Test Two Flashcards
What are the presumptive signs of pregnancy?
specific changes felt by the woman
- amenorrhea, fatigue, nausea/vomiting/breast changes, urinary frequency, fatigue, quickening
- Can be caused by reasons other than pregnancy, which is why it’s labeled as presumptive
What are the probable signs of pregnancy?
changes observed by the examiner
- Hegar sign (softening/compressibility of lower uterine segment), ballottement, pregnancy tests, Goodell sign, Chadwick sign, Braxton Hicks contractions, uterine soufflé
- can be other possible causes which is why it’s labeled probable
What are the positive signs of pregnancy?
signs that are attributable only to the presence of the fetus
-hearing fetal heart tones, visualization of the fetus, palpating fetal movements
What is the role and function of estrogen? What does it cause? What are its effects?
relaxes ligaments in chest wall increasing lung expansion, increases vascularity of upper respiratory tract (increased feelings of congestion),
- enlarges genitals, uterus, breasts and vasodilatation.
- relaxation of pelvic ligaments and joints, retention of Na and H2O by kidney tubules.
- Decreases hydrochloric acid and pepsin (~nausea during preg)
- cause selective increased vascularity and connective tissue proliferation (gums are spongy, swollen, bleed easily)
- Alters metabolism of nutrients by interfering with with folic acid metabolism, increasing the level of total body proteins and promoting retention of sodium and water by kidney tubules
What is the role and function of progesterone? What does it cause? What are its effects?
- Maintains pregnancy by relaxing smooth muscles, resulting in decreased uterine contractility and prevention of miscarriage
- responsible for increasing the sensitivity of the respiratory center receptors and an acid-base balance that pregnancy is a compensatory resp. alkalosis
- increased progesterone = decreased GI motility/constipation and “heartburn
- decreased tone and motility of smooth muscles, resulting in esophageal regurgitation, slower emptying time of the stomach and reverse peristalsis (heartburn or pyrosis)
- causes loss of muscle tone and decreased peristalsis resulting in an increase in water absorption from the colon leading to constipation
- Progesterone causes increase in cholesterol production, thickening of bile and decreased emptying time (gallstones)
Estrogen and progesterone together are responsible for…
- cause fat deposits in abdomen, back, and upper thighs
- are responsible for the increased sensitivity of the respiratory center to carbon dioxide
- change renal structure (renal pelves and ureters dilate and a larger volume of urine is held in the pelves and ureters and urine flow rate is slow resulting in urinary stasis, UIT, nocturia, etc)
What is the role and function of hcg? What does it cause? What are its effects?
is earliest biochemical marker for pregnancy; pregnancy tests are based on recognition of hCG or beta subunit of hCG, secreted by the placenta, detectable 7-10 days after conception
-High levels: may indicate abnormal gestation (e.g. Downs syndrome)
Low levels: slow increase or a decrease may indicate impending miscarriage
-maintains the production b the corpus luteum of estrogen and progesterone until the placenta takes over production
At 20 weeks where is the fundus?
The umbilicus!
Estrogen and Progesterone: How do they effect the respiratory adaptation of pregnancy?
Estrogen cause the ligaments of the rib cage to relax, increasing chest expansion
- Estrogen makes the upper respiratory tract become more vascular (as capillaries engorge, edema and hyperemia develop within the nose, pharynx, larynx, trachea, and bronchi leading to congestion, epistaxis, changes in voice, mild upper resp. infection
- Progesterone and estrogen: responsible for the increased sensitivity of the respiratory center to carbon dioxide (pregnant women become more aware of the need to breathe)
- Progesterone may be responsible for increasing the sensitivity of the respiratory center receptors (tidal volume increases, PCO2 decreases, and pH increases slightly) leading to compensatory respiratory alkalosis (these changes help transport carbon dioxide from fetus and oxygen release from the mother to the fetus)
Estrogen and Progesterone:
How do they effect renal adaptation of pregnancy
- Changes in renal structure, renal pelves and ureters dilate, increased GFR and RPF (renal plasma flow)
- estrogen alters metabolism of nutrients by interfering with folic acid metabolism, increase the total body proteins, and promoting the retention of sodium and water by the kidney tubles
- Estrogen can make gums hyperemic, swollen, and bleed easily
What is the mechanism that causes the mild peripheral edema?
- 500-900 mEq of sodium is retained to meet fetal needs. Because of the need for increased fluid volume (for mom and baby), additional sodium is needed to expand fluid volume and maintain an isotonic state
- Kidneys can excrete water during the early weeks of pregnancy more efficiently than later in pregnancy. The pooling of fluid in the legs in the latter part of pregnancy decreases renal blood flow and GFR (requires no treatment).
What causes the nausea?
possibly in response to high hCG
-estrogen may decrease secretion of hydrochloric acid and pepsin (which may be responsible for digestive upsets such as nausea)
How does estrogen and progesterone effect GI system (constipations, etc)?
decreased hCl acid (leading to peptic ulcer formation, nausea), decreased tone and motility of smooth muscles resulting in esophageal regurgitation, slower emptying time of the stomach, and reverse peristalsis (heartburn aka pyrosis), increase in water absorption from the colon and may cause constipation,slight hypercholesterolemia may lead to gallstones
Why does the center of gravity change?
Abdominal distention gives the pelvis a forward tilt, decreased abdominal muscle tone, and increased weight bearing cause realignment of the spinal curvature late in pregnancy and move the woman’s center of gravity forward
-An increase in the cure of the back (lordosis) develops, and exaggerated anterior flexion of the head develops to help her maintain her balance
Why does she waddle? What does estrogen and progesterone do to the joints
Walking is more difficult with the center of gravity shift
- the ligamentous and muscular structures of the middle and lower spine may be severely stressed
- Estrogen and relaxin hormones relax and soften the body, enlarged pelvic dimensions, separation of the symphysis pubis and instability of the sacroiliac joints may cause pain and difficulty in walking
What are some of the psychosocial things mom and dad go through to adapt to pregnancy?
Mother: accepting the pregnancy, identifying with the role of mother, reorder the relationships between herself and her mother and between herself and her partner, establishing a relationship with the unborn child, and preparing for the birth experience
Father: accepting the pregnancy (announcement phase, moratorium phase, and the focusing phase), identifying with the father role, reordering personal relationships, establishing a relationship with the fetus, and preparing for childbirth
What is couvde syndrome?
men who experience pregnancy-like symptoms, such as nausea, weight gain, and other physical symtoms
What are the normal lab tests you would do prenatally?
H&H, WBC, blood type, Rh, Rubella titer, TB, UA, BUN, creatinine, electrolytes, total protein excretion, pap test, vaginal smear for gonorrhea, chlamydia, HPV, GBS, HIV, hep B, MSAFP/Quad-screen, glucose tolerance tests, ECG, chest x-ray, and echo
Would you give a pregnant woman a live vaccine?
No
What are some variations of adolescent pregnant mothers?
- much less likely than older women to receive adequate prenatal care, more likely to smoke and less likely to gain adequate weight during pregnancy, increased risk of LBW, serious and long-term disability, and of dying during the first year of life
- delayed prenatal care can result in late recognition of pregnancy, denial of pregnancy, or confusion about the available services, inadequate time before birth to attend to correctable problems, higher risk for conditions associated with first pregnancy regardless of age (gestational hypertension)
What are some variations of older pregnant mothers?
- Multiparous women: some have never used contraceptives and some have used them but stop as menopause approaches and become pregnant
- Primiparous: often successfully established in a career and lifestyle with a partner with time for self-attention
- partners seem to share the preparation for parenthood and plan a family-centered birth, women seek lots of information, adverse perinatal outcomes are more common in older primiparas even with good prenatal care (LBW, premature birth, and multiparas), increased risk of maternal mortality (hemorrhage, infection, embolisms, HTN disorders, cardiomyopathy, and strokes)
What are some nutritional needs during pregnancy?
Energy needs, weight gain, protein, fluids, fiber, calcium, iron, zinc, iodine, magnesium, vitamin A, D, E, C, folate and B6, B12, grain products, vegetables, fruits, milk and milk products, meats, nuts, eggs
What are some specific vitamin needs during pregnancy and why?
Iron Calcium Sodium Zinc Fluoride Fat-soluble vitamins Water-soluble vitamins Multivitamin-multimineral supplements during pregnancy
What are some things they should avoid pregnancy?
caffeine, alcohol, smoking, high levels of mercury in fish
What is important to know when doing an OB history?
age at menarche, menstrual history, contraceptive history, nature of any infertility or gynecologic conditions, STI history, sexual history, detailed history of all pregnancies and outcomes, date of last Pap test and result, LMP
What would you ask mom about diet, exercise?
Did you exercise before pregnancy?
Dietary behaviors, preferences, cravings, what herbs, supplements, allergies, etc
If no medical or OB problems preg. women should perform 30 minutes of moderate physical exercise/day
-Drink enough fluid before, during, and after exercise (dehydration can trigger premature labor), and calorie intake should be sufficient to meet the increased needs of pregnancy and demands of exercise
What are some adolescent pregnancy nutritional needs?
choose a weight fain goal at the upper end of the range for their BMI, improving the nutrition knowledge, meal planning, food preparation, promote prenatal care, develop nutrition interventions, and strive to understand the factors that create barriers
What are the 5 P’s of labor?
Read study guide for more in depth on 5 Ps**
- Passenger (fetus and placenta)
- Passageway (birth canal)
- Powers (contractions)
- Position of the mother
- Psychologic response
What is the Ferguson reflex?
The urge to bear down (when the presenting part of the fetus reaches the perineal floor)
What are the 3 phases in the first stage of labor?
1st stage of labor: onset of regular uterine contractions to full dilation of the cervix -1-20 hours long Latent Phase: 0-3 cm dilated Active Phase: 4-7 cm dilated Transitional: 8-10 cm dilated
Describe the 2nd stage of labor
lasts from the time the cervix is fully dilated to the birth of the fetus. Average of 20 minutes for multiparous woman 50 minutes for a nulliparous woman
Describe the 3rd stage of labor
birth of the fetus until the placenta is delivered, 3-30 minutes, the risk of hemorrhage increases as the length of the third stage increases
Describe the 4th stage of labor
about 2 hours after delivery of placenta, period of immediate recovery, when homeostasis is reestablished, an important period of observation for complications, such as abnormal bleeding
What are the mechanisms of labor?
(watch a video to understand*) The 7 cardinal movements that occur in a vertex presentation are:
engagement, descent, flexion, internal rotation, extension, external rotation (restitution), and birth by expulsion
What’s the most important thing for extra-uterine life of the infant?
First breath of oxygen
-pressure from birth, PO2 decreases, PCO2 increases, arterial pH decreases, bicarb decreases, fetal respirator movements decrease during labor
these changes stimulate chemoreceptors in the aorta and carotid bodies to prepare the fetus for initiating respirations immediately after birth
Continuous lumbar epidural
C/s or vag pain relief by injecting local anesthetic (bupivacaine, ropivacaine), an opioid analgesic (fentanyl, sufentanil) or both into the epidural space
-the opioid combo with anesthetic reduces the does of anesthetic required
Where are epidurals inserted?
between the 4th and 5th lumbar vertebrae
How is continuous block achieved?
by using a pump to infuse the anesthetic solution through an indwelling plastic catheter
What are the advantages of an epidural block?
woman is alert, comfortable, able to participate, airway intact, gastric emptying is not delayed, blood loss is not excessive, the dose can be modified to allow the woman to push and to assume upright positions and even to walk
What are the disadvantages of epidural block?
control is limited, orthostatic hypotension,sedation, leg weakness, CNS effects if accidentally injected into blood vessel, too high of a dose leads to respiratory arrest, higher rate of fever, severe hypotension can result in significant decrease in uteroplacental perfusion and oxygen delivery to fetus, urinary retention, stress incontinence, pruritus,longer second-stage labor, for some women it is not effective
Review the process of maternal hypothermia with analgesia, what is that process?
- Defined as core body temperature of less than 35° C (95F)
- Caused by effects of analgesia and anesthesia
- May result in cardiovascular, pulmonary, circulatory, hematologic, neurologic, or renal complications
What is the purpose of amniotic fluid?
maintains temperature, cushions the baby, allows freedom of movement, helps the build muscle strength, source of oral fluid and waste, kepps fetus from tangling with the membranes
-800-1200mL present at term
Having less than 300 mL of amniotic fluid is called _____ and is associated with _____
oligohydramnios
-fetal renal abnormalities
Having more than 2L of amniotic fluid is called ____ and is associated with _______
hydraminos
-gastrointestinal and other malformations