Maternity part 2

McDonald's Rule

fundal height in cm's equals wks gestation w/in 2 wks

Chadwick's sign

Bluish purple discoloration of the cervix, vagina, and labia during pregnancy as a result of increased vascular congestion.

Preparation of the uterus to receive a fertilized egg. Progesterone stimulates differentiation of the endometrium into a secretory type of tissue. Progesterone is an endogenous steroid hormone that is commonly produced by the adrenal cortex as well as the gonads, which consist of the ovaries and the testes.

The chief function of progesterone is the

Eighth week to the time of birth. In the first 7-14 days, the ovum is known as a blastocyst; it is called an embryo until the eighth week; the developing cells are then called a fetus until birth.

The developing cells are called a fetus from the

preterm

a pregnancy that has reached 20 weeks of gestation but ends before completion of 37 weeks of gestation

Paridity

# of pregnancies in which the fetus reaches 20 weeks

Nausea and vomitiing (mainly in the first triemester Delayed gastric emptying. Decreased peristalsis. Heartburn. Constipation.

What changes occur in the gastrointestinal system in response to pregnancy.

Moved upward and left due to growing fetus Systolic murmur is common ( can persist up to 4 wks after delivery) Blood volume increases 40-50 percent plasma increases 40-60 percent RBC mass increases20-30 percent Physiologic anemia due to decrease in concentration of Hbg and a decrease in iron -Increased need for iron At risk for supine HoTN cardiac output is higher lying on the side Increased blood flow to reproductive organs and kidneys Varicosities due to weight of uterus partially obstructing blood return from legs

What changes occur in the heart in response to pregnancy

o2 consumption increases 15-20 percent slight hyperventilation which is normal Heightened awareness of dyspnea Nose bleeds and nasal stuffiness

What changes occur in the respiratory system in response to pregnancy.

Urinary frequency during first (position of uterus) and third trimester (weight of belly). Glycosuria.

What changes occur in the urinary tract in response to pregnancy.

Linea nigra — dark, pigmented line in middle of abdomen. Chloasma, Malasma — darkened skin over forehead and around eyes. Striae may occur.

What changes occur with the skin in response to pregnancy

Braxton Hicks contractions

intermittent painless uterine contractions that occur with increasing frequency as the pregnancy progresses Walking around can help alleviate.

abortion

termination of pregnancy or miscarriage

Colostrum

thin, milky fluid secreted by the breast during pregnancy and during the first days after birth before lactation begins

G = 2, T = 0, P = 1, A = 0, L =1 Therefore, a woman who is pregnant with twins and has a child has a gravida of 2. Because the child was delivered at 37 weeks, the number of preterm births is 1, and the number of term births is 0. The number of abortions is 0, and the number of live births is 1.

A nurse is collecting data during an admission assessment of a client who is pregnant with twins. The client has a healthy 5-year-old child that was delivered at 37 weeks and tells the nurse that she doesn't have any history of abortion or fetal demise. The nurse would document the GTPAL for this client as what?

A softening of the cervix In the early weeks of pregnancy, the cervix becomes softer as a result of increased vascularity and hyperplasia, which causes the Goodell's sign.

A nurse is reviewing the record of a client who has just been told that a pregnancy test is positive. The physician has documented the presence of a Goodell's sign. The nurse determines this sign indicates

"It is the fetal movement that is felt by the mother." Quickening is fetal movement and may occur as early as the 16th and 18th week of gestation, and the mother first notices subtle fetal movements that gradually increase in intensity.

A nursing instructor asks a nursing student who is preparing to assist with the assessment of a pregnant client to describe the process of quickening. Which of the following statements if made by the student indicates an understanding of this term?

2 Rationale: Leukorrhea begins during the first trimester. Many clients notice a thin, colorless or yellow vaginal discharge throughout pregnancy. Some clients become distressed about this condition, but it does not require that the client report to the health care clinic or emergency department immediately. If vaginal discharge is profuse, the client may use panty liners, but she should not wear tampons because of the risk of infection. If the client uses panty liners, she should change them frequently.

A pregnant client in the first trimester calls the nurse at a health care clinic and reports that she has noticed a thin, colorless vaginal drainage. The nurse should make which statement to the client? 1. "Come to the clinic immediately." 2. "The vaginal discharge may be bothersome, but is a normal occurrence." 3. "Report to the emergency department immediately" 4. "Use tampons if the discharge is bothersome, but be sure to change the tampons every 2 hours"

G5 T2 P1 A1 L4 5 pregnancies; 2 term births; twins count as 1; one abortion; 4 living children.

A pregnant client is making her first antepartum visit. She has a 2-year-old son born at 40 weeks, a 5-year-old daughter born at 38 weeks, and 7-year-old twin daughters born at 35 weeks. She had a spontaneous abortion 3 years ago at 10 weeks. Using the GTPAL format, the nurse should identify that the client is:

Turn the woman on her left side. During a fundal height measurement, the woman is placed in a supine position. This woman is experiencing supine hypotension as a result of uterine compression of the vena cava and abdominal aorta. Turning her on her side will remove the compression and restore cardiac output and blood pressure.

A pregnant woman at 32 weeks' gestation complains of feeling dizzy and lightheaded while her fundal height is being measured. Her skin is pale and moist. The nurse's initial response would be to:

Shortness of breath on exertion. This is an expected cardiopulmonary adaptation during pregnancy; it is caused by an increased ventricular rate and elevated diaphragm.

An expected cardiopulmonary adaptation experienced by most pregnant women is

They grow in size. The nipples become larger the areola become larger and darker.

How do the breast change in response to pregnancy

becomes blue due to increased blood flow Mucous plug forms to prevent bacteria from entering the cervix Increase in vaginal discharge and this discourages growth of bacteria but favors the growth of yeast (especially in diabetic pts)

How does the cervix change in response to pregnancy

It grows 12 wks- palpated right above the pubic synthesis 16 wks- midway between synthesis and umbilicus 20 wks- located at the umbilicus The uterus can contract

How does the uterus change in response to pregnancy

- Secrete progesterone to maintain the uterine lining for first 6-7 wks

How to the ovaries change in response to pregnancy

Chadwick's sign. A purplish color results from the increased vascularity and blood vessel engorgement of the vagina. It can be observed as early as 6 to 8 weeks after conception, and its presence is an early sign of pregnancy.

The nurse is aware that an adaptation of pregnancy is an increased blood supply to the pelvic region that results in a purplish discoloration of the vaginal mucosa, which is known as:

An increase in blood volume. The blood volume increases by approximately 40-50% during pregnancy. The hematocrit decreases as a result of the increased blood volume.

The nurse recognizes that an expected change in the hematologic system that occurs during the 2nd trimester of pregnancy is:

living

living children

Gravidity

number of pregnancies

term pregnancy

pregnancy from 38 weeks to 42 weeks