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Test 3 3rd week
Care of the Antepartum Patient
| Question | Answer |
|---|---|
| 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
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