Families Exam 1
Presumptive signs of pregnancy: What is it *** changes that makes a woman think that she might be
pregnant (pts perspective)
Presumptive signs of pregnancy: Signs *** - Amenorrhea (absence of menstruation)
- Fatigue
- N/V or N/V in pregnancy (NVP)
- Urinary frequency
- Breast changes: darkened areolae, enlarged Montgomery's glands
- Quickening: slight fluttering movements of fetus felt by pt, usually between 16-20 wks of gestation
- Uterine Enlargement
Presumptive signs of pregnancy: Evaluation *** - Ask pt about signs
- might be a result of physiological factors other than pregnancy: peristalsis, infections, stress
Probable signs of pregnancy: What is it *** changes that make the examiner suspect a pt is pregnant
(primarily related to physical changes of the uterus/pelvic organs)
Probable signs of pregnancy: Signs *** - abdominal enlargement related to changes in uterine size,
shape, and position
- Hegar's sign: softening and compressibility of LOWER UTERUS
- Chadwick's sign: deepened VIOLET-BLUISH color of cervix and vaginal mucosa
- Goodell's sign: softening of CERVICAL TIP
- Ballottement: rebound of unengaged fetus
- Braxton Hick's contractions: false contractions that are painless, irregular, and usually relieved by
walking
,- POSITIVE PREGNANCY TEST (test is positive, but doesn't mean your pregnant bc it could be false. blood
or urine tests provide accurate assessments for presence of hCG)
- fetal outline palpated by examiner
Probable signs of pregnancy: Evaluation *** Palpitation/urine testing
Positive signs of pregnancy *** - signs that can ONLY be explained by pregnancy
- fetal heart sounds (usually heard by 8-10 wks)
- visualization of fetus by ultrasound (6 wks)
- fetal movement: palpated by an experienced examiner
Patient education for verifying pregnancy *** - some meds (anticonvulsants, diuretics, tranquilizers) can
cause false pos./neg. results
- home pregnancy tests: urine samples should be 1st-voided morning specimens and follow directions
for accuracy
What do higher levels of hCG indicate? *** - multifetal pregnancy
- ectopic pregnancy
- hydatidiform mole
- genetic abnormality like down syndrome
What do lower levels of hCG indicate? *** - miscarriage
- ectopic pregnancy
When does production of hCG peak and decline? *** - Peaks: 60-70 days of gestation
- Declines: around 100-130 days of pregnancy
,Respiratory Physiological/psychological changes related to Pregnancy *** - RR unchanged or slightly
increased
- Some SOB noted as uterus size increases and pushes against the diaphragm (maternal oxygen needs
increase)
Cardiovascular Physiological/psychological changes related to Pregnancy *** - HR increases to 10-15
bpm around 32 weeks, remains elevated
- Supine hypotensive syndrome/supine vena cava syndrome: hypotension, fetal hypoxia, dizziness,
lightheadedness, pallor, and clammy skin
- in the SUPINE position, BP may appear LOWER due to the weight and pressure of the gravid uterus on
the VENA CAVA which decreases venous blood flow to the heart
- lay on the left lateral side or semi-Fowler's position, or, if supine, with a wedge (pillow) placed under
one hip to alleviate pressure to the vena cava to prevent supine hypotensive syndrome/supine vena
cava syndrome
Physiological/psychological changes: Gastrointestinal *** - N/V: eat small amounts frequently and fluids
in between meals, crackers/dry toast upon rising in morning, ginger can help
- constipation may occur
- avoid alcohol, caffeine, spicy/fried/fatty food and avoid an empty stomach
Physiological/psychological changes: Genitourinary *** - urinary frequency: empty bladder frequently,
no fluid before bed, peri pads and kegel exercise
- UTI: due to vaginal flora being more alkaline
Skin and Hair (Hormonal) Endocrine Physiological/psychological changes: *** - striae (stretch marks
mostly on abdomen and thighs)
- linea nigra (dark line from umbilicus to pubic area)
- chloasma (increase of pigmentation on face)
- vascular spider veins: elevate, compression stockings, no constrictive clothing, avoid crossing legs
, Hormonal Changes During Pregnancy *** - Mood swings
- Breast changes and uterus growth
- Cervix becomes soft
- Pelvic joints relax to prepare for delivery
Naegele's Rule - configure EDC *** - Take first day of last menstrual period
- Subtract 3 months
- Add 7 days and 1 year
- Ex: May 2nd, '24 = Feb. 9th, '25
What does GTPAL tell us? *** Gravidity: total # of pregnancies (includes current, miscarriages,
abortions, etc; twins/triplets = 1)
Term births: the # of births (alive or stillborn) that were 37 wks or more (twins/triplets = 1)
Preterm births: the # of births (alive or stillborn) that were between 22 to 37 wks. (twins/triplets = 1)
Abortions/Miscarriages: pregnancy losses BEFORE 22 wks
Living children
Why is GTPAL important? *** Helps to create background of pregnancy pts and whether they have a risk
for miscarriage or are high-risk pregnancy (pre-term births)
Prenatal Care *** - initial assessment typically at 12 weeks of pregnancy or as soon as positive sign is
detected
- visits scheduled monthly for 16-28 weeks, q 2 weeks from 29-36 weeks, and q week from 36 weeks-
birth
- birth plan (the pts goals, birthing methods, pain control) is established
Presumptive signs of pregnancy: What is it *** changes that makes a woman think that she might be
pregnant (pts perspective)
Presumptive signs of pregnancy: Signs *** - Amenorrhea (absence of menstruation)
- Fatigue
- N/V or N/V in pregnancy (NVP)
- Urinary frequency
- Breast changes: darkened areolae, enlarged Montgomery's glands
- Quickening: slight fluttering movements of fetus felt by pt, usually between 16-20 wks of gestation
- Uterine Enlargement
Presumptive signs of pregnancy: Evaluation *** - Ask pt about signs
- might be a result of physiological factors other than pregnancy: peristalsis, infections, stress
Probable signs of pregnancy: What is it *** changes that make the examiner suspect a pt is pregnant
(primarily related to physical changes of the uterus/pelvic organs)
Probable signs of pregnancy: Signs *** - abdominal enlargement related to changes in uterine size,
shape, and position
- Hegar's sign: softening and compressibility of LOWER UTERUS
- Chadwick's sign: deepened VIOLET-BLUISH color of cervix and vaginal mucosa
- Goodell's sign: softening of CERVICAL TIP
- Ballottement: rebound of unengaged fetus
- Braxton Hick's contractions: false contractions that are painless, irregular, and usually relieved by
walking
,- POSITIVE PREGNANCY TEST (test is positive, but doesn't mean your pregnant bc it could be false. blood
or urine tests provide accurate assessments for presence of hCG)
- fetal outline palpated by examiner
Probable signs of pregnancy: Evaluation *** Palpitation/urine testing
Positive signs of pregnancy *** - signs that can ONLY be explained by pregnancy
- fetal heart sounds (usually heard by 8-10 wks)
- visualization of fetus by ultrasound (6 wks)
- fetal movement: palpated by an experienced examiner
Patient education for verifying pregnancy *** - some meds (anticonvulsants, diuretics, tranquilizers) can
cause false pos./neg. results
- home pregnancy tests: urine samples should be 1st-voided morning specimens and follow directions
for accuracy
What do higher levels of hCG indicate? *** - multifetal pregnancy
- ectopic pregnancy
- hydatidiform mole
- genetic abnormality like down syndrome
What do lower levels of hCG indicate? *** - miscarriage
- ectopic pregnancy
When does production of hCG peak and decline? *** - Peaks: 60-70 days of gestation
- Declines: around 100-130 days of pregnancy
,Respiratory Physiological/psychological changes related to Pregnancy *** - RR unchanged or slightly
increased
- Some SOB noted as uterus size increases and pushes against the diaphragm (maternal oxygen needs
increase)
Cardiovascular Physiological/psychological changes related to Pregnancy *** - HR increases to 10-15
bpm around 32 weeks, remains elevated
- Supine hypotensive syndrome/supine vena cava syndrome: hypotension, fetal hypoxia, dizziness,
lightheadedness, pallor, and clammy skin
- in the SUPINE position, BP may appear LOWER due to the weight and pressure of the gravid uterus on
the VENA CAVA which decreases venous blood flow to the heart
- lay on the left lateral side or semi-Fowler's position, or, if supine, with a wedge (pillow) placed under
one hip to alleviate pressure to the vena cava to prevent supine hypotensive syndrome/supine vena
cava syndrome
Physiological/psychological changes: Gastrointestinal *** - N/V: eat small amounts frequently and fluids
in between meals, crackers/dry toast upon rising in morning, ginger can help
- constipation may occur
- avoid alcohol, caffeine, spicy/fried/fatty food and avoid an empty stomach
Physiological/psychological changes: Genitourinary *** - urinary frequency: empty bladder frequently,
no fluid before bed, peri pads and kegel exercise
- UTI: due to vaginal flora being more alkaline
Skin and Hair (Hormonal) Endocrine Physiological/psychological changes: *** - striae (stretch marks
mostly on abdomen and thighs)
- linea nigra (dark line from umbilicus to pubic area)
- chloasma (increase of pigmentation on face)
- vascular spider veins: elevate, compression stockings, no constrictive clothing, avoid crossing legs
, Hormonal Changes During Pregnancy *** - Mood swings
- Breast changes and uterus growth
- Cervix becomes soft
- Pelvic joints relax to prepare for delivery
Naegele's Rule - configure EDC *** - Take first day of last menstrual period
- Subtract 3 months
- Add 7 days and 1 year
- Ex: May 2nd, '24 = Feb. 9th, '25
What does GTPAL tell us? *** Gravidity: total # of pregnancies (includes current, miscarriages,
abortions, etc; twins/triplets = 1)
Term births: the # of births (alive or stillborn) that were 37 wks or more (twins/triplets = 1)
Preterm births: the # of births (alive or stillborn) that were between 22 to 37 wks. (twins/triplets = 1)
Abortions/Miscarriages: pregnancy losses BEFORE 22 wks
Living children
Why is GTPAL important? *** Helps to create background of pregnancy pts and whether they have a risk
for miscarriage or are high-risk pregnancy (pre-term births)
Prenatal Care *** - initial assessment typically at 12 weeks of pregnancy or as soon as positive sign is
detected
- visits scheduled monthly for 16-28 weeks, q 2 weeks from 29-36 weeks, and q week from 36 weeks-
birth
- birth plan (the pts goals, birthing methods, pain control) is established
