Study Guide Test 1 Flashcards
- Describe what is obtained on the first prenatal visit including the lab tests.
• History
Chief Complaint – missed menstral cycle
Reproductive History
Medical–Surgical History
Family History
Social History
• Physical Examination
Breat examination
A speculum examination with a Pap test and a biannual examination of uterus
• Laboratory Assessment
Complete Blood Count
Hemaglobin electrophoresis
Hematocrit
Blood Type
Antibody Screen
Labs for Infection: Hep B, HIV, Syphilis, gonorrhea, chlamedia
Urine Culture Screen – bacteria in urine
Glucose Tolerance screening
• Due Date Estimation
• Risk Assessment
- What does the acronym GTPAL stand for?
• G: Gravida—the total number of pregnancies
• T: Term—the number of pregnancies that ended at term (at or beyond 38 weeks
gestation)
• P: Preterm—the number of pregnancies that ended after 20 weeks and before the end of 37 weeks gestation
• A: Abortions—the number of pregnancies that ended before 20 weeks gestation
• L: Living—the number of children delivered who are alive when the history is taken
- What do the terms EDC and EDD mean? What is the “Naegele Rule” and what does it calculate?
• (EDC) – an older term that is sometimes used is estimated date of confinement “old fashion term”
• Estimated Date of Delivery (EDD) - the estimated date that the baby will be born, also called the “due date.”
• Naegele Rule - a formula used to determine the pregnancy due date by adding 7 days to the date of the first day of the last menstrual period (LMP), then subtracting 3 months.
- Describe the difference between an amniocentesis and chorionic villus sampling? What is an advantage of chorionic villus sampling?
• Amniocentesis - a diagnostic procedure whereby a needle is inserted into the amniotic sac and a small amount of fluid is obtained and used for biochemical, chromosomal, and genetic studies.
• Chorionic villus sampling (CVS) - a procedure similar to amniocentesis that can provide chromosomal studies of fetal cells.
One advantage of chorionic villus sampling testing is that it is done earlier in the pregnancy than amniocentesis.
One advantage of chorionic villus sampling testing is that the results are available in 7 to 10 days, much faster than with amniocentesis.
- What is a reactive nonstress test?
• Nonstress Test (NST) - is a noninvasive way to monitor fetal well-being.
- What should a Rh-negative woman receive after an invasive procedure? Pg 253
• If the woman is Rh-negative, she will need laboratory studies to determine if she is a candidate for a Rho(D) immune globulin injection before discharge
• Determine the woman’s rubella status - If she is nonimmune, she will need a rubella immunization before she is discharged home.
- Describe what should be assessed on subsequent prenatal visits and what complications should the pregnant woman be encouraged to report?
• During subsequent visits, weight, blood pressure, urine protein and glucose, and fetal heart rate (FHR) are all data that are routinely collected.
• At every visit, inquire regarding the danger signals of pregnancy.
Fever or severe vomiting
Headache, unrelieved by acetaminophen or other relief measures
Blurred vision or spots before the eyes
Pain in the epigastric region
Sudden weight gain or sudden onset of edema in the hands and face
Vaginal bleeding
Painful urination
Sudden gush or constant, uncontrollable leaking of fluid from the vagina
Decreased fetal movement
Signs of preterm labor
o Uterine contractions (four or more per hour)
o Lower, dull backache
o Pelvic pressure
o Menstrual-like cramps
o Increase in vaginal discharge
o A feeling that something is not right – fundal height is measured.
• Ask the woman about fetal movement, contractions, bleeding, and membrane rupture.
- List the types of tests that can be done to determine fetal well-being during pregnancy.
• Fetal Movement (Kick) Count
• Ultrasonography
• Transabdominal Ultrasound
• Transvaginal Ultrasound
• Doppler Flow Studies
• Maternal Serum Alpha-Fetoprotein Screening
• Amniocentesis
• Chorionic Villus Sampling
• Percutaneous Umbilical Blood Sampling (known as Cordocentesis)
• Nonstress Test
• Contraction Stress Test
• Biophysical Profile
9.What is an AFP, and what could abnormal levels indicate? Pg. 127
(Maternal Serum Alpha-Fetoprotein Screening)
• Abnormal levels (high or low) may indicate a problem and the need for additional testing.
• Manufactured by the fetus
• Done between 15-20 weeks gestation
• High - he woman is carrying multiple fetuses, or if the fetus has died in utero, or in the presence of neural tube defects.
• Low - Low levels may indicate Down syndrome.
10.Describe involution. Pg. 240
• Involution - is the process through which the uterus, cervix, and vagina return to the nonpregnant size and function
11.Describe the three stages of lochia and what the client should expect over the next 6 weeks including reasons to call the Dr’s office.
• Lochia rubra: Occurs during the first 3 to 4 days; is of small to moderate amount; is composed mostly of blood; is dark red in color; has a fleshy odor.
• Lochia serosa: Occurs during days 4 to 10; decreases to a small amount; takes on a brownish or pinkish color.
• Lochia alba: Occurs after day 10; becomes white or pale yellow because the bleeding has stopped, and the discharge is now composed mostly of white blood cells
If the lochia is malodorous or smells rotten, suspect infection. Report this finding immediately to the RN or health care provider.
12.When is it necessary for the postpartum woman to begin using birth control?
• Advise the woman to use birth control even if she is breast-feeding or if her menses have not yet returned.
• Women can ovulate without a menses in the postpartum period.
• Women who are breast-feeding should be encouraged to use a nonhormonal method of birth control to avoid a decrease in their milk supply.
• Although lactation may suppress ovulation it is NOT a dependable form of birth control
13.Describe the changes that occur to the cardiovascular system, vital signs, and the integumentary system in the postpartum period. Pg. 242
Cardiovascular System
• In the early postpartum period, the woman eliminates the additional fluid volume that is present during the pregnancy. This fluid loss occurs via the skin, urinary tract, and through blood loss.
vaginal delivery loses approximately 300 to 500 mL of blood during delivery.
cesarean delivery, normal blood loss is between 500 and 1,000 mL.
• Plasma fibrinogen levels are elevated, as are other coagulation factors. This helps to protect the woman against hemorrhage, but at the same time it predisposes the woman to the development of blood clots in the deep veins of the legs called deep vein thrombosis (DVT).
• White blood cell count is elevated to approximately 15,000 to 20,000/mL and may reach as high as 30,000/mL. High WBC helps protect the woman from infection
• Immediately or very soon after delivery, the woman may experience shaking postpartum chills. There harmful unless accompanied by fever greater that 100.4 or tighter signs of infection.
• Vital Signs
Temperature may be elevated slightly during the first 24 hours because of the exertion and dehydration of labor.
Blood pressure should remain at the woman’s baseline level.
High BP - could be a sign of developing preeclampsia
Low BP - particularly in the presence of a rising pulse, is suggestive of hemorrhage
Pulse - It is normal for the pulse to be slow in the first week after delivery. The heart rate may be as low as 50 beats per minute
13.Describe the changes that occur to the cardiovascular system, vital signs, and the integumentary system in the postpartum period. Pg. 242
Integumentary System
• Diaphoresis occurs in the first few days after childbirth as the body rids itself of excess water and waste via the skin.
• The woman will likely have striae (stretch marks) on the abdomen and sometimes on the breasts. Immediately after birth, striae appear red or purplish
• Nipples/Areolas color gets lighter during postopartum
• Linea Nigra will get lighter during postpartum
• Immediately after delivery, approximately 12 to 14 lb (5.5 to 6.4 kg) is lost with the delivery of the fetus, placenta, and amniotic fluid
• The woman loses an additional 5 to 15 lb (2.3 to 6.8 kg) in the early postpartum period because of fluid loss from diaphoresis and urinary excretion
• Pregnant women will lose weight faster
14.Describe healthy bonding. Describe the warning signals of poor attachment.
• Healthy bonding behaviors include naming the newborn and calling the newborn by name. Making eye contact and talking to the newborn are other indicators that healthy attachment is occurring.
• Warning signals of poor attachment include turning away from the newborn, refusing or neglecting to provide care, and disengagement from the newborn.
15.Describe the signs and symptoms of post-partum blues. Pg. 246
• Postpartum blues is a temporary condition that usually begins about the third day after delivery, lasts for 2 or 3 days, and usually has resolved by 2 weeks postpartum.
Symptoms
anxiety sadness or tearfulness for no apparent reason
difficulty sleeping or eating.
may have decreased concentration.
irritability
tearfulness for no apparent reason
* sadness
16.What are the issues with respiratory adaptation when an infant is born by Cesarean section? Pg. 267
• This newborn often has more fluid in their lungs, making respiratory adaptation more challenging. Closely monitor this newborn’s respiratory rate, lung sounds, and oxygen saturation levels.
17.List the newborn assessment findings that would indicate the newborn is adapting to extra-uterine life. Pg. 270
The Apgar score is means of quickly assessing the newborn’s transition to extrauterine life based upon evaluation of five newborn parameters:
• Heart rate
• Respiratory effort
• Muscle tone
• Reflex irritability
• Color
