Module 5

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mfabian
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Module 5
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2011-05-15 21:28:22
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Chapters 11,12
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  1. Signs and symptoms of pregnancy are group into what categories?
    • Presumptive (subjective)
    • Probable (objective)
    • Positive
  2. In which category are the signs and symtpoms that are experienced by the woman herself and are the least reliable indicator of pregnancy?
    Presumptive
  3. Presumtive signs and time of occurrence
    • Fatigue (12 wk)
    • Breast tenderness (3-4 wk)
    • Nausea and vomiting (4-14 wk)
    • Amenorrhea (4 wk)
    • Urinary frequency (6-12 wk)
    • Hyperpigmentation of the skin (16 wk)
    • Fetal movements (quickening; 16- 20 wk)
    • uterine enlargement (7-12 wk)
    • Breast emlargement (6 wk)
  4. Probable signs and time of occurrence
    • Braxton Hicks contractions (16- 28 wk)
    • Positive pregnancy test (4-12 wk)
    • Abdominal enlargement (14 wk)
    • Ballottement (16-28 wk)
    • Goodell's sign (5 wk)
    • Chadwick's sign (6-8 wk)
    • Hegar's sign (6-12 wk)
  5. Positive signs and time occurrence
    • Ultrasound verification of embryo or fetus (4-6 wk)
    • Fetal movement felt by experienced clinician (20 wk)
    • Auscultation of fetal heart tones via Doppler (10- 12 wk)
  6. What is the definition of cystocele?
    a herniation of the urinary bladder into the vagina
  7. Signs of pregnancy that are apparent on physical examination by a health care professional fall in which category?
    Probable signs (objective)
  8. What is Hegar's sign?
    Softening of the lower uterine segment or isthmus
  9. What is Goodell's sign?
    Softening of the cevix
  10. What is Chadwick's sign?
    A bluish purple coloration of the vaginal mucosa and cervix
  11. Define ballottement.
    The examiner pushes against the woman's cervix during a pelvic examination and feels a rebound from the floating fetus
  12. What is the earliest biochemical marker for pregnancy?
    Human chorionic gonadotropin (hCG)

    hCG levels in normal pregnancy usually double q 48-72 hours until peak about 60-70 days after fertilization ; then decrease to a plateau at 100-130 days of pregnancy
  13. What is the (ELISA)?
    Enzyme-linked immunosorbent assay

    • Basis for most home pregnancy tests
    • Blood or serum specimen
    • Enzyme bonds with hCG
    • reliable 4 days after implantation
    • 99% accurate
  14. Agglutination inhibition pregnancy tests
    • Urine specimen
    • Agglutination does not occur if hCG is present in urine
    • reliable 14-21 days after conception
    • 95% accurate
  15. Immunoradiometric assay pregnancy test
    • Blood serum specimen
    • Measures ability of blood sample to inhibit the binding of radiolabeled hCG to receptors
    • reliable 6-8 after conception
    • 99% accurate
  16. Changes in uterus during pregnancy
    • Estrogen stimulates uterine growth
    • weight of uterus increases from 70 g to about 1100 g at term
    • capacity increases from 10 ml to 5000 ml or more at term
    • Postive Hegar's sign at during first 6-8 wks
    • remains in pelvic cavity for the first 3 months
    • By 20 wks fundus is at the level of the umbilicus and meaures 20 cm
    • Reaches highest level at xiphoid process at approx. 36 wks
  17. Fundal height can be typical of gestational weeks between 18 and 32 weeks, but after 36 weeks gestation, this measurement is no longer reliable because of the beginning of fetal descent.
  18. What is lightening?
    fetal head begins to descend and engage in the pelvis
  19. Changes in the cervix during pregnancy
    • Goodell's sign begins during weeks 6 and 8 (due to vasocongestion)
    • Chadwick's about same time as Goodell's
  20. Changes in the vagina during pregnancy
    Increase in a whitish vaginal discharge, called leukorrhea
  21. Changes in the ovaries during pregnancy
    • Ovulation ceases b/c of elevated estrogen and progesterone, which block secretion of follicle stimulating hormone (FSH) and luteinizing hormone (LH) from the anterior pituitary
    • very active in hormone production until weeks 6-7 , when corpus luteum regresses and the placenta takes over the major production of progesterone
  22. What are tubercles of Montgomery on the breasts?
    sebaceous glands
  23. Definition of friable
    marked by erosion and bleeding
  24. Gastrointestinal changes during pregnancy
    • excessive salivation (ptyalism)
    • smooth muscle relaxation and decreased peristalsis related to the influence of progesterone
    • slowed gastric emptying combined with relaxation of cardiac sphincter allows relux, which causes heartburn (pyrosis)
  25. Cardiovascular system adaptation during pregnancy
    • Blood volume
    • 50% increase in plasma
    • 25% to 33% increase in RBCs
    • causes hemodilution = lower hematocrit and hemoglobin
    • Cardiac output and heart rate
    • CO increases 30-50% by 32nd wk
    • HR increases by 10 to 15 bpm between 14 and 20 wks
    • Blood pressure
    • Diastolic pressure decreases 10 to 15 mmHg to reach lowest by mid pregnancy then normalizes by term
    • Both fibrin and plasma fibrinogen levels increase plus other blood clotting factors making pregnancy a hypercoaguable state
  26. Respiratory adaptations during pregnancy
    • uterus shifts diaphram up 4 cm above usual position
    • conversion from abdominal breathing to thoracic breathing
    • 50% increase in air volume per minute
    • Tidal volume increases by 30% to 40% (from 500 to 700 ml)
    • increased estrogen causes increased vascularity of respiratory tract which leads to congestion
  27. Changes in the renal/urinary system
    • renal pelvis becomes dilated
    • ureters (esp. the right) elongate, widen, and become more curved above the pelvic rim
    • bladder tone decreases and capacity doubles by term
    • GFR increases 40% to 60%
    • blood flow to kidneys increases by 50% to 80% due to increased CO
  28. Adaptation of the musculoskeletal system
    • Pelvis tilts forward, shifting center of gravity
    • woman develops lordosis
    • hormone progesterone and relaxin relax and increase mobility of joints causing the "waddle gait"
  29. Integumentary changes during pregnancy
    • Hyperpigmentation of skin results from estrogen, progesterone, and melanocyte-stimulating hormones
    • Striae gravidarum (stretch marks) may appear- from reduced connective tissue strength resulting from the elevated adrenal steroid levels and stretching of structures
    • linea nigra develops
    • Melasma (mask of pregnancy) -irregular blotchy areas of pigmentation of face
  30. Changes in the thyroid gland during pregnancy
    • enlarges slightly and becomes more acitve as a result of increased vascularity and hyperplasia
    • increase in secretion of thyroid hormone
    • basal metabolic rate increases by 25%
  31. Changes in the pituitary gland during pregnancy
    • FSH (follicle stimulating hormone) and LH (lutieninizing hormone) are inhibited during pregnancy
    • Thyroid stimulating hormone TSH is reduced during the first trimester
    • Decrease in the number of frowth hormone producing cells and a corresponding decrease in GH blood levels
    • Prolactin secreted in pulses and increases ten-fold to promote breast development and lactation process
    • high level of progesterone produced by placenta inhibits the influence of prolactin on breast and suppresses lactation
    • Melanocyte-stimulating hormone increases
  32. During early pregnancy the glucose and insulin levles decrease or increase?
    decrease
  33. Where does the fetus get its insulin to facilitate the entry of glucose into its cells?
    The fetus produces its own insulin. Insulin cannot cross the placenta.
  34. Why must more insulin be secreted in the mother during the last half of the pregnancy?
    • hPL from the placenta and steroids (cortisol)from the adrenal cortex act against insulin
    • increased levegs of insulin are needed to counteract the increasing levels of hPL and cortisol
  35. Why is glucose more likely to cross over the placenta to the fetus than to enter the mother's cells?
    Because prolactin, estrogen , and progesterone are also thought to oppose insulin.
  36. Changes in the adrenal gland
    • key change---marked increase in cortisol secretion, which regulates carbohhydrate and protein metabolism and is helpful in times of stess
    • Cortisol increases in response to increased estrogen levels throughout pregnancy and returns to normal levels within 6 weeks postpartum
  37. During the stress of pregnancy, cortisol:
    • helps keep up the level of glucose in the plasma by breaking down noncarbohydrate sources, such as amino and fatty acids, to make glycogen.
    • Breaks down proteins to repair tissues and manufactures enzymes
    • Has anti-insulin, anti inflammatory, and antiallergic actions.
    • Is needed to make the precursors of adrenaline which the adrenal medulla produces and secretes
  38. What are prostaglandins?
    • chemical mediators or local hormones
    • fetal membranes are believed to be involved in production of the prostaglandins
  39. What hormones does the placenta produce?
    • hCG
    • hPL
    • Relaxin
    • Progesterone
    • Estrogen
  40. Which to supplements must be taken during pregnancy?
    iron and folic acid
  41. What is the function of iron and folic acid?
    • to form new blood cells for the expanded maternal blood volume and to prevent anemia
    • Folic acid essential before pregnancy and in early weeks in pregnancy to prevent neural tube defects in the fetus
    • 30 mg of ferrous iron and 600 mcg of folic acid per day recommended
  42. What is the purpse of hCG?
    • maintains maternal corpus letuem, which secretes progesterone and estrogens, with synthesis occuring before implantation
    • Production by fetal trophoblast cells until the placenta is developed sufficiently to take over function
    • Basis for early pregnancy tests
    • production peaks at 8 weeks then gradually declines
  43. What is hPL (also known as human chorionic somatomammatropin [hCS])
    • Preparation of mammary glands for lactation and involved in the process of making glucose available for fetal growth by altering maternal carbohydrate, fat, and protein metabolism
    • Antagonist of insulin because it decreases tissue sensitivity or alters the ability to use insulin
    • Increase in the amount of circulating free fatty acids for maternal metabolic needs an decrease in maternal metabolism of glucose to facilitate fetal growth
  44. What is relaxin?
    • Secretion by the placenta as well as the corpus luteum during pregnancy
    • thought to act synergistically with progesterone to maintain pregnancy
    • Increase in flexibility of the pubic symphisis, permitting the pelvis to expand during delivery
    • Dilation of the cervix, making it easier for the fetus to enter the vaginal canal; thought to suppress the release of oxytocin by the hypothalamus, thus delaying the onset of labor contractions
  45. What is progesterone?
    • hormone of pregnancy-critical role in supporting the endometrium of uterus
    • Supports the endometrium to provide an enviroment conducive to fetal survival
    • Produced by the corpus luteum during the first few weeks of pregnancy and then by the placenta until term
    • Causes thickening of the uterine lining in anticipation of implantation of fertilized ovum. Then maitains the endometrium, inhibits uterine contracitility, and assists in the development of the breasts for lactation
  46. What is estrogen?
    • promotes enlargement of the genitals, uterus, and breasts, and increases vascularity, causing vasodilation
    • Relaxation of pelvic ligaments and joints
    • Associated with hyperpigmentation, vascular changes in skin, increased activity of salivary glands, and hyperemia of gums and nasal mucous membranes
    • Aids in developing the ductal system of breasts in preparation for lactation.
  47. What types of fish should a pregnant woman avoid eating? Why?
    • shark
    • swordfish
    • king mackerel
    • tilefish

    Because of the mercury levels
  48. What are good sources of folic acid?
    • dark green vegetables
    • baked beans
    • black eyed peas
    • citrus fruits
    • peanuts
    • liver
  49. Any woman who has a prepregnancy BMI of less than 19.8 is considered to be high risk and hsould be referred to a nutritionist.
  50. Categories of BMI according to the CDC
    • Underweight : less than 18.5
    • Healthy weight: 18.5 to 24.9
    • Overweight: 25-29.9
    • Obese: 30-or higher
  51. Calculating BMI
    weight in pounds divided by height in inches squared, multiplied by 704.5
  52. During second and third trimester, what is normal weight gain for a women whose prepregnant weight is within normal weight range?
    1 pound per week
  53. What is the reason for lactose intolerance?
    the lack of an enzyme (lactase) needed for the breakdown of lactose into its component simple sugars, glucose, and galactose.
  54. What is a lacto-ovo-vegetarian?
    omit red meat, fish, and poultry but eat eggs, milk, and dairy products, in addition to plant based foods.
  55. What is a lacto-vegetarian?
    consume milk and dairy products along with plant based foods; they omit eggs, meat, fish, and poultry
  56. What is a vegan?
    eliminate all foods from animals, including milk, eggs, and cheese, and eat only plant based foods
  57. What is couvade syndrome?
    sympathetic response to partner's pregnancy
  58. When is the period of greatest environmental sesitivity and consequent risk for the developing embryo?
    17-56 days after conception
  59. Risk factors for adverse pregnancy outcomes:
    • taking retinoic acid (Accutane) to clear cystic acne
    • alcohol use
    • antiepileptic drugs
    • autoimmune disorders
    • diabetes (preconception)
    • folic acid deficiency
    • HIV/AIDS
    • maternal phenylketonuria (PKU)
    • rubella seronegativity
    • obesity
    • STI
    • smoking
    • underweight
  60. What is Nagele's rule?
    • used to establish the EDD or EDB
    • subtract 3 months and then add 7 days to the first day of the LMP
    • margin of error of plus or minus 2 weeks
  61. What does gravid mean?
    state of being pregnant
  62. What does gravida mean?
    a pregnant woman; gravida I (primagravida) during the first pregnancy, gravida II (secundigravida) during the second pregnancy, and so on
  63. What does para mean?
    • the number of pregnancies that a woman has, regardless of whether the newborn is born alive or dead.
    • pregnancy of at least 20 weeks
  64. Meaning of GTPAL or TPAL
    • G= gravida; the current pregnancy
    • T= term births; the number of prenancies ending >37 weeks' gestation
    • P= preterm births; the number of preterm pregnanies ending > 20 weeks or viability but before completion of 37 weeks
    • A= abortion; the number of pregnancies ending before 20 weeks or viability
    • L=living children; the number of children currently living
  65. Where can the fundus be palpated at 12 weeks?
    at the symphysis pubis
  66. Where can the fundus be palpated at 16 weeks?
    midway between the symphysis and the umbilicus
  67. Where can the fundus be palpated at 20 weeks?
    at the umbilicus and measures approx. 20 cm from the symphysis pubis
  68. Where is the fundus located at 36 weeks?
    just below the ensiform cartilage and measures approx. 36 cm
  69. If edema is present in early pregnancy, further evaluation may be needed to rule out what?
    gestational hypertension
  70. What are the three measurements taken during the pelvic assessment?
    • diagonal conjugate
    • true conjugate
    • ischial tuberosity
  71. Diagonal conjugate pelvic measurement
    • usually 12.5 cm or greater
    • most useful measurement for estimating pelvic size because a misfit with the fetal head occurs if it is too small
  72. True conjugate pelvic measurement
    • cannot be measured directly
    • estimated by subtracting 1 or 2 cm from the diagonal conjugate measurement
    • actual diameter through which the head will pass
    • ranges from 10.5 cm to 11 cm
    • smallest front to back diameter through which the fetal head must pass
  73. Ischial tuberosity pelvic measurement
    10.5 cm or more is considered adequate for passage of the fetal head
  74. Lab tests conducted on pregnant women
    • urinalysis- analyzed for albumin, glucose, ketones, and bacteria casts
    • Complete blood count (CBC)
    • blood typing
    • rubella titer
    • hepatitis B
    • HIV
    • STI screening
    • Cervical smears
  75. What is the schedule for follow up visits for a pregnant woman?
    • q 4 weeks up to 28 weeks
    • q 2 weeks from 29 to 36 weeks
    • q week from 37 weeks to birth
  76. What is the McDonald's method of measuring fundal height?
    measuring with a tape measure from the top of the pubic bone to the top of the uterus with the client lying on her back with her knees slightly flexed
  77. Fundal height in cm equals weeks of gestation. Example 36 cm equals 36 weeks.
  78. What might a decrease in fetal movement indicate?
    • asphyxia
    • IUGR
    • use of central nervous system depressants by mother
    • fetal sleep cycles
    • hydrocephalus
    • bilateral renal agenesis
    • bilateral hip dislocation
  79. What are the Cardiff and Sadovsky techniques?
    techniques for determining fetal movement, also called fetal movement counts
  80. Cardiff's technique
    • woman lies or sits and concentrates on fetal movements until she records 10 movements
    • must record the length of time during which the 10 movements occurred
    • instructed to notify her health care provider is she doesn't feel at least 10 movements within 1 hour
  81. Sadovsky technique
    • woman lies down on her left side for 1 hour after meals and concentrates on fetal movement
    • four movements should be felt within 1 hour
    • if four movements are not felt within 1 hour, then the woman should monitor movement for a second hour
    • If after 2 hours, four movements haven't been felt then she should contact her doctor
  82. Always instruct a woman to report a count of less than three fetal movements within an hour.
  83. Between weeks 24 and 28, a blood glucose level is obtained using a 50 g glucose load followed by a 1 hour plasma glucose determination. What result would warrant further testing and what would that test be?
    • a result of more than 140 mg/dL
    • the next test would be a 3 hour 100 g glucose tolerance test to determine if gestational diabetes is present
  84. Periorbital edema around the eyes, edema of the hands, and pretibial edema are abnormal and could be signs of what?
    gestational hypertension
  85. A group B streptococcus, gonorrhea, and a chlamydia test is done at how many weeks of gestation?
    between 37-40 weeks
  86. What is alpha-fetoprotein
    • a substance produced by the fetal liver between weeks 13 and 20 of gestation
    • linked to the occurrence of fetal neural tube defects
    • present in amniotic fluid in low concentration between 10 and 14 weeks of gestation and can be detected in maternal serum beginning approx. 12-14 weeks of gestation
    • optimal time AFP screening is 16-18 weeks of gest.
  87. Causes of elevated maternal serum AFP
    • open neural tube defect
    • under estimation of gestational age
    • presence of multiple fetuses
    • gastrointestinal defects
    • low birthweight
    • oligohydramnios
    • decreased maternal weight
  88. lower than expected maternal serum AFP levels are caused by:
    • fetal gestational age is overestimated
    • fetal death
    • hydatidiform mole
    • increased maternal weight
    • maternal type I diabetes
    • fetal trisomy 21 (down syndrome)
    • trisomy 18 (edward's syndrome)
  89. Triple marker screening test
    • performed at 16-18 weeks of gestation
    • uses levels of three maternal serum markers: AFP, unconjugated estriol, and hCG in combination of maternal age
    • low AFP and unconjugated estriol levels and a high hCG suggests down syndrome
    • high AFP are associated with open neural tube defect, ventral wall defects, some renal abnormalities, multiple gestation, certain skin disorders, fetal demise, and placental abnormality
    • enhances detection rate from 25 to 69%
  90. Quadruple marker screening test
    • Maternal serum: AFP, unconjugated estriol, hCG, and inhibin A
    • done at 14 to 22 weeks
    • detects 85% of trisomy 21 cases
    • AFP and inhibin A levels decreased in infants with trisomy 21 (down syndrome)
  91. Nuchal translucency screening
    • between 11 and 14 weeks
    • earlier detection and diagnoses of some fetal chromosomal and structural abnormalities
    • ultrasound identifies increase of nuchal translucency, which is due to the subcutaneous accumulation of fluid behind the fetal neck.
  92. Amniocentesis
    • usually performed between 16-18 weeks
    • if done early, associated with spontaneous miscarriage and amniotic fluid leakage
    • detect chromosome abnormalities and variou other conditions
    • can be used to determine fetal lung maturity after 35th week via analysis of lecithin-to sphingomyelin raties
  93. Amniotic fluid analysis and implications

    Normal findings
    • Color: Clear with white flecks of vernix caseosa in a mature fetus
    • Bilirubin: absent at term
    • Meconium: absent (except in breech presentation)
    • Creatinine: More than 2 mg/dL in a mature fetus
    • Lecithin-sphingomeylin ratio (L/S ratio): More than 2 generally indicates fetal pulmonary maturity
    • Phosphatidylglycerol: Present
    • Glucose: Less than 45 mg/dL
    • Alpha-fetoprotein: variable, depending on gestation age and laboratory technique; highest concentration (about 18.5 ug/mL) occurs at 13 to 14 weeks
    • Bacteria: absent
    • Chromosomes: normal karyotype
    • Acetycholinesterase: absent
  94. Amniotic fluid analysis and implications

    Abnormal findings
    • Color: blood of maternal origin is usually harmless. Port wine fluid may indicate abruptio placentae. Fetal blood may indicate damage to the fetal placental, or umbilical cord vessels.
    • Bilirubin: high levels indicate hemolytic disease of the neonate in isoimmunized pregnancy
    • Meconium: Presence indicates fetal hypotension or distress
    • Creatinine: Decrease may indicate immature fetus (less than 37 weeks)
    • Lecithin-sphingomyelin ratio (L/S ratio): a ratio of less than 2 indicates pulmonary immaturity and subsequent respiratory distress syndrome
    • Phosphatidylglycerol: absence indicates pulmonary immaturity
    • Glucose: Excessive increases at term or near term indicate hypertrophied fetal pancreas and subsequent neonatal hypoglycemia
    • Alpha-fetoprotein: inappropriate increases indicate neural tube defects such as spina bifida or anencephaly, impending fetal death, congenital nephrosis, or contamination of fetal blood.
    • Bacteria: presence indicates chorioamnionitis
    • Chromosomes: abnormal karyotypes may indicate fetal sex and chromosome disorders
    • Acetylcholinesterase: presence may indicate neural tube defects, exomphalos, or other serious malformations
  95. Nursing managment for amniocentesis
    • have client empty bladder before procedure to prevent puncture of bladder
    • inform her that a 20 minute electronic fetal monitoring strip usually is obtained to evaluate fetal well being and obtain a baseline to compare after
    • after procedure administer RhoGAM intramuscularly if woman is Rh negative to prevent potential sensitization to fetal blood
    • vital signs and fetal heart rate q 15 minutes for an hour after
    • observe puncture site for bleeding or drainage
    • rest after returning home
    • report fever, leaking amniotic fluid, vaginal bleeding, or uterine contractions or any changes in fetal acitivity
  96. Chorionic villus sampling (CVS)
    • a procedure for obtaining a sample of the chorionic villi for prenatal evaluation of chromosomal disorders, enzyme deficiencies, and fetal gender determination and to identify sex-linked disorders such as hemophilia, sickle cell anemia, and TaySachs disease
    • Chorionic villi are finger like projections that cover the embryo and anchor it to the uterine lining before the placenta is developed
    • results available usually within 48 hours
  97. Nursing management for chorionic villus sampling
    • explain that procedure will last about 15 minutes
    • ultrsound will be done to locate embryo
    • fill bladder by drinking increased amounts of fluid
    • after procedure report signs of fever, cramping, and vaginal bleeding
    • do not engage in strenuous activity for the next 48 hours
    • administer RhoGAM to an unsensitized Rh-negative woman after the procedure
  98. Percutaneous unbilical blood sampling
    • permit the collection of blood specimen directly from fetal circulation
    • specifically for women at risk for genetic anomalies and those with potential blood disorders, such as blood incompatibility or hemoglobinopathies
  99. Potential complications of a percutaneous umbilical blood sampling test
    leakage of blood from the puncture site, cord laceration, cord hematomas, transient fetal bradycardia, infection, thromboembolism in umbilical cord, preterm labor, and premature rupture of membranes
  100. Nursing management for Percutaneous umbilical sampling test
    • assess fetal heart rate continuously and perform external fetal monitoring for up to 2 hours before the woman is discharged from the outpatient area.
    • repeat ultrasound usually done within an hour after the procedure to rule out bleeding or hematoma formation
    • instruct client to report signs of infection, an increase in contractions, or a change in fetal activity level from normal
    • reinforce the need to count fetal movements
  101. Nonstress test
    • an indirect measurement of uteroplacental function
    • in healthy fetus there is an acceleration of fetal heart rate with fetal movement
    • NST is recommended twice weekly after 28 weeks for clients with diabetes and other high-risks conditions, such as IUGR, preeclampsia, postterm pregnancy, renal disease, and multifetal pregnanies
    • not sensitive to fetal oxygen
    • high false positive rate
  102. Nonstress test procedure
    • client eats a meal before the procedure to stimulate fetal activity
    • then client is placed in left lateral recumbent postion to avoid supine hypotension syndrome
    • procedure usually lasts 20 to 30 minutes
  103. Nursing management for nonstress test
    • empty bladder before procedure
    • position client in semi-fowler's position and apply the two external monitor belts
    • obtain baseline fetal monitor strip over 15 to 30 minutes
    • observe for signs of fetal activity with a concurrent acceleration of the fetal heart rate
    • a reactive test includes at least two fetal heart rate accelerations from the baseline of at least 15 bpm for at least 15 seconds within the 20 minute recording
    • if test does not meet these criteria after 40 minutes it is considered nonreactive
    • a nonreacitve test is characterized by the absence of two fetal heart rate accelerations using the 15 by 15 criterion in a 20 minute time frame
    • a nonreactive test correlates with a higher incidence of fetal distress during labor, fetal mortality, and IUGR
    • Additional test would be needed, such as contraction stress test or biophysical profile
  104. Contraction stress test
    • formerly called the oxytocin challenge test
    • determines the fetal heart rate response under stress
    • goal is to achieve three unterine contractions in a 10 minute period
  105. Biophysical profile
    • uses a real-time ultrasound to allow assessment of various parameters of fetal well being, fetal tone, breathing, motion, and amniotic fluid vlolume.
    • these four parameters together with the NST constitute the biophysical profile
    • based on the concept that a fetus with hypoxia loses behavioral parameters in the reverse order in which they were acquired : tone at 8 weeks; movement at 9 weeks; breathing at 20 weeks; and fetal heart rate reactivity at 24 weeks
    • Each parameter controlled by a different structure in the fetal brain: fetal tone by the cortex; fetal movements by the cortex and motor nuclei; fetal breathing movements by the centers close to the fourth ventricle; and the NST by the posterior hypothalamus and medulla
  106. Scoring and interpretation of the biophysical profile
    • highest possible score of 10
    • 5 components each worth 2 points
    • Following criteria must be met to obtain a score of 2
    • body movement: three or more discrete limb or trunk movements
    • fetal tone: one or more instances of full extension and flexion of a limb or trunk
    • fetal breathing: one or more fetal breathing movements of more than 30 seconds
    • Amniotic fluid volume: one or more pockets of fluid measuring 2 cm
    • NST: normal NST=2 points; abnormal NST= 0 points

    • Score of 8 is considered normal if amniotic fluid is adequate
    • score of 6 or below is suspicious
  107. Signs of preeclampsia
    generalized edema, appearing in the face, hands, and feet, when accompanied by dizziness, blurred vision, headaches, upper quadrant pain, or nausea
  108. The heat of hot tub and saunas may cause what in the fetus?
    tachycardia as well as raise the maternal temperature
  109. What should you tell the client to do immediately after vomiting?
    rinse mouth with baking soda (1/4 teaspoon) and warm water (1 cup) to neutralize the acid
  110. Advise pregnant women to avoid live virus vaccines and to avoid becoming pregnant within 1 month of having received one of these vaccines because of the theoretical risk of transmission to fetus
  111. Vaccines contraindicated during pregnancy
    • influenza (live, attenuated vaccine)
    • measles
    • mumps
    • rubella
    • varicella
  112. FDA pregnancy risk classification of drugs

    What is category A
    • tested and found safe during pregnancy.
    • Examples: folic acid, vitamin b6, and thyroid medicine
  113. FDA pregnancy risk classification of drugs

    What is category B?
    • used fequently during pregnancy and do not appear to cause major birth defects or other fetal problems
    • examples: antibiotics, aceteminophen (tylenol), aspartame (artificial sweetner), famotidine (Pepcid), prednisone (cortisone), insulin, and ibuprofen.
  114. FDA pregnancy risk classification of drugs

    What is category C?
    • more likely to cause problems and safety studies have not been completed
    • examples: prochlorperazine (Compazine), fluconazole (Diflucan), ciproflozacin (Cipro), and some antidepressants
  115. FDA pregnancy risk classification of drugs

    What is category D?
    • have clear health risks for the fetus
    • examples: alcohol, lithium (treats bipolar disorders), phenytoin (dilantin); all chemotherapeutic agents used to treat cancer
  116. FDA pregnancy risk classification of drugs

    What is category X?
    • shown to cause birth defects and should never be taken during pregnancy
    • examples: accutane (treats cystic acne), androgens (treats endometriosis), Coumadin (prevents blood clots), antithyroid medications for overactive thyroid; radiation therapy (cancer treatments), Tegison or Soriatane (treats psoriasis), streptomycin (treats tuberculosis); thalidomide (treats insomnia), diethylstilbestrol (DES) (treats menstrual disorders), and organic mercury from contaminated food
  117. Three most common childbirth methods
    • Lamaze (psychoprophylactic) method
    • Bradley (partner-coached childbirth) method
    • Dick-read (natural childbirth) method
  118. What is the Lamaze childbirth method?
    • a psychoprophylactic (mind prevention) method of preparing for labor and birth that promotes the use of specific breathing and relaxation techniques
    • Slow-paced breathing: half the normal breathing rate; for relaxation
    • modified paced breathing: to increase alertness or focus attention
    • Patterned-paced breathing: similar to modified paced but with rhythmic pattern
  119. What is the Bradley childbirth method?
    uses various exercises and slow controlled abdominal breathing to accomplish relaxation
  120. What is the Dick-Read childbirth method?
    relaxation and reduced pain by arming herself with the knowledge of normal childbirth and using abdominal breathing during contractions

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