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NM 717 Comps > Module 4 Antepartum Canvas > Flashcards

Module 4 Antepartum Canvas Flashcards

1
Q

What is Hegar’s sign?

A

the unusual compressibility of the lower uterine segment at 4-6 wks GA

*probable sign of pregnancy

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2
Q

Explain where you would expect the fundus as different gestations.

A

Pelvic organ until 12 weeks!
16 weeks-midway between symphysis pubis and umbilicus
20 weeks-at umbilicus
After 20 weeks, measure in cm from pubic bone

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3
Q

Patients with severe N/V in 1st trimester may have what condition?

A

Subclinical hyperthyroidism

the alpha subunit of hCG is able to stimulate the thyroid gland as though it were TSH. (crazy!)

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4
Q

How does HR and BP change in pregnancy?

A

HR increases by 10 BPM

BP gradually decreases then returns to prepregnancy level in weeks 22-24

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5
Q

What murmurs are common and benign in pregnancy?

A

-mild pulmonic or tricuspid regurgitation
-systolic ejection murmur
-3rd heart sound

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6
Q

How should the NP care for a patient with pre-existing cardiomyopathies?

A

REFER PROMPTLY TO A PHYSICIAN!!!

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7
Q

What are the key hematological changes of pregnancy?

A

-pregnancy is a hypercoagulable state
-Protein S levels fall
-Activated protein C levels fall

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8
Q

What is the gold standard for diagnosis of IDA?

A

serum ferritin

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9
Q

How can physiologic dyspnea be distinuished from pathologic?

A

-Physiologic dyspnea can be distinguished from pathologic dyspnea by respiratory rate
-Tachypnea is a sign of possible respiratory compromise

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10
Q

What causes the GI changes in pregnancy?

A

Progesterone relaxes the smooth muscles, resulting in decreased peristalsis

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11
Q

What thyroid change is normal in pregnancy and what physical exam is abnormal

A

Overall enlargement is normal but nodules are ABNORMAL

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12
Q

Why is it important to maintain a euthyroid state in pregnancy?

A

-the fetus does not start secreting thyroid hormone until approx 18-20 wks gestation
-the fetus is depending on maternal thyroid hormone for critical metabolic functions

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13
Q

To assess the thyroid, what levels must be assessed?

A

TSH, FT4, T4

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14
Q

What hormone is the reason we screen all pregnant people for GDM and why?

A

hPL induces maternal insulin resistance & hepatic glucose formation

-these raise glucose levels in maternal circulation

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15
Q

What keeps the maternal immune system from rejecting the fetus?

A

The fetus is an allograft

Trophoblastic tissue does NOT express the cell membrane proteins that would stimulate an innate or cellular immune response

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16
Q

What are the steps of fertilization and implantation?

A

Fertilization (fusion of two haploid [23 chromosome] cells) -> Blastocyst (rapid cell division as it moves to the uterus) -> implants in the decidua

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17
Q

What is a normal AFI?

A

5-23.9

Oligo: <5
Poly: >24

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18
Q

How can neural tube defects be prevented?

A

Folic acid supplementation can reduce occurrence by 60-70%

Enriched cereal products and supplementation
400-800 mcg per day prior to conception through 8 weeks of pregnancy

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19
Q

Why should NTD screening be offered to everyone?

A

95% of cases occur in families that are previously unaffected

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20
Q

What is the gold standard of diagnosis of chromosomal disorders?

A

Evaluation by karotyping

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21
Q

Is an amniocentesis a screening or diagnostic test?

A

Diagnostic

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22
Q

What follow up testing should be offered for a positive NIPT?

A

CVS or amniocentesis

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23
Q

Why can the AFP only be done at a certain time?

A

This is a protein made by the fetal liver and is not produced until the second trimester

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24
Q

What diagnostic tests can be done during pregnancy?

A

CVS: between 10-14 weeks. Used for karyotyping. Does not detect NTD.
Amniocentesis: between 16-18 weeks. Used for karyotyping, aneuploidies and NTD

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25
Q

What is the preferred type of carrier screenign?

A

“Panethnic screening”

ALL PREGNANT PEOPLE ARE OFFERED CARRIER TESTING FOR CYSTIC FIBROSIS, HEMOGLOBINOPATHIES, AND SPINAL MUSCULAR ATROPHY IF THESE TESTS HAVE NOT BEEN PERFORMED PREVIOUSLY*

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26
Q

How should the NP respond when a patient has a positive genetic disorder test?

A

Refer to genetic gounselor, MFM, neonatologist.

Offer additional testing

Discuss pregnancy termination vs continuation

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27
Q

What BhCG and U/S results increase concern for an ectopic pregnancy?

A

BhCD less than 6500

TVUS: no intrauterine sac

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28
Q

What is the most accurate method for dating a pregnancy?

A

A first trimester ultrasound

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29
Q

At least one ultrasound is recommended for all pregnant people at what point in pregnancy?

A

In the first or early second trimester

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30
Q
A
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31
Q

What U/S measurement is used to determine GA in the first trimester?

A

CRL

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32
Q

What U/S measurement is used to determine GA in the second and third trimester?

A

BPD, HC, AC, FL

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33
Q

Explain presumptive signs of pregnancy

A

A person says: “I presume it might rain later today because I see some rain clouds here at my house.”

Weatherperson: “Ok…well, just because you see rain clouds, doesn’t mean it is 100% going to rain.”

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34
Q

Explain probable signs of pregnancy

A

Weatherperson says, “I’m looking here at my fancy weather doppler system and these patterns suggest that it will rain later today.”

Person: “OK…that is consistent with these rain clouds I’m seeing out my window.”

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35
Q

Explain positive signs of pregnancy

A

Weatherperson says (dressed in rain gear standing in a hurricane), “It is raining. It’s positively raining cats and dogs out here.”

Person: “OK. I see the weather person in the rain, and I’m looking out my window and it is raining. No doubt about it, it is raining!”

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36
Q

What is the only diameter of the pelvic inlet that can be clinical measured and what is the normal length?

A

Diagonal Conjugate

11.5cm or more

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37
Q

Which plane is the most difficult for the baby to traverse and why?

A

The midplane because it has the least dimensions

38
Q

If a patient received her rhoGAM at 28 weeks, when should she be given a repeat dose?

A

If she does not begin labor within 12 weeks

39
Q

Who should receive an early 1-h GTT?

A

per ACOG, any person with at least 1 risk factor

40
Q

What patients do NOT need to be screened for GBS in pregnancy?

A

-Those who were GBS + on their urine during pregnancy (sign of heavy colonization)
-Those with an infant + for GBS PP

41
Q

What vaccines can a pregnant person recieve?

A

Hep A/B, Flu (inactive), Meningococcal, pneumonia, TDAP

42
Q

How much iodine is necessary in pregnancy?

A

220 mcg daily

43
Q

How much Vit D is recommended in pregnancy?

A

600-4,000 IU daily

44
Q

How much iron is recommended in pregnancy?

A

27 mg/day

45
Q

What are the differential diagnoses and treatments and cause/timing of back pain in pregnancy?

A

Dx: Sciatica, PTL, pyelonephritis, kidney stone

Tx: Belly band, supportive bra, heat/ice, massage, chiropractor

Cause: 1st trimester=Upper back-increased breast size, 3rd trimester=low back from weight of uterus and relaxing ligaments

46
Q

What are the differential diagnoses and treatments and cause/timing of breast tenderness in pregnancy?

A

Dx: Fibrocystic breast changes, benign mass, breast CA, mastitis

Tx: Good bra, avoid caffeine

Cause: 1st trimester=increase in size

47
Q

What are the differential diagnoses and treatments and cause/timing of constipation in pregnancy?

A

Dx: GI disorder

Tx: Fluids and change diet. Increase fiber, stool softener/laxatives

Cause: Progesterone slows peristalsis, enlarging uterus pushes on GI tract.

48
Q

What are the differential diagnoses and treatments and cause/timing of dyspareunia in pregnancy?

A

Dx: Vaginitis, hemorrhoids

Tx: position changes, water-based lube, counseling, assess for abuse

Cause: Pelvic congestion

49
Q

What are the differential diagnoses and treatments and cause/timing of dyspnea in pregnancy?

A

Dx: panic attack, resp. infection, cardiac dx

Tx: Explain normalcy

Cause: Sensation of dyspnea without tachypnea due to increase in progesterone

50
Q

What are the differential diagnoses and treatments and cause/timing of edema in pregnancy?

A

Dx: DVT, phlebitis, pre-e

Tx: Regular exercise, avoid prolonged standing, elevate legs, compression socks

Cause: Impaired venous circulation and increased venous pressure. Most common in 3rd trimester

51
Q

What are the differential diagnoses and treatments and cause/timing of fatigue in pregnancy?

A

Dx: Anemia, depression

Tx: regular exercise, avoid caffeine at night

Cause: Increased energy requirements

52
Q

What are the differential diagnoses and treatments and cause/timing of flatulence and gas pain in pregnancy?

A

Dx: Dietary, IBS, GI disorder

Tx: Exercise, decrease caffeine, knee chest position

Cause: Decreased GI motility and intestine displacement

53
Q

What are the differential diagnoses and treatments and cause/timing of gingivitis in pregnancy?

A

Dx: Periodontal disease

Tx: Oral hygiene, dental care

Cause: Pregnancy changes in oral mucosa

54
Q

What are the differential diagnoses and treatments and cause/timing of heartburn (pyrosis) in pregnancy?

A

Dx: GERD, PUD, cholecystitis, pancreatitis

Tx: Small frequent meals, avoid laying after eating, Meds (Tums->Pepcid->Protonix)

Cause: Progesterone relaxes the lower esophagus

55
Q

What are the differential diagnoses and treatments and cause/timing of palpitations/tachycardia in pregnancy?

A

Dx: Anxiety, cardiac dx, thyroid dx

Tx: Hydration, decrease stress, decrease caffeine tobacco and alcohol. Reassurance of normalcy

Cause: Increase in blood volume

56
Q

What are the differential diagnoses and treatments and cause/timing of hemorrhoids in pregnancy?

A

Dx: thrombosed hemorrhoid, CA

Tx: Avoid constipation and straining. Meds (witch hazel, espom salt, topical cortisone/anesthetics)

Cause: Progesterone induced relaxation of the walls in the rectum, pelvic venous congestion.

57
Q

What are the differential diagnoses and treatments and cause/timing of insomnia in pregnancy?

A

Dx: Sleep disorder, anxiety, RLS

Tx: regular exercise, meds (benadryl, unisom, melatonin)

Cause: Discomforts of pregnancy, nocturia

58
Q

What are the differential diagnoses and treatments and cause/timing of leg cramps in pregnancy?

A

Dx: DVT, phlebitis, RLS

Tx: dosiflexion, magnesium supp.

Cause: etiology unknown: possibly changes in electrolyte levels

59
Q

What are the differential diagnoses and treatments and cause/timing of leukorrhea in pregnancy?

A

Dx: STI, BV, ROM, PTL

Tx: proper hygiene, reassurance of normalcy

Cause: 2nd-trimester normal secretions

60
Q

What are the differential diagnoses and treatments and cause/timing of nasal congestion in pregnancy?

A

Dx: URI, sinusitis, HTN, drug use

Tx: humidifier, nasal sprays

Cause: Hyperemia and increased blood flow due to estrogen

61
Q

What are the differential diagnoses and treatments and cause/timing of nausea and vomiting in pregnancy?

A

Dx: Hyperemesis, GERD, GI disorder, Viral GI infection

Tx: small frequent meals, ginger, acupressure, B6, antiemetics

Cause: Etiology unknown. Peaks in 1st trimester

62
Q

What are the differential diagnoses and treatments and cause/timing of ptyalism in pregnancy?

A

Dx: Hyperemesis

Tx: resolves spontaneously, hard candies

Cause: etiology unknown

63
Q

What are the differential diagnoses and treatments and cause/timing of round ligament pain in pregnancy?

A

Dx: PTL, appendicitis, constipation, gas pain

Tx: Belly band

Cause: lengthening of ligaments

64
Q

What are the differential diagnoses and treatments and cause/timing of sciatica in pregnancy?

A

Dx: cauda equina syndrome, herniated disc

Tx: Side lying on opposite side, heat, ice, belly band, APAP, Chiro/PT

Cause: Pressure on the sciatic nerve from joint laxity. Usually unilateral in third trimester

65
Q

What are the differential diagnoses and treatments and cause/timing of syncope in pregnancy?

A

Dx: Hypoglycemia, seizure dx

Tx: Lower head, elevate legs

Cause: Enlarged uterus impairs venous return.

66
Q

What are the differential diagnoses and treatments and cause/timing of tingling and numbness of fingers in pregnancy?

A

Dx: carpal tunnel

Tx: wrist splint

Cause: Kyphosis places pressure or traction on nerves

67
Q

What are the differential diagnoses and treatments and cause/timing of urinary frequency and nocturia in pregnancy?

A

Dx: UTI, pyelo

Tx: decrease fluid intake at night

Cause: Pressure from the enlarging uterus

68
Q

What are the differential diagnoses and treatments and cause/timing of varicosities in pregnancy?

A

Dx: DVT, venous dx

Tx: Rest and compression clothing

Cause: Venous distention. 2nd/3rd trimester

69
Q

What is the diagnostic criteria for hyperemesis gravidarum?

A
  1. persistent vomiting before 9 weeks GA
  2. dehydration and/or ketonuria
  3. weight loss greater than 5% of initial body weight
  4. electrolyte imbalance
70
Q

At what BhCG level should a gestational sac be seen on TVUS?

A

1500 mIU/mL hCG

71
Q

At what BhCG should you be able to see the gestational sac on transabdominal U/S?

A

6,000 mIU/mL

72
Q

Describe the classic presentation of an ectopic pregnancy.

A

a person who may or may not realize they are pregnant who is having no bleeding or slight irregular spotting
sudden sharp, stabbing, severe, lower abdominal pain
followed by hypotension and signs of shock
***Pain in neck or shoulder

73
Q

At what fetal size can offer a primary c/s for macrosomia?

A

more than 5000 g or 11 lbs in a woman WITHOUT diabetes or

more than 4500 g or 9.9lbs in a woman WITH diabetes

74
Q

What type of FGR is the highest risk?

A

Symmetric

FETAL GROWTH RESTRICTION WITH ABSENT OR REVERSED END-FLOW DOPPLER VELOCIMETRY INDICATES A FETUS AT GREAT RISK*

75
Q

If a patient presents with vaginal bleeding and you do not know the location of their placenta. What assessment should NOT be done?

A

Vaginal exam

76
Q

Which dermatoses of pregnancy are associated with serious adverse outcomes?

A

ICP and PG

77
Q

Describe classic atopic eruption of pregnancy.

A

Eczema of pregnancy onsets in 1st and 2nd trimester. Covers whole body including palms and soles. Treat with topical steroids.

78
Q

Describe classic intrahepatic cholestasis of pregnancy.

A

Onset last 2nd/3rd trimester. Intense itching on palms and soles without rash, and jaundice. Elevated bile acids. Treat with ursidiol and delivery at 37w.

Associated with mec, stillbirth, and ptb

79
Q

Describe classic pemphigoid gestationis.

A

Onset in 2nd and third trimester. Urticarial papules, plaques, bullae. On abdomen and body but spares face. Treat with systemic steroids, antihistamines and monitoring.

Associated with PTB, IUGR, neonatal lesions.

80
Q

Describe classic polymorphic eruption of pregnancy.

A

Onset in third trimester and postpartum. Urticarial papules/plaques on abdomen then body. Spares face, palms, soles, and umbilicus. Treat with topical steroids

81
Q

What is the most common skin disorder of pregnancy? What is it characterized by?

A

Atopic eruption of pregnancy

Intense itching

82
Q

Which dermatosis of pregnancy is characterized by intense itching without a rash?

A

ICP

83
Q

Which dermatoses of pregnancy is characterized by vesicobullous eruptions on the abdomen and spares the face?

A

Pemphigoid gestationis

84
Q

Which dermatoses of pregnancy is often found in the striae and spreads to the truck and extremities but spares the periumbilical area?

A

PEP/PUPPs

85
Q

What should you suspect in a pregnant patient with right lower quadrant pain?

A

Appendicitis

86
Q

What should you suspect in a pregnant patient with right upper quadrant pain?

A

Cholecystitis

87
Q

A patient presents with a microcytic anemia, what is your next step of assessment?

A

Serum ferritin

Low ferritin=IDA
Normal-draw hgb electrophoresis

88
Q

Which epilepsy medications are safe in pregnancy?

A

Lamictal and Keppra

88
Q

Is universal thyroid screening recommended in pregnancy?

A

No

88
Q

What is the upper limit of TSH in pregnancy?

A

4.0

88
Q

When is a UTI considered recurrent?

A

2 or more infections in 1 year

NM 717 Comps (31 decks)

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