Obstetrical History Assessment
40 Questions
1 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What defines the antepartum period in pregnancy?

  • The time from labor until delivery
  • The time when the fetus begins to move
  • The period following childbirth
  • The time from conception to the onset of labor (correct)

    • Which of the following correctly defines gravidity?

  • The status of never having been pregnant
  • The number of pregnancies a woman has experienced (correct)
  • The number of births at or beyond 20 weeks
  • Another term for childbirth

    • What is the estimated date of confinement if the first day of the last menstrual period is September 12, 2014?

  • March 12, 2015
  • June 19, 2015 (correct)
  • September 19, 2015
  • June 12, 2015

    • Which statement describes a primigravida?

    <p>A woman pregnant for the first time</p> Signup and view all the answers

    What is the significance of a nullipara in obstetric history?

    <p>A woman who has been pregnant but never had a birth over 20 weeks</p> Signup and view all the answers

    Which method involves using fundal height to estimate pregnancy duration?

    <p>McDonald's rule</p> Signup and view all the answers

    How long is a typical gestation period from fertilization to delivery?

    <p>280 days</p> Signup and view all the answers

    What is the primary focus of nursing care during the antepartum period?

    <p>Health maintenance and prevention of complications</p> Signup and view all the answers

    Which of these terms refers to a woman who has experienced at least one pregnancy?

    <p>Multigravida</p> Signup and view all the answers

    What is a characteristic of a nulligravida?

    <p>Has never been pregnant</p> Signup and view all the answers

    What does 'G' represent in the GTPAL system?

    <p>Number of pregnancies</p> Signup and view all the answers

    Which of the following is considered a presumptive sign of pregnancy?

    <p>Breast enlargement and tenderness</p> Signup and view all the answers

    What is not included in the parity (P) count in the GTPAL system?

    <p>Elective abortion before 20 weeks</p> Signup and view all the answers

    During which trimester may women commonly experience morning sickness?

    <p>First trimester (1-3 months)</p> Signup and view all the answers

    What happens to the heart during pregnancy?

    <p>Heart is displaced upward and to the left</p> Signup and view all the answers

    Which sign indicates that the uterine segment has softened?

    <p>Hegar’s sign</p> Signup and view all the answers

    Which physiological change occurs in the urinary system due to pregnancy?

    <p>Increased frequency and urgency of urination</p> Signup and view all the answers

    What significant change occurs in the respiratory system during pregnancy?

    <p>Oxygen consumption increases by approximately 15% to 20%</p> Signup and view all the answers

    What change happens to the blood volume during pregnancy?

    <p>Total blood volume increases by approximately 40% to 50%</p> Signup and view all the answers

    What is a common gastrointestinal symptom experienced in early pregnancy?

    <p>Nausea and vomiting</p> Signup and view all the answers

    What is the primary cause of the cervix becoming shorter and more elastic during pregnancy?

    <p>Increased vascularization and estrogen levels</p> Signup and view all the answers

    What is the expected weight gain during pregnancy for most women?

    <p>9-12 kg</p> Signup and view all the answers

    Which of the following is NOT a potential reaction of a mother to her body image during pregnancy?

    <p>Complete detachment from body image</p> Signup and view all the answers

    What hormonal changes primarily lead to the hypertrophy and thickening of the vagina during pregnancy?

    <p>Increased levels of estrogen</p> Signup and view all the answers

    What is a common cause of striae gravidarum (stretch marks) during pregnancy?

    <p>Weakening of connective tissue</p> Signup and view all the answers

    What physiological change occurs in the uterus during pregnancy?

    <p>Increase in the size and number of blood vessels</p> Signup and view all the answers

    What do facial chloasma and linea nigra have in common during pregnancy?

    <p>Both result from hormonal changes</p> Signup and view all the answers

    What is pica during pregnancy associated with?

    <p>Consumption of non-food substances</p> Signup and view all the answers

    How does ambivalence manifest in mothers during early pregnancy?

    <p>Conflicts between dependence and independence</p> Signup and view all the answers

    What physiological change occurs in the metabolic rate during pregnancy?

    <p>Increased metabolic rate</p> Signup and view all the answers

    What is a recommended intervention for managing urinary urgency during pregnancy?

    <p>Voiding at regular intervals</p> Signup and view all the answers

    Which condition is typically managed by sitting upright for 30 minutes after meals?

    <p>Heartburn</p> Signup and view all the answers

    What intervention can alleviate backache during pregnancy?

    <p>Obtaining rest</p> Signup and view all the answers

    What is a recommended strategy to manage shortness of breath during the second and third trimesters?

    <p>Taking frequent rest periods</p> Signup and view all the answers

    Which of the following dietary changes is advised during pregnancy to prevent constipation?

    <p>Incorporating high-fiber foods</p> Signup and view all the answers

    What is an effective intervention to help reduce ankle edema during pregnancy?

    <p>Elevating the legs regularly</p> Signup and view all the answers

    What caloric increase is recommended during lactation?

    <p>500 cal/day</p> Signup and view all the answers

    Which aspect is NOT typically associated with urinary frequency during pregnancy?

    <p>Decreased renal function</p> Signup and view all the answers

    What is a common complication if high sodium is not restricted during pregnancy?

    <p>Edema</p> Signup and view all the answers

    Why is folic acid essential for women of childbearing age?

    <p>To prevent neural tube defects</p> Signup and view all the answers

    Study Notes

    Obstetrical History/ Assessment

    • Gravidity: Refers to the number of pregnancies a woman has had.
      • Nulligravida: A woman who has never been pregnant.
      • Primigravida: A woman who is pregnant for the first time.
      • Multigravida: A woman in at least her second pregnancy.
    • Parity: Refers to the number of births (not fetuses) carried past 20 weeks' gestation, regardless of whether the fetus was born alive.
      • Nullipara: A woman who has not had a birth at more than 20 weeks of gestation.
      • Primipara: A woman who has had one birth that occurred after the twentieth week of gestation.
      • Multipara: A woman who has had two or more pregnancies to the stage of fetal viability.
    • GTPAL (or GTPALM) System: A method used to document previous pregnancies:
      • G: Number of pregnancies (gravida).
      • T: Number of term infants born (longer than 37 weeks' gestation).
      • P: Number of preterm infants born (para) (before 37 weeks' gestation).
      • A: Number of pregnancies ending in spontaneous or elective abortion (before 20 weeks).
      • L: Number of living children.
      • M: Total number of multiple pregnancies the client has experienced.
      • Example: A woman is pregnant for the fourth time (G4). She had one elective abortion in the first trimester (A1), a daughter who was born at 40 weeks' gestation (T1), and a son who was born at 36 weeks' gestation (P1). She has two living children (L2). Her GTPAL is 4, 1, 1, 1, 2.

    Signs and Symptoms of Pregnancy

    • Presumptive Signs: Subjective changes experienced by the woman.

      • Amenorrhea (absence of menstruation).
      • Breast enlargement and tenderness.
      • Fatigue.
      • Increased skin pigmentation.
      • Nausea and vomiting.
      • Quickening (first recognizable fetal movement).
      • Linea nigra (dark line on abdomen).
      • Chloasma (pigmentary skin change on the face).
      • Striae gravidarum (stretch marks on abdomen).
      • Urinary frequency and urgency.

    • Probable Signs: Objective changes that can be observed by the healthcare provider.

      • Uterine enlargement.
      • Hegar's sign: Softening of the lower uterine segment.
      • Goodell's sign: Softening of the cervix.
      • Chadwick's sign: Violet coloration of the cervix, vagina, and vulva.
      • Ballottement: Rebounding of the fetus against the examiner's fingers.
      • Braxton Hicks contractions (irregular, painless contractions).
      • Positive pregnancy test.

    • Positive Signs: Objective changes that confirm pregnancy.

      • Fetal heart rate detected by electronic device (Doppler transducer) or non-electronic device (fetoscope).
      • Active fetal movement felt by a trained provider.
      • Ultrasound showing fetal outline.

    Antepartum Diagnostic Testing

    • Numerous tests are performed to confirm pregnancy and detect maternal and fetal complications.
      • Blood type, Rh factor, and abnormal antibodies: To identify whether the fetus is at risk for erythroblastosis fetalis (hemolytic disease of the newborn) or hyperbilirubinemia.
      • Immunologic tests: Include rubella antibodies, rapid plasma regain (syphilis), and hepatitis B surface antigen.
      • Papanicolaou's smear: Screens for cervical neoplasia (cervical cancer) during the initial prenatal examination.

    Maternal Physiological Changes

    • Physiological Adaptations of Body Systems: Changes that occur in the maternal organ systems to accommodate the pregnancy and prepare for labor.

    • Cardiovascular System:

      • Increased blood volume, plasma, and red blood cell volume (approximately 40% to 50% increase).
      • Physiological anemia: Plasma increase outpaces red blood cell production.
      • Increased iron requirements.
      • Heart size increases and is displaced upward and to the left due to diaphragm elevation.
      • Sodium and water retention may occur.
      • Supine Hypotension: Can occur if pregnant woman lies on her back. The weight of the uterus compresses the vena cava, trapping blood in the lower extremities. Turning on her side relieves pressure.

    • Respiratory System:

      • Oxygen consumption increases by 15% to 20%.
      • Diaphragm is elevated due to the enlarged uterus.
      • Shortness of breath may occur.

    • Gastrointestinal System:

      • Smooth muscle relaxation (progesterone) leads to constipation, hemorrhoids, and heartburn.
      • Appetite usually increases after early pregnancy nausea and vomiting.
      • Morning sickness (nausea & vomiting) between 4-12 weeks of pregnancy.

    • Urinary System:

      • Pressure on the bladder from the uterus causes urinary frequency in the first and second trimesters. This pressure can also lead to urinary tract infections.
      • Kidneys grow and filter more blood due to increased blood volume.
      • Increased risk of bladder and kidney infections.
      • Bladder compression causes frequent urination and incontinence.

    • Endocrine System:

      • Basal metabolic rate increases.
      • Anterior pituitary gland, thyroid, parathyroid, and aldosterone levels increase.
      • Body weight increases due to water retention and fetal growth.

    • Reproductive System:

      • Uterus: Enlarges significantly in size and mass due to hyperplasia (estrogen) and hypertrophy. Blood vessels and lymphatics increase in size and number. Irregular contractions occur.
      • Cervix: Shortens, becomes more elastic, and widens. Endocervical glands secrete a mucus plug that is expelled during labor. Chadwick's sign appears at about 4 weeks of gestation.
      • Ovaries: Secrete progesterone for the first 6 to 7 weeks of pregnancy. Ovum production ceases.
      • Vagina: Muscle hypertrophy and thickening occur. Increased vaginal secretions occur, typically thick, white, and acidic.
      • Breasts:
        • Develop ducts and glands at 6 weeks.
        • Bluish surface veins, tenderness, and enlargement at 8 weeks.
        • Primary areola darkens at 8-12 weeks.
        • Secondary areola appears at 16-18 weeks.
        • Colostrum production begins at 16-18 weeks.

    • Dermatological System:

      • Increased pigmentation in areola, nipples, vulva, and perianal area.
      • Linea Nigra: Dark pigmentation in the linea alba.
      • Facial Chloasma: Irregular pigmentation on the cheeks, forehead, and nose, accentuated by sun exposure.
      • Striae Gravidarum: Stretch marks on breasts and abdomen due to connective tissue weakness.
      • Vascular Spider Nevi: Small, bright-red elevations of the skin caused by increased blood flow due to estrogen. Develop on chest, neck, face, arms, and legs.

    • Musculoskeletal System:

      • Postural changes (lordosis) lead to a waddling gait due to increased progesterone and relaxation hormone. This helps counterbalance the protruding abdomen.
      • Increased curvature can result in low back pain.

    • Metabolic Changes:

      • Increased metabolic rate.
      • Increased demand for carbohydrates, protein, and minerals.
      • Increased water requirement to supply the fetus, placenta, and amniotic fluid.

    • Immunological System:

      • Resistance to infection is decreased.
      • Maternal IgG levels decrease.

    Maternal Psychological Changes

    • Ambivalence: Early pregnancy is characterized by emotional conflict and ambivalence related to role changes and dependence/independence. This also applies to the partner.

    • Acceptance: Acceptance of pregnancy depends on readiness for the experience and identification with the motherhood role.

    • Emotional Lability: Frequent and extreme changes in mood are common, which can worry the mother.

    • Body Image Changes: Changes in perception of body image are gradual and can be positive or negative.

    • Relationship with the Fetus: The woman may daydream about motherhood, maternal qualities, and motherhood preparation. She develops a distinct sense of the fetus as a separate person to nurture.

    Common Minor Discomforts in Pregnancy

    • Nausea and Vomiting: Related to increased HCG, changes in CHO metabolism, and fatigue.
      • Interventions include avoiding offending odors, eating dry crackers upon waking, eating small, low-fat meals, avoiding spicy foods, and drinking fluids between meals.
    • Pica: Eating non-food substances, such as dirt, clay, or starch. The cause is unknown, but cultural factors and iron deficiency anemia may play a role.
    • Urinary Urgency and Frequency: Common in the first and third trimesters due to bladder pressure.
      • Interventions include limiting fluids in the evening, voiding regularly, side-lying at night, wearing peri-pads, and Kegel exercises.
    • Heartburn: Occurs in the second and third trimesters due to increased progesterone, decreased gastrointestinal motility, reflux, and stomach displacement.
      • Interventions include eating small meals, sitting upright after meals, drinking milk between meals, avoiding fatty and spicy foods, and antacids.
    • Backache: Common in the second and third trimesters due to a pronounced lumbosacral curve.
      • Interventions include rest, correct posture, comfortable shoes, and a firm mattress.
    • Shortness of Breath: Can occur in the second and third trimesters due to diaphragm pressure.
      • Interventions include rest periods, sleeping with an elevated head or on the side, and avoiding overexertion.
    • Leg Cramps: Occur in the second and third trimesters due to altered calcium-phosphorus balance, nerve pressure, or fatigue.
      • Interventions include regular exercise (walking), dorsiflexing the foot, and stretching.
    • Constipation: Occurs in the second and third trimesters due to increased progesterone, decreased motility, intestinal displacement, and iron supplements.
      • Interventions include high-fiber foods, adequate hydration, regular exercise, and stool softeners/laxatives as prescribed.
    • Ankle Edema: Common in the second and third trimesters due to vasodilation and increased venous pressure.
      • Interventions include leg elevation, side-lying position, supportive stockings, and avoiding prolonged sitting or standing.

    Antepartum Period: Nursing Care

    • Nursing Diagnoses:

      • Ineffective health maintenance.
      • Risk for deficient fluid volume.

    • Nursing Planning and Goals:

      • Client's health history, physical exam, and diagnostic tests will be within normal limits.
      • Client will describe warning signs of pregnancy complications.
      • Client will express acceptance of body changes.
      • Client will discuss concerns about pregnancy related to personal and family needs.
      • Client will return for routine follow-up visits.

    • Nursing Evaluation:

      • Client's health history, physical exam, and diagnostic tests are within normal limits.
      • Client describes warning signs and the importance of reporting them.
      • Client identifies sources of support.
      • Client has scheduled their next appointment.

    Nutrition

    • Increase of about 300 calories per day is needed during pregnancy, with higher needs in the last two trimesters.
    • Increase of about 500 calories per day is needed during lactation.
    • Diet high in folic acid and folic acid supplements is recommended to prevent neural tube defects and orofacial clefts in the fetus.
    • At least 8-10 (8-oz) glasses of fluid are needed each day, with 4-6 glasses being water.
    • Sodium is not restricted unless prescribed by the healthcare provider.

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Description

    Test your knowledge on obstetrical history and assessment with this quiz. The content covers key terms like gravidity, parity, and the GTPAL system. Understanding these concepts is essential for effective maternal health care.

    More Like This

    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser