Antepartal Nursing Assessment & Care of the Expectant Family

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Terms in this set (43)
How do you use the EDB wheel?
- calculates due date
- put "last menses began" arrow on date of LMP
What are some changes the uterus goes through?
- capacity increases
- muscle fibers enlarge
- increased vascularity
- later in preg due to fetus & placenta
What is uterine positions thru pregnancy?
-early: palpable in pelvis
- 10-12 wks: top of symphyhsis pubis
- 20-24 wks: umbilicus
- 36 wks: xiphoid process
-40 wks: lightening
* fundal height correlates w/ wks gestation
What are cervix/vaginal changes?
-Goodell's sign: cervix softens
- Hegar's sign: isthmus softens @ 7wks
- Chadwick's sign: bluish color
- cervical glands hypertrophy
- mucus plugs form (barrier 2 infection"
what changes occur in the breasts?
- increase in size
- tender & heavy by 8 wks
- darker areola
- montgomery's follicles (dots on areolas)
-colostrum
what changes occur in abdomin?
- diastasis recti- separation of abd muscles
- decreased peristalsis= constipation
- decreased bowel sounds
- linea nigra
- striae gravidarum
what are changes in the cardiovascular system?
- heart moves up & left
- CO, HR, SV increases
- BV peaks @ 30-34 wks
- women get dizzy supine- position left laterally
What changed are made in fibrin levels?
- factors VII, VIII, IX, X increase (hypercoaguable)
- increased risk for thrombosis & clots
- stay hydrated
What respiratory changes occur?
- oxygen need increases
- VC increased
- ribs flare out; dyspnea in 3rd tri
- thoracic breathing
- stuffy nose & bleed d/t estrogen induced edema
what genitourinary changes occur?
- GFR & RPF increase
- decreased BUN
- UTIs common in 3rd tri
what GI changes occur?- N&V d/t HCG - heartburn d/t reflux & relaxed cardiac sphincter - delayed gastric emptying - PICAwhat changes occur in liver?- decreased albumin & serum cholinesterase - gallbladder- takes longer to empty= hypercholesterolemia= gallstoneswhat changes occur in musculoskeletal?- relaxin & progesterone= pelvic joints relaxed - diastasis recti - lordosis - center of gravity changeswhat integumentary changes occur?- chloasma (mask of pregnancy) - spider angiomas (broken capillaries on face) - linea nigra - erythemawhat weight changes occur?- 2-3 lbs in 1st tri - 1 lb/wk 2nd & 3rd tri - overweight: 15-25 lbs - underweight: 28-40 lbswhat metabolism changes occur?- fetus needs protein & fat last 1/2 of preg - fats more absorbed=increased lipids & cholesterol - increased need for ironwhat changes occur with hormones?- estrogen provides plush uterus - progesterone- maintains preg, inhibits contractions - human placental lactogen- insulin antagonist - HCG-what are emotional changes the expectant father goes thru?- 1st tri: may feel left out til hears heartbeat -2nd tri: hears heart, helpful & accepting; adjusting to changes in mother - 3rd: thinks about finances - couvade: father experiences changes that mom doesDefine Gravida & Para- Gravida: # of pregnancies including present one - Para: # of pregnancies (NOT fetuses) that reached age of viability and have been born (incl still births, premature & live births)What is G-TPAL?-G: gravida -T: term (infants born after 37 wks) - P: preterm- after 20 wks but less than 37 wks - Abortions: before 20 wks - LivingWhat are the types of abortions?- occurs prior to 20 wks gestation - spontaneous (miscarriage) - therapeutic - electiveWhat is included in a pregnancy history?- previous pregnancies - gestational age, birth weight, outcome - length of labor, type of delivery, presentation - anesthesia, preterm labor, complications, delivery, postpartumWhat is included in the PMH: ROS?- infection/STI screening - TORCH infection historyWhat is included in a genetic screening?- over 35 - downs, sickle cell, tay-sach's - NTD, muscular dystrophy - CF - meds since LMPWhat is an autosomal dominant disease?- affected person has 50% chance of passing on abnormal gene (1 parent) - huntington's chorea, NFWhat is an autosomal recessive gene?- if both parents are carriers, 25% of offspring are affected - CF, PKUWhat are x-linked recessive disorders?- no male to male transmission - 50% chance a carrier mother will pass gene to each of sons who will be affected - hemophilia, color blindness, MDWhat are risk factors for preterm birth?- low SES - previous PTL - DES exposure - previous abortion - stress, infection, twins - smokerWhat is nagele's rule?- based on 28 day cycle - determine LNMP - subtract 3 months, add 7 days & 1 year from 1st day of LMPWhat are other assessment ways to estimate due date?- uterine assessment per exam - fundal height - ultrasound - quickening - fetal heart beatWhat are other signs of pregnancy?-subjective/presumptive: changes the woman experiences - objective/probable: changes examiner observes - diagnostic/positive: objective & directly due to fetusWhen are prenatal visits scheduled?- months 1-6: every 4 wks - months 7-8: every 2 wks - last month: every weekWhat is noninvasive prenatal screening?-beginning to replace triple & quadruple screens - uses maternal serum - isolates fetal DNA from maternal blood - very early & accurate detectionWhat routine care is done in the second trimester?- urine - quadruple screen - amnio 2 15-20 wks - ultrasound (16-20 wks) for genderWhat routine prenatal care is done in the third trimester?- H&H - urine - group B strep - fetal activity monitoring - Rh antibody screen & rhogam given @ 28 wks - BPP & NST - ultrasound - cervical check if at risk - weekly visits for last 4 wksWhat are some danger signs during pregnancy?- PTL signs: abd & back pain - edema of hands/face - epigastric pain - decreased/no fetal movement - dysuria/oliguria - fluid leak/bleeding from vagina -blurry/double vision; spots - persistent vomitingWhat are some patient education tips?- low heel shoes - get up & ambulate if sitting for long periods of time at job - assess hazards at work - avoid excess physical strain - use seat belt - stretch/walk q2hrs if in carWhat are exercise rules while pregnant?- 3 or more times per week - maintains muscle tone/bowel function - fewer complications during L&D -prevents gestational diabetes - non-weight bearing best -avoid supine -contraindicated: pre-eclampsia, PTL, multiple pregnancies - avoid over heating -avoid: scuba diving, bouncing, contact/twisting sportsWhat are special exercises pregnant women can do?- pelvic tilt: prevents back strain/strengthens abd - kegels: strengthens pelvic floor/increases elasticity - tailor sitting: stretches inner thighs - abd tighteningWhat meds should be avoided?- chance of fetal anomalies greatest in 1st tri - check before taking OTC - meds rated from category A to X - no live virusesWhat does ketones, glucose and proteins in urine indicate?- ketones: elevated = starvation - glucose: elevated= gestational diabetes - protein: increased= PIH after 20 wksWhat foods need to be avoided in pregnancy?- soft cheese - undercooked meat -wash raw fruits/veggies w/ hot water & soap - no raw shellfish, unpasteurized, partially cooked foods, lunch meat & hotdogs -swordfish, shark, tuna, king mackerel have mercury - don't eat more than 12 oz of tuna/wkWhat the caloric intake be during pregnancy?- in first trimester, no calorie intake is needed - 300 cal/day increase for tri 2&3