Nur254 Exam1 maternity

Childbearing Exam #1
Galen College
Nur-254
Childbearing / maternity
Unit 1: Antepartum
What in yellow was on this exam
Nursing Management
o Page 178 Signs/symptoms related to pregnancy
 Categorizing signs/symptoms of pregnancy
 Presumptive: subjective (Patient says they experience), least reliable – not definitive signs of
pregnancy, COULD be caused by something other than pregnancy, QUICKENING
o Breast changes, amenorrhea, nausea and vomiting, urinary frequency, fatigue,
quickening
 Probable: objective, (practitioner can see) “more than likely” pregnant
o Positive pregnancy test, Braxton Hicks (false), Goodell’s sign (cervical softening),
Chadwick’s sign (increased cervical vascularization), Hegar’s sign (softening of lower
uterine segment), enlarging uterus, ballottement (pushing of the uterus – do you feel a
fetus move and come back?)
 Positive: visualization, hearing fetus HR, feel the fetus, VISUAL ULTRA SOUND; practitioner feels
kicking
 What is considered normal or expected?
 Effects on body systems
o Breasts: increase in size, fullness, heaviness, tingling, darkening of the areola, lactation
can occur as early as 18 weeks
o GI: delayed GI motility, constipation, heartburn, nausea and vomiting, hemorrhoids,
increased vascularity of gums, increased saliva
o GU: increased urination; NORMAL
o Cardio: pulse increase, increased blood volume, increased cardiac output
o Respiratory: increased O2 consumption, nasal and sinus congestion, increased
vascularity
o Musculoskeletal: center of gravity shifts, unsteady gait
o Sensory: sciatica, restless legs, muscle cramps, syncope, tension headache
o Integumentary: melasma mask (hyperpigmentation), striae gravidarum (stretch marks),
vascular malformation (spider veins)
 Vital signs
o HR: slight increase
o BP: should not change dramatically from baseline
o RR: SOB is common, difficulty breathing is NOT
o O2: remains stable
o Temp: can slightly increase
▫ Page 187 Calculating GTPAL
 G: gravida
 Number of pregnancies, regardless of the outcome – including current
 T: term
 Delivery at 37-42 weeks
 P: preterm
 Delivery between 20 weeks and 36 weeks 6 days
 A: abortion
 Before 20 weeks, including miscarriage
 L: living
 Number of children that are still living
 REMEMBER! With multiples, they count as one pregnancy!
▫ Page 178 Calculating Naegele’s Rule/EDD (expected date of delivery) – two ways to calculate
 First day of last menstrual period
 Add 7 days + 9 months
 OR
 Add 7 days – 3 months + one year
 EXAMPLE:
 LMP: 1/12/22
 + 7 days = 1/19/22
 + 9 months = 10/19/22
▫ Analyzing labs
 Blood work
 Titers
o Rubella/Varicella: provides passive immunity
 Live vaccines are contraindicated (page 193)
o No booster while pregnant, can offer postpartum
o Toxoplasma- Don’t not clean cat litter, eat raw meat or touch dirt
 CBC

, o H&H will increase ( normal Hemoglobin for PG 11)
o Monitor for anemia
 Coombs screening: Rh factor and antibodies
o Rh negative mom, Rh positive baby
o ( rh+ fetal blood crosses into maternal blood stimulating maternal antibodies)
 Rhogam UP to 72hr after birth or any instance when blood may become mixed
 Blood type
 STI screening: HIV, syphilis, chlamydia, gonorrhea
▫ Therapeutic communication
 Speaking with patients about common symptoms of pregnancy
 Current exercise can continue, unless uncomfortable
 HYDRATE
 Careful in HOT weather
 Sleep 8 hours every day if possible
 Change bra, shoes and other clothing to ensure comfort
 Sleep on side after 1st trimester
▫ Providing culturally competent care- don’t offend, always ask about preferences of food/ pain ect; check chart for previous
pain management
o Priority Actions
 What to do first?
▫ Page 198 Relieving discomforts of PG signs/symptoms
 Breast changes= wear supportive maternity bra
 Urgency frequency- empty bladder, kegel exercises, limit fluid before bed, avoid coffee
 N/V= avoid empty overload stomach; dry carb and hot tea, Avoid fried, spicy food;
 Bleeding gums= go to dentist; eat fresh fruit & veggies and soft toothbrush
 Constipation= Drink 2L of water; no stool softner, no laxative, only w/ Dr order
 Not preventable=mask of pg, spider nevi, pruritis, palpitations, food craving, carpal tunnel
 Education
o Page 208 Dietary management
 Weight gain of 25-35lbs is normal
 First trimester: no increase in calories
 2nd and 3rd: 300 calorie increase
 Iron-deficiency anemia
 Organ meats, green veggies, nuts, beans; PeanutButter; cereal, whole wheat, spinach, eggs
omelet
 Take supplements on an empty stomach – mild nausea is common
 Vitamin C will increase absorption= orange , broccoli
 Stools can turn dark green to black and cause constipation
 No calcium blocks absorption of Iron; can take 2hrs before and 2 hours after > no milk, yogurt,
butter
 Folic acid
 Low levels linked to fetal neural tube defects
 Leafy greens
▫ Page 200 Signs of possible complications of PG
 1st trimester
 Severe vomiting= hyperemesis gravida
 Chills, fever; burning upon urination; diarrhea= infection
 Abd cramps; vag bleeding= miscarriage, ectopic pg
 2nd & 3rd Trimester
 Persistent severe vomiting= hyperemesis gravida, HTN, Preclampsia
 Sudden discharge fluid from vag before 37w= Preterm Pre labor rupture of membranes
 Vag bleed, severe abd pain=miscarriage, placenta previa, abruptio placental
 Chills, fever, burning on urination, diarrhea= infection
 Severe backache or flank pain= kidney infection or stones, preterm labor
 Change in fetal movements = absence after quickening, any usual pattern or amt=fetal
jeopardy, intrauterine fetal death
 Absence of FHR=intrauterine fetal death
 Uterine contractions, pelvic pressure; cramping before 37w= preterm labor
 Visual; disturbances, blurry, 2x vision, spots=htn , preeclampsia
 Swelling of face or fingers , over sacrum= htn , preeclampsia
 Headache, severe frequent or continuous= htn , preeclampsia
 Muscular irritability or seizures= htn , preeclampsia
 Epigastric / abd pain = htn , preeclampsia, placenta abruption
 Glycosuria, + glucose tolerance reaction= gestational DM
o Knowing if teaching is effective/ineffective
 Red flag /warning pregnancy symptoms
 Fluid from vagina that is not leukorrhea (thin, white, scant vaginal discharge)
 Abdominal or pelvic pain
 Epigastric pain or severe heartburn
 Sudden or severe edema in face and hands