Test 1 Flashcards
1.Describe what is obtained on the first prenatal visit including the lab tests. (Chapter 7 page121)
Goal is confirm a diagnosis of pregnancy
History
Chief complaint: Missed menstrual period
Reproductive History: LMP
Medical-Surgical History
Family History
Social History
Physical examination: breast examination, A speculum examination with a Pap test and a biannual examination of the uterus
Laboratory Assessment: A complete blood count, blood type, antibody screen, test screen for the presence of infection ( HepB, HIV, Syphilis, Gonorrhea, and Chlamydia, Rubella titer), A urine culture screens for bacteria in the urine (UTI), Screening for hypothyroidism is done only when the woman has risk factors or symptoms of hypothyroidism, and glucose tolerance test (GTT) is done to evaluate the woman for gestational diabetes for women who are at risk may be screened as early as the first prenatal visit.
Due Date Estimation
Risk Assessment
- What does the acronym GTPAL stand for? (Chapter 7; page 121; BOX 7-1)
Gravida: Total number of pregnancies
Term deliveries: Number of pregnancies that went to term (at or beyond 38 weeks’ gestation)
Preterm deliveries: The number of pregnancies that delivered 20 weeks and before the end of 37 weeks’ gestation
Abortions: the number of pregnancies that ended before 20 weeks’ gestation
Living children: the number of children delivered who are alive at the time of history collection
Susie is 38 weeks pregnant. This is her second pregnancy. She delivered a healthy baby boy at 39 weeks with her first pregnancy. What is this woman’s GTPAL?
Right now, her GTPAL is G2, T1, P0, A0, L1 because she has not yet delivered her second baby. Once she does, she will be at G2, T2, P0, A0, L2
- What do the terms EDC and EDD mean? What is the “Naegele Rule” and what does it calculate? (Chapter 7; page 123)
EDC: An older term that is sometimes used is estimated date of confinement “old fashion term”
EDD: Estimated date of delivery “ woman’s due date” “Modern term”
Naegele Rule: A common way to calculate the EDD
-To determine the die date using Naegele rule> add 7 days to the date of the first day of the LMP “last menstrual period”, then subtract 3 months.
- This is a simple way to estimate the due date, but it is dependent upon the woman knowing when the first day of her LMP was is also based upon the women having a 28-day menstrual cycle. Sometimes the EDD is impossible to determine based upon Naegele rule, Particularly if the woman experiences irregular menstrual cycles, or if she cannot remember the date.
- Describe the difference between an amniocentesis and chorionic villus sampling? What is an advantage of chorionic villus sampling? (Chapter 7; page 129&145)
Amniocentesis: Involves aspiration of amniotic fluid through the abdominal wall to obtain fetal cells for chromosomal analysis. Amniocentesis is usually done between 15 and 20 weeks’s gestation
Chorionic Villus Sampling: Is similar to amniocentesis, but it can be performed earlier, usually to 10 to 12 weeks. Placental tissue is aspirated through a catheter that is introduced through the cervix or it can be done transabdominally
-One advantage of chronic villus sampling testing is that it is done earlier in the pregnancy than amniocentesis. Chorionic villus sampling is typically performed at 8 to 12 weeks’ gestation. Because chorionic villus sampling is an invasive procedure, informed consent is required
5.What is a reactive nonstress test? (Chapter 7; page 145)
The non stress test (NST) measures fetal heart rate acceleration patterns. A reactive NST is reassuring
6.What should a Rh-negative woman receive after an invasive procedure? (Chapter 7; Page 129)
Rho(D) immune globulin should be administered after the procedure to Rho(D)-negative women
7.Describe what should be assessed on subsequent prenatal visits and what complications should the pregnant woman be encouraged to report? (Chapter 7 page124)
Weight
Blood pressue
Urine protein
Glucose
Fetal heart rate (FHR)
Explain danger signs of pregnancy (Ask the woman about fetal movement, contraction, bleeding and membrane rupture)
-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:
-Uterine contractions (four or more per hour)
-Lower, dull backache
-Pelvic pressure
-Menstrual-like cramps
-Increase in vaginal discharge
-A feeling that something is not right
Fundal height is measured (to do this a type measure is placed at the base of the uterus, at the symphysis pubis, and then laid against the abdomen. The fundal height is measures in centimeters with the reading at the top of the fundus. Between weeks 18 and 32, the fundal height in centimeter should match the gestational age of the preganancy. Ex.18 weeks, the fundal height should measure 18cm)
8.List the types of tests that can be done to determine fetal well-being during pregnancy. (Chapter 7 Page 126)
Fetal movement (kick) count
-Ultrasonography: uses sound waves to visualize fetal and maternal structures. Ultrasound is done to determine or confirm gestational age, observe the fetus, and diagnose fetal and placental abnormalities.
o Transabdominal Ultrasound
o Transvaginal Ultrasound
o Doppler
-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? (Chapter 7 page 127)
Alpha-fetoprotein is a protein manufactures by the fetus.
Higher then expected levels of MSAFP are seen when the woman is carrying multiple fetuses or if the fetus has died in uterus, or in the presence of neural tube defects.
The main reason MSAFP is measured is to check for neural tube defects such as anencephaly (Failure of the brain to develop normally) or spina bifida (failure of the spine to close completely during development) MSAFP levels are usually elevated if the fetus has either of these anomalies. Omphalocele and Gastroschisis (Both are caused by a failure of the abdominal wall to close) are two other conditions that cause elevated MSAFP levels.
Low MSAFP levels may indicate Down Syndrome
10.Describe involution. (Chapter 12 page 240)
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.(Chapter 12 ; pages 241)
Lochia: Blood, mucus, tissue and white blood cells compose the uterine discharge
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
- Lochia may persist for the entire 6 weeks after delivery but often subsides by the end of the second or third week. Lochia should never contain large clots. Other abnormal findings include reversal of the pattern ( the Lochia has been serosa, then goes back to rubra), Lochia that fails to decrease in amount or actually increases versus gradually decreasing or is malodorous.
12.When is it necessary for the postpartum woman to begin using birth control? (Chapter 12 page 241)
It is wise for the woman to use some type of birth control to prevent an unplanned pregnancy when she resumes sexual activity.
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. (Chapter 12 Page 243)
Cardiovascular system:
o (Early postpartum period)The woman eliminate the additional fluid voulme that is present during the pregnancy. The fluid loss occurs via the skin, urinary tract, and through blood loop. The woman who experiences a normal vaginal delivery loses approximately 300 to 500 mL of blood during delivery. If she has a cesarean delivery, normal blood loss is between 500, and 1,000mL
o 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). Dehydration, immobility, and trauma can ass to the risk for DVT.
o The white blood cells count is elevated to approximately 15,000 to 20,000/mL and may reach as high as 30,000/mL. Leukocytosis, a high white bloof cell count, helps protect the woman from infection
o Immediately pr very soon after delivery, the woman may experiencing shaking postpartum chills. Hormonal and physiological changes are the likely cause of the shaking and chills. In any event, chills are not harmful, unless accompanied by fever greater than 100.4F or other signs of infection. Chills normally resolve within minutes, especially if a pre warmed blanket is placed over the woman.
Vital Signs:
o Temperature may be elevated slightly during the first 24 hours because of the exertion and dehydration of labor. After the first 24 hours, a temperature of 100.4F or greater is abnormal and may indicate infection
o The blood pressure should remain at the woman’s baseline level. AN elevated blood pressure could ve a sign of developing preeclampsia and should be promptly reported. A falling blood pressure, particularly in the presence of a rising pulse, is suggestive of hemorrhage. Monitor the woman carefully for a source of blood loss if her blood pressure drops
o 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. Occasionally, the woman may experience tachycardia. This is more likely to occur after a difficult labor and delivery, dehydration, or it may indicate excessive blood loss.
Integumentary System:
o Diaphoresis occurs in the first few days after childbirth as the body rids itself of excess waster and waste via the skin. The woman notices th perspiration particularly at night. She may wake wake up and be drenched in sweat. This is a normal finding and is noty a cause for concern
o The woman will likely have striae (stretch marks) on the abdomen and sometimes on the breast. Immediately after birth, striae appear red or purplish. Over time, they fade to light silvery color and remain faintly visible
o The nipples and Arnold’s often darken in color during pregnancy and this color tends to lighten during the postpartum period. In addition, a woman who has linea nigra may notice it darkening and the lightening in color during the postpartum period
14.Describe healthy bonding. Describe the warning signals of poor attachment (Chapter 12 page 246).
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. It is important to differentiate between a new parent who is nervous and anxious about her new role and one who is rejecting her parenting role
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.(Chapter 12 Page 246)
Sadness
Tearfulness for no apparent reason
Irritability
Anxiety
Difficulty sleeping or eating
May have decreased concentration
