NSG 1027 Exam 3 Antepartum and L&D

-amenorrhea -nausea/vomiting -fatigue -frequent urination -breast tenderness/lumpy -quickening (1st perception of fetal movement)

what are some presumptive, subjective signs of pregnancy? (6 listed)

-partner refuses to leave so client can't speak openly -avoids eye contact -anxiety, depression, substance abuse -injuries

what are some red flags for domestic violence?

-CBC -blood type -Hep B surface antigen -syphilis -rubella immunity -urine culture

what are some tests ran during the first prenatal visit?

-preterm labor -epigastric pain -leaking vaginal fluids -vision changes -infection -swelling of face/hands -severe headache -bleeding vaginally -decreased fetal movement

what are the danger signs of pregnancy? (9 listed)

-ultrasound -fetal heart rate -fetal movement (perceived by examiner)

what are the only 100% positive signs of pregnancy?

nausea/vomiting, RUQ pain, fever

what are the s/s of gallstones?

-weight -urine screen for glucose/protein -blood pressure -fundal height -fetal heart rate -fetal movement

what are the six things assessed during every prenatal visit?

-physical assessment -fetal heart tones -fundal height measurement

what are the three things assessed during the first prenatal visit?

-stimulates uterine contractions -stimulates milk let-down reflex

what are the two things oxytocin does during pregnancy?

iron, calcium, iodine

what are three important minerals during pregnancy?

folic acid, vitamin A (eat foods with beta-carotene)

what are two important vitamins during pregnancy?

-feelings about pregnancy -intimate partner violence

what are two things that would be included in a psychical screening of an expecting mother?

flex hip/knee, lay on opposite side, heating pad, acetaminophen

what comfort measures could be take for a pt with round ligament pain?

increase water intake

what comfort measures could be taken for a pt with uterine cramping and intermittent low backache?

-Gravida -Term deliveries (>38 wks) -Preterm deliveries -Abortions/miscarriages -Living children

what does G TPAL stand for?

insufficient contractions

what does it mean if you test "insufficient" on a CST?

inc by 40-45%

what happens to blood volume during pregnancy?

inc by 25-50%

what happens to cardiac output during pregnancy?

decreases

what happens to vascular resistance during pregnancy?

10

what is a perfect score on a BPP?

-medical/surgical hx -reproductive hx -previous pregnancies -current pregnancy -LMP (last premenstrual period)

what is assessed during the first prenatal visit?

"sympathetic pregnancy"

what is couvade syndrome?

-add 7 days to the first day of the last menstrual period -subtract 3 months -add one year

what is the formula to calculate Naegele's rule? (calculate due date)

electrolytes (Na+, K+) hemoglobin/hematocrit

what labs would be monitored during nursing care?

left-tilt side lying position

what position is good for a pregnant woman experiencing air hunger/SOB?

weight, turgor, hair/skin/nails

what things would be done during a physical exam for nursing care?

-facilitates fetal cell growth -provides rich blood supply for the placenta, which nourishes the embryo/fetus

what two things does estrogen do during pregnancy?

10, 2

when doing fetal kick counts, the baby should move at least ___ times in ___ hours

done at 8-12 weeks for genetic studies (chromosomal concerns)

when is chronic villus sampling done and what is it for?

-preterm labor -vaginal bleeding -ruptured membranes

when is sexual activity not okay during pregnancy?

35-37 weeks

when is the GBS screen done?

15-20 weeks (from venous blood)

when is the MSAFP tested?

24-28 weeks

when is the Rh retest and screen for antibody conversion done?

as soon as the woman establishes she is pregnant

when is the first prenatal visit generally scheduled?

24-28 weeks

when is the screening for gestational diabetes done?

2nd trimester

which trimester? mother accepts the baby, focuses on the fetus as a distinct from herself, rapid mood changes persist

1st trimester

which trimester? mother accepts the pregnancy, has ambivalence and rapid mood swings

3rd trimester

which trimester? mother prepares for parenthood, is tired of pregnancy but anxious about delivery, starts nesting

protein

women should eat 5-6 grams more of ______ per day (60 grams total) during the entire pregnancy

calories

women should eat _____ more calories prepay during the 2nd and 3rd trimesters

Chadwick's sign

bluish/purplish color of the cervix (checked by looking)

Preeclampsia

gestational hypertension plus protein urea

converse

if SOB occurs during exercise, decrease the level of intensity to a point where she can ______

catabolic

in the _____ phase, protein stores are broken down and used to meet fetal demands during the last semester

anabolic

in the ______ phase, protein is stored up during the first two trimesters

25-35

normal pre-pregnant BMI

28-40

overweight pre-pregnant BMI

nipple

oxytocin is released by _____ stimulation

metabolic

pregnancy increases ______ activity (BMR inc by 20%)

10

pregnant women should not lift anything over ____ pounds

placenta

progesterone is produced by the ______

-relaxes uterine muscle -prevents preterm labor -relaxes ureters in renal system -slows GI motility to facilite absorption -vasodilation of blood vessels

progesterone sustains the pregnancy. what else does it do? (5 listed)

ballottement

rebound of fetus noted when tapping on cervix

contractions

______ cause a reduction of blood flow to the placenta that can potentially stress the fetus

iron

______ supplementation is needed after 20 weeks

2, 20, 15, 15

a reactive NST has at least ___ accelerations in ___ minutes that increases at least ___ bpm above baseline AND last at least ___ seconds

estimated date of confinement

EDC

estimated date of delivery

EDD

clay, dirt, laundry starch, freezer frost/ice

most common ingested things in people with pica

amniocentesis

this diagnostic study is done at 15-20 weeks and is used for genetic studies, tests for fetal alpha-fetoprotein (accurately), lung maturity (during 3rd trimester)

prolactin

this hormone is produced by the pituitary and stimulates production of breast milk

Tobacco, alcohol, cocaine

Three teratogens that cause fetal growth problems, neonatal withdrawal syndrome, fetal birth defects, and preterm labor and birth

2

ultrasound dating is accurate within __ weeks in the 2nd trimester

3

ultrasound dating is accurate within __ weeks in the 3rd trimester

3-5

ultrasound dating is accurate within ___-___ days in the 1st trimester

15-25

underweight pre-pregnant BMI

16

weight gain of less than ___ lbs is associated with low-birth-weight babies

-teratogen exposure -maternal age -cardiac disease -Rh incompatibility -poverty -diabetes

what are 6 pregestational conditions affecting pregnancy?

-position/posture -body mechanics -PT -massage

what are some comfort measures for back pain?

inc water intake, high fiber diet, physical exercise

what are some comfort measures for constipation during pregnancy?

small, frequent meals; elevate HOB while sleeping; antacids (only if prescribed)

what are some comfort measures for heartburn/reflux during pregnancy?

preparation H, Anusol, witch hazel, elevate legs

what are some comfort measures for hemorrhoids during pregnancy?

-hydration -K+ -dorsiflex foot

what are some comfort measures for leg cramps/Charlie horses? (3 listed)

-tender -lumpy -size inc -areolas darken -montgomery tubercles more prominent -presence of striae -colostrum production (may be seen as early as 16 wks)

what are some physiological changes in breasts during pregnancy? (7 listed)

-loosens pelvic ligaments (causes pregnancy gait) -carpal tunnel syndrome/other aches and pains -leg cramps (Charlie horses) -back pain -curvature of spine inc.

what are some physiological changes in musculoskeletal system during pregnancy? (5 listed)

-hyperpigmentation -stretching

what are some physiological changes in the integumentary system that occur during pregnancy? (2 listed)

-thoracic cavity enlarges -"air hunger"/sensation of SOB

what are some physiological changes in the respiratory system of a pregnant person? (2 listed)

-inc vascularity -inc discharge

what are some physiological changes that occur in the cervix/vagina during pregnancy? (2 listed)

-frequent urination -high risk for UTI's -glycosuria

what are some physiological changes that take place in the urinary system during pregnancy? (3 listed)

-constipation -hemorrhoids -heartburn/reflux -gallstones

what are some physiological changes to the GI system during pregnancy? (4 listed)

Exchange blood transfusion

If an Rh incompatibility occurs and affect the fetus, the fetus develops hemolytic anemia. How is this treated?

Methotrexate

If an ectopic pregnancy is caught early, ______ can stop fetal growth and may be able to save the fallopian tube

12

If hypertension develops during the first 20 weeks of pregnancy, it cannot be confirmed chronic until it persists beyond ____ weeks postpartum

Ectopic pregnancy

Implantation of a fertilized egg outside of the uterus

Molar

In a ______ pregnancy, chromosomal errors cause growth of only the chorionic villi (no fetus)

Two, 4

In order to be considered just stational hypertension, the patient has to be hypertensive on at least ___ ovations and at least ___ hours apart

Toxoplasmosis parasite

Transmitted through cat feces, contaminated soil, undercooked meat, unfiltered water

D&C or induce contractions

Treatment for a missed spontaneous abortion

Watch and see, ibuprofen

Treatment for an inevitable spontaneous abortion

Emotional support

Treatment for complete spontaneous abortion

D&C, IV pitocin, oral methergine

Treatment for incomplete spontaneous abortion

No vaginal exams, bed rest until delivery

Treatment for placenta previa

Prompt delivery, blood transfusion, observe for s/s of DIC

Treatments for placenta abruption

Labor dystocia

What might hypotonic contractions cause

Severe preeclampsia

What might severe and persistent right upper quadrant or epigastric pain be a sign up?

VBAC

What puts mom is at high risk for uterine rupture?

When an RH negative woman is exposed to Rh positive blood

When does Rh sensitization (isoimmunization) occur?

-at 28 weeks -after invasive procedures or trauma -after delivery within 72 hours (including miscarriage/ectopic)

When is RhoGAM given?

Chloasma

"mask of pregnancy"; darkened spots on the face

striae

"stretch marks"

Infection

#1 cause of PPROM

24-28 weeks

When is screening for diabetes routinely done?

Invasive procedures, trauma, delivery

When might maternal exposure to fetal blood occur?

41-42 weeks

When should a post-term pregnancy be induced?

trans abdominal, transvaginal

2 types of ultrasound

Cancer

20% of molar pregnancies develop into a malignant ____

Catecholamines

Anxiety releases ______ (causes fight or flight which slows labor)

Cerclage

A purse string stitch done to hold the cervix closed

Fetal distress

Any ominous fetal heart rate pattern

38 weeks

At what point in the pregnancy do lungs fully mature?

Shoulder dystocia

Birth emergency in which shoulders become stock; most often caused by macrosomia and also associated with maternal diabetes

Prolapsed cord

Birth emergency in which the umbilical cord comes before the presenting part; causes feel distress due to Compromised fetal circulation; caused by rupture of membranes before the head is engaged into the pelvis

Cyromegalovirus

Causes seizures, microcephaly, intrauterine growth restriction

NO

Can moms with HIV/AIDS breast-feed?

Placenta previa

Caused by abnormal implantation and growth of the placenta, either completely over or every near the Cervical

Herpes simplex virus

Causes IUGR, Spontaneous abortion, stillbirth, premature labor, congenital herpes

-painless vaginal bleeding at 8-16 was gestation -ultrasound reveals mass of cysts without a fetus -absence of fetal heart sounds -excessive size of uterus and hCG levels -hypertension

Clinical manifestations of Hydatidiform Mole (molar pregnancy)

Vascular disease

Damage to blood vessels associated with diabetes

Triggering

DIC follows a ______ event, like preeclampsia/eclampsia, GTD/molar pregnancy, placenta abruption, or infection

Birth without waiting

Delivery that is unattended by the physician or nurse midwife

Vascular disease, retinopathy, nephropathy, hypertension

Diabetes during pregnancy will more than likely he's in the development of what four diabetic problems?

Gestational diabetes

Diabetes that develops as a result of pregnancy

Bishop score

Exam done to determine labor readiness (score of 6 oral less indicates unripe cervix)

Rubella

German measles; Causing permanent hearing loss, cataracts, heart defects, other birth the fax

-deliver the baby! -manage safety of fetus and mother until delivery (lab values, pain, mag to prevent seizures)

How do you manage a patient in HELLP Syndrome

-IV fluids -blood transfusion -antihypertensives -monitor for DIC

How do you stabilize a pt with molar pregnancy?

You need less during the first trimester and more during the second and third trimesters

How do you the amount of insulin needed throughout the pregnancy compare?

RhoGAM

How is Rh sensitization prevented?

Cerclage

How is cervical insufficiency treated?

Oxytocin (pitocin) IV infusion

How is labor induced?

140, 90

Hypertension is defined as SBP over ____ or DPB over ____

Gestational HTN

Hypertension that develops after 20 weeks gestation

Chronic HTN

Hypertension that develops before pregnancy or during the first 20 weeks of pregnancy

Preeclampsia

Hypertensive does order that can present any time from 20 weeks just station up to 48 hours post partum

Prevention of cardiac decompensation and if it occurs, early detection and treatment

Is the goal in a pregnant woman with cardiac disease?

Precipitous labor

Labor that lasts less than 3 hours

Disseminated Intravascular Coagulation (DIC)

Life threatening disorder; paradoxical clotting disorder; profuse bleeding externally and internal clotting at the same time

maternal serum alpha fetal protein

MSAFP

Quad

MSAFP is part of the "______ screen"

Fallopian tube

Most frequent spot for an ectopic pregnancy

Mild - 140/90 Severe - 160/110

Name the blood pressures for mild and severe preeclampsia

Nuchal cord/true knot

Name two umbilical cord abnormalities

HAART (highly active anti-retroviral therapy)

Newborns exposed to HIV are given what?

Spontaneous rupture of the amniotic sac

Number one reason for preterm delivery

Hypertension

One of the top for leading causes of maternal death in the US and significant contributor to stillbirth and neonatal morbidity and mortality

Percutaneous Umbilical Blood Sampling (aka cordocentesis)

PUBS

Abruption placentae (placenta abruption)

Painful vaginal bleeding could be a sign of what?

Cervical insufficiency

Painless dilation of the cervix without contractions

Placenta previa

Painless vaginal bleeding could be a sign of what?

Caused by early detachment of the placenta

Placenta abruption

Eclampsia

Preeclampsia plus seizure activity or coma

Spontaneous abortion

Pregnancy which and spontaneously before 20 weeks

Terbutaline

Smooth muscle relax sent that stops preterm labor

PROM

Spontaneous rupture of the amniotic sac before labor Begins but after 37 weeks gestation

PPROM

Spontaneous rupture of the amniotic sac before labor begins and before 37 weeks gestation

Isoimmunization

Rh sensitization, aka ______

Clonus

Rhythmic muscle spasm when ankle is Dorsiflexed

Preterm labor

Second leading cause of infant death

Cocaine

Teratogen that causes placental abruption

Rh antibodies produced by isoimmunized mother the next pregnancy

The RH factor does not cross the placenta. What does?

2

The goal is to give ___ doses of corticosteroids to promote fetal lung maturity and speed up surfactant production

Elective

Type of Induced abortion; abortion performed at the woman's request that does not involve preservation of health

Therapeutic

Type of induced abortion; termination of a pregnancy for reasons related to maternal or fetal health or disease

Threatened

Type of spontaneous abortion characterized by Bleeding with or without cramping, no dilation of the cervix, and no expulsion of any products of conception

Inevitable

Type of spontaneous abortion characterized by Cramping and bleeding, dilation of the cervix but POC not yet expelled

Complete

Type of spontaneous abortion characterized by complete expulsion of all POC

Missed

Type of spontaneous abortion characterized by death of the embryo or fetus before 20 weeks and complete retention of products of conception

Incomplete

Type of spontaneous abortion characterized by some but not all POC expelled

Recurrent or habitual

Type of spontaneous abortion characterized by three or more consecutive spontaneous abortions

Threatened

Type of spontaneous abortion that can be saved if we can stop it

Inevitable

Type of spontaneous abortion that is incompatible for continuation of the pregnancy

Ineffective

Uterine irritability is when contractions are ______

Duration of 60-90 sec every 2-3 min

What are contraction timing goals?

-edema of face and hands -Rapid weight gain from fluid retention -Hyperactive reflexes -Clonus -Severe headache -Visual disturbances -Epigastric pain from a swollen liver

What are signs and symptoms indicating advanced preeclampsia progression? (7 listed)

-fetal distress -shoulder dystocia -umbilical cord prolapse -uterine rupture -placental abnormalities -umbilical cord abnormalities

What are some birth emergencies? (6 listed)

Monitor blood sugar closely, monitor for infections, fetal surveillance

What are some interventions for a pregnant mom with diabetes?

-Hypoglycemia -DKA -Hypertensive disorders -Delivery complications

What are some maternal risks during pregnancy because of diabetes? (4 listed)

Membrane stripping and catheterballoon

What are some mechanical methods for Cervical ripening

Episiotomy, vacuum, forceps

What are some methods a provider can use to assist a delivery?

Prostaglandin E2 (cervadil), amniotic year, AROM

What are some pharmacologic methods to cervical ripening?

-aspiration -cerebral hemorrhage -stroke -hepatic rupture -placental actuation (fetal compromise/death)

What are some possible complications of eclampsia? (5 listed)

-History of LGA infant -History of GDM -Family history of DM -Advanced maternal age -Obesity -Non-Caucasian

What are some risk factors for GDM? (6 listed)

-perinatal mortality -oligohydramnios -Mec-stained fluid -macrosomnia

What are the complications that are at increased risk in a post-term pregnancy?

-Birth defects -Macrosomia -Hydramios -Delayed lung maturity -Miscarriage and still birth

What are the fetal risks that may happen because of diabetes during pregnancy?

Increased risk for down syndrome, preeclampsia, gestational diabetes, Ectopic pregnancy, Preterm labor, hypertension, C-section deliveries

What are the risks for having a baby when you're over 35?

Increased risk for preterm labor, hypertension, anemia, STI, preeclampsia, In adequate weight gain

What are the risks of having a baby at 19 years old or less?

Tachycardia, palpitations, anxiety

What are the side effects of terbutaline?

Crackles, dyspnea, dizziness, cyanosis, edema, heart murmur, heart palpitations, chest pain, tachycardia

What are the signs and symptoms of cardiac decompensation? ( 9 listed)

Uterine contractions, pelvic pressure, backache with vaginal bleeding

What are the signs and symptoms of preterm labor?

-Nonreassuring fetal heart rate pattern -Maternal shock -Excessive maternal pain -Higher fetal station

What are the signs and symptoms of uterine rupture? (4 listed)

Hypovolemic shock and shoulder pain

What are the symptoms of hemorrhage due to a fallopian tube rupture?

-History of previous preterm birth -Multiple gestation pregnancy -Infection

What are the three risk factors for preterm labor?

Monitor blood glucose, glycemic control with diet, exercise, and medication

What are the treatments for GDM?

Counseling, determine a cause to decide on a treatment that will prevent future miscarriages

What are the treatments for re-current or habitual spontaneous abortions?

-Bedrest and monitor symptoms closely -NSTs -Amniocentesis to check for lung maturity

What are the treatments of preeclampsia? (3 listed)

-Infusion of magnesium sulfate -Immediate delivery

What are the treatments of the eclampsia? (2 listed)

-Fetal malposition (OP) -fetal malpresentation -multiple gestation

What are three problems of the passenger that may lead to labor dystocia

-Abnormal shape of pelvis -Cephalopelvic disproportion(CPD)

What are two passageway complications that may cause labor dystocia?

Blockage or scarring of the fallopian tube's

What causes an ectopic pregnancy in a fallopian tube?

Induce labor

What do you NEVER do during a molar pregnancy due to risk of hemorrhage ?

-Hemolysis -Elevated Liver enzymes -Low Platelets

What does HELLP stand for?

Chorioamnionitis

What does PROM increase the risk for?

Toxoplasmosis parasite Other infections Rubella Cytomegalovirus Herpes simplex virus

What does TORCH stand for?

Glycemic control with diet, exercise, and insulin

What is the goal for a mother with diabetes?

Deliver the baby

What is the only cure of hypertension during pregnancy?

Hysterectomy

What is the preferred treatment for a molar pregnancy?

"Pelvic rest"

What is the treatment for threatened spontaneous abortion?

better

are fats absorbed better or worse during pregnancy?

pica

associated with iron-deficiency anemia

week

between 18-32 weeks the fundal height in cm should match the ______ of pregnancy

linea nigra

dark line down the center of the abdomen

BPP (biophysical profile)

diagnostic study that determines fetal well-being by assessing -NST (fetal HR) -fetal breathing -fetal body movement -fetal tone -amniotic fluid volume

increase

do clotting factors increase or decrease during pregnancy?

decrease

does BP increase or decrease during pregnancy?

negative; no late decals (positive means late decels)

during a CST (contraction stress test), is it better to test negative or positive?

Pica

eating non food items

placenta

estrogen is produced by the _______

hCG

hormone that sustains corpus luteum nearly pregnancy

progesterone

hormone that sustains the pregnancy

avoid standing still so blood doesn't pool in the legs (venous stasis); elevate feet when possible

how can comfort measures be taken during pregnancy to help with decreased vascular resistance?

28 weeks

how far into the pregnancy should mothers start to do fetal kick counts?

8-10 glasses

how much water should be drinken daily?

3-4 pounds

how much weight are you supposed to gain during the 1st trimester?

1 pound per week

how much weight are you supposed to gain during the 2nd and 3rd trimester?

weekly until delivery

how often are prenatal visits scheduled after 36 weeks?

every 2 weeks

how often are prenatal visits scheduled from 32-36 weeks?

every month

how often are prenatal visits scheduled up to 32 weeks?

reactive; non-reactive is not good

is it better to have a reactive or non-reactive NST

mercury

it is important to avoid seafood contaminated with ______

insulin

maternal tissue becomes resistant to ______

hormonal

metabolic changes are caused by ______ changes

Goodell's sign

softening of the cervix

Hegar's sign

softening of the uterine isthmus (checked manually with one hand in vagina and other on top of pelvis)

alcohol

teratogen that causes fetal cognitive deficits and fetal alcohol syndrome

tobacco

teratogen that causes fetal hypoxia and respiratory disorders

multiparous

term for 2nd or more time giving birth

primigravida

term for first pregnancy

multigravida

term for more than one pregnancy

nulliparous

term for never haven given birth

nulligravida

term for no pregnancies ever

primiparous

term for the first time giving birth

28

the NST (non-stress test) is done after ___ weeks

energy

the demands of pregnancy require increased ______

supine hypotension syndrome

this cardiovascular change causes light-headedness, pallor, and clammy skin; can be avoided by keeping off the back

parity

total number of deliveries

gravida

total number of pregnancies

false

true or false? pregnant women are fine to use hot tubs and saunas