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Maternity Ch4 CCC105

Maternity Chapter 4 CCC PN 105

3 phases of pregnancy antepartum, intrapartum, postpartum
antepartum prenatal, before birth
intrapartum during birth
postpartum after birth
who provides prenatal care obstetricians, family practice physicians, certified nurse midwives, nurse practitioners
goals of prenatal care ensure safe birth for mother and child, teach health habits, educate self-care, provide physical care, prepare parents for responsibility of parenthood
role of nurse during prenatal care collecting data, identify/evaluate risk factors, educate self care, provide nutirtion counseling, promote family adaptation to pregnancy
healthcare for pregnancy begins when before conception
preconception care identifies risk factors to be changed before conception to reduce impact on pregnancy
folic acid prior to pregnancy reduces incidence of congenital abnormalities (neural tube defects)
esitmated date of delivery (EDD) is based upon last normal menstrual period (LNMP)
prenatal visit schedule; conception to 28 wks every 4 wks
prenatal visit schedule; 29 wks - 36 wks every 2-3 wks
prenatal visit schedule; 37 wks - birth weekly
regular prenatal care reduces... low-birth weight and morbidity/mortality weight for mothers/newborns
gravida any pregnancy
nulligravida woman never been pregnant
primigravida pregnant for first time
multigravida has been pregnant before
para has given birth to child that reached age of viability (20 wks gestation)
primipara has given birth to first child that reached age of viability (20 wks gestation)
multipara has given birth to 2 or more children that reached age of viability (20 wks gestation)
nullipara no birth past point of viability (20 wks gestation)
abortion termination of pregnancy before viability (20 wks gestation)
gestational age prenatal age of fetus based on LNMP
fertilization age prenatal age of fetus based on date of conception (2 wks less than gestational)
age of viability fetus capable of living outside uterus (20 wks)
Nagele's Rule determines EDD: date of LNMP, backwards 3 months, add 7 days, correct year
avergae duration of pregnancy 40 wks from LNMP, plus of minus 2 wks
length of trimester 13 wks
number of trimesters 3
3 groups of pregnancy signs presumptive, probable, positive
presumptive pregnancy signs definite diagnosis cannot be made; amenorrhea, nausea, vomiting, breast changes, prgmentation changes, frequency/urgency of urination, fatigue/drowsiness, quickening
chloasma mask of pregnancy; increased pigmentation of the face
linea nigra line extending in midline of abdoment from just above the unbilicus to the sumphysis pubis
quickening fetal movement felt by mother, usually around 16-20 wks gestation
probable pregnancy signs goodells sign, chadwicks sign, hegars sign, mcdonalds sign, braxton hicks contractions, ballottement, fetal outline, abdominal striae
Goodell's sign softening of cervix
Chadwick's sign purplish/bluish discoloration of cervix, vagina, and vulva
Hegar's sign softening of lower uterine segment
McDonald's sign easily flex the uterine body again the cervix
Braxton Hicks contractions irregular, painless uterine contractions that begin the the second trimester
ballottement fetal part is displaced by light tap of examining finger on cervix
fetal outline identified by palpataion after 24 wks gestation
abdominal striae stretch marks
positive pregnancy signs fetal heartbeat, uterine souffle, funic souffle, identification by ultrasound
fetal heartbeat rate low of 110-120, high of 150-160; higher in early gestation and slows as term approaches
routine assessments at each prenatal visit risk factors, vital signs, urinalysis, blood glucose screening, fundal height, leopolds maneuvers, fetal heart rate, nutrition intake, any discomforts/problems
common vaginal discharge problems bacterial vaginosis (milky-white discharge), no toerh clinical symptoms, caused by hormonal changes
effects of pregnancy on vagina increased blood supply causes bluish color, secretions increase, pH more acidic, higher clyucogen level promoting yeast growth
effects of pregnancy on respiratory system O2 consumption increases by 15%, dyspnea can occure until fetus descends into pelvis, nasal stuffiness, epistaxis, voice changes, diaphragm rises 4cm
effects of pregnancy on cardiovascular system blood volume increases by 45% for nutrient exhange, expanded maternal tissue, and birthing blood loss; pluse rate increases by 10-15 beats/min; orthostatis hypotension, palpitations, increased clotting factors (2nd/3rd trimesters)
effects of pregnancy on GI system appetite/thirst increase, stomach/intestinal displacement, increased salivary secretions, delayed gastric emptying
effects of pregnancy on urinary system secretes waste of both mother and fetus, water retention due to increased blood volume, more susceptible to UTI, 99% sodium reabsorbed leading to fluid retention; frequent urination in first and last trimester
effects of pregnancy on integumentary/skeletal systems striae, spider nevi, postural changes (low back aches, pelvic joint relaxation, waddling gait in 3rd trimester, center of gravity change)
supine hypotension syndrome (aortocaval compression/vena cava symdrome) uterus compresses inferior vena cava and reduces blood flow due to soman lying on her back
relieve/prevent supine hypotension by turning to one side (preferably left)
nurtition changes for pregnancy only 300 cal/day (500 cal/day breastfeeding) - not eating for two
normal pregnancy weight gain 25-35 lbs
obese pregnancy weight gain 11-20 lbs
overweight pregnancy gain 31-50 lbs
multifetal pregnancy gain 34-54 lbs
low weight gain can lead to pre-term labor
special nutritional considerations inclue adolescent pregnancies, sodium intake, vegetarians, pica (non-food substances), lactose intolerance, cultural preferences, gestational diabetes
exercise during pregnancy for maintenance of fitness, not improvement or weight loss
problems with elevated temperature impact fetal circulation and cardia function - do not exceed 100.4 (no saunas or hot tubs), can lead to miscarriage
problems with hypotension reduces blood flow to fetus
take with your for travel during pregnancy take copy of obstetric records; safest during 2nd trimester
common pregnancy discomforts fatigue, nasal stuffiness, nausea, heartburn, constipation, hemorrhoids, vaginal discharge, backache, varicose veins, leg cramps, lower extremity edema
most important factor in dealing with pregnanct adolescent establish trust
most imporatnt factor in dealing with single mother no judgements made, may have unique emotional needs
most important factor in dealing with single father may take active interest, mayh want to participate in plans for child, may be rejected by woman
drugs during pregnancy category A is safe at any time,all drugs should only be taken if told by physician
immunizations during pregnancy no live virus vaccines, no thimerosal due to mercury poisoning, avoid MMR one month prior to pregnancy
Created by: cmp12345