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HAPE > pregnant female exam 3 > Flashcards

pregnant female exam 3 Flashcards

1
Q

define 1st, 2nd, 3rd trimesters of pregnancy

A

1st trimester= 0-13 weeks 6 dats
2nd trimester= 14-27 weeks and 6 days
3rd trimester= 28-40 weeks and 6 days

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2
Q

Chadwick sign

A

bluish discoloration of vagina and cervix

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3
Q

Leukorrhea of pregnancy

A

white, milky, vaginal discharge that is normal during pregnancy

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4
Q

Naegele’s Rule

A

-used to calculate estimated date of confinement aka due date
-first day of pt’s last menstrual period + 7 days - 3 months +1 year

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5
Q

gestational age

A

time of pregnancy counting from the first day of the last menstrual period

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6
Q

developmental age

A

time of pregnancy counting from fertilization

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7
Q

embryo

A

fertilization - 8 weeks

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8
Q

fetus

A

8 weeks - birth

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9
Q

previable

A

before 24 weeks

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10
Q

preterm

A

24-36 weeks

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11
Q

term

A

37-42 weeks

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12
Q

increased estrogen

A

-promotes endometrial growth
-stimulates increased prolactin output
-contributes to hypercoagulable state of pregnancy

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13
Q

increased progesterone

A

-1st produced by corpus luteum but then by placenta after implantation
-causes increased tidal volume and alveolar ventilation
-relaxes tone of esophageal sphincter, ureters, and bladder

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14
Q

HCG (human chorionic gonadotropin)

A

-produced by placenta and support progesterone synthesis
-prevents loss of early embryo to menstruation
-stimulate tsh receptors

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15
Q

when do increased erythrocyte mass, increased blood volume, and increased cardiac output begin in pregnancy?

A

4 weeks

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16
Q

physiologic anemia

A

plasma volume expansion exceeds increase in red cell volume

**helps protect against blood loss during birth

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17
Q

increased basic metabolic rate

A

increases 15-20% which increases caloric needs

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18
Q

hegars sign

A

softening of the cervical isthmus *above cervix

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19
Q

symptoms of pregnancy

A

-breast enlargement/tenderness- 6weeks
-areolar enlargment and increased pigmentation- 6weeks
-cololstrum secretion- 16 weeks
-nausea w o vomiting
-urinary frequency

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20
Q

vaginal changes during pregnancy

A

-chadwicks sign
-vaginal walls become thicker and more rugated due to increase thickness of the mucosa, loosening of connective tissue, and hypertrophy of smooth muscle cells
-vaginal secretions are thick, white, and more profuse
-vaginal pH is more acidic from lactobacillus acidophilus

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21
Q

cervix and ovarian changes during pregnancy

A

-cervix looks and feels different
-chadwicks sign
-cervical canal fills w tenacious mucus plug
-red velvety mucosa
-corpus luteum may be felt on affected ovary as a small nodule

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22
Q

uterine changes during pregnancy

A

-uterus loses its firmness and resistance
-hegars sign
-volume expands 5 to 20 liters
-weight increases from 50-70 grams to 800-1200 grams
-muscle cell hypertrophy
-increase in blood vessels, size, lymphatics

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23
Q

uterus as fetus grows

A

-uterus pushed into anteverted position into the space occupied by blader
-uterus rotates to the right to accomodate the rectosigmoid structures on the left side of the pelvis

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24
Q

abdominal enlargement

A

12th week-uterus rises out of pelvis into abdomen
15th week- apparent increase in abdominal girth
linea nigra
diastasis recti

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25
Q

breast changes

A

6th week- increase in vascularity associated with a sensation of heaviness, tenderness
8th week- nipple and areola become more pigmented, and montgomery tubercle become more prominent
16th week- colostrum
20th week- further pigmentation and mottling of the areola

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26
Q

relaxin

A

One of the effects of relaxin is the loosening of ligaments throughout the body, making pregnant women less stable and more prone to injury, especially in their backs

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27
Q

sensation of fetal movement

A

usually begins at 20 weeks in the primagavida or 17/18 weeks in the multipara

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28
Q

lightening

A

“dropping” late in pregnancy when fetus descends into lower pelvis

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29
Q

when should healthy pregnant pts come in for first apt?

A

8-10 weeks

30
Q

urine hcg (when positive, what can cause false negatives)

A
  • positive ~4 weeks
  • false negatives can be from being done too early or dilute urine
31
Q

ultrasound time line (transvag, abd)

A

transvaginal
4-5 weeks gestation- sac
8-10 weeks- dating

abdominal- after 1st trimester

32
Q

what is increased if the yolk sac is larger than 7 mm without signs of a developing fetal pole?

A

increased chance of abnormal pregnancy

33
Q

goals of prenatal visit

A

-increase probability of a healthy baby without maternal compromise

-determine health of fetus and mother
-determine gestational age of fetus
-initiate a plan of continuing care
-focus on risk assessment

34
Q

prenatal visits: when and how often

A

-ideally initail visit before conception
-less than 28 weeks=every month
-28-36 weeks= every 2-3 weeks
-36 weeks= once per week until delivery if pregnancy is uncomplicated

35
Q

prenatal care timeline for labs and diagnostics

A

first visit:
-pap smear, Rh screen, std screen, other labs

weeks 8-12
-1st sonogram, amniocentesis, noninvasive prenatal testing

weeks 24-28
-diabetes screen**, cbc

week 36
-group B strep culture

36
Q

gravidity

A

total number of pregnancies (if twins G=1)

37
Q

parity

A

outcome of pregnancies

38
Q

determining gestational age

A

count the number of weeks and days from last menstrual period

~40 weeks

39
Q

positioning of pt during ob exam

A

-gown opening in front
-semi sitting position with knees bent for pelvic exam **dont lay all the way flat as can compress descending aorta and inferior vena cava
-all other exams procedures should be done in sitting or left side lying positions

40
Q

cervical brush (cytobrush)

A

DO NOT USE ON PREGNANT PATIENTS
may cause bleeding

41
Q

gestational HTN

A

systolic- over 140
diastolic- over 90

occuring after wk 20 without proteinuria that resolves by 12 weeks post partum

42
Q

chronic HTN

A

systolic = over 140
diastolic= over 90

before pregnancy, before wk 20, and after 12 wks postpartum

43
Q

preeclampsia

A

systolic= over 140
diastolic= over 90
after wk 20 WITH PROTEINURIA

44
Q

first trimester weight loss

A

shouldnt exceed 5% of prepartum weight

45
Q

thyroid gland and pregnancy

A

inspect and palpate as modest symmetric enlargement is suspected

46
Q

what does facial edema after 24wks GA indicate?

A

gestational HTN

47
Q

mammary souffle

A

the mammary souffle is commonly heard during late pregnancy or lactation, is strongest in the second or third intercostal space at the sternal border bilaterally, and is typically both systolic and diastolic, though only the systolic component may be audible.

48
Q

diastolic murmur in pregnancy

A

A diastolic murmur in pregnancy is never normal and should be investigated further.

49
Q

what to listen for when auscultating heart during pregnancy

A

Listen for a venous hum or a continuous mammary souffle that are common in pregnancy due to circulation

50
Q

when is the uterus at the level of the umbilicus?

A

20 weeks

51
Q

uterine contractility before 37 weeks

A

before 37 weeks regular contractions with or without bleeding is abnormal = preterm labor

52
Q

fundal height greater than 4 cm

A

consider large fetus, extra amniotic fluid, or uterin leiomyoma

53
Q

fundal height less than 4 cm

A

consider missed abortion, transverse lie, growth retardation or false pregnancy

54
Q

what to check with the cervix during bimanual exam

A

-effacement= degree to which cervix has thinned (4cm is unchanged or unaffected)
-dilation

55
Q

where is FHR best heard when head down and when breech

A

head down= best heard in LLQ
breech=best heard in RUQ

56
Q

normal doppler FHR

A

120-160 bpm

57
Q

fetoscope

A

a special stethoscope used to hear FHR after 20 weeks

58
Q

4 parts of leopolds maneuvers

A

1= determine what fetal part occupies the fundus
2= determines what side is the fetal back
3= identify descent of the presenting part
4=identify the cephalic prominence

*from 28th week on these provide useful info to assess the lie and presentation of the fetus

59
Q

fetal lie

A

relationship of the long axis of the fetus to the mother
-longitudinal lie vertex presentation
-longitudinal lie breech presentation
-transverse lie shoulder presentation

60
Q

fetal presentation

A

vertex presentation, breech presentation, shoulder presentation

*normal presentation= vertex

61
Q

leopolds 1st maneuver

A

-used to determine the fetal part that is in the uterine fundus
-buttocks feels firm but irregular
-the head feels hard and may be movable

62
Q

leopolds 2nd maneuver

A

-locate the position of the fetal back
-on one side the back will be rounded and firm
-on the other side the limbs will be irregular, lumpy, and mvmt may be felt

63
Q

leopolds 3rd maneuver

A

-palpate the lower pole of the fetus
-if lower pole is not engaged moveable part will be felt

64
Q

leopolds 4th maneuver

A

-performed to confirm the presenting portion and to located the side of cephalic prominence

65
Q

pregnancy nutritonal rules

A

-3 meals a day
-add extra 300 cals beginning 2nd trimester
-rx multivitamin with atleast 400 mcg of folic acid per day

CAUTION AGAINST
-soft cheese
-deli meats/cold cuts
-excessive amounts of vitamin A
-seafood

66
Q

pregnancy weight gain

A

low bmi=28-40 lbs
normal bmi= 25-25 lbs
high bmi=15-25 lbs
obese=15 lbs
women carrying twins= 35-45 lbs

young adolescents=upper end of range
short women= lower end of range

67
Q

exercise after 1st trimester

A

NO exercise in supine position

68
Q

what vax should all pregnant women be up to date on?

A

tdap and flu vaccines

69
Q

if indicated pregnant women may have what vax

A

-pneumococcal
-meningococcal
-hep B

70
Q

concluding prenatal visits

A

-discuss next steps and sequence of future events
-discuss plans for breast feeding
-review need for contraception post partum

71
Q

otc meds ok for pregnant women

A

benadryl, tylenol, robitussin, vicks, metamucil, imodium, neosporin, maalox, tums, mylanta

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