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types of families ✔✔
nuclear family ✔✔Mother, father and children living as a unit
multigenerational families ✔✔a family with three or more generations alive at the same time;
considers the needs of middle generation, not just young and old as with intergenerational
extended family ✔✔a family that extends beyond the nuclear family, including grandparents,
aunts, uncles, and other relatives, who all live nearby or in one household.
no-biologic-parents ✔✔those in which children live independently in foster or kinship care such
as living with a grandparent
married-blended families ✔✔those formed as a result of divorce and remarriage, consist of
unrelated family members who join to create a new household
Cohabitating-parent families ✔✔those in which children live with two unmarried biologic
parents or two adoptive parents
single-parent family ✔✔comprise an unmarried biologic or adoptive parent who may or may not
be living with other adults.
homosexual families ✔✔lgbtq+ families that live together and may or may not have children
Anemia ✔✔common medical disorder of pregnancy, results in reduction of the oxygen-carrying
capacity of the blood; thus the heart tries to compensate by increasing cardiac output, may result in CHF, increased risk of req blood transfusions, higher instance of postpartum complications.
iron deficiency anemia ✔✔most common anemia of pregnancy 75% of cases. check hemoglobin
(normal above 11) and hematocrit (normal above 33)
what do we do for Iron deficiency? ✔✔iron supplementation: vitamin C helps absorb iron so eat foods high in iron, no milk may have constipation; increase fiber, water and exercise.
Magnesium toxicity ✔✔depresses the function of the CNS essential that nurses assess pt
respiratory status, deep tendon reflexes, and level of consciousness to identify toxicity treatment is calcium Gluconate because it contracts.
Terbutaline ✔✔tocolytic, anticontraction med to delay premature labor for up to 72 hrs. given
sub q things to watch out for; maternal s/e: tachy, nervousness, tremors, h/a, and pulmonary edema. fetal s/e: tachy and hypoglycemia.
Nifedipine ✔✔calcium channel blocker, tocolytic agent that can suppress contractions do not
give with mag sulfate or terbutaline; educate on orthostatic hypotension, oral given with corticosteroids
antenatal glucocorticoids ✔✔given IM to the mother to accelerate fetal lung maturity by
stimulating fetal surfactant production
Betamethasone and dexamethasone ✔✔* Corticosteroids that increase the production of
surfactant to accelerate fetal lung maturity & reduce the incidence or severity of RDS.
- Used for a client in preterm labor between
28-32 weeks' gestation whose labor can be inhibited for 48 hrs without jeopardizing the mother or fetus.
ADVERSE REACTIONS:
May decrease the mother's resistance to infection.
Pulmonary edema secondary to Na+ & fluid retention can occur.
Elevated blood glucose levels can occur in a client with diabetes mellitus.
INTERVENTIONS:
Monitor maternal vital signs, lung sounds, & for edema.
Monitor mother for signs of infection.
Monitor WBC.
Monitor blood glucose levels.
endometriosis ✔✔Growth of endometrial tissue outside of uterus symptoms include; pelvic pain,
dysmenorrhea, dyspareunia (painful intercourse), abnormal bleeding, pain in thighs, constipation, diarrhea or pain with defication. treatment based on severity of symptoms and goals from nsaids surgery
oligomenorrhea ✔✔infrequent menstruation
Syphilis ✔✔Treponema pallidum, can be transmitted sexually, through kissing, biting, or oral
sex. transplacental transmission may occur during pregnancy, degree of risk is calculated by amount of spirochetes in mothers bloodstream. causes genital ulcers, rash on palms or feet, fever, headache, malaise can cause miscarriage, preterm labor, neurological, cardiovascular, musculoskeletal. or multi-organ system complications in late stage. fetal effects; IUGR, stillbirth, congenital infection. Dx. blood test, treatment, Penicillin G, or if allergic to PG tetracycline, doxycycline, erythromycin.
pelvic inflammatory disease (PID) ✔✔infectious process that most commonly involves uterine
tubes, causes endometritis, increases risk for ectopic pregnancy, infertility, chronic pelvic pain, dysparenuria, pyosalpinx (pus in uterine tubes) after ectopic pregnancy risk for more potential ectopic pregnancy is x7, treatment education, broad-spectrum antibiotic; ceftriaxone plus doxycycline
Human Papillomavirus (HPV) ✔✔also known as condylomata alumina or genital warts, approx
100 types, 40 of those cause anogenital infections, several that cause cancer, two highly cancerous types are type 16 and 18, primary cause of cervical cancer. infections more common in pregnancy, symptoms can include; irritating vaginal discharge, itching, dispareunia, postcoidal bleeding, bumps on vulva or labia. Dx. physical inspection of vulva, perineum, anus, vagina and cervix, abnormal pap, biopsy, colposcopy. treatment; education, prevention guardasil vaccine
herpes simplex ✔✔HSV type 1 (non sexually transmitted), mouth sores HSV type 2 (sexually
transmitted) genital sores or lesions, initial infection signs and symptoms; painful lesions, fever, chills, malaise, severe dysuria may Last 2-3 wks. during pregnancy, maternal infection with HSV2 can have adverse effects on mother and fetus, congential infection is possible. primary infections in 1rst trimester have been associated with miscarriage. DX lab test, management anti viral acyclovir used for mother and child.
Hepatitis B virus ✔✔most threatening virus to fetus and neonates. found in all body fluids, a
disease of the liver, could be fatal. symptoms include; arthralgias, arthritis, Lassitude, anorexia, nausea, vomiting, headache, fever, mild abdominal pain, clay colored stool, dark urine, jaundice. DX lab TX. education, symptoms management
Zika Virus ✔✔spread to people primarily through the bite of an infected Aedes species mosquito
but also through sex. increased risk of neonates with microcephaly, risk for Guillane barre syndrome
Group B strep ✔✔Is considered normal vaginal flora in a women who are not pregnant. infection
is associated with poor pregnancy outcomes. infects infant in birth canal. can cause UTI, chorioamnitis, postpartum endometriosis. sepsis, Meningitis, culture performed by 36 weeks. antibiotics given to all who test positive. if test has not been given at onset of labor antibiotics
signs and symptoms of pre term labor ✔✔change in type of vaginal discharge (watery, mucus or
bloody), increase in amount of vaginal discharge, pelvic or lower abdominal pressure, constant low, dull backache, mild abdominal cramps with or without diarrhea, regular or frequent contractions or uterine tightening often painless, ruptured membranes,
diagnosis of preterm labor ✔✔gestational age between 20 weeks and 36 wks 6 days.
regular uterine activity accompanied by a change in cervical effacement, dilation or both
initial presentation with regular contractions and cervical dilation of atleast 2 cm.
fetal development respiratory system ✔✔lungs are formed by 23rd wk but not enough alveoli to
maintain gas exchange outside uterus, surfactant isn't produced until 24 wks, matures by week 35/36 prognosis is more favorable now
fetal development cardiac system ✔✔heart beats at 4-6wks, most heart anomalies occur in weeks
6-8, inside the heart is the foramen ovale (an opening in the septum between L&R atrium, closes 24-48 hrs after birth), hemoglobin in fetus has greater attraction of O2, ensuring fetus recieves adequate oxygenation, blood type is determined at conception.
fetal development reproductive system ✔✔sex is determined at conception, gonads are
undifferentiated until week 7, with Y chromosome gonads differentiate into testes, otherwise
female development continues, by week 12 external genitalia can be identified in the ultrasound week 17-
fetal development musculoskeletal system ✔✔fetal movement at 7 weeks via ultrasound, ossification of bones begins at week 12, 16-20 weeks quickening (first movements felt by mother.)
first trimester ✔✔1-13 weeks
2nd trimester ✔✔14-26 weeks
3rd trimester ✔✔27-40 weeks
Premature Rupture of Membranes (PROM) ✔✔spontaneous rupture of the amniotic sac and
leakage of amniotic fluid beginning before the onset of labor at any gestational age, infection is the greatest risk, 24-33 weeks decreased chance of lung maturity
chorioamnionitis ✔✔bacterial infection of the amniotic cavity, is a major cause of complications
for both mothers and newborns at any gestational age. dx by clinical findings of maternal fever,
- after diagnosis pt will recieve education on diet, exercise, blood glucose monitoring, will begin being seen weekly.
Glyburide ✔✔oral hypoglycemic medication for GDM acts on pancreas to increase insulin production educate to take medication atleast 30 mins but up to 1 hr before meals and continue to monitor Blood glucose levels
Metformin ✔✔oral hypoglycemic medication GDM, try glyburide first bc metformin crosses
placenta and decreases hepatic glucose production and increases peripheral sensitivity to insulin
hyperemesis gravidarum ✔✔pregnancy-related vomiting; an extreme form of the more common morning sickness, can last all through pregnancy. increased risk; younger maternal age, nulliparity, bmi of less than 18.5 or greater than 25, poor socioeconomic status, asthma, migraines, preexisting diabetes, psychiatric illness, hyperthyroid disorders, GI disorders, previous pregnancy complicated by hyperemesis gravidarum. more likely with a girl, multifetal gestation, gestational trophoblastic disease. TX. electrolyte balance via IV if mother unable to drink, enteral therapy, vitamin b6, doxylamine (unisom), promethazine (phenegran), chlorpromazine (thorazine), prochlorperazine (compazine) and trimethobenzomide (tigan), metoclopromide (reglan), ondansetron (zofran), droperidol (inapsine), methylprednisolone (medrol), hydrocortisone. heartburn or reflux meds.
recurrent or habitual abortion ✔✔three or more abortions of any type before 20 weeks. do
chromosomal analysis on parents. cervical cerclage may be used it there is a cervical insufficiency
threatened abortion ✔✔Uterine bleeding & cramping occur; however, the products of conception have not been expelled--S&S (cramping, back pain, bright red vaginal bleeding; no cervical dilation)--Treatment: ultrasound to determine status of fetus; limiting activity to no strenuous activity; bed rest
elective abortion ✔✔legal termination of a pregnancy for nonmedical reasons before 20 weeks
gestation
therapeutic abortion ✔✔termination of a pregnancy for the health of the mother or another
medical reason
first trimester abortion ✔✔up to 10 weeks, has little effect on subsequent pregnancies, medical
methods include mifepristone with prostaglandin and methotrexate with misoprostol can include surgery or aspitation
surgical abortion ✔✔surgical procedure that ends a pregnancy
vital signs including FHTs
complete lab work including STD/HIV labs
complete family history
assessment of potential neonatal risk factors
assessment of maternal education needs for pregnancy
assessment of cultural needs for pregnancy care and delivery
measure the size of the abdomen:
-pubic bone to fundus
-# of cm correlates with # of weeks
education at first prenatal visit ✔✔family, health, social, IPV, experiential and occupational (see
if she is exposed to teratogens), nutrition, head to toe assessment, transvaginal ultrasound,
diagnostic tests at first prenatal visit ✔✔sti testing, blood typing and rh type, hep b screen or
titer, rubella titer
-gravida ✔✔number of pregnancies including current
para ✔✔number of pregnancies past 20 weeks (not current)
GTPAL ✔✔gravida, term births, preterm births, abortions, living children
Inevitable abortion ✔✔bleeding and cramping with cervical dilation but no passage of tissue
d&c often performed
incomplete abortion ✔✔heavy bleeding,, mild to severe cramping, with cervical dilation without
expulsion of all of the products of conception may require d&c
complete abortion ✔✔slight bleeding,, mild cramping,, cervix closes after all products of
conception are expelled
Positive signs of pregnancy ✔✔xray, ultrasound, auscultation of fetal HR on doppler 10 weeks,
examiner (not the mother) palpates fetal movement
Goodall's sign ✔✔softening of the cervical tip
Chadwick's sign ✔✔Bluish purple discoloration of the cervix, vagina, and labia during pregnancy as a result of increased vascular congestion.
Hegar's sign ✔✔softening of the lower uterine segment
legal concerns in pregnancy ✔✔abortion, failure to rescue people i.e comparing a set of vitals to
only the last vitals taken instead of looking at them as a whole.
nutrition in pregnancy food sources of folate ✔✔liver; chicken, turkey, goose, lamb, beef, veal,
cooked legumes (blackeyed peas, chickpea) beans, lentils, asparagus, spinach, papaya, cereal, wheat germ, broccoli, greens, spinach, avocado, orange or orange juice, pasta, rice, bread, egg, corn
supine hypotension ✔✔a drop in blood pressure due to altered venous return from a gravid
uterus exerting pressure on the ascending vena cava, can be caused by lying supine. keep head elevated, turn to left side
when tocolytics should not be given ✔✔use caution when administering to pts with cardiac disease, especially those on medication or have a history of CHF, cardiac surgery, significant pulmonary disease, or maternal infection (pneumonia, appendicitis, pylondphritis). specific tocolytic agents should not be used whenever known allergies exist.
pyelonephritis ✔✔renal infection most common serious medical complication of pregnancy and
the leading cause of septic shock during pregnancy. associated with sepsis, ARDS, and preterm labor. usually develops in 2nd trimester and usually caused by e coli. infection develops only in right kidney in more than half the cases. s/s include; fever, shaking, chills, low backache, anorexia, nausea, vomiting, tenderness of costovertebral angles. TX. for mild case and hemodynamically stable with no evidence or pre term labor ( amoxicillin, augmentin, Bactrim, rocephin IV or IM, worse cases IV, hospitalized, ceftriaxone (rocephin, gentamyacin, aztreonam monitor closely for sepsis, ards, preterm labor. dx. lab draw
hydratitiform mole ✔✔molar pregnancy, benign proliferative growth of the placental trophoblast
in which chorionic villi develop into endematous, cystic, avascular transparent vesicles that hang in a grape-like cluster. no viable fetus, caused by abnormal fertilization, can be invasive. dx.
