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215 Cards in this Set
- Front
- Back
What is the recommended amount of weight an underweight mother should gain during pregnancy?
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28-40 lb
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What is the recommended amount of weight an overweight mother should gain during pregnancy?
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15-25 lb
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The recommended amount of weight for a normal weight mother should gain during pregnancy is 25-35 pounds, with ____ to _____ pounds gained in the first trimester and one pound a week thereafter.
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2-4 lb
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What is the ideal weight gain range for a woman who is 25 weeks pregnant?
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14-16 lb
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What is the ideal weight gain range for a woman who is 31 weeks pregnant?
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20-22 lb
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True or False? A pregnant woman who is vegan may be deficient in vitamin B12
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True
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A lactoovo-vegetarian who is pregnant may need not have adequate _______ and ______.
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Zinc & Iron
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True or False? During lactation, a women needs 500 calories less than during pregnancy.
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False: Need 500cal MORE
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Many Recommended Dietary Allowances (RDAs) increase during lactation or stay the same as the pregnancy amount. Name one element whose intake is recommended to be less than the pregnancy amount.
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Iron
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True or False? There is no difference in the recommended daily intake of calcium between a non-pregnant woman and a pregnant woman.
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True
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The inability to digest milk sugar caused by the absence of the lactase enzyme in the small intestine is called ________________.
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Lactose intolerance
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True or False? Urine pregnancy tests are less expensive and provide faster results than serum pregnancy tests.
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True
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What is the biologic marker that pregnancy tests are based on (abbreviation and full name)?
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HCG Human Chorionic Gonadotropin
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A woman who is pregnant for the first time
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Primigravida
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Any pregnancy, regardless of duration, including present pregnancy
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Gravida
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A woman who has never been pregnant
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Nulligravida
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Beginning of 38th week to end of 41st week
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Term
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A woman who has had two or more births at more than 20 weeks gestation
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Multiparous
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Delivery that occurs after 20 weeks but before the completion of the 37th week
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Preterm
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Weeks 14-26 of the pregnancy
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2nd trimester
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Use the 5 digit system to describe the obstetric history for Angela who is 6 weeks pregnant. Her previous pregnancies resulted in the live birth of a daughter at 40 weeks of gestation, the live birth of a son at 38 weeks of gestation, and a miscarriage at 10 weeks of gestation
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42012
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Use the 5 digit system to describe the obstetric history for Constance who is pregnant for the fourth time. Her first pregnancy ended in a miscarriage at 12 weeks, the second resulted in the live birth of twin boys at 32 weeks, and the third resulted in the live birth of a daughter at 39 weeks.
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41113
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Your patient is at 28 weeks gestation, and her BP is 138/90 what is her Mean Arterial Pressure (MAP)? Is she at risk for PIH (pregnancy-induced hypertension)?
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138-90 = 48
48/3 = 16 16+90 = 106 2nd trimester Map should be < 90 so yes, Mom at risk! |
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An MAP > ______ in the third trimester is an indication of PIH.
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>102
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What signs are presumptive of pregnancy?
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Presumptive = Subjective
Amenorrhea Nausea & Vomiting Urinary frequency Breast tenderness Quickening |
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At which gestational age is quickening most likely to occur?
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16-20 wk
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What are the probable signs of pregnancy?
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Probable = Objective
Palpation for fetal outline Pregnancy test Ballottement Braxton Hicks contractions Enlargement of abdomen Changes in pelvic organs: - Chadwick's sign - Goodell's sign - Hegars's sign - Uterine enlargement |
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True or False? Presumptive signs of pregnancy are objective signs that are perceived by the examiner
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False: pre-s-umptive signs = subjective = said.
They are experences the woman reports (says). |
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Identify the type of pregnancy sign
(presumptive, probable, positive) Breast tenderness |
Presumptive
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Identify the type of pregnancy sign
(presumptive, probable, positive) Fetal heart tones detected during an ultrasound |
Positive/Diagnostic
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Identify the type of pregnancy sign
(presumptive, probable, positive) Chadwick sign |
Probable
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Identify the type of pregnancy sign (presumptive, probable, positive)
Quickening |
Presumptive
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Identify the type of pregnancy sign
(presumptive, probable, positive) Urinary frequency |
Presumptive
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Identify the type of pregnancy sign
(presumptive, probable, positive) Positive pregnancy test (serum) |
Probable
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Identify the type of pregnancy sign
(presumptive, probable, positive) Fetal movements visible |
Positive/Diagnostic
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Your patient is at 22 weeks gestation. Would you expect her to be complaining of “morning sickness”?
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No: N & V occurs between weeks 4-14
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The softening of the lower uterine segment that occurs between weeks 6-12 is called _____.
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Hegar's sign
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The softening of the cervical tip that occurs about the 5th week is called _____.
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Goodell's sign
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What are the two main hormones that are responsible for uterine growth?
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Estrogen & Progesterone
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While assessing the fundal height of your patient, you palpate the fudus almost at the umbilicus. The best estimate of gestation is:
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20-22 weeks
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Your pregnant patient has been complaining of difficulty breathing for weeks. Today she says she is able to breathe much easier, but now she has some pelvic pain. She is 38 weeks gestation. What is she most likely causing these changes?
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Lightening
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True or False? Low or high maternal MAP, contractions of the uterus, and the mother lying in the supine position can decrease blood to the uterus and decrease placental perfusion.
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True
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_____ is a diagnostic technique using internal palpation that can be done between wks 16 - 18. The floating fetus moves away when tapped or pushed and then returns to touch the examiner’s hand.
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Ballottement
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While examining your patient who is at 8 weeks gestation, you observe a violet-bluish color of the vaginal mucosa and cervix. Is this a normal finding?
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Yes, it is Chadwick's sign & is caused by increased vascularity.
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Your patient is 16 weeks pregnant and she tells you she is as “horny as a hound dog in heat”. What is the most appropriate response?
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Tell her that increased sexual interest is normal during the second trimester
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True or False? Because the vaginal secretions become more acidic during pregnancy, the risk of yeast infections decreases during pregnancy
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False: Risk of yeast infections increase during pregnancy.
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True or False? The operculum (mucous plug) acts as a barrier against bacteria during pregnancy.
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True
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Your primigravida patient calls and is upset about a whitish-gray mucoid discharge she is having. Is this normal? What is this called? What teaching would you do?
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Yes, this is normal. It is called Leukorrhea. Teach:
it is not preventable do not douche (ever) wear perineal pads wipe front to back call Dr. if accompanied by pruitus, foul odor or change in color or character |
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Bladder tone decreases as the pregnancy progresses. Does this allow the bladder to hold more or less urine?
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The woman holds MORE urine (decreased tone = bladder stretches out and holds more)
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Which position is the worst for renal function during pregnancy?
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Supine
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Why should diuretics be avoided during pregnancy?
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Diuretics decrease perfusion of the placenta
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Is it ok to have glucosuria during pregnancy?
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Yes. Only if it is a trace amt
Occurs when maternal glucose is <160mg/dl |
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Your patient has +2 proteinuria. Is this ok?
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No: proteinuria should only be present in trace to +1 levels
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Your patient is at 14 weeks gestation. Where would you expect to palpate the fundus?
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Just above pelvis/symphasis pubis (14 cm)
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What is the purpose for the changes to the body that occur during pregnancy?
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Changes protect the woman’s normal physiologic functions
Changes are required to meet metabolic demands Changes provide a nurturing environment for fetal growth and development |
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During pregnancy, what changes occur to blood volume? Why is this change needed?
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Blood volume increases 40-45 % (about 1500 mL).
1. To protect the mother by giving a reserve for delivery and postpartum (300-500 mL of blood is lost during delivery), and 2. to provide placental perfusion |
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Changes to the musculoskeletal system include loss of muscle tone due to the stretching of the abdominal muscles. What change occurs related to the center of gravity?
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Center of gravity shifts forward
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What is lordosis?
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Lordosis is an increase in the normal lumbosacral curve that occurs during pregnancy to help maintain balance
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Discuss changes to blood pressure during each trimester.
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Blood pressure usually stays at the pre-pregnancy level in the 1st trimester, drops during 2nd trimester due to vasodilation, and in the 3rd trimester returns to the same as the 1st trimester.
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What is physiological anemia?
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Physiological anemia occurs because the increase in plasma during pregnancy exceeds the increase in RBCs which causes hemodilution.
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What hemoglobin and hematocrit levels indicate true anemia?
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True anemia occurs when hemoglobin decreases to ≤10 and hematocrit decreases to <33.(norms for pre-pregnant: HgB 12-16; Hcrt 37-47)
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True or False? The reason for increased WBC production during the 2nd and 3rd trimester is to meet the increased oxygen demands of the fetus.
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False. White blood cells increase to build up protection against the risk of infection during delivery. Red blood cells increase to provide increased oxygen to the fetus
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True or False? Both coagulants and fibrinolytic activity increase during pregnancy.
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False. Coagulants increase but fibrinolytic activity decreases. (Fibrinolytics breakdown fibrin in clots)
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True or False? Cardiac output increases by as much as 30-50% by the 32nd week.
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True
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What is the most common & permanent integumentary change?
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Striae gravidarum "stretch marks"
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Use Nagele’s rule to calculate the EDD (estimated date of delivery) for a woman whose LMP (last menstrual period) was May 20, 2004.
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LMP = May 20
Subtract 3 months (or add 9 mon) Then add 7 days **Feb 27, 2005** |
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True or False? The first screening for gestational diabetes usually occurs at 12 weeks gestation
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False. Gestational diabetes screening is not usually done until 24-28 weeks.
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A glucose level above _________ mg/dl from the Glucola screening (O”Sullivan Lab) is considered positive and should be followed by a 3-hour oral glucose tolerance test.
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>140 mg/dl
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True or False? According to Rubin’s Safe Passage, a woman demonstrates Safe Passage in the first trimester by being concerned more for herself than the baby.
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True
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According to Rubin’s Safe Passage, in what trimester would you want to educate your patient about the signs of true labor vs. false labor?
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3rd trimester
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What is the purpose of a Nonstress test (NST)? Do you want the results to be reactive or nonreactive?
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A Nonstress test is done to observe the response of the fetal heart rate to activity (heart rate should increase when the baby is moving). You want results to be REACTIVE.
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What test is ordered if a patient’s NST is read Non-reactive? When would this test be done?
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Contraction Stress Test (CST). The same day as the NST.***(this is outdated, Dr.s now would do a biophysical profile but we need to know CST for NCLEX)
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True or False? You want the results of a CST to be negative which is indicated by 3 contractions in 10 minutes without late decelerations.
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True
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True or False? A good result to a fetal kick test is at least 3 movements in one hour.
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True
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Ultrasounds can be done anytime during a pregnancy. What is the main purpose for doing an ultrasound?
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Determining fetal age and due date.
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Amniocentesis may be done after week 14. What can be determined by amniocentesis?
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Genetic disorders or genetic anomalies
pulmonary maturity fetal hemolytic diseases |
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What nursing instructions should you provide to your patient after amniocentesis?
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Instruct patient to call if leaking, fever, or cramping occurs to rule out preterm labor, or if fetal movement decreases or is absent after test.
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An L/S ratio test may be done after the 35th week and is used to determine fetal lung maturity and if the infant can be safely delivered. What L/S ratio indicates lung maturity?
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2:1. (L/S study is completed with amniotic fluid from amniocentesis).
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A biophysical profile is usually done the same day as a nonreactive NST and gives more information about the fetus. List the 5 elements of a biophysical profile.
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Fetal breathing movement
Gross body movement Fetal tone Fetal heart rate Qualitative amniotic fluid volume |
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What are some danger signs in pregnancy?
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Chills and fever, Cerebral disturbances (headaches), Abdominal pain, Blurred vision, Elevated Blood pressure, Bleeding, Swelling around the eyes, Sudden escape of fluid (ruptured membranes)
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Your patient is complaining of nausea and vomiting during the first trimester. What advise would you give her?
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Have small frequent meals (every 2-3 h)
Take meals dry (don’t drink with meals, drink between meals) Eat dry crackers or toast before getting up in the morning Avoid greasy & highly seasoned foods Drink carbonated beverages. |
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Your patient is complaining of heartburn (pyrosis). What advise would you give her?
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Eat small and more frequent meals
Use low sodium antacids Avoid overeating Avoid fatty and fried foods Avoid laying down after eating |
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True or False? Your patient is complaining of varicose veins. You should advise her to elevate her legs frequently, wear supportive hose (full length not knee highs), avoid standing for long periods, and to increase walking.
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True
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Cervical and uterine contractions occurring between 20-36 weeks of pregnancy is known as ______________.
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Preterm labor
(Braxton Hicks contractions do not involve the cervix) |
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A woman in her 25th week believes she is having preterm labor. What advise would you give her?
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Drink 2-3 glasses of water or juice (dehydration can cause uterus to contract)
Lie down on left side for an hour If signs don’t go away or if fluid begins to leak from vagina call doctor immediately. |
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What are Tocolytic drugs used for?
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To stop preterm labor.
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True or False? Risk factors for preterm labor include age (under 17 or over 35), low socioeconomic status, smoking and substance abuse, but the single most risk factor associated with preterm labor is a previous history of preterm labor.
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True
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Your patient is at 28 weeks gestation and her BP is 138/90. What is her Mean Arterial Pressure (MAP)? Is she at risk for HIH (pregnancy-induced hypertension)?
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138-90 = 48
48/3 = 16 16+90 = 106 3nd Trimester MAP <102 Yes, at risk! |
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Hormones that increase during pregnancy
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Estrogen, Progesterone, & Prolactin (starts to increase in 1st trimester)
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1st trimester side effects of pregnancy
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frequent urination
nausea & vomiting decreased appetite Chadwick's (from 4th wk) Goodell's (from 6th wk) Hegar's (8-12 wk) |
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2nd trimester side effects of pregnancy
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decreased BP
increased sexual interest palpitations faintness heartburn constipation round ligament pain increased appetite quickening (16-20 wks) |
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3rd trimester side effects of pregnancy
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Blood volume reaches peak (32-34 wks)
shortness of breath lightening |
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Pregnancy weight gain is based on _____.
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BMI (body mass index)
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Which is more important, total amount of weight gained or pattern of weight gain.
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Pattern
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Poor weight gain early in pregnancy may risk ...
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SGA (small for gestational age) baby
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Increased weight gain during last half of pregnancy may risk...
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preterm birth
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Inadequate weight gain may indicate
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fetal growth retardation
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What is the rule of thumb for pregnancy weight gain?
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1st trimester: 2-4 lb total
2nd & 3rd trimesters: 1 lb per week |
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What is the weight guideline for an underweight pt?
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28-40 lb
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What is the weight guideline for an overweight pt?
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15-25 lb
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What is the weight guideline for an average pt?
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25-35 lb
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Lactoovovegetarians
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Eat dairy, eggs & vegetables
Low in Zinc & Iron |
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Lactovegetarians
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Eat milk & vegetables
Do not eat eggs or butter Low in Zinc |
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Vegans
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Only plant products
No dairy, eggs, honey Low in Zinc, Iron & B12 (may be low in protein) |
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Nutrient needs during Lactation
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+500 calories
"ABCZIPE" Vit A, B, C, E, Zinc, Iodine, & protein |
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Nutrient needs higher in pregnancy than during lactation
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"IM FaN"
Iron, Magnesium, Folic acid, Niacin |
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S/S of lactose intolerance
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abdominal cramping
bloating diarrhea |
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Biological marker pregnancy tests are based on
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hCG
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A woman whose gestation is no greater than 20 wks
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Nulliparous
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Weeks 1-13
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1st trimester
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Weeks 27-40
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3rd trimester
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Has never been pregnant before (and not pregnant now)
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Nulligravida
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Delivery that occurs prior to the end of 20 wks gestation
No viable fetus present |
Abortion
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Number of weeks since the first day of the last menstrual period
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Gestation
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Delivery that occurs after the beginning of the 42nd week
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Postterm
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Time between the conception and the onset of labor or birth
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Antepartum or Prenatal
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Time from the onset of labor until the delivery (including baby & placenta)
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Intrapartum
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Time from birth until the body returns to pre-pregnancy state (up to 6 wks following delivery)
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Postpartum
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A fetus born dead after 20 wks gestation
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Stillborn
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The period of time from the point of viability through the neonatal period
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Perinatal
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The capacity to live outside the uterus
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Viability
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The first 28 days of life
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Neonate
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The number of pregnancies (not babies) in which the fetus(es) have reached viability
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Parity
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Changes in BP by trimester
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1st trimester: stays the same
2nd trimester: decreases (due to increased progesterone) 3rd trimester: returns to same |
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An increased MAP in pregnancy may indicate ...
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PIH (pregnancy induced hypertension)
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Woman may be at risk for PIH during 2nd trimester when...
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MAP >90
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Woman may be at risk for PIH during 3nd trimester when...
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MAP >102
|
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Growth stimulated from estrogen and progesterone, results in
increased vascularity and dilation of blood vessels, hyperplasia and hypertrophy and deciduas |
Uterus Enlargement
|
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Irregular, painless, intermittent contractions that occur
after the 4th month and become definite after 28 weeks but usually cease with walking or exercise and cause no change in the cervix. |
Braxton Hicks Contractions
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Diagnostic signs of Pregnancy
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Diagnostic = Postive
(basically, visualization, fetal heart beat, fetal movement) Visualization of fetus by ultrasound or x-ray Fetal heart tones detected by ultrasound – around wk 6 Fetal heart tones detected by Doppler - around 10-12 wks Fetal heart tones detected by fetoscope – around 17-20 wks Fetal movements palpated by examiner Fetal movements visible to examiner |
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Discharge clear to cloudy in appearance and may turn yellow after drying; slightly slimy, is nonirritating, and has a mild inoffensive odor.
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Leukorrhea
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Location the uterus may be palpated between the 12-14 wk.
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Symphysis Pubis
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Location the uterus may be palpated between the 22-24 wk.
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Umbilicus
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Location the uterus may be palpated between the 38-40 wk.
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Xiphoid
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Why does vascular volume need to increase during pregnancy?
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For adequate placenta perfusion.
|
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Musculoskeletal System Changes
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-Center of gravity shifts forward
-Lordosis develops to help maintain balance -Slight relaxation & >mobility of the pelvic joints (Relaxin, estrogen) permit enlargement of pelvic dimensions to facilitate labor & birth -waddling gait -separation of rectus abdominis muscles |
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Integumentary System Changes
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-Hyperpigmentation
-Facial melasma/chloasma/“mask of pregnancy” -Linea nigra -Striae gravidarum -Palmar erythema -Pruritus -Increased hair/nail/sweat/sebaceous gland -Increased circulation/vasomotor activity = "glow" |
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Darkening around eyes: "racoon"
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Chloasma
Facial Melasma "mask of pregnancy" |
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Dark line from pelvis to top of uterus
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Linea Nigra
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Separation within the underlying connective (collagen) tissue of the skin
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Striae gravidarum
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Red palms during pregnancy
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Palmar erythema
"slapped hand" ?r/t increased estrogen lvls? |
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What do pregnancy hormones do?
|
Adequate levels needed to support pregnancy
Prepare the vagina for stretching during L&D by causing the vaginal mucosa to thicken Connective tissue to loosen Smooth muscle to hypertrophy Vaginal vault to lengthen |
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Hypertrophy of sebaceous glands embedded in areolae, may have a protective role in that they keep the nipples lubricated for breastfeeding
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Montgomery tubercles
|
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Cardiovascular System Changes
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-hypertrophy of heart muscle (gets larger)
-enlarged uterus displaces heart up & to the left -pulse increases 10-15 bpm -BP decreased in 2nd trimester -hypotension occurs in supine position -Blood volume gradually increases by 40-45% -clotting activity increased -fibrinolytic activity decreased |
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Respitory System Changes
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-Increase in tidal volume (amt breathed in)
-Increase in respiratory rate (need more O2 to perfuse placenta for baby) -Rib cage relaxes & expands (caused by estrogen) -BMR increases up to 15-20% -Mom becomes slighly alkalotic to facilitate O2 to baby & release CO2 from baby |
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Renal System Changes
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-Enlarging uterus presses on renal system
-Urine rate slows (ureters & urethra lengthen) -Blatter irritated (nocturia, frequency, urgency) -Decreased bladder tone -Mom goes from normal 350ml to 500ml bladder capacity -Risk for UTI (urine stasis) -Renal function best in left side lying position |
|
GI System Changes
|
-Appetite increases (b/c BMR increases)
-May have non-food cravings: PICA -Pregnancy gingivitis may occur -Ptyalism (excess saliva) occurs -Pyrosis (heartburn) may occur due to decreased tone & motility of smooth muscle -Increased water absorbtion in colon leads to constipation -gallstones may occur |
|
Endocrine System Changes
(list major players) |
Estrogen
Progesterone Prolactin Oxytocin hCS |
|
Prolactin
|
Responsible for initial lactation
Starts in 1st trimester produced by anterior pituitary |
|
Progesterone
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Relaxes smooth muscle, results in decreased uterine contraction, so prevents miscarriage
|
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Estrogen
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-Responsible for enlargement of genitals, uterus, breasts
-increases vascularity, causing vascularity -relaxes pelvic ligaments & joints -alters metabolism -promotes retention of Na & H20 (kidney tubules) |
|
Oxytocin
|
-Stimulates uterine contractions (high levels of progesterone keep at bay until near term)
-stimulates let-down/milk ejection reflex after birth in response to infant sucking -produced by posterior pituitary as fetus matures |
|
hCS
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Produced by placenta
Acts as growth hormone Contributes to breast development |
|
Blood Volume
|
-Increases approx. 1500 ml, or 40% to 45% above non-pregnancy levels
-Starts to increase at approx. 10th –12th wk, peaks at approx. 32nd-34th wk -Peripheral vasodilatation maintains a normal blood pressure despite the increased blood volume in pregnancy |
|
RBC's
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-There’s an accelerated production of RBC
-% of increase depends on the amount of iron available -increased by 30-33% with iron supplement -only 18% without iron supplement |
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WBC's
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-Increases during the 2nd trimester and peaks during the 3rd trimester
-Primarily granulocytes; lymphocyte count stays same throughout pregnancy |
|
Coagulation Factors
|
Increase
|
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Fibrinolytic activity
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the splitting up or (the dissolving of a clot)
-Depressed during pregnancy and PP |
|
Hemodilution
|
Physiologic Anemia
Plasma increase exceeds increase of RBC Hgb <11; Hcrt <35 |
|
Heart Rate
|
Increases approx 10-15 bpm between 14-20 wks
Palpations may occur |
|
CO2
|
-Increases from 30% to 50% over the nonpregnant rate by 32nd wk
-Declines to approximately 20 % at 40 wks gestation -This elevated CO2 is a result of > stroke volume & heart rate and occurs in response to > tissue demands for oxygen -CO2 is higher when on lateral recumbent position (side lying) than when supine. |
|
Diabetes Screen
(Glucola Screen) |
-Usually done at 24 to 28 weeks of gestation
-1st, do 1-hour glucose tolerance: drink 50 mgs glucose, after 1 hour check the blood glucose level. If the result over 140 mg/dl, then order 3-hour glucose tolerance -3-hour glucose tolerance: Drink 100 mgs glucose under NPO situation, then check blood glucose level after 1h, 2h, and 3h. If there are two readings over the normal range, consider this Mom has gestational diabetes |
|
How many times should H&H be tested?
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2:
once at initial visit, and again between wks 24-28 |
|
Rubin's Safe Passage
1st trimester |
-Concern about self.
-Alerted, something is “not there.” -“Am I sick or am I pregnant?” -Seeks competent maternity care to provide a sense of control -Keeps all prenatal appointments |
|
Rubin's Safe Passage
2nd trimester |
-Concern about baby
-Care of and for baby. “Is my baby all right?” -Engages in self care activities related to diet, exercise, alcohol consumption and so forth |
|
Rubin's Safe Passage
3rd trimester |
-Concern about self and baby. Seeking delivery care. “Will my baby and I safely go through labor and delivery.”
-Nurse discusses signs of labor and when to go to hospital/doctor -Reassure pt. regarding her fears -Have her ventilate her concerns |
|
NST
|
-Purpose is to observe the response of the fetal heart rate to the stress of activity
-A normal fetus will increase heart rate in response to fetal movement -In a healthy fetus with an intact CNS, 90% of gross fetal body movements are associated with accelerations of the FHR -You want it to be read reactive -Usually this test is ordered after 27th week of pregnancy -Procedure requires approximately 20-30 minutes -Mother is in semi-fowler’s position or positioned in a supine position with a wedge under her right hip -External monitor is applied to document fetal activity -Mother activates the “mark” button on electronic fetal monitor when she feels fetal movement |
|
Ultrasound (Generally)
|
-Produces a three-dimensional view from which a pictorial image is obtained
-Performed either abdominally or transvaginally -Done anytime during pregnancy |
|
Amniocentesis
|
-Possible after 14 wk
-performed to obtain amniotic fluid -Under direct ultrasonographic visualization, a needle is inserted transabdominally into uterus, amniotic fld is withdrawn into a syringe, & various assessments are performed -Indications for the procedure include prenatal dx of Genetic disorders or congenital anomalies (neural tube defects in particular) Assessment of pulmonary maturity Diagnosis of fetal hemolytic disease |
|
Ultrasound
1st trimester |
Information obtained on:
-Number, size & location of gestational sacs -Presence/absence of fetal cardiac & body movements -Presence/absence of uterine abnormalities (i.e.: ectopic pregnancy) -Date of pregnancy - by measuring crown rump length & biparietal diameter of fetus |
|
Ultrasound
2nd & 3rd trimester |
Info on the following is sought:
-Fetal viability, number, position, gestational age, growth pattern, & anomalies -Amniotic fluid volume -Placental location & maturity -Uterine fibroids & anomalies -Adnexal masses -Cervical length |
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Amniocentesis Complications
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-occur in fewer than 1%
-Maternal hemorrhage -Fetomaternal hemorrhage w/ possible maternal Rh isoimmunization -Infection, labor, abruptio placentae, inadvertent damage to the intestines or bladder, and amniotic fluid embolism -fetal-leakage of amniotic fluid -direct injury from the needle, miscarriage or preterm labor, and death. |
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Kick Count/DFMC
(daily fetal movement count) |
-Usually starts 24-28 wk gestation (after quickening)
-presence of fetal movements is generally a reassuring sign of fetal health -Mom is reliable -YOU WANT 3 fetal movements/hr -Generally, a count of less than three fetal mvts w/n 1 hr warrants further evaluation by NST or CST, BPP or a combination of these -Nursing Alert: Fetal movement is usually not present during the fetal sleep cycle and are temporarily reduced if the woman is taking depressant med., drinking alcohol, or smoking a cigarette; and do not decrease as woman nears term |
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Danger/warning signs of pregnancy
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"CABS"
CHILLS AND FEVER (infection) CEREBRAL DISTURBANCES (Headache during pregnancy=severe preeclampsia) ABDOMINAL PAIN (may be due to edema of the liver capsule & may indicate a convulsion is impending. A rigid, board-like abdomen during the last trimester usually indicates abruptio placenta) BLURRED VISION (high BP or complication w/severe preeclampsia) BLEEDING (miscarriage, abortion, ectopic pregnancy or hydatiform mole, placenta previa or abruptio placenta) SWELLING (edema: periorbital & digital areas - mild preeclampsia) SUDDEN ESCAPE OF FLUID (rupture of membranes) |
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premature separation of the placenta and occurs in the area of the decidua basalis after the 20th wk of pregnancy and before the birth of the baby
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Abruptio placenta
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Placenta implanted in the lower uterine segment near or over the internal cervical os.
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Placenta previa
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Low birth weight
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a newborn whose wt falls within last 10%
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GBS (Group B Strep)
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often causes/associated with preterm labor
treated with Penicillin G |
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Plan of Care/Interventions:
Preterm Labor |
-early recognition & diagnosis
-bed rest -home uterine activity monitoring -lifestyle changes: decrease sexual activity (may stimulate labor) long trips (not close to resourses) Heavy lifting or carrying Climbing stairs Hard physical work |
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Tocolytics
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Betamethasone
Terbutaline Magnesium Sulfate Nifedipine (calcium antagonistic) Prostaglandin Synthetics (motrin/naproxen) |
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Maternal contraindications to Tocolytics
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Severe PIH or Eclampsia
Intrauterine infection Active vaginal bleeding Cardiac disease |
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Eclampsia
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Had seizure
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Fetal contraindications to Tocolytics
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> 37 wks
Dilation >4cm Fetal demise Lethal fetal anomaly Chorioamnionitis Acute fetal distress Chronic IUGR |
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Betamethasone
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Glucocorticoids
increases production of surfactant in fetal lungs can use between 20 to 32/35 wks |
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Terbutaline
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Relaxes smooth muscle
relaxes uterus (inhibits uterine contraction) bronchodilation vasodilation hypotension Makes pt jittery |
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Uterus
1st trimester |
Hyperplasia (new muscle fibers)
Hypertrophy (enlargment of existing fibers) Increase vascularity and dilation of vessels Decidua developes 12 wks: size of grapefruit & rises out of pelvis |
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Uterus
2nd & 3rd trimester |
20th week: at umbilicys
dextorated (lies more to the right side b/c of shape of colon) In contact abdominal wall (anterior wall provides support) 38-40wks: reaches xyphoid process lightening at 38-40 wks |
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Placentap perfusion depends on what?
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Maternal blood flow
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Amount of maternal blood volume in uterine vascular system
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1/6
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Blood flow to uterus decreases when...
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MAP (mean arterial pressure) is low or high
uterus contracts (is a temporary decrease) supine position DM (vascular damage) Multiple gestations (vascular issues) |
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Noises from the uterus
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Uterine souffle (blood flow shuffle from placenta)
Funic souffle (blood flow from cord - lighter sound) Fetal Heart Rate (120-160, like a horse canter) |
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Changes of Vagina & Vulva
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-Influenced by estrogen & progesterone
-vaginal mucosa thickens -connective tissue loosens -smooth muscles hypertrophy -vaginal vault lengthens (making room for baby to position) -mucous plug/operculum formation -leukorrhea -Chadwick's sign -estrogen causes vagina to become more acidic (increasing yeast infections) -increased sensitivity (sexual interests) -external structures enlarge |
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Increased cardiac output may cause...
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varicose veins
hemorroids labial vericosities |
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Neurological System Changes
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-Compression of pelvic nerves may cause sensory changes (numbness, tingling)
-Carpal tunnel -Vasomotor hypotensio (lightheadedness) -Hypocalcemia (muscle cramps in legs) |
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Ovum & chorionic villi produce _____ until placenta takes over.
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hCG
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Thyroid Gland
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Gland & hormone increased due to increased levels of estrogen
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Parathyroid gland
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Controls Ca & magnesium metabolism
Increased fetal needs creates slight hyperparathyroidism in mom |
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Diabetic Moms
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-Fetus depletes mom's glucose = less need for insulin (in beginning of pregnancy)
-very unstable Gestational diabetes: risk of developing type II later in life |
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Rh - mom
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Assume baby is + and give RhoGAM
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RhoGAM
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Blood product that prevents mom from making antibodies to baby's blood
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Rubella titer
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>1:8
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AFP test
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detects chromosome defects & neural tube defects
at 15-22 wks unreliable if don't have correct hisory/information increase may indicate NT defects decrease may indicate downs syndrome |
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Penicillin G
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Group B Strep
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Ambivalence
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Mixed feelings regarding pregnancy
Excited & happy one moment, unhappy & depressed the next |
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Binding in
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The commitment that the pregnant woman forms to her baby by the end of pregnancy
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Emotional Liability
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Frequency &/or extremes in emotional changes experienced by a woman during pregnancy
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Maternal
Psycological Changes 1st trimester |
acceptance vs denial
shock & disbelief ambivalence (#1 emotion) emotional lability self focus |
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Maternal
Psycological Changes 2nd trimester |
introverted in latent period
increased dependence altered body image dreams & fantasies alterations in sexual responsiveness increased awareness of fetus prenatal attachment (binding in) seeking acceptance of fetus by others beginning to give of self to fetus |
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Maternal
Psycological Changes 3rd trimester |
increased anxiety
self-absorbtion anticipation vs dread concerns of safety giving of self to fetus nesting |
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Paternal
Psycological Changes 1st trimester |
Joy/excitement vs anger/disappointment
pride ambivalence |
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Paternal
Psycological Changes 2nd trimester |
emotional distancing
introspection detachment jealousy |
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Paternal
Psychological Changes 3rd trimester |
acceptance of reality
protectiveness active involvement increased anxiety altered sexual desire prenatal attachment |
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Magnesium Sulfate
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Relaxes smooth muscle so decreased uterine contractions
causes CNS depression "MS: muscle, smooth" |
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Prostaglandin Synthetase Inhibitors
(Naproxen, Motrin) |
Interfers with prostaglandins
(prostaglandins cause uterus to contract) |
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(Calcium Antagonistic)
Nifedipine |
"CAN"
prevents return of uterine contractions by inhibiting Ca to re-enter cell membrane (Ca needed for muscle contraction) |