Maternal Newborn ATI-3

Metabolic Changes

100

By 20 weeks gestation, maternal pulse increases by

10-15 beats/min.

200

In the second trimester, systolic and diastolic BP decreases by

5-10 mm Hg

300

Describe 2 normal physiologic respiratory changes in the pregnant woman.

1) Respirations increase by 1-2/min; 2) Uterine pressure may elevate the diaphragm by up to 4 cm, decreasing room for lung expansion; 3) Some shortness of breath may occur, especially in 3rd trimester.

400

Blood volume increases by ____%, with maximum hemodilution at 28 weeks.

40%.

500

A woman at 36 weeks gestation is worried about her chloasma, linea negra and striae gravidarum. What are these and how would you counsel her about them?

Chloasma, or mask of pregnancy, is a darkening of the cheeks or face. The linea negra is a dark line from the umbilicus to the pubis. Both are caused by pregnancy hormones, and lighten postpartum. Striae gravidarum are stretch marks, most commonly on the abdomen, thighs and breasts, which will gradually become less fiery red and more silver after pregnancy. All are normal.

Pregnancy Symptoms

100

Give 3 suggestions for decreasing morning sickness.

1) Small, frequent meals; 2) Avoid greasy or strong-smelling foods; 3) Eat dry crackers before getting out of bed; 4) Ginger tea; 5) Sea bands; 6) Anti-emetics such as Reglan or Zofran, as prescribed.

200

Why do women have urinary frequency while pregnant?

1) Increased renal filtration rate; 2) Uterine pressure on the bladder.

300

Waddling or pain at the pubic symphysis near term are caused by

Relaxation of the pelvic joints (from the hormone relaxin) in anticipation of labor.

400

Fatigue and orthostatic dizziness in pregnancy may be due to... [give 2 possible explanations]

1) Anemia; 2) Dehydration; 3) Low blood sugar; 4) May be normal

500

At 12 weeks gestation, your client has gained 10 pounds and wants to know if this is all right. What do you tell her?

This is high. Her goal should be a 25-35 pound weight gain in the entire pregnancy (about 3-4 in the 1st trimester, then about a pound a week in the 2nd and 3rd trimesters).

Nutrition

100

How many extra calories does a pregnant woman need to eat?

300 calories a day.

200

0.4 mg of folic acid a day reduces the fetus' risk of

neural tube defects.

300

Name 3 good sources of dietary calcium for a woman who dislikes milk.

1) Yogurt; 2) Cheese; 3) Calcium-fortified soy milk; 4) Fortified orange juice; 5) Dark leafy greens; 6) Legumes; 7) Nuts

400

Cravings to eat non-food substances such as dirt, clay, ice or laundry starch

Pica

500

Your anemic patient tells you she takes her iron supplements at breakfast with her coffee and cereal. What counseling should you do?

Explain that iron is best absorbed between meals, with vitamin C, and that milk and caffeine both interfere with iron absorption. Maybe she could take her iron with orange juice mid-morning.

Special Diets

100

Vegetarians may have diets low in [name 3]

Protein, iron, vitamin B12, zinc, and (if vegan) calcium.

200

Treatment for hyperemesis gravidarum includes [3 out of 5]

1) NPO; 2) IV fluids; 3) Controlling nausea and vomiting (eg. Zofran); 4) Slowing progressing to small feedings as tolerated; 5) Parenteral feedings if necessary.

300

A woman with gestational diabetes should have these blood sugar targets for fasting and 2 hours postprandiol.

FBS <90-95; 2 hour postprandiol <120.

400

Name 4 dietary sources of protein.

Meat, poultry, fish, eggs, beans, nuts (including peanut butter), low fat dairy (including milk and yogurt).

500

On intake at 8 weeks gestation, a patient's hemoglobin was 12.8 and hematocrit 34%. At 28 weeks, it has dropped to 11/32%. How would you counsel her?

Explain that this is a normal drop due to hemodilution since the body makes so much extra blood during pregnancy. She does not need treatment as these values are normal at 28 weeks.

Hormones

100

What medications can cause false positive pregnancy tests?

Anticonvulsants, diuretics, tranquilizers.

200

An hCG level which is rising very slowly may indicate

an ectopic pregnancy.

300

Name 3 hormones produced by the placenta.

1) hCG (human chorionic gonadotropin); 2) progesterone; 3) estrogen; 4) human placental lactogen; 5) prostaglandins.

400

Name 2 reasons for abnormally high hCG levels.

1) Multiple gestation; 2) Hydatidiform mole or other trophoblastic disease; 3) Pregnancy further along than calculated; 4) Down syndrome

500

Your patient at 5 weeks gestation is spotting so the clinician orders quantitative hCG testing and an ultrasound. The ultrasound finds no IUP. Her hCG was 960, then 620 48 hours later. How would you explain these results to her?

She is most likely having an SAB. Although the absence of an IUP on U/S could be due to her being earlier than 5 weeks but we'd expect her hCG to be doubling every 48 hours. It could be due to an ectopic pregnancy, but then we'd expect her hCG to be flat or rising slowly. The fact that the hCG is dropping makes it most likely she's miscarrying.