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Test 3 3rd week

Care of the Antepartum Patient

QuestionAnswer
Chadwick's Sign deepened violet- bluish color of vaginal mucosa secondary to increased vascularity of the area
Goodell sign softening of the cervical tip
Ballottement Rebound of unengaged fetus
Braxton Hicks Contractions False contractions, painless,irregular, and usually relieved by walking
Positive signs of pregnancy Fetal heart sounds,Visualization of fetus by ultrasound,Fetal movement palpated by an examiner.
Serum and urine tests provide an accurate assessment forMcDonald's Method The presence of human chorionic gonadotropin(hcg)
hCG production can start as early as the day of implantation and can be detected as early as 7-10 days after conception
Production of hCG begins with implantation, peaks at about 60-70 days of gestation and then declines until around 80 days of pregnancy, when it begins to gradually increase until term
Higher hCG levels can indicate multifetal pregnancy, ectopic pregnancy, hydatidiform mole(gestational trophoblastic disease)or Downs syndrome
Low Levels of hCG may suggest Miscarriage
Some medications(anticonvulsants,duuretics,tranquilizers Can cause false-positive or false-negative pregnancy results
Urine samples should be First voided morning specimens
Nagele's Rule Take the first day of the women's last menstrual cycle,subtract 3 months,and then add 7 days and 1 year
McDonald's Method Measures uterine fundal height in cm. fron the symphysis pubis to the top of the uterus fundus between 18-30 weeks of gestation
Gravidity Number of pregnancies
Nulligravida A women who has never been pregnant
Primigravida A women in her first pregnancy
Multigravida A women who has had two or more pregnancies
Parity Number of pregnancies in which the fetus or fetuses reach viability(20-24 wks)or fetal wt. of more than 500g (2lbs)reguardless of whether the fetus is alive or not.
GTPAL acronym Gravity,Term Births,Preterm,Abortion,Living Children
G Gravity
T Term births (38 wks or more)
P Preterm births(from viability up to 37 weeks)
A Abortions/ Miscarriage (prior to viability)
L Living Children
Reproductive The uterus will increase in size and change shape and position
Ovulation and menses Cease during pregnancy
Cardiovascular Cardiac output and blood volume increases (45-50% at term)to meet the greater metabolic needs.HR increases during pregnacy
Respiratory Maternal oxygen needs increase
During the last trimester, the size of the chest may enlarge, allowing for lung expansion,as the uterus pushes upward,Increased respiratory rate and decreased total lung capacity
Musculoskeltal Body alteration and weight increase necessitate and adjust in posture.Pelvic joints relax.
Gastrointestinal N/V may occur due to hormonal changes(Estrogen)
Constipation may occur due to increased Transit time of food through the GI system and thus , increase water absorption
Renal Filtration rate increases
Blood pressure Decreases 5-10mm Hg for both the diastolic and the systolic during the 2nd trimester
Blood Pressure should return to prepregnancy baseline range after 20 weeks of gestation
Pulse increases 10-15/min around 20 weeks of gestation and remains elevated throughout the remainder of pregnancy.
Respirations increase by 1-2 min due to elevation of the diaphragm by as much as 4 cm
Fetal heart tones are heard at a normal baseline rate of 110-160/min with reassurinf FHR accelerations noted, which indicate an intact fetal CNS
Murmurs are common in pregnant women
Breast changes occur due to Hormones secreted during pregnancy
Chloasma Mask of pregnancy(pigmentation increases on the face)
Lonea Nigra Dark line of pigmentation from the umbilicus extending to the pubic area
Striae Gravidarum Stretch marks most notably found on the abdomen and thighs
The client should be encouraged to keep all follow up appointments and to contact the physician immediately if there is any bleeding,leakage of fluid, or contractions at any time during the pregnancy
Prenatal care begins with an initial assessment and continues throughout pregnancy.Prenatal visits are scheduled Every Month for 7 months, every 2 weeks during 8th month and every week during last month.
Monitoring Fetal Heart Rate(FTR) Fetal HR can be heard by a doppler at 10-12 weeks gestation
Fetal heart rate can be heard with ultrasound at 16-20 weeks
Start measuring the funfal height after 12 weeks gestation.
Between 13-30 weeks of gestation, the fundal height measured in cm. should Equal the week of gestation
Have the client empty her bladder and measure from the Symphysis pubis to the upper border of the fundus
Begin assessing for fetal movement between 16-20 weeks of gestation
Administer Rh (D) immune globulin(RhoGAM) IM around 28 weeks of gestation for clients who are Rh negative
It is recommended that mothers count fetal activity 2 or 3 times a day for 60 min each time
Fetal movements of less than 3 in/hr or movements that cease entirely for 12 hours indicate a need for further evaluation
Nausea and vomiting may occur during the first trimester The client should eat crackers or dry toast 1/2 to 1 hour before rising in the morning to relieve discomfort.
Instruct client to avoid having an empty stomach and ingesting spicy foods,greasy or greasy or gas forming foods.
Encourage client to drink fluids between meals
Breast tenderness should occur during the 1st trimester.Client should wear a support bra
Urinary frequency may occur during the 1st and 3rd trimesters
The client should empty her bladder frequently and Decrease fluid intake before bedtime and use perineal pads.
Kegel exercises(alternating tightening and relaxation of pubococcygeal muscles)to reduce Stress incontience(leakage of urine with coughing and sneezing)
Urinary tract infections(UTI) are common during pregnancy because of Renal changes and the vaginal flora becoming more alkoline
UTI risk can be decreased by encouraging the client to Wipe the perineal area from font to back after voiding,Avoid bubble baths,wearing cotton underpants,avoid tight fitting clothes and 8 glasses of water a day.
The client should urinate before and after intercourse to flush bacteria from the Urethra that can be introduced during intercourse
Advise client to notify her primary care provider if her urine is Malodorous or contains blood or pus.
Fatigue may occur during the first and third trimester Encourage client to engage in frequent rest periods
Heartburn may occur during the 2nd &3rd trimester due to Stomach being displaced by the enlarging uterus and a slowing of GI tract mobility and digestion brought on by increased progesterone levels.
Heartburn The client should eat small frequent meals,not get to full or to empty,sit up 30 min after meal,and ask doctor about OTC antacids.
Constipation may occur during 2nd & 3rd trimester.The client should be encouraged to Drink plenty of fluids,high fiber diet, and exercise regularly
Hemorrhoids may occur during the 2nd & 3rd trimester A warm sitz bath,witch hazel pads,and topical ointments applied to the area will help relieve discomfort.
Backaches are common during 2nd and 3rd trimesters.The client should be encouraged to Exercise regularly,perform pelvic tilt exercises(alternately arching and straightening the back), use proper body mechanics using the legs to lift rather than the back and use side laying position.
Shortness of breath and dyspnea may occur because the diaphram is Elevated about 4cm by the enlarged uterus.
The client should maintain good posture, sleep with pillows and Contact the primary care provider if systems worsen.
Recommended weight gain during pregnancy is usually 25-35lbs
The general rule is that a client should gain 3-4lbs during the first trimester,and then1lb per week for the last two trimesters
Increasing protein intake is essential to basic growth
Increasing foods high in folic acid is crucial for Neorological development and the prevention of neural tube defects
Foods high in Folic Acid Leafy vegetables,dried peas and beans,seeds and orange juice,breads cereals and other grains.
It is recommended that 600 mcg of Folic Acid should be taken during pregnancy
Current recommendations for women lactating include Consuming 500mcg of folic acid
Iron supplements are ofter added to the prenatal plan to facilitate an increase of RBC mass
Iron is best asorbed between meals and when given with a good source of Vitamin C
Milk and Caffeine interfere with the absorption of Iron supplement
2 to 3 L of fluids are recommended daily Fluids that are preferable include water,fruit juice and milk
Caffeine intake should be limited to 300md/day
The equivalent of 500-750mL/day of coffee may increase the risk of Spontaneous abortion or fetal intrauterine growth
It is recommended that women abstain from Alcohol consumption during pregnancy
PKU This is a maternal genetic disease in which high levels of phenylalanine pose danger to the fetus
It is important for the female client to resume the PKU diet for at least 3 months prior to pregnancy and continue the diet throughout pregnancy
The clients blood phenylaline levels should be Monitored throughout pregnancy
HIV is transmitted from the mother to a neonate perinatally through the Placenta and postnatally through the breast milk
TORCH Is an acronym for a group of infections that can negatively affect a women who is pregnant
T-Toxoplasmosis Is caused by consumption of raw or undercooked meats or handling cat feces.Symptoms are similar to influenza
R-Rubella(german measles) Is contracted through children who have rashes or neonates born to mothers who had rubella while pregnant
C-Cytomegalovirus(member of the herpes virus family) Is transmitted by droplet infection from person to person, a virus found in semen,cervical and vaginal secretions,breast milk,placenta tissue,urine feces and blood.
H-Herpes Simplex Virus(HSV) Is spread by direct contact with oral or genital lesions.Transmission to the fetus is greatest during vaginal birth if the woman has active lesions
Rubella, vaccinations of women who are pregnant are Contraindicated because Rubella infection may develop.These women should avoid crowds of young children
Women with low titers prior to pregnancy should Receive immunizations
Because no treatment for cytomegalovirus exist, tell the client To prevent exposure by frequent hand hygiene before eating,and avoiding crowds of young children.
Created by: angelal0010