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nur220 > EXAM 1 > Flashcards

EXAM 1 Flashcards

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
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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)

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3
Q

When does the zygote embed into the uterus?

A

-about day 7

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4
Q

**What is the umbilical cord composed of?

A

2 arteries

1 vein

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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

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6
Q

What prenatal vitamins are most important? (5)

A
  • folic acid
  • iron
  • calcium
  • magnesium
  • vitamin D
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7
Q

**What are presumptive signs of pregnancy? (6)

A
  • amenorrhea
  • N/V
  • breast changes
  • fatigue
  • urinary frequency
  • quickening
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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
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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)
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10
Q

What is Chadwick’s sign?

A

-bluish color of the cervix and vaginal mucosa

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11
Q

What is Goodell’s sign?

A

-softening of the cervical tip

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12
Q

What is Hegar’s sign?

A

-softening of the lower uterus

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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

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14
Q

What is gravidity?

A

-the number of pregnancies that woman has had

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15
Q

What is parity?

A

-the number of pregnancies in which the fetus or fetuses reached 20 weeks

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16
Q

How many weeks is considered preterm?

A

-up to 37 weeks

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17
Q

**What is the acronym GTPAL for?

A 
G- gravida
T- term
P- preterm
A- abortion
L- living children
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18
Q

During the first trimester, how is the mother psychologically reacting?

A

-she reacts with AMBIVALENCE

“I’m pregnant?!”

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19
Q

During the second trimester, how is the mother psychologically reacting?

A

-she reacts with EXCITEMENT

“Look everyone! I’m pregnant!”

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20
Q

During the third trimester, how is the mother psychologically reacting?

A

-she reacts by PREPARING

“Wait! I’m not ready!”

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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

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22
Q

When is urinary urgency and frequency most often noted during pregnancy?

A

-in the first and third trimester

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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%
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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
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25
Q

What week is the fundal height at the umbilicus?

A
  • 20 weeks, or halfway

* by 36 weeks it is at the xyphoid process*

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26
Q

**What is the recommended weight gain for an underweight pregnant woman?

A

underweight BMI: <18.5

weight gain: 28-40 lbs

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27
Q

**What is the recommended weight gain for a normal weight pregnant woman?

A

normal BMI: 18.5-24.9

weight gain: 25-35 lbs

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28
Q

**What is the recommended weight gain for an overweight pregnant woman?

A

overweight BMI: 25-29.9

weight gain: 15-25

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29
Q

What are the s/s that the pregnant woman should report during her first trimester? (6)

A
  • abdominal cramping/pain (persistent)
  • vaginal spotting/bleeding
  • absence of FH tone
  • dysuria, frequency. urgency
  • fever, chills
  • prolonged N/V
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30
Q

What does AFP test for and when is it typically done?

A

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
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31
Q

What is GTT test for and when is it typically done during pregnancy?

A
  • 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
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32
Q

What is rH screening test for during pregnancy and when is it typically done?

A

-it determines the risk for maternal-fetal blood incompatibility and it is done at 28 weeks

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33
Q

What is GBS testing for and when is it typically done during pregnancy?

A

GBS (group B streptococcus) testing happens at 37-38 weeks to assess for infection

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34
Q

How to perform a fetal kick count?

A

2 hr time period (preferably after meals) should feel at least 10 distinct movements

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35
Q

What is a normal FHR?

A

a normal fetal heart rate is 110-160

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36
Q

What is Leopold’s maneuver?

A

specific palpation of the abdomen to determine the position of the fetus

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37
Q

What are the s/sx of preterm labor? (5)

A
  • rhythmic lower abdominal pain/cramping
  • low backache
  • pelvic pressure
  • leakage of amniotic fluid
  • increased vaginal discharge
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38
Q

**What are Reva Rubin’s maternal tasks of pregnancy? (4)

A
  • 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
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39
Q

What is couvade?

A

couvade which is pregnancy s/s in men

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40
Q

What is chorionic villus sampling? When is it done? Pros/Cons?

A
  • 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

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41
Q

What is amniocentesis? When is it done? Pros/Cons?

A
  • 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%

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42
Q

What is percutaneous umbilical blood sampling? When is it done?

A
  • 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

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43
Q

What does a fetal nonstress test do? What is considered a good result?

A
  • 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

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44
Q

What is a CST test for? When would is be used during in pregnancy?

A

Contraction Stress Test: records FHR in response to uterine contractions

-used when NST findings are nonreactive

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45
Q

What score is considered normal for biophysical profiling? Abnormal?

A
  • 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
Q

How many calories extra do pregnant women need per day?

A

300 calories/day EXTRA

47
Q

Pregnant women need how much protein per day at minimum?

A

25g/day

48
Q

How much omega-3 fatty acids should pregnant women have?

A

200-300mg/day

49
Q

How much folic acid should pregnant women have daily?

A

600mcg

50
Q

Where can folic acid be found in food?

A
  • dark leafy greens (asparagus, spinach)
  • legumes (beans and peas)
  • orange juice
  • fortified cereals
  • pasta
51
Q

Where can iron be found in food?

A

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
Q

How much iron do pregnant women need?

A

27mg/day

53
Q

Why do pregnant women need fiber? Where can they get it?

A
  • constipation from the enlarged uterus and increased intake of iron
  • can be found in dark leafy greens, prunes, metamucil
54
Q

How much calcium should pregnant women get in per day? What should lactose intolerant women do?

A

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
Q

What is the limit for pregnant women of caffeine?

A

200mg/day (1-1.5 cups of coffee a day)

56
Q

What are forbidden foods during pregnancy?

A
  • alcohol/marijuana
  • fish
  • saccharin (sweetener)
  • cold cuts
  • raw eggs, undercooked chicken, sushi
  • unpasteurized cheese or milk
  • weight loss pills or supplements
57
Q

What is the correct needle gauge, length, and angle of injection for an intradermal injection?

A

Gauge: 25-27 gauge
Length: 5/8-1/2
Angle: 5-15 degrees

58
Q

What is the correct needle gauge, length, and angle of injection for a subcutaneous injection?

A

Gauge: 25-27 gauge
Length: 3/8-5/8
Angle: 45-90

59
Q

What is the correct needle gauge, length, and angle of injection for a subcutaneous INSULIN injection?

A

Gauge: 28-31
Length: 5/16-1/2
Angle: 45-90

60
Q

What is the correct needle gauge, length, and angle of injection for a intramuscular injection?

A

Gauge: 18-25
Length: 5/8-1 1/2
Angle: 90

61
Q

What do rhonchi sound like?

A

-low-pitched snoring throughout respiration, may clear after coughing (nose/pharynx obstruction)

62
Q

What does stridor sound like?

A

-high pitched on inspiration

63
Q

What does wheezing sound like?

A

-high-pitched whistle heard throughout respiration (constriction in lower trachea/bronchioles)

64
Q

What do crackles/rales sound like?

A

-fine crackling heard on inspiration (alveoli are filled with fluid)

65
Q

What vaccines are given at birth?

A

-Hep B

66
Q

What vaccines are given at 2 months?

A
  • Hep B
  • DTaP
  • IPV
  • PCV
  • RV
  • Hib
67
Q

What vaccines are given at 4 months?

A
  • DTaP
  • IPV
  • PCV
  • RV
  • Hib
68
Q

What vaccines are given at 6 months?

A
  • Hep B
  • DTaP
  • IPV
  • PCV
  • RV
  • Hib
69
Q

What vaccines are given at 1 year?

A
  • DTaP (at 15-18 mos)
  • PCV
  • Hib
  • MMR
  • Varicella
  • Hep A (2nd dose 6-18mos later)
70
Q

What vaccines are given at 3-6 years?

A
  • DTaP
  • IPV
  • MMR
  • Varicella
71
Q

What vaccines are given at 11-12 years?

A
  • TDaP
  • HPV
  • meningococcal
72
Q

When does the anterior fontanel close? Posterior?

A

Posterior: closes by 2-3 months
Anterior: closes by 12-18 months

73
Q

When do we expect erect head posture?

A

at 4 months of age

74
Q

How should an infant gain weight in their first year?

A
  • by 6 months they should have doubled their brith weight

- by 12 months they should triple their birth weight

75
Q

What stage of psychosocial development do infants go through from birth to 1 year?

A

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
Q

What stage of psychosocial development do toddlers go through from 1-3 years?

A

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
Q

What stage of psychosocial development do preschoolers go through from 3-6 years?

A

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
Q

What stage of psychosocial development do school-age children go through from 6-12 years?

A

Erikson
industry vs. inferiority
-industry develops when kids learn the pleasure of applying themselves
-inferiority develops if they feel inferior

79
Q

What stage of psychosocial development do adolescents go through from 12-18 years?

A

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
Q

What URI presents with low fever, sneezing, rhinitis, cough, vomiting, and diarrhea?

A

Nasopharyngitis (common cold)

81
Q

How should we treat the child with nasopharyngitis?

A
  • tylenol/ibuprofen
  • nasal spray
  • bulb syringe for secretions
  • elevate the HOB
  • encourage fluid
  • rest
82
Q

What URI presents with low fever, rhinitis, cough, diarrhea, and pain when laying down?

A

Otitis Media (middle ear infection)

83
Q

How should we treat the child with otitis media?

A
  • spontaneous resolution may happen in 72 hrs
  • antibiotics (amox oral or IM for noncompliant parents)
  • tympanostomy tube placement (chronic)
84
Q

What URI presents with high fever, drooling, apnea, mouth-breathing, and red enlarged tissue?

A

Tonsillitis

85
Q

How should we treat the child with tonsillitis?

A
  • antipyretic
  • analgesic
  • antibiotics (PCN/amox)
  • tonsillectomy (not very common d/t risks)
86
Q

What URI presents with red throat, dry cough, rhinitis, and red eyes?

A

Strep Throat (viral)

87
Q

How should we treat the child with a case of viral strep throat?

A
  • tylenol/ibuprofen
  • rest
  • fluids
  • warm salt water gargle
88
Q

What URI presents with fever, headache, enlarged tonsils, painful swallowing, white exudate, strawberry tongue, vomiting, and rash?

A

Strep Throat (bacterial)

89
Q

How should we treat the child with bacterial strep throat?

A
  • antibiotics (penicillin)

* *they will not be contagious after 24 hours of abx

90
Q

What URI presents with inspiratory stridor, barking cough, retractions, and hypoxemia?

A

Laryngotracheobronchitis (Croup)

91
Q

How should we treat the child with croup?

A
  • steamy bathroom OR cool nighttime air will alleviate

- dexamethasone (corticosteroids)

92
Q

What URI presents with inspiratory stridor, high fever (sudden onset), sore throat, hoarseness, protruding tongue, drooling, tripod position, and an absence of cough?

A

Epiglottitis

93
Q

How do we treat a child with epiglottitis?

A
  • *NEVER TRY TO VISUALIZE THE EPIGLOTTIS**
  • moist air, oxygen
  • racemic epinephrine
  • tracheostomy
  • intubation
94
Q

What LRI presents with low fever, lots of mucus, retractions, nasal flaring, tachypnea, and low O2 sat?

A

Bronchioloitis

95
Q

How should we treat the child with bronchiolitis?

A
  • bulb suction
  • HOB elevated
  • small, freq meals
  • nasal saline drops
  • antipyretics
  • hydration
  • humidified O2
  • droplet precautions
96
Q

What LRI presents with low fever, a cough that can’t be suppressed, runny nose?

A

Pertussis “whooping cough”

**“the 100 days cough” bc it takes so long to resolve

97
Q

How should we treat the child with pertussis?

A
  • antibiotics (erythromycin/azithromycin)

- make sure the family gets tested too, its highly contagious

98
Q

What should you do if you are listening to a child’s lungs who is having an asthma attack and the wheezing stops?

A

!! this may mean they are in respiratory failure !!

  • keep the child calm
  • give O2 humidified 90-100%
  • IV steroids
  • hydration
99
Q

How can we diagnose cystic fibrosis?

A
  • sweat test (>60 mmol/L is positive)

- infants will not pass the meconium ileus in the first 24 hours

100
Q

What are the treatments for cystic fibrosis?

A

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
Q

What things can mothers do to help prevent SIDS?

A
  • 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
Q

What are the signs of true labor?

A
  • contractions get stronger, longer, and do not go away
  • progressive cervical changes
  • bloody show
103
Q

What are the signs of false labor?

A
  • irregular contraction
  • no cervical changes
  • contractions do not increase in intensity
  • hydration/sedation slows/stops contractions
104
Q

What is the baby’s “station”?

A

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
Q

What is the concern if the baby’s station is negative and the membranes rupture?

A

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
Q

How can we describe contractions?

A

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
Q

What is the most common type of pelvis (best for giving birth)?

A

gynecoid

108
Q

What is the best position of the baby for vaginal birth?

A

cephalic (vertex) LOA

109
Q

How long are contractions during early labor? Active? Transition?

A

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
Q

What are the medications we can give the mother for pain during labor?

A
  • 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
Q

What kinds of anesthesia could be given during labor?

A

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

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