South University, SavannahNSG 3047OB Final Exam Study Guide (2).

OB Final Exam Study Guide Signs of Pregnancy: Presumptive, Probable, & Positive  Presumptive o Things that could be due to pregnancy but could also be explained by something else  Fatigue, breast tenderness, N/V, A ...

OB Final Exam Study Guide Signs of Pregnancy: Presumptive, Probable, & Positive  Presumptive o Things that could be due to pregnancy but could also be explained by something else  Fatigue, breast tenderness, N/V, Amenorrhea, Urinary Frequency, hyperpigmentation of the skin, quickening, uterine enlargement, and breast enlargement.  Probable o You’re probably pregnant, but we don’t know for sure  Braxton hicks contractions, Positive pregnancy test, abdominal enlargement, ballottement (examiner pushes on cervix and feels rebound from fetus), Goodell’s sign, Chadwick’s sign, Hegar’s sign  Positive o You are definitely pregnant!  Seeing a fetus or embryo on an ultrasound  Fetal movement felt by a clinician  Auscultating fetal heart tones w/ doppler GTPAL classification  G – How many pregnancies  T – How many pregnancies to term >38 weeks  P – How many pregnancies were preterm <38 weeks  A – How many abortions <20 weeks  L – How many living children Naegle’s Rule  First Day of LMP – 3 months + 7 Days = Due date Nutrition in Pregnancy  INCREASE o Calories – 2,500 calories/day o Protein – 80g/day o Iron – 27g/day o Folic acid – 800mcg/day Weight gain in pregnancy  Underweight women should gain 28-40 pounds o 5 lbs in the 1st trimester o Then 1.2 lbs per week  Normal weight women should gain 25-35 pounds o 3.5-5 lbs in the first trimester o Then ~1lb per week  Overweight women should gain 15-25 pounds o 2 lbs in first trimester o Then 2/3 lb per week  Obese women should gain no more than 15 pounds Exercise in pregnancy  Exercise during pregnancy is encouraged but the intensity and duration should be modified  Contraindicated in preterm labor, poor weight gain, anemia, face and hand edema, pain, hypertension, threatened abortion, dizziness, SOB, multiple gestation, decreased fetal activity, cardiac disease and palpitations  150 minutes of moderate intensity exercise per week  Helps return the woman’s body to normal after pregnancy  Low-impact aerobic exercises with stretching before and after  Never exercise to the point of exhaustion Danger/warning signs of pregnancy  First trimester o Spotting or bleeding, painful urination, severe persistent vomiting, lower abdominal pain with dizziness and shoulder pain.  Second Trimester o Regular uterine contractions, pain in calf, often increased with foot flexion, sudden gush or leakage of fluid from the vagina, and absence of fetal movement for more than 12 hours  Third Trimester o Sudden weight gain, periorbital or facial edema, severe abdominal pain, headache w/ visual changes, decrease in fetal daily movement for more than 24 hours. Common discomforts of pregnancy  First Trimester o Urinary frequency or incontinence  Decrease fluids 2-3 hrs before bed, limit intake of caffeine, Kegel exercises, empty bladder with first full sensation o Fatigue  Get a full night’s sleep, healthy well-balanced diet, nap in the early afternoon, rest when you feel tired. o N/V  Avoid an empty stomach, eat dry crackers before getting out of bed, eat several small meals throughout the day, avoid brushing teeth immediately after eating, Acupressure wristbands, drink fluids between meals, avoid greasy, fried foods, or foods with a strong odor. o Breast tenderness  Wear a larger bra with good support even while she’s sleeping o Constipation  Eat fresh or dried fruit with the skins on, whole grain cereal and breads, increase physical activity, pelvic floor exercises, stretching exercises, and yoga daily, meals at regular intervals, defecate at a certain time each day, use a Squatty Potty, increase water intake, decrease refined carbs, warm fluids in the morning, avoid large amounts of cheese. o Nasal stuffiness, bleeding gums, and epistaxis  Increase fluids, use a humidifier in room at night, advise her to blow her nose gently, one nostril at a time, avoid nasal decongestants and sprays. If her nosebleed advise her to loosen clothing around her neck, tilt her head forward, pinch nostrils for 10-15 minutes, and apply an ice pack to her nose. Advise her to practice good oral hygiene, soft toothbrush and flossing daily, warm saline mouth washes. o Cravings  Watch out for Pica o Leukorrhea  Keep perineal area clean and dry, wash with mild soap during shower, avoid pantyhose or tight nylon clothes, encourage cotton underwear and the use of a nightgown, avoid douching and tampon use.  Second Trimester o Backache  Avoid standing or sitting for long periods, apply heating pad, put pillows behind back when sitting, use proper body mechanics when lifting, avoid excessive bending, lifting or walking without rest, wear supportive shoes, avoid heels, maintain good posture. o Leg Cramps  Elevate the legs above heart level, straighten both legs and flex feet toward your body, taking additional calcium supplements o Varicosities of the leg and vulva  Walking daily, elevate legs, avoid standing in one positions too long, avoid constrictive knee-high stocking and socks, don’t cross legs when sitting, wear support stockings for better circulation. o Hemorrhoids  Establish a regular time to have a BM, avoid constipation and straining during pooping, drink plenty of fluids and eat fiber rich foods, exercise, warm sitz bath and cool witch hazel compresses. o Flatulence with bloating  Avoid gas forming foods (beans, cabbage, and onions) and foods with high amounts of white sugar, add more fiber, fluids, and exercise, avoid chewing gum, get into the knee-chest position, reduce carbonated beverages and cheese, eating mints.  Third Trimester o SOB and Dyspnea  Adjust body position to allow maximum expansion of the chest, avoid large meals, raise the HOB, lying on her left side, periodically stand up and reach her arms over her head and take a deep breath, avoid overheating, rest after exercise. o Heartburn and Indigestion  Avoid spicy foods, eat small frequent meals, elevate head to 30 degrees while sleeping, stop smoking, avoid caffeinated drinks, don’t lay down for 3 hours after meals, drink sips of water, avoid foods that trigger symptoms, take antacids if severe. o Dependent Edema  Elevate feet and legs, wear support hose, change positions frequently, walk a sensible pace, stop every 2 hours during long car rides to walk around, rock from ball of foot to toes while standing, lie on left side, avoid foods high in sodium, avoid knee-high support hose, adequate fluid intake, avoid sugar and fats o Braxton Hicks contractions  Change position, engage in mild exercise, and drink more fluids. Smoking in pregnancy  Preterm birth, fetal addiction to nicotine, and low birth weight is caused by smoking. Encourage smoking cessation before or in early pregnancy. Timing of Doctors appointments  For a normal pregnancy o Every 4 weeks up to 28 weeks o Every 2 weeks from 29-36 weeks o Every week from 37 weeks to birth Changes or things that happen in each trimester of pregnancy  Reproductive: uterus increase in size/ shape and position change  Cardiovascular: CO/BV increase, HR increase @5 weeks peaks (10-15min pre-pregnancy) @32 weeks  Respiratory: Oxygen need increase/ lung capacity decrease  Musculoskeletal: weight increase/ pelvic joints relax  GI: N/V may occur/ constipation ( increase water intake  Renal: urine production same/ increase urinary frequency  Endo: Placenta become endocrine organ produces hormones  Ambivalence: unsure/ conflicting feelings  Acceptance: readiness  Emotional liability: frequent changes in motional state  Body image changes: o First semester: waiting on baby bump o Second semester: rapid physical changes (belly/ breast ) skin changes, mobility decrease, tired  Relationship with fetus: daydream  Vital Signs: o BP: normal first trimester/ 24-32 weeks diastolic decreases  Complication: Maternal hypotension o Pulse: increase 10-15/ min @ 32 weeks o RR: some SOB/ rate does not change for the most part  Expected Findings: o FHR 110-160 with accelerations notes o Heart sounds change/murmurs possibility – change after delivery o Uterine size 50-1000 (0.1 to 2.2 lbs) @ 36 weeks fundus reach xiphoid process o Cervical changes (purplish-blue color into the vaginal) o Breast changes o Skin changes  Chloasma: face  Linea nigra: dark line on belly  Striae gravidarum: stretch mark  Lightening  Fetal descent into the pelvis  Happens typically by 40 weeks  For first time mothers it occurs 2 weeks prior to the onset of labor  For multipara mothers it occurs at the onset of labor Quickening  feelings of the baby moving  occurs in 16 - 20 weeks Engagement and station  Station is the centimeters of the presenting art in relation to the ischial spines  -2, -1, 0, 1, 2  0 Station = Engagement o Typically happens in primigravida’s 2 weeks before term o Multiparas may experience several weeks before onset of labor or not until labor begins Diagnostic tests such as: NST, BPP, CST  Nonstress Test: NST o Provides an indirect measurement of uteroplacental function o NST is recommended twice weekly after 28 weeks for clients with diabetes, IUGR, preeclampsia, post-term pregnancy, renal disease, and multifetal pregnancies. o Prior to the procedure the client eats a meal to stimulate fetal movement o Women should empty her bladder and sit in a semi fowler’s position. o For the test to be reactive there must be at least two fetal heart rate accelerations 15bpm above baseline for 15 minutes within a 20-minute period o If no accelerations are detected the test is extended for another 20 minutes o If still not accelerations, then the mother is sent for a BPP  Biophysical Profile (BPP) o Assessment of various parameters of fetal well-being o The biophysical profile looks at fetal body movements, fetal tone, fetal breathing, amniotic fluid, NST o Each worth 2 points o 10 points possible, a score of 8 or higher is considered normal  Contraction Stress Test (CST) o Women lightly brushing her palm across her nipple for 2 mins causing pituitary gland to release oxytocin, then stopping nipple stimulation when contraction begins  Repeat after 5 min rest period  See how fetal responds to contraction to determine tolerate stress labor  Pattern with at least 3 contraction within 10 minutes duration of 40-60 seconds  Contraction longer 90 seconds/5+ contraction avoid nipple stimulation True vs false labor  True labor is indicated by cervical change. The contraction are regulars and get progressively stronger. The pain is felt in the back and radiates to the front of the abdomen. They continue regardless of position change and are worsened by physical activity such as walking.  False labor is indicated by irregular uterine contractions that do not progressively get stronger and are felt in the abdomen. They do not produce cervical change. These contractions may be weakened by walking or changing positions.