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N416 > Prenatal Care & Early Pregnancy Loss > Flashcards

Prenatal Care & Early Pregnancy Loss Flashcards

(57 cards)

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1
Q

Cultural Assessment

A

Customs are often tied to significant life events

Ask, listen, and observe to meet pt and family’s needs

Allows nurse to provide care that is appropriate and responsive

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2
Q

Prenatal Care: Obtaining a History

A

Current and past pregnancies (G-TPAL)

Gynecologic hx, Genetic hx

Current and PMH including substance abuse

Family medical hx

Religious, spiritual, and cultural hx

Occupation/repetitive movements

Physical and social hx for father/sperm donor

Personal hx and preferences

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3
Q

Subjective/Presumptive Signs of Pregnancy

A

Pregnant person reports:

Amenorrhea

Breast tenderness

Fatigue

Missed period

Etc

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4
Q

Objective/Probable Signs of Pregnancy

A

Practitioner detects but could be caused by other pathology

Pregnancy tests

Enlarged uterus

Changes in pelvic organs

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5
Q

Diagnostic/Positive Signs of Pregnancy

A

Practitioner detects and could not be d/t other cause

Fetal heart beat on doppler or ultrasound

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6
Q

G/P

A

G = Gravida

P = Para

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7
Q

Gravida

A

ANY pregnancy regardless of length, includes current one

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8
Q

Para

A

Delivery at >20 weeks gestation regardless of outcome

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9
Q

G-TPAL

A

G = gravida

T = Term births

P = Preterm births

A = Abortions

L = living children

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10
Q

T = Term Births

A

Births at 37 0/7 or greater

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11
Q

P = Preterm Births

A

Births btw 20 0/7 and 36 6/7 weeks

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12
Q

A = Abortions

A

<20 weeks

Spontaneous (SAB) and/or terminations (TAB)

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13
Q

EDB

A

Estimated Date of Birth

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14
Q

EDD

A

Estimated Delivery Date

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15
Q

EDC

A

Estimated Date of Conception

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16
Q

Nagele’s EDB

A

Use the first day of the last menstrual period (LMP)

Subtract 3 months

Add 7 days

Change year accordingly

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17
Q

Major Prenatal Screening Tests

A

Blood type & Rh
Antibody Screening
CBC (H&H for anemia)
HIV screening
Hep B surface antigen
UA and culture
Rubella titer
Varicella titer
Urine drug screen
STIs
Offer: cystic fibrosis, spinal muscular atrophy, Hg electrophoresis (thalassemia), genetic screening, hemoglobin A1c, Pap smear

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18
Q

Rh Antigen

A

Is a protein on RBC (A+ or A-)

Blood from fetus may cross into maternal circulation

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19
Q

Rh Incompatibility

A

Pregnant person is Rh negative

Fetus is Rh positive

Antibodies are created against antigen for future pregnancies if blood mixes

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20
Q

Rh Incompatibility 2nd Pregnancy

A

Antibodies cross placenta and attack RBC if fetus is Rh positive = hemolytic anemia

RBC destroyed faster than body can replace them

RBC carry O2 so can lead to hypoxia in fetus and even death

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21
Q

Rh Incompatibility Treatment

A

Rhogam IM or IV

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22
Q

Rhogam Indications

A

Rh negative pregnant people w/

Vaginal bleeding
Pregnancy loss (miscarriage, ectopic)
At 28 weeks
After delivery if baby is Rh positive

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23
Q

Coombs Test

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A

Checks if Rh antibodies were made

Direct: baby
Indirect: birthing person

Risk for jaundice for baby from RBC breakdown more than liver can filter

24
Q

Screening Test: Rubella “German Measles”

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A

Live vaccine so it cannot be given when pregnant

Screen in early pregnancy - if low, give MMR after delivery

25
Congenital Rubella Syndrome
Most serious if infection in 1st trimester, minimal if after 20 weeks May cause: Deafness Cataracts Heart defects Intellectual disabilities Liver and spleen damage Low birth wt and more
26
Screening Tests: Genetic Screening
Screening = NOT diagnostic Nuchal Translucency US + maternal serum for trisomies 13, 18, & 21 Quad screen maternal blood test Cell-Free fetal DNA maternal blood test Diagnostic = for increased risk of amniocentesis and Chorionic Villi Sampling (CVS) For increased risk of miscarriage w/ diagnostic procedures
27
Screening Test: Gestational Diabetes Mellitus (GDM)
Glucose intolerance w/ onset of pregnancy ALL screened at 24-28 weeks gestation 2 step process
28
Gestational Diabetes Mellitus Process
50g 1-hr glucose screen, non-fasting = measure serum glucose level at 1 hr and if too high, complete 3-hr test 3 hr test 100g glucose, fasting
29
GDM Complications
If poorly managed, may have bigger babies that get stuck + low blood sugar after birth Poorly managed pre-existing diabetes may have very sick, small babies d/t vasculopathy
30
Screening Test: Group B Streptococcus (GBS)
Bacteria in vaginal and/or rectum area Can cause serious problems for newborns, such as sepsis, meningitis, pneumonia, even death Sample taken via vaginal & rectal swab at 35-37 weeks' gestation
31
GBS Treatment
PCN Q4H in labor If allergic to PCN, ampicillin is ok alternative or sensitives ordered
32
Subsequent Prenatal Vists
Q4 weeks until 28 weeks Q2 weeks 28-36 weeks Weekly visits 36+ weeks
33
Danger Signs in Pregnancy
Sudden gush of fluid from vagina Vaginal bleeding Abdominal pain Temp above 100.4 and chills Blurred vision, epigastric pain, HA, edema of face & hands Muscular irritability and/or seizures Uterine contractions <37 weeks Absence of fetal movement Oliguria Dysuria Persistent vomiting
34
First Trimester Discomforts
N/V Urinary frequency, UTI Fatigue Breast tenderness Increased vaginal discharge Nasal stuffiness Ptyalism (consistent spitting) Constipation
35
Second & Third Trimester Discomforts
Heartburn Backache Ankle edema Leg cramps Varicose veins Faintness Flatulence Dyspnea Hemorrhoids Insomnia Round ligament pain Carpal tunnel syndrome
36
Teratogenic Substances
Substances that adversely affect normal fetal growth and development Medications Alcohol Tobacco Marijuana Illicit drugs Pesticides X-rays
37
Pregnancy Infections (TORCH)
Cause constellation of similar symptoms in affected newborn Fever Difficulty feeding Petechia Enlarged liver and spleen Jaundice Hearing impairments Eye abnormalities
38
TORCH
T = toxoplasmosis (cat feces) O = other R = rubella C = cytomegalovirus (herpes family) H = herpes
39
Pregnancy Loss
Abortion = <20 weeks gestation (miscarriage/spontaneous/SAB; termination/elective/TAB) Ectopic pregnancy Gestational trophoblastic disease ("molar pregnancy")
40
Abortion - Spontaneous "SAB"
15-20% of pregnancies Types: threatened, imminent, complete, incomplete, missed Always call an SAB a "miscarriage"
41
Threatened SAB
Unexplained bleeding, cramping, and backache Closed cervix May resolve w/out loss of pregnancy
42
Imminent SAB
Bleeding and cramping increase Cervix dilates
43
Complete SAB
All products of conception expelled
44
Incomplete SAB
Some products are retained Requires medical treatment
45
Missed SAB
Fetal/embryonic death in-utero but not expelled Cervix is closed Requires medical treatment
46
SAB: Nurse's Role
Many people will miscarry at home For those who do not, they will need meds or a D&C Monitor amt and color of vaginal bleeding (pad count) Avoid performing vaginal exams Assist w/ US Monitor blood transfusion if needed Offer client emotional support
47
Ectopic Pregnancy
Implantation not in the uterus; usually fallopian tube Fallopian tube can rupture and cause internal bleeding Usually diagnosed before 8 weeks' gestation
48
Ectopic Pregnancy Clinical Manifestations
One-sided abdominal pain Vaginal bleeding N/V Abdominal rigidity (late sign) Abdominal tenderness (late sign)
49
Ectopic Pregnancy DX
Serial bHCGs and US hCG = do not rise normally with this type of pregnancy
50
Ectopic Pregnancy Care
Medication - methotrexate IM (avoid ETOH & sun exposure) Surgical - laparoscopic options
51
Ectopic Pregnancy Nursing Care
Monitor IV replacement fluids, serum electrolytes Provide education and emotional support Prepare pt for surgery, if not stable
52
Gestational Trophoblastic Disease
Pathologic proliferation of trophoblastic cells Uterine enlargement greater than expected for gestational age Dx w/ US Types - hydatidiform mole or choriocarcinoma
53
Hydatidiform Mole
Molar Pregnancy Complete - empty egg fertilized by normal sperm Partial - normal ovum fertilized by 2 sperms
54
Choriocarcinoma
Usually associated w/ complete molar pregnancy May be fatal to pregnant person
55
Gestational Trophoblastic Disease Clinical Manifestations
Vaginal bleeding is a brownish color that resembles prune juice
56
What happens to serum hCG levels in Gestational Trophoblastic Disease?
Are markedly elevated which leads to Hyperemesis Gravidarum
57
Gestational Trophoblastic Disease While Pregnant
Pregnant person monitored x 1 yr Advised against pregnancy during this time d/t risk of choriocarcinoma

N416 (9 decks)

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