Term
| Why is it important to ask the reasons for seeking care during the first trimester? |
|
Definition
The pt may have other concerns besides the pregnancy
EX such as abortion, or may have ended up in the unit because of abdominal pain. |
|
|
Term
| What is important to include in the history taking of a 1st trimester patient? |
|
Definition
Reasons for seeking care
How the current pregnancy is going
OB/Gyn history
Nutritional history
History of drug use
Family history
Psychosocial history
History of physical/verbal abuse |
|
|
Term
| What should you review when checking the status of the current pregnancy of a 1st trimester patient? |
|
Definition
| Signs and symptoms of pregnancy |
|
|
Term
| What should be included in the OB/GYN history taking? |
|
Definition
a. menstrual history
b. contraceptive history
c. any infertility concerns
d. any Gyn concerns
e. ck last Pap and cultures for STI’s |
|
|
Term
| What should be included in Medical history of a 1st trimester patient? |
|
Definition
a. pre-existing medical conditions/concerns
b. history of surgical procedures |
|
|
Term
| What should be included in taking nutritional history of a 1st trimester patient? |
|
Definition
a. assess for food allergies
b. any special dietary concerns
c. If vegan assess for anemia, Fe deficieny |
|
|
Term
| What should be included in taking a history of drug usage? |
|
Definition
a. past and present use of legal medications
ex: motrin (anitprostagladin)
b. h/o illegal drug use
c. use of herbal supplements |
|
|
Term
| What should be included when taking a history of psychosocial behaviors? |
|
Definition
a. situational factors
b. any previous care of infants
c. coping mechanisms |
|
|
Term
| What is important to remember when taking a history/assessing for signs of physical/emotional abuse? |
|
Definition
a. abuse may increase during pregnancy
b. may need immediate clinical intervention
c. Look for retraction of arm during BP
d. Look for patients who wear many layers of clothing
d. favorite spot is the abdomen |
|
|
Term
| What labs are in the blood work-up for a first trimester pregnancy? |
|
Definition
a. CBC
b. blood type and Rh factor
c. rubella titer
d. HIV screen
e. HbsAG screen
f. RPR/VDRL
g. Tay-Sachs
h. Sickle-cell
i. glucose tolerance test |
|
|
Term
| What is included in a urine screen for a first trimester pregnancy? |
|
Definition
a. urinalysis with culture
b. UDAP |
|
|
Term
| What happens if an abnormality is detected in the blood work? |
|
Definition
| If titer is positive for abnormality an amniocentesis may be ordered |
|
|
Term
| What lab tests are included from the pelvic region? |
|
Definition
1. Pap smear
2. cultures for STI’s |
|
|
Term
| What skin test is given to a pregnant woman in the 1st trimester? |
|
Definition
|
|
Term
| What is a NT-nuchal translucency and when is it performed? |
|
Definition
| During amniocentesis and it measures the nuchal folds using ultra sound indicative a chromosomal anomaly |
|
|
Term
| What are two tests done in and amniocentesis? |
|
Definition
a. serum testing for free beta hCG and PAPP-A
b. ↑ NT, ↑ free beta hCG, and ↓ PAPP-A can suggest aneuploidy |
|
|
Term
| When and how much folic acid supplement should a pregnant women take? |
|
Definition
| They should start before the pregnancy 400mg/800 for second preg of pt with nueral tube deficit |
|
|
Term
| What vaccines are ok for pregnant mothers and which are not? |
|
Definition
Inactive are ok- flu, DT, Hep B, rabies (TDAP after 26 wks)
Live not ok- measles, MMR, C pox, mumps, polio |
|
|
Term
| Whats are education topics to talk about with a pregnant mother in the first trimester? |
|
Definition
1. Schedule of visits
2. Rationale of labs
3. Kegel exercises
4. Clearing OTC & other meds with provider as safe to take
5. Immunizations
6. Review nutritional needs
7. Ok to travel & exercise
8. Alcohol, tobacco usage
9 tips w/ nausea & vomiting |
|
|
Term
| What should be included in the physical exam during ongoing care of a pregnant women during 2nd trimester? |
|
Definition
a. weight-approx. 1 lb per week past 1st trimester
Moms who are smaller should gain a little more, moms who are big should be gain less to avoid complications
b. BP-watch for ↑ 140/90 or ↑ systolic 30>baseline
↑ diastolic 15>baseline
c. dip urine for protein, glucose
d. auscultate FHT
e. assess breasts/nipples (good time for lactation to come in.
f. review birth plan
g. ask about quickening-approx 20 weeks |
|
|
Term
| What are pertinent laboratory tests during the ongoing care of a pregnant women in the second trimester? |
|
Definition
Quad Screen-done between 15-20 weeks:
1. MSAFP
2. hCG
3. UE-unconjugated estriol
4. inhibin-A
5.Assessing for possible spina bidifa, Down syndrome, or other chromosomal defects
6. amniocentesis
Remember to follow-up on any prior test results |
|
|
Term
| What are potential complications of a pregnant women in the second trimester? |
|
Definition
a. bleeding
b. decreased fetal activity (tell mother to do kick counts)
c. PIH/GHTN
d. PROM (Premature rupture of membranes)
-amniotic fluid discharge
e.infections |
|
|
Term
| What are signs and symptoms of PIH/GHTN? |
|
Definition
-headache
-swelling of face/fingers
-epigastric pain
-muscular irritability
-visual disturbance |
|
|
Term
| What are signs of an infection? |
|
Definition
-chills
-fever
-burning with urination |
|
|
Term
| How do you determine the fundal height and what else can it tell you? |
|
Definition
It is measured from symphysis pubis to top of
uterus.
1. The # in cm = weeks of gestation
(weeks 18-36)
2. excessive increase-multifetal gestation,
hydramnios |
|
|
Term
| How much weight does the mother gain after the first 13 weeks (first trimester)? |
|
Definition
|
|
Term
| How do you determine gestational age? |
|
Definition
1. determined from LMP, contraceptive history, and
pregnancy test results
2. usually confirmed with U/S |
|
|
Term
| What are interventions and discomforts during second trimester? |
|
Definition
a. assess skin changes
b. headaches-rest, hydration, acetaminophen
c. constipation-hydration, exercise, prune juice (softens poor, gives iron)
d. varicose veins-elevate legs, support stockings
e. food cravings-6 small meals-keep BS level even
f. heartburn-small meals, sit up after eating, ↓ spicy
foods, antacids
g. joint/ligament pain-support garments |
|
|
Term
| What are good educational topics for second trimester patients? |
|
Definition
a. warning signs
b. assess nutrition status
c. hygiene-R/T increase perspiration
d. UTI prevention-hydration, freq. Voids
e. breast shields for inverted nipples
-too much stimulation can lead to PTL
f. dental care
g. R & R
h. risk factors at work-i.e. caustic agents
i. travel-if not high risk, ok
j. avoid alcohol, cigarettes
k. need for support garments |
|
|
Term
| What should be in the assessment of a pregnant patient in the third trimester? |
|
Definition
1. vaginal exams may begin in the last month
2. assess for S & S of PTL, PIH, GDM |
|
|
Term
| What lab tests are conducted during the third trimester? |
|
Definition
1. Group Beta strep culture-35-37 weeks
2. rhogam injection-26-28 weeks for Rh - moms
3. glucose tolerance test
4. may retest for STI’s |
|
|
Term
| What is given if positive test for B strep? |
|
Definition
| Penicillin, Clindamycin if allergic |
|
|
Term
| What are the interventions for discomforts in 3rd trimester patients? |
|
Definition
a. assess skin changes
b. headaches-rest, hydration, acetaminophen
c. constipation-hydration, exercise, prune juice (softens poor, gives iron)
d. varicose veins-elevate legs, support stockings
e. food cravings-6 small meals-keep BS level even
f. heartburn-small meals, sit up after eating, ↓ spicy
foods, antacids
g. joint/ligament pain-support garments |
|
|
Term
| What are adjustments for a soon to be mother? |
|
Definition
a. accept the concept of being pregnant
b. may dislike pregnancy but love child
c. if happy about pregnancy-usually have
higher self-esteem, confidence
d. dealing with rapid mood changes
e. may have feelings of ambivalence
f. prepare for childbirth
g. practice of mothering role
h. may need to work on communication with
family members
i. work on relationship with her mother
j. trust and share with the partner
k. work on sexual relationship with spouse |
|
|
Term
| What are the 3 phases of development pattern for a pregnant mother? |
|
Definition
-accept biological fact-“I am pregnant”
-accepts need to nurture fetus-“I am going to have a baby”
-prepares for role of parent-“I am going to be a mother” |
|
|
Term
| Who has more psychosocial issues? |
|
Definition
Older moms: may be a surprise, higher risk for perinatal outcomes
Teens moms: unexpected pregnancies, priority to get these patients in |
|
|
Term
| What are paternal tasks for an expectant father? |
|
Definition
a. acceptance of pregnancy
-may express joy or dismay
-unwanted vs. unplanned
-affairs/battery of spouse
b. couvades
-observance of rituals = transition to fatherhood
-may have psychosomatic symptoms of preg.
c. participate in childbirth education
d. identify with father role
-may be influenced by how their father was
e.reordering personal relationships
-may see fetal as a rival
-may feel wife is too dependent on MD/CNM
f. observer vs. expressive vs. instrumental
g. establish relationship with fetus
-kiss or rub abdomen
-talk to fetus
-assist with preparing baby’s room |
|
|
Term
| What are sibling adjustments? |
|
Definition
a. first crisis for a child
b. may feel replaced
c. need to prepared to become the big sister or
brother
d. sibling classes |
|
|
Term
| How may grandparents respond to pregnancy? |
|
Definition
a. if only in 30’s or 40’s-may not be as interested
b. may be non-supportive-try to decrease new
mother’s self esteem
c. most see the pregnancy as a renewal of their
youth
d. continuity of past and present
e. may help bridge a previous estrangement
f. now have classes on being a grandparent |
|
|
Term
| What are examples of preparation classes for childbirth? |
|
Definition
preparation for childbirth classes
a. prenatal yoga
b. Lamaze
c. prenatal breast feeding
d. cesarean information |
|
|
Term
| What are potential complications of labor? |
|
Definition
a. PIH
b. PTL/PROM
c. bleeding
d. ↓ FM |
|
|
Term
| At what month should a pregnant woman avoid air travel? |
|
Definition
|
|
Term
| What are the risks of substance abuse? |
|
Definition
1. no such thing as a safe level of drugs
2. alcoholism-risk of fetal alcohol syndrome, abortion
-problem with using antabuse-suspected teratogenic
3. smoking-retards fetal growth and development
a. ↑ risk for PTL, PROM, abruption
b. second-hand smoke just as bad
4. caffeine-since it’s a stimulant, best to limit-300 mg/day
a. risk of SAB
b. risk of growth restriction |
|
|
Term
| What are complications of multifetal pregnancies? |
|
Definition
1. blood volume ↑→↑ strain on CV system
2. ↑ anemia
3. ↑ uterine distention→separation of abdominal muscles
4. ↑ risk for placenta previa
5. ↑ for separation of placenta
6. lack of emotional preparement |
|
|
Term
| What is the most common cause of fetal death? |
|
Definition
| MVA mother wasn't wearing seatbelt |
|
|
Term
| What are dizygotic twins? |
|
Definition
Fom 2 fertilized ova/2 spermatozoa
1. 2 placentas
2. 2 chorions
3. 2 amnions
4. there will be 2 corpus luteum seen |
|
|
Term
| What are monozygotic twins and what are complications? |
|
Definition
originating from one fertilized ovum
- ↑ risk of congenital malformations-in monozygotic twins, ie: 2-vessel cord
- twin to twin shunting
- delivery complications |
|
|
Term
| What are dichorionic-diamniotic twins? |
|
Definition
(20-30%) of twins, Monozygotic
-if division 3 days after fertilization
-may have separate or fused placentas
-# of chorions=# of placentas
(don’t know if identical or fraternal twins until delivery) |
|
|
Term
| What are monochorionic-diamniotic twins? |
|
Definition
| if division 5 days after fertilization |
|
|
Term
| What are monochorionic-monoamniotic twins? |
|
Definition
| -if division 7-13 days after fertilization ()rarest |
|
|
Term
| What are some examples of cultural variations during pregnancy? |
|
Definition
1. belief of whether pregnancy is state of illness/health
2. behavioral expectations of mother/provider
3. dietary prescriptions/restrictions
a. warm vs. cold
b. like to like
c. pica
4. activity restrictions
5. availability of advice/if advice is sought at all
6. consideration of modesty/religion
a. clothing
b. amulets, beads
7. pain
a. inevitable, to be endured
b. can be avoided completely
c. punishment for sin
d. can be controlled
8. no tying of knots-leads to knot in umbilical cord
9. knife under bed to cut the pain |
|
|
Term
| What are some Mexican attitudes towards pregnancy? |
|
Definition
-stoic until just before delivery
-avoid eclipse of moon-cleft palate
-everybody present at delivery |
|
|
Term
| What are some Middle Eastern attitudes about pregnancy? |
|
Definition
-only female attendants
-FOB usually not at delivery |
|
|
Term
| What are some Asian attitudes about pregnancy? |
|
Definition
-prefer warm fluid
-natural childbirth
-labor in silence
-may eat during labor
-FOB may or may not be present |
|
|
Term
| What is the caloric requirements for a pregnant woman? |
|
Definition
|
|
Term
| What is important to remember about protein for a pregnant patient? |
|
Definition
a. needed for growing fetus
b. milk, meat, eggs, cheese-complete proteins
c. only slightly higher need than non-pregnancy |
|
|
Term
| What are fluid recommendations for pregnant mothers? |
|
Definition
a. recommend 8-10 glasses (2-3 liters)
b. caffeinated drinks don’t count-diuretic
c. may be good to avoid artificial sweeteners
d. proper hydrations helps prevent headaches,
constipation, and uterine cramping |
|
|
Term
| Why is iron important for pregnant mothers? |
|
Definition
| It is needed for fetus and expansion of maternal RBC mass |
|
|
Term
| What causes iron deficiency? |
|
Definition
| Poor iron intake/absorption |
|
|
Term
| What can iron deficiency lead to maternally and in the fetus? |
|
Definition
1. maternal: cardiac failure, PP infections, poor wound healing, death
2. fetal: PTL, low-birth weight infant |
|
|
Term
| Who is at the highest risk for iron deficiency? |
|
Definition
| deficiencies more common in teen moms, vegans, and African-Americans |
|
|
Term
| What is the recommended amount of calcium intake for a pregnant mother? |
|
Definition
Same DRI for nonpregnant
1000 mg if 19 yrs or older
1300 mg if under 19 yrs old |
|
|
Term
| What does calcium help prevent in pregnant patients? |
|
Definition
| Leg cramps from imbalance of calcium/phosphorus ratio |
|
|
Term
| What are important considerations in regards to sodium? |
|
Definition
-slight increase in need
-essential for maintaining water balance
-restriction only needed in women with HTN, renal or liver failure |
|
|
Term
| What should be given to pregnant patients on high dose iron supplement? |
|
Definition
| Zinc supplement, it is also needed for protein metabolism |
|
|
Term
| What is associated to zinc deficiency in a pregnant patient? |
|
Definition
|
|
Term
| What vitamins can lead to toxicity in pregnant women if there is a chronic overdose? |
|
Definition
| fat-soluble vitamins-A, D, E, K can lead to toxic levels |
|
|
Term
| What acne medication may cause multiple birth defects if taken when pregnant? |
|
Definition
|
|
Term
| What is vitamin K important for? |
|
Definition
|
|
Term
| What water soluble vitamins should be supplemented during pregnancy? |
|
Definition
| B,C because they are readily excreted in the urine |
|
|
Term
| What supplement drops the rate of NTD and anaencephaly by 50-70% ? |
|
Definition
| Folic acid, 400-800 mcg daily because pregnant women need 50% folic acid |
|
|
Term
| What is the expected weight gain during the 1st trimester? |
|
Definition
|
|
Term
| What is the expected weight gain during the 2nd & the trimester? |
|
Definition
|
|
Term
| What is the normal total weight gain for a pregnant mother? |
|
Definition
Normal BMI: 11.5-16 kg (25-35 lbs)
underweight-12.5-18 kg (28-40 lbs)
overweight-7-11.5 kg (15-25 lbs)
obese-7 kg (≤ 15 lbs) |
|
|
Term
| What are nutritional risk factors for pregnant women? |
|
Definition
1. Vegetarian
2. Pica
3. Lactose Intolerant
4. Anorexia/Bulimia |
|
|
