Nursing 434. Exam 2
Physical signs of pregnancy (presumptive) - answer deals with personal experiences
breast changes, n/v, amenorrhea, urinary frequency, fatigue, quickening (baby
movement)
Physical signs of pregnancy (probable) (probably of pregnant) - answer involves a
health provider's examination
good ell sign (softening of the cervix)
chadwick sign (discoloration of the vagina ((blue))
hegar sign (softening of the lower uterine segment)
positive pregnancy test (looks at the presence of HCG levels)
Braxton hick contractions
ballottement (how does the uterus feels)
Physical signs of pregnancy (positive) (def pregnant) - answervisualization of fetus by
real-time ultrasound, fetal heart tones, fetal movements palpated by examiner, fetal
movements visible to examiner
Methods for assessing due date and gestational age (naegele's rule) - answer1.
naegele's rule
2. ultrasound
3. fetal heartbeat
4. uterine sizing
5. fundal height measurement (really estimates weeks of gestation)
Naegele's Rule - answerLast menstrual period - 3 months + 7 days
looks at gestational age
what test identifies potential pregnancy - answerHCG levels - biochemical marker
-detected as early as 7-8 days after conception
-double every 48-72 until 60-70 days after fertilization and continue to increase till day
100-120 (if this term is doubled it can indicate a molar pregnancy, and if it is lower than
expected it can indicate a miscarriage or ectopic pregnancy)
,common pregnancy concerns/discomfort and how to manage - answercommon
concerns and discomfort: typical s/s of pregnancy
management:
1. primary prevention: educate about nutrition, physical activity (30 minutes), self-
management of pregnancy discomforts, and psychosocial impact of pregnancy
2. secondary prevention: screening for risk factors
pregnancy history: obstetric history using 5 digit system - answerG: Gravidity: number of
pregnancies (including current)
T: Term Births: birth at 37 days (0 days and beyond)
P: Preterm: pregnancies that ended in preterm births (20 weeks, 0-36 weeks, 6 days of
gestation)
A: Abortion: number of pregnancies that ended before 20 weeks spontaneously or
electively terminated
L: Live at time of birth: number of living children
(go to parties and live)
prenatal assessment: maternal and fetal (initial, continuing, frequency) - answer1. initial
visit: determine estimated DOB, baseline weight and signs, flu vaccine, lab tests,
education, referral, head to toe assessment, and pelvic exam, nutrition, family history,
meds, substance abuse, psychosocial history, abuse history (building trust is important
here)
2. continuing visits: weight, BP, manage common discomforts, monitor fetal
development and well-being by looking at fetal heart tones (FHT), fundal height in the
second trimester, fetal movement at 16 weeks gestation
3. Frequency: monthly until 28th week, bi-weekly from 28-36 weeks, weekly from 36
weeks to DOB (increased frequency if pregnancy is high-risk)
warning signs - answer1. gush of fluid from the vagina (indicates preterm labor (PROM)
2. vaginal bleeding accompanied with abdominal pain (miscarriage during the first
semester and placenta previa or abruption during the second or third trimester)
3. Temperature >38.3C or persistent vomiting (infection, dehydration)
4. visual disturbances (blurriness) and edema -- preeclampsia/hypertensive
5. decreased fetal movement (fetal distress or demise)
first questions to ask: how far along are you or when is your due date
physiologic adaptations to pregnancy: cardiovascular - answer1. cardiac output
increases 30-50%
- HR increases 15-20 bpm// BP remains stable
, 2. compression of iliac veins and inferior vena cava
- vena cava syndrome (laying down during late pregnancy can cause
dizziness/lightheadedness due to the fetus pushing down on the vena cava and
decrease our BP(promote laying on the side)
-dependent edema:
-varicose veins; hemorrhoids
-increased risk for VTE
3. increase total blood volume (increase RBC, decrease HgB and HCT (causing anemia
since blood volume increases this dilutes the RBCs)
- Prefuse uterus, hydrate tissues, fluid reserve for blood loss
4. increase blood coagulation (increase clotting factor and decrease coagulation factors
= hypercoagulability increasing our risk of thrombus)
- decrease fibrinolytic activity, decrease risk of bleeding, increased risk of thrombus
5. increase in white blood cell count (increase granulocytes)
physiologic adaptations to pregnancy: respiratory (upper, structural, and pulmonary) -
answerupper: nasal stuffiness, epistaxis, changes in the voice, impaired hearing,
earache, ear fullness
structural adaptations: diaphragm raises 4 cm, chest circumference increases by 5-7 cm
(rib cage flexes outwards due to increase of lung volume)
pulmonary function: tidal volume increases by 40%, mild/chronic hyperventilation,
reduced arterial carbon dioxide (it becomes harder to breathe)
physiologic adaptations to pregnancy: GI system - answerappetite and mouth: appetite
fluctuates, food cravings and aversions, gums bleed easily
esophageal changes: gastric emptying is delayed, decreased peristalsis, heartburn,
bloating, cramping, flatulence, constipation
gallbladder distends and gallstones are formed
physiologic adaptations to pregnancy: Renal (anatomic, functional, F&E) - answer1.
anatomic changes:
- ureters dilate and elongate to become tortuous (bendy) -- this causes urinary stasis
and alkalotic environment which will increase UTI risk
- uterus becomes enlarged and presses against the bladder to cause irritability,
nocturia, and urinary frequency
2. functional changes:
Physical signs of pregnancy (presumptive) - answer deals with personal experiences
breast changes, n/v, amenorrhea, urinary frequency, fatigue, quickening (baby
movement)
Physical signs of pregnancy (probable) (probably of pregnant) - answer involves a
health provider's examination
good ell sign (softening of the cervix)
chadwick sign (discoloration of the vagina ((blue))
hegar sign (softening of the lower uterine segment)
positive pregnancy test (looks at the presence of HCG levels)
Braxton hick contractions
ballottement (how does the uterus feels)
Physical signs of pregnancy (positive) (def pregnant) - answervisualization of fetus by
real-time ultrasound, fetal heart tones, fetal movements palpated by examiner, fetal
movements visible to examiner
Methods for assessing due date and gestational age (naegele's rule) - answer1.
naegele's rule
2. ultrasound
3. fetal heartbeat
4. uterine sizing
5. fundal height measurement (really estimates weeks of gestation)
Naegele's Rule - answerLast menstrual period - 3 months + 7 days
looks at gestational age
what test identifies potential pregnancy - answerHCG levels - biochemical marker
-detected as early as 7-8 days after conception
-double every 48-72 until 60-70 days after fertilization and continue to increase till day
100-120 (if this term is doubled it can indicate a molar pregnancy, and if it is lower than
expected it can indicate a miscarriage or ectopic pregnancy)
,common pregnancy concerns/discomfort and how to manage - answercommon
concerns and discomfort: typical s/s of pregnancy
management:
1. primary prevention: educate about nutrition, physical activity (30 minutes), self-
management of pregnancy discomforts, and psychosocial impact of pregnancy
2. secondary prevention: screening for risk factors
pregnancy history: obstetric history using 5 digit system - answerG: Gravidity: number of
pregnancies (including current)
T: Term Births: birth at 37 days (0 days and beyond)
P: Preterm: pregnancies that ended in preterm births (20 weeks, 0-36 weeks, 6 days of
gestation)
A: Abortion: number of pregnancies that ended before 20 weeks spontaneously or
electively terminated
L: Live at time of birth: number of living children
(go to parties and live)
prenatal assessment: maternal and fetal (initial, continuing, frequency) - answer1. initial
visit: determine estimated DOB, baseline weight and signs, flu vaccine, lab tests,
education, referral, head to toe assessment, and pelvic exam, nutrition, family history,
meds, substance abuse, psychosocial history, abuse history (building trust is important
here)
2. continuing visits: weight, BP, manage common discomforts, monitor fetal
development and well-being by looking at fetal heart tones (FHT), fundal height in the
second trimester, fetal movement at 16 weeks gestation
3. Frequency: monthly until 28th week, bi-weekly from 28-36 weeks, weekly from 36
weeks to DOB (increased frequency if pregnancy is high-risk)
warning signs - answer1. gush of fluid from the vagina (indicates preterm labor (PROM)
2. vaginal bleeding accompanied with abdominal pain (miscarriage during the first
semester and placenta previa or abruption during the second or third trimester)
3. Temperature >38.3C or persistent vomiting (infection, dehydration)
4. visual disturbances (blurriness) and edema -- preeclampsia/hypertensive
5. decreased fetal movement (fetal distress or demise)
first questions to ask: how far along are you or when is your due date
physiologic adaptations to pregnancy: cardiovascular - answer1. cardiac output
increases 30-50%
- HR increases 15-20 bpm// BP remains stable
, 2. compression of iliac veins and inferior vena cava
- vena cava syndrome (laying down during late pregnancy can cause
dizziness/lightheadedness due to the fetus pushing down on the vena cava and
decrease our BP(promote laying on the side)
-dependent edema:
-varicose veins; hemorrhoids
-increased risk for VTE
3. increase total blood volume (increase RBC, decrease HgB and HCT (causing anemia
since blood volume increases this dilutes the RBCs)
- Prefuse uterus, hydrate tissues, fluid reserve for blood loss
4. increase blood coagulation (increase clotting factor and decrease coagulation factors
= hypercoagulability increasing our risk of thrombus)
- decrease fibrinolytic activity, decrease risk of bleeding, increased risk of thrombus
5. increase in white blood cell count (increase granulocytes)
physiologic adaptations to pregnancy: respiratory (upper, structural, and pulmonary) -
answerupper: nasal stuffiness, epistaxis, changes in the voice, impaired hearing,
earache, ear fullness
structural adaptations: diaphragm raises 4 cm, chest circumference increases by 5-7 cm
(rib cage flexes outwards due to increase of lung volume)
pulmonary function: tidal volume increases by 40%, mild/chronic hyperventilation,
reduced arterial carbon dioxide (it becomes harder to breathe)
physiologic adaptations to pregnancy: GI system - answerappetite and mouth: appetite
fluctuates, food cravings and aversions, gums bleed easily
esophageal changes: gastric emptying is delayed, decreased peristalsis, heartburn,
bloating, cramping, flatulence, constipation
gallbladder distends and gallstones are formed
physiologic adaptations to pregnancy: Renal (anatomic, functional, F&E) - answer1.
anatomic changes:
- ureters dilate and elongate to become tortuous (bendy) -- this causes urinary stasis
and alkalotic environment which will increase UTI risk
- uterus becomes enlarged and presses against the bladder to cause irritability,
nocturia, and urinary frequency
2. functional changes:
