NUR244 EXAM PREP, (ANSWERED) WITH COMPLETE VERIFIED SOLUTION 2023/2024
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Course
NUR 244
Institution
NUR 244
NUR244 EXAM PREP, (ANSWERED) WITH COMPLETE VERIFIED SOLUTION 2023/2024
What is pregnancy?
Events that occur from fertilization until infant is born; the period in which a fetus develops inside a woman's womb or uterus.
What is preconception care and why is it important?
Involves obtaining a c...
NUR244 EXAM PREP, (ANSWERED) WITH
COMPLETE VERIFIED SOLUTION 2023/2024
What is pregnancy?
Events that occur from fertilization until infant is born; the period in which a fetus
develops inside a woman's womb or uterus.
What is preconception care and why is it important?
Involves obtaining a complete health history and physical examination of the woman
and their partner.
improve pregnancy outcomes and women's health in general through prevention of
disease and management of risk factors that affect pregnancy outcome and the health
of future generations.
What topics would be discussed during a preconception appointment?
1. Immunisation status of mother
2. Underlying medical conditions
3. Reproductive health data - pelvic exam, contraceptives, STIs
4. Sexuality and sexual practices - safer sex practices and body image issues
5. Nutrition history and present status
6. Lifestyle practices including occupation and recreational activities
7. Psychosocial issues - stress and exposure to abuse/violence
8. Medication and drug use - tobacco, alcohol, prescription medications and illicit drugs
9. Support system - family, friends, and community
What are the different trimesters? and when do they occur?
First trimester - 1-12 weeks
Second trimester - 13-27 weeks
Third trimester - 28-40 weeks
Physiological changes during pregnancy:
Weight gain due to fetus, amniotic fluid
Increased storage of proteins, triglycerides and minerals
Marked breast enlargement
Lower back pain - lordosis
Psychological changes during pregnancy:
First trimester:
- Pleasure, excitement, elation
- Dismay, disappointment
- Ambivalence, emotional lability
- Increased femininity
Second trimester:
- A feeling of wellbeing
- A sense of increased attachment to the fetus;
- Stress and anxiety
- Feelings of the need for increasing detachment from work commitments
Third trimester:
- Loss of or increased libido
,- Altered body image
- Psychological effects from physiological discomforts such as backache and heartburn
- Anxiety about labour (e.g. pain)
- Anxiety about fetal abnormality, which may disturb sleep and cause nightmares.
- Increased vulnerability to major life events such as financial status, moving house or
lack of supportive partner
Cardiovascular changes during pregnancy:
Increased blood volume
- 45% increase in plasma
- 25% increase in erythrocytes
Better circulation of blood
Haemodilution
Increased cardiac output - stroke volume and HR increase
Increased blood flow to placenta
Can lead to decrease in BP - diastolic
Hypertension in pregnancy:
Systolic BP around 140mmHG and/or Diastolic BP around 90mmHg
- Essential HTN
- Gestational HTN
- Pre-eclampsia
Pre-eclampsia:
Hypertension arising after 20 weeks of gestation
- Proteinuria
- renal insufficiency
- liver involvement - epigastric pain
- neurological - convulsions, headaches, visual disturbances
- haematological disturbances
- pulmonary oedema - dyspnoea and agitation
- fetal growth restriction
Anaemia in pregnancy:
Hb (g/L) <110 in first and third trimesters
<105 in second trimester
Serum ferritin of <30 mcg/L is diagnostic of iron deficiency
Anaemia management in pregnancy:
Encourage an iron rich diet
Oral iron
Haemoglobin should increase within 2 weeks
Intravenous iron
Common discomforts in pregnancy:
- Gastro-oesophageal reflux/heartburn
- Pelvic girdle and lower back pain
- Varicose veins and leg oedema
- Carpel tunnel syndrom
- Haemorrhoids
- Leg cramps
- Nausea and vomiting
, - Sleep disturbances
- Vaginal discharge
Bleeding in pregnancy:
Can occur at any stage during pregnancy
- prior to 20 weeks -> spontaneous abortion
- after 20 weeks -> antepartum haemorrhage (APH)
- Cervicitis, vaginitis, polyps
- Haemorrhoids, vulval varicosities, UTIs
- Coitus
Types of Misscarriages:
Threatened abortion
Inevitable abortion
Complete and Incomplete Abortion
Missed abortion
Placental abruption...
Premature separation of the normally situated placenta
Partial or complete
Causes are largely unknown- Trauma, Hypertensive disorders
Placenta Previa...
Part of or the entire placenta is abnormally sited in the lower uterine segment
Test to assess maternal wellbeing:
Maternal assessment
Test to assess fetal wellbeing:
Fetal assessment
What are the recommended follow-up schedules for pregnant women?
- Every 4 weeks up to 28 weeks gestation
- Every 2 weeks from 29 weeks to 36 weeks gestation
- Every week from 37 weeks gestation to birth
What are routine blood tests performed at booking?
- Blood group and antibody screening
- Full blood count
- Rubella
- Hepatitis B and C -> can be passed to baby
- Human immunodeficiency virus (HIV) -> can be passed to baby
- Syphilis
- Varicella immunoglobulin G (IgG)
- Vitamin D -> low vitamin D levels = harder to form baby bones
- Fasting blood glucose
- Additional screening as indicated by history
RhD negative in pregnancy:
Rhesus D (RhD)
- Test offered at first pregnancy visit
- Used to determine if mother's blood has the Rh factor
- Most women (85%) have Rh factor in their blood - Rh D positive
- If mother is RhD negative they will be given preventative treatment with an injection of
RhD Immunoglobulin - Anti-D at 28-34 weeks
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