OB NURS 306 STUDY GUIDE WEEK 2 CONTENT.

OB NURS 306 STUDY GUIDE WEEK 2 CONTENT. Study Guide for Week 2 Content (Chapters 5, 6 & 9) Chapter 5 ▪ Overview of the transition the woman goes through into her new maternal role (Page 88-89) ▪ Common psycho-social changes that accompany pregnancy o Decrease ability to deal with stress o Ambivalent feelings ▪ Special needs regarding specific patient populations o Teenagers ▪ Specific concerns regarding teenage parents: ▪ Coping with the role/tasks of pregnancy and adolescence at the same time • Erickson’s: Ego Identity vs Role Confusion ▪ Abandonment ▪ increased adverse pregnancy outcomes, ▪ and inability to complete school education, which may ultimately limit their future social and economic opportunities ▪ no prenatal care or delayed entry into prenatal care ▪ body image changes ▪ acceptance of pregnancy ▪ higher rates of abuse ▪ Intimate partner violence (1 in 12 pregnancies) o Risk factors: o pregnancy and unintended pregnancy o Screening tools and possible barriers to screening ■ Common questions asked in an IPV screening tool are: ■ Has your partner ever hit you? ■ Do arguments with your partner result in you feeling bad about yourself? ■ Do you ever feel frightened by what your partner says or does? ■ Do you feel safe in your current relationship? o Assessment findings / conflicting emotions ▪ Recommended weight gain in pregnancy: BMI 1st trimester: 1lb/month Underweight: 30-40 lbs <18.5 2nd trimester: ½ lb to 1 lb per week Normal weight: 25-35 lbs 18.5 – 24.9 3rd trimester: 1 lb per week Overweight: 15-20 lbs 25.0 – 29.0 Morbidly obese: 11-20 lbs >30.0 o Basic nutritional requirements (calories needed and what extra vitamins and minerals are needed) an additional ▪ 300 calories / day  cal/day ▪ Increase protein to 60 g/day ▪ Fat: linoleic acid (not manufactured in the body (vegetable oils) ▪ Folic acid ▪ Minerals: calcium, phosphorous, iodine, iron, fluoride, sodium, zinc Chapter 6 ▪ Indications for first trimester ultrasound o Pregnancy is intrauterine / within the uterus (not ectopic) o Confirm cardiac activity o Number of fetuses o Size and correlation to EDC (determining gestational age) o Evaluate pelvic anatomy o Explore cause of vaginal bleeding o Detect other potential abnormalities in early pregnancy o Position LITHOTOMY as Transvaginal Ultrasound with EMTY bladder o Abdominal Ultrasound with FULL bladder ▪ What does nuchal translucency NT screen for? o Done @ 11 – 14 weeks gestation o Down syndrome / Trisomy 21 o Look for the fetus’ increase fluid at the base of the neck called nuchal fold Anatomy Ultrasound o When is it performed: 2nd trimester 18-22 weeks gestation o What does it look for: sex, heart, body ▪ ▪ ▪ Indication for umbilical artery Doppler flow o It assesses resistance to blood flow in the placenta o to assess fetal status in intrauterine growth restricted (IUGR) fetuses o Umbilical artery Doppler is considered abnormal if the systolic/diastolic (S/D) ratio is above the 95th percentile for gestational age, or a ratio above 3.0, or the end-diastolic flow is absent or reversed. Chronic Villus Sampling – CVS (PG 121) Chorionic villus sampling (CVS) is aspiration of a small amount of placental tissue (chorion) for chromosomal, metabolic, or DNA testing. ▪ This test is used for chromosomal analysis between 10 and 12 weeks’ gestation to detect fetal abnormalities caused by genetic disorders. ▪ It tests for metabolic disorders such as cystic fibrosis but does not test for neural tube defects (NTDs). o Indication (who is it offered to?) ▪ History of birth defects o Procedure: transvaginal insertion of catheter to aspirate small amount of placental tissue (chrion) for chromosomal, metabolic, or DNA testing ■ The woman is in a supine position or lithotomy position depending on route of insertion. ■ A catheter is inserted either transvaginally through the cervix using ultrasonography to guide placement, or abdominally using a needle and ultrasongraphy to guide placement as well. ■ A small biopsy of chorionic (placental) tissue is removed. ■ The villi are harvested and cultured for chromosomal analysis and processed for DNA and enzymatic analysis as indicated Administer RhoGAM to Rh-negative women postprocedure ▪ Timing in pregnancy: 10 – 12 weeks gestation o Risks: Bleeding or miscarrhiage, infection, ROM, fetal loss 7% - 10% of women experience bleeding after the procedure. o Pros and cons for parents ▪ Can be performed earlier than amniocentesis, but is not recommended before 10 weeks . ▪ Examination of fetal chromosomes ▪ Results within 1 week and can decide to safely terminate the pregnancy ▪ Can identify sex of baby as well as any sex related diseases Amniocentesis @ 12 - 20 weeks gestation o Done for: ▪ for genetic testing, ▪ assessment of fetal lung maturity, ▪ assessment hemolytic disease in fetus ▪ intrauterine infection ▪ paternity testing o Indication: ▪ Women over 35 year old ▪ history of genetic disorders, ▪ positive screening test such as a positive alphafetoprotein, ▪ known or suspected hemolytic disease in the fetus. o Procedure: needle through maternal abdominal wall into the uterine cavity to obtain amniotic fluid. ▪ Explain that a FULL BLADDER may be required for ultrasound visualization if the woman is less than 20 weeks’ gestation ▪ Instruct woman not to lift anything heavy for 2 days.