During pregnancy the blood volume increases. Plasma increases by 50% and RBC's increase by 25%. Because of this the hemoglobin molecules are diluted. This is physiologic anemia.
Why does the BP stay about the same during pregnancy?
BP stays about the same because while the cardiac output increases the peripheral vascular resistance decreases and it evens out.
What is Vena Caval Syndrome (aka, Supine Hypotensive Syndrome) ?
Laying supine puts a lot of pressure on the inferior vena cave and descending aorta which can cause dizziness, nausea, faintness, syncope.
Name a few nursing interventions for Vena Caval Syndrome
1. use a pillow or wedge
2. change to the lateral recumbent position
Describe the lateral recumbent positon
lateral recumbent position is laying on your side to reduce pressure on the descending aorta and inferior vena cava with a leg forward and a pillow underneath
Describe body system changes to the respiratory system during pregnancy
Oxygen consumption increases 15-20%
The patient should do more deep breathing
Physical changes include lifting of the diaphragm and the chest expands.
Describe the hormonal changes in a pregnant woman
progesterone - decreases airway resistance, relaxes muscles (can cause constipation, vericosities because of relaxed motility)
estrogen - increased vascularity of upper respiratory tract causing stuffiness, polyps, bloody nose
Describe the body system changes to the GI system during pregnancy
1. mouth - bleeding gums, ptyalism
2. esophagus - acid reflux
3. stomach & small intestine - slower to empty
4. large intestine - decreased motility
5. liver and gallbladder - increased cholesterol
The gallbladder gets ___________ due to prolonged emptying which can cause _________ during pregnancy and require the gallbladder to be removed right after delivery.
hypotonic
cholecystitus
define cholecystitus
pregnancy causes increased cholesterol in the gallbladder causing stones to develop which do not go away. This requires removal of the gallbladder after delivery.
Describe body system changes to the Urinary system during pregnancy
more pressure on the bladder
increased GFR in the kidneys and ureters causes increased pressure causing dilation and stasis
Describe body system changes to the Integumentary system during pregnancy
hyperpigmentation
cutaneous vascular changes
What is Choloasma?
the "mask of pregnancy", darkening of the skin
_____________ in the hands is secondary to dilated blood vessels during pregnancy
Palmar erythema
______________ is linear tears in the connective tissue of the belly
striae gravidarum (aka, stretch marks)
______ is the dark vertical line from the pubis to the umbilicus
linnae negra
what is hCG ?
Human Chorionic Gonadotropin is the hormone that gives us a positive result in a pregnancy test
___________ is produced by the placenta once mature
Human Placental Lactogen (aka, HPL) because the fetus has a need for glucose
________ inhibits uterine activity
relaxin
What is considered normal weight gain?
25 - 35 pounds (11.5 - 16 kg)
What is maternal tissue insulin resistant ?
If the mother doesn't use the insulin that the pancreas produces then the baby gets more glucose (because of the unused insulin). Therefore, as the pregnancy progresses the mother's pancreas makes even more insulin which makes the mother insulin resistant.
Carbs provide _____ kcal per gram
4 kcal/g
protein provides ____ kcals per gram
4 kcal/g
fats provide ____ kcal/g
9 kcal/g
a pregnant woman needs ____ extra calories per day
300
Define multiparity
multiparity is more than 1 pregnancy
define noliparity
noliparity is never having been pregnant
define primiparity
primiparity is the first pregnancy
__________ oils are needed during pregnancy but just ___ 6oz serving of fish per week can cause problems (because of mercury)
omega-3
1
the presumption indications of pregnancy are ________ and _______ reliable
subjective and least reliable
Name some presumption indications of pregnancy
amenorrhea
nausea and vomiting
fatigue
urinary frequency
breast and skin changes
vaginal and cervical color changes
fetal movement (it could be gas or tumor)
List some probably indications of pregnancy
abdominal enlargement
cervical softening
uterine changes
pregnancy tests
name some positive indications of pregnancy
auscultation of fetal heart sounds
fetal movements by examiner
visualization of the fetus
True or false... one cannot declare pregnancy with presumptive and probably indications.
true
true or false... marijuana, aspirin, methodone and psych meds can cause false positives
true
what is multifetal pregnancy?
2 or more fetuses
the # of pregnancies is called __________
gravida
the # of deliveries after 20 weeks is called _____
para
What does TPAL stand for?
T=Term pregnancies (37+)
P=Pre-term pregnancies (>20 <37)
A=Abortions (spontaneous or elective)
L=Live births
Practice calculating TPAL...
Mary had 3 pregnancies: 1 set of twins at 35 weeks, 1 delivery at 39 weeks and 1 spontaneous abortion at 10 weeks
What is her TPAL?
T=1
P=1
A=1
L=3
TPAL = 6
What is the formula for calculating the EDD (estimated due date) ?
subtract 3 months from the last menstrual period
add 1 week
dont forget to change the year when needed
Calculate the EDD for the following:
LNMP = May 3, 2009
1. subtract 3 months = February 3, 2009
2. add 7 days = February 10
3. EDD = Feb. 10, 2010
A woman with an uncomplicated pregnancy should visit the doctor when:
a. from conception to 28 weeks ?
b. 29 weeks -> 36 weeks ?
c. 37 weeks -> birth ?
a. q4 weeks
b. q2 weeks
c. q1 week
Antepartum assessment includes ?
-OB
-Menstrual
-Contraceptive
-Medical and Surgical
-Family Health/genetic issues
-Psychosocial Health
_______ and _____ sheets are started in the doctors office and put on file and ready for their admittance at delivery
Hollister sheets
ACOG sheets
list some initial lab tests for baseline of a pregnant woman
CBC, Blood grouping, Rh factor and antibody screen
VDRL/syphillus, Rubella titer, skin test
Hgb electrophoresis, Hepatitis B antigen
HIV ( state law, must know the status of the baby because meds given early enough can reduce the chances to 6% of baby having HIV)
urinalysis, pap smear, cervical cultures (for STD's) maternal glucose
measuring from the pubic bone to the umbilicus with a tape is measuring the ______________ to determine fetus' growth
fundal height
What is Leopold's Maneuvers?
What does an Ultrasonography detect (US)?
fetal heartbeat, activity and movements
In the first trimester the US is done ___________
transvaginally
in the first trimester the US measures the CRL which is the ___________________
crown rump length
The purpose of the 1st semester US is
a. confirmation
b. location of pregnancy (ectopic?)
c. age
d. viability
e. aid with procedures
What is MSBD?
Maternal Serum screen for Birth Defects
What is the Quad Screen used to detect?
Down Syndrome
Neural Tube Defect
Trisomy 18
If the AFP (alpha fetal protein) is low, there is a higher risk for __________?
If the AFP is high, then there is a higher risk for ________?
down syndrome
neural tube defects
Describe kick counts as part of the antepartum fetal surveillance
kick counts should start around 7 months, the mother records fetal movement. Should be aprox 10 times / hour
The mother needs to come into the office for a NST (non-stress test). A belt is put around the fundus and measures movement. The purpose of the NST is to ...
a. assess fetal well being
b. FH accelerations in response to movement (basically means the fetal heart)
c. Accelerations - adequate oxygenation
In the NST (non stress test) there are ______ and ________ results
reactive (2 accesl 15 secs in (10-20 min)
non-reactive
What is the purpose of the Vibroacoustic Stimulation Test?
To confirm a non-reactive NST
shorten time of NST
What is the risk of the vibroacoustic stimulation test, where a loud noise wakes the baby up?
potential for fetal hearing loss
prolonged fetal tachycardia
The contraction stress test is indicated for a ___________ __________.
nonreactive NST
True or false... the Contraction Stress Test (CST) uses nipple stimulation and/or low does oxytocin to induce a contraction
true
The ______ profile assess 5 parameters for fetal well being
biophysical profile
the 5 parameters of a biophysical profile include... ; how many points for each? What score is reassuring? What score is non-reassuring?
1. NST
2. Fetal breathing movements
3. Gross body movements
4. Fetal Tone
5. Amniotic Fluid
2 points for each; 8+ reassuring; <4 non-reassuring.
List some common discomforts of pregnancy and some interventions to relieve them
n/v - eat small meals, water between meals, vitamins, avoid greasy foods
heartburn - tums, avoid late night eating, limit acidic foods
backache - change position
urinary frequency - stay near BR, DO NOT LIMIT FLUIDS
varicosities - support hose
leg cramps - NO MASSAGE! take calcium
constipation - fiber, water, fruits, vegies
hemorrhoids
True of false... heparin crosses the placenta during pregnancy
false
true or false... cumadin crosses the placenta during pregnancy
true
Teaching
is this activity okay?
Bathing
Hot Tubs or saunas
Douching
Exercise
Sleep and Rest
Sex
Bathing yes
Hot Tubs or saunas no
Douching no
Exercise yes
Sleep and Rest yes
Sex yes
immunizations sometimes
employment okay
travel car rides okay but walk around every 2 hours
breast care wear a support bra
true or false... OTC drugs, tobacco, alcohol, illegal drugs and fumes can cause small birth weight?
true
true or false... OTC drugs, tobacco, alcohol, illegal drugs and fumes can cause SIDS?
true
true or false... OTC drugs, tobacco, alcohol, illegal drugs and fumes can cause developmental problems?
true
true or false... OTC drugs, tobacco, alcohol, illegal drugs and fumes cannot cause prematurity?
false, they CAN cause prematurity
true or false... OTC drugs, tobacco, alcohol, illegal drugs and fumes can cause abruption?
true
What is Abruption?
When the placenta separates from the wall of the uterus
