BC3 Maternity
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| Physiological Anemia | normal due to increase blood volume
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| Blood Volume during pregnancy | up 30-50%
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| Pseudoanemia | HGB 11, HCT 37%
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| True Anemia during pregnancy | HGB under 10, HCT under 35%
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| Leukocytes during pregnancy | above 10,000 - reflects increased blood volume and increased protection against infection for mother
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| Pregnancy is a hypercoagulable state therefore what happens .... | increased risk of thrombophlebitis or venous thrombosis (Increased circulating fibrinogen & fibrin
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| GI system changes during pregnancy | intestines and stomach are displaced by increasing uterus - appendix can be as high as the right flank
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| What is the cause of n/v during pregnancy | primarily result of high HCG levels and progesterone/estrogen levels; can occur 1-2 weeks after conception
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| Treatment for n/v | dry crackers prior to sitting up (CHO foods) - eat small meals throughout the day - limit fluids with meals - avoid fatty foods - take prenatal vits at night
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| Relaxin | hormone secreted by corpus luteum and stimulated by progesterone - softens the cervix and relaxes the uterus; also relaxes the cardiac sphincter and stomach leading to reflux and heartburn
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| Constipation is caused by | decreased motility of the intestines and prolonged emptying and absorption time r/t the relaxin - may also be the result of increased pressure from the uterus
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| Tx of constipation during pregnancy | fiber, increase fluids and activity (eat lots of fruits and veggies - walk regularly)
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| Gall bladder function and tone during pregnancy | decreased; gall bladder may also become distended which can lead to gallstones and disease - decreased emptying of bile from the gallbladder leads to reabsorption of bilirubin which causes dry itching skin
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| Gums & teeth during pregnancy | can be swollen - increase blood supply to teeth, increased acid content of mouth and increased eating can lead to tooth decay
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| Urinary system during pregnancy | progesterone & relaxin cause relaxation of smooth muscle through the urinary system especially in 1st & 3rd trimester
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| Urinary stasis during pregnancy | common - important to drink lots of water
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| What causes pressure on the bladder | the enlarging uterus - especially during 3rd trimester can cause frequency
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| Lab changes during pregnancy | decrease is specific gravity, BUN and creatinine, tendency to spill dextrose in urine (1+)
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| Pica | craving for non-food items such as starch, dirt, chalk, ice
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| Skeletal system changes during pregnancy | relaxin causes gradual softening of pelvic ligaments leading to excess mobility of the joints
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| Pelvic instability | puts more strain on the back muscles and thighs
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| Endocrine changes during pregnancy | Thyroid & pituitary slighly enlarges; Adrenals also slightly enlarge and their activity increases
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| What is the major endocrine gland during pregnancy | the placenta
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| Anterior lobe responsible for | gonadotropins suppressed to stop ovulation & menstruation; Prolactin secreted - responsible for initial lactation
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| Posterior lobe responsible for | secretes Oxytocin which promotes uterine contracitility during pregnancy and stimulates the ejection of breast milk
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| HCG | All blood and urine pregnancy tests are based on the presence of this hormone
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| What excretes HCG | chorionic villi of implanted ovum
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| What does HCG do | prolongs the life of the corpus luteum, which leads to continued production of estrogen and progesterone until the placenta takes over after the second month of pregnancy
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| Chronic villi | produce Human Placental Lactogen (HPL) - this influences cell growth of the fetus and stimulates breast changes for lactation and is present in maternal serum by the 6th week
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| Aldosterone | increases and is responsible for the retention of sodium by the kidneys. Any imbalance here can lead to Na retention and edema
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| Neurologic changes during pregnancy | sensory changes in legs, back pain r/t lumbar lordosis, carpal tunnel syndrome, acrothesia, tension HA, light headedness, stuffy nose
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| Lumbar lordosis | the overexaggerated curve of the lumbar spine
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| Acrothesia | ??
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| Danger signs of pregnancy | PROM, vaginal bleeding, severe HA/blurred vision, abdominal pain, temp 101.9/chills, swelling of lower legs, hands and face, absence of fetal movement
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| PROM | Premature Rupture of Membranes - sudden gush of clear fluid from vagina
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| What are the risks r/t PROM | infection and premature labor
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| Assessment of vaginal bleeding | depends on timing
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| Light spotting | early is normal
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| Bright red bleeding early | could indicate a spontaneous abortion
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| Brigh red bleeding later | could indicate a placental problem
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| Assessment of abdominal pain | depends on time - sharp cramping indicates danger sign
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| Oral temp above 101.9 F | could indicate infection
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| Swelling of lower legs, hands and face | not uncommon, but if peri-orbital or increased weight gain it could indicate pre-eclampsia
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| When is the first fetal movement felt | usually 18-20 weeks for first time moms; second time moms may feel earlier b/c they know what they are feeling
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| What is one component of amniotic fluid | fetal urine
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| Hyperemesis gravidum | persistent vomitting - every day for 1st trimester
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| Tx of Hyperemesis gravidum | hospitalized with central line for weeks - TPN; mom is worse off than baby
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| When can an US detect gestational sac | 5-6 weeks
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| When can an US show fetal heart beating | 11 weeks
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| When can an US detect fetal breathing | 11 weeks
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| When can an US show fetal movement | 12 weeks
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| When should mom report n/v | if she shows signs of dehydration and concentrated urine
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| What should mom do in regards to urinary frequency | good cleanliness - reports signs of UTI - drink 2000 mL/day (bladder spasms can lead to uterine contractions)
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| What should a mom do about heartburn | Avoid baking soda - may take Maalox (give her a measurable amount)
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| How can a mom decrease edema and varicosities | keep legs elevated as much as possible
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| What can a mom do about a backache | good posture is important
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| What should a mom do about faintness | moderate exercise, deep breathing, avoid sudden changes in position and warm crowded areas (usually happens in 1st trimester)
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| What can a mom do regarding Vena Caval Syndrome | teach to lie on side - not back
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| Breast Care during pregnancy | wide straps, bras large enough, good cleanliness, check if nipples are inverted - use nipple shield
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| Nipple stimulation | may stimulate uterine activity - should be avoided during last trimester if there is any danger of pre-term labor
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| Exercise | moderate exercise is important to strengthen muscles for childbirth (no full sit-ups); Kegel exercises and Pelvic tilt
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| Sexual activity | only limited if woman prone to pre-term labor, bleeding or ROM
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| Teratogens | subsatnce that harm the growth and development of fetus -can be alcohol, cocaine, caffein, etc.,
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| Overall weight gain during pregnancy | 25-35 pounds
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| Caloric intake | should only increase by 300 Kcal/day above usual allowance (Approx 18Kcal/lb of mom's ideal body weight)
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| Weight gain during the first trimester | 2-4 pounds
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| Weight gein during the 2nd and 3rd trimester | 0.8-1 pound / week
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| A sharp weight gain after the 20th week may indicate | increased water retention and the beginning of PIH
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| What do CHO provide | Protective substances (vitamins & minerals), bulk (fiber), and energy
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| CHO promote | weight gain and growth of the fetus, placenta and other maternal tissues
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| Sources of CHO | milk, fruit, veggies & whole-grain cereals & bread
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| Fats provide | essential fatty acidsq
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| Function of protein | build and repair all body cells - preferably not to be used as an energy source
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| Increased amount of protein is needed during pregnancy for | growth & development of maternal and fetal tissue
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| Vitamins | organic substances essential to life
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| Fat-soluable vitamins | ADEK - stored by body, it is possible to overdose with large supplements
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| Water soluable vitamins | all B's & C's - not stored in the body, need replenishing - excreted in urine
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| Dairy needs for pregnant woman | 2 servings
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| Grain needs for pregnant woman | 6-11 servings
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| Fat needs for pregnant woman | 2 servings
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| Veggie needs for pregnant woman | 3-5 servings
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| Fruit needs for pregnant woman | 2-4 servings
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| Meat needs for pregnant woman | 2-3 servings
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| Antiflexed | uterus bends forward
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| Dextrorotate | uterus turns to the right
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| Size changes of the uterus | Normal 60-70g goes to 1100-1200g; Capacity 10ml (2tsp) - greater than gallon
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| The growth of the uterus is principally r/t | enlargement of pre-existing muscle fibers
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| The effect of estrogen on uterine muscle | increase fibroelastic tissue between the muscle bands
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| Braxton - Hicks | painless, irregular, beginning of 4th month, prepare the uterus for labor
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| Fundal height is important to assess to determine | fetal well-being
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| Fundal height is first palpable | above symphysis at 12 weeks at umbilicus by 20 wks
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| How is fundal height measured & when | with a paper tape from the symphysis to fundus of uterus at prenatal visits
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| Fundal Height # of weeks gestation = | # of centimeters measured until 3rd trimester (17wks gest = 17cm)
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| McDonald's Rule (wks) | # of cm x 8/7 = wks gestation
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| McDonald's Rule (months) | # of cm x 2/7 = duration of pregnancy in months
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| If the fundal height is low for gestation | IUGR due to problems with placenta or other disorders
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| If fundal height is greater than it should be for gestational age | twins, hydraminios, hydatidiform mole, internal hemorrhage
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| Goodell's Sign | Cervix softens with pregnancy
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| Normal cervix feels like | the tip of the nose
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| The pregnant cervis feels like | an earlobe
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| The cervix is bluish discoloration is due to | increased vascularity
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| operculum | mucous plug
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| Why is the mucous plug formed | due to increased excretion of endocervical glands
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| Chadwick's sign | vagina has increased vascularity which leads to blue discoloration
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| If mom gets yeast infections, newborn can get? | thrush
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| Vaginal pH | acidic during pregnancy to discourage bacteria - but can encourage yeast infections
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| Breast changes in pregnancy r/t | increased circulation and increased endocrine activity
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| What are the breast changes | larger, firmer, tender; areola enlarges & darkens; colostrum can be expressed during last trimester
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| Abdominal wall changes | stretches to accommodate uterus; stretch marks on abd., thighs, breasts; Diastasis recti
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| Striae Gravidarum | Stretch marks (younger women tend to have less)
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| Diastasis Recti | separation of the rectus muscle of the abdomen; May leave a blue groove on the abdomen
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| Skin Changes | Linea Nigra; Cloasma; Spidernevi; Glowing
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| Linea Nigra | Black line from mons veneris to umbilicus; r/t increased hormones; will lighten 6-12 wks post partum
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| Cloasma | Mask of pregnancy; r/t hormones; sunburn like
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| Spidernevi | Vascular, spider-like red blemishes on the skin with branching legs; do disappear
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| Glowing | increased activity of sebaceous & sweat glands
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| Metabolic changes (BMR) | BMR increased 15-20%
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| Metabolic changes (CHO) | pregnancy mimics a subclinical diabetes; glucose excreted in urine - don't test urine for glucose it won't be accurate
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| Metabolic changes (weight gain) | r/t presence of grownig fetus, placenta, fetal membranes, and amniotic fluid more than to a change in metabolism; Increased water retention r/t increased aldosterone
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| Respiratory changes | O2 consumption inc. by 20%; mom's need for O2 inc.; Inc resp effort, dec. PCO2 d/t progesterone; mucous mem engorged > stuffiness & epistaxis; level of diaphragm displaced as much as 4cm upward; mild hyperventilation >resp alk>Inc urinary output
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| If mom has a stuffy nose | do not take OTC meds for congestion
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| Circulatory changes (blood vol) | Inc. 30-50%; Inc begins by the end of the 1st trimester & peaks by 24-30th wks
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| Circulatory changes (pulse) | Inc. 10-15 bpm
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| Circulatory changes (BP) | slightly inc 1st trimester; drops 2nd trimester - r/t lower peripheral resistance; returns to normal during 3rd trimester
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| Circulatory changes (placement of heart) | gets displaced to a transverse position to the right by 2 degrees
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| Postural hypotension can occur r/t | increased blood volume in lower legs
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| During last trimester, blood flow to lower extremities may be impaired by | pressure of the uterus on veins and arteries - leads to edema, varicosities of the vulva, rectum & legs
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| Vena Caval Syndrome | the enlarging uterus presses on the vena cava when the pregnant woman lies supine - it decreases blood to the right atrium
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| S/S of vena caval syndrome | dizziness, rapid pulse, diaphoretic
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| LMP | The date of the first day of the Last Menstrual Period
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| EDC | Naegles rule to determine the estimated date of confinement
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| Gestation | Literally "pregnancy"
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| Gestational age | # of weeks since LMP
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| Gravida | A pregnant woman
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| Primigravida | Woman pregnant for the first time
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| Multigravida | Woman pregnant for 2 or more times
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| Para | A woman who has delivered offspring who reached the age of viability
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| Nullipara | Woman who has never delivered her 1st baby over 20 weeks
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| Primipara | Woman who has delivered her 1st baby over 20 weeks gestation (primip)
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| Multipara | Woman has delivered more than one neonate after the age of viability
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| Abortion | Delivery of a fetus at 20 weeks gestation or less (can be spontaneous - miscarriage or elective)
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| age of viability | over 20 weeks
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| GTPAL | Gravida/Term/Preterm/Abortion/Living
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| Term | 38-42 weeks
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| Preterm | 20-37 weeks
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| Abortion | under 20 weeks
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| Naegles Rule | LMP - 3 months + 7 days = EDC
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