Nursing Management During Pregnancy

What is Nagele's rule?

1st day of LMP + 7 days - 3 months

A pregnant client tells the nurse that the first day of their last menstrual period was September 21st. Using Nägele's rule, what is the estimated date of delivery (EDD)?

A. June 21st

B. July 28th

C. June 28th

D. May 21st

C. June 28th

What does gravida stand for?

of pregnancies regardless of outcome

What does para stand for?

of deliveries > 20 weeks

What does T stand for in TPAL?

of term deliveries (>37 weeks)

What does P stand for in TPAL?

of preterm deliveries (<37 weeks)

What does A stand for in TPAL?

of abortions (<20 weeks)

What does L stand for in TPAL?

of living children

A.B. is currently pregnant. Their first child was born at 39 weeks gestation. They then experienced a miscarriage at 10 weeks gestation and another at 15 weeks. What is the client's gravida and para? Their TPAL?

Gravida: 4

Para: 1

TPAL: 1021

L.C. is pregnant for the 3rd time. Their first child was born at 38 weeks gestation. They then gave birth to twins at 35 weeks gestation. What is the client's gravida and para? Their TPAL?

Gravida: 3

Para: 2

TPAL: 1103

twins are considered ____ (#) pregnancy and _____ (#) delivery

one pregnancy and one delivery

How is fundal height (McDonald's Method) measured?

Measure from symphysis pubis to the top of the fundus

fundal height correlates with __________

gestational age

a normal fundal height is +/- ____(#) of gestational age

2

What should pregnant woman know about quickening?

once it is felt, it should continue to be felt

What lab test is important to test for in the first trimester?

blood type and Rh factor

What lab test is important to test for in the second trimester?

screening for gestational diabetes

What lab test is important to test for in the third trimester?

Group B strep (GBS) screening

What is given to pregnant woman during labor if she is GBS positive?

antibiotics

If BP is continually increasing in pregnant woman, what is it indicative of?

preeclampsia

If protein is found in urine, what is it indicative of?

preeclampsia

seatbelt safety for pregnant women

put bottom strap of seatbelt under baby bump

What is 1,000 days campaign?

says that the first 1,000 days of a childs life (including time in utero) is crucial for development and focuses on nutrition

What type of clothing should be avoided in pregnancy?

tight restrictive clothing and heels

Are hot tubs and saunas okay for a pregnant woman to be in?

no

Can pregnant women still exercise?

yes

Is sexual activity contraindicated during pregnancy?

no

Can pregnant women still work?

yes

When are pregnant women usually not allowed to fly?

after 30 weeks gestation because airlines don't want mom giving birth on flight

What vaccines are recommended for pregnant women?

flu, Tdap, and covid vaccine

nursing education to help pregnant patient relieve nausea and vomiting (4)

-dry crackers before arising

-avoid brushing teeth right after waking up

-small, frequent meals

-carbonated beverages

nursing education to help pregnant patient relieve urinary frequency (2)

-sleep side lying at night

-kegel exercises

nursing education to help pregnant patient relieve fatigue (3)

-go to bed early

-regular exercise

-avoid eating/drinking foods with stimulant properties

nursing education to help pregnant patient relieve breast tenderness

wear a supportive bra

nursing education to help pregnant patient relieve constipation (2)

-increase fluids, fiber, and exercise

-warm fluids

nursing education to help pregnant patient relieve increased vaginal discharge (2)

-cotton underwear

-avoid douching

nursing education to help pregnant patient relieve nasal stuffiness and epistaxis (2)

-humidifier

-avoid nasal decongestants

nursing education to help pregnant patient relieve varicose veins (3)

-elevate legs and wear supportive hose

-avoid crossing legs at knees

-avoid standing for long periods

nursing education to help pregnant patient relieve hemorrhoids

use Tucks pads, sitz baths

nursing education to help pregnant patient relieve backaches (3)

-pelvic tilt exercises

-avoid high heeled shoes

-avoid lifting heavy loads

nursing education to help pregnant patient relieve leg cramps (2)

-dorsiflex feet to stretch

-apply heat

nursing education to help pregnant patient relieve heartburn (2)

-small, frequent meals

-avoid overeating or lying down right after eating

nursing education to help pregnant patient relieve ankle edema (2)

-dorsiflex feet frequently

-elevate legs above heart

nursing education to help pregnant patient relieve flatulence

chew well

nursing education to help pregnant patient relieve faintness (3)

-avoid prolonged standing in warm or stuffy environments

-arise slowly

-avoid supine position

The nurse is providing instructions to a pregnant client experiencing heartburn. Which of the following statements by the client indicates the teaching has been effective?

A. "I should use spices in my cooking instead of salt."

B. "I should avoid in between meal snacking."

C. "I should lie down after eating to promote absorption."

D. "I should avoid gas producing foods."

D. "I should avoid gas producing foods."

What hormone causes heartburn?

progesterone

Which of the following education should be included as part of an education plan about self-care measures for a pregnant client?

A. Avoid foods that are high in iron and folate to decrease the likelihood of constipation

B. Increase caloric intake by at least 500 calories/day to provide nourishment for the growing fetus

C. Get a seasonal flu vaccine during the autumn or winter months

D. Avoid physical activities, such as swimming, as this increases the risk of preterm labor

C. Get a seasonal flu vaccine during the autumn or winter months

What is an elevated alpha-fetoprotein associated with?

neural tube defects

What is important to educate patient about alpha-fetoprotein test?

the test is for screening ONLY, NOT diagnostic

nursing care for amniocentesis (3)

-empty bladder prior

-pre and post FHTs

-RhoGAM if Rh (-)

If pregnant mom feels that they haven't felt their baby move all day, what can nurse tell them to try first?

lay down on left side and assess for fetal movement

What is a normal occurrence that may make pregnant mom think something is wrong because their baby is not making movement?

normal to have up to 40-minute sleep cycles

What are characteristics of a reactive NST? (4)

-normal baseline

-moderate variability

-TWO or more accelerations in 20 minutes

-absence of decelerations

What are characteristics of a non-reactive NST? (2)

-absence of accelerations in 40 minutes

-abnormal baseline, variability, or decelerations

What is one of the first indications of fetal compromise?

a non-reactive NST

What is vibroacoustic stimulation?

sound and vibration are used to stimulate fetus

Is a negative CST good or bad?

good

Is a positive CST good or bad?

bad

The nurse would explain to a gravid client that the maternal serum alpha fetoprotein testing is recommended for which of the following reasons?

A. Assess for preeclampsia

B. Monitor the functioning of the placenta

C. Detect fetal cardiovascular disorders

D. Screen for neural tube defects

D. Screen for neural tube defects

The nurse is assessing a client at 37 weeks gestation who is having a non-stress test (NST). After 10 minutes, the nurse observes the absence of contractions, the fetal heart rate (FHR) baseline is 135 bpm, and there are no accelerations in the FHR. Which of the following actions are appropriate for the nurse to take?

A. Ask the client if they have felt any fetal movement

B. Check the client for urinary bladder distension

C. Have the client stimulate the baby to move

D. Notify the health care provider

A. Ask the client if they have felt any fetal movement

What things are assessed in BPP? (5)

-fetal breathing movements

-fetal movement

-fetal tone

-amniotic fluid index

-NST