NUR 318 Chapters 11 & 12
What is Chadwick's sign? When is it seen?
Bluish purple coloration of the vagina mucosa and cervix Begins 6 to 8 weeks gestation
What types of foods work well for morning sickness?
Citrus and ginger
How can a mother stimulate fetal movements? When should a mother be worried about a decrease in fetal movements?
Get in a comfortable position in a relaxed environment, ideally at the same time each day "Count to 10": If there haven't been 10 movements in 2 hours, contact the HCP
What are Braxton Hicks contractions? How can they be relieved?
False labor contractions that begin around 16 to 20 weeks and present as painless and irregular, felt more strongly at front of stomach Therapies: hydration, side-lying position, rest, breathing techniques
What should a pregnant mother with lactose intolerance include in her diet?
Foods with calcium peanuts, almonds, sunflower seeds, broccoli, salmon, kale, molasses, lactose free dairy, calcium-enriched OJ, soy milk
What does being underweight before or during pregnancy increase the risk of? Being overweight before or during pregnancy?
Risk for low-birth-weight infant (encourage women to eat high calorie snacks) Risk for high-birth-weight infants, cephalopelvic disproportion, and potentially surgical birth
What is Goodell's sign? When is it seen?
Softening of the cervix Begins 5 weeks gestation
What is Hegar's sign? When is it seen?
Softening of the lower uterine segment or isthmus as a result of increased blood supply to the area Begins 6 to 12 weeks gestation
What cardiovascular changes occur during pregnancy?
1. increase in cardiac output 2. increase in venous return 3. increase in heart rate by 10-15 bpm 4. hypercoagulable state d/t increase in iron, fibrin, and fibrinogen
What musculoskeletal changes occur during pregnancy?
1. softening and stretching of ligaments and joints 2. increase swayback and upper spine extension 3. center of gravity shifts forward 4. lordosis 5. waddle gait 6. stretch of abdominal muscles
What are positive signs of pregnancy?
1. ultrasound verification of embryo or fetus 2. fetal movement felt by experienced clinician 3. auscultation of fetal HR via Doppler
What are some first trimester discomforts and how can they be relieved?
1. urinary frequency: Kegels 2. fatigue: rest often 3. nausea/vomiting: eat small, bland meals 4. breast tenderness: wear full support bra 5. constipation: increase water intake 6. nasal stuffiness, bleeding gums, epistaxis: use humidifier 7. cravings: assess type (pica) 8. leukorrhea: keep area clean
How much weight should a woman with a BMI >30 gain during pregnancy?
11 to 20 lbs First trimester: 2 lb Second and third trimesters: +2/3 lb/week
How much weight should a woman with a BMI >25 gain during pregnancy?
15 to 25 lbs First trimester: 2 lb Second and third trimesters: +2/3 lb/week
How does blood pressure change during pregnancy?
1st trimester: remains at pre-pregnancy level 2nd trimester: decreases by 5-10 mm Hg 3rd trimester: returns to first trimester level
How much water should a pregnant woman drink daily?
2 L
What gastrointestinal changes occur during pregnancy?
1. gums become hyperemic, swollen, and friable 2. ptyalism 3. dental problems and gingivitis 4. decreases peristalsis and smooth muscle relaxation 5. hemorrhoids 6. heartburn 7. prolonged gallbladder emptying 8. nausea/vomiting
Which foods can possibly be contaminated with Listeria and should be avoided during pregnancy?
1. hot dogs, lunch meats, deli meats 2. soft cheeses 3. refrigerated pate or meat spreads 4. refrigerated smoked seafood 5. pre-packaged salads
What are probable signs of pregnancy?
1. Braxton Hicks contractions 2. abdominal uterine enlargement 3. positive pregnancy test 4. ballottement 5. Hegar's sign 6. Chadwick's sign 7. Goodell's sign
What labs and tests should be done prenatally?
1. CBC (HgB, HcT, RBCs, WBCs, platelets) 2. blood typing and Rh factor 3. Rubella titer 4. Urinalysis (albumin, glucose, ketones, bacteria) 5. renal function (BUN, Cr, electrolytes) 6. Pap smear 7. STIs, HIV, VDRL, RPR 8. Hep B 9. glucose tolerance 10. ultrasound 11. genetic testing 12. cardiac evaluation (if h/o cardiac problems or HTN)
What are presumptive signs of pregnancy?
1. amenorrhea 2. breast tenderness/enlargement 3. nausea/vomiting 4. urinary frequency 5. uterine enlargement 6. fatigue 7. hyperpigmentation 8. fetal movement
Explain each of the following maternal emotional responses: 1. ambivalence 2. introversion 3. acceptance 4. mood swings 5. changes in body image
1. conflicting feelings, most common in 1st trimester 2. mother becomes increasing preoccupied with herself and fetus, seen in early pregnancy 3. acceptance: physical changes bring reality and validity to pregnancy, 2nd trimester 4. emotional lability, throughout 5. varies but highly dependent on mother's body image prior to pregnancy
How much weight should a woman with a BMI between 18.5 and 24.9 gain during pregnancy?
25 to 35 lbs First trimester: 3.5 to 5 lbs Second and third trimesters: +1 lb/week
How much weight should a woman with a BMI <25 gain during pregnancy?
28 to 40 lbs First trimester: 5 lbs Second and third trimesters: +1 lb/week
What does each letter of "GTPAL" stand for?
Gravida: number of times pregnany T: number of term births (>37 weeks) P: number of pre-term births (>20 weeks and <37 weeks) A: number of abortions/miscarriages (<20 weeks) L: number of living children
What does each letter of "GP" stand for?
Gravida: total number of times a woman has been pregnant Para: number of times a woman has given birth to a fetus of at least 20 weeks (regardless of viability or birth of multiples)
What is chloasma/melasma?
Hyperpigmentation on the face d/t higher levels of progesterone, estrogen, and melanocyte stimulating hormones "Pregnancy mask"
What is linea nigra?
Hyperpigmented line running vertically down pregnant belly
What should a pregnant mother who's a vegetarian include in her diet?
Protein: soy foods, beans, lentils, nuts, grains, seeds Iron: meat alternatives and Vit C rich foods Calcium: soy, calcium-fortified OJ Vitamin B12: fortified soy foods, B12 supplement
What is Vena Cava Syndrome? What are the symptoms?
In the last trimester, the heavy gravid uterus can fall back against the inferior vena cava when the mother is in the supine position Symptoms: dizziness, tachycardia, N/V Advise mother to lay on her side instead of her back
How does the RBC count change during pregnancy?
Increase in number by 30% Plasma volume will increase more than RBCs, leading to hemodilution and physiologic anemia
How does the plasma volume change during pregnancy?
Increase in volume by 50% Begins at 10 to 12 weeks and peaks at 32 to 34 weeks
How does the WBC count change during pregnancy?
Increases and the lower limit becomes 6,000 per microliter of blood Leukocytosis during pregnancy is due to physiologic stress induced by the pregnant state
What are the nursing indications for a pregnant women who has to fly across the country?
Request and aisle seat and walk around every 2 hours and practice calf-tensing exercises (d/t hypercoagulable state)
Define pre-term, term, and post-term.
Pre-term: delivered prior to beginning of week 37 Term: delivered between beginning of week 37 and end of week 42 Post-term: born after end of week 42
Which seafoods should be avoided during pregnancy?
Those high in mercury 1. shark 2. swordfish 3. king mackerel 4. orange roughy 5. ahi tuna (canned tuna is OK) 6. tilefish
What is Nagele's rule?
Used to calculate estimated date of birth LMP - 3 months + 7 days + 1 year = EDB
How is the fundal height measured? What heights are expected?
Uses a tape measure to measure from the top of the pubic bone from the top of the uterus The fundus reaches the level of the umbilicus at around 20 weeks and measures 20 cm From 24 to 36 weeks, the fetal height should correspond with the number of weeks gestation After 36 weeks, the fundal height will drop due to lightening and no longer corresponds to weeks gestation
What is leukorrhea?
Vaginal secretions during pregnancy that are thicker, more acidic, and white