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S3 1538 > S3 M2 Reproduction > Flashcards

S3 M2 Reproduction Flashcards

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1
Q

S/S of pregnancy

subjective

A 
Urinary frequency
N/V
Breast tenderness
Uterine/breast enlargement
Hyperpigmentation of skin
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2
Q

S/S of pregnancy objective

A 
Braxton hicks
Abdominal enlargement
Ballottement
Goodells sign
Chadwicks sign
Hegars sign
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3
Q

Braxton hicks

A

when the womb contracts and relaxes

objective sign of pregnancy

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4
Q

Chadwicks sign

A

Dark blue or purplish red congested appearance of vag mucose

First trimester
Softening of uterus at junction with cervix

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5
Q

Hegars sign

A

First trimester

Softening of uterus at junction with cervix

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6
Q

Goodwells sign

A

Softening and cyanosis of the cervix

At of after 4 weeks

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7
Q

Ladins sign

A

Softening of uterus after 6 weeks

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8
Q

Pregnancy adaptation

Ptyalism

A

overproduction of saliva

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9
Q

GI pregnancy adaptations

A 
Ptyalism
Gingivitis
Decreased peristalsis
Hemorrhoids 
Heartburn
N/V
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10
Q

Cardiovascular pregnancy adaptation

A

50% more blood

^ cardiac output

v blood pressure at first, increase later

^ RBC x2^ plasma causing hemodilution (anemia)

^ in demands for iron, fibrin, and clotting factors leading to hypercoagulable state

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11
Q

Resp pregnancy adaptations

A

Breathing more diaphragmatic

^ in O2 consumption

Congestion secondary to increased vascularity

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12
Q

Renal/urinary pregnancy adaptations

A

Dilation of pelvis and ureters

^ length/weight of kidneys

^ Glomerulofiltration rate (pee more)

^ kidney activity when lying down

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13
Q

Musculoskeletal pregnancy adaptations

A

Softening of sacroiliac ligaments

^swayback and upper spine extension

Lordosis

Waddle gait

Center of gravity shifts forward

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14
Q

Integument pregnancy adaptation

A

Hyperpigmentation

Linea nigra

Varicosities

Decline in hair growth

Increase in nail growth

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15
Q

Thyroid pregnancy adaptation

A

^BMR

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16
Q

Pituitary pregnancy adaptation

A

v TSH GH

inhibition of FSH and LH

^ Prolactin MSH oxytocin

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17
Q

Pancreas pregnancy adaptation

A

Insulin resistance in second half of pregnancy

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18
Q

Adrenal pregnancy adaptation

A

^ Cortisol and aldosterone

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19
Q

What does the placenta secrete

A 
hCG
hPL - insulin inhibitor
relaxin
estrogen
progesterone
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20
Q

Pregnancy insulin and glucose

A

early pregnancy
^ in glucose demand due to baby growth
Fetus must make its own insulin

mid pregnancy
^ in insulin production to work against hPL and extra cortisol which desensitize insulin to give more sugar to baby

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21
Q

Nutrition pregnancy

A

intake IDRECTLY = wellbeing/outcome of birth

Need vitamins and minerals

Avoid mercury fish
Increase protein, iron, folate, and calories
MyPlate

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22
Q

Nutritional sugestion

A 
1/2 plate, fruit and veg
Whole grain
^ Fiber
NO Hydrogenated fats
2 quarts of water daily
2 servings of fish weekly, 1 of them fatty
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23
Q

Bad food during pregnancy

A

NO Artificial sweeteners

NO Mercury fish (king, mackerel, ahi tuna, shark/sword fish) smoked seafood

NO processed meats (lunch meat, hotdogs, spreads)

NO soft cheeses (feta, brie, camembert)

NO unpasteurized milk

NO store made salads

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24
Q

Good fish for pregnancy

A

shrimp
salmon
pollock
catfish

up to 12 ounces

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25
When is the embryo at greatest risk
17 to 56 days after conception
26
First prenatal visit points
Establish trust Educate wellness Detection/prevention of problems Comprehensive history/examination/labs
27
Pregnancy history
suspicion of pregnancy date of last period s/s urine or blood test for hCG past history
28
what do you test urine and blood for for pregnancy
hCG
29
Gravida I II
Pregnant woman first pregnancy second pregnancy etc
30
Para
woman who produced VIABLE/OR NOT offspring carrying 20 weeks or more
31
Primipara (Primip) Multipara (Multip) Nullipara (Nullip)
One birth after 20 week prego 2 or more pregnancies with viable offspring post 20 weeks No viable offspring
31
Primipara Multipara Nullipara
One birth after 20 week prego 2 or more pregnancies with viable offspring No viable offspring
32
GTPAL
``` Gravida Term births Preterm births Abortions Living children ```
33
Term birth
birth with 37 weeks gestation
34
preterm
birth with 20 to 37 weeks gestation
35
abortion
nonviable birth | less than 20 weeks gestation
36
OB history
GTPAL
37
So Primigravida means
first pregnancy
38
Menstrual history
``` Age at menarche Days in cycle Flow characteristics Discomforts Use of contraception ```
39
NAGELEs RULE Calculate expected date of birth
Last menstrual period LMP date LMP - 3 months + 7 days + 1 year BEST method is ultrasound
40
Weight gain during pregnancy
BMI less than 18 - 28-40lb BMI more than 25 - 12-25lb Normal BMI 18 to 25 - 25-35lb
41
First Prenatal visit focus not sensitized
Rh - if negative, repeat at 28 weeks if still negative give Rh immune Globulin (RhoGAm) to prevent sensitization
42
First Prenatal visit sensitized
``` Monitor closely blood work check ABX doppler ultrasound to fetal brain aminocentesis at 15 weeks to check fetal blood type Mother will see preinatologist ``` Rhogam will NOT work if woman is already sensitized Good for 12 weeks
43
If mother is Rh sensitized Rhogam will
NOT work
44
Amniocentesis
blood type check at 15 weeks
45
If Rh is sensitized, mother will need to see a
perinatologist
46
Coombs test
determines weather mother has developed isoimmunity to the Rh antigen detects antibodies harmful to fetus
47
If Coombs test is negative the woman is a candidate for
RhoGAM
48
Current standard of giving RhoGAM
between 28 and 32 weeks | again 72 hours after birth
49
Which Rh destroys Which
Rh negative blood will attack Rh positive blood this is called Sensitization
50
Why is Rh a problem during second pregnancy
Mother and baby blood does not mix until birth, so first baby is good. Once it mixes, mother develops antibodies, bad for second baby
51
Rh Sensitization can cause what in baby
Anemia Jaundice Hemolytic anemia (erythrocytosis fetalis)
52
Visits for pregnancy
Q4 weeks up to 28 weeks Q2 weeks 29 to 36 weeks Every week after 37 weeks to birth
53
What is measured during pregnancy follow ups
``` Wight and BP Urine for protein, glucose, ketones, nitrites Fundal height Quickening/fetal movement Fetal HR ``` Teach danger signs
54
Measure fundal height
Top of uterus to pubic bone
55
When does fetal movement begin
Second trimester
56
First perception of fetal movement Range of movement determins
"Quickening" Gentle fluttering Pregnancy outcome Good movement = good outcome
57
Fetal heart rate
Women lies down Use doppler on abdomen Normal range for fetus 110 to 160 bpm
58
1st trimester | includes
0-13 weeks History Lab First visit
59
2nd Trimester includes
``` 14-27 weeks visit every 4 weeks V/S Wt BP gluc, prot FH FHT ```
60
3rd trimester includes
``` 28-40 weeks Visit every 2 weeks till 36 week then Q1 week V/S Wt BP Gluc Prot FH FHT ```
61
1st trimester lower abdominal pain with dizziness and shoulder pain spotting and bleeding severe vomiting
ruptured ectopic pregnancy miscarriage hyperemesis gravidarum
62
2nd trimester pain in calf with felxion 2nd trimester absence of fetal movement for 12h regular contractions sudden gush or leakage
DVT fetal distress or demise preterm labor premature rupture
63
3rd trimester edema abdominal pain visual changes and headache 3rd trimester 24h without fetal movement What else
Gestational hypertension or preeclampsia possible demise Literally everything from first 2 trimesters
64
Congenital malformation checks happen at
18-20 weeks
65
Nuchal translucency ? is done at
test for downs 11-14 weeks
66
Alpha fetoprotein ? is done at
Down 16-18 weeks
67
Aminocentesis Chorionic Villus
Genetic testing for abnormalities in fetus MOST ACURATE Less accurate
68
Anemia in fetus
Mild more common than normal pregnancy moderate - may need transfusion or early delivery severe - hemolytic anemia, WILL need transfusion and early delivery
69
Hemolytic anemia | Erythrocytosis fetalis
RBC destroyed faster than produced No RBC to Oxygen Breakdown = ^bilirubin = jaundice/brain damage No Oxygen = ^HR = HF Hydrops fetalis
70
Labor contractions
4-6 min apart lasting 30-60 sec Stronger over time feeling of vaginal pressure Contractions start in back and radiate to front of abdomen NO alleviation with positional change STAY HOME UNTIL contractions are 5min apart lasting 45-60 sec and conversation is not possible
71
Primary power of labor
Uterine contractions which are | involuntary
72
Normal rate of contractions Tachysystole or hyperstimulation
5 or less in 10 min More than 5 contractions in 10 min
73
Effacement
Thinning of the cervix
74
Cervical ripening agents
Dinoprostone - vaginal insert Prepidil gel - must be at room temp Misoprostol - orab or vag tab
75
Cervical ripening
softening and opening the cervix before labor starts
76
Assessment of contractions includes
Frequency Duration Intensity Uterine resting tone
77
Intensity of contractions is measured in
MVUs
78
What class of drugs is given for analgesia to women in labor
Opioids Antiemetics Benzodiazepines narcan if OD
79
Early/Latent phase
``` Cervical dilation to 3cm Cervical effacement to 40% Contractions q5-10min Contractions last 30-45 sec Contraction intensity mild ```
80
Nullipara Multipara
A woman who has never given birth A woman who has given birth before
81
Phases of 1st stage of labor
Latent/early Active Transition
82
Active phase
``` 4-7cm dilation 40%-80% effacement Contractions q2-5min Contraction duration 45-60sec Contraction intensity Moderate ```
83
Transitional phase
``` 8-10cm dilation 80%-100% effacement Contractions q1-2min Contraction duration 60-90sec Strong intensity ```
84
Pitocin(oxytocin)
used to initiate or improve contractions used in 3rd stage to CONTROL BLEEDING given via DRIP MONITOR uterine activity and FHT fetal heart tone
85
Pitocin(oxytocin) dosing
10 units to 1000ml NS start at 0.5-1 MU/min increased to 1-2 MU/min until desired contraction pattern
86
FHT
Fetal heart tone
87
Document V/S, contractions and fetal well being q_min when giving pitocin(oxytocin)
15
88
Fetal Heart Rate Tachycardia Bradycardia
110-160bmp greater than 160 less than 110
89
Treatment for variable in FHR baseline
FIRST change mothers position give O2 to mother give IV fluids Slow or stop pitocin Slow or stop pushing
90
Prolapse cord
If prolapse cord, push head off cord and DO NOT remove your hand this is an EMERGENCY requiring IMMEDIATE c-section
91
VEAL CHOP FHR Decelerations
Variable deceleration - Cord compression Early deceleration - Head compression Acceleration - Okay Late deceleration - Placental insufficiency
92
Early deceleration
Head compression Deceleration and contraction mirror one another lowest point at peak of contraction 40bpm decrease No intervention required
93
Variable deceleration
Cord compression Abrupt unpredictable decrease usually good outcome
94
Late decel
Placentae insufficiency occurs AFTER peak of contraction fetal hypoxia, asphyxia, acidosis, cns depression Always abnormal EMERGENCY
95
Conditions that can lead to late decel, placental insufficiency
maternal hypotension gestational hypertension placental aging due to diabetes hyperstimulation via oxytocin
96
Late decel placental insufficiency treatment AND Prolonged decel treatment
Stop oxytocin Turn client on side and do knee to chest - increases placental perfusion Admin O2 ^IV rate Assess Notify MD
97
Prolonged decel
abrupt FHR decline of at least 15bpm that lasts between 2 and 10 min USUALLY rate drops to less than 90bpm
98
If late or prolonged decel is unresolved
immediate c-section
99
Second stage of labor
Dilation to birth Contractions ever 2-3 min contraction duration 60-90 sec
100
Phases of the second stage of labor
``` Pelvic phase (fetal descent) Perineal phase (active pushing) ```
101
Third stage of labor
Delivery of placenta Gush of blood Cord lengthening Globular and firm uterus Uterus rises anteriorly Massage uterus until firm to promote constriction of blood vessels
102
Blood loss during birth
vaginal 500ml cesarean 1000ml blood loss over 1000ml SEVERE
103
Nursing management of hyperstimulation
``` STOP pitocin admin O2 Lateral position Flush IV Notify MD ```
104
Forth stage of labor
Post partum time Attachment with baby fundal massage Focus is to prevent hemorrhage, urinary distention and venous thrombosis Monitor mom every 15min
105
Placental function
Nutrition to fetus Pregnancy hormones Immune protection Gas exchange for baby Removes waste
106
Does placenta and mother blood mix
NO all process is done by diffusion
107
Shultz Duncan Amniotic sac
Fetal side Maternal side sac
108
Episiostomy cut made at the opening of the vagina during childbirth healing REEDA
``` Redness Edema Ecchymosis (bruising) Discharge Approximation (closing) ```
109
Post partum check | BUBBLE-HE
``` Breasts Uterus Bladder Bowel Lochia Episiotomy (perineum) Homans' sign Emotions (psych) ```
110
Uterus descend after birth
1cm per a day for 10 days everything falls back into true pelvis
111
Lochia
Rubra Serosa Alba
112
Lochia rubra
1st stage Deep red mucus and debris first 3 day
113
Lochia serosa
2nd stage pinkish brown 3 to 10 days
114
Lochia alba
Creamy white or light brown 10 days to 6 weeks
115
Normal pregnancy length
38-42 weeks
116
Biophysiological risk factors for baby examples
Genetics | Pre-existing conditions
117
Psychosocial risk factors for baby Examples
Poor fam support, abuse, mental health issues
118
Sociodemographic risk factors for baby
Single parent, education, age
119
Environmental risk factors for baby
lead exposure, viruses
120
Lab diagnostics for preeclampsia H EL LP
H Hemolysis EL Elevated liver enzymes LP Low platelet count
121
Vaccines for mothers TORCH
``` T-toxoplasmosis O-other; hep, hiv varicella R-rubella C-cytomegalovirus H-herpes ```
122
antithyroid drugs in mom can lead to hypothyroidism in mom can lead to
fetal demise fetal demise or cretinism
123
Labor and delivery is also called
intrapartum
124
False labor
``` IRREGULAR contractions NO change in intensity Discomfort in abdomen NOT back to front Walking helps Cervix unchanged Rest helps ```
125
In L/D lie means
long axis of fetus to long axis of mother
126
In L/D presentation means
Part of fetus to first enter pelvis
127
In L/D attitude means
Relationship of fetal head to fetal spine
128
in L/D station means
fetal head to maternal ischial spine +5 to -5 + means BELOW - means ABOVE 0 means level
129
in L/D Effacement means
Shortening/thinning of the cervix
130
in L/D Dilation means
Opening of cervix in centimeters
131
Multigravida Multipara
Woman who has multiple pregnancies Woman who has carried past 20 weeks
132
in L/D lightening means
Occurs at 38 week fetus has settles into pelvis "Dropped" eases breathing pressures bladder
133
in L/D bloody show means
passing of protective blood stained mucus before birth
134
Vaginal exam is done at is not done at
Admission, client in labor with no contractions NOT DONE if active bleeding
135
Postpartum time
first 6-8 weeks Mothers body returns to normal Immediate period during hospital stay within 2-3 days Assessment Comfort Potential complications
136
Interventions for breast pain postpartum
Warm compress if lactating | Cold compress if not
137
Interventions for back pain post partum
Pelvic tilt, change positions
138
Interventions for perineum pain post partum
Ice x24h then sitz bath, stool softeners sprays tucks
139
Interventions for leg pain post partum
Assess NO massage Walk if no indication of DVT
140
Interventions for bladder pain post partum
^fluid help void straight cath antibiotics
141
Position for uterine infection
Semi fowler to help drain
142
Ductus venosus
a shunt that allows oxygenated blood in the umbilical vein to bypass the liver and is essential for normal fetal circulation
143
Foramen ovale
a small opening between the two upper chambers of the heart, the right and the left atrium
144
Ductus arteriosus
Helps bypass lungs in fetus as O2 is gotten from placenta
145
Assessment of new born
Weight Head and chest Gestational aging
146
SGA | LGA
Small for gestational age | Large for gestational age
147
Late premature
Bork between 34 and 36 weeks
148
Antepartum
1st week till birth starts which is called intrapartum
149
Amenorrhea
Absence of menstruation
150
Ballottement
Objective sign of pregnancy | pressure on one side of belly, baby moves to the other
151
Positive signs of pregnancy
Ultrasound Fetal movement felt by provider Fetal heart beat
152
What is done at first visit
``` Rubella VDRL/RPR Blood type and Rh CBC UA Hep B HIV TB V/S Weight Height of fundus FHT's Blood glucose Pap GC ```
153
how long is RhoGAM good for
12 weeks
154
If you are Rh negative then you MUST get
RhoGAM
155
Tests for fetal well being
156
18-20 and 11-14 week Doppler flow Alpha fetoprotein Triple/quad screenings for malformities tests are
NOT DIFINITIVE | If dates are off of twins = false positive
157
Male pelvic shape | Female pelvic shape
Android | Gynecoid
158
Leopold Maneuver
Hands at top of fundus looking for butt, we WANT hand to be down Bring hands down the middle to look for hard surface, that's the back. THIS IS WHERE WE MEASURE FETAL HEART BEAT the soft surface is the chest arms and legs aka place to move Feel lower to find the head, it will be HARD
159
LOA vs ROP
how the baby lies in relation to mama Left Occipital Anterior Babys back is on mothers left leaning to the back Right Occipital Posterior Babys back in on mother right leaning to the front
160
You wan the baby to face the _ before birth
Anterior Mothers spine
161
STOP pitocin if
Contractions are 90 seconds or less than 2 min apart More than 5 contractions in 10 min GIVE O2 Place mother in lateral position
162
Goal of cervical ripening agents
To help achieve effacement
163
Sings of 3rd stage that you NEED TO KNOW
Gush of blood Cord lengthening Globular and firm uterus Uterus rises anteriorly
164
Where should the fundus be at about 12 weeks of pregnancy
at the symphyses pubis
165
Fundus at 20 weeks of pregnancy
At about the belly button
166
Fundus location at 36 weeks
Xiphoid process
167
fundal location at 37 to 40 weeks
Goes DOWN from xiphoid by 4 cm | getting ready to pop
168
Treatment for variable deceleration
Change moms position Cervical exam for CORD Give O2 and IV fluids Slow contraction/Stop pitocin Push every OTHER contraction

S3 1538 (15 decks)

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