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N416 > Prenatal Care & Early Pregnancy Loss > Flashcards

Prenatal Care & Early Pregnancy Loss Flashcards

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

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”

A

Live vaccine so it cannot be given when pregnant

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

25
Q

Congenital Rubella Syndrome

A

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
Q

Screening Tests: Genetic Screening

A

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
Q

Screening Test: Gestational Diabetes Mellitus (GDM)

A

Glucose intolerance w/ onset of pregnancy

ALL screened at 24-28 weeks gestation

2 step process

28
Q

Gestational Diabetes Mellitus Process

A

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
Q

GDM Complications

A

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
Q

Screening Test: Group B Streptococcus (GBS)

A

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
Q

GBS Treatment

A

PCN Q4H in labor

If allergic to PCN, ampicillin is ok alternative or sensitives ordered

32
Q

Subsequent Prenatal Vists

A

Q4 weeks until 28 weeks

Q2 weeks 28-36 weeks

Weekly visits 36+ weeks

33
Q

Danger Signs in Pregnancy

A

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
Q

First Trimester Discomforts

A

N/V

Urinary frequency, UTI

Fatigue

Breast tenderness

Increased vaginal discharge

Nasal stuffiness

Ptyalism (consistent spitting)

Constipation

35
Q

Second & Third Trimester Discomforts

A

Heartburn

Backache

Ankle edema

Leg cramps

Varicose veins

Faintness

Flatulence

Dyspnea

Hemorrhoids

Insomnia

Round ligament pain

Carpal tunnel syndrome

36
Q

Teratogenic Substances

A

Substances that adversely affect normal fetal growth and development

Medications

Alcohol

Tobacco

Marijuana

Illicit drugs

Pesticides

X-rays

37
Q

Pregnancy Infections (TORCH)

A

Cause constellation of similar symptoms in affected newborn

Fever
Difficulty feeding
Petechia
Enlarged liver and spleen
Jaundice
Hearing impairments
Eye abnormalities

38
Q

TORCH

A

T = toxoplasmosis (cat feces)

O = other

R = rubella

C = cytomegalovirus (herpes family)

H = herpes

39
Q

Pregnancy Loss

A

Abortion = <20 weeks gestation (miscarriage/spontaneous/SAB; termination/elective/TAB)

Ectopic pregnancy

Gestational trophoblastic disease (“molar pregnancy”)

40
Q

Abortion - Spontaneous “SAB”

A

15-20% of pregnancies

Types: threatened, imminent, complete, incomplete, missed

Always call an SAB a “miscarriage”

41
Q

Threatened SAB

A

Unexplained bleeding, cramping, and backache

Closed cervix

May resolve w/out loss of pregnancy

42
Q

Imminent SAB

A

Bleeding and cramping increase

Cervix dilates

43
Q

Complete SAB

A

All products of conception expelled

44
Q

Incomplete SAB

A

Some products are retained

Requires medical treatment

45
Q

Missed SAB

A

Fetal/embryonic death in-utero but not expelled

Cervix is closed

Requires medical treatment

46
Q

SAB: Nurse’s Role

A

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
Q

Ectopic Pregnancy

A

Implantation not in the uterus; usually fallopian tube

Fallopian tube can rupture and cause internal bleeding

Usually diagnosed before 8 weeks’ gestation

48
Q

Ectopic Pregnancy Clinical Manifestations

A

One-sided abdominal pain

Vaginal bleeding

N/V

Abdominal rigidity (late sign)

Abdominal tenderness (late sign)

49
Q

Ectopic Pregnancy DX

A

Serial bHCGs and US

hCG = do not rise normally with this type of pregnancy

50
Q

Ectopic Pregnancy Care

A

Medication - methotrexate IM (avoid ETOH & sun exposure)

Surgical - laparoscopic options

51
Q

Ectopic Pregnancy Nursing Care

A

Monitor IV replacement fluids, serum electrolytes

Provide education and emotional support

Prepare pt for surgery, if not stable

52
Q

Gestational Trophoblastic Disease

A

Pathologic proliferation of trophoblastic cells

Uterine enlargement greater than expected for gestational age

Dx w/ US

Types - hydatidiform mole or choriocarcinoma

53
Q

Hydatidiform Mole

A

Molar Pregnancy

Complete - empty egg fertilized by normal sperm

Partial - normal ovum fertilized by 2 sperms

54
Q

Choriocarcinoma

A

Usually associated w/ complete molar pregnancy

May be fatal to pregnant person

55
Q

Gestational Trophoblastic Disease Clinical Manifestations

A

Vaginal bleeding is a brownish color that resembles prune juice

56
Q

What happens to serum hCG levels in Gestational Trophoblastic Disease?

A

Are markedly elevated which leads to Hyperemesis Gravidarum

57
Q

Gestational Trophoblastic Disease While Pregnant

A

Pregnant person monitored x 1 yr

Advised against pregnancy during this time d/t risk of choriocarcinoma

N416 (9 decks)

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