ATI - TEST 1 Flashcards
The human ovum can be fertilized —hrs after fertizilation?
Motile sperms ability to fertilize the ovum lasts an average of
24hrs
48-72hrs
What are factors that affect the female in fertility?
-Greater than 35
-Atypical secodary sexual characteristic (Abnormal body fat or hair growth)
-Pelvic/abdominal procedures
-Past spontaneous abortions
-abnormal uterine contours
-History of sti
-Exposure to teratogenic
-Overweight/underweight. Nutritional deficiencies
-Substance use
What are the factors that affect male fertility?
Mumps, after adolescence. Endocrine disorder, genetic disorder. Anomales in reproductive system
-Substance abuse & STI
-Exposure to teratogenic & scrotum to high temp
What are the female diagnostic prodecures for fertility?
Pelvic exam -
Hormone analysis
Postcoital test
Ultrasound
Hysterosalpingography - dye used to test patency of fallopian tubes
Hysteroscopy - Uterus is examinated for scar/defect
Laparoscopy - gas insufflation to observe internal organs
What are the diagnostic tests for male for fertility?
Semen analysis
Ultrasound - visualize testes and scrotum. Transrectal to assess ejaculatory ducts, seminal vesicles and vas deferens
What are some medications for ovulation
Ovarian stimulation?
Support ovulation?
Ovarian stim - Clomiphene citrate & letrozole
Ovarian support - metformin
What are the assisted reproductive technologies?
Intrauterine insemination
IVF-ET
Gamete intrafallopian transfer
Donor oocyte
Donor embryo
Gestational carrier
Surrogate mother
Therapeutic donor insemination
Intrauterine insemination - place sperm in uterus at ova
In vitro fetilization- embroyo transfer - Collect eggs, fertilize in lab, transfer embroyo to uterus
Gamete intrafallopian transfer - oocytes are retreived and placed with sperm. Gamests are injected into fallopian tubes via laparoscopy
Donor oocyte: Donated eggs. eggs inseminated, Embryos placed in uterus. Pt undergoes hormonal therapy
Donor embroyo - Donated embryo placed in uterus. Hormonal therapy
Gestation carrier - Embroyo placed in another person
Surrogate mother - Person inseminated with semen and carries until birth
Therapeutic donor insemination: donor sperm is used
Majority of birth defects occure between what weeks gestation?
2-8weeks
What are the inital lab tests drawn and cultures at initial prenatal visit?
Hemoglobin
hematocrit
WBC
blood type and Rh
rubella titer
urinalysis
fenal function test
pap test
cervical cultures
HIV antibody
Hep b
toxoplasmosis
RPR or VDRL
Routine prenatal lab tests
What does Blood type, Rh factor, presence of irregular antibodies determine?
risk for maternal-fetal blood incompatibility or neonatal hyperbilirubinemia
Indirect coombs test ids - clients sensitized to Rh-positive blood.
*negative results are repeated between 24-28weeks
Routine prenatal lab tests
CBC with differential, Hgh, Hct
Detects infection and anemia
Routine prenatal lab tests
Hgh electrophoresis
id’s hemoglobinopathies (sickle cell anemia and thalassemia)
Routine prenatal lab tests
Rubella titer
Determines immunity to rubella
Routine prenatal lab tests
Hep B screen
Ids carriers of Hep B
GBS - Group B streptpcpccus
Obtain vaginal/anal culture at 35-37 weeks to assess for infection
Routine prenatal lab tests
Urinalysis with microscopic exam of pH, specific gravity, color, sediment, protein, glucose, albumin, RBC, WBC, casts, acetone, and human chorionic gonadotropin
Identified pregnancy, DM, gestational hypertension, renal disease, and infection
Routine prenatal lab tests
One-hour glucose tolerance
(oral ingestion with venous sample taken 1hr later) Fasting not necessary
Ids hyperglycemia, done at initial visit for at risk clients and at 24-28 for all pregnant clients
greater than 140mg/dl requires follow up
Routine prenatal lab tests
3 hr glucose tolerance
(fasting overnight prior to oral ingestion or IV of concentrated gluocse with venous sample taken at 1,2,3 hours later
Used in clients who have elevated 1hr glucose test as screening for DM. Diagnosis of gestational diabetere requires 2 elevated blood glucose readings
Routine prenatal lab tests
Papanicolaou test (PAP)
Used as a screening tool for cervical cancer, herpes simplex 2 or human papillomavirus
Routine prenatal lab tests
Vaginal/cervical culture
Detects streptococcus beta hemolytic, bacterial vaginosis, or STI gonorrhea and chlamydia
Routine prenatal lab tests
PPD (TB screening), chest X-ray after 20wks with PPD Test
Ids exposure to TB
VDRL - Veneral disease research laboratory
Syphilis screening mandated by law
Routine prenatal lab tests
HIV
Detects HIV infection
Routine prenatal lab tests
Toxoplasmosis, other infections, rubella, cytomegalovirus, herpes virus (TORCH) screening when indicated
Screening for group of infections capable of crossing the placenta and adversely affecting fetal development
MSAFP - Maternal serum alpha-fetoprotein
Screening occurs between 15-22wks. Used to rule out down syndrome, neural tube defects.
Provider might opt for quad screen at 16-18wks, which is more reliable and includes AFP, inhibin-A, combo analysis of human chorionic gonadotropin and estriol
What are the danger signs during first trimester
Buring during urination (infection)
Severe vomiting
Diarrhea
Fever/chills
Ab cramping/bleeding (miscarriage, ectopic)
What are danger signs in 2nd and 3rd trimesters
Gush of fluid prior to 37 wks
Vag bleeding (placental problems)
Ab pain (premature labor, abrupto placenta, ectopic)
Changes in fetal activity (fetal distress)
Persistent vomiting (hyperemesis gravidarum)
Severe headaches (Gest HTN)
Elevated temp (infection)
Dysuria (UTI)
Blurred vision (Gest HTN)
Edema of face/hands** (Gest HTN)**
Epigastric pain (Gest HTN)
Concurrent occurance of flushed, dry skin, fruity breath, rapid breathing, increased thirst/urination and headache (hyperglycemia)
Concurrent occurance of clammy pale skin, weakness, tremors, irritability, lightheadedness (hypoglycemia)
What is the recommended weight gain during pregnancy
25-25lbs
What is the general rule for weight gain
1st trimester
last 2 trimesters
1st - 1-4.4lb
2nd/3rd 0 1lb/wk
What can excessive weight gain lead to
macrosomia and labor complications
What can inability to gain weight lead to
low birth weight
What is client education for nutrition during pregnancy
Increase calories: 340/day during 2nd. 452/day during 3rd
Increase protein:
Folic acid: crucial for neurologic develop and prevention of neural tube defects.
Iron supplements: Increase in maternal RBC
Calcium: invovled in bone and teeth formation
Fluid: 8-10 glasses a day
What foods are high in folate
leafy veg, dried peas and beans, seeds, orange juice.
Fortified with folic acid: breads, cereals, other grains
nonpreg of childbearing age: 400mcg
Preg: 600mcg
Food sources of iron
When is iron best absorbed
What interfers with iron absorption
Food: beef liver, red meats, fish, poultry, dried peas, beans, fortified cereals and breads
Iron is best absorbed between meals with a vit C source
Milk and caffeine interfere with absorption of iron supplements
What are sources of calcium
milk
calcium fortified soy milk
fortifiied orange juice
nuts
legumes
dark green veg
*1000mg/day 19-50years
1300mg/day under 19
How much caffeine should a pregnant woman have
no mor ethan 200mg
Excessive intake can lead to infertility, spontaneous abortion, intruterine growth restriction
What is Maternal phenylketonuria (PKU)
maternal genetic disease in which high levels of phenylalanine pose a danger to fetus
(intellectual disability, behavioral problems)
What is a PKU diet and when should a woman start
3 months before preg
Foods high in protein (fish, poultry, meat, eggs, nuts, dairy) MUST be AVOIDED due to high phenylalanine
Also avoid aspartame
What is a high frequence sound wave used to visualize internal organs and tissues producing a real-time, 3d image of developing fetus and maternal structures?
Ultrasound
What is a safe noninvasive procedure where ultrasound transducer is moved over clients abdomen to obtain an image
External abdominal ultrasound
More useful after 1st trimester / bladder should be full
WHat is an invasive procedure in which a probe is inserted vaginally to allow for more accurate evaluation
Transvaginal ultrasound
When is a transvaginal ultrasound useful
Obese, 1st trimester, in 3rd trimester in conjunction with abdominal scanning to eval for preterm labor
In 1st trimester what are they looking for when doing a transvaginal ultrasound?
ectopic pregnancy, identify abnormalities, establish gestational age
What is a noninvasive external ultrasound method to study maternal-fetal blood flow my measuring velocuty at which RBCs travel in uterine and fetal vessels using a handheld device that reflects sound waves from a moving target?
Doppler ultrasound blood flow analysis
When is doppler ultrasound blood flow analysis especially useful
Fetal intrauterine growth restriction, poor placental perfusion, adjunct in at risk preg for HTN, DM, multiple fetuses, preterm labor
What are some client presentations you would do an ultrasound to determine? (all ultrasounds)
Vaginal bleeding eval
Questionable fundal height measuring in relation to gestational weeks
Reports of decreased fetal movement
Preterm labor
Questionable rupture of membranes
What uses a real-time utrasound to visualize physical and physiological characteristics of fetus and observe for fetal biophysical responses to stimuli?
*combines FHR Monitoring and fetal ultrasound
Biophysical profile
What would be the potential diagnosis for biophysical profile?
Nonreactive stress test
Suspected oligohyframnios or polyhydraminos
Suspected fetal hypoemia or hypoxia
What would some symptoms of pt be in order to do a biophysical profile>
Premature rupture of membranes
Maternal infection
Decreased fetal movment
Intrauterine growth restriction
How to interprete findings on biophyscial profile
FHR
FETAL BREATHING MOVEMENTS
GROSS BODY MOVEMENTS
FETAL TONE
QUALITATIVE AMNIOTIC FLUID VOLUME
FHR - Reactive = 2
nonreactive = 0
**FETAL BREATHING MOVEMENTS **= AT least 1 episode of greater than 30 sec in 3mins = 2
Absent or less than 30 sec = 0
GROSS BODY MOVEMENTS - At least 3 body/limb extensions with return to flexion in 30 min = 2
Less than 3 episodes = 0
**FETAL TONE **- AT least 1 episode of extension with return to flexion = 2
Slow extension and flexion, lack or absent movement = 0
**QUALITATIVE AMNIOTIC FLUID VOLUME **- AT least 1 pocket of fluid that measures at least 2cm in 2 perpendicular planes = 2
Pockets absent or less than 2cm = 0
Total score 8-10 NORMAL, 4-6 ABNORMAL. less than 4 ABNORMAL - suspect ch
Noninvasive procedure that monitors response of the FHR to fetal movement, uses doppler transducer (to monitor FHR) and tocotransducer (to monitor uterine contraction) to obtain tracing strips. Patient pushes down on button when they feel fetal movement
Nonstress test
What are disadvantages of NST
High rate of false nonreactive results with fetal movement response blunted by sleep cycles, fetal immaturity, maternal medications and nicotine use disorder
WHat would be potential diagnosis for nonstress test
ASsessing for intact fetal CNS during 3rd trimester
Ruling out risk for fetal death for moms who have DM (used twice a week 28-32 weeks)
What would pt symptoms be to order Nonstress test?
Decreased fetal movment
Intrauterine growth restriction
Postmaturity
Gestational HTN or DM
Systemiatic lupus erythematosus
Kidney disease
Intrahepatic cholestatis
oligohydraminos
multple gestation
How to interpret NST results
Reactive is FHR is accelerated at least 15/min for at least 15 sec and occurs 2 or more times in 20 min (10/min prior to 32wks)
Nonreactive - does not demonstrate at least 2 qualifiying accels in 20 min window - further assessment is needed
What are the 2 types of contraction stress tests?
Nipple-stimulated contraction test
Oxytocin stimulated contraction test
What test is lightly brushing plan across nipple for 2 min then stopping when contraction begins
Nippple stimulated contraction test
How are nipple stimulated contraction test results analyzed
Analysis of FHR response to contraction determines how fetus will tolerate stress of labor
Patter of at least 3 contractions within 20 min period with duration of 40-60 sec must be obtained for data
Avoid tacysystole of uterus by allowing rest periods and stim of only 1 nipple
What test consist of IV admin of oxytocin to induce contractions
Ocytocin stimulated contraction test
What are warnings and contraindications for oxytocin stimulated contraction test?
- Can be difficult to stop once started - lead to preterm labor
- Contra- placenta previa, vasa previa, preterm labor, multiple gestation, previous incision from c-section, reduced cervical compentence
Contraction stress test results
Negative CST (Normal)
Positive CST (abnormal)
Negative - 10 min 3 uterine contractions and no late decels
Postive - persistent and consistent late decels with 50% or more of contractions, SUGGESTIVE of uteroplacental insufficiency, variable - cord compression, early decel - head compression.
Aspiration of amniotic fluid for analysis by insertion of needle transabdominally into pt uterus and amniotic sac under direct ultrasound guidance
Amniocentesis
Alpha fetoprotein can be measured in amniotic fluid between what weeks? and determine what
15-20wks
Neural tube defects and chromo disorder
When would an amniocentesis test be indicated
Previous birth with chromo anomaly
Parent who is a carrier
Family history of neural tube defects
Prenatal diag of genetic disorder
AFP level for abnormalities
Lung maturity assessment
FEtal hemolytic disease
How to interpret findings of amniocentesis?
Alpha-fetoprotein
Fetal lung maturity
Alpha-fetoprotein - high levels - assoc wtih neural tube defects also with multifetal preg
low levels - chromo disorders or gestational trophoblastic disease
Fetal lung maturity - gestation less than 37 weks. L/S ratio - 2:1 ratio indicated fetal lung maturity (3:1 for DM)
PG - absence of PG is assoc with respiratory distress
What are complications with amniocentesis?
Amniotic fluid emboli
Materal/fetal hemorrhage
infection
Inadvertent fetal damage or anomalies involving limbs
fetal death
Inadvertent maternal intestional or bladder damage
premature rupture of membranes
leakage
Obtains fetal blood from umbilical cord by passing fine-guage, fiber-optic scope into amniotic sac using amniocentesis technique
Percutaneous umbilical blood sampling
What do blood studied from Percutaneous umbilical blood sampling consist of
Kleihauer betke test confirms fetal blood was obtained
CBC count with differential
Indirect coombc for Rh
Karyotyping
Blood gases
What can info from Percutaneous umbilical blood sampling tell us
Isoimmune fetal hemolytic anemia
Assess need for fetal transfusion
Determine specifics regarding genetic mutations
Assesement of portion of developing placenta which is aspirated through a thin sterile catheter or syringe inserted through ab wall or cervix
Chorionic villus sampling
Why would they do chorionic villus sampling
Risk for giving birth to neonate who has genetic chromo abnormality
What are complications for chorionic villus sampling
SPontanous abortion
risk for fetal limb loss
miscarrage
chorioamniontitis and rupture of membranes
blood test that ascertains info about likelihood of fetal birth defects. has 3 test
Quad marker screening
WHat test are in quad marker screening
hCG
AFP
Estriol
Inhibin A
What are interpretation of findings of quad marker screening
Low levels of AFP - risk for down syndrome
high AFP - risk for neural tube defect
Hgiher HCG and inhibin A - down syndrome
Low levels of estriol - down syndrome
Screening tool used to detect neural tube defects
MSAFP
Maternal alpha-fetoprotein
How to interpret MSAFP
High levels - neural tube defect or open abdominal defect
Low - down syndrome
Spontaneous abortion
Occurs when pregnancy ends as the result of natural causes before 20 weeks
Threatened, inevitable, incomplete, complete, missed
What are the expected findings for sponaneous abortion
Ab cramping/pain
Anomalies in fetus or placenta
Dilation of cervix
Fever
manifestations of hemorrhage (hypotension, tachycardia)
What are causes of bleeding during 1st trimester?
Spontaneous abortion
Ectopic abortion
What are causes of bleeding during 2nd trimester?
Gestational trophoblastic disease - uterine size increasing abormally fast, abnormally high levels of HCG, nausea, increased emesis, no fetus on ultrasound, scant or profuse dark brown or red bleeding
What are causes of bleeding during 3rd trimester?
Placenta previa
Abruptio placentae
Vasa previa
Ectopic pregnancy
abnormal implantation of a fertilized ovum outside of uterine cavity usually in fallopian tube
What are expected symptoms of ectopic pregnancy
Unilateral stabbing pain and tenderness in lower abdominal quad
Menses that is delayed and lighter
Scant, dark red or brown vaginal spotting 6-8 weeks after last normal menses; red is rupture has occured
Referred shouldr pain
Findings of hemorrhage and shock (hypotension, tachycardia. pallor dizziness)
How to treat ectopic pregnancy
Methotrexate - inhibits cell division and embryo enlargement, dissolving pregnancy (AVOID folic acid!!)
Salpingostomy - done to salvage fallopian tube if not ruptured
Laparoscopic salpingectomy - removal of tube if ruptured
