Unit 2 Flashcards

Question

Describe the development of the fetal circulatory system Describe the 3 shunts

Answer 1

The heart is the first organ to function in developing embryo. It starts to beat 21 days (3 weeks) after conception (5 weeks after LMP) FHR: 110-160 bpm Because the fetal lungs are not functioning, there are 3 different shunts in fetal circulation that direct blood away from the lungs: (close within 24 hr after birth) 1. Ductus venosus - Vein that connects umbilical vein to the fetal inferior vena cava -> goes to right atrium 2, Foramen ovale - Opening between right and left atrium of the heart. Blood goes from right atrium to left atrium (pressures in pulmonary area is high, blood wants to take path of least resistance, so it goes to the left side and NOT the lungs) 3. Ductus arteriosus - Shunt that takes blood from pulmonary artery to the aorta, bypassing the lungs. Some blood still makes it to right ventricle (from right atrium), so the PDA redirects that blood.

Answer 2

The last organ system to mature Development begins in embryonic stage and continues through fetal life and childhood Alveolar formation - continue to develop up to term; begin secreting surfactant near term, usually around 36-37 weeks Pulmonary surfactant - holds alveoli open and keeps them from collapsing; can be detected in amniotic fluid. Amniocentesis can be used to detect surfactant Respiratory movements - fetuses will do these movements when they are moving fluid in and out of their lungs; this contributes to the fluctuation of amniotic fluid. This movement prepares the baby for breathing, develops the chest wall muscles. “Practice breathing” - can be seen on ultrasound, it is a sign of fetal well-being. Will see respiratory issues in babies born by C-section (going through the vaginal canal “pushes” out fluid)

Answer 3

Fetal urine is a part of amniotic fluid volume Fetus typically secretes urine by end of first 1st trimester Kidney problems can be diagnosed in utero, it can be seen on ultrasound Kidneys are fully developed at delivery; babies should pee within the first 24 hours

Answer 4

Sensory awareness By 12 weeks, babies can be seen “sucking” on thumb or fist on ultrasound By 24 weeks, babies can hear Later in pregnancy, baby will make purposeful movements Babies will respond to mom’s voice or loud noises; “jump” Babies will feel pain, at least by 23 weeks

Answer 5

Sex differentiation - appearing distinctly male or female. This process starts during the 7th week By end of 1st trimester, the baby is distinctly male or female

Answer 6

G — the number of pregnancies including current pregnancy or GRAVIDA T — the number of pregnancies that were delivered at TERM (37 weeks or >) P — the number of pregnancies that were delivered PRETERM between 20 and 37 weeks (36 weeks and 6 days, even is baby was born dead) A — the number of pregnancies ending in ABORTION (spontaneous or elective) L — the number of children currently LIVING Example- G T-P-A-L can be written as: G2 P1001 This patient is currently pregnant This patient has had 1 term delivery, 0 preterm deliveries, 0 abortions, and has 1 living child

Answer 7

- It is the earliest biochemical marker for pregnancy. - Production begins as early as day of implantation. - Can be detected as early as 7 to 10 days after conception. - There is an expected increase in hCG levels, it will double every other day throughout the 1st trimester (if they don’t, it could be an indicator of abnormal pregnancy) - Towards the end of the 1st trimester, hCG will decline and level off - Lower hCG = poor outcome such as ectopic pregnancy or miscarriage - A higher hCG = multiples - hCG is thought to cause all the nausea and vomiting during pregnancy; women carrying multiples tend to have more N/V. This could be why N/V tends to go away after 1st trimester - Best time to take a pregnancy test = morning, when hCG is highest in urine

Answer 8

Presumptive: changes noticed by the woman but DO NOT confirm pregnancy (subjective) Symptoms: - Amenorrhea (missed period) - Morning sickness - Fatigue - Breast changes - Urinary frequency - Quickening (mom’s perception of feeling baby movements)

Answer 9

Probable: changes observed by the examiner but don’t 100% confirm the pregnancy (objective findings by providers) Signs and symptoms: - Goodell’s sign: softening of the cervix (can be palpated in exam) - Hegar’s sign: softening of the lower uterine segment (can be palpated in exam) - Chadwick’s sign: bluish discoloration of the cervix that can be visualized in speculum exam - Uterine Enlargement: found on internal palpation during exam - Braxton Hicks contractions (fibroids can feel like this because they are firm) - a positive Pregnancy test (not 100% positive)

Answer 10

Positive: changes only attributable to the presence of a fetus (100% confirms a pregnancy) - Auscultate fetal heart tones (using a doppler) - Visualization of fetus on ultrasound - Fetal movements present (examiner palpating fetal movements)

Answer 11

The uterus increases in size. This has to do with increase in blood flow to the uterus. After the 1st trimester, the growing fetus is what's behind the increase in size

Answer 12

- The fundal height changes throughout pregnancy - Lightening: the baby is getting its head engaged in the pelvis, getting ready to be born - Pregnancy may “show” after the 14th week (LMP): when they “show” depends on whether it’s the woman’s first pregnancy or not; in first time moms, the muscles are tighter, they show early; weight also has to do with it (“body habitus”) skinny women will show a lot sooner, while women that are overweight, will “show” later. - Displacement of abdominal organs - the uterus pushes everything to the side; bowel sounds are still heard, but may be heard in different places - Hegar’s sign - softening of the lower uterine segment; can be assessed on a physical exam

Answer 13

12 weeks: fundus can be palpated just above the symphysis pubis 16 weeks: fundus can be palpated halfway between symphysis pubis and umbilicus 20 weeks: fundus is at the umbilicus 21-36 weeks-fundal height in centimeters correlates with weeks gestation +/- 2 cm 36 weeks: fundus typically reaches its highest point at - women feel short of breath, diaphragm is being push 40 weeks: the fundal height drops - “lightening” - the baby is getting its head engaged in the pelvis; the baby “drops”, getting ready to be born

Answer 14

Braxton Hicks contractions - The uterus is a muscle; it starts to “warm up” contractions during the pregnancy; NOT the same as labor contractions; they are usually painless, and they are very irregular; they don’t increase in frequency like normal contractions, and they do not dilate the cervix. These can begin in the 2nd trimester, but it varies depending on the woman

Answer 15

Uterine blood flow increases rapidly as the uterus increases in size in order to accommodate the rapidly growing placenta and fetus. Perfusion is important to the health of the pregnancy Factors that decrease uterine blood flow include smoking, cocaine, hypertension, and lying flat on back.

Answer 16

- Tissue changes from increased estrogen - Mucus plug: an increase in vaginal discharge contributes to the mucus plug; the mucus plugs up the endocervical canal. This mucus has immunoglobulins that help prevent infection. As labor process begins, mom will pass the mucus plug - Goodell’s sign: softening of the cervix (under hormonal influence) - Chadwick’s sign: bluish discoloration of the cervix and vaginal walls (under hormonal influence)

Answer 17

Fetal movement or “flutter.” Mom’s first perception of fetal movement First movements feel like “butterflies”; also feels like peristalsis, like a gas bubble moving around. When quickening happens vary woman to woman. It also depends on if it’s the first pregnancy or not First time moms don’t know what it feels like; multiparous moms tend to feel quickening sooner than nulliparas moms It also depends on body habitus: Obese women will feel quickening later in the pregnancy; a skinny mom that is multiparous could feel the baby moving a lot sooner Range for when women should feel baby moving: 16-20 weeks LMP

Answer 18

Passive movement of the unengaged fetus Prior to lightening, the baby is floating around in the amniotic fluid, this is when the baby can be balloted. This is done during a pelvic exam; the examiner can feel the patient’s cervix and tap upwards on it, causing the fetus to rise. The fetus then sinks, and a gentle tap is felt on the finger. This term is seen later in the pregnancy when examining to see if labor is going to begin -> if baby is “ballotable” then labor is not about to happen because baby is not engaged

Answer 19

- Vaginal epithelium: vaginal mucosa thickens; the vaginal canal lengthens (hormonal influence); increase in vaginal discharge is normal and expected - Chadwick’s sign: bluish discoloration of cervix and vagina - Leukorrhea: thin, white or slightly gray mucous discharge with a faint odor; the increase in vaginal discharge is normal, but it should NOT have a foul odor. - Vagina becomes more acidic during pregnancy, preventing bacterial infections. However, this makes the pregnant woman more prone to yeast infections

Answer 20

Positives: increase in sensation and sexual arousal Negatives: women are more prone to hemorrhoids, varicose veins, edema (vulvar edema, external genitalia can get very swollen)

Answer 21

- The breast increase in size. - Feeling of fullness, heightened sensitivity, tingling. - Heaviness is normal. - Nipples and areola; nipples will get more erect; nipples and areola will become more darkly pigmented. - As blood flow to breasts increase and the vascularity increases, venous patterning will occur (increased appearance of veins) - Striae gravidarum (pregnancy stretch marks) in areas that grow quickly, like the breasts - Montgomery tubercles: Hypertrophy of the oil glands embedded in the areola, may be seen around the nipples. Little oil glands all over the areola will become more prominent in pregnancy because they are getting ready to secrete a substance that will lubricate the area for lactation. - Colostrum

Answer 22

Very first “milk” produced early on in pregnancy Creamy white to yellowish premilk fluid Can be expressed from the nipples as early as 16 weeks NOT the same as true lactation, which doesn’t begin till after birth Usually produced 2nd trimester onward What baby will get the first few days after birth; it is very nutrient dense for baby, produced in small amounts

Answer 23

Blood volume increases by 1500 mL (by 50%). This is a compensatory mechanism to accommodate the need to increase blood flow to the uterus while perfusing mom’s body and her vital organs. An increase in blood volume is a protective mechanism. Women bleed in the postpartum period, some bleed excessively (postpartum hemorrhage); the body is bulking up blood volume to protect the woman in case she has excessive bleeding after giving birth.

Answer 24

Increase in RBC production and plasma as blood volume increases. RBCs increases because the RBC's oxygen-carrying capacity is needed during pregnancy. The plasma component increases more than the RBC component, creating a diluting effect in the blood -> "hemodilution" This hemodilution leads to a physiologic anemia, leading to a normal H&H drop in pregnancy. Cutoff levels for hemoglobin in pregnancy: 1st trimester: 11 2nd trimester: 10.5 3rd trimester: 11

Answer 25

Tendency for blood clots because of increase in clotting factors for pregnant AND postpartum women (for about 6 weeks postpartum). This is a protective mechanism for the bleeding that will occur after birth.

Answer 26

Pregnancy temporarily increases the workload of the heart and increases blood volume. There is slight hypertrophy of the heart due to the increased workload. Cardiac output increases to 50% over the non-pregnant rate by 32 weeks. Stroke volume increases. Heart rate increases. By 3rd trimester, HR increases by 10-15 beats per min (dependent on mom's normal resting rate). May hear an extra heart sound or murmur; can hear an S3; can also hear a systolic murmur -> a result of all the extra blood volume, doesn’t mean there is anything wrong

Answer 27

- Dependent edema: swelling in legs and vulva is common - Varicosity of veins in legs, vulva and anus (hemorrhoids) - Blood pressure: throughout pregnancy, blood pressure actually stays the same or slightly decreases because everything in pregnancy relaxes, including arteries. “vasodilatory effect”. This balances out with the increased blood volume. Depends on maternal position - Supine hypotension: typically seen in 2nd half of the pregnancy; the systolic blood pressure drops; Remedy: lay her on her side Change throughout pregnancy

Answer 28

- Increase in O2 requirements: Works to increase the amount of oxygen that mom takes in; Remember increase in RBCs increases oxygen-carrying capacity. The lungs need to take in more air, so there may be a slight increase in RR. - Increased vascularity to respiratory tract (estrogen causes increased blood flow) - Nasal stuffiness and epistaxis (nose bleed) are common - also changes in voice, a little more nasally due to swollen tissues - The uterus pushes up on diaphragm as it grows; the higher the diaphragm, the hard it is to take a good deep breath. When “lightening” occurs and fundal height drops -> mom can get a good deep breath

Answer 29

Nocturia, urinary frequency/urgency are common early pregnancy symptoms - especially in 1st trimester. They may go away for while, then return closer to term related to uterine pressure on the bladder. The ureters dilate. Due to this, a larger volume of urine is held in the ureters and urine flow rate is slowed, causing urinary stasis. A lag occurs between the time urine is formed and when it reaches the bladder. Because of this urinary stasis, pregnant women are more at risk for UTIs.

Answer 30

Kidneys must manage increased metabolic and circulatory demands of maternal body and fetal waste products. GFR is increased by 50%, so kidneys are filtering more and faster. Because of this, Creatinine decreases Pregnant women may have 0.5-0.6 Cr For pregnant women, a creatinine of 1.2 may be too high, even though for normal people that is a normal number

Answer 31

Physiologic edema -> dependent edema is normal in pregnancy; to resolve this, the woman can elevate her feet and lay her on her side (NOT laying flat) - Generalized edema is NOT normal in pregnancy Proteinuria -> Because of renal changes (increased GFR), extra proteins are allowed to slip past reabsorption, that’s why you see a small increase of protein in the urine. - Excess is bad, especially with hypertension Glycosuria -> Because of increased GFR, glucose is moving so fast, it is not reabsorbed as much; so you may see a little more glucose in the urine - Excessive amount of glucose in the urine = concern of gestational diabetes Proteinuria and glycosuria are checked at every prenatal visit on a urine dipstick; a small amount is fine in pregnancy; an excess is not good

Answer 32

- Chloasma (aka melasma or mask of pregnancy): Increase in splotchy or blotchy areas of increased pigmentation on the face; seen in more darker-complexioned women; the sun will make this worse. May or may not go away after delivery, but will usually fade. Also seen in women using birth control. - Linea nigra: Pigmented line extending from the symphysis pubis to the top of fundus midline. Some women get this and some do not. - Striae gravidarum: Stretch marks show up in places that are rapidly growing including the abdomen, breasts, and maybe the thighs.The color of the stretch marks depends on skin tone Will normally fade after birth, but won’t go away. - Palmar erythema: Pinkish red blotches over palmar surfaces (palms of the hands) occurs as a result of increased blood flow to subcutaneous layer. - Spider nevi: Tiny star-shaped or branched, slightly raised, and pulsating end-arterioles usually found on the neck, thorax, face, and arms. Typically fades and go away after baby is born. - The effect of pregnancy on acne is variable. In some women, the skin clears and looks radiant. Acne can worsen or occur for the first time during pregnancy or postpartum. - Nail and hair growth may be accelerated.

Answer 33

- Posture changes: As uterus and abdomen grows, the center of gravity is thrown off to compensate, lordosis can be developed. Lordosis can lead to low back pain. - Relaxation of the pelvic joint: Leads to “pregnant waddle”. Pelvic joints are getting ready for baby. The hips will widen and joints will relax. This can lead to pain in the pelvic area and hip pain. Can never go back (hips widen and relax and won’t go back). -Diastasis recti abdominis: Separation of abdominal wall muscles to the point that abdominal contents protrude through the space that is created. After baby is born, this may resolve; but some women still have this well into the postpartum period. - Another joint that relaxes that doesn’t go back to normal -> joints in feet. Shoe size may change during pregnancy

Answer 34

Lordosis may cause pain, compressing nerves Pregnant women may have some neuropathy in lower extremities Carpal tunnel is not uncommon; women will get pins and needles in hands, may drop things

Answer 35

Morning sickness: Doesn’t just happen in the morning; thought to be mediated by hCG (when hCG gets lower after 1st trimester, nausea goes away) - Seen in women with higher hCG levels (multiples) - For women that are throwing up all the time and getting dehydrated, further evaluation may be needed Changes in taste: “Cravings”; may develop aversions to things they previously liked Pica: Craving of non-food items (dirt, starch, clay, ice); usually associated with anemia - Becomes a problem when craving for pica is stronger than craving actual food -> weight needs to be checked, check to see if she has anemia

Answer 36

Gums: Because of increase in blood flow, the gums can get really red and swollen and can bleed really easily. Ptyalism (excessive salivation): hormonally mediated; having to constantly spit; sucking on hard candy can be beneficial. Under influence of progesterone, there is relaxation -> muscles of the gut and the sphincters of GI tract will relax. Pyrosis: Heartburn -> gastroesophageal sphincter is relaxed, food is sitting in stomach, uterus is pushing things up Constipation: Decreased gastric emptying, decreased peristalsis - Prone to hemorrhoids, constipation makes it worse

Answer 37

Increase in thyroid hormone production -> increase in metabolism, normal effect in pregnancy Most metabolic functions increase in pregnancy because mother must meet her own needs and needs of growing fetus. Increase levels of parathyroid hormone to take over for the demands of the fetus for calcium for fetal skeleton growth (remember PTH targets bones, intestines, and kidneys to increase calcium in blood)

Answer 38

First: weeks 1-13 Second: weeks 14-26 Third: weeks 27-40

Answer 39

Every 4 weeks for the first 28 weeks: ideally the first visit happens in the 1st trimester; we want the woman to come as soon as she knows she is pregnant Every 2 weeks to week 36: increase in frequency during the 3rd trimester because the risk of complications increases (preeclampsia, worsening of diabetes, risk of stillbirth). We want to be aware of these problems asap so we can intervene when needed Weekly from week 36 to birth: final 4 weeks

Answer 40

- Reason for seeking care: What brought her in? A positive pregnancy test? Missing period? - Assessment of current pregnancy: Presumptive signs of pregnancy? Is pregnancy planned or unplanned? Any cramping or bleeding since LMP? - Assessment of past pregnancies: Gravida and Parity? How many? At how many weeks was there or a loss or delivery? Previous birth weights? How long did previous labors last? - Gynecological history: Any GYN surgery? Up to date on Pap smear? Any history of STI? - Current and past medical/surgical history: What medical problems could affect pregnancy? Diabetic? Chronic hypertension? Epilepsy? Mental health issues? - Drug use: Alcohol? Street drugs? Current medications? - Family medical history: Genetic conditions or any birth defects in the family? - Father’s family history of genetic conditions: Any history of genetic conditions? Dad’s blood type? How does Dad feel about pregnancy, is he supportive? - Social and occupational history: Level of education? Income range? What does she do for work? Social support? Housing? Cultural or religious preferences? - History of abuse/Intimate partner violence: This escalates during pregnancy; screen the woman once per trimester, then in the postpartum period. Ideally, we want to screen the woman alone (abusers tend to be overbearing and do not want to leave the partner alone)

Answer 41

- Pregnancy Test: usually urine test, may do blood test - Menstrual history: When was the first day of the last menstrual period? - Signs and symptoms of pregnancy: presumptive (nausea, breast tenderness, fatigue, urinary frequency) - Calculation of due date: EDD and EDC are used interchangeably - Laboratory Tests: Blood type and screen: Rh + or - CBC: get a baseline H&H and platelets Rubella titer: if nonimmune, can’t get vaccine till postpartum HIV, RPR (syphilis), and Hepatitis B Urinalysis/ urine culture Gonorrhea/Chlamydia cervical swabs PAP test - Physical Exam: baseline weight, vital signs, head to toe - Pelvic Exam - Assess fetal heart tones (FHTs): can be heard as early as 10-12 weeks using a doppler; can be seen on ultrasound before that (5-6 weeks after LMP)

Answer 42

EDD: Estimated date of delivery EDC: Estimated date of confinement Ultrasound: may do an ultrasound to confirm pregnancy; if not at first visit, it will be scheduled. Ultrasound in the 1st trimester is very accurate at dating the pregnancy . Measures the crown length -> calculates gestational age Nägele’s rule - formula, need to know first day of LMP. In order for the date to be accurate, the woman must have regular 28-day cycles First day of LMP + 7 days – 3 months Gestational wheel can also be used to calculate due date.

Answer 43

Interview: Interval history -> Any new issues since last visit? Physical examination: more focused -> Check weight, vital signs, urine dipstick Fetal assessment: - Fetal movement or “quickening”: Starting at 16 weeks, has mom felt the baby moving? - Listening for fetal heart tones: can be heard as early as 10-12 weeks using a doppler - Comparing fundal height and gestational age Review appropriate trimester warning signs

Answer 44

Assessing Fundal Height - Measured with a cm measuring tape; lay client on the table, feel for the pubic bone, place the tape at the pubic bone. Palpate top of the fundus; measure pubic bone to top of fundus - Measuring fundal height shows fetal growth; fundal height should not be staying the same at each visit - If fundal height is going up above average: excessive amniotic fluid (polyhydramnios), multiples, bigger baby - If fundal height is below average: oligohydramnios, small baby - To assess fundal height, mom's bladder needs to be empty Fetal movement or “quickening” - Mom’s perception of fetal movement is the most important thing to know about fetal well-being - Starting at 16 weeks, ask if mom has felt the baby moving yet - Babies can have periods of sleep when they are not moving for a little while, it is concerning when movement hasn't been felt for hours Assessing Fetal Heart Tones - Can be heard as early as 10-12 weeks using a doppler - Normal FHR ranges from 110-160 bpm

Answer 45

At initial visit then repeated at 28 Repeated earlier if mom has signs of amnesia

Answer 46

Genetic screening test offered to all moms, but it is not required. Predicts risk of Trisomy 21, 13, 18. Screens for neural tube defects. Maternal serum alpha feta protein (MSAFP) is included in the Quad Screen, it specifically tests for neural tube defects. It has to be done within 15 (0 days )-20 (6 days) weeks.

Answer 47

Done at initial visit then repeated at 28 weeks. Rhogam is given at 28 weeks to Rh (-) mothers - Given to ALL Rh - moms to prevent sensitization to Rh factor (A-, B-, O-, AB-) After birth, if the baby is Rh +, mom is given Rhogam again

Answer 48

ALL pregnant women are screened. GBS is a bacteria, it is part of normal flora for most women in the rectum and vagina; It is not sexually transmitted. However, it can have detrimental effects on a newborn; can lead to newborn having GBS sepsis, GBS pneumonia, GBS meningitis, or neonatal death. Done at 35-37 weeks. If mom is GBS +, there are protocols for antibiotic administration during labor.

Answer 49

Done at every prenatal visit. Tests for... Glucose (excessive = diabetes) Protein (excessive = HTN) Nitrites and leukocytes (+ nitrites, + leukocytes = UTI)

Answer 50

Screens for gestational diabetes. ALL pregnant women are screened. Done at 24-28 weeks. The woman drinks a 50 g glucose drink and will have blood drawn in 1 hr; they do not have to fast for the one hour test The cut-off number is 140 mg/dL. If blood sugar is above 140 mg/dl, the test is failed, and the woman has to do a 3 hour glucose test. The 3 hr test is done in the morning, they do have to fast, they have to drink a bigger load of glucose, 4 blood draws done every hour

Answer 51

Maternal adaptation - Accepting the pregnancy : Was it planned? Is the father and family supportive? Fear over finances? Anxiety? - Ambivalence is normal (getting “cold feet” about pregnancy even when it was planned) - Emotional responses may vary by trimester - 2nd trimester is usually when pregnancy is accepted, the baby is viewed as a second person

Answer 52

Seatbelts: - Definitely want to use a seatbelt - Put lap belt over the thighs - While driving a car, be as far from the steering wheel as possible - If it’s a long trip, make sure you are walking every couple of hours, do leg and foot exercises Airlines: - If it’s a long trip, make sure you are walking every couple of hours; do leg and foot exercises - You can fly on domestic flights up to 36 weeks, it is capped earlier for international flights

Answer 53

Medication/herbal preparations: - Be careful about OTC and herbal medications as well as prescriptions, talk to doctor or pharmacist - Take Tylenol, not ibuprofen Immunizations: - No live virus vaccines during pregnancy: MMR, varicella - Tdap, influenza, Hep B vaccines are fine during pregnancy - Very common to give MMR to postpartum patient

Answer 54

It is usually okay to have sex during pregnancy. There are a few circumstances when women should abstain from sex during pregnancy -> history of preterm labor, history of miscarriage, bleeding during pregnancy. Not uncommon to have spotting after sex during pregnancy due to increased blood flow in cervix.

Answer 55

- Abdominal cramping or vaginal bleeding - Chills or fever (infection) - Burning on urination (UTI, kidney infection) - Uncontrolled vomiting (dehydration, electrolyte disturbance) - Diarrhea (dehydration)

Answer 56

Sudden leakage of fluid from vagina prior to 37 weeks (“water breaks”) Vaginal bleeding with or without abdominal pain (possible placental abruption) Chills, fever, burning on urination, flank pain (UTI, kidney infection -> can lead to preterm labor) Decreased fetal movement Increased pressure, uterine contractions, or cramping < 37 weeks (preterm labor) Visual disturbances or severe headaches (gestational hypertension, preeclampsia) Swelling in face and/or fingers (gestational hypertension, preeclampsia) Abdominal pain, epigastric pain (gestational hypertension, preeclampsia)

Answer 57

Nausea and vomiting Urinary frequency Fatigue Breast changes Increased vaginal discharge Nasal stuffiness and epistaxis Ptyalism Mood swings

Answer 58

Pyrosis (heartburn) Ankle edema and Varicose Veins Flatulence Hemorrhoids Constipation Backache Leg cramps Faintness Shortness of breath Difficulty sleeping Round ligament pain Carpal tunnel syndrome

Answer 59

Physiology: Hypertrophy of mammary gland tissue and increased vascularization, pigmentation, and size and prominence of nipples and areolae caused by hormonal stimulation. Education for Self-Management: Wear supportive maternity bras with pads to absorb discharge, may be worn at night; wash with warm water and keep dry; breast tenderness may interfere with sexual expression or foreplay but is temporary

Answer 60

Physiology: Vascular engorgement and altered bladder function caused by hormones; bladder capacity reduced by enlarging uterus and fetal presenting part. Education for Self-Management: Empty bladder regularly; perform Kegel exercises; limit fluid intake before bedtime; avoid caffeine; wear perineal pad; report pain or burning sensation to obstetric care provider.

Answer 61

Physiology: Unexplained; may be caused by increasing levels of estrogen, progesterone, and hCG or by elevated basal body temperature; psychologic response to pregnancy and its required physical and psychologic adaptations. Education for Self-Management: Rest as needed; eat well-balanced diet to prevent anemia

Answer 62

Occur in up to 70% of pregnant women; typically begins by 4-6 weeks of pregnancy, peaks by 9 weeks, and resolves by 12 weeks; can occur any time during day Physiology: Cause unknown; may result from hormonal changes, possibly hCG or estradiol; psychologic disposition; emotional response to pregnancy; evolutionary adaptation to protect mother and fetus Education for Self-Management: - Avoid empty or overloaded stomach; maintain good posture—give stomach ample room - Stop smoking; eat dry carbohydrate on awakening; remain in bed until feeling subsides, or alternate dry carbohydrate every other hour with fluids such as hot herbal decaffeinated tea, milk, or clear coffee until feeling subsides - Eat five or six small meals per day; avoid fried, odorous, spicy, greasy, or gas-forming foods - Wear acupressure bands used to treat motion sickness; ginger or acupuncture may be helpful; vitamin B6 and doxylamine (Diclegis) may be ordered if weight loss occurs; consult primary health care provider if intractable vomiting occurs.

Answer 63

Physiology: Possibly caused by elevated estrogen levels; may be related to reluctance to swallow because of nausea. Education for Self-Management: Use astringent mouthwash, chew gum and eat hard candy as comfort measures.

Answer 64

Physiology: Increased vascularity and proliferation of connective tissue from estrogen stimulation. May be due to inadequate dental care and chronic inflammation of the gums; can be associated with preterm labor and premature birth. Education for Self-Management: See dentist early in pregnancy, eat well-balanced diet with adequate protein and fresh fruits and vegetables; brush teeth gently with soft toothbrush and observe good dental hygiene.

Answer 65

Physiology: Hyperemia of mucous membranes related to increased estrogen levels Education for Self-Management: Use humidifier; avoid trauma; normal saline nose drops or spray may be used.

Answer 66

Physiology: Hormonally stimulated cervix becomes hypertrophic and hyperactive, producing an abundant amount of mucus. Education for Self-Management: Not preventable; do not douche; wear perineal pads; perform hygienic practices such as wiping front to back; report to obstetric care provider if accompanied by pruritus, foul odor, or change in character or color.

Answer 67

Physiology: Hormonal and metabolic adaptations; feelings about female role, sexuality, timing of pregnancy, and resultant changes in life and lifestyle. Education for Self-Management: Participate in pregnancy support group; communicate concerns to partner, family, and health care provider; request referral for supportive services if needed (i.e., for financial assistance).

Answer 68

Physiology: Melanocyte-stimulating hormone (from anterior pituitary). Education for Self-Management: Not preventable; usually resolves during puerperium.

Answer 69

Physiology: Focal networks of dilated arterioles (end arteries) from increased concentration of estrogens. Education for Self-Management: Not preventable; they fade slowly during late puerperium; rarely disappear completely.

Answer 70

Physiology: Unknown cause; various types: nonpapular; closely aggregated pruritic papules. Increased excretory function of skin and stretching of skin possible factors. Education for Self-Management: Not preventable; contact obstetric care provider for diagnosis of cause; keep fingernails short; use comfort measures for symptoms; distraction; tepid baths with sodium bicarbonate or oatmeal added to water; lotions and oils; change of soaps or reduction in use of soap; loose clothing; oral or topical antihistamines or topical steroid cream if recommended by health care provider.

Answer 71

Physiology: Unknown; should not be accompanied by persistent cardiac irregularity. Education for Self-Management: Not preventable; contact primary health care provider if accompanied by symptoms of cardiac decompensation.

Answer 72

Physiology: Caused by pressure of gravid uterus on ascending vena cava when woman is supine; reduces uteroplacental and renal perfusion. Education for Self-Management: Side-lying position or semisitting posture with knees slightly flexed.

Answer 73

Physiology: Vasomotor lability or postural hypotension from hormones; in late pregnancy may be caused by venous stasis in lower extremities. Education for Self-Management: Moderate exercise, deep breathing, vigorous leg movement; avoid sudden changes in position and warm crowded areas; move slowly and deliberately; keep environment cool; avoid hypoglycemia by eating five or six small meals per day; wear elastic hose; sit as necessary; if symptoms are serious, contact obstetric health care provider.

Answer 74

Physiology: Cause unknown; craving influenced by culture or geographic area. Education for Self-Management: Not preventable; satisfy craving unless it interferes with well-balanced diet; report unusual cravings to obstetric health care provider.

Answer 75

Physiology: Progesterone slows gastrointestinal (GI) tract motility and digestion, reverses peristalsis, relaxes cardiac sphincter, and delays emptying time of stomach; stomach displaced upward and compressed by enlarging uterus. Education for Self-Management: Limit or avoid gas-producing or fatty foods and large meals; maintain good posture; sip milk for temporary relief; drink hot herbal tea; obstetric care provider may prescribe antacid between meals; contact health care provider for persistent symptoms

Answer 76

Physiology: GI tract motility slowed because of progesterone, resulting in increased resorption of water and drying of stool; intestines compressed by enlarging uterus; predisposition to constipation because of oral iron supplementation. Education for Self-Management: Drink 2 L (8-10 glasses) of water per day; include high-fiber foods in diet; engage in moderate exercise; maintain regular schedule for bowel movements; use relaxation techniques and deep breathing; do not take stool softener, laxatives, mineral oil, other drugs, or enemas without first consulting obstetric care provider.

Answer 77

Physiology: Reduced GI motility because of progesterone, allowing time for bacterial action that produces gas; swallowing air. Education for Self-Management: Chew foods slowly and thoroughly; avoid gas-producing foods, fatty foods, large meals; maintain moderate exercise; maintain regular bowel habits.

Answer 78

Physiology: Hereditary predisposition; relaxation of smooth muscle walls of veins because of hormones causing tortuous dilated veins in legs and pelvic vasocongestion; condition aggravated by enlarging uterus, gravity, and bearing down for bowel movements; thrombi from leg varices rare but can occur in hemorrhoids. Education for Self-Management: Avoid lengthy standing or sitting, constrictive clothing, and constipation or bearing down with bowel movements; moderate exercise; rest with legs and hips elevated; wear support hose; thrombosed hemorrhoid may be evacuated; relieve swelling and pain with warm sitz baths, local application of astringent compresses.

Answer 79

Physiology: Emotional tension (more common than vascular migraine headache); eye strain (refractory errors); vascular engorgement and congestion of sinuses resulting from hormone stimulation Education for Self-Management: Conscious relaxation; contact obstetric health care provider for constant or “worst ever” headache to assess for preeclampsia; OTC analgesics may be used if recommended by health care provider (e.g., acetaminophen)

Answer 80

Physiology: Compression of median nerve resulting from changes in surrounding tissues; pain, numbness, tingling, burning; loss of skilled movements (e.g., typing); dropping of objects Education for Self-Management: Not preventable; elevate affected arms; splinting of affected hand may help; regresses after pregnancy; surgery is curative

Answer 81

Physiology: Brachial plexus traction syndrome resulting from drooping of shoulders during pregnancy (occurs especially at night and early morning) Education for Self-Management: Maintain good posture; wear supportive maternity bra; condition will disappear after birth if lifting and carrying baby do not aggravate it

Answer 82

Physiology: Stretching of ligament caused by enlarging uterus Education for Self-Management: Not preventable; rest, maintain good body mechanics to avoid overstretching ligament; relieve cramping by squatting or bringing knees to chest; sometimes heat helps

Answer 83

Physiology: Relaxation of symphyseal and sacroiliac joints because of hormones, resulting in unstable pelvis; exaggerated lumbar and cervicothoracic curves caused by change in center of gravity resulting from enlarging abdomen Education for Self-Management: Maintain good posture and body mechanics; avoid fatigue; wear low-heeled shoes; abdominal support may be useful; practice conscious relaxation; sleep on firm mattress; apply local heat or ice; get back massages; do pelvic tilt exercises; rest; condition will disappear 6-8 weeks after the birth

Answer 84

Physiology: Expansion of diaphragm limited by enlarging uterus; diaphragm is elevated about 4 cm; some relief after lightening Education for Self-Management: Maintain good posture; sleep with extra pillows; avoid overloading stomach; stop smoking; contact health care provider if symptoms worsen to rule out anemia, emphysema, and asthma

Answer 85

Physiology: Fetal movements, muscle cramping, urinary frequency, shortness of breath, or other discomforts Education for Self-Management: Reassurance; conscious relaxation; back massage or effleurage; support of body parts with pillows; warm milk or warm shower or bath before bedtime; no TV or other screen devices in the bedroom or 1 h before bedtime

Answer 86

Physiology: Pressure from enlarging uterus, especially when standing or walking; worse with multiple gestation Education for Self-Management: Rest, conscious relaxation, and good posture; contact obstetric health care provider if pain is present

Answer 87

Physiology: Intensification of uterine contractions in preparation for work of labor Education for Self-Management: Reassurance; rest; change of position; practice breathing techniques when contractions are bothersome; effleurage; differentiate from preterm labor

Answer 88

Physiology: Compression of nerves supplying lower extremities because of enlarging uterus; reduced level of diffusible serum calcium or elevation of serum phosphorus; aggravating factors: fatigue, poor peripheral circulation, pointing toes when stretching legs or when walking, drinking more than 1 L (1 qt) of milk per day Education for Self-Management: Dorsiflex foot until spasm relaxes. Stand on cold surface; oral supplementation with calcium carbonate or calcium lactate tablets; aluminum hydroxide gel, 30 mL, with each meal removes phosphorus by absorbing it (consult obstetric health care provider before taking these remedies)

Answer 89

Physiology: Edema aggravated by prolonged standing, sitting, poor posture, lack of exercise, constrictive clothing, or hot weather Education for Self-Management: Ample fluid intake for natural diuretic effect; put on support stockings before arising; rest periodically with legs and hips elevated; exercise moderately; contact health care provider if generalized edema develops; diuretics are contraindicated

Answer 90

Adolescents - Less likely than older women to receive adequate prenatal care - More likely to miss visits or enter prenatal care late - Tied to poor outcomes -> LBW, infant mortality - More likely to not gain enough weight during pregnancy Women older than 35 years - Incidence is increasing: women are starting to delay having children for the sake of careers; also seeing more advances in fertility treatments; reversible long-term contraception - Age related medical risks: see more stillbirth or IUFDs, chromosomal abnormalities, preterm births, diabetes and hypertension - Prenatal Care: need more surveillance - Genetic screening and amniocentesis: additional screenings and tests are offered, instead of waiting for the quad screen - Ultrasounds are increased - More frequent visits at the end of pregnancy for older moms

Answer 91

Inadequate weight gain and pregnancy -> growth restriction of the baby, LBW baby, preterm labor Gaining too much weight -> risk for preeclampsia, IUFDs, fetal macrosomia (very large baby), cephalopelvic disproportion (CPD), emergency C-section, postpartum hemorrhage, C-section wound infections

Answer 92

1st trimester: same as non pregnant 2nd trimester: ~350 calories more 3rd trimester: ~450 calories more

Answer 93

Underweight woman: 28–40 lbs Normal weight woman: 25–35 lbs Overweight woman: 15–25 lbs Obese woman: less than 15 lbs

Answer 94

1st trimester: 3.5-5 lbs total Duration of pregnancy: 0.5 kg/week for underweight women: 1-1.3 lbs 0.4 kg/week for normal weight: 0.8-1 lbs 0.3 kg/week (overweight): 0.5-0.7 lbs 0.2kg/week (obese): 0.4 - 0.6 lbs

Answer 95

Adequate protein intake is essential to meet demands of pregnancy Protein is needed for tissue growth Protein requirement for lactating women is higher than pregnant women (a LOT higher than non-pregnant women) **Vegans at risk for not getting enough protein

Answer 96

8-10 glasses/day of water Helps with hydration and constipation Caffeine: Limit caffeine in pregnancy, could be associated with growth issues. 200 mg per day is acceptable Aspartame: considered safe in pregnancy Dehydration and pregnancy -> want to avoid dehydration because it can lead to cramping and preterm labor -> when woman comes into hospital cramping, she is given IV fluids

Answer 97

Most mineral/vitamin needs can be met in diet, except for iron and folate (need supplementation) Iron: - 30 mg/ day supplement starting at 12 weeks - Allows adequate amount of iron to be transported to fetus, because the fetus stores iron in its liver - Moms needs adequate iron since she is producing more blood volume (to avoid anemia) - Women that are carrying multiples have even greater blood volume, at risk for anemia Calcium: - Usually requirements are met with diet; problems with those that don’t drink milk or eat dairy, are lactose intolerant, or are vegan - 1000 mg daily is sufficient for fetal bone and tooth development Folate acid: - Pregnant women should consume 50% more than non pregnant women. - Non-pregnant: 400 mcg -> pregnant women: 600 mcg - Adequate folic acid helps prevent neural tube defects

Answer 98

500 mcg: • Liver: chicken, turkey, goose (100 g [3.5 oz]) 200 mcg • Liver: lamb, beef, veal (100 g [3.5 oz]) 100 mcg: • Legumes, cooked (½ cup) • Peas: black-eyed, chickpea (garbanzo) • Beans: black, kidney, pinto, red, navy • Lentils • Vegetables (½ cup) • Asparagus • Spinach, cooked • Papaya (1 medium) • Breakfast cereal, ready-to-eat (½ to 1 cup) • Wheat germ (¼ cup) 50 mcg: • Vegetables (½ cup): Broccoli; Beans: lima beans, baked beans, or pork and beans; Greens: collards or mustard, cooked; Spinach, raw • Fruits (½ cup): Avocado, Orange or orange juice • Pasta, cooked (1 cup) • Rice, cooked (1 cup) 20 mcg: • Bread (1 slice) • Egg (1 large) • Corn (½ cup)

Answer 99

30 min of exercise per day is recommended, associated with shorter/easier labor Avoid sports with potential abdominal trauma or falls -> swimming is great during pregnancy Avoid overheating STOP EXERCISING IF: vaginal bleeding, leaking fluid, decreased fetal movement, dizziness, HA, chest pain, calf pain, dyspnea Make sure that fluid and caloric intake accounts for exercise

Answer 100

Needs for energy, protein, vitamins, minerals are greater than non pregnant needs Consumption of at least 1800 calories/day is recommended (2000-2200 is better) About 500 calories/day above pre-pregnant levels Protein requirement is higher than pregnant women (a LOT higher than non-pregnant women) Lactation commonly leads to slow and steady weight loss Fluid intake is important while breastfeeding Avoid smoking while breastfeeding -> decreases milk production Caffeine kept to a minimum because it can get into the breast milk Alcohol consumption is okay, but time it around breastfeeding

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Unit 2 Flashcards

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