EXAM 1 Flashcards
(111 cards)
1
Q
What is a teratogen? Examples?
A
- any drug, virus, infection, of other exposure that impacts fetal development
examples: tobacco, alcohol, drugs, ACE inhibitors, anticonvulsants, cat feces (toxoplasmosis), heat (hot tub), varicella/Zika/rubella
2
Q
When is exposure to teratogens most harmful to the fetus?
A
during the first 8 weeks of gestation (this is the MOST CRITICAL timeframe)
3
Q
When does the zygote embed into the uterus?
A
-about day 7
4
Q
**What is the umbilical cord composed of?
A
2 arteries
1 vein
5
Q
How much amniotic fluid is there at most?
A
800-1000ml (at around 34 wks)
*it decreases at term to 500-600ml to make room
6
Q
What prenatal vitamins are most important? (5)
A
- folic acid
- iron
- calcium
- magnesium
- vitamin D
7
Q
**What are presumptive signs of pregnancy? (6)
A
- amenorrhea
- N/V
- breast changes
- fatigue
- urinary frequency
- quickening
8
Q
**What are probable signs of pregnancy? (7)
A
- Chadwick’s sign
- Goodell’s sign
- Hegar’s sign
- abdominal growth
- skin changes (melasma, linea nigra)
- ballottement
- positive pregnancy test
9
Q
**What are signs that pregnancy is confirmed? (3)
A
- auscultation of the fetal heart (10-12 weeks)
- observation/palpation of fetal movement (by provider)
- ultrasound exam (4-8 weeks can confirm)
10
Q
What is Chadwick’s sign?
A
-bluish color of the cervix and vaginal mucosa
11
Q
What is Goodell’s sign?
A
-softening of the cervical tip
12
Q
What is Hegar’s sign?
A
-softening of the lower uterus
13
Q
How do we calculate the EDD (estimated due date)?
A
Nagele’s Rule
-first day of the last menstrual period - 3 months + 7 days
*if LMP is not known US or pelvic exam may give an estimate
14
Q
What is gravidity?
A
-the number of pregnancies that woman has had
15
Q
What is parity?
A
-the number of pregnancies in which the fetus or fetuses reached 20 weeks
16
Q
How many weeks is considered preterm?
A
-up to 37 weeks
17
Q
**What is the acronym GTPAL for?
A
G- gravida T- term P- preterm A- abortion L- living children
18
Q
During the first trimester, how is the mother psychologically reacting?
A
-she reacts with AMBIVALENCE
“I’m pregnant?!”
19
Q
During the second trimester, how is the mother psychologically reacting?
A
-she reacts with EXCITEMENT
“Look everyone! I’m pregnant!”
20
Q
During the third trimester, how is the mother psychologically reacting?
A
-she reacts by PREPARING
“Wait! I’m not ready!”
21
Q
Where is HCG produced early in pregnancy and what does it do?
A
- produced by the ovaries initially
- supports implantation and establishment of pregnancy
22
Q
When is urinary urgency and frequency most often noted during pregnancy?
A
-in the first and third trimester
23
Q
What cardiovascular changes occur in the pregnant woman?
A
- cardiac output increases 30-50%
- HR increases 15-20 bpm
- RBC increase by 30%
- blood volume increases by 18-30%
24
Q
What is supine hypotension and how do we correct it?
A
- when the pregnant woman lies on her back it partially occludes the inferior vena cava and the aorta
- correct it by assuming a lateral position
25
What week is the fundal height at the umbilicus?
- 20 weeks, or halfway
| * by 36 weeks it is at the xyphoid process*
26
**What is the recommended weight gain for an underweight pregnant woman?
underweight BMI: <18.5
| weight gain: 28-40 lbs
27
**What is the recommended weight gain for a normal weight pregnant woman?
normal BMI: 18.5-24.9
| weight gain: 25-35 lbs
28
**What is the recommended weight gain for an overweight pregnant woman?
overweight BMI: 25-29.9
| weight gain: 15-25
29
What are the s/s that the pregnant woman should report during her first trimester? (6)
- abdominal cramping/pain (persistent)
- vaginal spotting/bleeding
- absence of FH tone
- dysuria, frequency. urgency
- fever, chills
- prolonged N/V
30
What does AFP test for and when is it typically done?
MSAFP (maternal serum alpha-fetoprotein) is done at 15-20 weeks to rule out:
- Down Syndrome: low levels
* down low*
- neural tube defects such as anencephaly or spinal bifida: high levels
31
What is GTT test for and when is it typically done during pregnancy?
- GTT (glucose tolerance test) is done at 24-28 weeks to detect gestational diabetes
* *a result greater than 140 requires followup for a fasting GTT
32
What is rH screening test for during pregnancy and when is it typically done?
-it determines the risk for maternal-fetal blood incompatibility and it is done at 28 weeks
33
What is GBS testing for and when is it typically done during pregnancy?
GBS (group B streptococcus) testing happens at 37-38 weeks to assess for infection
34
How to perform a fetal kick count?
2 hr time period (preferably after meals) should feel at least 10 distinct movements
35
What is a normal FHR?
a normal fetal heart rate is 110-160
36
What is Leopold's maneuver?
specific palpation of the abdomen to determine the position of the fetus
37
What are the s/sx of preterm labor? (5)
- rhythmic lower abdominal pain/cramping
- low backache
- pelvic pressure
- leakage of amniotic fluid
- increased vaginal discharge
38
**What are Reva Rubin's maternal tasks of pregnancy? (4)
- ensuring safe passage for herself and her child
- ensuring social acceptance of her child
- attaching or "binding in" to the child
- giving of oneself to the demands of being a mother
39
What is couvade?
couvade which is pregnancy s/s in men
40
What is chorionic villus sampling? When is it done? Pros/Cons?
- diagnostic test to detect fetal chromosomal, metabolic, or DNA abnormalities
- performed at 10-13 weeks
Pros- results are faster than amniocentesis
Cons- 1% risk of loss of pregnancy, limb reduction defects may happen if done at less than 10 weeks
41
What is amniocentesis? When is it done? Pros/Cons?
- diagnostic test to detect chromosomal, metabolic, or DNA abnormalities AS WELL AS fetal lung maturity, and fetal infections or amniotic fluid disorders
- performed at 15-20 weeks
Pros- its been around for a long time
Cons- test results not available for 10-14 days, pregnancy loss 1%
42
What is percutaneous umbilical blood sampling? When is it done?
- aspiration of fetal blood from the umbilical cord (also called cordocentesis)
- done at 18 weeks
RISKY: fetal bradycardia, bleeding, thrombosis, infection, preterm labor, pregnancy loss
43
What does a fetal nonstress test do? What is considered a good result?
- it observes the FHR in response to fetal movement
- FHR going up when the baby is moving is a good sign
Results: reactive is good, nonreactive is bad
44
What is a CST test for? When would is be used during in pregnancy?
Contraction Stress Test: records FHR in response to uterine contractions
-used when NST findings are nonreactive
45
What score is considered normal for biophysical profiling? Abnormal?
- each component gets a score of 0 or 2
- a score of 8 or 10 is normal
- a score of 6 is ok as long as the amniotic fluid amount is normal
- a score of 0-4 is not good
46
How many calories extra do pregnant women need per day?
300 calories/day EXTRA
47
Pregnant women need how much protein per day at minimum?
25g/day
48
How much omega-3 fatty acids should pregnant women have?
200-300mg/day
49
How much folic acid should pregnant women have daily?
600mcg
50
Where can folic acid be found in food?
- dark leafy greens (asparagus, spinach)
- legumes (beans and peas)
- orange juice
- fortified cereals
- pasta
51
Where can iron be found in food?
EAT LOTS OF IRON
Egg Yolk
Apricots
Tofu
Leafy Greens
Oysters
Tuna
Sardine/Seeds
pOtato
Fish
Iron-fortified Cereals
Raisins/Red Meat
pOultry
Nuts
**also cooking in a cast iron pan**
52
How much iron do pregnant women need?
27mg/day
53
Why do pregnant women need fiber? Where can they get it?
- constipation from the enlarged uterus and increased intake of iron
- can be found in dark leafy greens, prunes, metamucil
54
How much calcium should pregnant women get in per day? What should lactose intolerant women do?
about a quart of milk
*if lactose intolerant there are calcium supplements, TUMS, calcium fortified OJ, spinach, collard greens, tofu, rhubarb, kale, and broccoli
55
What is the limit for pregnant women of caffeine?
200mg/day (1-1.5 cups of coffee a day)
56
What are forbidden foods during pregnancy?
- alcohol/marijuana
- fish
- saccharin (sweetener)
- cold cuts
- raw eggs, undercooked chicken, sushi
- unpasteurized cheese or milk
- weight loss pills or supplements
57
What is the correct needle gauge, length, and angle of injection for an intradermal injection?
Gauge: 25-27 gauge
Length: 5/8-1/2
Angle: 5-15 degrees
58
What is the correct needle gauge, length, and angle of injection for a subcutaneous injection?
Gauge: 25-27 gauge
Length: 3/8-5/8
Angle: 45-90
59
What is the correct needle gauge, length, and angle of injection for a subcutaneous INSULIN injection?
Gauge: 28-31
Length: 5/16-1/2
Angle: 45-90
60
What is the correct needle gauge, length, and angle of injection for a intramuscular injection?
Gauge: 18-25
Length: 5/8-1 1/2
Angle: 90
61
What do rhonchi sound like?
-low-pitched snoring throughout respiration, may clear after coughing (nose/pharynx obstruction)
62
What does stridor sound like?
-high pitched on inspiration
63
What does wheezing sound like?
-high-pitched whistle heard throughout respiration (constriction in lower trachea/bronchioles)
64
What do crackles/rales sound like?
-fine crackling heard on inspiration (alveoli are filled with fluid)
65
What vaccines are given at birth?
-Hep B
66
What vaccines are given at 2 months?
- Hep B
- DTaP
- IPV
- PCV
- RV
- Hib
67
What vaccines are given at 4 months?
- DTaP
- IPV
- PCV
- RV
- Hib
68
What vaccines are given at 6 months?
- Hep B
- DTaP
- IPV
- PCV
- RV
- Hib
69
What vaccines are given at 1 year?
- DTaP (at 15-18 mos)
- PCV
- Hib
- MMR
- Varicella
- Hep A (2nd dose 6-18mos later)
70
What vaccines are given at 3-6 years?
- DTaP
- IPV
- MMR
- Varicella
71
What vaccines are given at 11-12 years?
- TDaP
- HPV
- meningococcal
72
When does the anterior fontanel close? Posterior?
Posterior: closes by 2-3 months
Anterior: closes by 12-18 months
73
When do we expect erect head posture?
at 4 months of age
74
How should an infant gain weight in their first year?
- by 6 months they should have doubled their brith weight
| - by 12 months they should triple their birth weight
75
What stage of psychosocial development do infants go through from birth to 1 year?
Erikson:
trust vs mistrust
-trust develops if comfort, feeding, stimulation, and caring needs are met
-mistrust develops if needs are inconsistently or inadequately met
76
What stage of psychosocial development do toddlers go through from 1-3 years?
Erikson:
autonomy vs shame/doubt
-autonomy develops when toddlers exercise will and do things for themselves
-shame/doubt develops if they doubt their abilities
77
What stage of psychosocial development do preschoolers go through from 3-6 years?
Erikson:
initiative vs guilt
-initiative develops when they learn to initiate tasks and carry out plans
-guilt develops if they are made to feel guilty about these efforts
78
What stage of psychosocial development do school-age children go through from 6-12 years?
Erikson
industry vs. inferiority
-industry develops when kids learn the pleasure of applying themselves
-inferiority develops if they feel inferior
79
What stage of psychosocial development do adolescents go through from 12-18 years?
Erikson
identity vs. confusion
-identity develops when they integrate aspects of themselves into a single identity
-confusion develops if they do not know who they are
80
What URI presents with low fever, sneezing, rhinitis, cough, vomiting, and diarrhea?
Nasopharyngitis (common cold)
81
How should we treat the child with nasopharyngitis?
- tylenol/ibuprofen
- nasal spray
- bulb syringe for secretions
- elevate the HOB
- encourage fluid
- rest
82
What URI presents with low fever, rhinitis, cough, diarrhea, and pain when laying down?
Otitis Media (middle ear infection)
83
How should we treat the child with otitis media?
- spontaneous resolution may happen in 72 hrs
- antibiotics (amox oral or IM for noncompliant parents)
- tympanostomy tube placement (chronic)
84
What URI presents with high fever, drooling, apnea, mouth-breathing, and red enlarged tissue?
Tonsillitis
85
How should we treat the child with tonsillitis?
- antipyretic
- analgesic
- antibiotics (PCN/amox)
- tonsillectomy (not very common d/t risks)
86
What URI presents with red throat, dry cough, rhinitis, and red eyes?
Strep Throat (viral)
87
How should we treat the child with a case of viral strep throat?
- tylenol/ibuprofen
- rest
- fluids
- warm salt water gargle
88
What URI presents with fever, headache, enlarged tonsils, painful swallowing, white exudate, strawberry tongue, vomiting, and rash?
Strep Throat (bacterial)
89
How should we treat the child with bacterial strep throat?
- antibiotics (penicillin)
| * *they will not be contagious after 24 hours of abx
90
What URI presents with inspiratory stridor, barking cough, retractions, and hypoxemia?
Laryngotracheobronchitis (Croup)
91
How should we treat the child with croup?
- steamy bathroom OR cool nighttime air will alleviate
| - dexamethasone (corticosteroids)
92
What URI presents with inspiratory stridor, high fever (sudden onset), sore throat, hoarseness, protruding tongue, drooling, tripod position, and an absence of cough?
Epiglottitis
93
How do we treat a child with epiglottitis?
* *NEVER TRY TO VISUALIZE THE EPIGLOTTIS**
- moist air, oxygen
- racemic epinephrine
- tracheostomy
- intubation
94
What LRI presents with low fever, lots of mucus, retractions, nasal flaring, tachypnea, and low O2 sat?
Bronchioloitis
95
How should we treat the child with bronchiolitis?
- bulb suction
- HOB elevated
- small, freq meals
- nasal saline drops
- antipyretics
- hydration
- humidified O2
- droplet precautions
96
What LRI presents with low fever, a cough that can't be suppressed, runny nose?
Pertussis "whooping cough"
| **"the 100 days cough" bc it takes so long to resolve
97
How should we treat the child with pertussis?
- antibiotics (erythromycin/azithromycin)
| - make sure the family gets tested too, its highly contagious
98
What should you do if you are listening to a child's lungs who is having an asthma attack and the wheezing stops?
!! this may mean they are in respiratory failure !!
- keep the child calm
- give O2 humidified 90-100%
- IV steroids
- hydration
99
How can we diagnose cystic fibrosis?
- sweat test (>60 mmol/L is positive)
| - infants will not pass the meconium ileus in the first 24 hours
100
What are the treatments for cystic fibrosis?
Respiratory: chest PT 2x/day, supplemental oxygen, respiratory medications, careful to avoid sickness, lung transplant
Metabolic: supplement fat soluble vitamins (ADEK), take pancreatic enzymes before meals and snacks, monitor blood sugars
GI: take stool softeners, DRINK LOTS OF WATER
101
What things can mothers do to help prevent SIDS?
- lay supine to sleep
- no excess bedding
- do not sleep in same bed
- no smoking
- dont overdress the baby for sleep
- breastfeed
- try a pacifier
102
What are the signs of true labor?
- contractions get stronger, longer, and do not go away
- progressive cervical changes
- bloody show
103
What are the signs of false labor?
- irregular contraction
- no cervical changes
- contractions do not increase in intensity
- hydration/sedation slows/stops contractions
104
What is the baby's "station"?
Station refers to the position of the baby in the pelvis.
negative station: the baby is not engaged (floating)
"0" station: the baby's presenting part is at the level of the ischial spines
positive station: the baby is engaged in the pelvis (+4 is "on the floor!")
105
What is the concern if the baby's station is negative and the membranes rupture?
Cord Prolapse: the cord can fall down infront of the baby's presenting part which means it will be compressed when the baby engages in the pelvis
**Keep the mother on bedrest if this happens
106
How can we describe contractions?
Frequency: minutes from the beginning of one contraction to the beginning of the next
Duration: length of one contraction in seconds
Intensity: mild, moderate, severe
107
What is the most common type of pelvis (best for giving birth)?
gynecoid
108
What is the best position of the baby for vaginal birth?
cephalic (vertex) LOA
109
How long are contractions during early labor? Active? Transition?
early: 30-45 secs every 5-30 minutes
active: 45-60 secs every 3-5 minutes
transition: 60-90 secs every 2-3 minutes
110
What are the medications we can give the mother for pain during labor?
- merperidine (demerol)
- butophanol (stadol)
- sublimaze (fentanyl)
- nalbuphrine (nubain)
**give these during the active phase, if given too late the baby can be depressed at birth**
111
What kinds of anesthesia could be given during labor?
Epidural- given during active phase, not total numbness, may decrease the sensation to push, give with a fluid bolus to prevent hypotension
Spinal- total numbness (spinal headache)
General- only for c-section, baby needs to be delivered ASAP ROCKY
