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Antepartum Flashcards

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1
Q

End of Week 1

A

Blastocyst implants in endometrium

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2
Q

End of Week 4

A

weighs 400mg

  • at greatest vulnerability to teratogens
  • Blood vessels and heart form
  • Neural tube is forming
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3
Q

End of Week 8

A

FHR 110-160
Iron and glycogen get stored in the liver (and for 5mos after)
-End of the embyronic period

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4
Q

End of Week 12

A

FHR can be hears w/ doppler

  • sex is apparent
  • movements occur
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5
Q

End of Week 16

A

Amniotic fluid is adequate for an amniocentesis

-Face looks human

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6
Q

End of Week 20

A

Quickening can now be felt

  • Fetus is viable or at 500g+
  • Meconium accumulates in the colon
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7
Q

End of week 24

A

weight is 600g

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8
Q

End of week 28

A

Surfactant forming on alveolar surfaces - lungs are developed but not mature

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9
Q

End of week 32

A

Bones are fully developed

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10
Q

End of week 36

A

LS ratio is 2:1 so lungs are mature

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11
Q

End of Week 40

A

weight of about 7lbs

-full term!

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12
Q

TORCH: Toxoplasmosis

A

Maternal - flu like aches, lymphadenopathy, spontaneous abortion
Fetal - LBW, congenital toxoplasmosis

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13
Q

TORCH: Rubella

A

Maternal - rash, fever, malaise, spontaneous abortion during 1st trimester
Fetal - deafness, IUGR, microcephaly

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14
Q

TORCH: Cytomegalovirus

A

Maternal - cervical discharge, flu-like symptoms

Fetal: death, hemolytic anemia, jaundice, microcephaly, hydrocephaly

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15
Q

TORCH: Herpes

A

Maternal - lesions, pain, papules, ulcers, fever, malaise, dysuria, dyspareunia
Fetal - crosses placenta and can also be giver o baby at birth

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16
Q

Common risks in childbearing years

A
  • STDs
  • IPV
  • nutrition issues (obesity v eating disorders
  • TORCH
  • Cancer (hormonal)
  • Economis issues
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17
Q

Risk factors affecting Fetus

A
  • Alcohol
  • Tobacco
  • Caffeine
  • Drugs
  • Prescription drugs
  • nutrient deficiencies
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18
Q

Sentinel events in OB setting

A
  • APGAR less than 7
  • Preterm labor and preterm birth
  • Giving more than 3 or 4 units of blood to mom
  • Placental abruption
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19
Q

Tocolytics for preterm labor

A

Magnesium Sulfate
Terbutaline
Nifedipine
Indomethacin

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20
Q

Glucocorticoid - assist premature infant to grow

A

Betamethasone

Dexamethasone

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21
Q

Care for Preeclapmsia

A
  • Assess BP often
  • Give magnesium sulfate + watch I&Os (125ml/hr)
  • Decrease stimulation
  • Assess DTRs
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22
Q

HELLP Syndrome

A

Hemolysis
Elevated Liver Enzymes
Low Platelet count
-can be caused from Preeclampsia

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23
Q

DIC

A

Blood cannot clot and patient can bleed out from everywhere

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24
Q

1st Trimester

A

wk0 - 13

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25
2nd trimester
wk14 - 26
26
3rd Trimester
wk27 - 40
27
Warning signs during 1st Trimester
severe vomiting - Chills, fever - dysuria - diarrhea - Abd cramping - Vaginal bleeding
28
Warning signs 2nd & 3rd trimesters
- Persistent, severe vomiting - Sudden discharge of fluid from vagina < 37wks - Vaginal bleeding - Severe backache/flank pain - Change in fetal movements - Contractions; pressure; cramping < 37 wks. - Visual disturbances - Face/fingers/sacrum swelling - Headaches - Muscular a or convulsions - Epigastric/Abd pain - Glycosuria, + GTT reaction
29
Prenatal Visit Schedule
wk16 - 28: every 4 weeks wk29 - 36: every 2 weeks wk36 - term: every week Post: 2x week
30
Emergency Situations
- uterine contractions q10 minutes or less for an hour or more - vaginal bleeding - fluid leaking from vagina - odorous vaginal discharge
31
Ultrasound
L1: fetal viability, presentation, age, placental location, structures, AFV L2: fetal presentation, FHT L3: anatomically or physiologically abnormal fetus
32
Types of Ultrasound
Abdominal: gel is placed on abd, bladder must be full Transvaginal: lithotomy position, determines cervical length
33
Non-Stress Test (NST)
Reactive: normal FHR with 2 accelerations Nonreactive: additional testing needed *Vibroacoustic stimulation
34
Contraction Stress Test (CST) or Oxytocin Contraction Test (OCT)
-FHR baseline --> you want a NEGATIVE TEST Contractions started by nipple stimulation of pitocin Negative: no late decelerations Positive: late decelerations
35
Biophysical Profile
-Fetal breathing movements -Gross body movement -Fetal tone -Qualitative amniotic Fluid volume -Reactive non-stress test Normal score 10:10
36
Amniocentesis
* *after 14 weeks + informed consent - LS ratio - Alpha-fetoprotein (NTDs) - Desquamated fetal cells (genetic testing)
37
Complications of Amniocentesis
- infx - injury to fetus - leaking AF - pregnancy loss - maternal hemorrhage - Rh isoimmunization - Amniotic Fluid Embolism - Fetal death
38
Nursing: Amniocentesis
- Mother empties bladder - Monitor fetus before and for 1hr after - watch for vaginal bleeding, leaking AF, cramping or fever - EDUCATE - Give expectations for mild discomfort
39
Chorionic Villus Sampling
* *10-13 weeks + informed consent - genetic defects - sample of blood and tissue taken from chorionic villi
40
PUBS test
kleihauer-betke test --> tests for fetal or maternal bleeding
41
Maternal Serum Alpha-Fetoprotein (MSAFP)
***15-20wks | elevated levels associated w/ open neural tubes
42
Coombs test
Screens for Rh incompatibility and detects fetal hemolytic anemia
43
Recommended weight gain: underweight
28-40lbs
44
Recommended weight gain: Normal
25-35lbs
45
Recommended weight gain: Overweight
15-25lbs
46
Recommended weight gain: Obese
11-20lbs
47
Recommended amount of Folic Acid for pregnancy
400mcg daily
48
Foods w/ folic acid in them
fortified cereals, dark green leafy veggies, oranges, broccoli, asparagus, artichokes, liver
49
Ductus Arteriosis
Bypasses lungs - blood flows from pulmonary arteries to the aorta
50
Ductus Venosus
bypasses liver from umbilical vein to the inferior vena cava
51
Foramen ovale
blood passes thru right atrium through the FO to the left atrium
52
Components of Biophysical Profile
``` Breathing movements Amniotic Fluid Volume Fetal Tone Heart rate reactivity Body movements ```
53
Good score for BPP
10:10 or 2 rating for each section
54
Diagnosis for Chlamydia
Culture or immunoassay in 1st trimester
55
Treatment for Chlamydia
Azithromycin
56
Effects of Chlamydia
PROM, PTL, ectopic pregnancy
57
Diagnosis of Gonorrhea
Gram stain culture
58
Treatment of Gonorrhea
Ceftriaxone
59
Effects of Gonorrhea
amnionitis, PTL
60
Diagnosis of Syphilis
VDRL or RPR serologies
61
Treatment of Syphilis
Penicillin + treat by 18th week
62
Effects of Syphilis
spontaneous abortion, PTL, congenital syphilis
63
Diagnosis of Herpes
examination and culture of lesions/ulcers
64
Treatment of Herpes
Acyclovir + cryotherapy
65
Effects of Herpes
can cross the placenta
66
Management: Toxoplasmosis
Blood test for titer; no cat litter; avoid uncooked meat; elective abortion if titer is too high
67
Management: Varicella
Immune globulin for exposed pregnant women
68
Management: Rubella
Rubella titer 1:8 means immune
69
Management: Cytomegalovirus
Therapeutic abortion if primary infection is prior to 20wks
70
Precipitous Labor
Labor that lasts 3 hours or less from onset of contractions to birth of the baby
71
Nursing interventions post ROM
- take temperature often - count and weigh pads that mom uses - check moms abdomen for tenderness at least q2 hours
72
Signs of Placenta previa
Painless bright red bleeding after 20 weeks
73
Signs of Placental abruption
Severe Abdominal pain, with or without bleeding
74
ACHES
``` A - abdominal pain C - Chest pain/SOB H - headaches/vascular accident/increased BP E - eye problems S - severe leg pain ```
75
BRAIDED
B: benefits R: risks A: alternatives
75
BRAIDED
``` B: benefits R: risks A: alternatives I: inquiries D: decisions E: explanations D: documentation ```
76
Acid - Base balance
Respiratory Alkalosis compensated by metabolic acidosis

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