Women's Health Exam 1 JMU

Signs of Pregnancy: Presumptive

those changes felt by the woman (e.g., amenorrhea, fatigue, breast changes, nausea)

Signs of Pregnancy: Probable

those changes observed by an examiner (e.g., Hegar sign, ballottement, pregnancy tests)

Signs of pregnancy: positive

those signs attributed only to the presence of the fetus (e.g., hearing fetal heart tones, visualizing the fetus on an ultrasound, palpating fetal movements)

Probable sign of pregnancy: Hegar sign

softening of the lower uterine segment that is classified as a probable sign of pregnancy can increase the need for urination

Probable sign of pregnancy: Ballotement

fetal part is displaced by a light tap of examiners fingers on the cervix and then rebounds quickly

Cervix changes: Godell's sign

softening of the cervix tip, making it highly elastic

Chadwick's sign

Bluish purple discoloration of the cervix, vagina, and labia during pregnancy as a result of increased vascular congestion.

Naegele's Rule

add 7 days to first day of LMP, subtract 3 months, add 1 year

Gravidity

Total number of pregnancies a woman has had regardless of duration, including a present one

Gravida/Para

Gravida (gravidity): # of Pregnancies

Para (parady): # of live births (past 20 weeks)

Term (# of births)

woman has had a baby at 37 week or more (early, full, late, post-term)

Preterm (# of births)

# of births between 20-36 weeks

Abortion

birth of fetus before 20 weeks or baby weighing less than 500g

Living

# of current living children

A 30 year old female is 25 weeks pregnant with twins. She has 5 living children. Four of the 5 children were born at 39 weeks gestation and one child was born at 27 weeks gestation. Two years ago she had a miscarriage at 10 weeks gestation. What is her GTPAL?

G: 7, T: 4, P:1, A:1, L:5

Urine testing during pregnancy

Protein, ketones, glucose, urine culture

Abnormal reading of protein in the urine of a pregnant woman

greater than 300mgterm-18

sign of preeclampsia

preeclampsia

a complication of pregnancy characterized by hypertension, edema, and proteinuria

can cause inhibition of oxygen to fetus

ketones in urine

Body doesnt have adequate glucose or calories in the body and starts to break fast and muscles down for energy

caused by nausea and vomiting or diabetes

Bacteria in urine culture

woman could develop kidney infection (pyelonephritis) which can increase risk of pre term labor

hyperemesis gravidarum

severe nausea and vomiting in pregnancy that can cause severe dehydration in the mother and fetus

needs IV fluids

H & H norms during first trimester

HGB: 12-16 G/dl

Hct: 37-47%

If a woman's HGB drops below __________ she is considered anemic:

11 g/dl

What blood type do nurses need to look out for in a pregnant woman?

O type

What Rh sign in the mother can cause alarm if baby is Rh positive?

Rh negative

STDs tested during preganancy

gonnorhea, chlamydia, syphilis, HIV, Hep B

If a woman has this STD, it is recommended that she doesnt breast feed

HIV +

Can you give a Rubella vaccine to a pregnant woman?

no

Other vaccines that pregnant women canNOT recieve during gestation include:

Mumps and varicella vaccines

Vaccines women can receive during pregnancy

Hep ABC, Flu, Tdap

Second trimester: Supine hypotension syndrom

caused by woman laying on their back and uterus pushing up on their aorta and IFV

decrease in cardiac output

Second trimester: femoral venous pressure

due to growing of the uterus the blood return from the legs and pelvis area to the heart are decreased making pregnant women more prone to clots and DVTs

lightening

The movement of the fetus down into the pelvis late in pregnancy.

What disease has put newborn babies at most risk for infections such as sepsis, pneumonia, and meningitis?

Group B Strep

nullipara

a woman who has never borne a viable child

primipara

a woman who has borne one viable childterm-36

multipara

woman who has given birth to two or more children

gynecoid pelvis

typical female pelvis and most favorable pelvis for successful vaginal labor.

anthropoid pelvis

oval shaped, with a wider anteroposterior diameter

android pelvis

the typical male pelvis; in the woman, the heart shape of the android pelvis is not favorable to a vaginal delivery so c-section is recommended

platypelloid pelvis

pelvis that is flat in its dimensions with a very narrow anterior-posterior diameter and a wide transverse diameter; this shape makes it extremely difficult for the fetus to pass through the bony pelvis

which fetal skull diameter is the most important?

suboccipitobregmatic

Leopold's Maneuvers

A series of four maneuvers designed to provide a systematic approach whereby the examiner may determine fetal presentation and position.

Cardinal movements of labor: step 1

Engagment

Cardinal movements of labor: step 2

Descent

Cardinal movements of labor: step 3

flexion

cardinal movements of labor: step 4

internal rotation

cardinal movements of labor: step 5

extension

Cardinal movements of labor: step 6

restitution/external rotation

cardinal movements of labor: step 7

external rotation

cardinal movements of labor: step 8

expulsion

A woman is having irregular contractions and says that walking helps alleviate the pain. what type of labor is she in?

False

a woman is having contractions that keep increasing in duration and intensity. What type of labor is she in?

true

What two things must you always document after ROM?

TACO and FHT

what does TACO stand for?

Time, Amount, Color, Odor

Percipitous labor

extremley fast labor (<3 hrs)

when is the best time to educate a pregnant woman about pain management?

before labor

What must you do before administer an epi?

administer 1000 cc of fluid bolus

spinal anesthesia

smaller dose (subarachnoid space)

quicker onset (5 min)

smaller needle (25-27g)

epidural anesthesia

larger dose (5x-10x)

longer onset (20 min)

larger needle (17g)

epidural space

Side effects of opioids and regional anesthesia/analgesics

urine retention

respiratory depression

postural hypo-tension

pruritus

increase HR

may slow labor <4-5cm dilation

Which hormone needs to decrease in order to stimulate lactation?

Progesterone

8 point part assessment

(BUBBLEEE) Breasts, Uterus, Bladder, Bowels, Lochia, Episiotomy, Extremities, Emotions

What is involution?

the return of the uterus to a non pregnant state after birth. Uterus contraction

Lochia rubra

Reddish or red-brown vaginal discharge that occurs immediately after childbirth; composed mostly of blood., 2-4 days

Lochia serosa

Pinkish/brown, serosanguineous. Lasts day 4-10 postpartum

Lochia alba

Yellowish, white cream color. Lasts approx 11 days-6 weeks postpartum

Rubins framework: Taking in

Focus: self, Behavior: dependent

Rubins framework: Taking hold

Focus: baby, Behavior: independent/dependent

Rubins framwork: Letting go

Focus: family as unit, Behavior: interdependent

Is the mom bonding with the baby?

(TEST): Talking, Enface, Smile, Touch

what is the most common cause of Postpartum hemorrhage?

Uterine atony

If a woman presents with a firm fundus but some gushes of blood, what is causing her PP hemorrhage?

laceration

If a woman presents with a boggy fundus but it is firm during massage, what may be causing this?

Retained placental fragments

if a woman presents with a boggy fundus and soaked peri pad after 20 min PP, what may be the cause?

uterine atony

accreta

superficial invasion of the placenta into the uterine myometrium

increta

placenta invades myometrium

Percreta

placenta invades through the myometrium into the uterine serosa

Which PP bleeding medication should NOT be given to someone with hypertension?

Methergine

Which PP hemorrhage drug is first line AFTER pitocin?

cytotec

Idiopathic Thrombocytopenic Purpura (ITP)

coagulation/autoimmune disorder in which a deficiency of platelets results in abnormal blood clotting, antibodies attack platelets, marked by tiny purple bruises (purpura) that form under the skin

Von Williebrand Disease

Hereditary defect, affects clotting factor, platelet dysfunction

Diseminated Intravascular Coagulation (DIC)

rare disease that causes abnormal clotting in blood and can cause bleeding

Post partum infection

The 7 W's

Womb (endometritis)

Wind (pneumonia)

Water (UTI)

Walk (DVT/PE)

Wound (incision site)

Weaning (engorgement/mastitis)

Wonder (Drug fever)