NURS 330-01 Exam 1: Nursing Management During Pregnancy

How can we promote a healthy pregnancy before conception?

Promoting the health of the mother and her partner prior to conception and identifying genetic, biomedical, social, and behavioral risks.

How to calculate estimated due date?

Last menstrual period, minus 3 months, plus 7 days.

What is the standard schedule of prenatal visits?

Every 4 weeks until 28 weeks, every 2 weeks until 36 weeks, and every week until delivery.

What is the most accurate method of determining gestational age?

Ultrasound

What is the age of a high risk pregnancy?

<16 or >35

What is the weight of a high risk pregnancy?

<100lbs or >200 lbs

How many pregnancies is considered high risk?

5 or subsequent

Other factors of high risk pregnancy

Recurrent abortions, previous stillbirth or fetal demise, substance use, physical abuse, Hx of preterm births or anomalies, low SES.

What medical conditions create a high risk pregnancy?

Cardiac, thyroid, renal, epilepsy, or diabetes

Gynecoid pelvis

A true female pelvis. About 40% of women. Less common in men. More favorable for vaginal delivery. Wide, round opening.

Anthropoid pelvis

More common in men. About 25% of women. Second most favorable for vaginal delivery. Long, round opening.

Android pelvis

True male pelvis. About 20% of women. Heart shaped pelvis, common for baby to get stuck or have trouble rotating.

Platypelloid pelvis

Only 3% of population. Difficulty with vaginal delivery. Narrow front to back oval.

What initial labs are important?

Rh factor and blood typing, antibody screen, CBC, renal function panel, rubella titer, HIV screening, hep B surface antigen, RPR (Syphilis), toxoplasmosis

Other lab work

Pap smear, gonorrhea, chlamydia, UA and cultures, fetal cell free DNA

Indirect Coombs

Testing mother for Rh antibodies

Direct Coombs

Testing baby for hemolytic anemia related to Rh incompatibility

What is given to Rh negative mothers to prevent antibody formation against an Rh positive baby?

RhoGAM, given at 26-30 weeks, after delivery, and any other procedure with risk of blood mixing (amniocentesis, chorionic villi sampling, miscarriage)

What is assessed at period prenatal visits?

BP, weight, UA, other labs if needed, fundal height, FHR, fetal movement.

What tests are done at 16-22 weeks?

Ask about fetal movement, anatomy scan, quadruple screening.

What is part of a quadruple screen?

hCG, maternal alpha fetoprotein, estriol, and inhibin A

When is 1 hour Glucose Tolerance Test done?

24-28 weeks. Normal <140, abnormal indicates 3 hour GTT.

High risk tests in third trimester

Additional ultrasounds, non stress test, biophysical profile,

Nonstress Test

Observation of accellerations of FHR. Fetal activity causes accels, indicating intact CNS. Void before. Mother in SF or left lateral position. 2 or more accels of at least 15 beaths for 15 seconds within 20 minutes.

Biophysical Profile

Predictor of feal wellbeing. Uses US and a NST. Measures fetal breathing movements, fetal movements, fetal tone, amniotic fluid volume, and NST. 0-2 points per category.

What are we watching for in the third trimester?

Pre-term labor, gestational diabetes, pre-eclampsia, IUGR, oligohydramnios, polyhydramnios

Group B Strep

Cultures of vagina/rectum, if positive, mother will be treated with antibiotics during labor.

What are danger signals?

Vaginal bleeding, pprom, fever, absence of fetal movement, abdominal pain/cramping/pressure, persistent vomiting.

Signs of preeclampsia

Severe headache, epigastric pain, swelling of hands/face, visual disturbances, dizziness.

PPROM

Prelabor premature rupture of membranes.

Discomforts of 1st trimester

N/V, urinary frequency, fatigue, breast tenderness, leukorrhea, excessive salivation (ptyalism), nasal stuffiness/epistaxis.

Remedies for nausea

Ginger, B6 and Doxylamine, saltines, small meals.

Remedy for breast tenderness

Well-fitting, supportive bra

Remedy for leukorrhea

Good hygene, loose cotton underwear.

Discomforts of 2nd and 3rd trimester

Heartburn (pyrosis), constipation, hemorrhoids, backache, dizziness/faintness, leg cramps, varicosities, difficulty sleeping.

Remedies for pyrosis

Small frequent meals, avoid fatty/greasy food, stay upright after eating, consult PCP for antacid.

Remedies for constipation

encourage fluids, high fiber diet.

Remedies for hemorrhoids

Ice packs, topical ointments, sitz bath.

Remedy for backache

pelvic tilt exercises.

Remedies for leg cramps/dorsiflexion

Avoid sitting with legs crossed, standing/sitting for long time. Dorsiflexion of foot and compression socks.

Routine self care

Prenatal vitamins, prenatal visits, dental visits every 6 months, limit caffiene to 200mg, limit car to 6hrs per day.

Things to avoid

X-rays, mosts meds/herbal remedies, tobacoo, alcohol, illicit drugs, hot baths if bleeding or ROM

What is a normal amount of fetal movement after 24 weeks?

10 movements in 1 hours. Less than 10 minutes in 2 hours should be reported. Fetus moves more at night.

Vaccines of Pregnancy

Tdap in 3rd trimester, Influenza, Hep B, Covid. Avoid live attenuated vaccines (MMR, Varicella, nasal influenza)

Risks of Tobacco Use

Miscarriage, IUGR, placental abruption, preterm delivery, increased risk of SIDS.

Fetal Alcohol Syndrome

Spectrum disorder caused by exposure to alcohol during pregnancy. Depends on time of exposure and how much.

TORCH

Toxoplasmosis, Other (Syphillis, varicella, GBS, Hep B, HIV), Rubella, Cytomegalovirus, HSV 2

What is TORCH?

Infections which can cross the placenta or ascend to the fetus after ROM.

Conditions that may limit sexual activity.

Preterm labor, placenta previa, threateded miscarriage.

How are fetal movement counts performed?

Lay down for one hour and count movements. Encourage to do at same time every day. Less than 3 movements per hour warrants further testing. No fetal movement for 12 hours is cause for alarms. Fetal sleep cycles are approx. 40 minutes.

Ultrasounds

Used to confirm pregnancy, viability, FHR, and gestation age, as well as assess for complications and guide testing such as amniocentesis. Can be transabdominal or transvaginal. Full bladder preferred.

Where do we want the placenta?

Posterior and high, mostly high.

Contraction Stress Test

Mother in SF or lateral. Record FHR and contractions and maternal VS. Negative if no late decels with at least 3 contractions within 10 mins.

Amniocentesis

Aspiration of fluid from amniotic sac, provides info about fetal genetics and lung maturity. Ultrasound guided. Indication fo Rhogam.

Chorionic Villi Sampling

Needle aspiration done in first trimester to diagnose genetic issues. Can be transcervical or transabdominal. Indication for Rhogam.

Percutanous Umbilical Blood Sampling

Aspiration of cord blood in 2nd or 3rd trimester. Genetic conditions, fetal infection, fetal anemia, hemolytic disease, or thrombocytopenia. Ultrasound guided needle aspiration.

Premonitory Signs of Labor

Backache, weight loss 1-3 lbs, energy burst, lightening, increased Braxton Hicks, increase or change in vaginal discharge.