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NR 602 WEEK 4 MIDTERM REVIEW
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NR 602 WEEK 4 MIDTERM REVIEWNR 602 Midterm Study Guide
Signs of preg. Presumptive Signs: least obj. or subj. signs;can also be caused by many other
(presumptive, conditions
probable, (+)) Presumptive signs include:
• Amenorrhea:
o Highly suggestive of preg. in a healthy fem w/ regular & predictable
period. Difficult to determine in a fem w/ irregular periods or in those who
do not keep track of their menstrual cycles
• Nausea & vomiting:
o Common symptom (~50% of pregnancies) typically occurring between 2-
16 wks. gest
• Breast engorgement & darkening of areolas:
o Occurs as early as 6-8 wks. gest
• Breast tenderness
• Fatigue
• Urinary Frequency
• Slight increase in body temperature:
o Rise in temp. coincides w/ luteal phase & is the result of progesterone
• “Quickening”:
o Mother feels baby’s movements for 1st time; starts @ 16 wks.
Probable Signs: a high likelihood of preg. but there are still other conditions that
may cause the findings. Preg. tests are considered probable because β-hCG also
presents in molar pregnancies & ovarian cancer
Probable signs include:
• Goodell’s sign:
o Cervical softening (around 4 wks.)
• Chadwick’s sign:
o Blueish coloration of the vagina & cervix (6-8 wks.)
• Enlarged uterus
• (+) urine or blood preg. test (β-hCG)
[+] Signs of Preg.: The most reliable & most obj. signs of (+) preg. are those where
the provider can confirm the presence of a fetus
(+) signs include:
o Palpation of the fetus by HCP
o US & visualization of the fetus
o Fetal Heart Tones auscultated by the HCP
Preg. & fundal 12 wks. gestation:
height • the fundus is located @ the level of the symphysis pubis.
measurement 16 wks. gestation:
• fundus rises to midway between symphysis pubis & the umbilicus
Schuiling, pg. 20 wks. gestation:
774 & Wk. 1 • the fundus is typically @ the same height as the umbilicus
Lecture
,NR 602 WEEK 4 MIDTERM REVIEW
>20 wks. gestation: the fundus enlarges approx. 1cm/wk. As the time for birth
approaches, the fundal height drops slightly.
• This process, which is commonly called lightening, occurs for a woman who
is a primigravida around 38 weeks’ gestation but may not occur for the
woman who is a multigravida until she goes into labor
25-35 wks. gestation: Measure the distance between the upper edge of pubic
symphysis & the top of the uterine fundus w/ a tape measure. Fundal height in
centimeters equals the number of gestational weeks (+/- 2cm). For example, a 28-
wk. gestation fetus should have a fundal height that measures between 26 & 30cm.
Naegele’s rule The due date or expected date of confinement (EDC) can be calculated using
Naegele’s Rule
• Begin on the 1st day of the last menstrual period (LMP), subtract 3 mos., add
7 days, & then add 1 yr.
Example
LMP: February 14, 2015
Subtract 3 mos. (Great Scott x 3): November 14, 2014
Add 7 days (N-A-E-G-E-L-E): November 21, 2014
Add 1 bear (year): November 21, 2015
Hematological Nonpregnant Fem., Ages 19–65
,NR 602 WEEK 4 MIDTERM REVIEW
changes during o Hgb: 12–16 g/dL
preg. o Hct: 37–47%
o RBC: 3.5–5.5/mm3
Schuiling, pg. o WBC: 4.5–11/mm3
778 1st Trimester
TABLE 29-3 Lab o Hgb: 11.6–13.9 g/dL
Value Changes in
o Hct: 31–41%
Preg.
o RBC: 3.4–5.2/mm3
o WBC: 4–13/mm3
nd
2 Trimester
o Hgb: 9.7–14.8 g/dL
o Hct: 30–39%
o RBC: 2.8–4.5/mm3
o WBC: 6–14/mm3
3rd Trimester
o Hgb: 9.5–15 g/dL
o Hct: 28–40%
o RBC: 2.7–4.4/mm3
o WBC: 6–17/mm3
Indications & Combined Hormonal Contraceptives (COCs)
contraindications • Most COCs contain 10-35 mcg of ethinyl estradiol & 1 of several different
for prescribing progestins.
combined • Drospirenone has a mild K+-sparing diuretic effect; K+ levels checked
estrogen vs. during the 1st cycle in fem. using ACE inhibitors, chronic daily NSAIDs,
progesterone- angiotensin-II receptor antagonists, K+-sparing diuretics, heparin, or
only birth control aldosterone antagonists.
• Fem. w/ conditions that predispose them to hyperkalemia should not use
drospirenone.
COC Disadvantages:
• Increase the risk of VTE.
• May BP in some through an in plasma angiotensin.
• HTN is a cofactor in the dev of CV disease
• development of benign hepatocellular adenomas, this SE is very rare w/
low-dose pills.
• a slightly risk of develop breast cancer; in the incidence of cervical cancer
• Mood changes, depression, anxiety, irritability
• Decreased libido & anorgasmia is unusual, but possible
• No protection against STDs or HIV
• N/V especially in the first few cycles
• Breast tenderness or pain; HA may increase
Estrogen Specific SEs include:
• nausea
• cervical ectopy & leukorrhea
• telangiectasis
, NR 602 WEEK 4 MIDTERM REVIEW
• chloasma (darkening of sun-exposed skin)
• growth of breast tissue (ductal tissue or fat deposition)
• increased cholesterol content w/in the bile (can lead to gallstones)
• benign hepatocellular adenomas/changes in the clotting cascade.
Effects specific to the androgenic impact of progestins include
• appetite & subsequent weight gain; mood changes & depression
• fatigue; complexion changes; changes in carb metabolism
• LDL & HDL cholesterol; libido; pruritus.
Effects that can be either estrogen or progestin related include
• HA; HTN; breast tenderness.
COC Benefits
• risk of ovarian cancer (by 20% for each 5 yrs. of COC use)
• risk of endometrial cancer by approximately 50%.
• rates of PID requiring hospitalization, fewer ectopic pregnancies, &
incidence of endometriosis.
• may Tx or improve anemia; Increased bone mineral density
• Decreased pain & frequency of sickle cell disease crises
• Reduces risk of ectopic preg.
• Effective to treat acne, hirsutism & other androgen excess/sensitivity
states
• Reduced vasomotor symptoms & effective contraception in
perimenopausal fem.
• Decreased menstrual cramps & pain w/ more predictable menses
• Can be used to manipulate the timing of menses
• Effective Tx for mittelschmerz, dysmenorrhea, endometriosis,
premenstrual symptoms,
Progestin-only contraceptives: include the progestin-only pill (POP),
injection/implant/ 3 progestin-IUD
• are used continuously; no hormone-free interval
• Minimal effects on coagulation factors, BP, or lipid levels & are generally
considered safer for fem. w/ contraindications to estrogen, such as CV risk
factors, migraine w/ aura, or a hx of VTE
• do not provide the same cycle control as methods containing estrogen, &
unscheduled bleeding is common w/ all progestin-only methods.
• unscheduled bleeding occurs most frequently during the first 6 mos., w/ a
substantial number of users becoming amenorrheic by 12 mos.
• Overall blood loss decreases over time
• protective against iron-deficiency anemia.
• All are likely to improve menstrual symptoms, including dysmenorrhea,
menorrhagia, premenstrual syndrome, & anemia
• The thickening of cervical mucus is protective against PID.
Progestin-Only-Pills (POP)
• contain 0.35 mg of norethindrone. Each pill contains active ingredients; there
is no hormone-free interval
• Must be taken @ the same time each day; BC effect ends immediately upon
d/c
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