Term
|
Definition
1. Natural-Family Planning Method
2. Abstaining from having sexual intercourse eliminates the possibility of sperm entering a woman's vagina
3. Instructions: Refrain from sexual intercourse; can be associated with saying "no" but can say "yes" to other gratifying sexual activities: affectionate touching, communication, holding hands, kissing, massage, oral/manual stimulation
4. Advantages: most effective, abstinence during fertile period (rhythm method) can also be used but requires knowledge/awareness, can eliminate STDs if no genitalia contact
5. Disadvantages: Requires self control
6. Risks/possible complications/contraindications: no risk if complete abstinence |
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Term
| Coitus Interruptus (Withdrawal) |
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Definition
1. Natural-Family Planning Methods
2. Man withdraws penis from vagina prior to ejaculation
3. Instructions: be aware of fluids leaving the penis
4. Advantages: Possible choice for monogamous couples with no other option (opposed to birth control because of religion)
5. Disadvantages: Most ineffective method, no protection against STDs
6. Risk/possible complications/contraindications: Depends on man's ability to control ejaculation (adolescent boys frequently do not have this), leakage of fluid that contains spermatozoa prior to ejaculation can be deposited in vagina, risk of pregnancy |
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Term
| Calendar Method (Rhythm Method) |
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Definition
1. Natural-Family Planning Method
2. woman records her menstrual cycle by calculating fertile days based on assumption that ovulation occurs about 14 days before onset on next menstrual cycle.
3. Instructions: accurately record the number of days in each cycle counting from first day of menses for 6 cycles, start of fertile period is longest cycle -18 (26 days-18 = 8th day), end of fertile period is longest cycle -11 days (30 days-11=19th day), avoid intercourse during that time (8th-19th day)
4. Advantages: Most useful when combined with basal body temp or cervical mucus method, inexpensive
5. Disadvantages: not a very reliable technique, requires accurate record keeping, requires compliance from both partners in regards to abstinence
6. Risks/possible complications/contraindications: various factors can affect and change time of ovulation and cause unpredictable menstrual cycles, risk of pregnancy |
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Term
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Definition
1. Natural-Family Planning Method
2. Temp will decrease prior to ovulation (can be used to facilitate conception or be used as a natural contraceptive)
3. Instructions: woman is instructed to measure oral temp prior to getting out of bed each morning to monitor ovulation
4. Advantages: inexpensive, convenient, no side effects
5. Disadvantages: reliability can be influenced that can cause inaccurate interpretation (stress, fatigue, illness, alcohol, warmth or coolness of sleeping environment
6. Risks/possible complications, contraindications: risk of pregnancy |
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Term
| Billings Method (Cervical Mucus method) |
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Definition
1. Natural-Family Planning Method
2. Fertility awareness based on ovulation; after ovulation cervical mucus becomes thin and flexible. Ability for mucus to stretch between fingers is greatest during ovulation (spinnbarkeit sign)
3. Instructions: engage in good hang hygiene before and after, begin examining last day of menstrual cycle, obtained from vaginal introitus, do not douche
4. Advantages: woman can begin to recognize her mucus characteristics at ovulation and self-evaluation can be very accurate, self-evaluation can be diagnostically helpful in determining the start of ovulation while breastfeeding, planning pregnancy, and start of menopause
5. Disadvantages: may be uncomfortable touching genitals and mucus
6. Risks/possible complications/contraindications: risk of pregnancy |
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Term
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Definition
1. barrier method
2. instructions: place condom on erect penis, leave empty space for sperm reservoir, following ejaculation hold rim and withdraw to prevent spillage, may be used in conjunction with spermicidal gel or cream
3. Advantages: may be used to protect STDs
4. disadvantages: high rate of noncompliance, may reduce spontaneity of intercourse, penis must be erect to apply condom, if penis is withdrawn while still erect, can interfere with sexual intercourse
6. Risks/possible complications/contraindications: condoms can rupture/leak, have a one-time usage, cannot only be used by people allergic to latex, only water-soluble lubes can be used |
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Term
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Definition
1. barrier method
2. dome-shaped cup with a flexible rim made of latex or rubber that fits snugly over the cervix with the spermicidal cream or gel placed into the dome and around the rim
3. Instructions: female should be properly fitted, must be refitted every 2 years/15 lb weight change/full-term pregnancy/second-term abortion, requires proper insertion/removal with spermicidal jelly or cream on cervical side and around rim, in place 6 hrs post coitus, must spermicide reapplied each time, empty bladder prior to insertion
4. Advantages: eliminates surgery and gives woman more control
5. Disadvantages: inconvenient, interfere with spontaneity, require reapplication with spermicidal gel/cream/foam, requires prescription and visit to provider, must be inserted correctly
6. Risks/possible complications/contraindications: not for those who have hx of TSS or frequent UTIs, increased risk of TSS, cannot be worn by those allergic to latex |
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Term
| Combined oral contraceptives |
|
Definition
1. hormonal method
2. contains estrogen (suppress ovulation) and progestin (thicken cervical mucus to block semen), also alters uterine decidua to prevent implantation
3. Instructions: requires prescription and follow-up appt., med requires consistent and proper usage, observe for side effects (chest pain, SOB, leg pain from poss. clot, headache, eye problems, HTN). Miss a dose? Take missed pill ASAP, if 2 or 3 are missed, follow instructions and use alternate method.
4. Advantages: highly effective, can alleviate dysmenorrhea by decreasing menstrual flow and menstrual cramps, reduce acne
5. Disadvantages: no STD protection, can inc. risk of thromboses, breast tenderness, scant/missed menstruation, stroke, nausea, headaches, hormone-dependent cancers, teratongenic; exacerbates conditions affected by fluid retention (migraine, epilepsy, asthma, kidney, heart disease)
6. Risks/possible complications/contraindications: not advised to take if hx of blood clots, cerebrovascular accident, cardiac problems, breast/estrogen cancers, pregnancy, or smoking if over 35; effectiveness can decrease if taking antibiotics and anticonvulsants |
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Term
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Definition
1. Hormonal method
2. Oral progestins that provide same action as combined oral contraceptives
3. Instructions: take pill at same time daily to ensure effectiveness secondary to a low dose of progestin, cannot miss a pill, may need another form of birth control during 1st month
4. Advantages: fewer side effects than combined, safe during breastfeeding
5. Disadvantages: less effective in suppressing ovulation than combined, increases occurrences of ovarian cyst, no STD protection, frequent breakthrough/irregular vaginal bleeding and lowered libido, increases appetite
6. Risks/possible complications/contraindications: antibiotics and anticonvulsants decrease effectiveness |
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Term
| Emergency Oral Contraceptive |
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Definition
1. Hormonal Method
2. morning after pill that prevents fertilization from taking place
3. Instructions: taken within 72 hrs of unprotected coitus, OTC anti-emetic recommended 1 hr prior to counteract S/E of nausea, no menstruation in 21 days-recommend pregnancy test, provide client with counseling about contraception and risky sexual behaviors, considered form of "emergency birth control"
4. Advantages: not taken on regular basis, can be obtained w/put prescription if 17+
5. Disadvantages: nausea, heavier than normal menstrual bleeding, lower abd pain, fatigue, headache; no long-term contraception, does not terminate est. pregnancy; no STD protection
6. Risks/possible complications/contraindications: do not take if pregnant or undiagnosed abnormal vaginal bleeding, if menstruation does not start within 1 wk or normal time, might be pregnant |
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Term
| Transdermal Contraceptive Patch |
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Definition
1. Hormonal method
2. contains norelgestromin (progesterone) and ethinyl estradiol delivered at cont. level thru subQ tissue
3. Instructions: apply patch to dry skin overlying subQ tissue of buttock, abd, upper arm, or torso (excluding breast area); replace once a wk; applied same day a week for 3 wks, no application on 4th wk.
4. Advantages: maintins consistent blood levels of hormone, avoids liver metabolism of med since not absorbed in GI tract, decreases risk of forgetting daily pill.
5. Disadvantages: no STD protection, same side effects as oral contraceptives, skin rxn may occur
6. Risks/possible complications/contraindications: same as oral contraceptives, avoid applying patch to skin rashes/lesions |
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Term
| Injectable Progestins (Depo-Provera) |
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Definition
1. Hormonal method
2. IM injection given every 11-13 wks
3. Instructions: start of injections should be during first 5 days of period and every 11-13 wks thereafter, advise to keep follow-up instructions, should maintain an adequate intake of calcium and vit. D
4. Advantages: very effective and only requires 4 injections per year, does not impair lactation
5. Disadvantages: can prolong amenorrhea, irregular/unpredictable bleeding or spotting, inc. risk of thromboembolism, dec. bone mineral density (loss of Ca), no STD protection, should only be used for more than 2 years if other methods are inadequate
6. Risks/possible complications/contraindications: avoid massaging injection site which accelerates absorption |
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Term
| Contraceptive Vaginal Ring (NuvaRing) |
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Definition
1. hormonal method
2. contains etonogestrel and ethinyl estradiol that is delivered at cont. levels vaginally
3. instructions: insert ring vaginally, replace after 3 wks and new ring within 7 days, insertion on same day montly
4. advantages: does not have to be fitted, dec. risk of forgetting to take pill
5. disadvantages: no STD protection, same side effects as oral contraceptives, some report discomfort during intercourse
6. risks/possible complications/contraindications: blood clots, HTN, stroke, Heart attack, vaginal irritation, inc. vaginal secretions, headache, weight gain, nausea |
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Term
| Implantable Progestin Etonogestrel (Implanon) |
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Definition
1. hormonal method
2. requires minor surgical procedure to subdermally implant and remove a single rod containing etonogestrel on inner side of the upper aspect of the arm
3. instructions: avoid trauma to area of implantation
4. advantages: effective cont. contraception for 3 years, reversible, con be used by mothers who are breastfeeding 4 wks postpartum
5. disadvantages: etonogestrel can cause irregular menstrual bleeding and does not protect against STDs, most common side effect is irregular and unpredictable menstruation, headache
6. Risks/possible complications/contraindications: Increased risk of ectopic pregnancy if pregnancy occurs |
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Term
| Intrauterine device (IUD) |
|
Definition
1. hormonal method
2. chemically active t-shaped device that is inserted thru cervix and placed in uterus by primary care provider; releases chemical substance that damages sperm in transit to the uterine tubes and prevents fertilization
3. Instructions: device must be monitored monthly by client after period, ro assure presence of small string that hangs from device to rule out expulsion or migration
4. Advantages: maintain effectiveness for 1-10 years, can be reversed, does not interfere with spontaneity, safe for breastfeeding mothers, 99% effective in preventing pregnancy
5. disadvantages: can increase risk of pelvic inflammatory disease, uterine perforation, or ectopic pregnancy; should report late or abnormal spotting or bleedings, abd pain/pain with intercours, abdnormal or foul smelling vaginal discharge, fever, chills, change in string length or missing; no STD protection
6. Risks/possible complications/contraindications: not for women who have not had children or are not in monogamous relationship, may cause irregular menstrual bleeding, risk of bacterial vaginosis, uterine perforation, uterine expulsion, must be removed in event of pregnancy |
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Term
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Definition
1. transcervical sterialization
2. insertion of small flexible agents thru vagina into cervix and fallopian tubes that results in scar tissue in tubes preventing conception; exam after 3 months to ensure tube blockage
3. instructions: normal activities may be resumed by most clients within 1 day
4. advantages: quick procedure w/out general anesthesia, nonhormonal, 99.8% effective, rapid return to normal ADLs
5. disadvantages: not reversible, not for postpartum client, delay in effectiveness of 3 months, changes in menstrual patterns
6. risks/possible complications/contraindications: perforation can occur, unwanted pregnancy if have unprotected intercourse in first 3 months, inc. risk of ectopic pregnancy |
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Term
| Female sterilization (bilateral tubal ligation salpingectomy) |
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Definition
1. surgical method
2. surgical procedure consisting of severance and/or burning or blocking of fallopian tubes
3. procedure: cutting/burning/blocking of fallopian tubes to prevent the ovum from being fertilized by the sperm
4. advantages: permanent, unaffected sexual function
5. disadvantages: surgical procedure carrying risks related to anesthesia complications, infection, hemorrhage, or trauma; considered irreversible
6. risks/possible complications/contraindication: risk of ectopic pregnancy if pregnancy occurs |
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Term
| Male sterilization (Vasectomy) |
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Definition
1. surgical method
2. surgical procedure consisting of ligation and severance of the vas deferens
3. procedure: cutting of vas deferens, not effective for 20 ejaculations or 1 wk to several months to allow all sperm to exit vas deferens. Complete male infertility
4. Instruction: Scrotal support and moderate activity for a couple of days to reduce discomfort, sterility is delayed until all remaining sperm ejaculated (20 ejaculations), alternative form must be used until then, follow up appt. for sperm count
5. Advantages: permanent, procedure is short, safe, simple; no impaired sexual function
6. Disadvantages: requires surgery, considered irreversible
7. risks/possible complications/contraindications: rare but may include bleeding, infection, and anesthesia rxn. |
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Term
|
Definition
inability to conceive despite engaging in unprotected sexual intercourse for a period of at least 12 months
Common factors: decreased sperm prod., endometriosis, ovulation disorders, and tubal occlusions |
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Term
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Definition
1. Age: older than 35 years
2. Duration of infertility: more than 1 year of coitus w/out contraceptives
3. Med hx: atypical secondary sexual characteristic such as abnormal body fat distribution or hair growth, which is indicative of an endocrine disorder
4. Surgical hx: particularly, pelvic and abd. procedures
5. obstetric hx: past episodes of spontaneous abortions
6. gyno hx: abnormal uterine contours or any hx of disorders that may contribute to the formation of scar tissue that can cause blockage of ovum or sperm
7. Sexual hx: intercourse freq., # partners across lifespan, any hx of STDs
8. Occupational/environmental exposure risk assessment: exposure to hazardous teratogenic materials in the home or at a place of employment
9. Weight: women under or overweight |
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Term
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Definition
1. Semen collection
2. Pelvic exam
3. Ultrasonography
4. Hysterosalpingography
5. Hysteroscopy
6. Laparoscopy |
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Term
| Infertility Procedure: Semen collection |
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Definition
1. Semen is sterilely collected then evaluated and analyzed
2. 40% of couples who are infertile and unable to conceive is due to male infertility
3. Preferred starting point in evaluating couple b/c costs less and is less invasive |
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Term
| Infertility Procedure: Pelvic exam |
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Definition
1. assesses for for uterine or vaginal anomalies.
2. Nurse positions client and has equipment and supplies ready |
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Term
| Infertility Procedure: Ultrasonography |
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Definition
| 1. Transvaginal or abdominal ultrasound procedure performed to visualize female reproductive organs |
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Term
| Infertility Procedure: Hysterosalpingography |
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Definition
1. outpatient Radiological procedure where dye is used to assess patency of fallopian tubes.
2. Nurse should obtain hx and allergies to iodine and seafood |
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Term
| Infertility Procedure: Hysteroscopy |
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Definition
| 1. Radiographic procedure where uterus is examined for signs of defect, distortion, or scar tissue that may impair successful impregnation |
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Term
| Infertility Procedure: Laparoscopy |
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Definition
1. Procedure where gas insufflation is used to observe internal organs
2. May cause postprocedural pain
3. General anesthesia is required |
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Term
| Nursing interventions for Infertility |
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Definition
1. Encourage couples to express and discuss their feelings
2. Monitor for side effects associated with meds to treat female and male infertility
3. advise the use of meds to treat female infertility may increase the risk of multiple births by more than 25%
4. provide info regarding assisted reproductive therapies
5. Make referrals to support groups |
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Term
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Definition
1. Recommended if family hx of birth defects or if maternal age is <16 or >35
2. Identify clients who may need it and make referrals
3. Prenatal assessment of genetic disorders can post potential risks to the fetus
4. Provide and clarify information |
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Term
| Nursing Intervention for Genetic Counseling |
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Definition
1. Assist in construction of family med hx of several generations
2. Provide emotional support
3. Make referrals to support groups |
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Term
| Presumptive signs of pregnancy |
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Definition
Changes that are experienced by the woman that make her think she may be pregnant. Changes may be subjective symptoms or objective signs.
1. Amenorrhea
2. Fatigue
3. Nausea and vomiting
4. Urinary frequency
5. Breast changes (darkened areola, enlarged Montgomery's tubules)
6. Quickening (slight fluttering movements of the fetus felt by a woman, usually betw. 16-20 wks)
7. Uterine enlargement
8. Linea nigra
9. Chloasma (mask of pregnancy)
10. Striae gravidarum |
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Term
| Probable signs of pregnancy |
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Definition
Changes that make the examiner suspect a woman is pregnant (primarily related to physical changes of the uterus)
1. Abdominal enlargement related to changes in uterine size, shape, and position
2. cervical changes
3. Hegar's sign (softening and compressibility of lower uterus)
4. Chadwick's sign (deepened violet-bluish color of vaginal mucosa secondary to increased vascularity of the area)
5. Goodell's sign (softening of cervical tip)
6. Ballottement (rebound of unengaged fetus)
7. Braxton Hicks contractions (false contractions, painless, irregular, and usually relieved by walking)
8. Positive pregnancy test
9. Fetal outline felt by examiner |
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Term
| Positive signs of pregnancy |
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Definition
Signs that can only be explained by pregnancy
1. Fetal heart sounds
2. Visualization of fetus by ultrasound
3. Fetal movement palpated by an experienced examiner |
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Term
| Verifying Possible Pregnancy Using Serum and Urine Pregnancy Testing |
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Definition
1. Serum and urine tests provide an accurate assessment for the presence of human chorionic gonadotropin (hCG).
2. hCG can be detected 6-11 days in serum and 26 days in urine after conception following implantation
3. Prod. of hCG begins with implantation, peaks at about 60-70 days of gestation and then declines until about 80 days where it then gradually increases until term
4. Higher levels of hCG may indicate multifetal, ectopic pregnancy or hydatidiform mole (gestational trophoblastic disease) or a genetic abnormality
5. Lower levels of hCG may suggest a miscarriage or ectopic pregnancy
6. Some medications (anticonvulsants, diuretics, tranquilizers) can cause false-positive or false-negative pregnancy results
7. Urine samples should be first-voided morning specimens |
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Term
| Calculating Delivery Date |
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Definition
1. Nagele's rule: take 1st day of woman's last menstrual cycle, subtract 3 months, and then add 7 days and 1 year
2. McDonald's method: measure uterine fundal height in cm from the symphysis pubis to the top of the uterine fundus (betw. 18-30 wks). Age is equal to fundal height |
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Term
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Definition
Number of pregnancies
1. Nulligravida: never pregnant
2. Primigravida: in 1st pregnancy
3. Multigravida: 2+ pregnancies |
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Term
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Definition
# pregnancies in which fetus or fetuses reach viability (20-24 wks); does not matter if fetus is born alive
1. Nullipara: no viable pregnancy
2. Primipara: completed 1 pregnancy to viability
3. Multipara: 2+ pregnancies to viability |
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Term
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Definition
Gravity
Term Births (38+ wks)
Preterm Births (20-37 wks)
Abortions/Miscarriages (prior to viability)
Living Children |
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Term
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Definition
Gravity
Para (more than twenty weeks
Abortion (less than 20 wks)
If pregnant: (P+A)-1=G
If not pregnant P+A=G |
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Term
| Physiological Status of Pregnant Client |
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Definition
Reproductive: uterus will inc. in size and change shape and position. Ovulation and menses cease
Cardiovascular: CO and blood volume increase (45-50% at term) to meet the greater metabolic needs. HR increases
Respiratory: maternal O2 needs increase. During last trimester, size of chest may enlarge, allowing for lung expansion as uterus pushes upward. Increased respiratory rate and decreased total lung capacity
Musculoskeletal: body alterations and weight increase necessitate an adjustment in posture. Pelvic joints relax
GI: N/V may occur b/c of hormonal changes and/or increase of pressure in abd. cavity as stomach and intestines are displaced within abd. Constipation may occur due to increased transit time of food through GI system and thus, increased h2o absorption.
Renal: filtration rate increases during pregnancy secondary to influence of pregnancy hormones and increase in blood volume and metabolic demands. Amt of urine produced remains the same. Urinary frequency is common during pregnancy
Endocrine: placenta becomes an endocrine organ that produces large amts. of hCG, progesterone, estrogen, human placental lactogen, and prostaglandins. Hormones are very active during pregnancy and function to maintain pregnancy and prepare the body for delivery. |
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Term
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Definition
1. Pregnant woman requires support from family as her body changes
2. First trimester: physiological changes not very noticeable, many women anxiously wait for when pregnancy will be more noticeable.
3. Rapid physical changes during 2nd trimester. Most obvious in abdomen and breast enlargement. Skin changes (stretch marks and hyperpigmentation of face-chloasma). May find herself losing balance and feeling back/leg discomfort and fatigue.
4. All changes may lead to negative body image; may make statements of resentment towards pregnancy and express desires for it to be over. |
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Term
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Definition
1. BP remain in prepregnancy range during 1st trimester then decreases 5-10 mmHg during 2nd then after 20 wks back to prepregnancy baseline
2. Position of woman affects her BP, supine may lower it because of the pressure on the vena cava
3. Pulse increases 10-15/min around 20 wks and remains elevated
4. Respirations increase by 1-2/min; attributed to elevation of diaphragm by as much as 4 cm and changes to chest wall to facilitate increased maternal O2 demands
5. some SOB |
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Term
| Supine Hypotensive Syndrome or Supine Vena Cava Syndrome |
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Definition
caused from when the mother is in supine and the weight of the baby on the vena cava causes a decline in BP.
Signs/Symptoms: dizziness, lightheadedness, pale/clammy skin.
Encourage maternal positioning: left-lateral side, semi-fowler's position |
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Term
| Expected Physical Assessment Findings |
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Definition
1. Fetal Heart Tones heard at normal baseline rate of 110-160/min with reassuring FHR acceleration noted, which indicates an intact fetal CNS
2. Heart will change in size and shape with resulting cardiac hypertrophy to accommodate increased blood volume and increased cardiac output.
3. Altered heart sounds: more distinguishable splitting of S1 and S2 with S3 heard more easily heard following 20 wks. Murmurs may also be ausc. Heart size and shape will return to normal shortly after delivery.
4. Uterine size changes from uterine weight of 50-1000g by 36 wks, top of uterus and fundus will reach xiphoid process; pregnant woman will experience SOB as uterus pushes against diaphragm
5. Cervix becomes a purpleish-blue color that extends into vagina and labia. Known as Chadwick's wign. Markedly softens in consistency (Goodell's sign)
6. Breasts increase in size and areolas darken b/c of hormones
7. Chloasma: mask of pregnancy (pigmentation increases on face)
8. Linea nigra: dark line of pigmentation from umbilicus extending to pubic area
9. Striae gravidarum: stretch marks most notably found on abd. and thighs |
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Term
| Nursing interventions for pregnant client |
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Definition
1. offer encouragement in sharing feelings; create judgment free zone
2. discuss expected physiological changes and postpartum timeline to return to prepregnancy state
3. assist in goal making for self-care and newborn care postpartum
4. if body image starts to have negative impact on pregnancy, refer to counseling
5. provide edu. on expected physiological and psychological changes
6. encourage client to keep all follow-up appts and contact immediately if any bleeding, leakage of fluid, or contractions at any point. |
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Term
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Definition
| dramatically reduces infant and maternal morbidity and mortality rates by early detection and treatment of potential problems; majority of birth defects occur betw. 2-8 weeks of gestation |
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Term
| Nursing Assessments in Prenatal care |
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Definition
1. Reproductive and obstetrical hx (contraception use, gyno diagnoses, OB difficulties)
2. Medical hx, including immune status (rubella, hep B)
3. Family hx (i.e. genetic disorders)
4. Any recent or current illnesses or infections
5. Current meds, substance abuse, alcohol consumption. (be nonjudgmental!)
6. Psychosocial hx
7. Any hazardous environmental exposures, current work conditions
8. Current exercise and diet habits
9. Client's goals for birthing process as well as various birthing methods (Lamaze, pain control) |
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Term
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Definition
Begins with initial assessment
If uneventful pregnancy, have visit every month for 7 months, every 2 wks during 8th month, and every wk during last month |
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Term
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Definition
Determine estimated date of delivery based on last menstrual period. Vaginal ultrasound may be done to establish estimated date of delivery
Obtain medical and nursing hx: past med health, family hx, social supports, review of systems (for risk factors), past OB hx
Physical exam to include baseline weight, VS, pelvic exam. Empty bladder prior to exam
Initial lab work: blood type, Rh factor, HIV status, hep B, venereal disease research lab, rubella status, urinalysis, Papanicolaou test |
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Term
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Definition
monitor weight, BP, urine for glucose/protein/leukocytes, edema
monitor fetal development
1. FHR heard by doppler at 10-12 wks or ultrasound steth at 16-20 wks. Listen at midline right about symphysis pubis
2. Measure fundal height after 12 wks, between 18-30 fundal height in cm = weeks of gestation. Empty bladder then measure from level of symphysis pubis to upper border of fundus
3. Assess for fetal movement betw. 16-20 wks.
Provide edu. for self care and ways to manage common discomforts (N/V, fatigue, backache, varicosites, heartburn, activity, sexuality)
Pelvic exam to determine status of reproductive organs and birth canal to determine if baby will be able to pass thru.
Assess for costovertebral angle tenderness, indicative of renal infection |
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Term
Routine Lab Test in Prenatal Care
Blood type, Rh-factor, presence of irregular antibodies |
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Definition
Determines risk for maternal-fetal blood incompatibility (erythroblastosis fetalis) or neonatal hyperbilirubinemia.
If mom is Rh-negative and not sensitized, indirect Coombs' test will be repeated at 24-28 wks |
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Term
Routine Lab Test in Prenatal Care
CBC with differential, Hgb, Hct |
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Definition
| Detects infection and anemia |
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Term
Routine Lab Test in Prenatal Care
Hgb electrophoresis |
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Definition
| Identifies hemoglobinopathies (sickle cell anemia and thalassemia) |
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Term
Routine Lab Test in Prenatal Care
UA with microscopic exam of pH, specific gravity, color, sediment, protein, glucose, albumin, RBCs, WBCs, casts, acetone, and human chorionic gonadotropin |
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Definition
| Identifies diabetes mellitus, gestational HTN, renal disease, and infection |
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Term
Routine Lab Test in Prenatal Care
One-hour glucose tolerance |
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Definition
oral ingestion or IV admin of concentrated glucose with venous sample taken 1 hr later (no fasting necessary)
identifies hematuria; done at initial visit for at-risk clients, and at 24-28 wks for all pregnant women
result of >140 mg/dL requires follow up |
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Term
Routine Lab Test in Prenatal Care
Three-hour glucose tolerance |
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Definition
Fasting overnight prior to oral ingestion or IV admin of concentrated glucose witha a venous sample taken 1, 2, 3 hours later
used in clients with elevated 1-hr glucose test as a screening tool for diabetes mellitus.
Diagnosis of gestational diabetes requires two elevated blood-glucose readings |
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Term
Routine Lab Test in Prenatal Care
Papanicolaou (PAP) test |
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Definition
| Screens for cervical cancer, herpes simplex type 2, and/or human papillomavirus |
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Term
Routine Lab Test in Prenatal Care
Vaginal/Cervical culture |
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Definition
| Detects streptococcus B-hemolytic, Group B (routinely obtained at 35-37 weeks), bacterial vaginosis, or STDs (gonorrhea and Chlamydia |
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Term
Routine Lab Test in Prenatal Care
Rubella Titer |
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Definition
| Determines immunity to rubella |
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Term
Routine Lab Test in Prenatal Care
PPD (TB screening), |
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Definition
Chest screening after 20 wks with positive purified protein derivative
Identifies exposure to TB |
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Term
Routine Lab Test in Prenatal Care
Hep B screen |
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Definition
| Identifies carriers of hep B |
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Term
Routine Lab Test in Prenatal Care
Venereal disease research lab |
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Definition
| Syphilis screening mandated by law |
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Term
Routine Lab Test in Prenatal Care
HIV |
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Definition
| Detects HIV infections (recommended for all pregnancies) |
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Term
Routine Lab Test in Prenatal Care
Toxoplasmosis, other infections, rubella, cytomegalovirus, herpes virus (TORCH) screening when indicated |
|
Definition
| Screening for a group of infections capable of crossing the placenta and adversely affecting fetal development |
|
|
Term
| Materal serum alpha-fetoprotein (MSAFP) |
|
Definition
Screening occurs betw. 15-22 wks
Used to rule out Down's, neural tube defects |
|
|
Term
| Prenatal education: Health Promotion |
|
Definition
Avoid all OTC meds, supplements, and prescription meds unless OB okays it.
No alcohol (birth defects) or tobacco (low birth weight) or substance abuse
Encourage flu vaccine, treating infections, obtaining genetic testing/counseling
Determine maternal exposure to hazardous materials
Moderate exercise of 30 min (walking, swimming) daily; no hot tubs or saunas; drink 2-3 L of water/fluids daily |
|
|
Term
| Prenatal education: Preparation for Pregnancy and Birth |
|
Definition
Provide anticipatory teaching regarding: physical/emotional changes and interventions to provide relief; danger signs/symptoms to report; various birthing options
First trimester: physical/psychosocial changes, common discomforts and how to provide relief, lifestyle and STDs, possible complications and what to report, fetal growth and development, prenatal exercise, expected lab testing
Second Trimester: benefits of breastfeeding, common discomforts and relief measures, lifestyle, fetal movement, complications, childbirth prep
Third trimester: childbirth prep (classes, breathing, pain management, signs/symptoms of preterm labor and labor, labor process, infant care, postpartum care), fetal movement/kick (less than 3/hr or none in 12 hr requires eval), diagnostic test for fetal well-being (nonstress test, biophysical profile, ultrasound, contraction stress test) |
|
|
Term
| Common discomforts of pregnancy |
|
Definition
1. N/V in first trimester; try crackers or toast before getting out of bed; avoid empty stomach, greasy/spicy/gas-forming foods
2. Breast tenderness
3. Urinary frequency: empty bladder frequently, decrease fluid intake before bedtime, use perineal pads, practice Kegals
4. UTIs: decrease by encouraging client to wipe front to back, avoid bubble baths, wearing cotton underpants, avoid tight-fitting pants, and consume water; urinate pre/post sex, do not retain urine, notify provider if malodorous or contains blood/pus
5. Fatigue during 1st and 3rd trimesters; engage in frequent rest periods
6. Heartburn during 2nd and 3rd b/c of stomach displacement from uterus and slowing of digestion from hormones; eat small frequent meals, sit for 30 min post meal, OTC antacids, do not get too empty or full
7. Constipation during 2nd and 3rd; drink plenty fluids, high fiber, exercise regularly
8. Hemmorrhoids during 2nd and 3rd; warm sitz bath, witch hazel pads and topical ointments
9. Backaches during 2nd-3rd; exercise regularly, perform pelvic tilt exercises, proper body mechanics
10. SOB/dyspnea b/c diaphragm is elevated; maintain good posture, sleep with extra pillows and contact if symptoms worsen
11. Leg cramps during 3rd b/c of compression of nerves and vessels by uterus; massage and apply heat
12. Varicose veins and lower extremity edema during 2nd-3rd; rest with legs elevated, avoid constricting clothing, wear support hose, do not cross legs, sleep in left lateral, change positions often, frequent walking
13. Gingivitis, nasal stuffiness and epistaxis from elevated estrogen levels; gently brush teeth, use humidifier, use NS nose drops/spray
14. Braxton Hicks contractions; change in position or walking may make them subside.
15. Supine hypotension (disc. earlier) |
|
|
Term
| Danger Signs during Pregnancy |
|
Definition
1. Gush of fluid from vagina prior to 37 wks
2. Vaginal bleeding
3. abd pain
4. changes in fetal activity
5. persistent vomiting
6. severe headaches
7. elevated temperature
8. dysuria
9. blurred vision
10. edema of face/hands
11. epigastric pain
12. concurrent occurrence of flushed dry skin, fruity breath, rapid breathing, increased thirst and urination, headache
13. concurrent occurrence of clammy pale skin, weakness, tremors, irritability and lightheadedness |
|
|
Term
| Dick-Read Birthing Method |
|
Definition
"Childbirth without fear", controlled breathing and conscious/progressive relaxation of different muscle groups throughout body
instructs a woman to relax during contractions and keep all muscles except uterus relaxed |
|
|
Term
|
Definition
| Mission is to promote a healthy, natural, and safe approach to pregnancy, childbirth and early parenting by advocating and working with health care providers, parents and professional childbirth educators |
|
|
Term
|
Definition
method is "birth without violence", environmental variables imp. to ease transition of fetus into world. Water births are based on this method
dim lights, soft voices, warm birthing room |
|
|
Term
|
Definition
stresses partner's involvement as birthing coach.
Emphasizes increasing self awareness and teaching woman to deal with stress of labor by tuning into her own body; encouraged to trust her body through the use of natural breathing, relaxation, nutrition, exercise, and edu. throughout pregnancy |
|
|
Term
| Recommended weight gain during pregnancy |
|
Definition
25-35 lbs total
3-4 lbs during 1st
1 lb per wk during last 2 |
|
|
Term
| Nutrition plan of care for pregnant client |
|
Definition
Outcome: consume recommended dietary allowances/nutrients during pregnancy
Interventions: assess dietary journal on next visit, provide educational materials regarding nutritional benefits, weigh client and monitor for signs of inadequate weight gain, make referral if needed
Evaluation: adequate weight gain? client compliant with nursing plan of care? |
|
|
Term
| Caloric Increases during pregnancy |
|
Definition
1. Increase of 340/day during 2nd trimester
2. Increase of 452/day during 3rd trimester
3. Breastfeeding = 330/day during first 6 mo., additional 400/day during second 6 mo. |
|
|
Term
| Protein and folic acid intake during pregnancy |
|
Definition
Folic acid crucial in neurological development and prevention of neural tube defects
Foods high in folic acid = leafy vegetables, dried peans/beans, seeds, OJ, breads, cerals, other grains fortified with folic acid
600 mcg of folic acid during pregnancy
500 mcg of folic acid during lactation |
|
|
Term
| Iron intake during pregnancy |
|
Definition
Supplements often given to facilitate increase of maternal RBC mass.
Best absorbed betw. meals and when given with good source of vitamin C; milk/caffeine interfere with absorption
Good sources: beef liver, red meats, fish, poultry, dried peas/beans, fortified cereals/breads
May cause constipations (give stool softener) |
|
|
Term
| Calcium intake during pregnancy |
|
Definition
involved in bone and teeth formation
Good sources: milk, calcium fortified soy milk, fortified OJ, legumes, dark green leafy vegetables
1,000 mg/day for pregnant and nonpregnant over 19
1300 mg/day for those under 19 |
|
|
Term
| Fluids, caffeine, alcohol consumption during pregnancy |
|
Definition
2-3L of fluids daily: water, fruit juice, milk
300 mg/day max of caffeine
No alcohol consumption |
|
|
Term
| Risk factors to ensuring adequate nutrition during pregnancy |
|
Definition
1. adolescents who may have poor nutritional habits
2. vegetarians who have low protein, Ca, Zn, Fe, vit. B12
3. N/V
4. anemia
5. Eating disorders: anorexia, bulmia
6. Pica appetite disorder
7. Excessive weight gain
8. Financially unable to purchase/access food (recommend WIC) |
|
|
Term
| Dietary complications during pregnancy |
|
Definition
1. Nausea: eat dry crackers or toast; avoid alcohol/caffeine/fats/spices; avoid drinking fluids with meals
2. constipation: increase fluid consumption and include extra fiber
3. Maternal phenylketonuria (PKU): maternal genetic disease in which high levels of phenylaline pose danger to fetus. Resume PKU diet 3 mo. prior to pregnancy and throughout pregnancy; avoid fish/poultry/meat/eggs/nuts/dairy; monitor fetal blood levels to avoid complications such as mental retardation and behavioral probs. |
|
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Term
| Lactating woman's nutritional plan |
|
Definition
Instructions to:
1. Increase caloric intake
2. increase oral fluids
3 increase protein intake
4. avoid alcohol and caffeine
5. avoid food substances that do not agree with newborn
6. adhere to recommended, well-balanced diet
7. take Ca supplements if needed |
|
|
Term
|
Definition
lasts approx. 20 min, consists of high-frequency sound waves to visualize internal organs/tissues by producing real time 3D image of fetus and maternal structures
Allows for early diagnosis of complications to decrease neonate and maternal morbidity |
|
|
Term
| External abdominal ultrasound |
|
Definition
| Noninvasive, painless, safe procedure after 1st trimester. Ultrasound transducer is moved over abdomen to obtain image. |
|
|
Term
| Internal transvaginal ultrasound |
|
Definition
Invasive procedure where probe is inserted vaginally and allows for more accurate evaluation; does not require full bladder
used in 3rd trimester in conjunction with abd. scan to evaluate for preterm labor
esp. useful for obese and in 1st trimester to detect ectopic pregnancy, identify abnormalities, help est. gestational age |
|
|
Term
| Doppler ultrasound blood flow analysis |
|
Definition
external ultrasound to non invasively study maternal-fetal blood flow by measuring velocity by which RBCs are traveling in uterine and fetal vessels
useful in fetal intrauterine growth restriction (IUGR), identifying poor placental perfusion, as adjunct in pregnancies at risk because of HTN, diabetes mellitus, multiple fetuses, or preterm labor |
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|
Term
| Indications for Ultrasound |
|
Definition
Potential diagnosis for:
1. confirming pregnancy
2. confirming gestational age via biparietal diameter
3. identifying multifetal pregnancy
4. site of fetal implantation (uterine or ecotopic)
5. assessing fetal growth and development
6. assessing maternal structure
7. confirming fetal viability or death
8. ruling out or verifying fetal abnormalities
9. locating site of placental abnormalities
10. locating site of placental attachment
11. determining amniotic fluid volume
12. fetal movement observation (FHR, breathing, activity)
13. placental grading (evaluating placental maturation)
14. adjunct for other procedures (i.e. amniocentesis)
Clinical presentation
1. vaginal bleeding evaluation
2. questionable fundal height in relationship to gestational wk
3. reports decreased fetal movements
4. preterm labor
5. questionable rupture of membranes |
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|
Term
| Nursing action in ultrasound |
|
Definition
1. Explain procedure and lack of risk
2. Advise intake of 1-2 quarts of fluid to prepare
3. assist into supine position with wedge under right hip to displace uterus
4. apply gel to abd.
5. allow her to empty bladder after procedure |
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|
Term
| Nursing action for transvaginal ultrasound |
|
Definition
1. assist client into lithotomy position; probe is covered with protective device and lubricated
2. during procedure position probe or tilt table to facilitate view
3. inform client that she may feel some pressure
4. point out some structures to client as it is performed |
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|
Term
|
Definition
uses real-time ultrasound to visualize physical and physiological characteristics of fetus and biophysical responses to stimuli
Assesses fetal well-being with 5 variables, 2 = normal and 0 = abnormal.
1. Reactive FHR = 2, nonreactive = 0
2. Fetal breath movements (1 episode of 30 sec in 30 min) = 2, absent or less than 30 sec duration = 0
3. Gross body movements (at least 3 body or limb extensions with return to normal flexion in 30 min) = 2, slow extension and flexion, lack of flexion or absent movement = 0
4. Fetal tone (at least 1 episode of extension with return to flexion) = 2, slow extension and flexion, lack of flexion or absent movement = 0
5. Amniotic fluid volume (at least 1 pocket of fluid that measures at 1 cm in 2 perpendicular planes) = 2, pockets absent or less than 1 cm = 0
Score of 8-10 = normal
6 = equivocal
< 4 = abnormal
Potential diagnosis: nonreactive stress test, suspected oligohydramnios or polyhydramnios, suspected fetal hypoxemia or hypoxia
Client presentation: premature rupture of membranes, maternal infection, decreased fetal movement, intrauterine growth restriction |
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Term
|
Definition
Most widely used technique for antepartum eval of fetal well-being during 3rd trimester; noninvasive technique that monitors response of FHR to fetal movement
Doppler transducer (monitors FHR)and tocotransducer (monitor uterine contractions) attached externally to abd. to obtain paper tracing strips.
Client pushes button ever time she feels a fetal movement, its recorded on paper tracing
Disadvantages: high rate of false nonreactive results b/c of sleep cycles of fetus, fetal immaturity, maternal medications, chronic smoking |
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|
Term
| Indications for use of nonstress test during pregnancy |
|
Definition
Potential diagnosis for
1. assessing intact fetal CNS during 3rd trimester
2. ruling out risk of fetal death in clients who have diabetes mellitus (2x wk or after 28 wks)
Client presentation
1. decreased fetal movement
2. intrauterine growth restriction
3. postmaturity
4. gestational diabetes mellitus
5. pregnancy-induced HTN
6. maternal chronic HTN
7. Hx of previous fetal demise
8. advanced maternal age
9. sickle cell disease |
|
|
Term
| Interpretation of Findings of nonstress test |
|
Definition
Reactive if FHR is normal baseline rate with moderate variability, accelerates to 15 beats/min for at least 15 seconds and occurs 2 or more times during a 20 min period
Nonreactive NST indicates that FHR does not accelerate adequately with fetal movement and does not meet criteria after 40 min. CST or BBP is indicated |
|
|
Term
| Preparation of client for nonstress test |
|
Definition
1. Set client in reclining chair or in semi-fowler's, apply conduction gel, apply 2 belts to abd. and attach FHR and uterine contraction monitors
2. client presses button each time fetus moves
3. if fetus is not moving, vibroacoustic stimulation may be used to awaken |
|
|
Term
|
Definition
Women lightly brushes palm across nipple for 2-3 min (causes pituitary gland to release endogenous oxytocin). stop stimulation when contraction starts. Repeated after 5 min rest period
Stimulated contractions decrease placental blood flow and allows for analysis of FHR to determine how fetus will tolerate stress of labor. Pattern of three contractions within 10 min (each 40-60 sec)
Avoid hyperstimulation of nipple should be avoided.
If nipple stimulation fails; admin oxytocin (may cause contractions difficult to stop and thus causing preterm labor) |
|
|
Term
| Indications for use of contraction stress test |
|
Definition
Potential diagnoses
1. high risk pregnancies (gestational diabetes mellitus, postterm pregnancy)
2. non-reactive stress test
Client presentation
1. Decreased fetal movement
2. Intrauterine growth restriction
3. Postmaturity
4. Gestational diabetes mellitus
5. Pregnancy induced HTN
6. maternal chronic HTN
7. hx of previous fetal demise
8. adv. maternal age
9. sickle-cell disease |
|
|
Term
| Interpretation of contraction stress test findings |
|
Definition
Normal: negative CST- 3 uterine contractions and no late decelerations of FHR in 20 min
Abnormal: Positive CST- persistent and consistent late decelerations on more than half of the contactions
-uteroplacental insufficiency
-cord compression
-fetal head compression
Might induce labor or perform C-section |
|
|
Term
| Nursing Actions for contraction stress test |
|
Definition
1. Prep client by obtaining FHR, fetal movement, and contractions for 10-20 min; explain procedure and obtain consent; complete assessment
2. initiate nipple stimulations and halt when contractions start; monitor and provide adequate rest periods to avoid hyperstimulation
3. initiate IV admin if nipple stimulation fails
4. If hyperstimulation occurs: monitor for contractions lasting longer than 90 seconds and/or more freq. than 2 min; provide tocolytics; maintain bed rest; observe client for 30min afterward |
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Term
|
Definition
Aspiration of amniotic fluid for analysis by inserting needle transabdominally into client's uterus and amniotic sac under direct ultrasound guidance locating the placenta and determining position of fetus.
May be done after 14 wks gestation |
|
|
Term
| Indications for Amniocentesis |
|
Definition
1. maternal age >35 years
2. previous birth with chromosomal anomaly
3. parent who is carrier of chromosomal anomaly
4. family hx of neural tube defects
5. prenatal diagnosis of genetic disorder or congenital anomaly of fetus
6. alpha fetoprotein level for fetal abnormalities
7. lung maturity assessment
8. fetal hemolytic disease diagnosis
9. meconium in the amniotic fluid |
|
|
Term
Interpretation of Findings of amniocentesis
Alpha-fetoprotein (AFP) |
|
Definition
Can be measured in amniotic fluid betw. 16-18 wks to assess for neural tube defects in fetus or chromosomal disorders
High levels = neural tubes defects such as anencephaly, spina bifida, omphalocele, normal multifetal pregnancy
Low level: chromosomal disorders (Down's), gestational trophoblastic disease |
|
|
Term
Interpretation of findings of amniocentesis
Fetal Lung Maturity |
|
Definition
performed if less than 37 wks, in event of rupture of membranes, for preterm labor, complication indicating C-section birth
Determine if fetus will encounter resp. distress upon birth
If underdeveloped, more time in utero with admin of glucocorticoids to promote maturity
Lecithin/sphingomyelin (L/S) ratio- 2:1 indicates maturity
Presence of phosphatidyglycerol (PG)- absence is assoc. with resp. distress |
|
|
Term
| Procedure for amniocentesis |
|
Definition
Preprocedure: explain procedure/obtain consent, empty bladder
Intraprocedure: assist into supine with wedge under right hip, drape only exposing abd.; prepare for ultrasound, obtain baseline VS and FHR; cleans with antiseptic solu.; edu. to keep breathing even if feeling pressure
Postprocedure: monitor VS, FHR, uterine contractions throughout and 30 min post; rest for 30 min; admin Rho(D) immune globulin (RhoGAM) if Rh negative; edu. to rest and drink fluids and report any complications |
|
|
Term
| Complications of amniocentesis |
|
Definition
1. Amniotic fluid emboli
2. Maternal or fetal hemorrhage
3. Fetomaternal hemorrhage with Rg isoimmunization
4. Maternal or fetal infection
5. inadvertent fetal damage or anomalies involving limbs
6. Fetal death
7. Inadvertent maternal intestinal or bladder damage
8. miscarriage or preterm labor
9. premature rupture of membranes
10. leakage of amniotic fluid |
|
|
Term
| Percutaneous umbilical blood sampling |
|
Definition
Most common method of sampling fetal blood transfusion; obtain fetal blood by passing a fine gauge fiber optic scope into amniotic sac; needle is adv. into umbilical cord under ultrasound guidance and blood is aspirated from umbilical vein
Blood studies from cordocentesis:
1. Kleihauer-Betke: ensures blood is from fetus
2. CBC count with differential
3. Indirect Coombs' test for Rh antibodies
4. Karyotyping (visualization of chromosomes)
5. Blood typing |
|
|
Term
| Indications for percutaneous umbilical blood sampling |
|
Definition
1. Diagnosing prenatal blood and chromosomal disorders
2. karyotyping or malformed fetuses
3. detecting fetal infection
4. determining acid base balance status of fetuses with IUGR |
|
|
Term
| Interpretation of findings for Percutaneous umbilical blood sampling, client edu., complications |
|
Definition
Evaluate for isoimmune fetal hemolytic anemia and asses need for fetal blood transfusion
Provide med admin as prescribed; educate and provide support
Complications: cord laceration, preterm labor, amnionitis |
|
|
Term
| Chorionic villus sampling (CVS) |
|
Definition
assessment of portion of developing placenta is aspirated through a thin sterile catheter or syringe through the abd or intravaginally thru cervix under ultrasound guidance and analyzed
First trimester alternative to amniocentesis at 10-12 wks and rapid results for chromosome studies in 24-48 hr |
|
|
Term
Chorionic villus sampling
Indications, Education, Complications |
|
Definition
For women at risk of giving birth to neonate with genetic chromosomal abnormality
Provide support, instruct to drink fluids to fill bladder
Complications: spontaneous abortion, risk for fetal limb loss, miscarriage, chorioamnionitis and rupture of membranes (weight benefits against increased risk!!) |
|
|
Term
|
Definition
Blood test done betw. 15-20 wks that determines probability of fetal birth defects (not an actual diagnosis). More reliable findings than alpha-fetoprotein
Screens for presence of:
1. hCG: hormone produced by placenta (human chorionic gonadotropin)
2. AFP: protein produced by fetus (alpha-fetoprotein)
3. Estriol: protein produced by fetus and placenta
4. Inhibin A: protein produced by ovaries and placenta |
|
|
Term
| Indications and Findings for Quad Marker screening |
|
Definition
Indications: 15-20 wks, at risk for giving birth to neonate with genetic chromosomal abnormality
Low levels of AFP: at risk for Down's
High levels of AFP: risk for neural tube defects
High levels of hCG/inhubin-A: risk for Down's
Low levels of estriol: risk for Down's |
|
|
Term
| Maternal Serum AFP, indications, findings, actions |
|
Definition
Screening tool to detect neural tube defects; for all clients 16-18 wks
High levels: Neural tube defect or open abd. defect
Low levels: Down's syndrome
Abnormal findings: referred to quad marker screening, genetic counseling, ultrasound, amniocentesis
Actions: discuss testing, draw blood sample, offer support |
|
|
Term
| Causes of bleeding in the first trimester and its signs/symptoms |
|
Definition
Spontaneous Abortion: vaginal bleeding, uterine cramping, partial or complete expulsion of products of conception
Ectopic pregnancy: abrupt unilateral lower-quadrant abdominal pain with or without vaginal bleeding |
|
|
Term
| Causes of bleeding in the second trimester and its signs/symptoms |
|
Definition
| Gestational trophoblastic disease: uterine size increasing abnormally fast, abnormally high levels of hCG, nausea and increased emesis, no fetus present on ultrasound, and scant or profuse dark brown or red vaginal bleeding |
|
|
Term
| Causes of bleeding in the third trimester and its sign/symptoms |
|
Definition
Placenta previa: painless vaginal bleeding
Abruptio placenta: vaginal bleeding, sharp abd. pain and tender rigid uterus
Vasa previa: fetal vessel cross over the cervix abrupt bright red vaginal bleeding following rupture of membranes |
|
|
Term
|
Definition
Incompetent cervix: painless bleeding with cervical dilation leading to fetal expulsion
Preterm Labor: Pink-stained vaginal discharge, uterine contraction becoming regular, cervical dilation and effacement |
|
|
Term
|
Definition
When pregnancy is terminated before 20 wks (fetal viability) or fetal weight is less than 500g
Types of abortions are classified according to symptoms and weather the products of conception are partially or completely retained or expulsed
Types: threatened, inevitable, incomplete, complete, missed |
|
|
Term
| Risk factors of spontaneous abortion |
|
Definition
1. chromosomal abnormalities (account for 50%)
2. Maternal illness, such as insulin dependent diabetes mellitus
3. Adv. maternal age
4. Premature cervical dilation
5. chronic maternal infections
6. maternal malnutrition
7. trauma or injury
8. anomalies in fetus or placenta
9. substance abuse |
|
|
Term
| Assessment of spontaneous abortion |
|
Definition
Signs/Symptoms: backache, rupture of membranes, dilation of cervix, fever, abd. tenderness, hypotension, tachycardia
Lab tests: Hgb and Hct if considerable blood loss, clotting factors monitored for disseminated intravascular coagulopathy (DIC), WBC for suspected infection, serum hCG levels to confirm pregnancy
Diagnostic Procedures:
1. Ultrasound to determine presence of viable or dead fetus or partial or complete products of conception within uterine cavity
2. exam of cervix to determine open or closed
3. dilation and curettage (D&C) is done to dilate and scarp uterine walls to remove uterine contents for inevitable and incomplete abortions
4. Dilation and evacuation (D&E) done to dilate and evacuate uterine contents after 16 wks
5. Prostaglandin admin. in amniotic sac or by vaginal suppository to augment or induce labor to expulse products of conception for late term, incomplete, inevitable, or missed abortion |
|
|
Term
| Spontaneous Abortion Types, Cramps, Bleeding, tissue passed, cervical opening |
|
Definition
Threatened: with or without cramps, spotting to moderate bleeding, no tissue passed, cervical opening closed
Inevitable: moderate cramps, mild to severe bleeding, no tissue passed,dilated with membranes or tissues bulging at cervix
Incomplete: severe cramps, continuous and severe bleeding, partial fetal tissue or placenta passed, dilated with tissue in cervical canal or passage of tissue
Complete: mild cramps, minimal bleeding, complete expulsion of uterine contents, cervix closed with no issue in cervical canal
MIssed: no cramps, brownish discharge, no passing of tissue (prolonged retention of tissue), closed cervical opening
Septic: Malodorous cramps, malodorous discharge, various tissue passage, cervical opening usually dilated
Recurrent: cramps vary, bleeding varies, tissue IS passed, cervical opening usually dilated |
|
|
Term
| Nursing Care of spontaneous abortion |
|
Definition
1. observe bleeding amount and color
2. perform a pregnancy test
3. use the lay term (miscarriage)
4. place client on bed rest with admin of sedation for threatened, inevitable, and incomplete abortions
5. avoid vaginal exam
6. assist with ultrasound
7. admin analgesics and blood products as prescribed
8. determine how much tissue has passed and save all passed tissue for exam.
9. assist with termination of pregnancy (D&C, D&E) as indicated
10. provide edu and emotional support |
|
|
Term
| Medications, Therapeutic Intent, and Nursing considerations for spontaneous abortion |
|
Definition
Med: Rho(D) immune globin (RhoGAM) to suppress immune response of clients who are Rh-negative to Rh-positive RBC's from fetus
Also admin prostaglandins or IV oxytocin as prescribed to expulse products of conception in late, incomplete, inevitable, or missed abortions
Admin broad-spectrum antibiotics as prescribed for treatment of septic abortion |
|
|
Term
| Discharge instructions and client outcome for spontaneous abortion |
|
Definition
1. instruct to notify primary care provider of heavy, bright red vaginal bleeding
2. take prescribed antibiotics
3. tell client small amt. of discharge is normal for 1-2 wks.
4. Refrain from sexual intercourse or placing anything into vagina for 2 weeks
5. provide contacts for bereavement support groups
6. instruct client to avoid pregnancy for 2 months
Outcomes: no psychological or physiological signs or symptoms or complications |
|
|
Term
| Ectopic Pregnancy and risk factors |
|
Definition
Abnormal implantation of fertilized ovum outside the uterine cavity. Usually in fallopian tube, which can result in a tubal rupture and cause a fatal hemorrhage.
Second most frequent cause of bleeding in early pregnancy
Risk Factors: any factor that compromises tubal patency (pelvic inflammatory disease, IUD) |
|
|
Term
| Assessment of ectopic pregnancy |
|
Definition
Subjective Data
1. one or two missed menses
2. unilateral stabbing pain and tenderness in lower abd. quadrant
3. scant, dark red, or brown vaginal spotting if tube ruptures (bleeding may be into intraperitoneal area)
4. referred shoulder pain from blood irritation of the diaphragm or phrenic nerve
5. frequent nausea and vomiting after tube rupture
Objective Data:
1. Signs of hemorrhage and shock (HTN, tachycardia, pallor)
Lab Test
1. Hormone levels of progesterone and hCG elevated
2. WBC count elevated to 15,000/mm3
Diagnostic Procedures
1. Transvaginal ultrasound showing an empty uterus
2. rapid surgical treatment
3. linear salpingostomy is done to salvage the fallopian tube if not ruptured
4. Laparoscopic salpingostomy (removal of tube) is performed when the tube has ruptured |
|
|
Term
| Nursing care, Medication, Classification and Therapeutic Intent, Nursing Considerations of ectopic pregnancy |
|
Definition
Nursing Care
1. Replace fluids that are lost and maintain electrolyte balance
2. Provide client education and psychological support
3. Prepare the client surgery and postop care
Med: Methotrexate (MTX) used to inhibit cell division and enlargement of embryo, also prevents rupture of fallopian tube to preserve it.
Nursing considerations: obtain serum hCG levels, liver and renal function studies, CBC, and type and Rh |
|
|
Term
| Client education and outcomes of ectopic pregnancy treatment |
|
Definition
Edu: Instruct client who is prescribed methotrexate to avoid alcohol consumption and vitamins containing folic acid to prevent a toxic response to the medication and advise client to protect against sun exposure
Outcome: experience no psychological or physiological signs or symptoms of complications |
|
|
Term
| Gestational trophoblastic disease |
|
Definition
hydatidiform mole, choriocarcinoma, molar pregnancy
= proliferation and degeneration of trophoblastic villi in placenta that becomes swollen, fluid-filled, and takes on appearance of grape-like clusters. Embryo fails to develop beyond primitive state and these structures are assoc. with choriocarcinoma (rapidly metastasizing malignancy) |
|
|
Term
|
Definition
1. All genetic material is paternally derived
2. Ovum has no genetic material or material is inactive
3. complete mole contains no fetus, placenta, amniotic membranes, or fluid
4. no placenta to receive maternal blood; hemorrhage into uterus cavity occurs and vaginal bleeding results
5. Approx 20% of complete moles progress toward a choriocarcinoma |
|
|
Term
|
Definition
1. Genetic material is derived both maternally and paternally
2. A normal ovum is fertilized by two sperm or one sperm in which meiosis or chromosome reduction and division did not occur
3. Partial mole often contains abnormal embryonic or fetal parts, an amniotic sac, and fetal blood. No congenital anomalies are present
4. Approx 6% of partial moles progress toward choriocarcinoma |
|
|
Term
| Risk Factors of Gestational Trophoblastic Disease |
|
Definition
1. low protein intake
2. under 18 years of age
3. older than 35 years of age |
|
|
Term
| Subjective and Objective Data of Gestational Trophoblastic Disease |
|
Definition
Subjective
1. Vaginal bleeding at approx 16 wk
2. Excessive vomiting (hyperemesis gravidarum) due to elevated hCG levels
Objective Data
1. Rapid uterine growth larger than expected for duration of pregnancy due to over-proliferation of trophoblastic cells
2. Bleeding is often dark brown resembling prune juice, or bright red that is either scant or profuse and continues for a few days or intermittently for a few wks
3. Bleeding accompanied by discharge from clear fluid-filled vessels
4. Symptoms of pregnancy-induced HTN (PIH), including HTN, edema, proteinuria that occur prior to 20 wk (PIH is after 20 wk) |
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Term
| Lab Tests and diagnostic procedures of Gestational Trophoblastic Disease |
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Definition
Labs
1. UA for proteinuria (serial hCG immunoassays for pregnancy are strongly positive) and secondary hCG is produced by overgrowing trophoblastic cells
2. Analysis of serum hCG every 1-2 wks until levels are normal; every 2-4 wks for 6 months; every 2 months for 1 yr.
Diagnostic procedures
1. ultrasound will reveal dense growth with characteristic vesicles but no fetus in utero
2. suction curettage is done to aspirate and evacuate the mole
3. Following mole evacuation, client should undergo a baseline pelvic exam and ultrasound scan of abd. in addition to frequent follow-up pelvic exams |
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Term
| Nursing care and meds for gestational trophoblastic disease |
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Definition
Nursing care
1. measure fundal height
2. assess vaginal bleeding and discharge
3. assess GI status and appetite
4. assess client's extremities and face for edema
5. admin chemo for choriocarcinoma in event of abnormal rising hCG titer, enlarging uterus, findings of malignant cells
Meds
1. Admin RhoGAM to client who is Rh-negative |
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Term
| Discharge instructions and edu. and outcomes for gestational trophoblastic disease |
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Definition
1. Advise client to bring any clots or tissue passed to provider for exam.
2. Provide edu. about disease and emotional support regarding loss of anticipated pregnancy
3. use reliable contraception for 12 months because pregnancy would make it impossible to monitor the decline in hCG levels
4. Instruct client of imp. of follow up b/c of inc. risk of choriocarcinoma
5. no psychological or physiological signs or symptoms of complications |
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Term
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Definition
| Occurs when placenta abnormally implants in lower segment of uterus near or over cervical os instead of attaching to fundus. Abnormal implantation results in bleeding during 3rd trimester of pregnancy as cervix begins to dilate and efface |
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Term
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Definition
1. Complete or total: when cervical os is completely covered by placental attachment
2. Incomplete or partial: when cervical os is only partially covered by placental attachment
3. Marginal or low-lying: when placenta is attached to uterine segment but does not reach the cervical os |
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Term
| Risk factors for placenta previa |
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Definition
1. previous placenta previa
2. Uterine scarring (previous c-section, curettage, endometritis)
3. Maternal age >35
4. multifetal gestation
5. multiple gestations or closely spaced pregnancies |
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Term
| Subjective and Objective Data, Lab tests and Diagnostic procedures for placenta previa |
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Definition
Subjective: painless, bright red vaginal bleeding that increases as cervix dilates
Objective
1. soft, relaxed, nontender uterus with normal tone
2. fundal height that is greater than expected
3. fetus in breech, oblique, or transverse position
4. palpable placenta
5. VS that are usual and WNL
6. decreasing urinary output
Lab Tests
1. Hgb and Hct for blood loss assessment
2. CBC
3. ABO blood typing and Rh-factor
4. Coagulation profile
5. Kleihauer-Betke test (used to detect fetal blood in maternal circulation)
Diagnostic Procedures
1. transabdominal or transvaginal ultrasound for placement of placenta
2. fetal monitoring for fetal well-being assessment |
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Term
| Nursing care, meds, discharge instructions and edu for placenta previa |
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Definition
Nursing care
1. assess client for bleeding, leakage, contractions
2. assess fundal height
3. perform leopold maneuvers (fetal position and presentation)
4. refrain from performing vaginal exams (may exacerbate bleeding)
5. Admin IV fluids to client as prescribed
6. have O2 equip available in case of fetal distress
Meds: corticosteroids such as betamethasone (celestrone) are prescribed for fetal lung maturation if delivery of fetus is anticipated (C-section)
Discharge Instruc.
1. bed rest
2. nothing inserted vaginally
3. blood replacement as prescribed
Edu.
1. pregnancy maintained without any maternal or fetal compromise |
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Term
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Definition
Premature separation of the placenta from the uterus, which can be a partial or complete detachment; separation occurs after 20 wks, usually in 3rd trimester
Significant maternal and fetal morbidity and mortality; leading cause of maternal death
Coagulation defect (disseminated intravascular coagulopathy) often assoc. with moderate to severe abruption |
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Term
| Risk factors for abruptio placenta |
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Definition
1. Maternal hypotension
2. blunt external abd. trauma (motor-vehicle crash, maternal battering)
3. cocaine abuse resulting in vasoconstriction
4. previous incidents of abruptio placenta
5. cigarette smoking
6. premature rupture of embranes
7. short umbilical cord
8. multifetal pregnancy
9. high parity
10. adv. maternal age |
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Term
| Subjective and objective Data, Lab tess, diagnostic procedures for abruptio placenta |
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Definition
Subjective: sudden onset of intense, localized uterine pain with bright red vaginal bleeding
Objective
1. vaginal bleeding that is bright red or dark
2. board-like abd. that is tender
3. firm, rigid uterus with contractions (uterine hypotension)
4. fetal distress
5. signs of hypovolemic shock
Lab Tests
1. Hgb and Hct dec.
2. coagulation factors dec.
3. clotting defects (disseminated intravascular coagulation)
4. cross and type match for possible blood transfusions
5. Kleihauer-Betke test (used to detect fetal blood in maternal circulation
Diagnostic procedures
1. ultrasound for fetal well-being and placental assessment
2. biophysical profile to ascertain fetal well-being |
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Term
| Nursing Care and Meds, outcomes for abruptio placenta |
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Definition
Care
1. palpate uterus for tenderness and tone
2. assess FHR pattern (refrain from vaginal exam)
3. Admin IV fluids
4. Admin O2 8-10L via face mask
Meds
1. Admin blood products and fluid volume replacements to maintain urine output at 30 mL/hr or more and Hct at 30% or greater
2. Admin corticosteroids to promote fetal lung maturity
Outcome
1. birth of viable neonate |
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Term
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Definition
Presence of fetal blood vessels crossing the amniotic membranes over the cervical os.
High newborn mortality rate; risk assoc with fetal hemorrhage as cervix dilates or membranes rupture
Rarely diagnosed before start of labor |
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Term
| Objective data, lab test, and diagnostic procedures for vasa previa |
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Definition
Objective data
1. painless heavy bleeding upon rupture of membrane
2. Fetal bradycardia
Lab tests
1. Hgb and Hct dec.
2. cross and type match for possible blood transfusions
Diagnostic procedures
1. confirmed by sonography |
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Term
| Nursing care, meds, edu, outcomes for vasa previa |
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Definition
Nursing care
1. assess bleeding rate, amt. color
2. amin IV fluids
3. admin O2 8-10 L via face mask
4. prepare for an emergency C section
Med
1. Admin blood procuts and fluid volume replacements to maintain the clients urine output at 30 mL/hr on more and Hct at 30% or greater
Edu
1. Provide emotional support
Outcome
1. birth viable neonate |
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Term
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Definition
1. Retrovirus that attacks and causes destruction of T lymphocytes
2. causes immunosuppression in client
3. transmitted from mother to neonate perinatally thru placenta and postnatally through breast milk
4. Routine lab testing in early prenatal period as well as in third trimester for those at risk
5. Amniocentesis and episiotomy avoided due to risk of exposure
6. Use of internal fetal monitors, vacuum extraction, and forceps during labor avoided because of risk of fetal bleeding
7. admin injections and blood testing do not take place until first bath is given to neonate |
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Term
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Definition
1. IV drug use
2. Multiple sexual partners
3. Bisexuality
4. Maternal hx of multiple STDs
5. blood transfusion |
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Term
| Subjective and Objective data, lab tests for HIV/AIDS |
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Definition
Subjective
1. fatigue
objective
1. diarrhea
2. weight loss
3. anemis
Lab tests
1. Antibody screening test such as enzyme immunoassay; confirm positive results by confirming Western blot testing
2. Scree for STDs such as gonorrhea, chlamydia, syphilis, hep B
3. obtain frequent viral load levels and CD4 cell counts throughout the pregnancy |
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Term
| Nursing Care, meds, discharge instruc., outcome of HIV/AIDS |
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Definition
Nursing Care
1. Provide counseling before and after
2. refer to mental health consult, legal assistance, financial resources
3. use standard precautions
4. admin antiviral combo therapy as prescribed
5. obtain prescribed lab testing
Meds
1. Retrovir (Zidovudine): antiretroviral agent, nucleoside reverse transcriptase inhibitor
2. Admin retrovir at 14 wks, throughout pregnancy, and before onset of labor or C-section and admin to neonate following delivery and for 6 wks after
Discharge
1. do not breastfeed
2. discuss HIV and safe sexual relations
Outcomes
1. Client remain free from injury during pregnancy |
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Term
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Definition
Can cross placenta and have teratogenic affects on fetus; does not include all major infections
TOxoplasmosis: caused by consumption of raw or undercooked meat or handling cat feces; symptoms are similar to influenza or lymphadenopathy
RubellaL contracted thru kids who have rashes or neonates who are born to mothers who had rubella during pregnancy
Cytomegalovirus (member of herpes): transmitted by droplet infection from person to person, virus found in semen, cervical and vaginal secretions, breast milk, placental tissue, urine, feces, and blood. Latent virus may be reactivated and cause disease to the fetus in utero or during passage thru birth canal
Herpes simplex virus (HSV): spread by direct contact with oral or genital lesions; transmission to fetus is greatest during vaginal birth if woman has active lesions |
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Term
| Subjective and Objective data, labs, diagnostics for TORCH |
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Definition
Subjective
1. Toxoplasmosis: similar to influenza or lymphadenopathy
2. malaise, muscle aches
3. rubella joint and muscle pain
4. cytomegalovirus: asymptomatic or mononucleosis-like symptoms
Objective
1. signs of rubella: rash, mild lymphedema, fever, fetal consequences (miscarriage, congenital anomalies, death)
2. herpes simplex virus: initially with lesions
3. Toxoplasmosis: fever, tender lymph nodes
Labs
1. for HSV, obtain cultures for those who have HSV or are at or near term
Diagnostic
1. TORCH screen: immunologic survey used to identify existence of infections in mother or in newborn
2. prenatal screening |
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Term
| Nursing care, meds, edu, outcomes for TORCH |
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Definition
Care
1. monitor fetal well-being
2. edu. on prevention practices
Meds
1. admin antibiotics as prescribed
2. toxoplasmosis: sulfonamides, combo of pyrimethamine and sulfadiazine
Edu
1. Rubella = vaccination, avoid crowds of young women
2. no treatment for cytomegalovirus so prevent exposure with frequent hang hygiene before eating, and avoiding crowds of young kids
3. emphasize imp. of compliance
4. provide emotional support
Outcomes
1. remain free from infection |
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Term
| Streptococcus B-hemolytic, Group B and risk factors |
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Definition
Bacterial infection that can be passed to a neonate during labor and delivery
Risk factors:
hx of positive culture with prev. preg.
positive culture with pregnancy
prolonged rupture of membranes
preterm delivery |
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Term
| Objective Data, Lab tests, Nursing care, meds, edu, outcomes for Streptococcus B-hemolytic, Group B |
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Definition
Obejctive: maternal and fetal effects including premature rupture of membranes, preterm labor and delivery, chorioamnionitis, infections of urinary tract, maternal sepsis
Labs: vaginal and rectal cultures at 35-37 wks
Care: admin prophylaxis antibiotics during labor
Meds:
1. Penicillin G or ampicillin (Principen) to treat positive GBS
2. Admin penicillin 5 mill units initially IV bolus then 2.5 mill units intermittent IV bolus Q4hr
3. Ampicillin 2 g IV initially then 1 g Q4hr
4. Bactericidal antibiotic used to destroy GBS
Edu: Instruct to notify labor and delivery nurse of GBS
Outcomes: blood culture is negative for GBS with no clinical signs of sepsis |
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Term
| Chlamydia and risk factors |
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Definition
Bacterial infection caused by chlamydia trachomatis; most common STD.
Diff to diagnose b/c typically asymptomatic
Risk factors: multiple sex partners and unprotected sexual practices |
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Term
| Subjective and Objective Data, Labs, Nursing care, meds, edu, outcomes of chlamydia |
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Definition
Subjective: vaginal spotting and vulvar itching
Objective: white, watery vaginal discharge
Lab: endocervical culture
Care: instruct to take entire prescription, identify and treat all sexual partners, those who are pregnant should be retested 3 weeks post med regimen
Meds: Azithromycin (Zithromax), amoxicillin (Amoxil), erythromycin (Ery-Tab)
-broad spectrum antibiotic, bactericidal action
-admin erythromycin (Romycin) to all neonates following delivery
Outcome: infection free |
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Term
| Gonorrhea and risk factors |
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Definition
Neisseria gonorrhoeae; bacterial infection primarily spread by genital to genital contact (can also be anal to genital or oral to genital); can be transferred to neonate during delivery.
Women frequently asymptomatic
Risk factors: multiple sex partners and unprotected sexual practices |
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Term
| Subjective and Objective Data, Labs, Nursing care, meds, outcomes of gonorrhea |
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Definition
Subjective
1. Male: urethral discharge, painful urination, freq.
2. Female: lower abd. pain, dysmenorrhea
Objective
1. urethral discharge
2. yellowish-green vaginal discharge
3. reddened vulva and vaginal walls
4. can cause PID, heart disease, arthritis
Lab: urethral and vaginal cultures, urine culture
Care
1. provide info regarding disease transmission
2. instruct to take entire prescription
3. identify and treat all sexual partners
Meds: Ceftriaxone (Rocephin) IN or azithromycin (Zithromax) PO
1. given for 7 days
2. broad spectrum antibiotic
3. bactericidal action
Outcome: infection free |
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Term
| Candida Albicans and risk factors |
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Definition
fungal infection
Risk factors
1. diabetes mellitus
2. oral contraceptives
3. recent antibiotic treatment |
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Term
| Subjective and Objective Data, Labs, Nursing care, meds, edu, outcomes of candida albicans |
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Definition
Subjective: vulvar itching
Objective
1. thick, creamy white vaginal discharge
2. vulvar redness
3. white patches on vaginal walls
4. gray-white patches on tongue and gums (neonate)
Lab: wet prep
Diagnostics: Potassium hydroxide prep, presence of hyphae and pseudohyphae indicates positive finding
Meds: Fluconazole (Diflucan)
1. antifundal agent
2. fungicidal action
3. OTC clotrimazole (monistat)
Edu: avoid tight fitting clothes
outcome: infections free |
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