Exam 1 Flashcards
What are the guidelines for pap screening? Discuss the highlights.
-not until 21
-21 to 24 —pap test only every 3 years
-25 to 29 — pap every 3 years alone or
— HPV alone, but pap test is preferred
-30 to 65 — both every 5 years or
— HPV alone every 5 years or
— pap alone every 3 years
65 plus — if last 3 paps were negative no further
screening
— If last 2 HPV screenings were negative no
further screening
— If 2 negative co tests in the last 10 years
no further screening
** must not have a past history of cervical
changes and last screening must be
within 3-5 years depending on the test
used
** past history of cervical changes continue
screening for 20 years after surgery
What are the guidelines for mammograms? Discuss the highlights.
– teach self exam
–mammograms start between 40 to 50
get one done every 1 to 2 years until age 75
Discuss fetal circulation. What is the pathway? What are the key takeaways?
blood comes from the placenta in the vein then leaves the baby through 2 arteries - AVA
blood shunts from the IVC around the liver by way of ductus venosus
blood bypasses lungs in 2 ways
- -foramen ovale
- -ductus arteriosus
What is supine hypotension? How does it present? What is the priority nursing intervention?
it is the baby compressing the inferior vena cava preventing blood return to the heart when mom is supine
it makes mom feel light headed and dizzy
it causes baby to lack o2, shows on the monitor
priority is to get mom off her back
Explain the difference between presumptive, probable and positive signs of pregnancy.
presumptive signs make you think think something could be possible, probable means it is probably true, positive means it is true
What are presumptive signs of pregnancy?
missed period N/V breast tenderness fatigue urine frequency quickening
What are probable signs of pregnancy?
chadwick sign hegar sign - uterus goodell sign - cervix ballotment quickening positive pregnancy test - urine or serum
What are positive signs of pregnancy?
ultrasound visualization
x-ray visualization
fetal heart tones
palpation by an examiner
gravity means?
parity means?
pregnancy
fetus reached viability
G TPAL what are the timelines and rules?
Gravida - how many pregnancies term more than 37 weeks preterm 20 to 37 weeks abortion less than 20 weeks living - how many survived
twins count as one gravita, 2 living
Explain organogenesis. What is it? When is it complete?
It is the timeline of development of organs.
Organogenesis is complete at 8 weeks
1 - 2 weeks - zygote
3 - 8 weeks embryo
9 - term fetus
Develop a list of fetal development milestones, place them in chronological order.
4 weeks heart beats
12 weeks resembles a human
12 weeks all organs and body structures are in place
12 weeks gender is recognizable
16 weeks multipara quickening
20 weeks nulipara quickening
20 weeks vernix and lanugo develop
24 weeks - potentially viable
alveoli sacs develop and lecithin is
present in amniotic fluid
24 weeks - baby can hear
30 -31 weeks - sq fat develops
40 weeks - lanugo and vernix disappear
40 weeks - labia majora well developed, testes
descended
Calculate an EDB based on a LMP of July 6, 2022
Last known menstrual period date minus 3 months plus 7 days, adjust the year if needed (add 1 year)
Draw a timeline of a normal prenatal schedule.
1st visit within 12 weeks
once a month through 28 weeks
then every 2 weeks through
36 weeks every week until delivery
12-16-20-24-28-30-32-34-36-37-38-39-40
Explain fundal height measurement.
measure from the pubic symphysis to the highest part of the uterus, +/-2 cm or 1 fingerbreadth
12 weeks just above pubic bone
20 weeks at umbilicus
36-38 weeks just under the sternum
Explain the initial prenatal visit. What is included in this visit?
Prenatal interview
reason for seeking care current pregnancy history of female reproductive system and childbearing health history nutritional history...contraceptive hx history of meds/herbs family history social, experimental, occupational history mental health screening Hx or risk for partner violence
physical exam
urine, cervical, blood labs
Develop a list of foods that pregnant women should not eat.
Should not eat-
- high mercury fish - tuna, mackerel, swordfish, shark
- undercooked fish, esp. shellfish
- undercooked, raw and processed meats
- raw eggs - sauces, salad dressing, ice creams, icings
- organ meat only once a week
- caffeine keep under 200 mg
- raw sprouts
- unwashed produce
- unpasteurized milk, cheeses, and fruit juices
- alcohol
A woman weighs 70kg and she is 1.5m tall- how much weight should she gain during pregnancy?
BMI = kg/meters squared
wt gain for BMI <18.5 need to gain 28-40 lbs 18.5 - 24.9 need to gain 25-35 lbs 25 -29.9 need to gain 15-25 lbs 30 or more need to gain 11-20 lbs
If you are seeing a vegan, pregnant client, what are some considerations?
They need 4 mg of B12 to synthesize DNA and RBC
also need 1200 mg of calcium and 10mg of vitamin D
What are some key highlights for pregnancy nutrition?
folic acid should be started before pregnancy 400 mcg per day. best sources are animal livers, enriched cooked rice and cereals
Iron supplements starting at week 12 27-30 mg day. Take with vitamin c, avoid foods that decrease iron absorption
3 servings of calcium per day
What are the types of anesthesia used for labor? What about cesarean sections? What are potential complications?
Labor - analgesics and epidural
c-section - epidural or a spinal block
emergency - general anesthesia
complications of an epidural are decreased blood pressure, prolonged labor, increased need for oxytocin, fever, risk for c-section, increased risk for operative delivery, itching, bladder distension,
Insertion risk for epidural vein, subarachnoid space, or spinal HA
What are the different types of pelvis shapes? Which causes the most concern?
gynecoid - female - roundish - lateral
anthropoid - ape - roundish - anterior/posterior
android - male- heart shaped
platypelloid - flat - c-section - most concerning
Discuss important information about rupture of membranes. What are characteristics to assess? What tests determine ROM? Can you walk with ROM? What about tub baths
Assess monitor for fetal heart tones, if variable do a cervical exam to check for cord prolapse
risk for infection if prolonged period before birth may give ABX prophylactically 12 hours after ROM
Nitrazine test - dips into fluid if it turns blue it indicates alkaline fluid and is positive for amniotic fluid
Amnisure test is most reliable
What are the four steps of Leopold’s maneuver? What are you palpating at each step?
- palpate top of fundus- what do you feel? head or butt
- palpate lateral sides - where is the back? left or right
- pinch up on pelvis - is babies head engaged? movable or not
- feel back up the middle - looking for shoulders
Immunizations in pregnancy- which are safe? Which are not? When are they given?
safe - all but ones below, given at 27 to 36 weeks
not safe - varicella, MMR, FLU mist, and oral polio
get a Tdap with every pregnancy…pertussis is whooping cough
Explain the rubella titer and vaccine during pregnancy
Congenital Rubella Syndrome is life threatening to baby if mom gets rubella when pregnant. Titers are checked to see if mom has immunity to rubella. If not she will be vaccinates after baby is born.
What happens to a patient’s blood pressure during pregnancy?
It remains the same then decreases slightly
blood volume increases by 40 -50%
Discuss Rhogam. What is it? Who do we give it to? Why?
This is an immune globulin to prevent antibody formation to Rh + markers.
we give it to moms with Rh- blood having babies likely to have positive Rh factors to prevent the immune response if fetal blood gets loose inside of mom.
Given at 26-30 weeks, within 72 hours of birth, with CVS, amniocentesis, spontaneous or therapeutic abortion, ectopic pregnancy, abdominal trauma, external cephalic version.
Discuss normal hemoglobin and hematocrit levels in pregnancy. What is the reason for the changes?
anemia results due to an increase in plasma volume greater than an increase in RBC
What are the types of anesthesia used for labor? What about cesarean sections? What are potential complications?
Labor - analgesics and epidural
c-section - epidural or a spinal block
emergency - general anesthesia
complications of an epidural are prolonged labor, decreased blood pressure, infection, bleeding, HA,
What lab work is important when thinking about epidurals?
Platelets below 100,000, fibrinogen
pertinent labs to pregnancy 1st exam
platelets, fibrinogen
hgb/hct
antibody screening for Rh factor
rubella titer
urine culture for UTI
hCG - qualitative -yes no
- quantitative- doubles every 48 hours, used to
check viability
wbc - after water breaks, post partumDiscuss important information about rupture of membranes. What are characteristics to assess? What tests determine ROM? Can you walk with ROM? What about tub baths?
color, clarity, yellow, green, odor
amnisure test is the gold standard
no walking or tub baths could cause cord prolapse
