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NUR360 LS1 > Pregnancy Care Fundamentals > Flashcards

Pregnancy Care Fundamentals Flashcards

1
Q

Presumptive signs of pregnancy

A
  • Presumptive signs are the changes that are experienced by the client
  • Amenorrhea; absence of a period
  • Fatigue
  • Breast changes; caused by a wide range of factors; not necessarily pregnancy
  • Nausea and/or vomiting
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2
Q

Probable signs of pregnancy

A
  • Probable signs are changes observed by the examiner
  • Positive Goodell’s sign; is a softening of the cervix
  • Positive beta hCG; the first biomarker of pregnancy; once the ovum is fertilized, the corpus luteum that is left behind releases this. What pregnancy tests looks for as well as blood tests
  • But there are other factors that can causes a positive hCG test; confirm levels by blood
  • Braxton-Hicks; are uterine tone
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3
Q

Positive signs of pregnancy

A
  • Positive signs are the only signs that indicate fetal presence
  • Fetal heart tones
  • Visualization of the fetus
  • Palpation of fetal movement
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4
Q

Nagele’s Rule for EDB

A
  • EDB = estimated date of birth/when the baby is due
  • Nagele’s rule: based on very specific assumptions. Assumes the person has had a regular period every 28 days
  • LMP = last menstrual period
  • First day of LMP, add 7 days and count forward 9 months
  • OR first day of LMP, subtract 3 months, add 7 days plus 1 year
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5
Q

Obstetrical Wheel

A

• Obstetrical wheel: tool used, and always double check and used on practice

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6
Q

Timing of ultrasounds to EBD

A
  • The first ultrasound (T1; 8-10 weeks) is used for dating accuracy; growth is more predictable. Date is adjusted according to T1
  • Important to have fine-tuned EDB; all future decisions are made based on the day
  • T2 ultrasound is usually done 18-20 weeks
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7
Q

RN role antenatal

A
  • Assessing coping and adaptations
  • Informational support
  • Active listening, validation, reassurance
  • Data collection
  • Anticipatory guidance
  • Interprofessional collaboration
  • Documentation
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8
Q

Parental developmental tasks antenatal

A
  • Accepting the pregnancy
  • Identifying with role of mother/father/parent
  • Re-ordering personal relationships
  • Establishing a relationship with the fetus
  • Preparing for childbirth
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9
Q

ABO incompatibility

A
  • If mother’s blood type is O and baby’s is A or B
  • Mother’s plasma can make antibodies that can attack the baby’s RBCs
  • Can cause jaundice in baby
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10
Q

Rh+ status

A
  • Rh- don’t have antigens on them, Rh+ do
  • Rh- will recognize the Rh+ and start creating antibodies; will affect next pregnancies if Rh+ because sensitization will have occurred and will attack fetus
  • Rogam at 26-28 weeks to all clients who are Rh-; if later if mom is Rh- and baby is Rh+, rogam given again postpartum within 72 hours to the adult to reduce immune response so they don’t start that sensitized process
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11
Q

Prenatal care goals

A
  • Promote client, fetal, family health and well-being
  • Monitor client-fetal health status
  • Identify and minimize risk factors
  • Provide appropriate and holistic education and support
  • Referral to community resources
  • Empowering people to make informed decisions for themselves
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12
Q

Importance of prenatal care

A
  • Determining how to enter the health care system can be challenging for primips; many factors to weigh
  • Late entry/no prenatal care has poorer outcomes for client and baby
  • Client education is the key to healthy lifestyle choices and practices
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13
Q

Pre-conceptions and prenatal health promotion key components

A
  • Health diet (which includes folic acid ~1mth post conception)
  • Exercise and rest
  • Optimum weight
  • Supporting relationships (fetus, partner, family)
  • Use of risk reducing health and sexual practices; smoking, alcohol consumption, prescription medication use, workplace/environmental hazards
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14
Q

Frequency of prenatal visits

A
  • 1st trimester (up to 13 weeks); initial visit then monthly
  • 2nd trimester (14026 weeks); monthly
  • 3rd trimester (27-term); q2weeks until week 36, q1week until birth
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15
Q

Context of prenatal visits

A 
• Medical and OBGYN history
• Social and family history
• Physical assessment
• Fetal assessment
• Diagnostics:
- Initial screen 
- Biophysical testing
- Biochemical testing
• Health education and promotion; illness prevention
• Do's and Don'ts and Red Flags
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16
Q

Focused assessment of prenatal visits

A
  • Subjective (interview/history)
  • Weight
  • Vital signs (monitor BP especially)
  • Urinanalysis (as needed)
  • Fundal height
  • Fetal movement
  • FHR (fetal heart rate) auscultation
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17
Q

Anetnatal and BP

A
  • 140/90 is the first cut off for concerning BP
  • Don’t have to have a high BP for the preeclampsia process to start
  • Protein in the urine is a sign of preeclampsia; reason for urine tests
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18
Q

Fundal height measurement

A
  • Fundal height measurement
  • Bottom of tape at pubis synthesis
  • Then to top of the fundus
  • 20cm = 19/20 weeks gestation; a gross measurement
19
Q

Pregnancy Do’s

A
  • Healthy diet with adequate hydration
  • Folic acid and PNVs
  • Adequate rest and sleep
  • Physical activity
  • Flu shot, Tdap
20
Q

Pregnancy Don’ts

A 
• Foods to avoid:
- Raw meats
- Fish
• Smoking, alcohol abuse (no safe level)
• Substance abuse
• Hot tub/sauna
• Avoid risky behaviour
• Avoid cat litter
21
Q

Pregnancy Red Flags

A
  • Vaginal bleeding
  • Vaginal discharge (leaking)
  • Contractions
  • Pain (abdominal, back, urination, epigastric)
  • Decreased fetal movement
  • SOB, chest pain
  • Fever
  • Severe headache
  • Visual disturbances (blurry, spots, diplopia)
  • Accidents/falls/injuries
  • Any other concerns
22
Q

Ontario Prenatal Record (OPR)

A
  • Taken for all clients in province who are pregnant

* All information can be found there

23
Q

Prenatal Community Resources

A 
Examples:
• Toronto Public Health
• Health Babies Healthy Children
• Homeless At Risk Prenatal Program (HARP)
• Canada Prenatal Nutrition Program
• Community Health Centres
• Prenatal classes
24
Q

Role of Human chorionic gonadotropin during pregnancy

A
  • Source; Fertilized ovum and chorionic villi

* Maintains corpus luteum production of estrogen and progesterone until placenta takes over the function

25
Q

Role of Progesterone during pregnancy

A
  • Source; corpus luteum until 14 weeks of gestation, then the placenta
  • Suppresses secretion of FSH and LH by the anterior pituitary
  • Maintains pregnancy by relaxing smooth muscles, decreasing uterine contractility
  • Causes fat to deposit in subcutaneous tissues over the maternal abdomen, back, and upper thighs
  • Decreases mother’s ability to use insulin
26
Q

Role of estrogen during pregnancy

A
  • Source; corpus luteum until 14 weeks gestation, then the placenta
  • Suppresses secretion of FSH and LH by the anterior pituitary
  • Causes fat to deposit in subcutaneous tissue over the maternal abdomen, back and upper thighs
  • Promotes enlargement of genitals, uterus, and breasts
  • Increases vascularity
  • Relaxes pelvic ligaments and joints
  • Interferes with folic acid metabolism
  • Increases the level of total body proteins
  • Promotes retention of sodium and water
  • Decreases secretion of hydrochloric acid and pepsin
  • Decreases mother’s ability to use insulin
27
Q

Role of oxytocin during pregnancy

A
  • Source; posterior pituitary
  • Stimulates uterine contractions
  • Simulates milk ejection from breasts
28
Q

Role of prolactin during pregnancy

A
  • Source; posterior pituitary

* Prepares breasts for lactation

29
Q

Hemoglobin, hematocrit/WBC, differential

Lab test in prenatal period

A
  • Detects anemia

* Detects infection

30
Q

Hemoglobin electrophoresis

Lab test in prenatal period

A

• Identifies women with gemoglobinopathies (e.g. sickle cell anemia, beta-thalassemia)

31
Q

Blood type, Rh, and presence of antibodies

Lab test in prenatal period

A

• Identifies fetuses at risk for developing erythroblastosis fetalis or hyperbilirubinemia in neonatal period

32
Q

Rubella, varicella and parvovirus B19 titre

Lab test in prenatal period

A

• Determined immunity to rubella chicken pox, and parvovirus (particuarlly in woman with previous child or exposure to children in workplace)

33
Q

TB skin testing (depending on history); chest film after 20 weeks gestation in woman with reactive TB test
Lab test in prenatal period

A

• Screens for exposure to TB

34
Q

Urinalysis; including microscopic examination of urinary sediment, pH, specific gravity, colour, glucose, albumin, proteins, RBCs, WBCs, casts, acetone, hCG
Lab test in prenatal period

A
  • Identifies women with unsuspected diabetes mellitus, renal disease, hypertensive disease of pregnancy
  • Infection
  • Occult hematuria
35
Q

Urine culture

Lab test during pregnancy

A

• Identifies women with asymptomatic bacteriuria

36
Q

Renal function tests: BUN, creatinine, electrolytes, creatinine clearance, total protein excretion
Lab test in prenatal period

A

• Evaluates level of possible renal compromise in women with a history of diabetes, hypertension or renal disease

37
Q

Papanicolaou test

Lab test in prenatal period

A

• Screens for cerical intraepithelial neoplasma. herpes simplex type 2, and HPV

38
Q

Vaginal or rectal smear for Neisseria gonorrhoea, Chlamydia, HPV, and GBS
Lab test in prenatal period

A
  • Screens high-risk population for asymptomatic infection

* GBS screening recommended at 35-37 weeks for all women

39
Q

RPD/VDRL/FTA-ABS

Lab test in prenatal period

A

• Identifies women with untreated syphilis

40
Q

HIV antibody, hepatitis B surface antigen, toxoplasmosis

Lab test in prenatal period

A

• Screens for the specific infections

41
Q

1hr glucose tolerance

Lab test in prenatal period

A
  • Screens for gestational diabetes
  • Done at initial visit for woman with risk factors
  • Recommended to be done at 28 weeks for all pregnant woman (earlier if risk factors)
42
Q

2hr glucose tolerance

Lab test in prenatal period

A
  • Screens for diabetes in women with elevated glucose level after 1hr test
  • Must have 2 elevated readings for diagnosis
43
Q

Cardiac evaluation: ECG, chest x-ray, echocardiogram

Lab test in prenatal period

A

• Evaluates cardiac function in women with s history of hypertension or cardiac disease

NUR360 LS1 (6 decks)

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