N164 Maternity Exam 2

Presumptive signs of pregnancy

Subjective signs reported by the woman that have other possible causes, such as amenorrhea, nausea, breast tenderness, fatigue, and quickening

Probable signs of pregnancy

Objective signs found by the examiner that are still not fully conclusive, such as Chadwick sign, Goodell sign, Hegar sign, Braxton Hicks contractions, ballottement, and a positive pregnancy test

Positive signs of pregnancy

Signs that can be explained by nothing except a fetus, such as fetal heart tones heard by the examiner, fetal movement felt by the examiner, and visualization of the fetus by ultrasound

Goodell sign

Softening of the cervix, a probable sign of pregnancy present around 5 weeks

Chadwick sign

Bluish violet discoloration of the vagina and cervix, a probable sign of pregnancy present at 6 to 8 weeks

Hegar sign

Softening of the lower uterine segment, a probable sign of pregnancy present at 6 to 12 weeks

Ballottement

A probable sign of pregnancy in which the fetus rebounds when tapped gently during a pelvic exam, present at 16 to 28 weeks

Quickening

The first fetal movement felt by the mother, a presumptive sign of pregnancy usually felt at 16 to 20 weeks

hCG

Human chorionic gonadotropin, the hormone detected by pregnancy tests that doubles approximately every 2 days for the first 4 weeks of pregnancy

A woman reports a positive home urine pregnancy test and breast tenderness but has had no ultrasound yet. How should the nurse classify these findings

As presumptive and probable signs only, since a positive urine test and breast changes are not positive signs of pregnancy

Gravida

The number of times a woman has been pregnant, including the current pregnancy

Para

The number of pregnancies that reached 20 weeks of gestation or more, regardless of the outcome

Nulligravida

A woman who has never been pregnant

Primigravida

A woman who is pregnant for the first time

Multigravida

A woman who has had two or more pregnancies

Nullipara

A woman who has not completed a pregnancy past 20 weeks

GTPAL

A five digit system recording Gravida, Term births, Preterm births, Abortions, and Living children

Preterm birth

A birth that occurs between 20 weeks 0 days and 36 weeks 6 days of gestation

Full term birth

A birth that occurs between 39 weeks 0 days and 40 weeks 6 days of gestation

Postterm birth

A birth that occurs at 42 weeks 0 days of gestation or beyond

A woman is pregnant for the second time. Her first pregnancy ended in a birth at 35 weeks and that child is alive and well. How should the nurse document her GTPAL for the current pregnancy

G2 T0 P1 A0 L1

Naegele rule

A method of estimating the date of birth by taking the first day of the last normal menstrual period, subtracting 3 months, then adding 7 days and 1 year

A woman's last normal menstrual period began on December 10. Using Naegele rule, what is her estimated date of birth

September 17 of the following year

Most accurate method for dating a pregnancy

First trimester ultrasound measurement of the embryo or fetus

Melasma

Also called chloasma or the mask of pregnancy, blotchy brown hyperpigmentation of the face that appears after week 16 and is intensified by sun exposure

Linea nigra

A pigmented line extending from the symphysis pubis to the top of the fundus

Striae gravidarum

Stretch marks that appear on the abdomen, thighs, and breasts in the second half of pregnancy from separation of underlying collagen

Vascular spiders (angiomas) in pregnancy

Tiny star shaped, raised, pulsating arterioles on the neck, thorax, face, or arms caused by increased estrogen, usually resolving within 3 months postpartum

Palmar erythema

Pink red mottled blotches on the palms related to increased estrogen during pregnancy

A pregnant patient asks if the dark line running from her pubic bone to her belly button will go away. What should the nurse tell her

The linea nigra is a normal pigmentation change of pregnancy that typically fades after birth

Montgomery tubercles

Sebaceous glands on the areola that enlarge during pregnancy and secrete a lubricating, anti infective substance

Colostrum

The early, protein rich milk that can be expressed from the breast by the end of the first trimester

How does a nurse test for inverted nipples

Place the thumb and forefinger on the areola and press gently inward, a normal nipple will evert and an inverted nipple will retract

A pregnant patient with flat nipples asks the nurse to teach nipple rolling exercises to prepare for breastfeeding. What should the nurse do

Avoid teaching nipple rolling because breast stimulation can trigger uterine contractions, and discuss options such as breast shells with the provider instead

Physiologic anemia of pregnancy

Expected hemodilution in pregnancy caused by plasma volume increasing more than red blood cell mass

Normal hemoglobin range in pregnancy

11 to 13 grams per deciliter

Normal hematocrit in pregnancy

Greater than 33 percent

Anemia threshold in the first or third trimester

Hemoglobin less than 11 grams per deciliter or hematocrit less than 33 percent

Anemia threshold in the second trimester

Hemoglobin less than 10.5 grams per deciliter or hematocrit less than 32 percent, because hemodilution is most pronounced at this time

Normal white blood cell count in pregnancy

5000 to 15000 per cubic millimeter

Pregnancy and coagulation

Pregnancy is a hypercoagulable state with a 5 to 6 times increased risk of thromboembolism from increased clotting factors and decreased protein S

A pregnant patient in her second trimester has a hemoglobin of 10.8 grams per deciliter. How should the nurse interpret this value

As an expected finding of physiologic anemia of pregnancy rather than true anemia, since the second trimester threshold is 10.5

Rh immune globulin (RhoGAM)

A medication given to Rh negative women to prevent them from forming antibodies against Rh positive fetal blood

Standard timing for Rh immune globulin during pregnancy

300 micrograms given at 26 to 30 weeks to Rh negative women without evidence of sensitization

Rh immune globulin after birth

A repeat dose is given to the Rh negative mother within 72 hours after birth if the newborn is confirmed Rh positive

An Rh negative pregnant patient has an amniocentesis performed. What should the nurse anticipate administering

Rh immune globulin, because invasive procedures such as amniocentesis are an indication for prophylaxis

Ambivalence in pregnancy

Having conflicting feelings about the pregnancy at the same time, which is a normal response whether or not the pregnancy was planned

Emotional lability in pregnancy

Rapid, unpredictable mood swings during pregnancy driven by hormonal changes and stress

A patient with an unplanned pregnancy tells the nurse she feels excited but also resentful about the timing. What is the nurse's best response

Reassure her that mixed feelings are common and normal, and continue to assess her feelings without judgment

Persistent, intense ambivalence into the third trimester should prompt the nurse to

Further assess for unresolved conflict about the motherhood role and provide additional support or referral

Core principle of therapeutic communication for a patient with an unplanned pregnancy

Use open ended questions and active listening while avoiding judgmental language about how she should feel

McDonald rule

From about 18 to 30 weeks of gestation, fundal height in centimeters approximately equals the week of gestation, plus or minus 2 weeks

How should the nurse prepare a patient before measuring fundal height

Have the patient empty her bladder and lie supine with a small wedge under one hip

A patient at 28 weeks gestation has a fundal height of 24 centimeters that has not changed since her last visit. What should the nurse suspect

Possible intrauterine growth restriction, which should be reported to the provider

Danger sign in the first trimester

Abdominal cramping with vaginal bleeding, which can indicate miscarriage or ectopic pregnancy

Danger sign related to fluid loss before 37 weeks

A sudden gush of fluid from the vagina, which can indicate preterm prelabor rupture of membranes

Danger sign of visual disturbances during pregnancy

Blurring, double vision, or spots, which can indicate a hypertensive disorder such as preeclampsia

Danger sign of facial or hand swelling during pregnancy

Edema of the face, fingers, or over the sacrum, which can indicate a hypertensive disorder

Epigastric pain that will not resolve during pregnancy

A danger sign that can indicate preeclampsia or placental abruption

A pregnant patient at 32 weeks calls reporting a severe headache, blurred vision, and swelling of her face. What should the nurse advise

Come in for immediate evaluation because these are danger signs of a hypertensive disorder

A pregnant patient reports decreased fetal movement after her baby had been consistently active. What is the nurse's priority action

Instruct her to be evaluated promptly, since decreased fetal movement is a danger sign that can indicate fetal jeopardy

Perinatal mood disorder warning signs

Persistent sadness, hopelessness, excessive worry, frequent crying, or thoughts of death or self harm that should be reported to the provider

Supine hypotensive syndrome

A drop in blood pressure that occurs when the gravid uterus compresses the inferior vena cava and aorta while the woman lies flat on her back

Signs of supine hypotension

Pallor, dizziness, faintness, tachycardia, nausea, and cool clammy skin

What should the nurse do immediately if a pregnant patient becomes dizzy and pale while lying supine

Turn her onto her side, preferably the left side, until symptoms resolve

A nurse is preparing to perform a nonstress test on a pregnant patient who must lie supine. How can the nurse prevent supine hypotension

Place a wedge or pillow under one hip to tilt the uterus off the vena cava

Maternal serum alpha fetoprotein (MS-AFP)

A second trimester screening test for neural tube defects such as spina bifida and anencephaly

Quad screen

A second trimester blood test measuring hCG, AFP, unconjugated estriol, and inhibin A

Nuchal translucency

A first trimester ultrasound measurement used along with PAPP-A and hCG to screen for chromosomal abnormalities

Cell free DNA testing

A noninvasive maternal blood test that can be performed as early as 10 weeks to screen for common trisomies

A patient's MS-AFP result comes back elevated. What should the nurse explain about this result

That an elevated result is a screening finding, not a diagnosis, and further testing such as a targeted ultrasound or amniocentesis is needed to confirm any abnormality

Safe amount of alcohol during pregnancy

There is no known safe amount or type of alcohol at any time during pregnancy

Fetal alcohol syndrome

A group of effects from prenatal alcohol exposure including growth restriction, central nervous system abnormalities, and characteristic facial features

Recommended caffeine limit during pregnancy

Less than 200 milligrams per day, about one 12 ounce cup of coffee

A pregnant patient tells the nurse she drinks one glass of wine a week and does not plan to stop. What is the nurse's best response

Explain that no amount of alcohol has been proven safe during pregnancy and offer nonjudgmental education and support to help her stop

Vaccines contraindicated during pregnancy

Live virus vaccines such as MMR and varicella

Vaccines considered safe during pregnancy

Tdap, inactivated influenza vaccine, and recombinant hepatitis B vaccine

Recommended folic acid intake during pregnancy

600 micrograms per day of dietary folate equivalents

Recommended folic acid intake for women who could become pregnant

400 micrograms per day

Purpose of folic acid in pregnancy

Prevention of neural tube defects such as spina bifida and anencephaly

Food sources of folic acid

Fortified grains and cereals, dark green leafy vegetables, legumes, and orange juice

A patient who previously had a pregnancy affected by a neural tube defect is planning another pregnancy. What folic acid dose should the nurse expect the provider to recommend

A much higher dose of 4 milligrams per day starting at least one month before conception

Recommended total weight gain for a normal prepregnancy BMI

25 to 35 pounds

Recommended total weight gain for an underweight prepregnancy BMI

28 to 40 pounds

Recommended total weight gain for an overweight prepregnancy BMI

15 to 25 pounds

Recommended total weight gain for an obese prepregnancy BMI

11 to 20 pounds

Expected weight gain pattern in the first trimester

Very little total gain, usually only about 1 to 4 pounds for the entire trimester

Additional daily calories needed in the second trimester of pregnancy

About 340 kilocalories per day above nonpregnant needs

Additional daily calories needed in the third trimester of pregnancy

About 452 kilocalories per day above nonpregnant needs

Recommended daily protein intake during pregnancy

About 71 grams per day

A patient with a prepregnancy BMI of 32 asks how much weight she should gain during pregnancy. What should the nurse tell her

About 11 to 20 pounds total, since her BMI falls in the obese category

Pica

Persistent craving and ingestion of nonfood substances such as clay, dirt, starch, or ice, which is associated with iron deficiency anemia

Foods to avoid during pregnancy due to Listeria risk

Unpasteurized milk, juice, and soft cheeses, along with deli meats and hot dogs unless heated until steaming

High mercury fish to avoid during pregnancy

Shark, swordfish, king mackerel, and tilefish

Cause of constipation in pregnancy

Rising progesterone slowing gastrointestinal motility, along with pressure from the enlarging uterus and iron supplementation

Nursing interventions for constipation in pregnancy

Increase fluid intake, increase dietary fiber, and encourage regular physical activity

A pregnant patient reports craving and eating laundry starch several times a day. What should the nurse assess for

Iron deficiency anemia, since this behavior is consistent with pica

Apgar score

A rapid assessment of a newborn's transition to extrauterine life, scored at 1 and 5 minutes after birth

Apgar components

Heart rate, respiratory effort, muscle tone, reflex irritability, and color

Apgar score indicating a normal transition

8 to 10