NURS 629 EXAM 4 STUDY GUIDE LATEST UPDATE2022/2023
Presumptive signs of pregnancy
• Signs of symptoms frequently reported with pregnancy, although not
conclusiv e for pregnancy
• Signs and symptoms that are usually noted by the patient, which impel
her to make an appointment with a physician.
• These signs and symptoms are not proof of pregnancy, but they will make
the physician and women suspicious of pregnancy
o Amenorrhea
o N/V (morning sickness)
o Frequent Urination
o Breast Changes
Probable signs of pregnancy
Signs or symptoms that are more reliable indicators of pregnancy, often
noted on the physical examination or with laboratory testing
These signs include:
Uterine changes
Abdominal changes
Cervical changes
Basal body temperature
Positive pregnancy test by physician
Fetal palpation
Positive signs of pregnancy
Signs or symptoms that provide absolute confirmation of pregnancy
Fetal heart sounds
Ultrasound scanning of the fetus
Palpation of the entire fetus
Palpation of fetal movements
Actual delivery of an infant
Office Visit Labs
o ABO blood group/Rh Factor
o CBC
o Rubella Titer
o Syphillis Screening
o Hep B
o UA
o Chlamydia screen
o HIV screening
o Pap if indicated based on guidelines
o Answ er questions patients may hav e: Sexuality activity, w hat are
,NURS 629 EXAM 4 STUDY GUIDE LATEST UPDATE2022/2023
dangerous signs in pregnancy
Screening
o Amniocentesis at 16 weeks is performed for genetic studies
o Labs
▪ Lab studies performed are as follow s:
▪ CBC, Hgb or Hct to detect ane mia
▪ VRDL to identify patients with untreated syphilis
▪ Rh factor, blood type-to determine if the patient is Rh
negative
▪ Rubella antibody titer- to determine immunity to rubella
▪ Hepatitis screen is done if patient history indicated cause for
suspicion
o Screen for Gestational Diabetes with 1 hour glucose tolerance test
▪ If positive, order 3 hour glucose tolerance test.
Common signs and rules in pregnancy
o Chadwick’s sign: bluish discoloration of the cervix and v agina
o Goodells’ sign: softening of the cervix and v agina as being usually
indicativ e of pregnancy
o Baxton Hick sign: irregular contractions of the womb (the uterus)
occurring tow ards the middle of pregnancy
o Hegar’s sign: a softening of the isthmus of the uterine cervix that
occurs early in gestation. It is a probable sign of pregnancy
o Leukorrheals-thin, w hite, milky and mild smelling, normal and
nothing for you to worry about.
Fundal Height
,NURS 629 EXAM 4 STUDY GUIDE LATEST UPDATE2022/2023
Nagele’s rule and office visit intervals for pregnancy
o Negele’s rule, the NP computes estimated date of deliv ery (EDD)
o Most common method of pregnancy dateing.
o The EDD is calculated by counting back three months from the LMP
and adding seven days. This method assumes the patient has a 28
days menstrual cycle with fertilization occurring on day 14
Recommended office visit intervals of pregnancy
o In the US, the typical interv als for prenatal visits for nulliparous
women with uncomplicated pregnancy are every 4 weeks until 28
weeks of gestation, every 2 w eeks from 28-36 w eeks, and then
weekly until deliver.
o Parous w omen with uncomplicated medical and obstetrical histories
can be seen less frequently. Women with problems are seen more
frequently, depending on the nature of the problems. According to
this schedule, an uncomplicated pregnancy where the first visit is at
six weeks of gestation and the last visit is at 41 weeks will comprise
of 16 prenatal visits.
Common Complaints during pregnancy
o Complaints in the first trimester of pregnancy
▪ N/V
,NURS 629 EXAM 4 STUDY GUIDE LATEST UPDATE2022/2023
▪ Fatigue
▪ Low back aches
o Complaints in the third trimester of pregnancy
▪ Uterine contractions
▪ Urinary frequency
▪ Leukorrhea
First Trimester bleeding
o Overview -v aginal bleeding is common in the first trimester,
occurring in 20-40 percent of pregnant women. It may be any
combination of light or heavy, intermittent or constant, painless or
painful. The four major sources of nantraumatic bleeding in early
pregnancy are:
▪ Ectopic pregnancy
▪ Miscarriage (threatened, inevitable, incomplete, complete)
▪ Implantation of the pregnancy
▪ Cervical, v aginal or uterine pathology (eg polyps,
inflammation/infection, trophoblastic disease
Pregnancy induced Hypertension (PIH)
o Preeclampsia refers to the new onset of hypertension and either
proteinuria or end-organ dysfunction or both after 20 w eeks of
gestation in a previously normotensive woman
o Treatment
▪ Mild
▪ Moderate
▪ Severe
o Eclampsia refers to the development of grand mal siezures in a
woman with preeclampsia, in the absence of other neurological
conditions that could account for the seizure
o HELLP syndrome (Hemolysis, Elev ated Liver enzymes, Low Platelets)
probably represents a severe form of preeclampsia, but this
relationship remains controversial. HELLP may be an independent
disorder. As many as 15-20 % of affected patients do not have
concurrent hypertension or proteinuria, leading some experts to
believe that HELLP syndrome is a separate disorder from
preeclampsia
Symptoms of HELLP
o Headache
o N/V indigestion with pain after eating
o Abdominal or chest tenderness and upper right upper side pain
(from liver distention)
o Shoulder pain or pain when breathing deeply
o Bleeding
Presumptive signs of pregnancy
• Signs of symptoms frequently reported with pregnancy, although not
conclusiv e for pregnancy
• Signs and symptoms that are usually noted by the patient, which impel
her to make an appointment with a physician.
• These signs and symptoms are not proof of pregnancy, but they will make
the physician and women suspicious of pregnancy
o Amenorrhea
o N/V (morning sickness)
o Frequent Urination
o Breast Changes
Probable signs of pregnancy
Signs or symptoms that are more reliable indicators of pregnancy, often
noted on the physical examination or with laboratory testing
These signs include:
Uterine changes
Abdominal changes
Cervical changes
Basal body temperature
Positive pregnancy test by physician
Fetal palpation
Positive signs of pregnancy
Signs or symptoms that provide absolute confirmation of pregnancy
Fetal heart sounds
Ultrasound scanning of the fetus
Palpation of the entire fetus
Palpation of fetal movements
Actual delivery of an infant
Office Visit Labs
o ABO blood group/Rh Factor
o CBC
o Rubella Titer
o Syphillis Screening
o Hep B
o UA
o Chlamydia screen
o HIV screening
o Pap if indicated based on guidelines
o Answ er questions patients may hav e: Sexuality activity, w hat are
,NURS 629 EXAM 4 STUDY GUIDE LATEST UPDATE2022/2023
dangerous signs in pregnancy
Screening
o Amniocentesis at 16 weeks is performed for genetic studies
o Labs
▪ Lab studies performed are as follow s:
▪ CBC, Hgb or Hct to detect ane mia
▪ VRDL to identify patients with untreated syphilis
▪ Rh factor, blood type-to determine if the patient is Rh
negative
▪ Rubella antibody titer- to determine immunity to rubella
▪ Hepatitis screen is done if patient history indicated cause for
suspicion
o Screen for Gestational Diabetes with 1 hour glucose tolerance test
▪ If positive, order 3 hour glucose tolerance test.
Common signs and rules in pregnancy
o Chadwick’s sign: bluish discoloration of the cervix and v agina
o Goodells’ sign: softening of the cervix and v agina as being usually
indicativ e of pregnancy
o Baxton Hick sign: irregular contractions of the womb (the uterus)
occurring tow ards the middle of pregnancy
o Hegar’s sign: a softening of the isthmus of the uterine cervix that
occurs early in gestation. It is a probable sign of pregnancy
o Leukorrheals-thin, w hite, milky and mild smelling, normal and
nothing for you to worry about.
Fundal Height
,NURS 629 EXAM 4 STUDY GUIDE LATEST UPDATE2022/2023
Nagele’s rule and office visit intervals for pregnancy
o Negele’s rule, the NP computes estimated date of deliv ery (EDD)
o Most common method of pregnancy dateing.
o The EDD is calculated by counting back three months from the LMP
and adding seven days. This method assumes the patient has a 28
days menstrual cycle with fertilization occurring on day 14
Recommended office visit intervals of pregnancy
o In the US, the typical interv als for prenatal visits for nulliparous
women with uncomplicated pregnancy are every 4 weeks until 28
weeks of gestation, every 2 w eeks from 28-36 w eeks, and then
weekly until deliver.
o Parous w omen with uncomplicated medical and obstetrical histories
can be seen less frequently. Women with problems are seen more
frequently, depending on the nature of the problems. According to
this schedule, an uncomplicated pregnancy where the first visit is at
six weeks of gestation and the last visit is at 41 weeks will comprise
of 16 prenatal visits.
Common Complaints during pregnancy
o Complaints in the first trimester of pregnancy
▪ N/V
,NURS 629 EXAM 4 STUDY GUIDE LATEST UPDATE2022/2023
▪ Fatigue
▪ Low back aches
o Complaints in the third trimester of pregnancy
▪ Uterine contractions
▪ Urinary frequency
▪ Leukorrhea
First Trimester bleeding
o Overview -v aginal bleeding is common in the first trimester,
occurring in 20-40 percent of pregnant women. It may be any
combination of light or heavy, intermittent or constant, painless or
painful. The four major sources of nantraumatic bleeding in early
pregnancy are:
▪ Ectopic pregnancy
▪ Miscarriage (threatened, inevitable, incomplete, complete)
▪ Implantation of the pregnancy
▪ Cervical, v aginal or uterine pathology (eg polyps,
inflammation/infection, trophoblastic disease
Pregnancy induced Hypertension (PIH)
o Preeclampsia refers to the new onset of hypertension and either
proteinuria or end-organ dysfunction or both after 20 w eeks of
gestation in a previously normotensive woman
o Treatment
▪ Mild
▪ Moderate
▪ Severe
o Eclampsia refers to the development of grand mal siezures in a
woman with preeclampsia, in the absence of other neurological
conditions that could account for the seizure
o HELLP syndrome (Hemolysis, Elev ated Liver enzymes, Low Platelets)
probably represents a severe form of preeclampsia, but this
relationship remains controversial. HELLP may be an independent
disorder. As many as 15-20 % of affected patients do not have
concurrent hypertension or proteinuria, leading some experts to
believe that HELLP syndrome is a separate disorder from
preeclampsia
Symptoms of HELLP
o Headache
o N/V indigestion with pain after eating
o Abdominal or chest tenderness and upper right upper side pain
(from liver distention)
o Shoulder pain or pain when breathing deeply
o Bleeding
