what is the name of the hormone that induces amenorrhea?
progesterone
presumptive sign of pregnancy
amenorrhea, N/V, urinary frequency, breast tenderness
probable signs of pregnancy
positive pregnancy test Goodell's sign: softening of the cervix; second month chadwick's sign: bluish color of vaginal mucosa and cervix; 4 weeks hegars sign: softening of the lower uterine segment uterine enlargement braxton hicks:occur thoughout pregnancy; move blood through placenta pigmentation changes
what other conditions have increased hCG levels
hydatidiform (molar pregnancy)
what is a molar pregnancy and of not malignant what is required?
benign neoplasm of grape-like vesicles that can become malignant DNC is required with close follow-up care for 6 month to 1 year
linea nigra
dark line down center of abdomen
facial chloasma
mask of pregnancy
abdomen striae
stretch marks
darkening of the
areola
positive signs of pregnancy
fetal heartbeat fetal movement ultrasound
use a doppler at ________-________ weeks
10-12 weeks
use a fetoscope at _________-_________ weeks
17-20 weeks
gravidity
number of time someone has been pregnant
parity
number of pregnancies in which fetus reaches 20 weeks
viability
24 weeks gestation infant is able to live outside uterus
a 20 week baby is not considered
viability
what does the acronym TPAL mean
T=term P=preterm A=abortion L=living children
a spontaneous abortion S/S
bleeding, cramping, backache hCG begins to drop
most miscarriages occur before
20 weeks
naegeles rule for the EDD
find the day of the last missed period add 7 days subtract 3 months add 1 year
Naegel's rule is only accurate plus or minus _____ weeks
2
first trimester
week 1-week 13
first trimester: nutrition important to follow a ------- diet increase protein intake to _____ grams per day culture, consider nutritional influences such as:
well-balanced diet 60hot vs cold, kosher diet, fasting
first trimester: weight gain expect to gain ___-___ pounds dependent on starting _____-
1-4 pounds starting BMI
first trimester: prenatal vitamin supplements what are the biggest complaints with iron? always take Iron and vitamin _____folic acid prevents?daily dose?
constipation vitamin C neural tube defects 400 mcg/day
first trimester: exercise no high impact; ________ and swimming are best no heavy exercise program, but continue ______ exercise program Don't let heart rate get above _____If HR goes over 140=decreased ______ ________ and decreased ______ perfusion do not get overheated because
walking regular 140 decreased cardiac output and uterine perfusion can increase body temp and cause birth defects
danger signs and potential complications of maternity
sudden gush of vaginal fluid bleeding persistant vomiting severe headache abdominal pain increased temps edema no fetal movement
common discomforts
constipationankle edema N/Vbreast tenderness urinary frequency tender gums fatigue heartburn increased vaginal secretions nasal cogestion varicose veins hemorrhoids backache leg cramps
what are you going to tell a pregnancy person about taking meds?
no meds; ask HCP
what are you going to tell them about smoking? what is smoking during pregnancy associated with
stop small for gestational age, low birth weight, cleft lip or palate, and risk for placental abruption doubles
how often should client visit PHCP first 28 weeks?28-36 week?after 36 weeks? high risk clients will have
once a week every 2 weeks or twice a month weekly until delivery will have more prenatal visits
before an ultrasound, what would you ask client to do? why? what about an ultrasound is like an amniocentesis?
drink water to distend bladder, this pushes uterus up and get a better picture we want them to void
second trimester
week 14 - week 26
how many calories increase during 2nd trimester if they are adolescent, they can increase by what is the expected weight gain?what should the client not be expecting
300 calories a day 500 a day 1 pound N/V, breast tenderness, urinary frequency
when do you feel quickening
16-20 weeks fetal movement
what should fetal HR be during 2nd trimester what should you do if less than 110kegal exercises: 1)exercise frequently to strengthen the _______ muscles 2)the pubococcygeal muscle stop 3) keep uterus from
110-160panic!puboccygeal muscles urine flowfalling out
third trimester
week 27- week 40
weight gain per week in 3rd trimester monitor _____ and report any increase in baseline pre-eclampsia develops after _____ weeks and client will have? the client with pre-eclampsia can have? what drug is given for severe pre-eclampsia? pre-eclampsia is defined as BP of ________ or greater that is documented 6 hours apart
no more than 1 pound per week BP 20 , increased BP, proteinuria, and edema seizures magnesium sulfate 160/110
magnesium sulfate does what 3 things
acts like a anticonvulsant sedates vasodilates
what is the difference between pre-eclampsia and eclampsia
the seizure with eclampsia
fetal HR during 3td trimester? how is position/presentation determined? what should the client do 1st? if the client is having contractions, should the leopolds be done during or between contraction?
110-160leopold maneuvers void between
signs of labor: lightening usually occurs _____ weeks before term when the ___ part of the fetus descends in to the ________client will notice she is able to _____ more easily because?this puts more pressure on bladder - so urinary ______ is a problem again
2 weeks presenting part descends into pelvis breath easily because the pressure on diaphragm decreases urinary frequency
signs of labor: engagement fetal stations:
the largest presenting part is on the pelvic inlet (birth canal) measured in cm; measures the presenting part of the fetus to the ischial spines of the mother
other signs of labor: bracton hicks: more ____ and ______ than before softening of ______bloody _____sudden burst of _____ called ______diarrhea rupture of ___________
more frequent and stronger than before softening of cervix blood show sudden burst of energy called nesting diarrhea rupture of membranes
when should client goto hospital? what are we worried about when membranes rupture
when contractions are 5 mins apart or when membranes rupture prolapsed cord
true labor: contraction? regular or irregular contractions? increase or decrease in frequency and duration discomfort in back and radiates ______what happens in pain level with a change in activity?
regular increase abdomen increases
false labor: contraction?where is the discomfort? what happens to the pain with a change of activity?
irregular the abdomen decreases of goes away
premature labor: contraction occur with ______ between 20-37 weeks goal: _______treat any existing vaginal or urinary infection and _______ the mom will often stop preterm labor client will be placed on ________what medication may be prescribed
dilation goal: slop labor hydrating bedrestmagnesium sulfate IV - relax uterus betamethasone (IM)- steroid to help fetal lungs matureterbutaline (SQ)indomethacin (PO)nifedipine (PO)
epidural anesthesia: position? given in stage 1, at _____ to _____ cm dilated usually no ________major complication __________ so monitor _____ closely IVF's: bolus with 1000 mL of NS or LR to fight_________position ______ to decrease ________alternate from side to side _________dont forget to check their -------- and assess the ______
lie on left side, legs flexed, prop up over the bedside table 3-4 cm dilation headache hypotension, BP hypotension semi fowlers, BP hourly urine output and assess bladder
list the steps for emergency delivery
in book
normal post-partial period: VS: Temp may increase to _______ during 1st 4 hours BP is ______HR 50-70 common for _____ to _____ days after delivery breast: soft for _____-_____ days then the dreaded engorgement occurs abdomen: _____ and loose GI: _____ is common
100.4 stable 6-10 days 2-3 days soft/loose hunger
tachycardia + postpartum ........ think _______
hemorrhage
post partial period: uterus: the fundus midline ___-___ finger breadths below umbilicus few hours birth, it rises to _____ or ______want the fundus to be ______what do you do if fundus is boggy? the fundal height will decrease _________what is the proper term used when the fundus descends and the uterus returns to its pre-pregnancy state afterpains are common for the first 2-3 days and will continue if mother chooses to
2-3 level of umbilicus or 1 FB above firm massage until firm and then check for bladder distention 1 finger breadths a day involution breast feed
lochia: rubra: 3-4 days: color: _________serosa: 4-10days: color: _________alba: 10-28 days: color: ______can have alba for up to ________ weeks clots are okay as long as they are not larger than a ________urine output: diurese the excess fluid around _______ hours after delivery is dehydration possible? why should legs be inspected so closely?
dark red pinkish brown whitish-yellow 6 weeks nickel 24 hrs yes DVT
perineal care: intermittent ice packs for the 1st 24 hrs to decrease ______________ water rinses -------- baths 2-4 times a day ________ spray change ______ frequently peripad rule: teach to report _______ and __________
edema warm sitz bath anesthetic pads we do not want a client to saturate more than 1 peripad/hour report foul smell and lochia changes
bonding between a mother and baby and the father and baby develops __________ in the infant in the infant, trust is not only an emotional need but a _______ needhow does the newborn benefit physiologically from bonding? skin to skin ________* stabilizes _______* improves _________* regulates the infants __________* conserves ________* breast can change ________ to warm or cool the infant * skin to skin contact is called __________
trust physiologic skin to skin contact * HR* O2 sats * temperature * calories * temperature * kangaroo care
breast feeding: cleanse with ______ after each feeding let _____ dry support _____________ for soreness express some colostrum and let it _______breast pads absorb ________mother needs to initiate breastfeeding ASAP after _______ and alternate breast if breast feeding interrupted: mom can ______increase calorie intake by ______ calories per day fluid/milk intake: ________ 8 ounce glasses per day
water airbraointment dry moisture birth pump5008-10
non-breastfeeding mothers: _____ packs breast ______chilled __________ _________ decrease inflammation and engorgement no ______ of breast
ice binders cabbage leaves stimulation
postpartum infection: infection within _____ days after birth: E.Coli/Beta hemolytic strep teach proper ________good hand ________ usually get cultures and __________
10hygiene (front to back) washing antibiotics
postpartum hemorrhage Early: more than ________ mLs of blood lost in the 1st 24 hrs accompanied by 10% drop of hematocrit late: after ______ hrs and up to _____ weeks postpartum causes are?
50024, 6uterine atony lacerations retained fragments and forceps delivery
mediations used to halt excessive postpartum hemorrhage:
oxytocin methylergonovine maleate carboprost tromethamine misoprostol
mastitis: major bacteria is _________usually occur around 2-4 ________S/S: rapid onset of ______ and ______the breast will be ____ and hard, and tender to touch malaise (_______)
staphylococcus weeks fever and chills swollen malaise (feeling discomfort)
mastitis Tx: bed ______support _____ binding and chilled ______ _______if mom is going to continue breast feeding, she needs to initiate breastfeeding more frequently or ________________ (PCN)_________ meds heat or cold?feed the baby_______ always offer the affected breast ________-
rest bra cabbage leavespump penicillin pain heat frequently, 1st
newborn immediate care: maintain body ________Apgar: assessed at ______ and _______ mins this looks at? what do we want the score to be? what can be used to kill Neisseria gonococcus and chlamydia? __________(vit K) promotes the formation of _______ factors
temp 1 and 5 mins HR, resp, muscle tone, reflex irritability, and color 8-10erythromycin phytonadione, clotting
cord care: dries and falls off in _____ to ______ days cleanse with each diaper change using ______ or ______fold diaper _______ the cord no immersion until cord falls off. watch for _______
10-14 alcohol or NS below infection
why do babies sometimes experience hypoglycemia?what babies are at greatest risk for this?
because they are not getting enough glucose from mother. large or small for gestational age and babies of diabetic mothers
when does pathologic jaundice occur? when does physiological jaundice occur? why does this happen?
1st 24 hrs and usually mean Rh incompatibility after 24hrs, due to both the normal hemolysis of excess RBCs releasing bilirubin, and immaturity of the liver Rh s
Rh sensitization or Rh factor: occurs when? 1st preg: Rh + blood from baby come in contact with mother ______ blood this most likely occurs when? what does the mothers body look at baby blood like? and then the what does mom produce?is the baby affected by this?
you have a Rh - mother and and Rh + baby Rh -placenta separates at birth, miscarriage, amniocentesis or trauma to abdomen foreign body, antibodies no
Rh factor 2nd pregnancy: the mothers antibodies ______ with each pregnancy what happens if Rh - sensitized mom gets pregnant again? what does the baby begin to release? and this is called
increase the antibodies will enter baby bloodstream through the placenta and the baby RBCs begin the breakdown; known as hemolysis. immature RBCs , erythroblastosis fetalis
Rh factor diagnosis: indirect coombs: done on the _______; measures number of _____ in blood direct coombs: done on _______; tells if there is any antibodies stuck in ______. this is done on the _______
mom, antibodies baby, RBCs, cord
treatment for Rh factor: _________prevention? when is RhoGAM given to mother? most HCP give it _____once at _____ weeks of gestation and again _____ hrs after birth it is also given with any _______ episodes
frequent ultrasound RhoGAM 72 hrs after birth twice 28 weeks gestation and 72 hrs after birth bleeding
how does RhoGAM work?
destroys positive fetal blood cells that get into mother's negative blood and must do this before antibodies are formed