Women's Health - Exam 1: Maternal Adaptation andNursing Management During Pregnancy

What are the 4 steps of Naegele's rule ?

Use first day of last menstrual period (LMP) Subtract 3 months Add 7 days Add 1 year

What recommendations can a nurse suggest to address the fatigue seen in the 1st Trimester ?

Attempt full night sleep, without interruptions Side-lying position, release pressure in blood vessels

What are the 9 Presumptive Signs (subjective) of pregnancy ?

Fatigue (12 weeks) Amenorrhea (4 weeks) Breast tenderness (3-4 weeks) Fetal movements (quickening) (16-20 weeks) Urinary frequency (6-12 weeks) Nausea and vomiting (4-14 weeks) Hyperpigmentation of skin (16 weeks) Uterine enlargement (7-12 weeks) Breast enlargement (6 weeks)

What does the Dick-Read (natural childbirth) method focus on ?

Fear reduction via knowledge and abdominal breathing techniques

What is the ultrasound used to examine in the third trimester ?

Fetal size, Fetal growth, Placental position

What changes occur with the Cervix during pregnancy ?

Formation of mucus plug Increased vascularization

What is the function of pregnant women being in a hypercoagulable state ?

To protect women from hemorrhage during birth

What would be the expected date of birth (EDB) for a women whose first day of last menstrual period (LMP) was 11/21/19 ?

08/28/20

How long is pregnancy?

10 lunar months of 28 days or 40 weeks or 280 days total

What is the schedule for prenatal visits for entirety of the pregnancy ?

1st Prenatal Visit then follow up visits, Every 4 weeks up to 28 weeks Every 2 weeks from 29 to 36 weeks Every week from 37 weeks to birth

How is blood pressure altered during each trimester of pregnancy ?

1st trimester: remains at the pre pregnancy level 2nd trimester: decreases (5-10 mmhg) 3rd trimester: returns to the first trimester level

When does increase in blood volume in pregnancy peak to its highest levels ?

32-34 weeks, In the third trimester

HcG can be detected as early as _________________ after conception

7 to 10 days

_________________ of GTPAL notates the number of pregnancies ending before 20 weeks or viability.

A (abortions/miscarriages)

A pigmented line down the middle of the pregnant women's abdomen is described as? A. Linea nigra B. Striae gravidarum C. Melasma D. Vascular spiders

A. Linea nigra

In a client's eight month of pregnancy, she reports feeling dizzy when she lie down flat on the back. Which of the following is the explanation for this? A. That feeling often occurs due to pressure of the gravid uterus on the vena cava B. That feeling occurs because during pregnancy there is a 50% increase in blood volume C. That feeling occurs during pregnancy because of Physiologic anemia due to a decrease in hemoglobin level D. That feeling occurs due to pressure of the presenting fetal part on the diaphragm

A. That feeling often occurs due to pressure of the gravid uterus on the vena cava

GTPAL (gravidity, term, preterm, abortions, and living children) for a pregnant woman is "2-0-2-0-2." What does this means? A. The woman was pregnant twice, gave birth at the 35th week, and the babies survived. B. The woman was pregnant once and gave birth to twins at the 35th week of pregnancy, both survived. C. The woman was pregnant once, gave birth at the 39th week, and the baby died. D. The woman was pregnant once, gave birth at the 38th week, and the baby survived.

A. The woman was pregnant twice, gave birth at the 35th week, and the babies survived.

What are the 7 Probable (objective) signs of pregnancy ?

Abdominal uterine enlargement (14 weeks) Hegar's sign (6-12 weeks) Chadwick's (6-8 weeks) sign Goodell's sign (5 weeks) Positive pregnancy test (4-12 weeks) Ballottement (16-28 weeks) Braxton Hicks contractions (16-28 weeks)

When does the mucus plug come out of the cervix ?

About 4 weeks before birth to prepare for dilatation and effacement

_____________________ is when physical changes of the growing fetus, enlarging abdomen and fetal movement, bring reality and validity to the pregnancy (second semester).

Acceptance

___________________ refers to conflicting feelings and is the most common in the first trimester.

Ambivalence

What is the most precise method of dating a pregnancy ?

An ultrasound

What is the cause of the physiologic anemia seen in pregnancy ?

Apparent anemia that results because during pregnancy the plasma volume increases (50%) more than the erythrocytes increase (30%).

How is T, P and A of GTPAL for multiple pregnancies (twins, triplets, etc) counted ?

As 1

How are pregnancies consisting of multiples, such as twins or triplets counted ?

As ONE birth (Para 1)

What are the Positive signs of pregnancy ?

Auscultation of fetal heart tones via Doppler (10-12 weeks) Fetal movement felt by experienced clinician (20 weeks) Ultrasound verification of embryo or fetus (4-6 weeks)

What recommendations can a nurse suggest to address the shortness of breath and dyspnea seen in the 3rd Trimester ?

Avoid large meals that increase abdominal pressure Raising the head of the bed Lying to her side will improve breathing (vena cava)

A nurse is collecting data from an admission assessment of a client who is pregnant with twins. The client also has a 8-year-old child. The nurse would document which gravida (G) and para (P) status on this client? A. G1P1 B. G2P1 C. G2P2 D. G3P2

B. G2P1

Which time-based description of a stage of development in pregnancy is accurate? a. Viability- period from the beginning of the pregnancy to 20 weeks B. Term—pregnancy from the beginning of week 37 of gestation to week 42 C. Preterm—pregnancy from 10 to 18 weeks D. Postdate—pregnancy that extends beyond 38 weeks

B. Term—pregnancy from the beginning of week 37 of gestation to week 42

What are the common 2nd Trimester Discomforts ?

Backache Varicosities of the vulva and legs Hemorrhoids Flatulence with bloating

__________________ is thhe use of a finger to push sharply against the uterus and detect the presence or position of a fetus by its return impact.

Ballottement (seen at 16-28 weeks)

Why do pregnant women experience Hyperpigmentation ?

Because progesterone, estrogens stimulate the melanocytes

The ______________ method focuses on exercises and slow, controlled abdominal breathing

Bradley (partner-coached childbirth)

What does the Lamaze (psychoprophylactic) method focus on ?

Breathing and relaxation techniques

What respiratory system adaptations occur during pregnancy ?

Breathing more diaphragmatic than abdominal Increase in diaphragmatic excursion Increase chest circumference Increase tidal volume Increase in oxygen consumption Increased vascularity of nose leading to congestion, epistaxis and rhinitis.

When does increase in blood volume in pregnancy reach 50% above non-pregnant levels ?

By the 30th week

Where the nurse would expect to find the fundus at 20 week's gestation? A. Just above the symphysis pubis B. Mid-way between the pubis and umbilicus C. At the level of the umbilicus D. Mid-way between the umbilicus and xiphoid process

C. At the level of the umbilicus

A pregnant woman is planning to travel by airplane to visit her parents. The nurse educates the mother about this travel. What teaching content provided by the nurse is correct? A. Sit in a window seat so you can focus on the sky to relax B. Do not drink too much fluid so you don't have to urinate so often C. Get up and walk around the airplane about every 2 hours D. Do some upper arm stretches while sitting in the seat

C. Get up and walk around the airplane about every 2 hours

Which of the following changes in the musculoskeletal system would the nurse mention when teaching a group of pregnant women about the physiologic changes of pregnancy? A. Ligament tightening B. Decreased lordosis C. Increased lordosis D. Joint contraction

C. Increased lordosis

A mother asks the nurse, "How does my baby get air inside my uterus?" The correct response is A. The baby's lungs work in utero to exchange oxygen and carbon dioxide. B. The baby absorbs oxygen from your blood system. C. The placenta provides oxygen to the baby and excretes carbon dioxide into your bloodstream. D. The placenta delivers oxygen-rich blood through the umbilical artery to the baby's abdomen

C. The placenta provides oxygen to the baby and excretes carbon dioxide into your bloodstream.

The ___________________ ___________ is bluish-purple coloration of the vaginal mucosa and cervix.

Chadwick's sign (seen at 6-8 weeks)

What happens in Supine hypotensive syndrome or vena cava syndrome ?

Compression of the vena cava when a mother in third trimester lays in supine position, reducing venous return and decreases cardiac output and blood pressure, with increasing orthostatic stress.

What is the ultrasound used to confirm in the first trimester ?

Confirm pregnancy, Fetal Heart Rate, Gestational age

What is the ultrasound used to examine in the second trimester ?

Congenital malformation, Multifetal pregnancies (if present), Verification of gestational age and growth, Gender

What recommendations can a nurse suggest to address the Urinary frequency or incontinence seen in the 1st Trimester ?

Decrease fluid intake before bedtime Reduce caffeinated beverages Kegel exercises

What GI system adaptations occur during pregnancy ?

Decreased peristalsis and smooth muscle relaxation Constipation + increased venous pressure + pressure from uterus = Hemorrhoids Slowed gastric emptying + relaxation of the cardiac sphincter > Gastric reflux Heartburn Prolonged gallbladder emptying Nausea and vomiting (1st trimester morning sickness)

What Renal/Urinary system adaptations occur during pregnancy ?

Dilation of renal pelvis; elongation, widening, and increase in curve of ureters Increase in GFR; increased urine flow and volume Increase in kidney activity when a woman lies down, decreases on standing; Greater increase of kidney activity in later pregnancy when the woman lies on her side

What recommendations can a nurse suggest to address the nasal stuffiness, bleeding gums, epistaxis seen in the 1st Trimester ?

Drink extra water or use a humidifier for hydration of the membranes If nosebleed occurs, pinch nostrils for 10-15 min Use a soft toothbrush

What recommendations can a nurse suggest to address the constipation seen in the 1st Trimester ?

Drink water daily (2 liters) Physical activity and diet changes

The diagnosis of pregnancy is based on which positive sign(s) of pregnancy? A. Identification of fetal heartbeat (Doppler or ultrasound) B. Palpation of the umbilical cord C. Visualization of the fetus (ultrasound) D. Verification of fetal movement E. A,C,D

E. A,C,D

What recommendations can a nurse suggest to address the nausea and vomiting seen in the 1st Trimester ?

Eat small, frequent meals, bland, low fat Dry crackers, cheerios, cheese, ginger or lemonade

What recommendations can a nurse suggest to address the dependent edemas seen in the 3rd Trimester ?

Elevate feet and legs Change position When traveling, stop walk around every 2 hrs

What modification occur with the Ovaries during pregnancy ?

Enlargement until 12th to 14th week of gestation Cessation of ovulation

The nurse demonstrate understanding of the pregnancy signs and symptoms when she/he identifies which as presumptive sign(s) of pregnancy? A. Amenorrhea B. Nausea C. Visualization of the fetus with an ultrasound D. Braxton-Hicks contractions E. Fetal heart sounds F. A,B

F. A,B

What are the common 1st Trimester Discomforts ?

Fatigue Urinary frequency or incontinence Nausea and vomiting Bleeding gums Epistaxis Nasal stuffiness Constipation Cravings Leukorrhea

______________ of GTPAL notates the number of total pregnancies (pregnant).

G (gravida)

Alice is pregnant for the fourth time. She had an abortion at 6 weeks' gestation. She has a son who was born at 39 weeks' gestation and a daughter born at 33 weeks. How is the obstetric history notated using the GTPAL method ?

G = 4 T = 1, son born at 39 weeks P = 1, daughter born at 33 weeks A = 1, abortion at 6 weeks L = 2, living children

Which of the following are probable signs of pregnancy? A. Positive pregnancy test B. Ultrasound visualization of the fetus C. Auscultation of a fetal heart beat D. Ballottement E. Absence of menstruation F. Goodell's sign G. A,D,F

G. A,D,F

The _______________ ___________ refers to softening of the cervix.

Goodell's sign (seen at 5 weeks)

Alice is pregnant for the fourth time. She had an abortion at 6 weeks' gestation. She has a son who was born at 39 weeks' gestation and a daughter born at 33 weeks. How is the obstetric history notated using gravida/para ?

Gravida 4, Para 2

What does GTPAL stand for?

Gravida, Term, Preterm, Abortion, Living

How is dental health impacted by pregnancy ?

Gums become hyperemic, swollen, and friable Ptyalism (overproduction of saliva) Gingivitis can occur

What recommendations can a nurse suggest to address the Braxton Hicks contractions seen in the 3rd Trimester ?

Hydration Rest in a side lying position to relieve discomfort Breathing techniques

What Integumentary system adaptations occur during pregnancy ?

Hyperpigmentation of breast, genitalia and face Facial melasma or chloasma (70% of pregnant women) Linea nigra Striae gravidarum ( stretch marks reduce connective tissue strength) 6-7 months Varicosities (poor circulation, uterus compresion)

What cardiovascular system adaptations occur during pregnancy ?

Increase in blood volume (plasma 50% increase beginning by 10-12 weeks) Increase in cardiac output Increased venous return Increased heart rate (around 10 - 15 beats per minute)

What cellular changes occur during pregnancy ?

Increase in number of RBCs (30%) Increase in iron demands, fibrin, plasma fibrinogen levels, and some clotting factors Hypercoagulable state occurs White blood cell count is increased (stress of pregnancy)

What changes occur with the breasts during pregnancy ?

Increase in size and nodularity to prepare for lactation Increase in nipple size, becoming more erect and pigmented Production of colostrum

What adaptations occur with the uterus during pregnancy ?

Increase in size, weight, length, width, depth, volume, and overall capacity Pear shape to ovoid shape Enhanced uterine contractility; Braxton Hicks contractions Ascends into abdomen after first 3 months Fundal height by 20 weeks' gestation at level of umbilicus; 20 cm

___________________ refers to the mother becoming increasingly preoccupied with herself and her fetus (early part of pregnancy)

Introversion

What are the common maternal emotional responses ?

Introversion Changes in body image Ambivalence Acceptance Mood swings

If a client's last menstrual period was April 20. Using Nagele's rule, what would her expected date of birth (EDB) be ?

January 27

What recommendations can a nurse suggest to address the leukorrhea seen in the 1st Trimester ?

Keep the area clean and dry Avoid wearing pantyhose or nylon clothes Cotton underwear Wearing a nightgown rather than pajamas Avoid douching and tampon use

What physiological adaptations occur with the vagina during pregnancy ?

Lengthening of vaginal vault Increased vascularity with thickening Leukorrhea discharge (more acidic, white, and thick)

What topics would you discuss with a women for Preconception Care ?

Lifestyle practices Immunization status Medication and drug use Psychosocial issues Support system Reproductive health care practices Underlying medical conditions Nutrition Sexuality and sexual practices

What recommendations can a nurse suggest to address the backache seen in the 2nd Trimester ?

Maintain correct posture and wear low-heeled shoes When standing for long periods, place one foot on a box; elevate legs when possible. Place a pillow between legs when lying down

What gestational age is considered a Post term birth ?

More than 42 weeks of gestation

_________________ refers to two or more pregnancies resulting in viable offspring.

Multipara ("multip")

_________________ _________ is a method to calculate estimated or expected date of birth (EDB) or delivery (EDD) based on the last menstrual period (LMP).

Naegele's rule

What are the characteristics of Braxton Hicks contractions ?

Non-painful with NO clear pattern Can be palpated by healthcare provider

________________ refers to no viable offspring.

Nullipara (para 0)

What types of laboratory testing are required for pregnant women during prenatal visit ?

Pap smear Hepatitis B surface antigen Ultrasound Glucose tolerance (beginning and 24-28 weeks)* STIs, HIV, VDRL, and RPR testing Complete blood count (hemoglobin, hematocrit, red and white blood cell counts and platelets) Urinalysis (albumin, glucose, ketones and bacteria) Rubella titer (antibodies for German measles) Renal function (BUN, creatinine, electrolytes)* Blood typing and Rh factor

__________ is the number of deliveries at 20 weeks or greater

Para

What is a consequence of a post-term pregnancy ?

Placenta get older and less effective at providing nutrition baby needs

What is the role of Prostaglandins in pregnancy ?

Play a part in softening the cervix and initiating and /or maintaining labor.

What are the three stages of Pregnancy Diagnosis ?

Presumptive Probable Positive

What recommendations can a nurse suggest to address the heartburn and indigestion seen in the 3rd Trimester ?

Proper posture and remain in the sitting position 1 to 3 hours after eating Eat slow Avoid food that cause release of gastric acids.

What are the common 3rd Trimester Discomforts ?

Return of 1st trimester discomforts Shortness of breath and dyspnea Heartburn and indigestion Dependent edemas Braxton Hicks contractions

____________________ refers to softening, effacement, and increased distensibility of the cervix.

Ripening

The _______________ trimester occurs from weeks 14 through 26

Second

How is the Thyroid gland altered during pregnancy ?

Slight enlargement Increased activity Increase vascularity and hyperplasia Maternal thyroid hormone is transferred to the fetus beginning soon after the conception, this hormone is critical for fetal brain development

What is the Hegar's sign ?

Softening of the lower uterine segment or isthmus (seen at 6-12 weeks)

What subjective and objective data should be obtained from a women during the 1st pre-natal visit ?

Suspicion of pregnancy: Signs and symptoms of pregnancy Urine or blood test for hCG Date of last menstrual period Past medical, surgical, and personal history Menstrual, obstetric, and gynecologic history

______________ of GTPAL notates term deliveries >37 weeks' gestation

T (term births)

The ___________ trimester occurs from weeks 27 through 40.

Third

A ___________ birth is about 22 to 24 weeks since last menstrual period, or fetal weight greater than 500 g

Viable

What should be assessed with a women during the follow up pre-natal visits ?

Vital signs and physical examination Weight & BP compared to baseline values Urine testing for protein, glucose, ketones, and nitrites Fundal height Quickening/fetal movement (16-20 weeks) Fetal heart rate Screening for gestational diabetes Labs (based on the risk factors)

What Musculoskeletal system adaptations occur during pregnancy ?

Waddle gait Increased swayback and upper spine extension Increase in lumbosacral curve (lordosis) Center of gravity shifts forward Softening and stretching of ligaments and joints

What recommendations can a nurse suggest to address the flatulence with bloating seen in the 2nd Trimester ?

Walk Avoid gas forming foods (beans, onions, cabage) and with high content of sugar Reduce carbonate beverages

What recommendations can a nurse suggest to address the varicosities of the vulva and legs seen in the 2nd Trimester ?

Wear support hose Elevate the legs at least twice a day, avoid crossing the legs and knee high stockings Ice pack in the affected area

How is fundal height measured?

With a tape measure over the mothers abdomen to record the size of the uterus.

If a baby is born before 20 week it is considered an ________________.

abortion

Which of the following is true regarding the physiologic changes a woman may expect during her pregnancy ? a. Gastric emptying and large bowel motility are increased in pregnancy b Plasma volume increases around 50 % during the pregnancy c. Chloasma is present on the abdomen d. The urinary frequency during the third trimester decrease

b Plasma volume increases around 50 % during the pregnancy

Cardiovascular system changes occur during pregnancy. Which finding would be considered normal for a woman in her first trimester? a. Decreased plasma b. Blood pressure remains at the pregnancy level c. Increased blood pressure d. Decreased red blood cell (RBC) production

b. Blood pressure remains at the pregnancy level

During a vaginal exam, you notes that the cervix has a bluish color. You should documents this finding as: a. Hegar's sign b. Goodell's sign c. Chadwick's sign d. Ortolani's sign

c. Chadwick's sign

Gravida I (primigravida) refers to __________ ________________.

first pregnancy

What does L of GTPAL notate ?

living children

What does Primapara refer to ?

one birth after a pregnancy of at least 20 weeks ("primip")

What does P of GTPAL notate ?

pre term deliveries >20 weeks or viability but before completion of 37 weeks

A _______________ birth is less than 37 weeks of gestation

pre-term

Gravida II (secundigravida) refers to _______________ __________________.

second pregnancy ect.

An at Term birth is from beginning of ___________ ______ of gestation to end of ___________ ______ of gestation

week 37, week 42

The First trimester occurs from __________ _____ ______________ _______.

weeks 1 through 13

What should be done and assess with a women during the 1st pre-natal visit ?

•Establishment of trusting relationship •Focus on education for overall wellness •Detection and prevention of potential problems •Comprehensive health history, physical examination, and laboratory tests