Unit 1-Antepartum Flashcards

Question

When are yeast infections more common in pregnancy? | ASK

Answer 1

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...

Answer 2

changes in color and becomes odorus

Answer 3

streatching of uterus

Answer 4

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

Answer 5

Maternal changes @ 12 weeks

Answer 6

Kidneys start working, heart is visable.

Answer 7

Rises above pelvic brim

Answer 8

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

Answer 9

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)

Answer 10

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

Answer 11

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

Answer 12

between symphysis & umbilicus

Answer 13

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

Answer 14

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

Answer 15

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

Answer 16

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

Answer 17

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

Answer 18

Vernix develops, baby has regular sleep pattern, moving more

Answer 19

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

Answer 20

Above the umbilicus

Answer 21

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

Answer 22

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

Answer 23

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

Answer 24

1. Test done at 24weeks 2. Shot given at 28 weeks

Answer 25

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

Answer 26

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,

Answer 27

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

Answer 28

36-40 weeks

Answer 29

36-40 weeks

Answer 30

Lightening-- no longer struggles to breath as baby has dropped

Answer 31

below xiphoid process

Answer 32

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

Answer 33

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

Answer 34

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

Answer 35

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

Answer 36

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

Answer 37

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

Answer 38

Presumptive

Answer 39

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

Answer 40

miscarriage

Answer 41

1. anticonvulsants 2. diuretics 3. tranquilizers

Answer 42

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

Answer 43

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

Answer 44

1. Medical hx - psychosocial, obsterical, gyneocolgic & contraceptive

Answer 45

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

Answer 46

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

Answer 47

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

Answer 48

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

Answer 49

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

Answer 50

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

Answer 51

1. has only completed 1 pregnancy @ or >20 weeks

Answer 52

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

Answer 53

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

Answer 54

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

Answer 55

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

Answer 56

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

Answer 57

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

Answer 58

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

Answer 59

Pre-pregnancy BMI

Answer 60

1. AP, IP, PP complications

Answer 61

1. babies that are SGA 2. Preterm delivery

Answer 62

1st trimester: 2 to 4lbs 2nd trimester: average 1lbs per week Total weight gain: 25-35 lbs

Answer 63

LMP-3months+7days = EDB

Answer 64

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

Answer 65

1. Protien is good for fetal development -meats, eggs, legumes 2. Calcium is important for fetal bones and teeth - vegetables, green, deep yellow good source of vitamin C

Answer 66

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

Answer 67

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

Answer 68

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 7. **3rd trimester** - Patient is supine with hip wedge to displace uterus to left

Answer 69

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

Answer 70

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

Answer 71

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

Answer 72

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

Answer 73

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

Answer 74

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

Answer 75

1. 1% spontanous abortion 2. Fetal injury 3. Infection

Answer 76

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

Answer 77

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

Answer 78

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

Answer 79

Anyone with a viable festation experiening a high-risk pregnancy

Answer 80

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

Answer 81

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

Answer 82

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"

Answer 83

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

Answer 84

True Keep in mine that baby does sleep

Answer 85

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

Answer 86

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

Answer 87

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

Answer 88

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

Answer 89

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

Answer 90

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

Answer 91

Brief interruptions of oxygen transfer during contractions in compromised fetus

Answer 92

Hospital- because we are "inducing" stress on a fetus

Answer 93

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

Answer 94

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

Answer 95

No late decelerations (GOOD THING)

Answer 96

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

Answer 97

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

Answer 98

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

Answer 99

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

Answer 100

Reassuring

Answer 101

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

Answer 102

Delivery is recommended because of strong corrleation w/chornic asphyxia

Answer 103

A score of 2/10 or less prompts immediate deliery

Answer 104

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

Answer 105

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

Answer 106

conflicting feelings about pregnancy

Answer 107

Role play- hold, feed other infants practice

Answer 108

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

Answer 109

Fantasy- daydream about infant and behaviors

Answer 110

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 4. "nesting"- a sudden burst of of energy 5. ignore partner-strain relationships- increased risk of infidelities 6. Increasing depenence- partner easy to reach at all time 7. Maternal task of pregnancy: Role fit sets role expected to be a good mother 8. Ambilvalance should be resolved vy the 3rd trimester

Answer 111

3rd trimester

Answer 112

Role fit- sets role expected to be a good mother

Answer 113

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

Answer 114

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

Answer 115

Negotiates the role he will play in labor and delivery and parenthood concentrate on the pregnancy experience and seehimself as a father

Answer 116

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

Answer 117

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

Answer 118

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

Answer 119

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

Answer 120

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

Answer 121

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

Answer 122

Most likely cause of death in pregnant or recently pregnancy women

Answer 123

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

Answer 124

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

Answer 125

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.