1
Q
What are normal breast changes in pregnancy?
A
- growth of milk ducts
- development of mammory glands
- larger and dark areola
- visible blood vessels
- stretch marks
2
Q
Which 2 hormones are responsible for breast changes during pregnancy?
A
Estrogen and Progesterone
3
Q
How many weeks is the first trimester of pregnancy?
A
Week 1 to week 13.
4
Q
At how many weeks is the second trimester of pregnancy?
A
Week 14 to week 27.
5
Q
At how many weeks is the third trimester of pregnancy?
A
Week 28 to week 40.
6
Q
At what week of gestation can the sex of the fetus be determined?
A
At week 12 by ultrasound.
7
Q
What is the normal 1st trimester fetal heart rate?
A
160 - 170 beats per minute
8
Q
What is the normal heart rate of a fetus by the end of the 3rd trimester?
A
110 - 160 beats per minute
9
Q
What are some risk factors for a difficult pregnancy or loss of the fetus?
A
- age: less than 20 years old or older than 35 years old
- obesity
- abuse and violence
- diabetes or cardiac disorders
- drugs/smoking/alcohol
- medications
10
Q
How often are prenatal visits?
A
- every 4 weeks from confirmation of pregnancy until end of 2nd trimester
- every 3 weeks from 28 to 36 weeks (starting at 3rd trimester)
- then weekly until delivery
11
Q
What are the general assessments for every prenatal visit?
A
- pregnant woman assessment:
- blood pressure
- weight
- urine screening for proteins (pre-eclampsia)
- fetus assessment:
- fundal height (of woman)
- fetal ultrasound for heart tones and growth
12
Q
What is Nagele’s rule?
A
Calculating the due date of the baby:
- due date = + 9 months + 7 days (adjust the year) from the date of when the last period started
13
Q
Define:
Gravida and Para
A
- Gravida: the number of total pregnancies (including present one)
- Para: the number of births after 20 weeks
14
Q
What does GTPAL stand for?
A
- Gravida: number of pregnancies
- Term: births after 37 weeks
- Preterm: births before 37 weeks
- Abortions (miscarriages)
- Living children
15
Q
In regard to GTPAL, would twins be considered 1 or 2?
A
Twins is 1.
16
Q
What is a presumptive sign of pregnancy?
A
- quickening (feeling movement of fetus)
- nausea/vomiting
- sore breasts
- missed period
17
Q
What is a probable sign of pregnancy?
A
A pregnancy test that comes back positive and the signs detected by the HCP such as:
- Hegar’s sign
- Goodell’s sign
- Chadwick’s sign
18
Q
What is Hegar’s sign?
A
A probable sign of pregnancy when the lower part of uterus starts to get soft at about week 6.
19
Q
What is Goodell’s sign?
A
A probable sign of pregnancy when there is softening of the cervix at about week 9.
20
Q
What is Chadwick’s sign?
A
A probable sign of pregnancy when the cervix turns a bluish-purple color at about week 6.
21
Q
What is a cervical mucus plug?
A
A collection of mucus that forms at the cervix to protect the growing fetus from bacterial infections.
22
Q
What is ballottement?
A
A probable sign of pregnancy of when the fetus rebounds when the HCP presses on the uterus.
23
Q
What are Braxton-hicks contractions?
A
A probable sign of pregnancy of irregular contractions.
24
Q
What hormone indicates a positive pregnancy test?
A
Human chorionic gonadotropin (HCG) indicates a positive pregnancy test (which is a probable sign of pregnancy).
HCG can be detected in urine in as early as 8 days after conception.
25
What is a **positive sign** of pregnancy?
* fetal heart rate is detected by doppler and fetoscope
* HCP can feel the fetus move on palpation
* fetus is seen on ultrasound
26
What is the **fundal height**?
A measurement from **the top of the fundus to the symphysis pubis** as measured in centimeters.
## Footnote
It estimates the gestational age.
27
# Complete the sentence:
After week 18, the fundal height in centimeters = number of ______ pregnant.
After week 18, the fundal height in centimeters = number of **_weeks_** pregnant.
28
The **fundal height and gestational age** of fetus can be off by how many centimeters?
Fundal height and gestational age can be off by **plus or minus 2 centimeters.**
## Footnote
Ex: a fundal height of 20 cm can indicate that the fetus is somewhere between 18 and 22 weeks old.
29
What are the **physical and psychological changes** in pregnancy caused by?
**Hormones**.
30
What **cardiovascular changes** does a pregnant woman go through?
* lower than normal hemoglobin and hematocrit
* heart rate increases
* blood pressure changes
## Footnote
Changes are due to increased blood volume.
31
What hemoglobin and hematocrit levels is considered **anemia** in a pregnant client?
* Hemoglobin: **\< 10**
* Hematocrit: **\< 30%**
## Footnote
Pregnant clients have a slightly lower hemoglobin and hematocrit due to increased fluid volume.
32
How **high** does the heart rate of the pregnant woman increase due to increased blood volume during pregnancy?
Increases 10-15 beats per minute from the baseline.
## Footnote
Ex: if the heart rate is normally 60 bpm, it will increase to 70-75 bpm
33
What are the **blood pressure changes** of a pregnant woman?
* blood pressure ↓ in 1st and 2nd trimester - *hormonal changes cause vessel dilation*
* blood pressure ↑ in 3rd trimester - *due to increased blood volume being pumped to fetus*
34
At what **time of the day** can a pregnant woman experience nausea or vomiting?
Any time of the day!
Morning, afternoon or evening.
35
What **interventions** help relieve nausea and vomiting for a pregnant woman?
* Avoid triggers such as foods or smells
* Eat crackers before getting out of bed
* Eat smaller meals or snacks instead of large meals
36
At what **week of gestation** does nausea and vomiting start to resolve?
Week **13** of pregnancy.
37
When does nausea and vomiting in a pregnany woman start to become a **complication**?
When vomiting becomes so severe that there is a **fluid and electrolyte imbalance**.
**New onset nausea/vomiting** in the 2nd or 3rd trimester.
## Footnote
Severe nausea and vomiting is called hyperemesis gravidarum.
38
What **urinary changes** occur in a pregnant woman?
* 1st trimester **increased urination** is caused by hormone changes
* 2nd trimester urinary frequency **decreases**
* 3rd trimester **increased urination** is caused by increased pressure of fetus on bladder
39
What is **linea nigra** during pregnancy?
A **dark line** down the middle of the abdomen.
40
What is **chloasma** during pregnancy?
The "mask of pregnancy": **brown spots on the face.**
41
What are the typical **psychological changes** that occur to the woman when she finds out she is pregnant or in early pregnancy?
* ambivalent, excited or scared
* very emotional (crying and laughing)
## Footnote
Antidepressants are generally safe during pregnancy.
42
What are the **assessments** for a client who is experiencing emotional disturbances in early pregnancy?
* Assess for depression and stress
* Ask if they have a support person
* Screen for intimate partner violence (IPV)
43
What are the **interventions** for a client who is experiencing emotional disturbances in early pregnancy?
* make referrals
* encourage light exercise and healthy diet
* encourage a support group (friends, church, family)
44
What **gastrointestinal symptoms** are normal during pregnancy?
Pyrosis (heartburn) in the 1st trimester due to effects of progesterone which is relaxing the muscles.
Pyrosis (heartburn) in the 3rd trimester due to effects of the baby pushing up on the esophagus.
45
What is the **treatment for pyrosis** during pregnancy?
Don't overfill the stomach:
* small meals
* don't eat and drink at the same time (wait 30 minutes)
* sit up 30 minutes after eating
* take calcium carbonate (Tums) to neutralize stomach acid
46
What is **round ligament pain** in regard to pregnancy?
Pain in the lower abdomen that is described at stabbing, stretchy side pain when changing position starting at about 18-20 weeks gestation.
## Footnote
This is caused by the streching of the ligaments that surrounds the uterus.
47
What **conditions** can round ligament pain be confused with?
* Pre-term labor
* UTI or another kidney infection
* appendititis
## Footnote
Be sure to assess for any complications when client reports pain.
48
What are the **interventions** for round ligament pain during pregnancy?
* change positions slowly
* warm or ice therapy
* support belt
49
When is **fatigue** normal in pregnancy?
* During the 1st trimester due to hormone changes.
* During the 3rd trimester because it's hard to get comfortable and sleep is interrupted.
50
What **2 conditions** during pregnancy can commonly contribute to fatigue?
1. Diabetes
* check 24-28 week glucose screening
2. Anemia
* check hemoglobin and hematocrit
51
What are the **interventions** for fatigue during pregnancy?
Help to problem solve about ways to get rest.
52
What is the **recommended weight gain** for a pregnant woman for the entire pregnancy?
**25 - 35 pounds** (11 - 16 kg)
53
What is the recommended **weight gain during the first trimester** of pregnancy?
**3 - 5 pounds** (1.4 - 2.3 kg)
54
What is the recommended **weight gain during the 2nd and 3rd trimesters** of pregnancy?
**1 pound per week** (0.5 kg per week)
55
How many **extra calories per day** are recommended during pregnancy?
About an **extra 300 calories**.
56
How many **extra calories per day are recommended while breastfeeding**?
An **extra 200-500 calories**.
57
What **vitamin supplements** are commonly prescribed to pregnant clients?
* **folic acid** - to prevent neural tube defects
* **iron** - to prevent anemia due to increased blood plasma
58
# Classification and indication:
Rho D immune globulin
* given to Rh-negative moms to prevent blood incompatibility between mom and baby's blood
* given after miscarriage or abortion to prevent Rh antibody formation
* given after birth to moms that give birth to a Rh-positive baby
59
What vaccinations are **contraindicated during pregnancy** or when planning to become pregnant?
**Do not** give measles, mumps, rubella (MMR) and varicella vaccines.
## Footnote
Vaccine can harm fetus.
60
What could **glucose** in the urine of a pregnant client indicate?
**Diabetes mellitus.**
61
What does **protein** in the urine of a pregnant client indicate?
**Infection or pre-eclampsia**.
62
What is a **fetal ultrasound**?
**A picture of the fetus**. It includes information such as:
* gestational age
* breathing
* movements
* tone
* amniotic fluid volume
63
What will the pregnant client need to **prepare** for a fetal ultrasound?
**Drink 2 glasses of water one hour before the ultrasound** in order to see the fetus and structures better.
64
What is a **biophysical profile**?
A non-invasive test that **checks the fetus**. It includes:
* ultrasound
* non-stress test
65
What is a **nonstress test**?
A non-invasive test of the fetus to **check fetal heart rate patterns** with an external monitor.
## Footnote
The pregnant client lies down with two belts around her waist. One belt measures the fetal heartbeat and the other measures contractions. It takes about 20 minutes.
66
What is a **reactive** nonstress test?
A **normal** finding and that the fetal heart rate went up normally. It indicates that the fetal heart rate is "reassuring":
* fetal heart rate increases at least **15 beats per minute** over the baseline (between 120 and 160 beats per minute)
* The increase in heart rate lasts at least **15 seconds** within a 20-minute timeframe
67
What is a **NON-reactive** nonstress test?
An **abnormal** finding and that the fetal heart rate did not increase enough. It indicates more testing is needed.
## Footnote
It can also indicate that the fetus was sleeping.
68
What is an **amniocentesis**?
It tests the amniotic fluid for **genetic disorders and fetal lung maturity.**
## Footnote
A needle is used to aspirate a small amount of amniotic fluid through the pregnant client's abdomen guided by ultrasound.
69
What are the **interventions** before and after an amniocentesis?
1. **before procedure** - get informed consent
2. **after procedure** - assess for signs of complications
* bleeding, infection, decreased fetal movement, and cramping
70
What is **quickening** in pregnancy?
The moment when the pregnant woman **starts to feel or perceive fetal movements in the uterus**.
## Footnote
It usually occurs between week 15 and 25. About 50% of women don't feel anything until after 24 weeks gestation.
71
What is a **kick count test**?
When the pregnant client **counts the number of kicks** by the fetus in a 2-hour period.
## Footnote
Notify the HCP if there are \< 10 kicks in two consecutive 2-hour periods.
72
What is a **fern test**?
Identifies the presence of an **amniotic fluid leak.**
## Footnote
It will make a fernlike pattern on a microscopic slide.
73
What is a **nitrazine test**?
Identifies the presence of **amniotic fluid** in vaginal secretions by putting a drop of fluid on a paper strip.
## Footnote
It will turn the paper blue if there is amniotic fluid.
74
What is a **contraction stress test**?
Performed at the end of pregnancy to determine how well the **fetus will cope with the contractions** of childbirth.
## Footnote
Contractions are induced by administering oxytocin (or nipple stimulation) and the contractions and heart rate of the fetus is recorded.
75
What is a **positive** contraction stress test?
| (Immediate complication)
Indicates a **bad finding** and that late decelerations of the fetal heart rate were noted.
## Footnote
Late decelerations are never a good finding.
76
What is a **negative** contraction stress test?
Indicates a **good finding** and that no late decelerations of the fetal heart rate were noted.
77
If a client is bleeding from a miscarriage or abortion, how many saturated pads are considered **hemorrhage**?
| (Immediate complication)
* \> 1 saturated pad/hour
* one pad that gets saturated within 15 minutes
78
What are the **insulin needs** for a pregnant client with diabetes mellitus?
During 2nd and 3rd trimester, pregnant **client needs more insulin**.
## Footnote
The hormones in the placenta block insulin.
79
# Describe:
**Disseminated intravascular coagulation** (DIC) during pregnancy
| (Immediate complication)
A serious **bleeding and clotting complication** in a pregnant client with eclampsia, placenta abruption, a dead fetus, placenta retention, or infection.
## Footnote
The clotting factors are becoming over or underactivated.
80
# Interventions:
**Disseminated intravascular coagulation (DIC)** during pregnancy
* give oxygen
* blood transfusions if bleeding
* heparin if clotting
* monitor kidney function
## Footnote
Blood clots can damage vessels in the kidneys.
81
# Describe:
Hyperemesis gravidarum
When a **pregnant client has severe nausea and vomiting for about 24 hours.**
## Footnote
This puts her at risk of fluid and electrolyte imbalances.
82
# Interventions:
Hyperemesis gravidarum
* give IV fluids
* monitor intake and output
* antiemetics
83
# Describe:
Endometritis
An **infection of the lining of the uterus** that may lead to peritonitis.
84
# Medications:
Endometritis
Antibiotics.
85
# Describe:
Fetal death in utero
Fetal death that occurs at \> 20 weeks gestation.
## Footnote
Pregnant client can develop DIC if fetus is left in client for more than 3 weeks.
86
# Interventions:
Fetal death in utero
* appropriate cultural and religious care
* therapeutic communication
* possible touching of baby
* private room
* may be moved off maternity floor or away from any babies
87
# Describe:
Hepatitis B
A **viral infection** that can be transmitted to baby through blood, sputum, vaginal secretions, semen, and breast milk.
88
# Prevention:
Hepatitis B
* if pregnant client is positive for Hep B, clean newborn right away
* administer Hep B immune globulin and vaccination
* mom can breastfeed newborn as long as baby got vaccination
89
# Describe:
HIV and AIDs
A **viral infection** that can be transmitted to baby through blood, semen, vaginal secretions, or breastmilk.
## Footnote
Procedures that increase the mixing of blood increases the risk of the baby getting HIV.
90
# Prevention:
HIV and AIDs in newborn
* avoid internal scalp electrodes and episiotomy
* bottle feed if mom is HIV positive
* clean baby well before shots - avoid mixing of blood
* no live vaccines are given to baby (no MMR or varicella)
* antivirals
91
# Describe:
Gestational hypertension
**New-onset hypertension during pregnancy** after 20 weeks gestation.
92
# Describe:
Preeclampsia
New-onset hypertension after 20 weeks gestation and protein in the urine.
93
What are the **assessments** for preeclampsia?
* assess for headaches, heartburn and nausea/vomiting after 20 weeks
* take blood pressure
* get urine sample to check for proteins
## Footnote
These are all signs of hypertension.
94
# Describe:
Eclampsia
| (Immediate complication)
The onset of **seizures** for a pregnant client with preeclampsia.
95
# Describe:
HELLP syndrome
| (Immediate complication)
A condition that can cause **severe bleeding** in a pregnant client.
## Footnote
The cause is not known but associated with gestational hypertension and preeclampsia.
96
What are the characteristic **signs and symptoms** of HELLP syndrome?
* **H:** Hemolysis
* **EL:** Elevated Liver enzymes
* **LP:** Low Platelets
## Footnote
All these findings increase the risk of bleeding in a pregnant client.
97
# Interventions:
**HELLP** syndrome
* possible bedrest
* antihypertensives and magnesium sulfate to prevent eclampsia and pre-eclampsia
98
# Describe:
"TORCH" screening
Screening the pregnant client for **infections that are highly toxic to growing fetus.**
* **T:** Toxoplasmosis
* **O:** Other infections
* **R:** Rubella (German measles)
* **C:** Cytomegalovirus
* **H:** Herpes simplex virus
99
# Teaching:
Toxoplasmosis
Avoid raw meat and cleaning out the kitty litter box.
## Footnote
Bacteria is in raw meat and cat feces.
100
What are the **"Other" infections** for "TORCH"?
* Group B Streptococcus
* HIV
* syphilis
* parvovirus
* hepatitis B virus
* West Nile virus
## Footnote
These are all infections that are highly toxic to growing fetus.
101
# Medications:
TORCH infections
Antivirals or antibiotics.
102
# Interventions:
What are the **interventions** for sexually transmitted infections during pregnancy?
* screen pregnant client for infections
* if positive, give antibiotics, antivirals, or antifungals
* have partner tested and treated
103
# Interventions:
Tuberculosis in a pregnant client
* if x-ray is needed, perform after 20 weeks gestation and use lead shield on pregnant client
* TB skin test is safe during pregnancy
* Give antituberculosis drugs during pregnancy
104
# Interventions:
**Tuberculosis** in newborn
* if skin test is positive in newborn, they will get antituberculosis drugs for at least 6 months
* if mom's sputum culture comes back negative, newborn does not need to be isolated from mom
105
# Describe:
Ectopic pregnancy
When the **embryo is fertilized outside of the uterus**, usually in the fallopian tube.
106
What are the **characteristic signs and symptoms** of an ectopic pregnancy?
* vaginal spotting that is dark red or brown
* if it ruptures, it causes increased pain that radiates to the shoulder
107
# Interventions:
Ectopic pregnancy
1. **give methotrexate** - to prevent the fetus from developing
2. **prepare for laparotomy** - to remove fetus and tube
3. **give rho D immune globulin** (if woman is Rh-negative) - helps to prevent bleeding
108
What are some **risk factors** for infertility?
* **Woman**
* maternal obesity
* maternal age \> 35
* nutritional deficiencies
* **Man**
* alcohol and drug abuse
* exposure of testes to heat (sauna use)
* endocrine disorders that decrease testosterone
109
What are **kegel exercises** for?
**Strengthening the pelvic floor muscles in preparation for birth**. They can also help prevent incontinence later in the pregnancy and postpartum life.
## Footnote
A kegel exercise is like pretending you have to urinate and then holding it. (Men can do them also to strengthen the muscles for bladder control and sexual function).
110
# Define:
primigravida
Pregnant for the first time.
111
# Define:
nullipara
Never given birth.
112
How **often** are doctor's appointments for a pregnant woman?
* 1st and 2nd trimester: once a month visits
* 28-35 weeks pregnant: once every 2 week visits
* 36 weeks - delivery: once a week visits
113
What are the **risk factors** to the unborn fetus if the woman has a low hemoglobin and hematocrit?
There is an increased risk of low birth weight, pre-term delivery or death utero.
## Footnote
Prevent a low hemoglobin and hematocrit by taking iron supplements.
114
What are the **risks** if a pregnant client is obese?
There is an increased risk of gestational diabetes, pre-eclampsia and/or a difficult labor.
115
# Teaching:
Obese pregnant woman
* teach to eat a healthy diet
* do not go on a "diet" during pregnancy
* keep appointments
* perform kegel exercises to increase pelvic floor strength
Nursing Maternity
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