OB Ch. 26 Health Promotion & Pregnancy Study Guide

What is hyperemesis gravidarum?

Severe morning sickness

The nurse concludes that the prenatal pt has no need for further instruction when she correctly states that amniocentesis can determine which of the baby's characteristics? SATA:

Sex; Maturity; Health; Genetic defects

The nurse assures an anxious primigravida that during fetal development from week 34 & beyond, maternal antibodies are transferred to the baby. How long will these antibodies provide the baby with immunity?

6 months

How long does the embryonic stage of pregnancy typically last?

8 wks

When can the sex of the fetus be confirmed?

9 wks

A woman asks the nurse about the safety of sexual intercourse during her pregnancy. Which response by the nurse is the most correct?

"Sexual activity should be ceased in the case of vaginal bleeding."

Fetal heart tones:

10-12 wks with doppler.

The nurse assesses a reactive result to a nonstress test when the fetal heart rate increases ______ beats per minute.

15

At what week of fetal development can the nurse first hear fetal heart tones with an amplified stethoscope?

16

During which gestational week can a primigravida expect to first feel fetal movement?

16 (16-18 wks)

What is the recommended weight during each trimester?

1st: 1-4.5 lbs; 2nd &3rd trimester: 1-2 lbs per week.

The umbilical cord has ______artery(s) and ________vein(s)?

2; 1

During the 30th week of gestation, the nurse would anticipate that the fundus height would be ______ centimeters above the symphysis.

30

What is Wharton's Jelly?

A gelatinous tissue that remains when the embryonic body stalk blends with the yolks sac within the umbilical cord.

What happens to hemoglobin and increased blood volume when pregnant?

A higher circulating blood volume is required to provide extra blood flow through the placenta, so nutrients and O2 can be delivered to the fetus. The blood volume increases by 1500 mL or 40%-50% above pre-pregnancy level and the hemoglobin decreases.

Gravida:

A pregnant woman

What is the placental barrier?

A semi permeable layer of tissue that filters substances

What are presumptive signs can indicate a woman is pregnant?

Amenorrhea, nausea & vomiting (n&v), frequent urination, breast changes; swelling, tingling, and tenderness and changes in pigmentation of areolae, change in the shape of the abdomen, quickening , skin changes (pigment) , Chadwicks sign (violet or purplish color of genitals)

The physician decides to send the mother for a test to determine the fetal lung maturity. What is the name of this fetal well-being test?

Amniocentesis

Chloasma:

An irregular darkening of the cheeks forehead and nose.

What are the three cycles of pregnancy and childbirth?

Antepartal, Intrapartal, & Postpartal.

Teratogenic:

Any drug virus or substance that can cause malformation of the fetus.

A woman who has just discovered she is pregnant states that the first day of her last menstrual period was July 10. What will be her expected date of birth(EDB)?

April 17th. (Subtract 3 months, add 7 days)

A woman entering the 22nd week of pregnancy complains that she has become unsightly because of chloasma. What should the nurse recommend to reduce the appearance of chloasma?

Avoid exposure to the sun

Antepartal:

Begins with conception and ends with the onset of labor.

Embryonic stage:

Begins with implantation and encompasses approximately the first 8 weeks of pregnancy.

At how many weeks of pregnancy can you hear fetal heart tones with a Doppler?

Between 10-12 wks

What test is done to check for fetal lung development?

Biophysical profile (BPP) assesses the adequacy of the uterine environment to support the pregnancy. It applies a score to fetal breathing movements, fetal muscle tone, fetal movements, amniotic fluid, and an evaluation of the NST.

Chadwick's sign:

Blueish discoloration of cervix, vaginal and labia

Spider nevi:

Branched growth of dilated capillaries on the skin

What are they types of abortions?

By trimester- Methotrexate Misoprostol;Medical abortion; Vacuum aspiration; Induction dilation; & Evacuation

In utero what is functioning by 6 weeks? When is sex determined?

By week 6 the heart, blood circulation and digestive tracts have already taken shape, as well as, the heart has already started pumping blood; limb buds have already appeared and major divisions of the brain have been discerned; around week 6 eyes begin to take shape and external ears develop from skin folds. The sex of the embryo can be determined as early as week 9.

What does the increase in circulating blood volume during pregnancy cause in the mother?

Decreased hemoglobin

Positive signs of pregnancy (give signs and explain):

Definitely pregnant; Positive signs definitely identify the presence of the fetus. The signs include palpation of the fetal routine, visualization of the pregnancy with ultrasound scan and a presence of a fetal heart beat.

What is a contraction stress test?

CST oxytocin stress test uses external fetal monitoring and stimulation of contractions to evaluate how the fetal heart rate responds to the decreased oxygen supply during uterine contractions

How do you estimate the date of birth using the Nagele rule? Give an example:

Calculate start with first day of the woman's last normal menstrual period and count back three months and add seven days. For example if the first of the last menstrual period was June 14th counting back three months to match 14th and adding 7 days will yield estimated date of birth (EDB) of March 21.

What is fertilization?

Conception; when the sperm joins or fuses with the ovum.

Pica:

Craving and eating substances that are not normally considered edible.

What do the arteries in the umbilical cord carry?

Deoxygenated blood back to the placenta

What is outcome of a tubal pregnancy?

If the pregnancy is not aborted, it ultimately results in rupture of the tube and bleeding into the abdominal cavity.

Which of the following demonstrate culturally competent care of the pregnant pt? SATA:

Discuss beliefs with the pt & incorporate them in the plan of care ; Maintain the pt's modesty at all times; Strive to maintain a harmonious environment for the pt

Early in the first trimester, a woman complains of morning sickness. What does the nurse suggest to aid with the discomfort?

Eating dry crackers before getting up

Ectopic pregnancy/tubal pregnancy:

Ectopic/Tubal pregnancy is a serious condition that refers to the implantation of the fertilized egg outside the uterine cavity.

What is implantation? When does it occur? Where should it implant in the uterus?

Embedding of the fertilized ovum in the uterine mucosa. Implantation occurs in the fundus of the uterus on either the anterior or posterior surfaces. Occurs during secretary phase

What should a nurse instruct the pt to do before assessing fundal height?

Empty her bladder

What is a nonstress test?

Evaluates how the fetal heart rate responds to periods of fetal movements.

What tests are done to check for fetal well-being?

Fetal heart tones; Fundal HT; Human chorionic gonadotropin levels; Ultrasound scan; & Alpha-Fetoprotein screening

How do you measure fetal height and what results should you expect?

Fetal height is the measurement of the height of the uterus above the symphysis pubis. The height of the fundus in centimeters is approximately the same as the number of weeks gestation.

What is GTPAL?

Five point method includes the information about the total number of pregnancies a woman has had.

Where does implantation of the fertilized ovum usually occur?

Fundus of the uterus

Where in the uterus do we like the fertilized egg to implant?

Fundus of the uterus.

A woman tells the nurse that this is her third pregnancy. She has had twin girls at full term and one miscarriage. How does the nurse record the information?

G3, T1, A1, L2 (G = gravida; T = term; P = preterm birth; A = abortion; L = living children)

How do you do GTPAL and TPAL on a pregnant woman? What do you ask?

G: Gravidity (how many pregnancies) T: Term births (37-42 weeks) P: Preterm births (20-37 weeks) A: Abortions (miscarriage or elective) L: Living children

What are serious complications of a pregnancy?

Gestational hypertension, preeclampsia, gestational diabetes, miscarriage, preterm labor.

Human Chrorionic Gonadotropin Hormone (HCG):

HCG is the hormone assess the viability and gestation of the pregnancy.

What are the effects of hormones secreted during pregnancy on the uterus and breasts?

HCG: Initially secreted by the troohoplast in the developing pregnancy. It is responsible for stimulation of the corpus lutein to promote production of estrogen and progesterone until the placenta is functioning. HPL (human placental lactogen) this hormone promotes insulin resistance by the maternal cells resulting in elevations in serum glucose levels. It affects maternal metabolism resulting in the maintenance of energy sources for the fetus. Estrogen : Responsible for the increased muscularity needed in the developing pregnancy. Progesterone the maintenance hormone of pregnancy because it is Responsible for the normal contractility of the uterus being halted which enables implantation to take place without interruption. Relaxin: linked to softening of the cervix and pubic symphysis in preparation for labor and delivery.

The newly diagnosed primigravida who is 6 wks pregnant states, "I don't feel like I have a real baby inside me." To reassure mother, the nurse provides reassurance that which of the following is functioning in the 6-week-old embryo?

Heart

Which hormone is secreted by the placenta?

Human chorlonic gonadotropin (HCG)

Alpha-fetoprotein screening (AFP):

If blood work low woman could possibly have baby with Down's, if high it suggests neural tube defects. Screening influenced by maternal weight and age, gestational age, and presence of more than one fetus.

Why don't we want a pregnant woman to contact German Measles?

If contracted by the mother it can cause a wide range of congenital defects, including congenital heart disease, mental retardation, deafness, and cataracts.

Human Chorianic Gonadotropin (HCG) Levels:

In blood & urine.

What is the cause of frequent urination in early pregnancy?

Increased circulating volume

Human chorionic gonadotropin (hCG hormone):

Initially secreted by the troohoplast in the developing pregnancy. It is responsible for stimulation of the corpus lutein to promote production of estrogen and progesterone until the placenta is functioning. HPL (human placental lactogen) this hormone promotes insulin resistance by the maternal cells resulting in elevations in serum glucose levels. It affects maternal metabolism resulting in the maintenance of energy sources for the fetus.

What results can you determine from an amniocentesis?

Lab examination of the amniotic fluid can reveal genetic factors such as sex and chromosome abnormalities, health status, and maturity of the fetus.

An amniocentesis is performed to identify what conditions?

Lab examination of the amniotic fluid can reveal valuable information regarding genetic factors such as sex and chromosomal abnormalities, health status, and maturity of the fetus.

When the young primigravida asks about how to adjust her diet for her pregnancy, what should the nurse suggest the mother add to her diet?

Leafy green vegetables & fruit

What are some of the skin changes that can occur with pregnancy?

Linea nigra; Chloasma;Striae gravidarum; Spider nevi; Palmar erythema; & Hirsutism

Relaxin(hormone):

Linked to softening of the cervix and pubic symphysis in preparation for labor and delivery.

Smoking by the mother can have what effect in the fetus?

Low birth weight

During the last trimester of pregnancy, the nurse recommends that the woman wear low-heeled shoes. What is the nurse trying to prevent with this recommendation?

Lower back pain

Fundal HT:

Lying flat with an empty bladder, growth measure should coincide with weeks of gestation.

Nullipara:

No births

What is a treatment for morning sickness?

Mild nausea can usually be controlled by slowly eating a few soda crackers or dry toast before rising from bed. Other suggestions are eating smaller, more frequent meals and avoiding eating spicy or greasy foods. It rarely lasts beyond the fourth month. The most severe form called hyperemesis gravidarum may require hospitalization with IV therapy and close medical supervision.

Multipara:

Multiple births

Multigravida:

Multiple number of pregnancies

What are the 5 variables that a Biophysical Profile monitors?

NST, fetal breathing movements, fetal muscle tone, fetal movements, and amniotic fluid volume.

Nulligravia:

No pregnancies

What are the musculoskeletal changes that a woman may experience during pregnancy?

Noticeable changes in posture, the pelvis a forward tilt, decreased abdominal muscle tone and increased weight, lordosis, increased curvature in the cervicodorsal, exaggerated anterior flexion of the head.

Primipara:

One birth

Primigravida:

One pregnancy

What period of the maternity cycle does the intrapartal period cover?

Onset of labor to delivery of the placenta

How does smoking effect a fetus in utero?

Oxygen deprivation can lead to decreased intrauterine growth, low birth weight, and preterm delivery.

Estrogen(hormone):

Responsible for the increased muscularity needed in the developing pregnancy. Progesterone the maintenance hormone of pregnancy because it is Responsible for the normal contractility of the uterus being halted which enables implantation to take place without interruption.

How would you assess fetal heart tones?

Practitioners can auscultate fetal heart tones between 10 and 12 weeks with Doppler Scan. To hear FHTs place the instrument in the midline just above the symphysis pubis and apply firm pressure.

What is considered proper weight gain and nutrition during pregnancy?

Proper weight gain is 25-35 lbs, 1 lb a month for 1st trimester, 1 lb week for 2nd and 3rd trimester. If underweight recommended weight gain 28-40 lbs, overweight recommended weight gain 15-25 lbs.

Describe the common methods of a prepared childbirth:

Provide pamphlets and referrals to community based resources, libraries and book stores, special classes via hospital staff or public health agencies and internet resources.

During the final weeks of pregnancy, urinary frequency may return due to the enlarged uterus compressing the bladder against the pelvic bones. What does the nurse suggest to aid in relieving the urinary frequency?

Sleep on her side

Postpartal:

Starts after the delivery of placenta and lasts for approximately 6 weeks.

Striae gravidarum:

Stretch marks

Ballottement:

Technique that involves palpitating the uterus in such a way that the examiner feels the rebound of the floating fetus.

Fetal membranes:

The amniotic sac is composed of the two layers both of which originate in the zygote. The outer layer the chiron attaches to the fetal portion of the placenta. The inner layer the anion blends with the fetal umbilical cord.

What is quadruple marker screening?

The assessment is a screening with results that provide a prediction for the occurrence of certain birth defects.

What is goodell's sign?

The change and a softening or increased pliability of the cervix.

When do the changes in the breasts occur during pregnancy? Give examples of specific changes:

The changes include hypertrophy of the mammary glandular tissue and increased revascularization pigmentation size and prominence of the nipples and areolae.

Why is the nurse concerned about a pt in her first trimester of pregnancy being exposed to German measles?

The disease is capable of causing birth defects

What is the embryonic stage?

The embryonic stage begins at implantation and encompasses approximately the first 8 weeks of pregnancy.

What are the different sides of the placenta?

The fetal side is smooth and shiny "Shiny Schultze", The side attached to the uterine wall "Dirty Duncan" has a rough surface.

Abortion:

The medical term used to refer to the loss of a pregnancy before 20 weeks.

When will multigravida (multiple pregnancies) first feel fetal movement?

The mother is likely to feel the fetus movement as early as 13 weeks.

When will primigravida (first pregnancy) first feel fetal movement?

The mother may not feel the fetus movement until closer to 25 weeks.

How many arterie(s) and vein(s) are in the umbilical cord and what is their function?

The normal umbilical cord has 2 arteries and 1 vein. The vein carries oxygenated blood to the fetus and the arteries carry deoxygenated blood back to the placenta.

Intrapartal:

The period of onset of labor and ends with delivery of the placenta.

What is the function of the placenta?

The placenta functions as an endocrine gland that secretes HCG and the steroidal hormones estrogen and progesterone which maintain the pregnancy. In addition the placenta is the site of exchange of nutrients, oxygen, and waste products between the fetus and the maternal circulation. The placenta allows for the transfer of oxygen and nutrients through such processes of as diffusion and active transport and it also blocks the transfer of certain substances. This is called the placental barrier. Some viruses can cross the placental barrier but most bacteria too large to cross.

What hormones are secreted by the placenta?

The placenta secretes estrogen and progesterone.

What protects the fetus from most bacterial infections?

The placental barrier

A pt has be diagnosed with a tubal pregnancy. What is the typical outcome of a tubal pregnancy?

The pt will require surgery to remove the zygote

Hegar's sign:

The softening of the segment between the fundus and cervix

How do you figure out the Due Date?

To calculate, start with first day of woman's last normal menstrual period and count backwards 3 months, then add 7 days. (Nagele's rule)

What is TORCH?

Toxoplasmosis, other infections (hepatitis), rubella virus, cytomegalovirus, and herpes simplex are known collectively as TORCH, which is a group of infections that can negatively affect a client who is pregnant. These infections can cross the placenta and have teratogenic effects on the fetus.

What is a positive sign of pregnancy?

Ultrasonic tracing of the fetus

Why is an Ultrasound used in pregnancy?

Used to determine gestational age, monitor fetal growth, monitor fetal birth, determine the number of fetuses, location of the placenta estimate the volume of amniotic fluid and detect anomalies.

Which of the following discomforts of a young pregnant woman should be reported to the physician at the first occurrence?

Vaginal bleeding

Ultrasound scan:

Vaginal or abdominal scans-full bladder.

Probable signs of pregnancy (give the signs and explain)?

Very likely to be pregnant; Changes in reproductive organs: uterus grows and consistently of the isthmus; Positive pregnancy test: measures HCG.

A pregnant teenager presents with the following complaints. Which complaint could be an indicator of a serious complication?

Visual disturbances

What are the danger signs during pregnancy that may indicate the need for immediate medical attention?

Visual disturbances: double vision , blurring or spots; Headaches: severe sudden or continuous. Edema in face, pre-sacral or fingers. Rapid weight gain, severe pain, signs of infection, vaginal bleeding, vaginal drainage , persistent vomiting, muscle irritability or convulsions and absence or decrease in fetal movements.

How to do read a NST (non-stress test)?

With a baseline fetal heart rate of 120 - 160 bpm, the fetal heart rate accelerates 15 bpm for 15 seconds is considered normal or good. (reactive result). The mother notes when movement is felt and it is correlated to the fetal heart rates.

The nurse instructor reminds the nursing student that the "Shiny Schultz" is a name given to the ______ side of the placenta.

fetal

The chorion & the amnion are the two components of the ______.

fetal membrane

What is the placenta barrier?

he placenta allows transfer of O2 and nutrients through such processes as diffusion and active transport, and it also blocks certain substances, this is called the placenta barrier. Some viruses can cross the placenta barrier, but most bacteria are to large to cross. Some drugs do not cross the placenta, but most drugs do and can cause serious harm to the developing fetus.