OB TEST 1
Calories
340 + second trimester 462 + third trimester
Maternal Pulse
10 to 15/min around 32 of gestation and rains elevated throughout the reminded of pregnancy
Fetal Heart sounds
110 to 160
Rubella Titer
1:8 or greater = immunity
Viability
20 weeks
The nursing instructor is preparing to illustrate the various changes between the nonpregnant and pregnant female body. The instructor should point out the blood volume in the pregnant woman can increase by what percentage?
40% to 45%
Chromosomes
46 chromosomes. 22 pairs of autosomes (paired matching chromosomes), and 1 pair of sex chromosomes (two x sex chromosomes in female and an X and Y sex chromosome pair in the male)
fetus
5-8 weeks until term
Fluid
8 to 10 glasses (water, fruit juice, milk)
Prenatal Labs (1st trimester)
CBC (h&h) RPR Rubella titer PPD Hep b/c HIV screen UA pap smear cervical culture
During the physical exam at the first prenatal visit a speculum exam is performed. What sign of pregnancy does the practitioner look for during the speculum exam?
Chadwick's sign
Skin Changes
Chloasma ( pigmentation on the face) Linea nigra (dark line of pigmentation from the umbilicus extending to the pubic) straie gravidarum (Stretch marks)
A pregnant client comes to the prenatal clinic complaining of urinary frequency and lower back pain on the right, stating that this has never happened before. An exam validates the diagnosis of pyelonephritis. What factors would contribute to this condition?
Decreased peristalsis of urinary tract
1 hr GTT
Fasting not necessary >140 needs follow up 24 to 28 weeks of pregnancy
3 hr GTT
Fasting overnight prior to oral ingestion needs two elevated blood glucose readings
A pregnant woman comes to the clinic for a prenatal visit for her third pregnancy. She reveals she had a previous miscarriage at 12 weeks and her 3-year-old son was born at 32 weeks. How should the nurse document this woman's obstetric history?
G3, T0, P1, A1, L1
When teaching a pregnant client about the physiologic changes of pregnancy, the nurse reviews the effect of pregnancy on glucose metabolism. Which underlying reason for the effect would the nurse include?
Glucose moves through the placenta to assist the fetus.
GTPAL
Gravida Term births (38 weeks) Preterm (viability up to 37 weeks) Abortions/miscarriages (prior to viability) Living Children
Cardiovascular
HR increase during pregnancy beginning around week 5 and reaches a peak (10 to 15/min) above pre-pregnancy rate around 32 weeks Cardiac output increases 30-50% blood volume increases 30-45%
What physical changes take place when a woman becomes pregnant? Select all that apply.
Heart rate increases 10 to 15 beats per minute. The areola becomes more prominent. Nasal congestion increases due to edema.
During a vaginal exam, the nurse notes that the lower uterine segment is softened. The nurse documents this finding as:
Hegar sign.
UA with microscope exam of pH
Identifies pregnancy, dm, Gestational HTN, Renal and infection
Minor Body changes of Pregnancy
Nasal congestion N/V Palpitations breast tenderness SOB Abdominal discomfort Backache Braxton hicks Urinary freq Leukorrhea Hemorrhoids Muscle cramps varicosities ankles edema constipation
Ovulation
Ovaries, day 14 (OR before the end of the their cycle 3 days before, 3 days after), divides, prostaglandins are released and the graafian follicle ruptures. Ovum is set free = ovulation
Respiratory
RR increases due to size uterus pushing upwards
MSAFP
Screening between 15 to 22 weeks down syndrome (low levels) neural tube defects (high levels)
A nursing instructor is discussing the various events that occur during a pregnancy. The instructor determines the session is successful after the students put the following events in the correct chronological order. Use all the options.
Union of an ovum and sperm Implantation of the zygote Formation of the placenta Heart begins beating Age of viability Fetus kicks actively
Folic acid
childbearing 400 mcg become pregnant 600 mcg
A nurse is conducting a nutrition class for a group of pregnant women. What information accurately addresses this issue? Select all that apply.
Total iron requirements equal 1,000 mg, with the greatest need being in the second trimester. Calcium supplements may decrease the chance of developing pre-eclampsia in women who had a pre-existing deficiency. Since an iodine deficiency can cause intellectual deficits in infants, mothers are recommended to use iodized salt.
Ultrasound (abdominal, transvaginal, doppler)
Transvag does not require a full bladder
Third Trimester preparation
childbirth class coping methods breating/relaxation techniques effleurage and counter pressure head/cold, touch/massage TENS acupressure/acupuncture msuic/aromatherapy natural childbirth or epidural doula preterm/labor labor process infant care pospartum care
A client in her third trimester reports sleeping poorly: sleeping on her back results in lightheadedness and dizziness and lying on her side results in no sleep. Which suggestion for sleeping should the nurse prioritize for this client?
With a pillow under her right hip
A woman in her 16th week of pregnancy comes to the health center for a follow up visit. Which physiologic change would the nurse expect to assess? Select all that apply.
a uterus that is palpable colostrum that can be expelled from the nipples
Primigravida
a woman in her first pregnancy
multigravida
a woman who has had two or more pregnancies
NULLgravida
a woman who has never been pregnant
Probable signs "examiner thinks she's pregnant"
abdominal enlargement hegar's sign (softening of uterus) Chadwick's sign (depending violent blueish color of cervix and vagina) Goodell's sign (softening of the cervical tip) Ballottement (rebound of unengaged fetus) Braxton Hicks Positive pregnancy test fetal outline
Psychological 3rd trimester
accepting parenthood nesting
Psychological 2nd trimester
accepting the baby narcissim, introverison, role playing, increased dreaming
Psychological 1st trimester
accepting the pregnancy. ambivalence
Presumptive signs "think she is pregnant"
amenorrhea fatigue N/V Urinary frequency breast changes quickening (fluttering movements 16-20wks) uterine enlargement
Estrogen
hormone of the woman. mammary glands, lactation and stimulates uterine growth to accommodate the fetus
Menstruation
average age at onset 12.4 years (9-17 years) average, 28 days, cycles of 23-35 days not unusal average flow, 4-6 days, ranges of 2-9 are not abnormal 30 to 80ml per period
Health Promotion of pregnancy
avoid the use of hot tubs or saunas consume at least 8 to 10 glasses of water a day no live vaccines smoking cessation exercise during pregnancy 30 minutes daily (walking, swimming)
Iron source foods
beef liver red meats fish poultry dried peas and beans fortified cereals and breads
Second trimester preparation
benefits of BF Common discomforts and relief measurements lifestyle (sex and pregnancy) fetal movement complications (preterm, GHTN, GDM, Premature rupture) Preparation for childbirth/education class review of birthing methods development of birth plan
Retroflexion
bent sharply back just above the cervix
anteflexion
bent sharply forward at the junction with the cervix
Human Chorionic Gonadotropin (hCG)
hormone produced by the placenta to sustain pregnancy by stimulating the ovaries to produce estrogen and progesterone Fail safe measure to ensure the corpus lute of the ovary continues to produce progesterone and estrogen
Fallopian Tubes,
convey the ovum from the ovaries to the uterus and to provide a place for fertilization of the ovum by sperm. more prone to inflation due to open pathway
Breast Changes
darkening of the areola enlarged montgomery's glands increase in size and heaviness increased sensitivity
Progesterone
hormone that maintain pregnancy (reduces contractility of the uterus = preventing preterm labor)
Chadwick's sign
deepened violet-blue color of cervix and vaginal mucosa
Blood type, Rh factor, and presence of irregular antibodies
determines the risk for maternal fetal blood incompatibility or neonatal hyperbilirubinemia. Indirect Coombs' test identifies client sensitized to Rh positive blood (if negative, will be repeated 24 and 28 weeks gestation)
Which effect would the nurse identify as a normal physiologic change in the renal system due to pregnancy?
dilation of the renal pelvis
Gastrointestinal
elevate HOB N/V
fertilization depends on three factors
equal maturation of both sperm and ovum ability of the sperm to reach the ovum ability of the sperm to penetrate the zone pellucid and cell membrane and achieve fertilization
Positive signs
fetal heart sounds visualization of the fetus by ultrasound fetal movement (palpable)
Neagle's rule
first day of the woman's last menstrual cycle, subtract 3 months, and then add 7 days and 1 year
zygote
from fertilization to implantation
ovaries
grayish white, and appear pitted. To produce, mature and discharge ova (egg cells). Produces estrogen, and progesterone and intitate and regulate menstrual cycles
primipara
has completed one pregnancy to stage of viability
multipara
has completed two or more pregnancies to stage of viability
Fetal Circulation
highly oxygenated coming from the placenta (supplies kidneys, liver, brain and heart first...does not pass through lungs) pulse rate 80 to 140 beats/min
embryo
implantation to 5- 8 weeks
Human Placental lactogen (hPL)
important rule in regulating maternal glucose, protein, and fat levels for the fetus
Fertilization occurs ?
in the outer third of fallopian tube "ampullar portion"
During a routine antepartal visit, a pregnant woman says, "I've noticed my gums bleeding a bit since I've become pregnant. Is this normal?" The nurse bases the response on the understanding of which effect of pregnancy?
influence of estrogen and blood vessel proliferation
Prenatal Assessment
initial assessment 12 weeks 16 - 28 weeks (every month) 29 - 36 weeks (Every two weeks) 36 weeks - term (every week)
Beginning signs of labor
lightening slight loss of weight excess energy Backache ripening of the cervix rupture of membranes show uterine contractions
limit caffeine
no more than 200mg of caffeine (500 to 750ml/day could cause spontaneous abortion)
Nullipara
no pregnancy beyond the stage of viability
Upon assessing the umbilical cord, the nurse would identify what findings as normal?
one vein two arteries
Musculoskeletal
pelvic joints relax
First trimester preparation
physical and psychological changes common discomforts of pregnancy and measures to provide relief lifestyle (Exercise, stress, nutrition) possible complications (preterm labor)fetal growth and development prenatal exercises expected laboratory testing
Serum and urine test (verifying pregnancy)
production of hCG begins with implantation, peaks at 60 to 70 days of gestation, declines until around 100 to 130 days higher levels = multifetal pregnancy, ectopic, hydatidiform mole, genetic abnormality(downs) lower levels= miscarriage, ectopic)
A client who is entering her third trimester comes to the prenatal clinic for a follow-up examination. When assessing the breasts, which findings would the nurse expect? Select all that apply.
prominent veins hyperpigmentation of the nipple increased sensitivity
cervial changes color
purplish blue color, vagina and labia and the cervix
Ballottement
rebound of unengaged fetus
oligohydramios
reduction in the amount of amniotic fluid
Amniotic Fluid
shield the fetus against pressure or blow to the mother's abdomen, protects fetus from change in temperature aides in muscular development protects umbilical cord from pressure pH of 7.2
Fetal kick count
should count fetal activity two or three times a day for 2 hr after meals or bedtime fetal movements of less than 3 per hr or movements that ceases entirely for 12 hr indicate a need for further evaluation
Hegar's sign
softening and compressibility of lower uterus
Goodell's Sign
softening of cervical tip
measurement of fundal height
symphysis pubis to the top of the uterine funds (18 to 32 weeks of gestation)
Blood Pressure
systolic, slight or no increase from pre-pregnancy levels diastolic, decreases around 24 to 32 weeks until gradually return to pre-pregnancy level by the end of pregnancy supine position, might appear lower
The nurse is providing prenatal care to a young couple who is pregnant with their first child. In what period of development would the nurse explain to the couple that most congenital defects would occur?
the period of the embryo
Retroverison
tips far back
Anterverison
tips far forward
36 weeks of gestation (uterine size)
top of the uterus and the funds will reach the xiphoid process (SOB)
Umbilical Cord
transports oxygen and nutrients to the fetus from the placenta and to return waste products from the fetus to the placenta bulk of cord "Wharton Jelly" 1 vein, 2 artries "AVA"
