Nursing care for Pregnant patients

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  1. Functions of amniotic fluid?
    • Provides a medium for fetal movement
    • Injury protection
    • Temperature regulation
    • Nourishment
    • Prevents amnion from sticking to the fetus
  2. Functions of the umbilical cord?
    • Connection between fetus and placenta
    • *3 vessels;Artery, Vein, Artery
  3. Functions of the placenta?
    • Respiration
    • Nutrition
    • Excretion
    • Protection
    • Storage
    • Hormone production
  4. Major hormones of pregnancy?
    • HCG: Human Chorionic Gonadotropin: Prevents involution of the corpus luteum –continuing production of estrogen/progesterone.
    • Human Placental Lactogen: Causes changes in maternal metabolism to increase availability of glucose, protein, and minerals for the fetus.*Decreases maternal metabolism of glucose to support fetal growth.
    • Estrogen: Proliferative function; increase in uterine size, breasts, & glandular tissue.
    • Progesterone: Increases receptivity to implantation, reduces uterine contractility Relaxin: inhibits uterine activity, softens the cervix, & causes changes in connective tissue.
    • Prostaglandins: Maintain reduced placental vascular resistance, may have a role in pre-eclampsia, labor onset.
    • Prolactin: stimulates breast and milk production
  5. 1st trimester (conception-12W)
    • *Length: 8 cm crown – rump
    • *Weight: 45 grams
    • *Organs developed
    • FHT – fetal heart tones  doppler -10 weeks
  6. 2nd trimester (13W-24W)
    • *Length: 23 cm
    • *Weight: 780 grams
    • * Viability reached
    • FHT: stethoscope – 14 weeks
    • Fetal movement felt by examiner  20 weeks
  7. 3rd trimester (27W-birth)
    • *Length: 40-52 cm
    • *Weight: 3200+
    • *Complications related to prematurity decrease with greater gestational age
  8. Preconception education?
    • Accurate Health History & Physical Exam: diagnosis and treatment of maternal disorders
    • Teratogen
    • Nutrition & Supplementation (Folic acid)
    • timing conception
    • Healthy life style choices
  9. Signs of pregnancy?
    • Amenorrhea
    • Urinary frequency
    • Morning sickness
    • Breast changes (tenderness)
    • Skin pigmentation
    • Quickening(movement of baby)
  10. Chadwick’s sign
    * blue discoloration of cervix, vagina, & vulva
  11. *McDonald’s sign or Hegar’s sign
    softening of lower uterine segment
  12. Signs of Pregnancy
    Image Upload 1
  13. 4 maternal tasks
    • seeing safe passage 
    • securing acceptance
    • Learning to give of herself and to receive the care and concern of others
    • committing to child
  14. Discomforts of pregnancy?
    • Fatigue
    • Nasal stuffiness
    • Nausea
    • Heartburn
    • Constipation
    • Hemorrhoids
    • Vaginal discharge
    • Backache
    • Varicose veins
    • Leg cramps
    • Edema of the lower extremities
  15. Reproductive changes?
    • Uterus: Temp. abd. organ, 5000cc capacity
    • Cervix: mucous plug forms prevention of organisms from entering uterus
    • Ovaries: Produce progesterone to maintain uterine lining
    • Vagina: Increased blood supply (bluish), PH more acidic, High glycogen level=candida albicans
    • Breasts: Hormones prepare for lactation
  16. Colostrum
    *premilk” is* high in protein, fat-soluble vitamins, and minerals
  17. Glands of the breasts!
    Image Upload 2
  18. Respiratory system changes?
    • O2 consumption increase 15%
    • Diaphragm rises (4cm)
    • Dyspnea may occur until fetus descends into pelvis
    • Increased estrogen can cause edema of upper airways
  19. Cardiovascular changes?
    • Blood volume increase 45%: *Exchange of nutrients, oxygen, and waste products within the placenta*Needs of expanded maternal tissue*Reserve for blood loss at birth
    • Pulse increase 10-15 BPM
    • Orthostatic hypo-tension may occur
    • palpitations possible
    • dilutional anemia
    • clotting factors increase in 2nd/3rd trimester
  20. GI changes?
    • Displacement of stomach and intestine
    • Increased estrogen=increase glandular secretions
    • increased appetite/thirst
    • decreased gastric acid secretion
    • delayed gastric emptying-increased gastric reflux
    • progesterone and estrogen relax muscle tone of gallbladder=retained bile salts leading to possible pruritus
  21. GU changes?
    • excretion of fetus and women wastes
    • *Glomerular filtration rate of kidneys increases
    • *Glycosuria and proteinuria more common
    • Water retention
    • more susceptible to UTI
    • Due to hormones-99% of sodium reabsorbed 
    • Urinary stasis
  22. Integ/Skeletal changes?
    • Spider nevi
    • sweat and sebaceous glands increase production
    • posture changes-low back ache
    • relaxation of pelvic joints
    • waddling gaits
    • change in center of gravity
  23. Nagels rule?
    • First day of LMP
    • Subtract 3 months
    • Add 7
    • Add one year=EDD
  24. GTPAL system
    • G: Total number of pregnancies
    • T: babies born at term (> 37 weeks)
    • P: babies born preterm (<37 weeks)
    • A: number of pregnancies ending in spontaneous or therapeutic abortion (prior to 20 weeks gestation)
    • L: number of children currently living
  25. Gravida
    Number of pregnancies
  26. Para
    Number of births
  27. Prenatal care?
    • *Ongoing care
    • *Vital signs
    • *Weight
    • *Urinalysis
    • *Uterine growth
    • *Fetal heart rate
    • *Current health complaints
    • *Education
  28. Prenatal schedule?
    • *One office visit/month until 32 weeks*
    • *2 visits/month from 32-37 weeks*
    • *1 visit/week from 37 weeks to EDD*
    • *Postdates – 2 visits/week
  29. Recommended weight for pregnancy
    • *Women of normal weight: 25 to 35 pounds (11.5 to 16 kg)
    • *Underweight women: 28 to 40 pounds (12.6 to 18 kg)
    • *Overweight women: 15 to 25 pounds (7 to 11.5 kg)
  30. Pregnancy warning signs?
    • *Vaginal bleeding
    • *Swelling of face and hands
    • *Continuous headache
    • *Vision changes- dimness, blurring, flashes of light
    • *Persistent vomiting
    • *Abdominal pain
    • *Chills/fever
    • *Sudden leaking of fluid from the vagina
    • *Decreased fetal movement
  31. common teratogens?
    • Timing of exposure
    • duration of exposure
    • amount of exposure
    • genetics

    (Smoking, alcohol, caffeine, cocaine, meth) some herbal supplements
  32. Drug classifications for prego
    • A: shows no risk to fetus
    • B: no evidence of risk to humans
    • C: risk cannot be ruled out
    • D: positive evidence of risk
    • X: shows risk and positive teratogenic effects on fetus.
  33. Antibiotics/antipyretics with known teratogenesis
    • Tetracycline
    • Streptomycin
    • Chloramphenicol
    • ASA/Salicylates
    • NSAIDS
  34. Safest antibiotics or antipyretics
    • Acetaminophen
    • Penicillin & Erythromycin
  35. Chorionic villus sampling (CVS)
    Testing for birth defects and genetic abnormalities
  36. Pitocin
    used to induce labor
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318006
Card Set
Nursing care for Pregnant patients
Description
pregnancy
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