Antrepartal Period Review Midterm PDF

ANTREPARTAL PERIOD Category A Controlled studies in Possible fetal harm women fail to demonstrate appears remote risk to the fetus on 3rd trimester Category B Anim...

ANTREPARTAL PERIOD Category A Controlled studies in Possible fetal harm women fail to demonstrate appears remote risk to the fetus on 3rd trimester Category B Animal reproduction adverse effect on the 3rd studies have not trimester demonstrated a fetal risk but there are no controlled studies in women Category C Either studies in animals Drugs should be given have revealed adverse only if the potential effects on the fetus and no benefits justify the controlled studies in potential risk to fetus women Category D There is a positive If the drug is needed in a evidence of human fetal life threatening or for a risk but the benefits from serious situation or the pregnant women may disease for which safer be acceptable despite drugs cannot be used or the risk ineffective. Category X Studies in animals or The risk of the use of human being drugs in pregnant demonstrated fetal women clearly outweighs abnormalities or the any possible benefit. evidence of fetal risk The drug is based on human contraindicated in experience or both women who are or may become pregnant RH sensitisation Mother is Rh negative but fetus is Rh positive If the infant’s Rh positive enters the mothers circulation, she perceives this as foreign blood type by making Rh positive in response. Although the current infant is not affected, the next pregnancy is at risk. If the fetus has Rh positive, the mothers anti-Rh positive antibodies will attack the developing fetus causing hemolysis also known as erythroblastosis fetalis  Treatment RhoGAM 300 mcg ABO blood incompatibilities More common than Rh incompatibility but less serious Mothers blood type is O when fetus is A,B or AB O mothers produce anti-A and anti-B antibodies that crosses placenta These antibodies cause red blood breakdown in fetuses in A,B or AB blood types. Causes hyperbilirubinemia: phototherapy is the treatment TORCH infection T= Toxoplasmosis O=Others ( hiv,chlamydia, group B strep) R=Rubella C= Cytomegalovirus H=Herpes TORCH related complications Congenital heart defects Physical fetal anomalies intrauterine growth restriction (IUGR) Mental retardation Encephalitis Hydrocephalus TORCH infection can cross the placenta Place mother and baby in jeopardy due to associated complications Premature labors, premature rupture of the membrane Prenatal screening is important due of some virus are asymptomatic Streptococcus group B is frequent cause of sepsis in mother and neonate HIV in pregnancy Current maternal treatment is oral zidovudine (AZT) during pregnancy and IV AZT during labor. Newborn is also treated with AZT The antibody test will usually convert to negative before 18 months of age Reduce invasive procedures (AROMS, fetal scalp electrodes, IUPCs) Bath the baby as soon as possible after delivery wash with soap and water and cleanse with alcohol  Medical practitioner should wear eye shield , gown, doubler gloves during birth Group B strep infection Not harmful to the mother but cause complications to the infants Vaginal swab screened at 35-37 weeks of gestation because of pathogen can come and go during pregnancy If a positive mother is treated with IV antibiotics while in labor. Must have two separate doses administered every 4 hours before the birth to be treated ALPHA- FETOPROTEIN (AFP) Substance produced by fetal liver Elevated levels may indicate neural tube defect in fetus Decreased levels may indicate DOWN SYNDROME (TRSOMY 21) Abnormal level will necessitate for further testing, amniotic fluid will be asses for accurate findings 10-150 ng/mL is considered normal In pregnant women, elevated AFP concentrations are associated with open neural tube defects, multiple births, fetal demise, fetal distress, congenital defects, low birth weight, placentitis and spontaneous abortion. Abnormally low levels have been associated with poor fetal outcome and chromosomal defects. During pregnancy, if AFP blood levels are higher or lower than normal, it may be sign that: The baby has a high risk of having a genetic disorder, such as: A neural tube defect, which is a serious condition that causes abnormal development of a developing baby's brain and/or spine Domestic violence Pregnant women more abuse than normal population Related to the partner feeling the sense of lack of control or power. Questions to ask: In your relationship do you feel safe? Do you fear for your safety? Substance abuse If the nurse suspected that the mother is a drug user she must sent a urine for a test After the delivery the meconium must sent to the lab for meconium drug screen  NOTIFY if the infant meconium is positive. CPS involvement is mandatory NARCAN SHOULD NOT BE GIVEN to the mother on methadone or heroin as it may precipitate drug withdrawal. Tremors (trembling) Irritability (excessive crying) Sleep problems High-pitched crying Tight muscle tone Hyperactive reflexes Seizures Yawning, stuffy nose, and sneezing Poor feeding and suck Vomiting Diarhea Dehydration Sweating Fever or unstable temperature Rapid breathing -TACHYPNEA 60 bpm Fetal Alcohol Syndrome Microcephaly Growth retardation Short palpebral fissures Maxillary hypoplasia Smooth philtrum Nursing intervention Decrease environmental stimuli Provide gavage feedings if neonate has uncoordinated sucking and swallowing Long term implication of FAS: Mental retardation Poor coordination Facial abnormalities Behavioral deviation (IRRITABILITY) Cardiac and joint abnormalities Routine prenatal visit Blood pressure CBC Weight Abdominal exam Access fetal heart rate (FTH) Assess fetal position Prenatal testing Non stress test (NST) Use to evaluate fetal status WITHOUT uterine contractions Monitors FHR with fetal movement, which accelerate 15 beats per minute for 15 seconds Then should considered as ‘’reassuring’’ Contraction stress test (CST) The uterus is made to contract artificially with the use of pitocin or nipple stimulation Fetal heart monitoring evaluates the respiratory functions (oxygen/carbon) to the placenta Determines if the fetus can withstand the labor This test is no commonly used Amniocentesis : Amniotic fluid removed from the amniotic sac Genetic information Sex of the fetus Chromosomal abnormalities Determine the health or maturity of the fetus lecithin/ sphingomyelin ratio to determine lung maturity ; confirm lung fetal maturity ultrasound is used with this procedure to avoid injury to the fetus Bladder should be full when done at greater than 20 weeks of gestation Bladder should be empty when done at less than 20 weeks of gestation Chorionic villi sampling Sample of tissue (chorionic villi) from the edge of placenta Detects genetic disorders: done at 8-10 weeks Aspiration catheter or biopsy forcep is introduce through cervix guided and monitored by ultrasound Biophysical profile (BPP) Confirms fetal well-being and placental functioning Physiological changes of pregnancy Reproductive system: Uterus Enlarge times 20, irregular, painless contractions Ovarie Ovulation stops due to the high level of placental s estrogen and progesterone Vagina Becomes softer, mucosa thickens,vascularity increases, and become more acidic Breast Increase in size and become full and tender areola  is darken; colostrum is excreted Cervix Cervix soften (goodell’s sign) Becomes congested with blood (chadwick’s sign) Mucus plug forms Musculoskeletal system: Relaxation of joints due to relaxin hormone Widening of symphysis pubis Increase back strain Waddling gail Lordosis (nakatihaya –sigang buntis) Cardiovascular system: Blood volume increases by 30 to 50 % Pulse increases by 10-15 bpm Clotting factor increase that prevent hemorrhage however it increases the risk of DVT RBC mass increases (plasma portion faster before causing physiological anemia) BP basically remain essentially unchanged due to peripheral vasodilation related to progesterone 500-1000 mLs of blood to the uterus per minute Supine hypertension is a problem Hgb is less than-equal to 11g/dL Hct is less than-equal to 33% indicates anemia  The pregnant uterus compressing the aorta and the inferior vena cava Uterine Displacement with the wedge under hip to relief Respiratory system: Oxygen consumption increases about 20% Dyspnea is common Nosebleed and stuffiness are common and related to estrogen Rib cage widens Respiratory depth increases Gastrointestinal system Gums appear red and swollen,and bleed easier due to elevated estrogen Nausea occurs to 50% in first trimester Delayed gastric emptying reduce the tone of esophageal sphincter allows reflux that causes heartburn, cause by progesterone Decrease in motility in large intestine causing constipation and hemorrhoids Gallbladder stone Thirst and appetite increase Urinary system  Frequent urination primarily in the 1st and 3rd trimester Urinary stasis predisposition to urinary tract infection (UTI) Increases renal plasma flow Glucosuria may occur; normal findings Neurological system Loss consciousness Headache Reflexes (DTR’s) light - headedness fainting may due to: Hormones B/P Blood sugars Cardiac problems Anemia Endocrine system: placenta becomes an endocrine organ and produces large amounts of hormones Heat intolerance due vasodilation, fetal and maternal heat production Thyroid gland 25% larger during pregnancy; basal metabolic rate Oxytocin and prolactin are secreted by pituitary gland Endocrine system: placental hormones Estrogen: increases vascularity, levels remain high during pregnancy Progesterone: relaxes all smooth muscles, maintains the endometrium and prevents abortion by relaxing the uterine muscles Human chorionic gonadotropin (hCG) hormones measured in pregnancy tests. Stimulates the corpus luteum to produce estrogen and progesterone until the placenta can assume the function. Human placental lactogen HPL : acts as an insulin antagonist; increases availability of glucose for fetal growth and development  Relaxin: softens connective tissues and relaxes pelvic joints Placenta becomes an endocrine organ and produces large amounts of hormones Heat intolerance due to vasodilation fetal and maternal heat production thyroid gland 25% larger during pregnancy and basic metabolic rate increase 25% Oxytocin and prolactin are secreted by pituitary gland Metabolic changes Protein demand increases Carbohydrate demand increases Glycosuria maybe present Iron need increases Water requirement increases Fluid retention is common Dependent edema in lower extremities Weight gain should be approximately 25- 35 pounds Client should gain 1 pound per week in the 2nd and 3rd trimester Nutritional need during pregnancy Must eat nutritious well balanced meal; vitamin A and D to be found in teratogenic fetus (anything a person is exposed to or ingests during pregnancy that's known to cause fetal abnormalities.) PICA the urge to eat non-nutritious food –related to iron deficiency Nausea and vomiting are related to hCG and estrogen Ginger has been found to be a safe anti- emetic for pregnants Should not consume soft cheeses as they harbor listeria monocytogenes the  organism the cause listeriosis Effects of listeriosis ; meningitis, pneumonia, and sepsis Increase of delivering stillborn babies Don't eat fish …mercury poisoning Specified nutritional needs Protein 60 -65 g/day Calcium 1,200 mg/day Average 2,500 kcal a day; only 300 additional required for pregnants 500 kcal extra for breastfeeding moms Before conception: folic acid 400 mcg/day which prevents neural tube defects such as spina bifida. During pregnancy 600mcg/day