WEEK 2- ATI Flashcards
uncomplicated/healthy pregnancy
1
Q
amenorrhea
A
The lack of a menstrual period in a female client who is of reproductive age.
2
Q
progesterone
A
Female hormone excreted by the ovaries that prepares the uterine lining for pregnancy.
3
Q
estrogen
A
Ovarian-produced female hormone.
4
Q
breasts during early pregnancy
A
Breasts will increase in size as vascular remodeling occurs throughout the body. Estrogen and progesterone levels cause breast tissue to differentiate and create additional milk ducts to prepare for milk production
5
Q
colostrum
A
Fluid excreted from a breast at the onset of milk production.
6
Q
blood volume at the beginning of pregnancy
A
The maternal circulatory system must meet the oxygen demands of the growing fetus; thus, the maternal blood volume begins to increase early in pregnancy and reaches a volume of 30% to 50% greater than the prepregnant state, for a single pregnancy, by the middle of the third trimester
7
Q
what happens due to increase in blood volume in early pregnancy
A
increase in maternal…
cardiac output
stroke volume
and HR (which peak in the middle of the third trimester)
8
Q
maternal heart rate
A
may increase by 20% above the client’s expected heart rate in the prepregnant state
9
Q
heart enlargement at early pregnancy
A
Heart enlargement is not uncommon due to the increased workload of the heart, which is seen as increased left ventricular wall thickness
10
Q
blood pressure in pregnancy
A
experiences a decrease in peripheral vascular resistance, leading to a decrease in maternal blood pressure due to elevated estrogen levels.
11
Q
viscosity of blood in pregnancy
A
Lower hematocrit values in pregnancy decrease the blood viscosity and lower resistance for blood to reach the uteroplacental circulation to provide oxygen and nutrients to the growing fetus.
12
Q
define gravid
A
the medical term for pregnant
13
Q
respiratory system during pregnancy
A
Maternal and fetal oxygen demands increase during pregnancy, resulting in an increased maternal respiratory rate.
HIGH MATERNAL RR
14
Q
lightening
A
Decreasing pressure on the diaphragm as the fetus moves deeper into the pelvis, resulting in the ease of maternal respiratory effort.
at the end of pregnancy
15
Q
As the client’s body changes during pregnancy, the respiratory system must adapt. Sort the following respiratory changes into whether they increase or decrease during pregnancy
A
INCREASE: maternal oxygen demands, RR, chest diameter, CO2 production
DECREASE: total maternal lung volume expansion (leading to hyperventilation which leads to increase RR and CO2 production)
16
Q
gastrointestinal system
A
the gastrointestinal (GI) system is impacted by the growth of the uterus, which displaces the stomach and intestines upward
17
Q
what leads to heartburn in pregnancy
A
Hormonal changes, including the action of progesterone on smooth muscle, result in delayed gastric emptying and decreased gastroesophageal sphincter tone, causing clients to experience heartburn, which may lead to nausea and vomiting
18
Q
genitourinary system
A
cardiac output increased, blood is then directed to other organs like the KIDNEYS so they therefore increase in size by approximately 30%
19
Q
glomerular filtration rate (GFR)
A
increase by 50%
Rate of blood filtration per minute.
20
Q
common manifestation in pregnancy
A
urinary frequency caused by…
the increase in progesterone and human gonadotrophic hormone (hCG)
21
Q
nocturia
A
Interruption of sleep for the need to void.
22
Q
glycosuria
A
Glucose present in urine in abnormal amounts.
not normal manifestation, can indicate preg complications
23
Q
proteinuria
A
Protein present in the urine in unexpected amounts.
not normal manifestation, can indicate preg complications
24
Q
What are the possible causes of urinary frequency early and late in pregnancy?
A
early: urinary frequency can be caused by an increase in progesterone and hCG
late: urinary frequency can be caused by the pressure of the growing fetus on the bladder.
25
six essential pregnancy hormones
hCG
progesterone
estrogen
prolactin
relaxin
oxytocin
26
essential pregnancy hormones: hCG
Human chorionic gonadotropin
Basis for pregnancy testing and rises rapidly in early pregnancy. Produced by the trophoblast cells surrounding the embryo until the placenta can take over and produce throughout the rest of pregnancy.
27
essential pregnancy hormones: progesterone
Establishes placenta, maintains health of uterine wall, supports blood vessel growth, prevents uterine contractions.
28
essential pregnancy hormones: estrogen
Promotes blood vessel growth, maintains uterine lining, and aids in fetal organ development.
29
essential pregnancy hormones: prolactin
Stimulates breast growth and breastmilk production.
30
essential pregnancy hormones: relaxin
Promotes uterine relaxation, cervical softening, and maternal vasodilation.
31
essential pregnancy hormones: oxytocin
Stimulates uterine contractions and the release of prostaglandin.
32
human placental lactogens
Growth hormone in pregnancy and contributes to insulin resistance
33
musculoskeletal system
Mechanical effects of relaxin and progesterone cause joints to become more flexible to accommodate pregnancy changes, such as the pliability of the pelvis to promote fetal passage during the labor and birth process
34
diastasis recti
Separation of the abdominal wall muscles at the linea nigra, resulting in a bulging area in the abdomen.
35
linea alba
A tendon in the abdomen between the rectus abdominis muscles, extending from the xiphoid process to the symphysis pubis.
36
upper extremities
In upper extremities, some clients experience carpal tunnel syndrome in pregnancy that is thought to be exacerbated by the hormonal changes along with fluid accumulation in the body and nerve hypersensitivity.
37
A client who is 20 weeks pregnant is experiencing numbness and tingling in their fingers. The nurse knows these manifestations can be related to which of the following?
Hormonal changes
Fluid accumulation in the client’s body
Nerve hypersensitivity
38
integumentary system
Hormonal changes and increased blood volume during pregnancy contribute to integumentary changes during pregnancy
stretch marks occur
hyperpigmentation
darker linea nigra with striae gravidarum
melasma
39
striae gravidarum
Stretch marks.
hips, butt, legs, or breasts as well as the abdomen
40
melasma
Brownish colored patches on a pregnant client’s face; also known as the mask of pregnancy.
41
pubic symphysis
The joint between left and right side of the pelvic bone.
42
linea nigra
A darkened line running vertically down the midline of the abdomen is an expected finding.
43
Sort the following statements into expected and unexpected changes in pregnancy.
expected: increased CO, yellow/white color breast leakage, increased RR, abdominal striae gravidarum
unexpected: decreasing progesterone levels, increase in immune system function
44
prenatal
occurring prior to birth
45
why do you want good prenatal care?
Early prenatal care promotes positive health outcomes. This is done by testing and screening that will allow for identification of risk factors. Through early detection of these risk factors, the risk of maternal and fetal morbidity and mortality is decreased. Education given on weight gain, healthy behaviors, vitamins, and nutrition early in pregnancy can also help promote a safer and heathier pregnancy.
46
signs of pregnancy
there are...
presumptive, probable, and positive signs to pregnancy
47
presumptive signs of pregnancy
felt or experience by the client
amenorrhea
breast tenderness
breast enlargement
nausea
vomiting
fatigue
melasma
urinary frequency
48
probable signs of pregnancy
detected by the provider
positive at home pregnancy test
provider will see lab for...
positive serum hCG
and assess...
Goodell's sign
Hegar's sign
ballottement
Chadwick's sign
49
Goodell's sign
Cervical softening that occurs in pregnancy.
50
Hegar's sign
Softening of the lower portion of the uterus.
51
ballottement
Displacing the fetus by sharp upward pressure on the uterine wall and palpating the fetal return to original position.
52
Chadwick's sign
A blue discoloration of the cervix, vagina, and vulva due to increased vascularity.
53
positive signs of pregnancy
the only way to confirm...
presence of a pregnancy is visualization of the fetus and fetal heart activity on an ultrasound.
FETAL HEART SOUNDS
54
what does the first prenatal visit consist of?
history, estimated date of birth (EDB) calculation, physical examination, laboratory evaluation, diagnostic studies, health promotion, and education.
55
client history
Medical/surgical history
Pregnancy/menstrual history
Family history
Alcohol/tobacco/drug use
Sexually transmitted infections (STIs)
Partner violence
Mental health history
Pets
56
obstetrical history
will encompass the date of the last menstrual period and information specific to previous pregnancies
57
GTPAL system
Gravida (number of pregancies including current)
Term (number of births at 37 wks or more)
Preterm (number of births before 37 wks)
Abortion (number of medical, procedural and/or miscarriages)
Living (number of living children)
58
gravida
primigravida: preg for the first time
multigravida: who has many pregnancies
nulligravdia: client who has never been preg
59
Para
primipara: Client who has a first pregnancy reaching 20 weeks
multipara: Client who has multiple pregnancies reaching 20 weeks
nullipara: Client who has never had a pregnancy reach 20 weeks
59
EDB
first day of last menstrual period - 3 months plus 7 days
60
fundus
upper end of uterus
61
multiple gestation
Also known as a multiple pregnancy, it is when two or more fetuses are present in the uterus.
62
preeclampsia
A serious complication of pregnancy occurring after 20 weeks gestation in which a client’s blood pressure value is above 140/90 mm Hg. It can be accompanied by proteinuria, edema, headache, and vision changes. Preeclampsia can become severe resulting in seizures.
63
gestational diabetes
Diabetic condition specific to pregnancy.
64
what can proteinuria indicate
kidney disease or preeclampsia
65
glycosuria can indicate
gestational diabetes
66
What lab testing can be part of the prenatal panel in the first trimester of pregnancy?
Blood tests that are a part of the prenatal panel include CBC, blood type, Rh factor, rubella, HBsAg, and HIV. STI testing should be included. A urinalysis and urine culture can be performed to assess for infection, preeclampsia, and gestational diabetes.
67
prenatal panel laboratory testing
Complete blood count
Blood type
Rh factor screening
Hepatitis B status
Rubella status
HIV status
Rapid plasma reagin
Urinalysis
68
Which of the following is correct related to Naomi’s prenatal lab results?
Rh is b negative
RhoD immune globulin will be administered during the pregnancy.
69
FOODS TO AVOID DURING PREGNANCY
Fish with high levels of mercury (bigeye tuna, king mackerel, marlin, orange roughy, shark, swordfish or tilefish)
White tuna limit to 6 oz/week
Raw or undercooked seafood, meat or poultry
Unpasteurized juice or cider
Raw milk
Soft cheeses: brie, feta, queso fresco, camembert
Raw eggs
Unheated deli meat
Premade meat salads (tuna salad or seafood salad)
Meat spreads or pates
Raw cookie dough
Raw sprouts (alfalfa or bean sprouts)
70
chorionic villus sampling (CVS)
Removal of a small section of the placenta for genetic testing.
done between 10-13 weeks
71
safe vs. unsafe foods to eat during pregnancy
safe: Lentils and black beans
Spinach salad with sunflower seeds
Cooked chicken breast with broccoli
Cheerios with pasteurized milk
Whole wheat pasta with marinara sauce and parmesan cheese
unsafe: raw fish, raw meat
72
how often are clients encouraged to attend follow-up prenatal care visits during the second trimester?
every 4-6 weeks during the second trimester, which lasts from 14 to 27 weeks and 6 days of gestation
73
physical exam during second trimester
weight
BP and urine (to assess for hypertension and preeclampsia)
fundal height in centimeters (to assess fetal growth)
fetal HR (Doppler to ensure normal HR of 110-160)
74
Lab testing during second trimester
maternal serum screening between 15-20 weeks to test proteins in blood that can identify clients at risk for carrying a fetus with chromosomal disorder like Down syndrome
negative Rh need retesting at 24 weeks
between 24-28 weeks a glucose test is down to asses for gestational diabetes
75
oligohydramnios
Less than typical amount of fluid surrounding the fetus in pregnancy.
76
polyhydramnios
Large amount of fluid surrounding the fetus in pregnancy.
77
Diagnostic testing in second trimester
between 18-20 weeks there is an ultrasound to assess fetal anatomic structures
assess the...
head
skull
brain
nuchal skin folds
face
neck
thorax
heart
abdomen
spine
extremities
genitalia
also cervical length and amount of amniotic fluid
78
aminocentesis
screens amniotic fluid, assessing for proteins that could indicate chromosomal or genetic concerns, such as Down syndrome or cystic fibrosis.
needle into the amniotic sac to withdraw amniotic fluid
79
acetylcholinesterase
see this on an amniocentesis reading
Enzyme produced in fetal body that can be released into amniotic fluid in the presence of a neural tube defect.
80
body changes and discomfort in the second trimester
clients begin to gain weight
increased appetite
heartburn (due to the uterus enlarging)
difficulty sleeping
constipation
urinary frequency
edema
81
Samantha arrived at the first prenatal visit of the second trimester and asked the nurse about what discomforts she might experience. Which of the following discomforts should the nurse include in Samantha’s education as being possible in the second trimester?
constipation
stretch marks
back pain
82
fetal movement starts when?
around 16 to 20 weeks
aka quickening (Early fetal movements, typically felt between 16 to 20 weeks gestations, that are often described as fluttering, small muscle spasms, gas bubbles, flickering, tapping, or pulsations)
83
birth and newborn care
encouraged to begin planning for birth in the second trimester
things like...
breastfeeding
newborn care
birth (where and how)
84
prime time to travel when pregnant
second trimester
between 14 to 28 weeks gestation due to increased energy and decreased nausea and vomiting
85
Braxton Hicks contractions
Tightening and relaxation of the uterus that does not dilate or efface the cervix, often referred to as “practice contractions.”
86
prenatal appointments during the third trimester
every 2-4 weeks until 36 weeks when appts occur on a weekly basis
87
physical exam during third trimester
assess for...
BP (hypertension)
urine sample (preeclampsia)
edema
headaches
hemorrhoids
weight gain
vaginal bleeding
amniotic fluid leaking
fundal height
fetal HR with Doppler
after 34 weeks, Leopold maneuvers
88
Leopold maneuvers
Palpation method to determine fetal position, presentation, and engagement.
89
when will most clients deliever
between 37 and 42 weeks
90
postterm pregnancy
pregnancy extending beyond 42 weeks
91
fetus risks during postterm pregnancy
placental insufficiency, oligohydramnios, and birth injury
92
body changes and discomfort during the third trimester
hemorrhoids form because of the increased pressure from the fetus and hormone changes in pregnancy
Client education should include increasing dietary fiber and drinking at least 12 cups of water per day to decrease constipation and make stooling easier and less painful with hemorrhoids. Soaking in a warm tub, not sitting for prolonged periods of time, and applying icepacks or witch hazel pads to the area can also help relieve pain and swelling.
know the diff between this bleeding and vaginal bleeding!
93
manifestations of preeclampsia during third trimester
headaches
blurred vision
edema
shortness of breath
94
manifestations of preterm labor
vaginal bleeding
regular uterine contractions
fluid leaking
95
peripartum cardiomyopathy
Heart failure developing late in pregnancy or after birth.
96
The nurse is educating a client on kick counts. Which of the following statements by the client demonstrates an understanding of kick counts?
“If I feel less than 10 kicks or movements in two to three hours, I should call my provider.”
start at 28 weeks
97
high-risk pregnancy
A pregnancy in which risk factors or complications place the pregnant client and/or fetus at risk for poor outcomes.
98
Biophysical factors that can contribute to a high-risk pregnancy
genetics
Nutrional status
chronic illness
obstetrical disorders
99
Examples of genetic conditions that place a pregnancy at high risk
cystic fibrosis, Trisomy 21 (Down syndrome), and Trisomy 18 (Edwards syndrome).
100
Nutrional status that can contribute to high-risk pregnancy
low BMI
high BMI
anorexia
obesity
not good security
101
Obesity prior to conception has been associated with an increased risk
pregestational and gestational diabetes, spontaneous abortion, cesarean birth, fetal demise, preeclampsia, and preterm birth.
102
chronic illnesses that can impact pregnancy and/or maternal-fetal outcomes
hyperglycemia, hypertension, asthma, STIs, thyroid dysfunction, and seizure disorders.
103
hyperglycemia in pregnancy
places the client at risk for fetal macrosomia, preterm birth, preeclampsia, cesarean birth, fetal demise, and fetal hypoglycemia
104
macrosomia
A fetus or newborn who is larger than average (4,000 to 4,500 g [9 to 10 lb]).
105
fetal demise
When a fetus dies inside the uterus after 20 weeks of gestation; sometimes referred to as stillbirth.
106
what else can hyperglycemia lead to
polyhydramnios
increased amount of amniotic fluid
107
neonate
infant less than 1 month old, aka a newborn
108
A nurse is caring for a pregnant client who has gestational diabetes and has had a cesarean birth. What process could cause this newborn to have hypoglycemia following birth?
During pregnancy, the fetus is exposed to high levels of glucose, provoking increased insulin production by the fetus. At birth, the maternal blood supply is interrupted, but the fetus maintains higher levels of insulin, causing fetal hypoglycemia.
109
pathophysiology behind hyperglycemia contributing to hypertension
damaging effects of excess glucose on the circulatory system, which increases peripheral resistance.
110
Chronic hypertension can worsen during pregnancy, leading
preeclampsia, eclampsia, uteroplacental insufficiency, and fetal growth restriction.
111
uteroplacental insufficiency
A syndrome in which the placental vascular remodeling fails, impairing placentation and causing acidosis and fetal hypoxia.
112
A nurse is caring for a pregnant client who has preeclampsia. Which of the following is this client at risk for?
fetal hypoxia
fetal demise
seizures
113
chorioamnionitis
An infection within the amniotic sac.
114
Fetal complications resulting from STI
LBW, blindness, deafness, pneumonia, and fetal demise.
115
Hyperthyroidism can contribute to
preeclampsia, placental abruption, preterm birth, LBW, and spontaneous abortion
116
Neonatal myxedema
An extreme form of hypothyroidism.
117
potential complications of hypothyroidism.
Maternal anemia, preeclampsia, fetal demise, and placental abruption
118
Uterine fibroids can place the client at risk for
placental abruption, placenta previa, retained placenta, and postpartum hemorrhage
119
uterine fibroids
Benign tumors inside the uterus.
120
placenta previa
Occurs when the placenta is covering the cervical os, either partially or completely.
121
Multifetal pregnancies place the client at risk for
preeclampsia and gestational diabetes.
preterm birth, LBW, and long-term fetal complications, such as cerebral palsy.
122
Tobacco use during pregnancy increases the risk
SUID
fetal birth defects
LBW
preterm birth
123
Recommendations for caffeine intake during pregnancy
200 mg per day or less
124
Sociodemographic Factors
age (AMA) which is 35 and up
adolescent pregnancy
125
risks of adolescent pregnancy
preterm premature rupture of membranes (PPROM), preeclampsia, sexually transmitted infections, maternal anemia, postpartum depression, and maternal death.
126
preterm premature rupture of membranes (PPROM)
The rupture of the amniotic membranes before term or 37 weeks of gestation.
risk for adolescent pregnancy
127
parity
refers to the number of times a client gives birth after 24 weeks of gestation
128
multiparous
Two or more viable pregnancies defined as lasting at least 20 weeks.
129
Effect of Lead Exposure to the Growing Fetus
Small for gestational age
Low birth weight
Preterm birth
Damage to renal system and other organs
Neurocognitive impairment
Behavioral impairment
Increased risk for ADHD
Fetal malformation
Encephalopathy
Impaired motor control
130
TOXOPLASMOSIS
protozoal infection that can result from having contact with feline feces in either litter boxes or contaminated soil, eating unwashed or unpeeled and uncooked fruits or vegetables, handling raw meat without washing hands, or eating undercooked meat from infected animal
DONT CLEAN LITTER BOX
131
Avoiding Toxoplasmosis During Pregnancy
Cook meat to recommended temperatures and use a thermometer to ensure meat is thoroughly cooked.
Have someone else change the cat litter.
Wear gloves while working in the soil.
Wash and peel all fruits and vegetables. Avoid eating any food that may have been exposed to cat feces.
132
more severe forms of hypertension in pregnancy
preeclampsia
eclampsia
HELLP syndrome
133
HELLP syndrome (resulting from preeclampsia)
H-hemolysis (rupture of RBCs)
EL-elevated liver enzymes
LP-low platelet count
134
assessment and testing each visit for hypertension
BP measurement
urine testing for protein
inspection for...
headaches
edema
right side abd pain
vision changes
135
During each routine prenatal visit, clients should expect to have which of the following tests performed?
Urine testing for protein
for preeclampsia
136
Systemic lupus erythematosus (SLE)
disease in which the immune system attacks the body's own tissues.
137
pregnancy risks for lupus
fetal loss
preeclampsia
preterm birth
small birth size
138
cholestasis
Sluggish or poor flow of bile through the biliary system.
139
signs of cholestasis
severe itching without a rash
begins on the palms and soles of feet worsening at night
140
when is cholestasis most common
third trimester
can lead to preeclampsia and gestational diabetes
141
Prenatal testing usually employed with cholestasis
BPP
142
A nurse is caring for a pregnant client who is suspected of having cholestasis of pregnancy. Which of the following lab studies should the nurse anticipate the provider prescribing?
chemistry panel
liver function studies
bile acid levels
143
A nurse is teaching a nursing student about risk factors for fetal demise. Which of the following risk factors should the nurse include in the teaching?
oligohydramnios
intrahepatic cholestasis
previous fetal demise
144
risk for fetal demise
oligohydramnios
polyhydramnios
intrahepatic cholestasis
145
primary cause of oligohydramnios
premature rupture of membranes
146
A nurse is caring for a pregnant client at 35 weeks of gestation whose membranes have ruptured. Which of the following should the nurse suspect as contributing to the rupture of membranes?
twin preg
decreased copper levels
amniotic fluid infection
uterine contractions
147
