NUR 113 Exam 1

what is the function of estrogen – -development of female characteristics -helps uterus grow in size and weight during pregnancy what is the function of progestrone – -secreted by corpus luteum -"maintenance" hormone during pregnancy -can help w lactation -keeps uterus relaxed so it doesnt contract while implantation is occuring -prevents preterm labor what is an ectopic pregnancy - when the egg does not get to the uterus and gets fertilized in the fallopian tubes how to dissolved fertilized egg during a ectopic pregnancy - admin methotrexate what happens during days 1-7 of the menstrual cycle - lining breaks down, menstration occurs what happens during days 8-11 of the menstrual cycle - lining of womb thickens in prep for egg what happens during days 12-17 of the menstrual cycle - ovulation occurs, pregnancy most possible what happens during days 18-25 of the menstrual cycle - if no fertilization, corupus luteum fades away what is gravidity - number of pregnancies what is nulligravida - never been pregnant what is primigravida - first pregnancy what is multigravida - 2 or more pregnancies what is parity - number of pregnancy where fetus got to 20 weeks (no matter outcome) what is nullipara - no pregnancy that goes beyond viability what is primipara - 1 pregnancy that goes beyond viability what is multipara - 2 or more pregnancies that goes beyond viability what is viability - past 20 weeks or at 500 grams what is GTPAL - G- # of pregnancies T- # of full term (>37 weeks) P- # of pre term (20-36 weeks) A- # of abortions L- # of living children what is Nagele's rule - -how to determine due date from LMP +7 days -3 months +1 year how to calculate EDB if LMP is unknown - transvaginal ultrasound what can transvaginal ultrasounds determine - -expected due date -verifies fetal heart beat and status of pregnancy -location -can tell if multiple -looks for abnormalities -usually done at first prenatal confirmation visit what is the most accurate measurement of gestational age in the first trimester - within the ultasound, they measure the CRL (crown/rump length) what are the presumptive signs of pregnancy - -felt by the *women* -amenorrhea -N/V -morning sickness -extreme fatigue -sore, tender breast -urinary frequency what are probable signs of pregnancy - -observed by an *examiner* -Goodwells sign -Chadwick sign -Hegar's sign -Ballottement -pregnancy tests what is Goodwell's sign - softening of vaginal portion of cervix what is Chadwick's sign - bluish vagina and cervix due to increased vascularity what is Hegar's sign - examiner uses 2 hands to feel softening of cervix isthmus and increased bladder pressure what is Ballottement - use a finger to push on cervix, can feel gestational sac and bounce back consideration of pregnancy tests - -antiseizure meds, diuretics, tranquilizers, and testicular cancer can cause false positive -1st void in AM is the most accurate -testing for HCG= amount doubles every 72 hours -DO NOT use this as your definitive sign what are positive signs of pregnancy - -attributes to fetus -fetal heart beat clearly distinctive from mom -fetal movement felt by someone else -fetal visualization by ultrasound what signs can establish the diagnosis of pregnancy - positive signs what a normal fetal HR - 110-160 what is the fundus - top of uterus where is the fundus located during T1 - between pubis symphysis and umbilicus where is the fundus located during T2 - between the umbilicus and xiphoid process where is the fundus located during T3 - at the xiphoid process what is the McDonalds measurement - gestational weeks are measured by uterine growth when to start measuring the McDonalds measurement - -start at 18 weeks -use cm to measure symphysis to fundus -20cm = 20 weeks changes due to fetus presence - -contractility -uteroplacental blood flow what are the functions of the placenta - -gives O2 and nutrients to fetus -removes waste from babys blood when should the placenta be delivered - -between 5-30 mins -more than 30 mins increased risk for infection/hemorrhage what is the protective outer coating called around the umbilical cord - whartons jelly what is the material vs fetal side of the placenta - *MATERIAL*- "Dirty Duncan" placenta attached to the uterus *FETAL*- "Shiny Schultze" baby portion what is the function of the 1 vein in the umbilical cord - 1 Vein= oxygenated blood from placenta to babty what is the function of the 2 arteries in the umbilical cord - 2 Arteries= deoxygenated blood from baby to placenta what changes happen to the breast during pregnancy - -sore -growing -nipples darker and larger -leaking colostrum and discharge TRUE or FALSE: Pregnancy is considered a hypercoagulable state - true what type of anemia is most common during pregnancy - physiological anemia what cadiovasular changes occur during pregnancy - -blood volume increases 30- 45% -cardiac output increases 30-50% -stroke volume increases 30% -Heart rate increases 10-15/min -O2 consumption increases 30-40% -fibrinogen increases 40-50% what supplements are required during pregnancy - -iron -folic acid -prenatal vitamins why are RBC lower during pregnancy - plasma volume > RBC production hypercoagulation during pregnancy causes - -increased clotting factors -increased risk for DVT/embolisms TRUE or FALSE: respirations remain unchanged during pregnancy - true what is the normal hemoglobin during pregnancy - 11.5 what is the normal hematocrit during pregnancy - 32-34 what is the normal platelet range during pregnancy - 150-400 what is normal WBC range during pregnancy - 6,000-14,000 what is supine hypotension syndrome - when mom is laying supine and the weight of the baby compresses the aorta and vena cava which decreases blood flow to heart what are the signs and symptoms of supine hypotension syndrome - -dizzy -diaphoresis -pallor -clammy -lightheaded what position is best for supine hypotension syndrome - LEFT is best what integumentary changes that occur during pregnancy - -striae or stretch marks -linea nigra/alba -chloasma or temporary blotchy darkening of the skin over the nose and cheeks *(mask of pregnancy)* when does fatigue occur during pregnancy - weeks 5-8 when does N/V occur during pregnancy - weeks 6-7 what renal changes occur during pregnancy - -same amount of urine production -urinary frequency -pyelonephritis is common in T1 & T2 -causes fevers, chills, flank pain, miserable -admit mom and give abx for 24-48hrs w acetaminophen -UTIs what musculoskeletal changes occur during pregnancy - -relaxin which relaxes joint, important in T3 -lordosis from curvation in lower back -weight gain changes posture and bloating -feet and LE swelling is common -facial and UE is NOT common -diastasis recti what is diastasis recti - -LBP -poor posture/appetite -bloat -constipation -separation of ab muscles what are gastrointestinal changes during pregnancy - -NV -constipation -heartburn -gum hypertrophy what endocrine changes occur during pregnancy - *the placenta produces:* -HCG -progesterone -estrogen -human placental lactogen -prostaglandins how many weeks in 0-3 months - 0-13 weeks how many weeks in 3-6 months - 14-27 weeks how many weeks in 6-9 months - 28-42 weeks what occurs during the first prenatal visit - -reason for seeking care -current and past pregnancies -reproductive hx -detailed health hx -dental health hx -nutritional hx -drug use (recreational/ herb) -family hx -social/occupational hx -physical exam (pelvic) -baseline weight and VS and pelvic exam -head to toe assessment -review of systems -ultrasound to confirm and date -laboratory tests -prescribe meds -immunization admin when is the TDAP and MMR vaccine given to pregnanct client - -TDAP at 28 weeks -MMR atfer birth how often are prenatal visits - -monthly from weeks 16-18 -every 2 weeks from weeks 29-36 -every week from 36 weeks until birth what labs are obtained during the initial visit - -H&H -WBC -blood type -Rh -Rubella titer -urinalysis -renal fx test -pap test -cervical culture -HIV antibody -hepatits B surface antigen -toxoplasmosis -syphilis (RPR and VDRL) what are three instruments used to hear fetal heart beat - -doppler -external fetal monitor -fetoscope what can be used to listen to the fetal HR late in the first trimester at the midline, right above the symphysis pubis by holding firmly on the abdomen - doppler when should the fundal height be measured - in the second trimester from weeks 18-30 when should you assess for fetal movement - weeks 16-20 when to call the doctor - -baby moving less -your water broke -bleeding -contractions preparation for pregnancy/birth during 1st trimester - -physical and psychosocial changes -common discomforts of pregnnacy and measures to provide relief -lifestyle changes -possible complications and indications to report -fetal growth and development -prenantal exercise -expected laboratory testing preparation for pregnancy/birth during 2nd trimester - -benefits of breastfeeding -common discomforts and relief measures -lifestyle changes -fetal movement -complications such as preterm labor, gestational hypertension and DM, premature rupture -prep for childbirth and education classes -review of birthing methods -development of a birth plan preparation for pregnancy/birth during 3rd trimester - -childbirth preparation -fetal movement /kick counts to ascertain fetal well-being -diagnostic testing for fetal well-being what are some common discomforts of pregnancy - -NV -breast tenderness -urinary frequency -UTI -fatigue -heartburn -constipation -hemorrhoids -backaches -SOB -leg cramps -varicose veins and lower extremity edma -gingivitis, nasal stuffiness, epitaxis (nosebleed) -braxton hicks contractions -supine hypotension what relieve backaches during pregnancy - -pelvic rock/tilt exercise everyday -proper body mechanics TRUE or FALSE: a feeling of ambivalence about pregnancy is normal early and resolves before the third trimester - TRUE -ambivalence consisits of confilcting feelings (joy, pleasure, sorrow, hositility) about the pregnancy how much additional calories should be consumed in the 2nd trimester - increase of 340 calories how much additional calories should be consumed in the 3rd trimester - increase of 452 calories how much additional calories should be consumed if breastfeeding - 450-500 calories/per day if breastfeeding what recommended supplements are recommended during pregnancy - -increase in calories -increase protein -folic acid -iron supplement -calcium -fluids what foods are high in folic acid and what is the recommended intake - -*foods*: leafy vegtables, dried peas and beans, seeds, orange juice -breads, cereals and other grains are fortified w folic acid -400mcg if client wishes to get prego -600mcg if client is prego -crucial for neuro development and neural tube defects -prevent spina bifida nursing considerations while taking iron supplements - -*foods*: beef liver, red meats, fish, poultry dried peas and beans, fortified cereals and breads -best absorbed between meals and when give w vitamin C -milk and caffeine interfere w absorption -add stool softener to decrease constipation nursing considerations for calcium - -*foods*: milk, calcium-fortifief soy milk, fortified orange juice, nuts, legumes, and dark green leafy vegetables -important for bone and teeth formation -1,000 mg/day for pregnant woment good vs bad food during pregnancy - GOOD- yogurt, whole grains, lean meats, nuts, avocado, beans and lentils, eggs, green vegtables, sea fish BAD- alcohol, certain types of cooked fish, raw fish and sushi, excessive amounts of caffeine, undercooked meat, undercooked eggs how to calculate BMI - (weight/ height ^2) x 703 what are the BMI ranges - -underweight= <18 -normal= 18.5-24.9 -overweight= 25-29.9 -obese= >30 how much weight should pregnant women gain during their entire pregnancy - - underweight= 28-40lbs -normal= 25-35lbs -overweight= 15-25lbs -obese= 11-20lbs what is the weight pattern during the 1st and 2nd trimester - -1st trimester= 1-4.4 lbs -2nd/3rd trimester= 1 lb/week exercising in pregnancy - -discuss fitness rountine w HCP -consider decreasing jogging or running, substitute walking or non-weight bearing exercises -avoid risky activities like contact sports -you should be able to hold a conversation while exercising -rest for 10 mins after exercise including lying on side -drink plenty of water and include healthy snacks -wear supportive bra and shoes what are danger signs during exercise and contact the HCP if - -experience pain -SOB -headache -dizzy -numbness, tingling, chest pain -regular painful uterine contractions -decreased fetal activity -vaginal bleeding -muscle weakness affecting balance -calf pain or swelling what are some environmental hazards during pregnancy - -air pollutants -extreme heat -contaiminated water or food -weather related disasters what is the beta strep culture - -done 35-37 weeks -obtain vaginal/anal culture -assess for GBS infection -IV abx (penicillin) given to mom during labor what infections are treated during labor/following birth - -gonorrhea -chlamydia -HIV -GBS what infection is treated during pregnancy - TOCH infection nursing considerations for TOCH infection - -obtained from consuming undercooked meat -symptoms: joint pain, malaise, rash, tender lymph nodes when is RhoGRam administered - -when mom is Rh negative, give at 28 weeks -if mom still negative, give another dose at birth (baby is positive) what is gestational diabetes - -done at 24 to 28 weeks -impaired tolerance to glucose w first onset or recogntion during pregnancy -high blood glucose in mom brings extra glucose to baby and cause extra weight gain what are risk factors for gestational diabetes - -obesity -hypertension -glycosuria -materal age older than 25 years -family hx of DM -previous delivery of an infant that was large or stillbirth what are the physical assessment findings for gestational diabetes - - hypo/hyperglycemia -shaking -clammy -pale skin -shallow respirations -rapid pulse -vomiting -excess weight gain during pregnancy how to diagnose gestational diabetes - -50G given to nonfasted mom, if BS >140 in hr mom fails -100G given to fasted mom -if fasted BS is >95, mom fails -if BS in 1 hr >180, mom fails -if BS in 2 hrs >155, mom fails -if BS in 3 hr>140, mom fails what complications can occur during the 3rd trimester - -placenta previa -abruptio placenta -vasa previa what is placenta previa - when the placenta abnormally implants in the lower segment of the uterus near or over the cervical os instead of attaching to the fundus what are the risk factors for placenta previa - -previous placenta previa -uterine scarring (previous cesation birth, curettage, endometritis) -AMA above 35 yrs old -multifetal gestation -multiple gestation -smoking what are the expected findings for placenta previa - -*PAINLESS* bright red vaginal bleeding during the 2nd or 3rd trimester -uterus soft, relaxed, and nontender with normal tone -fundal height greater than usually expected for gestation age -fetus in breech, oblique, or transverse posititon -reassuring FHR -VS within normal limits -decreasing urinary output, which can be a better indicator of blood loss what labs to monitor for placenta previa - -H&H -CBC -blood type and Rh -coagulation profile -kleihauer betke test (used to detect fetal blood in maternal circulation) how to diagnose placent previa - ultrasound (always first) how to treat placenta previa - -assess for bleeding, leakage, or contractions -assess fundal height -AVOID vaginal exams or inserting anything into the vagina -no weight bearing -admin IV fluids, blood products, give O2 -admin *Betamethasone* to promote fetal lung maturation (if early delivery is anticipated via c section) -adhere to bedrest when to admin betamethasone for placenta previa - <32 weeks admin, give another dose in 24hrs for baby lung maturation what is abruptio placentae - the premature separation of the placenta from the uterus which can be a partial or complete detachment when does abruptio placentae occur - can happen anytime during pregnancy but MOST common at 20 weeks/3rd timester what condition is associated with moderate to sereve abruption of the placenta - coagulation defect such as Disseminated intravascular coagulopathy (DIC) what are risk factors for abruptio placenta - -maternal hypertension -blunt external abdominal trauma -*cocaine* use -previous incidents of abrupito placentae -smoking (nicotine) -premature rupture or membranes -multifetal pregnancy what are expected findings of abruptio placentae - -sudden onset of intense localized uterine pain w DARK red vaginal bleeding -area of uterine tenderness can be localized or diffuse over uterus and boardlike -contractions w hypertonicity -fetal distress -clinical findings of hypovolemic shock what labs to monitor for abruptio placenta - -H&H decrease -coagulation factor decrease -clotting defects -cross and type match for possible transfusion -kleihauer betke test (used to detect fetal blood in maternal circulation) nursing care for abruptio placenta - -palpate uterus for tenderness and tone -perform serial monitoring of the fundus height -assess FHR pattern -immediate birth is the management -provide emotional support what is a uterine rupture - complete rupture involves the uterine wall, peritoneal cavity, and/or broad ligament, internal bleeding is present what are the risk factors for uterine rupture - -congential uterine abnormality -uterine trauma due to accident or surgery (previous c section) -overdistention of the uterus from a fetus who is large for gestationa age, multifetal gestation, or polyhydramnios -tachysystole of the uterus (either spontaneous or from oxytocin admin) -external or internal fetal version done to correct malposition of the fetus -forcep assisted birth -multigravida clients what are the expected finding for uterine rupture - -sensation of "ripping" or "tearing" -sharp pain -abdominal pain -uterine tenderness what are the physical finding for uterine rupture - -brady FHR -variable and late decelerations -absent or minimal variability -change in uterine shape -manifestations of *hypovolemic shock*, hypotension, pallor, cool, clammy skin, tachycardia how to treat uterine rupture - -admin IV fluids, O2, blood products, abx -prep for immmediate cesarean birth what is vasa previa - a condition when the fetal umbilical vessels implant into the fetal membranes rather than the placenta how to treat vasa previa - -delivery baby ASAP -if not, neuro damage or death is possible GB what is preterm labor - uterine contractions AND cervical changes before 37 weeks what are risk factors of preterm labor - -infection