Diagnostic Testing/ First Trimester: 00-13 weeks

Question 1

CBC with differential, Hgb and Hct

Purpose: (2)

Answer 1

Complete Blood Count

Purpose: Detects infection and anemia

Question 2

Blood Typing
Determine: (1)
Purpose: (1)

Answer 2

Determine:  
Client's blood group 
Rh status 
Purpose/Identify:  
Risk for Maternal-fetal blood incompatibility

Question 3

TORCH(S) Screen
Determine:
Purpose:

Answer 3

Determine:
Purpose: If a woman becomes infected with certain germs during her pregnancy, the baby may also become infected while still in the womb. The baby is more sensitive to harm from infection during the first 3 to 4 months of the pregnancy.

These infections may lead to birth defects, growth delay, and brain and nervous system problems in the baby.

TORCH stands for
Toxoplasmosis: Parasite
Rubella: Virus, check immunization protocol
Cytomegalovirus,
Herpes simplex (HSV), and HIV
Syphilis
but it can also include other newborn infections.

Question 4

HSV: Herpes Simplex 2
Determine
Purpose

Answer 4

Determine: Virus
Purpose: Tx and type of delivery

Question 5

Group B Strep (STI)

1) What is
2) How to dx
3) What is the danger to the mother and fetus?
4) How to treat?
5) Current recommendations are to screen all women at _____wks?

Answer 5

1) Bacteria normal vaginal and intestine flora
2) Culture of vaginal and/or anorectum NOT cervix
3) Mother: UTI, preterm labor, chorioamnionitis
Fetus: Neonatal meningitis, sepsis, sepsis shock
4) If you’re pregnant and develop complications due to group B strep, you’ll be given oral antibiotics, usually penicillin or cephalexin, which are safe to take during pregnancy.
5) Screen at 35-37 weeks

Question 6

Ultrasound
Determine:
Purpose:

Answer 6

Determine:
Purpose:

Question 7

Chorionic Villus Sampling (CVS)

1) Purpose:
2) When is this test done?
3) What is the advantages of this procedure? (2)
4) Sampling can be done either (2)

Answer 7

1) Genetic abnormalities
2) 10-12 weeks
3) Early diagnosis and short waiting time for results
4) Transabdominally or transcervically

(London 289)

Question 8

Rh typing

1) Erythroblastosis fetalis:
2) Why does it happen

Answer 8

1) Erythroblastosis fetalis- Newborn Hemolytic Disease (HDN) affects fetus or newborn ABO incompatibility
2) Occurs when mother and baby have different blood types, mothers antibodies attack baby’s RBC’s

Question 9

Rubella titer:  If client is susceptibility (7)
(TORCH)
1)  Susceptibility
2)  Immunize when?
3)  Route?
4)  Inquire about?
5)  (3) things to teach client

Answer 9

1) If titer is negative it indicates susceptibility to rubella virus
2) Client receives immunization postpartum
3) Inject SubQ
4) Inquire about sensitive to eggs
5a) Client must be on effective birth control at the time of immunization
5b) Must not become pregnant 1-3 months after immunization
5c) Avoid contact with anyone immunocompromised

Question 10

T or F Rubella vaccine is not given during pregnancy because the live virus may cross the placenta and infect the fetus
(TORCH)

Answer 10

True

Question 11

Hgb & Hct increase or decrease during gestation ?

Why?

Answer 11

Hgb & Hct levels decline as a result of increased plasma volume

Question 12

Hep B surface antigens

1) Why test?
2) Specifically indicated for:

Answer 12

1) Prevalence in general population

2) Healthcare workers, tattoos, h/o blood transfusions, STI, dialysis or renal transplant

Question 13

Urinalysis & Urine Culture

1) Testing for what?
2) How often is this test done?

Answer 13

1) Sugars, WBC’s, protein, ketones (Saunders 319)

2) At every visit

Question 14

Cytomegavirus

TORCH

Answer 14

No cure, usually is dormant, DANGER: If immunocompromised can be passed to baby via breastfeeding but usually does not make baby sick. If mother has active infection this can be passed to baby.

Question 15

Syphilis (STI)

1) Caused by?
2) Transmission?
3) T or F Transmission can occur by crossing the placenta at anytime during pregnancy?
4) What medication is used to tx Syphilis even if client is pregnant?

Answer 15

1) Spirochete
2) Kissing, biting, intercourse
3) True
4) Penicillin type antibiotics

Question 16

Chorionic villus sampling (CVS)
Nursing Interventions (5)

Answer 16

1) Explain procedure: aspirate a small sample of chorionic villus tissue at 10-13 weeks
2) Informed consent
3) Pt needs full bladder
4) Obtain VS and fetal heart rate for baseline and monitor closely during procedure
5) Rh- women may be given RhoGAM

Question 17

Can Hep B vaccine be administered during pregnancy ?

Answer 17

Yes it is not contraindicated

Saunders 319

Question 18

1) Ultrasound uses _____?

2) Two types

Answer 18

xxx

Question 19

Can mother with Cytomegavirus breastfeed?

Answer 19

Yes, virus will pass to baby usually does not make baby sick unless immunocompromised

Question 20

Can Syphillis cross the placenta?

Answer 20

Yes

Question 21

Can Chorionic Villus Sampling be used to determine spina bifida or anencephaly (baby born without part of brain or skull)

Answer 21

No

Question 22

Does bladder need to full for CVS?

Answer 22

Yes

Question 23

CVS: Complications (4)

Answer 23

1) Spontaneous abortion (higher risk with CVS than with amniocentesis)
2) Risk for fetal limb loss
3) Miscarriage
4) Chorioamnionitis and rupture of membranes

Question 24

Chorioamnionitis:

What is it?

Answer 24

Chorioamnionitis is caused by a bacterial infection that usually starts in the mother’s urogenital tract. Specifically, the infection can start in the vagina, anus, or rectum and move up into the uterus where the fetus is located.

Question 25

Chorioamnionitis:

How to dx?

Answer 25

Chorioamnionitis is most often diagnosed by physical exam and the findings listed above. Other clues can be found by taking a blood sample from the mother and checking for bacteria. In addition, the doctor might take samples of the amniotic fluid to look for bacteria. The doctor might also use ultrasound to check on the health of the fetus.

Question 26

Chorioamnionitis:

How to Tx?

Answer 26

If your doctor diagnoses chorioamnionitis, he or she may treat you with antibiotics to help to treat the infection. However, often the treatment is to deliver the fetus. In addition, if the newborn has an infection, he or she will be given antibiotics, as well.

Question 27

Chorioamnionitis:

Signs and Symptoms

Answer 27

Although chorioamnionitis does not always cause symptoms, some women with the infection might have the following:

High temperature and fever
Rapid heartbeat (The fetus might also have a rapid heartbeat.)
Sweating
A uterus that is tender to the touch
A discharge from the vagina that has an unusual smell

Question 28

1) Ultrasound uses _____?

2) Two types

Answer 28

1) Sound waves to produce 3D image

2) Transvaginal and Abdominal

Question 29

Transvaginal Ultrasound
Purpose: (4)
Nurses Role: (3)

Answer 29

1)  Used primarily during the first trimester to evaluate
Pelvic anatomy
Assess developing fetus, Number and Size
Locate Placental anomalies
Establish gestational age
dx intrauterine pregnancy
2)  
Inquire about latex allergy
Informed consent
Educate about procedure

Question 30

Abdominal Ultrasound

Purpose:

Answer 30

1)  
Fetal viability
Amniotic fluid volume
Placenta location and maturity
Assess fetal well being

Question 31

Contracted by:

1) Toxoplamosis
2) Rubella
3) Cytomegalovirus
4) Herpes Simplex (HSV)

Answer 31

1) Toxoplamosis: Cat feces and eating raw meat
2) Rubella:
3) Cytomegalovirus: Droplet
4) Herpes Simplex (HSV): Direct contact
(ATI 83)

Question 32

Toxoplasmosis medication tx?

Answer 32

1) Sulfonamides or combo of pyrimethamine and sulfadizine (potentially harmful to the fetus, but parasitic tx is essential
(ATI 82)