Prenatal Care Flashcards
What are the presumptive signs of pregnancy?
“self reported”
1) Amenorrhea (no period)
2) N/V
3) Quickening (movement)
4) Urinary frequency
5) Breast tenderness & fatigue
What are the probable signs of pregnancy?
“objective signs”
1) Goodell’s Sign: cervical softening
2) Chadwick’s Sign: blue/purple birth canal
3) Hegar’s Sign: softening of lower uterine segment
4) Ballottement
5) + HCG Test: elevated levels of HCG
can also be caused by gestational trophoblastic disease
What are the positive signs of pregnancy?
“diagnostic”
1) Fetal heartbeat heard by Doppler device at 10-12 weeks
2) Ultrasound visualiziation of the fetus
3) Fetal movement (palpated or observed by HCP)
What is EDB?
“Expected Date of Birth”
Formula: 1st day of LMP - 3 months + 7 days = EDB
Uterine Growth & Fundal Height
12 weeks: above symphysis pubis
16 weeks: halfway between symphysis pubis and umbilicus
20 weeks: at umbilicus
fundal height in cm should = weeks of gestation + or - 2 weeks
36 weeks: xiphoid process
38 - 40 weeks: fetus engages & fundal height drops
GPTPAL Assessment
G: Gravida
number of pregnancies including abortion, miscarriage & current pregnancy
Nulligravida: 0
Primigravida: 1st pregnancy
Multigravida: more than once
P: Para
number of deliveries after 20 weeks gestation
T: Term Births
number of deliveries over 37 weeks gestation
P: Preterm Births
number of births between 20-37 weeks
A: Abortion
miscarriage
L: Living Children
live births
What medications should we avoid during pregnancy?
1) NSAIDS
N: Naproxen
S: Salyslic acid
A: Aspirin
I: Ibuprofen & Indomethacin
K: Ketorolac
2) ACE & ARBs
“-pril” (NO Prils during Pregnancy)
“-sartan” (Sartans = Satan to pregnancy)
3) Doxycycline & Tetracycline
Cycling on a bike is dangerous during pregnancy
4) Carbamazepine
Safe vaccines during pregnancy
Inactive influenza (flu shot)
Tdap vaccine 27 - 36 weeks
T: Tetanus
D: Diphtheria
P: Pertussis
Not safe vaccines during pregnancy
NO LIVE Vaccines
due to suppressed immune system and increased risk for illness.
no live vaccines given during & up to 1-3 months before pregnancy.
can cause serious birth defects
safe after pregnancy
Varicella - zoster
Rotavirus
Live or activated influenza
MMR: measles, mumps, rubella
General patient education
Avoid ETOH / tobacco
Obtain testing for rubella immunity
Scheduale dental wellness appt
2nd trimester:
gestational diabetes & preecampsia screening
anticipate quickening “light fetal movements”
abdominal ultrasound evaluation
Weight Gain:
expected weight gain: 25-35 lbs during pregnancy
maintian BMI of 18.5-24.9 kg
gain of 1 lb per week if pre pregnancy BMI was normal during 2nd/3rd trimester
Vitamins & Minerals Patient Education
Folic acid 400 mcg / day –> prevents neural tube defects
Calcium 500 mg / day
Iron (ferrous sulfate) –> prevent anemia
take on empty stomach
increase Vit C to aid absoprtion
risk for constipation
Food Patient Education
Protien foods rich w/ calcium, iron, & B vits
ex: grilled chicken, turnip greens, peanut butter, & juice
Avoid:
unhealthy: excess salt, butter, fat, margarine
unsafe dairy: unpasteurized
deli-made egg salad
Types of Anemia
1) Iron Deficiency
low iron
2) Sickle Cell
3) Pernicious
cannot absorb B12
4) Aplastic
impairment in bone marrow
5) Hemolytic
destruction of RBCs
Anemia Causes
Blood loss: surgery, truama, excessive menstruation
Chemo & Immunosuppressants: suppress bone marrow –> aplastic anemia
Lack of iron, B12 & other building blocks –> iron def & pernicious anemia
Hemoglobin Values
Normal 12 +
Bad: 8-9
Less than 7 = heaven
Iron Deficiency Anemia - Causes
Diet low in: meat, fish, poultry
Gastric Bypass surgery
Pregnancy: fetus stores iron
Pica: LOW hemetocrit & hemo levels
Other:
Low B 12
Hypochlorhydria (low stomach acid)
Gastric atrophy (atrophic gastritis)
Iron Def Anemia - Causes in Infant/Children
Premature birth
Insufficient oral intake
Excess milk intake
Preterm infants exclussively bottle fed w/ breast milk
Iron Def Anemia: Diet for Vegans
Fortified breads & cereals
HIGH iron foods w/ HIGH vit C
Calcium & Vit D
Txt for Iron Deficiency Anemia
Food rich in iron: meat, fish, poultry, green leafy veggies (spinach), whole grains
Iron + Vit C (alongside not with)
Txt of Fe Def Anemia for Infant/Children
limit EXCESSIVE milk intake
Pharmacology for Fe Def Anemia
Ferrous Sulfate (oral)
Iron Dextran (IV/IM)
dark or black stools are normal. IS NOT GI bleed.
empty stomach one hour before medications (Fe blocks other meds).
Sickle Cell Anemia
Distorted shape RBCs. They die quicker, carry less O2, & get clogged in tiny blood vessels –> ischemia to organs.
Sickle Cell Anemia S/S
Blood Clot Manifestations
- one sided arm weakness
- swelling of feet and hands (Dactylics)
New onset paralysis of ext
Sudden inability to be aroused
Sickle Cell Anemia Complications
Splenic sequestration crisis:
rapidly enlarging spleen
low blood pressure
Sickle Cell Anemia Txt
Hydration: IV fluids
Bed Rest
Pain Control: PCAP
Pernicious Anemia S/S
Glossitis: inflamed red smooth tongue
Extreme weakness
Jaundice
Pernicious Anemia Txt
B12 - injection: IM or IV // NOT orally
Discomforts of Pregnancy
- Morning Sickness
- Hyperemesis Gravidarum
- Constipation
- Intrahepatic Cholestasis
- UTI
- Heartburn
Morning Sickness
Nausea during the first trimester
Morning Sickness Interventions
- consume high protein snacks upon awakening
- small frequent meals
- drink fluids between meals (30 mins before or after)
- ginger
- vit B6
Hyperemesis Gravidarum
persistent n/v PAST 12 weeks –> considerable weight loss, fluid/electro imbalance, & malnutrition.
Hyperemesis Gravidarum S/S
- excessive vomiting –> dehydration
- electrolyte imbalance (hypokalemia)
- urine analysis: Ketonuria and high specific gravity
- weight loss & nutrition deficits
Hyperemesis Gravidarum Interventions
- monitor: weight and I&Os
- IV fluids
- Antiemetics: Ondansetron // B6 vit
- increase –> dairy, lemon water, & protein
Constipation
increased progesterone levels decreased GI motility & slowed further by iron supplementation
Constipation: Avoid what
- dairy: 2 hrs before & 1 hr after iron supplement –> decreases absorption
- laxatives & stool softeners: dehydration & electrolyte imbalance
- caffeine: limited to 200-300 mg daily
Constipation Txt
Increase fiber, fluids (10-12 cups daily), and exercise
Intrahepatic Cholestasis
- liver disorder during pregnancy:
- generalized itching on hands and feet that worsens at night w/ not rash.
- increases risk of fetal death
Intrahepatic Cholestasis Interventions
- bile acid testing
- fetal monitoring
- ursodeoxycholic acid
UTI S/S
- urinary frequency, urgency, burning & foul smelling urine
- pyelonephritis (kidney infection)
- report fever or pain in lower back or flank area –> increase risk for preterm labor
Heartburn (Pyosis) Education
- eat several small meals each day (6)
- eliminate fried fatty foods
- keep HOB elevated (pillows)
- avoid lying down right after eating
- avoid tight fitting clothes
- no caffeine, chocolate, peppermint & spicy food
