Nursing Care of Child Bearing Families Study guide #1:

Things to know for test one in Nursing care of childbearing families:

Contractions – Duration is the length of a wave, intensity can only be measured by an IUPC not an external monitor, And frequency is the length of time from the start of one wave to the start of the next.

baseline variability – How much the heart rate moves from the baseline

  • absent – flat line
    • associated with sleep
  • minimal – less than or equal to 5 bpm of variance from baseline
  • Moderate – best rhythm(best parasympathetic/sympathetic teeter-totter), 6-25 bpm variance from baseline
  • Marked variability – more than 25 bpm from base, usually does not last long

Accelerations are always good and show that the baby is reacting to stimulus

  • greater than 15 seconds and shorter than 2 min

folic acid, – start taking in healthy amounts of folic acid before you get pregnant, 500mg is the goal amount to take in each day.

  • neural tubes do not close correctly if there is not enough folic acid resulting in spina bifida, anencephaly, cleft palate, premature and/or low birth weight, and miscarriage.

weight gained in pregnancy – 1st trimester weight gain is 3-5 lbs

  • .5 – 1 lbs per week after 1st trimester
  • How much weight a person should gain determined by pre pregnancy BMI
    • Underweight BMI <18.5: 28-40 lbs.
    • Normal BMI 18.5-24.9: 25-35 lbs.
    • Overweight BMI  25-29.9: 15-25 lbs.
    • Obese BMI greater than 30: 11-20 lbs.

hormones:

  • progesterone – Hormone of pregnancy, dominant in ovarian cycle in the luteal phase (days 15-28)
  • estrogen – subtle dark skin on face and linea alba from estrogen
    • Estradiol
      • in the reproductive years
    • Estriol
      • only during pregnancy
    • Estrone
      • Menopause
  • HCG – Human chorionic gonadotropin, produced by the placenta only, pregnancy test for this.  
  • oxytocin starts labor through contractions, lactation, bonding, and orgasm. Positive feedback loop.
  • prolactin – enable production of milk, and produced by the pituitary gland
  • relaxin – produced in the placenta and the ovaries, and relaxes the ligaments in the pelvis to allow for the baby to pass through more easily.
  • human placental l (HPL) – produced by the placenta, allows more glucose to get to the baby from the mother’s blood stream by blocking the mother’s cells from using the glucose.

don’t lie women flat on her back or it will occlude the vena cava causing a drop in BP, also it may be harder for the mother to breathe due the shifting of organs allowing for less space for the lungs to expand.

changes in blood values and know the risk factors from lab values (HCT, and Hemoglobin),

  • hypercoagulable
  • left shift in WBC’s (elevated count)
  • Anemia
    • fetus starts to store Iron from the mother at twenty weeks
  • Decrease in HCT and Hemoglobin, treat the HCT if it drops below 11.
  • Increase in the GFR in the kidneys due to the increased blood volume.

Maternal mortality in the US and infant mortality in the US are ranked very low when compared to other developed countries, and this is due to minimal prenatal care.

Know the broad System changes that occur in a pregnant woman’s body.

Know the leopolds – so the lie of the baby and how to describe the positions: oblique, transverse, breach, cervical. 

Gs and Ps,  

  • Gravidity – # of pregnancies including the current one.
  • Parity – # of births after 20 weeks
  • Nulligravida – never been pregnant
  • Nullipara – never given birth
  • Primigravida – first time to give birth
  • Primipara – has given birth to a less than 20 week old fetus one time.
  • TPAL
    • Term – # of births after 37 6/7 weeks
    • PreTerm – # of births between 20 and 37 6/7 weeks
    • Abortion – # of miscarriages, spontaneous or therapeutic abortions
    • Living children – self explanatory

TORCH infections

  • Toxoplasmosis, Other, Rubella, Cytomegalovirus, Herpes
  • these infections need to be treated in pregnant women especially, because they correlate highly with congenital defects.

Chadwick’s sign is the darkening of the labia, cervix and vagina. this comes from the increased blood flow associated with pregnancy.  

Hegar’s sign is the separation of the cervix from the uterus upon palpation, and the softening of the uterus.

fetal development milestones,

  • Heartbeat at 6 weeks on ultrasound, can be heard at 10 week GA for the doppler.
  • Fetal movement at 18-22, it is sooner in women who have been pregnant previously, (multips)

Umbilical cord anatomy – two arteries carrying DEoxygenated blood AWAY from the fetus, and one vein carrying OXYgenated blood TO the fetus.

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