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Exam 1 Maternal Infant SG

by: Brieanna Phipps

Exam 1 Maternal Infant SG NSG 330

Brieanna Phipps

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This study guide covers conception, fetal development, anatomy, nutrition, family care, antepartum and high risk pregnancy (Modules 2 and 3).
Maternal Infant
Dr. Goff
Study Guide
ob, maternal, Infant, mother, baby, fetus, fetal, development, nutrition, anatomy, family, Antepartum, High Risk, pregnant, Obstetrics, Conception
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This 22 page Study Guide was uploaded by Brieanna Phipps on Sunday February 14, 2016. The Study Guide belongs to NSG 330 at University of North Carolina - Wilmington taught by Dr. Goff in Spring 2016. Since its upload, it has received 108 views. For similar materials see Maternal Infant in Nursing and Health Sciences at University of North Carolina - Wilmington.


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Date Created: 02/14/16
University of North Carolina Wilmington School of Nursing NSG 330 Maternal­Infant Nursing Exam 1 Study Guide Spring 2016 (Modules 2 & 3) Module 2:    Conception and Fetal Development, Chapter 12. Module 3:    Anatomy & Physiology of Pregnancy (Antepartum); Nursing Care of the Family  During Pregnancy; Maternal & Fetal Nutrition; Assessment of High Risk Pregnancy Chapters  13, 14, 15, 26, 19 (p. 431 only).  PowerPoints:  Conception & Fetal Development Anatomy & Physiology of Pregnancy Nursing Care of the Family During Pregnancy Maternal & Fetal Nutrition Word Document: Assessing Fetal Wellbeing Content: Explain products of conception, such as umbilical cord, amniotic fluid, and placenta. Umbilical Cord ­Two arteries: from embryo to placenta ­One vein: carries oxygenated blood with nutrients from placenta to fetus ­30 to 90cm long, 2 cm diameter ­Wharton’s Jelly surrounds the cord vessels ­Nuchal cord: when the cord is wrapped around the fetus’ neck Amniotic Fluid ­protects fetus from trauma ­protects fetal movements ­regulates temperature ­excretion repository  fetus swallows it and also urinates into it ­protects from membranes to facilitate growth ­slightly yellow to clear with no odor ­fluid flows in and out of fetal lungs ­increases weekly, and fluctuates during pregnancy ­replaced every 2 hours  1 ­800 to 1200 ml at term ­oligohydraminos: less than 300 ml  possible renal abnormalities ­hydraminos: more than 2 liters  GI and other malformations ­contains albumin, urea, uric acid, creatinine, lecithin, sphingomyelin, bilirubin, fat, fructose,  inorganic salts, epithelial cells, some leukocytes, enzymes and lanugo hairs Placenta ­fxns as lungs, GI tract, and kidneys ­structure complete in 12  week  grows until the 20  week ­transplants living tissue within the same species without usual immune response ­placental barrier is semi­permeable ­Cotyledons: 15­20 subdivisions ­2 main protein hormones     ­Human Chorionic Gonadotropin (hCG)         ­trophoblast, then chorionic villi of placenta         ­pregnancy test beginning 7­10 days after fertilization         ­preserves fxn of corpus luteum to produce progesterone and estrogen for pregnancy         ­miscarriage occurs if corpus luteum stops before placenta produces enough hormones         ­maximum level 50­70 days after gestation, sharply decreases, before leveling off at 80 days         ­remains stable until 30 weeks, then gradually increases until term         ­higher levels indicate multiple pregnancies, down syndrome, or abnormal pregnancy         ­lower levels indicate ectopic pregnancy, or impending miscarriage     ­Human Chorionic Sommatotropin (hCS)         ­formerly known as Human Placental Lactogen (hPL)         ­similar to growth hormone         ­stimulates maternal metabolism to supply the fetus needed nutrients         ­increases resistance to insulin         ­facilitates glucose transport across placental membrane         ­stimulate breast development to prepare for lactation Identify developmental landmarks during the embryonic and fetal periods, i.e. organ  development (Mainly use Powerpoint). 4 Weeks ­0.4 to 0.5 cm; 0.4g ­heart developing and beginning to beat ­double chambers visible ­aortic arch & major veins completed  ­other systems rudimentary 8 Weeks ­2.5 to 3cm; 2g ­body fairly well­formed 2 ­cerebral cortex and GI system developing ­1  indication of bone ossification  ­heart plan final ­sex organs distinguishable  12 Weeks ­6 to 9cm; 19g ­bile secreted ­nails and vocal chords appearing ­some bones well­outlined ­blood forming in marrow ­kidney able to secrete urine ­brain roughly complete ­early taste buds ­lungs have definite shape ­sex recognizable  16 Weeks ­11.5 to 13.5 cm; 100g ­head still dominant ­face looking human ­meconium in bowel ­most bones ossified ­heart muscle well developed ­elastic fibers in lungs ­cerebral lobes defined ­testes positioned for descent 20 Weeks ­16 to 18.5cm; 300g ­venix caseosa (cheese­like white coating on babies when they are born) and lanugo (fine hairs)  appearing 24 Weeks ­23 cm; 600g ­ability to hear Know general effects of teratogens on pregnancy and timeframe for greatest risk. ­the general effects of teratogens produce LBW babies, malformations, organ systems, and main  external features. The timeframe of the greatest risk if from day 15 to 8 weeks (1  trimester).  Interpret BMI, total weight gain, and weight gain patterns during pregnancy. Know  normal BMI. 3 ­Underweight: <18.5   25­35 lbs ­Normal: 18.5 to 24.9  28­40 lbs ­Overweight: 25 to 29.9  15­25 lbs ­Obese: >30 ­Multiple pregnancy  35­45 lbs ­Underweight: 0.5 kg/wk in 2  and 3  trimesters nd rd ­Normal: 0.4 kg/wk in 2  and 3  trimesters ­Overweight: 0.3 kg/wk in 2   and 3  trimesters ­weight gain should take place throughout pregnancy ­poor early pregnancy: SGA (small for gestational age) ­poor late pregnancy: preterm ­even if weight gain is adequate, these issues can arise ­both PATTERN and AMOUNT are important Determine gravidity and parity using the GTPAL system. ­G: number of total pregnancies  ­T: number of pregnancies ending after 37 weeks  ­P: number of pregnancies ending after 20 weeks but before 37 weeks  ­A: number of pregnancies ending before 20 weeks  ­L: number of children that are living   Ex) Madison is experiencing her fourth pregnancy.  Her first pregnancy ended in a spontanous  abortion at 12 weeks, the second pregnancy resulted in the live birth of twin boys at 32 weeks  gestation, and the third resulted in the live birth of a daughter at 39 weeks. G: 4     T: 1     P: 1     A: 1     L: 3 Calculate EDB using Naegele’s rule. ­Nagele’s Rule    ­take the first day of LNMP, subtract 3 months, add 7 days. Add one year (if necessary) Ex) LNMP: June 13, 2012        ­subtract 3 months: March        ­add 7 days: 20        ­add one year         ­EDB (Estimated Date of Birth): March 20, 2013 Explain progression of normal fundal height during pregnancy.  ­rises to umbilicus at 22­24 weeks and xyphoid process at 36 weeks, dropping at 40 4 Explain recommended vitamins, minerals, and other major components of diet during  pregnancy. ­Folic acid to prevent neural tube defects     ­0.6mg or 600mcg per day (increase about 50%)     ­leafy green vegetables, organ meats, grains     ­folate is found naturally, folic acid is fortifying ­IRON (30 mg daily) and FOLIC ACID (50% more) are the highest needs ­Iron helps prevent anemia, and folic acid helps prevent neural tube defects ­physiologic anemia is normal during the pregnancy d/t increased RBCs ­minerals, electrolytes, and vitamins ­protein     ­3 servings daily, 4 servings if teenager     ­meat, eggs, milk, peanut butter     ­NO high protein supplements ­caffeine     ­decrease because it causes vasoconstriction of blood vessels     ­can cause Intrauterine Growth Restriction (IUGR) and spontaneous abortion nd rd ­add 300 kcal/day for the 2  and 3  trimesters ­First trimester: little change ­Second: some change ­Third: significant change Recognize foods that would provide essential nutrients during pregnancy.   ­water, milk, dairy, fish, dark leafy greens, liver, meats, fruits, vegetables, nuts, whole grains  Describe nutritional discomforts during pregnancy (such as nausea & vomiting, heartburn, pica), possible complications, and suggested remedies. Nausea and Vomiting ­dry and starchy foods ­not a lot of fluid ­frequent small meals (q 2­3 hrs) ­do not skip meals ­move slowly ­decrease fried, fatty and spicy foods ­breathe fresh air ­cool and low aroma foods ­do not brush teeth right after eating because of gagging ­salty and tart foods help with nausea ­herbal teas ­antiemetics 5 ­vitamin B6 ­Ginger Hyperemesis Gravidarum ­prolonged, severe N/V ­can cause dehydration, ketonuria, electrolyte imbalances, and weight loss ­the cause is unknown ­happens to 1 in 200­300 women ­higher chance if the baby is female ­if it is prolonged, it can cause IUGR or preterm birth ­irritability, tearfulness, mood changes ­hospitalization     ­monitor I&Os     ­IV replacement     ­hyperemesis diet          ­clear liquids, dry toast to crackers (dry to soft)     ­vitamin B6, Unicom, Phenergan, Reglan Constipation ­increase fiber ­increase fluids ­regular moderate exercise Pyrosis/Heartburn ­small frequent means ­fluids BETWEEN meals ONLY ­avoid spicy foods ­no tight clothing ­do not lie down after eating Pica ­eating things that have no nutritional value Ex) Ice, clay, dirt, laundry starch ­most common in African American women, women in rural areas, and those with family hx ­interferes with absorption of nutrients ­lowers hemoglobin levels ­Corn starch is more popular in blacks ­Tierra, a soil used for pottery, is common in Mexican Americans Food Cravings ­ice cream ­pickles ­pizza ­could possibly be nutrients missing in diet 6 Explain typical physical and psychological changes during pregnancy  Cardiovascular  Heart enlarges slightly (hypertrophy) due to:*  Increased blood volume (40-50%) nd  Cardiac output (30-50% by end of 2 trimester)  Red blood cell volume increases by 18-30% (approximately 450 ml)  Increased vascularity nd  Plasma increases especially 2 trimester  Apical pulse shifted up and laterally about 1 cm  Pulse increased 10-15 bpm (14-20 weeks)*  Cardiac rhythm may be disturbed  Systolic BP stays the same or may decrease slightly*  Diastolic BP decreases, then becomes more normal near term*  Heart palpitations may occur  Supine hypotension*- prevent by putting a pillow for elevation of the lower back  Physiologic anemia is normal due to increase in plasma exceeding number of RBCs  Hemoglobin < 11 is not normal *  White blood cell count increases*  Due to the high flow and increased resistance (normal CV changes), it is similar to sepsis  Left ventricular hypertrophy Musculoskeletal   Diastasis recti abdominis: the separating of the abdominal muscles (rectus abdominis) o Relaxin causes this   Shift in center of gravity so their muscles have to adjust**  Increase in weight and postural changes (center of gravity changes­ goes forward) o Increased lumbosacral curve **  Uterus is pushed back over the pelvis   Pelvis tilts forwards. – uterine ant flexion**   Decreased abdominal muscle tone  Duck waddling gait***  Realignment of spinal curvatures   Decreased tone of smooth muscle b/c of progesterone increases*** o Progesterone also loosens the ligaments in the pubic symphysis and sacroiliac  joints   The ligaments and muscles in middle and lower spines are severely stressed 7 Gastrointestinal   Gums tend to bleed easily and become spongy and hyperemic (pregnancy gingivitis)   Appetite increases and fluctuates**  Increased progesterone causes constipation and acid reflux**  Indigestion and heartburn can develop as early as the 1  trimester (pyrosis)   Hiatal hernias can be caused by the enlarging uterus  Dec tone and motility of smooth muscles  Constipation    Morning sickness   Iron is absorbed more readily*  Gallbladder is often distended because of decreased muscle tone= dec emptying of GB  May develop gallstones  Pica:  cravings for non­edible foods   Hyper­salivation (ptyalism)*  Three P’s (pica, ptyalism, pyrosis)  Renal/ urinary  Renal plasma flows increases (peaks at end of 1  trimester) = more efficient kidneys in  early pregnancy   Frequency= increase bladder pressure   Increased pH bc of inc glucose= Increased risk for UTI’s**  Slower urine flow rate  Dec bladder tone  Decrease BUN, creatinine, uric acid  Respiratory   Increased size of thoracic cage*  Diaphragm displaced by up to 4 cm.*  State of compensatory respiratory alkalosis**  Gradual increase in oxygen consumption,** Oxygen requirement increases in response to increased BMR** & need to add to tissue matter in uterus and breast  Elevated levels of estrogen cause ligaments of the ribcage to relax, permitting increased  chest expansion  Chest breathing replaces abdominal breathing, becomes less possible for the diaphragm  to descend with inspiration  Thoracic breathing is accomplished primarily by diaphragm than by the costal muscles  Upper Resp Tract becomes more vascular** in response to elevated estrogen  As capillaries become engorged, can cause edema and hyperemia develop in the nose,  pharynx, larynx trachea and bronchi and causes nasal stuffiness*** can also cause  tympanic membranes gestation tubes to swell and leading to impaired hearing and ear  aches  The respiratory center has a lower threshold for CO2 due to estrogen and progesterone 8  Can cause Epistaxis Neuro ­decreased attention, concentration, and memory during and shortly after pregnancy ­decline in memory that could not be attributed to other physical changes of pregnancy (like  depression) ­sleep problems ­compression of pelvic nerves ­sensory changes in legs * ­dorsal­lumbar lordosis can cause pain * ­edema can result in carpal tunnel syndrome during last trimester  ­acroesthesia = numbness and tingling in limbs (even causes pain)** ­tension headaches** common with anxiety  ­lightheadedness**, faintness, and syncope common in early pregnancy  Endocrine ­thyroid increases in size and activity and can be palpated * ­increase in basal metabolic rate* ­increased parathyroid activity ­pituitary enlarges in 9  month and produces FSH, LH, thyrotropin, adrenotropin and prolactin* ­increased maternal blood glucose   ­increased insulin needs bc there is a decrease ability for cells to take up insulin  ­placenta produces HCG­HPL Skin  Warm temperature  Acne  Hyperpigmentation* (melasma or chloasma­ “Mask of pregnancy”; darkened plotches/  spots usually around face  Linea nigra*  Palmar erythema*  Stretch marks/ striae gravidum* (during pregnancy= pink/purple stripes; postpartum=  usually permanent and silvery stripes)  Hair and nails grow rapidly  After delivery­ hair loss occurs until 6­12 months postpartum   Increased sweating/perspiration  Hirsutism*­ excessive hairiness (usually unwanted male­pattern hair growth on a  woman's face, chest, and back)  Epulis*­ any tumor like enlargement (i.e. lump) situated on the gingival or alveolar  mucosa (word literally means “on the gingiva”) Breast 9  Tenderness due to elevated estrogen and progesterone   Nipples and areola darken  Montgomery’s Tubercles  Hypertrophy of sebaceous glands that go away after prego   Progressive Breast Enlargement  Striae Gravidarum  Heaviness, tingling, fullness  Colostrum*  Starts dav around third month   Could express at 16 weeks as thin watery secretions   Nutritious for baby for 4­5 days  Vagina  ­strongly influenced by estrogen ­hypertrophy ­hyperplasia of lining ­ Operculum: mucous plug ­Leukorrhea: whitish vaginal discharge that fills the vaginal area near the cervix and acts as a  barrier ­ Ph of vaginal secretions more acidic due to increased lactic acid= prone to vaginal infections  especially yeast ­ Increased vaginal and pelvic vascularity and sensitivity may lead to increased sexual interest  and arousal Uterus  ­Enlarges:** high levels of estrogen & progesterone in 1st trimester, then mechanical pressure of growing fetus ­Changes Shape: Pear shape to globular to ovoid 2 ounces (60 grams) to 2 pounds (1000 grams) ­Changes Position: Rises to umbilicus at 22­24 weeks & typhoid at term ­inc weight ­ inc fibrous tissue ­braxton hicks contractions ­softening  ­lightening­ baby drops and ready to push (38­40 weeks) Metabolism  ­weight gain  ­need protein, carbs, fat, Ca, iron, folate,  ­inc need for water ­ inc water retention Psychosocial changes 10 -1 trimester: nervous, emotional, anxious -2 : introverted, fetal attachment -3 : overprotective, finishing plans, role change, grief over lost roles Differentiate presumptive, probable, and positive signs of pregnancy. ­presumptive (subjective) ­probable (objective) ­positive (due to the the fetus) Differentiate typical changes in maternal VS and lab values (hemoglobin, hematocrit,  platelets, white blood cells) and urine protein during pregnancy. Heart rate:  increases 10­15 bpm BP:  remains at pre­pregnancy level    in first trimester, slight decrease in  2nd trimester, return to pre­pregnancy   level in 3rd trimester ­position of pt can affect BP Blood Volume: increases 40­50% Respiratory rate: unchanged or slightly increased Decreased hmt/hgb  Increase volume Increase WBC Decrease platelets  HcG is the biochemical marker for pregnancy and detected with urine samples. ** know rules  about pregnancy tests.  Also monitor for proteins and glucose in urine  Recognize appropriate anticipatory guidance for care during pregnancy, managing  common discomforts (Table 14­2 on pages 324­325).  First Trimester ­breast changes; pain, tingling, tenderness, enlargement  wear support bras, wash with warm  water and keep dry ­urgency and frequency or urination  empty bladder regularly; Kegel exercises, limit fluids  before bedtime, wear perineal pad, report pain or burning to HCP ­languor and malaise; fatigue  rest as needed, eat well balanced diet 11 ­N/V  avoid empty or overloaded stomach, maintain good posture, stop smoking, eat dry  carbs, remain in bed until it subsides, wear acupressure bands, small meals, avoid fried, odorous,  spicy and greasy foods,  ­Ptyalism (excessive salivating)  use astringent mouthwash, chew gum, eat hard candy ­Gingivitis and euplis (hyperemia, hypertrophy and bleeding of the gums)  eat well balanced  diet with protein fruits and vegetables; brush teeth gently with soft toothbrush; see dentist ­Nasal stuffiness and epistaxis  humidifier, normal saline drops or spray ­Leukorrhea  do not douche, wear pads, perform hygiene, contact HCP if foul, itching and  change in color happens Second Trimester ­pigmentation deepens, darkening of areola and vulva, linea nigra, acne oily skin  not  preventable ­spider nevi  not preventable ­pruritis  keep fingernails short and clean; contact HCP for dx; tepid baths, steroid cream,  loose clothing, antihistamines ­palpitations  not preventable, contact HCP if accompanied with symptoms of cardiac  decompensation ­supine hypotension  side lying position or semi sitting posture with knees slightly flexed ­faintness and syncope  moderate exercise, deep breathing, leg movement, avoid sudden  changes in position, keep environment cool, small meals, sit as necessary ­food cravings  satisfy craving unless it interferes with well balanced diet, report unusual ones  to HCP ­pyrosis  limit gas­producing foods, sip milk, drink herbal tea, avoid large meals ­constipation  drink 2L of water per day, include roughage in diet, moderate exercise, use  relaxation techniques, mineral oil, enemas and stool softeners only with HCP consult ­flatulence chew foods slowly and thoroughly, exercise ­varicose veins  avoid lengthy standing or sitting, moderate exercise, rest with legs and hips  elevated, warm sitz baths ­headaches  relaxation, contact HCP, OTC analgesics ­carpal tunnel  elevate affected arms ­periodic numbness  maintain good posture, supportive maternity bra ­round ligament pain  rest, good body mechanics, avoid overstretching ­joint pain, backache, pelvic pressure  good body posture and mechanics, avoid fatigue, low  heeled shoes, abdominal support, sleep on firm mattress, apply heat or ice, rest Third Trimester ­SOB and dyspnea  good posture, sleep with extra pillows, avoid overloading stomach, stop  smoking, contact HCP if worsens ­insomnia  conscious relaxation, back massage, support of body with pillows, warm milk or  shower before bedtime ­mood swings, mixed feelings, anxiety  support from significant other and HCP,  communications with family and others 12 ­urinary frequency and urgency return  empty bladder regularly; Kegel exercises, limit fluids  before bedtime, wear perineal pad, report pain or burning to HCP ­perineal discomfort and pressure  rest, relaxation, posture ­Braxton Hicks contractions  reassurance, rest, change of position, breathing techniques,  effleurage ­leg cramps  check for Homans’ sign, use massage and heat, dorsiflex foot until it subsides,  stand on cold surface, calcium supplement ­ankle edema  fluid intake, support stockings, rest periodically with hips and legs elevated,  moderate exercise, contact HCP if generalized edema develops Explain major components and rationale of teaching an adolescent who is pregnant. Increased risk of complications because they’re still developing body Goal to reduce LBW infants- really prone to having Lbw Increased risk of obesity later in life Improve nutritional knowledge Promote access to prenatal care Decrease barriers to change in adolescent population Determine immunizations that are safe or unsafe during pregnancy. Safe immunizations ­Rubella ­Tetnas ­diptheria ­rabies ­hepatitis B recombinant ­flu vaccine because it’s not a virus UNSAFE immunizations ­any live virus immunization ­MMR (measles, mumps, rubella) ­(if titer is negative, give immunization 6 weeks after delivery) Describe assessments and screenings typically performed on first prenatal visit and those  performed during ongoing routine prenatal visits. Prenatal Care Visits ­Initial visit     ­when the woman suspects she is pregnant, usually after missed period 13     ­usually the longest visit ­Subsequent visits     ­first visit within the first trimester (12 weeks)     ­every month between the 16  and 28  weekh     ­every 2 weeks between the 19  through 35  weekth th     ­every week from 36  week until birth ­if problems arise, she goes more often Assessment on the initial visit ­chief concern ­first day of LNMP (last normal menstrual period)    ­cramping, spotting, bleeding? ­hx of menstrual periods ­date of conception and EDD (Estimated Delivery Date) ­contraceptive hx ­feelings about the pregnancy ­any discomfort since LNMP ­gynecologic hx ­family profile ­current and past medical history ­medical history of both mother and father ­religious and/or cultural perspectives     ­prenatal care     ­modesty and clothing     ­view of healthcare     ­prescriptions and proscriptions     ­response to emotions     ­physical activity and rest     ­eating habits ­occupational history and personal habits     ­be aware of teratogens and riskiness     ­the 1  trimester is the most harmful to the baby ­personal information ­physical exam ­lab tests     ­UA: protein and glucose     ­Blood: typing, Rh factor, CBC, H&H     ­injections: Hep B, Rubella titer, Varicella titer, toxoplasmosis, syphilis (RPR and VDRL),  gonorrhea and chlamydia culture, TB, renal fxn (BUN), sickle cell, cystic fibrosis, HIV,  ­assessment of the well being of the baby Standard prenatal lab tests: when performed and purpose (Chapter 14, p. 312 Table 14­1).  ­H&H, WBC, differential: detects anemia and infection 14 ­Hemoglobin electrophoresis: Identifies women with hemoglobinopathies (sickle cell, etc) ­Blood type, Rh, irregular antibody: identifies women who are risk for developing  erythoblastosis fetalis or hyperbilirubinemia  ­Rubella titer: determines immunity to rubella ­PPD: chest film after 20 weeks in women with positive skin test. ­Urinalysis: identifies women with glycosuria, renal disease, hypertensive disease of pregnancy,  infection, occult hematuria, hCG for confirmation of pregnancy ­Urine culture: identifies women with asymptomatic bacteriuria ­Renal fxn tests: evaluates level of possible renal compromise in women with hx of DM, HTN,  or renal disease ­Pap test: screens for cervical intraepithelial neoplasia; also HPV ­Cervical cultures for Gonorrhea and Chlamydia: screens for asymptomatic infection at 1  visit ­Vaginal/anal culture: GBS test done at 35­37 weeks for infection ­RLR, VDRL, or FTA­ABS: identifies women with untreated syphilis ­HIV antibody, hep B, toxoplasmosis: screens for the specific infections ­1 hour glucose tolerance: gestational diabetes, done at initial visit for women with risk  factors, done at 24­48 weeks whose initial screen was negative and others not tested ­3 hour glucose tolerance: gestational diabetes, women with elevated 1­hour test, must have 2  elevated test for diagnosis ­Cardiac evaluation, ECG, chest x­ray and echocardiogram: evaluates cardiac functioning in  women with a Hx of HTN or cardiac disease Interpret patient antepartum assessments and prioritize patients with risk factors.  First Trimester/ initial assessment ­all the history (slide 10­12 of nursing care ppt) including  ­physical exam/ vaginal exam ­estimation of birth date­ Nagele’s rule ­look for different signs ­prego test (ELISA is most popular)­ detect HcG in urine and detected 7­14 days after  conception  ­palpate ab and fetus ( leopold maneuvers/ ballottement) ­ Hegar’s sign (inc softening an vascularity of lower uterus at 6­12 weeks) ­Goodell’s sign (inc softening of cervical tip at 5 weeks) ­ Chadwick’s sign (inc vascularity leading to purple­bluish color about 6­8 weeks) ­past pregnancy history (GTPAL)­ gravidity, term births (>37), preterm (up to 37),  abortions/miscarriages, living children  ­Fetal assessment  ­ Gestational age ­Chromosome testing (11 to 14 weeks) if indicated ­Health status ­Ultrasound (5­6 weeks)  15 : confirm pregnancy, verify location of the pregnancy, detect multiple gestation,  confirm fetal viability, determine gestational age, determine the position of the uterus and cervix, guide the needle insertion for CVS. ­ UA­ always done every visit to look at proteins and glucose ­ lab tests: Hemoglobin; hematocrit; WBC; differential Blood type; Rh; irregular antibody Rubella titer PPD tuberculin test Urinalysis; urine culture Renal function tests Pap test Cervical cultures and vaginal smears for gonorrhea, chlamydia, and cytologic studies  RPR, VDRL (for syphilis)  FTA­ABS HIV antibody strongly recommended Hepatitis B­ if not received proof must get Anti­ body/ antigen Toxoplasmosis (parasite test) Second trimester  Fundal height  FHR  Lab testing (urine for sugar/albumin)  MSAFP* (16-18 weeks) ­ Blood screening test determine ­ -If higher= more than one baby or May determine neural tube defect ­ If lower= down syndrome  O’Sullivan 1-hour glucose screening (24-28 weeks)- non fasting test  If not at minimum range- give a 3 hr glucose test  Multiple-Marker or Triple Screen ** (16-18 weeks): MSAFP, hCG, unconjugated estriol; placental hormone (inhibin A)  Everyone woman should get the triple screen], but mainly recommended in women with birth defects in family, 35 and older, has diabetes and uses insulin, uses harmful meds, viral infection during pregnancy, and exposed to high levels of radiation  Quad Screen (15-20 weeks) 16 Third trimester/ ongoing prenatal care  Measure fetal growth  Determine fetal activity and well-being  Assess effect of pregnancy processon mother’s health and well-being: adaptation; risk factors; culture; stressors  Assess strengths and resources  Provide for educational needs  Fetal well being (look at document and ATI book)  Biophysical Profile (BPP)- real time ultra sound  Non stress test (NST)- monitors response of FHR to fetal movement. rd Done during 3 tri  Contraction stress test (CST) (nipple or oxytocin stimulated)- assesses FHR to contractions  -done over 10 min period with 40 to 60 seconds each  - negative results= no late decelerations  Amniocentesis- aspiration of amniotic fluid done usually at 14 weeks  -used for Alpha-fetoprotein (if high = neural tube defect; if low= down syndrome)  -used for fetal lung tests (lecithin/sphinogomyelin (L/S) = 2:1; indicates lung maturity; also phosphatidylglycerol should be present)  Percutaneous Umbilical blood sampling (PUBS) -for high risk pregs  -fetal blood sampling that looks at CBC, blood gases, karyotyping, Rh antibodies  Chronic Villus Sampling (CVS) -for high risk pregs  -assessment of developing placenta during the 10-12 weeks of gestation; alternate for amniocentesis  -it’s an earlier Dx for abnormalities  GBS (35-37 weeks)- Group Beta strep 17  Can pass to baby during delivery  Can give baby bacterial respiratory infection  Leading cause of neonatal sepsis and death  20-30% positive; in African American  Adequate nutrition  Kegal exercises  Regular dental care  **Periodontal disease= preterm birth; lbw babies; inc risk for pre- eclampsia  No live virus immunizations  Tetnas; diphtheria, rabies, hep B (recombinant), flu vaccine shot bc it is not virus = CAN GIVE  MMR, chicken pox= DON’T GIVE  Management of common discomforts (examples on slides 45-47)  Assess birth plan and setting Danger signs of pregnancy  Visual disturbances or severe headaches  Facial edema or swelling of fingers  Fever; nausea and vomiting  Change in fetal activity patterns  Vaginal bleeding or fluid  Abdominal or epigastric pain  Uterine contractions, pressure, cramping Explain danger signs that should be reported by pregnant woman to health care provider  (Chapter 14, p. 314). 18 First Trimester ­severe vomiting ­chills, fever ­burning on urination ­diarrhea ­abdominal cramping, vaginal bleeding Second and Third Trimesters ­persistent, severe vomiting ­sudden discharge of fluid from vagina before 37 weeks ­vaginal bleeding, severe abdominal pain ­chills, fever, burning on urination, diarrhea ­severe backache or flank pain ­change in fetal movements ­uterine contraction; pressure; cramping before 37 weeks ­visual disturbances: blurring, double vision or spots ­swelling of face or fingers and over sacrum ­headaches: severe, frequent or continuous ­muscular irritability or convulsions ­epigastric or abdominal pain ­glycosuria, positive glucose tolerance test reaction Describe the educational needs of the woman throughout each trimester of pregnancy. The overall goal for education: To assist individuals and family members to make  informed, safe, wise decisions about pregnancy, birth, and early parenthood, comprehend  long­lasting potential that childbirth experiences can have in the lives of women, and  convey the impact of early parenting experiences on the development of children and  family. SLIDES 53-65 First trimester -if you suspect you’re prego, stop harmful behaviors ( teratogens can harm when you don’t know you’re prego) - consult medications taken with doctor -educate this is the most vulnerable trimester for the fetal development -edu on nutrient requirements (IRON= 30 mg/ daily; FOLIC ACID= 50% or more) -edu the importance of weight gain based on BMI Second trimester -explain what each screening is for -tell about different prenatal providers (physicians, nurse- mid wife, doula) Third trimester 19 -educate about support system - educate about different birth settings -Early methods of childbirth education Grantly Dick-Read: Helps you relax and breathing techniques during labor Lamaze: relax by muscle isolation Bradley: Partner coach; emphasized partner’s presence during preg. And relaxing environment -give info about birthing center options - edu on pain management, childbirth prep, relaxation techniques, imagery - Childbirth education teaches tuning in to the body’s inner wisdom and strategies that enhance coping during labor and birth - encourage to attend a pregnancy support class - teach about breastfeeding if they are wanting to Know how a home pregnancy test is conducted to achieve more accurate results. ­Home pregnancy tests are based on hCG especially the Beta portion. It can be detected in urine  7­8 days after implantation. These have high accuracy because it measures the exact amount of  hCG in the blood and can detect even small amounts. hCG levels greater than 25 IU/L are  diagnostic for pregnancy. A common error is doing the test too early and receiving a false­ negative. Describe nursing care to prevent supine hypotension in a pregnant woman. Encourage pt to engage in maternal positioning on the left­lateral side, semi­ fowler’s  position, or if supine, with a wedge placed under one hip to alleviate the pressure to the  vena cava.  Describe test, when usually performed, its purpose, interpretation of results, and nursing  care for ultrasound (abdominal and transvaginal) (chapter 26, pp. 635­639) and MSAFP  (pp. 645­46). Ultrasonagraphy (Abdominal) ­more useful after the 1  trimester ­woman should have a full bladder Ultrasonography (Vaginal) ­used in the 1  trimester to detect ectopic pregnancies, monitor the developing embryo, help  identify abnormalities, and establish gestational age. ­useful in obese women ­optimal to view the pelvic structures Indications for use 20 ­provides earlier diagnoses thereby decreasing severity and morbidity ­nurses counsel and educate women about the procedure ­First Trimester     ­number, size and locations of gestational sacs     ­presence or absence of fetal cardiac and body movements     ­presence or absence of uterine abnormalities (bicornuate uterus or fibroids)     ­adnexal masses (ovarian cysts or ectopic pregnancy)     ­pregnancy dating ­Second and Third Trimester     ­fetal viability     ­number     ­position     ­gestational age     ­growth pattern     ­anomalies     ­amniotic fluid volume     ­uterine fibroids or anomalies     ­adnexal masses     ­cervical length MSAFP (Maternal Serum Alpha­Fetoprotein) ­screening tool for NTD (neural tube defects) ­80­85% of all open NTDs and open abdominal wall defects can be detected early ­can be performed any time between 15 and 20 weeks of gestation  ­AFP is found in the fetal GI tract and liver Explain major components and rationale of teaching an adolescent who is pregnant. Increased risk of complications because they’re still developing body Goal to reduce LBW infants- really prone to having Lbw Increased risk of obesity later in life Improve nutritional knowledge Promote access to prenatal care Decrease barriers to change in adolescent population Describe signs/symptoms that determine when the pregnant woman should go to the  hospital to be evaluated for onset of true labor (p. 431 upper right of page, Teaching for  Self Management: How to Distinguish True Labor From False Labor.) True Labor: Contractions ­occur regularly, becoming stronger, lasting longer, and occurring closer together 21 ­become more intense with walking ­are usually felt in the lower back, radiating to the lower portion of the abdomen ­continue despite use of comfort measures Cervix (by vaginal exam) ­shows progressive change (softening, effacement, and dilation signaled by the appearance of  bloody show) ­moves to an increasingly anterior position Fetus ­presenting part usually becomes engaged in the pelvis, which results in increased ease of  breathing; at the same time, the presenting part presses downward and compresses the bladder,  resulting in urinary frequency False Labor Contractions ­occur irregularly or become regular only temporarily ­often stop with walking or position change ­can be felt in the back or the abdomen above the umbilicus ­can often be stopped through the use of comfort measures Cervix (by vaginal exam) ­may be soft but with not significant change in effacement or dilation or evidence of bloody  show ­is often in a posterior position Fetus ­presenting part is usually not engaged in pelvis Differentiate roles of a midwife, obstetrician and doula. ­Obstetrician: the physician , sees low risk and high risk pregnancy women, pharmacologic and  medical management of problems as well as use of technologic procedures ­Nurse Midwives cannot do C­sections and can only work with non­complicated births, nurses’  training then midwifery program ­Direct­entry midwife: do not have nurses’ training ­Doula: a person who is like a coach 22


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All subscriptions to StudySoup are paid in full at the time of subscribing. To change your credit card information or to cancel your subscription, go to "Edit Settings". All credit card information will be available there. If you should decide to cancel your subscription, it will continue to be valid until the next payment period, as all payments for the current period were made in advance. For special circumstances, please email


StudySoup has more than 1 million course-specific study resources to help students study smarter. If you’re having trouble finding what you’re looking for, our customer support team can help you find what you need! Feel free to contact them here:

Recurring Subscriptions: If you have canceled your recurring subscription on the day of renewal and have not downloaded any documents, you may request a refund by submitting an email to

Satisfaction Guarantee: If you’re not satisfied with your subscription, you can contact us for further help. Contact must be made within 3 business days of your subscription purchase and your refund request will be subject for review.

Please Note: Refunds can never be provided more than 30 days after the initial purchase date regardless of your activity on the site.