Pregnancy - Quia

Pregnancy - Quia

Pregnancy Anatomy and Physiology Nursing Care Nutrition Chapters 10-12

General Terms, See page 235 Gravida; number of pregnancies Term; 37 complete weeks

Preterm; 20-end of 37 weeks Aborted; spontaneous or therapeutic Living Parity; note this is the number of

fetuses delivered after 20 weeks gestation

GTPAL Questions A woman presents to the clinic in the first trimester of pregnancy. She has three

children living at home. One of them was born prematurely at 34 weeks. The other two were full term at birth. She has a history of one miscarriage. How do you

record her obstetric history using the GTPAL format? Kathy has just given birth to preterm twins. She has a four year old child from another pregnancy as well as had a miscarriage.

How do you record her obstetric history? Signs of pregnancy; page 238 Presumptive

Probable Positive Note that presumptive and

probable signs have other possible causes Table 10-2 Estimating date of Birth;

page 256 Nageles rule Take the first day of the

LMP, subtract 3 months and then add 7 days plus one year OR Take the first day of the

LMP add 7 days and Prenatal Care Schedule First visit in first trimester Monthly visits until 28

weeks Every weeks

Every gestation 2 weeks until 36

gestation week until birth Preconception Visit

To identify risk factors that may harm the health of patient or her fetus To provide counseling on measures to

promote optimum health of patient and fetus Issues include Diabetes screen for high risk Rubella screening

Folic acid intake Optimum weight STD screening; Safer sex practices Genetic screening if necessary

Lab Tests; Page 267 Initial labs, note you must gain consent for HIV testing

Blood and Rh type as well as antibody screen Hct/HGB Rubella VDRL

Urine culture and dip HBsAg 16 weeks gestation screening for neural

tube defects (273) Diabetes screening at 24-28 weeks gestation unless high risk

Elements of Physical Exam at Visits

Blood Pressure Urine dip for protein Evaluation of edema Fetal heart tones Fundal height assessment

Leopolds manuevers in third trimester Changes in the reproductive system Pre pregnancy capacity 10 ml term 5 liters!

Above the symphysis pubis at 12-14 weeks At umbilicus at 22-24 weeks At xyphoid process at 38 weeks. Note the probable signs of pregnancy are due to

changes in the uterus Increased blood flow; by term 1/6 of maternal blood flow is to the uterine vascular system!!

Increased leukorrhea Glycogen rich vaginal environment means increased vulnerability to vaginal infections.

Fundal Height Measurement Is approximately the same in centimeters as gestational age from 18-30 weeks

gestation May detect interuterine growth retardation if the height is stable or decreased May detect multifetal gestation or hydramnios if the height is greater than

expected. Fundal Height Measurement

Breast Changes Increasing Estrogen and Progesterone bring early presumptive breast symptoms

Nipples and areola become more pigmented Increased blood supply Second and Third trimesters growth of the

mammary glands Colostrum may be seen as early as 16 weeks gestation Note that mothers who miscarry after 16

weeks gestation may have milk come in like mothers who deliver their babies. Preparing for Breast feeding

Discuss feeding of infant early in prenatal care Ask open ended questions such as, what have you heard about breast feeding? or

how do you plan to feed your baby? Gently give information on the benefits of breastfeeding to both Mom and Baby Contraindications to breast feeding are:

HIV positive Breast cancer Active tuberculosis???????

Breast feeding and TB according to the CDC Breastfeeding should not be

discouraged for women being treated with the first-line antituberculosis drugs because the concentrations of these drugs in

breast milk are too small to produce toxicity in the nursing newborn. F

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