NR602 Midterm Review
Primary Care Of The Childbearing (Chamberlain University)
, NR 602 Midterm Study Guide:
Signs of pregnancy (presumptive, probable, positive)
o Presumptive — Clinical findings include amenorrhea (menstruation is absent), nausea, vomiting,
increased urinary frequency, excessive fatigue, breast tenderness, quickening at 18-20 weeks
(All subjective signs)
o Probable — Clinical findings include uterine enlargement, Braxton hicks contractions (may be
palpated by 28 weeks), uterine souffle (soft blowing sound due to blood pulsating through
placenta), integumentary pigment changes, ballottement, fetal outline definable, positive
pregnancy test, Goodell sign (softening of cervix), Chadwick sign (cervix is blue/purple), Hegar's
sign (softening of lower uterine segment). {All Objective signs}
o Positive — Fetal heart rate auscultated by fetoscope at 17 —20 weeks or by Doppler at 10 — 12
weeks, palpable fetal outline, and fetal movement after 20 weeks, visualization of fetus
with cardiac activity by ultrasound (fetal parts visible by 8 weeks). (All Diagnostic)
Pregnancy and fundal height measurement
o As pregnancy progresses, the fundus rises out of the pelvis. At 12 weeks' gestation, the fundus
is located at the level of the symphysis pubis. By week 16, it rises to midway between
symphysis pubis and the umbilicus. By 20 weeks' gestation, the fundus is typically at the same
height as the umbilicus. Until term, the fundus enlarges approximately 1 cm per week. As the
time for birth approaches, the fundal height drops slightly. This process, which is commonly
called lightening, occurs for a woman who is a primigravida around 38 weeks' gestation but
may not occur for the woman who is a multigravida unfil she goes into labor.
, Naegele's rule
o The EDD is calculated by adding seven days to the first day of the last menstrual period,
subtracting three months and adding one year.
Hematological changes during pregnancy
o Anatomically, the kidneys are displaced and increase in size during pregnancy. The renal tubules
dilate, leading to urinary stasis, which in turn increases the risk for urinary tract infections.
Bladder tone is decreased due to the effects of progesterone, which can lead to urinary
frequency and incontinence. Urinary frequency is more common in the first and third trimesters.
Urinary incontinence is most common in women who have had more than one pregnancy
(multiparas)
Hematologic Nonpregnant First Second Third
Measure Women, Ages Trimester Trimester Trimester
19-65
Hemoglobin 12—16 g/dL 11.6—13.9 9.7—14.8 9.5—15 g/dL
g/dL g/dL
Hematocrit 37—47% 31—41% 30—39% 28—40%
Red blood cell 3.5—5.5/mm° 3.4— 2.8—4.5/mm’ 2.7—4.4/mm°
count 5.2/mm’
White blood cell 4.5—11/mm› 4—13/mm° 6—14/mm° 6—17/mm°
count
Indications and contraindications for prescribing combined estrogen vs. progesterone-only
birth control
o Two types of hormonal contraceptives are available: those that contain progestin (progestin-
only) and those that contain progestin and estrogen (combined). Progestin, the synthetic
version of the endogenous hormone progesterone, is highly effective alone as a contraceptive,
but may cause irregular bleeding. The addition of estrogen to progestin in combined methods
results in more predictable bleeding patterns due to stabilization of the endometrium. Estrogen
as a single agent for contraception requires doses that may cause unacceptable risks of serious
side effects, such as thromboembolic events and endometrial hyperplasia. The synergistic
activity of estrogen and progestin makes it possible to combine these hormones in lower doses
to produce successful contraception than would be possible using either hormone alone
o During the first few postpartum weeks, the risk of venous thromboembolism (VTE; deep
vein thromboses and pulmonary emboli) is greatly elevated in all women; consequently,
estrogen-
Primary Care Of The Childbearing (Chamberlain University)
, NR 602 Midterm Study Guide:
Signs of pregnancy (presumptive, probable, positive)
o Presumptive — Clinical findings include amenorrhea (menstruation is absent), nausea, vomiting,
increased urinary frequency, excessive fatigue, breast tenderness, quickening at 18-20 weeks
(All subjective signs)
o Probable — Clinical findings include uterine enlargement, Braxton hicks contractions (may be
palpated by 28 weeks), uterine souffle (soft blowing sound due to blood pulsating through
placenta), integumentary pigment changes, ballottement, fetal outline definable, positive
pregnancy test, Goodell sign (softening of cervix), Chadwick sign (cervix is blue/purple), Hegar's
sign (softening of lower uterine segment). {All Objective signs}
o Positive — Fetal heart rate auscultated by fetoscope at 17 —20 weeks or by Doppler at 10 — 12
weeks, palpable fetal outline, and fetal movement after 20 weeks, visualization of fetus
with cardiac activity by ultrasound (fetal parts visible by 8 weeks). (All Diagnostic)
Pregnancy and fundal height measurement
o As pregnancy progresses, the fundus rises out of the pelvis. At 12 weeks' gestation, the fundus
is located at the level of the symphysis pubis. By week 16, it rises to midway between
symphysis pubis and the umbilicus. By 20 weeks' gestation, the fundus is typically at the same
height as the umbilicus. Until term, the fundus enlarges approximately 1 cm per week. As the
time for birth approaches, the fundal height drops slightly. This process, which is commonly
called lightening, occurs for a woman who is a primigravida around 38 weeks' gestation but
may not occur for the woman who is a multigravida unfil she goes into labor.
, Naegele's rule
o The EDD is calculated by adding seven days to the first day of the last menstrual period,
subtracting three months and adding one year.
Hematological changes during pregnancy
o Anatomically, the kidneys are displaced and increase in size during pregnancy. The renal tubules
dilate, leading to urinary stasis, which in turn increases the risk for urinary tract infections.
Bladder tone is decreased due to the effects of progesterone, which can lead to urinary
frequency and incontinence. Urinary frequency is more common in the first and third trimesters.
Urinary incontinence is most common in women who have had more than one pregnancy
(multiparas)
Hematologic Nonpregnant First Second Third
Measure Women, Ages Trimester Trimester Trimester
19-65
Hemoglobin 12—16 g/dL 11.6—13.9 9.7—14.8 9.5—15 g/dL
g/dL g/dL
Hematocrit 37—47% 31—41% 30—39% 28—40%
Red blood cell 3.5—5.5/mm° 3.4— 2.8—4.5/mm’ 2.7—4.4/mm°
count 5.2/mm’
White blood cell 4.5—11/mm› 4—13/mm° 6—14/mm° 6—17/mm°
count
Indications and contraindications for prescribing combined estrogen vs. progesterone-only
birth control
o Two types of hormonal contraceptives are available: those that contain progestin (progestin-
only) and those that contain progestin and estrogen (combined). Progestin, the synthetic
version of the endogenous hormone progesterone, is highly effective alone as a contraceptive,
but may cause irregular bleeding. The addition of estrogen to progestin in combined methods
results in more predictable bleeding patterns due to stabilization of the endometrium. Estrogen
as a single agent for contraception requires doses that may cause unacceptable risks of serious
side effects, such as thromboembolic events and endometrial hyperplasia. The synergistic
activity of estrogen and progestin makes it possible to combine these hormones in lower doses
to produce successful contraception than would be possible using either hormone alone
o During the first few postpartum weeks, the risk of venous thromboembolism (VTE; deep
vein thromboses and pulmonary emboli) is greatly elevated in all women; consequently,
estrogen-
