Pregnancy II Flashcards
What are some barriers to prenatal care?
Financial, Institutional practices, Denial, Cultural
What can happen if you don’t take time with the client?
They might feel defensive
When should prenatal care begin?
First trimester
What is the purpose of a preconception visit?
To ideally start prenatal care
What is the purpose of the initial prenatal visit?
Confirm pregnancy and evaluate maternal health
What are some things assessed during the initial prenatal visit?
Growth and health of fetus, maternal psychological needs, and teaching needs
What is discussed during the initial prenatal visit?
Plan of care for pregnancy
Can live vaccines be given to pregnant mothers?
No
Can MMR be given to pregnant mothers?
No
What is the recommended folic acid dosage for a non-pregnant person of childbearing age?
400 mcg
What is the recommended folic acid dosage for a pregnant person?
600 mcg
What is the recommended folic acid dosage for a person with a history of a neural tube defect?
4,000 mcg
What is the EDD?
40 weeks from LMP
What is Nägele’s rule?
subtract 3 months, add 7 days, and correct the year if necessary
What is a gestational wheel?
A tool used to estimate the gestational age
What is an ultrasound used for?
To determine the size of the fetus
What is Nagele’s rule used for?
Calculating expected delivery day
How does Nagele’s rule calculate expected delivery day?
Date of last period - three months + 7 days
What does Nagele’s rule calculate?
Gestational age
What does GP stand for in obstetric history?
G = # pregnancies, P = # pregnancies >20 wks.
What does GTPAL stand for?
G = gravida, T = term pregnancies delivered, P = preterm pregnancies delivered, A = abortions, L = living children
How many weeks does a term pregnancy last?
T = term pregnancies delivered; 38-42 weeks
How many weeks is considered a preterm delivery?
Anything below 38 weeks and up to 20 weeks
What does gravida G represent?
Number of pregnancies
What is the term for a pregnancy that lasts between 38 and 42 weeks?
Term pregnancy
What is the term for a pregnancy that ends between 20 weeks and 37 weeks and 6 days?
Preterm pregnancy
A 34-year-old female is 32 weeks pregnant with her first set of twins. She has three living children. Two of the three childrenwere each bornat 39 weeks gestation. One child was born at 24 weeks gestation. Two years ago, she had a miscarriage at 16 weeks gestation. What is her GTPAL?
_____________
A 42-year-old female is currently 16 weeks pregnant. She has two-year-old twins that were born at 39 weeks gestation and a stillbirth at 22 weeks gestation. What is her GTPAL?
______________
What is the term for a pregnancy that ends before 20 weeks?
Abortion
What are some components of a physical examination?
Height and weight, vital signs, fundal height, fetal heart sounds
What measurements are taken for height and weight during a physical examination?
if patient has normal bmi you want mom to gain about 25 to 30 lbs
What are vital signs?
hypertension 130 twice in a doctors office
What is fundal height in terms of week 20 to 32 weeks?
from 20-32 wks.., fundal height in cm. is approx. equal to gestational age) ( not as accurate when there is more than one baby)
What are fetal heart sounds?
Fetal heart sounds
What is the impact of BMI on pregnancy weight gain?
25-35 pounds gained if they have a regular BMI at the start of their pregnancy
What vital signs should be monitored during pregnancy?
Baseline vital signs
Why is fundal height measured during pregnancy?
To track fetal growth at a certain rate
When should fundal height be measured at 15 weeks?
Just above the symphysis pubis
What should be monitored regarding fetal development?
Fetal heart sounds
What is a common test done during a physical examination?
Urinalysis
T/F monthly until third trimester after you go bimonthly and at 37 you wanna see them every week
TRUE
What areas of the body are examined during a physical examination?
Breast and reproductive organs because abnormalities can indicate infections
What can protein in the urine indicate during pregnancy?
Preeclampsia
What is an expected finding of glucose in the urine during pregnancy?
Normal 70 to 100
When can ketones in the urine occur?
Uncontrolled nausea/vomiting or dehydration
Why can a UTI occur during pregnancy?
Due to urinary stasis caused by pressure on the uterus
What can discharge indicate during pregnancy?
Gonorrhea or chlamydia
What does a blue cervix indicate during pregnancy?
Chadwick’s sign
How often should prenatal visits be scheduled during the first trimester?
Once a month
What are some things that are typically monitored during ongoing visits?
Vital signs, progress of weight gain, urinalysis, fundal height
What is correlated to fundal height?
Fundal height – from 20-32 wks.., fundal height in cm. is approx. equal to gestational age) ( not as accurate when there is more than one baby)
What is monitored during ongoing visits?
Vital signs, weight gain, urinalysis, fundal height
What is the recommended frequency of prenatal visits?
monthly until third trimester, twice a month in the 3rd trimester, every week closer to labor
When should prenatal visits be closer to each other?
37 weeks to delivery; once a week
Why is it important for pregnant women to void before measuring their fundal height?
ensures accuracy
What is the purpose of palpating the belly during an ongoing visit?
To determine how the baby is positioned
Why would a healthcare provider want to feel the baby’s back during an ongoing visit?
To hear the baby’s heart tones the best
What is quickening?
The fluttering feeling when the baby is moving
What is the recommended number of kick counts in an hour?
At least 10
What can help stimulate movement of the baby during an ongoing visit?
Drinking or eating
Looking for babies back and this is where you can hear heart tones the best, look for longest smoothest part to find baby
Leopold’s Maneuvers
What are some signs of labor?
Effacement and dilation, rupture of membranes, contractions, bleeding
What is the purpose of ultrasounds during an ongoing visit?
To check the baby’s gender, how the placenta is doing, and its location
When do you start counting quickens?
Quickening, kick counts - looks for a specific number within an hour 10 kicks/hr
start counting at 20 weeks along, baby is felt more
What is the purpose of a glucose screening?
To check for gestational diabetes
When is the glucose screening typically done?
Around 24-28 weeks
What is the cutoff value for the one-hour glucose screening?
140 mg/dL or more
When would you want to administer RhoGam?
she will get this at 28 weeks, so mom’s antibodies do not attack baby and then 72 hours after birth
What additional test is done if the one-hour glucose screening indicates high levels?
Tolerance test
What is RhoGAM used for?
Isoimmunization; RH positive baby with RH negative mom
What are some routine examinations that are done during ongoing visits?
Pelvic exam and Pap smear
What are two common mental health concerns during pregnancy?
Anxiety and depression
Why is RhoGAM given to a negative RH mother?
To prevent rejection of a positive blood type baby
When is RhoGam given?
At 28 weeks and within 72 hours post delivery
When would you want to administer RhoGam?
After invasive procedures like amniocentesis
What is the purpose of a pelvic exam and Pap smear?
To check for cancer
Why is screening for anxiety and depression done during pregnancy?
For open communication and support
What is the focus of each trimester?
1st: Mother, 2nd: Baby, 3rd: Roller coaster, checking on home life
What are some signs and symptoms of a multifetal pregnancy?
N/V three times more often, fatigue and backache
Why might a pregnant person with a multifetal pregnancy need more frequent prenatal visits?
To monitor the development and health of multiple fetuses
How does fundal height change in multifetal pregnancies?
Increases by 4 cm more than expected for gestational age
How much weight should a mother gain in a multifetal pregnancy?
37-54 pounds
How often should a mother with multifetal pregnancies have prenatal visits?
More frequent prenatal visits
During which trimester will mothers with multifetal pregnancies be seen more?
2nd trimester
What is N/V?
Morning sickness; hormone changes
What is a common discomfort of pregnancy?
Heartburn; because of progesterone decreasing the smooth muscles
What is another discomfort of pregnancy?
Backache
What causes round ligament pain?
Stretching of ligaments usually on the right side
What is a common urinary symptom during pregnancy?
Urinary frequency
What can cause heartburn during pregnancy?
Decreased progesterone
How can backache during pregnancy be alleviated?
Heat, tylenol, do not gain excessive weight
What is round ligament pain?
Pain in the ligament on the uterus
Where is round ligament pain usually felt?
On the right side
What can help with urinary frequency during pregnancy?
Drinking plenty of water
What can help with the inflammation of hemorrhoids?
witch hazel
What are some ways to alleviate constipation?
movement, fiber, water
How can leg cramps be managed?
point toe towards head, magnesium and calcium supplements
What can be used to alleviate varicose veins?
compression stockings
What can help with dependent edema?
resting with feet elevated
What is the importance of daily bathing?
Good for hygiene
How should hot tub use be approached?
Limited
Is douching considered good or bad?
bad
What should be done in terms of breast care?
educate about breast stimulation, don’t use soap on nipples
Can breast stimulation release oxytocin?
Yes
What type of clothing should be worn for health behaviors?
Nonrestrictive
What can help decrease nausea and vomiting?
Separating fluids from meals
What are some health behaviors related to exercise?
Beneficial in moderation
What is important for sleep and rest during pregnancy?
Pillows
Is sexual activity safe during pregnancy?
Yes
Are there any sexual taboos during pregnancy?
Yes
When is sexual activity not safe during pregnancy?
Ruptured membranes or at risk for preterm labor
What should pregnant women do during travel?
Proper seat belt use
Where should the seat belt go for pregnant women on a plane?
Under the belly
Until what week is it generally safe to travel by plane?
36 weeks
Are live vaccines safe?
Not safe
When is Tdap recommended?
27-36 weeks
Is smoking good for health?
Not good
Is alcohol consumption bad for health?
Bad
Are illicit drugs good for health?
Really bad
If you have a live vaccine, what should you do before getting pregnant?
Wait one month
What is the focus of perinatal education?
Preparing for pregnancy and childbirth
What topics are covered in preconception classes?
Preparing for pregnancy
What stages of pregnancy are covered in early pregnancy classes?
1st and 2nd trimester
What type of classes are available for exercise during pregnancy?
Exercise classes
What trimester is childbirth preparation covered in?
3rd trimester
What types of classes does Perinatal Education offer?
Refresher courses, breastfeeding classes, parenting and infant care classes, sibling classes
What are the recommendations for weight gain during pregnancy for women with a normal BMI?
Gain 25 to 35 lbs.
What should the weight gain recommendations be for adolescents with a normal BMI during pregnancy?
Use adult BMI
What are the weight gain recommendations for women with a multifetal pregnancy and a normal BMI?
Gain 37 to 54 lbs.
How much weight gain is considered normal in the first trimester of pregnancy?
Approx. 1.1 to 4.4 lbs.
What is the recommended weight gain per week for women with a normal BMI after the first trimester?
1 lb./week
What is energy?
Calculated in kilocalories
What is the average calorie intake needed in pregnancy?
2200-2900 calories/day
What are the additional calorie needs in the first trimester?
No additional needs
What are the additional calorie needs in the second trimester?
Increase of 340 calories
What are the additional calorie needs in the third trimester?
Increase of 452 calories
What are the additional calorie needs in the first 6 months of lactation?
330 calories
What are the additional calorie needs in the second 6 months of lactation?
400 calories
What are carbohydrates?
Macronutrients that provide energy
What are sources of simple sugars?
Fruits and vegetables
What are sources of complex carbohydrates?
Starches like cereal, pasta, and potatoes
How many grams of carbohydrates are needed per day for nonpregnant individuals?
130 g/day
How many grams of carbohydrates are needed per day during pregnancy?
175 g/day
How many grams of carbohydrates are needed per day during lactation?
210 g/day
What are proteins necessary for?
Metabolism, tissue synthesis, tissue repair
How much protein increase is needed during pregnancy?
25 g/day
How much protein is needed per day in nonpregnant individuals?
46 g/day
How much protein is needed per day during pregnancy?
71 g/day
How much protein is needed per day during lactation?
71 g/day
How long does it take to heal between births?
18-24 months
What do fats provide?
Energy and fat-soluble vitamins
What are the recommended daily intake of fats for a nonpregnant person?
10% of total food intake/day
What are the recommended daily intake of fats during pregnancy?
20-35% of total food intake/day
How much fats should be consumed daily?
6-8 tsp./day
What type of fats should be consumed mostly?
Unsaturated fats
What are the fat-soluble vitamins?
A, D, E, & K
What can happen with excessive intake of fat-soluble vitamins?
Toxicity
What are the water-soluble vitamins?
B6, B12, C, folic acid, thiamin, riboflavin, & niacin
What happens to excess water-soluble vitamins?
Excreted in urine
Can toxicity occur with excess water-soluble vitamins?
Yes
What is the recommended daily intake of folic acid for nonpregnant individuals?
400 mcg
What is the recommended daily intake of folic acid during pregnancy?
600 mcg
What is the recommended daily intake of folic acid for individuals with a previous child with neural tube defect?
4000 mcg (4 mg)
What is the benefit of folic acid intake?
Decreases occurrence of neural tube defects
Name some natural sources of folic acid?
Leafy greens, legumes, beans, lentils, orange juice
What food product also contains folic acid?
Cereal
What is the recommended daily intake of iron?
27 mg/daily
What is the recommended daily intake of iron supplementation?
60-120 mg/day
What are the side effects of iron supplementation?
N/V, heartburn, constipation, diarrhea, and black stools
What mineral helps with neural development?
Choline
What should iron be taken with?
Vitamin C
What are some other recommendations?
Prenatal vitamin supplements, Water intake, choosemyplate.gov
How much water should be consumed daily?
Approximately 10 cups
What food should you avoid during pregnancy?
Raw fish
What can high levels of mercury do to the fetus?
Damage fetal CNS
What can Listeria monocytogenes cause?
Listeriosis
Where can Listeria monocytogenes be found?
Refrigerator with cold meats
What can Listeria monocytogenes cause in pregnancy?
Stillbirths and preterm labor
What can cause Toxoplasmosis during pregnancy?
Unpasteurized products, undercooked eggs & meat, cold deli salads, raw sprouts, and cat feces
What are some factors that influence weight gain?
Age, Knowledge, Exercise, Culture
How does age influence weight gain?
No answer provided
How does knowledge influence weight gain?
No answer provided
How does exercise influence weight gain?
No answer provided
What should be considered before making assumptions related to culture?
Assess each woman individually
What can hot or cold food be influenced by?
Cultural factors
Give examples of cultures where hot or cold food preferences exist.
Asian and Latino
What are some nutritional risk factors?
Poverty
What are the signs and symptoms of lactose intolerance?
nausea, bloating, flatulence, diarrhea, and intestinal cramping
What are the signs and symptoms of anemia?
see slide on minerals
What are the nutritional risk factors associated with abnormal prepregnancy weight?
Need to gain more if you weigh less
What are the nutritional risk factors associated with eating disorders?
Eating disorders
How long does it take to heal up from the first pregnancy in the case of multiparity?
18-24 months
How many additional calories should be consumed for each baby in the case of multifetal pregnancy?
300 calories more per baby
What is pica?
Craving nonnutritive substances
What may food cravings be related to?
Changes in senses
What do some cultures believe cravings during pregnancy signify?
Baby’s craving needs to be satisfied
What is one substance that interferes with fetal growth?
Smoking
What is the recommended caffeine intake during pregnancy?
< 200 mg/day
How many milligrams of caffeine are in an 8 oz cup of coffee?
137 mg
How many milligrams of caffeine are in an 8 oz cup of brewed tea?
48 mg
How many milligrams of caffeine are in a 12 oz can of cola beverages?
37 mg
How many milligrams of caffeine are in a packet of cocoa mix?
8-12 mg/packet
What is the association of alcohol with pregnancy?
Fetal alcohol spectrum disorders
Are drugs dangerous to both mom and baby?
Yes
What is the recommended amount of coffee that is considered okay?
up to 8 oz
What are some potential complications for adolescents who are pregnant?
Higher risk for complications
How does the growth of the mother compare to the growth of the fetus?
Mother’s growth vs. fetal growth
What are some common concerns about pregnancy for adolescents?
Body image concerns
How should suggestions be approached when working with pregnant adolescents?
Minimize suggestions
What should be the focus when working with pregnant adolescents?
Focus on important changes
What is a helpful approach when working with pregnant adolescents?
Ask for her input
How many extra calories does a lactating mother need in the first 6 months?
330 calories
How many extra calories does a lactating mother need in the second 6 months?
400
Are there any food restrictions for a lactating mother?
No
What should a lactating mother avoid?
Alcohol and caffeine
What is a safe rate of weight loss for a lactating mother?
1-1.5 lbs./week
Will weight loss compromise milk supply?
No
What should you be aware of when it comes to your baby and food?
Some foods can aggravate your baby.
What diet is recommended for a nonlactating mother?
Pre-pregnancy recommended diet
What nutrients promote healing for a nonlactating mother?
Protein and vitamin C
Should a nonlactating mother continue taking prenatal vitamins?
Continue prenatal vitamins
How long should a nonlactating mother wait before dieting after delivery?
Wait three weeks after delivery
How long should they let the injuries heal before exercising?
3 weeks
How much weight can be lost immediately?
10-13 lbs.
How much weight can be lost during the first week?
7-11 lbs.
How much weight can be lost per week?
1-1.5 lbs.
How much weight can be lost within the first year?
All but 2.2 lbs.
