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N164 Maternity Final Exam Questions And Accurate Answers
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N164 Maternity Final Exam Questions And Accurate AnswersGTPAL vs GP
Gravidity/Term birth/ Preterm/Abortions and miscarriages/ Living Children
GTPAL: #pregnancies/ #pregnancies ending in term births at 37 weeks+/ #pregnancies
that ended in preterm births ie 20 weeks 0 days to 36 weeks 6 days/ #pregnancies that
ended in miscarriage-spontaneous abortion or elective termination-therapeutic
abortion-before 20 weeks/ #children currently living
G/P: the # of pregnancies the woman has head (including the present one)/ the # of
pregnancies that have reached 20 weeks or more
- if full acronym is GTPAL, then P includes T + P (ignore A & L)
How to calculate gestational age
count backwards from the EDD (assume EDD is exactly week 40)
Past
How to calculate EDD
Naegele's rule: take LMP, subtract 3 months and add seven days + 1 year
Cervical exam (dilation, effacement)
Dilation: thinning of cervix (up to 10 cm)
Effacement: shortening and thinning of cervix (up to 100%
,Station:
Cervical exam: what is station?
the relationship of the presenting fetal part to an imaginary line drawn b/w maternal
ischial spines + a measure of degree of descent of presenting part through the birth
canal
above spines is & below spines is + +0= engagement- aligned with R & L maternal ischial
spines
+2 = pushing starts
+3 = baby is crowning
+4 to +5= birth is imminent
Presumptive signs of pregnancy
subjective and reported by the woman
amenorrhea, fatigue, breast changes, N/V, quickening (could be flatulence), uterine
enlargement
Probable signs of pregnancy
Objective and reported by the examiner
-Goodell's sign, Hegar's sign, Chadwick's sign, ballottement; Braxton-Hicks
contractions; + pregnancy test
Positive signs of pregnancy
only the presence of a fetus can explain these findings
fetal heart sounds, visualization of the fetus, fetal outline and movement movement
palpated by an experienced examiner; US visualization
Physiologic adaptation of pregnancy - CV
- Blood volume increases 45% to 50% to meet needs of woman and fetus
,- Physiologic anemia is caused by hemodilution (ratio 75% plasma: 25% RBCs
- Increase in clotting factors to protect against blood that will be lost during birth (but in
2nd and 3rd trimesters may increase risk of thrombophlebitis)
Physiologic adaptation of pregnancy- Resp
- Mild hyperventilation with decreased PaCO2 and increased PaO2-- state of respiratory
alkalosis
- diaphragm elevates and is displaced by 4cm= more room for the baby, may cause SOB
- inc. estrogen relaxes rib cage and inc. vascularization in upper respiratory tract
- BMR inc 10-20% due to utero-placental-fetal demand for O2
Physiologic adaptation of pregnancy- Renal
bladder irritability, nocturia, urinary frequency; may experience proteinuria
- by term gestation, there is an increase in total body water of 6.5-8.5 L
- selective reabsorption to maintain Na and H2O balance; esp Na to help expand fluid
volume
- physiologic/dependent edema: req no tx; as pregnancy progresses, capacity of
kidneys to excrete water is less efficient
Physiologic adaptation of pregnancy- Integ
- chloasma: mask of pregnancy
- linea nigra: vertical line replaces linea alba
- striae gravidarum: stretch marks
, - angiomatas: vascular spiders caused by inc. estrogen
- palmar erythema: redness in palms
- pruritis gravidarum: mild itching, usually over abd
Physiologic adaptation of pregnancy- MS
- dec. abd muscle tone
stretch during 3rd trimester-- may lead to diastasis recti abdominis (abd muscles
separate)
-center of gravity shifts
Lordosis (inc. lumbosacral curve) + exaggerated anterior flexion to compensate--> leads
to aching, numbness, and weakness of UEs
Waddling gait
Relaxin and progesterone loosen ligaments of pubic symphysis and sacroiliac joints
Physiologic adaptation of pregnancy- Neuro
hypothalamic-pituitary neurohormonal changes:
nerve compression/ vascular stasis= sensory changes in legs
lordosis= pain bc nerve compression
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