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CNUR 303: Pregnancy and Childbirth - Key Concepts and Questions, Exams of Public Health

A comprehensive overview of key concepts and questions related to pregnancy and childbirth, covering topics such as hormonal changes, physical adaptations, prenatal care, fetal development, and common complications. It includes definitions, explanations, and examples, making it a valuable resource for students in nursing or related healthcare fields.

Typology: Exams

2024/2025

Available from 12/29/2024

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CNUR 303 Questions and Answers
Rated A+
Recommended weight gain for singleton pregnancy ✔✔11.5-16kg
25-35lbs
hCG ✔✔Human Chorionic Gonadotropin
a hormone secreted by the trophoblast cells of placenta
stimulates estrogen and progesterone
Estrogen ✔✔uterus and breast enlargement
Progesterone ✔✔A hormone produced by the ovaries
acts with estrogen to bring about the mensural cycle
maintains endometrium and inhibits contractions
Relaxin ✔✔softening collagen in joints
softens cervix
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CNUR 303 Questions and Answers

Rated A+

Recommended weight gain for singleton pregnancy ✔✔11.5-16kg

25 - 35lbs

hCG ✔✔Human Chorionic Gonadotropin

a hormone secreted by the trophoblast cells of placenta

stimulates estrogen and progesterone

Estrogen ✔✔uterus and breast enlargement

Progesterone ✔✔A hormone produced by the ovaries

acts with estrogen to bring about the mensural cycle

maintains endometrium and inhibits contractions

Relaxin ✔✔softening collagen in joints

softens cervix

inhibits contractions

hPL ✔✔human placental lactogen

insulin antagonist

BMR ✔✔increases 20-25% d/t fetal metabolic activity

may cause sensation of overheating

Thyroid Gland ✔✔increases by 50%

more thyroxin released

parathyroid gland ✔✔increase size and hormone concentration

increases use of calcium and vit D

blood volume increase during pregnancy ✔✔1500mLs (~45%)

heart rate increase in pregnancy ✔✔ 10 - 15bpm

Breasts during pregnancy ✔✔o Soon after conception - tingling, tenderness, swelling

o Size & nodularity increase

o Superficial veins more prominent

Nipples increase erectile

o Areola darkens

o Montogomery's Tubercules

§ Sebaceous glands of the areola become enlarged

§ Secretions from these glands prevent cracking

o Colostrum

§ Antibody Rich

§ May be expressed around 16 weeks

§ May leak in last trimester

Respiratory changes in pregnancy ✔✔· Tidal volume increases throughout pregnancy

o 30- 4 0% rise in volume of air each minute

· O2 consumption increased by 20-40%

· Rib cage flare - up to 6cm

· Elevated diaphragm

Subjective changes in pregnancy ✔✔o Amenorrhea

o "Morning Sickness"

o Excessive Fatigue

o Urinary Frequency

o Changes in breasts

Objective changes in pregnancy ✔✔o Goodell's Sign

o Chadwick's Sign

o Hegar's Sign

o Positive Pregnancy Test

o Progressive Uterine Enlargement

o Palpation of Fundus

1st trimester ✔✔week 1-

2nd trimester ✔✔14-26 weeks

add 7 days to LMP and count forward 9 months

GPTPAL ✔✔G: Gravida -Total # of pregnancies including current pregnancy

P: Para- Total # of pregnancies carried and DELIVERED to a viable age

o (>20 weeks)

T: Term - # of term births (≥ 37 wks gestation)

P: Premature - # of premature births

o (≥ 20 weeks gestation <37 weeks)

A: Abortion - # of therapeutic or spontaneous abortions

o (<20 weeks gestation)

L: # of living children

Leopold's Maneuvers ✔✔A series of four maneuvers designed to provide a systematic approach whereby the examiner may determine fetal presentation and position.

1st Maneuver - Fundal Grip

o Assess which fetal part is in the fundus by placing hands on top of the fundus.

2nd Maneuver - Umbilical Grip

o Assess which parts are on the side of the uterus by placing the hands on the side of the uterus

3rd Maneuver- Pawlick's Grip

o Grasp the lower abdomen with the thumb and fingers just above the symphysis pubis to assess what part of the fetus is presenting

4th Maneuver- Pelvic Grip

o Place both hands on the lower abdomen and assesses engagement

If the presenting part has descended deeply, only a small portion of it may be outlined

Isoimmunization ✔✔If fetal Rh-positive blood leaks into the Rh-negative mother's circulation, her body may respond by making antibodies to destroy the Rh-positive erythrocytes.

To prevent: 28weeks: ALL Rh negative woman are given 300 ug of anti-D IgG IM (WinRho)

Indirect Coombs' test (DAT) ✔✔indicates if a woman (or infant) has been sensitized (exposed) to Rh positive blood

Kleihauer-Betke Test ✔✔measures fetal hemoglobin transferred from fetus to maternal bloodstream.

Monozygotic ✔✔developed from a single fertilized ovum, as identical twins

o Polycythemic, circulatory overload to hydrops (kinda like fetal edema)

o Heart failure, hyperbilirubinemia à kernicterus

Biophysical profile ✔✔- Score out of 10

  • Based on:

§ NST (nonstress test)

§ Breathing Movement

§ Body Movement

§ Muscle Tone

§ Amniotic Fluid Volume

  • 8-10: Baby is healthy; 5-7: Retest in 12-24 hours; 4 or less: fetus' @ risk.

Weight gain for twins ✔✔o Between 9.1-13.6 Kg by 20 weeks

o Approx. 0.68 Kg/week

Goal term for twin pregnancy ✔✔36-37 weeks

Group B strep ✔✔Need to be tested every pregnancy, as mom may be negative one time, positive the next

Increase infant mortality rate

Swab at 35-37wk

Mom needs 2 doses of antibx and even then, monitor baby after delivery

Group B step risk factors ✔✔Positive prenatal culture

Preterm birth

Premature rupture of membranes (for longer than 18 hours)

Intrapartum maternal fever > 38 degrees.

  • Hx of early onset neonatal GBS.*

GBS positive bacturia- regardless of culture count

TDAP ✔✔Pertussis increasing infant mortality

Tx is to vaccinate/booster shot mom (even if she's upto date, recc'd EVERY pregnancy 21- 32wks) and surrounding family (partner/dad, grandma, grandpa, make sure siblings are up to date, etc.)

Mrs. Gonzalez is 28 weeks pregnant. She has a 2 year old born at 36+6, 4 year old born at 37+0, 7 year old born at 41+2 and 10 year old born at 38+1. She had an 11 week loss, 17 week loss and 21 week loss ✔✔GPTPAL:

8, 5, 3, 2, 2, 4

hyperemesis gravidarum ✔✔severe nausea and vomiting in pregnancy that can cause severe dehydration in the mother and fetus

5% weight loss

hyperemesis gravidarum risk factors ✔✔o Young maternal age

o Nulliparous

o Low SES

o Unplanned Pregnancy

o High BMI

o Smoking

o HG in previous pregnancy

hyperemesis gravidarum treatments ✔✔IV fluids

I&O monitoring

· Dipping urine for protein & ketones

Pharmacological interventions

· Diclectine (PO and vaginal supp)

TPN

Fetal monitoring - consider gestation

placenta previa ✔✔4 types:

low lying - Does not cover internal cervical os

marginal - Includes lower edge of the placenta extending but not covering the internal os (not pictured)

partial - partially covers dilated internal cervical os

complete - covers internal cervical os

Risk factors for placenta previa ✔✔Previous C/S

Previous Previa

Previous Termination

Multiparity

Maternal age > 35 years

gestational diabetes ✔✔o No pre-existing diabetes

o Develops carbohydrate intolerance in pregnancy

o Approximately 4% of pregnant women

o May be controlled with diet or medication depending on severity

Less microvascular complication to mom dt being short lived, more complications for fetal development

gestational diabetes risks for fetus ✔✔Macrosomia

Congenital Anomalies

SA (spontaneous abortion)

Gestational diabetes test ✔✔1hr Glucose Challenge Test (50 g) @ 24-28 Weeks

Ø 10.3 mmol/L = GDM

Ø 7.8-10.2 mmol/L = 75 g GTT

Ø <7.8 mmol/L = normal

Maternal Hyperglycemia ✔✔Macrosomia

Congenital Anomalies

IUFD (intrauterine fetal demise)

Gestational Diabetes Goals ✔✔Goal: Maintain BGM between 4-7 mmol/L

D5W infusion when 3cm+ dilated in labour, automatically

BGM >7.0mmol/L in labor =Insulin drip started w. D5W

Postpartum - monitor BGM

o Tend to return to pre-pregnancy levels.

Future Considerations.....

o DM type 2 risk for mom and baby

Hypertensive Conditions in Pregnancy ✔✔2 Categories:

  1. Pre-existing: before 20 weeks
  2. Gestational: after 20 weeks

Preeclampsia: hypertension after 20 weeks w. proteinuria

Eclampsia: Medical emergency (siezures)

Pregnancy hypertension risk factors ✔✔Primipara

New partner

Hypertonic Reflexes (hyperreflexia, CNS is very easily excited)

CLinical management of gestational htn ✔✔BP

Reflexes Fluid Balance Urine Blood Work Pharmacological Anti-hypertensive Anti-seizure Rest DELIVERY***

HELLP syndrome ✔✔Hemolysis,

Elevated Liver Enzymes,

Low Platelet Count

Tx for cervical insufficiency ✔✔Cerclage - stitch to prevent cervix from opening on own

Ruptures of membranes ✔✔PROM- premature rupture of membranes

SROM- spontaneous rupture of membranes

PPROM- preterm premature rupture of membranes

AROM/ARM- artificial rupture of membranes

When to go to hospital?

when contractions are... ✔✔Regular

Gradually become closer together

o Q4-6 min & lasting 30-60 seconds for about an hour

4 Ps of Labour ✔✔Passage

Passenger

Powers

Phases

The passage ✔✔4 Classical Types:

Gynecoid**