prenatal Flashcards
• Concept of fundal height. What are the normal assessment levels?
Fundus of the uterus is at symphysis pubis at 10-12 weeks gestation. Fundus at umbilicus at 20-22 weeks.
How does fundal height correlate with gestational age?
1 cm per week after 20 weeks
What is the significance if the fundus is below expected level or higher than expected level?
Intrauterine growth restriction or macrosomia due to various conditions
Prior to measuring the fundal height what must the patient do?
void
• Supine hypotensive syndrome. What is it?
Baby presses on the vena cava causing a decreased blood return to the heart. This occurs when mom is lying on her back.
What are the signs and symptoms of Supine hypotensive syndrome
Decrease in blood pressure and mom becomes pale.
What is the priority nursing intervention for Supine hypotensive syndrome
Have the woman lie on her left side or put a pillow under her right buttock.
How is that intervention modify in case of surgery or a woman is unresponsive- Supine hypotensive syndrome
right buttock
How do you know your nursing intervention was effective-Supine hypotensive syndrome
Blood pressure will return to baseline and tissue perfusion returns to pink
• Skin changes associated with pregnancy-4
- Linea Nigra line from umbilicus to symphysis pubis. 2. Mask of pregnancy (chloasma or melisma gravidarum) dark skin over cheek, nose, and forehead.
- Striae or stretch marks may not disappear completely.
- Vascular spider nevi, chest, neck, face and arms
What is important to tell the mother regarding these skin changes
Usually disappear in 6 weeks except for striae (may just fade some)
• Physiological anemia of pregnancy.
? RBC increases by 30% and plasma volume increases by 50 % which causes a decrease in the hematocrit
-iron supplements
What are the presumptive (subjective) signs-6
Amenorrhea, nausea and vomiting (morning sickness), fatigue, urinary frequency, changes in breast and quickening (18-20 weeks)
What are the probable (objective) signs-9
Goodells, Chadwick’s sign, Hegar’s sign, McDonalds sign ,Braxton Hicks contractions after 28 weeks, uterine soufflé, pigment skin changes, fetal outline after 24 weeks, pregnancy tests.
Goodells
softening of the cervix
Chadwick’s sign
bluish, purple or deep red cervix, vagina, mucous membranes
Hegar’s sign
softening of the isthmus
McDonalds sign
ease of flexing the cervix
What are the positive signs-4
Diagnostic: fetal heartbeat Doppler 10-12 weeks, fetoscope 17-20 weeks, fetal movement at 20 weeks, visualization of the fetus at 8 weeks ultrasound
• Psychological responses to pregnancy for mother?
1st trimester: Ambivalent seems unreal, 2nd trimester: feels best and may feel baby move, 3rd trimester: Discomfort, insomnia, concerned about Labor and has pride of pregnancy.
Psychological responses to pregnancy for Father of the baby
1st trimester: Tends to feel left out. 2nd trimester: Fathering behaviors 3rd trimester: Involvement and attends childbirth classes
GTPAL
G= gravida, T= term, P= preterm, A=abortion and L= living.
Nagele’s rule
add 1 year, subtract three months and add 7 days
timing of pregnancy appointments
once a month until 28 weeks, at which point she will be seen every two weeks until 36 weeks, then she will be seen every week until birth.
• Discomforts of pregnancy 1st T-4
urinary frequency, nausea/vomiting, breast tenderness, vaginal discharge
-accupressure wristbands, ginger, pyridoxine (B6)
Discomforts of pregnancy 2nd T-4
heartburn, varicose veins hemorrhoids, backache
-low-sodium antacid (*avoid Na bicarb and alkaseltzer), avoid bending at waist
Discomforts of pregnancy 3rd T-2
hemorrhoids, backache
• Weight gain in pregnancy
1T- 3.5 – 5 lbs
2T- 12-15
3T- 12-15
weight gain based on gestation
4.4 1T then 1 lb per week after
calorie intake in 2T and 3T
extra 300
