Module 5 Flashcards
1
Q
GI motility ________ during pregnancy
A
decreases
2
Q
GI motility decreases during pregnancy due to high levels of __________ (hormone) in the system
A
progesterone
3
Q
diaphoresis, pallor, SOB are all symptoms of _______________ in pregnancy
A
vena cava compression
4
Q
\_\_\_\_\_\_\_\_\_\_\_\_\_ in pregnancy results in these symptoms: reflux/heartburn bloated feeling delayed emptying nausea constipation flatulence hemorrhoids
A
decreased GI motility
5
Q
leg cramps are best relieved by:
A
dorsiflexion of the foot and stretching calf muscle
6
Q
round ligament pain usually starts in the _________ trimester
A
late 1st/early 2nd
7
Q
What causes normal heart palpitations in pregnancy?
A
increased blood volume
8
Q
RBC mass _________ in pregnancy
A
increases
9
Q
WBC count will _________ in pregnancy
A
increase
10
Q
Hct will ___________ in pregnancy
A
decreases
11
Q
Hgb will ___________ in pregnancy
A
decreases
12
Q
plasma volume will ___________ in pregnancy
A
increases
13
Q
serum ferritin will ____________ in pregnancy
A
decreases
14
Q
HR _________ by about 10-20 bpm by week 32 of pregnancy
A
increases
15
Q
BP __________ and reaches nadir at mid-pregnancy
A
decreases
16
Q
cardiac output ___________ 30-50% with most of this happening by 8 weeks gestation
A
increases
17
Q
a __________ murmur is usually heard during the 2nd and 3rd trimesters
A
systolic
18
Q
mild dilation of kidney in pregnancy (hydronephrosis) is considered ___________ in pregnancy
A
normal
19
Q
Due to the effects or progesterone, maternal vascular resistance ______________
A
decreases
20
Q
a decrease in maternal vascular resistance, results in blood vessels ___________ and _____________
A
widening and relaxing
21
Q
rapid increase in blood volume in pregnancy results in a ___________ venous return from the lower extremities, which can cause vasovagal episodes/fainting
A
slower
22
Q
symptom related to increased blood volume and heart rate in pregnancy, hormones, increased sympathetic nervous system activity
A
heart palpitations/arrythmias
23
Q
heart palpitations/arrythmias are most common during ______ weeks when hypervolemia peaks and stroke volume is highest.
A
28-32
24
Q
symptoms of \_\_\_\_\_\_\_\_\_\_\_\_: “fluttering” skipping a beat then “catching up” “pressure” in neck beating “fast”
A
heart palpitations/arrythmias
25
danger signs associated with heart palpitations/arrythmias
SOB, dizziness, or a history of heart problems
26
treatment of heart palpitations/arrythmias
explain normalcy, reassurance
27
Split first sound due to earlier valve closure and increased blood flow starts between ___-___ weeks
12-20
28
decrease in ____ is caused by lag in compensatory changes for decreased SVR, vasodilation, and hormonal factors
BP
29
this is caused by increased venous return and increased right ventricular output
increase in cardiac output
30
increases by about 25% when turned onto left side
Cardiac output
31
compression of ____________ results in decreased venous return, decreased stroke volume, and decreased cardiac output.
vena cava
32
```
Relief measures for ____________:
Elevation of the legs
lyingon the left side with feet elevated on a pillow
avoid standing for prolonged periods
avoid crossing legs when sitting down
walk or exercise daily
weight management
keep legs elevated while lying down
avoid tight knee-high socks or stockings
wearcompression hoses with pressure gradient
```
Varicosities
33
```
Relief measures for _____________:
well-ventilated environment
no prolonged standing
arise from bed slowly
walk in place while standing
adequate hydration
compression hoses
avoid overheating
```
dizziness/syncope
34
lung volume __________ in pregnancy which improves alveolar gas exchange
increases
35
reserve lung volume __________ in pregnancy
decreases
36
Minute ventilation _________ in pregnancy and changes start by 8 weeks gestation
increases
37
Pregnant women hyperventilate in pregnancy due to effects of ___________ on respiratory center
progesterone
38
Pregnant women are normally in a state of compensated respiratory ___________ due to effects of progesterone and increased minute volume
alkalosis
39
PCO2 is _______than pre-pregnancy (starts in first trimester)
lower
40
_________ affiliation of oxygen for hemoglobin causes more oxygen to be available for the fetus
Decreased
41
The respiratory effects on acid-base balance in pregnancy are stimulated by the _________ in maternal pH
increase
42
Caused by increased progesterone which increases sensitivity to CO2 and leads to hyperventilation in an attempt to maintain normal PO2 levels; increased respiratory drive and load, mechanical changes
Shortness of Breath
43
Treatment for SOB
Explain normalcy
Reassurance;
Educate on positions to expand lung capacity (sleep sitting up, raising arms, etc.)
44
dangers signs associated with SOB in pregnancy
tachypnea with respiratory rates > 20, coughing, chest pain, fever/chills, dizziness
45
caused by increased capillary permeability, fall in colloid osmotic pressure, increased femoral venous pressure
edema
46
edema effects ___% of pregnant women
75
47
Treament for ______:
Ted hose (reduce venous pooling and increase SVR)
**don’t reduce fluid intake**
water immersion for 20 minutes chest-deep
exercise (walking)
elevate legs
Edema
48
danger signs associated with edema
when accompanied by other signs and symptoms of preeclampsia in later pregnancy.
49
Changes which causes increase in ____________:
Major change is dilation of renal pelvis and ureters
Kidneys become hypertrophic
Ureters enlarge and can become compressed which leads to hydronephrosis
Bladder tone decreases
urinary frequency
50
Renal System Functional Changes that lead to increase in ______________:
hemodynamics changes
glomerular filtration changes
tubal handling changes of some substances
urinary frequency
51
Urodynamic Changes that lead to increase in _____________:
Urine output increases
Flow time and time to maximal flow increases
urinary frequency
52
GI changes in pregnancy result in part from effects of ________ hormone on the liver
estrogen
53
Changes of the __________:
Decrease in lower sphincter tone and non-propulsive motor activity
Change in the esophageal-gastric angle as the diaphragm flattens
esophagus
54
```
Changes in the _____________:
Decreased motility, hypotonic
Tendency toward less gastric acidity
Duodenal villi enlarge
Increased transit time in colon:
Constipation
Hemorrhoids
```
Stomach/Intestines
55
Changes in the ____________:
Muscle tone and motility decrease
Gallstones
Pruritus
Gallbladder
56
Changes in the _________:
Moves up and out toward both the front and back
Function is essentially unchanged
Liver
57
onset of N/V in pregnancy
5-6 weeks
58
peak of N/V in pregnancy
9-11 weeks
59
___-___% of women have N/V into 3rd trimester
15-20
60
____% of women have N/V until delivery
5
61
```
outcomes associated with _________:
Fewer birth defects
Larger placenta
Decreased miscarriage rate
Decreased preterm birth
Less low birth weight
Less stillbirth
```
N/V in pregnancy
62
The higher the score of this test, the higher the likelihood of ER visits, hospitalizations, and the lower the quality of life.
Pregnancy Unique Quantification of Emesis (PUQE)
63
```
Objective Data for ________:
Urine Ketones
Skin Tone
Mucosa
Weight
Labs (rarely)
```
N/V in pregnancy
64
```
Differential Diagnoses for ___________:
Hyperemesis
Multiple gestation
Molar Pregnancy
HELLP
Pre-eclampsia
```
N/V in pregnancy
65
```
Medical Diagnoses for ____________:
Bulimia
Anorexia
Pyelonephritis
Gallbladder Disease
Hepatitis
Appendicitis
Hyperthyroidism
Migraine
Tumor
```
N/V in pregnancy
66
Incidence of Hyperemesis in pregnancy: ___-___%
0.3-2%
67
```
Criteria for Dx of ____________:
Persistent N&V prior to 22 weeks gestation
Weight loss over 5% of body weight
Electrolyte imbalance
Dehydration and/or persistent ketonuria
```
Hyperemesis Gravidium
68
```
Adverse Effects of ________:
heartburn
belching
reflux
arrhythmia
headache
affects platelet aggregation
```
Ginger
69
Safety Considerations for ___________:
Don’t combine with Dramamine (interaction unknown)
Don’t take with hypoglycemic drugs or insulin (could potentiate effects)
Don’t take with other meds that impair clotting (Garlic, Ginsing, Ginkgo biloba)
Use with caution in patients on anti-arrhythmic drugs or CNS depressants
Increases gastric acid, so don’t take with H2 blockers or proton pump inhibitors
May interact with other medications
Use with caution in patients taking Heparin, Coumadin, Aspirin
Ginger
70
Standard dose of Ginger for N/V in pregnancy
1 gm/day
71
Standard dose of B6 for N/V in pregnancy
up to 100 mg daily (25 mg TID or 50 mg BID)
72
effective for N/V, use with caution in certain populations, available in many forms
ginger
73
better than placebo, about same effectiveness as ginger, works best for nausea, not for vomiting
B6
74
most studied N/V relief, effective, safe, can cause drowsiness, FDA approved for prescription form
B6 + Unisom (doxylamine)
75
ligament laxity in pregnancy is caused by ___________ (hormone)
estrogen
76
lower back pain in pregnancy is caused by __________ joint mobility
increased
77
treatment for _____________:
350 mg. magnesium before bed (weak evidence)
adequate calcium in diet (not supplementation)
stretching before bed (placebo?)
leg cramps
78
```
treatment for __________:
listen
change sleep habits
reassurance
consultation for medication
```
restless leg syndrome
79
etiology of carpal tunnel syndrome in pregnancy
increased fluid volume compressing median nerve
80
symptoms of ____________:
numbness/tingling in thumb/index finger/middle fingers
wrist pain
loss of grip strength/dexterity
carpal tunnel syndrome
81
lower back pain in pregnancy is contributed to ___________________ required to counterbalance the weight of the growing uterus
lumbar lordosis
82
pelvic girdle pain can often be misdiagnosed as:
sciatica
83
most headaches in pregnancy are __________ headaches
tension
84
most women with history of migraines, have __________ frequency and severity of headaches in pregnancy
decreased
85
```
treatment for ___________:
keep food diary for 24 hrs
exercise 30 min per day
acetominophen
massage
acupuncture
warm compress
relaxation exercises
increase rest
regular exercise
avoid environmental triggers
avoid food triggers
```
headaches
86
```
danger signs of ____________:
no relief w/ analgesia
new onset w/ neuro symptoms
sudden severe onset
increase in BP
proteinuria
papilledema (swelling of optic nerve)
```
headaches in pregnancy
87
cause of increased ____________ in pregnancy:
increased blood flow through the skin
vasodilation resulting from effects of progesterone
increased basal metabolic rate
warmth/perspiration
88
```
treatment for ____________:
wear light clothing
ensure adequate hydration
lower environmental temp
bathe/shower as often as needed
```
warmth/perspiration
89
cause of ______________ in pregnancy:
increased levels of estrogen and progesterone which enables the milk ducts and milk-producing cells to form in preparation for breastfeeding
increased blood flow in the breasts
extra layers of fat are added
existing cysts/galactoceles/fibroadenomas enlarge
breast tenderness
90
bleeding gums is caused by the hormone:
estrogen
91
low back pain in pregnancy is exacerbated by:
lax abdominal muscles
92
___________ accompanying heart palpitations requires an office visit
dizziness
93
dependent edema in pregnancy is associated with:
maternal obesity
94
typical b6+unisom dose
25 mg B6 QID + 1/2 tab unisom
