MCN 273 MOD 1 (GTPAL, Intro to OB)

What is Nagele's rule?

*- used to establish estimated due date (EDD) - subtract 3 months from month of her LMP (last menstrual period - then add 7 days to first day of the LMP - correct year by adding 1 if necessary OR - add 7 days and then 9 mo * margin +/- 2 weeks

what should be included in a comprehensive health history?

- age - menstrual history - prior obstetric hx - past medical and surgical history - psychological screening - family hx - genetic screening - dietary and lifestyle habits - medication of drug use - history of exposure to STIs

talk through an exam of the abdomen (pregnancy)

- appearance depends on number of weeks of gestation - inspect for striae, scars, shape, size - linea nigra - palpate abdomen (should be rounded and contender) - muscle tone may be noted due to progesterone levels - hight of funds is measured (varies at different stages)

questions for reproductive history

- description of menstrual cycle - age at menarche - number of days in cycle - typical flow characteristics (discomfort?) - use of contraceptives

angel's rule is less accurate especially under what circumstances?

1. regular irregular cycles 2. conceives while breast-feeding 3. conceives before her regular cycle is established after childbirth

what vessels are found in the umbilical cord?

2 arteries, 1 vein

A pregnant patient's prenatal labs are as follows: A+, Rubella Immune; Hep B Pos; HIV Neg; VDRL NR; GBBS Neg. The nurse understands that which lab result will require follow up: A. Rubella Immune -requires vaccination of the mother after delivery B. Hep B Pos- requires treatment of the newborn after delivery C. VDRL NR-requires treatment for syphilis D. GBBS Neg-requires antibiotic treatment during labor

B. Hep B Pos- requires treatment of the newborn after delivery

how many weeks in a pregnancy

40 weeks

This part of the uterus is used to assess growth of the fetus, uterine contractions, and involution after delivery: A. fundus B. vagina C. cervix D. cervical canal

A. fundus

A patient has had an uncomplicated pregnancy and is now 37 and 3/7 weeks gestation with a healthy fetus. The fetus/pregnancy is considered: Select all that apply: A. pre-term B. term C. post-term D. viable E. non-viable

A. pre-term B. term C. post-term D. viable E. non-viable

A patient presents at the first prenatal visit. The patient reports regular menstrual cycles of 28 days, and an LMP of November 5, 2021. Using Nagele's rule, what is the EDD for this patient? A. January 2, 2022 B. August 12, 2022 C. January 12, 2021 D. August 2, 2022

B. August 12, 2022 (subtract 3 mo from LMP, add 7 days, change the year +1)

The nurse accurately explains to a group of newly pregnant patients that their baby receives nutrients and oxygen via: A. the placenta and two umbilical arteries B. the placenta and one umbilical vein C. the chorion and two umbilical arteries D. the chorion and one umbilical vein

B. the placenta and one umbilical vein

A pregnant patient at 8 weeks GA presents for a prenatal visit. The patient's states that she has 4 biological children. An obstetric history is taken that reveals: 38 2/7 weeks GA singleton NSVD; 41 4/7 weeks GA VAVD; 16 weeks GA loss; 34 4/7 weeks GA twin c/s delivery; The nurse accurately records the patient's history using the GP TPAL system in the chart as: A. G3P4 T2 P2 A1 L4 B. G4P4 T2 P1 A0 L4 C. G5P3 T2 P1 A1 L4 D. G3P3 T2 P1 A1 L4

C. G5P3 T2 P1 A1 L4

A patient is pregnant for the third time. This patient would be referred to as: A. nulligravida B. primigravida C. multigravida D. secundigravida

C. multigravida

As described in the Clinical Overview Presentation in Module 1, the most accurate definition of the medical term abortion is: A. an elective termination of a pregnancy B. a spontaneous loss of pregnancy also referred to as a miscarriage C. a loss of a pregnancy after 20 weeks gestation D. a pregnancy less than 20 weeks gestation that ends spontaneously or therapeutically

D. a pregnancy less than 20 weeks gestation that ends spontaneously or therapeutically

A 35 year old female is currently pregnant with twins. She has 10 year old triplets who were born at 32 weeks gestation, and a 16 year old who was born at 41 week gestation. Twelve years ago she had a miscarriage at 19 weeks gestation. What is her GTPAL?

G=4, T=1, P=1, A=1, L=4

A 39 year old female is currently 18 weeks pregnant. She has two sets of twin daughters that were born at 38 and 39 weeks gestation and an 11 year-old son who was born at 32 weeks gestation. She has no history of miscarriage or abortion. What is her GTPA

G=4, T=2, P=1, A=0, L=5

A 30 year old female is 25 weeks pregnant with twins. She has 5 living children. Four of the 5 children were born at 39 weeks gestation and one child was born at 27 weeks gestation. Two years ago she had a miscarriage at 10 weeks gestation. What is her GTPAL?

Gravida (# of all pregnancies regardless of outcome, count multiple infants as one) = 7 Term = 4 (birth > 38 w) Preterm = 1 Abortions = 1 (ending before 20 w or not viable) Living children = 5

A 20 year old female is currently 8 weeks pregnant. She had a miscarriage at 12 weeks gestation two years ago. She has no living children. What is her GTPAL?

Gravida = 2 Term = 0 Preterm = 0 (carry > 20 w or viable but before 37 w) Abortions = 1 Living = 0

A 26 year old female is currently 26 weeks pregnant. She had a miscarriage at 10 weeks gestation five years ago. She has a three year old who was born at 39 weeks. What is her GTPAL?

Gravida = 3 Term = 1 Preterm = 0 Abortions = 1 (# of pregnancies ending before 20 w or viability Living = 1

A 27 year old female is currently 16 weeks pregnant. She has 2 year-old twins that were born at 39 weeks gestation and a 5 year-old who was born at 40 weeks gestation. She had no history of miscarriage or abortion. What is her GTPAL?*

Gravida = 3 Term = 2 (> 38 w) Preterm = 0 Abortion = 0 Living children = 3

gravida vs para

Gravida refers to the number of times a woman has been pregnant, regardless of whether the pregnancies were interrupted or resulted in a live birth. "nulligravida" is a woman who has never been pregnant. Para means number of deliveries.

calculate the EDD LMP: September 20, 2020

June 27, 2022 subtract 3 mo, add 7 days, +1 year

Calculate EDD LMP: August 27, 2020

June 3, 2021

calculate EDD LMP: February 15, 2021

November 27, 2021

what is a birthing center?

a medical facility in which women with low-risk pregnancies can deliver their babies in a homelike setting

what does nullipara mean?

a woman who has not produced a viable offspring

waste and carbon dioxide from the baby are removed through what vessel?

arteries

what is the meaning of sequalae?

conditions that result from an injury, condition etc (ie sequelae of long term infection could be scaring, cough or changes to the infected area after it has resolved)

what does CLE mean?

continuous labor epidural

what is linea nigra?

dark line of pigmentation from the umbilicus extending to the pubic area

what does a rubella titer do?

detects antibodies for the rubella virus (aka German measles

why is the cervix important during pregnancy and labor?

dilation = how much its opened effacement = how much its thinning

GA or EGA means?

gestational age, estimated gestational age

a woman has been pregnant 3 times and is currently pregnant with twins. she has given birth to 3 babies: 32w, 40w, and 38w. What is her gravida and para?

gravida (G) = 4 (pregnancies including current) para (P) = 3 (birth experiences after 20 w

what is prenatal care?

medical care during pregnancy - assess problems with pregnancy = identify and treat - risk assessment, health promotion, medical and psychosocial interventions, follow ups

what does parity mean?

number of pregnancies, NOT number of fetuses, carried to the point of viability regardless of outcome

What is the GTPAL system?

obstetric history terms G- gravida (# of pregnancies regardless of outcome or multiple infants) T = Term births ( # of term gestations delivering between 38-42w) P = preterm births (# of preterm pregnancies ending >20w or viability before completion of 37 w) A = abortions (pregnancies ending before 20w or viability) L = living children

what stage of pregnancy is a woman if she is 42+ wks?

post-term

What does gravid mean?

pregnant

what stage of pregnancy is a woman if she is 20-37 wks?

preterm

primipara vs multipara

primipara = given birth once after a pregnancy of at least 20 weeks (primip) multipara = two or more pregnancies

primipara vs nullgravida

primipara = has given birth once after a pregnancy of at least 20 weeks (para = # of births) nullgravida = never experienced pregnancy

what extraneous heart sound might be heard in pregnant woman and why?

soft systolic murmur caused by increase in blood flow

why is asking about reproductive tract surgeries important for pregnacy?

surgery on the uterus may affect its ability to contract effectively during labor

what stage of pregnancy is a woman if she is 38-41 wks?

term

a patients chart says she is gravida I, what does this mean?

the patient is pregnant with their first pregnancy (primigravida)

edema of the nasal mucosa or hypertrophy of gingival tissue in the mouth during pregnancy typically indicates what?

this is a response to increased estrogen levels - increased in estrogen causes increased blood flow to gums and they become sensitive

nutrients and oxygen to the baby are delivered through what vessel?

vein

what is a VDRL screening?

veneral disease research labaroraty test (VDRL) --> detects for syphilis (sexually transmitted bacterial infection)

talk through chest assessment (pregnancy)

- auscultate heart sounds (note abnormalities) - anticipate HR increase by 10-15 bpm (starting after 14-20w) - breath sounds - symmetry of chest movement - breathing patterns - expect slight increase in RR (accommodation to increase tidal volume and oxygen consumption) - breasts may feel full and more nodular sensitivity - blood vessels may become more visible - striae gravidarum (stretch marks) - colostrum (yellowish secretion) precedes mature breast milk

what do these terms mean? EDC EDD EDB

- estimated date of confinement - estimated due date - estimated date of birth

1q54common CAM (complimentary, alternative medicine) used for nausea and vomiting in early pregnancy. Why as nurses should we assess thoroughly about the use of CAMs?

- ginger lollipops - ginger tea - sea-bands - acupuncture or acupressure - vitamin B6 for morning sickness assessing this is important because during pregnancy, most substances cross the placenta and can reach the fetus = stress to all pregnant woman to discuss all remedies

what is GBBS/GBS testing?

- group B beta streptococcus (or group B strep) - natural occurring bacteria that could place fetus at risk for infection

why is the funds important during pregnancy?

- important measurement = indicates how well the fetus is growing - palpating fundus = contraction start and end, how long is it ending - post part palpation = looking for it involuting/contracting down to pre pregnancy size (looking for it to be firm and midland)

what changes to HR do we expect with pregnancy?

- increase in HR by 10-15 beats - starting between 14 and 20 weeks - secondary to increase in cardiac output and blood volume

talk through examination of extremities for a pregnant woman

- inspect and palpate - edema, pulses, varicose veins - may need to investigate gestational HTN - dependent edema is normal during 3rd trimester - does pain in calf increases with ambulation? = indicates possible DVT

what are the advantages of a home birth?

- least expensive - experience labor and birth in privacy and comfort - maintain control over aspects of her labor (attire, support people) - minimize interference and - one-on-one care by midwife - develops trusting relationship with nurse midwife

disadvantages of home birth?

- limited access to pain medication - danger to mother and baby in emergency (placental abruption, uterine rupture, cord prolapse, distressed fetus - delay in getting to hospital

what methods are used to calculate EDD?

- nagels rule - ultrasounds to measure head circumference (most accurate) - gestational or birth calculator or wheel

what does "Para" mean?

- number of deliveries of at least 20 gestational weeks - counts multiple births as one birth event

talk through a head and neck assessment (pregnant)

- sings of injury and sequelae (condition that is a consequence of an injury - limitation in ROM - palpate for enlarged lymph nodes or swelling - edema of nasal mucosa - hypertrophy of gingival tissue in mouth - palpate thyroid gland (marked enlargement may indicate hyperthyroidism)

The female perineum is: A. the area extending from the vaginal opening to the anus B. the bottom portion of the uterus C. dilates to allow passage of the fetus for delivery D. houses the fetus, placenta, and amniotic sac

A. the area extending from the vaginal opening to the anus

The term gravida is defined as: A. the total number of birth experiences a person has had including any therapeutic or spontaneous abortions B. the total number of birth experiences a person has had including any twins, triplets or other multiple infants born C. the total number of pregnancies a person has had, including current pregnancy and any therapeutic or spontaneous abortions D. the total number of pregnancies a person has had, including any therapeutic or spontaneous abortions

C. the total number of pregnancies a person has had, including current pregnancy and any therapeutic or spontaneous abortions

Identify the GTPAL for this example: Mary Johnson is pregnant for the fourth time. She had one abortion at 8 weeks' gestation. She has a daughter who was born at 40 weeks' gestation and a son born at 34 weeks. Mary's obstetric history would be

Gravida = 4, Para = 2 Term births = 1 Preterm births = 1 Abortions = 1 Living children = 2