Ob Crider Exam 2

Goodell's sign

- Softening of cervical tip - Probable sign

Glucose challenge test

- most accurate at 24-28 weeks - random - 50 gm load - test 1 hour later for "tolerance" - less than 140 is generally considered normal

When is chorionic villus sampling done? (cvs)

10-12 weeks: paternity test, chromo abnormal(optional)

fundal height

12-13 weeks: rises out of the symphysis; 20 weeks: at umbilicus; 24 weeks: measured in cm, with the number of cm above the symphysis equal to the number of weeks of gestation, this tells how the baby is growing

When is aminocentesis performed?

14-20 weeks; test for chromo abnormals, paternity test, lung status, (optional)

Nagele's Rule

1st day of last period - 3 months + 7 days = estimated date of birth

Preterm

20-37 completed weeks

Group B strep

35-37 weeks: vaginal/ rectal culture and treat in labor if positive

term

38 weeks

length of pregnancy

40 weeks or 280 days

Skin changes in pregnancy

Chloasma(mask of pregnancy) areolas darken Linea nigra striae gravidarum(stretch marks)

GI changes in pregnancy

Gums swollen, slower peristalsis, Pyrosis(heartburn), constipation, hemorroids from consipation and vasodilation and fetal pressure, morning sicknesses from ^ HCG, ptyalism(salvia) CAUSED BY progesterone

What are false negatives of pregnancy test

Impending abortion, misread, medications, etopic pregnancy, too early/late in pregnancy, urine improperly stored, urine dilute

Renal changes in pregnancy

Inc--- filtration, GFR, tubeless absorption 50%, frequency, risk for uti, Dcr--bladder tone, urinary flow Nursing Intervention: encourage frequent urination, Kegas to improve tone, need inc fluids

Respiratory changes in pregnancy

Inc--demand for O2 Dcr--chest size from the upward elevation of uterus mom becomes for of a diaphragm breather Dcr-- airway resistance Dyspnea (caused by progesterone) Nursing Intervention: Stop smoking Eat small meals, plans activities, good posture, sleep on pillows, Kidneys help compensate for some of respiratory effort

What causes nasal congestion?

Increase vascularity and vasodilation Nursing interventions: blow nose gently, keep nares lubricated apply ice if bleeding, increase air humidity

What are false positives of pregnancy Test

Misread, protein/blood in urine, antidepressants, aldoment use, THC use, cross reaction of LH, tumors

Presumptive signs of pregnancy

Mom feels these: N/v, breast changes, urinary frequency,

Cardiac nursing interventions

Position pt on left side, don't lay flat on back, offer support for knees, elevate legs as much as possible, dont stand for long periods dont cross legs

What happens to gallbladder in pregnancy

Predisposition to cholecystitis and cholelithelasis S/S: pain in RUQ after eating fatty meal

Office visit schedule

Q month (4 wks) -1st 28wks Q 2wks until 36wks Q week after 36 weeks until delivery can be inc as needed (pt. Education is given Q visit)

Nursing Interventions for GI changes

Sitz bath, tucks pads eat small frequent meals, elevate HOB, increase fiber, fruits, stool softener, avoid caffeine, use mouth wash cher gum,

Chadwick's sign

The bluish-purple coloration of the vaginal mucosa and cervix Probable sign

trimester

a period of three months

nutrition in pregnancy

additional 300-500 cal/day

living

alive today (not just born alive)

What causes leg cramps in pregnancy

an increase in pressure on the pelvic nerve (sciatc nerve) maybe related to dcr calcium and phosphorus Nursing intervention: support hose, avoid standing elevate legs

pseudoanemia

anemia occurring because red cells(30%) increase less than plasma volume( 50%)

abortion

any pregnancy that ended before 20 wks

Postive pregnancy signs

audible fetal heartbeat, fetal movement felt by examiner, ultrasound visualization of fetus

Morning sickness treatment

avoid overly warm places, smell triggers, take naps, rise slowly in am, eat dry crackers, avoid greasy/spicy foods, eat a small meal, eat high protein meals, eat salty food before meals, avoid fluids with meals, try peppermint leaves, take prenatal later in the day (CAUSED BY progesterone)

Hypercoagulable state

b/c increase in fibrin & fibrinogen & RBC and venous stasis increasing risk for DVT

Low BMI are at risk for

fetal growth restriction,

primigravida

first pregnancy

what are some Obese women at risk for

gestational diabetes, pre-eclampsia, need for emergency c-section

What are the Cardio changes

increase in blood volume, 50% increase in plasma, ^output , ^ pulse by 10-15 beats, decrease in BP,

back pain in pregnancy

lumbar lordosis from Relaxin hormone makes mom waddle, Nursing Intervention: cont. exercise (pelvic rock), pelvic tilt, no heels, no heavy lifting, no uncomfortable working heights like ladder/ climbing Encourage good body mechanics, local heat and a good mattress,

multipara

many births

Fundal Ht 37-40 wks

moves down 4cm because baby preparing for the birth

nullipara

never been pregnant

Maternal Weight Gain

normal 25-25 underweight 28-40 overweight 15-25 obese atleast 15 gain of 3.5lbs 1st trimester gain 1lbs wks remainder

What happens to Hct

normal Hct: 38-47 Pregnant Hct: 33-34

para

number of births

Ballottement

rebound of unengaged fetus: Probable sign, visible by 4-5 months

Probable pregnancy signs

s/s observed by examiner ballottment quickening Positive pregnancy test

PUPPP (pruritic urticarial papules and plaques of pregnancy)

small red bumps from stretch marks in pregnancy that itch usually given hydrocortisone cream or oral antihistamine

uterine souffle

soft, blowing sound made by the blood in the arteries of the pregnant uterus and synchronous with the maternal pulse

funic souffle

soft, muffled, blowing sound produced by blood rushing through the umbilical vessels and synchronous with the fetal heart sounds:mom pulse can be palpated to differentiate the two and this is not heard continually

diastsis recti

the separation of rectus abdominal muscles that can result in back pain: Pelvic rock helps with this

endocrine system

thyroid enlargement inc--metabolic rate Anterior pituitary secretes FSH & LH Pituitary prolongs corpus luteal Posterior secretes oxytocin that promotes uterine contraction Pancreas push out more insulin

vena cava syndrome

uterus compresses the vena cava and Aorta when the woman is supine. This reduces the blood flow returning to the heart and may cause maternal hypotension: decrease in BP, dizzy, cold, clammy

How do you measure fundal ht

with a tape measure from symphysis pubis to top of the fundus in cm

Screening for families at risk

women over 35 substance abuse battering low socioeconomic levels Adolescent

Fundal height at 36 wks

xiphoid process causes SOB