OB Module 1&2 - Contraception/Antepartum Care
NPH
neutral protein Hagedorn
+2 reflex
normal
gravidity (GTPAL)
number of total pregnancies
probable signs of pregnancy
objective findings that can be documented by the examiner
s/sx of iron deficiency
pallor, fatigue, lethargy, & headache
food cravings
pickles, ice cream, pizza, cake, spicy foods, etc.
montgomery follicles
- small glands on the areola around the nipples - a presumptive sign of pregnancy
early indications of preterm labor
- the causes are not well understood - prompt identification enables the most effective therapy to delay this
complex carbs
present in starches, such as cereal, pasta & potatoes, they supply vitamins, minerals & fiber
preterm (GTPAL)
preterm deliveries (from viability 20 to 37 6/7 weeks)
minerals
prevent deficiencies in the growing fetus & maternal stores
progesterone
prevents spontaneous abortion, tissue rejection of the fetus, maintains uterus for implantation of the fertilized ovum
preterm labor
regular uterine contractions that begin before 37 weeks of gestation that result in changes of the cervix
positive signs of pregnancy
signs that are only caused by pregnancy
+3 reflex
slightly brisker than normal
estimated date of delivery (EDD)
subtract 3 months, add 7 days & then adjust the year also called EDC, for estimated date of confinement) from the first day of the woman's last menstrual period (LMP) by adding one year, subtracting three months, and adding seven days to that date.
eclampsia
the onset of convulsions/seizures that cannot be attributed to other causes
amniocentesis
the sampling of amniotic fluid using a hollow needle inserted into the uterus, to screen for developmental abnormalities in a fetus.
presumptive signs of pregnancy
these are subjective changes the woman experiences, least reliable indicators of pregnancy
nonstress test (NST)
this identifies whether an ↑ in the FHR occurs w/ fetal movement, indicating adequate oxygenation.
nonreactive/nonreassuring nonstress test
tracing does not demonstrate the characteristics of a reactive tracing w/in a 40 min. period & should be followed up w/ further testing
vibracoustic stimulation/fetal vibroacoustic stimulation
use of an artificial larynx to produce a loud noise to "awaken" the fetus, this can confirm whether NST findings are nonreactive
magnesium sulfate
used in the management of pregnancy-associated hypertension (HTN) to prevent seizures & decreases the frequency & intensity of uterine contractions
chorionic villus sampling
uses transcervical or transabdominal sampling of the placental tissue, villi (from the chorion) to diagnosis fetal chromosome abnormalities & other inherited disorders.
management of hyperemesis gravidarum
- assess factors that contribute to n/v - reduce or eliminate factors that contribute to n/v - tx w/ ginger & antiemetics as ordered - emotional support
tx for preeclampsia
- bed rest - reducing environmental stimuli - administering magnesium sulfate, antihypertensives, & anticonvulsants
clonus at the ankle is tested by
- rapidly flexing the foot into dorsiflexion (upward), inducing a stretch to the gastrocnemius muscle. - subsequent beating of the foot will result, however only a sustained clonus (> 2 beats) is considered abnormal.
complications for fetus & preeclampsia
- reduced blood flow to the placenta - preterm delivery
risk factors for preeclampsia
- 1st pregnancy - family hx of preeclampsia - gestational diabetes - chronic HTN, kidney disease, lupus or DM prior to pregnancy - obesity - age younger than 20 or older than 35 years - previous preeclampsia or eclampsia - multiple gestation
mild preeclampsia
- BP > 140/90 after 20 weeks - lab values indicate ↑liver function tests, diminished kidney function, & altered coagulopathies
severe preeclampsia
- BP ≥ 160/110 on at least 2 readings taken 4 hours apart w/ the woman on bedrest - visual problems, pulmonary edema, abnormal kidney tests, low platelets, liver abnormalities, HELLP syndrome
prenatal blood profile during prenatal visit
- Rh factor & blood grouping - CBC, Hgb or Hct - rubella titer, VDRL - Hepatitis B - HIV - TB skin test - glucose testing - pap Smear - gonorrhea & chlamydia
terbutaline (Brethine)
- a beta-adrenergic for tocolysis - used as a bronchiodilator, but is used off label for tocolysis to stop preterm labor
nifedipine (Adalat, Procardia)
- a calcium channel blocker - usually given for hypertension, but calcium is essential for muscle contraction in smooth muscle, such as the uterus, so blocking calcium reduces uterine contractions
tocolytics
- a drug the inhibits uterine contractions, that is used to prevent preterm delivery - four types of drugs are used for tocolytic therapy
preeclampsia/eclampsia
- a multisystem disorder of pregnancy w/ an unknown etiology - BP rises to 140/90 - proteinuria - usually occurs after 20 weeks gestation - can occur gradually or have a rapid onset - cure is to deliver the baby
Human Immunodeficiency Virus (HIV)
- a retrovirus that gradually causes a fall in the effectiveness of the maternal immunity - perform routine screening starting at the first prenatal visit - maternal treatment w/ at least three antiretroviral drugs - provide education & counseling on the plan of care
clonus/ankle clonus/foot clonus
- a series of abnormal reflex movements of the foot, induced by sudden dorsiflexion, causing alternate contraction & relaxation of the triceps surae muscle. - determining the degree is a simple procedure & part of the whole clinical assessment for preeclampsia
lecithin/sphingomyelin (L/S) ratio
- a test of the amniotic fluid to determine fetal lung maturity - usually performed when a delivery is being considered before 38 weeks gestation
abortions/miscarriages (GTPAL)
- abortions both spontaneous or induced - surgical abortions or miscarriages
7 dimensions of maternal role development
- acceptance of the pregnancy - identification w/ the motherhood role - relationship to her mother - reordering partner relationships - preparation for labor - prenatal fear of losing control in labor - prenatal fear of losing self-esteem in labor
home care for mild preeclampsia
- activity restrictions - frequent office visits - blood pressure monitoring - antenatal testing
oxytocin
- also stimulates contractions of the uterus but during pregnancy this action is inhibited by progesterone, which relaxes smooth muscle fibers - after childbirth progesterone levels decrease when the placenta is removed & oxytocin keeps the uterus contracted
musculoskeletal system physiological changes during pregnancy
- altered posture & gait - increased progesterone & relaxin causes softening of the joints causing the woman to have an altered gait & a waddling gait because of a change in the center of gravity - lordosis - an abnormal anterior curvature of the lumbar spine - joint discomfort - softened cartilage & connective tissue leading to joint instability
lordosis
- an abnormal anterior curvature of the lumbar spine - also called swayback, the spine curves significantly inward at the lower back.
how accurate are pregnancy tests?
- are accurate but are not 100% - a probable sign of pregnancy
labetalol crosses the placenta
- beta-blockers have been associated w/ persistent bradycardia, hypotension, & IUGR; - IUGR is probably related to maternal hypertension. - available evidence suggests beta-blockers are generally safe during pregnancy. - cases of neonatal hypoglycemia have been reported following maternal use of beta-blockers at parturition or during breast-feeding. - monitor breastfed infant for symptoms of beta-blockade.
Chadwick's sign
- bluish purple color of the vaginal, cervix & vulva - a probable sign of pregnancy
anemia - iron deficiency
- causes 75% of anemias in pregnancy. - is difficult to meet pregnancy needs for iron through diet alone. - iron supplement w/ 200 mg daily of elemental iron compounds - discuss strategies to deal w/ constipation
tx for incompetent cervix/cervical insufficiency
- cerclage. - the physician will apply a stitch in the cervix to keep it from opening. - the stitch is removed at about 36-37 weeks of pregnancy.
cultural beliefs & practices
- each culture has it's own health & healing beliefs for pregnancy & childbirth - the success of healthcare will depend on how well those beliefs can be included in their care
pica
- eating nonfood or some food that is not considered a part of the normal diet ex. ice, clay, diet & laundry starch
gestational hypertension
- elevated blood pressure developing for the first time after 20 weeks during pregnancy, - systolic BP ≥ 140/90 - w/o other signs
integumentary physiological changes during pregnancy
- estrogen & progesterone causes increased melanin deposits of light brown to dark brown pigmentation - melasma/chloasma (mask of pregnancy), brown blotchy areas on the forehead, cheeks, & nose - linea nigra, the skin in the middle of the abdomen may develop a darkened line - striae gravidarum (stretch marks), stretching of the skin due to growth of breasts, hips, abdomen & buttocks
management of gestational trophoblastic disease (Hydatidiform Mole)
- evacuation of pregnancy w/ aspiration/suction dilation & curettage - regular follow-up to detect malignant changes
patho of preeclampsia
- generalized vasospasm decreases circulation to all organs of the body including the placenta - liver, kidneys, eyes, coagulation system, pulmonary, fluid & electrolytes & central nervous system are all affected - can progress to generalized seizures
chronic hypertension
- high BP ≥ 140/90 - present before conception, or detected before 20 weeks of gestation
antihypertensives
- hydralazine (Apresoline) - nifedipine (Adalat, Procardia) - labetalol (Trandate)
women w/ diabetes have a greater risk for
- hypertensive disorders & preeclampsia - preterm labor - diabetic ketoacidosis in second trimester - spontaneous abortion - cesarean delivery - UTIs, chorioamnionitis, & postpartum endometritis
in addition to congenital anomalies, the infant of a diabetic mother is at increased risk for:
- hypoglycemia - hypocalcemia - macrosomia - intrauterine growth restriction - asphyxia - hyperbilirubinemia - respiratory distress syndrome (delayed lung maturity) - prematurity - birth injury & stillbirth
maternal effects of gestational diabetes include:
- hypoglycemia & DKA - preeclampsia - cesarean birth - development of non-gestational diabetes
magnesium sulfate is used to prevent seizures in preeclampsia
- hyporeflexia precedes respiratory depression. - nurses monitor the patient to determine the effectiveness of medical therapy. - control external stimuli & initiate measures to protect the woman in case preeclampsia proceeds to eclamptic seizures.
ectopic pregnancy
- implantation of fertilized ovum outside the uterine cavity - signs are pelvic or abdominal pain, light or heavy bleeding, abdominal/pelvic pain that can be sudden or sharp occurring only on one side & the pain may come & go - surgical intervention is required & will vary depending upon whether the tubal pregnancy is intact or ruptured
incompetent cervix/cervical insufficiency
- inability of the cervix to remain closed long enough during pregnancy for the fetus to survive - can be difficult to diagnose because usually there are no symptoms
endocrine physiological changes during pregnancy
- increased prolactin to stimulate the breasts to produce milk - increased human chorionic gonadotropin (hCG), maintenance of the corpus luteum until the placenta becomes fully functional - increased progesterone, to maintain the pregnancy & decreases GI motility & slows digestive processes
gestational diabetes is responsible for major complications in the fetus:
- macrosomia - hypoglycemia - IUGR - hyperbilirubinemia - shoulder dystocia - respiratory distress syndrome
four types of drugs are used for tocolytic therapy
- magnesium sulfate - nifedipine (Adalat, Procardia) - indomethacin (Indocin) - terbutaline (Brethine)
insulin
- maintaining control of maternal metabolism requires more frequent doses of this than usual - some pregnant women rely on 3 daily injections, w/ a combination of Regular (short-acting) & NPH (intermediate-acting) insulin - some diabetic type 1 women may require 3 or 4 injections per day of Humulin insulin - pregnancy causes needs to change, so coverage will have to be adjusted
renal physiological changes during pregnancy
- renal plasma flow, the glomerular filtration rate (GFR) & renal tubular absorption will all increase - the left lateral recumbent position can maintain optimal blood pressure, decrease dependent edema, maintain fluid & electrolyte balance & maximize urine output, cardiac output & plasma volume - the stasis of urine promotes bacterial growth & predisposes the woman to UTIs during pregnancy - mild proteinuria & glycosuria can normally occur
the nurse should observe for side effects of nifedipine (Adalat, Procardia):
- report a maternal pulse > 120 bpm - observe for dizziness or faintness due to the medication's hypotensive effects (orthostatic hypotension) - common side effects are: flushing of the skin, headache, & transient increases in maternal & fetal heart rate
alpha-fetoprotein
- maternal serum alpha-fetoprotein (MSAFP), is a blood test usually performed between 15-20 weeks gestation to assess for abnormally elevated levels indicating neural tube defects ex. anencephaly, spina bifida - most widely used biochemical blood test - is a protein normally made by the immature liver cells in the fetus. at birth, infants have relatively high levels of AFP, which fall to normal adult levels by the first year of life. also, pregnant women carrying babies w/ neural tube defects may have high levels of AFP. (A neural tube defect is an abnormal fetal brain or spinal cord that is caused by folic acid deficiency during pregnancy.) - blood test checks the level of AFP in a pregnant woman's blood. AFP is a substance made in the liver of an unborn baby (fetus). the amount of AFP in the blood of a pregnant woman can help see whether the baby may have such problems as spina bifida & anencephaly. an AFP test can also be done as part of a screening test to find other chromosomal problems, such as Down syndrome (trisomy 21) or Edwards syndrome (trisomy 18). an AFP test can help find an omphalocele, a congenital problem in which some of the baby's intestines stick out through the belly wall.
contraction stress test (CST)
- may be done if NST is nonreactive, use of nipple stimulation or IV infusion of oxytocin to induce contractions - the purpose is to make sure the fetus can get the oxygen they need from the placenta during labor. - also called a stress test or an oxytocin challenge test - may be done during pregnancy to measure the baby's heart rate during uterine contractions.
ABO incompatibility
- mom blood type O - baby blood type A or B - cause of hemolytic disease in the newborn resulting in hyperbilirubinemia to more severe anemia
nursing implications for magnesium sulfate
- monitor BP & RR of at least 12 breaths/min - O₂ sat of 95% or higher - presence of deep tendon reflexes - monitor serum magnesium levels - urinary output greater than 30/mL before administering magnesium - place resuscitation equipment (suction, oxygen) in the room - keep calcium gluconate (10%), (an antidote), in the room along w/ syringes & needles
nursing implications of hydralazine (Apresoline)
- monitor the client's blood pressure & pulse frequently during initial dosage - note the side effects: dizziness, drowsiness, headache, tachycardia, angina, arrhythmias, edema, orthostatic hypotension, diarrhea, n/v, rashes, & sodium retention
pregnancy care
- monitoring glycemic control - monitoring renal function - maintaining glycemic control - insulin therapy - diet therapy & exercise - fetal surveillance - timing of the delivery
gastrointestinal physiological changes during pregnancy
- morning sickness - nausea & vomiting during early pregnancy - occurs in 90% of pregnant women, 60% of cases resolve by 12 weeks & 90% have symptom improvement by 16 weeks - heartburn - caused by a general relaxation of the GI tract & displacement for the stomach, this allows reflux of acidic stomach contents into esophagus - pica - is craving for & consumption of non food substance, can result in toxicity or malnutrition
spontaneous abortion
- most common cause is severe congenital abnormalities that are often incompatible w/ life - may be accompanied w/ various amounts of bleeding
common discomforts of pregnancy
- nausea & vomiting (increased levels of hCG) - heartburn - backache - urinary frequency - varicosities - constipation - hemorrhoids - leg cramps
folic acid (vitamin B)
- necessary for formation of the nervous system - diet should include at least 400 micrograms of this per day
a sustained clonus > 2 beats may indicate
- nervous system excitability sufficient to indicate possible risk of seizure (eclampsia). - its presence along w/ others symptoms indicates a need for seizure prophylaxis.
indomethacin (Indocin)
- nonsteroidal anti-inflammatory drug - prostaglandins stimulate contractions, so this drug inhibits contractions, & this drug is used most often for tocolysis - the nurse should observe for maternal side effects: nausea, heartburn, vomiting, rash, GI bleeding, and any abnormal bleeding because this drug can prolong bleeding time - observe for fetal & neonatal side effects constriction of the ductus arteriosus, if mother receives the drug for more than 48-72 hours & the gestation is later than 32 wks; impairs fetal renal function, which may reduce the amount of amniotic fluid & result in cord compression
nursing implications of terbutaline (Brethine)
- observe for maternal & fetal tachycardia, other maternal effects palpitations, hypotension, chest pain, dysrhythmias, hyperglycemia, hypokalemia, pulmonary edema - black box warning due to cardiovascular events, should not use parenterally for more than 48-72 hours or prolonged treatment w/ oral route
gestational trophoblastic disease (Hydatidiform Mole)
- occurs when trophoblasts (cells that attach the fertilized ovum to the uterine wall) develop abnormally inside the uterus after conception - as a result the placenta, not the fetus develops, this molar pregnancy is proliferating growth of the trophoblast where the chorionic villi develop into edematous, cystic vesicles that hang like grapelike vesicles
respiratory physiological changes during pregnancy
- oxygen consumption ↑ by 20 % in pregnancy - increases in estrogen, progesterone & prostaglandins, results in edema & tissue congestion leading to : ex. epistaxis (nosebleeds) ex. dyspnea ex. nasal & sinus congestion
hyperemesis gravidarum
- persistent, uncontrollable vomiting that begins in the first weeks of pregnancy & may continue throughout, this leads to dehydration, electrolyte & acid-base imbalance, starvation, ketosis & weight loss - Princess Kate had this condition
Monitoring renal function:
- plasma creatinine & BUN - 24 hour urine protein & creatinine clearance MEASURE EACH TRIMESTER
nursing care for spontaneous abortion
- priority, monitoring for heavy bleeding - prevention & identification of hypovolemic shock: ↑ pulse, lightheadedness, syncope, hypotension (late sign), tachycardia (earliest sign of hypovolemia), pale skin & mucous membranes, confusion, restlessness, cool & clammy skin - monitor fluid & blood replacement as ordered, give Rhogam if indicated - support the family as they grieve the loss
eclampsia can lead to
- seizures - cerebral hemorrhage, cerebral vasospasm, cerebral ischemia, & cerebral edema
cardiovascular physiological changes during pregnancy
- the muscles of the heart slightly enlarge due to hypervolemia & increased cardiac output - red blood count (RBC) increases by 30% - supine hypotension may occur in the 2nd half of pregnancy if the woman is in the supine position when the uterus compresses the inferior vena cava
cardiac disease
- this disease during pregnancy may be categorized as congenital, acquired, or ischemic - management involves interventions to minimize risk during pregnancy & delivery - nursing measures are directed toward prevention of complications & early identification of deteriorating cardiac status - see textbook for specific interventions
tx for preterm labor
- tocolytics - used to suppress uterine contractions in preterm labor - steroid therapy to promote fetal lung maturity ex. betamethasone or dexamethasone - magnesium sulfate to reduce microcapillary brain hemorrhage in premature birth of the neonate
vitamin A
- too much can be toxic to the fetus - too little can stunt fetal growth & cause impaired dark adaptation & night blindness
dx procedures of pregnancy
- ultrasound - amniocentsis - nonstress test (NST) - vibracoustic stimulation/fetal vibroacoustic stimulation - contraction stress test (CST) - biophysical profile - chorionic villus sampling - lecithin/sphingomyelin (L/S) ratio
what are some tests that are usually performed at the initial prenatal visit?
- urine testing - prenatal blood profile
biophysical profile
- used to assess fetal well-being - evaluates 5 parameters: ex. FHR reactivity ex. fetal breathing ex. fetal movements ex. fetal tone (fine body movements, ex. sucking) ex. amniotic fluid volume (together they give a score) - the test combines fetal heart rate monitoring (nonstress test) & fetal ultrasound
labetalol (Trandate)
- used to treat hypertension (high blood pressure). - it is a beta-blocker. - this medication is available in generic form. - common side effects include dizziness or tiredness. scalp tingling may occur as your body adjusts to the medication. - this medication is both an alpha blocker & beta blocker. it works by blocking the action of certain natural chemicals in your body such as epinephrine on the heart & blood vessels. this effect lowers the heart rate, blood pressure, & strain on the heart.
reproductive physiological changes during pregnancy
- uterus - by the end of pregnancy, the uterus has grown from 40-50 g to about 1,100-1,200 g - vagina & vulva - an ↑ in the number of vessels causes the vagina & cervix to appear bluish purple in color (Chadwick's sign) also, pH of vaginal discharge is acidic which helps prevent growth of harmful bacteria, but allows for overgrowth of candida albicans (yeast infection) - breasts - become larger, more vascular w/ visible veins, "stretch marks" or striae gravidarum may appear, nipples enlarge & colostrum appears
vegetarianism
- vegans avoid all animal products & may have the most difficult time in meeting their nutritional needs - their diets may be lacking in in vitamins, calcium, iron, zinc, & riboflavin - vegans may need to take supplements or food fortified w/ these nutrients
management of gestational diabetes
- well balanced diet & exercise - managed w/ insulin (40%) - oral hypoglycemics may be used - cesarean birth is recommended - women need to be monitored for type 2 diabetes after the birth
corpus luteum
- yellow, hormone-secreting body in the female reproductive system. - it is formed in an ovary at the site of a follicle, or sac, that has matured & released its ovum, or egg. - the "yellow body" secretes progesterone, a hormone that causes changes in the uterus that make it more suitable for implantation of the fertilized ovum & the nourishment of the embryo.
quickening or subjective fetal movement in a multigravida occurs between
14-16 weeks gestation
how much weight should an expectant mother gain who is obese (> 30)?
11-20 lbs. weight gain
how much weight should an expectant mother gain who is overweight (25-29.9 BMI)?
15-25 lbs. weight gain
quickening or subjective fetal movement in a primigravida occurs between
18-20 weeks gestation
reactive/reassuring nonstress test
2 or more FHR accelerations in a 20 min. period, lasting for at least 15 seconds occurring for at least 15 bpm above the baseline (15x15)
how much weight should an expectant mother gain who is normal weight (18.5-24.9 BMI)?
25-35 lbs. weight gain
how much weight should an expectant mother gain who is underweight (< 18.5 BMI)?
28-40 lbs. weight gain
+1 reflex
hyporeflexic
estrogen
increases uterine growth, prepares the breasts for lactation, & promotes the changes in the skin
immune physiological changes during pregnancy
is altered during pregnancy to allow the fetus, that is foreign tissue, to grow w/o being rejected by the mother's body
preexisting or type 1 diabetes mellitus
lack of insulin
living (GTPAL)
living children
+4 reflex
markedly hyperreflexic
primary sources of iron
meat, fish, chicken, & green leafy vegetables
the nurse should observe for maternal side effects of indomethacin (Indocin):
nausea, heartburn, vomiting, rash, GI bleeding, & any abnormal bleeding because this drug can prolong bleeding time
HELLP syndrome
a complication of pregnancy characterized by: - hemolysis - elevated liver enzymes - low platelet count. (usually begins during the last three months of pregnancy or shortly after childbirth.)
ultrasound scan
a medical test that uses high-frequency sound waves to capture live images from the inside of your body.
hydralazine (Apresoline)
a vasodilator & is usually used because of its record of safety
A second-trimester patient is being seen for routine prenatal care. Which of the following assessments will the nurse perform during the visit? Select all that apply a. Urine albumin b. Blood glucose c. Blood pressure d. Fetal heart rate e. Pelvic ultrasound
a. Urine albumin c. Blood pressure d. Fetal heart rate Urine glucose is performed, not blood glucose & a pelvis ultrasound is performed only when needed albumin=protein
eating disorders
anorexia nervosa & bulimia
anemia
need to increase iron rich foods in the diet, take iron supplements, also to take zinc & copper because high intake of iron inhibits these minerals
calcium
nerve cell transmission, muscle contraction, bone building, & blood clotting
A patient, 32 weeks pregnant with a severe headache, is admitted to the hospital with preeclampsia. In addition to obtaining baseline vital signs and placing the patient on bed rest, the physician ordered the following items. Which of the orders should the nurse perform first? a. Obtain complete blood count b. Assess deep tendon reflexes c. Obtain routine urinalysis d. Assess baseline weight
b. Assess deep tendon reflexes B is correct because the nurse can assess the severity of the preeclampsia by assessing the patellar reflexes. Patient at +2, the patient is less likely to become eclamptic than a patient who has +4 reflexes with clonus
The nurse notes each of the following findings in a 12-week gestation patient. Which of the findings would enable the nurse to tell the patient that she is positively pregnant? a. Montgomery gland enlargements b. Fetal heart rate via Doppler c. Positive Chadwick's sign d. Positive pregnancy test
b. Fetal heart rate via Doppler
A nurse is caring for a 25 year old patient who has just had a spontaneous first trimester abortion. Which of the following comments by the nurse is appropriate? a. "You can try again very soon." b. "It is probably better this way." c. "I'm here to talk if you would like." d. "At least you weren't very far along."
c. "I'm here to talk if you would like." This statement is appropriate, the nurse is offering her assistance to the patient, this is the most therapeutic response
The nurse is grading a woman's reflexes. Which of the following grades would indicate reflexes that are slightly brisker than normal? a. +1 b. +2 c. +3 d. +4
c. +3
A pregnant woman informs the nurse that her last normal menstrual period was on September 20, 2021. Using Nagele's rule, the nurse calculates the patient's estimated date of delivery would be? a. May 30, 2022 b. June 20, 2022 c. June 27, 2022 d. July 3, 2022
c. June 27, 2022 EXAMPLE 4/11/2017- 3 mon+7 days= 1/18/2018
A 10 week pregnant patient is being seen in the prenatal clinic. For the nurse providing anticipatory guidance for which of the following should be a priority? a. Pain management during labor b. Characteristics of the newborn c. Methods to relieve backaches d. Breastfeeding positions
c. Methods to relieve backaches C is correct because , in a few weeks the patient will be entering the 2nd trimester & as the uterus grows the patient is more likely to experience backaches
phosphorus
calcium metabolism requires a normal amount of this to build strong bones
neurological physiological changes during pregnancy
clinical s/sx: ex. headache ex. syncope
maternal hyperglycemia during the first trimester increases the risk for
congenital anomalies in the fetus.
A 16 year old GI P0, is being seen at her 10-week prenatal visit. She tells the nurse that she felt the baby that morning. Which of the following responses by the nurse is appropriate? a. "That is very exciting. The baby must be very healthy." b. "That is impossible. The baby is not big enough yet." c. "Would you please let me see if I can feel the baby?" d. "Would you please describe what you felt for me."
d. "Would you please describe what you felt for me." D. Is correct because the nurse should get more information to determine what the teen has felt. At 10 weeks gestation it would be impossible for the young woman to feel fetal movement.
The nurse in the clinic is collecting data about a pregnant client, the client has a 17 year-old born at 40 weeks , a 6 year-old born at 36 weeks, a 2 year-old born at 37 weeks and had a spontaneous abortion at 10 weeks. Which of the following information is correctly documented by the nurse? a. G 4 P 4 b. G 4 P 3 c. G 5 P 4 d. G 5 P 3
d. G 5 P 3
preconception care for women w/ diabetes is the key to
decrease risks to the woman & her fetus for a successful pregnancy
type 2 diabetes mellitus
decreased production of insulin &/or insulin resistance
lactose intolerance
deficiency of enzyme lactase in the small intestine, avoidance of milk
urine testing during prenatal visit
detects renal disease or infection
increased estrogen during pregnancy
facilitates uterine & breast development, increases in vascularity, & hyperpigmentation
assessment of the antepartum patient includes
fetal growth & development
zinc
fetal growth & milk production
gestational diabetes mellitus (GDM)
first recognition during pregnancy
common side effects of nifedipine (Adalat, Procardia)
flushing of the skin, headache, and transient increases in maternal and fetal heart rate
s/sx of magnesium sulfate overdose
flushing, sweating, hypotension, depressed deep tendon reflexes (DTRs), & CNS depression, including respiratory depression
nursing care for ectopic pregnancy
focuses on stabilizing cardiovascular status, offering explanations & reassurance, giving Rhogam if indicated & providing psychological support
genetic counseling
focuses on the family to provide services to help people under about various disorders & the risk that it will occur in their family
iron
formation of hemoglobin; essential to the oxygen-carrying capacity of the blood
term (GTPAL)
full births between 38-42 weeks
proteins
growth & repair of fetal tissue, placenta, uterus, breasts, & maternal blood volume
adolescence
high risk for mother & infant, nutritional deficiencies, failure to take prenatal supplements, poor diet, peer pressure, fast food & body image
preeclampsia
hypertension accompanied by proteinuria after the 20th week of gestation
