#2 Pregnancy Test #4 114 (antepartum Assessment)

kelsscoot's version from 2015-11-26 01:59

Section 1

Question Answer
Setting the stage for antepartum assessmentpreserve dignity, clean-catch urine sample, explain what is being done
Positions for Setting the stagesitting, lying, lithotomy (supine but feet in sturps)
Position used to inspect perineum and rectum of postpartum clientside-lying position (think if she had a C section)
AntepartumDuring pregnancy
Postpartumafter birth

Section 2

Question Answer
Focused interview is subjective or objective?subjective
ask questions related to Demographic information, Menstural history, Gynecologic history, obstetric history
GTPALgravida, term, preterm, abortions, living
Gravidanumber of pregnancy's
TermBirth after 38 weeks
Paralive births over 20 weeks (20-37 weeks)
Abortionsboth surgical and miscarriages
LivingLiving children
Female that has been pregnant 2 times before this one had a spontaneous abortion and a living child at home would be what?G-3, P-1
why ask about genetic information?risks for abnormalities
why ask about past medical and family historymedical dx, family history of congenital birth defects or exposure to teratogens
Why ask about lifestyle and social health practices?Smoking, drinking, illicit drug use, environmental exposures
Why ask about Nutrition and exercise?what mom eats, baby eats, lactation concern
Vegan diets with no consumption of animal products lackVitamin B12
females with a history of phenylketonuria should have what done?plasma assay for phenylalanine to screen for elevated levels
how does elevated phenylalanine levels affect the fetus?harmful to fetal brain development
Expected Date of delivery, number of weeks of gestation, signs and symptoms, and reaction to pregnancymake sure these are stated
Nagele's Ruleused to estimate DOB, first day of LMP + 7, number of month - 3(year of LMP +1 if Jan 1 is passed during pregnancy)
Avoid these to help prevent birth defectscigarette smoke, lead (water and plants), carbon monoxide, mercury, pesticides, insect repellents, some oven cleaners, solvents such as alcohol and degreasers, pain, paint thinners, benzene, formaldehyde

Section 3

Question Answer
Common TestsCommon Tests
Blood typeinitial & at 28 weeks for Rh-
administered if Rh- because if baby is Rh + the body may see it as foreignRho GAM
Hemoglobin and Hematocritdetermine need for iron supplements
WBCincrease sign of infection
Sexually Transmitted diseasesrisk to newborn, HIV (specific consent needed, dramatic decrease in transmission with medication), Hepatitis B, Gonorrhea, Chlamydia, Syphilis
Rubella titer (Common infections risks)recommended maternal immunization after birth, avoid pregnancy for 3 months after immunized. Avoid 1st trimester exposure due to risk of congenital rubella syndrome
Respiratory - TB (Common infections risks)teach respiratory precautions and smoking cessation
Urinalysisevery visit, look for protein, glucose, ketones, RBC's & WBC's
Plasma lipid levelsincrease as normal physiology, may be unrelated to nutrition, requiring no intervention. Special consideration should be given to screen for plasma and lead in females who report pica (eating not food items), because consumption of earth or clay can be a source of environmental contamination.
Urine Culturepositive for bacteria is > 100,000 colony forming units. Report urgency, flank pain, frequency, &burning
Pap smearrefrain from intercourse or douching 2-3 days prior for accuracy
Multiple marker genetic screen15-20 weeks, need for diagnostic testing if positive.
During the multiple marker genetic screening, blood tests check for what?down syndrome and spina bifida
Other names for multiple marker genetic screenquad screen test, triple screen, AFP plus
Alpha-fetoprotein16-18 weeks, testing for neural tube defects, blood test including Alpha-fetoprotein, E3, and Inhibin A. factors in age (>35 higher risk), ethnic background, Weight, Gestational age
What are neural tube defects?Abnormal fetal brain or spinal cord that is caused by folic acid deficiency during pregnancy.
Unconjugated estriol (E3) form of estrogen only made during pregnancy
Inhibin Ahormone released by placenta
Amniocentesis11-20 weeks and/or3rd trimester for fetal lung maturity, a <1% risk of pregnancy loss, checks the AFP level in amniotic fluid
Chorionic villus sampling10-12 weeks, genetic abnormalities, questionable results may require more testing
Using ultrasound, it can rule out what kind of birth defects?down syndrome, trisomy 21 (markers on ultrasound), check baby's brain, spinal cord, kidneys, and heart
50g glucose challenge (GCT) not fasting, done at 20-24, may be done at initial prenatal visit for clients with increased risk of GDM (gestational diabetes mellitus)
If initial 50g glucose challenge screening is negative, when should they be rescreened again?Between 24 and 28 weeks
50g glucose challenge normal value140 (some use 135)
If 50g glucose challenge normal value is greater than 140, they then do what?the 3 hour
blood is drawn exactly how long after glucose is injected?1 hour
3hour GTT (glucose tolerance test)Follow up test after the 50g glucose challenge test results were greater than 140. pt must FAST. no smoking, no cafeine prior to or during
How much glucose is given for the 3 hour GTT?100g. 50g was given to the original test done before this one.
3hour GTT blood draws, when and valuesfasting (<95), 1hr (<180), 2hr (<155), 3hrs (<140)
What is considered to be positive results to confirm a patient is positive for GDM?a fasting plasma glucose level above 105 mg/dl and a 1-hour glucose greater than 180mg/dl following ingestion of a 100g glucose load.
Group B strep 3rd trimester 35-37weeks, antibiotics via IV given in active labor to decrease transmission to infant
What is given to mom's with Group B strep to decrease transmission from mom to baby?IV antibiotics during active labor

Section 4

Question Answer
Antepartum Physical Assessment (by trimester)1st - tired, ambivalence, 2nd - well-being, energy, 3rd - increased fatigue and concerns about birth
Vital signsincrease slightly in pregnancy, heart rate increases, BP may drop to below prepregnancy baseline during the school trimester, watch for supine hypotension
Weightshould gain 25-25 pounds
Thorax and LungsInspection, palpation, percussion, auscultation
Breast and AxillaeInspection and palpation
ExtremitiesInspection and palpation (Vascular and Neurologic)
AbdomenInspection and palpation
Fundal height measurement (what rule is used)McDonald's rule
fetal heart rateauscultation

Section 5

Question Answer
Leopold'suses palpation of abdomen in sequence to answer series of questions to determine position of fetus in abdomen and pelvis after 28 weeks gestation
First Leopold's maneuver: what is in the fundus?Client in supine position, stand facing her head, place ulnar surface of both hands on fundus, fingertips pointing to midline, palpate shape and firmness of contents of upper uterus
Second Leopold's maneuver: Where is the fetal back?Move the hands down the sides of the abdomen along the uterine contour, a smooth, long, firm, continuous outline is found on the side with the fetal back. Irregular, lumpy, moving parts are found on the side with the fetal small parts, or feet and hands
Third Leopold's maneuver: What part of the fetus is presenting at the pelvis?Slide hands down to area above symphysis pubis to determine the "presenting" part of the fetus, the part of the fetus entering the pelvic inlet. Palpate shape and firmness of presenting part. Use thumb and third finger of one hand to grasp the presenting part.
Fourth Leopold's maneuver: How deep in the pelvis is the presenting part?Face client's feet. place ulnar surface of your two hands on each side of the client's abdomen. Follow uterine/fetal contour to pelvic brim. If fingers come together above superior edge of symphysis pubis, presenting part is floating above the pelvic inlet. If fingers snap over the brim of pelvis before coming together, the presenting part has descended into the pelvis.

Section 6

Question Answer
Position of the fetusrelationship of the presenting part to the four quadrants of the maternal pelvis
Where can the fetus be?left or right half of the maternal pelvis; in the anterior, posterior, or transverse portion of the pelvis
What 3 notations are used to designate the fetal position?Left or right, letter abreviating part of fetus that is presenting at the top of the pelvis, indicates if presenting part is in the anterior, posterior, or transverse portion of the pelvis
Lindicating left half of maternal pelvis the presenting part is in
Rindicating right half of maternal pelvis the presenting part is in
first notation indicatesRight or Left
2nd notation indicatesletter abreviating part of fetus that is presenting at the top of the pelvis,
3rd notation indicatesindicates if presenting part is in the anterior, posterior, or transverse portion of the pelvis
Oocciput, back of the head in a flexed position
Ssacrum for a breech presentation
Scscapula in a transverse lie
Mmentum or face presentation
Example, LOApresenting part is the occiput, left half of anterior part of pelvis

Section 7

Question Answer
Where is the fetal heart loudest?over the left scapula
How do you auscultate the fetal heart rate?place fetoscope or fetal doppler in the location where the Fetal Heart tones are most likely to be heard given the findings of Leopold's maneuvers
When would you need an ultrasound evaluation of the fetal viability?if the fetal heart beat is not found by 12 weeks with a fetal doppler, or 20 weeks with a fetoscope.
What could causes that could prevent heart beat being found include?incorrect dating of pregnancy or retroverted uterus
how long should you auscultate the FHT?1 minute

Section 8

Question Answer
Back pain can be due to Breast enlargement and/orgradual lordosis (spine bent inward)
kyphosisspine bent outward/hunchback
External Genitaliainspection, Bartholin's glands, urethra, and Skene's glands (see page 837)
Vagina/cervix will what colorishbluish (chadwick's sign)
Increased whitish, odorless dischargeleucorrhea (this is normal)
Use speculum to visualize cervix. warmed, it should be how big in diameter?2-3cm
(Pelvis, Angle of pubic arch) It may be more difficult for fetus to navigate if the angle of pubic arch is less than ___?90 degrees
Assess the interspinous diameter, determine if the spine is blunt, flat, or sharp (can impede labor).see page 840.
What is the average diameter of interspinous is10.5cm
Diagonal conjugateless than 11.5cm may prevent vaginal birth
Palpation of what (pelvis)cervix, uterus, adnexa (fallopian tubes and ovaries) and vagina
Measurements of the pelvic outlet11cm avg., 8.5 or greater adequate., small than 8.5 may inhibit fetal descent during expulsion

Section 9

Question Answer
(Developmental Considerations) pregnant adolescentspsychosocial and physical risks, prolonged labor, postpartum complications
Toxemiablood poisoning by toxins from a local bacterial infection, like preclampsia (1.a condition in pregnancy characterized by high blood pressure, sometimes with fluid retention and proteinuria.)
anemiacondition marked by a deficiency of red blood cells or of hemoglobin in the blood, resulting in pallor and weariness.
Deliverypremature or low-birth weight infant
povertyincomplete education, lack of support

Section 10

Question Answer
(Developmental Considerations) woman older than 35chronic diseases, medical complications (Diabetes and HTN)
Increased risk of perinatal deathsstill born
Increased risk of neonatal deathsdeath of a young, liveborn infant; classified as: early neonatal death, death of a liveborn infant occurring fewer than 7 completed days (168 hours) from the time of birth; late neonatal death, death of a liveborn infant occurring after 7 completed days of age but before 28 completed days.
Infertilitycan't get pregnant
giving birth to infant with Down Syndrome or other anomaliesgenetic counseling, prenatal screenings