Week 1 Flashcards
what are the effects of ace inhibitors on fetuses?
Renal tubular dysplasia causing renal failure and fetal or neonatal death and intrauterine growth restriction
how does warfarin affect fetuses?
Spontaneous abortion, fetal demise, fetal or newborn hemorrhage, CNS abnormalities
how does the cytomegalovirus affect fetuses?
Hydrocephaly, microcephaly, cerebral calcification, mental retardation, hearing loss
how does herpes varicella affect fetuses?
Hypoplasia of hands and feet, blindness and cataracts, and mental retardation
how does rubella affect fetuses?
Risk of heart defects, deafness or blindness, mental retardation, and fetal demise
how does syphilis affect fetuses?
Risk of skin, bone and teeth defects, and fetal demise
What are the three phases of the ovarian cycle?
follicular ovulatory and luteal phases
what are the three phases of the endometrial cycle?
Proliferative, secretary, and menstrual phases
in which menstrual cycle phase does the luteal hormone and follicle-stimulating hormone increase? What is their function?
To mature the Graafian follicle and produce estrogen; in the follicular phase
which phase does estrogen levels peak?
ovulatory
a surge in what hormone occurs before ovulation and what happens to other hormones?
Luteal hormone surges 12 to 36 hours, and estrogen decreases and progesterone increases
When does the luteal phase begin?
after ovulation, lasting for about 14 days
what happens in the luteal phase?
Empty follicles morph to form the corpus luteum which causes high progesterone and low estrogen to support a pregnancy
when does the proliferative phase begin?
After menstruation ending with ovulation
when does the secretory phase begin and end with?
After ovulation and ends with menstruation
what happens during the secretory phase and what hormone is secreted?
The endometrium thickens and progesterone is secreted from the corpus luteum
what happens to the endometrium if there is a pregnancy?
Why coercion is produced to become an energy source for the blastocyst
in approximately 12 days what forms in the fetus?
Embryonic disc
In fetal development what is created in approximately 20 days?
The head of the embryo
when would you see the head of the embryo, limb buds, and the umbilical cord?
Approximately 4 to 5 weeks
what should the fetal heart tones be in the first trimester?
110-160 bpm
What kind of tissue is the placenta formed from?
fetal and maternal
what are two functions of the placenta?
Metabolic and gas exchange
hormone production
what are hormones produced in the placenta?
Progesterone, estrogen, hCG, hPL
What are the two parts of the amniotic sac and which is the inner and which is the outer?
The amniotic membrane (inner) and the chorionic membrane (outer)
what does progesterone do in the placenta?
Facilitates implantation and decreases uterine contractility
what does estrogen do in the placenta?
Stimulates the enlargement of the breasts and uterus
what does the hormone hCG do in the placenta?
Stimulates the corpus luteum to continue secreting estrogen and progesterone until the placenta is mature enough to secrete these hormones
why is the hormone hCG important to test in pregnancy?
It rises in the first trimester and then has a rapid decline until 100-130 days
what does the hormone hPL do in the placenta?
Promotes fuel growth by regulating glucose available to the developing human
stimulates breast development and preparation for lactation
what are some viruses that can cross the placental membrane?
Rubella cytomegalovirus
at what week of gestation is the placenta fully functional?
8-10 Weeks
by the 9th month the placenta is how many grams, how many centimeters thick, and how many centimeters across?
15-25 cm In diameter, 3 cm thick, and ways approximately 600 grams
what is the amniotic sac made of?
Water, proteins, carbs, lipids, electrolytes, fetal cells, lanugo, and vernix caseosa
what is the function of amniotic fluid?
Cushions fetus, prevents adherence of fetus to amniotic membranes, allows freedom of fetal movement to aid in symmetrical musculoskeletal development, and provides a consistent thermal environment
what are some abnormalities of the amniotic fluid?
Polyhydramnios
oligohydramnios
what is the definition of oligohydramnios? What can it lead to?
Decrease the amount of amniotic fluid less than 500 milliliters at term or 50% reduction of normal amount which causes decrease in placental function and can cause congenital renal problems
what is the definition of polyhydramnios? What kind of complications can it lead to?
Excessive amount of fluid 1500 to 2,000 milliliters which can increase the incidence of chromosomal, gastrointestinal, cardiac or neural tube disorders
what are the three fetal circulation?
Ductus venosus
foramen Ovale
ductus arteriosus
What is the medication that induces ovulation?
Clomid also known as clomiphene citrate
what are some lifestyle changes that can impact fertility?
Improved nutrition, elimination of tobacco, stress, and other drugs
what are some surgeries to induce fertility?
Surgery to open up tubes, remove uterine fibroids called myomectomy
why might antibiotics be used as fertility treatments?
They can help with getting rid of infections in the cervix
what is the indication of clomid?
anovulatory infertility
what is the action of clomid?
Stimulates release of FSH and LH, which stimulates ovulation
what are some common side effects of clomid?
Hot flashes, breast discomfort, headaches, and insomnia
when should clomid be taken?
PO from cycle day three to seven
what are some barriers to conception in females?
Age greater than 35, abnormal uterine contours, history of STI’s, tobacco use, nutritional deficiencies, occupational or environmental risks, and abnormal secondary sexual characteristics
what are some barriers to conception regarding males?
Medical history of mumps especially after adolescence endocrine disorders, frequency of intercourse and history of STI’s, alcohol tobacco heroin and methadone use, and exposure to hazardous teratogenic materials in the home or work environment, and exposure of scrotum to high temperatures
What are some physiological changes in the reproductive system regarding the breasts?
Tenderness, feeling of fullness, and tingling sensation
increase in weight my 400 grams
enlargement of breasts, nipples, and areola add Montgomery follicles
what causes the breasts to increase during pregnancy?
Increase of prolactin which increases blood supply to the breasts
what does prolactin do to the breasts?
Increase the growth of mammary glands, lactiferous ducts and alveolar system, and production of colostrum
what is colostrum and when is it produced?
Yellow secretion rich in antibodies which is secreted as early as 16 weeks
what are some physiological changes in the reproductive system regarding the uterus?
Hypertrophy of the uterine wall
uterus contractility increases because increased estrogen levels (also known as Braxton Hicks contractions)
Enlargement and stretching of uterus to accommodate developing fetus and placenta
what are some physiological changes regarding the cervix and vagina?
Softening of the vaginal muscles and connective tissue to prepare for fetus expulsion
hypertrophy of cervical glands to form mucus plug as a barrier
increased vascularity and hypertrophy of vaginal and cervical glands leading to leukorrhea
expanded circulatory volume leads to increased what in the reproductive system?
Blood flow to the uterus is 500 to 600 mL/min at term
Goodells sign: softening of the cervix
Hegar’s sign: softening of the lower uterine segment
Chadwicks sign: bluish cervix, vaginal mucosa, and vulva
what happens to the pH of the vagina in pregnancy?
It becomes more acidic to inhibit the growth of bacteria but it also allows the growth of candida albicans, increasing the risk of a yeast infection
what are some physiological changes regarding the blood pressure?
decrease in peripheral vascular resistance and BP
what happens to blood volume, BMR, and cardiac output in pregnancy?
Blood volume increases by 40 to 45%
cardiac output increases by 40%
BMR increases to 10 to 20% by the 3rd trimester
what happens to what are some signs of increased blood volume and cardiac output during pregnancy?
Hypervolemia of pregnancy
increased heart rate of 15 to 20 beats per minute increased stroke volume of 25 to 30%
systolic murmurs, load and wide S1 split, load S2, obvious S3
increase in heart size
what happens to the WBC count during pregnancy?
Values up to 16,000 square millimeters w/o infection
what constitutes iron deficiency anemia in pregnant people?
Hemoglobin less than 11 grams per dL
hematocrit less than 33%
what are some signs and symptoms of increased venous blood pressure and decreased blood flow to the extremities?
Edema of the lower extremities
varicosities and leg and vulva
hemorrhoids
what might cause supine hypotensive syndrome?
When a pregnant woman lays down and it compresses the inferior vena cava causing reduced blood flow back to the right atrium
why might tidal volume increase during pregnancy?
Hormones stimulate the respiratory center and act on lung tissue to increase and enhance respiratory function
what is the oxygen consumption in pregnant people?
Increase by 15 to 20%
what are some signs and symptoms of changing respiration during pregnancy?
Increase in total volume by 35 to 50%
slight increase in respiratory rate
increase in inspiratory capacity
decrease in expiratory volume
slight hyperventilation and respiratory alkalosis
what hormones are responsible for smooth muscle relaxation?
Estrogen, progesterone, and prostaglandins
estrogen, progesterone and prostaglandins affect the respiratory system how?
Dyspnea, nasal and sinus congestion, and epistaxis
what are some signs that the diaphragm is becoming displaced by the uterus?
There’s a shift from abdominal to thoracic breathing
what happens to the renal system during pregnancy?
Increased cardiac output and blood plasma volume increases blood flow in the first trimester by 50 to 80% and then decreases
why might a woman have UTI’s during pregnancy?
Increased progesterone levels causes relaxation of the sphincters
what urinary habits might a woman in her 3rd trimester experience?
Urinary frequency and nocturia
what is hyperemia?
Increased vascularity and bloodflow to organs or other part of the body
what are some signs and symptoms of increased hCG levels?
Nausea and vomiting during early pregnancy
increased progesterone levels can cause what to the GI system?
Relax smooth muscles to slow the digestive process and movement of stool causing bloating, flatulence, and constipation
how does gallstone formation end Cholestasis increase in pregnancy?
Increased progesterone levels decrease muscle tone of gallbladder and result in prolonged emptying time
increased levels of estrogen can lead to what regarding blood flow and bleeding?
Increased vascular congestion of the mucosa, gingivitis, bleeding gums, which increase the risk of periodontal disease
when might a woman feel a round ligament spasm?
During their second trimester belly distends with diastasis recti
what are some musculoskeletal signs and symptoms of a pregnant person?
Altered gate such as waddling, low back pain or pelvic discomfort, pelvic tilts such as lordosis, and increased risk of falls
what are three signs and symptoms of estrogen and progesterone’s effect on the integumentary system?
Linea nigra
melasma also known as chloasma
increased pigmentation of nipples, areola, vulva, scars, and moles
increase blood flow affects the integumentary system how?
Hot flashes, facial flushing, alternating sensations of hot and cold, and increased perspiration
what causes the cutaneous elastic tissues to become fragile and what happens to the skin?
Increased adrenal corticosteroids me too stretch marks or striae gravidarum
increased estrogen levels can cause what color and vascular changes?
Angiomas
Palmarerythema- pinkish red mottling over palms of hands and redness of fingers
increased androgens lead to what in pregnancy?
Increased oiliness of skin and acne
decreased follicle stimulating hormones in pregnancy lead to what?
Amenorrhea
increased progesterone generally leads to what in pregnancy?
Maintains pregnancy by relaxation of smooth muscles
decreases uterine activity to reduce spontaneous abortions
decreases gastrointestinal motility and slows digestive processes
increased estrogen generally leads to what in pregnancy?
Facilitates uterine and breast development, increases in vascularity, and hyperpigmentation
alters metabolic processes and fluid and electrolyte balance
increased oxytocin leads to what in pregnancy?
Stimulates uterine contractions and milk let down or ejection reflex in response to breastfeeding
what does increased human chorionic gonadotropin hormone lead to?
Facilitates sentence of corpus luteum until the placenta becomes fully functional
what does human placental lactogen or human chorionic somatomammotropin hormone do?
Facilitates breast development
alters carb and protein and fat metabolism
facilitates fetal growth by altering maternal metabolism by acting as an insulin antagonist
what does hyperplasia and increased vascularity of the thyroid manifest as?
Enlargement of thyroid
heat intolerance and fatigue
increased BMR can lead to what alteration and blood sugar?
Depletion of maternal glucose stores leads to increased risk of maternal hypoglycemia
why does insulin production increase in pregnancy?
There is an increased need for glucose from the developing fetus
how does increased circulating cortisol manifest as?
Increase in maternal resistance to insulin leads to increased risk of hyperglycemia
At what week should the fundus be at the umbilicus?
20
around what week does the fundus start to drop?
40 weeks
what is lightening?
It’s when the fundus starts to drop to prepare for birth
What kinds of fish should be avoided during pregnancy?
King mackerel, shark,, and tilefish because high levels of methylmercury
What are some foods to avoid during pregnancy?
Unpasteurized juices or dairy products, raw sprouts of any kind, soft cheeses like Brie or feta, refrigerated or smoked seafood, unheated deli meats are hot dogs
how many months before pregnancy should you increase folic acid supplementation?
One month before pregnancy and through the first trimester
what are some actions to decrease risk behavior and eliminate exposure two harmful substances during Gestation?
Alcohol or tobacco or second hand smoke
excessive use of caffeine
illicit drugs
contraindicated medications
safe sex practices
maintain optimal oral health and treat any periodontal disease
apply sunscreen when outdoors
ensure that smoke alarm and carbon monoxide detectors are working
maintain adequate relaxation and sleep
how many months before pregnancy should a woman exercise?
Several months before
what are some medical conditions that can affect conception?
Asthma, CVD, PM, ED, HTN, SLE, PKU, MH conditions, AKI, epilepsy, RA, thyroid disease
during pregnancy how much iron should you get?
50% more or around 27 milligrams a day
What are probable signs of pregnancy?
Chadwicks sign, Goodell’s sign, Hegar’s sign, melasma, linea nigra, uterine growth and abdominal growth, ballottement, darkening nipples and areola, pregnancy test
what are positive signs of pregnancy of labs?
Laboratory tests with hCG (not 100%)
Return all blood pregnancy test
uterine pregnancy test
what are presumptive signs of pregnancy?
Nausea and vomiting, fatigue, amenorrhea, breast changes, urinary frequency, quickening
What are positive signs of pregnancy that are observable by the examiner?
Auscultation of a fetal heart
observation and palpation of fetal movement
sonographic visualization of the fetuses cardiac movement
when can a fetal heart be auscultated with a Doppler?
10-12 weeks (late in the first trimester)
When can a fetus be palpated by the examiner?
20? earlier on ATI
when can cardiac movement be detected on a sonogram?
4 to 8 weeks
Chadwick’s sign
Bluish purple coloration of the vaginal mucosa, cervix, and vulva seen at 6-8 weeks
Goodell’s sign
Softening of cervix and vagina with increased leukorrheal discharge palpated at 8 weeks
Hegar’s sign
Softening of lower uterine segment palpated at 6 weeks
What would you suggest to someone with Constipation?
Resume normal bowel patterns by assessing fire patterns
auscultate bowel sounds
encourage high fiber and fresh fruit and vegetables with water
restablish regular times for bowel movements
explore options of stool softener
what would you suggest to someone with altered fluid intake because of nausea and vomiting?
Normal fluid intake by eating small frequent meals, decreasing fluid intake with meals, avoiding high fat and spicy foods, exploring contributing factors to nausea and pregnancy, suggesting B6 or ginger
what would you increase to someone with decreased gastric motility?
Goal: increased motility and normal bowel movement
Provide dietary information to increase fiber and ruffage such as pears apples prunes Kiwis
encourage brand cereal in the morning for at least 4 to 5 grams of fiber per serving
encourage exercise to promote peristalsis
Drink warm liquid upon rising
what would you suggest to someone with discomfort with defecation because of hemorrhoids?
Reinforce strategies to avoid Constipation
encourage to not avoid defecation
instruct women to avoid straining on evacuation
discuss care of hemorrhoids including TUCKS pads and hemorrhoid creams
support foot on a footstool mine defecating
using stool softeners
what are some goals of prenatal care?
Maintain maternal fetal health
accurate determination of gestational age
ongoing assessment of risk status and implementation of interventions
field report with childbearing family
referrals to appropriate resources
What kind of Laboratory screenings would be done in the initial visit?
Blood type and Rh factor
antibody screen
CBC
Syphilis, Hepatitis B, HIV and rubella and PPD titer
Urinalysis and urine culture
what screenings of STI’s would be done in the initial visit?
Gonorrhea and chlamydia with HIV and syphilis and pap smear
what genetic screenings are based on what?
Family history racial ethnic background
What are some assessments that are done in the initial visit?
Comprehensive health and risk assessment
Current pregnancy history
Complete physical and pelvic examination
Determine EDD
Nutrition assessment including 24 hour diet recall
Psychosocial assessment
assessment for intimate partner violence
when is the first ultrasound done?
During the initial visit
how often should you return to the doctors after the first visit?
Every four weeks
after the initial visit in the first trimester what are some assessments?
Interval history, focused physical assessment such as vital signs, urine, weight, and fundal height
when might a triple or quad screen be done in pregnancy and what is it for?
During the second trimester between 16 and 20 weeks of pregnancy to identify neural tube defects or Down syndrome or trisomy 18
what are some assessments done in the second trimester?
Interval history,
nutrition follow up,
focus assessment with vital signs, urine displayed for glucose, albumin, ketones, weight, fundal height, fetal heart movement and rate, leopold maneuver (not in ATI), and edema
Pelvic exam or sterile vaginal exam if indicated
Confirm established due date
how often would you come back to the doctors during your 2nd trimester?
Every four weeks
when would you screen for gestational diabetes?
In the second trimester at 24 to 28 weeks
when would you screen for Rh antibody screen?
Usually first or second trimester
when would you administer RhoGAM?
If the Rh-negative and antibody screen is negative during the second trimester
what are some screenings during the third trimester?
Group B streptococcus screening before labor
hematocrit and hemoglobin if not done in the second trimester
repeat gonorrhea chlamydia rubella HIV if indicated and not done in the late 2nd trimester
one hour glucose challenge tests
how often would you visit the doctor in the third trimester?
Every two weeks until 36 weeks and then weekly until 40 weeks and then twice a week after 40 weeks
Warning or danger signs of the 1st trimester
- Abdominal cramping or pain indicates possible threatened abortion, UTI, or appendicitis.
- Vaginal spotting or bleeding indicates possible threatened abortion.
- Absence of fetal heart tone indicates possible missed abortion.
- Dysuria, frequency, and urgency indicate possible UTI.
- Fever or chills indicate possible infection.
- Prolonged nausea and vomiting indicate possible hyperemesis gravidarum; increased risk of dehydration.
Warning or danger signs of the 2nd trimester
Abdominal or pelvic pain indicates possible preterm labor (PTL), UTI, pyelonephritis, or appendicitis.
* Absence of fetal movement after feeling daily movement indicates possible fetal distress or death.
* Prolonged nausea and vomiting indicates possible hyperemesis gravidarum; at risk for dehydration.
* Fever and chills indicates possible infection.
* Dysuria, frequency, and urgency indicate possible UTI.
* Vaginal bleeding indicates possible infection, friable cervix due to pregnancy changes, placenta previa, abruptio placenta, or PTL.
Warning or danger signs of the 3rd trimester
- Abdominal or pelvic pain
- Decreased or absent fetal movement (fetal hypoxia or death)
- Prolonged nausea and vomiting (dehydration, hyperemesis gravidarum)
- Fever, chills (infection)
- Dysuria, frequency, urgency (UTI)
- Vaginal bleeding (infection, friable cervix due to pregnancy changes or pathology, placenta previa, placenta abruptio, PTL)
- Signs/symptoms of PTL
- Signs/symptoms of hypertensive disorders:
what might hypertensive disorders indicate in the third trimester?
Severe headache that does not respond to usual relief measures, visual changes, facial or generalized edema.
what might abdominal of pelvic pain indicate in the third trimester?
PTL, UTI, pyelonephritis, appendicitis
What are some signs of preterm labor?
Rhythmic lower abdominal cramping or pain, low backache, pelvic pressure, leaking of amniotic fluid, increased vaginal discharge
Underweight weight gain
28 to 40 lbs (1)
normal BMI weight gain
25 to 35 lbs (1)
overweight BMI weight gain
15 to 25 lbs (0.6)
obese
11 to 20 lbs (0.5)
What to do for fatigue?
Normal response
plan for extra rest during the day at night
and list support and assistance from friends and family
encourage optimal diet with adequate caloric intake of iron rich food if anemic
When is fatigue experienced?
1st and 3rd
what to do for insomnia?
Regular bedtime, relaxing pre bedtime rituals
encourage comfortable sleeping environment with pillows
teach breathing exercises relaxation
effleurage- massage very lightly 2 fingers in repetitive circular patterns over abdomen
warm bath
evaluate caffeine use
When is insomnia experienced?
Throughout pregnancy
what to do for tender breasts?
Encourage well fitting and supportive bra
instruct good body mechanics
when are tender breasts experienced?
Throughout the pregnancy but tenderness mostly in the first trimester
what to do for leaking colostrum?
Normal
cotton breast pads
when is leaking colostrum expected?
2nd trimester and on
when are Braxton Hicks contractions expected?
Mid pregnancy and onward
what to do for Braxton Hicks contractions?
Normal
call provider if it becomes regular and persist before 37 weeks
ensure adequate fluid intake
recommend a maternity girdle for uterus support
what to do for increased secretions and possible yeast infection?
Encourage daily bathing
recommend cotton underwear and panty liner
Avoid douching or feminine hygiene sprays
Inform provider of foul order or color change
what to do for dyspareunia
Normal
suggest alternative positions
what to do for supine hypotension
avoid supine position or place pillow under one hip
when is supine hypotension expected?
Mid pregnancy and onward
what to do for epistaxis and nasal congestion
Suggest cool air humidifier
avoid use of decongestants and nasal sprays and use normal saline drops
when is dependent edema in the lower extremities or vulva expected?
Late pregnancy
when is anemia?
Throughout pregnancy blood more common in late second trimester
what to do for dependent edema or varicosities
instruct loose clothing
maternity girdle
avoid prolonged standing or sitting
Dorsiflex feet periodically when standing or sitting next to line elevate legs when sitting
Position on side one line down
avoid crossing legs when sitting
where supportive socks or hose
what to do for frequency and urgency
reassure normalcy
UTI prevention instruction
when is frequency and urgency or nocturia expected?
1st and 3rd trimesters more commonly
what to do for nausea and or vomiting?
Normal
avoid strong odors and causative factors
eat small frequent meals slowly before or as soon as hunger comes
eat crackers or toast before rising
Drink cold clear or sour or carbonated beverages
avoid fluid with meals
eat ginger or peppermint flavored suckers
Brush teeth after eating
wear P6 acupressure wristbands
take vitamin at bedtime with snack not mornings
suggest vitamin B6 25 milligrams PO 3x daily
oral or rectal medications
when is nausea and vomiting expected?
First trimester and sometimes into the second
when are bleeding gums expected?
Throughout pregnancy
when is flatulence expected?
Throughout pregnancy
when is increased salivation expected?
Usually in the first trimester associated with nausea
when is Constipation expected?
Throughout pregnancy
what to do for flatulence
encourage regular exercise non gas producing foods, chew foods slowly and thoroughly, use chest to knee position, and maintain regular bowel habits
when is heartburn expected?
Later in pregnancy
when are hemorrhoids expected?
Later in pregnancy
what to do for heartburn
Small frequent meals, good posture, adequate fluid intake without meals, avoid fatty foods, remain upright for 30 to 45 minutes after eating, refrain from eating three hours prior to bedtime at least
what to do for Constipation
adequate fluid intake, regular exercise, increase fiber and diet, good bowel habits and posture
When is constipation experienced?
usually from the 2nd trimester, but throughout
what to do for lower back pain and joint discomfort
utilize proper body mechanics, maintain good posture play pelvic rock and tilt exercises, supportive shoes with low heels, maternity girdle, firm mattress
what to do for round ligament spasm and pain
lie on side and flex knees up to abdomen
bend it towards pain
use sideline and exaggerated Sims position with pillow support
maternity belt
what to do for hemorrhoids
avoid Constipation, avoid bearing down with bowel movements, instruct comfort measures with ice packs or warm baths, elevate hips and lower extremities during rest., and gently reinsert into the rectum while doing kegel exercises
what to do for diastasis recti
gentle abdominal strengthening exercises but no sit-ups
teach proper technique for sitting up from lying down such as rolling to the side and using arms
when are round ligament spasm and pain expected?
Late 2nd and 3rd trimester
what to do for leg cramps
dorsiflex foot to stretch muscle
change positions slowly
regular massage and exercise
When is RhoGAM administered?
At 28 weeks’ gestation and within 72 hrs post-birth
What are indications to RhoA\GAM
Rh- negative women who have an Rh+ neonate
what is the action of RhoGAM?
Prevents production of antibodies of anti-Rh
what are side effects of RhoGAM-
pain at the injection site and anemia
what is the test to screen for anti Rh antibodies?
Coombs’ test
what are some significant maternal tasks of pregnancy?
Ensuring a safe passage for herself and her child
Ensuring social acceptance of child by engaging social network
attaching or binding-in of the child
giving oneself to the demands of being a mother
identification with motherhood role
what are some things that strengthen attachment to the fetus?
Hearing the fetal heartbeat
seeing the fetus move during an ultrasound exam
feeling the fetus kick or move
Fetal attachment influences the woman’s sense of her child
Relationship to the mother
reordering relationships with her partner
preparation for labor
What are some factors that can influence maternal adaptation?
Multi parity
maternal age
lesbian mothers
multigestational pregnancy
single parenting
socioeconomic factors
abused women
military deployment
what are some nursing actions that can facilitate adaptation to pregnancy during the first trimester?
Promote pregnancy and birth as a family experience
promote family support
Assess Learning needs
Offer anticipatory guidance regarding normal developmental stressors and feelings
Assess for increased anxiety and fear
Listen and validate and provide reassurance
Educate partner and family members
Discuss common phases of expectant fathers and encourage communication outlets
what are some nursing actions that can facilitate adaptation to pregnancy during the 2nd trimester?
Encourage verbalization regarding possible grief process of old life and changing relationships
discuss normal changes
encourage tuning into fetal movements
reinforce to partner and family the importance of giving that expectant mother extra support
what are some nursing actions that can facilitate adaptation to pregnancy during the 3rd trimester?
Encourage childbirth classes
discuss birth preparations
expectations of Labor and a parenthood
assess partners comfort level
refer to appropriate educational material
help mother identify support systems
plan for appropriate referrals
If a woman is feeling ambivalent about her pregnancy what would you assess for?
Reason and intensity of ambivalence
What are some challenges of adolescent mothers?
Abandonment by their partners, increased adverse pregnancy outcomes, and inability to complete school education
What are some factors that can increase successful adaptation to pregnancy?
Age of the teen mother
higher levels of support
existing programs to support teen mother
what are three questions to ask to identify abused women?
Within the last year have you been hit, slapped kicked, or otherwise physically hurt by someone?
Since you have been pregnant have you been hit, slapped, kicked, or otherwise physically hurt by someone?
Within the last year, has anyone forced you to have sexual activities?
What are the ABC’s of intimate partner violence patient care?
Alone: reassure the woman that she is not alone belief: articulate your belief in the victim
Confidentiality: explain implication of mandatory reporting
Documentation: documentation with photographs taken with permission and verbatim account
Education: community resources and restraining order
Safety: tell the woman to call 911 and neighbors
What are the three phases of paternal adaptation to pregnancy?
Announcement, moratorium, and focusing
What emotions happen in the announcement phase?
Joy, distress, or combination of emotions, depending on whether their pregnancy is planned or unwanted
what happens in the announcement phase generally?
As pregnancy is revealed can last for few hours to weeks
common for men to feel ambivalent
main developmental task is to accept the biological fact of pregnancy
what emotions occur in the moratorium phase?
Many men appear to put conscious thought of pregnancy aside for some time even though partners are undergoing dramatic physical and emotional changes
what happens in the moratorium phase generally?
Can cause potential conflict with communicating, sexual adaptation will be necessary, feelings of rivalry may surface as the fetus grows larger
main developmental task is to accept pregnancy and reality of fetus
what happens in the focusing phase?
Men begin to think of themselves as fathers
preparation of Labor and delivery on the newborn
negotiate with partner their role in labor and parenthood
what emotions occur in the focusing phase?
Actively involved with pregnancy and relationship with the child
What might you do to a child to prepare for a younger sibling?
Take them on a prenatal visit to listen to the fetal heartbeat and feel the baby move
move the child to a bed if still in a crib two months before the baby arrives
enroll them in a sibling preparation class
take them to see other babies
What might be some feelings of an older sibling with a newborn sibling?
Feelings of jealousy and a sense of loss
what are some ways to prepare the sibling after birth?
Spend some quality time uninterrupted with the older child
reassure that regressive behaviors are a part of sibling adjustment
encourage sibling visitation or call them on the phone
give a gift to the new sibling from the newborn
watch the older child because they may express jealous behavior
What are some types of social support during pregnancy?
Material such as financial, chores, and meals
emotional such as affection and encouragement
informational such as sharing advice
comparison such as help given by someone in a similar situation
What are some ways to improve social support?
Provide opportunities to ask for support and rehearse with her the appropriate language
invite key support providers to attend prenatal and postpartum visits
facilitate supportive functioning and interactions with the family
encourage interaction with other pregnant or postpartum women
suggest church, health clubs, work, or schools as site to meet other women with similar interests and concerns
What are some options for providers?
Physicians, midwives, nurse-midwives
what is the focus of midwifery?
Non interventionist care with an emphasis on normalcy of birth process
in places like the US primary providers are midwives for healthy pregnancies and physicians are consulted when medical or surgical intervention is required
10% of births in the US use what kind of provider?
Nurse-midwives
Lay midwives how what type of training
self-taught to formal training and licensing
What are some places for labor and delivery?
Hospitals, birth centers, homebirths
What criteria will promote a safe home birth experience?
The woman must be comfortable with her decision
woman should be in good health and not high risk
access to the transportation in case of transferred to hospital
should be attended by a well trained health care provider with adequate medical supplies and resuscitation equipment
What is a doula?
Individual who provides support to women and their partners during labor, birth, and postpartum but not clinical care
What is the advantage of a written birth plan?
Individual who provides support to women and their partners during labor, birth, and postpartum but not clinical care
What is the advantage of a written birth plan?
Helps clarify desires and expectations and communicates them with their healthcare providers
What are some childbirth education classes?
Lamaze- psychoprophylaxis
Dick- Read- Natural childbirth
Bradley- husband coached childbirth
what is one of the goals for healthy people 2020 maternal infant and child health?
Objective to commit to increasing proportion of pregnant women who attend formal series of prepared childbirth classes
What does the G and P mean for G/P?
Gravida- number of pregnancies including current
Para- how many births after 20 weeks gestation. (multiples count as one)
What does GTPAL mean?
G- Gravida: number of pregnancies, including current
T- number of term infants born after 37 weeks
P- preterm infants born between 20 and 37 weeks including stillborn
A- pregnancies ending in SAB or TAB regardless of age
L- current number of living children
The fetal heartbeat is audible by Doppler stethoscope between__________weeks of gestation.
8 to 17
Lanugo covers the fetal body at week ___of gestation and begins to disappear by week ___.
20, 36
Quickening, the feeling of fetal movement, begins between weeks __to___ of gestation in multiparous women and at week ____ or later in _________ women.
14-16 week; 18 nulliparous
implantation occurs between _______ days following conception.
6 to 10
In which trimesters should you measure fundal height?
all three, but starting from second in ATI
In which trimesters should you measure fetal heart rate?
all three
In which trimester should a Leopold’s maneuver be done?
third according to ATI, and 2nd and 3rd according to text book
What congenital alterations in the newborn are associated with maternal alcohol abuse.
ventricular septal defects and central nervous system malfunctions,
Clients who smoke place their newborns and themselves at risk for diverse complications, including
fetal intrauterine growth restriction, placental abruption, placenta previa, preterm delivery, and fetal death.
When might leukorrhea be experienced?
Normal and common discomfort in the first trimester and might be present throughout the pregnancy
What is one of the responses to increased hCG levels?
nausea and vomiting
What is a missed miscarriage?
fetus has died but the client retains the products of conception for several weeks. The client might have spotting or no bleeding at all.
What is an inevitable miscarriage?
The client has moderate to heavy bleeding, cervical dilation, and often, ruptured membranes.
What is a complete miscarriage?
the client has expelled all the products of conception.
What an incomplete miscarriage?
The client has expelled some, but not all, of the products of conception.
Chloasma is what sign of pregnancy?
probably
The client can safely receive what vaccines during pregnancy?
tetanus, diphtheria, pertussis (TdaP
