Week 1: Antenatal Assessment and Care Flashcards
What are some health promotions for preconception care
- nutrition and healthy diet (folic acid intake)
- optimum wt
- exercise
- avoidance of tobacco, alc, recreational drugs
- risk-reducing sexual practices
- infertility
What to ask about med history for preconception care
immune status
family history
illness
use of meds: use micromedex and look in the preg/lactation area
reproductive history:
contraceptive
obstetrical
Strong family history of a genetic history - discuss consult to a genetic tester
Discuss previous pregnancies, therapeutic abortions, time in between pregnancies
when does folic acid need to be taken and why
taken 3 months prior to conception to support pregnancy
when can you get a infertility consult
1) within 6 months
2) within a year
1) age 32+
2) younger
what is RNAO
Screening for abuse
what is vasovagal
blood pooling (can happen when a pregnant person stands for long hours, for ex at work)
1) why is folic acid so important for pregnancy
2) what is the dose for low risk
3) what is it for higher risk
1)
Folic acid supplementation during preconception and pregnancy helps prevent neural tube defects
Decreases incidence of facial cleft palate, neural tube defects, congenital heart diseases, and limb differences
describe conception as well as the 3 steps
- union of single egg and sperm
- process including gamete formation, ovulation, result of an embryo, and implantation
1) fertilization occurs in uterine tube within 24 hrs of ovulation
2) transport the early embryo down uterine tube into uterus
3) implantation when blastocyst embed into endometrium
what does a zygote contain?
46 chromosomes; 23 from the mature ovum and 23 from sperm
(22 pairs of autosomes and one pair of sex chromosomes from ovum and sperm)
what do chorionic villi do
obtain o2 and nutrients from maternal bloodstream and dispose of carbon dioxide in maternal blood.
Look @ lecture 1 diagram i dont have the time for this shit
what is the earliest biochemical marker of pregnancy?
human chorionic gonadotropin (hCG)
what is hCG
- hormone produced by cells in the placenta during pregnancy
- supports maintenance of corpus luteum in ovary, producing progesterone during early stages of preg
- essential for maintaining uterine lining + early development of embryo
what is the most popular test for pregnancy
enzyme-linked immunosorbent assay (ELISA)
(basis for most over-the-counter preg tests)
how far along are most clients when they find out they r pregnant
4-7 weeks (1-2 months)
how accurate are OTC preg test
90%
if too early it may not pick up
how long is pregnancy
9 months
40 weeks
280 days
how is length of preg calculated
from the 1st day of the last menstrual period (LMP), conception occurs approximately 2 weeks after 1st day of LPM
most clients give birth within how many days of their due date?
14 days before to 14 days after
what is Nagele’s rule
(assumes 28 day cycle and pregnancy occurred on day 14)
- first day of last menstrual period (LMP), minus 3 months, add 7 days, plus 1 yr
OR - add 7 days to LMP and count forward 9 months
most clients give birth 7 days before or after EDB
inconsistent cycle can affect this calculation, and as fetus grows there is more variable
how accurate are ultrasounds at dating early preg
it is accurate dating the gestational age during early preg
what is classified as the 1st trimester
weeks 1-13
whats classified as the 2nd trimester
weeks 14-26
whats classified as the 3rd trimester
weeks 27 through term
what are some presumptive signs of preg
subjective felt by client
breast changes (3-4 wk)
amenorrhea (4 wk)
nausea/vomiting (4-14 wk)
urinary frequency (6-12 wk)
fatigue 12 wk
quickening (fluttering related to fetal movement) 16-20 wk
probable signs of preg
objective by examiner
+‘ve preg test
goodell sign 5-6wk
chadwick sign 6-8wk
hegar sign
ballottement
what is goodell sign
softening of cervical tip due to increased vascularity, hyperplasia, and hypertrophy
what is chadwick sign
violet bluish colour of the vaginal mucosa and cervix
hegar sign
softening and compressibility of lower uterine segments
ballottement
technique of palpitating a floating structure by bouncing it gently and feeling it rebound
positive signs of preg
shows presence of fetus
visualization of fetus
fetal heart tones by stethoscope, doppler, ultrasound
fetal movements at 19-22wks
fetal movements visible during late stages of preg
what are therapeutic abortions and when do they occur
intentional interruption of preg b4 20 wks
describe first trimester abortions
- surgical (aspiration) abortion
- methotrexate and misoprostol
- mifepristone and misoprostol
describe 2nd trimester abortions
- dilation and evacuation (D+E)
- medical induction (prostaglandins, hypertonic and uterotonic agents)
- emotional considerations
what is gravidity
pregnancy
what is gravida
client who is pregnant
what is primigravida
pregnant for the 1st time
what is multigravida
client who has had 2 or more pregnancies
what is nulligravida
client who has never been pregnant
what is parity
of pregnancies which the fetus or fetuses have reached 20 weeks gestation
- whether fetus is born alive or is stillborn after viability is reached does not affect parity
what is primipara
completed 1 pregnancy to 20 weeks or more
what is multipara
clients who has completed 2 or more pregnancies to 20 weeks or more
what is nullipara
clients who has not completed a pregnancy with fetus/fetuses to 20 weeks or more
what is preterm
pregnancy beyond 20 weeks gestation but delivered prior to completion of 36 weeks
what is term
pregnancy from the beginning of week 37- end of 40
what is early term
pregnancy between 37-38 weeks
what is full term
pregnancy 39-40 weeks
what is late term
pregnancy in the 41 week
what is post term
pregnancy after 42 weeks
what is viability
capacity to live outside of the uterus 22-25 weeks
what is abortus
total # of spontaneous or therapeutic abortions occurring prior to 20+0 weeks
spontaneous
simon is preg for the 3rd time. 1st preg resulted in a spontaneous abortin @ 9 weeks. they delivered their second preg at 39 weeks. what is their GTPAL 5 number.
G3T1P0A1L1
what is the GP 2 Digit System
only uses
G (gravidity): total # of pregnancies
P (para): indicates # of pregnancies that have completed 20 weeks gestation and beyond regardless of outcome
where is the placenta supposed to embed, and what would be considered abnormal
Placenta embeds in top back part of uterus (abnormal is at the bottom)
what is the abdominal cavity filled with in preg
amniotic fluid
what does the amnion layer blend with
the umbilical cord
what does the chorion layer blend with
with the placenta
during implantation how many fetal membranes surrounding the embryo begin to form
2
what is the chorion
- it is the membrane covering the fetal size of the placenta
- contains major umbilical blood vessels branching out over the surface of the placenta
how does the chorion develop
from the trophoblast and contains the chorionic villi on the surface
what is the amnion
- inner cell membrane
- developing embryo draws amnion around itself to form a fluid-filled sac
- becomes the covering of the umbilical cord and covers the chorion on the fetal surface of the placenta
what does the amnion develop from
blastocyst
what is the amniotic cavity first filled with
fluid derived by maternal blood by diffusion
what is amniotic fluid
fluid secreted by the respiratory and GI tract of the fetus that then enters the amniotic cavity
how much amniotic fluid is regular by term, does it increase or decrease throughout pregnancy
amount increases throughout pregnancy, 700-1000 mL by term
what is oligohydramnios and what is this associated with
means having less than 300 mL and is associated with fetal renal abnormalities
what is polyhydramnios and what is this associated with
having more than 2000 mL and is associated with GI and other malformations
what are the 6 functions of amniotic fluid
- constant body temp
- source of oral fluid and reposition for waste
- cushions the fetus from trauma
- allows freedom of movement for MSK development
- barrier to infection
- allows lung development
what does amniotic fluid contain
albumin, urea, uric acid, creatinine, lecithin, sphingomyelin, bilirubin, fructose, fat, leukocytes, protein, epithelial cells, enzymes, and lanugo hair
how many arteries/veins for the umbilical cord and what are each of their purposes
- 2 arteries carry blood from the embryo/fetus to chorionic villi
- 1 vein returns blood to the embryo/fetus
what percent of umbilical cords contain only 2 vessels, what can this impact
around 1% and may be associated w congenital malformation
what is wharton’s jelly
a connective tissue that prevents compression of the blood vessels to ensure nourishment to the embryo/fetus
at term how long is the umbilical cord
cord is 2 cm thick, 30-90 cm in length
where is the umbilical cord normally attached
centrally to the placenta
when is maternal-placental-embryonic circulation established
by day 17 when the embryo’s heart begins beating
when is the structure of the placenta complete
complete by week 12, grows wider until week 20 then continues to get thicker
what is the placenta
is an endocrine gland that produces four hormones to maintain the pregnancy and support the embryo/fetus
what 4 hormones does the placenta produce
- Human chorionic gonadotropin (hCG)
- Human chorionic somatomammotropin or human placental lactogen (hPL)
- Progesterone
- Estrogen
what is usually the traditional prenatal care frequency
- initial visit usually in the 1st trimester
- monthly visits until 28 weeks
- visits every 2 weeks until 36 weeks
- weekly visits until birth
what are some factors that may prevent clients in poverty to care
- may not have access
- lack of culturally sensitive care
- communication interferes w care
- birth outcomes less positive, higher rates complications
what is the purpose of prenatal care
- to identify existing risk factors - health promotion
emphasis on preventive care/self care
what does an initial pregnancy visit include (6-8 weeks)
- reason for seeking care
- current preg
- obstetric and gynecologic history
- medical history
- nutrition history
- history of drug use and herbal preparations
what is true about perinatal nurses?
a) provide care for only high risk mothers and infants
b) work with families from preconception throughout childbearing yrs
c) provide care for families w children up to 18 yrs
d) provide care for only low risk families from conception to birth
a
true/false
clients at low risk should take 0.4 mg of folic acid while pregnant
true
B-hCG begins are early as day of implantation and can be detected as early as _____ days after conception
7-10
