Exam 1 Review Concepts Flashcards
1
Q
No pap screening before age…
A
21
2
Q
Age 21-24 USPSTF pap screening
A
pap test every 3 years
3
Q
Age 21-24 ACS pap screening
A
no test
4
Q
Age 21-24 ACOG pap screening
A
pap test alone every 3 years
5
Q
Age 25-29 USPSTF pap screening
A
pap test every 3 years
6
Q
Age 25-29 ACS pap screening
A
HPV every 5 years - preferred
HPV + pap every 5 - acceptable
Pap every 3 years - acceptable
7
Q
Age 25-29 ACOG pap screening
A
Pap alone every 3 yrs
HPV alone can be considered but pap preferred
8
Q
Age 30-65 USPSTF pap screening
A
Pap every 3
HPV every 5
Or HPV+Pap every 5
9
Q
Age 30-65 ACS pap screening
A
HPV every 5 - preferred
HPV+Pap every 5- acceptable
Pap every 3 - acceptable
10
Q
Age 30-65 ACOG screening
A
Any of the three:
Pap+HPV every 5
Pap alone every 3
HPV alone every 5
11
Q
Pap screening over age 65
A
No screening unless previous abnormal
12
Q
Pap screening for post-hysterectomy
A
No screening unless it was done for cervical cancer changes
13
Q
Age to start mammograms
A
40-50
14
Q
When to stop mammograms
A
Less than 10 years life expectancy
Age 75 or higher
15
Q
Frequency of mammograms
A
Annual or biannual
Every 2 years after age 55
16
Q
Are 3d mammograms beneficial?
A
Inconclusive or yes, reduces risk for cancer
17
Q
There is little evidence that self breast exams reduce risk of breast cancer…
A
IF THE WOMAN IS GETTING MAMMOGRAMS
18
Q
Pallor, dizziness, breathlessness, tachycardia, nausea, diaphoresis, clammy skin, are all signs of…
A
supine hypotension or vena cava syndrome
19
Q
Intervention for supine hypotension
A
Position woman on her left side (lateral decubitus)
If dental procedure place pillow under 1 hip
Semi-sitting with knees slightly flexed
20
Q
A woman is at higher risk for supine hypotension if she is…
A
obese, dehydrated, or hypovolemic, or large uterus
21
Q
Sign of pregnancy: fatigue
A
presumptive
22
Q
Sign of pregnancy: breast tenderness
A
presumptive
23
Q
Sign of pregnancy: nausea/vomiting
A
presumptive
24
Q
Sign of pregnancy: amenorrhea
A
presumptive
25
Sign of pregnancy: urinary frequency
presumptive
26
Sign of pregnancy: quickening
presumptive
27
Sign of pregnancy: Goodell sign
probable
28
Sign of pregnancy: Chadwick's sign
probable
29
Sign of pregnancy: Hegar's sign
probable
30
Sign of pregnancy: Positive pregnancy test
probable
31
Sign of pregnancy: Braxton Hicks contractions
probable
32
Sign of pregnancy: Ballottement
probable
33
Sign of pregnancy: Quickening
probable
34
Quickening def
feeling baby move
35
Goodell sign
softening of cervix, at 6 weeks, increased vascularity and hypertrophy/hyperplasia
36
Probable signs are
OBJECTIVE by the provider
37
Chadwick sign
6-8 weeks of pregnancy, bluish color of cervix by increased vascularity
38
Hegar sign
4-6 weeks, softening of lower uterus (isthmus)
39
Ballottement
Passive movement of unengaged fetus, press on cervix, 16th-18th week
40
Sign of pregnancy: ultrasound visualization
positive
41
Sign of pregnancy: fetal heart tones
positive
42
Sign of pregnancy: xray visualization
positive
43
Sign of pregnancy: fetal movements palpated or visualized by examiner
positive
44
Recommended weight gain: BMI under 18.5
28-40
45
Recommended weight gain: BMI 18.5-24.9
25-35
46
Recommended weight gain: BMI 25-29.9
15-25
47
Recommended weight gain: BMI 30 or greater
11-20
48
How to calculate bmi
kg/m2 or weight/inches2 * 703
49
Live vaccines contraindicated:
Varicella
Measles
Poliomyelitis
Recomb Hep B is OK
50
TDAP (for pertussis) should be administered...
27-36 weeks gestation
If not, then immediately post partum
Friends/fam should be immunized too
51
Flu vaccine
Offered to all pregnant patients
| Intranasal flu vaccine contraindicated
52
Prenatal appointment schedules
First visit within the first trimester (12 weeks)
Monthly visits weeks 16 through 28
Every 2 weeks from weeks 29 to 36
Weekly visits week 36 to birth
53
GPTPAL
```
Gravita - number of pregnancies
Para - number of births
Term - 37 and above
Preterm - Under 37
Abortion - under 20 wks
Living - number of living children
```
54
late preterm
34-36 6/7
55
early term
37 - 38 6/7
56
late term
41 -41 6/7
57
post term
42 and above
58
How much folic acid
0.4 mg
59
How much calcium
1000 mg
60
How much caffeine
200 mg or less
61
Limit
artifical sweeteners
62
Vegan mothers need...
4 mg b12
1200 mg calcium
10 mg vit d
63
Contraindicated foods in pregnancy
```
Alcohol
Homemade dressings
Anything unpasteurized
Processed meats
Soft cheeses such as brie
High mercury fish (shark, swordfish, king, tuna)
Raw fish or meat
Organ meat
Raw eggs
Raw sprouts and unwashed produce
```
64
White tuna (albacore) no more than...
6 oz a week
65
27-30 mg recommended at 12 weeks
iron supplement
66
What is the EDD for LMP July 6, 2022
April 13th, 2023
67
Vegan pregnant woman considerations
Refer to dietitian, preferably preconception
| May need additional DHA
68
What is fundal height
measurement of the height of the uterus above the symphysis pubis
69
How to measure fundal height
A disposable paper metric tape measure is preferred for measuring fundal height
The tape can be placed in the middle of the woman’s abdomen and the measurement made from the upper border of the symphysis pubis to the upper border of the fundus, with the tape measure held in contact with the skin for the entire length of the uterus
70
What should be noted in measuring fundal height
Conditions under which the measurements are taken can also be described in the woman’s records, including whether the bladder was empty and whether the uterus was relaxed or contracted at the time of measurement.
71
Leopold's Maneuver: Step 1
Fundal grip: fundus palpated, determine which part feeling, head is hard and breech is nodular mass
72
Leopold's Maneuver: Step 2
Umbilical grip: Around sides of belly, level of umbilicus, which side is fetal back?
fetal back is hard convex, and small structures are nodular
73
Leopold's Maneuver: Step 3
Pawlick's grip: Pubic symphysis, thumb and fingers to determine baby presentation
If fetus not engaged a moveable structure can be palpated
74
Leopold's Maneuver: Step 4
Pelvic grip: Lower quadrants to determine engagement of fetal presenting part
75
Fetal development milestone: 4 weeks
Heart begins beating
76
Fetal development milestone: 12 weeks
Resembles human
77
Fetal development milestone: 20 weeks
Fetal movements strong enough for mother to feel, vernix caseosa and lanugo appear
78
Fetal development milestone: 24 weeks
Alveolar ducts and sacs appear, lecithin beings to appear in amniotic fluid, potentially viable, red skin wrinkles, body lean
79
Fetal development milestone: 30-31 weeks
Subq fat forming, L/S ratio 1.2 : 1
80
Fetal development milestone: 36-40 weeks
Lanugo and vernix disappear, L/S 2:1, definite sleep wake cycles, testes descended, labia majora well developed
81
maternal blood pressure remains the same or decreases slightly because...
reduced systemic vascular resistance caused primarily by the vasodilatory effects of progesterone, prostaglandins, and relaxin
82
Factors that influence maternal BP
age, activity level, presence of health problems, circadian rhythm, alcohol consumption, smoking, anxiety, and pain
83
Explain rubella titer and vaccine during pregnancy
Measures immunity to rubella
a subcutaneous injection of rubella vaccine is recommended in the postpartum period prior to hospital discharge to prevent the possibility of contracting rubella in future pregnancies
84
Rubella vaccine considerations
Women are cautioned to avoid becoming pregnant for 28 days after receiving the rubella vaccine because of the potential teratogenic risk to the fetus. The live attenuated rubella virus is not communicable in breast milk; therefore breastfeeding mothers can be vaccinated
85
What is rhogam and when is it given?
within 72 hours after birth prevents sensitization in the Rh-negative woman who has had a fetomaternal transfusion of Rh-positive fetal red blood cells
or 28 week mark
86
Why is rhogam given?
Administration of Rh immune globulin is intended to prevent problems in future pregnancies should the Rh-negative woman have an Rh-positive fetus
87
Normal H&H in pregnancy
Hemoglobin: greater than 11 g/dL
HCT: greater than 33%
Low = anemia
88
Hemoglobin 1st trimester
11-14
89
Hemoglobin 2nd trimester
10-13
90
Hemoglobin 3rd trimester
10-14
91
HCT 1st trimester
31-41
92
HCT 1st trimester
30-38
93
HCT 1st trimester
32-41
94
When is GBS tested
36 wks
95
1 hr gtt abn
greater than 140
96
Explain organogenesis. What is it? When is it complete?
Embryonic stage, day 15-8 weeks, period of organogenesis and the most critical time in the development of the organ systems and the main external features
At the end of the eighth week, all organ systems and external structures are present, and the embryo is unmistakably human
97
What is included in the initial prenatal visit?
```
Prenatal interview
Reason for seeking care
Current pregnancy
Childbearing and reproductive system history
Health history
```
98
What is included in the prenatal interview?
```
Nutrition
Meds/Supp/Herbs
Family and social history
Substance abuse screening
IPV screening
```
99
Define an acceleration
visually apparent, abrupt (onset to peak less than 30 seconds) increase in FHR above the baseline rate
The peak is at least 15 beats/min above the baseline, and the acceleration lasts 15 seconds or more, with the return to baseline less than 2 minutes from the beginning of the acceleration. If before 32 weeks, changes to 10
100
Accelerations are a...
GOOD THING!
101
Fetal tachycardia
Greater than 160 for 10 mins or longer
102
What does fetal tachycardia indicate?
Early sign of fetal hypoxemia, especially with minimal or absent variability or late decelerations
103
Causes of fetal tachycardia
Maternal fever
Maternal infection
Maternal hyperthyroidism
Or in response to drugs such as... Brethine, atropine, cocaine
104
What is the nursing intervention for fetal tachycardia?
Depends on cause. Notify HCP. Tylenol for fever and o2 at 10L non rebreather face mask
105
What is fetal bradycardia?
HR less than 110 for 10 mins or longer
106
Nursing intervention for fetal bradycardia?
Notify HCP
107
Causes of fetal bradycardia
Fetal heart defects
Fetal viral infection (CMV)
Maternal hypoglycemia
Maternal hyperthermia
108
Late decelerations and then prolonged bradycardia (minimal variation) might indicate...
Uterine rupture (need emergency C section)
109
What are the nursing interventions if the nurse suspects uterine rupture?
NOTIFY HCP. Turn to left side, o2 10L NRB face mask, prepare for emergency c section
110
What are the nursing interventions for prolonged decelerations?
NOTIFY HCP. Turn to left side, o2 10L NRB face mask, prepare for emergency c section
111
What is a prolonged deceleration?
Greater than 2 mins
112
What causes absent variability?
```
CNS depressants
Fetal sleep cycle
Neuro injury
Congenital abnormalities
Extreme premature
Fetal hypoxemia
Fetal metabolic acidosis
```
113
Minimal variability
<5 bpm
114
Moderate variability
6-25 bpm
115
Marked variability
>25 bpm
116
What is the significance of marked variability?
Unclear, may be normal, may be early sign of hypoxemia
117
What is the only accurate way to determine variability?
Intrauterine monitoring
118
What causes early decelerations?
Head compression, considered normal
119
What causes variable decelerations?
Cord compression, not normal
120
What causes late decelerations?
Placental insufficiency, onset to nadir greater than 30 seconds
121
Define a variable deceleration
Sharp decline to nadir, less than 30 seconds, with drop of 15 bpm or more, less than 2 mins duration. Not related to contractions
122
Variable deceleration intervention
```
Dx pitocin/oxytocin if infusing
Repostion side to site or knees to chest
O2 10LNRB
Notify HCP
Vaginal exam for prolapsed cord
Amniocentesis may be needed, assist
Vacuum or forceps assisted birth, or c section
```
123
What is a common cause of variable decelerations?
Baby is a negative station, amniotic fluid drains and allows cord to come with it, then baby comes out pressing on cord
124
What causes placental insufficiency?
HTN, hypotension, hypovolemia, hemorrhage, severe anemia, uterine hypertonus, DM, infection, IUGR, placental separation
125
What is uterine hypertonus and what causes it?
Sustained contraction due to excessive pitocin
126
Late deceleration nursing interventions
```
Dx Pitocin
Side lying position
10L O2 NRB
Correct hypotension by elevating legs, increase maintenance fluids
Palpate uterus to assess for too fast of contractions
Notify HCP
Internal monitoring
Assist with birth
```
127
Active labor normal contraction frequency
2-5 every 10 mins, most frequent in second stage
128
Active labor normal contraction duration
No longer than 90 seconds
129
Relaxation time between contractions
60 seconds or more in 1st stage
| 45 seconds or more in 2nd stage
130
Normal resting tone
Avg 10 mmhm, should be soft to palpation, never more than 20
131
When is acoustic sound contraindicated?
decals or bradycardia
132
Ductus arteriosus shunts blood away from...
liver
133
When do fetal shunts close
Immediately after birth
134
What type of vessels are in the umbilical cord?
2 arteries and 1 vein
135
What is the umbilical cord surrounded by?
Wharton's Jelly
136
When does fundal height measurement start?
20 weeks, it should be at the umbilicus at 20 weeks. Measure from symphysis pubis to funds of uterus
137
What is the fundal height threshold?
Plus or minus two
138
Multigravita may feel quickening at...
16 weeks
139
Rubella titer levels
less than 1:8 not immune, greater than 1:10 is immune
140
What is lightning?
Dropping of baby into the pelvis (process of moving down)
141
Engagement
at the level is ischial spine
142
What to assess for ruptured membranes
clear or blood tinged, odor
143
What tests determine if membranes are actually ruptured
Amnisure, should be positive if ruptured
144
If membranes are ruptured can mother walk?
Only if the baby is engaged, if still up in the uterus then cord could prolapse
145
What types of anesthesia are used for labor?
Epidural
Pain meds
Spinal block
146
What type of anesthesia is used for c sections?
Spinal
147
What are we concerned about with anesthesia and pregnancy?
```
CNS depression
Prolonged labor
Hypotension
Bleeding
Spinal headaches
Bladder distention
```
148
What lab work is important for epidural?
Platelets
149
What do platelets need to be for an epidural?
Over 100,000
150
Which pelvis shape causes the most concern for delivery and most often results in c section?
Platypelloid
151
Shapes of pelvis
Platypelloid, gynecoid, arthoropoid, android
152
Platypelloid shape
short and normal width
153
gynecoid
round and wide
154
arthropoid
normal width but long height
155
Android
heart shaped
156
True labor
Cervical changes, contractions become longer, and closer together and more intense, starts in lower back to abdomen
157
False labor
Contractions are irregular, get better with comfort measures, starts upper back stays at naval level
158
Cardinal movements in order
Even Diana feels insecure every event
```
Engagement
Descent
Flexion
Internal rotation
External rotation
Expulsion
```
