NURS 354 - chap. 12 nursing management during pregnancy

Embryo is at greatest risk from environmental factors between day ___ and day ___ after conception

17; 56

Gravid

“The state of being pregnant”

Gravida

-Total number of times a woman has been pregnant, regardless of the outcome

-Inclusive of multiple infants born

Para 

“Number of times a woman has given birth to a fetus of at least 20 weeks’ gestation (viable or not) with multiple births counting as one birth event.” 

Miscarriage/spontaneous abortion

loss of fetus prior to 20 weeks

Still birth

birth of fetus (not viable) after 20 weeks

Naegele’s Rule

First day of LMP – 3 months + 7 days = EDD/EDB

(Adjust the year by adding 1 year as necessary)

“Globally, ________ is the leading cause of mortality in children less than 5  years of age.”

prematurity

GTPAL

G = Gravity

T = Term

P = Preterm

A = Abortion

L = Living

G = Gravity

-Total number of pregnancies.  Include the current pregnancy

T = Term

-Term births

-Delivered between 38- and 42-weeks gestation.

P = Preterm 

-Preterm births

-Pregnancy ending > 20 weeks but prior to completion of the 37th week of gestation

A = Abortion

Pregnancies ending prior to 20 weeks or viability (spontaneous or elective/therapeutic)

L = Living

Currently living children to whom the woman has given birth

Fundal height measurement: After __ weeks’ gestation

20

Diagonal conjugate

-Measured from sacral promontory to exterior portion of symphysis pubis

-Most useful in determining pelvic size

-Should be 11.5 cm or greater (is often 12.5 or greater)

True conjugate (obstetric conjugate)

-Estimated measurement (cannot be directly measured)

-Subtract 1-2 cm from diagonal conjugate

-Should be at least 10 cm for a vaginal delivery

-Smallest front to back diameter through which fetal head passes

Transverse diameter

Between the ischial tuberosities

External measurement … clenched fists/known hand span

 -Adequate = 10.5 cm or greater

Future Prenatal Visits: First 28 weeks

every 4 weeks

Future Prenatal Visits: 29-36 weeks

every 2 weeks 

Future Prenatal Visits: 37 weeks-delivery

every week

Gestational Weeks Assessments: Screening for Gestational Diabetes 

24-28 weeks gestation

Gestational Weeks Assessments: RhoGAM administration 

28 weeks gestation (for Rh-negative moms)

Gestational Weeks Assessments: Edema (periorbital, hands, face, pretibial) & Gestational HTN

29 – 36 weeks gestation

Gestational Weeks Assessments: Group B Strep (GBS), Chlamydia and Gonorrhea, and Fetal position 

37 – 40 weeks gestation

McDonald method

-Patient lies on her back with knees slightly flexed

-The nurse or provider measures from the top of the pubic symphysis to the top of the uterine fundus using a tape measure

-Correlates well with weeks of gestation between 22 and 36 weeks (+/- 2 cm) 

At the symphysis pubis

12 weeks

Midway between symphysis and umbilicus

16 weeks 

At the umbilicus

20 weeks

Just below the xiphoid

36 weeks

First Trimester Onset 

-N/V 

-Urinary frequency or incontinence 

-Fatigue 

-Breast tenderness 

-Ptyalism (hypersalivation) 

-Food cravings 

-Constipation 

-Nasal stuffiness/bleed gums/epistaxis (nosebleed)

-Leukorrhea (normal vaginal discharge)

N/V

-Begins:  5th week after LMP (2^nd – 3^rd week of pregnancy)

-Peaks:  8-12 weeks

-Ends:  16-18 weeks

-Usually ends in early 2^nd trimester

Non-med tx for N/V

Ginger, acupressure, wristbands

Meds to treat N/V

-Diclegis (doxylamine pyridoxine): 10 mg. .. 2 tabs. at bedtime and if needed 1 tab. in the morning and one mid-afternoon (a combination antihistamine and B-6)

-Others: Benadryl, Dramamine, Compazine, Phenergan, Zofran

Urinary frequency or incontinence and fatigue

1^st and 3^rd

In which trimester do pregnant woman have the highest energy usually?

2^nd trimester

Breast tenderness

Ends

What can be a first indicator of pregnancy?

Breast tenderness

-Ptyalism (hypersalivation) 

-Food cravings (usually sodium and sugar foods)

-Constipation 

-Nasal stuffiness/bleed gums/epistaxis (nosebleed)

-Leukorrhea (normal vaginal discharge)

1^st, 2^nd, 3rd

Metamucil

Bulk-forming laxative

Second Trimester Onset 

-Backache 

-Leg Cramps

-Varicosities of the Vulva and Legs

-Hemorrhoids

-Flatulence and Bloating

**  All of the following may continue into the 3^rd trimester

Meds to tx backache 

Tylenol 

Adequate ___ and ___ to prevent leg cramps

Ca++ and PO4-

Tx of hemorrhoids

-Preparation H

-Anusol 

-Witch hazel 

-Cool compresses 

Gas-producing foods 

Beans, cabbage, and onions

Third Trimester Onset

-Shortness of breath and Dyspnea (does not indicate respiratory distress)

-Heartburn (Gastroesophageal Reflux, Pyrosis) and Indigestion

-Dependent Edema

-Braxton Hicks contractions

What should you avoid eating/drinking to prevent heartburn and indigestion?

Caffeine, alcohol, chocolate, citrus, spearmint/peppermint, spicy/greasy food