Latent-irregular contraction 30-45 sec.
Active- reg. contr. 40-70 sec. 4cm
Transition-2-3 min reg. cont. 8cm
Second stage: 10cm cont 1-2 min
Third stage: delivery of neonate
Fourth stage: delivery of placenta stabilization of Maternal VS
61
Q

Pain management: gate control theory

A

Sensory nerve pathways used by pain sensations to get to the brain will only allow a limited number of sensations to travel at any given time. By sending alternate signals using these pathways pain signals can be blocked.

62
Q

Pain management:

Sensory stimulation strategies

A 
Aromatherapy
Breathing techniques
Imagery
Music
Use of focal points
Subdued lighting
63
Q

Pain man.

Cutaneous strategies

A

Back rubs and massages
Effleurage- light gentle circular stroking of client’s abdomen w/ fingertips in rhythm w/ breathing during contractions.
Sacral counterpressure- consistent pressure applied using heel of hand against sacral area to counter lower back pain
Heat or cold therapy
Hydrotherapy- increases endorphin levels
Acupressure

64
Q

Analgesic med risk

A

Vaginal exam evaluating uterine contractions must be done to verify that labor is well established to avoid slowing progress of labor.

65
Q

General anesthesia nursing actions:

A 
Ensure client is NPO
IV infusion in place
Apply anti embolic stockings and SCD
Premedicate with antacid
Admin. H2 receptor antagonist (Zantac)
Reglan- increase gastric emptying
66
Q

Continuous internal fetal monitoring

Advantages:

A 
Early detection of abnormal FHR patterns
Accurate assess. of FHR variability
Accurate measurement if intensity
Tracing not affected by fetal activity, maternal position changes 
Or obesity
67
Q

Disadvantages of continuous internal fetal monitoring.

A

Membranes must have ruptured with presenting part having descended along with cervix being dilated 2-3cm
Potential risk to fetus if improperly placed.
Contraindicated with vaginal bleeding
Increase risk of infection
Specially trained to perform

68
Q

Hispanic:

A

Prefer mother to be present

69
Q

African American:

A

Prefer female family members for support.

70
Q

Asian American:

A

May prefer mother, partner not active participant, labor in silence, C-Section undesirable.

71
Q

Native American:

A

Female nursing personnel
Family involved in birth
Use of herbs
Squatting position for birth.

72
Q

European American:

A

Birth is public concern
Focus on technology
Partner expected to be involved
Provider seen as head of health care team.

73
Q

Single most important indicator of progress of labor?

A

Cervical dilation: both fetal descent and cervical dilation are caused by contractions.

74
Q

Transition phase of labor:

A

Discourage pushing efforts until cervix is fully dilated.

75
Q

Third stage of labor-

Signs of placental separation from the uterus

A

Fund us firmly contracting
Swift gush of dark blood
Umbilical cord appears to lengthen
Vaginal fullness on exam

76
Q

What is a External cephalic version and what are it’s contraindications?

A

Attempt to manipulate the abdominal wall to direct a malpositioned fetus into normal vertex presentation after 37 weeks of gestation. (High risk of umbilical cord prolapse)
C/I: uterine anomalies, prev. C section, cephalopelvic disproportion, placenta previa, multi fetal gestation, oligohydramnios.

77
Q

Bishop Score:

A 
Cervical: 
dilation
Effacement
Consistency
Position
Station of presenting part
Score of 0-3 for each one
78
Q

Liver: 3rd trimester

A
  • Alkaline phosphatase increases to 2-4X

* Albumin and total protein decrease

79
Q

Estrogen:

A
  • Uterine growth
  • Increasing blood supply to uterine vessels
  • developing ductal system
  • hyperpigmentation
  • vascular changes in skin
  • increased salivation (starch)
  • Hyperemia of gums and nasal mucus.
80
Q

Progesterone

A 
Maintain endometrial layer
Prevent spontaneous abortion
Prevent tissue rejection of fetus
Develop lobes in breast
Facilitate deposit of maternal fat stores
Relax smooth muscle
Increase resp. Sensitivity to CO2
Stimulates ventilation
Suppresses immunologic resp. Preventing rejection of baby.
81
Q

Estrogen effects:

A
  • Increased blood supply to uterus= uterine growth
  • develops ductal system
  • hyperpigmentation, salivary glands, Hyperemia of gums and nasal mucous membranes.
82
Q

Progesterone effects:

A
  • Maintaining endometrial layer for implantation
  • relaxes smooth muscle of uterus preventing spont. Abortion.
  • develops lobes/lobules of breast
  • deposit of maternal fat stores
  • relaxing smooth muscle: uterus, lower esophageal sphincter, intestines, ureters, bladder.
  • increased sens. To CO2
83
Q

human chorionic somatomammotropin also called human placental lactogen.

A

Insulin antagonists that makes insulin more available to fetus.
Decreases maternal metabolism of glucose and has her rely more on free fatty acids.

84
Q

Relaxin:

A

Inhibits uterine activity
Softens ct of cervix
Lengthens pubic ligaments

85
Q

What is the third stage and what are the four signs of separation?

A 
Placenta is expelled after is separated from uterine wall.
•uterus has spherical shape
•uterus rises upward
•uterine contractions
•vaginal drainage
86
Q

What is Schultz in regards to placenta?

A

Shiny fetal side first

87
Q

What is Duncan in regards to placenta?

A

Rough maternal side presenting

88
Q

Regional pain management

A

•Epidural: s/e = hypotension, bladder distention, prolonged second stage, migration of epidural cath, fever, N/V, pruritus, delayed resp. Dep.
•intrathecal (subarachnoid) opioid anal.
-subarachnoid– spinal block

89
Q

Systemic drugs:

A

Opioid analgesics: Demerol, fentanyl
Opioid antagonists: reverse opioid
Adjunctive drugs
Sedatives__ for women fatigued from false labor.

90
Q

Vaginal birth anesthesia:

A

Local infiltration for episiotomy or suture

Pudendal block– same as local infiltration.

91
Q

General anesthesia:

A

For C/S when mother refuses block or is not a candidate or emergency does not allow.

OB FIRST WEEK (8 decks)

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