Essential of Maternity, Newborn, and Women's Health Nursing, 3rd Edition Chapter 12 Nursing Management During Pregnancy correctly Answered

alpha-fetoprotein - ANSWERS amniocentesis - ANSWERS biophysical profile (BPP) - ANSWERS chorionic villus sampling (CVS) - ANSWERS gravid - ANSWERSthe state of being pregnant gravida - ANSWERS*a pregnant woman *gravida I (primigravida) during the first pregnancy *gravida II (secundigravida) during the second pregnancy, and so on high-risk pregnancy - ANSWERS linea nigra - ANSWERS natural childbirth - ANSWERSa birth without pain-relieving medication para - ANSWERSthe number of deliveries at 20 weeks or greater that a woman has, regardless of whether the newborn is born alive or dead perinatal education - ANSWERS preconception care - ANSWERS Individual responsibility across the lifespan recommendation 1 of preconception care - ANSWERSeach woman, man, and couple should be encouraged to have a reproductive life plan Consumer awareness recommendation 2 of preconception care - ANSWERSincrease public awareness of the importance of preconception health behaviors and preconception care services by using information and tools appropriate across various ages; literacy, including health literacy; and cultural/linguistic contexts Preventive visits recommendation 3 of preconception care - ANSWERSas a part of primary care visits, provide risk assessment and educational and health promotion counseling to all women of childbearing age to reduce reproductive risks and improve pregnancy outcomes Interventions for identified risks recommendation 4 of preconception care - ANSWERSincrease the proportion of women who receive interventions as follow-up preconception risk screening, focusing on high-priority interventions (i.e., those with evidence of effectiveness and greatest potential impact) Interconception care recommendation 5 of preconception care - ANSWERSuse the interconception period to provide additional intensive interventions to women who have had a previous pregnancy that ended in an adverse outcome (i.e., infant death, fetal loss, birth defects, low birth weight, or preterm birth) Prepregnancy checkup recommendation 6 of preconception care - ANSWERSoffer, as a component of maternity care, one prepregnancy visit for couples and persons planning pregnancy Health insurance coverage for women with low incomes recommendation 7 of preconception care - ANSWERSincrease public and private health insurance caiverage for women with low incomes to improve access to preventive women's health and preconception and interconception care Public health programs and strategies recommendation 8 of preconception care - ANSWERSintegrate components of preconception health into existing local public health and related programs, including emphasis on interconception interventions for women with previous adverse outcomes Research recommendation 9 of preconception care - ANSWERSincrease the evidence base and promote the use of the evidence to improve preconception health Monitoring improvement recommendation 10 of preconception care - ANSWERSmaximize public health surveillance and related research mechanisms to monitor preconception health Isotretinoins adverse pregnancy outcomes - ANSWERS*Use of isotretinoins (e.g., Accutane) in pregnancy to treat acne can result is miscarriage and birth defects. *Effective pregnancy prevention should be implemented to avoid unintended pregnancies among women with childbearing potential who use this medication Alcohol misuse adverse pregnancy outcomes - ANSWERS*No time during pregnancy is safe to drink alcohol, and harm can occur early, before a woman has realized that she is or might be pregnant *Fetal alcohol syndrome and other alcohol-related birth defects can be prevented if women cease intake of alcohol before conception Anti-epileptic drugs adverse pregnancy outcomes - ANSWERS*Certain antiepileptic drugs are known teratogens (e.g., valproic acid) *Recommendations suggest that before conception, women who are on a regimen of these drugs and who are contemplating pregnancy should be prescribed a lower dosage of these drugs Diabetes (preconception) adverse pregnancy outcomes - ANSWERSThe threefold increase in the prevalence of birth defects among infants of women with type 1 and type 2 diabetes is substantially reduced through proper management of diabetes Folic acid deficiency adverse pregnancy outcomes - ANSWERSDaily use of vitamin supplements containing folic acid (400 mcg) has been demonstrated to reduce the occurrence of neural tube defects by two thirds Hepatitis B adverse pregnancy outcomes - ANSWERS*Vaccination is recommended for men and women who are at risks for acquiring hepatitis B virus (HBV) infection *Preventing HBV infection in women of childbearing age prevents transmission of infection to infants and eliminates risk to the woman of HBV infection and sequelae, including hepatic failure, liver carcinoma, cirrhosis, and death HIV/AIDs adverse pregnancy outcomes - ANSWERSIf HIV infection is identified before conception, timely antiretroviral treatment can be administered, and women (or couples) can be given additional information that can help prevent mother-to-child transmission Hypothyroidism adverse pregnancy outcomes - ANSWERS*the dosages of Levothyroxine required for treatment of hypothyroidism increase during early pregnancy *Levothyroxine dosage needs to be adjusted for proper neurologic development of the fetus Maternal phenylketonuria (PKU) adverse pregnancy outcomes - ANSWERS*Women diagnosed with PKU as infants have an increased risk for delivering neonates/infants with intellectual disability *However, the adverse outcome can be prevented when mothers adhere to a low-phenylalanine diet before conception and continue it throughout their pregnancy Rubella seronegativity adverse pregnancy outcomes - ANSWERSRubella vaccination provides protective seropositivity and prevents congenital rubella syndrome Obesity adverse pregnancy outcomes - ANSWERS*Adverse perinatal outcomes associated with maternal obesity include neural tube defects, preterm delivery, diabetes, cesarean section, and hypertensive and thromboembolic disease. *Appropriate weight loss and nutritional intake before pregnancy reduce these risks Oral anticoagulant adverse pregnancy outcome - ANSWERS*Warfarin, which is used for the control of blood clotting, has been demonstrated to be a teratogen *To avoid exposure to warfarin during early pregnancy,medications can be changed to a nonteratogenic anticoagulant before the onset of pregnancy STIs adverse pregnancy outcome - ANSWERS*Chlamydia trachomatis and Neisseria gonorrhoeae have been strongly associated with ectopic pregnancy, infertility, and chronic pelvic pain *STIs during pregnancy might result in fetal death or substantial physical and developmental disabilities, including intellectual disability and blindness *Early screening and treatments prevents these adverse outcomes Smoking adverse pregnancy outcome - ANSWERS*Preterm birth, low birth weight, and other adverse perinatal outcomes associated with maternal smoking in pregnancy can be prevented if women stop smoking before or during early pregnancy. *Because only 20% of woman successfully control tobacco dependency during pregnancy, cessation of smoking is recommended before pregnancy Preconception care involves obtaining a complete health history and physical examination of the woman and her partner. Key areas include: - ANSWERS*Immunization status of the woman *Underlying medical conditions, such as cardiovascular and respiratory problems or genetic disorders *Reproductive health data, such as pelvic examination, use of contraceptives, and sexually transmitted infections (STIs) *Sexuality and sexual practices, such as safer-sex practices and body image issues *Nutrition history and present status *Lifestyle practices, including occupation and recreational activities *Psychosocial issues such as levels of stress and exposure to abuse and violence *Medication and drug use, including use of tobacco, alcohol, over-the-counter and prescription medications and illicit drugs *Support system, including family, friends, and community At first prenatal visit - ANSWERSonly high-risk women should undergo testing of fasting plasma glucose hemoglobin A1c or random plasma glucose testing based on her risk factors, weight status, and family history Threshold for diagnosis of overt diabetes during pregnancy are: - ANSWERS*Fasting plasma glucose: 126 mg/dL *Hemoglobin A1c level: at least 6.5% *Random plasma glucose: 200 mg/dL If glucose testing is not diagnostic of overt diabetes - ANSWERSthe woman should be tested for gestational diabetes from 24 to 28 weeks of gestation with a 75-g oral glucose tolerance test Gravid - ANSWERSthe state of being pregnant Gravida - ANSWERSrefers to a pregnant woman Gravidity - ANSWERSrelates to the number of times that woman has been pregnant, irrespective of the outcome Nulligravida - ANSWERSa woman who has never experienced pregnancy Primigravida - ANSWERSa woman pregnant for the first time Multigravida - ANSWERSa woman pregnant for at least the third time Para - ANSWERSthe number of deliveries at 20 weeks or greater Parity - ANSWERSrefers to the number of pregnancies, not the number of fetuses, carried to the point of viability, regardless of the outcome Multipara - ANSWERSa woman who has had two or more pregnancies resulting in viable offspring GTPAL or TPAL - ANSWERS*G=gravida *T=term births *P=preterm births *A=abortions *L=living children G-gravida - ANSWERSthe current pregnancy to be included in count T-term births - ANSWERSthe number of term gestation delivering between 38 and 42 weeks P-premature births - ANSWERSthe number of preterm pregnancies ending >20 weeks or viability but before completion of 37 weeks A-abortion - ANSWERSthe number of pregnancies ending before 20 weeks or viability L-living children - ANSWERSthe number of children currently living The recommended follow-up visit schedule for a healthy pregnant woman is as follows: - ANSWERS*every 4 weeks up to 28 weeks (7 months) *every 2 weeks from 29 to 36 weeks *every week from 37 weeks to birth At each subsequent prenatal visit the following assessments are completed: - ANSWERS*weight and blood pressure, which are compared to baseline values *urine testing for protein, glucose, ketones, and nitrites *fundal height measurement to assess fetal growth *assessment for quickening/fetal movement to determine fetal well-being *assessment of fetal heart rate (should be 110 to 160 bpm) Complete blood cell count (CBC) lab during pregnancy - ANSWERS*Evaluates hemoglobin (12-14 g) and hematocrit (42%+ 5) *levels and red blood cell count (4.2-5.4 million/mm3) to detect presence of anemia *identifies white blood cell level (5,000-10,000/mm3), which if elevated may indicate an infection *determines platelet count (150,000-450,00 mL3) to assess clotting ability Blood typing lab during pregnancy - ANSWERS*Determine woman's blood type and Rh status to rule out and blood incompatibility issues early *Rh-negative mother would likely receive Rhogam (at 28 week's gestation) and again within 72 hours after childbirth, if she is Rh negative Hepatitis B lab during pregnancy - ANSWERSDetermines if mother has hepatitis B be detecting presence of hepatitis antibody surface antigen (HbsAg) in her blood Rubella titer lab during pregnancy - ANSWERS*Detects antibodies for the virus that causes German measles *It titer is 1:8 or less, the woman is not immune *Requires immunization after birth, and woman is advised to avoid people with undiagnosed rashes HIV testing lab during pregnancy - ANSWERSDetects HIV antibodies and if positive requires more specific testing, counseling, and treatment during pregnancy with antiretroviral medications to prevent transmission to fetus STI screening: Venereal Disease Research Laboratory (VDRL) or rapid plasma reagin (RPR) serologic tests or by cervical smears, cultures, or visual identification of suspicious lesions lab during pregnancy - ANSWERSDetects STIs (such as syphilis, herpes, HPV, gonorrhea) so that treatment can be initiated early to prevent transmission to fetus Cervical smears lab during pregnancy - ANSWERSDetects abnormalities such as cervical caner (Pap test) or infections such as gonorrhea, chlamydia, or group B streptococcus so that treatment can be initiated if positive Danger signs during the first trimester - ANSWERS*spotting or bleeding (miscarriage) *painful urination (infection) *severe persistent vomiting (hyperemesis gravidarum) *fever >100 degree F (37.7 degree C) (infection) *lower abdominal pain with dizziness and accompanied by shoulder pain (ruptured ectopic pregnancy) Danger signs during the second trimester - ANSWERS*regular uterine contractions (preterm labor) *pain in calf, often increased with foot flexion (blood clot in deep vein) *sudden gush or leakage of fluid from vagina (premature rupture of membranes) *absence of fetal movement for more than 12 hours (possible fetal distress or demise) Danger signs during the third trimester - ANSWERS*sudden weight gain; periorbital of facial edema, severe upper abdominal pain or headache with visual changes (pregnancy-induced hypertension) *decrease in fetal daily movement for more than 24 hours (possible demise) *Any of the previous warning signs and symptoms can also be present in this last trimester Assessment of Fetal Well-being - ANSWERS*Ultrasonography *Doppler Flow Studies *Alpha-fetoprotein analysis *Marker screening tests *Nuchal translucency screening *Amniocentesis *Chorionic villus sampling (CVS) *Nonstress test *Contraction stress test *Biophysical profile Urinary frequency or incontinence management during pregnancy - ANSWERS*Try Kegel exercise to increase control over leakage *Empty your bladder when you first feel a full sensation *Avoid caffeinated drinks, which stimulates voiding *Reduce your fluid intake after dinner to reduce nighttime urination Fatigue management during pregnancy - ANSWERS*Attempt to get a full night's sleep, without interruptions *Eat a healthy balanced diet *Schedule a nap in the early afternoon daily *When you are feeling tired, rest Nausea and vomiting management during pregnancy - ANSWERS*Avoid an empty stomach at all times *Munch on dry crackers/toast in bed before arising *Eat several small meals throughout the day *Drink fluids between meals rather than with meals *Avoid greasy, fried foods or ones with stronger odor, such as cabbage or Brussels sprouts Backache management during pregnancy - ANSWERS*Avoid standing or sitting in one position for long periods *Apply heating pad (low setting) to the small of your back *Support your lower back with pillows when sittings *Stand with your shoulders back to maintain correct posture Leg cramps management during pregnancy - ANSWERS*Elevate legs above heart level frequently throughout the day *If you get a cramp, straighten both legs and flex your feet toward your body *Ask your health care provider about taking additional calcium supplements, which may reduce leg spasms Varicosities management during pregnancy - ANSWERS*Walk daily to improve circulation to extremities *Elevate both legs above heart level while resting *Avoid standing in one position for long periods of time *Don't wear constrictive stockings and socks *Don't cross the legs when sitting for long periods *Wear support stockings to promote better circulation Hemorrhoids management during pregnancy - ANSWERS*Establish a regular time for daily bowel elimination *Prevent straining by drinking plenty of fluids and eating fiber-rich foods and exercising daily *Use warm sitz baths and cool with witch hazel compresses for comfort Constipation management during pregnancy - ANSWERS*Increase your intake of foods high in fiber and drink at least eight 8-ounce glasses of fluid daily *Exercise each day (brisk walking) to promote movement through the intestine *Reduce the amount of cheese consumed Heartburn/Indigestion management during pregnancy - ANSWERS*Avoid spicy or greasy foods and eat small frequent meals *Sleep or several pillows so that your head is elevated *Stop smoking and avoid caffeinated drinks to reduce stimulation *Avoid lying down for at least 2 hours after meals *Try drinking sips of water to reduce burning sensation *Take antacids sparingly if burning sensation is severe Braxton Hicks Contraction management during pregnancy - ANSWERS*Keep in mind that these contractions are a normal sensation. Try changing your position or engaging in mild exercise to help reduce the sensation *Drink more fluids if possible Other helpful tips to deal with nausea and vomiting include: - ANSWERS*Get out of bed in the morning very slowly *Avoid sudden movements *Eat a high-protein snack before retiring at night to prevent an empty stomach *Take ginger (up to 1g daily) which increases tone and peristalsis in the GI tract *Open windows to remove odors of food being cooked *Eat more protein than carbohydrate and take in more liquids than solids *Limit intake of fluids or soups during meals (drink them between meals) *Avoid fried foods and foods cooked with grease, oils, fatty meats, because they tend to be upset the stomach *Avoid highly seasoned foods such as those cooked with garlic, onions, peppers, and chili *Drink a small amount of caffeine-free carbonated beverages (ginger ale) if nauseated *Avoid strong smells *Avoid wearing tight or restricting clothes, which might place increased pressure on the expanding abdomen *Avoid stress Hot tubs and saunas in pregnancy - ANSWERS*the heat may cause fetal tachycardia as well as raise the maternal temperature *exposure to bacteria in hot tubs that have not be cleaned sufficiently is another reason to avoid them during pregnancy Perineal Care - ANSWERS*advise pregnant women to shower frequently and wear all-cotton underwear to minimize the effects of extra vaginal secretions *caution pregnant women not to douche, because douching can increase the risk of infection *not to wear panty liners, which block air circulation and promote moisture *explain they should also avoid perfumed soaps, perineal sprays, and harsh laundry detergents to help prevents irritation and potential infection Dental Care - ANSWERS*Periodontal disease is a contributing factor to systemic conditions , such as heart disease, respiratory diseases, diabetes mellitus, adverse pregnancy outcomes (preteerm births, low-birth-weight infants, and small-for-gestational-age infants) Additional guidelines that the nurse should stress regarding maintaining dental health include: - ANSWERS*Seek professional dental care during the first trimester for assessment and care *Obtain treatment for dental pain and infection promptly during pregnancy *Brush twice daily 2 minutes, especially before bed, with fluoridated toothpaste and rinse well. Use a soft-bristle toothbrush and be sure to brush at the gum line to remove food debris and plaque to keep gums healthy *Floss teeth daily with dental floss and rinse well afterward with plain water *Eat healthy foods, especially those high in vitamin A,C, and D and calcium *Avoid sugary snacks *Chew sugar-free gum for 10 minutes after a meal if brushing is not possible *After vomiting, rinse your mouth immediately with baking soda (1/4 teaspoon) and warm water (1 cup) to neutralize the acid Breast care - ANSWERS*instruct the woman to anticipate buying a larger-sized bra about halfway through her pregnancy because of the increasing size of the breasts *avoid using soap on the nipple area because it can be very drying *encourage her to rinse the nipple with plain water while bathing to keep it clean *Montgomery glands secrete a lubricating substance that keeps the nipples moist and discourages growth of bacteria, so there is no need to use alcohol or other antiseptics on the nipples Clothing - ANSWERS*point out that loose clothing will be more comfortable for the client and her expanding waistline *advise pregnant women to avoid wearing constricting clothes and girdles that compress the growing abdomen *urge the woman to avoid knee-high hose, which might impede lower-extremity and increase the risk of developing DVT *low-heeled shoes will minimize pelvic tilt and possible backache *wearing layered clothing that can be removed as the temperatures fluctuate may be more comfortable, especially toward term, when the woman may feel overheated Exercise - ANSWERS*improves circulation, helps reduce constipation, bloating, and swelling *mat help prevent to treat gestational diabetes *promotes muscle tone, strength,and endurance *may improve the woman's ability to cope with labor *increase energy level *improves posture *helps sleep and promotes relaxation and rest *relieves lower back discomfort and often arises as the pregnancy progresses *duration and difficulty of exercise should be modified throughout pregnancy because of a decrease in performance efficiency with gestational age *modification also helps to reduce the risk of injury cause by laxity of the joints and connective tissue due to the hormonal effects Exercise during pregnancy is contraindicated in women with - ANSWERS*preterm labor *poor weight gain *anemia *facial and hand edema *pain *hypertension *threatened abortion *dizziness *shortness of breath *multiple gestation *decreased fetal activity *cardiac disease *palpitations Sleep and Rest; the following tips can help promote adequate sleep: - ANSWERS*Stay on a regular schedule by going to bed and waking up at the same times *Eat regular meals at regular times to keep external body cues consistent *Take time to unwind and relax before bedtime *Establish a bedtime routine or pattern and follow it *Create a proper sleep environment to reducing the light and lowering the room temperature *Go to bed when you feel tired; if sleep does not occur, read a book until you are sleepy *Reduce caffeine intake later in the day *Limit fluid intake after dinner to minimize trips to the bathroom *Exercise daily to improve circulation and well-being *Use a modified Sims position to improve circulation in the lower extremities *Avoid lying on your back after the fourth month, which may compromise circulation to the uterus *Avoid sharply bending your knees, which promotes venous stasis below the knees *Keep anxieties and worries out of the bedroom. Set aside a specific area in the home or time of day for them Sexual Activity and Sexuality - ANSWERS*common symptoms such as fatigue, nausea, vomiting, breast soreness, and urinary frequency may reduce her desire for sexual intimacy *many women report enhance sexual desire due to increasing levels of estrogen *sexual satisfaction does not change in pregnancy compared with the prepragnancy pattens despite a decline of sexual activity during the third trimester Reassure the women and her partner that sexual activity is permissible during pregnancy unless there is a history of any of the following: - ANSWERS*vaginal bleeding *placenta previa *risk of preterm labor *cervical insufficiency *premature rupture of membranes *presence of infection Employment hazardous occupations - ANSWERS*health care workers *daycare providers *laboratory technicians *chemists *painters *hairstylists *veterinary workers *carpenters *jobs requiring strenuous work such as heavy lifting, climbing, carrying heavy objects, and standing for prolonged periods which place a pregnant woman at risk is modification are not instituted Travel - ANSWERS*pregnant women can travel safely throughout their pregnancy, although the second trimester is perhaps the best time to travel because there is the least chance of complications *a woman in the third trimester should be advised to defer overseas travel because of concerns about access to medical care in case of problems such as hypertension, phebitis, or premature labor *contact health care provider before making any travel decisions Teaching to promote safe travel on planes and in foreign countries - ANSWERS*Bring along a copy of the prenatal record if your travel will be prolonged in case there is a medical emergency away from home *When traveling abroad, carry a foreign dictionary that includes words of phrases for the most common pregnancy emergencies *Travel with at least one companion at all times for personal safety *Check with your health care provider before receiving and immunizations necessary for foreign travel; some may be harmful to the fetus *When in a foreign country, avoid fresh fruit, vegetables, and local water *Avoid any milk that is not pasteurized *Eat only meat that is well cooked to avoid exposure to toxoplasmosis *Request an aisle seal and walk about the airplane every 2 hours *While sitting on long flights, practice calf-tensing exercises to improve circulation to the lower extremities *Be aware of typical problems encountered by pregnant travelers, such as fatigue,heartburn, indigestion, constipation, vaginal discharge, leg cramps, urinary frequency,and hemorrhoids *Always wear support hose while flying to prevent the development of blood clots *Drink plenty of water to keep well hydrated throughout the flight Vaccines that should be considered it otherwise indicated - ANSWERS*Hepatitis B *Influenza (inactivated) injection *Tetanus/diphtheria (Tdap) *Meningococcal *Rabies Vaccines contraindicated during pregnancy - ANSWERS*Influenza (live, attenuated vaccine) nasal spray *Measles *Mumps *Rubella *Varicella *BCG (tuberculosis) *Meningococcal *Typhoid Subjects commonly addressed in perinatal education include: - ANSWERS*Anatomy and physiology of reproduction *Fetal growth and development *Prenatal maternal exercise *Physiologic and emotional changes during pregnancy *Sex during pregnancy *Infant growth and development *Nutrition and healthy eating habits during pregnancy *Teratogens and their impact on the fetus *Signs and symptoms of labor *Preparation for labor and birth (for parents, siblings, and other family members) *Options for birth *Infant nutrition, including preparation for breast-feeding *Infant care, including safety, CPR, and first aid *Family planning