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Mom/Baby Exam 2

Chs: 8, 9, 13-16

Nutrients important during pregnancy calcium, protein, iron, B-complex vitamins, vitamin C, magnesium
Birth preference plan writing down preferences; prospective parents can identify aspects of the childbearing experience that are most important to them
Doula specialized childbirth support person; caters to mother; cannot facilitate birth, may assist in breathing techniques
Prenatal education provide important opportunities to share information about pregnancy and childbirth and to enhance the parents' decision-making skills
Early prenatal classes (First trimester) early gestational changes, self-care, fetal development, environmental dangers, sexuality, birth settings and types of HCPs, nutrition, rest, or exercise suggestions, relief measures, psychologic changes, danger signs, feeding choices/breastfeeding
Later prenatal classes (Second and Third trimester) prep for birth, post self-care, birth choices, relaxation techniques, breathing techniques, alt. therapies, infant stimulation/massage, safety issues (car seats, sleeping position, etc), sibling prep
Adolescent Preparation classes how to be a good parent, newborn care, health dangers, weight gain issues and nutrition, how to recognize that baby is ill, baby care (physical and emotional), sexuality, peer relationships
Breastfeeding programs advantages/disadvantages of breastfeeding, maternal nutrition, techniques, methods of storage, involvement of fathers, returning to work, cultural considerations
Abdominal effleurage a light stroking movement made over the abdominal wall with the fingertips; provides TACTILE stimulation to fetus
La Leche League nonprofit organization that promotes breastfeeding
Pelvic-tilt exercises rocking in a rocking chair or actually exercising; provides VESTIBULAR stimulation to fetus
Auditory stimulation speaking to fetus; causes heart rate accelerations and a motor response
Vaginal birth after cesarean (VBAC) supply information about vaginal births; parents should prepare 2 birth plans in the event of c-section again;
Bradley method "best, safest, and most rewarding birth experience possible"; goals: natural, active participation of husband as coach, excellent nutrition, breastfeeding; work in harmony c body using abdominopelvic breathing; relaxation
Lamaze method "childbirth education empowers..."; goals: normal, natural, healthy birth, experience profoundly affects, inner wisdom guides thru birth, women have right to no meds; disassociation, muscular relaxation, breathing patterns, positioning
Kitzinger method "information to make decisions; home birth for those not at risk"; sensory memory to help prepare body; chest breathing & ab relaxation, Stanislavsky method for relaxation
Hypnobirthing method "eliminate fear; stress-free, calm, and gentle environment"; mind and body relaxed, endorphins are body's natural anesthesia; deep, slow breathing, relaxation, breathing baby down, comfort and eliminate pain
Changes: uterus increased amounts of estrogen and progesterone; enlargement in size; increase in weight, strength, elasticity, and vascularity
Changes: cervix increased estrogen levels; hyperplasia; formation of mucous plug - prevents organisms from entering; discharge may increase - thick and sticky
Goodell's sign softening of cervix
Chadwick's sign bluish discoloration of cervix
Braxton Hicks contractions irregular, generally painless contractions of the uterus; occurs intermittently throughout pregnancy; may be felt around the 4th month
Changes: vagina increased estrogen levels; increased thickness of mucosa; increased secretions to prevent infections; connective tissue relaxes; pH becomes more acidic; increased blood flow - darker pigmentation
Changes: breasts increased estrogen and progesterone levels; increased in size and number of mammary glands; nipples more erectile and areolas darken; colostrum produced during 3rd trimester - rich in antibodies and nutrients; superficial veins more visible; stretch marks
Montgomery's tubercles sebaceous glands on breasts; enlarge during pregnancy
Changes: respiratory system increasing levels of progesterone causes: increased volume of air, decreased airway resistance, increased anteroposterior diameter, thoracic breathing occurs as uterus enlarges; some hyperventilation may occur; nose bleeds and stuffy nose
"lightening" baby "drops" into pelvic area allowing for easier breathing
Changes: cardiovascular system increased levels of estrogen and progesterone; cardiac output and blood volume increases; swelling in lower extremities (edema); increased levels of RBC (40-50%), increase O2; clotting factors increase; pulse incre by 10-15 BPM
Changes: GI system rising levels of progesterone cause: delayed gastric emptying and peristalsis (consti, naus, vomit); change in carb metabolism; may bleed from gums easier; smooth muscle relaxation
Changes: GU system increased blood volume; glomerular filtration rate increases; urinary frequency in 1st/3rd trimester; renal tubular reabsorption increases;
Changes: skin and hair increased skin pigmentation caused by increased estrogen and progesterone; areola, vulva, and linea nigra; "mask of pregnancy" on face - should fade post; vascular spider nevae; increased nail strength
Changes: musculoskeletal relaxation of joints caused by increased estrogen and progesterone; no changes to teeth - bleeding gums; waddling gait, center of gravity changes, lordosis, lower back pain, separation of muscle in abdomen
Changes: CNS decreased attention, concentration, and memory at tail end of pregnancy and early post; headaches - BAD
Changes: metabolism and weight gain increased during pregnancy; baby takes what it needs, left overs to mom; average = 25-35 lbs, overweight = 15 lbs, underweight = up to 40 lbs
Changes: endocrine system thyroid: enlarges, inc serum protein, inc bound iodine, Basal M rate inc; pituitary: makes preg possible, maintains, prolactin; adrenals: cortisol reg carb/protein metabolism; pancreas: inc insulin needs
Supine hypotensive syndrome enlarging uterus may also press on the aorta and its collateral circulation; AKA - vena caval syndrome or aortocaval compression; have woman lie on side or pillow under right hip
cholasma (melasma gravidarum) "mask of pregnancy"
diastasis recti pressure on enlarging uterus on the abdominal muscles may cause the rectus abdominis muscle to separate
Water retention is caused by... increased level of steroid sex hormones; affects sodium and fluid
Human chorionic gonadotropin stimulates progesterone and estrogen production by the corpus luteum to maintain pregnancy until placenta takes over
Human placental lactogen antagonist of insulin; decreases fetal metabolism of glucose
Estrogen produced primarily by the placenta as early as the 7th week; stimulate uterine development; helps develop ductal system of the breasts in prep for lactation
Progesterone greatest role in maintaining pregnancy; inhibits spontaneous uterine contractility; helps prep for lactation
Relaxin inhibits uterine activity, diminishes strength of uterine contractions, aids in the softening of cervix, long-term effects of remodeling connective tissue
Hegar's sign softening of the isthmus of the uterus; area between the cervix and the body of the uterus
McDonald's sign: ease in flexing the body of the uterus against the cervix
Ballottement passive fetal movement elicited when the examiner inserts two gloved fingers into the vagina and pushes against the cervix
Rubin's Four Tasks ensuring safe passage thru pregnancy, labor and birth; seeking acceptance of child by others; seeking commitment and acceptance of herself; learning to give oneself on behalf of child
Early adolescence pregnancy age 14 and under; still sees authority in his/her parents; gains independence by spending more time c friends; egocentric and concrete thinker; minimal ability to see future or consequences of actions
Middle adolescence pregnancy ages 15-17 years; time for challenging and experimenting; begin to move from concrete to formal operational thought; still struggles with consequences
Late adolescence pregnancy ages 18-19 years; more at ease c individuality and decision-making ability; think abstractly and anticipate consequences; formal operational thought; accept consequences
Nursing care for the pregnant adolescent provide info: regular prenatal visits, signs of complications, STIs, substance abuse
Ultrasound early identification of preg (week 5-6);fetal heartbeat (11 wks);ID of multiples;measure head to assess growth;estimation of birth weight;fetal/facial abnormalities;location of placenta and grading;fetal death;position
Nuchal translucency testing (NTT) 11-13 weeks gestation; screening for trisomies 13,18,21; looks at clear area on back of neck and measures diameter
Umbilical velocimetry noninvasive ultrasound test; measures blood flow changes that occur in maternal and fetal circulation in order to assess placental function
Nonstress test (NST) evaluates fetal status; based on the knowledge that when the fetus has adequate oxygenation and an intact CNS, there are accelerations of the fetal heart rate with fetal movement
Biophysical profile (BPP) fetal breathing and movement; fetal movements of body or limbs; fetal tone (extension and flexion of extremities); amniotic fluid volume; reactive FHR with activity; combines ultrasound c NST
Contraction stress test (CST) means of evaluating the respiratory function of the placenta; contraindicated in 3rd trimester bleeding, and many others; contractions must be present; do not overstimulate; negative is normal; positive means the fetus may not be able to handle labor
Amniocentesis procedure used to obtain amniotic fluid for genetic testing for abnormalities or fetal lung maturity in 3rd trimester; early or 15-16 wk; 22 gauge needle to take 15-20 mL
Quadruple screen used to screen for Down syndrome (trisomy 21), trisomy 18, and neural tube defects; amniocentesis required
Chorionic villus sampling (CVS) obtain a small sample of chorionic villi from the developing placenta; 1st trimester; diagnosis of genetic, metabolic, and DNA studies; 10-12 weeks; cannot detect neural tube defects; higher risk of fetal loss
Alcohol CNS depressant and potent teratogen; 3-8 weeks is crucial time - alcohol does most damage; fetal alcohol spectrum disorders - physical and psychological deformities; excreted in breast milk - "pump and dump"
Drug abuse (cocaine/crack and marijuana) cocaine and crack: maternal hypotension, small head and shorter babies, dilated pupils, crosses into milk; marijuana: no evidence of teratogenic effects, withdrawal
Drug abuse (Ecstasy and Heroin) Ecstasy: little is known, may cause death; heroin: malnutrition, intrauterine growth restriction, inc risk of HIV, hypoxia, shrill cry, withdrawal occurs within 72 hrs, given valium and methodone
Methadone given to mothers who are suffering from withdrawal from heroin; crosses placenta; blocks symptoms of withdrawal; low incidence of tolerance
Diabetes mellius during pregnancy endocrine disorder; maternal risks - hydraminos, pre/eclampsia, ketoacidosis, infections; fetal risks - macrosomia, IUGR, resp distress syn, polycythemia, jaundice; CONTROL!
Anemia hemoglobin of less then 11 g/dL in the 1st trimester, 10.5 g/dL in 2nd, 11 g/dL in 3rd; fatigue, pallor; low birth weight, premature, stillbirth; iron, folic, sickle, thalassemia
Human Immunodeficiency Virus (HIV) infection can pass HIV to baby - transplacental, breastmilk, or vaginally; three-part ZDV prophylaxis regimen; c-section and no breastfeeding
Heart disease during pregnancy decreased cardiac reserve and diminished capacity to handle pregnancy workload; rheumatic fever - untreated group A beta-hemolytic strep infections; mitral valve prolapse -usually tolerate well; peripartum cardiomyopathy-not well
Hepatitis B during pregnancy does not affect course of pregnancy but can be transmitted; routine vaccinations of all infants at birth
Thyroid medications during pregnancy breastfeeding is contraindicated; not medicated - fetal loss is great
Maternal phenylketonuria (PKU or hyperphenylalaninemia) low phenylalanine diet is mandatory at conception and during pregnancy; fetal levels are generally 50% higher than mother; can cause mental retardation, microcephaly, heart defects, IUGR
Multiple sclerosis during pregnancy in remission - okay; rest is important; labor may be almost painless; voluntary pushing may be hindered; genetic predisposition
Systemic lupus erythematosus (SLE) remission, okay; plan pregnancy because meds are teratogenic; prenal visits and testing are more frequent; prognosis of infant varies, may need pacemaker
Tuberculosis (TB) supplemental B6 vitmains; extra rest and limited contact with others; if maternal TB is inactive, breastfeed; newborn cannot have contact until mother is healthy
Abortion (or miscarriage) expulsion of the fetus prior to viability; spontaneous - occurring naturally, induced - result of a medical or surgical means; pelvic cramping and backache
Ectopic pregnancy implantation of the fertilized ovum in a site other than the endometrial lining of the uterus; cannot growth and thrive; may cause infertility
Hydatidiform mole (molar pregnancy) disease in which abnormal development of placenta occurs, resulting in hydropic vesicles (fluid-filled, grapelike cluster) and the trophoblastic tissue proliferates; loss of pregnancy; complete-empty egg, can lead to cancer; partial-69 chromosomes, miscar
Incompetent cervix premature dilation of the cervix in 4th or 5th month; purse string suture of cervix and planned c-section
Hyperemesis gravidarum excessive vomiting during pregnancy; woman vomits everything she eats and retches between meals; dehydration may occur, metabolic acidosis, low potassium
Preeclampsia most common hypertensive disorder; increase in blood pressure after 20 weeks gestation accompanied by proteinuria; mild or severe; eclampsia - most severe form; generalized seizures or coma can develop; only cure is birth and removal of baby and placenta
HELLP syndrome hemolysis, elevated liver enzymes, and low platelet count; sometimes associated with severe preeclampsia;
Pre/eclampsia (maternal risks) CNS changes: hyperreflexa, headache, and seizures; increased risk for: thrombocytopenia, renal failure, abrupto placentae, DIC, ruptured liver, and pulmonary embolism
Rh alloimmunization fetus is incompatible with the Rh of the mother; if Rh negative woman carries an Rh positive baby; the mother's body begins attacking fetus; RhoGAM is given to prevent the attack
Surgery during pregnancy early second trimester is the best time; place a wedge under hip during and after surgery; catheter and NG tube placed; endotracheal tube required during surgery
Trauma during pregnancy save mom - saves baby; turn on left side, oxygen, IV fluids, control bleeding, ABCs; fetal monitoring for at least 4 hours; fetus born after 5 minutes of maternal death is okay
Abused pregnant woman if violence in a relationship is to occur, more likely during pregnancy; may result in loss of pregnancy, preterm labor, low birth weight, c-section; delay in starting prenatal care and higher rates of complications; safe environment
Rubella during pregnancy AKA German Measles; period of greatest risk is 1st trimester; congenital cataracts, sensorineural deafness, congenital heart defects; isolated at birth (elevated IgM titer); prevention!; abortion
Placenta previa placenta's position is slightly turned; may cover cervical os partially, completely or just near the os
Abrupto placentae the placenta separates from the uterine wall
Magnesium sulfate anticonvulsant; given during preeclampsia and eclampsia to avoid seizures; given as a bolus
Created by: jodybreeze2013