WEEK 2- ATI Flashcards
uncomplicated/healthy pregnancy
amenorrhea
The lack of a menstrual period in a female client who is of reproductive age.
progesterone
Female hormone excreted by the ovaries that prepares the uterine lining for pregnancy.
estrogen
Ovarian-produced female hormone.
breasts during early pregnancy
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
colostrum
Fluid excreted from a breast at the onset of milk production.
blood volume at the beginning of pregnancy
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
what happens due to increase in blood volume in early pregnancy
increase in maternal…
cardiac output
stroke volume
and HR (which peak in the middle of the third trimester)
maternal heart rate
may increase by 20% above the client’s expected heart rate in the prepregnant state
heart enlargement at early pregnancy
Heart enlargement is not uncommon due to the increased workload of the heart, which is seen as increased left ventricular wall thickness
blood pressure in pregnancy
experiences a decrease in peripheral vascular resistance, leading to a decrease in maternal blood pressure due to elevated estrogen levels.
viscosity of blood in pregnancy
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.
define gravid
the medical term for pregnant
respiratory system during pregnancy
Maternal and fetal oxygen demands increase during pregnancy, resulting in an increased maternal respiratory rate.
HIGH MATERNAL RR
lightening
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
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
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)
gastrointestinal system
the gastrointestinal (GI) system is impacted by the growth of the uterus, which displaces the stomach and intestines upward
what leads to heartburn in pregnancy
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
genitourinary system
cardiac output increased, blood is then directed to other organs like the KIDNEYS so they therefore increase in size by approximately 30%
glomerular filtration rate (GFR)
increase by 50%
Rate of blood filtration per minute.
common manifestation in pregnancy
urinary frequency caused by…
the increase in progesterone and human gonadotrophic hormone (hCG)
nocturia
Interruption of sleep for the need to void.
glycosuria
Glucose present in urine in abnormal amounts.
not normal manifestation, can indicate preg complications
proteinuria
Protein present in the urine in unexpected amounts.
not normal manifestation, can indicate preg complications
What are the possible causes of urinary frequency early and late in pregnancy?
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.
six essential pregnancy hormones
hCG
progesterone
estrogen
prolactin
relaxin
oxytocin
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.
essential pregnancy hormones: progesterone
Establishes placenta, maintains health of uterine wall, supports blood vessel growth, prevents uterine contractions.
essential pregnancy hormones: estrogen
Promotes blood vessel growth, maintains uterine lining, and aids in fetal organ development.
essential pregnancy hormones: prolactin
Stimulates breast growth and breastmilk production.
essential pregnancy hormones: relaxin
Promotes uterine relaxation, cervical softening, and maternal vasodilation.
essential pregnancy hormones: oxytocin
Stimulates uterine contractions and the release of prostaglandin.
human placental lactogens
Growth hormone in pregnancy and contributes to insulin resistance
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
diastasis recti
Separation of the abdominal wall muscles at the linea nigra, resulting in a bulging area in the abdomen.
linea alba
A tendon in the abdomen between the rectus abdominis muscles, extending from the xiphoid process to the symphysis pubis.
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.
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
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
striae gravidarum
Stretch marks.
hips, butt, legs, or breasts as well as the abdomen
melasma
Brownish colored patches on a pregnant client’s face; also known as the mask of pregnancy.
pubic symphysis
The joint between left and right side of the pelvic bone.
linea nigra
A darkened line running vertically down the midline of the abdomen is an expected finding.
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
prenatal
occurring prior to birth
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.
signs of pregnancy
there are…
presumptive, probable, and positive signs to pregnancy
presumptive signs of pregnancy
felt or experience by the client
amenorrhea
breast tenderness
breast enlargement
nausea
vomiting
fatigue
melasma
urinary frequency
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
Goodell’s sign
Cervical softening that occurs in pregnancy.
Hegar’s sign
Softening of the lower portion of the uterus.
ballottement
Displacing the fetus by sharp upward pressure on the uterine wall and palpating the fetal return to original position.
Chadwick’s sign
A blue discoloration of the cervix, vagina, and vulva due to increased vascularity.
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
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.
client history
Medical/surgical history
Pregnancy/menstrual history
Family history
Alcohol/tobacco/drug use
Sexually transmitted infections (STIs)
Partner violence
Mental health history
Pets
obstetrical history
will encompass the date of the last menstrual period and information specific to previous pregnancies
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)
gravida
primigravida: preg for the first time
multigravida: who has many pregnancies
nulligravdia: client who has never been preg
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