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NURS 2725 Clinical > Prenatal Labour And Delivery > Flashcards

Prenatal Labour And Delivery Flashcards

1
Q

presumptive signs

A
  • subjective changes reported by the patient
  • potential to be caused by other conditions

ex. amenorrhea, fatigue, breast changes

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2
Q

probable signs

A
  • objective changes assessed by examiner
  • strong indicator of pregnancy when combined with presumptive signs of pregnancy

ex. ballottement, pregnancy tests

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3
Q

positive signs

A
  • objective signs assessed by an examiner that can be attributed only to the presence of the fetus
  • definitive confirmation of pregnancy

ex. ultrasound of fetus

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4
Q

what adaptations to preg occur in the reproductive system and breasts

A

changes in size, shape, postition, contractility
uteral placental blood flow changes
cervical changes
changes related to fetal prescence

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5
Q

what does the height of the fundus measure

A

growth of fetus in uterus

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6
Q

why does the fundal height drop slightly at 40wks

A

baby drops into pelvic cavity

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7
Q

what adaptations during preg occur in the breasts

A

increase in size (fullness, heaviness)
heightened sensitivity from tingling or sharp pain
areolae become more pigmented
Montgomery’s tubercles more pronounced
colostrum

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8
Q

montgomerys tubercles

A

promote fluid for lubrication when feeding
protects skin from breakdwon

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9
Q

colostrum

A
  • first milk produced
  • contains nutrients and antibodies
  • won’t lactate until after delivery
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10
Q

what adaptations occur in preg with CVS

A

blood pressure decreases
increased cardiac output
increased circulation and coagulation time
increased blood volume,
changes in blood composition

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11
Q

why does bp decrease in preg

A

fetal pressure on IVC and veins

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12
Q

what is a hyperdynamic circulation

A

increased cardiac output
heart rate
and blood volume

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13
Q

how does blood composition change in pregnancy

A

increased plasma and RBC
decreased hemoglobin and hematocrit

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14
Q

hemodilution physiological anemia

A

Decreased hemoglobin and hematocrit

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15
Q

gestational thrombocytopenia

A
  • mild and asymptomatic
  • platelet > 70 000
  • resolves in 2-12 weeks post-partum
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16
Q

hypercoaguable state

A

causes increase risk of PE, DVT and decreased bleeding at deliv

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17
Q

what respiratory adaptations occur during pregnancy

A

increased nasal congestion
increased need for O2
changes in ventilation
alkalosis

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18
Q

why does respiratory alkalosis occur in pregnancy

A

helps co2 cross the placenta

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19
Q

what GI adaptations occur in pregnancy

A

decreased motility (constipation)
suppressed/increased appetite
bleeding in oral mucosa
gastroesophageal reflux
increased gallstones

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20
Q

what renal system adaptations occur in pregnancy

A

increased renal tubule reabsorption (swelling)
increased excretion of proteins/albumin
decreased bladder capacity
increased urinary frequency
increased kidney stones, UTI

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21
Q

what integumentary adaptations occur in pregnancy

A

chloasma
linea nigra
striae gravidarum
angiomas
palmar erythema
polymorphic eruption of pregnancy (PEP)

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22
Q

what Musculoskeletal adaptations occur in preg

A

increase in relaxin causes relaxation of pelvic ligaments and joints
growing uterus stretches abdominal muscles (diastasis recti abdominis)

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23
Q

what are the functions of the placenta

A

(endocrine gland) produces hormone necessary to maintain pregnancy and support embryo/fetus

metabolic function (respiration, nutrition, excretion, and storage)

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24
Q

hCG human chorionic gonadotropin

A

excreted by: fertilized ovum and chorionic villi

effects: maintains corpus luteum and prod. of est. and prog. until placenta takes over

levels: highest at 60-90 days –> progressive fall during pregnancy

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25
Q

Progesterone

A

excreted by: placenta (corpus luteum until wk. 14)

effects:
- suppresses secretion of FSH and LH

  • relaxes smooth muscle
  • decreases uterine contractility
  • decreases maternal ability to utilize insulin
  • causes fat deposition in SC tissue

levels:
- decreased with expulsion of placenta

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26
Q

Estrogen

A

excreted by: placenta (corpus luteum until wk. 14)

effects:
- suppresses secretion of FSH and LH

  • decreases maternal ability to absorb insulin
  • promotes Na and H2O retention
  • increased vascularity

levels:
- decreased with expulsion of placenta

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27
Q

hCS human chorionic somatomammotropin

A

excreted by: placenta

effects:
- acts as growth hormone –> contributes to breast development

  • increases fatty acids for metabolic needs
  • decreases maternal metabolism of glucose

levels:
- decreased with expulsion of placenta

28
Q

serum prolactin

A

excreted by: anterior pituitary gland

effects: prepares breasts for lactation

levels: decreases with placenta, increases with breastfeeding

29
Q

Oxytocin

A

excreted by: posterior pituitary gland

effects: stimulates uterine contraction and breastmilk ejection

30
Q

first trimester

A

weeks 1-13

31
Q

2nd trimester

A

wks 14-26

32
Q

3rd trimester

A

wks 27-term

33
Q

whats the earliest biochemical marker of pregn

A

hCG (beta subunit)

34
Q

whas the most accurate method to determine EDB

A

first trimester ultrasound

35
Q

Nageles rule

A

determine first day of last missed period (LMP) subtract 3 months add 7 days plus a year

36
Q

what is GTPAL

A

5 digit system

Gravidity- total number of preg at any gestation
T- # term infants delivered (more than 37wks gestation)
P- number of preterm infants (delivered at 20-37wks)
A- number of abortions or losses (intrauterine with fetus less than 20 wks or 500g of weight induced or spontaneous)
L- number of living children

37
Q

what is gravidity/parity

A

2 digit system
less accurate

G- number of preg
P- number of preg reaching 20+ wks gestation

38
Q

heartburn

A
  • relaxation of lower esophageal sphincter increases risk of reflux from stomach
  • trimester 1,2,3
39
Q

constipation

A

decreased peristalsis
trimester 1,2,3

40
Q

round ligament pain

A
  • pain in right/left lower quadrant that’s worse with walking and improves with rest
  • caused by increased stress on round ligament
  • trimester 2
41
Q

urinary freq

A
  • decreased plasma osmolarity,
    -increased vascularity
    -pressure of enlarged uterus
    -pressure of fetal head on bladder
  • trimester 1,2,3
42
Q

leukorrhea

A
  • hormonal effects of pregnancy lead to increased blood flow to vagina resulting in increased white/yellow mucous discharge from the vagina
  • trimester 1,2,3
43
Q

what are key nutritional recommendations in preg

A

Fish (not too much bcz of mercury)
omega 3 fatty acids
folate
iron

44
Q

what increases as obesity increases in relation to preg

A

gestational diabetes
issues maintaining baby’s blood sugar
increased risk for c-section

45
Q

what are excercise recommendations in preg

A

at least 150 min of moderate intensity physical activity per week, over minimum 3 days a week
aerobic and resistance training, pelvic floor muscle training

46
Q

whats the main goal of nursing in prenatal care

A

promote health and well being of the pregnant patient, fetus, newborn and family

47
Q

whats a main emphasis during a nursing and prenatal care

A

preventative care and optimal self care

48
Q

whats the main goal of perinatal and childbirth education

A

assist women and family to make informed safe decisions about
- pregnancy
-birth
-early parenthood

49
Q

what occurs during the initial nursing management

A

interview
physical exam
lab tests

50
Q

what nursing management occurs during subsequent visits?

A

fetal assessment (gestational age)
health status
laboratory tests
collaborative care

51
Q

the frequency of visits is based on gestational age

A

up to 32 weeks: every 4 weeks

32-36 weeks: every 2 weeks

36 week to delivery: every week

52
Q

topics of childbirth education programs

A
  • physical and emotional changes
  • chest feeding
  • nutrition
  • working
  • labour and birth pain management
  • becoming a parent; transition
  • newborn care
53
Q

components of education program

A
  • births
  • pain management
  • relaxation, imagery and visualization, conscious breathing, biofeedback, and massage
54
Q

how to assess and identify part of the fetus in the upper uterus

A

use hands to feel top of the fundus

55
Q

how to assess location of the fetal back

A

use hands to palpate sides of the fundus (vertical)

56
Q

how to asess for presenting part of the fetus

A

one hand at the bottom of the baby bump to papate for the head

57
Q

how to determine the descent of the presenting part

A

palpate with both hands to determine which is the back and where the arms are (vertical)

look for either side of the babys spine

58
Q

whats the rule for fundal height measurements

A

matches number of weeks of pregnancy +/- two cm

59
Q

steps to measuring the fundal height

A
  • mother semi recumbent with bladder empty
  • palpate to determine fundus with two hands
  • secure tape with hand at top of fundus
  • measure to top of symphysis pubis
  • measure along longitudinal axis of uterus, note metric measurement
60
Q

whats the benefit of focused breathing in labour

A

interrups the pain signals to the brain and stimulates endorphines
reframes thoughts about labour too

61
Q

how to perform
abdominal
belly
diaphragmatic breathing

A
  • breath in, abdomen moves out
  • breath out, abdomen moves in
62
Q

support with breathing

A
  • support person breathes in sync with birth partner
  • eye contact, hands on shoulder, leaning on them
63
Q

pant blow breathing

A
  • encourage change of position
  • 4 pants, blow, 4 pant, blow, and so on
  • encourages breathing between contractions
64
Q

breathing when pushing

A

encourage pushing as many times per contraction as they feel the urge

65
Q

cervical cap

A

fits snugly over the cervix, preventing sperm from entering the uterus

barrier method

NURS 2725 Clinical (4 decks)

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