Terms in this set (138)
Presumptive Signs of Pregnancy
Frequency-very first sign
Breast tenderness-due to excess hormones
What hormone causes amenorrhea
Positive Pregnancy test is based on what level
What other conditions can cause increase in hCG
Hydatidiform mole, drugs
Softening of cervix, second month
Bluish color of vaginal mucosa and cervix, Week 4
Softening of the lower uterine segment, 2nd /3rd month
# of times someone has been pregnant
# of pregnancies in which the fetus reaches 20 weeks
24 weeks , infant has ability to live outside the uterus
Any pregnancy loss occurring before 20 weeks
What does the acronym G.T.P.A.L. stand for?
gravidity, term births, preterm births, abortions, and miscarriages, living children
-First day of last LMP
-Add 7 days
-Substract 3 months
-Add 1 year
increase calories by how much after the first semester
Increase calories by how much if they are an adolescent
Increase Protein by
Note symptoms of malnutrition
Glossitis, cracked lips, dry, brittle hair
Who prescribes prenatal vitamins?
How much weight should the patient gain in the 2nd and 3rd trimester gain?
How many servings from dairy?
How many servings of Protein ?
How many servings of Vegetables?
How many servings of Breads and Cereals?
How many servings of Fruit?
Expected weight gain in the first trimester?
Why don't women like to take iron?
It causes constipation and GI upset
Take iron with what vitamin to increase absorption?
Folic acid prevents?
Neural tube defects
Daily dose of folic acid?
Don't let your heart rate get above 140
When is the best time to teach
Excess estrogen causes what?
How often should a a client who is up to 28 weeks visit the HCP
If a women is 28-36 weeks, how often should she visit the HCP?
36 weeks or greater?
weekly, until delivery
Second Trimester: should they still be experiencing N/V
Second Trimester: should they still be experiencing Breast tenderness?
Second Trimester: should they still be experiencing Frequency?
No (uterus enlarges and rises up)
HR in 2nd trimester?
What should the client do before Lepold's maneuver?
If a client is having contractions, should Leopold's maneuver should be performed when?
in between contractions
Occurs 2-3 weeks before term
Presenting part of the fetus (usually head) descends into the pelvis
Client will feel less congested but frequency will be a problem again
Largest part of is in the pelvic inlet
Hopefully, the fetal head is present first
Measured in cm, compared to ischial spines of the mother
When should the client go to the hospital?
when contractions are 5 minutes apart or when the membranes rupture
What are we worried about when the membranes rupture?
Nonstress Test (NST)
Want to see HR increase by 15 for at least 15 seconds. This needs to happen twice in a span of 20 minutes.
Do you want an NST to be nonreactive?
BPP Measures What?
1) Heart rate
2) Muscle tone: does baby have at least 1 flexion-extension movement in 30 minutes
3)Movement: does the baby move at least 3 times in 30 minutes
4) Breathing: does the baby have breathing movements at least once in 30 minutes?
5) Amniotic Fluid: is there enough?
How long do you observe BPP?
Done when NST is non reactive
Performed on high risk pregnancies: preeclampsia, maternal diabetes, and any condition in which placental insufficiency is suspected.
Results are good for one week
Purpose of CST?
To determine if the baby can handle stress of uterine contractions
If you see late decelerations during a CST, is this positive or negative?
Positive! You are positive there is a problem
When is a CST normally performed?
Signs of True Labor?
REgular contractions, that increase in frequency and duration and pain level increases with activity, and discomfort in back radiates to abdomen.
Irregular contractions, discomfort in the abdomen, and pain goes away with a change in activity.
When do you give an Epidural?
Stage 1, 3-4 cm, dilation
Hyperstimulation or tetany of the uterus is characterized by what?
Contractions over 90 seconds or contractions with less than 30 seconds in between
Fetal heart activity is apparent as early as 6-7 weeks gestation
Drink 3-4 glasses before coming in (if done transvaginally, this is not needed).
Gestational age is best determined by?
An early sonogram
When is a CVS done?
CVS results are obtained in how many weeks?
Complications of CVS?
1) spontaneous abortion
2) Fetal anomalies (limb)
Determines Fetal genetic dx (first trimester), fetal lung maturity (last trimester), fetal well being
When is an Amniocentesis Performed?
Results of an Amniocentesis take how long?
10 days to two weeks
Amniocentesis can dx
Down syndrome (low levels), neural tube defects (high levels)
Fetal lung maturity (L:S ratio 2:1), Rh disease or fetus is septic, PG is present after 35 weeks
Bilirubin delta optical density (OD) assessment
Done at 24 weeks, performed in mothers previously sensitized to the fetal RH+ RBCs and have antibodies to the RH+ circulating cells.
Amniocentesis Nursing care
Mom needs to lay supine with hands across chest, scrub with betadine, mom needs to stay hooked up to FHR one hour after procedure.
Complete uterine rupture s/s
Sudden sharp pain, contraction may stop, pain will be relieved,sign of hypovolemic shock due to hemorrhage, fetal heart tones will be absent
Incomplete uterine rupture s/s
Pain may not be present, late decels, client may vomit, have hypotonic uterine contractions, lack of progress, fetal heart tones may be lost
Want a contraction
1 q 2-3 minutes, each lasting 60 seconds
Fetal heart rate is unreassuring
Place mom on her left side
When should a women push?
With each contraction, dilation is complete
Temp during 1st 4 hours after delivery
Tachycardia + Postpartum...
When do breast become engorged?
Uterus immediately after birth
2-3 finger breadths below umbilicus
Few hours after birth it rises to
Umbilicus or one FB above umbilicus
Full bladder can do what post partum?
Make the fundus boggy, usually displaces it to the right
Fundal height will decrease how many FB a day?
When the uterus goes back to pre-pregnancy size
3-4 days, dark
4-10 days, pinkish brown
10-28 days (as long as 6 weeks), whiteish-yelow
How many peripads/hour
Postpartum infection occurs
10 days after birth E.Coli, beta hemolytic strep
10% drop of HCT, 500 cc blood lost in 24 hours
after 24 hours, up to 6 weeks pp
Medications to stop Hemorrhage
Oxytocin (pitocin), Methylergonovine Maleate (Methergine), Carboprost Tromethamine (Hemabate)
When does mastitis occur?
2-4 weeks (staph causes this). Not properly breastfeeding can cause stagnation of milk
Is it ok to take PCN while breast feeding?
Yes, take abx after feeding
What is Phtyonadione (Aquamephytone)
Promotes formation of clotting factors. Give vitamin K in the vastus lateralis
Which babies are at greatest risk for hypoglycemia?
LGA, SGA, preterm, babies of diabetic moms
Occurs after 24 hours, due to normal hemolysis of excess RBCs releasing bili, or liver immaturity.
1st 24 hours, usually means RH/ABO incompatibility
Mom is Rh- and is exposed to Rh + by miscarriage, birth, amniocentesis, or when there is trauma to mom's abdomen
Mom gets antibodies which means what for subsequent pregnancies?
Erythroblastosis fetalis (increase of immature RBCs in the fetal circulation) will result in:
4) HF (heart failure)
5) Neurologic damage
6) Hydrops fetalis (severe form of erythroblastosis fetalis)
Done on mom: measures # of antibodies in blood
Done on baby: tells you if there are any antibodies stuck to the RBCs
What do you do it you ahve Rh+ fetus and a sensitized mother?
Earl birth (whenever baby stops growing)
When do you check for Rh antibodies?
28 weeks (just incase there is mixing)
72 hours: protect next baby
Ectopic Pregnancy tx
Methotrexate (rheumatrex/trexall) or a laprotomy
Painless bleeding around the seventh month, spotting, brief
What increases risk for placental previa
Cocaine use, PIH, and smoking increases the risk for what?
Rapid decompression of the uterus
S/S of Abruptio Placenta
Rigid board-like abdomen, with or without vaginal bleeding
When does the incompetent cervix dilates?
4th month of pregnancy
What client will have repeated, painless miscarriages during the 2nd trimester?
Incompetent Cervix clients
Tx for incompetent cervix?
Cerclage at 14-18 weeks.
What two hormones are responsible for hyperemesis gravidarum?
Estrogen and hCG
Increased BP, proteinuria, edema after 20th week
What is considered to be mild preeclampsia?
1) Terbutaline (brethine): increases pulse and causes hyperactivity
2) Mg Sulfate
3) Betamethasone (celestone): Give IM to mom
4) Indomethacin (Indocin)
5) Nifedipine (Procardia)
Group B Streptococcus (GBS)
Cultured around 35-37 and on admission to L & D
Risk for factors for GBS
Preterm birth less than 37 weeks, + prenatal cultures in current pregnancy, premature ROM (longer than 18 hours), intrapartum maternal fever higher than 100.4, previous infant with GBS
Treatment for GBS
Treatment for Variable and Late Decels
Changing position to left side, discontinuing pit, adminsitering o2 10 liters, notify doctor.
3-4 cm, mildly anxious
4-7 cm, increase anxiety, doesn't want to be left alone, contractions moderate to severe 2-3 minutes apart.
8-10 cm, changed behavior, sudden nausea, hiccups, extreme irritability and unwillingness to be touched, although desires companionship.
Normal Maternal VS
BP: 140/90 >
Don't give to asthmatic
Do not give to clients with hypertension
First sign of block's effectiveness
Warmth and tingling in the ball of the foot
When is the pudenal block and subarachnoid (saddle) used?
Second stage of labor
Peridural and epidural blocks can be used when?
all stages of labor
Stop continuous infusion when
Client is at the end of stage 1 or during transition to increase effectiveness of pushing
What is the cardinal sign of persistent posterior fetal position?
Regional blocks can cause the use of?
Forceps or vacuums
Postpartum Blues S/S
5-7 days after delivery, unexplained tearfulness, feeling down, and having a decreased appetite.