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Module 6 > Unit 1-Antepartum > Flashcards

Unit 1-Antepartum Flashcards

1
Q

What are the goals of Antepartum nursing

Review Card

A
  1. Assess and identify potential risks
  2. Educate to promote health and prevent disease
  3. Famililes can make informed healthcare choices
  4. Healthier pregancy
  5. Best possible outcome for mother and baby
  6. Family centered maternitiy care
    • Pregnancy & childbirth is a normal life event
    • Developmental life transistion vs. Medical event
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2
Q

What are some barriers to reaching the goals of antepartum care?

Review card

A
  1. Health disparities- differences in health care access & outomes
    • Low income, no transportantion are examples of barriers to health care access
    • Consequences of health disparities… essential lack of care = increased risk of a complication with mom/baby
  2. Teen pregnancies
    • increased concern of not using contraceptives appropriately
    • Increased risk of hypertension, body is still growing this also increases the risk of pre eclampsia,
    • Increased risk of dropping out
  3. LGBTQ
    • Lack of social support and fear of provider discrimination
  4. Tobacco & substance abuse– Maternal and neonatal risk factors
    • Baby–> low birth weight, premature, SIDS, resp Issues, IUGR (intrauterine growth restriction), Fetal alcohol syndrome, learning disabilities
  5. Obesitiy
    • Increased risk for mom and baby, large for gestational age, increased risk of diabetes, increased csection rate, increased risk of hypertension for mom.
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3
Q

What is IUGR?

Ask

A

Intrauterine growth restriction

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4
Q

What is the number 1 goal for antepartum nursing?

Ask

A

Ensure mom and baby are fine

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5
Q

Preconception vists include…

review

A
  1. +implementation
    • Modify behaviors and reduce risks– educate mom on healthy habits
  2. Pregnancy history and family health hx
  3. Medical hx & physical exam to assess for health problems
    • chronic conditions & medications (prescribed , OTC, illicit)
    • social problems or harmful habits
  4. Contraception– Educate on stopping and tracking fertility
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6
Q

Pregnancy length is…
(days, weeks, lunar months, calander months)

ASK

A

280 days
40 weeks
10 lunar months (28days/months)
9 calander months

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7
Q

How many trimesters are there in a pregnancy and how long do they last?

ASK

A

1st trimester- 1st day LMP through 13 weeks

2nd trimester- 14 weeks through 26 weeks

3rd trimester- 27 weeks through 40 weeks

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8
Q

What is considrered a term pregnancy?

ASK

A

38-42 weeks

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9
Q

What is considered a pre-term pregnancy?

ASK

A

Prior to the completion of 37 weeks

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10
Q

What is considred a post term preganancy?

A

After 42 weeks

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11
Q

How is fundal height calculated

ASK

A

1cm per week

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12
Q

What is lightening?

ASK

A

When the fundus drops around 36-39 weeks

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13
Q

What is HCG and what is its function?

ASK

A
  1. Human Chorionic Gonadtropin (HCG)
    • Hormone dected by pregnancy tests (tells us that we are pregnant)
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14
Q

What are the 6 key hormones in pregnancy?

ask

A
  1. HCG
  2. Progesterone
  3. Estrogen
  4. Prolactin
  5. Relaxin
  6. Oxytocin
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15
Q

What is the function of progesterone

ASK

A

Maintains uterine lining: relaxes smooth muscle helps uterine grow as baby grows in pregnancy

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16
Q

What is the function of estrogen

ASK

A

Stimulates uterine growth, increases blood supply and helps fetal organs grow

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17
Q

What is the function of prolactin

ASK

A

Preperation for lactation. Contributes to enlargement of mammory glands preps milk production

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18
Q

What is relaxin functions?

ASK

A

Inhibits the uterine activity preventing premature birth: softens and legthens cervix and relaxes joints

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19
Q

What is oxytoxin function in pregnancy?

ASK

A

Causes uterine muscle contractions and triggers prostaglandins to increase contractions further; if labor dosent start naturally this hormone can be given to induse labor; stimulates milk.

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20
Q

What is the function of HCG?

ASK

A

Hormone detected by pregnancy tests that indicates possible pregnancy

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21
Q

The following are maternal changes of pregnancy at ____ weeks?

  1. Increased estrogen levels lead to blood congestion and increased vasculatirty (visible/prominent veins) in cervix, vagina, vulva
    • Hegar’s sign
    • Goodells sign
    • Chadwicks signs
  2. Hypertropy of uterine muscle fiber which streatch in preparation for delivery
    • Round ligament pain possible
  3. N/V up to 12wks due to estrogen and HCG levels
  4. Increased glycogen may cause Candida (yeast) to appear vaginally
  5. no noticable weight gain

ASK

A

Maternal changes at 8 weeks

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22
Q

What is hegar’s sign and when is it seen?

ASK

A

It is the softening os isthus cervix appears as a maternal change at 8 weeks

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23
Q

What is goodells sign and when is it seen?

ASK

A

Softening of the cervix– maternal changes at 8 weeks

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24
Q

What is chadwicks sign and when is it seen?

ASK

A

Bluish purple color of vagina– seen w/maternal changes around 8 weeks

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25
Q

When are yeast infections more common in pregnancy?

ASK

A

Around 8 weeks and beyond

  1. Yeast infections common in pregnanccy
  2. Acid pH of vagina helps to decrease bacteria growth
  3. Leukorrhea increases– white discharge– normal helps protect against bacteria.. will eventually turn into the mucus plug…
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26
Q

The only time white discharge isnt normal in pregnancy is….

ASK

A

changes in color and becomes odorus

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27
Q

Hypertrophy of uterine muscle fiber means….

ASK

A

streatching of uterus

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28
Q

What are our nursing interventions at 8 weeks gestation?

ASK

A
  1. Nausea prevention
    • Eating dry crackers before getting out of bed in A.M.
    • Eating small frequent meals; avoid fatty meals
  2. Hyperemesis Gravidarum
    - IV hydration required for dehydration & electrolyte imblance
  3. Dicuss to AVOID hot tubs, saunas & steam rooms
    • Increased risk of neural tube defects in 1st trimester
    • Hypotension and fainting
  4. Prepare for pregnancy
    • Include partner and family & discuss attitude towards pregnancy
    • Provide information on childbirth classes
  5. Periodontal care
    • Refer to dentist for checkup if needed– Gum inflammation and periodental disease d/t inflammation and increased saliva which leads to cavities d/t hormone increases
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29
Q

The following are maternal changes at ____ week of pregnancy?

  1. Uterus rises above pelvic brim
  2. Placenta
    • Fully functioning and producing hormones
    • uterine blood flow increased due to o2, nutrients & waste exchange between mom & fetus
  3. Thyroid increased in size
    • Increased hormone production to support & maintain pregnancy
    • Hormones help with fetal growth & development
  4. Increasecd progesterone
    • Bladder tone decreases & increases in capcity
    • Increase potential for UTI’s due to urinary stasis
  5. Weight gain of 2-4lbs in 1st trimester

ASK

A

Maternal changes @ 12 weeks

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30
Q

What is happening with baby around 12 weeks?

A

Kidneys start working, heart is visable.

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31
Q

Where is your uterus around 12 weeks gestation?

ASK

A

Rises above pelvic brim

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32
Q

Why are women more prone to UTI’s around 12 weeks gestation?

ASK?

A

D/T the increased progesterone the bladder tone decreases and increases in capacity which increases the potential for UTI and urinary stasis

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33
Q

What are our nursing interventions for 12 weeks gestation?

ask

A
  1. Prevention of urinary tract infections-
    • Adequate fluid intake of 3L/day
    • Void frequently (Q2hrs while awake); before and after intercourse
    • Wipe front to back
  2. Nutrition & exercise
    • discuss effects of pregnancy on sexual relationships (alternate intimacy if issues are present)
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34
Q

The following are maternal changes that occur at ____week?

  1. Fundus between symphysis & umbilicus
  2. Braxton hicks occus
  3. Quickening- 1st perception of fetal movement
  4. Weight gain- 1lb per week not to delivery
  5. Serum cholesterol increases for growth & development of baby
  6. Placenta is clearly defined & increased hormone production occuring
    • Increase in estrogen causing blood supply increase two-fold
    • Increase in prolactin levels 10 fold to prep breasts for lactation (colostrum may be expressed)–changes in breast are occuring.
    • Increase in progesterone “hormone of pregnancy” to maintain lining of uterus & relax smooth muscles.

ask

A

16 weeks

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35
Q

What are our hormones doing during the 16 week of gestation?

ask

A
  1. Increase in estrogen causing blood supply to two fold
  2. Increase in prolactin levels 10 fold to prep breasts for lactation– colostrum may be expressed
  3. increase in progesterone “hormone of pregnancy” to maintain lining of uterus & relax smooth muscles
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36
Q

What changes are happening to our breasts at 16 weeks pregnant

ask

A
  1. sore
  2. darker and larger nipples
  3. growing
  4. leaking colstrum and discharge
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37
Q

At 16 weeks gestation where is the fundus?

ask

A

between symphysis & umbilicus

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38
Q

Our nursing interventions for women 16 weeks pregnant include?

ASK

A
  1. Provide education on true vs. false labor
  2. Maternal serum alpha-feto protien test (preformed between 15-22wks)
  3. Explain purpose of additional testing if necessary:
    • genetric carrier testing (free cell DNA)
    • CVS/Amniocentesis
    • Ultrasound
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39
Q

Maternal serum alpha-feto protien test (performed between 15-22wks) can tell us what?

ask

A
  1. Elevated levels are associated with neural tube defects
  2. Low levels associated with down syndrome (think LOW-DOWN)
  3. Abnormal levels are followed up in 2nd trimester with in-depth ultrasound
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40
Q

The following are maternal changes that occur at _____ weeks

  1. Fundus at the umbilicus
  2. Breasts continue to secrete colostrum & areolas darken more
  3. Aminiotic sac now holds approximately 400ml
  4. Uterus enlargement
    • Postural hypotension
  5. Increased blood volume
    • Sinus congestion, headache & stuffy nose
    • Leg cramps & varicosities (legs, vulva & rectum)
  6. Increased progesterone causes gut to work less effectively
    • Constipation

ask

A

20 weeks

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41
Q

What is one way of telling the difference between braxton hicks and true labor?

ask

A

Braxton hicks usually stays at the front of the belly… if you drink water and rest it tends to get better

True labor pain is like a hug from the back that wraps around the belly and is constant and isn’t relieved. Starts to worsen… dilation also occurs

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42
Q
A
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43
Q

At 20 weeks sex positions become an issue why…

ask

A

Uterus enlargement– some sex positions can cause pressure on the vena cava which can in turn cause postural hypotension.

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44
Q

True or false: dependant edema is normal around 20 weeks gestation?

ask

A

True

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45
Q

At what week of pregnancy might we see sinus congestions increase?

ask

A

20 weeks– increased blood volume caused by increase in estrogen.

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46
Q

Whats going on with baby around 20 weeks

review

A

Vernix develops, baby has regular sleep pattern, moving more

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47
Q

What are our nursing interventions for women at 20 weeks gestation?

ASK

A
  1. Educate comfort measures
    • Encourage to remain active to decrease risk of DVT
    • Sit with feet elevated when possile (help with edema)
    • Avoid pressure on lower thighs
    • Use of support stockings may be helpful
    • Dorsiflex foot to relieve cramps
    • Apply heat to cramped muscles
    • cool air vaporizer or saline spray for stuffiness
  2. avoid constipation
    • Eat raw fruits, veggies, cereals w/bran
    • Drink 3L of fluid/day
    • exercise frequently
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48
Q

The following are changes that occur around ____ weeks?

  1. Fundus rises above the umbilicus
  2. Blood pressure
    • diastolic b/p gradually increase to prepregnancy level
    • Systolic b/p remains the same
  3. Systolic murmur sometimes heard
    • Heart shifts upward & laterally
  4. blood volume increase necessary to
    • Continue transport of nutrients & o2 to placenta
    • Meet demands of expanded maternal tissue in uterus & breasts
    • Provide a reserve to protect from adverse effects of blood loss from childbirth

ask

A

24 weeks

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49
Q

Where is the fundus at 24 weeks gestation?

ASK

A

Above the umbilicus

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50
Q

What is going on with baby around 24 weeks?

ask

A
  1. alveolar ducs and sacs are present. Lung maturity can be detected more easily by looking at lipidis that make up surfactant
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51
Q

What happens to our blood pressure at 24 weeks gestation and why are there changes?

ask

A
  1. Diastolic b/p gradually increase to pre-pregnancy level
  2. Systolic b/p remains the same

As hormones are released blood bessels dialate which causes the inital drop as estrogen increases and blood volume increase our blood pressure will go back up

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52
Q

What is our nursing interventions for 24 weeks gestation?

ASK

A
  1. Explain and perform glucose challage
    • Glucose screen (1-hour glucose screening- if abnormal 140 or greater) than 3-hour GTT– if failed again tx with medication –> no improvment may need insulin
  2. Ultrasound measurement taken & about 24-32 weeks
  3. Perform antibody screen on RH negative patients
    • If negative, give Rho (D) immune globulin (~28weeks)
  4. CBC, HIV and RPR (Syphillis) reassessed in 3rd trimester
    • if needed, pt will take iron pills or need iron infusion for anemia
    • Treatment of care will be performed in + for syphillis
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53
Q

The test for Rho(D) immune globulin is done when and shot is given when…

A
  1. Test done at 24weeks
  2. Shot given at 28 weeks
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54
Q

The following maternal changes occur at ___weeks

  1. Fundus halfway between umbilicus and xiphoid
  2. Breathing
    • Thoracic breathing replace abdominal breathing
    • Increase chest circumference & respiratory rate
  3. Estrogen increases vascular engorgement
    • Upper respiratory tract edema
  4. Progesterone increases
    • Muscle relaxation thus decrease in airway resistance
  5. fetal outline is palpable
  6. Introsepctive: concentrate on the unborn baby
  7. Uterus displaces stomach liver & intestines
    • Heartburn begins
    • hemorrhoids may develope
    • constipation, flatulence, & bloating

Ask

A

28 weeks

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55
Q

At 28 weeks estrogen increases and we have vascular engorgment which causes…

ask

A
  1. Upper respiratry tract edema
    -congestion, deeper voice, nose bleeds, nasal stuffy
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56
Q

At what week do moms have an increased risk for gallbladder issues?

ask

A

28 weeks

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57
Q

What are our nursing interventions for 28 weeks gestation?

ask

A
  1. Educate tx of hemorrhoids
    • suggest sitz bath and stool softners
    • topical anesthetic agents
  2. Avoid heart burn
    • Avoid fatty foods
    • small frequent meals
    • avoid laying down after meals
    • take antacids as prescribed
    • avoid sodium bicarbonate
  3. Comfort measures
    • Elevate legs when sitting
    • assume a side lying position when resting
    • Disscuss breat pleasure and what comfrotable with mom… nipple stimulation releases oxytocin which could potentially send mom into preterm labor.
  4. Discuss delivery
    • Expectations for delivery & caring for infant–> are there plans to cord bank,
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58
Q

The following are maternal changes that can be seen at ____ weeks?

  1. Fundus reaches the xiphoid process
  2. Increase progesterone
    • Increase blood flow leads to increased GFR
    • Urinary frequency returns
    • Bladder tone decreases and capcity increases
    • Renal pelvis dilates
    • Urinary stasis-promotes bacteria grwoth
  3. Swollen ankles may develop
  4. Sleeping problems
    • Dyspnea develops
    • Nocturia-d/t sodium and water rentention during the day
  5. Breast are full and tender

Ask

A

32 weeks

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59
Q

At what gestational age are we concerened about edema reaching upper area?

ask

A

28 weeks

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60
Q

What are our nursing interventions for 32 weeks gestation?

ask

A
  1. Educate measures to decrease edema
    • elevate legs 1-2 times per day for 1 hr
    • Left lateral position- increase cardiac output and urine output
  2. Comfort measures
    • Wear well-fitting supportive bra
    • Use semi-fowler position
  3. Prepare for delivery
    • review signs of labor
    • discussion plans for other children if any and transportation
    • Assess partners role in childbirth
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61
Q

The following are maternal changes that can be seen in what week of pregnancy?

  1. Fundus is below xiphoid process again
    • Lightening occurs (baby drops)
    • Urinary frequency increases even more
  2. Increase progesterone & relaxin
    • Relaxation of the ligaments & joints
    • diastasis recti- abdominal midline muscles seperates 3rd trimester
  3. Muscluoskeletal discomforts
    • Postrual changes progress
    • Increased backaches
    • Altered posture- the center of gravity shifts- increased fall risk
    • Lordosis- a shift in the center of gravity
    • Altered gait- pregnant waddle

4.mother is eager for birth
- burst of energy “nesting”

  1. Braxton hicks intensify

ask

A

36-40 weeks

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62
Q

When does moms antibodies transfer to baby?

A

36-40 weeks

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63
Q

During 36-40 weeks mom gets relief from…

A

Lightening– no longer struggles to breath as baby has dropped

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64
Q

True or false: Calcium and iron demands increase during week 36-40?

A

true

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65
Q

Where is the fundus around 36-40 weeks

ask

A

below xiphoid process

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66
Q

What are our nursing interventions for 36-40 weeks gestation?

ask

A
  1. Safety measures
    • wear low heeled shoes or flats
    • avoid heavy lifting
    • sleep on side to relieve bladder pressure
  2. prepare for delivery
    • Teach pelvic tilt exercises
    • pack a suitcase
    • Tour labor and delivery
    • Discuss postpartum cirucumstances- breast feeding, circumcision, postpartum blues
  3. Educate on group b streptococus screening performed at 35-36 weeks
67
Q

What should we educate women on around 36-40 weeks gestation regarding group b streptococcus screening?

ASK

A
  1. If + = required antibiotics (penG) during labor & 4 hours until delivery
  2. Status unknown = assume postive and treat
  3. Scheduled c-section w/intact membrane = no treatment
68
Q

what is GBS?

ASK

A

Natural vaginal flora that can cause complication if it is able to move up the vagina

69
Q

What are presumptive signs of pregnancy?

ask

A
  1. Amenorrhea
  2. fatigue
  3. N/V
  4. urinary frequency
  5. breat increase size and fullness
  6. Areolas darken
  7. pronounced nipples
  8. linea nigrea
  9. melasma
  10. quickening-fetal movements– usually felt 18-20wks for a primi and 14-16 wks for multip
70
Q

What are probably signs of pregnancy?

ask

A
  1. Uterine enlargment
  2. chadwicks sign- bluing of vagina
  3. Goodell’s sign- softening of the cervix
  4. Hegars sign- softening of the cervical isthmus
  5. Bollottement
  6. Braxton hicks contractions
  7. Postive pregnancy test
71
Q

What are postive signs of pregnancy?

ASK

A
  1. Fetal heart sounds 10-12wks
  2. fetal movement- observed/palpated
  3. ultrasound visualization of the fetus
    • Cardiac movement at 4-8weks
    • transvaginal US- detect sac at 4.5-5wks
72
Q

The following are presumptive, probably or postive signs of pregnancy?

  1. Increased circulation to skin
    • Hot flashes & facial flushing
    • increased perspiration
    • Increased sebaceous glands activity- oily skin and acne
  2. Increased estrogen & progresterone
    • melasma- mask of pregnancy “pregnancy glow”
  3. Linea nigra- darker vertical line umbilicus to the mons pubis
    • Straie graviarum- stretch marks to the breasts,hips abdomen, buttocks
    • Hair & nails- rapid growth during prgnancy

ask

A

Presumptive

73
Q

The following are presumptive, probable or postive signs of pregnancy?

  1. Serum or Urine HCG
    - HCG production begins at implantation
    - detected 7-8 days after conception

ask

74
Q

Higher levels of HCG indicates?

ask

A

higher levels could indicate- multiples, ectopic, molor pregnancy genetric abnormatilites can cause postive HCG

75
Q

Lower levels of HCG can inidcate?

ask

A

miscarriage

76
Q

What medications can cause a false postive or negative pregnancy test?

ask

A
  1. anticonvulsants
  2. diuretics
  3. tranquilizers
77
Q

The following indicates… probable, presumptive or postive signs of pregnancy?

  1. Fetal heart rate
  2. Ultrasound transvaginal vs. Transabdominal
  3. Leopolds maneuver

ask

78
Q

What is normal fetal heart rate?

ask

79
Q

When is a FHR detectable on doppler or fetoscope?

ASK

A

Doppler- detectable @ 10-12 weeks gestation
Fetoscope- detectale at 15-20 weeks gestation

80
Q

What is leoplds maneuver?

ask

A
  1. External palpation of uterus to determine and identify presenting parts & outline of fetus
  2. Helps determine point of maximum impulse
81
Q

What information is important to gather during the 1st prenatal assessment?

review

A
  1. Medical hx
    • psychosocial, obsterical, gyneocolgic & contraceptive
82
Q

What assessments should we perform during a patients 1st prenatal visit?

ask

A
  1. Head to toe assessment of all system
    • reporductive exam- external and internal
  2. Calculate EDB & fundal height
  3. Vital signs- height, weight & BMI
  4. Fetal heart tones
    • Doptone used at 10-12 weeks
83
Q

When are prenatal visits typically scheduled?

ask

A

1x a month until 28 weeks
28-36 weeks– every 2 weeks
36-40 1x a week until delivery

84
Q

What is the age of viability?

ask

A

20 weeks- fetal lungs mature enough for fetal survival outside the uterus

85
Q

What is AB?

ask

A

any pregnancy loss occuring <20 weeks is counted as an abortion

86
Q

What is Gravida?

ask

A

number of pregnancies, regardless of duration, including a preganncy in progress

87
Q

What is para?

ask

A

number of pregnancies that have reached 20 weeks or more… multiple birth counts as 1 para

88
Q

What is primipara?

ask

A
  1. has only completed 1 pregnancy @ or >20 weeks
89
Q

What is a multipara?

ask

A
  1. has completed a pregnancy >20 weeks more than once
90
Q

What does GTPAL(M) stand for?

ask

A

G: Gravida- number of pregnancies
T: Term- number of pregnancies between 38-40 weeks
P: pre-term- number of pregnancies delievered PRIOR to completion of the 37 weeks
A: Abortions- number of miscarriages, spontaneous or induced abortions (<20 weeks)
L: Living– number of chidlren surviving birth (multiples count individually)
M: Multiples- number of multiple gestional pregnancies

91
Q

What should vitals look like during the 1st prenatal visit?

ask

A
  1. BP: increased 1st trimester due to peripheral vascular resistance
    • systolic- slight to no increase, no more than 30mm Hg
    • diastolic- slight decrease, 24-32 weeks 10-20 mmhg
    • gradual return to pre-pregnancy by the team
    • average range 90-140/60-90
    • maternal position-impacts blood pressure
    • supine-vena cava compression
    • left lateral is the position of choice
  2. Pulse: average 60-90bpm (increased 10-20 beats around 32 weeks)
  3. Respirations: 16-24 breaths/min
92
Q

What inital labwork will be done for pregnancy?

ask

A
  1. CBC w/diff
    • Hgb amd Hct-monitor for anemia
  2. Pap smear- screening tool for cervical cancer
    • cultures for chlamydia & gonorrhea
    • assess for herpes, HPV
  3. blood type, and RH factor & antibody screen
  4. HIV, Hep B, RPR/VDR (syphillis)
  5. Rubella (titer should be at least 1:8)
    • if non-immune will give booster shot AFTER delivery
  6. TB screening
93
Q

What are common test ran during pregnancy?

ASK

A
  1. UA & UDS (urine drug test)
    • Albumin-trace normal finding (could be preeclampsia)
    • Glucose- 1+ normal finding anything above a 2+ could indicate gestational diabetes
    • Protein- trace normal finding (<1+ mild preeclampsia, 2+-3+ severe preeclampsia)
  2. Progesterone level- placenta begins manufacturing at approximately 8 weeks
    • low levels of progesterone as associated w/spontanous abortions and eptopic pregnancy
94
Q

Common tests for pregnancy includes TORCH what does this stand for?

ASK

A

T: Toxoplasma- concern is with cats; parasitic disease
R: Rubella- rare but can lead to birth defects for futrure pregnancies if not vaccinated
O: Other viruses
C: CMV- type of herpes spread though saliva & body fluids
H: Herpes- assess for outbreask present and need for treatment

Yes… i know the o is in the wrong place

96
Q

True or false: Plasma volume does not exceed the increase in RBC during pregnancy?

ask

A

False: Plasma volume does exceed the increase in RBC during pregnancy

97
Q

What is the recommended total weight gain for pregnancy based around?

ask

A

Pre-pregnancy BMI

98
Q

When are obese women at risk for during pregnancy?

ask

A
  1. AP, IP, PP complications
99
Q

What are underweight pregnant women at risk for during pregnancy?

ask

A
  1. babies that are SGA
  2. Preterm delivery
100
Q

What is the pattern of weight gain during pregnancy (trimesters)?

ask

A

1st trimester: 2 to 4lbs
2nd trimester: average 1lbs per week

Total weight gain: 25-35 lbs

101
Q

According to nageles rule how do you calculate EDD?

ask

A

LMP-3months+7days = EDB

102
Q

What will be assessing for in subsequent prenatal visits?

review

A
  1. Vital signs
  2. Urine dip
  3. Weight gain
  4. Note signs of malnutrition
  5. Fundal height
  6. Fetal assessment
    • FHR
    • Fetal activity
  7. Education
    • Importance of prenatal care
    • Anticipatory guidance according to trimester
  8. Pelvic exam assessing for cervical change start at 36 weeks
103
Q

Protien is good for….. and calcium is important for….

review

A
  1. Protien is good for fetal development
    -meats, eggs, legumes
    1. Calcium is important for fetal bones and teeth
      • vegetables, green, deep yellow good source of vitamin C
104
Q

What are warning/danger signs that pregnant women should report to PCP ASAP

ask

A
  1. UTI
    • fevers, chills, dysuria, frequency, and urgency, odorous discharge
  2. PROM/SROM/PRETERM labor
    • Fluid, or bleeding from the vagina
    • Abdominal pain, cramping or backache
  3. Placenta Previa/Abruption
    • Vaginal bleeding
  4. S/S of hypo or hyperglycemia
  5. Pre-eclampsia
    • visual distrubances & severe headaches
    • Swelling of the face, fingers, or sacrum
    • Epigastric pain
    • severe hypertension
  6. Hyperemesis gravidarum/dehydration
    • prolonged n/v/d
  7. Fetal distress or death
    • change in fetal movement or FHR
  8. Pyelonephritis, appendicitis
    • Abdominal back or pelvic pain
105
Q

What should we know about transvaginal ultrasound?

review

A
  1. Usually done 1st trimester
  2. Useful in obese patients
  3. Does NOT require the women to have a full bladder
  4. Women placed in lithotomy postion and a sterile covered probe/tranducer inerted into vagina
  5. Can also be used to evaluate cervical status
106
Q

What should we know about a transabdominal ultrasound?

review

A
  1. Transducer is moved over maternal abdomen to create an image
  2. warm gel to at least room temp
  3. REmove gel from abdomen when procedure is complete
  4. Document teaching and toleration
  5. No complications
    6 1st 20 weeks:
    • Requires full bladder to help support uterus for imaging: allow pt to empty after scan and place pillow under neck & knees for uterus placement
  6. 3rd trimester
    • Patient is supine with hip wedge to displace uterus to left
107
Q

What is chorionic villus sampling?

ask

A
  1. Aspiration of small amount of placental tissue (chorion)-thin sterile catheter/syringe inserted though abdominal wall or cervix under US guidance for chromosomal metabolic or DNA testing

Results obtained usually in 1 wk

108
Q

Complications to the baby that can occur with a chorionic villus sampling?

ask

A
  1. Limb reduction defects
  2. culture failure rate in growing chromosomes
  3. subchrorionic hematoma
  4. infection
  5. spontaneous rupture of membranes
109
Q

What is the advantage of doing a chorionic villus sampling?

ASK

A

can be done earlier than an amniocentesis (normally performed between 10-13 weeks)

110
Q

What is the nurses responsibility during a chorionic villus sampling?

ask

A
  1. Obtain consent
  2. if pt is RH negative-give Rho (D) immune globulin
  3. Place patient in lithotomy position
  4. Warn patient of sharp pain with catheter insertion
111
Q

What should we teach patient post chorionic villus sampling?

ask

A
  1. Report cramping, heavy bleeding, clot or tissue passage, leakage of fluid
  2. Notify if temp greater than 100.4
  3. rest 24 horus
  4. avoid exercise, heavy lifting and sexual intercourse for several days
112
Q

What is an amniocentesis?

ask

A

Needle inserted into uterine cavity to obtain amniotic fluid guided by US

Early pregnancy- bladder should be full to push the uterus up in the abdomen for easier access
Late pregnancy- bladder should be empty so it will not be punctured

113
Q

What are the risks of an amniocentesis?

ask

A
  1. 1% spontanous abortion
  2. Fetal injury
  3. Infection
114
Q

What is the purpose of an amniocentesis?

A
  1. Genetic testing (usually done between 15-20 weeks)
  2. Assessment of hemolytic disease in fetus-
    • elevated bilirubin levels indicate fetal hemolytic disease
  3. assessment for intrauterine infection
    • Meconium in amniotic fluid may cause fetal distress
  4. Determination of down syndrome
    • Pt could be well into 2nd trimester so choice for abortion is dangerous
  5. Primary method of evaluating fetal lung maturity
    • Lecithin-tosphingomyelin (L/S) ratio- 2:1 or greater indicates adequate surfactant and mature fetal lungs
    • Lamellar bodies (sorage form of surfactant)
    • IDM have delayed fetal lung matruation
115
Q

What is the nurses responsibility post amniocentisis?

ask

A
  1. Obtain vaseline VS & FHR
  2. Only to be performed when the uterus rises above the symphysis (12-13 weeks) and when amniotric fluid is formed
  3. **Administer RHO (D)) immune globulin for RH neg patients **
  4. Provide emotional support
  5. Monitor FHR for 1 hr

Make sure to remember bold

116
Q

What post procedure teaching should we give after an amniocentesis?

ask

A
  1. Report cramping, heavy bleeding, clot or tissue passage, leakage of fuid or temperature greater than 100
  2. Rest for 24 horus and avoid exercise, heavy lfiting and sexual intercourse for several days
  3. report a change in fetal movements
117
Q

Who might need fetal testing after >24 weeks?

ask

A

Anyone with a viable festation experiening a high-risk pregnancy

118
Q

What are examples of high-risk pregnancy?

Review

A
  1. hypertensive disorders
  2. Diabetes
  3. Multiple gestations
  4. Lupus
  5. Renal or heart disease
  6. Interruption of oxygen pathways
119
Q

What is the purpose of fetal movement counting (fetal kick counts)

ASK

A

Fetal movement counting is a method to evaluate fetal well being.

120
Q

Why is fetal movement counting important if you suspect a baby in utero is hypoxic?

ASK

A

A hypoxic fetuses activing is reduced to concerve oxygen and can eventually lead to stillbirth. Counting ensures baby is not hypoxic and is doing “well”

121
Q

What are the steps to fetal kick counting?

Ask

A
  1. Rest in a quiet location and count distinct fetal movements such as kicks or rolls
  2. Mternal perceptions of 10 distinct movements in a 1-2 hour
    • Period is reflective or nonhypoxic fetus at that moment in time
  3. Count is discontinued once 10 movments are percieved
  4. Fetal movement is then recorded
122
Q

Ture or false: Perception of decreased fetal movement should be reported

A

True Keep in mine that baby does sleep

123
Q

What is a non-stress test procedure? NST

ASK

A

An NST evaluates the ability of the fetal heart to accelerate either spontaneously or in association with fetal movement

124
Q

What is the nurses responsibility during a NST?

ASK

A
  1. place patient in comfy postion with lateral lift
  2. Place ultrasound and tocodynometer
  3. Advise pt to push button when she feels baby move so fetus response can be observed
  4. Monitor fetus for min. 20 mins; can be extended for another 20 mins to account for normal fetal sleep-wake cycles
  5. Fetal heart rate and uterine activity is recorded and interpreted
125
Q

If baby is not moving during an NST what might we do as nurses?

ASK

A

Stimulation may be required to provoke a fetal response if not active
1. Patient can eat a snack, drink water/juice or gently palpate abdomen
2. Artifical larynx placed near fetal head
- Stimulation applied for 1 to 2 seconds- can be repeated up to 3 times

126
Q

What is considered a reactive NST?

Ask

A
  1. FHR increased 15 beats above baseline for 15 seconds 2-3 times in 30 mins for fetus over 32 weeks (15x15)
  2. FHR increases 10 beats above baseline for 10 seconds 2-3 times in 20 mins for fetus less than 32 weeks (10x10)

HINT: 15x15 or 10x10

127
Q

What is considered a non-reactive NST?

ASK

A
  1. Fewer than two accelerations during 40-min period
  2. Decelerations that persist for 1 min or longer during an NST have been associated with increased cesection rates and still births
128
Q

What is a contraction stress test (CST)

Ask

A

Tool to assess fetal well-being and uteroplacental function by monitoring fetal heart rate in response to contractions

Healthy, oxygenated fetuses can physiologically tolerate contractions and maintain FHR with normal characteristics

129
Q

During a CST late decelerations are defined as…

ASK

A

Brief interruptions of oxygen transfer during contractions in compromised fetus

130
Q

Where is CST performed and why?

ASK

A

Hospital- because we are “inducing” stress on a fetus

131
Q

How are CST performed?

ASK

A

Can be completed w or w/o artifical stimulation of contractions if it is happening spontanously

If adequate contractions are not present oxytocin or nipple stimulation is required

132
Q

What is the nurses responsiblity during a CST?

ASK

A
  1. Explain procedure and obrain informed consent
  2. Monitor FHR and fetal activity for 20 mins
  3. A recording of at least 3 contractions in 10 minsutes are obtained
  4. Duration of each contraction should be 40 seconds or longer to be recorded and palpable to the nurse
133
Q

What is considered a negative CST?

ASK

A

No late decelerations (GOOD THING)

134
Q

What is a postive CST?

ASK

A

Late decelerations are present with a min of 50% of the contractions even when fewer than 3 contractions occur in 10 mins

discuss further testing or expediated delivery

135
Q

A positve CST is linked to an increased incidence of….

ASK

A

Fetal growth restriction,
late decelerations in labor,
meconium-stained fluid,
low apgar scores and
still birth

136
Q

What is a biophysical profile (BPP)

ASK/REVIEW

A

Combines electronic fetal-monitoring (EFM-NST) with ultrasound assessment of fetal biophysical characteristcs

  1. Fetal movement- 3 or more discrete body or limb movements
  2. Fetal tone- one or more fetal extremity extension w/return to fetal flexion or opening and closing of the hand
  3. Fetal breathing movement- one or more episodes of rhythmic breathing movements of 30 seconds within timeframe
  4. Aminotic fluid amount- pocket of amniotic fluid measuring at least 3cm in two planes perpendicular to each other
  5. NST reactive
137
Q

How is a BPP scored

ASK

A

Occurs over a 30 min period
2 points given for normal on each parameter. 0 points for abnormal

138
Q

A BPP score of 8/10 or 10/10 is…

ASK

A

Reassuring

139
Q

A BPP score of 6/10 is…

ASK

A

Equivicol and may indicte the need for delivery depending on gestational age

140
Q

A BPP score of 4/10 means…

ASK

A

Delivery is recommended because of strong corrleation w/chornic asphyxia

141
Q

A BPP score of 2/10 means..

A

A score of 2/10 or less prompts immediate deliery

142
Q

What factors influence family adaptation?

REVIEW

A
  1. Age-adolescent vs adult
  2. Primigravida vs. multigravida
  3. social support
  4. socioeconomic
  5. preganancy complications
  6. psychosocial issues/mental health
  7. substance abuse
  8. IPV
143
Q

1st trimester maternal responses include

REVIEW

A
  1. Uncertainty- no obcious change, seek confirmation, look forward to change
    • Primary foucs is on self- dealing w/ n/v, fatigue and mood swings
    • fetus seems vague
  2. Ambivalance- whether planned or unplanned conflicting feeling about pregnancy
    • 1st pregnancy- worries about added responsiblities, being a good parent
    • 2nd pregnancy- how will this pregnancy affect the other children and partner… worries if they will love this baby like the first
  3. Financial worries about increased responsibilites
  4. careers concerns
  5. Maternal task of pregnancy: role play- hold other infants, practice
144
Q

What is ambivalence?

ASK

A

conflicting feelings about pregnancy

145
Q

What is the maternal task of pregnancy in the 1st tirmester?

ASK

A

Role play- hold, feed other infants practice

146
Q

What is the 2nd trimester maternal responces to pregnancy?

REVIEW

A
  1. Physical evidence of pregnancy
    • Fetal growth & movement
    • Quickening occurs- pregnancy becomes real
  2. Fetus becomes the primary focus
    • nickname the fetus
    • talking to the fetus
    • rubbing their abdomen
    • ambilvalance begins to wane
  3. Perception of her body image occurs gradually
  4. Postive or negative- physical changes and signs and symptoms she has experienced
  5. Maternal task of pregnancy: fantasy- daydream about the infant and before
147
Q

What is the maternal task of pregnancy in the 2nd trimester

ASK

A

Fantasy- daydream about infant and behaviors

148
Q

3rd trimester maternal responses are…

REVIEW

A
  1. Negative body image- resentment
    2.Introverted and vulnerable
    3.becomes self-absorbed
    • Worries about baby, day dream, fantasize or have nightmares about the baby or birth
    • anxious to see her baby, tired of being pregnant and she prepares for the birth
  2. “nesting”- a sudden burst of of energy
  3. ignore partner-strain relationships- increased risk of infidelities
  4. Increasing depenence- partner easy to reach at all time
  5. Maternal task of pregnancy: Role fit sets role expected to be a good mother
  6. Ambilvalance should be resolved vy the 3rd trimester
149
Q

Ambilvalance should be resolved by what trimester?

ASK

A

3rd trimester

150
Q

What is the maternal task of pregnancy in the 3rd trimester

ASK

A

Role fit- sets role expected to be a good mother

151
Q

What is the announcement phase of the paternal response to pregnancy?

ASK

A

Accepts biological fact of pregnancy
1. confirmation of pregnancy- joy or dismay depending on planned or unplanned
2. Ambivalence is common in early stages of pregnancy
3. Couvade syndrome- experience pregnancy- like symptoms for days or weeks

152
Q

What is the moratorium phase of the paternal response to pregnancy?

ASK

A
  1. Accepts pregnancy
  2. Introsepctive- puts pregnancy thoughts aside & engages in discussion about parenting
  3. Phase can be short or last into 3rd trimester depending on the fathers readiness
153
Q

What is the focusing phase of the paternal response to pregnancy?

ASK

A

Negotiates the role he will play in labor and delivery and parenthood

concentrate on the pregnancy experience and seehimself as a father

154
Q

Birth of a new infant can be a major crisis for the sibling and sibling adaptation is often influenced by….

review

A
  1. Influenced by the siblings age & developmental level & parents attitude
    • Child experiences loss, jealousy, feels “replaced”
    • Younger- loss of baby role
    • Older- increased responsiblity
    • Adolescents- embarrassed
155
Q

How can we prepare the child for arrival of a new baby?

review

A
  1. talk about expected baby arrival
  2. Hear heartbeat
  3. Feel baby move
  4. Sibling classes
  5. attend birth
156
Q

What are risk complications of an adolecent pregnancy?

ASK

A
  1. pregnancy induced HTN
  2. Poor nutrition- anemia
  3. Preterm labor & birth
  4. Depression
  5. Substance abuse
  6. Intimate partner violence
  7. Death
  8. Preterm/LBW infant
157
Q

What are risk factors associated with teen pregnancy?

ASK

A
  1. Homelessness, juvenille justice system, foster care
  2. Maintain relationships
  3. Means to independence
  4. high risk sexual behaviors
  5. economic burden- goverment programs
  6. increase in high school dropout rate
  7. child is at higher risk for abuse and cognitive delays
158
Q

impact of teen pregnancy on adolescent fathers include…

review

A
  1. May accept responsibility
  2. “phantom father”- absent or rarely involved
  3. Conflicting roles of adolescent and fatherhood
  4. large number live in poverty and lack job skills
  5. education may be intrrupted to find a job
  6. Transition between childhood and adulthood
  7. lack patiences to parent well
159
Q

IPV (intmate partner violence) actual or threatened includes?

ASK

A
  1. Physical-slapping, punching, kicking, & pushing escalate
  2. sexual- rape
  3. Emotional- continous mental abuse, threat, coercision, isolation
  4. Reproductive coercion- interfere w/ choice of contraception/pregnancy
160
Q

What should we know about IPV and homicide

Review

A

Most likely cause of death in pregnant or recently pregnancy women

161
Q

IPV- Serious impact on meternal and fetal well-being…. what are some potential complications

ASK.

A

Maternal- uterine ruptured, placental abruption
Fetal- Prematurity, LBW

162
Q

What are 3 simple questions we can ask to assess for abuse in pregnant women?

ASK

A
  1. Have you been hit, slapped, kicked or physically hurt during the last year
  2. Have you been hit, slapped, kicked or physically hurt during this pregnancy
  3. Has anyone forced you to have sexual activites
163
Q

What are the ABCDE’S of abuse?

ASK

A

A-alone, interview alone, reassure not alone
B- Belief- let them know you believe them, abuse not her fault
C- confidentilality- explain mandatory reporting laws if applicable
D- Documention- verbatim, descriptive injuries, photos
E- Education- community resources, restraining orders
S- Safety- most dangerous time is when women decide to leave, danger plan.

Module 6 (19 decks)

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