Week 2 Content Flashcards

Question

* Maternal adaptation ⚬ Accepting the pregnancy ⚬ Identifying with the mother role ⚬ Reordering personal relationships ⚬ Establishing a relationship with fetus ￭ Emotional attachment ⚬ Preparing for childbirth

Answer 1

⚬ Accepting the pregnancy ⚬ Identifying with the mother role ⚬ Reordering personal relationships ⚬ Establishing a relationship with fetus ￭ Emotional attachment ⚬ Preparing for childbirth

Answer 2

⚬ Accepting the pregnancy ￭ Three phases – announcement, moratorium, focusing ⚬ Identifying with parental role ⚬ Reordering personal relationships ⚬ Establishing relationship with fetus ⚬ Preparing for childbirth ￭ Couvade syndrome * Siblings: Toddlers, Older Children, Adolescents

Answer 3

⚬ Current pregnancy ⚬ Childbearing and reproductive history ⚬ Health history ⚬ Nutrition history ⚬ History of drug use and herbal preparations ⚬ Family history ⚬ Social, experiential, and occupational history ⚬ Mental health history ⚬ History of physical abuse/risk ⚬ Review of systems ⚬ Physical exam ⚬ Laboratory tests

Answer 4

* Goal of prenatal care is to promote the health and wellbeing of the pregnant woman, the fetus, the newborn, and family * Emphasis on preventive care and optimal self-care * Prenatal care is sought routinely by women of middle or high socioeconomic status

Answer 5

* Women in poverty or lacking health insurance may not have access to public or private care ⚬ Lack of culturally sensitive care and communication interferes with access to care ⚬ Immigrant women may not seek prenatal care ⚬ Birth outcomes are less positive with higher rates of maternal and newborn complications ⚬ Problems with low birth rate and infant mortality associated with inadequate prenatal care

Answer 6

⚬ Lack of motivation to seek care ⚬ Inadequate finances ⚬ Lack of transportation ⚬ Unpleasant clinic personnel ⚬ Unpleasant facilities or procedures ⚬ Inconvenient clinic hours ⚬ Problems with child care ⚬ Personal and cultural attitudes

Answer 7

⚬ Physical examination ￭ Vital signs, height/weight ⚬ Fetal assessment ￭ Fundal height ￭ Fetal heart tones ￭ Gestational age ￭ Health status ￭ Laboratory tests * Clean catch urine * Multiple-marker or triple-screen blood test * Other blood tests (RPR/VDRL, CBC, anti-Rh) ￭ Other tests * Ultrasonography * Amniocentesis * Group B streptococcus between 35 - 37 weeks gestation

Answer 8

￭ 0-28 wks q 4, 29-35 q 2-3, 36+ weekly ￭ Centering Pregnancy – start 12-18 wks q month x 4 months then weekly

Answer 9

⚬ Education about maternal and fetal changes ⚬ Education for self-management ￭ Nutrition ￭ Personal hygiene ￭ Prevention of urinary tract infections ￭ Kegel exercises ￭ Preparation for breastfeeding newborn ￭ Dental health

Answer 10

⚬ Education for self-management ￭ Physical activity ￭ Posture and body mechanics ￭ Rest and relaxation ￭ Employment ￭ Clothing ￭ Travel ￭ Medications and herbal preparations

Answer 11

⚬ Education for selfmanagement ￭ Immunizations ￭ Rh immune globulin ￭ Substance abuse * Alcohol * Tobacco * Caffeine * Marijuana * Cocaine * Opioids

Answer 12

￭ Normal discomforts ￭ Recognizing potential complications ￭ Sexual counseling ￭ Sexual history ￭ Countering misinformation ￭ Safety and comfort during sexual activity ￭ Psychosocial support

Answer 13

* Nausea and vomiting * Heartburn * Backache * Round ligament pain * Urinary frequency * Varicosities * Hemorrhoids * Constipation * Leg cramps

Answer 14

* Vaginal bleeding, with or without discomfort * Rupture of membranes * Swelling of fingers, puffiness of face or around eyes * Continuous, pounding headache * Visual disturbances ⚬ Blurred vision, dimness, spots * Persistent or severe abdominal pain * Chills or fever * Painful urination * Persistent vomiting * Changes in frequency or strength of fetal movements * Signs of preterm labor: ⚬ Uterine contractions, cramps, constant or irregular low backache, pelvic pressure

Answer 15

* Cultural influences ⚬ Emotional response ⚬ Clothing ⚬ Physical activity and rest ⚬ Sexual activity ⚬ Diet

Answer 16

⚬ Adolescents ￭ Much less likely than older women to receive adequate prenatal care ⚬ Women older than 35 years old ￭ Multiparous women ￭ Nulliparous women

Answer 17

* Multifetal pregnancy ⚬ Increased risk of adverse outcomes for both mother and fetuses ⚬ Twin pregnancies often end in prematurity ⚬ Rupture of membranes before term common ⚬ Congenital malformations twice as common in monozygotic twins as in singletons ⚬ No increase in incidence of congenital anomalies in dizygotic twins

Answer 18

⚬ Multifetal pregnancy likelihood increased when one or more of the following factors are noted in the assessment: ￭ History of dizygous twins in female lineage ￭ Use of fertility drugs ￭ Rapid uterine growth for weeks of gestation ￭ Polyhydramnios

Answer 19

￭ Palpation of more small or large parts than expected ￭ Asynchronous fetal heartbeats or more than one fetal electrocardiographic tracing ￭ Ultrasound evidence of more than one fetus

Answer 20

￭ more frequent visits. ￭ amount of weight gained. ￭ nutritional intake observed. ⚬ Uterine distention can cause severe backache

Answer 21

￭ finances ￭ space ￭ workload ￭ woman’s and family’s ability to cope ⚬ Lifestyle changes may be necessary ⚬ National organizations available for support

Answer 22

⚬ Assist individuals and their families to make informed, safe decisions about childbirth ⚬ Assist to sort out reliable information from online sources ⚬ Assist to comprehend the long-lasting effects an empowering birth experience can have ⚬ Ideally this begins in the preconception period

Answer 23

Energy Needs - assessment of weight gain assess whether kcal intake is adequate. This is important determinant of fetal growth! * Poor weight gain associated with low birth weight infants and preterm birth. * Excessive weight gain may lead to macrosomia and other complications. If starting at a normal weight: Should gain 11.5 to 16 kg (25 to 35 lbs) * First trimester: 1-2 kg/2-4 pounds total * Second and third trimester: 0.4 kg per week/1 pound per week

Answer 24

* Folate –600 mcg *Women with history of baby with Neural tube defect 4 mg (4,000 mcg) folic acid daily

Answer 25

* Iron –27 mg –Pregnant women are at-risk for physiologic anemia of pregnancy –The nurse should educate the patient about iron supplementation (dark stools, take with vitamin C, avoid dairy or taking with Ca, etc)

Answer 26

*Strict vegan vegetarians should supplement vitamin B12 *Important to consider whether proteins are “complete” *Those that avoid dairy should ensure adequate calcium intake *Fe and zinc may be less well-absorbed from plant sources

Answer 27

* Passenger - fetus and placenta * Passageway - birth canal * Powers - primary and secondary * Position of the laboring woman * Psychologic response

Answer 28

* Fetus ⚬ Head ￭ Size, bones, sutures, fontanels ⚬ Presentation ￭ The part of the fetus that enters the pelvin inlet first and leads through the birth canal during labor ⚬ Lie ￭ Relation of the long axis (spine) of fetus to the long axis of mother ⚬ Attitude ￭ Relation of the fetal body parts to one another ⚬ Position ▪ The relationship of a reference point on the presenting part to the four quadrants of the mother’s pelvis

Answer 29

1. Vertex (head down) 2. Breech (buttocks down) 3. Shoulder (transverse)

Answer 30

* Station - relationship of presenting part to maternal ischial spine and degree of descent of presenting part of fetus * Engagement - indicates the largest transverse diameter of the presenting part has passed through the maternal pelvic brim or inlet, into the true pelvis

Answer 31

* The passageway consists of the maternal pelvis and its soft tissues. ⚬ The bony pelvis is more important to the outcome of labor, because the bones and joints do not readily yield to the forces of labor. ⚬ Softening of the cartilage linking the pelvic bones increases as term approaches and the hormone relaxin increases.

Answer 32

* Primary ⚬ Uterine contractions (effacement and dilation) * Effacement - shortening and thinning of cervix * Dilation - enlargement or widening of the cervical opening and the cervical canal ￭ First stage of labor - through dilation ￭ Uterine contractions are the primary forces moving the fetus through the maternal pelvis * Secondary ⚬ Bearing down efforts (after full dilation) ￭ Second stage of labor - dilation through birth ￭ Voluntary pushing efforts propel the fetus through the pelvis. ￭ Ferguson reflex - stretch receptors cause release of oxytocin, triggers urge to bear down

Answer 33

⚬ Position affects woman’s anatomic and physiologic adaptations to labor ⚬ Frequent changes in position ￭ Relieve fatigue ￭ Increase comfort ￭ Improve circulation ⚬ Laboring women should be encouraged to find positions most comfortable to them ￭ Upright: often most helpful for descent ￭ “All fours” ￭ Lithotomy ￭ Semirecumbent ￭ Lateral

Answer 34

* Crucial aspect of childbirth. * Marked anxiety, fear, or fatigue decreases a woman's ability to cope with labor pain. * Maternal catecholamine secreted in response to anxiety or fear. ⚬ Inhibit uterine contractility and placental blood flow. * Relaxation augments the natural process of labor.

Answer 35

* Signs preceding labor ￭ Braxton Hicks contractions * watch out for dismissing contractions that may truly be causing cervical change ￭ Lightening or dropping ￭ Increase in clear and nonirritating vaginal secretions ￭ "Bloody show" ￭ Energy spurt ￭ Small weight loss - 0.5-1.5 kg * Onset of labor ⚬ Onset of true labor cannot be ascribed to single cause ￭ Factors include changes in maternal uterus, cervix, and pituitary gland ￭ Typically determined by cervical change

Answer 36

* First stage ⚬ Latent Phase ⚬ Active Phase * Second stage ⚬ Latent Phase ⚬ Active Phase * Third stage * Fourth Stage

Answer 37

* First stage ⚬ Onset of contractions to full dilation of the cervix ⚬ Latent Phase ￭ Onset of labor, characterized by regular, painful uterine contractions that cause cervical change to the beginning of the active phase ￭ More progress in effacement of cervix and little increase in descent. ⚬ Active phase ￭ Period during which the greatest rate of cervical dilation occurs, begins at 6 cm and ends with complete cervical dilation at 10 cm ￭ More rapid dilation of cervix, increase rate of descent on presenting part

Answer 38

* Second stage ⚬ Full dilation to birth ⚬ Latent Phase ￭ Passive fetal descent ⚬ Active Phase ￭ Pushing phase - laboring down/bear down ⚬ Mechanism of birth: vertex presentation ￭ Birth of head ￭ Birth of shoulders ￭ Birth of body and extremities ⚬ Nurse must be alert for signs of impending birth ￭ “The baby’s coming” ￭ Grunting sounds ￭ Bearing down ￭ Check the perineum

Answer 39

* Third stage ⚬ Birth of the fetus until delivery of the placenta ⚬ Placental separation and expulsion ￭ Firmly contracting fundus ￭ Change in shape of uterus from a discoid to globular ￭ Sudden gush of dark blood from introitus ￭ Apparent lengthening of umbilical cord ￭ Vaginal fullness

Answer 40

* Fourth stage ⚬ Delivery of the placenta and until the woman’s condition is stable ￭ Typically 2 hours after giving birth ⚬ Assessment ⚬ Post anesthesia recovery ⚬ Care of the new mother ⚬ Care of the family

Answer 41

⚬ Turns and adjustments necessary in human birth process ⚬ Seven cardinal movements of mechanism of labor - occur in vertex presentation ￭ Engagement ￭ Descent ￭ Flexion ￭ Internal rotation ￭ Extension ￭ Restitution and external rotation ￭ Expulsion (birth)

Answer 42

* Neurologic origins ⚬ Visceral pain: from cervical changes, distention of lower uterine segment, and uterine ischemia ￭ Located over lower portion of abdomen * Referred pain: originates in uterus, radiates to abd. wall, lumbosacral area of back, iliac crests, gluteal area, down thighs, lower back ￭ First stage of Labor ⚬ Somatic pain: pain described as intense, sharp, burning, and localized ￭ Stretching and distention of perineal tissues and pelvic floor to allow passage of fetus from distention and traction on peritoneum and uterocervical supports during contractions and lacerations of soft tissue

Answer 43

⚬ Physiologic factors ⚬ Culture ⚬ Anxiety ⚬ Previous experience ￭ Early labor may be more painful for nullips ⚬ Gate-control theory of pain ￭ Hypnosis, childbirth prep ⚬ Comfort and support ⚬ Environment ￭ People and tone in the room

Answer 44

* Nonpharmacologic measures often simple, safe, few adverse reactions, and inexpensive * Provide sense of control over childbirth * Methods require practice for best results (classes) * Try variety of methods and seek alternatives, including pharmacologic methods, if measure used is not effective

Answer 45

* Alternative therapies ⚬ Relaxation ⚬ Imagery and visualization ⚬ Breathing techniques ⚬ Effleurage and counterpressure ⚬ Touch and massage ⚬ Applications of heat and cold ⚬ Acupressure and acupuncture ⚬ Transcutaneous electrical nerve stimulation ⚬ Water therapy (hydrotherapy) ⚬ Intradermal water block ⚬ Aromatherapy ⚬ Hypnosis ⚬ Biofeedback ⚬ Music

Answer 46

* Should be implemented before pain becomes so severe that catecholamines increase and labor is prolonged * Combinations of pharmacologic and nonpharmacologic measures increased pain relief and create a more positive birth experience * Sedatives ⚬ Relieves anxiety and induce sleep * Analgesia and anesthesia ⚬ Anesthesia ￭ Rids pain perception by interrupting nerve impulse to the brain ⚬ Systemic analgesia ￭ Alleviates sensation of pain or raises threshold for pain perception without LOC

Answer 47

* Opioid (narcotic) agonist analgesics ⚬ Stimulate major opioid receptors - create a feeling of euphoria ￭ meperidine (Demerol) (rare now) * Crosses placenta, can cause prolonged neonatal sedation/respiratory depression and neurobehavioral changes * Metabolite related effects not reversible with naloxone ￭ fentanyl (Sublimaze) (common) * Rapid onset, short half life, short duration * Commonly given by PCA, epidural

Answer 48

* Opioid (narcotic) agonist-antagonist analgesics ⚬ Agonist activates/stimulates receptor to react ⚬ Agonist block a receptor/medication designed to activate a receptor ⚬ Ceiling effect for respiratory depression, increased dose doesn’t cause additional resp. depression ￭ butorphanol (Stadol) ￭ nalbuphine (Nubain) ￭ IM, IV, SubQ ⚬ Contraindicated for women with opioid dependence --> can cause withdrawal in mother and baby * Rapid onset, short half life, short duration

Answer 49

⚬ Consent ⚬ Timing of administration ⚬ Prep for procedures ⚬ Administration fine skills: IV, IM, Regional * IV medication administration ⚬ Given slowly ⚬ Small amounts ⚬ During a contraction or over a period of three to five consecutive contractions ⚬ Naloxone (Narcan) is your antidote ￭ Can reverse most CNS depressant effects (opioid induced resp. depression) ￭ IV, IM, intranasal

Answer 50

⚬ Local perineal infiltration anesthesia ⚬ Pudendal block (rare now) ⚬ Regional analgesia (Epidural) - some pain relief and motor block ⚬ Regional anesthesia (Spinal) - complete pain relief and motor block

Answer 51

o Disadvantages/Side Effects: ￭ Hypotension ￭ Itching ￭ Headache ￭ Inadequate pain relief ￭ Ineffective pushing ⚬ Contraindications: ￭ Hemorrhage ￭ Hypotension ￭ Coagulopathy ￭ Infection at injection site ￭ Allergy to anesthetic drug ￭ Maternal refusal or inability to cooperate

Answer 52

￭ “Laughing gas” ￭ Used extensively in other countries ￭ Increasing popularity in the United States as an alternative ￭ Safe for mother and fetus ￭ Self-administered ￭ Side effects: nausea and dizziness

Answer 53

* Fetal response ⚬ Labor is a period of physiologic stress for fetus ⚬ Frequent monitoring of fetal status is part of nursing care during labor ⚬ Fetal oxygen supply must be maintained during labor to prevent fetal compromise and promote newborn health after birth * Electronic fetal monitoring EFM) ⚬ Visualizing fetal heart rate (FHR) patterns on monitor screen or printed tracing

Answer 54

Fetal Response * Fetal oxygen supply can decrease: ⚬ Reduction of blood flow through maternal vessels ￭ Maternal hypertension: chronic or pregnancy-induced ￭ Hypotension ￭ Hypovolemia ⚬ Reduction of oxygen content in maternal blood as result of hemorrhage or severe anemia ⚬ Alterations in fetal circulation with compression of umbilical cord ⚬ Reduction in blood flow to intervillous space in placenta

Answer 55

* Intermittent auscultation (IA) ⚬ Listening to fetal heart sounds at periodic intervals to assess FHR ⚬ IA can be performed with: ￭ DeLee-Hillis fetoscope ￭ Pinard stethoscope ￭ Doppler ultrasound device

Answer 56

* Electronic fetal monitoring ⚬ Assess the adequacy of fetal oxygenation during labor ⚬ Anticipated effect - decrease cerebral palsy; however rate was not declined ⚬ Primary mode of intrapartum assessment in the U.S. * External monitoring ⚬ FHR: ultrasound transducer ⚬ UCs: tocotransducer ⚬ Wireless monitoring * Internal monitoring (invasive, membranes must be ruptured first!) ⚬ FHR: Spiral electrode ⚬ UCs: intrauterine pressure catheter - IUPC (transducer)

Answer 57

* Baseline fetal heart rate ￭ Normal is 110-160 ￭ Average rate during 10-minute segment ￭ Excludes: periodic or episodic changes, periods of marked variability, and segments of the baseline that differ by more than 25 beats/min ⚬ Baseline FHR variability ￭ Irregular waves or fluctuations in baseline FHR during two cycles per min or greater ⚬ Tachycardia ￭ Baseline FHR >160 beats/min for 10 min or longer ⚬ Bradycardia ￭ Baseline FHR <110 beats/min for 10 min or longer

Answer 58

* Periodic and episodic changes in FHR ￭ Periodic changes - occurs with UCs ￭ Episodic changes - not with UCs ⚬ Accelerations ￭ Visually apparent, abrupt increase in FHR above the baseline rate ￭ Onset to peak <30 seconds ⚬ Decelerations ￭ Early decelerations - in response to fetal head compression ￭ Late decelerations - uteroplacental insufficiency ￭ Variable decelerations - umbilical cord compression ￭ Prolonged decelerations

Answer 59

* Electronic fetal monitoring pattern recognition and interpretation ⚬ Categorizing FHR tracings ⚬ Standards set by ACOG and AWHONN ⚬ Nursing management of abnormal patterns ⚬ RNs must be certified every 2 years * Other methods of assessment and intervention ⚬ Assessment techniques ￭ Fetal scalp stimulation ￭ Vibroacoustic stimulation ￭ Umbilical cord acid-base determination ￭ Fetal scalp blood sampling

Answer 60

* True vs False labor * Begins with onset of regular uterine contractions ⚬ Ends with full cervical effacement and dilation ⚬ Three phases: ￭ Latent phase: up to 3 cm dilation ￭ Active phase: 4-7 cm dilation ￭ Transition phase: 8-10 cm dilation * Care Management ⚬ Nulliparous women seek admission during latent phase ⚬ Multiparous women do not usually come to hospital or birth center until active phase ⚬ Care givers can strongly influence lingering impressions of childbirth experience * EMTALA - Emergency Medical Treatment and Active Labor Act ⚬ Federal regulation enacted to ensure that women receives emergency treatment/ labor care ⚬ Nurses must be familiar with their responsibilities ⚬ Agencies must have policies and procedures in place to ensure compliance

Answer 61

⚬ Physical examination ￭ General systems assessment ￭ Vital signs ￭ Leopold maneuvers ￭ Assessment of fetal heart rate (FHR) and pattern ￭ Assessment of uterine contractions ￭ Vaginal examination ⚬ Laboratory and diagnostic tests ￭ Urine specimen ￭Blood tests ￭ Assessment of amniotic membranes and fluid ￭ Infection

Answer 62

* Nursing interventions ⚬ General hygiene ⚬ Nutrient / fluid intake ￭ Oral intake ￭ IV intake ⚬ Elimination ￭ Voiding ￭ Catheterization ￭ Bowel elimination ⚬ Ambulation and positioning

Answer 63

⚬ Labor support by the: ￭ Nurse ￭ Father/partner ￭ Doulas ￭ Grandparents ￭ Siblings ⚬ Emergency interventions ￭ Change position to left or right lateral ￭ Administer IV bolus (usually 250 ml) ￭ Turn off Pitocin (oxytocin) ￭ Consider O2 10L non-breather mask ￭ And then...call the MD/midwife (if not already there)

Answer 64

⚬ Begins with full cervical dilation (10 cm) and complete effacement (100%) ￭ Ends with baby’s birth ⚬ Median duration is 50 min in nulliparous ￭ 30 min in multiparas * Two phases: ⚬ Latent phase: period of rest and relative calm ￭ “Delayed pushing, laboring down or passive descent” ⚬ Active pushing phase: strong urge to bear down as presenting part presses on the stretch receptors of pelvic floor

Answer 65

* Preparing for birth ⚬ Maternal position ⚬ Bearing-down efforts ⚬ FHR and pattern ⚬ Support of father or partner ⚬ Supplies, instruments, and equipment * Birth in delivery or birthing room * Mechanism of birth: Vertex presentation ⚬ Management of Nuchal cord

Answer 66

* Immediate assessments and care of the newborn * Perineal trauma related to childbirth ⚬ Perineal lacerations ￭ First degree tear - laceration confined to the skin ￭ Second degree tear - laceration extends into perineal body ￭ Third degree tear - involves injury to the external anal sphincter ￭ Fourth degree tear - extends completely through the anal sphincter and rectal mucosa ⚬ Vaginal and urethral lacerations ⚬ Cervical injuries ⚬ Episiotomy * Emergency childbirth

Answer 67

* Care management * Placental separation and expulsion ⚬ Firmly contracting fundus ⚬ Change in shape of uterus ⚬ Sudden gush of dark blood from introitus ⚬ Apparent lengthening of umbilical cord ⚬ Vaginal fullness * Provider examines the placenta and membranes for intactness

Answer 68

* Retained placenta is an obstetric emergency!! Can be caused by: ⚬ Uterine anomalies ⚬ Trapped by the cervix ⚬ Hormonal - adrenaline is released into the blood (a hormone released into the blood during “fight or flight” response), oxytocin release can be inhibited and therefore prevent the uterus from contracting. * Nurse needs to observant and responsive

Answer 69

* Begins with the expulsion of the placenta and lasts until the woman is stable in the immediate postpartum period ⚬ Usually 1-2 hours after birth * Care management * Assessment ⚬ Postanesthesia recovery * Nursing interventions ⚬ Care of the new mother ⚬ Care of the family ⚬ Family—Newborn relationships

Answer 70

* Birth of fetus through a transabdominal incision of uterus ⚬ Most commonly performed surgical procedure * Preserve life or health of mother and her fetus * Indications ￭ Maternal - specific cardiac disease ￭ Fetal - nonreassuring fetal status, malpresentation, active maternal herpes infection ￭ Maternal-fetal - failure to progress, placental abruption, placenta previa, history of previous c/sec, c/s per maternal request * Elective cesarean birth (“forced” C/Sec) * Planned or unplanned * Surgical techniques (skin incision may not “match” uterine incision) ⚬ Vertical ⚬ Transverse

Answer 71

* Anesthesia - Spinal, epidural or general * Preoperative care ⚬ NPO 8 hours prior (if planned) ￭ Clear liquids up to 2 hours prior to surgery ⚬ Blood test 1-2 days prior * Intraoperative care ⚬ Allowing the woman and/or partner choose music during procedure ⚬ Implementing skin-to-skin care and breastfeeding in operating room (if able to) * Immediate postop care ⚬ BP and pulse every 15 min for 2 hours or longer if complications arise

Answer 72

* Nursing Care ⚬ Be alert to a woman’s physiologic needs, managingcare to ensure adequate rest and pain relief. ⚬ Daily care: ￭ Perineal ￭ Breast ￭ Routine hygienic * Discharge teaching

Answer 73

pregnancy tests

Answer 74

￭ Stimulates maternal metabolism to supply needed nutrients for fetal growth. ￭ Increases the resistance to insulin * Facilitates glucose transport across the placental membrane ￭ Stimulates breast development * Prepares for lactation- 2nd trimester

Answer 75

endometrium

Answer 76

first pregnancy

Answer 77

pregnant more than once

Answer 78

never given birth

Answer 79

given birth once

Answer 80

Given birth more than once

Answer 81

Gravidity: # of pregnancies ever Term: Births 37 weeks – 41 weeks and 6 days Preterm: Births 20 – 37 weeks Abortion: Loss of pregnancy < 20 weeks Living: # of living children

Answer 82

-Stimulates production of estrogen and progesterone (up to 8 weeks) -Hormone identified on pregnancy test (detected 7-8 days after conception)

Answer 83

-Maintains pregnancy -Prevents uterine contractions

Answer 84

-Production of milk -Lactation is inhibited during pregnancy d/t high levels of estrogen and progesterone

Answer 85

-Initiation of labor -Stimulates uterine contractions -Stimulates let-down reflex

Answer 86

HR may increase (10-15 bpm) Know pre-pregnancy BP BP usually drops until week 22-24 Supine hypotensive syndrome Increased venous pressure: edema, varicosities, hemorrhoids Increased thromboembolic risk

Answer 87

O2 consumption increases Nasal congestion & epistaxis possible r/t increased estrogen

Answer 88

Heavier kidney workload Increased risk of bladder infection Proteinuria: preeclampsia Glucosuria: diabetes Ketones: inadequate fluid/food, strenuous exercise

Answer 89

Alteration is taste and smell Constipation: increasing uterus puts pressure and decrease GI motility OR poor appetite Hemorrhoids

Answer 90

Vagina & Vulva become more sensitive Vaginal discharge (leukorrhea): provides lubrication and prevents infection Breasts enlarge, areola darkens, increase blood supp

Answer 91

Rises very high in abdomen Palpable by 12 weeks

Answer 92

Shorter, more elastic, larger diameter Thick mucous plug expelled when dilation begins Chadwick’s sign: violet discoloration (@ 6 weeks) Goodell sign: softening of the cervix

Answer 93

Increased pigmentation Linea Nigra Chloasma (melasma) Striae Gravidarum Vascular Spider Nevi

Answer 94

Amenorrhea – absence of period N/V Breast Fullness Increase urinary frequency Quickening – mom feels the baby move Fatigue *felt by patient

Answer 95

Positive pregnancy test (hCG - blood or urine) Uterine enlargement Chadwick’s/Goodell/Hegar sign Braxton Hicks *observed by practitioner or patient (home pregnancy test)

Answer 96

Fetal heart rate (doppler transducer) Outline of fetus on US Active fetal movements * Observed by practitioner

Answer 97

– 3 months + 7 days + 1 year

Answer 98

malformations

Answer 99

Folic Acid Supplementation: decrease neural tube defects Green leafy vegetables Whole grains Fruits Liver Beans Fortified cereals/breads/pastas

Answer 100

Expected weight gain: 25-35 lb Additional 300 cal/day during pregnancy Additional 500 cal/day during breastfeeding 8-10 (8oz) glasses fluid (preferably more that 50% water) Protein: helps with fetal growth Calcium: dairy, legumes, sardines

Answer 101

Protein: 70 g Growth of tissue | meats, eggs, cheese, yogurt Fiber: 28 g Healthy GI | whole grains, vegetables, fruits Water: 3 L Blood volume, excretion | water, milk, juice

Answer 102

Iron: 30 mg Hemoglobin | meats, enriched grains, breads, dark leafy greens Folate: 600 mcg Neural Tube Defects | fortified cereal/grains, dark leafy greens, oranges Calcium: 1000 mg Fetal and maternal skeleton | dairy, sardines, dark leafy greens

Answer 103

Passenger*: fetus Passageway: birth canal Powers: contractions (primary) & bearing down (secondary) Position: of the laboring mother (all fours, upright etc.) Psychological Response: state of the woman

Answer 104

Cervical dilation is complete > Delivery of fetus Increase in bloody show Urge to push Latent phase: laboring down Active phase: pushing Transition: presenting part is on the perineum Assess fetal HR throughout contraction

Answer 105

Separation of placenta > Expulsion of placenta

Answer 106

Physical recovery

Answer 107

Counterpressure can relieve back pain Massage as tolerated Narcotics: not the go to but may be used, when is best? Support System: Doula Nerve Blocks

Answer 108

Tocotransducer: contraction Ultrasound transducer: FHR

Answer 109

Variable deceleration Early deceleration Acceleration Late acceleration Cord compression Head compression Okay! Placental insufficiency Maternal repositioning Identify labor progress None Execute interventions

Answer 110

a. amenorrhea. Amenorrhea is a presumptive sign of pregnancy. Presumptive signs of pregnancy are felt by the woman. A positive pregnancy test, the presence of Chadwick's sign, and the presence of Hegar's sign are all probable signs of pregnancy.

Answer 111

b. Slightly above the symphysis pubis In normal pregnancies, the uterus grows at a predictable rate. It may be palpated above the symphysis pubis sometime between the 12th and 14th weeks of pregnancy. As the uterus grows, it may be palpated above the symphysis pubis sometime between the 12th and 14th weeks of pregnancy. The uterus rises gradually to the level of the umbilicus at 22 to 24 weeks of gestation.

Answer 112

d. Striae gravidarum

Answer 113

attitude Attitude is the relation of the fetal body parts to one another. Lie is the relation of the long axis (spine) of the fetus to the long axis (spine) of the mother. Presentation refers to the part of the fetus that enters the pelvic inlet first and leads through the birth canal during labor at term. Position is the relation of the presenting part to the four quadrants of the mother's pelvis.

Answer 114

b. the cervix is 3 cm dilated, it is effaced 30%, and the presenting part is 2 cm above the ischial spines.

Answer 115

belly button

Answer 116

* Complete blood count (CBC) * Blood type. * Urinalysis. * Urine culture. * Rubella. * Hepatitis B and hepatitis C. * Sexually transmitted infections (STIs) * Human immunodeficiency virus (HIV)

Answer 117

Bleeding & Leaking of fluid

Answer 118

* First degree: Laceration that is confined to the skin * Second degree: Laceration that extends into the perineal body * Third degree: Laceration that involves injury to the external anal sphincter muscle * Fourth degree: Laceration that extends completely through the anal sphincter and the rectal mucosa

Answer 119

counterpressure

Answer 120

Massage, aromatherapy, hypnosis, and acupressure can be acceptable non pharmacological pain remedies.

Answer 121

decreased BP

Answer 122

* Turn the patient * IV Bolus * Turn off Pitocin if it is being used * Apply Oxygen 8-10 liters by face mask (last resort) AND then * Inform the provider * Do not wait for a provider to OK these interventions!

Answer 123

dilation, effacement

Answer 124

variability

Answer 125

fetal sleep cycle.

Answer 126

ruptured membranes

Answer 127

position changes, IV fluid bolus, turn off the Pitocin, give a tocolytic like terbutaline, or as a last resort, oxygen by non-rebreather mask)