NSG 1027 Exam 3 Antepartum and L&D
-amenorrhea -nausea/vomiting -fatigue -frequent urination -breast tenderness/lumpy -quickening (1st perception of fetal movement)
what are some presumptive, subjective signs of pregnancy? (6 listed)
-partner refuses to leave so client can't speak openly -avoids eye contact -anxiety, depression, substance abuse -injuries
what are some red flags for domestic violence?
-CBC -blood type -Hep B surface antigen -syphilis -rubella immunity -urine culture
what are some tests ran during the first prenatal visit?
-preterm labor -epigastric pain -leaking vaginal fluids -vision changes -infection -swelling of face/hands -severe headache -bleeding vaginally -decreased fetal movement
what are the danger signs of pregnancy? (9 listed)
-ultrasound -fetal heart rate -fetal movement (perceived by examiner)
what are the only 100% positive signs of pregnancy?
nausea/vomiting, RUQ pain, fever
what are the s/s of gallstones?
-weight -urine screen for glucose/protein -blood pressure -fundal height -fetal heart rate -fetal movement
what are the six things assessed during every prenatal visit?
-physical assessment -fetal heart tones -fundal height measurement
what are the three things assessed during the first prenatal visit?
-stimulates uterine contractions -stimulates milk let-down reflex
what are the two things oxytocin does during pregnancy?
iron, calcium, iodine
what are three important minerals during pregnancy?
folic acid, vitamin A (eat foods with beta-carotene)
what are two important vitamins during pregnancy?
-feelings about pregnancy -intimate partner violence
what are two things that would be included in a psychical screening of an expecting mother?
flex hip/knee, lay on opposite side, heating pad, acetaminophen
what comfort measures could be take for a pt with round ligament pain?
increase water intake
what comfort measures could be taken for a pt with uterine cramping and intermittent low backache?
-Gravida -Term deliveries (>38 wks) -Preterm deliveries -Abortions/miscarriages -Living children
what does G TPAL stand for?
insufficient contractions
what does it mean if you test "insufficient" on a CST?
inc by 40-45%
what happens to blood volume during pregnancy?
inc by 25-50%
what happens to cardiac output during pregnancy?
decreases
what happens to vascular resistance during pregnancy?
10
what is a perfect score on a BPP?
-medical/surgical hx -reproductive hx -previous pregnancies -current pregnancy -LMP (last premenstrual period)
what is assessed during the first prenatal visit?
"sympathetic pregnancy"
what is couvade syndrome?
-add 7 days to the first day of the last menstrual period -subtract 3 months -add one year
what is the formula to calculate Naegele's rule? (calculate due date)
electrolytes (Na+, K+) hemoglobin/hematocrit
what labs would be monitored during nursing care?
left-tilt side lying position
what position is good for a pregnant woman experiencing air hunger/SOB?
weight, turgor, hair/skin/nails
what things would be done during a physical exam for nursing care?
-facilitates fetal cell growth -provides rich blood supply for the placenta, which nourishes the embryo/fetus
what two things does estrogen do during pregnancy?
10, 2
when doing fetal kick counts, the baby should move at least ___ times in ___ hours
done at 8-12 weeks for genetic studies (chromosomal concerns)
when is chronic villus sampling done and what is it for?
-preterm labor -vaginal bleeding -ruptured membranes
when is sexual activity not okay during pregnancy?
35-37 weeks
when is the GBS screen done?
15-20 weeks (from venous blood)
when is the MSAFP tested?
24-28 weeks
when is the Rh retest and screen for antibody conversion done?
as soon as the woman establishes she is pregnant
when is the first prenatal visit generally scheduled?
24-28 weeks
when is the screening for gestational diabetes done?
2nd trimester
which trimester? mother accepts the baby, focuses on the fetus as a distinct from herself, rapid mood changes persist
1st trimester
which trimester? mother accepts the pregnancy, has ambivalence and rapid mood swings
3rd trimester
which trimester? mother prepares for parenthood, is tired of pregnancy but anxious about delivery, starts nesting
protein
women should eat 5-6 grams more of ______ per day (60 grams total) during the entire pregnancy
calories
women should eat _____ more calories prepay during the 2nd and 3rd trimesters
Chadwick's sign
bluish/purplish color of the cervix (checked by looking)
Preeclampsia
gestational hypertension plus protein urea
converse
if SOB occurs during exercise, decrease the level of intensity to a point where she can ______
catabolic
in the _____ phase, protein stores are broken down and used to meet fetal demands during the last semester
anabolic
in the ______ phase, protein is stored up during the first two trimesters
25-35
normal pre-pregnant BMI
28-40
overweight pre-pregnant BMI
nipple
oxytocin is released by _____ stimulation
metabolic
pregnancy increases ______ activity (BMR inc by 20%)
10
pregnant women should not lift anything over ____ pounds
placenta
progesterone is produced by the ______
-relaxes uterine muscle -prevents preterm labor -relaxes ureters in renal system -slows GI motility to facilite absorption -vasodilation of blood vessels
progesterone sustains the pregnancy. what else does it do? (5 listed)
ballottement
rebound of fetus noted when tapping on cervix
contractions
______ cause a reduction of blood flow to the placenta that can potentially stress the fetus
iron
______ supplementation is needed after 20 weeks
2, 20, 15, 15
a reactive NST has at least ___ accelerations in ___ minutes that increases at least ___ bpm above baseline AND last at least ___ seconds
estimated date of confinement
EDC
estimated date of delivery
EDD
clay, dirt, laundry starch, freezer frost/ice
most common ingested things in people with pica
amniocentesis
this diagnostic study is done at 15-20 weeks and is used for genetic studies, tests for fetal alpha-fetoprotein (accurately), lung maturity (during 3rd trimester)
prolactin
this hormone is produced by the pituitary and stimulates production of breast milk
Tobacco, alcohol, cocaine
Three teratogens that cause fetal growth problems, neonatal withdrawal syndrome, fetal birth defects, and preterm labor and birth
2
ultrasound dating is accurate within __ weeks in the 2nd trimester
3
ultrasound dating is accurate within __ weeks in the 3rd trimester
3-5
ultrasound dating is accurate within ___-___ days in the 1st trimester
15-25
underweight pre-pregnant BMI
16
weight gain of less than ___ lbs is associated with low-birth-weight babies
-teratogen exposure -maternal age -cardiac disease -Rh incompatibility -poverty -diabetes
what are 6 pregestational conditions affecting pregnancy?
-position/posture -body mechanics -PT -massage
what are some comfort measures for back pain?
inc water intake, high fiber diet, physical exercise
what are some comfort measures for constipation during pregnancy?
small, frequent meals; elevate HOB while sleeping; antacids (only if prescribed)
what are some comfort measures for heartburn/reflux during pregnancy?
preparation H, Anusol, witch hazel, elevate legs
what are some comfort measures for hemorrhoids during pregnancy?
-hydration -K+ -dorsiflex foot
what are some comfort measures for leg cramps/Charlie horses? (3 listed)
-tender -lumpy -size inc -areolas darken -montgomery tubercles more prominent -presence of striae -colostrum production (may be seen as early as 16 wks)
what are some physiological changes in breasts during pregnancy? (7 listed)
-loosens pelvic ligaments (causes pregnancy gait) -carpal tunnel syndrome/other aches and pains -leg cramps (Charlie horses) -back pain -curvature of spine inc.
what are some physiological changes in musculoskeletal system during pregnancy? (5 listed)
-hyperpigmentation -stretching
what are some physiological changes in the integumentary system that occur during pregnancy? (2 listed)
-thoracic cavity enlarges -"air hunger"/sensation of SOB
what are some physiological changes in the respiratory system of a pregnant person? (2 listed)
-inc vascularity -inc discharge
what are some physiological changes that occur in the cervix/vagina during pregnancy? (2 listed)
-frequent urination -high risk for UTI's -glycosuria
what are some physiological changes that take place in the urinary system during pregnancy? (3 listed)
-constipation -hemorrhoids -heartburn/reflux -gallstones
what are some physiological changes to the GI system during pregnancy? (4 listed)
Exchange blood transfusion
If an Rh incompatibility occurs and affect the fetus, the fetus develops hemolytic anemia. How is this treated?
Methotrexate
If an ectopic pregnancy is caught early, ______ can stop fetal growth and may be able to save the fallopian tube
12
If hypertension develops during the first 20 weeks of pregnancy, it cannot be confirmed chronic until it persists beyond ____ weeks postpartum
Ectopic pregnancy
Implantation of a fertilized egg outside of the uterus
Molar
In a ______ pregnancy, chromosomal errors cause growth of only the chorionic villi (no fetus)
Two, 4
In order to be considered just stational hypertension, the patient has to be hypertensive on at least ___ ovations and at least ___ hours apart
Toxoplasmosis parasite
Transmitted through cat feces, contaminated soil, undercooked meat, unfiltered water
D&C or induce contractions
Treatment for a missed spontaneous abortion
Watch and see, ibuprofen
Treatment for an inevitable spontaneous abortion
Emotional support
Treatment for complete spontaneous abortion
D&C, IV pitocin, oral methergine
Treatment for incomplete spontaneous abortion
No vaginal exams, bed rest until delivery
Treatment for placenta previa
Prompt delivery, blood transfusion, observe for s/s of DIC
Treatments for placenta abruption
Labor dystocia
What might hypotonic contractions cause
Severe preeclampsia
What might severe and persistent right upper quadrant or epigastric pain be a sign up?
VBAC
What puts mom is at high risk for uterine rupture?
When an RH negative woman is exposed to Rh positive blood
When does Rh sensitization (isoimmunization) occur?
-at 28 weeks -after invasive procedures or trauma -after delivery within 72 hours (including miscarriage/ectopic)
When is RhoGAM given?
Chloasma
"mask of pregnancy"; darkened spots on the face
striae
"stretch marks"
Infection
#1 cause of PPROM
24-28 weeks
When is screening for diabetes routinely done?
Invasive procedures, trauma, delivery
When might maternal exposure to fetal blood occur?
41-42 weeks
When should a post-term pregnancy be induced?
trans abdominal, transvaginal
2 types of ultrasound
Cancer
20% of molar pregnancies develop into a malignant ____
Catecholamines
Anxiety releases ______ (causes fight or flight which slows labor)
Cerclage
A purse string stitch done to hold the cervix closed
Fetal distress
Any ominous fetal heart rate pattern
38 weeks
At what point in the pregnancy do lungs fully mature?
Shoulder dystocia
Birth emergency in which shoulders become stock; most often caused by macrosomia and also associated with maternal diabetes
Prolapsed cord
Birth emergency in which the umbilical cord comes before the presenting part; causes feel distress due to Compromised fetal circulation; caused by rupture of membranes before the head is engaged into the pelvis
Cyromegalovirus
Causes seizures, microcephaly, intrauterine growth restriction
NO
Can moms with HIV/AIDS breast-feed?
Placenta previa
Caused by abnormal implantation and growth of the placenta, either completely over or every near the Cervical
Herpes simplex virus
Causes IUGR, Spontaneous abortion, stillbirth, premature labor, congenital herpes
-painless vaginal bleeding at 8-16 was gestation -ultrasound reveals mass of cysts without a fetus -absence of fetal heart sounds -excessive size of uterus and hCG levels -hypertension
Clinical manifestations of Hydatidiform Mole (molar pregnancy)
Vascular disease
Damage to blood vessels associated with diabetes
Triggering
DIC follows a ______ event, like preeclampsia/eclampsia, GTD/molar pregnancy, placenta abruption, or infection
Birth without waiting
Delivery that is unattended by the physician or nurse midwife
Vascular disease, retinopathy, nephropathy, hypertension
Diabetes during pregnancy will more than likely he's in the development of what four diabetic problems?
Gestational diabetes
Diabetes that develops as a result of pregnancy
Bishop score
Exam done to determine labor readiness (score of 6 oral less indicates unripe cervix)
Rubella
German measles; Causing permanent hearing loss, cataracts, heart defects, other birth the fax
-deliver the baby! -manage safety of fetus and mother until delivery (lab values, pain, mag to prevent seizures)
How do you manage a patient in HELLP Syndrome
-IV fluids -blood transfusion -antihypertensives -monitor for DIC
How do you stabilize a pt with molar pregnancy?
You need less during the first trimester and more during the second and third trimesters
How do you the amount of insulin needed throughout the pregnancy compare?
RhoGAM
How is Rh sensitization prevented?
Cerclage
How is cervical insufficiency treated?
Oxytocin (pitocin) IV infusion
How is labor induced?
140, 90
Hypertension is defined as SBP over ____ or DPB over ____
Gestational HTN
Hypertension that develops after 20 weeks gestation
Chronic HTN
Hypertension that develops before pregnancy or during the first 20 weeks of pregnancy
Preeclampsia
Hypertensive does order that can present any time from 20 weeks just station up to 48 hours post partum
Prevention of cardiac decompensation and if it occurs, early detection and treatment
Is the goal in a pregnant woman with cardiac disease?
Precipitous labor
Labor that lasts less than 3 hours
Disseminated Intravascular Coagulation (DIC)
Life threatening disorder; paradoxical clotting disorder; profuse bleeding externally and internal clotting at the same time
maternal serum alpha fetal protein
MSAFP
Quad
MSAFP is part of the "______ screen"
Fallopian tube
Most frequent spot for an ectopic pregnancy
Mild - 140/90 Severe - 160/110
Name the blood pressures for mild and severe preeclampsia
Nuchal cord/true knot
Name two umbilical cord abnormalities
HAART (highly active anti-retroviral therapy)
Newborns exposed to HIV are given what?
Spontaneous rupture of the amniotic sac
Number one reason for preterm delivery
Hypertension
One of the top for leading causes of maternal death in the US and significant contributor to stillbirth and neonatal morbidity and mortality
Percutaneous Umbilical Blood Sampling (aka cordocentesis)
PUBS
Abruption placentae (placenta abruption)
Painful vaginal bleeding could be a sign of what?
Cervical insufficiency
Painless dilation of the cervix without contractions
Placenta previa
Painless vaginal bleeding could be a sign of what?
Caused by early detachment of the placenta
Placenta abruption
Eclampsia
Preeclampsia plus seizure activity or coma
Spontaneous abortion
Pregnancy which and spontaneously before 20 weeks
Terbutaline
Smooth muscle relax sent that stops preterm labor
PROM
Spontaneous rupture of the amniotic sac before labor Begins but after 37 weeks gestation
PPROM
Spontaneous rupture of the amniotic sac before labor begins and before 37 weeks gestation
Isoimmunization
Rh sensitization, aka ______
Clonus
Rhythmic muscle spasm when ankle is Dorsiflexed
Preterm labor
Second leading cause of infant death
Cocaine
Teratogen that causes placental abruption
Rh antibodies produced by isoimmunized mother the next pregnancy
The RH factor does not cross the placenta. What does?
2
The goal is to give ___ doses of corticosteroids to promote fetal lung maturity and speed up surfactant production
Elective
Type of Induced abortion; abortion performed at the woman's request that does not involve preservation of health
Therapeutic
Type of induced abortion; termination of a pregnancy for reasons related to maternal or fetal health or disease
Threatened
Type of spontaneous abortion characterized by Bleeding with or without cramping, no dilation of the cervix, and no expulsion of any products of conception
Inevitable
Type of spontaneous abortion characterized by Cramping and bleeding, dilation of the cervix but POC not yet expelled
Complete
Type of spontaneous abortion characterized by complete expulsion of all POC
Missed
Type of spontaneous abortion characterized by death of the embryo or fetus before 20 weeks and complete retention of products of conception
Incomplete
Type of spontaneous abortion characterized by some but not all POC expelled
Recurrent or habitual
Type of spontaneous abortion characterized by three or more consecutive spontaneous abortions
Threatened
Type of spontaneous abortion that can be saved if we can stop it
Inevitable
Type of spontaneous abortion that is incompatible for continuation of the pregnancy
Ineffective
Uterine irritability is when contractions are ______
Duration of 60-90 sec every 2-3 min
What are contraction timing goals?
-edema of face and hands -Rapid weight gain from fluid retention -Hyperactive reflexes -Clonus -Severe headache -Visual disturbances -Epigastric pain from a swollen liver
What are signs and symptoms indicating advanced preeclampsia progression? (7 listed)
-fetal distress -shoulder dystocia -umbilical cord prolapse -uterine rupture -placental abnormalities -umbilical cord abnormalities
What are some birth emergencies? (6 listed)
Monitor blood sugar closely, monitor for infections, fetal surveillance
What are some interventions for a pregnant mom with diabetes?
-Hypoglycemia -DKA -Hypertensive disorders -Delivery complications
What are some maternal risks during pregnancy because of diabetes? (4 listed)
Membrane stripping and catheterballoon
What are some mechanical methods for Cervical ripening
Episiotomy, vacuum, forceps
What are some methods a provider can use to assist a delivery?
Prostaglandin E2 (cervadil), amniotic year, AROM
What are some pharmacologic methods to cervical ripening?
-aspiration -cerebral hemorrhage -stroke -hepatic rupture -placental actuation (fetal compromise/death)
What are some possible complications of eclampsia? (5 listed)
-History of LGA infant -History of GDM -Family history of DM -Advanced maternal age -Obesity -Non-Caucasian
What are some risk factors for GDM? (6 listed)
-perinatal mortality -oligohydramnios -Mec-stained fluid -macrosomnia
What are the complications that are at increased risk in a post-term pregnancy?
-Birth defects -Macrosomia -Hydramios -Delayed lung maturity -Miscarriage and still birth
What are the fetal risks that may happen because of diabetes during pregnancy?
Increased risk for down syndrome, preeclampsia, gestational diabetes, Ectopic pregnancy, Preterm labor, hypertension, C-section deliveries
What are the risks for having a baby when you're over 35?
Increased risk for preterm labor, hypertension, anemia, STI, preeclampsia, In adequate weight gain
What are the risks of having a baby at 19 years old or less?
Tachycardia, palpitations, anxiety
What are the side effects of terbutaline?
Crackles, dyspnea, dizziness, cyanosis, edema, heart murmur, heart palpitations, chest pain, tachycardia
What are the signs and symptoms of cardiac decompensation? ( 9 listed)
Uterine contractions, pelvic pressure, backache with vaginal bleeding
What are the signs and symptoms of preterm labor?
-Nonreassuring fetal heart rate pattern -Maternal shock -Excessive maternal pain -Higher fetal station
What are the signs and symptoms of uterine rupture? (4 listed)
Hypovolemic shock and shoulder pain
What are the symptoms of hemorrhage due to a fallopian tube rupture?
-History of previous preterm birth -Multiple gestation pregnancy -Infection
What are the three risk factors for preterm labor?
Monitor blood glucose, glycemic control with diet, exercise, and medication
What are the treatments for GDM?
Counseling, determine a cause to decide on a treatment that will prevent future miscarriages
What are the treatments for re-current or habitual spontaneous abortions?
-Bedrest and monitor symptoms closely -NSTs -Amniocentesis to check for lung maturity
What are the treatments of preeclampsia? (3 listed)
-Infusion of magnesium sulfate -Immediate delivery
What are the treatments of the eclampsia? (2 listed)
-Fetal malposition (OP) -fetal malpresentation -multiple gestation
What are three problems of the passenger that may lead to labor dystocia
-Abnormal shape of pelvis -Cephalopelvic disproportion(CPD)
What are two passageway complications that may cause labor dystocia?
Blockage or scarring of the fallopian tube's
What causes an ectopic pregnancy in a fallopian tube?
Induce labor
What do you NEVER do during a molar pregnancy due to risk of hemorrhage ?
-Hemolysis -Elevated Liver enzymes -Low Platelets
What does HELLP stand for?
Chorioamnionitis
What does PROM increase the risk for?
Toxoplasmosis parasite Other infections Rubella Cytomegalovirus Herpes simplex virus
What does TORCH stand for?
Glycemic control with diet, exercise, and insulin
What is the goal for a mother with diabetes?
Deliver the baby
What is the only cure of hypertension during pregnancy?
Hysterectomy
What is the preferred treatment for a molar pregnancy?
"Pelvic rest"
What is the treatment for threatened spontaneous abortion?
better
are fats absorbed better or worse during pregnancy?
pica
associated with iron-deficiency anemia
week
between 18-32 weeks the fundal height in cm should match the ______ of pregnancy
linea nigra
dark line down the center of the abdomen
BPP (biophysical profile)
diagnostic study that determines fetal well-being by assessing -NST (fetal HR) -fetal breathing -fetal body movement -fetal tone -amniotic fluid volume
increase
do clotting factors increase or decrease during pregnancy?
decrease
does BP increase or decrease during pregnancy?
negative; no late decals (positive means late decels)
during a CST (contraction stress test), is it better to test negative or positive?
Pica
eating non food items
placenta
estrogen is produced by the _______
hCG
hormone that sustains corpus luteum nearly pregnancy
progesterone
hormone that sustains the pregnancy
avoid standing still so blood doesn't pool in the legs (venous stasis); elevate feet when possible
how can comfort measures be taken during pregnancy to help with decreased vascular resistance?
28 weeks
how far into the pregnancy should mothers start to do fetal kick counts?
8-10 glasses
how much water should be drinken daily?
3-4 pounds
how much weight are you supposed to gain during the 1st trimester?
1 pound per week
how much weight are you supposed to gain during the 2nd and 3rd trimester?
weekly until delivery
how often are prenatal visits scheduled after 36 weeks?
every 2 weeks
how often are prenatal visits scheduled from 32-36 weeks?
every month
how often are prenatal visits scheduled up to 32 weeks?
reactive; non-reactive is not good
is it better to have a reactive or non-reactive NST
mercury
it is important to avoid seafood contaminated with ______
insulin
maternal tissue becomes resistant to ______
hormonal
metabolic changes are caused by ______ changes
Goodell's sign
softening of the cervix
Hegar's sign
softening of the uterine isthmus (checked manually with one hand in vagina and other on top of pelvis)
alcohol
teratogen that causes fetal cognitive deficits and fetal alcohol syndrome
tobacco
teratogen that causes fetal hypoxia and respiratory disorders
multiparous
term for 2nd or more time giving birth
primigravida
term for first pregnancy
multigravida
term for more than one pregnancy
nulliparous
term for never haven given birth
nulligravida
term for no pregnancies ever
primiparous
term for the first time giving birth
28
the NST (non-stress test) is done after ___ weeks
energy
the demands of pregnancy require increased ______
supine hypotension syndrome
this cardiovascular change causes light-headedness, pallor, and clammy skin; can be avoided by keeping off the back
parity
total number of deliveries
gravida
total number of pregnancies
false
true or false? pregnant women are fine to use hot tubs and saunas