Exam 2 OB - Preparation For Professional Nursing

Exam 2 OB 1. GTPALM/GP 1. G: Gravida (Number of pregnancies) 2. T: Term (37wks and above 3. P: Preterm (20wks to 36 6/7) 4. A: Abortion (below 20 weeks 5. L: Living children 6. M: Multiple pregnancy 7. G: Number of pregnancies 8. P: Para (Number of deliveries after 20wks) 1. Naegele's rule • 1st day of LPM minus 3 months plus 7 days • Age of viability - 20wks 1. Nulligravida - never been pregnant 2. Nullipara - never have given birth 3. Primigravida - 1st pregnancy (Primps) 4. Multigravida - baby number 2-5 5. Grand multigravida - 6th baby and above 6. Presumptive signs (maybe pregnant) • Urinary frequency • Quickening • Nausea and vomiting : Perile slangement • Goodell's sign: softening of overall cervix • Hagar's sign: softening of lower portion of cervix • Chadwick sign: bluish discoloration of vagina (due to vaginal congestion of blood) • Braxton hicks: 1st trimester = blood flow in tissues: 3rd trimester= body is getting ready for labor • Ballottement: Rebounding as palpating abdomen • Positive pregnancy test: Accurate when following instructions from the box (uterine cancer can and medications can make positive PT) : Peativeses at 10 weeks with doppler (external fetal monitor 17wks and above : Palpating (ai move be by MD) Quickening - felt around 16-20weeks (4-5month) FHT: 110-160bpm Preemie: 170s to 180s Discomforts of pregnancy N/V: normal due to high HCG Intervention: crackers, toast, and ginger ale Excessive vomiting (dropping weight): needs to be seen by MD = hyperemesis gravidarum = fluids IV with electrolytes and antiemetic Constipation 0 Fluids • High fiber • Exercise • Swelling • Make sure do not do strenuous (blood is being shunted away from uterus and high temp = fetal distress) Do not try to lose weight Elevate legs throughout the day Excessive edema (legs, hands, and face) = sign of preeclampsia • Stretching of uterine ligament = happens in 2nd trimester • Support • Lordosis, sciatica, and back-pain = extra weight toward the front o Sacral pressure 0 Pelvic rocking • No balance • Do not wear any high heels and stiletto (flat shoes) • Be careful with showers • Venous congestion/Increase blood clots • No stockings • No tight clothes • Dizziness • Never lie flat instead, do left side lying is the best position Physiological changes Increase growth in breast: getting ready for breastfeeding (can increase one to two cups) Increase melanin = increase pigmentation on areolar, linea negra, chloasma (mask of pregnancy) all of these are going to subside except stretch marks • Growing uterus 12wks: symphysis pubis • 20wks: umbilical 36wks: Xiphoid SOB - will subside when baby drops (lightening) • Lightening: breath better but increase in urine • Sudden SOB and chest pain = pulmonary embolism (report to MD) • Braxton hicks 1st trimester • 3rd trimester • Spotting 1st trimester: Common due to increase hormones, tissues, blood vessels • 3rd trimester: lose mucus plug • Any spotting = report to MD • Increased Clotting factors in 2nd trimester (body is getting for labor, to prevent postpartum hemorrhage) • Will go back within 2weeks postpartum • Risk for PE • Increase blood volume (plasma only) • Anemia • Foods high in iron: lentils, legumes, beef, liver, meat, beans, spinach, iron fortified cereal (seafood = be careful) Iron pills Taken on empty stomach Take with vit. C = increase absorption Increased inspiration and expiration = oxygenating for baby Blood Pressure • Usually goes down by 5-10 • High BP: preeclampsia can cause seizure and organ failure • Sudden increase in BP -> report to MD (20 points or more) •Evaluate, Labs and monitor Preconception care Never recommended to get pregnant without planning • Vaccine should be up to date • Rubella -> teratogenic • Do not get pregnant for 3 months • No live vaccine • Treat STI and STDs (infection) • Nutrition • Adequate folic acid • • Prevents neural tube defects High folic foods: dark green leafy veg, citrus juice, orange 0 Genetic testing • Sickle cell, Tay sacs, down syndrome Prenatal care Monitor to make sure mom will not develop any complycations 0 Gestation DM • HTN • Placenta previa -> low placenta is catastrophic (abruption = massive blood loss) • Monitor baby • Normal FHT • No defect or deformity -> ultrasound Urine o Glucose - possible GDM Protein -> preeclampsia • Ketones -> metabolizing fat due to insufficient nutrition or N/V GTT 0 24 to 28 weeks to Rule out GDM 4 0 Check up First 7 months --> once a month 8th month --> twice a month 9th month -> every week Make sure gaining adequate amount of weight High risk pregnancy --> more frequent Normal BMI -> 25 to 35 lbs. Teenager/underweight -> 35 to 45 lbs. Overweight/obese -> gain Less weight depends on MD 340 more calories in 2nd trimester 500 more calories in 3rd trimester and breastfeeding Nutrition Calcium -> for strong bones of fetus 1200mg/day Foods high in Ca -> dairy, milk, yogurt, cheese, green leafy vegetables, high Ca orange juice and cereal Folic acid Dark green leafy veg, beans, rice, pasta, citrus, breads, cereal Vaccine Tetanus booster, flu shot, Hep B -> allowed vaccine during pregnancy Avoid: Smoking Alcohol -> alcohol fetal syndrome drugs -> can cross placenta Cocaine -> can cause preterm labor (hyperstimulation = abrupt) Caffeine 200mcg/day (2cups of coffee) Ibuprofen Not recommended during third trimester - cause to ductus arteriosus to prematurely close S/sx to report Bleeding Abruption Previa Headache and blurry vision, sudden weight gain, increased BP Preeclampsia Leaking or discharge Ruptured Infection Decrease fetal movement Problem with oxygenation Fever Infection Pyelonephritis Flank pain, N/V