OB exam 1

what is contraception ?

the deliberate prevention of pregnancy

how long does sperm have the capability to fertilize the ozum?

48-72 hr

what is abstinence ?

Abstaining from having sexual intercourse eliminates the possibility of sperm entering the vagina.

what are the advantages of absetince?

Most effective method of birth control.

No chemicals involved or introduction of foreign objects into the body.

Abstinence during fertile periods (rhythm method) can be used, but it requires an understanding of the menstrual cycle and fertility awareness.

Can eliminate the risk of sexually transmitted infections (STIs) if there is no genitalia contact.

what are the natural forms of contraception?

1. abstinence

2. Coitus interruptus (withdrawal)

3. calendar rhythm method

4.Basal body temp method

5. cervical mucus ovulation detection method

6. penile and vaginal condoms

what are the hormonal methods of contraception ?

Combined oral contraceptives (COCs)

Progestin-only pills (minipill)

Emergency Oral Contraceptive (morning after pill

Transdermal contraceptive patch

Injectable progestins

Implantable progestin

Intrauterine device (IUD)

Combined oral contraceptives (COCs):

how do they work?

they are pills containing estrogen and progestin which acts by suppressing ovulation.

it thickens cervival mucus to block semen and alters the uterine decidua prevent implantation

Progestin-only pills (minipill)

how do they work?

pills that proved more progestin which inhibits fertilization and implantation

what is a big nursing consideration to tell pt when taking pills?

make sure you take them at the same time everyday

when do you need to take the morning after pill?

within 72 hrs of sex

what is Transdermal contraceptive patch?

-a patch that contains estrogen and progesterone or progestin, which is delivered at continuous levels through the skin into subcutaneous tissue

-Inhibits ovulation by thickening cervical mucus

Injectable progestins

what do they do?

Medroxyprogesterone is an intramuscular or subcutaneous injection given to a female client every 11 to 13 weeks. It inhibits ovulation and thickens cervical mucus.

explain Intrauterine device (IUD)?

A chemically active T-shaped device that is inserted through the cervix and placed in the uterus by the provider. Releases a chemical substance that damages sperm in transit to the uterine tubes and prevents fertilization. The most effective contraceptive methods at preventing pregnancy are the long-acting reversible contraceptive (LARC) methods: implant and IUDs. IUDs can be used by nulliparous and multiparous female clients.

Expected Physiological Changes During Pregnancy

Expected Physiological Changes During Pregnancy

what do presumptive signs of pregnancy mean?

changes that the client experiences that make them think that they might be pregnant

what are some presumptive signs of prego the pt may feel?

-amenorrhea

-faitgue

-nausea and vomiting

-urinary frequency

-breast changes

-quickening

-uterine enlargement

what are probable signs of pregnancy mean?

changes that make the examiner suspect a client is pregnant

what are some probable signs of pregnancy ?

-abdominal enlargement

-hegar sign

-chawicks sign

-goodells sign

-ballottement

-braxton hicks contractions

-positive pregnancy test

what are Hegar's sign:

softening and compressibility of lower uterus

what are Chadwick's sign:

deepened violet-bluish color of cervix and vaginal mucosa

what are Goodell's sign:

softening of cervical tip

what are Ballottement:

rebound of unengaged fetus

what are Braxton Hicks contractions:

false contractions that are painless, irregular, and usually relieved by walking

what are positive signs of pregnancy ?

-fetal heart sounds

-visualization of fetus by ultrasound

-fetal movement

what is the main way we verify pregnancy?

blood and urine test

what do blood and urine tests test for?

hCG production and amount

what is hCG?

Human Chorionic Gonadotropin

A hormone found in the urine of women only when they're pregnant

what does high hCG mean?

-multifetal pregnancy

-ectopic pregnancy

-genetiic abnormalities such as down syndrome

what do low levels of hCG mean?

might suggest miscarriage or ectopic pregnancy

What is Nagele's rule?

how to calculate delivery date

1. take the first day of the pt last menstrual cycle

2. subtract 3 months

3. add 7 days and 1 year

what is fundal height?

the distance from the top of the uterus to the pubic bone measured in centimeters.

what can fundal height tell us?

the age of the baby in weeks should be equal to the fundal height in centimeters

what is gravida ?

the total number of times the pt has been pregnant

what is para?

number of pregnancies that reached 20 weeks gestation

-these include still born and live born

what is Nulligravida?

a client who has never been pregnant

Primigravida=

a client in their first pregnancy

Multigravida=

a client who has had two or more pregnancies

Nullipara=

no pregnancy beyond the stage of viability

Primipara=

has completed one pregnancy with a fetus or fetuses who have reached at least 20 weeks of gestation

Multipara=

has completed two or more pregnancies to 20 weeks of gestation or more

GTPAL=

gravida

term births

preterm births

abortions or miscarriage

living children

Reproductive changes with pregancy:

the uterus will?

increase in size and changes shape-position

Reproductive changes in pregnancy:

ovulation and menses ___________

stop

Reproductive changes in pregnancy:

where does the uterus move and how does it move?

moves from the pelivs to the abdominal cavity

Reproductive changes in pregnancy:

vaginal discharge ______________ and becomes more ______________ _________________

increase

clear white

Reproductive changes in pregnancy:

how will breast change?

-become vascular

-grow in size

-nipples grow in size

Reproductive changes in pregnancy:

when does the cervix begin to open?

37 weeks

Reproductive changes in pregnancy:

changes in the cervix include?

-soften

-dilate

-creates mucus

-get thinner

-paper thin

-

Cardiovascular changes in pregnancy:

cardiac output increases ________________

30% to 50%

Cardiovascular changes in pregnancy:

blood volume increases ......

40% to 50% at term

Cardiovascular changes in pregnancy:

why do blood volume and cardiac output increase?

to meet the greater metabolic needs

Cardiovascular changes in pregnancy:

the heart rate will ______________

increase

Respiratory changes in pregnancy:

maternal oxygen needs _____________

by 20%

increase

Respiratory changes in pregnancy:

how does mom compensate for increased oxygen needs?

progesterone causes her to take more deep breathes

Respiratory changes in pregnancy:

respiratory rate increase and total lung capacity ______________

decreases

Musculoskeletal changes in pregnancy:

her calcium absorption _____________

doubles

Musculoskeletal changes in pregnancy:

what will happen with her pelvic joints ?

they will increase in mobility and relax

Musculoskeletal changes in pregnancy:

what can happen?

-mom may begin to lean backwards more

-she will start to waddle

-abdominal muscles may be stretched beyond their capacity during the 3rd trimester causing diastasis recti

Gastrointestinal changes in pregnancy;

why do they get nausea and vomiting ?

due to hormonal changes and/or an increase of pressure within the abdominal cavity as the pregnant client's stomach and intestines are displaced within the abdomen

Gastrointestinal changes in pregnancy;

as the uterus grows it can block-press on parts of the digestive tract which can cause.....

constipation

Gastrointestinal changes in pregnancy;

pregnancy can lead to increased cholsterol which can lead to.....

gallstone formation

Gastrointestinal changes in pregnancy;

progesterone causes smooth muscle to relax... this includes the relaxation of smooth muscle in GI tract... what can this lead to ?

slow digestion and constipation

Gastrointestinal changes in pregnancy;

symptoms causes by pregnancy ?

-NV

-constipation

-hemorrhoids

-GERD

-cravings

-increased appetite

-decreased appetite

Renal changes in pregnancy ?

they may experience urinary _______________

frequency

Renal changes in pregnancy ?

the filtration rate.............

increases secondary to the influence of pregnancy hormones and an increase in blood volume and metabolic demands. The amount of urine produced remains the same

Endocrine changes in pregnancy:

the placenta becomes an endocrine gland... what does it produce?

large amounts of

hCG

progesterone

estrogen

human placental lactogen

prostaglandins

integumentary changes in body with pregnancy:

-circulation to skin increases to help dissipate excess heat produced by increased metabolism

-increased pigmentation

-strech marks

-a dark line from belly button down

-pt needs to wear sunscreen

-darker skin features

-hair grows more

-spider web lines

Fetal heart tones are heard at a normal baseline rate of.....

110 to 160 / min

to accommodate the moms increased blood volume and increased cardiac output what will happen to heart?

an increase in size and shape with cardiac hypertrophy

how may pt heart sounds change while pregnant ?

more distinguishable splitting of S1 and S2, with S3 more easily heard

Heart size and shape should return to normal shortly after birth.

true

Uterine size changes from a uterine weight of 50 to 1,000 g (0.1 to 2.2 lb). By 36 weeks of gestation, the top of the uterus and the fundus will reach the xiphoid process. This might cause the pregnant client to experience _____________ ______ _________________ as the uterus pushes against the diaphragm.

shortness of breath

Chloasma=

an increase of pigmentation on the face

Linea nigra=

dark line of pigmentation from the umbilicus extending to the pubic area

Striae gravidarum=

stretch marks most notably found on the abdomen and thighs

prenatal care

prenatal care

Reproductive and obstetrical history to know:

-contraception use

-gynecological diagnoses

-history of STIs

-previous pregnancies

-obstetrical difficulties

Medical history to know:

-physical preexisting conditions

-surgical procedures

-any handicap conditions

-pt immune system

Nutritional history to know:

-what does their diet look like

-food practices and beliefs

family history to know:

any genetic disorders that will or could affect mom and new baby

what other things to know about pt when they just got pregnant or they are planning to be?

-current medications they are taking

-any recent or current illness or infections

-current medications

-psychosocial history

-any hazardous enviromental exposures

-current exercise and lifestyle

-any abuse or risk

an initial pre natal assessment should be conducted by week _____

12

In an uneventful pregnancy, prenatal visits are scheduled ______________for weeks 16 through 28

monthly

In an uneventful pregnancy, prenatal visits are scheduled _____________________ from 29 through 36 weeks

every 2 weeks

In an uneventful pregnancy, prenatal visits are scheduled ________________________from 36 weeks until birth.

every week

Initial prenatal visit, what happens?

-determine the estimated delivery date based on LMP

-obtain medical and nursing history

-physical assessment... height wt BP HR RR and a pelvic exam

Ongoing prenatal visits:

what do you monitor for?

-presence of edema

-in urine monitor for glucose, protein, and leukocytes

Ongoing prenatal visits

Measure fundal height starting in the second trimester. From weeks 18 to 30, the fundal height in centimeters is approximately the same ..............

as the number of weeks gestation.

Routine laboratory tests

what is CBC with differential, Hgb, and Hct used for?

detects infection and anemia

Routine laboratory tests

rubella titer does what?

determines immunity to rubella

Group B Streptococcus (GBS):

Vaginal and rectal cultures are performed at 36 0/7 and up to 37 6/7 weeks of gestation to assess for GBS infect.

Urinalysis with microscopic examination of pH, specific gravity, color, sediment, protein, glucose, albumin, RBCs, WBCs, casts, acetone, and human chorionic gonadotropin:

Identifies pregnancy, diabetes mellitus, gestational hypertension, renal disease, and infection

One-hour glucose tolerance (oral ingestion with venous sample taken 1 hr later [fasting not necessary]):

Identifies hyperglycemia; done at initial visit for at-risk clients and at 24 to 28 weeks of gestation for all pregnant clients (greater than 140 mg/dL requires follow up).

Three-hour glucose tolerance (fasting overnight prior to oral ingestion or IV administration of concentrated glucose with a venous sample taken 1, 2, and 3 hr later):

Used in clients who have elevated 1-hr glucose test as a screening tool for diabetes mellitus. A diagnosis of gestational diabetes requires two elevated blood-glucose readings.

Papanicolaou (Pap) test: Used as a.....

screening tool for cervical cancer, herpes simplex type 2, and/or human papillomavirus.

Vaginal/cervical culture: Detects......

streptococcus beta-hemolytic, bacterial vaginosis, or sexually transmitted infections (gonorrhea and chlamydia).

PPD (tuberculosis screening), chest x-ray after 20 weeks of gestation with PPD test: Identifies exposure to.....

tuberculosis

Venereal disease research laboratory (VDRL)=

Syphilis screening mandated by law.

alpha-fetoprotein screening:

what is AFP?

the predominant protein in fetal plasma part of which crosses the placental membrane into the maternal circulation and can be measured.

alpha-fetoprotein screening:

can be used to test for ?

down syndrome

neural tube defects