NURS 434: Antepartum
What is HELLP syndrome?
-hypertensive disorder of pregnancy that occurs most often as a complication of preeclampsia · Hemolysis · Elevated · liver enzymes · Low · platelet count
What results indicates a diagnosis of GDM?
-if her blood glucose is above 130 mg/dL -an elevated blood glucose level indicates the need for 3 hour OGTT (if one hour OGTT is completed)
Primigravida
woman who is pregnant for the first time
Multipara (multip)
women who has had more than one pregnancy resulting in viable offspring
vaginal bleeding might indicate
· 1st trimester: miscarriage · 2nd and 3rd trimester: low-lying placenta (placenta previa), detaching placenta (placenta abruption), or bloody show (the breakdown of the mucus plug that seals off the cervix) · Signs of preterm labor, which are often subtle
If the mother is Rh(-) when will the nurse inform the patient she will receive RhoGam?
· 28 weeks of gestation
What is the recommend weight gain for a patient that is overweight?
· 6.8 to 11.3 kg (15-25 lb)
What is the recommended weight gain for a patient that is under weight?
· Advised to gain 12.7 to 18.1 kg (28-40 lb)
severe headache might indicate
· Preeclampsia- a dangerous hypertensive disorder exclusive to pregnancy that can start as early as 20 weeks
gush of fluid might indicate
· Premature rupture of membranes (rupture of membranes before contractions begin) - may present as copious clear, odorless discharge · Infection (if accompanied by odor, itching, or irritation) · Note: its normal to have an increase of milky, odorless discharge in pregnancy
antepartum risk factors
-<16 years of age ->35 years of age -low socioeconomic status or dependence on public assistance -nonwhite race -mulitparity -obesity -height <152 cm (5 feet) -smoking -DM -Cardiac and renal disease -table 7-5 in Notes**
nonstress test
-Assessment of a fetus' HR reactivity to its own movements, when no stress is placed on the fetus. it is used to evaluate whether the fetus is receiving adequate blood flow and oxygen. -Typically initiated only after 26-28 week of gestation, as the fetus is not neurologically mature enough prior to this time to initiate HR accelerations -reactive or nonreactive
Urinary problems might indicate
(frequency is normal, pain is NOT) · UTI (can cause pregnancy complications) · Any spasm, burning, cramping - want to know
quiz questions
-1st trimester diagnostic: screen sti -Fundal height at umbilicus: 20 weeks -Hormone pregnancy test: hCG -Most nausea: 1st trimester -Due date: first day of LMP -Magnesium: prevent seizure -Magnesium most concerning: urine output 80 ml in 4 hour -Weight gain 3.5 11 weeks: normal -Gestational diabetes: exercise regularly and work with nutritionist
How is placenta preview the same and how is it different than placenta abruption (Compare/contrast)?
-Both are complications that can occur with the placenta. Placenta abruption is detachment of the placenta from the uterus and placenta previa is low-lying placenta. -placenta abruption can cause complications, but monitor mom and baby -placenta previa can cause complications and high rate of blood transfusions are associated and C-section is almost always indicated
What teaching should the nurse provide regarding preventing supine hypotension and postural hypotension?
-Can be alleviated by woman shifting to her side or into an upright position -Change positions slowly
postural hypotension
-Confirmed by taking two BP measurements: one after a patient has been lying supine for at least 5 minutes and a second within 2-5 minutes after standing. A fall in systolic pressure of at least 20 mmHg or a fall in diastolic pressure of at least 10 mmHg when standing confirms the diagnosis. -Women experience lightheadedness when rising to an upright position.
initial lab data at 1st visit:
-H & H -WBC -blood type and Rh -rubella titer -UA -renal function -HIV antibodies -Hepatitis B surface antigens -toxoplasmosis -VDRL
Review priority physiological changes that occur during pregnancy.
-Integumentary system: striae gravidarum (stretch marks), can occur in breasts, abdomen, and thighs during pregnancy. Linea nigra (darker line vertically) is more common in darker women. Chloasma is the brownish patches over the face. -Vascular: superficial blood vessels often more prominent in early pregnancy in women with pale skin. Palmar erythema: redness on soles of feet and palms of hands. -Hair: can become thicker and more abundant during pregnancy. Hair loss can be excessive 4 months postpartum. -Pancreas: insulin needs initially the same, drop slightly in late first trimester and early second trimester, and increase steadily until end of pregnancy. These changes occur because the reduction in responsiveness of the cells of the mother's body to insulin. Women's pancreas who cannot keep up with the cellular demand for increased insulin develop gestational diabetes. -Adrenal glands: cortisol levels begin to climb in second trimester and peak at the end of the third trimester which may help promote both lung and neurologic development of the fetus. Aldosterone helps retain sodium which helps swell blood volume over the course of pregnancy. -Pituitary gland: prolactin is active in milk production. Oxytocin has a role in lactation, stimulates milk ejection, also acts on uterus to produce contractions prior to labor and during childbirth, keeps the uterus contracted postpartum to prevent atony and excessive uterine bleeding. -more in book*
amniocentesis
-Procedure performed from 14-20 weeks of gestation in which a needle is inserted into the patient's abdomen under ultrasound surveillance to make sure the fetus is not accidentally punctured, and a sample of amniotic fluid is withdrawn. -DNA analysis of fetal cells floating in the fluid is done to examine for genetic abnormalities. -Alpha-fetoprotein levels are also often evaluated for neural tube defects
contraction stress test
-Similar to nonstress test in that both monitor uterine activity and FHR. -Can be done ONLY in the presence of contractions, compared to nonstress test where there are no contractions -Requires uterine contractions induced either with oxytocin or with stimulation of the maternal nipples and is risker, typically making nonstress test evaluation of choice. -Contraindicated with any condition in which labor is a contraindication, including placenta previa and high risk for preterm delivery. -Non-reassuring results may occur with maternal ketoacidosis or maternal hyperglycemia and may be reversible -If the non-reassuring results are not reversible, pregnancy may be delivered promptly or after course of glucocorticoids if less than 34 weeks of gestation.
How can the thyroid gland impact pregnancy?
-Since the fetus cannot make it's own thyroid hormones until the 12th week of pregnancy, the mother must supply them in early pregnancy. Adequate amounts of thyroid hormones are critical to fetal neurologic development. -Maternal hypothyroidism has been associated with miscarriage, preeclampsia, gestational diabetes, preterm birth, placental abruption, cesarean section, and induction of labor. -Maternal hyperthyroidism has also been linked to preeclampsia and cesarean section. -During pregnancy, production of thyroid hormones may be cued by thyroid-stimulating hormone from pituitary gland, as well as estrogen and hCG. Blood levels of thyroid hormones are often increased during pregnancy.
supine hypotension
-Temporary state caused by compression of the inferior vena cava by the pregnant uterus when the woman lies on her back. -Typically occurs midway through pregnancy and may recur at any point until after delivery. -Symptoms: nausea, dizziness, and lightheadedness -Can be alleviated by woman shifting to her side or into an upright position
What would the nurse teach the patient about these changes?
-To be aware of these changes, what is normal to expect, what is not normal to expect, and when to notify the provider.
routine lab tests during 2nd trimester
-UA -diabetes screening -Rh(D) factor screening -screening for fetal anomalies
What are the priority concerns when a patient is experiencing an abruption?
-a large loss of blood and DIC may lead to hypovolemic shock, multiorgan failure, and the need for transfusion -surgical intervention of emergency C-section and/or hysterectomy may be needed -monitoring amount of blood loss -lab tests are typically ordered to evaluate coagulation for the manifestations of DIC, blood type, crossmatch is case of transfusion, kidney function (as renal dysfunction is common with severe abruption). -CBC including platelet count is necessary to evaluate for anemia related to an acute bleed -maternal fibrinogen levels at or below 200 mg/dL are highly predictive of severe hemorrhage, whereas values at or over 400 mg/dL strongly suggest lack of severe hemorrhage
placenta previa
-condition in which the placental tissue overlies the internal cervical os. -should be suspected for any woman of 20 weeks gestation or more with vaginal bleeding
When and what medications can be prescribed for GDM
-continued poor control of blood glucose level is an indication for starting medications -Glyburide and metformin -Glyburide is given 20-60 minutes before breakfast and possible second dose 20-60 minutes before dinner -Metformin is often used as first-line treatment in patients with type 2 diabetes.
1st visit:
-determine EDC based on LMP (Nagels rule) -health history including medications, family, psychosocial (including support system), review of systems -identify risk factors -baseline weight, VS, and provider performs pelvic exam
What are the treatments of placenta abruption
-largely depends on gestational age and degree of abruption, as well as complete clinical picture -woman with suspected minor abruption prior to 34 weeks with intact membranes, may be monitored on an outpatient basis with regular antepartum assessments of the fetus -woman with suspected acute abruption is likely to be admitted to L &D for assessment, monitoring, and management · Continuous monitoring of FHR and uterine activity · Wide-bore IV access in case a transfusion is needed, with IV rate set to maintain a urine output above 30 mL/h · Close monitoring of maternal hemodynamic status by urine output, HR, BP, and blood loss · After an estimated blood loss of 500-1,000 mL a transfusion may be ordered including platelets o Transfusion goals are maintenance of hematocrit level of 25-30%, fibrinogen level at or above 100 mg/dL, and platelet count at or above 75,000/uL
What are the priority concerns when a patient is diagnosed with placenta previa?
-major complication for the fetus is prematurity -fetuses are also at a higher risk for a nonvertex presentation, complicating delivery in the case of a low-lying placenta -nurse should NOT attempt a digital exam in patients with previa because it is associated with acute bleeding -educate to avoid exercise and vaginal intercourse after 20 weeks gestation because of the concern that uterine contractions cause by these activities may cause bleeding a. instruct women to seek care urgently if they experience bleeding or contractions -delivery is generally recommended from 36-37 weeks because of concerns of greater likelihood for catastrophic bleeding if pregnancy is prolonged -corticosteroids are given prior to 34 weeks of gestation to enhance maturity of fetal organ systems -magnesium sulfate may be administered for pregnancies 32-34 weeks of gestation because of its neuroprotective effects of the fetus when given prior to delivery
1. Discuss how Gas Exchange, Perfusion and Safety link to antepartum.
-making sure the mom and baby have enough oxygen, perfusion is adequate for both, and both are remaining safe from harm.
future visits (after 1st):
-monitor weight, VS, and urine for infection and BS -assess for edema -monitor fetal development a. FHR b. second trimester at approximately 18-20 weeks measure fundal height in cm (approximately same number in weeks) c. at approximately 16-20 weeks assess fetal movement (can mom feel movement? quickening is when mom first feels fetal movement) -self care: help mom manage pregnancy discomforts
instructions nurse would provide to patient about OGTT
-patient drinks a glucose solution and a serum test is done an hour later to assess the blood glucose level
Why and when would low dose Aspirin be prescribed with preeclampsia
-patients at high risk for preeclampsia may be advised to start taking aspirin in the first trimester of pregnancy, which has been associated with 24% reduction in the development of preeclampsia
placenta abruption
-premature detachment of the placenta from the decidua of the uterus after 20 weeks of gestation. -classic presentation of acute abruption is sudden onset of abdominal pain, vaginal bleeding, and frequent, hypertonic uterine contractions a. if related to trauma generally manifests within 24 hours -chronic abruption tends to develop over time and women may intermittently experience light bleeding as the only clinical sign a. maternal coagulation studies are usually remarkable due to the slow rate of blood loss and an ultrasound may or may not reveal retroplacental hemorrhage b. fetus showing a pregnancy measuring small for gestational age may be the first clue
treatment prescribed first for GDM
-primary treatment and intervention is usually management of diet, regular exercise, and home glucose monitoring -for patients who demonstrate poor control of blood glucose level, medication and induce or C-section delivery may be necessary
what is eclampsia
-tonic-clonic seizures resulting from preeclampsia
When would a pregnant women be required to take oral glucose tolerance test (OGTT)
24-28 weeks
S/S of hyperemesis gravidarum
Symptoms are so severe that they lead to weight loss, malnutrition, dehydration, ketonuria, and electrolyte imbalances -nurses must carefully evaluate for signs of dehydration: tenting of skin and dry mucous membranes -signs of malnutrition may include ketones in the urine and weight loss
at 20 weeks gestation
fundal height is at umbilicus (20 cm)
Oligohydramnios
low volume of amniotic fluid
Transvaginal ultrasound
o Invasive procedure in which a probe is inserted vaginally to allow for a more accurate evaluation o Advantage is that it does NOT require a full bladder* o Especially useful in obese clients and those in first trimester to detect ectopic pregnancy, identify abnormalities, and to establish gestational age o Can be used in the third trimester in conjunction with abdominal scanning to evaluate for preterm labor
Doppler ultrasound
o Noninvasive external ultrasound method to study the maternal-fetal blood flow by measuring the velocity at which RBC's travel in uterine and fetal vessels using a handheld ultrasound device that reflects sound waves from a moving target o Especially useful in fetal intrauterine growth restriction (IUGR) and poor placental perfusion, and as an adjunct in pregnancies at risk because of HTN, DM, multiple fetuses, or preterm labor o 2D: standard medical scan, black, white, or shades of gray o 3D: multiple pictures at once, almost as clear as a photograph, images look more lifelike than standard ultrasound images o 4D: like 3D but also shows fetal movements in a video
Abdominal ultrasound
o Safe, noninvasive, painless procedure where an ultrasound transducer is moved over the client's abdomen to obtain an image o More useful after the first trimester when the gravid uterus is larger o Client should have a full bladder for the procedure*
nonreactive nonstress test
o The above standards have not been met. o The fetal heart rate should be monitored for an additional 20-100 min. o The fetus' lack of reactivity may be due to low oxygen, fetal sleep, fetal anomalies, maternal smoking, and other reasons. o As many as 60% of nonreactive stress tests are false positives. o The test may be repeated in 30 min, or additional testing may be ordered to confirm the results.
reactive nonstress test
o Weeks 26 through 32: at least two accelerations of at least 10 beats per minute (bpm) lasting at least 10 s over 20 min o Weeks 33 and later: at least two accelerations of at least 15 bpm for at least 15 s over 20 min
Uterine hypoperfusion
oligohydramnios and fetal growth restriction
biophysical profile
table 1.2
Grand multipara
woman who has had greater than or equal to 5 births at greater than or equal to 20 weeks of gestation
Primipara (primip)
woman who is giving birth for the first time
Multigravida
woman who is or has been pregnant for at least a second time
What are the risks factors for preeclampsia?
· Age greater than 35 years and Age less than 20 years · African descent · Low socioeconomic status · Family history of preeclampsia · Nulliparity (first pregnancy) · Pregnancy with a new partner · Preeclampsia in a previous pregnancy · UTI · Gestational diabetes · Type 1 diabetes · Obesity · Chronic HTN (high BP that starts before 20 weeks gestation) · Kidney disease · Thrombophilia (increased tendency to clot)
What are the nursing care responsibilities when caring for a patient Gestational Hypertension? Preeclampsia? Severe preeclampsia:
· Assess level of consciousness · Obtain pulse ox · Monitor urine output · Obtain daily weights · Monitor VS with careful attention to BP measurement · Encourage lateral positioning · Perform NST and daily kick counts · Instruct client to monitor I & O
medications CANNOT use to treat preeclampsia
· Avoid ACE inhibitors and angiotensin II receptor blockers (ARBS)
What are the maternal risk factors for GDM?
· BMI greater than 25 (overweight or obese) · Prior history of gestational diabetes · Family history of type 2 diabetes · Previous unexplained fetal demise · Previous birth with macrosomia · Infant with congenital anomalies · Maternal age greater than 40 years · Hispanic, African American, Native American, Asian, or Pacific Islander ethnicity · Polycystic ovarian syndrome · HTN
When is a pregnant woman screened for GDM (range of gestational age)?
· BMI greater than or equal to 30 (obese) · Diagnosis of gestational diabetes with previous pregnancy · Diagnosis of impaired glucose metabolism (increased risk for diabetes) · Diagnosis of polycystic ovarian syndrome
What is the normal weight expected gain through the entire pregnancy?
· Based on a single pregnancy is usually 11.3 to 159 kg (25-35 lb)
How many calories should the woman eat per day?
· Because of the increased needs of fetus and mother, the basal metabolic rate increases by approximately 10-20%. · Mother must consume about 350 additional dietary calories per day in 2nd trimester and additional 450 calories per day in 3rd trimester
At what week gestation is the diabetes screening completed?
· Between 24 and 28 weeks of pregnancy · Using one-step or two-step oral glucose tolerance test
S/S of placenta previa
· Bleeding without pain · In the second half of pregnancy, have pain and contractions similar to those in placental abruption
teaching with first trimester nasal stuffiness:
· Can benefit from nasal sprays or humidifiers · NO decongestants because they can present a small increased risk for birth defects
teaching with first trimester N/V
· Common feature of early pregnancy and likely caused by increased hCG levels and metabolic alterations · Nausea is more common in pregnancies involving more than one fetus and pregnancies that include nausea are less likely to result in spontaneous abortion · Nausea may begin as soon as week 4 of pregnancy and typically stops by the end of the first trimester · Rarely dangerous for the mother or the pregnancy, and about 1% severe form called hyperemesis gravidarum · Nausea is coupled with dehydration and weight loss is particularly concerning as it may indicate hyperemesis gravidarum
Significant changes in fetal activity pattern can indicate
· Decreased fetal movement might indicate fetal distress
Nutrition is a priority concern? How come?
· Dehydration and malnutrition can occur because of high levels of N/V for prolonged periods of time
neurologic symptoms (seizures, double vision) might indicate
· Eclampsia · Blurred vision = gestational hypertension · S/S of preeclampsia · If Tylenol does NOT relieve headache, edema, epigastric pain, decreased or not feeling fetal movement = NEED to know*
What are the nursing care responsibilities when caring for a patient with HELLP?
· Educate about serious complications, including disseminated intravascular coagulation, placental abruption, acute renal failure, pulmonary edema, hematoma of the liver, and retinal detachment · Associated symptoms reflect cerebral edema and include severe (typically frontal) headache, blurred vision, and scotomata o May also present with RUQ pain or epigastric results from edema and subsequent distension of the liver capsule o Can also be less specific and include malaise, flu-like symptoms, and N/V · Only true cure is delivery o If develops after 34 weeks of gestation, the woman is delivered immediately o If before 34 weeks, delivery may be delayed for 48 hours to complete a course of IM corticosteroids to facilitate fetal lung development
How often is the woman seen after 28 weeks? After 36 weeks?
· Every 2 weeks until week 36 gestation and then weekly until the end of the pregnancy
a. How will the nurse assess the fetus's perfusion, gas exchange and safety?
· Fetal heart tones are heard at normal baseline rate of 110-160/min with reassuring FHR accelerations noted, which indicates an intact fetal CNS
What is the expected weight gain in the first trimester? 2nd & 3rd trimester?
· General rule: clients should gain 1-2 kg (2.2 to 4.4 lb) during the first trimester and after that approximately 0.5 kg (1 lb) per week for the last two trimesters
glucose challenge test
· Glucose screening test/1-hr glucose tolerance test: 50 g oral glucose load, followed by plasma glucose analysis 1 hr later performed at 24-28 weeks gestation · Fasting is not necessary
routine lab studies in 3rd trimester
· H&H, STI, and GBS o Hemoglobin less than 11 g/dL is anemia in first and third trimesters of pregnancy o CDC recommends rescreening for chlamydia for pregnant women 25 and younger between weeks 28 and 36 o GBS: swab is done of the rectum and the introitus of the vagina between 35 and 37 weeks of gestation § Presence of group B streptococcus is in indication for prophylactic treatment with IV antibiotics during labor and delivery
criteria for diagnosis of "severe preeclampsia"
· HTN: systolic BP >160 mm Hg or diastolic BP >110 mm Hg on two occasions at least 4 hours apart while patient is at rest (unless antihypertensive therapy is initiated before this time) · Thrombocytopenia (platelet count <100,000 platelets/uL) · Impaired liver function (elevated blood levels of liver transaminases to twice the normal concentration), severe persistent RUQ or epigastric pain unresponsive to medication and not accounted for by alternative diagnoses, or both · Progressive renal insufficiency: doubling of serum creatinine and/or serum creatinine level (>1.1 mg/dL) · Pulmonary edema · New onset of cerebral or visual disturbances
warning signs of pending eclamptic seizure
· Headache · Blurred vision · Restlessness
prolonged N & V might indicate
· Hyperemesis gravidarum- N & V, typically occurring in the 1st trimester that can result in weight loss, dehydration, nutritional and electrolyte imbalances, and even death, if untreated · Not good nutrition, getting dehydrated, baby is not getting nutrients it needs
fever might indicate
· Infection (although pregnant women are typically 0.4-0.6 degrees F warmer than their baseline temperature) · Can impact baby
1st prenatal visit cares: what assessments (subjective and objective) would the nurse complete?
· Interview about health history, occupation, lifestyle · Questions about pregnancy symptoms, like nausea and breast tenderness, feelings about the pregnancy, past experiences with pregnancy, hopes/expectations for this pregnancy · Any cramping or bleeding they may be experiencing, timing of pregnancy, LMP (due date and tracking to see if period cycles are regular or not), timing of intercourse, nature of last menses, any diagnosed or suspected spontaneous abortions · Medications or supplements, prescription, OTC, limit caffeine to two cups or less daily · Safe place to talk about use of opioids and intimate partner violence · Initial prenatal physical exam: BP (baseline and to see if HTN is underlying before pregnancy), height, weight (height and weight are to calculate BMI to determine appropriate weight gain), pelvic exam (size of uterus can be assessed and compared to later dates), adnexa (look for mass indicating ectopic pregnancy or ovarian or fallopian tube abnormality)
What diagnostics are completed to diagnose preeclampsia?
· Lab testing for proteinuria · BP
medication of choice for prophylaxis or treatment to depress the CNS and prevent seizures in the client who has eclampsia and severe preeclampsia:
· Magnesium sulfate*
a. How will the nurse assess the mother's perfusion, gas exchange and safety?
· Maternal oxygen needs increase · During last trimester the size of the chest might enlarge allowing for lung expansion as the uterus pushes upward · Respiratory rate increases and total lung capacity decreases · Cardiac output increases (30-50%) and blood volume increases (30-45%) to meet greater metabolic needs · HR increases during pregnancy beginning around week 5 and reaches peak (10-15/min) above pre-pregnancy rate around 32 weeks
medications CAN use to treat preeclampsia
· Methyldopa · Nifedipine · Hydralazine · Labetalol
What interventions and medications would the nurse administer/teach for each level of preeclampsia?
· Mild preeclampsia and gestational HTN typically receive care on outpatient basis · Women with mild preeclampsia may be initially evaluated on an inpatient basis, and carry their pregnancies to term - do not usually require medications · Women suspected of having progressed to severe preeclampsia are monitored at least initially as inpatients and may need to be induce and delivered early to protect their health and the baby · Immediate delivery is recommended for women with severe preeclampsia who are at 34 or more weeks of gestation or prior to 34 weeks and have unstable maternal-fetal conditions · Women with severe preeclampsia who are not delivered immediately are often given IV magnesium sulfate to prevent eclampsia o Also typically receive IV antihypertensive medications (nifedipine, labetalol, methyldopa, and hydralazine) to protect them from complications of HTN like stroke, renal damage, and heart failure · Women under 34 weeks pregnant may be given a series of corticosteroid injections to promote fetal maturity and reduce the risk of perinatal death
teaching with first trimester UTI:
· Occur approximately the same rate for women who are pregnant as for women who are not, although spread of infection to kidneys, leading to pyelonephritis (kidney infection) is more common. · Asymptomatic bacteriuria (bacteria in urine) is more common in pregnant women · Common teachings to avoid: urinating before and after sex, wiping from front to back, and excellent oral hydration
What assessment findings suggest the patient maybe experiencing preeclampsia?
· Ongoing assessment including symptom evaluation, accurate BP readings, 24-hour urine and other lab tests, and accurate assessment of weight · Ultrasound may be ordered at time of diagnosis and then every 3 weeks to evaluate fetal growth and fundal height is assessed with each visit · Evaluation typically includes fetal evaluation by nonstress test and BPP once or twice weekly · Lab test of CBC and platelets, liver enzyme level, and serum creatinine level is done weekly to monitor for thrombocytopenia, liver and renal dysfunction · Nurse should monitor BP and assess her urine for proteinuria twice weekly, and encourage woman to measure her BP at home
1st prenatal visit cares: what diagnostics would the nurse expect the provider to ordered?
· Pap test if the woman is due at the time, if unsure of her LMP an ultrasound may be ordered to determine her EDD · Lab studies: testing for Rh(D) factor or for genetic predisposition to certain congenital traits such as sickle cell anemia (if not completed at preconception visit) o If mother is Rh(D) negative, antibody screen is warranted · Screening for HIV is offered on an opt-out basis (test will be run unless declined) · TB and syphilis is done based on patient risk factors · Gonorrhea and chlamydia is done routinely
teaching with first trimester fatigue:
· Particularly common, encourage to rest or even nap when possible · Reassure it is common and will not persist.
test results of glucose challenge test - what result would require OGTT?
· Positive blood glucose screening is 130-140 mg/dL or greater · Additional testing with a 3-hr oral glucose tolerance test (OGTT) is indicated
Abdominal or Pelvic Pain can indicate
· Preeclampsia (epigastric pain- pain in upper, central abdomen) · Preterm labor
UA is completed at every prenatal appointment (first visit to last) what is the rationale for this test?
· Protein in the urine may indicate preeclampsia, but spillage of protein into the urine is common and only associated with preeclampsia 2-11% of the time. Its recommended all pregnant women be screened for asymptomatic bacteria with a urine culture between weeks 12 and 16 of pregnancy, with no repeat screening indicated in low-risk women with negative result.
S/S of preeclampsia
· Proteinuria · High BP · Oliguria · RUQ or epigastric pain (indicates edema of liver which is one of the complications of preeclampsia) · Rapid onset or worsening of edema and associated weight gain, particularly if the edema is facial
What assessments are completed during the third trimester (28-42 weeks gestation)?
· Review of her chart and interval health history · VS and asked questions about fetal movement · FHR is assessed and fundal height is measured when woman's bladder is empty o Should measure within a few centimeters of the number of weeks of gestation o Ex: woman who is 22 weeks pregnant anticipated to have fundal height of 20-24 cm o Purpose is to detect abnormal fetal growth, either large or small for gestational age
What assessments are completed during the second trimester (13-28 weeks gestation)?
· Review of the patient's chart and history taking about the time between visits · An interval history, including questions about nutrition, exercise, and possible complications and typical discomforts · Vital signs · FHR (normal between 110 and 160 bpm) · Weight assessment · Fundal height measurement after 16 weeks of gestation · Maternal assessment of fetal activity
Are there foods that should be avoided in pregnancy? How come?
· Soft cheeses made with unpasteurized milk (brie, feta) · Refrigerated meat spreads such as pates (canned is fine) · Refrigerated smoked seafood (except in cooked dishes, okay if canned or shelf-stable) · Cold cuts, or lunch meats, not heated to steaming · Hot dogs not heated to steaming · Raw or unpasteurized milk or milk products · ALL are common sources of Listeria
1st prenatal visit cares: what education would be important to provide the women at the first prenatal appointment?
· Take time to teach client pregnancy-related implications of nutrition, food safety, exercise, work, sexuality, substance use and abuse, exposure to environmental hazards, general safety, and travel safety · Should be advised of warning signs and symptoms that warrant follow-up and should be assessed for these clinical signs with each visit
A woman is come to the clinic for her first prenatal visit. What information would the nurse provide regarding scheduling her future visits?
· The first visit is scheduled for the first trimester, then subsequent visits are scheduled to occur monthly until week 28 of gestation, every 2 weeks until week 36 of gestation, and then weekly until the end of pregnancy. · The average visit takes fewer than 10 minutes · Average of 12-16 prenatal visits, the client is likely to receive a total of approximately 2 hours of direct prenatal care for each pregnancy
Signs of Preterm Labor (Often subtle) might indicate
· Uterine contractions · Pelvic or abdominal pain or cramping · Pelvic pressure · Lower headache
S/S of placenta abruption
· vaginal bleeding (none to very heavy) · uterus can be tender · contractions possible · tachycardia with orthostatic changes · low fibrinogen · hypovolemic shock · fetal distress · pain
Roles and Responsibilities in the Administration of Magnesium Sulfate
• It is the responsibility of the physician to provide the orders for the magnesium sulfate administration. • It is the responsibility of the nurse to verify the dose of the medication. • If the nurse has questions about a medication or dosage, she may consult with the physician and/or the pharmacist. • The hanging of the magnesium sulfate as a "piggyback" is a nursing responsibility, as is setting the pump to the rate ordered. • Regular patient assessments specific to magnesium sulfate administration, including deep tendon reflexes, are a nursing responsibility. • Immediate stoppage of magnesium sulfate administration due to suspected toxicity is a nursing responsibility. • Calcium gluconate administration as an antidote to magnesium toxicity is usually a physician responsibility.
Problems Requiring Urgent Assessment During Pregnancy
• Leakage of fluid from the vagina • Vaginal bleeding • Reduced fetal activity • Headache that does not improve with acetaminophen • Right upper quadrant pain • Vision changes • Persistent contractions • New-onset lower back pain • Sensation of pelvic pressure • Menstrual-like cramps • Dysuria
