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