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NCM 109 > ALL > Flashcards

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1
Q
  • Used to screen pregnant clients for gestational diabetes
A
  1. GLUCOSE TOLERANCE TEST (GTT)
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2
Q
  1. GLUCOSE TOLERANCE TEST (GTT) how many weeks before screening
A

(24-29 weeks AOG)

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3
Q

how many gram of oral glucose load in GTT

A

50g

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4
Q

The venous plasma glucose is assessed how many hours

A

1 hour after glucose load

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5
Q

if the findings of GTTS is ABNORMAL how many mg/dl

A

140 mg/dl

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6
Q

a Client with abnormal GTT result should be re assessed with how many hours and grams of oral

A

3-hour 100g-oral

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7
Q

Procedure in GTT

A

Client is told to eat a high-carbohydrate diet for 3 days before the test; then on the day of the test, the woman fasts for 8 hours (overnight) and a fasting serum glucose is obtained; following the fast, 100 g of oral glucose is administered and glucose levels are assessed at 1,2, and 3 hours.

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8
Q
  • Gestational diabetes is diagnosed if??
A

2 or more are abnormal

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9
Q
  • Results are borderline if
A

one value is abnormal

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10
Q

Abnormal OGTT result in Fasting

A

greater than 105 mg/dl

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11
Q

Abnormal OGTT result in 1 hour

A

greater than 190 mg/dl

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12
Q

Abnormal OGTT result in 2hours

A

greater than 165 mg/dl

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13
Q

Abnormal OGTT result in 3 hours

A

greater than 145 mg/dl

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14
Q

to screen for maternal syphilis

A

VDRL

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15
Q

WHAT IS ABBREVIATION OF VDRL

A

Venereal disease Research Laboratory

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16
Q

testing for women high risk for HIV infection.

A
  • Immunosorbent assay (ELISA)
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17
Q

ELISA means

A

enzyme-linked immunosorbent assay.

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18
Q

HIV If the result is positive, the diagnosis is confirmed

A

Western Blot test

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19
Q
  • Women with HIV are treated with
A

Zidovudine (AZT)

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20
Q

Zidovudine (AZT) is used

A

with HIV are treated with Zidovudine (AZT) during pregnancy to decrease the risk of the fetus acquiring the infection.

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21
Q
  • HIV screening is recommended for women:
A

a. Who are IV drug users
b. With multiple sexual partners
c. With sexual partner who are HIV positive or who belong to the high-risk group (homosexuals, IV drug users, hemophiliacs)
d. Who received blood transfusions bet 1977-1985 when HIV testing for blood products is not yet routinely conducted.

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22
Q

to determine the client’s level of immunity to certain infections that can cause serious consequences if acquired during pregnancy.

A

Antibody screen

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23
Q

titer of 1:8 or less indicates?

A

Lack of immunity

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24
Q

Test in Rubella antibody titer is for

A
  1. Hemagglutination-inhibition test – titer of 1:8 or less indicates lack of immunity
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25
Q

what to instruct to a woman; what to avoid?

A

children with rubella infection and who have just received rubella vaccine.

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26
Q

Rubella If with no immunity, advice women to be vaccinated

A

6 weeks after delivery

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27
Q

Titer more than 1:8 indicates

A

IMMUNITY

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28
Q

DM universal Screening performed on all pregnant women at

A

28 weeks gestation

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29
Q

DM universal screening is done?

A

as early as first clinic visit if woman is high risk.

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30
Q

Risk factors of DM universal

A
  • Age >25 years
  • Family history of diabetes
  • Glycosuria
  • History of unexplained pregnancy loses
  • Previous fetal or neonatal death
  • Previous infant with congenital anomalies
  • LGA infants or term infant more than 4,000 grams
  • Polyhydramnios
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31
Q
  1. Maternal serum Alpha-fetoprotein (AFP) Performed at
A

14-16 weeks gestation

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32
Q

Maternal serum alpha-fetoprotein * Elevated AFP indicates

A

neural tube defect, fetal nephrosis, omphalocele

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33
Q
  1. Maternal serum Alpha-fetoprotein (AFP) * Decreased maternal levels of AFP may indicate
A

Trisomy 21

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34
Q

Maternal serum Alpha-fetoprotein (AFP)
Abnormal levels of AFP may indicate a need for a

A

triple-screen test, ultrasound, or assessment of AFP levels in amniotic fluid.

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35
Q
  1. Maternal serum Alpha-fetoprotein (AFP) TEst for Down syndrome, trisomy 18 and neural defects
A
  1. Triple-screen test
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36
Q
  • Screening test for cervical cancer
A

Pap smear

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37
Q

1st Pap test is done within

A

3 years after a woman’s first sexual contact or at the age of 18 whichever comes first.

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38
Q
  • All woman who are sexually active should have a pap test every year during the
A

first 3 yrs. from the 1st coitus.

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39
Q
  • If these 1st examinations all revealed a “no pathologic finding” results, succeeding pap test can done every
A

3-5 years. However, all women should have routine pelvic examination every year

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40
Q

 If non-pregnant client, pap test

A

performed around ovulation and never on menstruation

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41
Q

Instruction in Pap smear

A

: no coitus, douche, and vaginal medications 24 hours before pap test

  • Client is placed in lithotomy position. Only sterile water is used as lubricant. No chemical lubricant such as KY jelly is used.
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42
Q

What are the 3 specimen collected in Pap smear

A
  1. Endocervix
  2. Endocervical – most common site of malignancy
  3. Vaginal pool specimen – from posterior fornix
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43
Q

Most common site of malignancy

A

Endocervical

44
Q

From posterior fornix

A

Vaginal Pool specimen

45
Q

Results in Pap smear

A
  1. Class 1 – normal findings
  2. Class II – normal with atypical cells present. The atypical cells are often caused by inflammatory conditions such as infection
  3. Class III – suggestive of malignancy with benign and possibly malignant cells.
  4. Class IV - Probably malignant, with signs of malignancy present
  5. Class V - definitely malignant cells are present
46
Q
  • Protein may normally be found in the urine during pregnancy at a level of trace to +1 using the
A

Dipstick method

47
Q

Increased protein may indicate? in Urinalysis

A

PIH or the Pregnancy Induced Hypertension

48
Q
  • WBCs or nitrites can indicate a possible
A

UTI which can place the client at risk for preterm labor.

49
Q

Urinalysis ketones indicates

A

diabetes and hyperglycemia.

50
Q

indicative of UTI

A
  • Greater than 10,000 bacteria/ml
51
Q

severe form of diabetes milletus is

A

Diabetic ketoacidosis

52
Q
  • a series of tests done on peripheral blood that provide information on the hematologic system as well other body systems.
A

CBC

53
Q

CBC IS DONE DURING

A

28-32 weeks TO DETERMINE ANEMIA

54
Q

NORMAL VALUES OF HEMOGLOBIN (Hgb)

A

12-16 g/dl; >11 g/dl (pregnancy)

55
Q

NORMAL VALUES OF HEMATOCRIT

A

(Hct) – 37-47%; >33% (pregnancy)

56
Q

normal values of WBC

A

5,000-10,000 mm3; 5,000-15,000 mm3 (pregnancy)

57
Q

normal values of Platelet count

A

150,000-400,000 mm3; none until 3-5 days after delivery (pregnancy)

58
Q

: to determine the client’s blood group and Rh status so that the fetus at risk for developing erythroblastosis fetalis or hyperbilirubinemia in the neonatal period may be identified

A

BLOOD TYPE AND RH FACTOR

59
Q
  • if multigravida is Rh (-), she should next undergo to determine?
A

Coomb’s test to determine presence of antibodies.

60
Q

Blood type and Rh factor - If not sensitized, should receive

A

RhoGAM at 28 weeks gestation and within 72 hours after delivery to prevent sensitization

61
Q

Non-invasive procedure that utilizes high frequency sound waves to visualize the products of conception.

A

Ultrasound

62
Q

To determine sex how many weeks

A

14-16 weeks

63
Q

requires full bladder, advice to drink 1 quart water 2 hours before ultrasound and assist to lie flat on back.

A

Abdominal Ultrasound

64
Q

does not require full bladder and useful for early confirmation of pregnancy.

A

Transvaginal Ultrasound

65
Q
  • Use to assess fetal well-being and maturity.
A

Amniocentesis

66
Q

small amount of amniotic fluid to determine genetic anomalies

A

Amniocentesis

67
Q

prenatal diagnosis of genetic disorders or congenital anomalies, assessment of pulmonary maturity, and diagnosis of fetal hemolytic disease.

A
  1. Amniocentesis
68
Q

used to asses fetal lung maturity; normal: 2:1

A
  • Lecithin to sphingomyelin (LS) ratio
69
Q

– phospholipid found in pulmonary surfactant – indicator of lung maturity.

A

Phosphatidylglycerol (PG)

70
Q

as well as the gender of the fetus can be determined from cells cultured for karyotype.

A
  • Genetic and chromosomal aberrations
71
Q

either increased or decreased can indicate anatomic abnormalities

A
  • Alpha-fetoprotein levels
72
Q

status and severity of hemolytic anemia can be assessed by measuring bilirubin pigment in the amniotic fluid.

A

RH isoimmunization

73
Q
  • a transcervical or transabdominal insertion of a needle into the fetal portion of the placenta
A

Chorionic Villus Sampling

74
Q

how many grams of chorionic villi for examination

A

5-8 grams

75
Q

CVS is performed at

A

8-12 weeks gestation under ultrasound guidance to ensure that the fetus is unharmed.

76
Q

indication of CVS

A

women who are >35 years old; who have had frequent spontaneous abortion, who have had fetuses with chromosomal abnormalities or other defects

77
Q
  • To determine some genetic aberrations
A

CVS

78
Q
  • involves performing a trans abdominal insertion of a needle under ultrasound guidance to withdraw 1-4 ml fetal blood sample from a fetal umbilical vessel for examination.
A

PUBS

79
Q

how many ml in PUBS

A

1-4 ml fetal blood sample

80
Q
  • this test assesses fetal well-being based on the reaction of FHR to fetal movement.
A

NONSTRESS TEST (NST)

81
Q

how to say in nonstress test is a reactive/normal

A

– the fetal heart rate should accelerate during fetal movement, by 15 beats for at least 15 secs., twice in a 20-minute period. A reactive NST indicates intrauterine survival for 1 week.

82
Q

how to say in nonstress test is a Nonreactive/Abnormal

A

No acceleration is observed or acceleration is below than what is expected.

83
Q
  • noninvasive method of assessing the general well-being of the fetus and the fetal environment.
A

BIOPHYSICAL PROFILE

84
Q

what are the 5 parameters evaluated in BPP

A
  1. fetal breathing movements
  2. fetal movement
  3. fetal tone
  4. amniotic fluid index
  5. Reactive FHT from Nonstress test
85
Q

scores and total in BPP

A
  • Score of 2 is given if findings for a criterion is normal
  • Score of 0 – abnormal
  • Total score of 8-10 – normal
  • Total score of 4-6 – possibly abnormal
  • Total score of less than 4 – indicate need for delivery
86
Q

At least 1 episode of breathing movement lasting at least 60 secs in a 30-min assessment period

A

Fetal breathing movements score 2

87
Q

At least 3 episodes of fetal movement in a 30-min assessment period

A

Fetal body movement score 2

88
Q

Fetal body movements
2 or fewer fetal movements

A

score 0

89
Q

At least 1 episode of extension and return to flexion during the assessment period

A

fetal muscle tone score 2

90
Q

Slow extension with return to only partial flexion

A

Fetal muscl tone score 0

91
Q

2 or more movement-associated heart rate increases of at least 15 bpm above baseline and 15 secs in duration in 20-min assessment period

A

Fetal heart rate activity score 2

92
Q

Fewer than 2 movement-associated heart rates

A

FHT score 0

93
Q

At least 1 pocket of amniotic fluid measuring 1 cm in two perpendicular planes

A

Amniotic Fluid Volume score 2

94
Q

Either fluid is absent in most areas of the uterine cavity of the largest pocket measures 1 cm or less in the vertical axia

A

Amniotic fluid volume score 0

95
Q

calculated by adding the largest vertical pockets of amniotic fluid in the four quadrants of the gravid uterus.

A
  1. Amniotic Fluid Index (AFI)
96
Q

Normal AFI is

A

10-24 cm

97
Q

fetal movement count considered normal

A

at least 3 movements in one hour

98
Q

– used to measure uteroplacental function or the feto-placental respiratory reserve by observing the response of fetal heart rate to uterine contractions induced by oxytocin administration or nipple stimulation.

A
  1. Contraction Stress Test
99
Q

Interpretation of CST Positive

A

Positive

Findings
There is persistent late deceleration or late deceleration with more than half the contractions

Actions
Fetus is no longer receiving adequate oxygen and needs to be delivered

100
Q

Interpretation of CST Negative

A

Findings
There is no late deceleration Safe for the fetus to remain in the utero for the next 7 days

Actions
Safe for the fetus to remain in the utero for the next 7 days

101
Q

Interpretation of CST Suspicious

A

Findings

Inconstant late deceleration pattern. Late deceleration occurring with less than half the uterine contraction

ACtions
TEst must be repeated

102
Q

Interpretation of CST Hyperstimulation

A

Findings
Uterine contractions occur more often than every 2 minutes or lasting longer than 90 seconds or there is a presence of hypertonicity of the uterus

Actions
the test must be repeated

103
Q

Interpretation of CST Unsatisfactory

A

Findings
Quality of the records is not sufficient to be sure that no late decelerations are present

ACtions
The test must be repeated

104
Q

waveform with a gradual decrease and return to baseline with time from onset of the deceleration to the lowest point of the deceleration (nadir) >30 seconds.

A

Early Deceleration

105
Q

waveform with a gradual decrease and return to baseline with time from onset of the deceleration to the lowest point of the deceleration (nadir) >30 seconds

A

Late deceleration

NCM 109 (1 decks)

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