Summary NUR 166 Ultimate Final Exam Study Guide

166 Final Outline

Trimesters:
• First: 0-13 weeks
• Second: 14-26 weeks
• Third: 27-40 weeks
Gestation: The period of intrauterine development from conception to birth; pregnancy
Gestational Age: Number of completed weeks counting from first day of last menstrual cyc
approximately 40 weeks; the period of time from conception to birth the fetus remains in th
uterus
Fetal Age: Age of developing fetus counting from the estimated date of conception (usually
minus 2 weeks from gestational age); approximately 38 weeks
Preterm Pregnancy: 20-36 6/7 weeks
Term Pregnancy: 37-42 weeks


Schedule for Prenatal Visits
• First Trimester – every 4 weeks
• Second Trimester – every 2 weeks
• Third Trimester – weekly

Routine Prenatal Tests in Frist Trimester (0-13 weeks)
• Blood Type, Rh Factor, Antibody Screen
o Determines risk for maternal-fetal incompatibility
• CBC
o Anemia
o Infections
o Cell abnormalities
• Hemoglobin + Hematocrit
o Anemia
o Hemoglobin – protein in RBCs that carry O2
o Hematocrit – % of blood volume composed of RBCs
• VDRL (Venereal Sex Disease Research Lab) or RPR (Rapid Plasma Regain)
o Syphilis screening
• Rubella Titer
o Determines immunity to rubella
o Titer – concentration of an antibody
• PPD Skin Test (Purified Protein Derivative – intradermal injection) or Serum Blood Test
(QuantiFERON-TB Gold)
o Tuberculosis screening
• Hepatitis B Screen
o Identifies carriers of Hep. B
• HIV Screening

, • Urinalysis + Culture
o Infections
o Renal disease
o Diabetes
o Asymptomatic bacteriuria
• Papanicolaou (Pap) Test
o Cervical cancer
• Vaginal Culture
o Group B streptococci – bacteria commonly found in lower GI + genital tract; not
an STI but can be dangerous for newborns
o STIs (gonorrhea, chlamydia)

Definition of Terms
• Gravida – any pregnancy, regardless of duration; total number of pregnancies including
the one in progress
• Para – a woman who has given birth to 1+ children who've reached the age of viability
(20 weeks), regardless of the number of fetuses delivered and whether they're alive
• Abortion – termination of pregnancy before age of viability (20 weeks)
• Age of Viability – a fetus that has reached the stage (20 weeks) where it's capable of
living outside of the uterus

TPALM System – used to describe the detailed outcomes of a woman's pregnancies on her
prenatal record
• T (term) – number of TERM infants born (37-42)
• P (preterm) – number of PRETERM infants born (20-366/7)
• A (abortion) – number of pregnancies ABORTED
• L (living) – number of children LIVING
• M (multigravida) – birth number of MULTIPLE gestations (twins, triplets, etc.)

Calculation GP/GTPALM
GP
• (G) Gravida – number of times a woman has been pregnant, regardless of duration
• (P) Para – number of deliveries after 20 weeks gestation; whether the infant is born
alive or dead and regardless of the number of fetuses
o Twins = P1, Triplets = P1
GTPALM
• (G) Gravida – number of times a woman has been pregnant, regardless of duration
• (T) Term – an infant delivered at 37 weeks gestation and beyond (370/7+); regardless of
the number of fetuses
o Twins = T1, Triplets = T1
• (P) Preterm – an infant delivered between 20 – 36 weeks gestation (200/7 – 366/7);
regardless of the number of fetuses
o Twins = T1, Triplets = T1

, • (A) Abortions – delivery that occurs between conception and before 20 weeks (196/7)
• (L) Living – number of children living
o Twins = L2, Triplets = L3
• (M) Multigravida – woman who has been pregnant 2+ times
Note:
• GP: (P) = Para; given birth to 1+ children who's reached the age of viability
• GTPALM: (P) = Preterm; an infant delivered between 20 – 36 weeks gestation

Example: A woman comes into the office and you’re taking her pregnancy history. She states
she’s currently pregnant. She has delivered one child at 38 weeks, one at 40 weeks, one at 16
weeks, and one at 32 weeks. What is her G/P? What is her GTPAL?
G/P: G=5, P=3
• Gravida – she’s been pregnant 5 times, Para – she has had 3 deliveries after 20 weeks
gestation
GTPAL: G=5, T= 2, P=1, A=1, L=3
• Gravida – 5 total pregnancies, Term – 38 weeks and 40 weeks, Pre-Term – 32 weeks,
Abortion – 16 weeks, Living – 38, 40, and 32 weeks

Diagnosis of Pregnancy – signs of pregnancy are divided into 3 groups depending on how likely
they are to be cause by factors other than pregnancy
• Presumptive – think mom; indications of pregnancy felt by the woman (subjective)
o Amenorrhea – cessation of menses)
o Nausea
o Breast tenderness/tingling
o Deeping pigmentation
o Urinary frequency
o Quickening – fetal movements felt by the mother around 16-20 weeks (faint
fluttering in lower abdomen)
• Probable– think doctor; provides stronger evidence of pregnancy w/ signs that the
nurse or doctor can observe (objective)
o Goodell's Sign – softening of the cervix + vagina caused by increased vascular
congestion
o Chadwick's Sign – purple/blue discoloration of the cervix, vagina, and vulva
caused by increased vascular congestion
§ C=Color/Chadwick's
o Hegar's Sign – softening of the lower uterus
o McDonald's Sign – ease of flexing body of uterus against cervix
o Braxton Hick's Contractions – irregular, painless uterine contractions starting at
2nd trimester
o Ballottement – when a finger pushes against the uterus + feels the return impact
of the displaced fetus
o Striae – stretch marks
o Professional Pregnancy Test – uses maternal uterine/blood for presence of hCG