Pregnancy II Flashcards
What are some barriers to prenatal care?
Financial, Institutional practices, Denial, Cultural
Why is it important to take time with the client?
Avoid putting the client on the defensive
When should prenatal care begin?
First trimester
What should ideally be done before getting pregnant?
Preconception visit
What are the goals of the initial prenatal visit?
Confirm pregnancy, evaluate maternal health, assess growth and health of fetus, establish baseline data, evaluate psychosocial needs, assess needs for teaching, discuss plan of care for pregnancy
Which type of vaccines should not be given to mothers, what is an example that cannot be give?
live vaccines (can hard fetus), MMR cannot be given
What is the recommended folic acid intake for child-bearing age women?
400 mcg
What is the recommended folic acid intake during pregnancy?
600 mcg
What is the recommended folic acid intake for women with a history of neural tube defect?
4,000 mcg
What is EDD and how is it calculated?
EDD is calculated as 40 weeks from the LMP.
What is Nägele’s rule used for in determining the EDD?
Nägele’s rule is used to calculate the EDD by subtracting 3 months, adding 7 days, and correcting the year if necessary from the LMP
What factors are considered in determining the size of the fetus?
Ultrasound is used to determine the size and growth of the fetus.
How is Nagele’s rule calculated?
Date of last period - three months + 7 days
What does Nagele’s rule help calculate?
Gestational age
What does GP stand for in obstetric history?
Gravida (number of pregnancies) and para (number of births)
What does GTPAL stand for?
Gravida, term, preterm pregnancies, abortions, living children
How many weeks constitute a term pregnancy?
38-42 weeks
When are pregnancies considered preterm?
Anything below 38 weeks up to 21 weeks; and at 20 weeks they are considered abortions
What does the ‘A’ in GTPAL represent? what is the cutoff?
Abortions (spontaneous and induced). 20 weeks
What does the ‘L’ in GTPAL represent?
Living children
What does gravida G stand for?
Number of times pregnant
What is the term for a full-term pregnancy?
Term T = 38-42 weeks
What is considered preterm?
P = 20 weeks – 37 weeks and 6 days
What is considered an abortion?
A = anything less than 20 weeks
What are some components of the physical examination?
Height and weight, vital signs, fundal height, fetal heart sounds
Urinalysis, breast and reproductive organs
What is measured to determine the position and growth of the uterus?
Fundal height
How does BMI impact pregnancy?
25-35 pounds gained if regular BMI
Why are vital signs important in pregnancy?
Baseline for comparison
What is fundal height?
Measurement of pregnancy growth
Where should the fundal height be at 15 weeks?
Just above symphysis pubis
What can protein in the urine indicate?
Preeclampsia
Is finding of glucose in the urine alarming?
No, it is ok.
When can ketones in urine be observed?
Uncontrolled nausea/vomiting or dehydration
What can cause UTI during pregnancy?
Urinary stasis due to pressure on the uterus
What can discharge indicate?
Gonorrhea or chlamydia
What does blue cervix color indicate?
Pregnancy, known as Chadwick’s sign
How often are prenatal visits recommended during the first trimester?
Once a month
What should be monitored during ongoing visits?
Vital signs, progress of weight gain, urinalysis
What is the significance of fundal height? when is it relevant?
Approximately equal to gestational age. 20-32 weeks
What is the recommended frequency of prenatal visits?
monthly until third trimester, twice a month in the third trimester, every week closer to labor
When should prenatal visits be scheduled every week?
37 weeks to delivery
Why is it important for patients to void before measuring their fundal height?
ensures accuracy
What is the purpose of palpating the belly during ongoing visits? what is this called?
To determine how the baby is positioned. Leopold’s Maneuvers - looking for babies back and this is where you can hear heart tones the best, look for longest smoothest part to find baby
What can help stimulate movement of the baby? how many kicks do you want an hour? when are they felt most?
Drinking or eating. 10 kicks in an hour, felt more around 20 weeks
What are the signs of labor?
Effacement and dilation, rupture of membranes, contractions, bleeding
What can ultrasounds check during pregnancy?
Gender, placenta status, and location
When is the glucose screening test done?
24-28 weeks along
What is the purpose of the glucose screening test?
Check for gestational diabetes
What happens if the FSBS is 140 mg/dL or more?
Tolerance test
Why is RhoGAM given to negative RH mothers?
To prevent the mother from rejecting a positive RH baby
When is RhoGAM given?
At 28 weeks and within 72 hours post delivery (if baby is positive)
When is RhoGAM less crucial?
For the first birth
When would you want RhoGAM?
If there is any invasive procedure or risk for exposure
Why is a pap smear done?
To check for cancer
Why is screening for anxiety and depression important?
To ensure open communication
What is the focus of the 1st trimester?
On the mother
What is the focus of the 2nd trimester?
On the baby
What can happen during the 3rd trimester?
Anxiety and fear, checking on home life
What are some possible signs of a multifetal pregnancy?
Fundal height, N/V three times more often, fatigue and backache
Why might a pregnant woman have more frequent prenatal visits?
Multifetal pregnancy
What is the significance of increased fundal height?
Possible indication of multifetal pregnancy. increases by 4cm than is expected for gestational age.
How much weight should a mom gain for multifetal pregnancies?
37-54 pounds
Are more prenatal visits needed for multifetal pregnancies?
Yes
During which trimester will a mom with multifetal pregnancy be seen more frequently?
2nd trimester
What are some discomforts of pregnancy? upper body
NV, heartburn, backache, round ligament pain (R side), urinary frequency.
What is round ligament pain and where does it usually occur?
Pain in the round ligament; usually on the right side; it is pain that occurs when uterus and surrounding ligaments are stretching for baby
What is a common issue with urinary system during pregnancy?
Urinary frequency
What can cause heartburn during pregnancy?
progesterone decreases smooth muscle.
How can backache be relieved during pregnancy?
Heat and tylenol, do not gain excess weight, pelvic tails, stretches
How can round ligament pain be relieved?
Heat is really going to help
Why do pregnant women experience urinary frequency?
Due to increased pressure
What is the recommendation for drinking water during pregnancy?
Still drink plenty of water
What are some discomforts of pregnancy? lower body
Hemorrhoids, constipation, leg cramps, varicose veins, dependent edema, urinary frequency
What can help reduce inflammation from hemorrhoids?
Witch hazel
How can constipation be relieved?
Increase movement, fiber, and water intake
What can cause constipation?
Iron
What should be done to alleviate leg cramps?
Point toe towards head (dorsoflex), take magnesium and calcium supplements
What can help with varicose veins?
Compression stockings
How should one position their legs to relieve dependent edema?
Rest with feet elevated
What is the recommended use of hot tubs?
Limited
Is douching considered good for health?
bad
Why is it important to educate about breast care?
Breast stimulation can release oxytocin and stimulate labor
What type of clothing is recommended for health?
Nonrestrictive
What are some teaching points for exercise?
Beneficial in moderation
What should be emphasized about sleep and rest?
Pillows
What should be mentioned about sexual activity?
Safe with some precautions
culture considerations
When should pregnant women avoid sexual activity?
Ruptured membranes and risk of preterm labor
What should pregnant women remember about travel?
seatbelt under the belly,
Until what gestational week is it generally considered safe to travel by plane?
36 weeks
Are live vaccines safe?
No
When should Tdap be given during pregnancy?
27-36 weeks
Is smoking good for your health?
No
Is alcohol consumption recommended?
No
Are illicit drugs harmful?
Yes
What should you do if you have a live vaccine?
Wait one month until you get pregnant
What stages of pregnancy are covered in early pregnancy classes?
1st and 2nd trimester
What is the focus of childbirth preparation classes?
Preparing for birth during the 3rd trimester
What are some types of perinatal education?
Refresher courses, breastfeeding classes, parenting and infant care classes, sibling classes
What are the recommendations for weight gain during pregnancy based on a normal pre-pregnancy BMI?
25-35 lbs.
How much weight gain is recommended for adolescents during pregnancy?
Use adult BMI
What is the recommended weight gain for a multifetal pregnancy of normal BMI?
37-54 lbs.
How much weight gain is typical in the first trimester of pregnancy?
Approx. 1.1-4.4 lbs.
What is the recommended rate of weight gain per week for someone with a normal BMI after the first trimester?
1 lb./week afterwards
how many calories on average do you need on average more than usual while pregnant?
2200-2900
What is protein necessary for?
Metabolism, tissue synthesis, and tissue repair
How long is the recommended healing time between births?
18-24 months
What are the fat-soluble vitamins?
A, D, E, & K
What can happen if there is excessive intake of fat-soluble vitamins?
Toxicity
Which vitamins are water-soluble?
B6, B12, C, folic acid, thiamin, riboflavin, & niacin
What happens to excess water-soluble vitamins?
Excreted in urine
Can toxicity occur with water-soluble vitamins?
Yes
What is the role of folic acid?
Decreases occurrence of neural tube defects
What is the daily recommended intake of folic acid for nonpregnant individuals?
400 mcg
What is the daily recommended intake of folic acid during pregnancy?
600 mcg
What is the daily recommended intake of folic acid for individuals with a previous child with neural tube defect?
4000 mcg (4 mg)
What stays in the fat?
Fat soluble vitamins
What are some sources of folic acid?
Leafy greens, legumes, beans, lentils, orange juice, cereal
What are the side effects of iron supplementation?
N/V, heartburn, constipation, diarrhea, black stools
What mineral helps with neural development?
Choline
What should iron be taken with?
Vitamin C
What type of supplements should be taken during pregnancy?
Prenatal vitamin supplements
How much water should be consumed daily?
Approximately 10 cups
What is one food precaution during pregnancy?
Avoid raw fish -high levels of mercury can damage fetal CNS
What is one potential risk of consuming high levels of mercury during pregnancy?
Can damage fetal CNS
What is one foodborne illness that can cause complications in pregnancy?
Listeriosis caused by Listeria monocytogenes
What type of food is commonly associated with Listeria infection?
Cold meats in the refrigerator
What are the potential consequences of Listeria infection in pregnancy?
Stillbirths and preterm labor
What is one source of toxoplasmosis that pregnant women should avoid?
Cat feces
What are some food products pregnant women should avoid to prevent toxoplasmosis?
Unpasteurized products, undercooked eggs & meat, cold deli salads, raw sprouts
What are some factors that influence weight gain?
Age, Knowledge, Exercise, Culture
Is culture a factor that influences weight gain?
Yes
Can cultural preferences influence whether food is served hot or cold?
Yes
What are some nutritional risk factors?
Poverty, vegetarians/vegans, lactose intolerance, n/v, anemia.
What are the symptoms of lactose intolerance?
Nausea, bloating, flatulence, diarrhea, intestinal cramping
What should a woman do if she weighs less before pregnancy?
Might need to gain more weight
What is one maternal condition that can pose a nutritional risk factor during pregnancy that is also a psychological disorder.
Eating disorders
How long does it typically take for a woman to heal from her first pregnancy before having another?
18-24 months
What is one nutritional recommendation for women with multiple fetuses?
Consume 300 extra calories per baby
What are food cravings often related to?
Changes in senses
What is pica?
Craving nonnutritive substances
What do some cultures believe about cravings?
Cravings are the baby having a craving and it needs to be satisfied so they dont die
How does smoking affect fetal growth?
Interferes with fetal growth
Spontaneous abortion, low birth weight, placental abruption, placenta previa, preterm birth, perinatal mortality, sudden infant death syndrome
What is the recommended caffeine intake for pregnant women?
< 200 mg/day
What can alcohol be associated with in the baby?
Fetal alcohol spectrum disorders
What is the recommended amount of coffee intake?
Up to 8 oz
What are the risk factors for adolescents who are pregnant?
Higher risk for complications
What is an important consideration for the growth of both the mother and the fetus in adolescent pregnancies?
Mother’s growth vs. fetal growth
What approach should healthcare providers take when giving suggestions to pregnant adolescents?
Minimize suggestions
What should healthcare providers focus on when caring for pregnant adolescents?
Important changes
How can healthcare providers actively involve pregnant adolescents in their care?
Ask for her input
How many additional calories does a lactating mother need during the first 6 months?
330 calories
How many additional calories does a lactating mother need during the second 6 months?
400 calories
Are there any food restrictions for a lactating mother?
No
What should a lactating mother avoid consuming?
Alcohol and caffeine
What is a safe rate of weight loss for a lactating mother that does not compromise milk supply?
1-1.5 lbs./week
What should a nonlactating mother’s pre-pregnancy diet include to promote healing?
Protein and vitamin C
What should a nonlactating mother continue to take after delivery?
Prenatal vitamins
How long should a nonlactating mother wait after delivery before dieting?
Three weeks
How long should they let their injuries heal before exercising after delivering?
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.
What is the average weekly weight loss?
1-1.5 lbs.
How much weight can be lost within the first year?
All but 2.2 lbs.
