WH Final Review Flashcards
A substance which causes damage to a pregnancy leading to physical or functional defects
Teratogen
ETOH, cocaine, radiation, hyperthermia, malnutrition, hyperglycemia, thyroid disorders, rubella, herpes, syphilis, toxoplasmosis
Examples of teratogens
creating of the zygote
Conception
Conception - week 2
Day 5: blastocyst (able to implant)
Pre-embryonic stage
implantation- week 8
Pregnancy most vulnerable to teratogens at this stage
Spontaneous abortion is common due to chromosomal errors
Week 3: neural tube fuses at the center and heart beings to beat, visible on ultrasound
Embryonic stage
Week 9 and onward
Fetal stage
Uterus enlarges, menstrual cycles cease, cervix softens and enlarges, cervix, vaginal and labia may have purple-blue discoloration. Breasts enlarge, areola may darken. Blood volume increase by 50%, blood vessels dilate, diastolic drops mid pregnancy (24-32 weeks) and then returns to normal. Heart rate and cardiac output increase. Supine hypotensive syndrome. Respirations may increase slightly. Posture changes, lordosis increases, joints relax later in pregnancy. Skin changes: striae gravidarum, chloasma, linea nigra. Hair grows longer and thicker. Diastasis recti may form in third trimester. Reduced peristalsis. Metabolic rate increases. White blood cell count increases. Increase in fibrinogen and other blood clotting factors.
Maternal physiologic changes
fetal movement begins
9-12 weeks
lungs begin to form surfactant
26 weeks
gas exchange in the lungs may be possible
28 weeks
enough surfactant to support lung function
35-40 weeks
Eat crackers and toast before getting out of bed. Avoid an empty stomach; spicy, greasy of gas-forming foods. Encourage fluids between meals
Comfort measures for nausea and vomiting
Wear a supportive bra
Comfort measures for breast tenderness
Encourage adequate rest including naps
Comfort measures for fatigue
Eat small frequent meals, use antacids as recommended by a provider, sit upright after eating
Comfort measures for heartburn
Increase fluid, increase fiber intake, exercise regularly
Comfort measures for constipation
Void frequency. Decrease fluid intake before bedtime. Perform kegel’s exercises. Reinforce usual recommendations to reduce risk of UTI: void after coitus, void frequently, cleanse perineal area from front to back, avoid bubble baths, wear cotton underwear, avoid tight fitting pants, increase fluid intake
Comfort measures for increased urinary frequency (especially first and third trimesters) and risk of UTI
Avoid sudden movements
Comfort measures for round ligament pain
Warm sitz bath, witch hazel pads, topical hemorrhoid ointments
Comfort measures for hemorrhoids
Exercise regularly, perform pelvic tilt exercises, use proper body mechanisms (use your legs!)
Comfort measures for backache
Maintain good posture, sleep with extra pillows, report worsening symptoms
Comfort measures for shortness of breath
Doriflex the foot on affected leg, extend the leg and dorsiflex if possible, apply heat
Comfort measures for leg cramps
Elevate hips and legs while resting. Avoid constricting clothing. Wear support hose. Avoid prolonged sitting or standing. Avoid crossing legs while sitting. Sleep in left-lateral position. Maintain moderate exercise.
Comfort measures for varicose veins and lower extremity edema
Use humidifier, saline nose drops or spray
Comfort measures for nasal congestion and epistaxis (nosebleed)
Acute nausea and vomiting in pregnancy leading to weight loss, dehydration, malnutrition and electrolyte imbalances. For some women this lasts throughout entire pregnancy. Cause of most first trimester pregnancy hospitalizations and a large portion of later pregnancy hospitalizations
Hyperemesis gravidarum
Evaluate for: Weight loss
Ketonuria
Dry mucous membranes
Skin tenting
Hyperemesis gravidarum Nursing Interventions
Pregnancy loss before 20 weeks, generally due to chromosomal abnormalities. 20%-50% of all pregnancies. Reduces to 6% at 6 weeks gestational age. Women may need emotional support, feel guilt, have conflicting feelings, may or may not grieve, and often have anxiety about future pregnancy outcomes
Spontaneous abortion/miscarriage
Bleeding, cramping, passing tissue, loss of early pregnancy symptoms
Spontaneous abortion/miscarriage S/S
Ovum implants in the fallopian tubes or abdominal cavity. Incompatible with successful outcome. As ovum grows, the fallopian tube can rupture, often leading to internal hemorrhage and one sided intense abdominal pain. This requires immediate surgical management with the loss of the affected tube. Identification of an ectopic before a tube ruptures may be managed by surgical removal or medical treatment with methotrexate to dissolve the pregnancy
Ectopic pregnancy
Slowly rising hCH levels. Absence of expected pregnancy in uterus. One sided abdominal pain. Vaginal bleeding.
Ectopic pregnancy S/s
This happened prior, pelvic infection, pelvic surgery, advanced maternal age, smoking, IUD in place, history of gonorrhea or chlamydia (especially if associated with pelvic inflammatory disease)
Increased risk of repeat and infertility
Risk factors for ectopic pregnancy
Nagele’s rule
LMP - 3 months + 7 days = EDD
Only works with 28 days menstrual cycles
After 14 weeks. Transabdominal needle into amniotic sac. Sample of amniotic fluid can be tested for AFP level and fetal DNA analysis
Administer Rhogam after procedure if mother is R negative
Amniocentesis
Risks: Bleeding, infection, preterm labor, or rupture of membranes
Risks of amniocentesis
10-13 weeks. Transvaginal or transabdominal needle into placental bed. Sample of chorionic villi can be tested for genetic disorders.
Administer Rhogam after procedure if mother is Rh negative
Chorionic villus sampling (CVS)
Risks: Bleeding, fetal limb loss, miscarriage, infection, rupture of membranes
Risks for Chorionic villus sampling (CVS)
Help for nausea, cravings, food aversions (first trimester). Weight gain expectations (25-35lbs). Caloric need increases (340 cal/day, increase to 452 cal/day third trimester)
Avoidance of mercury contaminated seafood, undercooked meat, highly-processed “food products”, soft cheeses, cold cuts and hot dogs, non-pasteurized mild products, alcohol. Limit caffeine intake, increase protein. Prenatal vitamins and DHA supplements recommended generally. If not taking a prenatal vitamin, encourage intake of folic acid 400mcg/day
Nutrition in pregnancy
Avoid supplements and medications unless approved. Review OTC medications considered safe for common discomforts. Exercise and sexual activity recommendations: maintain routine exercise unless extreme training or risk of injury/trauma, may introduce 30 min moderate exercise daily (unless advised otherwise), sexual intercourse is safe unless high risk for preterm labor or bleeding is present, HSV transmission precautions. Hydrate 8-10 glasses of water. Avoid overheating, hot tubs and saunas
Teaching points in pregnancy
The maternal blood type and antibody screen (indirect Coombs test) are determined upon presentation to care. RH- mothers may react to fetal Rh+ blood and develop antibodies to the Rh factor (isoimmunization). The greatest risk for this exposure is at delivery. Future pregnancies can then be attacked by the maternal immune system if that fetus is Rh+, this can lead to fetal hydrops or hemolytic disease of the newborn (fetal anemia, jaundice, hydrops and heart failure).
A blood product that cloaks the Rh+ marker on fetal cells and prevents exposure and isoimmunization
Cannot reverse prior isoimmunization
Is given to Rh- mothers with any pregnancy loss, abdominal trauma, invasive uterine procedure in pregnancy, or following delivery
Is also given at 28 weeks to Rh- mothers to prevent isoimmunization in late pregnancy
Lasts 12 weeks
Babies can be tested with the direct Coomb’s test which would identify maternal antibodies attached to their RBCs. This is normally done after birth from a cord blood sample.
Rhogam and RH factor
rhythmic contractions resulting in progressive dilation
First stage of labor
0-3cm
Latent labor
4-7cm
Active labor
8-10cm
Transition labor
Pushing and delivery of infant. Women usually notice rectal pressure or an urge to push. Exam must confirm full dilation before pushing. Can last from 20 min (or less!) to 3 (or more) hours. Nursing care is focused on coaching pushing efforts and monitoring FHR
Second stage of labor
Delivery of the placenta. A gush of blood may signal that the placenta has separated and is ready to deliver. Failure of continued contracting is termed uterine atony: primary cause of postpartum hemorrhage. Close assessment of uterine tone and ongoing bleeding is essential, at least every 15 mins. Normal blood loss at a vaginal delivery is 500 mL. Nursing care is focused on uterine tone, maternal VS and bleeding
Third stage of labor
Recovery, maternal stabilization of vital signs and bleeding. Uterine involution occurs here. Urinary retention can increase uterine atony; monitor return of bladder function and encourage voiding. The first attempt to stand or ambulate to the bathroom should be attempted when sensation has returned and vitals are stable; women are often syncopal. Closely monitor after a vaginal delivery for 2 hours, VS q 15 min
Fourth stage of labor