Antepartum/Intrapartum ADN 240 Exam 2022/2023
GTPAL
• G: number of pregnancies
P: number of deliveries (20 weeks)
T: delivery that occurred after 38
... [Show More] weeks
P: delivery before 38 week s
A: SAB or ETOP
L: Living
Nagele's rule
• EDD = LMP -3months, +7 days
Concerns for pediatric patient
• How is she coping?
Is FOB in the picture
How will it effect school?
Nutrition
Routine prenatal care
Presumptive signs of pregnancy
• (Subjective)
Amenorrhea
N/V/ urinary frequency
Fatigue
Probable signs of pregnancy
• (Objective)
+Pregnancy test
Hegar's sign
Ballotement
Goodell's sign
Chadwick's sign
Enlarged abdomen
Palpable fetal outline
Positive signs of pregnancy
• Fetal heart tones
Fetal movement felt by examiner
Ultrasound
Ballotement
• uterus will rebound when pushed
Goodell's sign
• Softening of the cervix
Hegar's sign
Softening of the uterus
Chadwick's sign
• Purple/blue color of the cervix
PICA
• craving and eating things that are not normally considered edible
-Due to imbalance of zinc/iron
Nursing interventions for nausea
• Small frequent meals
BRAT diet
Position upright after meals
Hormones that increase during pregnancy
• Estrogen
Progesterone
Increased estrogen
Increased blood supply
-Nasal stuffiness
-Bloody gums
-Bloody nose
Increased progesterone
Relaxes smooth muscles
Increases need to breath
Heightened awareness
-PPP: Progesterone protects pregnancy
Nutritional needs during pregnancy
Increased:
-Folic acid
-Calcium
-Iron
-Water
-Calories
Decreased/Eliminated:
-Caffeine
-Smoking (quit)
-Drugs (quit)
-Fried foods (moderation)
-Fish-mercury
-Lunch meat - Lysteria (avoid)
Folic acid in pregnancy
Prevents neural tube defects
Sources for calcium
Yogurt, cheese, milk
Caffeine recommendations
200mg (2 cups) per day
Fish-mercury in pregnancy
Risk for premature, miscarriage, brain damage
Cholesterol in pregnancy
Monitor cholesterol caloric intake if risk for preeclampsia
Iron deficiency anemia in pregnancy
Common
Low iron = baby at risk for bleeding
Smoking in pregnancy
IDPH has a program for smoking cessation
Patients must be automatically referred if a smoker
Expected weight gain in pregnancy
4.4lbs in first trimester
1 lb/week after 13 weeks
Expected weight gain for patient with a normal BMI
25-35lbs (11.5-16kg)
Expected weight gain for patient who is underweight
27.5-40lbs (12.5-18kg)
Expected weight gain for a patient who is overweight
15-25lbs (7-11.5kg)
Expected weight gain for a patient who is obese
15lbs (7kg)
Things done at every prenatal visit
Vital signs (know baseline)
Weight
Urine sample (risk for UTI)
Fundal height
Leopolds maneuvers
FHR (fetal activity)
Leopold's maneuver
Determines fetal position
BP risk for pre-eclampsia
140/90
Fundal height
Measured between 18-32 weeks
Measured in centimeters
Symphysis pubis to top of uterus fundus
Purpose: approximates gestational age
-Correlated with GA: 18 wks = 18cm (may be +/- 2)
When to call MD
Swelling
Decreased fetal movement
Pain with urination
Fluid leaking
Headache (sign of elevated BP)
S/s of infection
Vaginal bleeding
Backache (poss labor)
Labor s/s
Fetal kick counts
Recommended 10kicks/hour
Nitrazine paper test
Inserted into cervix
-If turns blue than +amniotic fluid
False labor
Contractions are irregular, mild, and relieved by rest
No cervical change
Labor
Contractions are strong and not relieved by rest
Cervical change/dilation
Abruptio placenta
Premature separation of placenta from uterine wall
-Will cause bleeding
Hemoglobin in pregnancy
1st trimester: 11
2nd trimester: 10.5
3rd trimester: 11
Negative Rh Factor
Needs rhogam
-Check baby's blood type, if negative ok, if positive mother will need another
round of rhogam
RPR
Rapid plasma regimen
-Checked in 1st trimester on all PG patients
-Checked in 3rd trimester for HR patients (hx of STD, noncompliance, many
sexual partners etc)
-Normal = non-reactive
GBS
Checked around 36 weeks
-If positive, start on antibiotics
-If no cultures available, will check blood culture of baby
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