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Quiz 2
OB
| Question | Answer |
|---|---|
| Integumentary system changes | Striae gravidarum (stretch marks) - breasts, abdomen, thighs Linea nigra - dark line from symphysis pubis to fundus ; fades postpartum ; more pronounced in darker skin tones (normal) |
| Integumentary system changes | Chlolasma (mask of pregnancy) - worsens with sun exposure; resolved postpartum. Teach SPF 30+ Nevi (moles), macules (freckles), and areolae darken Palmar erythema - increased blood flow; harmless and painless |
| Integumentary system changes | Hair grows long/thicker (estrogen effect); normal shedding resumes 1-4 months postpartum, alarming but self resolving Nails may become softer, harder, or more brittle |
| Endocrine system changes | Maternal thyroid supplies hormones to fetus until week 12, when fetal production begins, thyroid levels often increase Thyroid hormones are critical to fetal neurological development. Insulin needs increase steadily in the second half of pregnancy |
| Endocrine system changes | If pancreas cannot meet demand, gestational diabetes (GDM) Cortisol increases in 2nd trimester, promotes fetal lung and neurological maturation. Oxytocin (posterior pituitary); drives contractions, postpartum uterine involution, milk injection. |
| Respiratory system changes | Oxygen consumption increases 15-20% Tidal volume increases 40-50% - more air exchanged per breath Mild hyperventilation; physiological respiratory alkalosis; "blowing off" CO2 facilitates fetal gas exchange |
| Respiratory system changes | Diaphragm elevates about 5cm, ribs expand; subcostal angle widens Increased estrogen; mucous membrane congestion; chronic nasal congestion and nosebleeds |
| Respiratory system changes | Report to provider if any severe or sudden dyspnea , SPO2 <95%, chest pain with breathing, hemoptysis (coughing of blood) |
| Cardiovascular system changes | Cardiac output increases 30-50%, pulse increases 10-15 bpm Total blood volume increases 40-45%, RBC increases 30%, physiological anemia (hemoglobin and hematocrit decreases) - expected. |
| Cardiovascular system changes | WBC increases in 2nd and 3rd trimester - may not indicate infection Fibrinogen and clotting factors rise - increased DVT/PE/stroke risk Temporary benign heart murmurs are common in pregnancy |
| Cardiovascular system changes | Blood pressure: at pre-pregnancy levels (1st trimester), slight decreases (2nd trimester), returns to baseline (3rd trimester) |
| Cardiovascular system changes | Supine hypotension: gravid uterus compresses IVC when supine; dizziness, pallor, nausea; intervention; left lateral decubitus position |
| Urinary system changes | Renal blood flow increases 80%, GFR increases ~50% Small amounts of glucose and protein may spill into the urine, can be normal Glycosuria can be normal due to increased GFR - does not always mean GDM |
| Urinary system changes | Proteinuria >300mg/24 hours after 20 weeks = abnormal, evaluate for preeclampsia. Urinary frequency - early (uterine pressure) and late pregnancy (fetal descent) |
| Urinary system changes | Stress incontinence - teach kegel exercises (contract 10 sec, relax 10 sec, repeat 10x a day) Nocturia is common, reassure patient, do not restrict fluids Screen for asymptomatic bacteriuria at first prenatal visit, treat to prevent pyelonephritis |
| Reproductive system changes | Fundal height in cm ~ weeks of gestation between weeks 16-36 Braxton Hicks contractions irregular, do not change cervix, relieved by rest, hydration, ambulation Mucus plug (operculum); forms inside cervical canal, protective barrier against pathogens |
| Reproductive system changes | Goodell sign; cervical softening (~5 weeks) Chadwick sign; bluish/violet discoloration of cervix/vagina (~6-8 weeks) Leukorrhea; normal white/clear discharge, mild odor, report foul odor, color change, itching |
| Reproductive system changes | Colostrum (yellowish early milk) begins production; may leak from nipple Breasts become fuller, nipples and areolae darken |
| Musculoskeletal system changes | Lordosis; exaggerated lumbar curve shifts center of gravity, increased fall risk Relaxin + progesterone; increased pelvic mobility but less stable joints Round ligament pain; sharp/stretching sensation with position changes; change positions slowly |
| Musculoskeletal system changes | Diastasis recti (separation of abdominal wall at midline) Increased parathyroid hormone; calcium reabsorption, leg cramps Management: pelvic tilt exercises, support belt, pillow between knees, proper body mechanics |
| Gastrointestinal system changes | Reduced peristalsis; delayed gastric emptying, heartburn, constipation, gallstones Metabolic rate increases 10-20%, need +350 kcal/day (2nd trimester), +450+ kcal/day (3rd trimester) Nausea/vomiting - 1st trimester, driven by hCG levels |
| Gastrointestinal system changes | Progesterone relaxes lower esophageal sphincter - reflex/GERD Hemorrhoids from pelvic pressure + constipation Heartburn management: small meals, avoid fatty/spicy foods, do not eat 3 hours before bed, elevate head of bed |
| Gastrointestinal system changes | Constipation management: increase fiber, fluids, light exercise, stool softeners if needed |
| Physiologic changes priority notes | Integumentary: Reassure all skin/hair changes are normal and temporary — no intervention needed unless signs of infection Respiratory: Mild dyspnea is NORMAL — distinguish from wheezing/cough which signals asthma exacerbation requiring immediate action |
| Physiologic changes priority notes | Cardiovascular: Supine hypotension → FIRST action: turn patient to LEFT lateral position; physiological anemia is expected — do not treat unless Hgb <10.5 g/dL |
| Physiologic changes priority notes | Urinary: Glycosuria alone does NOT confirm GDM — assess full clinical picture; asymptomatic bacteriuria MUST be treated to prevent pyelonephritis |
| Physiologic changes priority notes | Reproductive: Braxton Hicks are NORMAL — educate patient on differences from true labor; report foul-smelling discharge immediately GI: Constipation is expected — increase fiber/fluids first before recommending stool softeners; avoid laxatives |
| Physiologic changes priority notes | Musculoskeletal: Lordosis increases fall risk — assess home safety and teach slow position changes |
| Braxton Hicks vs True Labor | Braxton Hicks: irregular, no progression, no cervical changes, relief by rest/hydration/ambulation, usually abdominal only True labor: regular, progressive frequency/intensity, dilates & effaces, not relieved by rest, often back & abdomen |
| Physiologic changes priority notes | First assess: is the cervix changing? Teach patients: if contractions are regular and progressing before 37 weeks, call provider immediately (preterm labor) Intervention for BH: hydration, ambulation, or rest, if not relieved evaluate further |
| Weight Gain Recommendations | BMI <18.5, underweight, 28-40 lb, ~1-1.3 lb/week BMI 18.5-24.9, healthy weight, 25-35 lb, ~1 lb/week BMI 25-29.9, overweight, 15-25 lb, ~0.6 lb/week BMI >30, obese, 11-20 lb, ~0.5 lb/week |
| Weight Gain Recommendations | First trimester ~5 lb total Too little gain - small for gestational age infant Too much gain - Pregnancy induced hypertension, increases surgical delivery risk |
| Weight Gain Recommendations priority notes | Assess weight at every prenatal visit — sudden large gains in a short time may indicate preeclampsia (fluid retention), not just fat gain |
| Weight Gain Recommendations priority notes | Educate: too little gain → SGA infant; too much gain → gestational HTN, macrosomia, increased surgical delivery risk Weight gain counseling should be done without stigma — focus on nutrition quality, not restriction |
| Nutritional needs (increase) | Folic acid 400mcg/day preconception through 1st trimester - prevents neural tube defects Iron - supports maternal RBC production, best absorbed with vitamin C (orange juice) Calcium - fetal bone development, prevents maternal bone loss |
| Nutritional needs (increase) | Protein - supports fetal, uterine, and placental development Caloric increase: ~300-400 kcal/day depending on trimester |
| Nutritional needs (avoid/limit) | NO alcohol - teratogen, causes fetal alcohol syndrome (no safe amount) Limit caffeine to <200 mg/day Avoid high-mercury fish; swordfish, king mackerel, shark, tilefish |
| Nutritional needs (avoid/limit) | Listeria risk: soft cheeses, unpasteurized milk, deli meats (heat until steaming), raw sprouts AVOID taking iron with milk - calcium inhibits iron absorption Pica: craving nonfood items - may indicate nutritional deficits |
| 1st trimester / 2nd trimester common discomforts & management | Nausea/Vomiting — small frequent meals, bland foods, ginger, vitamin B6; avoid triggers Fatigue — rest frequently; pace activities; iron-rich foods if anemic Breast tenderness — supportive bra; avoid caffeine |
| 1st trimester / 2nd trimester common discomforts & management | Nasal congestion/nosebleeds — saline spray, humidifier; direct pressure for nosebleeds Lightheadedness — change positions slowly; adequate hydration Leukorrhea — normal if white/clear; panty liner; report foul odor or itching |
| 1st trimester / 2nd trimester common discomforts & management | Headaches — rest, cool compress, acetaminophen (avoid NSAIDs); EVALUATE after 20 weeks Acne/skin changes — gentle cleanser; AVOID retinoids (teratogenic) Increased saliva — hard candies, mouthwash; reassure it resolves |
| Hyperemesis Gravidarum | Persistent vomiting + weight loss >5% + ketonuria + dehydration → Priority: NPO until vomiting stops → IV fluids, antiemetics, parenteral electrolytes |
| 3rd trimester common discomforts & management | Heartburn/GERD — small meals; avoid fatty/spicy foods; do not eat 3 hrs before bed; elevate HOB Constipation — increase fiber + fluids + light exercise; stool softeners if needed Low back pain — pelvic tilt exercises, support belt, pillow between knees |
| 3rd trimester common discomforts & management | Lower extremity edema — elevate legs; compression stockings; avoid prolonged sitting/standing Varicose veins/hemorrhoids — compression stockings; sitz baths; avoid constipation |
| 3rd trimester common discomforts & management | Carpal tunnel syndrome — wrist splints at night; elevate hands; resolves postpartum Dyspnea — improved posture; semi-Fowler's for sleep; reassure (lightening at ~36 wks helps) Braxton Hicks — hydration, ambulation, or rest; check cervical changes! |
| Priority notes | Hyperemesis Gravidarum priority intervention: NPO FIRST to stop vomiting → THEN IV rehydration (do not give fluids orally before vomiting stops) Headaches after 20 weeks must be evaluated for preeclampsia — do not reassure without BP check |
| Priority notes | Supine hypotension: instruct patient to avoid lying flat → position LEFT lateral decubitus AVOID retinoids (acne treatment) — teratogenic in pregnancy Edema that is sudden or involves face/hands is NOT normal → report to provider immediately |
| Danger Signs/ Emergency | Report to provider after 20 weeks: Severe headache Sudden facial/hand edema Visual changes (flashing lights, blind spots, double vision) |
| Danger Signs/ Emergency | BP ≥140/90 Epigastric/RUQ pain • Regular contractions before 37 weeks Sudden severe dyspnea or chest pain Decreased/absent fetal movement |
| Prenatal Care schedule & first visit | up to 28 weeks; every 4 weeks, key assessments: Vital signs, weight, FHR, fundal height (after 16 wks), urine dipstick, education 28-36 weeks; every 2 weeks, key assessments: + GBS culture at 35–37 wks; GDM screening at 24–28 wks |
| Prenatal Care schedule & first visit | 36 weeks+; weekly visits, key assessments: + Cervical assessment, NST/BPP if indicated, birth planning discussion |
| First visit (most comprehensive) | Complete healthy history Determine EDD (Naegele's rule or ultrasound) Review all medications and supplements, assess psychological response to pregnancy Evaluate genetic risk factors and family history |
| First visit (most comprehensive) | Screen for intimate partner violence (IPV) - always in privaate Labs: blood type, Rh factor, CBC, rubella titer, hepatitis B surface antigen, HIV, RPR (syphilis), Gonorrhea/Chlamydia, urinalysis, urine culture, pap smear if due |
| Care providers | Certified Nurse-midwife (CNM) Lay midwife Obstetrician (MD/DO) Doula - not a provider |
| Certified Nurse-midwife | RN with advanced graduate-level training in midwifery • Attends births in hospitals, birthing centers, or patient homes • Provides holistic care; best suited for low-risk patients • Can prescribe medications and order tests in most states |
| Lay midwife | Primarily cares for patients in home settings • May be trained formally or through apprenticeship • Licensing requirements vary significantly by state • NOT a licensed healthcare provider in all states |
| Obstetrician (MD/DO) | Performs births in hospital; manages low- and high-risk patients • Can perform cesarean births and operative vaginal deliveries (forceps, vacuum) • Manages complications requiring surgical or medical intervention |
| Doula | Emotional, physical, and informational SUPPORT only Does NOT perform clinical tasks or deliver babies NOT responsible for medical decisions or birth outcomes Evidence: doula support reduces cesarean rates and increases satisfaction |
| Priority notes prenatal | IPV screening is MANDATORY at every prenatal visit, hospitalization, and postpartum visit — always in PRIVATE First visit labs: blood type + Rh factor is critical — determines RhoGAM need throughout pregnancy |
| Priority notes prenatal | Asymptomatic bacteriuria must be screened and treated at first visit — can progress to pyelonephritis GDM screening at 24–28 weeks for ALL patients regardless of risk — do not skip |
| Priority notes prenatal | Educate patients on danger signs at every visit — this is a recurring nursing responsibility |
| Preembryonic Stage | Fertilized ovum becomes morula, then blastocyst before entering the uterus |
| Preembryonic Stage priority notes | Teratogen exposure is MOST dangerous during embryonic stage (weeks 2–8) when organ systems are forming Counsel all patients of childbearing age: folic acid, no alcohol, avoid teratogenic medications BEFORE conception |
| Embryonic Stage (Weeks 2–4) | Week 2: Implantation occurs Week 3: Neural tube fuses at center; tubular heart begins to beat Week 4: Respiratory and digestive tracts begin to form; neural tube fusion complete |
| Embryonic Stage (Weeks 5–8) | Week 5: Limb buds appear Week 6: Heart is in its final form Week 8: First brain waves are detectable |
| Preembryonic Stage priority notes | Week 3–4: neural tube closes — folic acid supplementation BEFORE this point is critical to prevent NTDs Weeks 2–8 = period of organogenesis — highest risk for congenital malformations from teratogen exposure |
| Fetal stage weeks (weeks 9-16) | Weeks 9–12: Fetal movement begins; kidneys begin to function; genitalia fully differentiated Weeks 13–16: Oogenesis established in females; blood vessels visible under skin; fingerprints/footprints forming |
| Fetal stage weeks (weeks 20-28) | Week 20: Fetal swallowing present; insulin production begins; lanugo and vernix caseosa cover the body Week 24: Lungs begin to form surfactant Week 28: Testes descend in males; fetus often moves to head-down position; blood produced in bone marrow |
| Fetal stage weeks (weeks 29-34) | Weeks 29–34: Subcutaneous fat deposits begin; FHR variability more pronounced (CNS maturity) |
| Fetal stage weeks (weeks 33-38) | Weeks 33–38: Visual acuity 20/600; vernix only in skin creases; lanugo only on upper back/shoulders; lungs and CNS mature; fetus continues to grow and gain weight |
| Embryonic development priority notes | Week 24: viability threshold — lungs begin forming surfactant; preterm birth before this is rarely survivable After week 20: assess fetal movement at every visit — decreased fetal movement requires NST |
| Embryonic development priority notes | Fetal kick counts: teach at ~28 weeks — 10 movements in 2 hours is reassuring; fewer requires provider notification |
| Placenta | Temporary organ — circulatory interface between gestational parent and embryo/fetus Forms at site of blastocyst implantation with finger-like projections (chorionic villi) |
| Placenta | Fully developed: ~2.5–3 cm thick, 38–51 cm diameter Fetal surface: smooth and translucent (shiny Schultz); Maternal side: red, meaty (dirty Duncan) |
| Placenta primary functions | Circulation: O2/nutrients from mother to fetus; CO2/waste from fetus to mother Protection: Filters many pathogens; however alcohol, drugs, rubella, and syphilis CAN cross |
| Placenta primary functions | Hormone production: hCG (sustains corpus luteum), estrogen, progesterone, human placental lactogen (hPL) |
| Placenta priority notes | Remember: alcohol, drugs, rubella, and syphilis CAN cross the placental barrier — educate at every visit hCG is the hormone that confirms pregnancy and is measured in serial lab tests to monitor pregnancy viability and molar pregnancy follow-up |
| Umbilical cord | At birth: ~55cm long, 2cm in diameter Contains 2 arteries (carry deoxygenated blood: fetus to placenta) and 1 vein (carry oxygenated blood: placenta to fetus) Covered in wharton's jelly - insulates and protects vessels from compression. |
| Umbilical cord | Delayed cord clamping (30-60 sec) after birth is now standard of care - improves newborn iron stores and outcomes Single umbilical cord may indicate anomalies |
| Preexisting conditions in pregnancy, asthma | Complicates 3–8% of pregnancies; can worsen, stabilize, or improve Severe asthma → maternal HTN, preeclampsia, placenta previa, uterine hemorrhage, oligohydramnios |
| Preexisting conditions in pregnancy, asthma | Fetal risks: IUGR, preterm birth, low birth weight, infant death — risk proportional to severity |
| Preexisting conditions in pregnancy, asthma assessment | Lung auscultation: wheezes, rhonchi, prolonged expiratory phase Acute attack S&Sx: wheezing, chest tightness, tachypnea, nonproductive cough, dyspnea |
| Preexisting conditions in pregnancy, asthma assessment | Continuous pulse oximetry during exacerbation — maintain SpO2 ≥ 95% FHR monitoring (NST) to assess fetal wellbeing; spirometry and O2 as ordered |
| Preexisting conditions in pregnancy, asthma nursing management | Strongly encourage continuation of ALL asthma medications (1/3 of patients worsen during pregnancy) Educate on trigger avoidance (allergens, irritants, smoke, stress, exercise) |
| Preexisting conditions in pregnancy, asthma nursing management | Patient positioning: upright/sitting during exacerbation Exacerbation not responding to rescue meds = MEDICAL EMERGENCY — escalate immediately |
| Preexisting conditions in pregnancy, asthma priority notes | FIRST priority in acute asthma: maintain SpO2 ≥95% — fetal hypoxia occurs rapidly with maternal hypoxia Exacerbation NOT responding to rescue inhaler = MEDICAL EMERGENCY → escalate immediately |
| Preexisting conditions in pregnancy, asthma priority notes | Never tell a patient to stop asthma medications — uncontrolled asthma is MORE dangerous than the medications Position patient UPRIGHT/SITTING during exacerbation — never supine |
| Preexisting conditions in pregnancy, asthma priority notes | Assess FHR (NST) during and after any asthma exacerbation to evaluate fetal wellbeing |
| Preexisting conditions in pregnancy, asthma nclex pearl | Uncontrolled asthma poses GREATER risk to the fetus than the medications used to treat it. Always encourage medication compliance. SpO2 must be maintained ≥95%. |
| Epilepsy / seizure disorder | ~1.2% of U.S. population has epilepsy Complications: preeclampsia, hemorrhage, preterm labor, placental abruption, fetal growth restriction, fetal demise |
| Epilepsy / seizure disorder | Antiseizure meds (esp. valproate, carbamazepine) → increased risk of congenital malformations; lamotrigine/levetiracetam safer in pregnancy Stopping antiseizure medications during pregnancy is MORE dangerous than continuing them |
| Epilepsy / seizure disorder medication protocol | Folic acid 4 mg/day — start 3 months before conception, continue at least 1 month postpartum Vitamin K (maternal, for pts on valproate): 10–20 mg/day for the last month of pregnancy → reduces neonatal bleeding |
| Epilepsy / seizure disorder medication protocol | Vitamin K (neonate): 0.5–1.0 mg IM at birth; monitor for bleeding Acute seizure in labor: benzodiazepine or phenytoin IV; continuous FHR monitoring |
| Epilepsy / seizure disorder monitoring & screening | Maternal AFP blood test at 14–16 wks: 80–90% sensitive for open neural tube defects Ultrasound at 17–20 wks: identifies NTDs and anatomic defects |
| Epilepsy / seizure disorder monitoring & screening | Amniocentesis at 16 wks: detects AFP and acetylcholinesterase C-section may be indicated for frequent recent or stress-induced seizures |
| Epilepsy / seizure disorder priority notes | Never advise patient to stop antiseizure medications — uncontrolled seizures pose greater risk than medication teratogenicity Folic acid 4 mg/day (not the standard 400 mcg) — start 3 months BEFORE conception |
| Epilepsy / seizure disorder priority notes | Acute seizure in labor: FIRST give benzodiazepine IV → then continuous FHR monitoring Neonatal vitamin K at birth is ESSENTIAL for infants of epileptic mothers on valproate — prevents bleeding |
| Epilepsy / seizure disorder priority notes | Postpartum caution: counsel patient about safe infant care (changing, bathing, carrying) due to seizure risk |
| preexisting condition, thyroid disorders, hypothyroidism | May cause: infertility, preeclampsia, gestational HTN, postpartum hemorrhage, LBW, preterm birth, placental abruption, early pregnancy loss Fetal risk: cognitive impairment and neuropsychological damage from abnormal T4 levels |
| preexisting condition, thyroid disorders, hypothyroidism | Many patients are asymptomatic Treatment: levothyroxine (T4 replacement); adjust dose based on TSH every 4 weeks to 3 months Teaching: take levothyroxine first thing in morning on an empty stomach; no oral intake for 1 hour after |
| preexisting condition, thyroid disorders, hypothyroidism | TSH is the best monitoring lab; goal is low-normal TSH in pregnancy |
| preexisting condition, thyroid disorders, hyperthyroidism (Graves disease) | May cause: pregnancy loss, LBW, preterm labor, preeclampsia, maternal heart failure symptoms and signs: heat intolerance, diaphoresis, tachycardia, weight loss despite normal diet, tremor, anxiety |
| preexisting condition, thyroid disorders, hyperthyroidism (Graves disease) | Graves disease: may also include goiter and ophthalmopathy (eye inflammation, lid retraction, bulging eyes) Treatment: thioamides (methimazole) suppress thyroid hormone synthesis; especially risky in 1st treimester for fetal anomalies |
| preexisting condition, thyroid disorders, hyperthyroidism (Graves disease) | Goal: maintain mild hyperthyroidism; avoid indicuing hypothyroidism in the fetus Thioamides cross the placenta - use lowest effective dose; encourage medication compliance |
| Thyroid disorders Nclex pearl | Hypothyroid: take levothyroxine on empty stomach, nothing by mouth for 1 hour Hyperthyroid (Graves): thioamides cross the placenta - goal is mild hyperthyroidism, not euthyroid, to protect the fetus from iatrogenic hypothyroidism. |
| Pre gestational diabetes (Type 1 & 2) | Key principle: achieve excellent glycemic control before conception for best outcomes Maternal/Fetal risks: preeclampsia, perinatal death, fetal macrosomia, congenital anomalies, polyhydramnios, fetal loss, preterm birth, should dystocia, |
| Pre gestational diabetes (Type 1 & 2) Fetal surveillance tools | NST: Reactive = ≥2 FHR accelerations in 20 min → reassuring CST: Negative = no late decelerations → reassuring; Positive = late decelerations = concerning |
| Pre gestational diabetes (Type 1 & 2) Fetal surveillance tools | BPP: 5 components (NST, breathing, movement, tone, fluid) scored 0 or 2 pts each; 8–10 = normal; ≤4 = consider delivery Modified BPP: NST + amniotic fluid index (AFI) |
| Pre gestational diabetes (Type 1 & 2) birth considerations | Vaginal birth NOT contraindicated; C-section may be recommended for macrosomia (>4,500 g) Labor often induced between 39–40 weeks to reduce stillbirth risk |
| Pre gestational diabetes (Type 1 & 2) birth considerations | Neonatal monitoring: blood glucose, signs of hypoglycemia, respiratory distress Breastfeeding encouraged — improves newborn glucose regulation |
| Pre gestational diabetes (Type 1 & 2) priority notes | Preconception glycemic control is the #1 priority — congenital anomalies form in the FIRST trimester before many women know they are pregnant NST: reactive = 2+ accelerations in 20 min = REASSURING; fewer = NONREACTIVE = needs follow-up |
| Pre gestational diabetes (Type 1 & 2) priority notes | CST: NEGATIVE (no late decelerations) = reassuring; POSITIVE (late decelerations with contractions) = CONCERNING BPP score ≤4 = consider immediate delivery |
| Pre gestational diabetes (Type 1 & 2) priority notes | Neonatal monitoring after birth: blood glucose, signs of hypoglycemia, respiratory distress — macrosomic neonates at risk Vaginal birth is NOT contraindicated — do not assume C-section for all diabetic patients |
| Pre gestational diabetes (Type 1 & 2) Nclex pearl | Achieving excellent glycemic control BEFORE conception is the key recommendation. Vaginal birth is NOT contraindicated for diabetic patients. C-section considered for macrosomia >4,500 g. |
| Chronic Hypertension | Mild-moderate: 140-159 mmHg systolic, 90-109 mmHg diastolic; interventions - diet, exercise, medication = provider, close monitoring |
| Chronic Hypertension | Severe: ≥ 160 mmHg systolic, ≥110 mmHg diastolic; interventions; medication indicated, IV labetalol or hydralazine for acute control |
| Chronic Hypertension priority notes | AVOID ACE inhibitors and ARBs — teratogenic in 2nd/3rd trimester; switch to labetalol, methyldopa, or nifedipine Severe HTN (≥160/110) requires IMMEDIATE medication — do not wait; IV labetalol or hydralazine |
| Chronic Hypertension priority notes | Monitor for superimposed preeclampsia at every visit — these patients are at the highest risk Teach daily home BP monitoring and preeclampsia warning signs — headache, vision changes, RUQ pain |
| Chronic Hypertension priority notes | Low-dose aspirin 81 mg starting at 12–16 weeks reduces preeclampsia risk in high-risk patients |
| Chronic Hypertension Nclex pearl | ACE inhibitors and ARBs are CONTRAINDICATED in pregnancy. Preferred: labetalol, nifedipine, methyldopa. Always monitor for superimposed preeclampsia. |
| Cardiovascular disease | Leading cause of nonobstetric maternal morbidity/mortality Cardiac output increases 30–50% → may exacerbate underlying conditions |
| Cardiovascular disease | Signs of decompensation: progressive dyspnea/orthopnea, persistent cough, palpitations, peripheral edema beyond normal, extreme fatigue, chest pain/pressure |
| Cardiovascular disease | Management: semi-Fowler's or left lateral position; activity restrictions; continuous FHR monitoring in labor; multidisciplinary care |
| Systemic Lupus Erythematosus (SLE) | Pregnancy safest when SLE has been in remission ≥6 months SLE increases pregnancy complication risk by 2–7× (preeclampsia, IUGR, fetal loss) Low-dose aspirin recommended for preeclampsia prevention |
| Systemic Lupus Erythematosus (SLE) | Hydroxychloroquine is safe and recommended to continue throughout pregnancy CONTRAINDICATED: methotrexate, mycophenolate |
| MMultiple Scleorosis (MS) | Pregnancy often = disease REMISSION — decreased relapse rate in 3rd trimester POSTPARTUM = significant time for RELAPSE — critical to counsel patient and support system |
| MMultiple Scleorosis (MS) | Many disease-modifying therapies (DMTs) are teratogenic — must be discontinued before conception Breastfeeding not contraindicated by MS itself, but some MS medications may not be safe for infant |
| SLE & MS priority notes | SLE: pregnancy must be PLANNED during remission (≥6 months) — active disease dramatically increases complication risk SLE: hydroxychloroquine is SAFE — do not stop it; methotrexate and mycophenolate are CONTRAINDICATED |
| SLE & MS priority notes | MS: anticipatory guidance is critical — counsel patient that postpartum period is high-risk for relapse BEFORE delivery MS: many DMTs are teratogenic — medication review and switching must occur BEFORE conception |
| SLE & MS Nclex pearl | SLE: remission ≥6 months before conception; low-dose aspirin for preeclampsia prevention. MS: expect REMISSION during pregnancy but RELAPSE postpartum — prepare patient and support system. |
| Obesity in pregnancy | ~39.7% of females ages 20–39 are classified as obese (BMI ≥30) Adipose tissue has endocrine function — disrupts inflammatory pathways, vasculature, and metabolism Prepregnancy weight loss can significantly improve outcomes |
| Obesity in pregnancy, complications | Gestational diabetes (GDM) Preeclampsia / hypertensive disorders Macrosomia - shoulder dystocia Postdate pregnancies Slower first stage of labor, increased caesarean risk Postpartum dvt/pe risk IUGR (paradoxically in severe obesity) |
| Obesity in pregnancy, nursing management | Discuss gestational weight gain goals without weight stigma (11–20 lb for BMI ≥30) Screen for GDM, HTN, sleep apnea; serial ultrasounds for fetal growth Encourage moderate exercise (150 min/week); early ambulation and compression stockings postpartum |
| Obesity in pregnancy, priority notes | Screen for GDM, HTN, and sleep apnea at every visit — obese patients are high risk for all three Use non-stigmatizing, weight-inclusive language — clinical communication affects engagement in prenatal care |
| Obesity in pregnancy, priority notes | Early ambulation and compression stockings postpartum are priority — high DVT/PE risk after delivery |
| Intimate Partner Violence (IPV) | ~324,000 pregnancies annually complicated by physical abuse; significantly underreported IPV frequently ACCELERATES (escalates) during pregnancy Screen at EVERY prenatal visit, hospitalization, and postpartum appointment — always in PRIVATE |
| Intimate Partner Violence (IPV) | Use validated screening tool (e.g., HITS, WAST, Abuse Assessment Screen) If positive: provide resources, hotline numbers, and safety planning Nurses do NOT advise patients to leave — provide options and support patient autonomy |
| Intimate Partner Violence (IPV) | Document objectively; mandatory reporting varies by state |
| Intimate Partner Violence (IPV) priority notes | Screen at EVERY visit — always in PRIVATE; partner must leave the room before screening NEVER advise the patient to leave the relationship — provide resources and support patient's autonomy and decision-making |
| Intimate Partner Violence (IPV) priority notes | IPV is a leading cause of maternal injury and death — take every disclosure seriously Document objectively in the medical record; understand mandatory reporting laws in your state |
| Substance Use in pregnancy | Alcohol: TERATOGEN — no safe amount; causes fetal alcohol syndrome (FAS) Nicotine/Smoking: preterm birth, IUGR, miscarriage, placental abruption, stillbirth, SIDS; most modifiable factor in improving pregnancy outcomes |
| Substance Use in pregnancy | Opioids: neonatal abstinence syndrome (NAS); MAT with methadone or buprenorphine preferred over abrupt cessation Cocaine: vasoconstriction → placental abruption, IUGR, preterm birth, stillbirth |
| Substance Use in pregnancy | Marijuana: impairs neurodevelopment; NOT safe in pregnancy Screen ALL patients verbally at every prenatal visit; stopping at ANY point improves outcomes Refer to treatment; address comorbid psychosocial challenges (homelessness, trauma, depression) |
| Substance Use in pregnancy priority notes | Screen ALL patients verbally at every prenatal visit — use a non-judgmental, compassionate approach Opioid use disorder: do NOT advise abrupt cessation — MAT (methadone/buprenorphine) is the safest approach |
| Substance Use in pregnancy priority notes | Stopping use at ANY point in pregnancy improves outcomes — reinforce this message, never shame |
| Substance Use in pregnancy priority notes | Counsel that NO amount of alcohol is safe at any point during pregnancy Nicotine is the most modifiable factor — cessation support at every visit |
| Depression in pregnancy | Up to 50% of affected patients go untreated — barriers: cost, stigma, fear of harming fetus Untreated → substance abuse, poor prenatal adherence, poor nutrition, suicide risk |
| Depression in pregnancy | SSRIs are first-line; no known teratogenic effects but may → slightly lower Apgar scores Antidepressants NOT contraindicated in breastfeeding Screen with Edinburgh Postnatal Depression Scale (EPDS) or PHQ-9 |
| Anxiety (GAD) in pregnancy | Affects ~7% of U.S. population; S&Sx: fatigue, muscle tension, irritability, pervasive apprehension SSRIs first-line; benzodiazepines non-teratogenic but may cause neonatal withdrawal — weigh benefits vs. risks |
| Anxiety (GAD) in pregnancy | Non-pharmacological: mindfulness, exercise, adequate sleep, social support |
| Iron deficiency Anemia in pregnancy | ~52% of patients become anemic during pregnancy; one of the most common and preventable issues Physiological anemia is EXPECTED: normal Hgb 11–14 g/dL; diagnostic threshold: Hgb <10.5 g/dL |
| Iron deficiency Anemia in pregnancy | Risks with true anemia: 2× risk of hysterectomy, blood transfusion, eclampsia, hemorrhage, preeclampsia Iron BEST absorbed with orange juice (Vitamin C); AVOID taking with milk (calcium inhibits absorption) |
| Depression, Anxiety & Iron Deficiency Anemia priority notes | Screen for depression using a validated tool (EPDS or PHQ-9) — up to 50% of cases go untreated Untreated depression leads to substance abuse, poor nutrition, and suicide risk — treat as a safety priority |
| Depression, Anxiety & Iron Deficiency Anemia priority notes | SSRIs are first-line and safe — do not withhold treatment due to fear of fetal harm Iron: Hgb <10.5 g/dL = true anemia; treat with oral iron + Vitamin C; AVOID calcium/milk with iron |
| Depression, Anxiety & Iron Deficiency Anemia priority notes | Anemia increases risk of hemorrhage, eclampsia, and hysterectomy — identify and treat early |
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