NUR 2421 Maternity Nursing Exam 3 Pregnancy Chapters 12-19 Latest

NUR 2421 Maternity Nursing Exam 3 Pregnancy Chapters 12-19 The following is content that you can expect to see on the exam. Please refer to all reading assignments, Power Point, ATI book and lecture notes for content. Items are listed topically. It is the student responsibility to be familiar with all content related to the topic. 1. Calculation of Due Date: 9 calendar months, Lunar months 28 days, 10 Lunar months equal 40 weeks, Every day counts, 3 trimesters: 1-13, 14-26, 27-term Naegle’s Rule: (1st day of LMP- 3 months)+ 7 days, Or (Month -3) + 7 days McDonald’s method- gestational age calculated in centimeters- symphysis pubis to fundal height- (distance in centimeters x 8) divided by 7= total weeks of gestation. Other indicators: FHT with doppler at 10–12 weeks, Fetal movement felt at about 20 weeks, Fundal height correlation with gestational age, Ultrasound 2. Presumptive: Amenorrhea, Nausea and vomiting, Fatigue, Urinary frequency, Breast enlargement and tenderness, Quickening 3. Probable: Goodell’s sign (softening of the cervix), Chadwick’s sign (bluish vaginal tissue), Hegar’s sign- lower uterine segment (also-considered softening of the cervix), Ballottement, Positive pregnancy test 4. Positive Signs of Pregnancy: Fetal heart tones, Fetal movement, Ultrasound 5. Integumentary changes: Spider angiomas and palmar erythema, Hyperpigmentation: Linea nigra, Chloasma; Striae gravidarum, Vascular Spider Nevi, Sebaceous glands, Hair/ Nails 6. Danger Signs: Persistent vomiting, Vaginal bleeding, Edema of face/hands, Temperature 101°F, Chills and fever, Persistent abdominal pain, epigastric pain. Dysuria, Intermittent back pain, pelvic pressure. Visual changes, Changes in fetal movement. Risk factors: Teratogens, Toxicity, Exposure to pesticides/herbicides, Heavy metals, Occupational risks, Medications, Alcohol, Tobacco, Illicit drugs 7. Weight gain and dietary guidelines: Individualized by pre-pregnancy weight, Average weight gain is 27.5 lbs.: 27.5–39.6 lb for underweight women; 25.3–35.2 lb for normal weight women; 15.4–25 lb for overweight women. Recommended the amount of weight gained equals at least the combined weight of fetus, placenta and amniotic fluid. Energy and caloric requirements are increased during pregnancy due to the growing fetus and the additional needs of the pregnant mother. Weight gain should be steady to support the growing fetus.8. Preterm labor: pregnancy that has reached 20 weeks of gestation but before completion of 37 weeks of gestation, and documented uterine contractions and cervical effacement of 80 percent or cervical dilation of more than one cm. Late preterm: pregnancy between 34-37 weeks (previously called near term). Treatment: Stop activity, Drink 2-3 glasses of H2O, CONTACT HCP, GO TO HOSPITAL 9. Musculoskeletal changes: Lordosis develops: Back pain common during pregnancy, Ligaments soften due to relaxin: Pelvic discomfort, Unsteady gait, Teeth/ Gums, Pelvic joints- Relaxin, Lumbodorsal Spinal Curve, Diastasis Recti 10.Cardiovascular changes: Heart displaced up and to the left, Heart enlarges, Systolic murmurs common, Cardiac output Increases by 10 weeks and peaks at 24 weeks, Heart rate increases by 20 beats/minute, Blood pressure Decreases in first trimester - Returns to normal reading by term, Systemic vascular resistance Decreases during pregnancy Cardiovascular Changes (adaptive and protective): Blood pressure: 140/90, 125/75, 130/85, 30mm change, Supine hypotensive syndrome Blood volume and composition: Anemia of pregnancy, Erythrocytes- 30% O2 requirements/Fetus Leukocytosis Plasma 50%, 1500ml/ 40% peak at 32 weeks Cardiac output: 30-50% by 32 weeks Circulation and coagulation times, Hypercoagulability 11.Quickening: When a woman feels her baby move for the first time. Usually between 18-20 weeks, but sometimes as early as 16 weeks in a multigravida or as late as 22 weeks in some primigravidas 12.Edema: Etiology: Increased fluid volume, Sluggish venous return Client teaching: Avoid long periods of standing, Elevate feet, Exercise 13.Reproductive system changes: Uterus: Changes in size, shape and position: Egg, pear, orange, grapefruit. 10 mL to 5000 mL, “Show” 14 weeks, Hegar’s sign- lower uterine segment, Changes in contractility - Braxton Hicks, Uteroplacental bloodflow- 20x flow, 1/6 mat. Vol., 500ml/min, Ovaries stop ovum production, 20–25% of cardiac output goes to uterus, Braxton Hicks contractions occur throughout pregnancy, Changes related to presence of fetus, Endometrium is referred to as decidua, Quickening- 16/18 weeks, Leukorrhea, Enlarges to hold a volume of 15– 20 liters, At 12 weeks rises out of the pelvis, Walls thin, but strengthened with fibrous tissue Cervical changes- Goodell’s sign, Softens and becomes bluish in color, Mucous plug forms to protect the fetus Vaginal changes- Chadwick’s sign “I’m so blue” (Ph 3.5-6, leukorrhea), Increased vascularity, Increased vaginal discharge: Acidic environment prevents bacterial infection, Yeast infection (candida) common during pregnancy Breasts: Size increases- hypertrophy/ nodular, Montgomery’s tubercles-lubrication for breastfeeding, Colostrum-16 weeks, Striae, Enlarge and become tender, Increased alveoli, Areola darken, Tubercles of Montgomery enlarge and secrete a substance to maintain areolar suppleness, Colostrum may leak from the breast Ovaries: Normal function ceases, Corpus luteum secretes progesterone, Placenta produces progesterone by six to seven weeks and corpus luteum regresses 14.Folic Acid supplementation: All women of childbearing age in the United States who are capable of becoming pregnant should consume 0.4 mg of folic acid per day for the purpose of reducing their risk of having a pregnancy affected with spina bifida or other neural tube defects (NTDs). Because the effects of higher intakes are not well known but include complicating the diagnosis of vitamin B((12)) deficiency, care should be taken to keep total folate consumption at less than 1 mg per day, except under the supervision of a physician. Women who have had a prior NTD-affected pregnancy are at high risk of having a subsequent affected pregnancy. 15.Gravidity and Parity: GPTAL: Gravida–number of pregnancies, Para–number of births after 20 weeks Five-digit system: G- Gravida- total number of pregnancies P- Para- number of births that occur after 20 weeks gestation regardless of dead or alive. Multiples count as one delivery T-term- number of term infants born after 37 weeks gestation P- premature- number of premature infants born between 20 and 36 weeks A- abortion or miscarriage- number of pregnancies that end in an abortion prior to 20 weeks gestation L- living- number of children currently living 16.Nausea and vomiting: Probably caused by hormones, Client education: Plenty of fluids, avoid caffeine and carbonation, Frequent, small meals, high protein, and carbohydrates, Eat crackers to avoid an empty stomach, Avoid noxious odors, Limit stress, Hyperemesis gravidarum–severe vomiting requiring medical intervention 17.WIC Program: WIC provides nutritious foods, nutrition education (including breastfeeding promotion and support), and referrals to health and other social services to participants at no charge. WIC serves low-income pregnant, postpartum and breastfeeding women, and infants and children up to age 5 who are at nutrition risk. WIC is a Federal grant program for which Congress authorizes a specific amount of funding each year for program operations. The Food andNutrition Service, which administers the program at the Federal level, provides these funds to WIC State agencies (State health departments or comparable agencies) to pay for WIC foods, nutrition education, breastfeeding promotion and support, and administrative costs 18.RH Factor: Rhesus (Rh) factor is an inherited protein found on the surface of red blood cells. If your blood has the protein, you are Rh positive. If your blood lacks the protein, you are Rh negative. If you're Rh negative and your baby is Rh positive, however, your body might produce proteins called Rh antibodies after exposure to the baby's red blood cells. The concern is with your next pregnancy. If your next baby is Rh positive again, your body will produce Rh antibodies that can cross the placenta and damage the baby's red blood cells. This could lead to life-threatening anemia, a condition in which there are not enough red blood cells. If this condition is not prevented, each Rh positive baby you carry after your first pregnancy might have severe anemia. 19.Maternal Respiratory system changes: Changes in mechanical function: Diaphragm rises 4 cm, Chest circumference increases 5 to 7 cm Progesterone: Causes increase in tidal volume (30–40%) and decrease in Pco2 (compensated respiratory alkalosis) Rate does not change, Changes facilitate removal of carbon dioxide from fetus. Structural changes- sub costal angle A/P diameter / elevated diaphragm: Pulmonary function: O2 requirements, Basal metabolism rate: “HOT HOT HOT”, Respiratory Rate, Acid-base balance: Respiratory Alkalosis/ Metabolic acididosis 20.Sequencing of events in pregnancy: example heart tones, movement, positive test etc. First Trimester The first trimester lasts from the first through the 13th week of pregnancy. Although you may not look pregnant during the first trimester, your body is going through enormous changes as it accommodates a growing fetus. In the first few weeks following conception, your hormone levels change significantly. Your uterus begins to support the growth of the placenta and the fetus, your body adds to its blood supply to carry oxygen and nutrients to the developing baby, and your heart rate increases. These changes accompany many of the pregnancy symptoms, such as fatigue, morning sickness, headaches, and constipation. The first trimester is vital for the development of your baby. The fetus will develop all of its organs by the end of the third month, so this is a crucial time. It's important to maintain a healthy diet, including adding an adequate amount of folic acid in order to help prevent neural tube defects. Cut out any bad habits, such as smoking and alcohol. Both have been related to serious complications in pregnancy and birth defects. Second Trimester The second trimester (weeks 13-27) is often the most comfortable period of time for the majority of pregnant women. Most of the early pregnancy symptoms will gradually disappear, and you should enjoy a more restful night's sleep and a surge in energy levels during the daytime. Your abdomen will start to look pregnant, as the uterus will grow rapidly in size. At the end of the second trimester, your baby will be almost four times as big as it was at the end of the first trimester. It's a good time to invest in maternity wear, and spread the good news of your pregnancywith your friends and family. While the discomforts of early pregnancy should ease off, there are a few new symptoms to get used to. Common complaints include leg cramps and heartburn. Screening tests are also performed in the second trimester, and this is when a diagnostic test would be performed. Be sure to talk to your doctor about your medical history and any issues that could put you or your baby at risk. Third Trimester The third trimester lasts from the 28th week through the birth of your baby. During the third trimester you will start seeing your health care provider more frequently. Your doctor will regularly: test your urine for protein, check your blood pressure, listen to the fetal heart rate, measure your fundal height (the approximate length of your uterus), check your hands and legs for any swelling. Your doctor will also determine the baby's position and check your cervix in order to monitor how your body is preparing for childbirth. The third trimester is a good time to educate yourself about labor and delivery. Take time out to enroll in a childbirth class. Childbirth classes are designed to prepare you and your partner for labor and delivery. It's a great way to learn about the different stages of labor and delivery options, and gives you the opportunity to ask any questions or voice any concerns to a trained childbirth instructor. Due Date A normal, full-term pregnancy can last anywhere from 37 to 42 weeks. Your due date is really an estimated date of delivery (EDD). It’s dated from the first day of your last period, even though you actually conceive two weeks or so after this date. The dating system works well for women who have fairly regular menstrual cycles. However, for women who have irregular periods, the dating system may not work and other methods may be needed to determine the EDD. The most accurate method of determining the due date is an ultrasound in the first trimester, because early fetal development is fairly regular across all pregnancies.21.Antenatal Laboratory testing: Genetic tests for inherited diseases Genetic testing for inherited diseases Check carrier status for certain genetic diseases to determine risk of having a baby with such a disease Pre-conception or first trimester Mother and father (blood sample) Genetic testing for hemoglobin disorders Check carrier status for certain abnormal hemoglobin disorders to determine risk of having a baby with such a disease Pre-conception or during pregnancy Mother and father (blood sample) Cystic fibrosis carrier testing Check carrier status for CF Pre-conception or first trimester Mother and father (blood sample) Testing to detect health conditions in the mother Blood glucose or hemoglobin A1c To screen women at risk of type 2 diabetes (which is different than gestational diabetes) Pre-conception or first trimester Mother (blood sample) Pap test and HPV testing Screen for cervical cancer and some STDs Pre-conception or first trimester Mother (cells from her cervix) Immunity to rubella (German measles) Check for immunity to the virus, which can cause birth defects Pre-conception or first trimester Mother (blood sample) HIV screening test Check for HIV infection so steps can be taken to reduce likelihood of transmission to the baby Pre-conception or first trimester; may be repeated in third trimester if at high risk Mother (blood sample) Gonorrhea, chlamydia, and syphilis tests Check for STD infections, which can cause miscarriage or infect the baby during delivery Pre-conception or first trimester; may be repeated in third trimester if at high risk Mother (cervical cells, urine or blood sample, depending on test) Hepatitis B and hepatitis C Detect hepatitis B or hepatitis C infection Pre-conception or first trimester; may Mother (blood sample)screening be repeated in the third trimester if at high risk Varicella zoster virus testing Check for immunity to chickenpox, which can cause birth defects Pre-conception or first trimester Mother (blood sample) TORCH panel Check for infection with toxoplasmosis and other infections that can cause birth defects Pre-conception or first trimester, if infections suspected Mother (blood sample) Bacterial vaginosis Detect infection, which can cause pre-term labor Pre-conception or whenever symptoms experienced Mother (vaginal secretions) Urine culture for bacteriuria Detect bacterial infection in the urinary tract, which can lead to kidney infection or increased risk of pre-term delivery and low birth weight First prenatal visit or between 12 and 16 weeks of pregnancy; may be repeated in third trimester Mother (urine sample) Group Bstreptococcus Detect infection, which can harm the baby during birth and infect the mother’s uterus, urinary tract, and any incision made during a cesarean section Between weeks 35 and 37 of pregnancy Mother (specimen from vaginal and rectal areas) Confirmation and monitoring of pregnancy and health of mother Pregnancy test (hCG) Confirm pregnancy First trimester Mother (blood sample) Urine screen for glucose and/or protein Check for signs of kidney or bladder infection, undiagnosed diabetes or gestational diabetes, or preeclampsia Each prenatal visit Mother (urine sample) Complete blood count (CBC) Check for anemia and/or detect low platelet count Pre-conception and/or early in the first trimester; repeated in third Mother (blood sample)trimester Blood typing and antibody screen Check for potential incompatibility in blood type between mother and fetus (such as Rh factor antibodies) First trimester; antibody screen repeated between weeks 28 and 29 of pregnancy Mother (blood sample) Glucose challenge test/oral glucose tolerance test Check for gestational diabetes Between 24 and 28 weeks of pregnancy Mother (blood sample) Thyroid stimulating hormone (TSH) In women with known thyroid conditions, to adjust medication if necessary Throughout pregnancy Mother (blood sample) Detection of fetal abnormalities or assessment of risk First trimester Down syndrome screen Assess risk of carrying a fetus with certain chromosomal abnormalities, such as Down syndrome Usually between 11 and 14 weeks of pregnancy Mother (blood sample plus ultrasound) Second trimester maternal serum screen Assess risk of carrying a fetus with certain chromosomal abnormalities or open neural tube defects Between 15 and 20 weeks of pregnancy Mother (blood sample) Cell-free fetal DNA Assess risk of carrying a fetus with certain chromosomal abnormalities; currently recommended for women at high risk of having babies with these disorders During or after the 10thweek of pregnancy Mother (blood sample) Chorionic villus sampling Detect chromosomal disorders in the fetus Between weeks 10 and 12 of pregnancy, if recommended Mother (cells from the placenta) Amniocentesis Detect certain birth defects and chromosomal abnormalities Between 15 and 20 weeks of pregnancy, if recommended Mother (amniotic fluid)Cordocentesis Detect chromosomal abnormalities, blood disorders, and certain infections Between weeks 18 and 22 of pregnancy, if recommended Mother/fetus (fetal blood sample obtained from vein in the umbilical cord) Fetal maturity/readiness for birth Amniocentesis Check fetal lung development After week 32 of pregnancy if risk of pre-term delivery Mother (amniotic fluid) Fetal fibronectin (fFN) Detect fFN; negative result is highly predictive that pre-term delivery will NOT occur in the next 7-14 days Between week 22 and 35 of pregnancy, if having symptoms of preterm labor Mother (cervical or vaginal fluid sample) 22.Exercise guidelines: SEE ATTACHED