Week 1 Lecture Flashcards
Why is folate or folic acid of particular concern in the preconception period?
It decreases congenital heart disease, limb defects and cleft lip (pallet)
What is the recommended dose of folic acid in clients that are low risk? What about high risk?
Low risk = 0.4mg/daily
High risk of having a child w/ neural tube defects (ex: they have diabetes, fam hx, epilepsy) = 1mg in pregnancy then 0.4mg after 1st trimester
Highest risk = previous pregnancy w/ neural defect = 4mg
When do most women find out they are pregnant?
Most women find out they are pregnant between four through seven weeks gestation.
What are some factors that can influence the accuracy of the results?
Brain tumors can increase hCG levels which may give a false positive reading, even for men.
If you’re very hydrated (diluting levels)
Taking pregnancy test too early may give you a false negative since the hCG levels are not as high as they should be (should be 7-10 days after)
Timing of day
Meds (anticonvulsants, tranquilizers)
What is the length of a typical pregnancy? How is it calculated?
9 calendar months, 40 weeks of 280 days
Calculated from the first day of the last menstrual period (LMP), however, conception occurs about 2 weeks after the 1st day of the LMP
Ex: someone 4 weeks pregnant didn’t conceive until 2 and a half weeks before
How can you determine the estimated date of birth (EDB)?
Ultrasound dating of the gestational age is accurate during early pregnancy
Nägele’s rule (assumes 28-day cycle and pregnancy occurred on day 14)
- Determine first day of last menstrual period (LMP), subtract 3 months, add 7 days plus 1 year
- OR add 7 days to LMP and count forward 9 months
- Most clients give birth from 7 days before to 7 days after EDB
Why is it important to make an accurate assessment of the estimated due date?
If it’s accurate, we can track the development of the fetus and determine if it is on track.
It gives the family time to prepare just in case there is something wrong.
Genetic screening is time-sensitive, thus, it’s important to know the accurate assessment of the EDB
What are some limitations with Nägele’s rule?
Accuracy is impacted if ppl don’t know when their last period was, ppl w/ longer cycles or ppl w/ irregular periods
How accurate are fetal ultrasounds for dating?
Dating ultrasounds are accurate in early pregnancy (may be a few days off)
When are the trimester?
First: weeks 1 through 13
Second: weeks 14 through 26
Third: weeks 27 through term
Define presumptive. What are the presumptive signs of pregnancy?
Presumptive: subjective changes felt by the client (subjective, not definite)
- Breast changes 3-4wk
- Amenorrhea (missed period) 4wk
- Nausea/Vomiting 4-14wk
- Urinary frequency 6-12wk
- Fatigue 12wk
- Quickening (fluttering related to fetal movement) 16-20wk
Define probable. What are the probable signs of pregnancy?
Probable: objective changes observed by an examiner (not definite, but high chance).
- Positive pregnancy test
- Goodell sign 5-6wk (softening of the cervical tip due to increase vascularity, hyperplasia, and hypertrophy).
- Chadwick sign 6-8wk (violet-bluish colour of the vaginal mucosa and cervix)
- Hegar sign (softening and compressibility of the lower uterine segments)
- Ballottement (technique of palpitating a floating structure by bouncing it gently and feeling it rebound)
Define positive. What are the positive signs of pregnancy?
Positive: these signs are attributed only to the presence of the fetus.
- Visualization of the fetus
- Fetal heart tones by ultrasound, doppler, fetal stethoscope
- Fetal movements palpitated 19-22wk
- Fetal movements visible during late stages of pregnancy
What are therapeutic abortion?
It’s the intentional interruption of pregnancy before 20 wks gestation. There are various contributing factors (pregnancy can be wanted but abortion may occur due to complications to the mom or infant), emotional considerations (sad or relief), legal/moral issues and nurses’ rights/responsibilities.
True or false: 50% of pregnancies are unplanned
True
Never assume they want to keep the baby. Ask them what they want and give them options.
What occurs during 1st trimester abortions?
Surgical (aspiration) abortion
Meds to stop development and contract uterus to expel contents
- Methotrexate and misoprostol
- Mifepristone and misoprostol
What occurs during 2nd trimester abortions?
Dilation and evacuation (D&E)
Medical induction
- Prostaglandins
- Hypertonic and uterotonic agents
Define gravidity, gravida, primigravida, multigravida and nulligravida.
Gravidity: pregnancy
Gravida: client who is pregnant
Primigravida: pregnant for the first time
Multigravida: client who has had two or more pregnancies
Nulligravida: client who has never been pregnant
Define parity, primipara, multipara and nullipara.
Parity: # of pregnancies in which the fetus or fetuses have reached 20 weeks gestation (not the number of fetuses born i.e. twins)
- Whether fetus is born alive or is stillborn after viability is reached does not affect parity
Primipara: completed one pregnancy to 20 weeks or more.
Multipara: client who has completed 2 or more pregnancies to 20 weeks or more.
Nullipara: client who has not completed a pregnancy with fetus/fetuses to 20 weeks or more.
Define preterm, term, early term, full term, late term, post term and viability.
Preterm: a pregnancy beyond 20 weeks gestation but delivered prior to completion of 36 weeks (36^6).
Term: a pregnancy from the beginning of week 37 to the end of 40^6
- Early Term: a pregnancy between 37 weeks and 38^6 weeks.
- Full Term: a pregnancy between 39 weeks and 40^6 weeks.
Late Term: a pregnancy in the 41 week.
Post Term: a pregnancy after 42 weeks.
Viability: capacity to live outside of the uterus 22-25 weeks.
What is GTPAL? **
Gravida: total # of pregnancies prior plus present pregnancies regardless of gestational age, type, time or method of termination/outcome. A pregnancy with twins/multiples is counted as just one pregnancy.
Term: total # of previous pregnancies with birth occurring at greater than or equal to 37 completed weeks.
Preterm: Total number of previous pregnancies with birth occurring between 20 + 0 and 36+7 completed weeks.
Abortus: total # of spontaneous or therapeutic abortions occurring prior to 20+0 weeks.
- Spontaneous abortions include miscarriage, ectopic pregnancy, missed abortion, and molar pregnancy.
Living children: total # of children the patient/client has given birth to that are presently living.
Wei is pregnant. What is her GTPAL?
G1T0P0A0L0
Wei delivers at term. What is her GTPAL?
G1T1P0A0L1
Wei is pregnant again. What is her GTPAL?
G2T1P0A0L1
Wei’s last pregnancy ends in a miscarriage at 8 weeks. What is her GTPAL?
G2T1P0A1L1
During Wei’s third pregnancy she delivers twins at 36 weeks. What is her GTPAL?
G3T1P1A1L3
True or false: there is a 5 and 2 digit system.
True (GTPAL and GP)
What is GP?
G (Gravidity):total # of pregnancies
P (Para):indicates the # of pregnancies that have completed 20 weeks gestation and beyond regardless of outcome (live or not) reached.
Tiffany is pregnant. What is her GP?
G1P0
Tiffany delivers to term. What is her GP?
G1P1
Tiffany is pregnant again. What is her GP?
G2P1
Tiffany’s pregnancy ends in a misscariage at 8 weeks. What is her GP?
G2P1
During Tiffany’s 3rd pregnancy, she delivers twins at 36 weeks.
G3P2
During implantation, two membranes that surround the embryo begin to form. What are they?
Chorion: develops from the trophoblast and contains chorionic villi on the surface.
- It becomes the covering of the fetal size of the placenta.
- It contains major umbilical blood vessels that branch out over the surface of the placenta.
Amnion: the inner cell membrane that develops from the blastocyst.
- The developing embryo draws the amnion around itself to form a fluid-filled sac.
- Amnion becomes the covering of the umbilical cord and covers the chorion on the fetal surface of the placenta.
What does the umbilical cord do? Discuss the anatomy.
2 arteries carry blood from the embryo/fetus to the chorionic villi. Meanwhile, 1 vein returns to the embryo/fetus.
Around 1% of umbilical cords only contain 2 vessels (1 artery and 1 vein), which may be associated with congenital malformation.
At term, the cord is 2cm thick and 30-90cm in length.
Wharton’s jelly is connective tissue that prevents compression of the blood vessels to ensure nourishment to the embryo/fetus.
It’s normally attached centrally to the placenta.
True or false: midwives are used for low-risk pregnancies
True
What is a doula?
Labour/postpartum support with no clinical tasks
What is a complication associated with a lot of amniotic fluid?
Increased pressure on fetus, which leads to constipation in mother and rupture during pregnancy.
What is the risk of having a long umbilical cord?
It can prolapse out.
When do pregnant women have to come in for appointments?
Initial visit in 1st trimester
- reason for seeking care
- current pregnancy
- obstetric and gynecologic history
- medical history
- nutrition history
- history of drug use and herbal preparations
Monthly visits until week 28
Visits every 2 weeks until 36 weeks
Weekly visits from 36 weeks until birth
What is the purpose of prenatal care?
To identify existing risk factors and other deviations from normal.
- Health promotion
- Emphasized preventative and self-care
What are some things to consider regarding who can access prenatal care?
It’s usually sought by women of middle or high SES.
Clients in poverty may not have access to public and/or private care:
- lack of culturally sensitive care and communication interferes w/ access to care
- birth outcomes less positive, higher rates of complications
What is the fundal height? What is it used for? How is it calculated? What are some nursing considerations?
It’s the distance from the symphysis pubic bone to the top of the uterus measured in cm.
It’s used as an indicator of fetal growth
From gestational weeks 18, the fundal height in cm should be equal to the gestational age (+/- 2cm)
Encourage the client to void prior to assessment as a full bladder can cause variations.
What are some factors that may result in variations in fundal height measurements?
1) Position of the fundus
- Measure at 18-20 weeks and beyond.
- Ex: at around 20 weeks, it’s at belly button.
2) Position of the fetus
3) Variations in the amount of amniotic fluid
4) Presence of more than one fetus
5) Maternal obesity
6) Variation in examiner technique
The fundal height drops from week 36 to 40. Why do you think the fundal height dropped at week 40?
At 40 weeks, it dropped b/c the baby is descending in preparation for labour
A client who is 22 weeks gestation comes in for her monthly assessment. The nurse completes an assessment and notes a fundal height of 25 cm.
What actions might be appropriate?
What are potential causes for an increase in fundal height for the gestational age?
Actions:
- Ask if pt has voided.
- Do ultrasound to see baby’s size (maybe a big baby or perhaps twins)
Cause:
- Big baby or twins
- May be due to too much amniotic fluid
- Fibroids in uterus
What is the Leopold’s maneuver?
Leopold’s maneuvers are completed in the 3rd trimester to assess for fetal lie, presentation, attitude, position, and engagement.
What is used for auscultating the fetal heart rate (FHR)? When is it detectable?
Doppler stethoscope or fetoscope can be used for intermittent auscultation. It’s detectable at 12 weeks
How is the FHR counted?
Count the FHR for 1 min and notes the quality and rhythm.
What is the normal range for FHR?
FHR is b/w 110-160 BPM.
Where is the best place to listen for the FHR?
Once fetal position is palpable, use Leopold’s maneuvers to determine the fetus’ back, which is the best listening point for the FHR.
What are some nursing considerations regarding the FHR?
Sometimes devices picks up the maternal HR. Assess maternal pulse to compare with the fetal sounds. If they are the same, readjust and listen again.
What is external noninvasive fetal monitoring (w/ tocotransducer and ultrasound transducer)?
Ultrasound transducer is placed over the area where FHR is best heard, and tocotransducer is placed on uterine fundus (looks at contractions).
It looks at contractions and FHR.
When do fetal movements typically occur?
Some women feel movement as early as 13-16 weeks (especially if they’ve had a baby before).
By 24 weeks, almost all women will feel their baby’s movements in a predictable way.
How are fetal movements assessed?
Kick counts
True or false: daily kick counts are recommended in high risk pregnancies.
True
Count the baby’s movements for 2 hours.
Minimum of 6 movements (such as kicks, flutters, or rolling movements) in 2 hours.
True or false: determinants of health have impact on dietary intake.
True
Good nutrition before and during pregnancy is an important preventive measure.
- Evidence indicates that maternal nutrition and lifestyle have long-term effects on children’s health.
What may occur as a result of inadequate nutrition during the prenatal period?
Low-birth-weight (LBW) infants (2500 g or less)
Preterm infants
True or false: weight gain should be slow and steady
True
What is the recommended weight gain recommended based on a woman’s pre-pregnancy BMI
BMI <18.5 = 28-40lbs
BMI 18.5-24.9 = 25-35lbs
BMI 25.0-29.9 = 15-25lbs
BMI >30.0 = 11-20lbs
Where does the weight go?
Ex: Pre-pregnancy BMI = 23 (recommended weight gain = 25-35lbs)
- Extra blood, fluids and proteins = 3.5kg
- Breasts and energy stores = 3kg
- Uterus = 1kg
- Placenta = 1kg
- Baby = 3.5kg
- Amniotic fluid = 1kg
~Total weight gain at 40 weeks = 13kg (29lbs)
True or false: the 1st trimester results in the least amount of weight gain.
True
As a nurse, how would you respond if a client had gained a significant amount more than the recommended weight gain by the end of the second trimester?
What would you assess?
Assess for:
- gestational diabetes
- size of fetus
- lifestyle (are they always sedentary?)
- diet
- thyroid disorder
What are the immunizations recommended during pregnancy?
1) Tetanus, diphtheria, pertussis (Tdap) vaccine (21-32 weeks)
2) Influenza (flu) vaccine
3) COVID vaccine
What does it mean if the pregnant woman is Rh-? What can you do to treat it?
Body may detect something foreign is developing (baby)
Mix of blood and antigen = antibodies attack future babies -> miscarriage (this only happens in Rh- mom and Rh+ baby)
Give winro med to protect future pregnancies (at 28wks then post-partum if baby is Rh+)
