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BC3 Maternity

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