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NSG 2203 > Unit I/Test 1 Prenatal > Flashcards

Unit I/Test 1 Prenatal Flashcards

1
Q

Assess Changes of Normal Pregnancy:

A
  • Psychological responses
  • Physiological responses
  • Pathophysiological responses
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2
Q

Developmental task of expectant family:

A

-assists with the adjustment to pregnancy

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3
Q

1st Trimester:

A

*acceptance (ambivalence)

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4
Q

2nd Trimester:

A
  • establishing relationships with unborn child
  • idea of fantasy child
  • feeling of movement-quickening
  • -16-20 weeks
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5
Q

3rd Trimester:

A

*Preparing for birth experience

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6
Q

Maintaining balance in women during prenatal period:

A
  • support
  • past childbirth experience
  • re-ordering relationships
  • identifying role of mother
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7
Q

Father-

A
  • perception of male and father role

- system that supports fatherhood

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8
Q

Role of grandparents:

A
  • historian

- What it was like when they were born or children

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9
Q

Teenage mother:

A
  • fear of pregnancy (fear of parents)
  • developmental stage
  • accepting reality of pregnancy (denial= lack of prenatal care)
  • accepting reality of parenthood (desire but lacks ability)
  • Most have knowledge and resources to get contraceptives
  • Non-use of condoms/birth control
  • feeling they may not become pregnant
  • unconscious wish for pregnancy
  • –moving into adulthood
  • –passion state
  • –evidence of being special (identity and attractiveness)
  • Majority give birth outside wedlock
  • Twice as many infants weighing less than 1500G
  • Socioeconomic and social handicap much more likely
  • Infants
  • Prominent targets for child abuse and neglect
  • SGA
  • Obstetric hazards:
  • increased mortality
  • increased anemia
  • vaginitis
  • STI
  • UTI
  • preeclampsia/pre-term labor
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10
Q

Physiological responses:

HUMAN PRENATAL DEVELOPMENT

A
  • ovum- conception until primary villi appear (12-14 days). Four weeks from LMP
  • embryo- rapid cell division. All organ system established (56 days). Ten week from LMP
  • fetus (latin for offspring). Placental function and structure develops (end of embryo stage until pregnancy is terminated)
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11
Q

Physiological Response:

MATERNAL CHANGES DURING PREGNANCY

A
  • Maternal changes during pregnancy
  • ovulation ceases, FSH and LH suppressed. Increased in estrogen and progesterone levels.
  • Corpus luteum secretes estrogen and progesterone during first 8 weeks then placental hormone secretion takes over function
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12
Q

Fetus stage- placental function and structure-

A
  • placentalization occurs when the chorionic villi invade the endometrium and with enzyme action opens a maternal vein and forms small blood lakes (lagunae) in the decidua basale/adjacent villi multiply rapidly and become the chorion frondosum or the fetal portion of the future placenta
  • chorion villi forms the structures for absorption (enzyme action)
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13
Q

Placental function and structure consists of:

A

15-20 cotelydons or segments and acts as a transport system for nutrients and waste. It serves as an effective lung, kidney, stomach and intestine and acts as an endocrine gland. It’s a protective barrier against many organisms- but not all.
*The placenta has intense O2 activity until approaching term. Thus reason for concern for post term babies.

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14
Q

Placenta:

A

*Life span is measured by its ability to provide oxygen and nutrients. It is dependent on maternal circulation and blood pressure. It’s membranes surrounding the fetus are called Amnion (inner membrane) and Chorion (outer membrane)

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15
Q

Fetus stage: The umbilical cord (funis) is the…

A

Life line of the fetus. It consists of two arteries, one vein, is surrounded by wharton’s jelly (50:55cm usually about the same length as the baby) and is rigid while it is still in the uterus and pulsating blood. After birth it becomes much more flexible.

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16
Q

Fetal development milestones table: Fetus stage:

A
  • can hear
  • can urinate
  • can suck thumb on ultrasound
  • can swallow amniotic fluid
  • has periods of awakefullness and sleeping
  • sense of taste
  • should not have bowel elimination (sign of trouble)
  • meconum
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17
Q

Functions of Amniotic fluid:

A
  • protects from trauma
  • separates fetus from the membranes
  • allows freedom of movement which allows symmetry of limb and body development
  • protects from heat loss
  • it is a source of oral fluid for the fetus
  • it is a collection for excretions
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18
Q

The fetus urinates into the

A

amniotic fluid but does not empty the bowels under normal circumstances. Much is unknown about amniotic fluid. Can study for fetal maturity, state of health and sex of fetus and detection of a number of genetic abnormalities. Abnormal amounts of aminiotic fluid is usually associated with fetal abnormalities.

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19
Q

Amounts of fluid:

A
  • normal 500-1500 ml
  • more than 2000 B poly hydramnious -tefibtuala/GI anomalies
  • less than 300 B oligohydraminos- kidney and GU problems
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20
Q

Fetal circulation:

A
  • fifth week heart develops into 4 chambered organ. (heart beats 22/days after conception)
  • can hear fetal heartbeat with doppler around 10 weeks
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21
Q

Maternal Adjustments: Hormone levels-

A
  • Estrogen- estriol- produced by placenta
  • Progesterone- placental hormone
  • HCG- tested for pregnancy (placental)
  • Relaxin- ovaries produce, helps prevent premature labor, relaxes the pelvic joints and softening of the cervix.
  • Oxytocin-post pituitary-initiates labor
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22
Q

Maternal Adjustments:

Cardiovascular:

A
  • slight enlargement
  • Sound exaggerated
  • Heart rate increased 15-20 beats per minute
  • Cardiac output increased 30%
  • Blood volume increased 50%
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23
Q

Maternal Adjustments:

Blood changes:

A
  • RBC have accelerated production- 30% with iron supplementation
  • HGB and HCT decrease due to increase of volume (2nd trimester)
  • WBC increase (up to 25, 000 at time of labor)
  • Coagulation factors increases- increase risk for thrombus during pregnancy and postpartum
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24
Q

Maternal Adjustments:

Respiratory changes:

A
  • Increase vascularity- edema in the nasal passages
  • rate increases about 2 breaths per minute
  • Anesthetics are absorbed more easily d/t increase in vascularity to pulmonary system.
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25
Q

Maternal Adjustments:

Renal changes:

A
  • Decrease in bladder tone/irritation-effect of progesterone (1st trimester)
  • Compression of bladder by the uterus (3rd trimester)
  • Urinary frequency/urgency-normal
  • glucose-diabetes
  • protein-hypertension or preeclampsia
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26
Q

Maternal Adjustments:

Reproductive changes:

A
  • ovaries-ovulation ceases
  • fallopian tubes-little change
  • Cervix- chadwick’s sign-violet purplish hue of the cervix (visible around 8 week) d/t increased vascularity.- Goodell’s sign- softening (evident around 6 weeks). Consistency- pre-pregnant consistency of the end of the nose. Early and mid pregnancy about like the ear lobe. Late pregnancy consistency of the lips. Dilation at term-1 cm for primip, 2 cm for multip
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27
Q

Maternal Adjustments:

Uterus

A
  • Sounds by doppler
  • uterine souffle- a rushing sound as blood circulates in the placenta- synchronous with the maternal heart beat.
  • funic souffle- fetal blood circulating in the umbilical cord.
  • fetal heart tones (FHT) 110-160
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28
Q

Maternal Adjustments:

Vaginal and vulva:

A
  • leukorrhea (thick white discharge)
  • Risk for vaginal infections
  • No tampons
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29
Q

Maternal Adjustments:

Breast

A
  • increase in vascularity, fullness
  • heightened sensitivity
  • Nipples and areola become more pigmented
  • blood vessels more prominent and colostrum (24 weeks)
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30
Q

Maternal Adjustments:

Integumentary Changes:Skin

A
  • chloasma (mask of pregnancy)
  • linea nigra (pigmented line extending from the symphysis pubis to the top of the fundus)
  • Striae gravidarum (stretch marks)
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31
Q

Maternal Adjustments:

Gastrointestinal changes:

A
  • Pica
  • Morning sickness
  • heartburn
  • constipation
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32
Q

Maintaining balance in women during prenatal period: Prenatal care:

A
  • Medical history
  • Family medical history
  • obstetrical history
  • physical exam
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33
Q

Gravida:

A

Number of pregnancies

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34
Q

Para:

A

Number of pregnancies that reach viability

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35
Q

Term:

A

37 weeks or greater

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36
Q

Preterm:

A

24-36 weeks gestation

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37
Q

Abortion:

A

less than 24 weeks gestation

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38
Q

Living:

A

Number of living children

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39
Q

Diagnostic: Experiential responses:

A
  • valuing, culture, religion
  • perceiving hopefulness
  • choosing prenatal care
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40
Q

Experiential responses: Stages of development-

A
  • amenorrhea
  • n/v
  • breast sensitivity
  • urinary symptoms
  • fatigue
  • increased pigmentation of skin
  • quickening (feeling fetal movement)
41
Q

Probable signs: Breast change-

A
  • enlargement, secondary areola, Montgomery’s tubercles, secretion of colostrum
  • Abdominal enlargement
  • Pelvic changes: Chadwick’s sign, Goodell’s sign, Hegar’s sign, Leukorrhea
  • Uterine enlargement
  • Braxton Hick’s contractions
  • Uterine souffle
  • positive pregnancy test
42
Q

Behavioral Responses: Positive observable and measurable:

A
  • Ultrasound
  • Fetal heart beat
  • External perception of fetal movement
43
Q

Diagnostic: rules

A
  • Naegele’s rule for calculating EDC
  • LMP + 7 days- 3 months + 1 year
  • Add 7 days to 1st day of lmp
  • subtract 3 months
  • add 1 year
  • naegele’s rule assumes a 28 day cycle
  • 4-10% will deliver on EDC
  • Majority will deliver + or -7 days of EDC
44
Q

Diagnostics: Initial

A
  • CBC
  • Type and RH
  • VDRL
  • Rubella (1:8 or 8 mg)
  • Hepatitis
  • Urinalysis
  • Cervical cultures
  • CBC (24-28 weeks)
  • Post -prandial blood sugar (24-28 weeks)
  • Cervical cultures for strep B (36 weeks)
  • HIV
45
Q

Diagnostics: Alpha-fetoprotein test:

A

15-18 weeks. AFP is a protein produced by a growing fetus. It is present in amniotic fluid, fetal blood, and in smaller amounts in the woman’s blood.

  • -increased open fetal defects. Spinal bifida
  • -decrease downs syndrome
46
Q

Advanced diagnostics:

A
  • Ultrasound
  • AFP
  • Triple marker test-screens at 16-18 weeks gestation- usues the levels of three markers (MSAFP, unconjugated estrol, and human chorionic gonadotropin (hCG). Fetus with down’s syndrome-MSAFP and unconjugated estriol levels are low, whereas the HCG level is elevated.
  • Amniocentesis
  • Chorionic Villi Sampling
47
Q

Behavior responses: Discomforts 1st trimester:

A
  • Breast changes
  • Urgency/frequency of urination
  • Kegal exercises-pelvic floor exercise
  • Malaise; fatigue
  • Nausea and vomiting “morning sickness”
  • Mood swings, mixed feelings
48
Q

Behavioral responses: Discomforts 2nd Trimester:

A
  • Supine hypotension-vena cava syndrome
  • GI- food cravings, heart burn, constipation, flatulence
  • Varicose veins
  • Round ligament pain (tenderness)
  • Backache-pelvic pressure-pelvic rock/tilt
49
Q

Discomforts 3rd Trimester:

A
  • dyspnea
  • insomnia
  • mood swings-increase anxiety
  • urinary frequency
  • perineal discomfort-pressure
  • Braxton Hicks contractions
  • Leg cramps/ankle edema
50
Q

Behavioral responses: client teaching-

A
  • travel in pregnancy
  • exercise in pregnancy
  • drugs/alcohol/smoking in pregnancy
  • nutrition-prenatal diet tips/handout
51
Q

High risk mother-pathophysiological response:

A
  • Hemorrhagic disorder:
  • early pregnancy
  • -abortion
  • -ectopic pregnancy
  • Late pregnancy
  • -abruptio placentae
  • -placenta previa
52
Q

Abortion:

A
  • early (6 weeks or less)
  • -little attachment
  • -little bleeding
  • -little cramping
  • Intermediate (7-13 weeks)
  • -moderate pain
  • -increase bleeding
  • -usually well attached
  • late (second trimester)
  • -uncomfortable as labor
  • -increase pain
  • -increase bleeding
53
Q

Abortion: Threatened-

A
  • slight bleeding
  • mild cramping
  • no passage of tissue
  • closed cervix
54
Q

Abortion: Inevitable-

A
  • moderate bleeding
  • moderate cramping
  • no passage of tissue
  • open cervix
  • possible D&C
55
Q

Abortion: Incomplete-

A
  • heavy bleeding
  • severe pain
  • passage of tissue
  • open cervix
  • D&C
56
Q

Abortion: complete-

A
  • slight bleeding
  • mild cramping
  • tissue already passed
  • closed cervix
  • D&C
57
Q

Abortion: septic-

A
  • bleeding varies
  • cramping varies
  • cervix open
  • sometimes passage of tissue
  • D&C and antibiotics
58
Q

Abortion: Missed

A
  • slight bleeding
  • no cramping
  • no passage of tissue
  • closed cervix
  • decrease size of uterus
  • D&C
59
Q

Abortion: Pattern 1-exchanging-

A

*Risk for fluid volume loss
-check for s/s of shock
-save anything passed through vagina (products of conception)
-no FHT’s
-bed rest
After loss
-IV with Pit
-check for shock
-no massaging of fundus

60
Q

High risk mother: hemorrhagic response:

A
  • Ectopic pregnancy
  • implanted outside uterus
  • severe one-sided pain
  • great risk for hypovolemic shock
  • no chance of saving pregnancy
61
Q

Ectopic pregnancy: Diagnosis and treatment:

A

Diagnosis- U/S and or culdacentesis

Treament- laparoscopy, methotrexate

62
Q

Placenta abruption:

A
  • severe abdominal pain
  • may have vaginal bleeding
  • risk are abdominal trauma, high or low blood pressure, cocaine use
  • emergency C/S
63
Q

Placenta Previa:

A
  • implanted over or near cervix (U/S)
  • painless vaginal bleeding
  • risk factors: older mother; multipara; previous C/S; multiple gestation
  • conservative treatment
  • C/S delivery
64
Q

Hyper emesis:

A
  • usually early pregnancy
  • monitor of fetal growth
  • prevention of dehydration- IV and clear fluids
  • use of antiemetics- reglan, zofran, phenergan supp
65
Q

Pre-eclampsia

A
  • proteinuria
  • edema- increase wt. gain (face and hands)
  • hypertension- +30 systolic +15 diastolic
66
Q

Eclampsia-

A
  • all of the above

- seizures

67
Q

Symptoms of worsening pre-eclampsia-

A
  • HA
  • Visual change
  • scotoma
  • tunnel vision
  • Vertigo
  • nausea
  • RUQ pain (epigastric pain)
  • Decrease renal output
  • Hyperactive reflexes
68
Q

Pre-eclampsia- treatment:

A
  • magnesium sulfate
  • prepare for delivery, only renal treatment
  • continue mg so4 24 hrs after delivery
69
Q

Pre-eclampsia- HELLP 20 weeks gestation:

A

H- hemolysis of RBC
E- elevated liver enzymes
L- Low platelets

70
Q

Prenatal period: High risk mother: chronic illness:

A
  • Heart disease
  • Diabetes
  • chronic hypertension
71
Q

High risk mother: heart disease:

A
  • Maintain current cardiac status
  • Maintain on current drugs
  • Watch weight gain
  • Increased iron in diet (anemia increase cardiac workload)
  • Activity restriction/lots of sleep
  • May need anti-coagulant therapy if on bedrest- no coumadin
  • Will need antibiotics in labor
  • vag birth preferred
72
Q

High risk mother: Diabetes Mellitus:

A

-inadequate production or utilization of insulin

73
Q

Normal pregnancy/carbohydrate metabolism:

A
  • 1st half of pregnancy
  • Increase in hormones stimulate insulin production
  • Increase tissue response to insulin
  • causes a anabolic state (building up)
  • storage of glycogen in the liver (other tissue)
74
Q

High Risk Mother-2nd half pregnancy-

A
  • Placental secretion of HCG and increased cortisol and glycogen levels
  • causes increased resistance to insulin and decreased glucose tolerance
  • catabolic state (destructive)-night time and after meal absorption- ketones in the urine
75
Q

Gestational Diabetes Mellitus:

A
  • carbohydrate intolerance with first time onset during pregnancy:
  • results from an undetected preexistent didease. Direct consequence of altered maternal metabolism stemming from changing hormonal levels
76
Q

Gestational diabetes mellitus: Treatment-

A
  • Diet
  • Insulin/Metformin
  • dietary management inadequate
  • needs rise late trimester and continue to increase through the end of pregnancy
  • increased energy during labor may require more insulin to balance intravenous glucose
  • decrease abruptly after birth (loss of HCG)
77
Q

Risk factors with Type 1 and type 2 diabetes and pregnancy- Maternal-

A
  • hydramnious (increase of amniotic fluid volume)
  • pre-eclampsia
  • Hyperglycemia-leads to ketoacidosis
  • Difficult labor (dystocia)
  • Complications of diabetes
78
Q

Risk factors with type I or type II diabetes and pregnancy: Fetal-neonatal-

A
  • Congenital anomalies (40%)
  • LGA (large gestational age)
  • Hypoglycemia
  • IUGR (intrauterine growth retardation)
  • Polycythemia
  • Hyperbilrubinemia
  • Hypocalcemia (unknown cause)
79
Q

Diagnosis of Diabetes:

A
  • urine testing-dip stick
  • every prenatal visit
  • 50 g oral glucose tolerance test (24 to 28 weeks)
  • 100 g oral glucose tolerance test (3 hours)
  • glycosylated hemoglobin (reflects glucose control over the previous 4-8 weeks)
80
Q

Diabetes Mellitus and pregnancy- goals

A
  • Needs to maintain blood glucose- 70 mg/dl-110 mg/dl
  • Delivering insulin/medication as needed
  • Monitoring fetus- potential early placental degeneration
  • -Estriol levels
  • -fetal movement tests
81
Q

High risk mother: Chronic Hypertension-

A
  • Maintain current health status
  • Maintain current medication (except diuretics)
  • Pregnant woman naturally hypotensive-helps with this situation
  • Babies may be SGA
  • Increased chance for pre-eclampsia
82
Q

High risk mother: Infection=

A
  • Chorioamnionitis
  • T-Toxoplasmosis
  • O-Other
  • R- Rubella
  • C- cytomeglovirus (CMV)
  • H- herpes
  • S- syphillis
  • STI’s
  • UTI- urinary stasis
83
Q

Torch syndrome is an

A

infection of the fetus born with one of the following torch agents: toxplasmosis, other viruses, rubella virus, CMV and herpes syndrome

84
Q

Apply diagnostic reasoning:

A

Reports of fear or anxiety

85
Q

Nursing diagnosis: Pattern 1-Exchanging

A
  • altered nutrition
  • constipation
  • risk for fluid volume excess
86
Q

Nursing diagnosis: Pattern 2-Communicating

A
  • knowledge deficit

* Language barrier

87
Q

Nursing diagnosis: Pattern 3- relating:

A
  • risk for altered parent/infant attachment
  • altered sexuality patterns
  • altered family process
  • altered role performance
88
Q

Nursing diagnosis: Pattern 4: Valuing

A

*potential for enhanced spiritual well-being

89
Q

Nursing diagnosis: Pattern 5: Choosing

A
  • Impaired adjustment
  • Ineffective denial
  • Ineffective family coping: disabling, compromised
  • Family coping: potential for growth
  • Decisional conflict-to continue pregnancy
  • Health seeking behaviors (prenatal care)
90
Q

Nursing diagnosis: Pattern 6: Moving

A
  • fatigue
  • risk for activity intolerance
  • sleep pattern disturbance
91
Q

Nursing diagnosis: Pattern 7- Perceiving

A
  • body image disturbance
  • hopelessness
  • powerlessness
92
Q

Nursing diagnosis: Pattern 8- Knowing

A
  • knowledge deficit

- prenatal care

93
Q

Nursing diagnosis: Pattern 9- Feeling

A
  • anxiety

* fear

94
Q

Develop Individual Plan of Care:

A
  • Identify anticipatory guided needed
  • assistance with what?
  • teaching
  • Collaborative judgement
  • community referrals
95
Q

Identify Interventions:

A
  • prevention
  • implement prenatal care
  • teaching
  • communication
96
Q

Evaluation of responses:

A
  • were outcomes met?
  • teritary prevention needed?
  • complications?
97
Q

Members of discipline:

A
  • Economics

* Legal/ethical issues

98
Q

Caring:

A
  • mother/father
  • grandparents
  • sibling
  • others

NSG 2203 (4 decks)

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