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Mother Baby - NUR 142 > Test 3 > Flashcards

Test 3 Flashcards

1
Q

What is assessed on the first prenatal visit?

A 
history of mother and father.
OBGYN history - previous pregnancies, problems?
current pregnancy history - LMP, S/S, risks?
TPR, BP, height, weight.
GP/GTPAL
EDD 
breast
abdomen
pelvis - "adequacy"
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2
Q

How often do you visit the doctor while pregnant?

A

monthly until the 28th week.
then biweekly till the 36th week.
then weekly until delivery.

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3
Q

What happens at subsequent prenatal visits?

A

Interval history- physical symptoms, maternal well being, emotional adjustment.
BP, weight check, FHR.
urinalysis - glucose & protein
fundal height
leopolds maneuvers
pelvic exam, if indicated - signs of active labor <36weeks, doctors only
other tests of fetal well being

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4
Q

When is a nonstress test performed?

A

at 24 weeks, with concerns.

high risk - 2x a week

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5
Q

What are the advantages of prenatal care?

A 
accuracy of gestational age
identify risks early
timely interventions in post term pregnancy
identify IUGR
advance planning for problem deliveries
improve outcomes
time to educate mother
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6
Q

What are some baseline diagnostics with pregnancies?

A

pregnancy test
Blood: CBC, H&H, type/Rh, rubella titer, SCA,, HBsAg, RPR/VDRL, HIV, TORCH titer
cervical smears: pap, gonorrhea, herpes, chlamydia
possibly drug screen or urinalysis as well

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7
Q

What laps are repeated or additional throughout pregnancy?

A

urinalysis- protein & glucose, preeclampsia & gestational diabetes
genetic testing - if indicated by hx
Quad screen
tests for STIs, if indicated

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8
Q

What is tested on a Quad screen?

A

MsAFP, hCG, UE, inhibin-A
done at 15-20 weeks
identifies risks not diagnostic

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9
Q

What is glucose testing?

A

screen for gestational diabetes mellitus

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10
Q

When is the glucose testing done?

A

low risk - 1hr GTT at 24-28 weeks
1 hr results >140, 3 hr 100g GTT <100 = good
high risk - evaluate at 20 weeks

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11
Q

When is the H&H tested?

A

26-28 weeks

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12
Q

When is an indirect coomb’s test (antibody screen) done?

A

28 weeks

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13
Q

When is a GBS culture done?

A

35-37 weeks

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14
Q

What is ultrasound used to identify?

A 
gestational dating - best estimate at 5-6 wks from LMP
gestational sac - 4.5-5 weeks
embryo visible 5-6 weeks
FHR activity visible 6+ weeks
assess biparietal diameter 
assess femur length
ratio between fetal head &amp; abdomen circumferences
fetal number
fetal presentation
placental evaluation- location, grading
placenta previa vs placenta abruption
fetal viability
fetal anatomy, anomalies
amniotic fluid index
Doppler flow studies
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15
Q

What is a biophysical profile (BPP)?

A

intrauterine apgar score.

uses five criteria to test viability

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16
Q

What are the criteria of a BPP?

A 
fetal breathing movements
fetal body movement
fetal tone
fetal HR activity (NST)
AFI - indicator of chronic fetal compromise
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17
Q

When is a BPP done?

A

after a non reactive non stress test, after 28 weeks

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18
Q

What is a good BPP score?

A

8 or greater

19
Q

What is a non-stress test or electronic fetal monitoring?

A

assessment of fetal oxygenation & autonomic function

20
Q

What is considered a reactive non stress test?

A

accelerations of 15 beats/min lasting 15 seconds with fetal movement

21
Q

What is considered a nonreactive non stress test?

A

no accelerations of FHR with fetal movement

22
Q

How do you assess fetal movement?

A

beginning at 27-28 weeks. daily, about 1 hour after a meal. lie on side and count movements until 10 are felt. keep a record and note/report diminished rate of movement.

23
Q

When should you contact a doctor with fetal movement?

A

> 10 kicks in an hour or less than 4 in 30 minutes

24
Q

What is the purpose of amniocentesis?

A

tests surfactant levels, for fetal lung maturity

25
Q

What are some risk factors for genetic disease?

A 
maternal age 35+
balanced translocation
hx of genetic disorder
hx of infertility or repeated pregnancy loss
family hx unknown
26
Q

What risks to newborns occur with gestational diabetes?

A

macrosomia, immaturity/early delivery. operative delivery. hypoglycemia after delivery. risk of diabetes later in life.

27
Q

What are some risks with teen pregnancy?

A 
denial of pregnancy - late/absent PNC
nutritional deficits
pre-eclampsia
C/S
LBW babies
fetal/neonatal mortality
28
Q

What are the effects of environmental tobacco smoke on a pregnancy?

A 
increased chance of LBW
increased chance of SGA
increased risk for SIDs
increased risk for SABs
respiratory effects: asthma, acute lower respiratory symptoms, chronic respiratory symptoms, middle ear infections
29
Q

What are the FDA Pregnancy Risk Categories for medications/drugs?

A

A…. no risk (thyroid meds)
B…. no adverse effects in animals, no human studies (penicillin)
C… animal studies show adverse reaction, no human studies (betablockers, Colace)
D… definite fetal risks (lithium, some chemo drugs)
X… absolute fetal abnormalities (Accutane, Pitocin, estrogen)

30
Q

What are the principles underlying use of drugs in pregnancy?

A

any drug under certain circumstances may be detrimental to the fetus
the fetus is in greatest danger at the beginning of pregnancy (5-8 weeks)
drugs with lowest molecular weight cross over and produce greatest damage

31
Q

What are signs within a baby of fetal alcohol syndrome?

A

craniofacial anomalies
growth restriction
brain, spinal, and cardiac defects
behavioral disturbances, developmental, & intellectual disabilities

32
Q

What are some maternal behaviors associated with substance abuse?

A 
late PNC, failure to keep prenatal appts
inconsistent follow-through w/recommendations
poor grooming
inadequate weight gain
defensive or hostile reactions
anger or apathy regarding pregnancy
33
Q

What are signs and symptoms of recent cocaine use?

A

diaphoresis,
increased BP, Temperature
irregular respirations
dilated pupils
PTL - sudden onset, severe painful contractions, possible abruptions
fetal tachycardia, excessive fetal activity
anger, caustic, abusive reactions & paranoia

34
Q

What is the goal of therapy with a pregnant mother with HIV?

A

maternal well being
reduction of perinatal transmission
consider early delivery: c/s vs vaginal

35
Q

What are the danger signs of pregnancy?

A 
no fetal movement - 4x/30 min
chills or fever
sudden swelling
epigastric pain
vaginal bleeding - filling pad in 1 hr
painful urination
headache
abdominal pain
leaking fluid - filling pad in 1 hr
severe or prolonged vomiting- >12 hr
blurred vision
chest pain
36
Q

What are normal discomforts of 1st trimester of pregnancy?

A 
pain/tingling in breasts
urinary frequency
nausea/vomiting, ptyalism
nasal stuffiness, epistaxis
fatigue
mood swings
37
Q

What are normal discomforts of 2nd trimester of pregnancy?

A 
enlarged abdomen
vascular spider nevi
constipation
groin pain
headaches
food cravings
heartburn
leucorrhea
striae gravidarum
supine hypotension
leg cramps
38
Q

What are dangers signs of 2nd trimester of pregnancy?

A 
vaginal bleeding
fever
nausea/vomiting
swelling of face or fingers
headache, visual disturbances
epigastric pain
abdominal pain or cramping
reduction in or absence of fetal movement
burning or painful urination
39
Q

What should you teach women in their 2nd trimester?

A

comfort measures for discomforts
anticipatory guidance
S/S of PTL
choices of prenatal education classes

40
Q

What are normal discomforts of 3rd trimester pregnancy?

A 
dyspnea/SOB
Braxton-hicks contractions
indigestion, pyrosis
vaginal discharge
back ache
leg &amp; feet cramps
pedal edema
urinary frequency
insomnia
constipation
fatigue
41
Q

What are danger signs of 3rd trimester pregnancy?

A 
visual disturbance
headache, fever
hand &amp; facial edema
vaginal bleeding
abdominal pain, uterine contractions
PROM - most common concern
42
Q

What teaching is needed for the 3rd trimester pregnancy?

A

S/S of labor/PTL
when to call health care provider
when to go to hospital/birthing center
comfort measures for trimester related discomforts
anticipatory guidance regarding duration of present discomforts
reinforce and reiterate previous teaching

43
Q

What are some general prenatal recommendations?

A 
good nutrition and folic acid
educate to seek early and regular PNC
teach S/S of PTL
employers modify work conditions
out reach education for foreign-born populations
screen all women for abuse
promote community awareness programs
44
Q

What are the goals of perinatal nursing?

A

maintenance of maternal-fetal health
accurate determination of gestational age
ongoing risk assessment & risk-appropriate intervention
women/family education about pregnancy, birth, parenting
rapport with the childbearing family
referral to appropriate resources

Mother Baby - NUR 142 (1 decks)

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