Obstetrics History and Pregnancy Assessment

Podcast Beta

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the duration of a typical pregnancy from fertilization to estimated date of delivery?

280 days (correct)

300 days

240 days

305 days

Which term describes a woman who has been pregnant for the first time?

Primigravida (correct)

Nullipara

Nulligravida

Multigravida

What does the term 'parity' refer to in obstetrical history?

The number of pregnancies resulting in complications

The number of live births

The number of births post 20 weeks' gestation (correct)

The number of pregnancies

What is one method for estimating the date of confinement during pregnancy?

McDonald's rule Signup and view all the answers

When using Nägele’s rule, what is the first step if the first day of the last menstrual period is September 12, 2014?

Subtract 3 months Signup and view all the answers

Why is a nullipara significant in obstetric history?

She has not had a birth after 20 weeks' gestation Signup and view all the answers

What does gravidity signify in the context of obstetrics?

The total number of pregnancies Signup and view all the answers

During the antepartum period, what is a primary focus of nursing care?

Health maintenance and complication prevention Signup and view all the answers

What is a common discomfort that may occur during pregnancy?

Nausea and vomiting Signup and view all the answers

How is fundal height used in pregnancy assessments?

To estimate the duration of pregnancy Signup and view all the answers

What does the 'T' in the GTPAL system represent?

Number of term infants born Signup and view all the answers

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

Line of pigmentation on the abdomen Signup and view all the answers

What physiological change occurs in the cardiovascular system during pregnancy?

Increase in total red blood cell volume Signup and view all the answers

What is indicated when a woman experiences a positive Chadwick's sign during examination?

Increased blood flow to pelvic area Signup and view all the answers

Which of the following symptoms is most likely to occur during the first trimester of pregnancy?

Morning sickness Signup and view all the answers

What is the primary reason for increased urinary frequency during the first and second trimesters?

Pressure from the growing uterus Signup and view all the answers

Which test is typically part of the initial prenatal examination to screen for cervical neoplasia?

Papanicolaou's smear Signup and view all the answers

How does the respiratory system adapt during pregnancy?

Elevated diaphragm Signup and view all the answers

What characterizes Braxton Hicks contractions?

Irregular painless contractions Signup and view all the answers

Which of the following best describes the term 'multipara'?

A woman who has had two or more pregnancies Signup and view all the answers

What is the primary reason for the increase in uterine mass during pregnancy?

Hyperplasia and hypertrophy Signup and view all the answers

Which change in the cervix occurs during pregnancy?

It increases in diameter and softens. Signup and view all the answers

What is Chadwick’s sign related to during pregnancy?

Softening and discoloration of the cervix Signup and view all the answers

Which change is true regarding breast development during pregnancy?

Glands and ducts develop by six weeks. Signup and view all the answers

What common skin change occurs due to hormonal changes in pregnancy?

Facial chloasma Signup and view all the answers

How does pregnancy affect metabolic rate and nutritional needs?

It increases the need for all macronutrients and minerals. Signup and view all the answers

What psychological change is commonly observed during early pregnancy?

Ambivalence about the pregnancy Signup and view all the answers

What causes the common condition known as pica during pregnancy?

Iron deficiency anemia Signup and view all the answers

Which of the following describes a musculoskeletal change during pregnancy?

Waddling gait due to lordosis Signup and view all the answers

What is the main cause of urinary urgency and frequency during pregnancy?

Pressure of the uterus on the bladder Signup and view all the answers

What is a characteristic symptom of nausea and vomiting during pregnancy?

Altered carbohydrate metabolism Signup and view all the answers

During which trimesters is heartburn most likely to occur in pregnancy?

Second and third trimesters Signup and view all the answers

Which intervention is NOT recommended for managing backache during pregnancy?

Engaging in high-impact exercise Signup and view all the answers

What can contribute to the occurrence of leg cramps during pregnancy?

Altered calcium-phosphorus balance Signup and view all the answers

Which dietary recommendation is essential for preventing neural tube defects in the fetus?

High intake of folic acid and folic acid supplements Signup and view all the answers

What intervention should be avoided to manage ankle edema during pregnancy?

Standing still for long periods Signup and view all the answers

Which condition typically occurs due to increased progesterone production during pregnancy?

Constipation Signup and view all the answers

How many extra calories per day are generally needed during the last two trimesters of pregnancy?

300 cal/day Signup and view all the answers

Which of the following is a recommended intervention for managing shortness of breath in pregnant women?

Sleeping with the head elevated Signup and view all the answers

What is one of the nursing diagnoses identified during the antepartum period related to pregnancy?

Ineffective health maintenance Signup and view all the answers

Study Notes

Obstetrics History/Assessment

Gestation is the time between fertilization and the estimated date of delivery, roughly 280 days
Nägele's rule estimates delivery date by subtracting 3 months and adding 7 days from the first day of the last menstrual period. Adding a year completes the calculation.
McDonald's rule uses fundal height to determine gestation in lunar months or weeks.
Gravidity is the number of pregnancies a woman has experienced
Parity denotes the number of births after 20 weeks' gestation, regardless of live birth.
GTPAL system documents pregnancies:
- G - total pregnancies
- T - term infants born
- P - premature infants born
- A - abortions
- L- living children
GTPALM adds "M" for the number of multiple pregnancies

Signs and Symptoms of Pregnancy

Presumptive Signs:
- Amenorrhea
- Breast enlargement and tenderness
- Fatigue
- Increased skin pigmentation
- Nausea and vomiting
- Quickening (first fetal movement)
- Linea nigra (dark line on abdomen)
- Chloasma (pigmentation on the face)
- Striae gravidarum (stretch marks)
- Urinary frequency and urgency
Probable Signs:
- Uterine enlargement
- Hegar's sign (softening of lower uterine segment)
- Goodell's sign (softening of the cervix)
- Chadwick's sign (violet coloration of cervix, vagina, and vulva)
- Ballottement (rebounding of the fetus on palpation)
- Braxton Hicks contractions
- Positive pregnancy test
Positive Signs:
- Fetal heart rate detected by electronic device
- Active fetal movement felt by a trained provider
- Ultrasound showing fetal outline

Diagnostic Evaluation

Blood tests: blood type, Rh factor, abnormal antibodies (risk of erythroblastosis fetalis and hyperbilirubinemia)
Immunologic tests: rubella antibodies, rapid plasma regain, hepatitis B surface antigen
Papanicolaou smear (screening for cervical neoplasia)

Maternal Physiological Changes

Cardiovascular System
- Blood volume increases by 40-50%
- Physiological anemia due to plasma increase exceeding red blood cell production
- Increased iron requirements
- Heart size increases, elevating slightly upward and to the left
- Sodium and water retention can occur
- Supine hypotension occurs when lying on the back due to compression of the vena cava
Respiratory System
- Oxygen consumption increases by 15-20%
- Diaphragm elevates due to uterus enlargement
- Shortness of breath may occur
Gastrointestinal System
- Gums become hyperemic
- Smooth muscle relaxation due to progesterone, causing constipation, hemorrhoids, and heartburn
- Appetite increases after temporary decrease due to nausea and vomiting
- Morning sickness occurs between 4-12 weeks
Urinary System
- Urinary frequency in the first and second trimesters due to uterine pressure on the bladder
- Increased risk of infection and trauma
- Kidneys grow and filter more blood
Endocrine System
- Increased basal metabolic rate
- Anterior pituitary gland enlarges
- Thyroid and parathyroid glands increase in size
- Increased aldosterone levels
- Body weight increases
- Water retention increases
Reproductive System
- Uterus
  - Enlarges to accommodate a growing fetus
  - Increased blood vessels and lymphatic system
  - Irregular contractions occur
- Cervix
  - Shortens, becomes more elastic and larger in diameter
  - Endocervical glands secrete a thick mucous plug
  - Increased vascularization, evident as Chadwick's sign
- Ovaries
  - Secrete progesterone for the first 6-7 weeks
  - New follicle maturation blocked
  - Ovum production ceases
- Vagina
  - Muscle hypertrophy and thickening
  - Increase in vaginal secretions, thick, white, and acidic
Breasts
- Develop ducts and glands (6 weeks)
- Bluish surface veins become visible (8 weeks)
- Primary areola darkens (8-12 weeks)
- Secondary areola appears (16-18 weeks)
- Colostrum secretion begins (3rd month)
Dermatological System:
- Increased skin pigmentation: areola, nipples, vulva, perianal area
- Linea nigra (dark line on abdomen)
- Facial chloasma (pigmentation on face)
- Striae gravidarum (stretch marks)
- Vascular spider nevi (red elevations on skin) caused by increased blood flow due to estrogen
Musculoskeletal System
- Postural changes: Lordosis, Waddling gait
- Lordosis helps counterbalance the protruding abdomen
- Increased curving can lead to backache
Metabolic Changes
- Increased metabolic rate
- Increased demand for carbohydrates, proteins, and minerals
- Increased water requirement
Immunological System
- Resistance to infection decreases
- Maternal IgG levels decrease
Maternal Psychological Changes
- Ambivalence: early in pregnancy, may experience dependence-independence conflict
- Acceptance: readiness for motherhood and identification with the role
- Emotional Lability: frequent changes in mood or extremes in emotions
- Body Image Changes: acceptance or rejection of body changes
- Relationship with the Fetus: Acceptance of pregnancy, acceptance of the fetus as a person, and preparation for birth and parenting

Common Minor Discomfort In Pregnancy

Nausea and Vomiting:
- Caused by HCG, CHO metabolism changes, and fatigue
- Interventions: avoid offending odors, eat dry crackers upon waking, eat 5-6 small, low-fat meals, avoid spicy foods, drink liquids between meals
Pica:
- Eating non-food substances, like dirt, clay, or starch
- Potential cause: cultural beliefs or iron deficiency anemia
Urinary Urgency and Frequency:
- Common in first and third trimesters due to uterine pressure on the bladder
- Interventions: limit evening fluid intake, void regularly, sleep side-lying, wear perineal pads, practice Kegel exercises
Heartburn:
- Occurs in the second and third trimesters due to increased progesterone, decreased gastrointestinal motility, esophageal reflux, and stomach displacement
- Interventions: small, frequent meals, sit upright after meals, drink milk between meals, avoid fatty foods, consult with the HCP about antacids.
Backache:
- Occurs in the second and third trimesters due to exaggerated lumbosacral curve
- Interventions: rest, correct posture, comfortable shoes, firm mattress
Shortness of Breath:
- Occurs in the second and third trimesters due to diaphragm pressure from the uterus
- Interventions: frequent rest, elevate the head, sleep on the side, avoid overexertion
Leg Cramps:
- Occur in the second and third trimesters due to calcium-phosphorus imbalance, nerve pressure, or fatigue.
- Interventions: regular exercise, dorsiflex the foot,
Constipation:
- Occurs in the second and third trimesters due to increased progesterone, decreased intestinal motility, displacement of intestines, uterine pressure, or iron supplements
- Interventions: high-fiber diet, drink plenty of fluids, exercise, consult with the HCP about stool softeners
Ankle Edema:
- Occurs in the second and third trimesters due to vasodilation and increased venous pressure below the uterus
- Interventions: elevate the legs, sleep side-lying, wear supportive stockings, avoid prolonged sitting or standing.

Antepartum Period (Conception to onset of Labor)

Nursing Diagnoses:
- Ineffective health maintenance
- Risk for deficient fluid volume
Nursing Planning and Goals:
- Normal results from health history, physical and diagnostic exams
- Client can describe warning signs of pregnancy complications
- Client can verbalize acceptance of body changes
- Client can discuss their pregnancy concerns related to personal and family psychosocial needs
- Client returns for routine follow-up visits
Nursing Evaluation:
- Normal results from health history, physical and diagnostic exams
- Client can describe warning signs and importance of reporting
- Client can identify sources of emotional and material support
- Client has scheduled their next appointment
Nutrition
- Increase of 300 calories per day is needed during pregnancy (500 during lactation)
- Diet high in folic acid, important for all women of childbearing age to prevent neural tube defects
- 8-10 glasses of fluids daily, 4-6 of which should be water
- Sodium restriction is not necessary unless prescribed

Studying That Suits You

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

Description

This quiz covers essential knowledge in obstetrics, focusing on key aspects of gestation, the GTPAL system, and signs and symptoms of pregnancy. It is designed for students or professionals looking to test their understanding of pregnancy assessment techniques and terminology.