Naegeles Rule
During a prenatal visit a patient tells you her last menstrual period was May 21, 2016. Based on the Naegele's Rule, when is the estimated due date of her baby?
February 28, 2017
May 21 + 7 days = May 28 - 3months = Feb 28
1st Trimester period is:
2nd Trimester period is:
3rd Trimester period is:
1st: week 1 - 13
2nd: week 14 - 27
3rd: week 28 - 40+
What 2 things interfere with iron absorption?
Milk & Caffeine
A pregnant client in her third trimester, lying supine on the examination table, suddenly grows very short of breath and dizzy. Concerned, she asks the nurse what is happening. Which response should the nurse prioritize?
A. The uterus requires more blood in a supine position.
B. Sympathetic nerve responses cause dyspnea when a woman lies supine.
C. Cerebral arteries are growing congested with blood.
D. Blood is trapped in the vena cava in a supine position.
D. Blood is trapped in the vena cava in a supine position.
uterine changes in pregnancy
uterus increases in size, changes shape
lower uterine softens = Hegar's sign
During a prenatal visit a patient tells you her last menstrual period was November 25, 2016. Based on the Naegele's Rule, when is the estimated due date of her baby?
September 1, 2017
General feelings of pregnancy in 1st, 2nd and 3rd Trimester
1st - ambivalence (unsure, excited, scared) & morning sickness (N/V)
2nd - feel baby move, fetus separate being, fetal heartbeat, look pregnant, develop bond, ↑ energy , ↓ morning sickness = ACCEPTING PREGN
3rd - ambivalence (fear, excitement, joy) & nesting behaviors (getting home ready for baby)
You are assessing the nutrition of a pregnant woman who has 2 children (ages 1 and 4) and previously had heavy menstruation. She is currently taking folic acid and is vegetarian. What other prenatal nutrition advice would you give?
Frequent pregnancies/multiple children & heavy menstruation - risk for low iron & vegetarian may be lacking in vitamins, minerals and proteins
iron supplementation - food sources like red meats, fish, poultry, dried peas & beans and possible nutritionist
When counseling a client about getting enough iron in her diet, the maternity nurse should tell her that:
A. Milk, coffee, and tea aid iron absorption if consumed at the same time as iron.
B. Iron absorption is inhibited by a diet rich in vitamin C.
C. Iron supplements are permissible for children in small doses.
D. Constipation is common with iron supplements.
D. Constipation is common with iron supplements.
These beverages inhibit iron absorption when consumed at the same time as iron. Vitamin C promotes iron absorption. Children who ingest iron can get very sick and even die. Constipation can be a problem.
cervical changes in pregnancy
cervix softens = goodell's sign
cervix color change = chadwicks sign
mucus plug (operculum) to protect from ascending bacteria
cervix pH drop - watch for candida (Yeast Infections)
During a prenatal visit a patient tells you her last menstrual period was January 20, 2016. Based on the Naegele's Rule, when is the estimated due date of her baby?
October 27, 2016
Lower uterine segment softens (identifiable in wks 6-12)
Hegar's Sign
Folic Acid is crucial for ...?
Folate is found in ...?
neurological development & prevention of neural tube defects
Folate foods: leafy veggies, dried peas & beans, seeds, OJ, breads
A pregnant woman with a body mass index (BMI) of 22 asks the nurse how she should be gaining weight during pregnancy. The nurse's BEST response would be to tell the woman that her pattern of weight gain should be approximately:
A. A pound a week throughout pregnancy.
B. 2 to 5 lbs during the first trimester, then a pound each week until the end of pregnancy.
C. A pound a week during the first two trimesters, then 2 lbs per week during the third trimester.
D. A total of 25 to 35 lbs.
B. 2 to 5 lbs during the first trimester, then a pound each week until the end of pregnancy.
Rationales:
A - A pound a week is not the correct guideline during pregnancy.
B - A BMI of 22 represents a normal weight. Therefore, a total weight gain for pregnancy would be about 25 to 35 lbs or about 2 to 5 lbs in the first trimester and about 1 lb/wk during the second and third trimesters.
C - These are not accurate guidelines for weight gain during pregnancy.
D - The total is correct, but the pattern needs to be explained.
breast changes in pregnancy
increase size & sensitivity
colostrum occurs (early breast milk packed w the good stuff)
nipples darken
Purple color change from increased vascularity in the (blank) is called the (blank)
Purple color change from increased vascularity in the cervix is called the Chadwick's Sign
Women with an inadequate weight gain during pregnancy are at higher risk of giving birth to an infant with:
A. Spina bifida.
B. Intrauterine growth restriction.
C. Diabetes mellitus.
D. Down syndrome.
B. Intrauterine growth restriction
STAT: Identify women at risk for maladaptive pregnancy (lack of interest/bonding):
A. 19 year old accidentally pregnant with her physically abusive ex.
B. 30 year old woman, 2 existing children, husband currently deployed
C. 33 year old married woman who has had an dysfunctional relationship with her own mother
D. 35 year old recently widowed woman, who became unwantedly pregnant from a 1-night stand
all of them - A, B, C, D
skin changes in pregnancy
pigmented tissue darkens (nipples & perineum)
formation of Linea Nigra (line down abdomen)
Striae Gravidarum (stretch marks)
Melasma - mask of pregnancy
increase in sweat glands & acne
Cervix softens is called the...?
Goodell's Sign
An underweight pregnant lady is at risk for:
Increased risk for preterm labor & baby w/ low birth weight
SATA: Which of the following are considered teratogenic meds?
a. ACE inhibitors
b. seizure meds
c. oral hypoglycemics
d. some antibiotics
A, B, C, D
SATA: Which of the following respiratory changes are true in pregnancy?
A. Maternal Oxygen needs increase
B. Total lung capacity increases
C. Respiratory rate unchanged or slightly increases
A & C
Total lung capacity decreases
True or false: Operculum is present to protect uterus from ascending bacteria
True! Operculum or mucus plug is to protect uterus from ascending bacteria.
An overweight pregnant women is at risk for:
issues with birth - prolonged (baby too big), may need c-sec, preeclampsia, gestational diabetes
potential defects with baby heart or cleft lip/palate
Match the fxn to the hormone: progesterone, prolactin, estrogen, oxytocin, relaxin
1. enlarges uterus & breasts, promotes vascularity, allows skin stretch
2. ↑ levels to produce milk
3. ↑ to begin labor (contractions), prevent hemorrhage, produce breast milk
4. ↓ smooth musc. irritability, softens cervix & joints
5. maintains cervix, ↓ smooth musc. irritability
1. estrogen
2. prolactin
3. oxytocin
4. relaxin
5. progesterone