The Obstetric Patient 1

Question 1

What are early signs of pregnancy?

Answer 1

Extreme fatigue
Mood swings
Bloating
Unusual spotting or light period
Subtle motion sickness
Frequent mild HAs
Sore breasts and nipple darkening
Cramps
Heightened sense of smell

Question 2

What does para mean?

Answer 2

number of births, regardless of the number of infants born

Question 3

What does gravida mean?

Answer 3

number of pregnancies; a woman who has been pregnant, regardless of pregnancy outcome

Question 4

What ways can you document pregancy/births?

Answer 4

G#P#

4 numbers: #fullterm infants, #preterm infants, #abortions, #children currently alive

Question 5

What is nullipara?

Answer 5

A woman who has not completed a pregnancy beyond 20 weeks of gestation. She may or may not have been pregnant or have had an abortion or spontaneous miscarriage.

Question 6

What is primipara?

Answer 6

A woman who has had one delivery beyond 20 weeks of gestation.

Question 7

What is multipara?

Answer 7

A woman who has delivered two or more pregnancies beyond 20 weeks of gestation; regardless of whether the fetuses were born live or still born (not the number of fetuses delivered).

Question 8

What is multigravida?

Answer 8

A woman who has had more than one pregnancy, regardless of outcome. The # represents the # of pregnancies.

Question 9

What is gestation?

Answer 9

Duration of pregnancy, usually 280 days, or 40 weeks, marked from the first day of the last menstrual period

Question 10

What is a trimester?

Answer 10

Division of weeks of pregnancy
First trimester=1 to 13
Second=14 to 27
Third 28-40

Question 11

What is preeclampsia?

Answer 11

Sudden increase in BP, usually signals kidney damage-cause is unknown, although may be pressure in placental blood vessels-emergency, signals immediately delivery

Question 12

What are the sx of preeclampsia?

Answer 12

HA, blurred vision

Question 13

What are the sx of pregnancy-induced HTN?

Answer 13

HA, blurred vision

Question 14

What is ectopic pregnancy?

Answer 14

Egg is implanted in the fallopian tube instead of uterus

Question 15

What are some sx of ectopic pregnancy?

Answer 15

Sever lower abdominal pain, dizziness or lightheadedness, nausea

Question 16

What is placental abruption?

Answer 16

Placenta peels away from the uterus, may deprive fetus of oxygen, may require early delivery

Question 17

What are sx of placental abruption?

Answer 17

Severe lower abdominal pain, vaginal bleeding

Question 18

What are sx of fetal distress or demise?

Answer 18

Decreased fetal movement

Question 19

What are the sx of osteoporosis of pregnancy?

Answer 19

Pain in the hip/low back, pain with weightbearing

Question 20

What is placenta previa?

Answer 20

placenta covering cervix; may resolve itself, or may require early delivery

Question 21

What are the sx of placenta previa?

Answer 21

vaginal bleeding

Question 22

What are some sx of retained placenta?

Answer 22

Increased post-partum bleeding

Question 23

What are the sx of mastitis?

Answer 23

Localized breast tenderness

Question 24

What are the sx of cystitis?

Answer 24

Pain or burning, frequency or urgency of urine, suprapubic pain

Question 25

What are the sx of acute pyelonephritis?

Answer 25

Flank pain, fever, chills, malaise, may have frequency or urgency

Question 26

What are the sx of deep venous thrombosis?

Answer 26

Localized calf, popliteal, or anterior thigh or groin pain; calf or lower extremity swelling; pitting edema

Question 27

What pregnancy conditions require immediate referral?

Answer 27

``` Pre-eclampsia (can lead to seizure activity) Pregnancy induced HTN (urgent) Ectopic pregnancy Placental Abruption Placental previa Retained placenta Cystitis (urgent) Pyelonephritis (urgent) DVT (urgent/emergent) ```

Question 28

What vascular changes occur in pregnancy?

Answer 28

Decreased tone/vasodilation-SVR decreased 20% Positional effects Placenta-low resistance shunt

Question 29

What hematologic changes occur in pregnancy?

Answer 29

Blood volume increases 50-100% RBC increases 25-40% (causes relative "physiologic" anemia) Become hypercoagulable-increased risk for thromboemolic disease Decrease in platelets Increase in WBC

Question 30

What cardiac changes occur in pregnancy?

Answer 30

Cardiac axis is displaced cephalad and left, point of maximum impulse lateral and elevated, left axis deviation Murmurs, virtually all valves Increased rate Ventricular distention-25% increase Rhythm changes-nonspecific ST and T changes, increase in dysrhythmias (physiologic hypokalemia) LVH and pericardial effusion Increased and markedly fluctuating output

Question 31

What is the placenta? What type of nutrients does it receive?

Answer 31

A veritable hormone factory Receives 20-25% of cardiac output Uses as much O2 as fetus

Question 32

What are the s/s of normal pregnancy that may mimic cardiac disease?

Answer 32

``` Peripheral Edema JVD (venous distention) Reduced exercise tolerance Dyspnea Changes with auscultation Change in heart position and size Increased vascular markings Nonspecific ST-T wave changes Axis deviations LVH ```

Question 33

What kidney changes occur with pregnancy?

Answer 33

Renin increased-stimulation by progesterone and made by the placenta--> leads to net absorption of Na+, excretion of K+, and water retention of 6 to 8 L Increased renal blood flow-50-75% increase GFR-50% increase Decreased albumin=lower oncoid oncotic pressure

Question 34

What is the cycle from angiotensinogen to the distal tubule?

Answer 34

Angiotensinogen-Angiotensin 1-Angiotensin 2-Aldosterone-Distal tubule

Question 35

What urinary tract changes occur with pregnancy?

Answer 35

Ureteral dilation/hydroureter-smooth muscle relaxation, later exacerbation by uterine obstruction, urinary stasis Dilation of pelves and calyces Increased kidney size

Question 36

What respiratory adaptations occur with pregnancy?

Answer 36

``` No change in rate or IRV Increased minute ventilation Reduced FRC-20% Increased tidal volume-30 to 40% Compensatory respiratory alkalosis-pH 7.4+, increased oxygen partial pressure, decreased carbon dioxide partial pressure ```

Question 37

What gastrointestinal adaptations occur with pregnancy?

Answer 37

Slowed GI motility-constipation, early satiety Relaxation of LES-GERD N/V-often proportional to HCG levels Liver/gallbladder-biliary stasis and cholesterol saturation (more stones), coagulation factors, increased binding proteins (thyroid, steroid, vitamin D)

Question 38

What other adaptations occur with pregnancy?

Answer 38

Altered center of gravity Altered gait Greater joint laxity-widening of pubic symphysis, affects other joints, thorax-widened costovertebral angle Fatigue/solemnolence

Question 39

What integumentary changes occur with pregnancy?

Answer 39

``` Spider angioma and palmar erythema Hair growth (abdomen and face) Mucosal hyperemia Striae gravidarum Hyperpigmentation (esp. linea nigra)-rashes and acne are relatively common ```