prenatal continued Flashcards
cardio changes (5)
- inc in blood volume 50% above prepregnant levels (total 1500 ml)
- inc in cardiac output, inc venous return, incr heart rate
- slight decline in bp until mid-preg when return to pre-preg levels
- inc of 450 ml rbc and 1000ml plasma vol > RBC leading to hemodilution/physiologic anemia (fatigue, paleness)
- inc in iron demands, fibrin and plasma fibrinogen levels, some clotting factors, leading to hypercoagulable state (after pt delivers, risk for blood clots, bed rest)
- peripheral vasodilation from progesterone, slight dec in bp
resp changes (3)
- breathing more diaphragmatic than abdominal due to increase in diaphragmatic excursion, chest circumference, and tidal vol. (diaphragm moves upward)
- incr in oxygen consumption
- congestion secondary to increased vascularity
- congestion can cause nose bleeds
- need to assess breathing
renal/urinary system changes (4)
- dilation of renal pelvis, elongation, widening, and increase in curve of ureters
- inc in length and wt of kidneys
- inc in GFR, inc urine flow and volume
- inc in kidney activity with the person lying down, this is greater for preg women. Later in preg, greater increase lying on side because pressure is off inf vena cava, more blood, and more urine
- at night need to use restroom more. if there is pressure on the inf vena cava GFR dec occluding blood flow)
musculoskeletal system changes (5)
-softening and stretching of ligaments holding sacroiliac joints and pubis symphysis
-postural changes: inc swayback and upper spine extenstion
-forward shifting of center of gravity
-inc in lumbosacral curve (lordosis), compensatory curve in cervicodorsal area
-waddle gait
(pain in back could be pre-term labor or bc of posture change)
skin system (7)
-hyperpigmentation, mask of pregnancy that 70% get (facial melasma, more prevalent in hispanic, and asian, doesn’t always fade)
-linea negra (usually fades, results from estrogen, progesterone, melatonin)
-striae gravidarum
-varicosities: uterine pressure on veins dec venous return, from standing, use stockings to prevent dec venous return)
-vascular spiders: tiny blood vessels
-palmar erythema
-decline in hair growth, inc in nail growth
(dec skin marks with moisturizer, mineral oil, sunscreen, vit e)
endocrine system (5)
- thyroid gland: slight enlargement, increased activity, incr in BMR, can’t feel nodules
- pit gland enlargement, dec in Thyroid Stim Hormone, GH. inhibition of FSH & LH (bc releases hormones/target organs that inhibit its own release) incr in prolactin production (only released when placenta is out and progesterone dec so lactation can start), Melanocyte SH, gradual inc in oxytocin with fetal maturation (rel by post pit, for contractions)
- adrenal glands: incr in cortisol and aldosterone secretion
- prostaglandin secretion: softening of cervix, smooth muscle contraction, endogenous/local hormone, play a role in initiate or maintain labor
- placental secretion: hCG, hPL, relaxin (makes rib cage movable when preg) progesterone, estrogen (table 11.3)
nutrition (3)
-direct of nutritional intake on fetal well-being and birth outcome
-need for vitamin and mineral supplement daily
-dietary recommendations: incr in protein, iron, folate, and cal (11.5)
:use of usda food gyidemyplate (11.5)
:avoidance of some fish due to mercury content
maternal wt gain (3)
-healthy wt bmi: 25-35 ib
:1st trimester: 3.5-5 ib
-bmi 25: 15-25 ib
:1st trimester : 2 ib
:2nd & 3rd trimesters: 2/3 ib/week
-needs to be consistent, slow, gradual, steady
-bad if theres both too much and too little wt bc baby is growing wrong
nutrition promotion
- client education (11.1)
- special considerations: cultural variations, lactose intolerance, vegetarian, pica (caused by nut. deficiencies, chemical imbalance, iron def.)
emotional responses (5)
- ambivalence
- introversion: world becomes internalized
- acceptance
- mood swings
- changes in body image
maternal role (4)
- ensuring safe passage throughout pregnancy and birth
- seeking acceptance of infant by others
- seeking aceptance of self in maternal role to infant (binding in)
- learning to give of oneself (11.4)
pregnancy and sexuality (4)
- numerous changes, possibly stressing sexual relationship
- changes in sexual desire with each trimester
- sexual health link to self-image
- sex is good as long as there are no complications with preg
- libido inc in 2nd 3rd trimester
- sperm can help in late preg for dilation
nursing management: prenatal care and dx testing (6)
-amniocentesis: sample amniotic fluid to do DNA tests for baby, use ultrasound to find out where in abdomen is a pocket of amniotic fluid
:16-18 wk
:risks-miscarraige, stick the baby, introduce foreign material, injury to body
-biophysical profile
-chorionic villus sampling (cvs): remove sample of fetal tissue
:10-13 wk, still within time to do abortion, genetic screen except for neural tube defects,
: same risks as amnio
-natural childbirth
-perinatal education
-preconception care
calculating EDB/EDD/EDC (5)
-date of LNMP
-calculation of estimation or expected date of birth, delivery, confinement
-nagele’s rule: first day of LNMP
:subtract 3 mo
:add 7 days
:add 1 yr
-gestational or birth calculator or wheel (12.3)
-ultrasound is best method of dating a pregnancy
physical exam
-v.s
-head to toe
:head and neck
:chest
:abdomen (including fundal ht if approp)
:extremities
pelvic exam (3)
- exam of external and internal genitalia
- bimanual exam: one hand inside, one outside
- pelvic shape: gynecoid (50%), android (male-like), anthropoid (ape-like), platypelloid (flat, most probs, need c-section)
- pelvymity: x-ray to see pelvis, but harmful to baby
lab tests (9)
- urinalysis
- cbc
- blood typing
- rh factor: if neg and baby is pos then attack baby’s blood which could be death, damage to baby
- rubella titer
- hep b surface antigen
- HIV, VDRL, RPR testing
- cervical smears
- ultrasound
initial prenatal visit (6)
- assessment
- interviews, physical exam, lab test
- nursing dx
- goals
- implementation
- evaluation
health hx (6)
-setting, confidentiality, nurse-pt rln, creating a comfortable environment
-leep language simple
-complete info
-includes: demo data
-family/med hx
:screen-infection, genetic hx, menstrual hx
-previous and present preg hx
infection screening (6)
-STI
-measles and chickenpox
-TB
-hep
-group beta strep hx: overgrowth of bact in woman’s body (perenium, rectum) no prob for mom
: if pos give antibiotics (Amp, PCN) right away during labor
: do culture during 32-36 wk for GBS test
-hiv
genetic screening (3)
- id of inherited dz or disorders
- chart genetic disorders
- failure to id these risks can have devastating consequences
maternal serum alpha fetoprotein (msaf) (5)
- used to detect open Neural tube defects, spina bifida or open abdominal wall defects
- 1-2/1000 risks incr if present in earlier preg
- drawn at 16-18 weeks
- msafp and estriol low with hCG elevated
- down syndrome-msafp with hCG, unconjugated estriol, inhibin and maternal age
- blood draw
- an option to get test, if ADM
- risk: could cause meningocele so need to inspect the babys back, hair, indent, hole
hepatitis b (3)
- virus has been id as the most threatening to the fetus and neonate
- transmission occurs from mother to infant during intrapartum and postpartum periods
- all women now screened prenatally
urinalysis (5)
- protein: should not be present, may indicate kidney or hypertensive dz in preg
- glucose: found on occasion, if frequently found, further screening should be done bc shouldnt be there
- ketones: found only during fasting, exercise or N/V
- blood: uti or kidney dz, unless you are breaking the water or infection, shouldn’t be blood
- wbc and/or bact: may indicate uti if elevated
screening for GDM (4)
- standard part of prenatal care
- 24-28 wk
- 1 hr screening test
- level above 135 indicates further screening, can do the 3hr test
- hormones block insulin and affect sugar, shows up @ 27 wk
group b strep screening (3)
- standard part of prenatal care
- causes significant neonatal sickness and death during and after delivery, life threatening infections
- tx: amp (2/1gm q4) PCN (5/2.5 mill q4)
more on initial visit (5)
- cultural/religious expectations
- occupational hx
- personal habits
- prenatal programs
- comp therapies used during preg
follow-up prenatal visits (4)
- every 4 wk until 28 wk of preg
- every 2 wk until 29-36 wk of preg
- every wk from 37 wk to delivery
- fewer visits may be safe for low-risk women
care management during the trimesters (6)
- sexual activity
- general hygiene
- nutritional needs
- promotion of safety
- drug consumption
- discomforts of preg
fetal activity counting (5)
- commonly called “kick counts”
- baby should move ten times in 1-4 hours
- low intervention
- low tech
- lack of clear association with perinatal outcome
- start at end of 1st trimester
warning signs in preg (8)
- vaginal bleeding
- prom
- contractions before 37 wk
- change in fetal activity
- sx of PIH
- vomiting
- signs of infection
- edema
exercise in preg (4)
- studies on exercise in preg
- body changes in preg
- exercise recommendations
- no contraindications to exercise in preg if no complications
preg loss (5)
-potential and actual
-sab
-ectopic preg
-gestational trophoblastic dz: proliferative growth of endometrial, grow clusters in woom
:molar preg, abnormal cells, pseudo preg
:larger uterus than # of weeks, preg is lost, no fetus but mass still needs to be removed
:produces abnormal amnt of hCG
-stillborn
Biophysical profile (5)
- 1 fetal breathing movements
- 2 gross body movements
- 3 fetal tone
- 4 reactive fetal heart rate: use NST, doppler, toco, external monitor to detect if baby is reactive or not.
- 5 qualitative amniotic fluid volume
- to determine the overall health of the baby, most is done through ultrasound
- only performed if something needs to be checked
interpretation bpp
- 8-10 normal, low risk
- 4-6 suspected chronic asphyxia, may rely on other scales to help determine
- 2 strong suspicion of asphyxia, need c-section
- baby reacting fits the criteria of baby being well and oxygenated
stages of fetal development (3)
-1)Preembryonic stage: fertilization (in infundibulum of fallopian tube) thru 2nd week
:fertilization, cleavage, morula
:blastocyst and trophoblast
:implantation (in endometrium)
-2)embryonic stage: end of 2nd wk thru 8th wk (g/b differentiation)
:basic structures of major body organs and main external features
-3)fetal stage: end of 8th wk to birth
embryonic layers (3)
- ectoderm: forms the central nervous system, special senses, skin and glands
- mesoderm: forms skeletal, urinary, circulatory, and reproductive organs
- endoderm: forms respiratory system, liver, pancreas and digestive system
Fn of the placenta (6)
- serving as the interface btn the mother and fetus
- making hormones to control the physiology of mother
- protecting fetus from immune attack by the mom
- removing waste products from the fetus
- inducing the mother to bring more food to the placenta
- producing hormones that mature into fetal organs
placental hormones (5)
:2 levels, chorion and amnion
- hCG
- human placental lactogen (hPL) or human choronic somatomammotropin (hCS)
- estrogen
- progesterone
- relaxin
umbilical cord (5)
- formed from the amnion
- lifeline from the mother to growing embryo
- contains one large vein and two small arteries
- wharton’s jelly surrounds the vein and arteries to prevent compression
- at term the average umbilical cord is 22in long and about 1 in wide
role of amniotic fluid (5)
- helps maintain a constant body temperature for the fetus
- permits symmetric growth and development
- cushions the fetus from trauma
- allows the umbilical cord to be relatively free of compression
- promotes fetal movement to enhance musculoskeletal development
fetal circulation (2)
:blood from the placenta to and through the fetus and then back to the placenta
:three shunts during fetal life
-ductus venosus: connect the umbilical vein to the inferior vena cava
-ductus arteriosus: connects the main pulmonary artery to the aorta
-foramen ovale: anatomic opening between the right and left atrium
genetics and advances in genetic knowledge (5)
- study of heredity and its variation
- pharmacogenomics: study of genetic and genomic influences on pharmacodynamics and pharcotherapeutics
- part of perinatal care for decades
- genetic testing
- gene therapy
human genome project (3)
- international 13-yr effort started in 1990 to produce a comprehensive sequence of the human genome
- goal: map, sequence, determine the fn of all human genes
- genome: person’s genetic blueprint determining
1) genotype: genes inherited from parents
2) phenotype: observed outward characteristics
inheritance (3)
-genes: individual units of heredity of all traits
: organized into long segments of deoxyribonucleic acid that occupies a specific location on a chromosome
: determination of a particular characteristic in an organism, physical and mental characteristics of humans
-chromosome: long, continuous, strand of DNA carrying genetic information
-karyotype: pictorial analysis of number, form, size of chromosomes
karyotype (3)
- pictorial analysis of number, form, and size of an individual’s chromosomes
- commonly uses wbc and fetal cells in amniotic fluid
- chromosomes are numbered from largest to smallest 1-22, with sex chromosomes designated by X and Y
patterns of inheritance (3)
-mendelian or monogenic disorders \: autosomal dominant inheritance \: autosomal recessive inheritance \: X-linked inheritance 1) x-linked recessive inheritance 2) x-linked dominant inheritance -multifactorial disorders -nontraditional inheritance
chromosomal abnormalities (3)
-abnormalities of chromosome number \: monosomies, trisomies \: polyploidy -abnormalities of chromosome structure \: deletions \: inversions \: translocations -sex chromosome abnormalities
types of chromosomal abnormalities (2)
- structural abnormalities: cri du chat syndrome, fragile x syndrome
- sex chromosome abnormalities: turner syndrome, klinefelter syndrome
potential misuse of genetic info (5)
- risk profiling
- privacy and confidentiality breaches
- workplace discrimination and access to health insurance
- loss of autonomy
- possible injustices with risk determination years before disorder occurs
genetic evaluation and counseling (3)
- genetic counseling: process by which pt or relatives, at risk of inherited disorder, are advised of the consequences and nature of disorder, its probability, and options open in management and family planning in order to prevent, avoid, or ameliorate it.
- variety of reasons an individual should be referred to genetic counseling (10.2)
- ideal time: before conception
nursing roles and responsibilites (11)
- beginning the preconception counseling process and referring for further genetic info
- taking a fam hx
- scheduling genetic testing
- explaining the purposes, risks/benefits of all screening and dx test (10.1)
- answering ques and addressing concerns
- discussing costs, benefits, risks of using health insurance and potential risks of discrimination
- recognizing ethical, legal, and social issues
- safeguarding privacy and confidentiality
- monitoring emotional rxn after receiving info
- providing emotional support
- referring to appropriate support groups
hematocrit/globin
- hematocrit: 12-15
- hemoglobin: 35-40
