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Nur254 Exam1 maternity
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Nur 254 Maternity Exam 1 anything in yellow on exam
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Childbearing Exam #1Galen College
Nur-254
Childbearing / maternity
Unit 1: Antepartum
What in yellow was on this exam
Nursing Management
o Page 178 Signs/symptoms related to pregnancy
Categorizing signs/symptoms of pregnancy
Presumptive: subjective (Patient says they experience), least reliable – not definitive signs of
pregnancy, COULD be caused by something other than pregnancy, QUICKENING
o Breast changes, amenorrhea, nausea and vomiting, urinary frequency, fatigue,
quickening
Probable: objective, (practitioner can see) “more than likely” pregnant
o Positive pregnancy test, Braxton Hicks (false), Goodell’s sign (cervical softening),
Chadwick’s sign (increased cervical vascularization), Hegar’s sign (softening of lower
uterine segment), enlarging uterus, ballottement (pushing of the uterus – do you feel a
fetus move and come back?)
Positive: visualization, hearing fetus HR, feel the fetus, VISUAL ULTRA SOUND; practitioner feels
kicking
What is considered normal or expected?
Effects on body systems
o Breasts: increase in size, fullness, heaviness, tingling, darkening of the areola, lactation
can occur as early as 18 weeks
o GI: delayed GI motility, constipation, heartburn, nausea and vomiting, hemorrhoids,
increased vascularity of gums, increased saliva
o GU: increased urination; NORMAL
o Cardio: pulse increase, increased blood volume, increased cardiac output
o Respiratory: increased O2 consumption, nasal and sinus congestion, increased
vascularity
o Musculoskeletal: center of gravity shifts, unsteady gait
o Sensory: sciatica, restless legs, muscle cramps, syncope, tension headache
o Integumentary: melasma mask (hyperpigmentation), striae gravidarum (stretch marks),
vascular malformation (spider veins)
Vital signs
o HR: slight increase
o BP: should not change dramatically from baseline
o RR: SOB is common, difficulty breathing is NOT
o O2: remains stable
o Temp: can slightly increase
▫ Page 187 Calculating GTPAL
G: gravida
Number of pregnancies, regardless of the outcome – including current
T: term
Delivery at 37-42 weeks
P: preterm
Delivery between 20 weeks and 36 weeks 6 days
A: abortion
Before 20 weeks, including miscarriage
L: living
Number of children that are still living
REMEMBER! With multiples, they count as one pregnancy!
▫ Page 178 Calculating Naegele’s Rule/EDD (expected date of delivery) – two ways to calculate
First day of last menstrual period
Add 7 days + 9 months
OR
Add 7 days – 3 months + one year
EXAMPLE:
LMP: 1/12/22
+ 7 days = 1/19/22
+ 9 months = 10/19/22
▫ Analyzing labs
Blood work
Titers
o Rubella/Varicella: provides passive immunity
Live vaccines are contraindicated (page 193)
o No booster while pregnant, can offer postpartum
o Toxoplasma- Don’t not clean cat litter, eat raw meat or touch dirt
CBC
, o H&H will increase ( normal Hemoglobin for PG 11)
o Monitor for anemia
Coombs screening: Rh factor and antibodies
o Rh negative mom, Rh positive baby
o ( rh+ fetal blood crosses into maternal blood stimulating maternal antibodies)
Rhogam UP to 72hr after birth or any instance when blood may become mixed
Blood type
STI screening: HIV, syphilis, chlamydia, gonorrhea
▫ Therapeutic communication
Speaking with patients about common symptoms of pregnancy
Current exercise can continue, unless uncomfortable
HYDRATE
Careful in HOT weather
Sleep 8 hours every day if possible
Change bra, shoes and other clothing to ensure comfort
Sleep on side after 1st trimester
▫ Providing culturally competent care- don’t offend, always ask about preferences of food/ pain ect; check chart for previous
pain management
o Priority Actions
What to do first?
▫ Page 198 Relieving discomforts of PG signs/symptoms
Breast changes= wear supportive maternity bra
Urgency frequency- empty bladder, kegel exercises, limit fluid before bed, avoid coffee
N/V= avoid empty overload stomach; dry carb and hot tea, Avoid fried, spicy food;
Bleeding gums= go to dentist; eat fresh fruit & veggies and soft toothbrush
Constipation= Drink 2L of water; no stool softner, no laxative, only w/ Dr order
Not preventable=mask of pg, spider nevi, pruritis, palpitations, food craving, carpal tunnel
Education
o Page 208 Dietary management
Weight gain of 25-35lbs is normal
First trimester: no increase in calories
2nd and 3rd: 300 calorie increase
Iron-deficiency anemia
Organ meats, green veggies, nuts, beans; PeanutButter; cereal, whole wheat, spinach, eggs
omelet
Take supplements on an empty stomach – mild nausea is common
Vitamin C will increase absorption= orange , broccoli
Stools can turn dark green to black and cause constipation
No calcium blocks absorption of Iron; can take 2hrs before and 2 hours after > no milk, yogurt,
butter
Folic acid
Low levels linked to fetal neural tube defects
Leafy greens
▫ Page 200 Signs of possible complications of PG
1st trimester
Severe vomiting= hyperemesis gravida
Chills, fever; burning upon urination; diarrhea= infection
Abd cramps; vag bleeding= miscarriage, ectopic pg
2nd & 3rd Trimester
Persistent severe vomiting= hyperemesis gravida, HTN, Preclampsia
Sudden discharge fluid from vag before 37w= Preterm Pre labor rupture of membranes
Vag bleed, severe abd pain=miscarriage, placenta previa, abruptio placental
Chills, fever, burning on urination, diarrhea= infection
Severe backache or flank pain= kidney infection or stones, preterm labor
Change in fetal movements = absence after quickening, any usual pattern or amt=fetal
jeopardy, intrauterine fetal death
Absence of FHR=intrauterine fetal death
Uterine contractions, pelvic pressure; cramping before 37w= preterm labor
Visual; disturbances, blurry, 2x vision, spots=htn , preeclampsia
Swelling of face or fingers , over sacrum= htn , preeclampsia
Headache, severe frequent or continuous= htn , preeclampsia
Muscular irritability or seizures= htn , preeclampsia
Epigastric / abd pain = htn , preeclampsia, placenta abruption
Glycosuria, + glucose tolerance reaction= gestational DM
o Knowing if teaching is effective/ineffective
Red flag /warning pregnancy symptoms
Fluid from vagina that is not leukorrhea (thin, white, scant vaginal discharge)
Abdominal or pelvic pain
Epigastric pain or severe heartburn
Sudden or severe edema in face and hands
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