Exam 1 - OB Flashcards
1
Q
how do you use naegele’s rule to determine due date?
A
date of LMP
+ 7 days
- 3 months
(adjust for year if needed)
2
Q
what is GTPAL? describe each component
A
Gravida: # pregnancies (including current)
Term: # pregnancies 38 weeks or more
Preterm: # pregnancies after 20 weeks, but before 38 weeks
Abortion: # pregnancy losses before 20 weeks (spontaneous or therapeutic)
Living children
3
Q
what is GP?
A
Gravida: # pregnancies including current)
Para: # times carried past 20 weeks + AND delivered
4
Q
Fundal height measurement
A
measuring fetal growth in cm. from symphysis pubis to fundus. cm will usually match gestational week (+/- 2 weeks)
5
Q
re: fundal height, where would 12 weeks measure?
A
pubic bone
6
Q
re: fundal height, where would 20 weeks measure?
A
umbilicus (halfway up stomach = halfway through pregnancy)
7
Q
re: fundal height, where would 36 weeks measure?
A
around xiphoid process
8
Q
Presumptive signs of pregnancy (7)
A
things the pregnant person FEELS (subjective)
- amenorrhea
- N/V
- breast changes
- uterine growth
- quickening
- urinary frequency
- fatigue
9
Q
what is quickening?
A
“fluttering” sensation - when pregnant person feels fetal movement
10
Q
when does quickening occur for multigravida + primagravida?
A
multi: earlier - 16 weeks
prima: later - 18-20 weeks
11
Q
what are probable signs of pregnancy? (8)
A
things the examiner finds that makes them suspect pregnancy
- braxton hicks
- abdominal enlargement
- chadwick’s sign
- hegar’s sign
- goodell’s sign
- ballottement
- pregnancy test
- hyperpigmentation
12
Q
what is chadwick’s sign?
A
blue-ish color of cervix
13
Q
what is hegar’s sign?
A
softening of lower uterus
14
Q
what is goodell’s sign?
A
softening of tip of cervix
15
Q
what is ballotement?
A
fetal rebound when tapped with finger
16
Q
what are the positive signs of pregnancy?
A
signs that can only be explained by pregnancy
- fetal movement
- fetal heart sounds
- palpation of fetus
- visualization of fetus (US)
17
Q
name some CV changes in pregnancy (4)
A
- increased BP + CO
- increased HR (10-15 bpm)
- supine hypotension
- orthostatic hypotension
18
Q
name some lab changes in pregnancy (CBC) - (4)
A
- increased RBCs
- increased WBCs
- decreased H+H (b/c of increased plasma volume)
- normal platelets
19
Q
what is supine hypotension in pregnancy related to? and what can we do for this?
A
pressure on vena cava b/c of fetus → tingling, dizziness, pain → lay on side or wedge hip
20
Q
the orthostatic hypotension experienced in pregnancy is because of what?
A
progesterone
21
Q
if a pregnant person had iron deficiency anemia (Hgb <11 / Hct <33%), what could we do for them?
A
give iron supps (w/vit C or citrus juice for maximum absorption)
22
Q
name some respiratory changes in pregnancy? (6)
A
- O2 demands increase
- RR increases
- chest expands b/c of shifting organs + growing uterus/fetus
- dyspnea
- nasal + sinus congestion
- epistaxis
23
Q
what kind of breathing would you often see in pregnancy b/c of increased pressure on the diaphragm?
A
chest breathing
24
Q
with nasal + sinus decongestion and nose bleeds, what should pregnant people avoid + what is safe to use?
A
avoid nasal sprays + pharmaceutical decongestants
can use: saline + humidity
25
name some GI changes in pregnancy? (8)
1. increased salivation
2. bleeding gums
3. heartburn
4. N/V
5. gallstones
6. constipation
7. hemorrhoids
8. flatulence
26
name some ways we can we mitigate N/V in pregnancy (5)
1. small frequent meals
2. crackers or toast before getting out of bed
3. limit liquids during meals
4. ginger ale + lemon bevs
5. hard candies
27
what interventions can we use for constipation in pregnancy?
fiber + fluids
28
what interventions can we use for increased salivation/bitter taste in mouth in pregnancy?
hard candies. avoid starchy foods.
29
what interventions can we use for bleeding gums in pregnancy?
soft toothbrush. oral hygiene. avoid irritating foods. adequate nutrition.
30
what interventions can we use for flatulence in pregnancy?
avoid spicy + gas-producing foods. have small meals
31
what interventions can we use for heartburn in pregnancy?
avoid spicy foods. sit up after eating. don't eat right before bed. have small frequent meals.
32
what interventions can we use for hemorrhoids in pregnancy?
sitz bath. witch hazel.
33
name some integumentary changes in pregnancy (8)
1. hyperpigmentation (nipples, areola, vulva)
2. chloasma
3. stretch marks
4. linea nigra
5. dry + itchy skin
6. angiomas
7. acne
8. thickened hair
34
integumentary changes in pregnancy are r/t what?
1. hormonal changes
| 2. stretching of the skin
35
name some MS changes in pregnancy (6)
1. low back pain
2. lordosis
3. increased mobility of pelvic joints
4. difficulty walking
5. leg cramps
6. separation of abdominal muscles
36
interventions for all MS changes in pregnancy (6)
1. good posture
2. correct lifting
3. support belts
4. firm mattress
5. supportive shoes
6. exercise + movement
37
name some urinary changes in pregnancy (4)
1. increased urinary frequency
2. UTI risk
3. yeast infection risk
4. increased GFR
38
what interventions can we do for urinary changes in pregnancy (r/t urinary frequency)?
kegel exercises + perineal pads
39
interventions for UTI + yeast infection risk in pregnancy (6)
1. pee after sex
2. avoid baths (shitty advice)
3. clean cotton undies
4. wipe front to back
5. pee when you gotta go
6. get proper fluids
40
what hormones INCREASE during pregnancy? (4)
1. estrogen
2. progesterone
3. hCG
4. hPL
+
prostaglandins (hormone-like)
41
the _______ acts as an endocrine organ in pregnacy + produces lage amts of ________
placenta
hormones
42
progesterone in pregnancy is responsible for what? (2)
***KNOW***
1. maintaining the pregnancy
| 2. relaxing the smooth muscle (vascular relaxation)
43
estrogen in pregnnacy is responsible for what? (2)
1. uterine development
| 2. f+e balance
44
Human placental lactogen is responsible for what in pregnancy?
maternal metabolism
45
prostaglandins are responsible for what in pregnancy?
initiating labor
46
during pregnancy, there's a decrease in which hormone?
FSH
47
there's an increased need for ______ during pregnancy, which in turns calls for an increased need for what?
glucose
insulin
48
name some neuro changes in pregnancy (3)
1. syncope
2. carpal tunnel
3. fatigue
49
name some reproductive changes in pregnancy
1. breast changes
2. uterine enlargement
3. cervical + vaginal changes
50
out of these vaccines, which are OK to have during pregnancy?
- varciella
- influenza intranasal
- influenza
- rubella
- tdap
influenza, tdap
(NO LIVE VIRUSES)
(wait 1 month after pregnancy to get vaccines, according to ATI)
51
what is expected total weight gain during pregnancy (for single bebe) for person of avg weight?
25-35 lbs
52
what is expected weight gain for person of avg weight in 1st trimester?
2.2-4.4 lbs total
53
what is expected weight gain for person of avg weight in 2nd and 3rd trimester?
1 lb/week
54
what is expected total weight gain during pregnancy for person that's underweight?
28-40 lbs
55
what is expected total weight gain during pregnancy for person that is overweight?
15-25 lbs
56
how many extra calories/day is adequate pregnancy nutrition?
350-450
57
what is the most critical time in embryonic development? why?
first 8 weeks - b/c organogenesis
58
embryo definition according to time frame
implantation → 8 weeks gestation
59
fetus definition according to time frame
week 9 → birth
60
what is the purpose of the placenta? (3 things)
1. prevent mixing of fetal + maternal blood
2. gas exchanged
3. hormone production
61
3 main structures to support fetal development
1. placenta
2. amniotic sac + fluid
3. umbilical cord
62
what is purpose of amniotic sac + fluid (4)
1. hold + cushion fetus
2. allow for movement
3. MS development
4. maintain thermal environment
63
what is polyhydramnios? oligohydramnios?
poly: excess amniotic fluid
oligo: too little amniotic fluid
64
the umbilical cord contains how many arteries and how many veins?
2 arteries
1 vein
"AVA"
65
with the umbilical cord, the arteries carry ______ blood, while the veins carry _______ blood.
arteries: deoxygenated
veins: oxygenated
**opposite of usual**
66
re: fetal circulation, what are shunts for?
to bypass lungs + liver b/c not fully developed
67
when do shunts close?
@ birth
68
re: fetal circulation, this is the name of the shunt that connects umbilical vein to inferior vena cava (bypasses liver)
Ductus venosus
69
re: fetal circulation, this one is the opening in the septum of heart between R and L atria
foramen ovale
70
re: fetal circulation, this is the name of the shunt between pulmonary artery + descending aorta (bypass lungs)
Ductus arterosus
71
when should 1st prenatal appt occur?
within 1st 12 weeks
72
what are the components of ongoing monitoring with prenatal appts?
```
VS (pregnant person + fetus)
fundal height
weight
fetal movement
urinalysis
```
73
re: prenatal care, when does group B strep screening happen?
35-37 weeks (3rd trimester)
74
you're smart and would be able to identify these on an exam or in real life, so memorized lists aren't needed, but here's some prenatal assessment pieces if you want... ◡̈
Physical assessment, weight, vitals, pelvic exam, labs, OB hx (contraceptives, complications), nutrition, family, meds, psychosocial, feelings around pregnancy, environmental exposures/hazards, work conditions, exercise, lifestyle, social support, substance use, abuse hx or risk
75
what things should a pregnant person avoid?
saunas, hot tubs, ETOH, smoking, OTC meds, substances, teratogens
76
what kinds of feelings are common with pregnant people in 1st trimester?
ambivalence
77
what kinds of feelings are common with pregnant people in 2nd trimester?
body image issues + nesting
78
what kinds of feelings are common with pregnant people in 3rd trimester?
over being preggo but excited for bebe
79
re: hormones, what is happening during the follicular phase?
estrogen, FSH + LH increasing
80
estrogen peaks during which phase of the menstrual cycle?
ovulation
81
ovulation happens at what day of menstrual cycle?
day 14
82
right after ovulation, the empty follicle turns into what?
corpus luteum
83
re: hormones, what is happening during the luteal phase?
estrogen decreases
| progesterone increases
84
re: menstrual cycle, if pregnancy occurs, what will release progesterone + estrogen until the placenta is formed
corpus luteum
85
what is the term for abnormal implantation of placenta?
placenta previa
86
when does bleeding usually begin with placenta previa?
after 24 weeks
87
what are the s+s of placenta previa? (3)
1. Painless bright red bleeding
2. Relaxed, soft uterus, nontender
3. Abnormal fetal positioning
88
are fetal vital signs usually normal or abnormal with placenta previa?
usually normal
89
main intervention for placenta previa
pelvic rest: no vaginal exams, inserts, sex, etc
90
if placenta previa isn't urgent, what interventions occur? (3)
1. Bed rest
2. monitor VS
3. monitor I+O
91
knowing placenta previa can cause premature birth, what interventions should we begin for the fetus?
steroids for fetal lung development
92
what is placental abruption?
premature detachment of placenta from uterus
93
placental abruptions can be various types. what are they?
complete or partial (detachment)
concealed or apparent (bleeding)
94
s+s of placental abruption (use acronym - DETACHED)
```
Dark red bleeding
Extended fundal height
Tender, firm uterus
Abdominal pain
Concealed bleeding
Hard abdomen
Experience DIC
Distressed fetus (Decels)
```
95
SUDDEN, INTENSE, LOCALIZED uterine pain is often associated with which complication in pregnancy?
placental abruption
96
what are some risk factors for placental abruption? (4)
1. HTN
2. trauma
3. multifetal pregnancy
4. substance use
97
what condition is described as HTN after 20 weeks w/ protein in the urine ?
preeclampsia
98
diagnostic BP of preeclampsia (values)
140/90 2x or more, 4 hours apart
99
risk factors for preeclampsia (8)
1. young or old pregnancy (<19 or >40)
2. multifetal pregnancy
3. Primiparity
4. Obesity
5. CKD
6. Chronic HTN
7. Fam hx
8. Other underlying health conditions
100
s+s of preeclampsia (4)
1. elevated BP
2. HA
3. irritability
4. edema
101
severe preeclampsia is associated with damage to what?
organs
102
s+s of severe preeclampsia (11)
1. visual disturbances (blurred vision)
2. BP 160/110
3. pulmonary edema
4. Extensive peripheral edema (dependent - side they’re laying on)
5. elevated liver enzymes
6. epigastric + RUQ pain
7. N/V
9. proteinuria
9. elevated creatinine
10. oliguria
11. hyperreflexia w/ankle clonus (3+ or 4+)
103
what 2 things should we ALWAYS ask in assessment with pre eclamptic patients?
1. do you have a HA, blurred vision or any visual disturbances?
2. do you have any epigastric or RUQ pain?
could be sign of worsening leading to eclampsia :(
104
if someone is in hospital for preeclampsia, what precautions should they be on? what does this include?
seizure precautions:
| suction, O2, airway kit, IV access, padded bed rails, low stimulus
105
if preeclamptic patient is in active seizure, what care do we provide?
```
turn on side
maintain airway
stay with them + keep safe/free of injury
monitor start and stop time
assess fetal HR monitor
administer O2 @ 10L
```
106
re: fetal heart rate, at what rate are we worried that the fetus isn't doing well?
<110
107
re: eclampsia + mag sulfate, which antihypertensive should not be given with mag. why?
NO nifedipine - can cause cardiopulmonary arrest
108
re: eclampsia, which drug class should not be given with asthmatic patients? (b/c of bronchoconstriction)
LOLs / beta blockers
ex: labetolol
109
MOA of mag sulfate. why do we give this drug?
MOA: suppress CNS
use: seizure prevention
110
what s+s should we teach our clients to expect with mag sulfate administration? (5) *think of MOA*
1. hot
2. flushing
3. sedation
4. N/V
5. weakness
111
what baseline measurement should we give before administering mag sulfate?
baseline respiratory status
112
how often should respiratory rate be assessed with mag sulfate administration?
***KNOW***
q 15-30 min
113
how often should neuro assessments happen with mag sulfate administration?
***KNOW***
at least hourly
114
therapeutic level for mag sulfate
4-7
115
toxic level for mag sulfate
>7
116
s+s of mag sulfate toxicity (5)
1. absent DTR
2. respiratory depression
3. bradycardia
4. sudden drop in BP
5. oliguria
117
what antidote can we administer for mag sulfate toxicity?
calcium gluconate
118
what is HELLP syndrome? (think of acronym)
Hemolysis of RBCs --> anemia + jaundice
Elevated Liver enzymes
Low Platelets
119
re: HELLP syndrome, what s+s would go along with elevated liver enzymes?
epigastric pain
| N/V
120
tx for HELLP syndrome
fresh frozen plasma or platelets
121
impaired glucose tolerance that BEGINS during pregnancy
gestational diabetes
122
ideal blood glucose range (pregnant person)
70-110
123
when should the glucose tolerance test occur?
24-28 weeks
124
re: gestational diabetes, describe the 1 hr test 1 hr test:
no prep needed. drink 50g glucose + test 1 hr later
125
re: glucose tolerance test, what's a positive result? and if they get a positive result, what happens next?
**KNOW**
130 or greater
next step: 3 hr test
126
protocols/steps/rules for 3 hr glucose tolerance test (3)
1. fasting
2. avoid caffeine
3. avoid tobacco
127
what is the only antidiabetic med approved for use during pregnancy ?
Glyburide
128
ectopic pregnancy
when fertilized egg implants in site other than uterus (usually fallopian tube)
129
1 s+s of ectopic pregnancy
unilateral stabbing pain in lower abdomen
130
what is sign of ruptured ectopic pregnancy?
cullen's sign (bluish tint around the belly button)
131
what is Hydatidiform mole?
abnormal tumor forming in uterus where placenta should be - excessive tissue growth
132
what is hallmark sign of hydatidiform mole? and 2 others?
1. Hallmark: rapidly growing uterus **
2. High hCG
3. Extreme N/V
133
when is the rh factor relevant in pregnancy?
when pregnant person is rh negative + fetus is rh positive
134
when is rho gam administered?
@ 28 weeks and then within 72 hrs after birth
135
how long should we monitor patient after administration of rho gam?
20 mins to watch for allergic rxn
136
the purpose of this test in pregnancy is to detect antibodies (both maternal + fetal)
coombs test
137
what is indirect coombs test?
testing maternal blood for rh + antibodies
138
what is direct coombs test?
testing fetal blood for maternal antibodies
139
what happens if you get a positive coombs test?
more frequent monitoring
140
what is the term for excessive N/V for prolonged period (beyond 16 weeks)?
hyperemesis gravidarum
141
interventions for hyperemesis gravidarum (5)
1. monitor F+E
2. watch for dehydration: skin turgor, mucous membranes,
3. check I+O
4. monitor weight
5. eat frequent, small meals of bland foods → then transition to soft diet and eventually normal diet
142
WHEN + HOW do we diagnose group B step in pregnant person?
vaginal + rectal culture @ 35-38 weeks
143
tx for group B strep in pregnancy
PCN or ampicillin during labor
