lOMoARcPSD|17706574
XIV. MATERNITY NURSING 2) Parity: # of pregnancies in If the heart rate goes over
A. First trimester (Week 1 through which the fetus reaches 20 140bpm = CARDIAC OUTPUT and
Week 13): WEEKS. uterine
1. Assessment:
3) Viability 24 weeks = Infant has perfusion will drop.
a. Presumptive Signs of Pregnancy:
the ability to live outside the e. Danger Signs:
Amenorrhea – what is the name
uterus. Sudden gush of vaginal fluid
of the hormone that causes
A 20 week baby is NOT Bleeding
this?
considered VARIABLE. Persistent vomiting
PROGESTERONE
4) TPAL: acronym that gives you Severe headache
N/V
further information on parity Abdominal pain
Frequency – can be one of the
T= term Increased temps
first signs. UTERUS STRETCHES
P= preterm Edema
IMMEDIATELY.
A= abortion – this includes No fetal movement
Breast Tenderness – excess
spontaneous and elective f. Common Discomforts:
hormones N/V
b. Probable Signs of Pregnancy: abortions
L= living children Breast Tenderness
A positive pregnancy test –
5) Nagele’s Rule: Frequency
since it is based on the
Find the first day of the LMP Tender gums
presence of hCG levels.
Add 7 days Fatigue
There are other conditions
Subtract 3 months Heartburn
that can ↑ hCG levels:
Add 1 year Increased vaginal secretions
hydatidiform mole; drugs.
2. Client Education/Teaching: Nasal stuffiness – nasal
Goodell’s sign (softening of
a. Nutrition: sprays, steams. Excess estrogen
CERVIX; second month) 4 food groups Varicose veins
Chadwick’s sign (bluish Increase calories by 300 per Ankle edema – elevate those
color of vaginal mucosa and day after the first trimester feet.
cervix; week 4.) Adolescent: ↑ calories by 500 Hemorrhoids
Hegar’s sign (softening of after first trimester Constipation- eat more fiber.
the lower uterine segment; Increase protein to 60 grams Walk a lot.
2nd/3rd month) per day Backache
Uterine enlargement b. Weight Gain: Leg cramps
Braxton Hicks contractions Expect to gain 4 pounds in g. Medications:
(throughout pregnancy; move the first trimester What are you going to tell
blood through the c. Prenatal vitamin supplements: the pregnant person about
placenta). Why don’t women like to take taking medications?
Pigmentation/changes of skin iron? It causes CONSTIPATION DON’T unless you ask the
Linea nigra – DARK LINE CENTER AND GI UPSET. doctor.
OF ABDOMEN Take iron with vitamin C to h. Smoking:
Abdominal striae – STRETCH enhance absorption. What are you going to tell
MARKS Folic acid prevents? NEURAL them? STOP
Facial chloasma (mask of TUBE/SPINAL BIFIDA defects Hurst Review Services 181
pregnancy) Daily dose? 400 mcg/day i. Physician visits:
Darkening of the areola (around 180 Hurst Review Services How often should a pregnant
the nipple) d. Exercise Rules: client visit the physician?
c. Positive Signs of Pregnancy: No high impact; WALKING and First 28 weeks: ONCE A MONTH
Fetal heartbeat: Doppler→ 10 swimming are best. 28-36 weeks: TWICE A MONTH
- 12 weeks No heavy or unaccustomed 36 weeks: weekly until
Fetoscope→ 17 - 20 weeks exercise program. delivery
Fetal movement No overheating (no hot tubs j. Ultrasounds:
Ultrasound or electric blanket either) Before an ultrasound what
Hurst Review Services 179 Why? INCREASES TEMPERATURE = will you ask the client to do?
d. Miscellaneous Information: birth defects DRINK WATER
1) Gravidity: # of times someone Exercise Rule: Don’t let your heart To distend the bladder →
has been pregnant rate get above 140. pushes CLOSE to abdominal
surface.
Downloaded by Nicholas Marks ()
, lOMoARcPSD|17706574
What about an ultrasound prior When the presenting part of b. Each increase should last for
to a procedure? VOID the fetus (usually the head) 15 seconds and recorded for 20
B. Second Trimester (Week 14 descends into the min.
through Week 26): pelvis. c. Do you want this test to be
S/S: The client will feel less reactive or non-reactive?
1. Weight Gain:
CONGESTED, and breathe easier, REACTIVE.
Expected weight gain per
but urinary 2. Biophysical Profile Test: (BPP)
week? 1 POUND a. Done in the trimester, but
FREQUENCY is a problem (again).
2. Should the client still be
2) Engagement: can be done at 32-34 weeks in
experiencing?
The largest presenting part high
Nausea and vomiting NO
is in the pelvic inlet. risk pregnancy.
Breast tenderness YES
Hopefully, the fetal head is High risk pregnancy may have
Frequency NO,
3. Quickening: presenting first. a BPP every week or twice a
What is it? FETAL MOVEMENT 3) Fetal stations: measured in cm, week in 3rd
4. Fetal Heart Rate: measures the relationship of trimester.
What should the fetal heart the presenting b. Measurements are done by
rate be during the second part of the fetus to the ultrasound, each parameter
trimester? 120-160BPM ischial spines of the mother. counts points.
5. Miscellaneous Information: Hurst Review Services 183 10/10 is great
Kegel Exercise: 4) Signs of labor (cont.): 184 Hurst Review Services
Exercise to strengthen the Braxton Hicks Contractions: c. BPP measurement.
pubococcygeal muscles; these More frequent and stronger 1) Heart rate – was Non-Stress
muscles help stop urine Softening of the CERVIX Test (NST) reactive?
flow, help prevent uterine Bloody show 2) Muscle tone
prolapse. Sudden burst of ENERGY, Does baby have at least 1
*TESTING STRATEGY* called NESTING flexion – extension movement in
*120 to 160: normal Diarrhea 30 minutes?
*110 to 120: worried and Rupture of the MEMBRANES 3) Movement
watching b. When should the client go to the Does the baby move at least 3
*Less than 110 panic hospital? times in 30 minutes?
182 Hurst Review Services When the contractions are 5 4) Breathing
Pregnancy is considered term minutes apart or when the Does the baby have breathing
if it advances to 27 to 40 membranes movements at least once in 30
weeks. RUPTURE minutes?
C. Third Trimester (Week 27 What are we worried about 5) Amniotic fluid
through Week 40): when membranes rupture? Is there enough fluid around
1. Assessment: PROLAPSE CORD the baby?
a. Expected weight gain per week? D. Diagnostic Tests: d. Observation time is 30 minutes.
NO MORE THAN 1LB A WEEK 1. Non-stress test: (NST) e. Results are evaluated:
b. Monitor BP and report any a. Want to see two or more 8-10 good 6 worrisome <4
INCREASE from the baseline. accelerations of 15 ominous
c. Fetal Heart Rate: 120-160BPM beats/minute (or more) with 3. Contraction Stress Test (CST):
d. How is fetal position/presentation Oxytocin Challenge Test:
fetal movement.
determined? LEOPOLDS a. Done when the NST is
MANEUVERS Acceleration is when the fetal
NONREACTIVE.
What should you have the heart rate has an abrupt
b. Performed on high risk
client do first? VOID increase from the
pregnancies: preeclampsia,
If the client is having baseline. This is visualized on
maternal diabetes, and any
contractions, should these the fetal heart monitor. The
condition in which placental
maneuvers be done during or increase is > 15
insufficiency is suspected.
between contractions? BETWEEN beats/min. above the baseline
c. This determines if baby can
2. Client Education/Teaching: and lasts at least 15 seconds
handle the stress of a UTERINE
a. Signs of labor: but the heart rate
CONTRACTIONS.
1) Lightening: should come back to baseline
Usually occurs 2 before term. d. Uterine contractions decrease
within 2 min.
blood flow to the uterus and to
the placenta.
Downloaded by Nicholas Marks ()
XIV. MATERNITY NURSING 2) Parity: # of pregnancies in If the heart rate goes over
A. First trimester (Week 1 through which the fetus reaches 20 140bpm = CARDIAC OUTPUT and
Week 13): WEEKS. uterine
1. Assessment:
3) Viability 24 weeks = Infant has perfusion will drop.
a. Presumptive Signs of Pregnancy:
the ability to live outside the e. Danger Signs:
Amenorrhea – what is the name
uterus. Sudden gush of vaginal fluid
of the hormone that causes
A 20 week baby is NOT Bleeding
this?
considered VARIABLE. Persistent vomiting
PROGESTERONE
4) TPAL: acronym that gives you Severe headache
N/V
further information on parity Abdominal pain
Frequency – can be one of the
T= term Increased temps
first signs. UTERUS STRETCHES
P= preterm Edema
IMMEDIATELY.
A= abortion – this includes No fetal movement
Breast Tenderness – excess
spontaneous and elective f. Common Discomforts:
hormones N/V
b. Probable Signs of Pregnancy: abortions
L= living children Breast Tenderness
A positive pregnancy test –
5) Nagele’s Rule: Frequency
since it is based on the
Find the first day of the LMP Tender gums
presence of hCG levels.
Add 7 days Fatigue
There are other conditions
Subtract 3 months Heartburn
that can ↑ hCG levels:
Add 1 year Increased vaginal secretions
hydatidiform mole; drugs.
2. Client Education/Teaching: Nasal stuffiness – nasal
Goodell’s sign (softening of
a. Nutrition: sprays, steams. Excess estrogen
CERVIX; second month) 4 food groups Varicose veins
Chadwick’s sign (bluish Increase calories by 300 per Ankle edema – elevate those
color of vaginal mucosa and day after the first trimester feet.
cervix; week 4.) Adolescent: ↑ calories by 500 Hemorrhoids
Hegar’s sign (softening of after first trimester Constipation- eat more fiber.
the lower uterine segment; Increase protein to 60 grams Walk a lot.
2nd/3rd month) per day Backache
Uterine enlargement b. Weight Gain: Leg cramps
Braxton Hicks contractions Expect to gain 4 pounds in g. Medications:
(throughout pregnancy; move the first trimester What are you going to tell
blood through the c. Prenatal vitamin supplements: the pregnant person about
placenta). Why don’t women like to take taking medications?
Pigmentation/changes of skin iron? It causes CONSTIPATION DON’T unless you ask the
Linea nigra – DARK LINE CENTER AND GI UPSET. doctor.
OF ABDOMEN Take iron with vitamin C to h. Smoking:
Abdominal striae – STRETCH enhance absorption. What are you going to tell
MARKS Folic acid prevents? NEURAL them? STOP
Facial chloasma (mask of TUBE/SPINAL BIFIDA defects Hurst Review Services 181
pregnancy) Daily dose? 400 mcg/day i. Physician visits:
Darkening of the areola (around 180 Hurst Review Services How often should a pregnant
the nipple) d. Exercise Rules: client visit the physician?
c. Positive Signs of Pregnancy: No high impact; WALKING and First 28 weeks: ONCE A MONTH
Fetal heartbeat: Doppler→ 10 swimming are best. 28-36 weeks: TWICE A MONTH
- 12 weeks No heavy or unaccustomed 36 weeks: weekly until
Fetoscope→ 17 - 20 weeks exercise program. delivery
Fetal movement No overheating (no hot tubs j. Ultrasounds:
Ultrasound or electric blanket either) Before an ultrasound what
Hurst Review Services 179 Why? INCREASES TEMPERATURE = will you ask the client to do?
d. Miscellaneous Information: birth defects DRINK WATER
1) Gravidity: # of times someone Exercise Rule: Don’t let your heart To distend the bladder →
has been pregnant rate get above 140. pushes CLOSE to abdominal
surface.
Downloaded by Nicholas Marks ()
, lOMoARcPSD|17706574
What about an ultrasound prior When the presenting part of b. Each increase should last for
to a procedure? VOID the fetus (usually the head) 15 seconds and recorded for 20
B. Second Trimester (Week 14 descends into the min.
through Week 26): pelvis. c. Do you want this test to be
S/S: The client will feel less reactive or non-reactive?
1. Weight Gain:
CONGESTED, and breathe easier, REACTIVE.
Expected weight gain per
but urinary 2. Biophysical Profile Test: (BPP)
week? 1 POUND a. Done in the trimester, but
FREQUENCY is a problem (again).
2. Should the client still be
2) Engagement: can be done at 32-34 weeks in
experiencing?
The largest presenting part high
Nausea and vomiting NO
is in the pelvic inlet. risk pregnancy.
Breast tenderness YES
Hopefully, the fetal head is High risk pregnancy may have
Frequency NO,
3. Quickening: presenting first. a BPP every week or twice a
What is it? FETAL MOVEMENT 3) Fetal stations: measured in cm, week in 3rd
4. Fetal Heart Rate: measures the relationship of trimester.
What should the fetal heart the presenting b. Measurements are done by
rate be during the second part of the fetus to the ultrasound, each parameter
trimester? 120-160BPM ischial spines of the mother. counts points.
5. Miscellaneous Information: Hurst Review Services 183 10/10 is great
Kegel Exercise: 4) Signs of labor (cont.): 184 Hurst Review Services
Exercise to strengthen the Braxton Hicks Contractions: c. BPP measurement.
pubococcygeal muscles; these More frequent and stronger 1) Heart rate – was Non-Stress
muscles help stop urine Softening of the CERVIX Test (NST) reactive?
flow, help prevent uterine Bloody show 2) Muscle tone
prolapse. Sudden burst of ENERGY, Does baby have at least 1
*TESTING STRATEGY* called NESTING flexion – extension movement in
*120 to 160: normal Diarrhea 30 minutes?
*110 to 120: worried and Rupture of the MEMBRANES 3) Movement
watching b. When should the client go to the Does the baby move at least 3
*Less than 110 panic hospital? times in 30 minutes?
182 Hurst Review Services When the contractions are 5 4) Breathing
Pregnancy is considered term minutes apart or when the Does the baby have breathing
if it advances to 27 to 40 membranes movements at least once in 30
weeks. RUPTURE minutes?
C. Third Trimester (Week 27 What are we worried about 5) Amniotic fluid
through Week 40): when membranes rupture? Is there enough fluid around
1. Assessment: PROLAPSE CORD the baby?
a. Expected weight gain per week? D. Diagnostic Tests: d. Observation time is 30 minutes.
NO MORE THAN 1LB A WEEK 1. Non-stress test: (NST) e. Results are evaluated:
b. Monitor BP and report any a. Want to see two or more 8-10 good 6 worrisome <4
INCREASE from the baseline. accelerations of 15 ominous
c. Fetal Heart Rate: 120-160BPM beats/minute (or more) with 3. Contraction Stress Test (CST):
d. How is fetal position/presentation Oxytocin Challenge Test:
fetal movement.
determined? LEOPOLDS a. Done when the NST is
MANEUVERS Acceleration is when the fetal
NONREACTIVE.
What should you have the heart rate has an abrupt
b. Performed on high risk
client do first? VOID increase from the
pregnancies: preeclampsia,
If the client is having baseline. This is visualized on
maternal diabetes, and any
contractions, should these the fetal heart monitor. The
condition in which placental
maneuvers be done during or increase is > 15
insufficiency is suspected.
between contractions? BETWEEN beats/min. above the baseline
c. This determines if baby can
2. Client Education/Teaching: and lasts at least 15 seconds
handle the stress of a UTERINE
a. Signs of labor: but the heart rate
CONTRACTIONS.
1) Lightening: should come back to baseline
Usually occurs 2 before term. d. Uterine contractions decrease
within 2 min.
blood flow to the uterus and to
the placenta.
Downloaded by Nicholas Marks ()
