Week 1 power points-prenatal care Flashcards
Healthy People 2020 Maternal and infant health goals
The health of a nation is reflected in the health of expectant women and their infants”
Some of the goals set by the CDC are to:
One overall goal is to decrease health care disparity in at risk lower income people.
One way to do that is to increase the number of women who receive early and adequate prenatal care.
Reducing SIDS (Sudden infant death) through education about safe sleeping practices.
Reduction of C-sections.
Reduction of substance abuse.
Diagnosing pregnancy
Presumptive.
Probable
Positive
Presumptive signs of pregnancy
Amenorrhea
Slight spotting in about 20% of patients. During implantation.
Urinary frequency.
N/V.
Breast enlargement and tenderness.
Fatigue.
Quickening. (perception of fetal movement) around 18-20
Many women experience these signs when they are pregnant.
Amenorrhea may be the most common sign in women who have regular periods
Spotting occurs due to the fertilized egg implanting into the uterine wall. It occurs anywhere from 10-14 days after fertilization and a few days before menstruation would have begun.
Probable signs of pregnancy
Chadwick’s sign (Bluish/purple mucous membranes of the vagina, cervix, and vulva) at 6-8 weeks.
Goodell’s sign- softening of the cervix with leukorrheal discharge. (cloudy white mucous caused from increased progesterone)
Hegar’s sign (softening of the lower uterine segment).
Ballottement (passive fetal movement).
Positive Pregnancy test. (Detects hCG levels)
Positive signs of pregnancy
Fetal heartbeat: 10-12 weeks gestation by Doppler.
Ultrasound visualization and cardiac movement at 4-8 weeks
These are true positive signs of pregnancy
Gravidity
Gravidity =number of pregnancies
Parity
Parity=number of pregnancies carried to viability. (20+ weeks or more specifically 24 weeks)
G T P A L
Can also be broken down further into: Gravidity = Number of pregnancies T= # of term pregnancies P= Preterm deliveries A= number of spontaneous or induced abortions L= the number of living children.
Gravidity is the number of pregnancies despite their possible outcomes.
Parity number of pregnancies carried to generally 20+ weeks
For example, if a women has 2 kids and is currently pregnant she is considered to be G3P2. A women who is pregnant for the first time is G1P0.
GTPAL is the longer version that is documented in her history.
Naegeles rule
Naegele’s rule: Minus 3 months from the first day of the last menstrual cycle and add 7 day.
Just an estimated due date. Many factors can influence this such as regularity of the menstrual cycle and or cycles that are greater than 28 days.
Not all women can remember the first day of their last menstrual cycle.
The Gestational wheel is helpful to aid calculation.
First prenatal Visit.
Obtain the Maternal health history
History of previous pregnancies.
Gynecologic history:
History of multiple births.
Use of prescription and nonprescription drugs
Use of alcohol, tobacco including vaping, THC, Illegal drugs. First day of last menses.
Do not forget to Ask her how she is doing. Has she been having any bleeding or cramping?
Physical changes in the female body during pregnancy
The changes to a women’s body is significant. It essentially effects every system. They are primarily protective mechanisms for the mother and fetus. I am going to highlight some of the changes. You can read about the other changes in your assigned reading.
Cardiovascular system
Blood volume increase
Increased cardiac output
Lower extremity edema or varicose veins
Blood volume increases from 40-45% and is primarily due to the increase in plasma and erythrocyte volume. This increases the mothers heart rate about 15-20 beats per minute.
Cardiac output increases and peaks at about 25-30%.
This hemodilution may cause the women’s hematocrit values to appear low. This called physiological anemia (also called Pseudoanemia) this is usually the most apparent at 32-34 weeks of pregnancy.
Leukocytes also increase up to 16,000 mm3 and can climb even higher in the postpartum period and not be a sign of infection.
During the first trimester the BP decreases and then returns to normal at term.
Increased progesterone levels is a compensatory mechanism to keep BP from elevating due to the increased volume. This is because Progesterone causes the relaxation of the smooth muscles.
These changes in vascular resistance combined with increased volume put the pregnant women at an increased risk for varicose veins and hemorrhoids.
Nurses can instruct the patient to elevate her legs and lye on her left side for 20 minutes a day to help improve the venous return from the lower extremities.
Reproductive system
Enlarged uterus
Breast enlargement and tenderness
Colostrum productions begins around 16 weeks.
Integumentary system
Darkening pigment due to the influence of estrogen and progesterone.
Striae (stretch marks) from the growth of the breasts, hips abdomen and buttocks
Respiratory system
Pressure on the diaphragm in the third trimester can cause shortness of breath.
Increased tidal volume to meet increased oxygen demand.