Test #1 Wks 1 and part of 2 Flashcards
What are the 3 P’s of labor
Passageway passenger powers position psyche
What is the purpose of the amniotic fluid
Protection- cushions the fetus
temp control- acts as insulation
facilitates movement & growth-
what facilitates the volume change of the amniotic fluid
the baby swallow it so the amount lessens
The baby urinates & fluid from the maternal blood crosses the placenta thus the amount increases
How much amniotic fluid is there at term
1 L on average
what would cause too much fluid in the amniotic sac
the fetus may not be swallowing thus revealing a possible GI problem or malformations of the gi tract, neural tube defects,
maternal problems such as maternal diabetes can lead to polyhydraminios
what are 1st trimester discomforts
- urinary frequency/ incontinence- increased fetus growth pressing on bladder
- fatigue d/t physical changes
- N&V- d/t possible increase in estrogen progesterone and hcg
- Breast tenderness- d/t increased estrogen and progesterone
- constipation- d/t increased progesterone(decreases gi contractility)
- nasal stuffiness, bleeding gums, epistaxis- increased estrogen causing edema
- cravings
- leukorrhea
what is the amnion and the chorion
the amnion is the inner layer of the amniotic sac that holds the amniotic fluid
the chorion is the outer sac next to the uterine wall
what can be the cause of oligohydramnios
fluid retention in the fetus- can indicate renal problems.
also
uterus placental insufficiency (the placenta is not doing its job-inadequate blood flow through the placental spacing not allowing enough nutrition to the fetus)
complications of oligohydramnios
low birth weight, increases risk for c-section which can cause fetal distress
complications of polyhydramnios
excess pressure which can lead to premature rupture of the amniotic sac increasing the risk for infection
complications, c-sections, low birth rate, premature baby
what is Whartons jelly
a specialized connective tissue surrounding the 2 arteries and vein to prevent compression.
after the umbilical cord is cut what should you check for
always check for the 3 vessels.
a lack of artery can be associated with fetal renal or GI issues.
what is the average length of the umbilical cord at term
22 inches
purpose of the placenta
fetal gas exchange
nutrition
excretion,
hormone production
once the placenta is delivered what needs to be checked and why
you need to check if the placenta is in tact. If there is a piece of the placenta left inside the mother it can cause a hemorrhage
what are the 3 fetal shunts
- Ductus venosus- connects the umbilical vein to the inferior vena cava. allows blood to bypass the liver except for the amount to nourish the tissues
- Ductus arteriosus- connects the main pulmonary artery to the aorta- allows blood to bypass the lungs
- Foramen Ovale- opening btw rt and lt atrium- blood coming into rt side of heart already oxygenated thus blood bypasses lungs going to lt atrium to lt ventricle
what is angels rule
estimating the date of delivery
subtract 3 months to LMP and add 7 days
so if a woman LMP was 1-20-17 her due date would be
10-27-17
what are ways to estimate due date
Nageles rule
measure the fundal height
ultrasound
what are presumptive signs of pregnancy
subjective signs & symptoms:
amenorrhea, n&v, fatigue, urinary frequency, breast changes, quickening (baby moving)
what are probable signs of pregnancy
Objective signs noticed by the examiner:
Hegars sign- softening of the uterine segment
Chadwicks sign-bluish color of the vaginal mucosa
Goodells sign-“good and soft” softening of the cervix
Braxton hicks ctonractions
positive pregnancy test
abdominal enlargement
how early can hcg levels be detected
1 week after conception
hcg levels in normal pregnancy usually double every 48-72 hours until they peak approx 60-70 days after fertilization.
Positive signs of pregnancy
HEAR the baby- auscultate heart beat
SEE the baby- u/s
FEEL the baby- palpate fetal movement
how long is the uterus in the pelvic cavity before ascending into the abdominal cavity
the uterus is in the pelvic cavity for the first 3 months and then ascends into abdominal cavity
If a patient has increased vaginal secretions should she be worried
no. vaginal mucosa thickens and connective tissue begins to loosen. this all results in an increase in a whitish vaginal discharge (leukorrhea) which is totally normal.
UNLESS it is accompanied by itching and irritation. this can be the result of vaginitis.
what hormones cause the breasts to become tender and enlarged
Progesterone and estrogen
how much does blood volume increase by wk 30 gestation
it increases 50%
related to fetal weight- the increase in blood volume is needed to provide adequate hydration of fetal and maternal tissues and to have a reserve for blood loss during birth.
what is the heart rate for a pregnant woman
the heart rate increases 10-15 bpm
why would BP drop for a pregnant woman
due to peripheral vasodilation caused by progesterone.
it decreases 5-10mmhg during the second trimester and returns to prepregnancy levels at 3rd trimester
as the uterus shifts upward towards the diaphragm what happens to the lungs
The lung housing gets smaller and the chest circumference widens to make room and allowing more space for deep breathing and increased tidal volume to compensate for the increased oxygen demands
what respiratory changes occur during pregnancy
maternal hyperventilation and hypocapnia(decreased co2 d/t rapid breathing) and her breathing becomes more diaphragmatic than abdominal
what is considered within normal limits of HCT and HgB
HCT= greater than or equal to 35 HgB = greater than or equal to 10
what is the cause of physiologic anemia of pregnancy
there is a plasma increase d/t the hormonal factors and sodium and water retention and because this plasma increase exceeds the increase of RBCs HgB and HCT decrease from hemodilution
what is round ligament pain
an intense grabbing sensation in the abdomen. the ligaments supporting the uterus are being pulled as the uterus grows
what can you advise a pregnant woman to do to minimize morning sickness
encourage woman to stay hydrated, avoid bad smells, eat smaller meals, take ginger and drink carbonated beverages
why do pregnant women get heartburn
d/t the increased smooth muscle relaxation from the progesterone and relaxin. This causes a relaxation of the pyloric sphincter resulting in acid reflux
what can you teach a woman on how to relieve heartburn
chew papaya enzymes prior to eating a meal.
What are changed in renal structure caused from
- Estrogen and progesterone
- Pressure from an enlarging uterus
- Increase in maternal blood volume
What happens to the GFR during pregnancy
It increases in the second trimester d/t the increases cardiac output and the relaxin
What is a complication from the renal pelvis and ureters relaxing
Urine retention and UTIs which can increase the chance of preterm labor
What position will better help urine flow in a pregnant woman
A side lying position because it takes pressure off of the vena cava and allows better blood flow through
What are the hormones in pregnancy
HCG Human placental lactogen Estrogen Progesterone Relaxin Prolactin Oxytocin Cortisol
What does HPL do
Human placental lactogen
Released by the placenta, promotes lipolysis so it can be used by the mother for energy
Also acts as an insulin antagonist this having an increase in glucose in the bloodstream. This will allow the baby to have enough energy to grow
What is estrogen responsible for
Increased vascularity as well as the relaxation of ligaments and joints. Especially the pelvis
What is progesterone responsible for
Facilitates fat deposits to act as energy packs for the mother for lipolysis
Also decreases uterine contractility
What is prolactin for
Initial lactation.
Estrogen and progesterone suppress the action until after placenta is detached and those levels drop. Then prolactin can begin to work
What is cortisol used for
Stimulates increased insulin production by the pancreas.
If you are traveling what precautions should you take
Walk q2h
Wear lap belt under abdomen
Drink plenty of fluids
What can happen if mothers weight gain gets too high
She had an increase risk of high birth weight baby and ceohalopelvic disproportion this risking inhibition of vaginal birth
What can happen if the mother doesn’t gain enough weight
Malnourishment and low birth weight baby
What are nutritional needs influenced by
Pre pregnancy weight and age
Teens need more calories because they are still growing themselves
What types of things need to be increased in a pregnant woman’s diet
-calories
-protein
-iron
-vitamin a and c
-folate
6-8 glasses of fluids per day
What should a pregnant woman avoid eating
Fish at the top of the food chain such as shark,swordfish,ahi tuna, macral
And do not eat fish more than twice a week
Avoid raw or undercooked meats or fish
Avoid bacon, hot dogs and deli meats b/c of the risk of listeria
And unpasteurized cheeses such as blue Brie and feta
What can vegans eat to get the nutrients they need
Protein: soy foods, beans, lentils, nuts, grains, seeds
Iron: meat alternatives and foods rich in vitamin c
Calcium: soy, calcium fortified OJ, tofu
Vitamin b12: fortified soy foods, b12 supplement
What may pica indicate
An underlying health problem…Nutritional deficiency
Anemia
Gravida
Parity
GTPAL
Gravida is how many pregnancies Para is how many births after 20 wks Gravida Term-37-42 weeks delivered Preterm-20-36 6/7 weeks delivered Abortion- pregnancy ending before 20 weeks L- current # of living children
How often are prenatal visits
First 28 weeks : q4weeks
28-36weeks; q2weeks
37 to birth: weekly
What is the typical kick count protocol
10 movements in 2 hours
When and how is AFP tested
At about 16-18 weeks
Done on maternal blood
what do low AFP levels indicate
Down sydnrome
what do increased AFP levels indicate
neural tube defects such as spina bifida
what should you do if AFP is abnormal
repeat blood test
obtain a high level U/S
amniocentesis
what are the indications for amniocentesis
- assess for genetic defects in the 2nd trimester
- assess for fetal lung maturity in the 3rd semester
- check for uterine infection
- monitor maternal Rh sensitization in Rh neg woman
what is RhoGAM and why its given
a globulin- the antibody a woman would naturally make if they were sensitized
this causes the body to relax and stop making the Rh antibody. the body metabolizes the RhoGAM and excretes it.
its to ensure the woman does not become sensitized to the Rh antigen if she is Rh neg and the baby is Rh positive
how long should the mother be monitored after an amniocentesis
20 minutes to ensure the procedure did not put her into early labor
when is a NST a valid test
at or after 28 weeks
what is a normal FHR
120-160 bpm
what is the purpose of a NST
-to evaluate FHR in response to its movement
(it should increase 2 accelerations-15bpm)
and should stay accelerated for at least 15 seconds
what could a non reactive NST be a result of
fetal acidosis or the fetal sleep cycle.
the test should be repeated
what is the BPP
biophysical profile- done with real time ultrasound
-evaluates the NST, fetal breathing movements, fetal body movements, fetal tone and amniotic fluid volume`
why is the BPP done
for someone who had a non reactive NST. will score them as: 8-10- normal 6-equivicol- hospitalization or monitoring and repeat tests required <4 further tests or delivery ASAP
when does the anterior fontonale close
up to 18 months to close
when does the posterior fontonale close
up to 6 weeks
what are the fetal attitudes
the way the baby is sitting in the uterus
- flexion-chin to chest
- military-chin at 90 deg angle to chest
- extension- chin tilting away from chest
- hyperextension- face presentation
what are the pelvis shapes
gynecoid- most favorable for birth
anthropoid
android
platypelloid
when is the head said to be engaged
when it is at zero station
at the ischial spines
what is floating
when engagement has not yet occurred and the fetus presenting part is freely moving above the pelvic inlet
what can happen if you begin pushing while there is still cerivx left
the remaining cervix can become edematous and increase labor time.
what are the primary and secondary forces of labor
primary- involuntary uterine contractions
secondary- voluntary use of abdominal muscles during second stage of labor
what are contractions responsible for
thinning and dilating the cervix
thrusting the presenting part toward the lower uterine segment
how are frequency of contractions monitored
the time from the ONSET of one to the ONSET of the next
what will walking and changing position facilitate in labor
it affects the pelvic joints which can facilitate fetal descent and rotation
what does squatting facilitate in labor
it enlarges the pelvic inlet and outlet diameters
how do you know a woman is in labor
- lightening- the baby moves down and it is easier to breathe but more pressure on bladder and LE edema w/ lower fundal height
- bloody show
- cervical ripening (goodells sign)
- stronger braxton hix
- energy burst(nesting)
- spontaneous rupture of membrane(water breaks)
how to tell if pt is having braxton hix
they are felt in the abdomen and groin
last about 30 seconds
relieved by walking, voiding, eating, increasing fluid
changing positions
where are true labor contractions felt
in the lower back
