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247 > ATI - TEST 1 > Flashcards

ATI - TEST 1 Flashcards

1
Q

The human ovum can be fertilized —hrs after fertizilation?
Motile sperms ability to fertilize the ovum lasts an average of

A

24hrs
48-72hrs

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2
Q

What are factors that affect the female in fertility?

A

-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

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2
Q

What are the factors that affect male fertility?

A

Mumps, after adolescence. Endocrine disorder, genetic disorder. Anomales in reproductive system
-Substance abuse & STI
-Exposure to teratogenic & scrotum to high temp

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3
Q

What are the female diagnostic prodecures for fertility?

A

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

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4
Q

What are the diagnostic tests for male for fertility?

A

Semen analysis
Ultrasound - visualize testes and scrotum. Transrectal to assess ejaculatory ducts, seminal vesicles and vas deferens

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5
Q

What are some medications for ovulation
Ovarian stimulation?
Support ovulation?

A

Ovarian stim - Clomiphene citrate & letrozole
Ovarian support - metformin

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6
Q

What are the assisted reproductive technologies?
Intrauterine insemination
IVF-ET
Gamete intrafallopian transfer
Donor oocyte
Donor embryo
Gestational carrier
Surrogate mother
Therapeutic donor insemination

A

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

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7
Q

Majority of birth defects occure between what weeks gestation?

A

2-8weeks

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8
Q

What are the inital lab tests drawn and cultures at initial prenatal visit?

A

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

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9
Q

Routine prenatal lab tests

What does Blood type, Rh factor, presence of irregular antibodies determine?

A

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

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10
Q

Routine prenatal lab tests

CBC with differential, Hgh, Hct

A

Detects infection and anemia

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11
Q

Routine prenatal lab tests

Hgh electrophoresis

A

id’s hemoglobinopathies (sickle cell anemia and thalassemia)

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12
Q

Routine prenatal lab tests

Rubella titer

A

Determines immunity to rubella

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13
Q

Routine prenatal lab tests

Hep B screen

A

Ids carriers of Hep B

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14
Q

GBS - Group B streptpcpccus

A

Obtain vaginal/anal culture at 35-37 weeks to assess for infection

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15
Q

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

A

Identified pregnancy, DM, gestational hypertension, renal disease, and infection

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16
Q

Routine prenatal lab tests

One-hour glucose tolerance
(oral ingestion with venous sample taken 1hr later) Fasting not necessary

A

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

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17
Q

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

A

Used in clients who have elevated 1hr glucose test as screening for DM. Diagnosis of gestational diabetere requires 2 elevated blood glucose readings

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18
Q

Routine prenatal lab tests

Papanicolaou test (PAP)

A

Used as a screening tool for cervical cancer, herpes simplex 2 or human papillomavirus

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19
Q

Routine prenatal lab tests

Vaginal/cervical culture

A

Detects streptococcus beta hemolytic, bacterial vaginosis, or STI gonorrhea and chlamydia

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20
Q

Routine prenatal lab tests

PPD (TB screening), chest X-ray after 20wks with PPD Test

A

Ids exposure to TB

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21
Q

VDRL - Veneral disease research laboratory

A

Syphilis screening mandated by law

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22
Q

Routine prenatal lab tests

HIV

A

Detects HIV infection

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23
Q

Routine prenatal lab tests

Toxoplasmosis, other infections, rubella, cytomegalovirus, herpes virus (TORCH) screening when indicated

A

Screening for group of infections capable of crossing the placenta and adversely affecting fetal development

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24
Q

MSAFP - Maternal serum alpha-fetoprotein

A

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

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25
Q

What are the danger signs during first trimester

A

Buring during urination (infection)
Severe vomiting
Diarrhea
Fever/chills
Ab cramping/bleeding (miscarriage, ectopic)

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26
Q

What are danger signs in 2nd and 3rd trimesters

A

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)

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27
Q

What is the recommended weight gain during pregnancy

A

25-25lbs

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28
Q

What is the general rule for weight gain
1st trimester
last 2 trimesters

A

1st - 1-4.4lb
2nd/3rd 0 1lb/wk

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29
Q

What can excessive weight gain lead to

A

macrosomia and labor complications

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30
Q

What can inability to gain weight lead to

A

low birth weight

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31
Q

What is client education for nutrition during pregnancy

A

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

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32
Q

What foods are high in folate

A

leafy veg, dried peas and beans, seeds, orange juice.
Fortified with folic acid: breads, cereals, other grains

nonpreg of childbearing age: 400mcg
Preg: 600mcg

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33
Q

Food sources of iron
When is iron best absorbed
What interfers with iron absorption

A

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

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34
Q

What are sources of calcium

A

milk
calcium fortified soy milk
fortifiied orange juice
nuts
legumes
dark green veg

*1000mg/day 19-50years
1300mg/day under 19

35
Q

How much caffeine should a pregnant woman have

A

no mor ethan 200mg

Excessive intake can lead to infertility, spontaneous abortion, intruterine growth restriction

36
Q

What is Maternal phenylketonuria (PKU)

A

maternal genetic disease in which high levels of phenylalanine pose a danger to fetus
(intellectual disability, behavioral problems)

37
Q

What is a PKU diet and when should a woman start

A

3 months before preg
Foods high in protein (fish, poultry, meat, eggs, nuts, dairy) MUST be AVOIDED due to high phenylalanine
Also avoid aspartame

38
Q

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?

A

Ultrasound

39
Q

What is a safe noninvasive procedure where ultrasound transducer is moved over clients abdomen to obtain an image

A

External abdominal ultrasound

More useful after 1st trimester / bladder should be full

40
Q

WHat is an invasive procedure in which a probe is inserted vaginally to allow for more accurate evaluation

A

Transvaginal ultrasound

41
Q

When is a transvaginal ultrasound useful

A

Obese, 1st trimester, in 3rd trimester in conjunction with abdominal scanning to eval for preterm labor

42
Q

In 1st trimester what are they looking for when doing a transvaginal ultrasound?

A

ectopic pregnancy, identify abnormalities, establish gestational age

43
Q

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?

A

Doppler ultrasound blood flow analysis

44
Q

When is doppler ultrasound blood flow analysis especially useful

A

Fetal intrauterine growth restriction, poor placental perfusion, adjunct in at risk preg for HTN, DM, multiple fetuses, preterm labor

45
Q

What are some client presentations you would do an ultrasound to determine? (all ultrasounds)

A

Vaginal bleeding eval
Questionable fundal height measuring in relation to gestational weeks
Reports of decreased fetal movement
Preterm labor
Questionable rupture of membranes

46
Q

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

A

Biophysical profile

47
Q

What would be the potential diagnosis for biophysical profile?

A

Nonreactive stress test
Suspected oligohyframnios or polyhydraminos
Suspected fetal hypoemia or hypoxia

48
Q

What would some symptoms of pt be in order to do a biophysical profile>

A

Premature rupture of membranes
Maternal infection
Decreased fetal movment
Intrauterine growth restriction

49
Q

How to interprete findings on biophyscial profile

FHR
FETAL BREATHING MOVEMENTS
GROSS BODY MOVEMENTS
FETAL TONE
QUALITATIVE AMNIOTIC FLUID VOLUME

A

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

50
Q

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

A

Nonstress test

51
Q

What are disadvantages of NST

A

High rate of false nonreactive results with fetal movement response blunted by sleep cycles, fetal immaturity, maternal medications and nicotine use disorder

52
Q

WHat would be potential diagnosis for nonstress test

A

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)

53
Q

What would pt symptoms be to order Nonstress test?

A

Decreased fetal movment
Intrauterine growth restriction
Postmaturity
Gestational HTN or DM
Systemiatic lupus erythematosus
Kidney disease
Intrahepatic cholestatis
oligohydraminos
multple gestation

54
Q

How to interpret NST results

A

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

55
Q

What are the 2 types of contraction stress tests?

A

Nipple-stimulated contraction test
Oxytocin stimulated contraction test

56
Q

What test is lightly brushing plan across nipple for 2 min then stopping when contraction begins

A

Nippple stimulated contraction test

57
Q

How are nipple stimulated contraction test results analyzed

A

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

58
Q

What test consist of IV admin of oxytocin to induce contractions

A

Ocytocin stimulated contraction test

59
Q

What are warnings and contraindications for oxytocin stimulated contraction test?

A
  • 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
60
Q

Contraction stress test results

Negative CST (Normal)
Positive CST (abnormal)

A

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.

61
Q

Aspiration of amniotic fluid for analysis by insertion of needle transabdominally into pt uterus and amniotic sac under direct ultrasound guidance

A

Amniocentesis

62
Q

Alpha fetoprotein can be measured in amniotic fluid between what weeks? and determine what

A

15-20wks
Neural tube defects and chromo disorder

63
Q

When would an amniocentesis test be indicated

A

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

64
Q

How to interpret findings of amniocentesis?
Alpha-fetoprotein
Fetal lung maturity

A

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

65
Q

What are complications with amniocentesis?

A

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

66
Q

Obtains fetal blood from umbilical cord by passing fine-guage, fiber-optic scope into amniotic sac using amniocentesis technique

A

Percutaneous umbilical blood sampling

67
Q

What do blood studied from Percutaneous umbilical blood sampling consist of

A

Kleihauer betke test confirms fetal blood was obtained
CBC count with differential
Indirect coombc for Rh
Karyotyping
Blood gases

68
Q

What can info from Percutaneous umbilical blood sampling tell us

A

Isoimmune fetal hemolytic anemia
Assess need for fetal transfusion
Determine specifics regarding genetic mutations

69
Q

Assesement of portion of developing placenta which is aspirated through a thin sterile catheter or syringe inserted through ab wall or cervix

A

Chorionic villus sampling

70
Q

Why would they do chorionic villus sampling

A

Risk for giving birth to neonate who has genetic chromo abnormality

71
Q

What are complications for chorionic villus sampling

A

SPontanous abortion
risk for fetal limb loss
miscarrage
chorioamniontitis and rupture of membranes

72
Q

blood test that ascertains info about likelihood of fetal birth defects. has 3 test

A

Quad marker screening

73
Q

WHat test are in quad marker screening

A

hCG
AFP
Estriol
Inhibin A

74
Q

What are interpretation of findings of quad marker screening

A

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

75
Q

Screening tool used to detect neural tube defects

A

MSAFP
Maternal alpha-fetoprotein

76
Q

How to interpret MSAFP

A

High levels - neural tube defect or open abdominal defect
Low - down syndrome

77
Q

Spontaneous abortion

A

Occurs when pregnancy ends as the result of natural causes before 20 weeks

Threatened, inevitable, incomplete, complete, missed

78
Q

What are the expected findings for sponaneous abortion

A

Ab cramping/pain
Anomalies in fetus or placenta
Dilation of cervix
Fever
manifestations of hemorrhage (hypotension, tachycardia)

79
Q

What are causes of bleeding during 1st trimester?

A

Spontaneous abortion
Ectopic abortion

80
Q

What are causes of bleeding during 2nd trimester?

A

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

81
Q

What are causes of bleeding during 3rd trimester?

A

Placenta previa
Abruptio placentae
Vasa previa

82
Q

Ectopic pregnancy

A

abnormal implantation of a fertilized ovum outside of uterine cavity usually in fallopian tube

83
Q

What are expected symptoms of ectopic pregnancy

A

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)

84
Q

How to treat ectopic pregnancy

A

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

85
Q
A

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