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Hegar’s
sign
Childbearing Exam #1 well detailed updated version
comprehensive
Galen
College Nur-
Childbearing / maternity
Unit 1: Antepartum
Nursing Management
o Page 178 Signs/symptoms related to pregnancy
▪ Categorizing signs/symptoms of pregnancy
- Presumptive : subjective (Patient says they experience), least reliable – not definitive
signs of pregnancy, COULD be caused by something other than pregnancy,
QUICKENING
o Breast changes, amenorrhea, nausea and vomiting, urinary frequency,
fatigue, quickening
- Probable : objective, (practitioner can see) “more than likely” pregnant
o Positive pregnancy
test,
(false), (cervical softening),
Chadwick’s sign (increased cervical vascularization), (softening of lower
uterine segment), enlarging uterus, ballottement (pushing of the uterus – do you
feel a fetus move and come back?)
- Positive : visualization, hearing fetus HR, feel the fetus, VISUAL ULTRA SOUND; practitioner feels
kicking
▪ What is considered normal or expected?
o Breasts: increase in size, fullness, heaviness, tingling, darkening of the areola, lactation
can occur as early as 18 weeks
o GI: delayed GI motility, constipation, heartburn, nausea and vomiting,
hemorrhoids, increased vascularity of gums, increased saliva
o GU: increased urination; NORMAL
o Cardio: pulse increase, increased blood volume, increased cardiac output
o Respiratory: increased O2 consumption, nasal and sinus congestion,
increased vascularity
o Musculoskeletal: center of gravity shifts, unsteady gait
o Sensory: sciatica, restless legs, muscle cramps, syncope, tension headache
o Integumentary: melasma mask (hyperpigmentation), striae gravidarum (stretch
marks), vascular malformation (spider veins)
o HR: slight increase
o BP: should not change dramatically from baseline
o RR: SOB is common, difficulty breathing is NOT
o O2: remains stable
o Temp: can slightly increase
▫ Page 187 Calculating GTPAL
- Number of pregnancies, regardless of the outcome – including current
- Delivery at 37-42 weeks
- Delivery between 20 weeks and 36 weeks 6 days
- Before 20 weeks, including miscarriage
- Number of children that are still living
▪ REMEMBER! With multiples, they count as one pregnancy!
▫ Page 178 Calculating Naegele’s Rule/EDD (expected date of delivery) – two ways to calculate
▪ First day of last menstrual period
months OR
▪ EXAMPLE:
• LMP: 1/12/
▫ Analyzing labs
What in yellow was
on this
exam
P:
preterm
Braxton
Hicks
▪ T: term
▪ A: abortion
▪ L: living
Goodell’s
sign
Add 7 days – 3 months + one
year
▪ G:
gravida
▪ Blood work
• CBC
▪ Live vaccines are contraindicated (page 193)
o No booster while pregnant, can offer postpartum
o Toxoplasma- Don’t not clean cat litter, eat raw meat or touch dirt
- Titer
s o Rubella/Varicella: provides passive
immunity
- Sudden or severe edema in face and hands
- Severe or continuous headache
- Dizziness, blurred vision, seeing spots
- Persistent vomiting
- **Dysuria, oliguria
- No fetal movement for over 12 hours**
- Leg edema with pain or redness
- Chest pain or dyspnea (not just shortness of breath)
▫ Page 183 Preparing siblings for new baby
o Take child on Prenatal visit. Let them listen to FHR
o Involve child in preparations; help decorate
o If child in crib move to bed 2 months before baby due
o Read books, videos, dvd and hospital tour
o Answer questions about birth. Babies are like
o Take to homes of friends who have babies (realistic expectations)
o With baby doll show sibling how to hold
- Fundal height - measuring from pubic symphysis to highest part of uterus)
o 12 weeks
o 16-36 fundal hieght = weeks of pg
o 20 weeks @ umbilicus
o 36 weeks
o 36-38 weeks lightening
o 40 weeks
Unit 2: High-Risk Childbearing
o Priority actions
▪ Recognizing signs/symptoms that should be reported
- Page 294 Miscarriage/ spontaneous abortion: spontaneous loss of pregnancy
before
th
week
o Risk factors : maternal age, previous miscarriages, uterine or cervical
problems, smoking, alcohol, drugs
o TYPES:
▪ Threatened abortion : showing signs but cervix hasn’t opened, light
bleeding and cramping- treatment complete bedrest ..only one baby can be
safed
▪ Inevitable : vaginal bleeding, strong lower stomach cramps, dilated
cervix, fetus is expelled with bleeding
▪ Complete : all pregnancy tissues leaves uterus
▪ Incomplete : some pregnancy tissue remains (D&C might be indicated)
▪ Missed : placental and embryonic tissues remain in uterus but the embryo
has died or never formed – brownish vaginal discharge
- Page 299 Ectopic pregnancy : pregnancy develops/implants anywhere outside of the
uterus
o s/s : light vaginal bleeding with abdominal or pelvic pain referred to shoulder
o if blood from fallopian: shoulder pain, urge to have a BM; pink tinge
o if ruptured: stabbing pain in lower quadrant, can radiate to leg or chest, – followed
by lightheadedness, fainting or shock
o GOPHER - gush of blood; one sided pain , pain stops, hemorrhage, Emergency
for Rupture
o Treatment – methotrexate if only stretched; if bleeding sur remove part of
fallopian tube
- Page 297 Incompetent cervix : painless dilation of the cervix without labor or contractions
of the uterus
o Risk factors : congenital conditions, exposure to DES (synthetic estrogen),
cervical trauma, excessive cervical dilation = repeated D&C
o Starts between weeks 14 and 20: pelvic pressure, backache, mild abdominal
cramps, light bleeding or spotting
o Treatment - abd Cerclage (tie cervix) tocolytics, bedrest for a few days after
procedure, progesterone, anti inflammatory drugs, antibiotics, hydration
o I need Cerclage because my cervix is weak
▪ Recognizing signs/symptoms that require follow-up
o Hyperemesis gravidarum : severe nausea, vomiting, weight loss and dehydration
▪ Tx : IV hydration, control vomiting, stabilize mom
▪ Monitor for metabolic alkalosis
- Physician orders that contradict patient conditions
o NO vaginal exam if a mom is bleeding
o Stabilize mom first! ABCs
o Now, is baby still alive?
o Medication management for high-risk conditions
▪ Page 280
after 20 weeks> seizure related
- Risk factors : family history, multiple pregnancy, African-American, obesity, younger than 19yo,
older than 40yo, pre-existing medical or genetic conditions
- Decreased placental perfusion, generalized vasospasm, vasoconstriction, capillary
leaking, reduced organ perfusion, can affect liver and brain function
o Page 282 HELLP syndrome : lab diagnosis for a variant of preeclampsia that
involves hepatic dysfunction – starts because of hypertension
▪ H : hemolysis : breakdown of RBCs
▪ EL : elevated liver enzymes – AST, LST, LFTs
▪ LP: low platelets (normal 400,00-150,000)
▪ Increased risk for: pulmonary edema, renal failure, liver hemorrhage or
failure, DIC, placental abruption, acute respiratory distress syndrome,
sepsis, stroke,
fetal and maternal death
- Mild Preeclampsia : BP 140/90 or greater, urine dipstick > 1+ - Moderate Preclampsia : BP 160/110, urine dipstick > 3+, persistent or severe
headache,
blurred vision, photophobia, epigastric pain, intrauterine growth restriction of
fetus
- S/S : independent edema (edema in lower extremities is normal, NOT in upper
extremities or face), deep tendon reflexes = hyperreflexia, clonus = jerky spasms,
rhythmic and involuntary (over 3 )
Severe preeclampsia: BP126/110 prevent seizures, control blood pressure
o Assess respirations, level of consciousness, intake/output
o Pregnancy-safe medications : methyldopa or hydralazine
o
▪ Keep calcium gluconate
bedside
▪ Monitor Mg levels
(can also stop them)
▪ Page 289 Eclampsia : onset of seizure activity or coma in a woman with preeclampsia and no
prior history
▪ Page 242 Diabetes: can be pregestational or gestationa l (management is pretty much the
same)
- Monitor comorbidities, preterm labor, macrosomia (big baby), C-section, polyhydramnios,
hyper/hypoglycemia, increased risk for postpartum hemorrhage, sudden or unexplained
stillborn,
congenital malformations
- Insulin needs : change throughout pregnancy
o 1
st
trimester: reduced
o Birth: decrease
o Breastfeeding: decrease
- At 24-28 weeks: glucose tolerance test
o Negative = less than 130- 140
o Positive = more than 140 (requires further testing)
o Recognizing signs/symptoms
low lying placenta classified by where egg implants and how
much of the cervix is covered (total, partial, marginal)
o placenta covers some or all of the cervix
o Dx – with/ ultrasound
▪ usually occurs towards ends of 2
nd
trimester or later
o Tx : bed rest, monitoring, possible C-section depending on degree of cervical coverage
- Page 306 Abruptio placenta : partial or complete separation of the placenta from the
uterine lining
▪ If patient has protein in urine and High BP; nurse should give Magnesium
Sulfate
- Mg toxicity : decreased RR, decreased LOC, absent deep
tendon
reflexes
initially
Magnesium sulfate : manage and prevent
seizures
Preeclampsia: hypertension AND
proteinuria
▪ Placenta
abnormalities
o 2
nd
trimester: starts to
increase
o 3
rd
trimester: may increase to 2-4x more than
“normal”
o NO VAG EXAMS (if
bleeding) o S/S can cause painless, bright red , severe vaginal bleeding, fundal height
greater
than gestational age, non-tender
uterus
o MEDICAL EMERGENCY : C-section is necessary
o causes/risk factors : hypertension, abdominal trauma, cigarette smoking, alcohol
or cocaine use, blood clotting disorders, diabetes, previous history
▪ DIC (disseminated intravascular coagulation): “excessive clotting and bleeding at the same time”
- can be triggered by abruptio placentae, serious infection or trauma, escape of amniotic fluid
into bloodstream
pain,amopnitic
fluid port wine
color
o s/s : abdominal pain , vaginal bleeding, rigid-board like abdomen/fundus,
uterine contractions, port wine-stained amniotic fluid, dark red vag bleeding,
sudden
o Powers (changing of
▪ Primary powers
- Effacement : thinning cervix(%)
- Dilation : opening (cm) 10cm completely dialated - Ferguson reflex : baby is placing pressure on pelvic floor, mom feels she “ HAS” to push”
o I f not ready not dialted completely mom change positions
▪ Secondary powers
▪ External powers
- Gravity- (walk to help dilate)
- Medications-(pitocin help) (Tocolytic- slow down contractions) (prostaglandin cervidol gel to
ripen cervix)
o Positioning
▪ Encourage mom to find whatever position is the most comfortable for her
- Lithotomy ( stirr up), squatting
▪ Frequent changes in position: relieve fatigue, increase comfort and improve circulation
o Recognizing signs/symptoms
▪ Labor: process of moving fetus, placenta, and membranes out of uterus through the birth canal
- Changes can start to occur days to weeks before true labor onset
o Lightening : fetus drops into pelvis
o Bloody show/mucus plug: pink or blood-streaked mucus
▪ Page 327 Stages of labor
- Stage 1: onset of true contractions to full dilation (10cm) of cervix
o True contractions and cervical changes
1. Early phase: up to 5cm of dilation
▪ Usually the slower phase, may go quicker after 1
st
pregnancy
2. Active phase: 6-10 cm
Transitional phase = 8+ cm
o Epidural
▪ Offer between 4cm - 7cm
▪ Can give up to 7cm (then it cannot be given)
- Mom won’t be able to feel ANYTHING (meaning she won’t be able
to push properly)
- Baby will be “drugged” at birth
- Epidural contraindicated = maternal hemorrhage, maternal
hypotension, heparin within 12hrs, blood disorder, infection at site,
ICP,
allergy to anesthesia, refusal, some cardiac conditions
- Stage 2 : full dilation to birth
o Time for delivery!
o Push with contractions; rest when contraction over
o Latent = passive movement
o Active = actively pushing
- Stage 3 : birth of fetus to delivery of placenta
o You MUST assess placenta
▪ All of it HAS to come out (bleeding, infection)
▪ Placenta accreda: placenta is implanted too deeply into uterus
- Must be manually or surgically removed
- Stage 4 : 2 hours post-delivery of placenta to transfer to postpartum
o Immediate recovery
o Usually 2 hours – monitor bleeding and any abnormalities
o Page 328 7 cardinal movements of the mechanism of labor
- Engagement : head passes pelvic inlet
- Descent : refers to the progress of the presenting part through the pelvis
- Flexion : occurs when head meets resistance – normally, head will flex so the chin is
brought closer to fetal chest
- Internal rotation: head must rotate in order to exit, begins at ischial spine
- Extension : when head reaches perineum for birth
- External rotation (restitution): after head is born, it rotates back to previous position –
realigns with baby’s back and shoulders
- Expulsion: baby has emerged completely
▪ Analyzing contraction characteristics
- Intensity = peak, strength of contraction
- Duration = how long do they last (beginning to end of a single contraction)
- Frequency = how far apart they are occurring (beginning of one contraction to the
beginning of the next)
- Relaxation = uterus NEEDS time to
relax Questioning orders based on client condition
o Page 396 Priority
▪ Actions based on fetal heart patterns
- Page 362 Variability: changes from baseline
o Absent = not good sign
o Minimal = 5-10bpm difference
▪ Can occur if baby is asleep or if narcotics have been administered
o Moderate = 10-25bpm difference
▪ Normal
o Marked = over 25bpm difference
▪ Generally indicates distress
o Knowing if teaching is effective/non-effective
▪ Recognizing labor stages/phases
▪ Relieving labor discomforts
▪ Page 414 Preterm labor- birth that occurs between 20- 36w6 days
- Risk factors- previous preterm, genital infection, blk, bleeding, smoking, underweight,
periodontal disease, stress
- S/S- change in vag discharge (watery mucousy, bloody), increase in amt of discharge, pelvic
abd pressure. Constant low back pain, mild abd , no diarrhea, reg contractions no pain,
ruptured membranes.
▪ Page 425 Chorioamnionitis : bacterial infection of amniotic cavity
- s/s: maternal fever, fetal tachycardia, uterine tenderness, foul odor of amniotic fluid
▪ Page 426 Dystocia : dysfunctional labor = long, difficult or abnormal labor
- Ineffective uterine contractions, alterations and pelvic structure, fetal causes, maternal
position during birth and labor, psychological response of mom
- Increased risk: overweight or short stature, advanced maternal age, uterine
abnormalities, malpresentation or position of fetus, uterine overstimulation
▪ Page 428 Precipitous labor : labor less than 3 hours
▪ Labor induction : most HCPs will induce at 41 weeks
- Elective: over 39 weeks
- Oxytocin: stimulates contractions
- Trimester =13 1/3 weeks long
- Full term pregnancy is 10 months (40 weeks); Full term pregnancy= 37 weeks ; Late is 42 weeks
- Viability = 20 weeks (earliest amount of time a child can survive outside of pregnancy
- Mag sulfate - Preeclampsia; preterm labor (not first choice; Mag toxicity,
- Oxytocin (natural occurring)- jump start labor; Pitocin (drug)
- Cervidil – ripens cervix
- Cytotec – medical abortion
- Ovulation -14 days before next menstruation
- Methadone medication gives false +// Promethazine gives false neg -
- 6-8 weeks Women figure out they pregnant
- Hormones for PG Prostaglandin/ Estrogen
- 12-24hrs ovum stays intact after starts breaking down
- Sperm lives in female system up to 5 days
- Physical mature to have baby 17 years old
- Endometrium – carries baby; implantation
- HCG blood test accurate after 2 days of implantation
- HCG- urine test accurate 42 days after first day of missed period
- Week 9 – looks like a fetus
- Station 0 is ischial spine ( is most narrowest); above (-) ischial spine –1; below(+) ischial spine = +
- Abnormal = protein in urea= pre eclampsia
- Warning signs in PG
- Ultrasound if abnormality do MRI( in depth look)
- Nuchal translucency - behind baby neck ( check fluid I f there is too much fluid = possible defect
- Baby Normal FHR 110-160 HR for fetus
- Prolonged acceleration - baby HR spike and stay elevated ( linear) stress on baby - didn’t go back to base
- CVS sampling – earliest invasive test – 10weeks gestation; over 35 or young mom, sample of placenta side closet to
mom; probable issues with baby risk for spontaneous abortion are spontaneous membranes EARLIEST TEST TO
chromosomal
abnormalities
- PUBS - needle into umbilical
- 1 vein 2 artery AVA - fetal ( vein (o2) artery takes deoxygenated in artery opposite to adult
- Amniocentesis - genetic or metabolic issues 35 years automatically qualify ;
o Fetal lung maturity ( surfactant)med to help antenatal betamethasone ( steroid)
- Amniotic fluid clear/ cloudy infection/ greenish (bowel movement)/ Portwine ( bleeding/ abrupt placenta)
- Vena cava syndrome- laying flat on your back pressure on vea cava fetus affected; treatment- lie to the side
Diabetes mellitis – pregestational Screen 24-28weeks screen glucose test 3 hours
- Macrosomia ( big baby); polyhydraminos ( extra amniotic fluid) risk for preterm labor);
- After birth post ( finger stick risk for hypoglycemia ) insulin doses wil change ; adjust insulin doses
- First trimester hypoglycemia )congenital birth defects)
- Renal function and A1c
- Type one DM – does breast will not need as much insulin / doesn’t breastfeed back to original insulin req as before
pregnant
- Glucose challenge
- Dizzy, tremors – hypoglycemia
nd
trimester insulin needs are higher then in 1
st
trimester
- Glucose challenge 160cm- 28 weeks pg furthering testing
- Appt schedule - initial visit 28 weeks = appt once a month; 29-36 weeks = appt every 2 weeks; 37-40 weeks =
weekly appts
- 15-18 weeks – maternal blood tests triple or quad screen
- 15-26 weeks amniocentesis Dx certain birth defects and genetic conditions
- 24-28 weeks Glucose Tolerance test; if positive 3hr GTT; antibody screen required if RH neg
- 35-37- strep and herpes cultures
- 18-40 weeks ultrasound
- Ultrasoun d can DX= fetal hr, Fetal presentation, volume of amniotic fluid
- BPP ultrasound = four indicators= fetal tone; fetal breathing, fetal movements, amniotic fluid volume ( score
of 8-10 normal)
- HTN – chronic hypertension Dx at 20 weeks gestation; Gestational HTN onset proteinuria after 20 weeks gestation
- Eclampsia HIS SHRIMP= Hypertension 140/90-160-110; increased reflexes 3+, spasm- constriction, swelling
edema; headache, reduced placental perfusion ; increased clonus; Magnesium sulfate calcium gluconate
- FOCUS = for early vag bleeding = First trimester, Open cervix (inevitable abortion), closed cervix, ultrasound,
sustainable PG or missed abortion
- Preterm Labor= FISH CAT =Fetal Fibronectin , Infection, Short of 37wk; Hx of Preterm Labor; Cervical lgth,
Antenatal glucocorticoids, Tocolytics
- Bloody show= scant pink to bloody mucous plug ( not frank bleeding)
- PREPARE for late vag bleeding- Placenta previa, Red bright, Expectant management, Painless, Abruptio Placentae,
Red dark, Excruciation
- OH PIFFLE = Obstacles ( poor glycemic control) Huge baby(macrosomia), Pregestational Type 1&2, Insulin to control,
Finger sticks, First trimester Hypoglycemia-congenital birth defects; Later onset ( gestational diabetes (24-28 week),
Eating control diet/ exercise
- Bloody show- mucous plug out
- Lightening – fetus dropping into pelvis
- Contraction measured = duration,( length)frequency,( how often) intensity (strength)= have to progress to get baby out
- Uterues contracts – blood flow decreases , blood flow to placenta dcreases, decreased o2 to fetus
- tocotrasnducer –over fundus - measures contractions of uterus
- Fetal heart rate – ultrasound tranducer ; where is babe (LOA) place monitor ( based Leopalds
- Rupture of membranes ( eater breaks can use intraurine pressure catheter; scalp has a reader on it (head doen)
- Baseline FHR (each box 10 secs ) ; accerlation 15 by 15 rules no longer than 15 secs of accerlation went back to
baseline; mom changed oistions
th
degree worst degree;
- Start of birth occurs when cervis dilates
- Emtala – act law that ensires that emergency medical treatment can be given to pg women even without insurance
- Page 20 Culturally Asian not usual for them scream out in pain. Stoic ( cultural practices); pain meds, food
preferences, ASIAN cultural
- Give epideural between 4-7cm
- Nuli parous- first time mom / never given birth before
- Leopolds used to assess best location of FHR montitor and position for labor
- 110-160 FHR Normal
- If mom has hemoglobin 8 before child birth NEEDS blood profusion; O neg;
- Vena cava syndrome ; late deceleration will be seen FHR, give mom wedge
- Best way to evaluate contractions is monitor
- Once ruptured membranes ( artificially ) pain fully contractiosn are most intense
- PRIORTY after membrane ruptured – monitor FHR, Amniotic fluid accessment ( look at color),
- General anesthesia 0 will effect mom crosses placenta barrier - S **TERILE VAG exam ( maniual – lessen if membrane rupture ( risk for infection)
- Don’t start pushing til comletely dialted
- Fergeson REFELEX urge to push
- +5/ +4 station= crowning
- How to prevent epiosotomy- sterile drap , presure on perniem
- Forcept s or vaccum can be used to to help guide head from vag
- Placenta accreda= may requires hysterecty if too deep ( if left infection, hemorraging)**
- Preterm labor = 20 weeks =36 weeks and 6 days ; look at age over size
o Risk factors – race, prior, age, dm, htn, bleeding,
o Prevention- place on high risk; incopentence cervix (cevage), extra prenatal visit,
o Intervention-
o Fetal fibronectin- swab at 22-34 if postive = complication, cervial length
o Cervical shortening - effacement
o Know sign effacement 80% cervix dialter 2xm or greter
- Tocolytics – relaxed uterus stops contractions = prolong 2=7 days ; terbulinem indotheacin Mg sulfate last resort
- Anternatal glucoorticoid , lung maturity ( surfactan) give 24-34 weeks best time to give to baby= 1 coures needed
- 4cm birth will happen
- Magsulfate – nuero development and tocolytical ( stops neontal nuerolgic sequele)
- Premature ROM- labor hasn’t started = risk for infection go to hospital ; before 37 weeks ( 20-37 weeks)
- ROM – least 1 hour before labor
Chorioamniotis – tachycarfdia, feverm uterus tender, foul order of amniotic fluid 0 infection of amniotic cavity , prolong
deceleratins
Baby doesing past 42 weeks= POST TERM= maconsomia ( big baby) , complications dysfuntional labor , injury bleeding,
infection ( placenta gives out
Ingdice labor or c section ( aging placenta ,
Dystocia- dysfunctional laor – inffective contractions ( too weak , too strong powers) passage, passenger,
Gyencoid most favoorabile shape of pelvis ( round)
LOA most favorable psotion of baby
Cephalopelvic disportion = big head baby
Hypertonic – 6-10 in 10 mins= give tocolytics
Hyptonic uterine contractions = pitocin
Precipituos labor – labor less than 3 hours w/o augementaion= risk factor trauma coacaine, htn, uterues tacystole
Bishop score 5 or less nt candiate/ cervid is assessed postiom, constitancy, dialte , effacement,
Induce mom – placenta previa- contraindicated
Bleeding induction is contracincated
- Diabetes in PG can cause all of the following complications- postpartum hemorrhage, Macrosomia, Preterm labor
- Type 2 diabetes may require insulin assisted management during pregnancy= true
- A positive reaction for a non- stress test should NOT be followed by a contraction stress test- True
- CVS Chorionic villus sampling requires sample taken from the fetal side of the placenta
- In postpartum period, the nurse should expect the insulin requirements of mom to possible decrease- True
- What postpartum condition should the nurse monitor of mom and newborn for mom is diabetic-
Hypoglycemia 39.Maternal death is NOT a direct risk following an amniocentesis- True
40.Which exam looks like Rh+ antibodies in maternal blood= Coombs test
Yellow Alert boxes from book
o BP measured on same arm each visit always while sitting; if elevated let rest and retake (page 188)
o Exercise for PG = exercise every day for 30mins; like swimming, cycling, stretching; avoid activities that require holding
breath and Valsalva maneuver; should be able to converse while exercise; in air conditioning (NO hot tub, saunas); After 4
th
month of PG no exercises on back; rest 10 mins after exercising; drink water while exercise; drink 2-3 8oz of water after; (page
o Stop exercising and call MD if : SOB, dizziness, headache, numbness, tingling, chest pain, reg painful contractions,
decrease fetal activity, vaginal bleeding, dyspnea before exertion, muscle weakness affecting balance, calf pain or swelling
o Family members who will come in close contact with infant less than 12months are up to date with single of Tdap at
least 2 weeks before contact (page 193)
o Airplane Travel when PG = safe if no medical/ obstetric complications; airlines allow travel up 36 weeks; during flight
wear seatbelt; To minimize lower edema, or thrombosis wear support stocking, avoid restrictive clothing, move legs
periodically, ambulate occasionally, stay hydrated
o Sexuality in PG = libido lower in 1
st
trimester, increase in 2
nd
; alternative behaviors, alternate positions; Abstain from
missionary if cramping or bleeding; Avoid intercourse of hx of premature dilation cervix ask Dr; partner should not blow air
into V can cause air embolus (page 197)
o Signs of Potential complications : in 1
st
trimester = severe vomiting; chills, fever; burning urination; diarrhea; abd
cramping, vag bleeding.(miscarriage, ectopic pg) In 2
nd
rd
Trimester = persistent severe vomiting, Sudden discharge
fluid before 37 weeks (PPROM); Vag bleed w abd pain (miscarriage , placenta previa, abrutptio); chills, fever, burning
urination, diarrhea (infection); severe back/ flank pain; change in fetal movements;, absence of fetal movements after
quickening (fetal jeopardy/ intrauterine fetal death) , absence of fetal HR; uterine contractions , pelvic pressure, cramping
before 37 weeks; visual disturbance) swelling of face, fingers, sacrum area; muscular irritability/ seizures; epigastric/ abd
pain; glycosuria, positive glucose tolerance test (gestational diabetes (page 200)
o High mercury harm fetal development (nervous system) Avoid eating shark, swordfish, king mackerel, tilefish; check
local advisories about fish caught if not available only eat 6oz or less and no other fish during that week. Eat 12oz of fish
per week (shrimp, salmon, pollock, catfish, canned light tuna (limit albacore or white tuna) (page 213)
o Calcium Sources ( NON milk )- sardines, salmon, beans, baked beans molasses, tofu, collard, turnip, kale, cornbread,
muffins, French toast, waffles, figs, orange juice, pesto sauce, cheese sauce (page 215)
o Iron supplement teaching = Vit c helps w/ absorption, take on empty stomach, decrease iron absorption- bran, tea,
cofee, milk, egg yolk; don’t double dose if missed dose take within 13 hrs of scheduled dose, (page 316)
o Avoid Bone meal many times has lead; ask MD for a different source of Calcium
o PG women who contract listeriosis from Listeria are at increased risk of miscarriage premature birth, still birth; Do not
consume unpasteurized milk (avoid brie, camembert, queso blanco, panela, asadero cheese. Only consume luncheon
meats hotdog, bologna if reheated or steaming hot; Do NOT consume store bought salads such as egg, chicken, ham
seafood (page 221)
o Managing N/V during PG = eat starchy food, toasts, crackers; avoid excessive fluids early in day or when nauseated; eat
small frequent meals every 2-3 hrs, avoid large meals, avoid skipping meals, no sudden movements; decreased intake of
fried fatty food; inhale fresh air or good ventilation; try salty/ tart food when nauseated; try herbal tea w/ Rasbery leaf &
peppermint; try ginger; wear motion sickness wristband, Vitamin b6 (page 222)
o In assessing fetal movement remember usually not present during sleep cycle or depressed with CNS depreesant meds,
alcohol, smoking
o After amniocentesis administer Rh0D to women is Rh negative Is standard
o Iron deficiency falsely increased A1C (page 247)
o Complication of undiagnosed/ partially treated hyperthyroidism is thyroid storm occurring from stress from labor,
birth, infection, preeclampsia, surgery. Women with thyroid storm give o2 , IV fluid and high dose of PTU. After give
iodine
o Women w/ sickle cell anemia are not iron deficient (avoid prenetal vitamins with iron can cause iron overload (pg 267)
o Meds to avoid when PG due to tetrogenic effects- Accutane ( isotretinoin), valproic acid,
o Assessing Deep Tendon reflexes= No response 0 - 4+ Hyperactive response ; 2 is normal expected response
o Assessing clinical signs of Preeclampsia - Take BP meds; sit take BP, use right arm, report increase of BP, report
decrease in urine output, assess fetal movements daily( 4 or fewer movements per hour may indicate fetal
compromise); Keep daily log or diary of assessments; report headache, dizzy, blurred vision, seeing spots to MD
immediately (pg 285)
o Hospital Measures Women w/ Preeclampsia = environment (quiet, non-stimulating, light subdued); Seizure
precautions (suction, oxygen, call button); Emergency meds available (Hydralazine, Labetalol, Nifedipine, Magnesium
Sulfate, Calcium Gluconate); emergency birth pack (pg 287)
o High serum levels of MG cause smooth muscle relaxation (uterus) policy admin 4-6gram loading dose
followed by 1-2g Maintenace dose
o If Mg sulfate toxicity is suspected to prevent respiratory and cardiac arrest. Discontinue Mg and give antidote;
Calcium Gluconate
o Mg sulfate = high alert drug. NEVER ABBREVIATE magnesium Sulfate as MgSO4 anywhere in medical record (page 289)
o Eclampsia Emergency treatment : stage invasion (eyes fixed, twitching of face muscles; stage of contraction 15-
(eyes protrude , blood shot, body muscles tonic ; stage convulsion- muscle relax and contract clonic respiration halted and
begins with long deep stertorous inhalation, coma ensue INVETRERVENTION : keep airway, head to the side, place pillow
under 1 shoulder; call for assistance don’t leave bedside; raise side rails pad with folded blanket; observe and record seizure
