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Perinatal period
Mrs Herrera lecture Test 1 material
| Question | Answer |
|---|---|
| How is the length of a pregnancy calculated? | First day of the last menstrual period (LMP). 280 days, 40 weeks, 10 lunar months, 9 calendar months. |
| What does EDD & EDB stand for? | Expected/estimated date of delivery; expected,estimated date of birth. |
| What is the term for a woman who is pregnant or has been regardless to duration of pregnancy? | Gravida |
| What is the term for pregnancy? | Gravidity |
| ** What is the term for the number of pregnancies in which the fetus or fetuses have reached viability (20 wks gestation) not the number born. | Parity |
| What is the term for the capacity to live outside the uterus, usually around 22-24 wks since LMP, or greater than 500 grams? | Viability |
| Term for a woman who has NEVER been pregnant? | Nulligravida |
| Term for woman who is pregnant for the first time? | Primigravida |
| Term for a woman who has had two or more pregnancies? | Multigravida |
| ** Term for a woman who has NEVER completed a pregnancy beyond 20wks. | Nullipara |
| Term for a woman who has given birth after carrying a pregnancy for at least 20wks | Primipara |
| Term for a woman who has completed two or more pregnancies to the stage of fetal viability? | Multipara |
| ** Termination of pregnancy before stage of fetal viability(20wks). This can be elective or spontaneous; miscarriage | Abortion |
| Birth occurring between the beginning of the 38th week of gestation & the end of the 42nd wk of gestation? | Term Birth |
| Birth occurring after 20wks but before the beginning of the 38th week? | Preterm Birth |
| ** An infant born dead after 20wks gestation? | Stillbirth |
| Pregnancy is divided into three equal periods? | Trimesters |
| What is the First Trimester? | Weeks 1-13 |
| What is the Second Trimester? | weeks 14-26 |
| What are some presumptive signs of pregnancy? | Amenorrhea-absence of period(earliest symptom);N/V-^hCG levels, changes of CHO metabolism; Excessive fatigue-especially in 1st trimester; Urinary frequency-pressure on bladder, could be a UTI; Breast & skin changes, Vaginal/cervical changes; quickening |
| What is quickening? | Fetal movement felt in the 2nd trimester; described as a flutter, & difficult to distinguish from peristalsis or gas. Normally felt around 16wks in a multigravida & 18-20 in a primigravida. |
| What is the definition of Presumptive signs of pregnancy? | Those changes felt & reported by the woman; possible indicators of pregnancy; LEAST reliable; can be caused by other factors; not a diagnostic of pregnancy. |
| What is the definition of probable signs of pregnancy? | Objective changes that can be observed by an examiner; findings which are not conclusive of pregnancy but are more reliable indicators than presumptive signs. |
| What are some probable signs of pregnancy? | Abdominal enlargement-but could be tumors; Goodell's sign:softening of the uterine cervix: due to ^vascularization, edema,& hypertrophy & hyperplasia of muscle & connective tissue, cervix feels like ear lobe;Hegars sign,+preg test,braxton-hicks |
| ** What is a pregnancy test based on? | Detection of hCG which is produced by trophoblastic cells that later become the placenta; hCG can be detected in blood or urine. Blood is more reliable. |
| How often does hCG increase? | It doubles every other day |
| What is the Hegar's sign? | Softening & compressibility of the lower uterine segment, the uterine isthmus; one of the most valuable signs in early pregnancy. the uterus can be flexed against the cervix- Mc Donalds sign |
| What is Braxton Hicks? | Irregular, painless contractions that occur intermittently throughout pregnancy; contractions are felt as uterine firmness through the abdominal wall or evident b/c they raise & push the uterus forward; facilitate uterine blood flow through the placenta |
| What can a pregnant woman do if she starts feeling braxon-hicks contractions to ease them or stop it? | Exercise- walking should stop them |
| What is Ballottement? | Passive movement of the unengaged fetus between 16th & 18th weeks; technique of palpating a floating structure(like a balloon). |
| How does the doctor examine to feel for ballottement? | Through a vaginal exam & gently pushing up against the cervix with two fingers in vagina & feeling a rebound effect of the fetal body. usually done near mid-pregnancy. feels like a balloon floating up. |
| ** What are some positive signs that can be attributed only to the presence of a fetus? | Visulation of fetus through U/S or xray. x-ray is NEVER done in 1st trimester. |
| ** How early can the fetal sac be seen through regular U/S and how early with a vaginal U/S? | Regular U/S-as early as 4-5 days. Vaginal- as early as 10 days after implantation. The fetus is visible within sac as early as 8wks |
| Where on the baby is the FHR best heard? | Through the baby's back |
| When can you hear the FHR with a Fetoscpe? | About 10-18wks |
| When can you hear the FHR with a doppler? | 10-12 wks |
| What is a uterine souffle or bruit? | a rushing or blowing sound of maternal blood flowing through the uterine arteries to the placenta which is synchronous with the mother's pulse. |
| What is a Funic souffle? | It is caused by the fetal blood coursing through the umbilical cord; synchronous with the FHR. It flucuates and is like a galop. |
| When is fetal movement palpable? | Can be felt usually around 19-22wks by the examiner. |
| What can happen if a pregnant woman lies on her back? (Usually occurs in 3rd trimester) | Supine Hypotension Syndrome; which may result in fainting. |
| What causes hypotension in a pregnant woman with lying supine? | The weight of the uterus compresses the vena cava and aorta into the vertbral column; this decreases blood flow to uterus and brain.It can cause decrease b/p, dizziness, pallor, & clamminess |
| What nursing intervention should the nurse do to correct the hypotension? | Have woman lie on her side; preferably left side. |
| Measurement of the uterine enlargement can be used for what? | to estimate gestational age or duration of the pregnancy. |
| Where would you palpate the fundus @12 weeks? | Above the level of the symphysis pubis |
| Where would you palpate the fundus @16 weeks? | Midway between the symphysis pubis & umbilicus |
| Where would you palpate the fundus @20 weeks? | At the umbilicus |
| The measurement in cm correlates with weeks gestation until when? | Until between 38-40 weeks |
| What is the term to describe the fundal hight decreases as the fetus begins to descend & engage in the pelvis? | Lightening |
| What is one of the earliest signs related to the cervix changing during pregnancy? | Chadwicks sign |
| During labor the cervix softens,efaces, and dilates and what else is seen? | Bloody show |
| During pregnancy progesterone is secreted until about the 7th week to maintain what? | Maintains the endometrium until the placenta assumes the task. |
| during pregnancy there is an increase in cervical and vaginal secretions(leukorrhea); Lactic acid is produced by normal flora & estrogen to help maintain acid ph 3.5-6.0. why? | It helps protect fetus against bacteria |
| ** Women will see changes in their breast during pregnancy; ^in size, nodularity, & sensitivity under the influence of estrogen & progesterone, Striae gravidarum(stretch marks) and what else? | ** Blood vessels more noticeable under skin. Nipples enlarge, darken & become erect. Montgomery tubercles enlarge(sebaceous glands) |
| What is colostrum? | It is occurs in last trimester & is an antibody rich, creamy white-yellowish to orange secretion which will convert to mature milk during first few days after delivery. |
| During pregnancy there is cardio changes as well. Cardiac hypertrophy & dilation occur secondary to ^ blood volume & C.O. This is due to what? | This elevation is due to an increase in erythrocytes & plasma. |
| The diaphragm is elevated by pressure from the growing uterus, & the heart is displaced how? | It is displaced upward & rotated forward to the left. |
| ** Plasma volume is increased by what %? | 40-60% |
| **The increase in plasma volume sers what two purposes? | This hypervolemia is to transport nutrients and oxygen to the placenta; where they become available for the growing fetus. & protects against maternal insults such as: impaired venous return to mom's heart & blood loss @ delivery. |
| How much blood loss could the nurse anticipate that the mother may lose during delivery? | 500ml blood loss |
| What factors could influence the mother's B/P? | Position, anxiety, & size of cuff. Should use the same arm & position for ea prenatal visit & never take it while mom is on her back. |
| ** The HR rate is also affected during pregnancy. When does it usually change and how? | Between the 14 & 20 weeks, the pulse ^ 10 to 20 beats/min which persists to term. |
| ** How much does the RBC's increase if mother is taking iron supplements? & without supplements? | Increases 30% with & 18% without. |
| ** How much iron should the mother take during the 2nd trimester? | 30mg/day |
| ** What does pseudoanemia(dilutional anemia) mean? | There is a decrease in normal Hct & Hgb values due to ^ in plasma volume is > ^in RBC production. |
| ** What is considered "true anemia"? | If Hgb drops to 10 g/dl or less or if the Hct drops to 35% or less. |
| ** What are some other cardiac changes? | ^ C.O., ^ tendency for blood coagulate during pregnancy due to ^ in various clotting factors & fibrinolytic activity. |
| There are some respiratory changes also. There is a 15-20% increase O2 requirements related to what? | ^ BMR, added tissue mass of uterus, breasts, & fetal needs |
| Why would a pregnant woman have c/o SOB? | Diaphragm is elevated, subcostal angle ^, rib cage flairs, decrease in vertical diameter, ^ anterior-posterior diameter. Chest circumference may ^ up to 6cm. Thoracic breathing REPLACES abd breathing. |
| Breathes deeper(^ tidal volume) but how is the rate affected? | ^ respiratory rate only slightly- about 2 breaths/minute |
| Increased estrogen can cause some Upper resp tract problems r/t ^ vascularization & edema & hyperemia of the tissues of the nose, pharynx, trachea, bronchi, tympanic membrane & estachian tubes. This can cause what? | nasal & sinus stuffiness, epitaxis, deeper voice, impaired hearing, earaches, & feeling of fullness in the ears. |
| ** At the beginning of the 2nd trimester and continues to delivery; the glomeral filtration rate increase by? | 50% |
| Renal threshold for glucose is lowered; glucose is spilled in the urine causing a risk for what? | UTI, r/t ^secretion of glucose. Also ^ of folates, lactose, amino acids, vit b12, & ascorbic acid all play a factor b/c higher nutrient content of urine= good medium for rapid growth of bacteria |
| What are some integumentary changes with pregnancy? | Striae gravidarum(stretch marks)r/t reduced connective tissue strength due to ^adrenal steroid levels (may fade after but never go away); Linea nigra-pigmented line from symphysis pubis to top of fundus in midline. (will go away after delivery) |
| ** Other skin changes such as chloasma or mask of pregnancy commonly seen in dark haired women which usually fades after delivery is seen where on the woman? | The cheeks, nose, & forehead the skin is blotchy, brownish hyperpigmentation of the skin. appears in 50-70% of pregnant women. |
| ** What should the nurse advise the patient who has the chloasma(hyperpigmentation) on her face? | Avoid direct sunlight; also for a woman who has Vacular spider nevi (angiomas)due to ^estrogen- tiny red elevations branch in all directions on face, neck, upper chest,arms,& legs. also go away after delivery |
| Some women get palmar erythema-pinkish, red diffuse mottling or bloches on palmar surface of hands; when do these usually fade away? | Fade within a week after delivery |
| What hormone help the joints relax during pregnancy? which also causes what change? | relaxin; ^ in shoe size |
| Woman also have trouble with carpal tunnel r/t ^ fluid retention; when does that usually resolve? | Usually 3 months postpartum |
| An ^ level of hCG can cause what? | Vomitting; also causes morning sickness; nausea with or without vomitting. |
| ** There are some gastro changes.Cardiac sphincter becomes relaxed & HCL & pepsin decreases which cause what? | Leads to indigestion, reflux, heartburn(pyrosis), & constipation. |
| ^ level of progesterone relax all smooth muscles, decreasing GI tone and motility. This causes what? | The stomach & sm. intestines take longer to empty in late pregnancy |
| What is pytalism? | increase saliva production |
| What is Pica? | Craving a non-nutritive substance; clay, starch, soap, toothpaste, plaster |
| What is the pregnant woman at risk for due to gallbladder becoming sluggish & bile becomes viscous? | ^ risk for gallstones |
| How does estrogen play a part in pregnancy, as early as the 7th wk? | Stimulates uterine growth, ^ blood supply to uterine vessels, aids in developing ductal sys in the breast in preparation for lactation |
| How does progesterone play a part after the 11th wk? | maintain endometrial layer for implantaion of fertilized ovum, preventing spontaneous abortion & tissue rejection of fetus, stimulating the development of lobes in breast for lactation, deposit of fat stores -reserve of energy for preg. & lactation |
| ** How does hCG play a part in the pregnancy? | It's an indicator of fetal well-being. It should double q other day= baby doing well. If decrease= means baby in trouble. |
| ** what is an indicator that an eptopic & molar pregnancies? | hCG levels will decrease |
| In relationship to hCG, it stimulates production of androgenic steroids to ensure what? | Fetal testes to ensure masculine differentiation. |
| What does prolactin from anterior pituitary do? | Prepare breast for lactation |
| Relaxin is produced by corpus luteum and placenta. What does it do? | Inhibits uterine activity, softens cervix, relaxes pelvic joints, stimulates breast growth |
| The posterior pituitary produces oxytocin to do what? | Stimulate "Milk Let Down" & ejection; stimulates uterine contractions. (pitocin is the synthetic form of oxytocin) |
| What is the average weight gain for pregnant women? | 20-35 pounds for normal wt women, 28-40 pounds for underweight women, 15-25 pounds for obese women; women with twins 35-45 pounds |
| How much weight is normally gained in the 1st trimester & 2nd & 3rd also? | 1st-slight weight gain 31/2-5 lbs. 2-3 trimester- 12-15 lbs/trimester. |
| What are some nutritional needs to teach? | ^ caloric intake by 300kcal/day above prepregnancy needs during 2nd & 3rd trimester; drink 8-10 8-ounce glasses of H2O(1900-2400ml)/day |
| When teaching mom to take folic acid; it decreases risk for what? | Decrease risk of neural tube defects(spina bifida & cleft palate) |
| What is the recommended amount of folic acid to take? | 0.4mg/day or 400mcg/day prior to becoming pregnant. |
| Should a pregnant woman diet? | NO.....decrease wt gain= LBW infant(5 1/2lbs); IUGR(^ morbidity & mortality)it can also cause developmental problems |
| What foods should we encourage the mom to increase in her diet? | ^ meats,fruits, & veggies |
| How is the EDC determined? | Using Nagele's rule: 1st day of LNMP; subtract 3 months & add 7 days. |
| According to Nagele's rule; if pt's LMP was June 10th what would be her EDC | March 17th |
| If mom is RH- & dad is RH+ when and what will the mother need? | In her 28wk she will need to be isoimmunizided with Rhogam |
| ** In the intial visit the pregnant woman will undergo some lab testing. UA will be done and if there is protein and glucose in urine what can that cause and mean? | Glucose (ketones)-dehydration; protein can cause ^B/P |
| When is diabetic screening done? | 24-28 weeks |
| ** How often does the pregnant woman have to go to dr visits? | 1xmonth up to 28wks gestation; q 2-3 weeks until 36 wks gestation; then weekly until delivery |
| How soon do they listen for FHR? | 10-12 weeks gestation |
| What is a sign of preclampsia? | ^ wt gain of 9lbs/wk |
| What is couvade syndrome(3rd trimester)? | The unintentional development of physical symptoms & pregnancy-related behaviors by the male partner of a pregnant woman |
| A nurse should teach mom how to take cleansing breaths to avoid hyperventilation; how to explain it? | Relaxed breath in through the nose & out through the mouth; used at the beginning & end of ea contraction |
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