care of pregnant women pt 2

Increased metabolic rate, Increased need for oxygen, estrogen causes increased lung expansion but also nasal stuffiness, epistaxis, and ear aches, Elevation of diaphragm: thoracic breathing, increased sensitivity to CO2, dyspnea - may need to sleep with more pillows, more upright

respiratory system

Glomerular filtration rate & renal plasma flow are increased by —- by 2^nd trimester causing slight spillage of protein and/or glucose = many moms have slight increase of glucose in urine

50%

Relaxation of smooth muscle of bladder & sphincter allow bacterial ascent into bladder = —— especially if diabetic, can lead to pyelonephritis if not treated

more likely to get UTIs

in order to avoid UTIs, patient should be drinking —— glasses of water/day and emptying bladder q2-3 hrs

8-10

baby is laying on vena cava causing hypotension when lying down (also known as vena cava syndrome)

supine hypotensive syndrome

due to anterior pituitary hormone melanotropin increase, Increase color of vulva, nipple areola, axillae

hyperpigmentation

or chloasma or “mask of pregnancy” Hyperpigmentation over nose, cheeks, forehead

melasma

2nd half of pregnancy in skin caused by adrenocorticosteroids (stretch marks)

striae gravidarum

pinkish-red mottling or blotches on palmar surfaces of hands  - caused by estrogen

palmar erythema

Increased blood supply to skin >

increases perspiration

helps shift the center of gravity to remain over the legs - postural changes or pregnancy

lumbar lordosis

loosen ligaments in pubic symphysis & sacroiliac joints, Facilitates labor & birth

relaxin, progesterone

Symphysis widens > ——> back pain, difficulty walking (pregnancy waddle) > knee pain

instability of joints

From edema and compression, on peripheral nerves, Paresthesia, pain in wrist/ hand, hand splits for tx, very common

carpal tunnel syndrome

Increased levels of progesterone on smooth muscle cause what in GI system (decreased motility)

delayed emptying

maintain corpus luteum production of estrogen and progesterone until placenta takes over, comes from fertilized ovum and chorionic villi

HcG

surpasses section of FSH and LH from anterior pituitary, maintains pregnancy by relaxing smooth muscles, decreases uterine contractions, deposits fat in subcutaneous tissue, decreases ability to use estrogen

progesterone

works similar functions to progesterone, promotes enlargement of uterus/breasts, increases vascularity, relaxes pelvic ligaments/joints, interferes with folic acid metabolism, increases proteins, sodium and water retention

estrogen

prepares breasts for lactation, comes from anterior pituitary gland

prolactin

stimulates uterine contractions, stimulates milk ejection after birth, comes from posterior pituitary gland

oxytocin

Duration of pregnancy: ——Spans 9 calendar months,10 lunar months 40weeks or 280day

gestation

first trimester:

1-13 wks

second trimester:

14-26 wks

third trimester

27-40 wks

acts as a growth hormone, contributes to breast development, decreases maternal metabolism to glucose, increases the amount of fatty acids for metabolic needs, comes from placenta

human chorionic somatomammotropin

with adequate iodine intake there should be little to no enlargement of thyroid gland, total T3/4 are slightly increased, peak by mid pregnancy, by term are 10-15% lower than non pregnant, comes from thyroid gland

thyroxine binding globulin

Accurate dating of pregnancy is vital to promoting healthy outcomes for the woman and fetus

estimated date of birth

Most accurate assessment of the EDB is based on —-measurement of the embryo or fetus during the first trimester of pregnancy

ultrasound

to calculate EDB: Assumes that the woman has a 28-day cycle and that fertilization occurs on the 14th day After determining the first day of the LMP, subtract 3 calendar months and add 7 days

naegele’s rule

Start with the first day of the last menstrual period (LMP) and: Add 7 days + add 1 year − subtract 3 months, If the LMP = April 10, 2025: Add 7 days → April 17, 2026, Add 1 year → April 10, 2026Subtract 3 months → January 17, 2026

naegele’s rule

Pap test for pregnant women screens for - pre cancerous cells on cervix

cervical intraepithelial neoplasia

test that identifies women with untreated syphilis, done at first visit

RPR, VDRL, or FTA-ABS

screens for gestational diabetes, done at initial visit for women with risk factors, otherwise done at 24-28 wks for pregnant women at risk whose initial screening was negative and for others not previously tested

1h glucose tolerance

tests for gestational diabetes in women with elevated glucose levels after 1 hr test, must have two elevated readings for diagnosis

3h glucose tolerance

RBCs, plasma, and WBCs all increase but —- and ——, packed cell volume (PCV) decrease in the blood (exception being the mean corpuscular volumes which stay the same)

hemoglobin, hematocrit

the only blood coagulation factor to decrease in pregnancy is — everything else increases

factor XI

prothrombin has a slight —— in pregnancy

decrease

Slight decrease in pregnancy and decrease during second and third stage of labor (indicates dotting at placental Site) - partial thromboplastin time

PTT

No Significant change until 3-5 days after birth and then a rapid increase (may predispose woman to thrombosis) and gradual return to normal - per mm3

platelets

Decreases in pregnancy and then abruptly returns to normal (protection against thromboembolism)

fibrinolytic activity

Increased levels late in pregnancy

fibrinogen

7.40-7.45 (slightly increased, more alkaline)

blood pH

PO2 increases while —- and ——- decreases

PCO2, sodium bicarbonate

Increases from 16 to 32 weeks of pregnancy; remains at this level until after birth

cholesterol

Increases from week 12 of pregnancy to 6 weeks after birth

alkaline phosphate

this hepatic lab has a slight increase during pregnancy

albumin

non protein nitrogen (NPN), BUN, creatinine, and uric acid all ——

decrease

renal plasma flow (RPF) and ——— increase

GFR

Vitamin B₁₂, folic acid, ascorbic acid all moderately ——

decrease

At 28 weeks for Rh negative mothers, the mother is sent for a work-up to be sure she has not formed antibodies (become sensitized to baby’s blood) to the Rh factor, This is also given to Rh negative mothers who have had a miscarriage, abortion, ectopic pregnancy, CVS, amniocentesis, version, or abdominal trauma

Coombs test

if the mother is Rh negative (has negative blood), at 28 wks she will get ——-, may need another injection of this PP if baby’s blood is positive (also known as Rhophylac)

RhoGAM

Gestational age, Fetal heart tones, Health status, Fundal height

fetal assessment

at 12 wks fundal height should be at

pubic symphysis

at 20 wks the fundal height should be at the —-

umbilicus

at 36 wks the fundal height should be at ——

xiphoid process

at 37-40 wks fundal height should regress to between —- cm

32-36

Everyone needs to know about ——- including provider - Skin to skin, delayed cord clamping, etc. 

birth plans

Accepting the pregnancy, Identifying with the mother role Reordering personal relationships Establishing relationship with fetus: attachment process of the mother

maternal adaptation

phase of maternal adaptation: She accepts the biologic fact of pregnanc

phase 1

phase of maternal adaptation: She accepts the growing fetus as distinct from herself

phase 2

phase of maternal adaptation: She prepares realistically for the birth and parenting of the child

phase 3

second stage after announcing phase for expectant partners, psychologically processing the reality of parenthood - specifically for partners not the pregnant person

moratorium phase

third and final phase of adjustment for partners: full attention toward the reality of the baby, new role, and active preparation for birth

focusing phase

Increased emphasis on vegetables and fruit filling the plate balanced with grains and protein - good nutrition in general but good for pregnancy as well

my plate

0.4 mg (400 mcg) in fortified foods recommended, Neural tube defects can occur with poor intake - also good idea to increase intake if trying to get pregnant

folic acid

recommended protein intake for pregnancy (especially 2nd and 3rd trimesters)

71 g

recommended fiber intake

28 g

recommended iron intake

27 g

recommended calcium intake

1000-1300 mg

for a person with a normal BMI, the recommended weight gain for pregnancy is —-

25-35 lbs

for a person with a low BMI, recommended weight gain for pregnancy is —-

28-40 lbs

for an overweight person, recommended weight gain is ———

15-25 lbs

for an obese person, recommended weight gain is —-

11-20 lbs

for twin gestation (and normal BMI of pregnant person) recommended weight gain is —

37-54 lbs

weight gain - not really have restriction on weight gain because their bodies are still growing w/o pregnancy

adolescent

Shark, swordfish, sushi, raw cookie dough, soft cheeses, raw eggs, Limit the following foods: Low mercury fish & shellfish

food to avoid

Eating ice could be indicative of—-

anemia

A myth that ——- makes you lose more weight but we tell them anyway - It’s a really strong might 

breastfeeding

is the ingestion of non-nutritive substances: Dirt, clay, dry laundry starch, Others: ice, hair, gravel, charcoal, antacid tablets, baking soda, coffee grounds, inner tubes, Often displaces more nutritious foods in the diet

pica

appropriate PP weight loss goals for non lactating women:

0.5-0.9 kg/wk

appropriate PP weight loss goals for lactating women:

1 kg/mo

Similar to those during pregnancy, Needs for energy, protein, vitamins, minerals are greater than nonpregnant needs

nutrients needed for lactation

A pregnant client reports fatigue and poor dietary intake. What is the nurse’s priority action?

assess daily dietary intake

Which finding is most concerning in a pregnant client with poor weight gain?

fundal height lagging