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NR 602 Midterm Study
Guide week 1-4 2024-2025
Primary Care Of The Childbearing (Chamberlain University)
NR 602: MIDTERM STUDY GUIDE
Signs of pregnancy (presumptive, probable, positive)
• Presumptive Signs of Pregnancy: Symptoms that are suggestive of pregnancy are considered
“presumptive signs” which means that they are the least objective or subjective signs which can also
be caused by many other conditions other than pregnancy.
• Amenorrhea: Highly suggestive of pregnancy in a healthy female with regular & predictable periods.
Difficult to determine in a female who have irregular periods or in those who do not keep track of their
menstrual cycles
• Nausea & vomiting: Common symptom (~50% of pregnancies) typically occurring between 2-16 weeks
gestation
• Breast engorgement & darkening of the areolas: Occurs as early as 6-8 weeks gestation
• Breast tenderness
• Fatigue
• Urinary Frequency
• Slight increase in body temperature: Rise in temperature coincides with luteal phase and is the result of
increased progesterone
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• “Quickening”: Mother feels the baby’s movements for the 1st time; starts at 16 weeks.
• Probable signs of pregnancy: mean that there is a high likelihood of pregnancy but there are still
other conditions that may cause the findings.
• Pregnancy tests are considered probable because β-hCG also presents in molar pregnancies and
ovarian cancer.
• Positive Signs of Pregnancy: The most reliable and most objective signs of positive pregnancy are
those where the provider can confirm the presence of a fetus
• Palpation of the fetus by the health care provider
• Ultrasound and visualization of the fetus
• Fetal Heart Tones (FHT) auscultated by the health care provider
Pregnancy and fundal height measurement
• Fundal height can provide valuable information on assessing the gestational age of the fetus as well
as to monitor fetal growth.
o 12 weeks: Uterine fundus first rises above the symphysis pubis o 16 weeks: Uterine
fundus is between the symphysis pubis and umbilicus o 20 weeks: Uterine fundus is at the
level of the umbilicus o 25-35 weeks: Measure the distance between the upper edge of
pubic symphysis and the top of the uterine fundus with a tape measure. Fundal height in
centimeters equals the number of gestational weeks (+/- 2cm). For example, a 28 week
gestation fetus should have a fundal height that measures between 26 and 30cm.
Between 25-35 weeks the fundal height should measure equally to the number of gestational *
weeks (+/- 2cm).
Naegele’s rule
• The EDD is calculated by adding seven days to the first day of the last menstrual period, subtracting
three months and adding one year.
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*For example, if the patient's last menstrual period, LMP, was on August 10, 2019, the EDD
would be calculated as follows. LMP equals August 10, 2019 plus seven days. August 17, 2019,
minus three months. May 17, 2019 plus one year and that equals May 17 , 2020.
Hematological changes during pregnancy-See Table 29.2 p. 777
• blood volume increases by 30% to 50%, or 1,100 to 1,600 mL and peaks at 30 to 34 weeks’ gestation.
• The increase in blood volume improves blood flow to the vital organs and protects against excessive
blood loss during birth.
• Fetal growth during pregnancy and newborn weight are correlated with the degree of blood volume
expansion.
• Of the blood volume expansion occurring during pregnancy, 75% is considered to be plasma There
is also a slight increase in red blood cell volume (RBC).
• The blood volume changes result in hemodilution, which leads to a state of physiologic anemia
during pregnancy.
• As the RBC volume increases, iron demands also increase.
• Leukocytosis occurs in pregnancy, with white blood cell counts increasing to as much as 14,000 to
17,000 cells per mm3 of blood (Table 29-3).
• Clotting factors increase as well, creating a risk for clotting events during pregnancy.
• Systemic vascular resistance is reduced due to the effects of progesterone, prostaglandins, estrogen,
and prolactin.
• This lowered systemic vascular resistance, in combination with inferior vena cava compression, is
partly responsible for the dependent edema that occurs in pregnancy.
• Epulis of pregnancy, or hypertrophy of the gums accompanied by bleeding, may also occur and is due
to decreased vascular resistance and increase in the growth of capillaries during pregnancy
Indications and contraindications for prescribing combined estrogen vs. progesterone-only birth
control: See Appendix 11-A p. 248
• Most COC formulations now contain between 20 to 35 mcg of ethinyl estradiol plus one of 8
available progestins.
• Consider the “quick start” method when initiating oral contraceptives.
If last menstrual period (LMP) was within the last 5 days, the method can be started
immediately.
In unprotected sex within last 2 weeks, start the contraceptive method today and advise
patient to return to the clinic for a pregnancy test in 3 weeks.
Instruct women who are using the pill, patch, ring, injection, or implant to use backup
contraception for the first 7 days.
Research shows that there are no significant differences in the number of bleedingspotting
days or any other bleeding parameter between the immediate and conventional starters.
• Indications:
Women with dysmenorrhea and menorrhagia
Women who want to regulate menses
Women who will use a daily method consistently
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• Benefits of COC
Decreased blood loss and anemia
Decreased menstrual cramps and pain with more predictable menses
Can be used to manipulate the timing of menses
Decreases risk of ovarian cancer and endometrial cancer
Reduces risk of ectopic pregnancy
Effective to treat acne, hirsutism and other androgen excess/sensitivity states
Reduced vasomotor symptoms and effective contraception in perimenopausal women
Increased bone mineral density
Decreased pain and frequency of sickle cell disease crises
• Disadvantages of COC
Decreased libido and anorgasmia is unusual, but possible
Mood changes, depression, anxiety, irritability
No protection against STDs or HIV
Nausea & vomiting, especially in the first few cycles
Breast tenderness or pain
Headaches may increase Special Situations for COC
Endometriosis-continuous use are most effective in reducing severe symptoms (skip placebo week);
must use monophasic pills
Functional ovarian cysts-higher dose estrogen COCs may be slightly more effective
Breastfeeding women-progestin-only method
• Contraindications of COC:
Multiple risk factors for arterial cardiovascular disease, such as smoking, diabetes, hypertension
Known thrombogenic mutations
Current or history of current ischemic heart disease, history of stroke, history of or
current deep venous thrombosis or pulmonary embolism
Vascular disease
Complicated valvular heart disease
Hypertension (systolic ≥160 or diastolic ≥ 100)
Smoking (>15 cigarettes/day and age 35 or older)
Migraine headache with aura
Major surgery with prolonged immobilization
Current breast cancer
Active viral hepatitis
Severe cirrhosis
Benign or malignant liver tumors
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