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Mother Baby > WEEK 2- ATI > Flashcards

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.

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2
Q

progesterone

A

Female hormone excreted by the ovaries that prepares the uterine lining for pregnancy.

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3
Q

estrogen

A

Ovarian-produced female hormone.

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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

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5
Q

colostrum

A

Fluid excreted from a breast at the onset of milk production.

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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

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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)

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8
Q

maternal heart rate

A

may increase by 20% above the client’s expected heart rate in the prepregnant state

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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

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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.

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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.

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12
Q

define gravid

A

the medical term for pregnant

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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

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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

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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)

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16
Q

gastrointestinal system

A

the gastrointestinal (GI) system is impacted by the growth of the uterus, which displaces the stomach and intestines upward

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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

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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%

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19
Q

glomerular filtration rate (GFR)

A

increase by 50%

Rate of blood filtration per minute.

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20
Q

common manifestation in pregnancy

A

urinary frequency caused by…

the increase in progesterone and human gonadotrophic hormone (hCG)

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21
Q

nocturia

A

Interruption of sleep for the need to void.

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22
Q

glycosuria

A

Glucose present in urine in abnormal amounts.

not normal manifestation, can indicate preg complications

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23
Q

proteinuria

A

Protein present in the urine in unexpected amounts.

not normal manifestation, can indicate preg complications

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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.

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25
Q

six essential pregnancy hormones

A

hCG
progesterone
estrogen
prolactin
relaxin
oxytocin

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26
Q

essential pregnancy hormones: hCG

A

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.

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27
Q

essential pregnancy hormones: progesterone

A

Establishes placenta, maintains health of uterine wall, supports blood vessel growth, prevents uterine contractions.

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28
Q

essential pregnancy hormones: estrogen

A

Promotes blood vessel growth, maintains uterine lining, and aids in fetal organ development.

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29
Q

essential pregnancy hormones: prolactin

A

Stimulates breast growth and breastmilk production.

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30
Q

essential pregnancy hormones: relaxin

A

Promotes uterine relaxation, cervical softening, and maternal vasodilation.

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31
Q

essential pregnancy hormones: oxytocin

A

Stimulates uterine contractions and the release of prostaglandin.

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32
Q

human placental lactogens

A

​​​​​​​Growth hormone in pregnancy and contributes to insulin resistance

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33
Q

musculoskeletal system

A

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

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34
Q

diastasis recti

A

Separation of the abdominal wall muscles at the linea nigra, resulting in a bulging area in the abdomen.

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35
Q

linea alba

A

A tendon in the abdomen between the rectus abdominis muscles, extending from the xiphoid process to the symphysis pubis.

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36
Q

upper extremities

A

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.

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37
Q

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?

A

Hormonal changes
Fluid accumulation in the client’s body
Nerve hypersensitivity

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38
Q

integumentary system

A

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

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39
Q

striae gravidarum

A

Stretch marks.

hips, butt, legs, or breasts as well as the abdomen

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40
Q

melasma

A

Brownish colored patches on a pregnant client’s face; also known as the mask of pregnancy.

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41
Q

pubic symphysis

A

The joint between left and right side of the pelvic bone.

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42
Q

linea nigra

A

A darkened line running vertically down the midline of the abdomen is an expected finding.

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43
Q

Sort the following statements into expected and unexpected changes in pregnancy.

A

expected: increased CO, yellow/white color breast leakage, increased RR, abdominal striae gravidarum

unexpected: decreasing progesterone levels, increase in immune system function

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44
Q

prenatal

A

occurring prior to birth

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45
Q

why do you want good prenatal care?

A

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.

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46
Q

signs of pregnancy

A

there are…

presumptive, probable, and positive signs to pregnancy

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47
Q

presumptive signs of pregnancy

A

felt or experience by the client

amenorrhea
breast tenderness
breast enlargement
nausea
vomiting
fatigue
melasma
urinary frequency

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48
Q

probable signs of pregnancy

A

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

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49
Q

Goodell’s sign

A

Cervical softening that occurs in pregnancy.

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50
Q

Hegar’s sign

A

Softening of the lower portion of the uterus.

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51
Q

ballottement

A

Displacing the fetus by sharp upward pressure on the uterine wall and palpating the fetal return to original position.

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52
Q

Chadwick’s sign

A

A blue discoloration of the cervix, vagina, and vulva due to increased vascularity.

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53
Q

positive signs of pregnancy

A

the only way to confirm…

presence of a pregnancy is visualization of the fetus and fetal heart activity on an ultrasound.

FETAL HEART SOUNDS

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54
Q

what does the first prenatal visit consist of?

A

history, estimated date of birth (EDB) calculation, physical examination, laboratory evaluation, diagnostic studies, health promotion, and education.

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55
Q

client history

A

Medical/surgical history
Pregnancy/menstrual history
Family history
Alcohol/tobacco/drug use
Sexually transmitted infections (STIs)
Partner violence
Mental health history
Pets

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56
Q

obstetrical history

A

will encompass the date of the last menstrual period and information specific to previous pregnancies

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57
Q

GTPAL system

A

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)

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58
Q

gravida

A

primigravida: preg for the first time
multigravida: who has many pregnancies
nulligravdia: client who has never been preg

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59
Q

Para

A

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

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59
Q

EDB

A

first day of last menstrual period - 3 months plus 7 days

60
Q

fundus

A

upper end of uterus

61
Q

multiple gestation

A

Also known as a multiple pregnancy, it is when two or more fetuses are present in the uterus.

62
Q

preeclampsia

A

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
Q

gestational diabetes

A

Diabetic condition specific to pregnancy.

64
Q

what can proteinuria indicate

A

kidney disease or preeclampsia

65
Q

glycosuria can indicate

A

gestational diabetes

66
Q

What lab testing can be part of the prenatal panel in the first trimester of pregnancy?

A

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
Q

prenatal panel laboratory testing

A

Complete blood count
Blood type
Rh factor screening
Hepatitis B status
Rubella status
HIV status
Rapid plasma reagin
Urinalysis

68
Q

Which of the following is correct related to Naomi’s prenatal lab results?

Rh is b negative

A

RhoD immune globulin will be administered during the pregnancy.

69
Q

FOODS TO AVOID DURING PREGNANCY

A

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
Q

chorionic villus sampling (CVS)

A

Removal of a small section of the placenta for genetic testing.

done between 10-13 weeks

71
Q

safe vs. unsafe foods to eat during pregnancy

A

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
Q

how often are clients encouraged to attend follow-up prenatal care visits during the second trimester?

A

every 4-6 weeks during the second trimester, which lasts from 14 to 27 weeks and 6 days of gestation

73
Q

physical exam during second trimester

A

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
Q

Lab testing during second trimester

A

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
Q

oligohydramnios

A

Less than typical amount of fluid surrounding the fetus in pregnancy.

76
Q

polyhydramnios

A

Large amount of fluid surrounding the fetus in pregnancy.

77
Q

Diagnostic testing in second trimester

A

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
Q

aminocentesis

A

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
Q

acetylcholinesterase

A

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
Q

body changes and discomfort in the second trimester

A

clients begin to gain weight
increased appetite
heartburn (due to the uterus enlarging)
difficulty sleeping
constipation
urinary frequency
edema

81
Q

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?

A

constipation
stretch marks
back pain

82
Q

fetal movement starts when?

A

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
Q

birth and newborn care

A

encouraged to begin planning for birth in the second trimester
things like…
breastfeeding
newborn care
birth (where and how)

84
Q

prime time to travel when pregnant

A

second trimester

between 14 to 28 weeks gestation due to increased energy and decreased nausea and vomiting

85
Q

Braxton Hicks contractions

A

Tightening and relaxation of the uterus that does not dilate or efface the cervix, often referred to as “practice contractions.”

86
Q

prenatal appointments during the third trimester

A

every 2-4 weeks until 36 weeks when appts occur on a weekly basis

87
Q

physical exam during third trimester

A

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
Q

Leopold maneuvers

A

Palpation method to determine fetal position, presentation, and engagement.

89
Q

when will most clients deliever

A

between 37 and 42 weeks

90
Q

postterm pregnancy

A

pregnancy extending beyond 42 weeks

91
Q

fetus risks during postterm pregnancy

A

placental insufficiency, oligohydramnios, and birth injury

92
Q

body changes and discomfort during the third trimester

A

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
Q

manifestations of preeclampsia during third trimester

A

headaches
blurred vision
edema
shortness of breath

94
Q

manifestations of preterm labor

A

vaginal bleeding
regular uterine contractions
fluid leaking

95
Q

peripartum cardiomyopathy

A

Heart failure developing late in pregnancy or after birth.

96
Q

The nurse is educating a client on kick counts. Which of the following statements by the client demonstrates an understanding of kick counts?

A

“If I feel less than 10 kicks or movements in two to three hours, I should call my provider.”

start at 28 weeks

97
Q

high-risk pregnancy

A

A pregnancy in which risk factors or complications place the pregnant client and/or fetus at risk for poor outcomes.

98
Q

Biophysical factors that can contribute to a high-risk pregnancy

A

genetics
Nutrional status
chronic illness
obstetrical disorders

99
Q

Examples of genetic conditions that place a pregnancy at high risk

A

cystic fibrosis, Trisomy 21 (Down syndrome), and Trisomy 18 (Edwards syndrome).

100
Q

Nutrional status that can contribute to high-risk pregnancy

A

low BMI
high BMI
anorexia
obesity
not good security

101
Q

Obesity prior to conception has been associated with an increased risk

A

pregestational and gestational diabetes, spontaneous abortion, cesarean birth, fetal demise, preeclampsia, and preterm birth.

102
Q

chronic illnesses that can impact pregnancy and/or maternal-fetal outcomes

A

hyperglycemia, hypertension, asthma, STIs, thyroid dysfunction, and seizure disorders​​​​​​​.

103
Q

hyperglycemia in pregnancy

A

places the client at risk for fetal macrosomia, preterm birth, preeclampsia, cesarean birth, fetal demise, and fetal hypoglycemia

104
Q

macrosomia

A

A fetus or newborn who is larger than average (4,000 to 4,500 g [9 to 10 lb]).

105
Q

fetal demise

A

When a fetus dies inside the uterus after 20 weeks of gestation; sometimes referred to as stillbirth.

106
Q

what else can hyperglycemia lead to

A

polyhydramnios

increased amount of amniotic fluid

107
Q

neonate

A

infant less than 1 month old, aka a newborn

108
Q

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?

A

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
Q

pathophysiology behind hyperglycemia contributing to hypertension

A

damaging effects of excess glucose on the circulatory system, which increases peripheral resistance.

110
Q

Chronic hypertension can worsen during pregnancy, leading

A

preeclampsia, eclampsia, uteroplacental insufficiency, and fetal growth restriction.

111
Q

uteroplacental insufficiency

A

A syndrome in which the placental vascular remodeling fails, impairing placentation and causing acidosis and fetal hypoxia.

112
Q

A nurse is caring for a pregnant client who has preeclampsia. Which of the following is this client at risk for?

A

fetal hypoxia
fetal demise
seizures

113
Q

chorioamnionitis

A

An infection within the amniotic sac.

114
Q

Fetal complications resulting from STI

A

LBW, blindness, deafness, pneumonia, and fetal demise.

115
Q

Hyperthyroidism can contribute to

A

preeclampsia, placental abruption, preterm birth, LBW, and spontaneous abortion

116
Q

Neonatal myxedema

A

An extreme form of hypothyroidism.

117
Q

potential complications of hypothyroidism.

A

Maternal anemia, preeclampsia, fetal demise, and placental abruption

118
Q

Uterine fibroids can place the client at risk for

A

placental abruption, placenta previa, retained placenta, and postpartum hemorrhage

119
Q

uterine fibroids

A

Benign tumors inside the uterus.

120
Q

placenta previa

A

Occurs when the placenta is covering the cervical os, either partially or completely.

121
Q

Multifetal pregnancies place the client at risk for

A

preeclampsia and gestational diabetes.
preterm birth, LBW, and long-term fetal complications, such as cerebral palsy.

122
Q

Tobacco use during pregnancy increases the risk

A

SUID
fetal birth defects
LBW
preterm birth

123
Q

Recommendations for caffeine intake during pregnancy

A

200 mg per day or less

124
Q

Sociodemographic Factors

A

age (AMA) which is 35 and up
adolescent pregnancy

125
Q

risks of adolescent pregnancy

A

preterm premature rupture of membranes (PPROM), preeclampsia, sexually transmitted infections, maternal anemia, postpartum depression, and maternal death.

126
Q

preterm premature rupture of membranes (PPROM)

A

The rupture of the amniotic membranes before term or 37 weeks of gestation.

risk for adolescent pregnancy

127
Q

parity

A

refers to the number of times a client gives birth after 24 weeks of gestation

128
Q

multiparous

A

Two or more viable pregnancies defined as lasting at least 20 weeks.

129
Q

Effect of Lead Exposure to the Growing Fetus

A

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
Q

TOXOPLASMOSIS

A

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
Q

Avoiding Toxoplasmosis During Pregnancy

A

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
Q

more severe forms of hypertension in pregnancy

A

preeclampsia
eclampsia
HELLP syndrome

133
Q

HELLP syndrome (resulting from preeclampsia)

A

H-hemolysis (rupture of RBCs)
EL-elevated liver enzymes
LP-low platelet count

134
Q

assessment and testing each visit for hypertension

A

BP measurement
urine testing for protein
inspection for…

headaches
edema
right side abd pain
vision changes

135
Q

During each routine prenatal visit, clients should expect to have which of the following tests performed?

A

Urine testing for protein

for preeclampsia

136
Q

Systemic lupus erythematosus (SLE)

A

disease in which the immune system attacks the body’s own tissues.

137
Q

pregnancy risks for lupus

A

fetal loss
preeclampsia
preterm birth
small birth size

138
Q

cholestasis

A

Sluggish or poor flow of bile through the biliary system.

139
Q

signs of cholestasis

A

severe itching without a rash

begins on the palms and soles of feet worsening at night

140
Q

when is cholestasis most common

A

third trimester
can lead to preeclampsia and gestational diabetes

141
Q

Prenatal testing usually employed with cholestasis

A

BPP

142
Q

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?

A

chemistry panel
liver function studies
bile acid levels

143
Q

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?

A

oligohydramnios
intrahepatic cholestasis
previous fetal demise

144
Q

risk for fetal demise

A

oligohydramnios
polyhydramnios
intrahepatic cholestasis

145
Q

primary cause of oligohydramnios

A

premature rupture of membranes

146
Q

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?

A

twin preg
decreased copper levels
amniotic fluid infection
uterine contractions

147
Q
A

Mother Baby (6 decks)

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