Podcast
Questions and Answers
During pregnancy, which integumentary change is primarily associated with increased hormone levels and results in darkened pigmentation on the face?
During pregnancy, which integumentary change is primarily associated with increased hormone levels and results in darkened pigmentation on the face?
- Striae gravidarum
- Melasma (correct)
- Linea nigra
- Palmar erythema
Which of the following musculoskeletal changes during pregnancy increases the risk of falls?
Which of the following musculoskeletal changes during pregnancy increases the risk of falls?
- Diastasis recti
- Development of angiomas
- Increased elasticity of ligaments
- Waddling gait due to shift in center of gravity (correct)
A pregnant client reports craving non-food items such as clay. Which condition does this behavior indicate?
A pregnant client reports craving non-food items such as clay. Which condition does this behavior indicate?
- Cholestasis
- Hyperemesis gravidarum
- Ptyalism
- PICA (correct)
Which of the following hormonal changes contributes to an increased basal metabolic rate during pregnancy?
Which of the following hormonal changes contributes to an increased basal metabolic rate during pregnancy?
A client is in her third trimester and expresses minimal ambivalence about the pregnancy. Which psychosocial adaptation is she demonstrating?
A client is in her third trimester and expresses minimal ambivalence about the pregnancy. Which psychosocial adaptation is she demonstrating?
Which factor, if present, suggests that a pregnant client may be at increased risk for intimate partner violence?
Which factor, if present, suggests that a pregnant client may be at increased risk for intimate partner violence?
A pregnant patient with a history of mental health issues is at risk for poor pregnancy outcomes. What is the priority intervention for this patient?
A pregnant patient with a history of mental health issues is at risk for poor pregnancy outcomes. What is the priority intervention for this patient?
A new mother is planning her birth with considerations around support people, and pain interventions. What planning tool is she using?
A new mother is planning her birth with considerations around support people, and pain interventions. What planning tool is she using?
A patient at 12 weeks gestation is undergoing first trimester screening. Which combination of tests would be most appropriate?
A patient at 12 weeks gestation is undergoing first trimester screening. Which combination of tests would be most appropriate?
A quadruple screen result indicates a high level of alpha-fetoprotein (AFP). What condition does this result suggest an increased risk for?
A quadruple screen result indicates a high level of alpha-fetoprotein (AFP). What condition does this result suggest an increased risk for?
During a routine prenatal visit at 20 weeks gestation, a patient reports feeling fetal movement. This sensation is referred to as:
During a routine prenatal visit at 20 weeks gestation, a patient reports feeling fetal movement. This sensation is referred to as:
A patient's quadruple screen results show elevated hCG and Inhibin-A, along with decreased unconjugated estriol (UE). These results indicate an increased risk for which condition?
A patient's quadruple screen results show elevated hCG and Inhibin-A, along with decreased unconjugated estriol (UE). These results indicate an increased risk for which condition?
A pregnant patient is currently 30 weeks gestation. According to standard prenatal care guidelines, how often should she be scheduled for prenatal visits?
A pregnant patient is currently 30 weeks gestation. According to standard prenatal care guidelines, how often should she be scheduled for prenatal visits?
Which of the following antepartum tests involves directly obtaining fetal blood cells for analysis?
Which of the following antepartum tests involves directly obtaining fetal blood cells for analysis?
A pregnant woman in her second trimester reports feeling dizzy and lightheaded when lying on her back during a prenatal yoga class. What is the most likely cause of these symptoms?
A pregnant woman in her second trimester reports feeling dizzy and lightheaded when lying on her back during a prenatal yoga class. What is the most likely cause of these symptoms?
During a routine prenatal visit at 38 weeks gestation, a nurse assesses the fetal heart rate (FHR). Which of the following FHR values falls within the normal range?
During a routine prenatal visit at 38 weeks gestation, a nurse assesses the fetal heart rate (FHR). Which of the following FHR values falls within the normal range?
At which gestational age does the frequency of prenatal visits typically increase to weekly?
At which gestational age does the frequency of prenatal visits typically increase to weekly?
During a routine prenatal visit at 10 weeks gestation, a patient reports experiencing frequent nausea and vomiting. Which of the following recommendations is most appropriate as an initial intervention?
During a routine prenatal visit at 10 weeks gestation, a patient reports experiencing frequent nausea and vomiting. Which of the following recommendations is most appropriate as an initial intervention?
A pregnant woman at 30 weeks gestation reports a sudden onset of shortness of breath. What is the most likely physiological cause?
A pregnant woman at 30 weeks gestation reports a sudden onset of shortness of breath. What is the most likely physiological cause?
A patient at 16 weeks gestation presents with concerns about increased nasal congestion and occasional nosebleeds. What is the primary physiological change causing these symptoms?
A patient at 16 weeks gestation presents with concerns about increased nasal congestion and occasional nosebleeds. What is the primary physiological change causing these symptoms?
Which combination of the following signs are categorized as probable signs of pregnancy?
Which combination of the following signs are categorized as probable signs of pregnancy?
A pregnant patient's lab results show increased RBCs by 30% and plasma by 50%. What condition can arise because of this?
A pregnant patient's lab results show increased RBCs by 30% and plasma by 50%. What condition can arise because of this?
A pregnant woman reports experiencing frequent heartburn. What is the primary physiological reason for this?
A pregnant woman reports experiencing frequent heartburn. What is the primary physiological reason for this?
What is the purpose of the mucous plug that forms during pregnancy?
What is the purpose of the mucous plug that forms during pregnancy?
Which factor does NOT significantly contribute to disparities in maternal mortality rates?
Which factor does NOT significantly contribute to disparities in maternal mortality rates?
What physiological response is most closely associated with the 'Weathering Hypothesis'?
What physiological response is most closely associated with the 'Weathering Hypothesis'?
An adolescent who discovers she is pregnant may delay seeking prenatal care due to which of the following factors?
An adolescent who discovers she is pregnant may delay seeking prenatal care due to which of the following factors?
Which of the following describes a common emotional response in expectant fathers during their partner’s pregnancy?
Which of the following describes a common emotional response in expectant fathers during their partner’s pregnancy?
A pregnant patient's partner is exhibiting signs of Couvade syndrome. What symptoms might the partner be experiencing?
A pregnant patient's partner is exhibiting signs of Couvade syndrome. What symptoms might the partner be experiencing?
According to ACOG guidelines, violence screening should be conducted how often during prenatal care?
According to ACOG guidelines, violence screening should be conducted how often during prenatal care?
How might an older sibling (aged 9-12) typically react to the news of a new baby?
How might an older sibling (aged 9-12) typically react to the news of a new baby?
Which of the following is a potential negative reaction a grandparent might have upon learning about their child's pregnancy?
Which of the following is a potential negative reaction a grandparent might have upon learning about their child's pregnancy?
Using Naegele's Rule, if the first day of a woman's last menstrual period (LMP) was June 10th, what is her estimated due date?
Using Naegele's Rule, if the first day of a woman's last menstrual period (LMP) was June 10th, what is her estimated due date?
A patient is currently 39 weeks pregnant. According to gestational age classifications, how would this pregnancy be categorized?
A patient is currently 39 weeks pregnant. According to gestational age classifications, how would this pregnancy be categorized?
A patient's obstetric history is documented as G5 T3 P1 A1 L4. What does the 'A1' indicate?
A patient's obstetric history is documented as G5 T3 P1 A1 L4. What does the 'A1' indicate?
After confirming a pregnancy, what is the MOST important initial step a healthcare provider should take?
After confirming a pregnancy, what is the MOST important initial step a healthcare provider should take?
During the first prenatal assessment, in what position is the patient typically placed for a pelvic examination?
During the first prenatal assessment, in what position is the patient typically placed for a pelvic examination?
Which antepartum lab test is used to screen for gestational diabetes?
Which antepartum lab test is used to screen for gestational diabetes?
What does Non-Invasive Prenatal Testing (NIPT) primarily analyze to assess the risk of certain chromosomal abnormalities?
What does Non-Invasive Prenatal Testing (NIPT) primarily analyze to assess the risk of certain chromosomal abnormalities?
Flashcards
Presumptive Signs of Pregnancy
Presumptive Signs of Pregnancy
Symptoms suggesting pregnancy but not definitive, e.g., nausea, fatigue, breast tenderness.
Probable Signs of Pregnancy
Probable Signs of Pregnancy
Signs indicating pregnancy that can be observed by a provider, such as Goodell's sign or a positive pregnancy test.
Goodell's Sign
Goodell's Sign
Softening of the cervix, indicating pregnancy.
Hegar's Sign
Hegar's Sign
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Chadwick's Sign
Chadwick's Sign
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Positive Signs of Pregnancy
Positive Signs of Pregnancy
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Uterine Changes
Uterine Changes
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Cardiovascular Changes
Cardiovascular Changes
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PICA
PICA
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Pregnancy Gums
Pregnancy Gums
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Diastasis Recti
Diastasis Recti
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Linea Nigra
Linea Nigra
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Melasma
Melasma
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Increased Vascularity
Increased Vascularity
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Maternal-Psychosocial Acceptance
Maternal-Psychosocial Acceptance
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Intimate Partner Violence
Intimate Partner Violence
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Pregnancy-associated plasma protein-A
Pregnancy-associated plasma protein-A
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Chorionic villi sampling (CVS)
Chorionic villi sampling (CVS)
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Nuchal translucency testing (NTT)
Nuchal translucency testing (NTT)
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Quadruple screen
Quadruple screen
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Alpha-fetoprotein (AFP)
Alpha-fetoprotein (AFP)
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Amniocentesis
Amniocentesis
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Fundal height
Fundal height
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Quickening
Quickening
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Health Disparities
Health Disparities
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Maternal Mortality Rate
Maternal Mortality Rate
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Weathering Hypothesis
Weathering Hypothesis
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Adolescent Pregnancy
Adolescent Pregnancy
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Couvade Syndrome
Couvade Syndrome
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Sibling Reactions
Sibling Reactions
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Grandparent's Role
Grandparent's Role
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Pregnancy Trimesters
Pregnancy Trimesters
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Due Date Calculation
Due Date Calculation
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Gravida/Para
Gravida/Para
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Initial Data Collection
Initial Data Collection
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First Prenatal Visit
First Prenatal Visit
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Pelvic Examination
Pelvic Examination
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Antepartum Labs
Antepartum Labs
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Noninvasive Prenatal Testing (NIPT)
Noninvasive Prenatal Testing (NIPT)
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Study Notes
Presumptive Signs of Pregnancy
- Nausea/vomiting
- Fatigue
- Increased urinary frequency
- Breast enlargement and tenderness
- Fetal movement (20 weeks)
Probable Signs of Pregnancy
- Goodells sign - cervix softening
- Chadwicks sign - bluish purple coloration of the cervix and vaginal mucosa
- Hegars sign - softening of the lower uterine segment
- Ballottement - pushing on cervix, feeling the fetus moving away
- Positive pregnancy test
Positive Signs of Pregnancy
- Fetal heart auscultation by Doppler
- Fetal movement detected by a practitioner
- Ultrasound
Uterus, Cervix, Vagina
- Increase in uterine size/weight
- Goodells (softening of cervix)
- Hegars (softening of lower uterus)
- Chadwick's (bluish cervix coloration)
- Vaginal mucosa and vulva changes
- Vaginal pH (candidiasis)
- Increased blood flow and vaginal lubrication
Breasts
- Tenderness
- Enlargement (nipples, areola, Montgomery follicles)
- Striae
- Prominent veins due to increased blood flow
- Colostrum
- Nipple color change
Cardiovascular & Respiratory Changes
- Decrease in peripheral vascular resistance (lower blood pressure), increased blood volume (30-50%), hypervolemia, increased heart rate
- Increased RBCs (by 30%) and plasma (by 50%)
- Anemia, hemodilution, increased WBCs (white blood cells)
- Increased fibrin/fibrinogen
- Supine hypotensive syndrome – lay on left side.
- Increased O2 consumption (15-20%)
- Increased respiration rate
- Shortness of breath
- Nasal and sinus congestion
- Epistaxis (nosebleed)
- Vasodilation, increased permeability of respiratory system
- Thoracic breathing
GI & GU Changes
- Increased frequency
- Increased UTI risk
- Increased output
- Dependent edema
- Nausea and vomiting
- Heartburn (smooth muscle relaxation)
- Bloating, flatulence
- Constipation
- Pica
- Gingivitis/bleeding gums
- Increasing plaque build up (on gums)
- Hemorrhoids
Musculoskeletal (MSK) Changes
- Waddle gait
- Increased risk of falls due to change in center of gravity
- Increased elasticity and relaxation of ligaments
- Diastasis recti
Integumentary Changes
- Linea nigra
- Melasma
- Hot flashes
- Perspiration
- Striae gravidarum
- Angiomas (spider veins)
- Palmar erythema
- Increased sebaceous gland secretions
- Oily skin vs glow
Endocrine Changes
- FSH, Progesterone, estrogen, prolactin, oxytocin, hCG (human placental lactogen)
- Increased vascularity of thyroid
- Increased basal metabolic rate
- Increase in cortisol
Nervous System Changes
- Headaches
- Syncope
Psychosocial Aspects of Pregnancy
- Acceptance – profound and irrevocable changes in care-seeking, social acceptance, maternal-fetal attachment
- Family Dynamics – relationship with mother and partner
- Preparation – classes, education, birth plan
- Fear – loss of control, trust in medical staff (compassionate, empathetic, available), pain management
Factors Influencing Adaptation During Pregnancy
- Multiparity / Multigestational (Easier or harder)
- Maternal age (young mothers, older mothers – AMA)
- Family structure (sexual orientation, medical staff – M vs F, single-mothers, adoption, surrogacy, military, SES)
- Intimate Partner Violence (Increases with pregnancy – 1 in 6 women)
- Mental healthcare (concerns with pregnancy issues)
- Financial issues
- Accessibility to health care, daycare, transportation
- Previous birth experiences
Health Disparities Related to Race and Ethnicity
- Black women (three to four times more likely to die in pregnancy, five times more likely to die from pregnancy-related cardiomyopathy and blood pressure disorders than white women)
- Maternal mortality rate for Hispanic women increased by 44% from 2019-2020
- "Weathering Hypothesis" – stress leads to cortisol production which leads to HTN and elevated blood glucose and subsequent insulin resistance. Chronic exposure to social and economic disadvantage leads to accelerated decline in physical health outcomes
- Racism, poverty, bias, alienation, structural inequalities. Unfair access, lack of culturally appropriate services
Pregnant Adolescent
- Competing developmental tasks (of adolescence and those of becoming a mother)
- Priorities (appearance, peer group, own needs)
- Secret pregnancy (may keep it hidden until late in gestation)
- Anxiety informing parents, baby's father, and friends
- Behaviors – ambivalence, resistance, inconsistency
The Father
- Most important person during pregnancy – spouse or partner
- Partner accepting child
- Physical changes – Couvade syndrome
- Psychological changes – ambivalence, strong protective feelings, concerned about ability to be a good father, examining own father-child relationship, unplanned/unwanted pregnancy, may not accept changes in lifestyles/life plans, feeling left out, unsure of relationship after baby born, may engage in extramarital affairs, express disappointment and frustration with violence
- Screening for violence
Siblings
- New baby – major crisis
- Child's age
- Parents' attitudes
- Prepared for the birth?
- Toddlers: clingy, irritable, baby as a story
- Preschool: sense of loss, replaced, jealous
- Older children: interested, questions about conception, pregnancy, and childbirth, being helpful
- Older children and teenagers: embarrassed by parents' sexuality
Grandparents
- Most are pleased
- Remember their own experiences of pregnancy and raising children
- Used as link between generation
- Respond negatively to the news “too young to be grandparents”
- Nonsupport adds stress and decreases self-esteem for the parents-to-be
Nursing Care During Pregnancy
- Initial Data Collection
- Begins with the suspicion of pregnancy
- Diagnosis of pregnancy
- Amenorrhea (no menstruation – usually the first sign)
- Home pregnancy test (ensure correct use)
- Abdominal ultrasonography
- Transvaginal ultrasonography
- Health Promotion
- Schedule first prenatal visit after pregnancy confirmed
- Collect thorough past medical history and current health history
- Encourage questions; answer honestly
- Encourage laboratory test ordering
- Stressing subsequent prenatal visits and care
- Assisting with First Assessments
- Pelvic exam (lithotomy position used), external genitalia examination; culture for sexually transmitted infections
- Observing internal genitalia, particularly cervix for pregnancy signs
- Pelvic/vaginal exam for Pap smear
- Bimanual exam of uterus to determine size and adequacy for vaginal birth, pelvic bone assessment and measurements
- Antepartum Labs
- Complete blood count (CBC)
- Antibody screen
- Blood typing and Rh status
- Rubella titer
- Varicella titer
- Hepatitis B and C
- HIV and STI screening
- Pap smear
- Urinalysis
- Tuberculosis testing
- Glucose tolerance test (GTT)
- Group B Streptococci test (GBS)
- Antepartum Tests
- Teach, provide support, growth scans, confirmation scans, assist in sterile fields, conduct tests, monitor maternal and fetal response
- NIPT – Noninvasive Prenatal Testing
- Find chromosome abnormalities in the baby
- Down syndrome, trisomy 18, trisomy 13
- Look for DNA shed from placenta
- First Trimester Testing
- Pregnancy-associated plasma protein-A (11-13 weeks)
- Fetal ultrasonography
- Chorionic villi sampling (CVS) (11-13 weeks)
- Nuchal translucency testing (NTT) (11-13 weeks)
- Second Trimester Testing
- Quadruple screen (serum markers, 15-20 weeks)
- Alpha-fetoprotein (AFP)
- Human chorionic gonadotropin (hCG)
- Unconjugated estriol (UE)
- Inhibin-A
- Amniocentesis
- Percutaneous umbilical cord sampling (PUBS)
- Fetal Development Data
- Fetal heartbeat (110-160 bpm)
- Quickening
- Subsequent Visits and Care
- Frequency (monthly first 28 weeks, every two weeks until 36 weeks then weekly)
- Current weight, vital signs, physical or psychological concerns, U/A, glucose, ketones, protein, nitrates
- Fundal height, fetal heart rate, psychological assessment, education, intimate partner violence screening
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Description
Overview of the presumptive, probable, and positive signs of pregnancy. Discusses changes to the uterus, cervix, vagina, and breasts during pregnancy, including Goodell's, Hegar's, and Chadwick's signs. Also covers vaginal pH and increased blood flow.
