Acronym for pregnant woman:
GTPAL
- gravida
- term (38-42 weeks)
- preterm (= 37 weeks)
- abortions
- living
What marks the week of
... [Show More] viability:
20 weeks gestation
What is the rule used to determine gestational age:
Nagele's rule
- subtract 3 months and add 7 days and a year
Serum levels and hCG test:
- hCG can increase in production as early as the day of implantation and can be detected 7-10 days after conception
- hCG levels reach peak at 60-70 days gestation and begin to decline after 80 days
- high levels of hCG may mean ectopic pregnancy, multifetal pregnancy, or chromosomal problems such as Downs
- low levels of hCG likely mean a miscarriage
Ectopic pregnancy:
- when ovum implants into the fallopian tubes of abdominal cavity because endometrial tissue is present
- if the ovum begins to grow in the fallopian tube, it can lead to a rupture of the fallopian tubes --> fatal hemorrhage
- client will report of severe shoulder pain associated with ruptured ectopic pregnancy due to presence of blood in abdominal cavity
- unilateral stabbing pain in lower-abdominal quadrant
- can give client Methadextrone to stop the production of cells, can also surgically remove ovum
supine hypotensive syndrome:
can occur when a pregnant woman is in the supine position and an the fetus in the uterus is pressing against her inferior vena cava.
- encourage woman to roll onto her left side or go into semi-fowler's position
What does it mean when accelerations are noticed in FHR
it means that their CNS is intact
- accelerations are a good thing
Prenatal visit frequency:
- monthly for first 7 months
- every 2 weeks for the 8th month
- then every week for last months
Fetal HR can be heard by a _______ device from weeks (?-?) and it can be heard by a _________ at week (?-?)
- Doppler device at weeks 10-12
- ultrasound stethoscope around weeks 16-20
When will you apply RhoGAM
- administer RhoGAM at 28 weeks to moms who are Rh-, also can administer to mothers after delivery, should be within 72 hours
How much H2O should a pregnant woman consume?
- 2-3 liters daily
Feelings of _______ can occur during pregnancy but should resolve around_______
- ambivalence (mixed feelings)
- should resolve by 3rd trimester
First trimester:
Second trimester:
Third trimester:
- week 1-12
- week 13-27
- week 28-birth
During third trimester mother should count fetal movement for?
- at least 2-3 times a day for 60 minutes
- less than 3 fetal movements in 60 minutes means that there should be further assessment
UTIs during pregnancy:
UTIs are very common during pregnancy due to vaginal flora becoming more alkaline, which makes it easier for bacteria to grow, usually caused by e-coli
How to help with back pain:
- encourage mother to do pelvic rock exercises to help strengthen back muscles, also nurse can provide pressure on lower sacral region.
During second trimester, mothers should increase their caloric intake by:
- should eat an extra 340 cal/day
During the third trimester, mothers should increase their caloric intake by:
- should eat an extra 452 cal/day
During breastfeeding mothers should increase their caloric intake by:
- should increase caloric intake by 330 cal/day
During pregnancy mothers should also increase their intake in:
- protein: essential to basic growth
- folic acid: helps with infants neurologic development and helps prevent against fetal neural defects
- iron is also recommended and should be taken with Vit. C (helps with absorption), calcium and caffeine make it harder for iron to be absorbed
- calcium intake should be 1000mg/day
Caffeine should be limited to?
300 mg/day
- too much caffeine can increase the risk for spontaneous abortions
Vegetarians are usually low in:
- protein, vit. B 12, iron, zinc, and calcium
Low iron:
- can lead to anemia
- look for signs of pica: a condition where the person craves non-food items (chewing ice, eating chalk, laundry soap or dirt)
Excessive weight gain can lead to:
macrosomia and labor complications
Maternal Phenylketonuria (PKU)
- a genetic disorder in which mother has high levels of phenylalanie and it poses a danger to the fetus
- put mother on PKU diet
- stay away from foods high in protein (fish, beans, meat, eggs, and dairy products)
Woman who are breastfeeding should increase their intake of?
- calories by 330 cal
- iron (avoid drinking caffeine because can interfere with infants ability to absorb caffeine)
- protein
- oral fluids
- get an adequate amount of calcium
Weight gain expected during trimesters:
- first trimester: 3-4 ibs
- second trimester and third: 1 ibs/week
- weight gain for normal BMI: 25-35 ibs
External Ultrasound:
- done during the first trimester
- it is noninvasive
- does require a full bladder for best results
- want the uterus to be displaced
Transvaginal ultrasound:
- invasive procedure
- done during 3rd trimester
- gives a more accurate reading
- does not require bladder to be full
- helpful for obese patients
- want client in lithotomy position
Biophysical profile:
- looks at the physical and physiological characteristics of the fetus
- FHR
- breathing movements
- gross body movements
- fetal tone
- amniotic fluid
- give 2 pts each
- the higher the score the better
- low score can mean fetal asphyxia
Non-stress test (NST):
- checks accelerations
- monitors FHR in response to fetal movement
- Doppler transducer to monitor FHR
- tocotransducer to monitor maternal uterine contractions
- mother will have button she will press every time she fells the baby moving
- here we check to see if fetal CNS is in tact
- REACTIVE test is when there are accelerations for 15 seconds 15bpm and occurs 2+ times during 20 minute period
- NONREACTIVE test is when FHR does not accelerate adequately with fetal movements
What can the nurse do if there is no fetal movement?
nurse can use viroacoustic stimulation to try to wake the fetus up (not above 90 decibles and only for 3 seconds)
Contraction Stress Test (CST):
- looks at declarations
- analyze the FHR response to uterine contractions determines how the fetus will tolerate stress during labor
- want 3 contractions in a span of 10 minutes that last 40-60 seconds
Nipple stimulated CST:
mother will roll her nipple between her fingers to stimulate the release of oxytocin from the anterior pituitary gland, when oxytocin is released, it causes the uterus to contract
hyperstimulation of uterus:
- when uterine contraction lasts longer than 90 seconds and more frequent than 2/min, can administer tocolytics to slow down contractions and the progression of labor
oxytocin stimulate CST:
when contractions start with the administration of oxytocin (pitocin)
- may be difficult to stop
- may lead in preterm labor
- need to monitor contractions very closely
- CST
neg. CST is normal (3 uterine contractions within 10 minutes, no late decels)
+ CST
positive CST is abnormal (late decels on more than half of the contractions)
Variable decels can mean:
- cord compression
Early decels can mean:
- head compression
Prolonged decels:
- decels lasting longer than 90 seconds, these are the most concerning
What should you administer in the event of uterine hyperstimulation:
- tocolytics
Amniocentesis:
- aspiration of amniotic fluid for analysis by insertion of needle through the abdominal wall into the uterus and the amniotic sac
- can ONLY BE DONE after 14 weeks gestation
AFP:
- can be measured from the amniotic fluid between 16-18 weeks and may be used to assess for neural tube defects
- high levels: neural tube defect, spina bifida
- low levels: chromosomal disorder, downs syndrome
Lung Maturity:
- Lecithin/sphingomyelin:
want a 2:1 ratio
- want + phosphatidylglycerol (you want it to be present, because an absence is associated with respiratory distress
- can administer betamethadone to help with surfactant production --> lung maturity
Percutaneous Umbilical Blood Sampling (PUBS)
- obtains fetal blood from the umbilical cord
Chorionic Villus Sampling (CVS)
- assessment of chorionic villus from the developing placental wall
- can do this test at 10-12 weeks gestation
First trimester bleeding:
- spontaneous abortion
- ectopic pregnancy
Second trimester bleeding:
gestational trophoblastic disease
- uterine size increases at an alarming rate
- abnormally large amount to hCG
- scant or profuse dark brown or red vag. blood
Third trimester bleeding:
- placenta previa
- abruptio placenta
Spontaneous abortion:
- when pregnancy is terminated before 20 weeks of gestation or if fetal weight is less than 500g
- 50% of spontaneous abortions are caused by chromosomal abnormalities
Types of spontaneous abortions:
- threatened: moderate spotting and cervical opening closed
- inevitable: moderate cramps, mild/severe bleeding, cervix dilated, membranes or tissue protruding
- incomplete: severe cramps, bleeding, partial fetal tissue expulsion, some still left in cervical canal
- complete: all tissue expelled, minimal bleeding, mild cramps, cervical opening is closed
- missed: no cramps, brownish discharge, no tissue passed, opening is closed
- septic: usually dilated cervix and sometimes tissue passed
- reccurent: tissue passed, sometimes cramps, bleeding and usually dilated.
Dilation and Cureltage:
- D & C
- when a provider will go in a manually scrape out tissue in vaginal canal, usually used for incomplete or inevitable abortions
Dilation and Evaluations:
- used to scape out uterine contents after 16 weeks gestation
Gestational Trophoblastic Disease:
- molar pregnancy
- it is the proliferation and degradation of trophoblastic villi that will become swollen, fluid-filled and take on a grape like cluster shape
- these structures are associated with choriocarcinoma (rapidly metastasizing malignancy)
- rapid uterine growth
- excessive nausea and vomiting due to increased hCG levels
- preeclampsia before 24 weeks gestation
- scant, dark, discharge occurs in 2nd trimester
Placenta previa:
- this is when the placenta appears at the cervical opening before the fetal presenting part
- mother will be advised to remain bed rest
Abruptio Placenta:
- premature separation of the placenta from the uterine wall
- separation occurs after 20 weeks gestation
What drug is administered to promote lung maturity?
Betamethasome (Celestone)
- administer 2 injections, 24 hours apart
- requires a 24 hours period for it to become effective
- helps with fetal lung maturity and hastens surfactant production
HIV/AIDS:
- a retrovirus that destroys T-lymphocytes
- can be transmited perinatally through the placenta or even through breast milk
- when detected early providers can administer retrovir (zidovudine): antiretroviral agent
- instruct client not to breastfeed [Show Less]