nurs 3800 exam 2
What is the function human chorionic gonadoropin?
(hCG) can be detected in the maternal serum by 8-10 days after conception, shortly after implantation. This hormone is the basis for pregnancy tests. hCG preserves the function of the ovarian corpus luteum, ensuring the continued supply of estrogen and progesterone needed to maintain the pregnancy. Miscarriage occurs if the corpus luteum stops functioning before the placenta is producing sufficient estrogen and progesterone. The hCG reaches its max level at 60-70 days and then decreases to its lowest levels at approx 100-130 days as the placenta becomes the primary source of estrogen and progesterone
What is the function of human placental lactogen?
(hPL) protein hormone produced by the placenta, also known as chorionic somatotropin. This substance is similar to a growth hormone and stimulates the maternal metabolism to supply nutrients needed for fetal growth, hPL increases the resistance to insulin, facilitates glucose transept across the placental membrane and stimulates breast development to prepare for lactation.
Which indicates a reactive nonstress test?
2 or more accelerations of 15 BPM for 15 seconds in 20 minutes
When is the recommended time for GDM screening?
24-28 weeks
What are oligohydramnios?
AFV is less than expected for gestational age. It is typically diagnosed by ultrasound examination and may be described qualitatively or quantitatively
How should the nurse screen for mental health at prenatal visits?
All women should be assessed and screened mental health issues. Perinatal depression is the most common complication of pregnancy; if untreated it can have serious adverse effects on the mother, her newborn, and her family. SCreening for depression and anxiety symptoms at least once during the perinatal period using a standardized, validated instrument such as the patient health questionaire or the edinburgh postnatal depression scale. Appropriate follow-up and treatment, including referral to mental HCPs, is essential whenever there is a positive screening. Women are usually inlikely to initiate discussion with HCPs r/t mental health concerns when they are informed that the screening is part of routine prenatal care, when the HCP are interested and sensitive, adn when they are informed about the prevalence of mental health conditions during the perinatal period. Appropriate referral and follow-up are needed. Risk factors for depression or anxiety during pregnancy include lack of support from partner, inadequate social support, history of IPV, personal hx of mental illness, unintended pregnancy, pregnancy complications or loss, and stressful life events.
How do various types of anemia effect pregnancy? What is the management for each?
Anemia is a common medical disorder of pregnancy affecting from 20%-52% of pregnant women. It results in a reduction of the oxygen-carrying capacity of the blood, the heart tries to compensate by increasing CO. This effort increases the workload of the heart and stresses ventricular function. Therefore anemia that occurs with any other complication may results in congestive heart failure.When a women has anemia during pregnancy, the loss of blood at birth, even if minimal, is not well tolerated. She has an increased risk for requiring blood transfusions. Women with anemia have a higher incidence of puerperal complications, such as infection, than postpartum women with normal hematologic values.
What medication is used to promote fetal lung maturity when preterm birth is eminent?
Betamethasone is a corticosteroid used to promote fetal lung maturity when preterm is eminent
What are the desired results for a CST?
CST results want to be negative because i would not indicate risks to the pregnancy
Who is at risk for preterm birth (spontaneous or indicated)?
Causes are multifactorial. Infection, pre pregnancy colonization of the upper and lower genital tract and the maternal immune response to that colonization are increasingly recognized as important factors in the infection-related risk for preterm labor, women in spontaneous preterm labor with intact membranes commonly have organisms that are normally found in the lower genital tract present in their amniotic fluid, placenta, and membranes. Clinical and laboratory evidence of infection are more common when birth occurs earlier than 30-32 weeks of gestation rather than closer to term. Intraabdominal infections also have been related to preterm birth. However, the risk is not reduced by periodontal care, suggesting that the link between peiodontal disease have been shown to have an increased risk for preterm birth. However the risk is not reduced by periodontal care, suggesting that the link between periodontal disease have been shown to have an increased risk for preterm birth. However, the risk is not reduced by periodontal care
What is a cfDNA screen?
Cell-free DNA (cfDNA) is performed using a sample of maternal blood. The cfDNA screening test is an example of noninvasive prenatal testing (NIPT). Aneuploidy is defined as having one or more extra or missing chromosomes in the 23 pairs each individual normally possesses. Common aneuploidies are trisomies 13, 18, and 21, each of which results from an extra chromosome
What is chronic hypertension?
Chronic hypertension is defined as hypertension that is present before the pregnancy. Women may be diagnosed with chronic hypertension once is evident that hypertension persists after the postpartum period
What is the patho of preeclampsia? How does it impact placental perfusion?
Current thought is that the pathology changes in the woman are caused by disruptions in placental perfusion and endothelial cell dysfunction. These changes develop early in pregnancy, long before the s/s of preeclampsia occur. Normally, the spiral arteries in the uterus widen from thick-walled muscular vessels to thinner, saclike vessels with much larger diameters. This change increases the capacity of the vessels, allowing them to handle the increased blood volume of pregnancy. Placental ischemia is thought to cause endothelial cell injury and dysfunction by stimulating the release of substances that are toxic to endothelial cells
What is eclampsia?
Eclampsia is usually preceded by premonitory s/s including persistent HA, blurred vision, photophobia, severe epigastric or RUQ abdominal pain, and altered mental status. Seizures can appear suddenly and without warning in a seemingly stable woman with only minimal BP elevations. Eclamptic seizures are frightening to observe. Tonic contraction of all body muscles precedes tonic-clonic convulsion
What is the purpose of a quad screen? What are its components? What is the ideal time to offer this test?
First trimester screening using PAPP-A detecting fetuses wit trisomy 21 as quadruple screening in the second trimester. Detect chromosomal abnormalities depends on the accuracy of gestational age assessment. These tests are screening procedures only and are not diagnostic. A postiive screening test results indicates an increased risk but is not diagnostic of trisomy 21 or another chromosome abnormality. Women with positive screening results should be offered genetic counseling and diagnostic testing by amniocentesis or CVS for fetal karyotyping
What are the functions of the amniotic fluid?
Functions include helping to maintain a constant fetal body temperature serving as a source of oral fluid and repository for waste, and assisting in the maintenance of fluid and electrolyte homeostasis. Amniotic fluid allows the fetus freedom of movement for musculoskeletal development and, with the uterine walls, provides the fetus with resistance to movements while being active. In addition, it cushions the fetus from trauma by outside forces allowing pressure to be distributed from one side to another with minimal exertion on the fetus. The weightless state allows the face and body of the fetus to develop symmetrically. Auditory stimulation is provided by the rhythmic sounds of the blood flow through the umbilical cords, and the extrauterine sounds are transmitted in a muted form to the fetus. The fluid also has antibacterial factors, including transferin, fatty acids, immunoglobulins, and lysosome, to protect the fetus from infection and, with adequate volume, facilitates normal fetal lung development.
What are some of the consequences of endothelial dysfunction?
Generalized vasospasm, poor tissue perfusion in all organ systems, increased peripheral resistance and BP, and increased endothelial cell permeability, leading to intravascular protein and fluid loss and ultimately to less plasma volume
How should the nurse teach a mother about nutrition?
Good nutrition is important for the maintenance of maternal health during pregnancy and the provision of adequate nutrients for embryonic and fetal development. Assessing a woman's nutritional status and weight gain and providing ongoing education about nutrition are part of nurse's responsibility. Recommend about daily intake of nutrients, calories, vitamins, minerals. Based on the woman's BMI, the recommended weight gain during pregnancy is discussed. Mention foods high in iron, the importance of prenatal vitamins, and recommendations to avoid alcohol and to limit caffeine intake. Can be referred to a dietician
What is HELLP syndrome?
HELLP syndrome is a laboratory dx for a variant of preeclampsia that involves hepatic dysfunction, characterized by Hemolysis, Elevated Liver enzymes, Low Platelets
How do you assess for s/s of preeclampsia?
HELLP syndrome, searching for the biomarkers such as decreased levels of angiogenic proteins vascular endothelial growth factors (VEGF), and placental-like growth factor (PIGF) and increased levels of the antiangiogenic proteins soluble fas-like tyrosine kinase-I (sFlt-I), an soluble endoglin (sEng) have been found to precede the devlopment of preeclampsia. Accurate measurement of BP, assessment for edema, accurate measurement of deep tendon reflexes (DTR)/assessing for hyperactive reflexes, and loking for the presence of proteinuria
What is the most likely cause for decreased fetal accelerations when performing an NST? What are the other causes?
If the test does not meet the criteria after 40 min, a CST or BPP should be performed. Once the NST testing is initiated, it is usually repeated once or twice weekly for the remainder of the pregnancy
What should the nurse teach the mother about immunizations?
Immunizations with live or attenuated live viruses is contraindicated during pregnancy because of potential teratogenicity; recommended vaccination with these agents should be part of postpartum care. Live-virus vaccines include hose for measles (rubeola and rubella), varicella (chickenpox), and mumps as well as the sabin (oral) poliomyelitis vaccine (no longer in the US). Vaccines that can be administered during pregnancy include combined tetanus-diptheria-acellular pertussis (tdap), recombinant hep B and influenza (inactivated) vaccines. Tdap should be administered between 27-36 weeks of gestation. Maternal antipertussis antibodies are short-lived and antibody levels drop significantly during the first year after vaccination. This will likely transfer immunity onto fetus. Adolescents and adults (family) who will have close contact with an infant less than 12 months of age should receive a single dose of tdap if they have not been vaccinated previously. All women who are pregnant during flu season should be offered a flu shot
How is hyperemesis treated?
Implementing the medical plan of care whether in the hospital or home setting. Interventions may include initiating and monitoring IV therapy, administering drugs and nutritional supplements, and monitoring the woman's response to interventions. The nurse observes the woman for any signs or complications such as metabolic acidosis, jaundice, or hemorrhage and alerts the health care provider should these occur
What is the likelihood a woman with GDM is diagnosed with diabetes in the future? What is the recommended screening postpartum?
In most cases, the condition goes away after the baby is delivered,, however the women who have gestational diabetes have increased risks of developing type 2 diabetes later in life. To screen, the nurse should get an IV glucose measurement one hour after administration of 50 g of oral glucose solution. Women who meet or exceed the screening threshold in the initial test then undergo a 100-g, three hour oral glucose tolerance test
The nurse is caring for a client with poorly controlled gestational diabetes. Which risks to the fetus would the nurse anticipate during her later stages of pregnancy and birth? Select all that apply
Macrosomia, shoulder dystocia, facial nerve injury
What are the desired results for an NST?
NST results want to be reactive, if the baby's heartbeat accelerates to a certain level above the baseline twice or more at least 1- seconds within a 20-minute winow
How do you manage DIC?
OB emergency, counts for 50%, correct causing condition (ie hysterectomy), careful I&O- foley, cardiac monitoring (bleeding comes with inc HR and dec BP, could lead to organ failure), O2, blood products and volume (such as packed RBC [PRBC], platelets, plasma- what you give depends on what is causing the DIC), probable ICU admission
What are the indications for performing percutaneous umbilical blood sampling (PUBS)? What are the risks involved?
Percutaneous umbilical blood sampling is used for fetal blood sampling and transfusion. However, PIUBS haas been replaced in many centers by placental biopsy because its a safer, easier, and faster alternative. Improvements in cytogenic and molecular diagnostic testing have decreased the need for fetal blood samples. PUBS invovles the insertion of a needle directly into a fetal umbilical vessel, preferably the vein, under ultrasound guidance. Puncture of the umbilical cord near its insertion into the placenta is technically easier, but is associated with a higher risk for contamination with maternal blood. Bleeding from the cord puncture site is the most common complication of the procedure. Transient fetal bradycardia can also occur. maternal complications are rare but include amnionitis and transplant hemorrhage
What would you teach pregnant women regarding exercise?
Physical activity during pregnancy has minimal risks and promotes a feeling of well-being in pregnant women. it improves physical fitness and circulation, enhancces physiologic well-being, promotes relaxation and rest, and counteract boredom. Regular exercise helps with weight management and can reduce the risk of gestational diabetes, c-section, and giving birth to an infant that is large for gestational age
How would you know if a patient is progressing from preeclampsia to eclampsia with severe features?
Preeclampsia is a condition unique to human pregnancy. Occurs in 2-7% of healthy pregnant women. It is a progressive disorder, with the placenta as the root cause. Therefore the disease begins to resolve after the placenta has been expelled. HELLP syndrome is a laboratory dx for a variant of preeclampsia that involves hepatic dysfunction, characterized by Hemolysis, Elecated Liver enzymes, and Low Platelet count. Accurate measurement of BP is essential in early detection, and decreasing the factors that aide to preeclampsia. Also assess for edema.
How should the nurse teach about the common discomforts of pregnancy and management?
Pregnant women who have physical sx that would be considered abnormal in the non pregnant state. they need explanations of the causes of the discomforts and advice on ways to relieve them. Nurses can do much to allay a first-time mother's anxiety about such symptoms by telling her in advance and using terminology that the woman (or couple) can understand. Thus helping them to understand the rationale for treatment that will promote their participation in care. Interventions should be individualized, with attention given to the woman's lifestyle and culture.
What is PROM?
Prelabor Rupture Of Membranes and is the spontaneous rupture of the amniotic sac and leakage of amniotic fluid beginning before the onset of labor at any gestational age
How would you counsel a woman with GDM and her family regarding managing her GDM?
Routine prenatal lab tests are performed and a baseline renal function may be assessed with a 24-hour urine collection. Urinalysis and culture are performed to assess for the presence of a UTI, which is common in diabetic pregnancy. Because of the risk for coexisting thyroid disease, thyroid function tests may also be performed. The nurse should teach the patient related to diabetic pregnancy, management, and potential effects on pregnant woman and fetus, insulin administration and its effects, hypoglycemia and hyperglycemia, diabetic diet. Also the nurse should counsel on anxiety, grieving, decreased ability to cope, decreased adherence, decreased self- esteem r/t stigma of being labeled "diabetic", effects of diabetes and its potential sequelae on the pregnant women and the fetus. The nurse should go over potential for injury to the fetus related to disruption of oxygen transfer from environment to fetus and birth trauma. Also potential for injury to mother r/t improper insulin administration, hypoglycemia and hyperglycemia, cesarean or operative vaginal birth, postpartum infection.
Your client tests positive for Group B Strep (GBS) at her 36 week appt. Which education will you include in your teaching?
She will receive abx during delivery to prevent transmission to the baby
How does being an adolescent affect a woman's pregnancy?
Teenage (below age of 15/16) pregnancy is a global health concern. The US has one of the highest teen birth rates among industrialized nations, although rates have steadily declined since the most recent peak in 1991. Numerous adolescent pregnancy prevention programs hvae had varying degrees of success. Characteristics of programs that make a difference are those that have sustained commitment to adolescents over a long time, involve the parents and other adults in the community, promote abstinence and personal responsibility, and assist adolescents to develop a clear strategy for reaching goals such as a college education or a career. When adolescents become pregnant and decide to give birth, they are much less likely than older women to receive adequate prenatal care, often receiving no health care at all. These young women also are more likely to smoke and less likely to gain adequate weight during pregnancy. infants born to adolescents are at increased risk of LBW and VLBW infants and infant death. Adolescents are at increased irks for maternal anemia, preterm birth, preeclamsia, and/or HELLP syndrome, PPH, and chorioamniotitis, but they do not have likelihood of c-section birth. The role of the nurse in redicing the risk and consequences of adolescent pregnancy is to encourage early and continued prenatal care, to provide early and ongoing education about pregnancy, birth, and parenting; and to refer the adolescent, if necessary, for appropriate social support services, which can help decrease the effects of a negative socioeconomic environment. Adolescents often see the nurse as trust worthy and someone who will maintain confidentiality, as well as provide them with accurate info
What is the purpose and components of a biophysical profile (BPP)
The biophysical profile is a noninvasive dynamic assessment of a fetus that is based on acute and chronic markers of a fetal disease. BPP includes AFV, FBMs, fetal movements, and fetal tone determined by ultrasound and FHR reactivity determined by means of the NST. Therefore, the BPP can be considered a physical examination of the fetus, including determination of vital signs
What are the classifications of hypertensive disorders of pregnancy?
The classification of hypertensive disorders in pregnancy is confusing because standard definitions are not used consistently by all health care providers. The classification system most commonly used in the US since 2000 was based on recommendations from the American college of obstetricians and gynecologists (acog) and the national high blood pressure in pregnancy. The task force on htn in prep chose to continue the use of this classification system, although it modified some of the system components.
How would you instruct a patient to conduct a kick count assessment? What findings would indicate the need for further assessment?
The daily fetal movement count (DFMC) can be assessed at home and is noninvasive, inexpensive, and simple to understand and usually does not interfere with a daily routine. It is frequently used to monitor the fetus in pregnancies complicated by conditions that may affect fetal oxygenation.
Why is the embryonic stage the most critical time of human development?
The embryonic stage of the embryo lasts from day 15 until ~8 weeks after conception. The embryonic stage is the period of organogenesis and the most critical time in the development of the organ systems and the main external features. Developing areas with rapid cell division are the most vulnerable to malformation caused by environmental teratogens. At the end of the eighth week, all organ systems and external structures are present, and the embryo is unmistakably human
What are polyhydramnios?
The excessive accumulation of amniotic fluid- the fluid that surrounds the baby in the uterus during pregnancy. occurs in about 1-2% of pregnancies
What are the key components of the initial prenatal visit?
The first prenatal visit is longer and more detailed than future visits. The initial evaluation includes a comprehensive health history emphasizing the current pregnancy; previous pregnancies, the family, a psychosocial profile, a physical assessment, diagnostic testing, and an overall risk assessment. The first appointment is mainly for health history and education of the woman, especially if it is her first time, or there is a risk for the pregnancy. Get health hx, nutritional hx, hx of medicaiton and herbal used, family hx, social/experimental/occupational hx
What is the goal of prenatal care?
The goal of prenatal care is to promote the health and well-being of the pregnant woman, her fetus, the newborn, and the family. It includes education about healthy lifestyle behaviors such as nutrition and physical activity, self-care for the common pregnancy discomforts, and information about changes in the mother and growth of the developing fetus. There is a major emphasis placed on preventative aspects of care, primarily to support the pregnant woman in self-management between visits with health care professionals and to help her recognize and report changes that can signal problems early so that adverse effects for her and her fetus can be prevented or minimized. Women of middle or high socioeconomic status routinely seek prenatal care, women's reasons for delaying prenatal care include cost, lack of insurance, lack of child care, transpo barriers, or inability to take time off from work. Lack of culturally sensitive care providers, discrimination based on sexual orientation and barriers to communication resulting from differences in language also interfere with access to care
What are the indications for third trimester fetal assessments?
The goal of third-trimester testing is to determine whether the intrauterine environment continues to support the fetus. The testing is often used to determine the timing of birth for women at risk for interrupted oxygenated to the fetus by any of several mechanisms. Evidence based recommendations for conditions-specific testing schemes in cases of identified risk factors have been difficult to develop and often do not exist
What is the function of the placenta?
The placenta begins to form at implantation. During the third week after conception, the trophoblast cells of the chorionic villi continue to invade the decider basalis. As the uterine capillaries are tapped, the endometrial spiral arteries fill with maternal blood. The chorionic villi grow into the spaces wih two layers of cells: the outer syncytium and the inner cytotrophoblast. A third layer develops inot separate areas called cotyledones. in each of the 15-20 cotyledons, the chorionic villi branch out, and a complex system of fetal blood vessels form. Each cotyledon is a functional unit. Functions as a means of metabolic exchange. Exchange is minimal at this time because the two cell layers of the villous membrane are too thick. Permeability increases as the cytotrophoblast thins and disappears; nu the eighth week genetic testing can be done on a sample of chorionic villi by aspiration biopsy; however limb defects have been associated with chorionic villus sampling before 10 weeks. The structure of the placenta is complete by the 12th week. The placenta continues to grow wider until 20 weeks, when it covers approx half of the uterine surface. It then continues to grow thicker. The branching villi continue to develop within the body of the placenta increasing the functional surface area
What should the nurse teach the mother about medications?
The possible teratogenicity of many medications both prescription and OTC, is still unknown. This is especially true for new medications and combinations of drugs. Moreover, certain subclinical errors or deficiencies in. intermediate metabolism in the fetus may cause an otherwise harmless drug to be converted into a hazardous one. The greatest danger of drug-caused development defects in the fetus extends from time of fertilization through the first trimester, a time where a woman might not realize she is pregnant. Self-treatment must be discouraged. The use of all drugs - including OTC medications, herbs, and vitamins- should be limited and a careful record kept of all therapeutic and nontherapeutic agents used. The use of complementary and alternative modalities (CAMs) by pregnant women is widespread; as many as 1/3 of pregnant women admit to the use of CAMs. Actual use is likely higher, as some women do not disclose the use of CAMs. Actual use is likely higher, as some women do not disclose the use of CAMs to their HCPs. There is limited research evidence about the safety of herbal preparations, especially during pregnancy. Although the use of CAMs is consistent with a holistic, woman-centered approach to care, caution is warranted in their use because of the lack of evidence of their safety and efficacy.
What is traditional prenatal care?
The traditional model for provision of prenatal care has been used for more than a century. The initial visit usually occurs in the first trimester, with monthly visits scheduled every 2 weeks until week 36 and then every week after birth. The trend is toward individualizing the schedule of care. Women with low-risk pregnancies may have fewer routine prenatal visits, whereas those at risk for complications may be seen more frequently
How is asthma treated in pregnancy?
The ultimate goal of asthma therapy in pregnancy is maintaining adequate oxygenation of the fetus by preventing hypoxic episodes in the mother. Achieving this goal requires monitoring lung function objectively, avoiding or controlling asthma triggers, educating women about the importance of controlling asthma during pregnancy, and drug therapy. Current drug therapy for asthma emphasizes treatment of airway inflammation to decrease airway hyper responsiveness and prevent asthma symptoms.
What is conception?
The union of a single egg and sperm, marks the beginning of a pregnancy. Occurs not as an isolated even but as a part of a sequential process, which includes gamete (egg and sperm) formation, ovulation (release of egg), fertilization (union of the gametes), and implantation in the uterus
What do alpha-fetoprotein levels screen? When is the most opportune time for this maternal serum test?
Used as a screening tool for NTDs in pregnancy. Through this technique technique approx 85-92% of open NTDs and almost all cases of anencephaly can be detected early. Screening is recommended for all pregnant women. 16-18 weeks are ideal
What is the purpose and the components of a modified BPP?
Used increasingly as a way to shorten the testing time required for the complete BPP by assessing the components that are most predictive of perinatal outcome. The mBPP combines the NST which assesses the current fetal condition, with measurement of the quantity of amniotic fluid, an indicator of placental function over a longer period of time
Describe the purpose, procedure, and interpretation of acoustic stimulation
Vibroacoustic stimulation, fetal acoustic stimulation. Another method of testing antepartum FHR response. This test is generally performed in conjunction with the NST and uses a combination of sound and vibration to stimulate the fetus. Whether the acoustic or vibratory component alters the fetal state is unclear. The fetus is monitored for 5 minutes before stimulation to obtain a baseline FHR. If the fetal baseline pattern is nonreactive, the sound source is then activated for 3 seconds on the maternal abdomen over the fetal head. the desired result is a reactive NST, which usually occurs within 3 minutes of stimulation. The acceleration produced may have a significant increase in duration. The stimulus may be repeated at 1 minute intervals up to three times when no response is noted. Further evaluation is needed with BPP or a CST if the pattern is still nonreactive. VAS is safe for use during pregnancy. No long-term evidence of hearing loss has been found in children followed up to 4 years of age who were exposed to VAS during pregnancy
What happens when a fetal fibronectin is positive?
a positive result does not have any predictive value, so the plan of care should be based on monitoring and cervical change assessments
Case Study: Samantha calls the clinic c/o low back pain and pelvic pressure, the discomfort comes and goes every 10-15 minutes but makes her stop to pay attention. What is the best response of the nurse? a) That sounds like Braxton-Hicks contractions. Call back if they're every 3-5 minutes or if you are bleeding or leaking b) Its normal to have low back pain in pregnancy. Try a warm compress and some yoga c) im concerned you could be in preterm labor, you should come in and be evaluated
a) That sounds like Braxton-Hicks contractions. Call back if they're every 3-5 minutes or if you are bleeding or leaking
A patient at 34 weeks gestation with a severe headache is admitted to the hospital with a dx of pre-eclampsia. In addition to obtaining a baseline vital signs and placing the woman on bedrest, the provider ordered the following four items. Which of the orders should the nurse perform first? a) deep tendon reflexes b) obtain a CBC c) assess baseline weight d) obtain a urinalysis
a) deep tendon reflexes
What is type 1 diabetes?
accounts for 5-10% of all diabetes and includes cases that are caused primarily by pancreatic islet B-cell destruction and that are prone to ketoacidosis. People with type 1 diabetes usually have an abrupt onset of illness at a young age and an absolute insulin deficiency. Type 1 diabetes includes cases thought to be caused by an autoimmune process and for those for which the cause is unknown
What is a specialized ultrasound assessment, and what are the indications for its use?
also called detailed, or targeted; examinations are performed when a woman is suspected of carrying an anatomically or physiological abnormal fetus. Indications for the comprehensive exam include abnormal hx or laboratory findings, or the results of a previous standard or limited ultrasound examination. Specialized ultrasonography is performed by highly trained experienced personelle
Describe the purpose, procedure, and interpretation of contraction stress test (CST)
also called oxytocin challenge test (OCT) was the first widely used electronic fetal assessment test. It was devised as a graded stress test of the fetus, and its purpose was to identify the jeopardized fetus that was stable at the rest but showed evidence of compromise after stress. Uterine contractions decrease uterine blood flow and placental perfusion. If this decrease is sufficient to produce hypoxia in the fetus, a deceleration in FHR results. The woman is placed in the semi-fowler and monitored electronically with a fetal ultrasound transducer and a uterine tocodynameter. The tracing is observed for 10-20 minutes for baseline rate and variability and the possible occurrence of spontaneous hypotension
What are the indications for performing an amniocentesis? What are the risks involved in this procedure?
amniocentesis is performed to obtain amniotic fluid, which contains fetal cells. Under direct ultrasonographic visualization, a needle is inserted transabdominally into the uterus and amniotic fluid is withdrawn into a syringe. Then the carious assessments are performed on the fluid sample. Possible after week 14 of pregnancy, when the uterus becomes an abdominal organ and sufficient amniotic fluid is available for testing
What do positive genetic screens indicate?
an inherited gene mutation was found in one of the genes associated with cancer risk. Individual risk depends on which gene has the mutation, gender, age, family hx of cancer, etc
What is meant by preterm birth?
any birth that occurs between 20 0/7 weeks and 36 6/7 weeks of gestation
How does the GI system change anatomically during pregnancy?
appetite inc and 70% of women experience nausea with or without vomiting
What is a fetal assessment?
at each visit physical parameters are measured. The woman's BP and weight are assessed and the appropriateness of the gestational weight gain is evaluated in related to her BMI. Urine may be checked by dipstick, and the presence and degree of edema are noted. for exam of abdomen, the women lies on her back with her arms by her side and head supported by a pillow. A small wedge placed under her right hip to tilt her slightly to the left, and abdominal inspection is followed by measurement and height of the fundus. During each exam, the nurse must remain alert for supine hypotension (low BP that occurs while the woman is lying on her back). when any of the findings are outside the expected range, and in-depth examination is performed. In an uncomplicated pregnancy, fetal gestational age is estimated after the duration of pregnancy and the EDB have been determined. Fetal gestational age is estimated after the duration of pregnancy and the EDB have been determined. Fetal gestational age is determined from the menstrual hx, contraceptive hx, pregnancy test results, and other things. Quickening usually occurs between 16-20 weeks of gestation and is initially experienced as a fluttering sensation. The mother's report should be recorded. Multiparous women often percieve fetal movement earlier than primigracidae. ultrasounds in early pregnancy are used to est the duration of pregnancy and can detect a multiple gestation and provide info about the well-being of the fetus or fetuses. Fetal heart tones (FHTS) are assessed routinely at prenatal care visits. Early in pregnancy the fetal heartbeat can be detected during ultrasound examination. Late in the first trimester, the heartbeat can be heard with a doppler device that transmits FHTs through a speaker. Using doppler allows the mother to hear the fetal heartbeat. also the fetal health status is taken, fundal height is taken.
Case study: Brooklyn has kept her GDM in good control with diet and required no insulin; she has exercised regularly, all NST's have been reactive and today her NST is non reactive. What comes next? a) Immediate delivery of the fetus b) BPP with AFI to facilitate decision making c) patient to increase to three-times daily fetal kick counts d) admit to hospital for continuous monitoring and frequent blood sugar testing
b) BPP with AFI to facilitate decision making
How would you counsel a woman with GDM and her family regarding managing her exercise with GDM?
being active for 30-69 min/day is encouraged. daily activity has been shown to: increase utilization of glucose, especially after a meal; improve glucose control, perhaps eliminating the need for insulin therapy; reduce the risk for excessive weight gain; and reduce the weight of the newborn by approx 150g. Physical activity can be divided into 10- to 20- minute periods after each meal
How does the bladder change anatomically during pregnancy?
bladder has inc output because there is inc urine production and pressure of the uterus on the bladder; more pressure on the uterus, stagnant behind uterus, bacterial risk --> woman is more prone to kidney infection
Case Study: Brooklyn is now 26 weeks along and had her 1-hour GTT last week. Which result would tell the midwife that Brooklyn should have the GTT diagnostic test? a) 118 b) 127 c) 143 d) 195
c) 143
What genetic screening is done after the initial prenatal visit?
carrier screening and counseling is done in the preconception period to identify any risks for inherited medical conditions and genetic disorders. During pregnancy all women should be offered screening tests for chromosomal abnormalities based on factors such as age, previously obstetric history, family hx, gest age when prenatal care began, # of fetuses, availability of testing, and desire for easy results. Screening for aneuploidy can o detect Down syndrome and other trisomies. First-trimester screening can be done between 11-14 weeks using a sample of the maternal blood to measure biochemical markers, pregnancy associated plasma protein A and hCG, and ultrasound examination for nuchal translucency. Non- invasive cell-free DNA (cfDNA) testing can be done as early as 10 weeks to test for common trisomies. Women who begin prenatal care in the second trimester should be offered testing that includes quadruple screening, cfDNA screening, and ultrasound exam. Screening for neural tube tefects and other open fetal defects in the second trimester is done by measuring the maternal serum AFP (MSAFP) level by ultrasound. False-positive results are command warrant further testing with amniocentesis. Some experts recommend performing both first- and second- trimester screening to increase the accuracy of results. Integrated screening includes both first and second trimester tests. It has high sensitivity and low false-positive rate. Results are reported only after the second-trimester screening, she is offered diagnostic testing. Sequential screening, if the woman's risk for aneuploidy is high based on the first trimester screening, she is offered diagnostic testing (ie amniocentesis). If her risk is low or moderate, the second- trimester screening tests are done and a final adjusted risk is determined for trisomies 21 and 18.
What are the s/s of PTL?
change in type of vaginal discharge (water, mucus, or bloody), increase in the amount of vaginal discharge, pelvic or lower abdominal pressure, constant low, dull backache, mild abdominal cramps, with or without diarrhea, regular or frequent contractions or uterine tightening, often painless, ruptured membranes
What testing would be available to test for fetal genetic anomalies in a client who is 11 weeks gestation?
chorionic villus sampling because this is when the placenta is forming and the chorionic villi are interacting with the mom's side
What are the indications for performing a chorionic villus sampling (CVS)? What are the risks involved?
chorionic villus sampling is a popular technique for genetic studies int eh first trimester. Indications for the CVS are similar to those for amniocentesis, although CVS cannot be used for maternal serum marker screening because no fluid is obtained. CVS performed in the second trimester carries no greater risk of pregnancy loss than amniocentesis and is considered equal to amniocentesis in diagnostic accuracy. CVS is a relatively safe procedure. Pregnancy loss with CVS is similar to 2nd trimester amniocentesis. The incidence of IUGR, placental abruption, and preterm birth is higher in women undergoing CVS than would be expected in the general population
What lab tests are done after the initial prenatal visit?
clean-catch urine specimen tests for glucose, protein, nitrites, and leukocytes at each visit. Urine specimens for culture and sensitivity and cervical and vaginal smears and blood tests are repeated PRN. Recommended that glucose screening be taken on all pregnant women. Assess for risk factors, which is done through review of health hx, screening for clinical risk factors, or measurement of blood glucose levels. Risk factors that warrant early screening include obesity, hx of gestational diabetes, or known impairment of glucose tolerance test (GTT). If glucose level is elevated, further testing is done. Group B streptococcus (GBS) testing is recommended between 35-37 weeks of gestation. All pregnant women should have GBS testing, even those who are scheduled for a c-section because labor can begin or membranes can rupture prior to routine administration of abc
What is folic acid deficiency anemia?
common in even well- nourished women. Poor diet, cooking with large volumes of water, and increased alcohol use may contribute to folate deficiency. During pregnancy, the need for folate increases bith because of fetal demands and because it is less well absorbed from the GI tract during gestation. Folic acid is the form of the vitamin used in vitamin supplements. The recommended daily intake of folic acid for women planning a pregnancy or capable of becoming pregnant is 400 mcg. o Folate deficiency is the most common cause of megaloblastic anemia during pregnancy, but a vitamin b12 deficiency must also be considered. Vitamin b12 deficiency in pregnant women is seen much more now. Megaloblastic anemia rarely occurs before the third trimester of pregnancy. Women with megaloblastic anemia caused by folic acid deficiency have the usual presenting symptoms and signs of anemia: pallor, fatigue, and lethargy, as well as glossitis and skin roughness, which are associated specifically with megaloblastic anemia.
How should the nurse help strengthen the fetus?
corticosteroids to mom can increase fetal lung maturity, magnesium sulfate: bolus then 6-12 hour infusion (stablizes vessels), monitor fetal status (EFM, U/S, AFI/BPP prn)
Which of the following metabolic changes are associated with pregnancy?
decreased insulin sensitivity (increased insulin restistance) of the cells allows adequate glucose for the fetus during the second trimester
What is gestational diabetes?
defined as carbohydrate intolerance with the onset or first recognition occurring during pregnancy. This definition is appropriate whether or not management includes medication in addition to dietary changes or the diabetes persists after pregnancy. It does not exclude the possibility that the glucose intolerance preceded the pregnancy or that medication might be required for optimal glucose control
What are Kegel exercises?
deliberate contraction and relaxation of the pubococcygeus muscle, and strengthen the muscles around the reproductive organs and improve muscle tone. The muscles of the pelvic floor encircle the vaginal outlet and need to be exercised because an exercised muscle can streth and contract readily at the time of birth. Practice of pelvic muscles during pregnancy can also result in fewer complaints of urinary incontinence in late pregnancy and postpartum
How would you counsel a woman with GDM and her family regarding managing her diet with GDM?
dietary management during diabetic pregnancy must be based on blood (not urine) glucose levels. The diet is individualized to allow for increased fetal and metabolic requirements, with considerations of such factors such as prepregnancy weight and dietary habits, overall health, ethnic background, lifestyle, stage of pregnancy, knowledge of nutrition, and insulin therapy
What is DIC?
disseminated intravascular coagulation when the clotting factors go crazy in the whole body usually d/t trauma, disease, injury, or infection
Which finding is considered normal for a client in second trimester of pregnancy?
dyspnea, increased pulse rate, secretion of colostrum
How is pregnancy diagnosed?
early detection allows for early initiation of prenatal care. hCG is the earliest biomarker for pregnancy, and is what pregnancy tests are based off of. production of B-hCG begins as early as the day of implantation and can be detected in the maternal serum or urine as soon as 7-8 days before the expected menses. Sandwich-type immunoassay testing the most popular method of testing for pregnancy and is the basis for most home pregnancy tests. It uses a specific monoclonal antibody (anti-hCG) with enzymes that bond with hCG in urine.
What is a standard ultrasound assessment, and what are the indications for its use?
examinations are done most frequently and can be performed by ultrasonographers or other health care professionals, including nurses, who have had special training. In the second trimester and third, a standard ultrasound exam is used to evaluate fetal presentations, AFV, cardiac activity, placental position, fetal growth parameters, and numbers of fetuses.
What are some factors that put a woman and her fetus at risk for being high-risk?
factors that originate within the mother or fetus and affect the development or functioning of either one or both. Examples include genetic disorders, nutritional and general health status, and medical or obstetric-related illnesses
Which of the following would indicate premature (prelabor) rupture of membranes?
ferning of fluid, blue nitrazine test (pH 7.0)
What type of assessments occur at subsequent prenatal visits?
fetal assessments, laboratory tests, genetic screening
What is spontaneous abortion?
first trimester bleeding, may involve cramping, passing of blood, clots, possible identifiable products of conception; at a distance, provide emotional support and guidance regarding passing the products of conception and definition of hemorrhage, Rh- give rhogham and follow up with emotional care
What are trimesters?
first trimester is from week 1 to the end of week 12. the second trimester is from week 13 to the end of week 26. the third trimester is from week 27 to the end of the pregnancy.
What is the function of the yolk sac?
function aids in transferring maternal nutrients and oxygen that have diffused from the chorion, to the embryo. Blood vessels for, to aid transport. Blood cells and plasma are manufactured in the yolk sac during the second and third weeks while uteroplacental circulation is being established and is forming primitive blood cels until hematopoietic activity begins.
How is preterm labor (PTL) diagnosed?
generally diagnosed clinically as regular contractions along with a change in cervical effacement or dilation or both, or presentation with regular uterine contractions and cervical dilation of at least 2 cm that occurs at preterm gestation
What is group prenatal care?
group prenatal care is an alternative model to traditional care during pregnancy. In group prenatal care, authority is shifted from the provider to the woman and other women who have similar due dates. The model creates an atmosphere that facilitates learning, encourages discussion, and develops mutual support. Centering is a well known model of group prenatal care that involves three components: health care assessment, education, and peer support. groups consist of 8-12 women at similar gestational ages who participate in 1- sessions lasting about 90 minutes each. At each meeting, the first 30-40 minutes consist of assessments (by the woman herself or by HCP) and the remaining 60-75 minutes are spent in guided education and group discussion to specific issues such as the discomforts of pregnancy and preparation for labor and birth. Families associated with group prenatal care include improved birth outcomes such as lower rates of preterm birth, increased knowledge, improved satisfaction, and higher rates of breastfeeding initiation.
What are the various birth settings?
hospitals, houses, birthing centers
Why do polyhydraminos get gestational diabetes?
hyperglycemia leads to increased fetal peeing and more fluid in belly, which leads to GDM
What is indicated preterm birth?
iatrogenic because they occur as a means to resolve maternal or fetal risk r/t continuing the pregnancy. About 25% of all preterm births in the US are indicated because of medical or obstetric conditions that affect the mother, the fetus, or both. An increase in the number of indicated preterm births between 34-36 weeks of gestation accounts for much of the rise in late preterm births
How can PTL be predicted?
identifying risk factors. Risk factors in question above, social determinants such as living in a disadvantaged neighborhood, state, or region and lack of access o prenatal care also have been identified as risk factors. For example, women who were themselves born prematurely have an increased risk for giving birth prematurely and women whose sisters gave birth prematurely are. also more likely to do so, and the grandparents of women who give birth themselves then the grandparents of women who give birth at term
Which response is appropriate for the client who is in the 8th week of her first pregnancy and wants to know when she can feel the infant move?
in another 8-12 weeks (at 16-20 weeks; multigravidas woman might feel it earlier)
How does the CV system change anatomically during pregnancy?
inc BV, inc HR, inc SV, inc CO because there is more blood circulating in the body; the heart works a lot harder to more efficiently get blood to the fetus (beats 10-15 bpm faster); dec in BP d/t the placenta and increased progesterone which relaxes smooth muscle and causes dilation of those muscles, also because the placenta is a new "organ" that also needs blood so the BP everywhere else decreases; the heart also shifts to the left
How does the respiratory system change anatomically during pregnancy?
inc O2, inc CO2 out, diaphragm moves up, moms body needs to bring inc O2 into the blood by minute ventilation which is done by progesterone affecting respiratory center in the brain to tell lungs to bring in more air; more CO2 out takes acid out of body, so theres a dec in acid and inc in bicarb secretion, so theres a slightly basic blood pH
How does the uteroplacental blood flow change anatomically during pregnancy?
increases 10-fold over the course of pregnancy as the uterus increases in size. In a normal term pregnancy, 1/6 of the total maternal blood vol is within the uterine vascular system. The rate of flow averages 450-650 mL/min by term. Oxygen consumption of the gravid uterus increases to meet fetal needs with the greatest consumption occurring during the last trimester
What are the initial laboratory tests a nurse should get during prenatal visits?
initial laboratory tests provide important information concerning the sx of pregnancy and the woman's health status. Urine, cervical, and blood samples are routinely obtained during the initial visit for a variety of recommended screening and diagnostic tests for infectious diseases and metabolic conditions that can affect the mother and/or developing fetus. Women should. receive info about the various tests and the purpose of each and be given the opportunity to opt out of testing. Every pregnant woman should receive HIV risk reduction counseling and be notified that she will be tested for antibody to HIV as part of routine prenatal testing unless she declines it. If woman refuses HIV testing document it. The CDC recommends testing during the initial prenatal visit for syphilis and hep B. screening for chlamydia and gonorrhea is done for women who are less than 25 years of age and those older than 25 years who are at risk. Screening for HIV, syphilis, chlamydia, and gonorrhea is repeated in the third trimester for women who are at high risk for contracting these infections. Test for TB. Urine test done for protein, glucose, and leukocytes; urine culture done if indicated. Pap test performed during the pelvic exam if one is due based on the current cervical cancer screening guidelines. In addition, pregnant coulees with certain ancestry of family hc of genetically linked disorders may choose to undergo genetic testing
What is a limited ultrasound assessment, and what are the indications for its use?
limited examinations are performed to determine a specific piece of information about the pregnancy such as identifying fetal presentation during labor or estimating AFV. These examinations are usually performed by the woman's obstetric health care provider in the office or clinic, or the labor, and birth unit
What is the common hemorrhage treatment pathway?
measure/record EBL (weigh chux pads, color, clots), Manage shock (Oxygenate, Restore volume, Drug therapy, Evaluate response, Remedy cause), prepare for emergency delivery (previa: c/s only, abruption: case-by-case decision), monitor postpartum (uterine atony --> hemorrhage--> anemia, volume or blood product replacement, continued monitoring for DIC, possible renal failure- so look at urine and blood labs such as creat and BUN, also check the urine volume most likely with a foley)
The tocolysis appears to work for 7 days but when stephanie is 32 3/7 days her water breaks, now, what is the appropriate course of treatment?
monitor fetal status, continue bedrest, closely monitor for s/s infection, and begin triple antibiotic therapy; goal is to delay delivery (but tocolysis is discontinued)- WHY? tocolysis discontinued d/t isk of infection -start preparing for delivery
What is type 2 diabetes?
most prevalent form of the disease accounting 90-95% of all diabetes, and includes individuals who have insulin resistance and usually relative (rather than absolute) insulin deficiency
What is the difference between benign n/v versus hyperemesis gravidarum?
n/v complicated 50-80% of all pregnancies, typically beginning at 4-10 weeks of gestation. The cause of n/v in pregnancy is not well understood. When vomiting during pregnancy becomes excessive enough to cause weight loss, electrolyte imbalance, nutritional deficiencies, and ketonuria
What is a positive sign of pregnancy?
objective; changes observed and percieved by an examiner (ie fetal heart tones, ultrasound), indicate proof of pregnancy
What is a probable sign of pregnancy?
objective; changes observed/perceived by an examiner (ie positive pregnancy test, hegar sign, chadwick sign), strongly suggest pregnancy
What is spontaneous preterm birth?
occurs following an early initiation of the labor process in the apparent absence of maternal or fetal illness and make up nearly 75% of all preterm births in developed countries. Conditions such as preterm labor with intact membranes and preterm PROM often result in preterm birth
What are some of the treatment options for a woman with preeclampsia (ie magnesium sulfate)?
outpatient management is reliable for patients who don't have a really high BP. A regular diet without salt restriction, teaching the women to get help if they have abdominal pain, significant headache, uterine contractions, vaginal spotting, or decreased fetal movement. Magnesium sulfate
What is gestational trophoblastic disease (molar pregnancy)?
overgrowth of trophoblastic cells form an invasive tumor, pregnancy growth faster than expected, no visible fetus on the ultrasound and only clusters of grape-like tissue, can become malignant; uterine evacuation of trophoblastic tissue and endometrial tissue, observe for 1 year post for hcg levels, avoid pregnancy for 1 year, and chemotherapy if tissue was malignant
What is incompetent cervix?
painless dilation of cervix around 14-20 weeks, often spotting --> bleeding; tx includes bedrest, cerclage, rescue 14-24 weeks, 15-hydroxyprogesterone, trendelenburg position, antibiotic and steroid prophylaxis, suture cut at 36-37 wks unless SROM or s/s of infection
Who are the various types of providers who may care for the pregnant woman?
physicians, obstetricians, doulas, nurses, lactation nurses, labor and delivery nurses and doctors
What is previa?
placenta attached in wrong place and pulls the blood vessels apart, causing bleeding, this usually occurs in the mid-late 2nd trimester, and spotting could lead to hemorrhage; main complication is the need to get the baby out because of the no placental attachment, usually this is done by c-section d/t placental blockage, more at risk for PPH d/t scarring in uterus (could be from previous pregnancies, etc), miscarriage in past with DNC, advanced maternal age, smoking, living at high altitudes; tx include bedrest, fetal monitoring, no vaginal exams, maintain IV access in case of hemorrhage (give blood and fluids)- screen her for blood type; frequent VS monitoring= dec BP, inc HR, monitor for dec H&H, monitor platelets for DIC
What is abruption?
placenta attaches in the right place, but detaches all of the sudden, occurs in the late 2nd-3rd trimester, painful uterine contractions--> tetany, no bleeding but there could be spotting and hemorrhage because the blood could accumulate in the abdomen; this could happen as a result of smoking, drug use, or multiple babies; the HCP should deliver baby ASAP, emergency c-section if there is fetal distress or hemorrhage, monitor labs for DIC; the blood in spotting could be dark because its old, sign of blood in abdomen; risk to baby is still birth, IUGR, mom can lose enough blood to go into shock, DIC
A client at 39 weeks of gestation with a hx of preeclampsia is admitted into L&D. She suddenly experiences increased contractions every 1-2 minutes, dark red vaginal bleeding, a rigid and painful abdomen. Which condition does the nurse suspect?
placental abruption
What is preeclampsia?
pregnancy-specific condition in which htn and proteinuria develop after 20 weeks of gestation in a woman who previously had neither condition. The signs and symptoms of preeclampsia also can develop for the first time using the postpartum period. Leading cause of maternal and perinatal morbidity and mortality in the US and CAN
How do cultural beliefs influence health during pregnancy?
prenatal care as we know it is a phenomenon of western health practices. in the US model of health care, women are encouraged to seek prenatal care as early as possible. This recommendation may be unfamiliar or seem strange to women of other cultures. Many cultural variations are found in prenatal care. Even if the prenatal care described is familiar to a woman, some practices may conflict with the beliefs and practices of a subculture group to which she belongs. Because of these and other factors-such as lack of money, transport, or language barriers- women from diverse cultures may not seek prenatal care until late in pregnancy or at all. A concern for modesty can be a deterrent to seeking prenatal care. For some women, exposing body parts, especially to a male, is considered a serious violation of their modesty. For many women, an invasive procedure, such as a vaginal examination is so threatening that they cannot discuss it, even to their own partners. Many women prefer a female HCP. Too often, HCPs assume that women lose this modesty during pregnancy and labor, but most women value and appreciate efforts to maintain their modesty. because pregnancy is considered a normal process and the woman is in a state of good health, many cultural groups regard care from a HCP to be necessary only in times of illness. Cultural prescriptions tell a woman what to do, and cultural prescriptions establish taboos. To provide culturally responsive care, nurses must be attuned to the existence of practices and customs; it is not possible to know about every culture or the many lifestyles that exist. It is important to learn about the customs for the women and their families. The nurse can support and nurture those beliefs that promote physical or emotional adaptation. If potentially harmful beliefs or activities are identified, the nurse should sensitively provide education and partner with the woman to design modifications
What is ectopic pregnancy?
presents with severe lower abdominal pain, also may have severe shoulder pain, vaginal bleeding light and might hemorrhage, s/s of hypovolemic shock if not diagnosed quickly; medical tx is methotrexate-antineoplastic, surgical tx (second choice) necessary if fetus has cardiac activity and woman is hemodynamically unstable, salpingectomy vs salpingostomy
What is pPROM and what complications are associated with it?
preterm Prelabor Rupture Of Membranes complicates approx 3% of all pregnancies in the US. pPROM occurs twice as often in African Americans as in other racial groups. The frequency in pPROM appears to have decreased since the 1990s. pPROM most likelyl results from pathologic weakening of the amniotic membranes caused by inflammation, stress from uterine contractions, or other factors that cause increased intrauterine pressure. Infection of the urogenital tract is a major risk factor associated with pPROM as well as chorioamniotitis is the most common maternal complication of preterm PROM making it a major complication of pregnancy
How would you counsel a woman with GDM and her family regarding managing her insulin therapy with GDM?
primary factor in the maintenacne of euglycemia during pregnancy thus ensuring proper glucose metabolism of the woman and fetus. insulin requirements during pregnancy change dramaticallyas the pregnancy progresses, necessitating frequent adjustments in the dose
What primary preventions measures can be be taken to prevent preterm birth?
primary prevention strategies that address risk factors associated with preterm labor and birth are less costly in human and financial terms than the high-tech and often long-term care required by preterm infants and their families. Programs aimed at health promotion and disease prevention that encourage healthy lifestyles for the population in general and women of childbearing age in particular should be developed. Preconception counseling and care for women, especially those with a history of preterm birth, can identify correctable risk factors and provides a means to encourage women to participate in health-promotion activities. Smoking cessation, for example, has been shown to prevent preterm labor and birth. Preterm birth can be prevented in some women by administering prophylactic progesterone supplementation. Daily vaginal suppositories or creams or weekly IM injections of hydroxyprogesterone caproate have been shown to decrease the rate of preterm or with a short cervix before 24 weeks of gestation. Supplementation begins at 16 weeks and continues until 36 weeks of gestation progesterone supplementation. Progesterone supplementation does not affect the rate of preterm birth in women with multiple gestations Exactly how progesterone works to prevent preterm birth is unclear
When is a fetus considered viable?
refers to the capability of the fetus to survive outside the uterus and is usually defined by fetal weight and pregnancy duration for statistical and legal purposes. A standard definition is 20 weeks' gestation and birth wight of 350, 400, or 500 g, but varies by state. the nurses must be aware of the laws in their states. With modern technology and advancements in maternal and neonatal care, infants who are 22-25 weeks of gestation are on the threshold of viability. The limitations on survival outside the uterus when an infant is born at this early stage are based on CNS function and the oxygenation capability of the lungs.
How would you counsel a woman with GDM and her family regarding fetal surveillance with GDM?
required to assess the fetal growth and well-being. Because the fetus of a woman with diabetes is at increased risk for neural tubes defects such as spina bifida, anencephaly, or microcephaly, measurement of maternal serum a-fetoprotein is performed between 15-20 weeks of gestation. the NST is the preferred primary method of fetal well-being and performed at least twice weekly. If the NST is nonreactive, a BPP or contraction test will be performed
A pregnant client at 14 weeks gestation is admitted to the hospital with a dx of hyperemesis gravidarum. Which is the primary goal of her tx at this time?
reverse fluid, electrolyte, and acid base imbalances d/t the increased amount of vomiting
Is it safe to have sex while pregnant?
sexual counseling of expectant couples includes countering misinformation, providing reassurance of normality and suggesting alternative behaviors. Nurses can initiate discussion about sexual adaptions during pregnancy, based on sound knowledgable or comfortable with discussing sexual concerns of their clients. Nurses should be aware of their personal strengths and limitations in dealing with sexual content and be prepared to make referrals if necessary. Some women merely need permission to be sexually active during pregnancy. Others, however, need to be given information about the physiologic changes that occur during pregnancy, have the myths that are associated with sex during pregnancy dispelled and participate in open discussions of positions for sexual activity that avoid pressure on the gravid abdomen. Counseling about sex practice for same- and opposite- sex course is within the role of the nurse and should be an integral component of health are. Women should be aware that they are likely to experience alterations in sexual desire and comfort during sexual activity. Uterine activity can increase with sexual intercourse; this can be r/t breast stimulation, orgasm, or prostaglandins in male ejaculate. Couples who practice oral sex should be cautioned against the blowing of air in to the vagina, particularly during the last few weeks of pregnancy when the cervix can be slightly open. An air embolism can occur if air is forced between the uterine wall and teh fetal membranes and enters the maternal vascular system through the placenta.
What is the presumptive sign of pregnancy?
subjective; changes experienced by the woman (ie fatigue, breast changes, quickening); these suggest the possibility of pregnancy but can also be caused by conditions other than pregnancy
What are teratogens?
substances or exposure that cause abnormal development (ie alcohol, drugs)
What is fertilization?
takes place in the ampulla (outer third of the uterine tube). When a sperm successfully penetrates the membrane surrounding the ovum, both sperm and ovum are enclosed within the membrane, and the membrane becomes impenetrable to other sperm. The second meitotic division of the secondary oocyte is then completed and the nucleus of the ovum because the female pronucleus, and the tail delegates. The nuclei fuse, and the chromosomes combine, restoring the diploid number. Conception, the formation of the zygote (the first cell of the new unique individual), has been achieved. Mitotic cellular replication, called cleavage begins within 30 hours after fertilization. The zygote remains in the uterine tubes for the first 24 hours and then is propelled throughout the tubes into the uterus which takes about 3-4 days
How the estimated date of birth determined using Naegal's Rule?
the Naegal rule is based on the woman's accurate recall of her last menstrual period (LMP). It assumes that the woman has a 28-day cycle and that fertilization occurred on the 14th day. Only about 5% of women gave birth spontaneously on the EDB as determined by the Naegale rule; momst births ccur 7 days before-7 days after the EDB. For example, if the LMP was on 12/10/2019 you would subtract 3 from the month (12-3=9), add 7 to the day (10+7=17) and add 1 to the year (1+2019=2020); so the EDB is 9/17/2020
What is the goal of treatment for a woman with preeclampsia?
the goal is to ensure maternal safety and to deliver a healthy newborn as close to term as possible
Who is at risk for developing preeclampsia?
the incidence and severity of preeclampsia is sustainably higher in woman with multifetal gestation, a hx of preeclampsia, chronic hypertension, preexisting diabetes, and preexisting thrombiophilias. Women with limited sperm exposure with the same partner before conception also have a greater risk for preeclampsia. Men who have fathered a preeclamptic pregnancy are nearly twice as likely to father another preeclamptic pregnancy.
What is the frequency of prenatal visits?
the initial visit occurs in the first trimester, with monthly visits through week 28 of pregnancy. Thereafter visits are scheduled every 2 weeks until week 36 and then every week after birth. The trend is toward individualizing hte schedule of care. Women with low-risk pregnancies may have fewer routine prenatal visits, whereas those at risk for complications may be seen more frequently than the traditional schedule would suggest
How does the renal system change anatomically during pregnancy?
the kidney changes produce an inc BV because all of the arteries are dilated, so that theres more blood flow to the kidney and increased filtration rate to the kidney
What is iron deficiency anemia?
the most common anemia of pregnancy, accounting for approx 75% of cases. In developing countries, it is alarmingly common and is a major cause of maternal morbidity and mortality. It is diagnosed by checking of maternal morbidity and mortality. It is diagnosed by checking the woman's serum ferritin level in addition to her hemoglobin and hematocrit levels. Iron deficiency anemia is preventable or easily treated with iron supplements. Because of the increased amounts of iron needed for fetal development and maternal stores, pregnant women are often encouraged to take prophylactic iron supplementation. Most women with iron deficiency anemia can absorb as much iron as they need by taking one 325-mg tablet of ferrous sulfate twice each day. Can receive parenteral iron therapy. These meds can be given either IV or IM.
Describe the purpose, procedure, and interpretation of the non-stress test (NST)
the most widely applied technique for antepartum evaluation of the fetus. The basis for the NST is that the normal fetus produces characteristic HR patterns in response to fetal movement, uterine contractions, or stimulation. In the term fetus, accelerations are associated with movement more than 85% of the time. The most common reason for the absence of FHR accelerations is the quiet fetal sleep state. CNS depression medicaitons, chronic smoking, and the presence of fetal malformations can also adversely affect the test results. Women is seated with slight lateral tilt, the FHR is recorded with a doppler transducer. The tracing is observed for signs of fetal activity and a concurrent acceleration of FHR. If evidence of fetal movement is not apparent on the tracing, the woman may be asked to depress a button on a. Handheld event marker connected to the monitor when she feels fetal movement. NST results are either reactive or nonreactive. A reactive NST is considered normal, while a nonreactive test requires further evaluation. The testing period is often extended, usually for an additional 20 minutes, with the expectation that the fetal sleep state will change and the test will become reactive. During this time, VAS may be used to stimulate fetal activity.
What is gestational hypertension?
the onset of hypertension without proteinuria or there systemic findings diagnostic for preeclampsia after week 20 of pregnancy. Defined as greater than a systolic of 140 or a diastolic of 90. The htn should be recorded on two occasions at least 4 hours apart 20 weeks of gestation in a woman with a previously normal BP. Only one pressure (either s or d) must be elevated to meet the definition of hypertension
How do the ovaries change anatomically during pregnancy?
the ovaries do not go through ovualtion during pregnancy d/t the suppression of FSH and LH by estrogen and progesterone for the first 6-10 weeks of pregnancy until the placenta becomes the primary source of these hormones. amenorrhea during pregnancy
How long does the fetal stage last?
the stage of the fetus lasts from 9 weeks (when the fetus becomes recognizable as a human being) until the pregnancy ends. Changes during the fetal period are not so dramatic, because refinement of structure and function is taking place. The fetus is less vulnerable to teratogens, except for those affecting function of the CNS
What is the goal of antepartum assessment?
the two major goals of antepartum testing are to identify fetuses at risk for injury caused by acute or chronic interruption of oxygenation so that permanent injury or death might be prevented. The second goal is to identify appropriately oxygenated fetuses so that unnecessary intervention can be avoided. In most cases, monitoring begins by 32-34 weeks gestation and continues regularly until birth
How does the uterus change anatomically during pregnancy?
the uterus changes in size, shape, and postition. High levels of estrogen and progesterone stimulate significant uterine growth in the first trimester, which results from increased vascularity and dilation of blood vessels, hyperplasia, hypertrophy, and development of the decidua. Uterine weight increases dramatically from 4g to 70g in the non pregnant state to 1200g at term. Volume increases from 10mL to 5L at term. By 7 weeks of gestation, the uterus is the size of a large hen's egg, by 10 weeks it is the size of an orange, and by 12 weeks it is the size of a grapefruit. AFter the 3rd month, uterine enlargement is primarily the result of mechanical pressure of the growing fetus. As the uterus enlarges, it also changes shape and position. By 12 weeks the uterus changes to a spherical or globular shape. As the fetus grows the uterus becomes larger and more ovoid. By 12 weeks the uterus rises out of the pelvis into the abdominal cavity. As the uterus grows, it can be palpated above the symphysis pubis sometime between the 12th and 14th weeks of pregnancy. between the 20-22 weeks the uterus will gradually rise to the level of the umbilicus and nearly reaches the xiphoid process at term. As the uterus enlarges and rises in the abdomen, it rotates to the right, probably because of the presence of the rectosigmoid colon on the left side. There is tension on the round and broad ligaments as the uterus enlarges. Eventually the uterus touches the anterior abdominal wall and displaces the intestines to either side of the abdomen. At 6 weeks, the softening and compression of the lower uterine segment occurs. Results in exaggerated uterine and ante flexion during the first 3 months of pregnancy. In this position, the uterine fundus presses on the urinary bladder causing the woman to have urinary frequency.
How does the vagina and vulva change anatomically during pregnancy?
the vagina and vulva are prepared for labor by pregnancy hormones which cause the vaginal mucosa to thicken, the CT to lessen, the smooth muscles to hypertrophy, and the vaginal fault to lengthen. increased vascularity results in the violet-blue color of the vaginal mucosa and the cervix known as the Chadwick sign. Evident at 6-8 weeks. Vaginal discharge increases during pregnancy. leukorrhea is a white or slightly gray mucoid vaginal discharge with a faint musty odor. This copious mucoid fluid occurs in response to cervical stimulation by estrogen and progesterone
How should the nurse educate the mom on infant feeding choice? (breastfeeding vs formula)
the woman and her partner are encouraged to decide which method of feeding is suitable for them, however the benefits of breastfeeding should be emphasized. Once the couple has been given info about the advantages and disadvantages of breastfeeding vs formula feeding, they can make an informed decision. Assessment of a woman's breasts during the prenatal period can reveal potential concerns r/t breastfeeding. Scars on the breast can indicate previous breast reduction surgery, which can affect milk production. the woman may have breast implants; this too may affect successful breastfeeding. Asymmetry of the breasts or tubular-shaped breasts suggest a lack of glandular tissue and potential problems with adequate milk production. Exam of breasts can reveal flat or inverted nipples, which can affect the baby's ability to latch onto the breast. to determine whether nipples are inverted, a woman can perform a test on her nipples to gauge their freedom to protrude. The woman places her thumb and forefinger on her areola and presses inward gently. A normal nipple will evert or stand erect while an inverted nipple will appear to withdraw.
A client presents with bleeding and cramping. Her LMP was 6 weeks ago. On sterile spectulum exam the cervix is closed. The anticipated plan of care is based on the probable dx of
threatened spontaneous miscarriage
Why would the RN measure Ms. Frank's fundal height on admission to the hospital?
to assess growth in relationship to gestational norms
What is the function of the umbilical cord?
to carry blood from the embryo to the chorionic villi, and one vein returns blood to the embryo. Approx 1% of the umbilical cords contain only two vessels: one artery and one vein. This occurence is sometimes associated with congenital malformations, specifically fetal cardiovascular, GI, and UI anomalies. It rapidly increases in length. At term, the cord length averages from about 40-70 cm. It spirals on itself and loops around the embro/fetus.
How does the nurse preform tocolysis measures?
tocolysis measures should decrease contractions and delay birth and prevent mom from delivering. THis is done with nifedipine (also used for vasodilation), bedrest (pressure of infant can cause contractions so bedrest relieves the gravity), minimize vaginal exams, hydration (muscles contact when dehydrated), detect/treat infections (watch WBC, take temp)
What are the preterm labor management goals?
tocolysis/delay delivery, strengthen fetus
How does being over the age of 35 affect a woman's pregnancy? ** comeback and fix
two groups of older partners have emerged int eh popualtion of women having child late in their childbearing years.
How would you counsel a woman with GDM and her family regarding managing her glucose monitoring with GDM?
using a glucose meter is considered the standard of care for monitoring blood glucose levels during pregnancy. It provides the most important tool available to the woman to assess her degree of glycemic control
What is the purpose of routine ultrasounds?
usually done in the first trimester to establish or confirm gestational age. In addition, unless there are indications for earlier testing, a fetal anatomy scan is done between 18-22 weeks. Ultrasonography can also detect the number of fetuses, fetal presentation, fetal biometry, location of the placenta, amniotic fluid volume, and cardiac activity.
What is supine postural hypotensive syndrome?
when the uterus becomes larger, it can compress the inferior vena cava (which gathers bloor from the lower body and collects it to the heart), the compression means less blood returns to the heart and less blood is pumped out on each beat which leads to a decrease in BP (hypotension); s/s include lightheadedness when laying on back, so the woman should lay on her side
What is implantation?
when the zone pellucid degenerates, the trophoblast cells displace endometrial cells and the implantation site and the blastocysts embeds in the endometrium, usually in the anterior or posterior fundal region. Between 6-10 days after conception, the trophoblasts secrete enzymes that enable it to burrow into the endometrium until the entire blastocyst is covered.
What is a primiparous woman?
woman who are pregnant for the first time.
What is a multiparous woman?
woman who have had other pregnancies before
How should a nurse screen for IPV during prenatal care?
women are unlikely to initiate a conversation with HCPs about IPV, therefore it is critical that routine screening be done. ACOG recommends screening for IPV at the first prenatal visit, at least once every trimester, and at the postpartum visit. It is essential that screening be done in a safe, private setting with the women alone. A simple and widely used tool is the abuse assessment screen consisting of the five items with a diagram for the abused woman to mark areas where she has been injured. Nurses can ask the women screening questions with routine assessments during pregnancy. A pregnant woman is often accompanied by her partner to the prenatal appt, especially if the woman does not speak english and the partner does. An interpreter is needed who is part of the staff or from a telecommunicaation service so that the woman can be interviewed alone. If a woman discloses IPV, the first step is to assess for immediate danger and to protect the woman and her children if needed. A complete physical examination is needed to assess for injuries and to observe the woman's behaviors and verbal responses when asked about the various injuries. Nurses should should be aware that victims of human trafficking can be seen in prenatal settings because of unintended pregnancy. Like the victims of IPV, these women may have signs of physical abuse or neglect (such as scars, bruises, burns, unusual bald patches, tattoos that can be a sign of branding). Such a woman might be accompanied by someone who never leaves her alone and speaks for her. She may not speak english and may lack identification documents. If the woman is alone, she may have her cel phone on and in speaker mode so that the person on the other end can hear everything. Get the woman alone and ask if she is ok
