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Reproductive > Reproductive Health > Flashcards

Reproductive Health Flashcards

1
Q

coitus

A

Sexual union of two people of the opposite sex in which the erect penis is inserted into the vagina.

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2
Q

Conception

A
  • When spermatozoon enters ovum and forms viable zygote
  • The act/process of fertilization
  • Requires the right timing between the release of mature ovum and ejaculation of mature sperm into vagina
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3
Q

At what time during the pregnancy does conception occur?

A

at the beginning

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4
Q

When is the pre-embryonic phase?

A

first 2 weeks

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5
Q

When is the embryonic phase?

A

3rd-8th weeks

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6
Q

When is the fetal period?

A

9 weeks-birth

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7
Q

What are the 3 periods of prenatal development?

A

pre-embryonic, embryonic and fetal

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8
Q

Fetal development: weeks 9-12

A
  • Fetus weighs 1/2 oz
  • Moving but mom doesn’t feel it
  • Produces urine
  • External genital that looks girl/boy
  • Fetal heart tones(usually 11-12 weeks, sometimes at 10 weeks)
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9
Q

Fetal development: weeks 13-16

A
  • 4 oz
  • Grow in length
  • Quickening - noticeable fetal movement closer to 16 weeks
  • Fetus is starting to excrete urine
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10
Q

Fetal development: weeks 17 - 20

A
  • 11 oz
  • Clear fetal heart tones
  • Fetal movement
  • Meconium in bowel
  • Someone else can feel fetal movement
  • Vernus and menugo (fine hair)
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11
Q

Fetal development: weeks 21-24

A
  • 1 lb
  • Finger prints - 24 wks
  • Little subcutaneous fat
  • Little surfactant in lungs
  • Lungs immature
  • Least desirable time to be born, anything less than 24 weeks
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12
Q

Fetal development: weeks 25-28

A
  • 2 lb
  • Open/close eyes - 26 wks
  • Put on subcutaneous fat
  • Head starts to go downward into pelvis, head is heavier
  • Testicles should descend
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13
Q

Fetal development: weeks 29-32

A
  • 3-4 lb
  • Skin pigment
  • Toe/fingernails are well developed
  • Good chance of survival
  • Mature lungs if possible
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14
Q

Fetal development: weeks 33-38

A
  • 4-7 lb
  • Body systems are good to go
  • Getting fat (fetus)
  • Maturing lungs
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15
Q

How many weeks is full term?

A

38

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16
Q

What is the average length of pregnancy?

A

40 weeks

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17
Q

How many weeks do you not want to go beyond?

A

42

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18
Q

Can you induce prior to full term?

A
  • should not, it is not a std of practice

- kids induced earlier then full term lagged behind in kindergarten

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19
Q

What is the placenta?

A

Vascular fetal organ through which the fetus obtains oxygen, nutrients, and excretes CO2 wastes

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20
Q

maternal side of placenta

A

dirty dunken, attached to endometrium

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21
Q

fetal side of placenta

A

shiny shultz, attach to cord on baby side

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22
Q

Umbilical cord

A
  • 2 arteries and 1 vein

- when babies are not doing well in later pregnancy start to worry that there is only 1 artery

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23
Q

When mom delivers, what side of the placenta do you want to see first?

A

fetal side

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24
Q

What should you do if maternal side of placenta is delivered first?

A

look at placenta to see if pieces are missing and in the uterus

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25
Q

fundal height

A
  • pubic bone to top of fundus

- at 25 weeks it should be 25 inches

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26
Q

Does the fundal height work for estimating gestation for multiple births?

A

no

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27
Q

What do you do if the fundal height measurement does not coincide with weeks of gestation?

A

do add’l tests

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28
Q

What are the names of the fetal membranes?

A

amnion and chorion

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29
Q

amnion

A

fetal membrane closest to fetus

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30
Q

chorion

A

outer membrane

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31
Q

Do the amnion and chorion membranes rupture at the same time?

A

usually, rarely that they rupture at different times

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32
Q

amniotic fluid

A

protection and cushion for the fetus but also enhances the development of the fetus

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33
Q

what does the amniotic fluid come from?

A

fetal urine and maternal fluid

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34
Q

why does the fetus drink the amniotic fluid?

A

nourish lungs and digestive tract

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35
Q

Is amniotic fluid sterile?

A

yes

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36
Q

How much amniotic fluid should there be at term?

A

500-1000 mL

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37
Q

When do you worry about the amniotic fluid?

A

worry about under 500 and over 1000

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38
Q

Polyhydramnios

A
  • too much fluid

- sign of hydrocephalus

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39
Q

Olighydramnios

A
  • too little fluid
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40
Q

characteristics of amniotic fluid

A
  • fluid should be clear
  • never be foul smelling
  • never yellow or green (stool-meconium)
  • not cloudy (infection)
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41
Q

What are the three shunts in fetal circulation?

A
  • Ductus venosus
  • Ductus arteriosus
  • Foramen ovale
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42
Q

Foramen ovale

A

blood to go from rt to lt atrium

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43
Q

Ductus arteriosus

A

blood to go from rt ventricle to aorta

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44
Q

Ductus venosus

A

blood to bypass liver

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45
Q

why is blood diverted from the liver/lungs?

A

fetus does not breathe and liver is not metabolizing

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46
Q

How does blue baby occur?

A

deoxygenated and oxygenated blood are mixed if this foramen ovale is not closed

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47
Q

When are shunts closed?

A

upon first breath

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48
Q

Acrocyanosis

A

blue lips, acceptable for awhile

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49
Q

After birth, what happens to the ductus venosus and arteriosus and umbilical vessels?

A

they become ligaments

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50
Q

What does the dr sometimes do to the baby after a cesarean?

A

smack it on the butt, closes shunts

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51
Q

identical twins

A
  • monozygotic
  • one ovum and one sperm
  • genetic the same
  • same sex
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52
Q

fraternal twins

A
  • two ova
  • two sperm
  • can be different gender
  • infertility treatment result
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53
Q

What are the chances of having triplets without fertility treatments?

A

1 in 8100

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54
Q

What are the chances of having quads without fertility treatments?

A

1 in 750,000

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55
Q

What are the chances of having quints without fertility treatments?

A

1 in 55 million

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56
Q

changes in body system - reproductive

A

breast, uterus grows, and cervix

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57
Q

changes in body system - reproductive - breast

A
  • Colostrum - available for fetus

- Striae gravidarum - stretch marks

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58
Q

changes in body system - reproductive - uterus grows

A
  • 12 weeks - feels uterus slightly above pelvic
  • 20 weeks - feel uterus at naval
  • 36/37 weeks - goes up to xiphoid process
  • 40 weeks - slightly smaller as fetus descends
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59
Q

changes in body system - reproductive - cervix

A
  • Chadwick’s sign - turns purple/blue (instead of pink)
  • Goodell’s sign - very soft cervix (first 13/14 wks)
  • Mucus plug closes cervical canal
  • Non-pregnant female has an open cervical canal
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60
Q

changes in body system - urinary

A
  • Pressure on bladder, increased frequency and urgency
  • Stress/urge incontinence and nocturia
  • Pushes on ureters, may experience more UTIs - harder for urine to leave ureters and get to bladder
  • Renal colic - spasm in ureters
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61
Q

changes in body system - Cardiovascular

A
  • Heart muscle enlarges myocardium
  • Position - pushed to the left from rising uterus
  • Develops murmur that will go away after birth
  • Supine hypotension - lay down, drop pressure, sweaty nauseous, just need to get head up or turn on left side, don’t keep flat on back
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62
Q

Supine hypotension

A

lay down, drop pressure, sweaty nauseous, just need to get head up or turn on left side, don’t keep flat on back

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63
Q

Renal colic

A

spasm in ureters

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64
Q

Chadwick’s sign

A

cervix turns purple/blue (instead of pink)

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65
Q

Goodell’s sign

A

very soft cervix (first 13/14 wks)

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66
Q

Striae gravidarum

A

stretch marks

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67
Q

why does the mother’s heart move to the left?

A

rising uterus

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68
Q

changes in body system - integumentary

A

circulation, hyperpigmentation and hair

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69
Q

changes in body system - integumentary - hair

A

Hair growth increases/doesn’t lose as much, starts to fall out after pregnancy, be careful that it isn’t a sign of hyperthyroidism

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70
Q

changes in body system - integumentary - circulation

A

more circulation and fetus, feel warmer, perspire more

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71
Q

changes in body system - integumentary - hyperpigmentation

A
  • Linea alba - line from pelvic to navel get darker and becomes linea nigra
  • stretch marks, red heads get the most
  • more in face
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72
Q

Linea alba

A

line from pelvic to navel get darker and becomes linea nigra

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73
Q

changes in body system - respiratory

A
  • Need rises about an add’l 15-20% in order to provide for fetus
  • Breathes more deeply, rate doesn’t necessarily increase
  • Less room/volume to take deep breaths
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74
Q

changes in body system - musculoskeletal

A

calcium and posture changes

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75
Q

changes in body system - musculoskeletal - calcium

A
  • Fetus demands more calcium

- Doesn’t affect mother so you don’t see bone loss

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76
Q

changes in body system - musculoskeletal - posture changes

A
  • Pelvic joint relaxes, mid 2nd to last trimester
  • Wider base of support, waddle, prevents you from tipping over
  • Lordosis - curve in lower back, can cause back ache, lean backward to maintain balance
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77
Q

lordosis

A

curve in lower back, can cause back ache, lean backward to maintain balance

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78
Q

changes in body system - gastrointestinal

A
  • different hormones
  • mouth
  • esophagus
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79
Q

changes in body system - mouth

A
  • Inflammation/bleeding gums; may affect oral health

- More saliva - goes away after baby is born

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80
Q

changes in body system - esophagus

A

Decreased esophageal tone (peristalsis), leads to heartburn, nausea, and constipation

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81
Q

changes in body system - endocrine

A
  • Basil metabolic rate increases

- Thyroid works harder, make sure she doesn’t develop hypothyroidism

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82
Q

changes in body system - pancreas

A
  • diabetic/nondiabetic

- gestational diabetes

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83
Q

changes in body system - pancreas - diabetic/nondiabetic

A
  • glucose rate decreases

- If they are using insulin may need to change insulin dose, metabolism changes

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84
Q

change in body system - pancreas - gestational diabetes

A
  • 24-28 weeks - gestational diabetes develops in this time frame
  • Moms pancreas can’t give up anymore insulin
  • High demand from fetus
  • Everyone gets checked at this time unless there is a reason to do it sooner
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85
Q

indications of pregnancy

A

presumptive, probable, and positive

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86
Q

indication of pregnancy - presumptive

A
  • subjective, least reliable indications because they can be caused by conditions other than pregnancy
  • Amenorrhea
  • Nausea and vomiting
  • Fatigue
  • Urinary frequency
  • Breast/skin changes
  • Vaginal/cervical color changes
  • Fetal movement
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87
Q

indications of pregnancy - presumptive - amenorrhea

A

Secretion of progesterone and estrogen by the corpus luteum

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88
Q

indications of pregnancy - presumptive - nausea and vomiting

A
  • 4-8 weeks

- 60-80% experience this

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89
Q

indications of pregnancy - presumptive - fatigue

A
  • 1st trimester

- Might be related to progesterone

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90
Q

indications of pregnancy - presumptive - urinary frequency

A
  • Within first few weeks until the end

- Might have UTI and not be pregnant at all

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91
Q

indications of pregnancy - presumptive - breast and skin changes

A
  • 4-6 weeks

- Tenderness, tingling, fullness, increased size and pigment

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92
Q

indications of pregnancy - presumptive - vaginal/cervical color changes

A
  • Chadwick’s sign - change from pink to dark bluish purple, increased vascularity
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93
Q

Chadwick’s sign

A

change from pink to dark bluish purple, increased vascularity

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94
Q

indications of pregnancy - presumptive - fetal movement (quickening)

A
  • 16-20 weeks
  • Are you sure it is fetal movement?
  • Is it gas?
  • Confirmed by ultrasound
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95
Q

indication of pregnancy - probable

A
  • objective findings that need to be documented by an examiner
  • Abdominal enlargement
  • Cervix softens
  • Uterine changes
  • Pregnancy tests
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96
Q

indications of pregnancy - probable - abdominal enlargement

A

Pregnancy is more likely with uterus growth and amenorrhea

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97
Q

indication of pregnancy - probable - cervix softens

A

Goodell’s sign - softening of cervix

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98
Q

Goodell’s sign

A

softening of cervix

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99
Q

indication of pregnancy - probable - uterine changes

A

Consistency, ballottement, braxton hicks, palpation of fetal outline, and uterine souffle

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100
Q

indication of pregnancy - probable - pregnancy test

A
  • Reasons for false positives
  • Hydatidiform mole - growing mass of tissue inside your uterus that will not develop into a fetus
  • Cancer of uterus
  • Hematuria, certain drugs and proteinuria
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101
Q

indications of pregnancy - positive

A
  • signs of pregnancy that are only caused by pregnancy
  • Auscultation of fetal heart sounds
  • Fetal movement
  • Visualization of fetus
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102
Q

indications of pregnancy - positive - Auscultation of fetal heart sounds

A

16-20 weeks

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103
Q

indications of pregnancy - positive - Fetal movement

A

Felt by an experienced examiner

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104
Q

indications of pregnancy - positive - Visualization of fetus

A

As early as 3 weeks with transvaginal ultrasonography

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105
Q

Psych Responses to Pregnancy - 1st trimester

A

uncertainty, ambivalence, and self as primary focus

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106
Q

Psych Responses to Pregnancy - 1st trimester - uncertainty

A

look for signs to confirm pregnancy

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107
Q

Psych Responses to Pregnancy - 1st trimester - ambivalence

A

now that this is real start to question if you will be a good mother/father, are you financially ready, etc…

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108
Q

Psych Responses to Pregnancy - 1st trimester - self as primary focus

A

focus is on me

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109
Q

Psych Responses to Pregnancy - 2nd trimester

A
  • Physical evidence
  • Fetus as primary focus
  • Narcissism and introversion
  • Body image
  • Changes in sexuality
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110
Q

Psych Responses to Pregnancy - 2nd trimester - physical evidence

A

palpate uterus, weight increase, breast changes, ultrasound, quickening, bonding

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111
Q

Psych Responses to Pregnancy - 2nd trimester - Fetus as primary focus

A

Concerned with health of fetus

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112
Q

Psych Responses to Pregnancy - 2nd trimester - Narcissism and introversion

A
  • Narcissism - undue preoccupation with oneself
  • Introversion - concentration on oneself and one’s body
  • Ability to protect and provide for fetus
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113
Q

Narcissism

A

undue preoccupation with oneself

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114
Q

Introversion

A

concentration on oneself and one’s body

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115
Q

Psych Responses to Pregnancy - 2nd trimester - Body image

A
  • Change in body size and contour, thickening waist, bulging abdomen, and enlarged breast
  • Positive and negative view depending on how the mother perceives herself
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116
Q

Psych Responses to Pregnancy - 2nd trimester - Changes in sexuality

A
  • Libido may increase, decrease or stay the same
  • Can continue intercourse as long as it is safe
  • Support that semen start to soften cervix
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117
Q

Psych Responses to Pregnancy - 3rd trimester

A

Vulnerability, increased dependence, and preparation for birth

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118
Q

Psych Responses to Pregnancy - 3rd trimester - vulnerability

A

Fear of harming baby or that she might not be able to protect it

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119
Q

Psych Responses to Pregnancy - 3rd trimester - increased dependence

A
  • Feel big and unsteady

- Can’t reach to tie shoes, paint toes, etc..

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120
Q

Psych Responses to Pregnancy - 3rd trimester - preparation for birth

A
  • Get ready for baby to come
  • Look forward to experience
  • Nesting
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121
Q

Parental Tasks of Pregnancy - maternal

A
  • Seeking safe passage
  • Securing acceptance
  • Learning to give of self
  • Committing self to unknown child
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122
Q

Parental Tasks of Pregnancy - maternal - Seeking safe passage

A

carry to term, no problems with baby

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123
Q

Parental Tasks of Pregnancy - maternal - securing acceptance

A

how is my family going to feel, acceptance from important people/mother are very important

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124
Q

Parental Tasks of Pregnancy - maternal - learning to give of self

A

do I have enough time to do this, derive pleasure from giving, often by providing food or care for her family, the woman allows her body to give space to the fetus

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125
Q

Parental Tasks of Pregnancy - maternal - committing self to unknown child

A

how will I make this commitment, develop attachment, some women delay attachment until they are sure the pregnancy is normal/continue

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126
Q

Parental Tasks of Pregnancy - fraternal

A
  • Creating the role of involved father
  • Struggling for recognition as parent
  • Grappling with reality of pregnancy and child
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127
Q

Parental Tasks of Pregnancy - fraternal - Creating the role of involved father

A

come with to appt, make them feel welcome, important for mom let him know how you are feeling, seek closer ties with their own father, sufficient information will allow them to be less stressed

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128
Q

Parental Tasks of Pregnancy - fraternal - Struggling for recognition as parent

A

hard at first, want to be seen as a parent not just a helper

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129
Q

Parental Tasks of Pregnancy - fraternal - Grappling with reality of pregnancy and child

A

birth itself is a “reality booster”, initial reaction may be joy/pride but can change to ambivalence like the mother

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130
Q

Adaptation of Family Member

A
  • Grandparent

- Siblings

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131
Q

Adaptation of Family Member - grandparent

A
  • Age
  • # and spacing of other grandchildren
  • Perceptions
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132
Q

Adaptation of Family Member - grandparent - age

A
  • Older - excited to be grandparents

- Younger - may not have the time to devout to grandchild, some feel they are too young to be grand parents

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133
Q

Adaptation of Family Member - grandparent - # and spacing of other grandchildren

A
  • First one is most exciting

- Subsequent might be with less excitement

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134
Q

Adaptation of Family Member - grandparent - perceptions

A
  • Some want to be involved
  • Some are hurt when parents consult health care personnel for advise
  • Some plan not to participate in childcare or pregnancy (contemporary grandparent)
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135
Q

Adaptation of Family Member - siblings

A
  • toddler
  • older children
  • adolescent
136
Q

Adaptation of Family Member - siblings - toddler

A

might be jealous and resent the new baby

137
Q

Adaptation of Family Member - siblings - older children

A

want to be involved, need reassurance of their role, need to know that mom will go away but will come back with a baby

138
Q

Adaptation of Family Member - siblings - adolescent

A
  • Some are embarrassed or indifferent

- Second marriage, new child, surprise package, etc…

139
Q

Factors that Influence Adaptation

A
  • age
  • multiparity
  • socioeconomic status
  • social support
  • absence of a partner
140
Q

Factors that Influence Adaptation - age

A
  • Teenager - have a hard time dealing with developmental tasks of pregancy and adolescence at the same time
  • Older - major life change, health may impact baby
141
Q

Factors that Influence Adaptation - multiparity

A
  • More fatigue
  • Serious concerns about other children
  • Worry about finding time to get everything done
  • Great deal of time working out relationship with first child
142
Q

Factors that Influence Adaptation - socioeconomic status

A

Resources available for the family to meet the needs for food, shelter, and health care

143
Q

Factors that Influence Adaptation - social support

A
  • Partner and her mother are most important
  • Mothers with support are more likely to get prenatal care earlier
  • Mothers with less support or suffer from depression are more likely to seek prenatal care later
144
Q

Factors that Influence Adaptation - absence of a partner

A
  • Huge difference in resources or help to care for child
  • Struggle with how to tell parent/friends of pregnancy
  • More likely to delay prenatal care
145
Q

Cultural Influences

A
  • Health beliefs
  • Belief in fate
  • Preventing illness
  • Modesty
  • Female genital mutilation
  • Restoring health
  • Communication
146
Q

health beliefs

A
  • Different cultures have various requirements for maintaining health during pregnancy
  • Indian women not allowed to tie knots or braid because it will affect the umbilical cord
  • Puerto Rican women are indulged during pregnancy and allowed to exercise
  • Some cultures do not have moms or newborns seen for 40 days
147
Q

belief in fate

A
  • Eating correctly and observing taboos of their culture
  • Hot/cold foods - Asian culture
  • MOM will make baby more white
148
Q

preventing illness

A
  • Protective religious objects of charms - amulets, talismans, keep evil spirits away
  • Certain foods - Indians leave tobacco under crib
  • Adherence to religious codes, morals and practices
149
Q

modesty

A
  • Some may not want opposite sex to take care of them
  • Fear, modesty and desire to avoid examination by men may prevent some women from seeking prenatal care - Muslim, Hindu and Hispanic
150
Q

female genital mutilation

A
  • Female genital cutting (FGC), female circumcision
  • Removal of clitoris, labia minora/majora
  • Practiced in Africa, Asia and Middle East
  • Associated with premarital chastity
  • Need care from people who are knowledgeable about the custom and prepared for the abnormal appearance of the genitals
151
Q

restoring health

A
  • Moms that may use more than traditional medicine
    • Herbs, plants, holy words, charms, healers, curanderas, partera
  • As long as it doesn’t hurt someone else let it be
  • Placenta
    • Bring home and bury by front door - so spirit doesn’t wander
    • Eat it or it can be made into pills
    • Vascular, protein rich and nutritious
    • If something is wrong with baby it will be sent to pathology
152
Q

cultural influence - communication

A
  • language
  • communication style
  • decision making
  • eye contact
  • touch
153
Q

cultural influence - communication - language

A
  • female interpreters are ideal, don’t use a child
154
Q

cultural influence - communication - style

A
  • validate the person’s understanding by asking them to repeat the information
155
Q

cultural influence - communication - decision making

A
  • important to know who makes the decisions in the family
156
Q

cultural influence - communication - eye contact

A
  • know the culture, may not be appropriate for all cultures
157
Q

cultural influence - communication - touch

A
  • be sensitive to the response of the person being touched
158
Q

education classes

A
  • Learn about pregnancy, birth and parenting
  • Ability to make informed decisions, take an active role in maintaining health during pregnancy and birth, learn coping techniques to deal with pregnancy, childbirth and parenting
  • preconception, early pregnancy, exercise, childbirth, cesarean, breastfeeding, parenting, and postpartum
159
Q

education classes - preconception

A
  • Thinking about having a baby

- Emphasizes early and regular prenatal care and ways to reduce risk factors

160
Q

education classes - early pregnancy

A
  • Occurs in the 1st and 2nd trimester
  • Obtain early and regular prenatal care and avoiding hazards to the fetus
  • Childbirth choices
161
Q

education classes - exercise

A
  • help women keep fit and healthy

- avoid excessive heart rate elevation

162
Q

education classes - childbirth preparation

A
  • Lamaze
  • Self-help measures and what to expect during labor and birth
  • Information about labor, pharmacologic and non-pharmacologic methods of pain relief
  • Supervised practice and discussion of changes in the family and sibling adjustment
163
Q

education classes - cesarean birth preparation

A
  • Indication, options, surgical procedure and postoperative care
  • Feel control over what is happening
164
Q

education classes - breastfeeding

A
  • La Leche
  • Physiology of lactation, feeding techniques, establishing a milk supply, and solutions to common problems
  • Hospitals may offer courses, importance goes in cycles
  • Nurse will make or break experience
165
Q

education classes - parenting

A

General care and common concerns of parenting

166
Q

education classes - postpartum

A
  • Physiologic and psychological changes of the postpartum period, role transition, sexuality and nutrition
  • Postpartum depression and when to seek help
167
Q

What is considered adequate prenatal care?

A

started in 1st trimester and regularly continues until birth

168
Q

What does inadequate prenatal care lead to?

A

low birth weight and increased prematurity

169
Q

what does prenatal care encompass?

A
  • identify potential problems
  • assess pregnancy progression
  • health education
  • counseling
  • social support
170
Q

what are the antepartal visits?

A

preconception, initial and scheduled

171
Q

antepartal - preconception

A
  • Do not give MMR to anyone unless they are menstruating
  • Health history and physical exam
  • Opportunity to identify risks and makes changes that will support a healthy pregnancy
172
Q

antepartal - initial

A

within the first 12 weeks

173
Q

antepartal - scheduled

A
  • Pattern may change if high risk, diabetes, etc…
  • Conception to 28 weeks q 4 weeks
  • 29 to 36 weeks q 2-3 weeks
  • 37 weeks to birth q week
174
Q

when does the dr start doing cervical checks?

175
Q

Obstetric History

A
  • Gravida (G) Para (P)
  • TPAL
  • Weight of infants, gestational length
  • Labor experience, type of delivery
  • Anesthesia
  • Maternal and infant complications
  • Method of infant feeding
176
Q

Obstetric History - Gravida (G) Para (P)

A
  • G - how many pregnancy has she had, includes current pregnancy, doesn’t matter how long the pregnancy lasted
  • P - number of pregnancies that ended at 20 weeks or more, twins count as one
177
Q

Obstetric History - TPAL

A
  • Term (38-42 weeks), preterm (prior to 38 weeks), abortion, live birth
  • Abortion is spontaneous (naturally) or elective
  • Live birth/living children
  • L gives you a polite way to ask about children who are not living
178
Q

Obstetric History - Weight of infants, gestational length

A
  • Do not want to deliver large babies
    == 9 plus pound babies
  • Physician will work to keep weight down and possibly deliver early
    == Too many things go wrong with babies that are large
  • Reasons for large babies; Diabetes, how big are parents & something wrong with fetus
179
Q

Obstetric History - Labor experience, type of delivery

A
  • If mother had a previous bad experience she will make sure to let you know about it and that it doesn’t happen again
  • Mom will want things done a certain way
180
Q

Obstetric History - Maternal and infant complications

A
  • Mother - hypertension, diabetes, infection, bleeding, etc…
181
Q

Obstetric History - Method of infant feeding

A
  • Past and planned
  • Bottle/breast
  • Give information early
  • Give pros and cons of both
182
Q

Menstrual history-EDD

A
  • Last normal menstrual period (LNMP)
  • Naegele’s rule
  • First day of LNMP, add 7 days and subtract 3 months
  • Ex. 9/20/14 add seven days = 9/27/14 subtract 3 months = 6/27/15
  • Sonogram is often used to confirm date
  • Important to determine when to schedule certain tests
183
Q

Contraceptive history

A
  • IUD - discussion on risks for removal, spontaneous abort, perforate wall of uterus, attached to fetus
  • Hormonal - pill, patch or ring; studies have not shown the risk to be greater than for the general population in relation to congenital malformations
184
Q

Medical/surgical history

A
  • Chronic illness, diabetes, heart disease
  • Medicine - prescription, OTC, illicit
  • Nutrition
  • Allergies/sensitivities
  • Childhood diseases
185
Q

Family history

A
  • Information about the general health of family

- Chronic diseases and infections; genetics

186
Q

Psychosocial history

A
  • Mental - depression, anxiety, bipolar
  • Mom - come off or stay on medicine
  • Need to think about how it will affect mom and how it will affect fetus
187
Q

Physical Exam - Vitals - Blood pressure

A

greater than 140/90 mm Hg may indicate preeclampsia

188
Q

Physical Exam - Vitals - Pulse

A

normal is 60-90 bpm, apical pulse - 1 minute, tachycardia is associated with anxiety, hyperthyroidism and infection

189
Q

Physical Exam - Vitals - Respiratory effort

A

16 to 24 breaths per minute; tachypnea may indicate respiratory or cardiac disease

190
Q

Physical Exam - Vitals - Temperature

A

97.8-99.6 F (36.6-37.6 C); increased temp may suggest infection

191
Q

Physical Exam - Weight

A

Initial weight is established for a baseline, calculate BMI, obesity is associated with complication for mother/baby, underweight is associated with low-birth weight infants

192
Q

Physical Exam - Urinalysis

A
  • Every visit, most important part
193
Q

Physical Exam - Urinalysis - Glucose

A

may indicate physiologic “spilling” which is normal

194
Q

Physical Exam - Urinalysis - Protein

A

trace amt ok, may indicate contamination by vaginal secretion, kidney disease or preeclampsia

195
Q

Physical Exam - Urinalysis - Ketones

A

heavy exercise or inadequate intake of food/fluid

196
Q

Physical Exam - Urinalysis - Bacteria

197
Q

Physical Exam - Fundal height

A
  • Pubic bone to top of uterus, 23 weeks = 23 inches
  • Good for only one fetus, not reliable for multiple births
  • Tip off for multiple births or due date is off
198
Q

Physical Exam - FHR

A
  • Fetal heart rate
  • 12 weeks, doppler at 10 or 11 weeks
  • Don’t be concerned if you don’t hear it at 10/11 weeks
199
Q

Physical Exam - Pelvic Exam

A
  • Chadwick’s and Goodell’s sign
  • Screen for gonorrhea and chlamydia
  • Pap test - cervical cancer
  • Bimanual exam - uterus size, contour, tenderness and position
200
Q

Pap test

A

cervical cancer

201
Q

Bimanual exam

A

uterus size, contour, tenderness and position

202
Q

Physical Exam - Reproductive

A
  • Breast - size, symmetry, nipples, colostrum

- External reproductive organs

203
Q

Physical Exam - Cardiovascular

A
  • Venous congestion - legs and vulva (varicosities) or rectum (hemorrhoids)
  • Edema - pooling of blood in extremities, pitting edema is when a finger leaves a depression
204
Q

Venous congestion

A

legs and vulva (varicosities) or rectum (hemorrhoids)

205
Q

Edema

A

pooling of blood in extremities, pitting edema is when a finger leaves a depression

206
Q

Physical Exam - M/S

A

Posture and gait - body mechanics may place strain on lower back and legs

207
Q

Physical Exam - GI

A
  • Mouth - pink, smooth and glistening; gums maybe red/tender; dental referral
  • Intestine - bowel sounds diminish because of progesterone, increased if meal is overdue or diarrhea, constipation can be discussed
208
Q

Physical Exam - Neuro

A
  • Complete exam is not necessary for someone who doesn’t exhibit symptoms
  • Deep tendon reflexes (DTR) may indicate hyperreflexia
209
Q

Physical Exam - Integument

A

Consistent with racial background, pallor may indicate anemia, jaundice may indicate hepatic disease

210
Q

Physical Exam - Endocrine

A

Thyroid enlarges during pregnancy but be on watch for hyperthyroidism, treat during pregnancy to allow for optimal development of fetal CNS

211
Q

Blood Type and Rh - RH-

A
  • 24 weeks and then again at 28 weeks will have antibody titer
  • Want to know if you are building up antibodies against the fetus
  • If fetus is RH-, no problem
  • If fetus is RH+, then you may see antibodies
  • First pregnancy not a problem, subsequent babies are the problem
212
Q

Blood glucose

A
  • Between 24 and 28 weeks because this is when gestational diabetes would show up
  • If elevated, a glucose tolerance test is recommended
  • Glucose challenge - drink glucola and see what blood sugar does
213
Q

CBC

A
  • Not all dr do it

- Identify infection, anemia or cell abnormalities

214
Q

Hepatitis B

A
  • Not all dr do it

- Detect presence of antigens in maternal blood

215
Q

HIV

A
  • Not all dr do it, risk factors would be addressed

- Voluntary test encouraged at first visit to detect HIV antibodies

216
Q

Urinalysis

A
  • Always

- Detect renal disease or infection

217
Q

Pap Smear

A
  • Always; usually on first visit
  • If you have had spontaneous abortions may do later in the pregnancy
  • Screen fro cervical neoplasia
218
Q

Cervical Culture

A
  • History of not being in a monogamous relationship
  • Strep B and STI
  • Risk of preterm labor - strep B positive
  • Give medicine when you go into labor
219
Q

Tuberculin skin-test

A
  • Would do if mom is from prison or a new immigrant
  • Not always routine
  • Screen for tuberculosis
220
Q

Venereal Disease

221
Q

Rubella Titer

A
  • Federal law
  • Determine immunity
  • Not immune - not able to do anything about it, warn her to stay away from things/areas that are at a high risk of contracting it, if she contracts it during pregnancy has high risk of fetus with anomalies, assume that she is not immune to measles, mumps or rubella and give MMR after birth/before going home
222
Q

Triple Screen

A
  • Maternal AFP, hCG, Estriol
  • Screen for fetal anomalies - down syndrome and neuro tube defects
  • Positive - indicates that there is a possibility of a normal fetus
  • Additional tests will be done
  • Blood test
  • Not foolproof, only a screen, just an indication
223
Q

High Risk Pregnancy

A
  • age
  • multiparity
  • weight
  • smoke/alcohol
  • RH-
  • weight of previous infants
  • chronic disease
  • nonwhite
  • socioeconomical status
224
Q

High Risk Pregnancy - age

A
  • Under 16 or over 35, even if they are very healthy

- Preterm labor, preeclampsia, congenital anomalies, infant mortality

225
Q

High Risk Pregnancy - multiparity

A
  • 4 plus pregnancies (multiparity)

- Antepartum or postpartum hemorrhage, cesarean birth

226
Q

High Risk Pregnancy - weight

A
  • Under 100 - Low birth weight
  • Over 200 - Hypertension, prolonged labor, large infant, cesarean birth, infection, gestational diabetes, thromboembolic disorders, postpartum hemorrhage
227
Q

High Risk Pregnancy - Smoke or use alcohol

A
  • Smoke - Placenta previa, abruptio placenta, premature membrane rupture, spontaneous abortion, perinatal immortality, low birth weight, preterm birth, SIDS
  • Alcohol - Congenital anomalies, neonatal withdrawal, fetal alcohol syndrome
228
Q

High Risk Pregnancy - RH-

A

Fetal anemia, erythroblastosis fetalis, kernicterus

229
Q

High Risk Pregnancy - weight of previous infants

A
  • greater than 8.8 pounds

- cesarean birth, infant birth injury, gestational diabetes, neonatal hypoglycemia

230
Q

High Risk Pregnancy - Chronic disease

A

diabetes, heart, thyroid, etc…

231
Q

High Risk Pregnancy - Nonwhite

A

Preterm birth, infant/maternal death

232
Q

High Risk Pregnancy - Socio-economical status

A

Preterm birth, low birth-weight

233
Q

Pregnancy DANGER SIGNS

A
  • Vaginal bleeding
  • Rupture of membranes
  • Swelling of fingers, puffiness in face
  • Continuous pounding headache
  • Visual disturbance
  • Persistent or severe abdominal pain
  • Chills/fever
  • Painful urination
  • Persistent vomiting
  • Changes in frequency/strength of fetal movement
234
Q

Pregnancy DANGER SIGNS - Vaginal bleeding with or without pain

A
  • At the minimum call
  • Little bit with no pain - might not be an issue
  • Sign of implantation, spontaneous abortion, placenta previa, abruptio placenta, lesions on cervix/vagina, “bloody show”
235
Q

Pregnancy DANGER SIGNS - Rupture of membranes

A
  • Come in
  • Gush or leak of fluid
  • No scent to amniotic fluid
236
Q

Pregnancy DANGER SIGNS - Swelling of fingers, puffiness in face

A
  • Excessive edemia
  • Fingers and feet
  • If it is swollen at night and gone in morning - probably ok, probably dependent edema
  • If it is swollen at night and then the same in the morning - should look into
  • Face, puffy eyes/nose - remarkable of preeclampsia
237
Q

Pregnancy DANGER SIGNS - Continuous pounding headache

A
  • Come in

- Sign of preeclampsia, hypertension

238
Q

Pregnancy DANGER SIGNS - Visual disturbance

A
  • Come in

- Could be migraine, worsening preeclampsia

239
Q

Pregnancy DANGER SIGNS - Persistent or severe abdominal pain

A
  • Appendicitis - can perform surgery, not something you want to do but can be done
  • Gallbladder - attack can be ok, if gallstones need to come out, can perform surgery, not something you want to do but can be done
  • Puffiness, headache, change in vision, persistent abdominal pain probably liver - preeclampsia
240
Q

Pregnancy DANGER SIGNS - Chills or fever

A

Infection - need to know what it is

241
Q

Pregnancy DANGER SIGNS - Painful urination

242
Q

Pregnancy DANGER SIGNS - Persistent vomiting

A
  • Early pregnancy could be hyperemesis gravidarum

- Late pregnancy could be preeclampsia

243
Q

Pregnancy DANGER SIGNS - Changes in frequency/strength of fetal movement

A
  • Come in and check things out
  • Fetal compromise/death
  • Ask - babies respond to the following:
    = Drinking enough fluid
    = Eating enough
    = Glucose drops - movements slow down
    = Been sick?
244
Q

Common Pregnancy Discomforts

A
  • Nausea and vomiting
  • Heartburn
  • Backache
  • Round ligament pain
  • Urinary frequency
  • Varicosities
  • Hemorrhoids
  • Constipation
  • Leg cramps
245
Q

Common Pregnancy Discomforts - Nausea and vomiting

A
  • First 12 weeks - morning sickness
  • If it moves past 12 weeks - hyperemesis gravidarum
  • Starchy things - dry toast, crackers, etc…
  • Vitamin B6, Pyridoxine (B6)
  • Take B6 through the day (two/three times) and then unisom at night (sometimes half a tablet in the morning)
  • Hypnosis and acupressure have been effective
246
Q

Bendectin

A
  • used for nausea and vomiting

- found to possibly cause birth defects so it was taken off market

247
Q

hyperemesis gravidarum

A
  • nausea and vomiting move past 12 weeks

- concern for eight loss, dehydration, electrolyte imbalance and ketosis

248
Q

Common Pregnancy Discomforts - Heartburn

A
  • A little bit of TUMS ok because it is calcium
  • Not a lot because it can cause change in electrolytes
  • Acute burning sensation in the epi-gastric and sternal regions
249
Q

Common Pregnancy Discomforts - Backache

A
  • Position changes, stretching exercises, correct posture and body mechanics
  • Tylenol - safe to use for backache or muscoskeletal pain
  • Caused by lordosis, relaxed ligaments, and muscle strain
250
Q

Common Pregnancy Discomforts - Round ligament pain

A

Uterus gets bigger and stretches down, pain in side, no dilation, be careful going from sit to stand, usually on the right side

251
Q

Common Pregnancy Discomforts - Urinary frequency

A

Ok if no fever

252
Q

Common Pregnancy Discomforts - Varicosities

A
  • TED socks, elevation, good shoes, walking, watch weight
  • Don’t cross legs/ankles
  • Weight of uterus partially compresses the veins that return blood from the legs and estrogen causes elastic tissue to become more fragile
253
Q

Common Pregnancy Discomforts - Hemorrhoids

A
  • Increase water, fiber, exercise
  • Can use tucks safely (witch hazel)
  • Caused by vascular engorgement of the pelvis, constipation, straining at stool and prolonged standing/sitting
254
Q

Common Pregnancy Discomforts - Constipation

A
  • Increase water, fiber, exercise

- Caused by progesterone, pressure from the uterus and decreased activity

255
Q

Common Pregnancy Discomforts - Leg cramps

A
  • Low electrolytes - Ca, K, Mg, Phosphorus
  • Change diet; drink orange juice and eat a banana
  • Regular exercise - shorter and easier labor
  • Usually happens during sleep when muscles are relaxed
256
Q

Teaching Healthy Behaviors - Bathing essential

A
  • use nonskid pads in shower or tub

- Protect from infection and promotes comfort

257
Q

Teaching Healthy Behaviors - Avoid saunas and hot tubs

A
  • Change in temp

- May cause maternal hyperthermia which is associated with fetal anomolies

258
Q

Teaching Healthy Behaviors - Avoid douching

A
  • Infection, bacterial vaginosis

- Preterm birth, premature rupture of membranes and low birth weight

259
Q

Teaching Healthy Behaviors - Breast care

A
  • No soap on nipples - removes natural lubricant

- Wear supportive bra - prevent loss muscle tone

260
Q

Teaching Healthy Behaviors - Clothes and shoes

A
  • Wear comfortable and non-constricting clothes and shoes

- Varicosity, increases with tight/constricting clothes

261
Q

Teaching Healthy Behaviors - Adequate nutrition, prenatal vitamins

A
  • Higher in folic acid
  • Not over the counter unless you support with extra folic acid; Centrum with prescription folic acid
  • Prescribe in prenatal counseling especially with hormonal birth control
262
Q

Teaching Healthy Behaviors - Working

A
  • Frequent rest periods, avoid exposure to radiation/chemicals
  • Exposure to teratogens is of particular concern during the 1st trimester, the period of organogenesis
263
Q

Teaching Healthy Behaviors - Traveling

A
  • Use seat belt with lap belt under abdomen
  • Car - stop and rest every two hours
  • Plane - usually ok up to 36 weeks
264
Q

Teaching Healthy Behaviors - Immunization

A
  • No immunizations with live viruses
  • Live virus - measles, mumps, rubella, varicella and smallpox
  • Inactive - tetanus, hepatitis B and flu; ok for those who are at risk
  • Pertussis - during 3rd or late 2nd trimester
265
Q

Teaching Healthy Behaviors - Medicine

A
  • Take prescription, OTC, and herbal medication ONLY if okay with MD
  • Black and blue cohosh (herbal) - cause contractions, harm fetus
  • Aspirin - may increase bleeding
266
Q

Teaching Healthy Behaviors - Smoking, alcohol, and drugs

A
  • Smoking - preterm birth, respiratory distress syndrome, neonatal intensive care unit admission
  • Alcohol - known teratogen, intellectual disability, fetal alcohol syndrome
  • Illegal drugs - harmful to fetus
267
Q

Recommended Weight Gain - Normal

A

25-35 pounds

268
Q

Recommended Weight Gain - Underweight

A

28-40 pounds

269
Q

Recommended Weight Gain - Overweight

A

15-25 pounds

270
Q

Recommended Weight Gain - Obese

271
Q

Recommended Weight Gain - Twin

A

35-45 pounds

272
Q

Is sex safe for a healthy pregnant woman?

273
Q

How much exercise should a pregnant woman get?

A

30 minutes/day

274
Q

What should a pregnant person do about sleep?

A

Plenty of sleep, use pillows for comfort, naps

275
Q

Nutritional Needs with Pregnancy and Lactation - Energy

A
  • Kilocalories, approximately 80,000 additional calories
  • Protein and CHO - 4 calories/gram
  • Fat - 9 calories/gram
276
Q

Nutritional Needs with Pregnancy and Lactation - Carbohydrates (CHO)

A
  • Simple - sucrose; table sugar, candy, fruits, vegetables
  • Complex - starch; cereal, pasta, potatoes
  • Fiber - indigestible CHO; plant foods
  • 4 calories/gram
277
Q

Nutritional Needs with Pregnancy and Lactation - Protein

A
  • Metabolism, tissue synthesis and tissue repair
  • If calories are low and protein is used for energy, fetal growth may be impaired
  • Eat more protein rich foods
  • 4 calories per gram
278
Q

Nutritional Needs with Pregnancy and Lactation - Fat

A
  • Alpha linolenic acid and linoleic acid - neurological and visual development in fetus
  • If there is not enough the body will use protein, this decreases the amount of protein available for building/repairing tissue
  • DHA - fetal visual and cognitive development
  • Sources - Canola, soybean, walnut oil, bass, salmon
  • 9 calories per gram
279
Q

Nutritional Needs with Pregnancy and Lactation - Vitamin A

A
  • Too much can cause fetal defects
  • Isotretinoin (Accutane) - used to treat acne, form of vitamin A
  • Source - dark green, yellow, or orange vegetables, whole or fortified milk, egg yolk, butter and fortified margarine
280
Q

Nutritional Needs with Pregnancy and Lactation - Folic Acid (folate)

A
  • Decrease occurrence of neural tube defects (spina bifida and anencephaly)
  • May prevent cleft lip, cleft palate and some heart defects
  • Good idea to increase prior to pregnancy
281
Q

Nutritional Needs with Pregnancy and Lactation - Niacin

A
  • Forms coenzymes necessary to release energy, increased need due to increase calories
  • Meats, fish, poultry, legumes, enriched grains, milk
282
Q

Nutritional Needs with Pregnancy and Lactation - Vitamin C

A
  • Formation of fetal tissue, collagen formation, tissue integrity, healing, immune response and metabolism
  • Citrus fruit, peppers, strawberries, cantaloupe, green leafy vegetables, tomatoes, potatoes
283
Q

Nutritional Needs with Pregnancy and Lactation - Iron

A
  • Maternal red blood cells and for transfer to the fetus for storage and production of red blood cells
  • Iron is transferred to fetus even if mother is anemic
  • Usually take a supplement
284
Q

Nutritional Needs with Pregnancy and Lactation - Zinc

A
  • Fetal and maternal tissue growth, cell differentiation and reproduction, DNA & RNA synthesis, metabolism, acid-base balance
  • Meat, poultry, seafood, eggs, nuts, seeds, legumes, wheat germ, whole grains, yogurt
285
Q

Nutritional Needs with Pregnancy and Lactation - Iodine

A

Thyroid function, deficiency may cause abortion, stillbirth, congenital hypothyroidism, neurologic conditions

286
Q

Nutritional Needs with Pregnancy and Lactation - Water

A
  • Blood volume and tissue

- 8 to 10 glasses/day

287
Q

Factors That Influence Nutrition - Culture

A
  • Don’t make assumptions about culture, assess each individually
  • Hot/cold, taboos, special foods, kosher diets
288
Q

Factors That Influence Nutrition - Nausea & emesis

A
  • Frequent, small meals
  • Protein snack at night helps glucose level
  • Dry toast/crackers before getting up
  • Water between meals help
289
Q

Factors That Influence Nutrition - Age

A
  • Adolescent - need nutrition for her own growth

- Older - same nutritional requirement as younger moms

290
Q

Factors That Influence Nutrition - Anemia

A
  • Baby will take iron even if mom is low

- Need supplement and advised of iron rich foods

291
Q

Factors That Influence Nutrition - Knowledge

A

Become interested in what they eat and how it affects baby

292
Q

Factors That Influence Nutrition - Abnormal pre-pregnancy wt.

A
  • Below - may not have money for food or have an eating disorder
  • Above - hypertension that may affect nutritional guidelines
293
Q

Factors That Influence Nutrition - Socioeconomic status

A
  • Poverty - unable to afford food, refer to SNAP or WIC

- Food supplement program - WIC

294
Q

Factors That Influence Nutrition - Eating disorders

A
  • Electrolyte imbalance, low birth weight and small babies

- Need individualized counseling to ensure they meet nutrition requirements

295
Q

Factors That Influence Nutrition - Adolescence

A
  • Associate with higher risk for mom and baby
  • Same nutritional need as any other pregnant woman
  • Poor intake and unreliable supplementation decreases nutrient store and status
296
Q

Factors That Influence Nutrition - Pica

A
  • Eat chalk, dirt, or any nonfood item, deficient in some mineral
  • Cause is unknown
  • Decreases the intake of foods that are essential to pregnancy
297
Q

Factors That Influence Nutrition - Vegetarianism and vegan

A

Make sure you eat enough protein

298
Q

Factors That Influence Nutrition - Multiparity

A
  • Begin pregnancy with a nutritional deficit

- May be too busy meeting family needs when she should be concerned with herself

299
Q

Factors That Influence Nutrition - Lactose

A
  • Intolerance caused by deficiency in lactase

- Calcium

300
Q

Factors That Influence Nutrition - Factors That Influence Nutrition - Substance use - smokine

A

increases mom’s metabolism and decreases appetite, low birth weight, prematurity, spontaneous abortions

301
Q

Factors That Influence Nutrition - Substance use - caffeine

A

changes absorption/excretion of calcium, zinc, thiamine and iron

302
Q

Factors That Influence Nutrition - Substance use - alcohol

A

fetal alcohol syndrome

303
Q

Factors That Influence Nutrition - Substance use - drugs

A

increase danger to fetus and interfere with nutrition

304
Q

Nutrition for Lactating Women - Avoid dieting

A
  • To lose weight

- Can eat less but not outright diet, wait at least 3 weeks to allow the body to recover and establish a milk supply

305
Q

Nutrition for Lactating Women - Adequate intake

A
  • calories, protein, essential vitamins, minerals, and water

- well balanced diet will enable mother to meet the infant’s and their own needs

306
Q

Nutrition for Lactating Women - Avoid alcohol

A
  • Should not breast feed for at least 2 hours after
  • Pump and throw
  • Can metabolize out if you don’t feed for awhile (glass of wine at dinner and feed at 11p, probably ok)
307
Q

Nutrition for Lactating Women - Avoid caffeine

A

excess amounts can make infant irritable

308
Q

Nutrition for Lactating Women - Avoid certain foods

A

spicy, peanut butter, cabbage, broccoli, chocolate

309
Q

Nutrition for Lactating Women - OTC or Medicine

A
  • colase - baby may get softer stools

- prescription meds - talk to Dr

310
Q

Nutrition for Non-lactating Women

A
  • Return to pre-pregnancy diet, if it met RDA standards
  • Protein and vitamin C intake to promote healing
  • Continue prenatal vitamins till supply is gone
  • Wait at least 3 weeks after birth before dieting - healthy return to previous weight
311
Q

Nutritional Assessment - Interview

A
  • Appetite
  • Eating habits
  • Food preferences
  • Psychosocial influences
  • Diet history-24 hour recall, food intake record
312
Q

Nutritional Assessment - Interview - Appetite

A
  • Compare to before pregnancy

- Morning sickness and hyperemesis gravidarum can suppress appetite

313
Q

Nutritional Assessment - Interview - Eating habits

A
  • Pattern of meals

- Eating fast food

314
Q

Nutritional Assessment - Interview - Food preferences

A
  • Preferences and dislikes

- Pica

315
Q

Nutritional Assessment - Interview - Diet history

A
  • List the foods eaten
  • More accurate if food eaten is recorded after intake
  • Size and portions of ingredients
  • Beverages and snacks
316
Q

Nutritional Assessment - Physical Assessment

A
  • Weight at first visit
  • Weight at each visit
  • Signs of nutrient deficiency
  • Lab tests
317
Q

Nutritional Assessment - Physical Assessment - Weight at first visit

318
Q

Nutritional Assessment - Physical Assessment - Weight at each visit

A

Establish a pattern as well as total weight gain

319
Q

Nutritional Assessment - Physical Assessment - Signs of nutrient deficiency

A
  • Bleeding gums - inadequate intake of vitamin C

- Pallor, low hemoglobin levels, fatigue and susceptibility to infection - inadequate intake of iron

320
Q

Nutritional Assessment - Physical Assessment - Lab tests

A
  • Generally impractical

- May do some to detect anemia

321
Q

Reasons for prenatal testing include….

A
  • Baseline info
  • Gestational age
  • Condition of fetus
322
Q

Indications for testing include…

A
  • demographic factors
  • medical conditions
  • obstetric factors
323
Q

demographic factors for testing

A

maternal age under 16 or older than 35, poverty, nonwhite, and inadequate prenatal care

324
Q

medical conditions for testing

A

diabetes, hypertension, STD, anemia, infections, genetic disorders

325
Q

obstetric factors for testing

A

history of pregnancy difficulties

326
Q

Ultrasonography

A
  • Uses high-frequency sound waves to image fetus
  • Full bladder may be needed for exam, have woman drink several glasses of water 1 hr. before exam.
  • Confirms pregnancy/viability of fetus (heartbeat)
  • Evaluate fetal anatomy, growth (crown-rump measurements), presentation
327
Q

Doppler Ultrasound Blood Flow Assessment

A
  • Assess blood flow through umbilical artery
  • For a fetus that is lagging behind/multiple pregnancy
  • Kick count not adequate
  • Measures systolic/diastolic ratio
  • Usually decreases throughout gestation
  • Used in pregnancies with maternal hypertension or placental insufficiency
328
Q

Alpha-fetoprotein (AFP) Screening

A
  • not for diagnosis
  • AFP is protein in fetal plasma
  • AFP can be measured in maternal serum and amniotic fluid
  • Abnormal AFP associated with neural tube defects (spina bifida, anencephaly), Downs Syndrome
  • Screening offered between 16-18 weeks gestation
329
Q

Triple-Marker Screening

A
  • Screening only
  • Includes AFP, human chorionic gonadotropin and unconjugated estriol
  • Maternal serum samples 16-18 weeks gestation
  • Positive: AFP and estriol low, hcg high
  • Increases defection of trisomy 18 and trisomy 21
  • Positive results - amniocentesis
330
Q

Chorionic Villus Sampling (CVS)

A
  • Villi in the chorion reflect the fetal genetic makeup
  • For diagnosis of fetal chromosomal or metabolic abnormalities (open neural tube defects)
  • Performed at 10-12 or 13 weeks gestation
  • Transabdominal or transcervical methods to obtain chorionic villi with ultrasound imagin
331
Q

Amniocentesis

A
  • More diagnostic
  • Amniotic fluid aspirated with needle through mother’s abdomen
  • Identifies chromosomal abnormalities, elevated AFP levels, intrauterine infections
  • Includes lecithin/sphinomyelin ratio which determines fetal lung maturity before 38 weeks and L & S lipoproteins that make up surfactant
  • Responsibility: After procedure nurse is responsible for monitoring fetal/uterine activity for 30-60 minutes, kick count
332
Q

Fetal Surveillance

A
  • Nonstress test
  • Contraction stress test (CST)
  • Biophysical Profile
  • These tests help determine the health of the fetus or if there is fetal compromise. They help the doctor to determine intervention if needed.
333
Q

Nonstress Test

A
  • Determines the ability of the fetal heart to accelerate, often in association with fetal movement.
  • An external electronic monitoring device applied to woman’s abdomen
  • Reactive/Reassuring - Adequate oxygen, neural pathway from heart to CNS, respond to stimuli
  • Nonreactive/Nonreassuring - Fetal hypoxemia and acidosis, additional tests - CST and BPP
334
Q

Contraction Stress Test

A
  • Records the response of the FHR to stress induced by uterine contractions.
  • Nipple stimulation or IV oxytocin used to start contractions.
  • Late decelerations (decrease in FHR after contraction peaks and does not return to baseline after end of contraction) means fetus had inadequate O2 reserves.
  • Early or right on deceleration is expected in reaction to contraction
  • Negative results-no late decelerations
  • Positive results- late decelerations 50% of time or significant variable decelerations
335
Q

Biophysical Profile

A
  • Assess 5 parameters of fetal well being=nonstress test, breathing movements, gross fetal movements, fetal tone (position tightly), and amniotic fluid volume
  • Each parameter can score 0-2 points based on fetal health (total of 10 points possible)
  • Normal score/reassuring 8-10 points
  • Abnormal score/nonreassuring 4 points or less
336
Q

modified biophysical profile

A

breathing movements, gross fetal movements, fetal tone (position tightly), and amniotic fluid volume

Reproductive (2 decks)

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