Families Exam 1 Blueprint
Normal Physiological Changes of Pregnancy
o Presumptive/Positive Signs of Pregnancy (3 questions)
o Presumptive Signs—changes that the woman experiences that make her think that she
might be pregnant
Amenorrhea, fatigue, urinary frequency, N/V, changes in breasts (darkened areolae,
enlarged Montgomery’s glands), quickening (starts between 16-20wks), uterine
enlargement
o Positive Signs—can be explained only by pregnancy
Fetal heart sounds—listen right above symphysis pubis
Can be detected between 8-12wks
Fetal movement
Visualization of fetus by ultrasound
o (Probable Signs—changes that make provider suspect a woman is pregnant)
Abdominal enlargement, Braxton hicks contractions, positive pregnancy test,
physical changes of uterus
o Physiological/Psychological/Hormonal Changes (3 questions)
o Reproductive
Uterus size increases; ovulation/menses cease
o Cardiovascular
CO increases; blood volume increases; HR increases & peaks at 10-15bpm above
pre-pregnancy rate; murmurs may be heard
o Respiratory
O2 needs increase; RR increases; total lung capacity decreases
o Musculoskeletal
Weight increases—change in posture needed
o Gastrointestinal
N/V—due to hormones/increased pressure in abdominal cavity; constipation
o Renal
Filtration rate increases—hormones/increase in blood volume; amount of urine
produced remains the same; urinary frequency
o Endocrine
Placenta produces lots of hCG, progesterone, estrogen, human placental lactogen,
prostaglandins
o Integumentary
Stretch marks (striae gravidarum); hyperpigmentation of face (chloasma); linea
nigra (dark line of pigmentation from umbilicus to pubic area)
o Vitals
BP: in supine position, BP drops due to pressure on vena cava—can lead to fetal
hypoxia—if supine, use wedge under one hip
Pulse: increases 10-15bpm around 32wks
o Nagele’s Rule (1 question)
o To determine estimated due date (EDD):
Take first day of woman’s last menstrual cycle, subtract 3 months, add 7 days and 1
year
Ex. Last menstrual period Aug. 22
EDD: May 29th (Aug-3mos=May; 22+7=29)
, o GTPAL (1 question)
o G: Gravidity—number of pregnancies including current one total
o T: Term births (>38wks)
o P: Preterm births (20wks-37wks)
o A: Abortions/miscarriages (prior to viability; <20wks)
o L: Living children
Prenatal Care
o Gestational—expectations/danger signs of pregnancy (1 question)
o Common Discomforts of Pregnancy:
N/V—eat crackers/dry toast 30min-1hr before rising; avoid empty stomach; drink
fluids between meals
Breast tenderness—wear supportive bra
Urinary frequency—empty bladder frequently; decrease intake before bed; perineal
pads; Kegel exercises
UTIs—wipe front to back; avoid bubble baths/tight pants; pee before/after sex;
urinate as soon as urge occurs
Fatigue
Heartburn—small frequent meals; sit up for 30min after meals
Constipation—increase fiber/fluids; exercise
Hemorrhoids—warm sitz bath; topical ointments
Backaches—pelvic tilt exercises; lay on side; good body mechanics
SoB—good posture; use extra pillows when sleeping
Leg cramps—keep affected leg straight; heat; dorsiflex toes
Varicose veins/edema—elevate legs; supportive hose; don’t cross knees
Gingivitis, nasal stuffiness, epistaxis—because of increased estrogen
Braxton Hicks—change positions; walk
Supine hypotension
o Danger Signs of Pregnancy
1st trimester: burning on urination; severe vomiting; diarrhea; fever/chills; ab
cramps/vaginal bleeding
2nd & 3rd trimester: gush of fluid from vagina prior to 37wks; vaginal bleeding; ab
pain; changes in fetal movement; persistent vomiting; severe headaches; fever;
dysuria; blurred vision; edema of face/hands; epigastric pain; s/s of hypo or
hyperglycemia
o Diagnostic Testing—labs, amniocentesis, glucose tolerance (1-2 questions)
o Routine Lab Tests
Blood type/Rh factor
CBC-D, Hgb, Hct—detects infection; anemia
Rubella titer—shows immunity to rubella; can’t get MMR shot!!
Group B Streptococcus—vaginal/anal culture at 35-37wks
Urinalysis—IDs pregnancy, DM, gestational HTN, renal disease, infection
Glucose tolerance:
1hr: oral or IV admin of concentrated glucose w/ venous sample taken 1hr
later—initial visit if high-risk; 24-28wks everyone—if >140, follow up
3hr: fasting overnight, then admin of oral/IV concentrated glucose w/ venous
sample taken 1, 2, and 3hrs later
**Diagnosis of gestational DM requires 2 elevated blood glucose readings
Pap test—cervical cancer, herpes, HPV
Normal Physiological Changes of Pregnancy
o Presumptive/Positive Signs of Pregnancy (3 questions)
o Presumptive Signs—changes that the woman experiences that make her think that she
might be pregnant
Amenorrhea, fatigue, urinary frequency, N/V, changes in breasts (darkened areolae,
enlarged Montgomery’s glands), quickening (starts between 16-20wks), uterine
enlargement
o Positive Signs—can be explained only by pregnancy
Fetal heart sounds—listen right above symphysis pubis
Can be detected between 8-12wks
Fetal movement
Visualization of fetus by ultrasound
o (Probable Signs—changes that make provider suspect a woman is pregnant)
Abdominal enlargement, Braxton hicks contractions, positive pregnancy test,
physical changes of uterus
o Physiological/Psychological/Hormonal Changes (3 questions)
o Reproductive
Uterus size increases; ovulation/menses cease
o Cardiovascular
CO increases; blood volume increases; HR increases & peaks at 10-15bpm above
pre-pregnancy rate; murmurs may be heard
o Respiratory
O2 needs increase; RR increases; total lung capacity decreases
o Musculoskeletal
Weight increases—change in posture needed
o Gastrointestinal
N/V—due to hormones/increased pressure in abdominal cavity; constipation
o Renal
Filtration rate increases—hormones/increase in blood volume; amount of urine
produced remains the same; urinary frequency
o Endocrine
Placenta produces lots of hCG, progesterone, estrogen, human placental lactogen,
prostaglandins
o Integumentary
Stretch marks (striae gravidarum); hyperpigmentation of face (chloasma); linea
nigra (dark line of pigmentation from umbilicus to pubic area)
o Vitals
BP: in supine position, BP drops due to pressure on vena cava—can lead to fetal
hypoxia—if supine, use wedge under one hip
Pulse: increases 10-15bpm around 32wks
o Nagele’s Rule (1 question)
o To determine estimated due date (EDD):
Take first day of woman’s last menstrual cycle, subtract 3 months, add 7 days and 1
year
Ex. Last menstrual period Aug. 22
EDD: May 29th (Aug-3mos=May; 22+7=29)
, o GTPAL (1 question)
o G: Gravidity—number of pregnancies including current one total
o T: Term births (>38wks)
o P: Preterm births (20wks-37wks)
o A: Abortions/miscarriages (prior to viability; <20wks)
o L: Living children
Prenatal Care
o Gestational—expectations/danger signs of pregnancy (1 question)
o Common Discomforts of Pregnancy:
N/V—eat crackers/dry toast 30min-1hr before rising; avoid empty stomach; drink
fluids between meals
Breast tenderness—wear supportive bra
Urinary frequency—empty bladder frequently; decrease intake before bed; perineal
pads; Kegel exercises
UTIs—wipe front to back; avoid bubble baths/tight pants; pee before/after sex;
urinate as soon as urge occurs
Fatigue
Heartburn—small frequent meals; sit up for 30min after meals
Constipation—increase fiber/fluids; exercise
Hemorrhoids—warm sitz bath; topical ointments
Backaches—pelvic tilt exercises; lay on side; good body mechanics
SoB—good posture; use extra pillows when sleeping
Leg cramps—keep affected leg straight; heat; dorsiflex toes
Varicose veins/edema—elevate legs; supportive hose; don’t cross knees
Gingivitis, nasal stuffiness, epistaxis—because of increased estrogen
Braxton Hicks—change positions; walk
Supine hypotension
o Danger Signs of Pregnancy
1st trimester: burning on urination; severe vomiting; diarrhea; fever/chills; ab
cramps/vaginal bleeding
2nd & 3rd trimester: gush of fluid from vagina prior to 37wks; vaginal bleeding; ab
pain; changes in fetal movement; persistent vomiting; severe headaches; fever;
dysuria; blurred vision; edema of face/hands; epigastric pain; s/s of hypo or
hyperglycemia
o Diagnostic Testing—labs, amniocentesis, glucose tolerance (1-2 questions)
o Routine Lab Tests
Blood type/Rh factor
CBC-D, Hgb, Hct—detects infection; anemia
Rubella titer—shows immunity to rubella; can’t get MMR shot!!
Group B Streptococcus—vaginal/anal culture at 35-37wks
Urinalysis—IDs pregnancy, DM, gestational HTN, renal disease, infection
Glucose tolerance:
1hr: oral or IV admin of concentrated glucose w/ venous sample taken 1hr
later—initial visit if high-risk; 24-28wks everyone—if >140, follow up
3hr: fasting overnight, then admin of oral/IV concentrated glucose w/ venous
sample taken 1, 2, and 3hrs later
**Diagnosis of gestational DM requires 2 elevated blood glucose readings
Pap test—cervical cancer, herpes, HPV
