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OB > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

subjective signs of pregnancy (

A

Amenorrhea (missed period—one of the first signs unless irregular)

 Any bleeding during a period is a lot lighter than normal cycle

 Nausea and vomiting (usually 2-8 weeks: aka Morning sickness)

 Due to elevation of estrogen that occurs early in pregnancy - d/t slow emptying of

 Certain foods and odors set this off

 Lots of time first time in morning

 bloating

 Excessive fatigue (another early sign—pure exhaustion)

 Urinary frequency- as embryo enlarges, it presses on bladder

 Breast changes- breasts start to enlarge and tingle, very sensitive

 2-3 week of pregnancy, with estrogen

 Quickening- doesn’t happen until 18-20 weeks after first missed period. First awareness

of fetal movement. (fluttering, feeling of eyelashes)

 Elevated Basal Body Temperature—if you’re pregnant the raise during ovulation remains

there in pregnancy when estrogen rises, the temp also rises.

 Chloasma - under influence of increased estrogen, there’s a change in pigmentation in

skin (pregnancy mask - brownish); also from higher estrogen bcp

 Mood Swings- with high estrogen

stomach and HCG elevation

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2
Q

Probable pregnancy signs

A

 Changes in the pelvic organs such as uterus and cervix (see above)

 Goodell, Hegar, Chadwhick

 Hegar’s and Goodell’s Sign- pelvic exam (2-4 weeks) OBJECTIVE

 Goodell’s Sign (by touch)- softening of cervix in pelvic exam

 Hegar’s Sign (by touch): Softening of the isthmus (between cervix and uterus)

 Chadwick’s Sign (visible sign)- the vagina is deep bluish purple d/t

 Enlargement of the abdomen

 Braxton Hicks contractions- false type contractions (true labor starts in back); feeling

the uterus tightening and relaxing around 28 weeks. Women may mistake this for labor.

 Abdominal striae- Stretch Marks

 Uterine souffle and ballottement -

 Souffle- put a Doppler and hear rush of maternal blood flow through arteries to

 Ballottement after 18 weeks- use your fingers to touch cervix, and you feel the

 Changes in the pigmentation of the skin- chloasma

during pelvic exam

engorgement/vascularity; also lots of discharge (protects from bacteria); mucus

plug forms to protect from things going up in uterus

the uterus

 at about 10-12 weeks

fetus “bouncing” around inside.

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3
Q

Auscultate FHB with stethescope

A

17-20 weeks

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4
Q

Fetal movement can be felt at

A

20 weeks

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5
Q

The nurse is taking an initial history of prenatal client. Which sign would first indicate a

positive, or diagnostic, sign of pregnancy?

A

Fetal movement at 20 weeks gestation

 Visualization of fetal heart movement at 21 weeks gestation

 Fetal heartbeat with Doppler at 19 weeks gestation

 Fetal heartbeat with fetoscope at 18 weeks gestation

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6
Q

Naegele’s Rule

A

This rule assumes cycle is 28 days!

 Subtract 3 months from first day of LMP, add 7 days = 40 weeks from LMP or 38 weeks (266 days) from date of conception. Adjust for year as needed.

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7
Q

Ultrasound not necessary after

A

22 weeks

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8
Q

recommended frequency of prenatal visits

A

Up to 28 weeks – every 4 weeks

28-36 weeks – every 2 weeks

=>36 weeks – every week

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9
Q

Where is fundus at 10 weeks

A

at symphasis pubis

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10
Q

where is fundus at 16 weeks

A

half way to umbilicus

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11
Q

where is fundus at 20 weeks

A

at umbilicus

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12
Q

mcdonalds method for fundal measurement

A

Accurate between 22-36 weeks.
About 1 cm gain in fundal height per week. Usually concordant with

gestational age, plus or minus 1 cm. McDonald’s Method of Assessment most

accurate. (can’t do this less than 22 weeks gestation)

 So Fundal Height is 22 cm= 22 weeks gestation

 So Fundal height is 30 cm= 30 weeks gestation

 Critical to make sure the baby is growing properly

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13
Q

Goodell’s sign

A

softening of cervix

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14
Q

Chadwick’s sign

A

bluish/purple discoloration of cervix and vagina

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15
Q

Hegar’s sign

A

softening of the lower uterine segment

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16
Q

coagulability of women postpartum

A

somewhat hypercoagulable state with an increase of fibrogen

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17
Q

venal caval syndrome

A

Orthostatic Hypotension- blood pools in legs, baby could push on vena cava (don’t let mom lie flat on her back (strict supine). Best on one side or other) Have her rise slowly

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18
Q

Pregnancy calorie requirements

A

additional 300 kcal/day

Caloric requirements greater in women within 1-2 years of menarche and with multiple gestation (maybe bump it up more if teenagers or more than one baby)

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19
Q

breastfeeding calorie requirements

A

500 total. 300 from pregnancy plus 200 from breastfeeding

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20
Q

calcium requirements in breastfeeding

A

Calcium– 1000-1500 mg elemental calcium/d

 ~40% increase from baseline needs

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21
Q

pregnant teens

A

increase calories and intake of iron

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22
Q

Folic acid requirements

A

0.4 mg of folic acid/day

Prior history NTD or fm hx of NTD (anencephaly(born with half (or no) brain),

myelomeningocele, spina bifida, others)–

 Folic acid 4 mg/day for 1 month before pregnancy and during 1st 3 months gestation then resume 0.4-1 mg per day to promote placental/fetal growth

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23
Q

Iron needs

A

Women still need elemental iron 15-30 mg/d or 100% increase from baseline needs during pregnancy and lactation

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24
Q

if low on iron, pregnancy needs

A

iron 60 to 100 mg/d

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25
Q

normal weight gain for mom during pregnancy

A

25-35 lbs

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26
Q

Intervention for N/V

A

frequent small meals. avoid high fats

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27
Q

Anti-insulin effect?

A

Anti-insulin effect HPL produced by placenta.

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28
Q

recommended activity level

A

Mild to moderate Exercise for 30 min, 5 days per week.

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29
Q

pregnancy exercises

A

 Pelvic tilt/Good Posture

 Abdominal exercise

 Kegel exercise

 “Tailor-sit” stretch

 Certain yoga poses may be contraindicated

 NO SAUNAS AND NO HOT TUBS!

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30
Q

hormone changes

A

 Increase in estrogen and progesterone

 Progestorone- amenorrhea, keeps from contraction

 Estrogen- facilitates uterus and breast development, constipation, hyperpigmentation, alters metabolic process and F&E balance

Secretion of oxytocin and vasopressin- contrax and milk let down

31
Q

First response to learning you are pregnant

A

ambivilance

32
Q

Immunizations and Chemoprophylaxis in Pregnancy

A

No live vaccines: NO MMR, NASAL FLU VACCINE, VARICELLA

Vaccines that cannot be given during pregnancy: HPV, Influenza LAIV, Varicella, Chicken Pox, Nasal flu, MMR

33
Q

When to screen for gestational diabetes

A

all pregnant women should be screened for gestational diabetes at 24-28 weeks’ gestation, except for those who are at the lowest risk

34
Q

Teratogens

A

anything that is toxic to a pregnant woman

35
Q

Teratogen infections

A

 TORCH- generally mild in adult but significant consequences for fetus: (if exposed to any

of these)

 Toxoplasmosis- protozoan infection; undercooked pork or in cat feces

 Other- Varicella, Beta Strep

 Rubella- in first trimester is pretty bad - fetus will contract if mom has it -

 CMV (Cytomegalovirus)- transmitted across placenta or cervix resulting in

 Herpes Virus (Type 1 & 2)

microcephaly, MR, and fetal death, 30% mortality rate.

Also urinary tract infections, bacterial vaginosis, HIV

36
Q

Anemia in pregnancy

A

Iron deficiency anemia. Hgb less than 11 is iron deficiency anemia

37
Q

Hemorrhage

A

More than 500mls for vaginal and 1000mls for csection

38
Q

late pp hemorrhage

A

24 hours-6 weeks pp

39
Q

Initial s/s of hemorrhage

A

boggy uterus unresponsive to massage

40
Q

pp hemorrhage cause

A

uterine atony
lacerations
retained placental fragments

41
Q

pp hemorrhage risk factors

A

 Over-distension of the uterus - uterus doesn’t effectively contract postpartum. (at risk of atony)

 rapid or prolonged labor (3 hours or less)

 oxytocin induction (pitocin) (exogenous oxytocin)

o Contractile pattern is different - often stronger contractions;

 grand multiparity

 macrosomia (large baby) really big baby (macrosomia->4000g (8# 13 oz)

 Anesthesia (causes relaxation and factor for uterine atony)

 prolonged 3rd stage (delivery of placenta)

 infection

 preeclampsia

 operative birth – vacuum/forceps delivery

 retained placental fragments (uterus unable to completely contract because of retained fragment)

overworks uterus

42
Q

pp hemorrhage intervention

A

massage before calling the midwife

43
Q

pp hemorrhage meds

A
  1. oxytocin
  2. Methylergonovine maleate (Methergine)
  3. Ergonovine maleate (Ergotrate Maleate)
  4. Hemabate (Prostaglandin)
  5. Cytotec (Prostaglandin)
44
Q

perineal hematoma

A

 WIll not have excess blood flow because it’s captured in hematoma

 perineal pain - Sue said Rectal pressure like three times. Perhaps a sign? pt say pain feels like rectal pressure

 Can visualize it when examining perineum

 Edema in perineal tissue

 Tense tissue

 Fluctuant (can see blood move when pressing on it)

 Bulging mass

 shiny mass

45
Q

Metritis description

A

 Infection (inflammation) of the uterine lining (endometrium)

 Most common site of puerperal infection

46
Q

causes of metritis

A

 B strep(early)

 Chlamydia(late)

47
Q

signs of metritis

A

smell lochia in pads. UGH

48
Q

Risk factors for mastitis

A

 Milk stasis

o Prevent with frequent nursing – may have to pump

 poor hygiene

 nipple trauma (#1 RF)

 duct obstruction

49
Q

mastitis s/s

A

flulike symptoms

50
Q

Interventions for women with congenital heart disease

A

 Decrease any risk for fatigue during pregnancy and L&D

 Recommend Epidural anesthesia/analgesia as method of pain control

 During Stage 2- forceps or vacuum extraction may be recommended b/c we don’t

 May need Antibiotics—so that they don’t develop an infection that complicates their heart

issue.

 Moms who develop this during 1 pregnancy, it’s recommended they not get pregnant

again b/c damage is permanent

want to over exert these patients.

 If women hold their breath during L&D at all, they may pass out

51
Q

eptopic pregnancy

A

Fallopian tube pregnancy is usually in the ampula-

52
Q

medication for eptopic pregnancy

A

methyltrexate

53
Q

Salpingectomy

A

They usually remove the entire fallopian tube

54
Q

Trophoblastic Disease-

A

Hydatidiform Mole and Choriocarcinoma (Molar pregnancy)

55
Q

assessment for trophoblastic disease

A

Brown discharge from vesicles that have burst open (discharge - like cysts that look like

fluid filled grapes)

 Sometimes pt’s pass some of the vesicles and they appear in vaginal d/c

56
Q

medication for Hyperemesis Gravidarum

A

antihistamine & vitamin B6- Doxylamine (Trade name is Diclegis)

57
Q

Patho of preeclampsia

A

Damage to endothelial cells r/t inflammation.

Starts with mom’s abnormal spiral arteries. Pre-eclamptic- spiral artery walls are thick, hard, and non-expandable so that blood flow does not occur to the degree it needs. This artery is narrow and doesn’t open as larger to the placenta

 Less blood flow→ less oxygen→Interuterine growth delay, smaller fetus

58
Q

Cure for preeclampsia

A

delivery

59
Q

diagnosis of preeclampsia

A

 High Blood Pressure (140/90) without severe features OR

 Protein in your urine

 Or in the absence of proteinuria, new onset HTN with new onset of any of the following: (for Pre-Eclampsia)

 Renal insufficiency

 Elevated Hct

 Elevated Liver enzymes

 Low WBC (thrombocytopenia)

60
Q

HELLP Syndrome (subset of Preeclampsia with Severe Features)

A

Hemolysis Elevated Liver enzymes Low Platelet

61
Q

preeclampsia s/s

A

 stomach pain r/t liver necrosis right upper gastric pain_

 HA- r/t CNS constriction

 N/V

 Visual Disturbances- vasoconstrictive CNS (Seeing spots)

 Swelling in face, legs d/t loss of protein thru kidneys

 Gaining more than 5 pounds in a week

 Remember liver, renal, cerebral - those can be severely affected!!!

62
Q

eclampsia prevention medication

A

Magnesium Sulfate (with preeclampsia with severe features) IV, titrated because the risk is SEIZURING. As the BP increases, the risk of Seizure increases. MAG is a smooth muscle relaxant but MOSTLY an anti-seizure. Keep mom’s on Mag for 24-48 hrs after delivery..DANGEROUS drug

63
Q

What weeks are in which trimester?

A

 1st: 1-13 weeks

 2nd: 14-26

 3rd: 27-40

64
Q

When would you refer a patient to a genetic counselor (i.e.: taysachs, sickle cell)?

A

Genetic counseling referral is advised for any of the following categories: Congenital abnormalities, including developmental/cognitive/intellectual disability; familial disorders; known inherited diseases; metabolic disorders; chromosomal abnormalities. These categories can include disorders such as Tay-Sachs disease, Cystic fibrosis and the sickle cell trait.

65
Q

What happens to the fetus if mom becomes GDM?

A

Baby’s pancreas begins to produce large amounts of insulin. After birth, the pancreas continues to produce these large amounts of insulin and can make the baby
hypoglycemic!

66
Q

What position should you lay your patient in to check for a hematoma?

A

lateral sims

67
Q

Abortion-

A

pregnancy that ends before 20 weeks whether spontaneous (miscarriage) or induced (elective or therapeutic)

68
Q

What is the Nuemonic used to help remember the Pregnancy History Assessment?

A

G—Gravida = # of pregnancies, including current pregnancy

 T—Term = # of pregnancies carried to term (delivered at 37 weeks or later)

 P—Premature = of pregnancies that were delivered between 20 and 37 weeks

 A—Abortion = # of pregnancies ending in spontaneous or therapeutic abortion

 L—Living = # of currently living children

Para-# of births after 20 weeks, whether living or dead

69
Q

what should be done at the first prenatal visit?

A

Pap smear test if due, (Due to the nature of pregnancy and the changes in which the female body undergoes it is important to get a baseline pap smear to use to compare against future pap smears

70
Q

Components of a QUAD screen

A

 Alpha Feta Protein (AFP) – protein produced by fetal liver

 Unconjugated Estriol (UE) – protein produced in placenta and fetal liver

 Human Chorionic Gonadotrpoin (hCG) – hormone produced by the placenta

 Inhibin A – hormone produced by the placenta -
Inhibin A and hcg are increased in tri 21, with AFP and UE3 decresed. AFP is increased in NTD, other lab normal

71
Q

tests during 24-28 weeks

A

GDM and rH factor

72
Q

tests during 35-37 weeks

A

Group B strep

73
Q

What are the 5 areas that you measure with a biophysical profile? BPP

A

 Fetal heart rate acceleration

 Fetal breathing

 Fetal movements

 Fetal tone

 Amniotic fluid volume

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