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NSG412 OB/Peds > Exam 1 - OB > Flashcards

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)

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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

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3
Q

what is GP?

A

Gravida: # pregnancies including current)
Para: # times carried past 20 weeks + AND delivered

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4
Q

Fundal height measurement

A

measuring fetal growth in cm. from symphysis pubis to fundus. cm will usually match gestational week (+/- 2 weeks)

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5
Q

re: fundal height, where would 12 weeks measure?

A

pubic bone

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6
Q

re: fundal height, where would 20 weeks measure?

A

umbilicus (halfway up stomach = halfway through pregnancy)

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7
Q

re: fundal height, where would 36 weeks measure?

A

around xiphoid process

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8
Q

Presumptive signs of pregnancy (7)

A

things the pregnant person FEELS (subjective)

  1. amenorrhea
  2. N/V
  3. breast changes
  4. uterine growth
  5. quickening
  6. urinary frequency
  7. fatigue
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9
Q

what is quickening?

A

“fluttering” sensation - when pregnant person feels fetal movement

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10
Q

when does quickening occur for multigravida + primagravida?

A

multi: earlier - 16 weeks
prima: later - 18-20 weeks

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11
Q

what are probable signs of pregnancy? (8)

A

things the examiner finds that makes them suspect pregnancy

  1. braxton hicks
  2. abdominal enlargement
  3. chadwick’s sign
  4. hegar’s sign
  5. goodell’s sign
  6. ballottement
    • pregnancy test
  8. hyperpigmentation
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12
Q

what is chadwick’s sign?

A

blue-ish color of cervix

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13
Q

what is hegar’s sign?

A

softening of lower uterus

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14
Q

what is goodell’s sign?

A

softening of tip of cervix

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15
Q

what is ballotement?

A

fetal rebound when tapped with finger

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16
Q

what are the positive signs of pregnancy?

A

signs that can only be explained by pregnancy

  1. fetal movement
  2. fetal heart sounds
  3. palpation of fetus
  4. visualization of fetus (US)
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17
Q

name some CV changes in pregnancy (4)

A
  1. increased BP + CO
  2. increased HR (10-15 bpm)
  3. supine hypotension
  4. orthostatic hypotension
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18
Q

name some lab changes in pregnancy (CBC) - (4)

A
  1. increased RBCs
  2. increased WBCs
  3. decreased H+H (b/c of increased plasma volume)
  4. normal platelets
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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

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20
Q

the orthostatic hypotension experienced in pregnancy is because of what?

A

progesterone

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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)

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22
Q

name some respiratory changes in pregnancy? (6)

A
  1. O2 demands increase
  2. RR increases
  3. chest expands b/c of shifting organs + growing uterus/fetus
  4. dyspnea
  5. nasal + sinus congestion
  6. epistaxis
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23
Q

what kind of breathing would you often see in pregnancy b/c of increased pressure on the diaphragm?

A

chest breathing

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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

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25
Q

name some GI changes in pregnancy? (8)

A
  1. increased salivation
  2. bleeding gums
  3. heartburn
  4. N/V
  5. gallstones
  6. constipation
  7. hemorrhoids
  8. flatulence
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26
Q

name some ways we can we mitigate N/V in pregnancy (5)

A
  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
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27
Q

what interventions can we use for constipation in pregnancy?

A

fiber + fluids

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28
Q

what interventions can we use for increased salivation/bitter taste in mouth in pregnancy?

A

hard candies. avoid starchy foods.

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29
Q

what interventions can we use for bleeding gums in pregnancy?

A

soft toothbrush. oral hygiene. avoid irritating foods. adequate nutrition.

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30
Q

what interventions can we use for flatulence in pregnancy?

A

avoid spicy + gas-producing foods. have small meals

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31
Q

what interventions can we use for heartburn in pregnancy?

A

avoid spicy foods. sit up after eating. don’t eat right before bed. have small frequent meals.

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32
Q

what interventions can we use for hemorrhoids in pregnancy?

A

sitz bath. witch hazel.

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33
Q

name some integumentary changes in pregnancy (8)

A
  1. hyperpigmentation (nipples, areola, vulva)
  2. chloasma
  3. stretch marks
  4. linea nigra
  5. dry + itchy skin
  6. angiomas
  7. acne
  8. thickened hair
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34
Q

integumentary changes in pregnancy are r/t what?

A
  1. hormonal changes

2. stretching of the skin

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35
Q

name some MS changes in pregnancy (6)

A
  1. low back pain
  2. lordosis
  3. increased mobility of pelvic joints
  4. difficulty walking
  5. leg cramps
  6. separation of abdominal muscles
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36
Q

interventions for all MS changes in pregnancy (6)

A
  1. good posture
  2. correct lifting
  3. support belts
  4. firm mattress
  5. supportive shoes
  6. exercise + movement
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37
Q

name some urinary changes in pregnancy (4)

A
  1. increased urinary frequency
  2. UTI risk
  3. yeast infection risk
  4. increased GFR
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38
Q

what interventions can we do for urinary changes in pregnancy (r/t urinary frequency)?

A

kegel exercises + perineal pads

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39
Q

interventions for UTI + yeast infection risk in pregnancy (6)

A
  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
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40
Q

what hormones INCREASE during pregnancy? (4)

A
  1. estrogen
  2. progesterone
  3. hCG
  4. hPL

+
prostaglandins (hormone-like)

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41
Q

the _______ acts as an endocrine organ in pregnacy + produces lage amts of ________

A

placenta

hormones

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42
Q

progesterone in pregnancy is responsible for what? (2)

KNOW

A
  1. maintaining the pregnancy

2. relaxing the smooth muscle (vascular relaxation)

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43
Q

estrogen in pregnnacy is responsible for what? (2)

A
  1. uterine development

2. f+e balance

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44
Q

Human placental lactogen is responsible for what in pregnancy?

A

maternal metabolism

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45
Q

prostaglandins are responsible for what in pregnancy?

A

initiating labor

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46
Q

during pregnancy, there’s a decrease in which hormone?

A

FSH

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47
Q

there’s an increased need for ______ during pregnancy, which in turns calls for an increased need for what?

A

glucose

insulin

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48
Q

name some neuro changes in pregnancy (3)

A
  1. syncope
  2. carpal tunnel
  3. fatigue
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49
Q

name some reproductive changes in pregnancy

A
  1. breast changes
  2. uterine enlargement
  3. cervical + vaginal changes
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50
Q

out of these vaccines, which are OK to have during pregnancy?

  • varciella
  • influenza intranasal
  • influenza
  • rubella
  • tdap
A

influenza, tdap

(NO LIVE VIRUSES)

(wait 1 month after pregnancy to get vaccines, according to ATI)

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51
Q

what is expected total weight gain during pregnancy (for single bebe) for person of avg weight?

A

25-35 lbs

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52
Q

what is expected weight gain for person of avg weight in 1st trimester?

A

2.2-4.4 lbs total

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53
Q

what is expected weight gain for person of avg weight in 2nd and 3rd trimester?

A

1 lb/week

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54
Q

what is expected total weight gain during pregnancy for person that’s underweight?

A

28-40 lbs

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55
Q

what is expected total weight gain during pregnancy for person that is overweight?

A

15-25 lbs

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56
Q

how many extra calories/day is adequate pregnancy nutrition?

A

350-450

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57
Q

what is the most critical time in embryonic development? why?

A

first 8 weeks - b/c organogenesis

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58
Q

embryo definition according to time frame

A

implantation → 8 weeks gestation

59
Q

fetus definition according to time frame

A

week 9 → birth

60
Q

what is the purpose of the placenta? (3 things)

A
  1. prevent mixing of fetal + maternal blood
  2. gas exchanged
  3. hormone production
61
Q

3 main structures to support fetal development

A
  1. placenta
  2. amniotic sac + fluid
  3. umbilical cord
62
Q

what is purpose of amniotic sac + fluid (4)

A
  1. hold + cushion fetus
  2. allow for movement
  3. MS development
  4. maintain thermal environment
63
Q

what is polyhydramnios? oligohydramnios?

A

poly: excess amniotic fluid
oligo: too little amniotic fluid

64
Q

the umbilical cord contains how many arteries and how many veins?

A

2 arteries
1 vein

“AVA”

65
Q

with the umbilical cord, the arteries carry ______ blood, while the veins carry _______ blood.

A

arteries: deoxygenated
veins: oxygenated

opposite of usual

66
Q

re: fetal circulation, what are shunts for?

A

to bypass lungs + liver b/c not fully developed

67
Q

when do shunts close?

A

@ birth

68
Q

re: fetal circulation, this is the name of the shunt that connects umbilical vein to inferior vena cava (bypasses liver)

A

Ductus venosus

69
Q

re: fetal circulation, this one is the opening in the septum of heart between R and L atria

A

foramen ovale

70
Q

re: fetal circulation, this is the name of the shunt between pulmonary artery + descending aorta (bypass lungs)

A

Ductus arterosus

71
Q

when should 1st prenatal appt occur?

A

within 1st 12 weeks

72
Q

what are the components of ongoing monitoring with prenatal appts?

A 
VS (pregnant person + fetus)
fundal height
weight 
fetal movement
urinalysis
73
Q

re: prenatal care, when does group B strep screening happen?

A

35-37 weeks (3rd trimester)

74
Q

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… ◡̈

A

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
Q

what things should a pregnant person avoid?

A

saunas, hot tubs, ETOH, smoking, OTC meds, substances, teratogens

76
Q

what kinds of feelings are common with pregnant people in 1st trimester?

A

ambivalence

77
Q

what kinds of feelings are common with pregnant people in 2nd trimester?

A

body image issues + nesting

78
Q

what kinds of feelings are common with pregnant people in 3rd trimester?

A

over being preggo but excited for bebe

79
Q

re: hormones, what is happening during the follicular phase?

A

estrogen, FSH + LH increasing

80
Q

estrogen peaks during which phase of the menstrual cycle?

A

ovulation

81
Q

ovulation happens at what day of menstrual cycle?

A

day 14

82
Q

right after ovulation, the empty follicle turns into what?

A

corpus luteum

83
Q

re: hormones, what is happening during the luteal phase?

A

estrogen decreases

progesterone increases

84
Q

re: menstrual cycle, if pregnancy occurs, what will release progesterone + estrogen until the placenta is formed

A

corpus luteum

85
Q

what is the term for abnormal implantation of placenta?

A

placenta previa

86
Q

when does bleeding usually begin with placenta previa?

A

after 24 weeks

87
Q

what are the s+s of placenta previa? (3)

A
  1. Painless bright red bleeding
  2. Relaxed, soft uterus, nontender
  3. Abnormal fetal positioning
88
Q

are fetal vital signs usually normal or abnormal with placenta previa?

A

usually normal

89
Q

main intervention for placenta previa

A

pelvic rest: no vaginal exams, inserts, sex, etc

90
Q

if placenta previa isn’t urgent, what interventions occur? (3)

A
  1. Bed rest
  2. monitor VS
  3. monitor I+O
91
Q

knowing placenta previa can cause premature birth, what interventions should we begin for the fetus?

A

steroids for fetal lung development

92
Q

what is placental abruption?

A

premature detachment of placenta from uterus

93
Q

placental abruptions can be various types. what are they?

A

complete or partial (detachment)

concealed or apparent (bleeding)

94
Q

s+s of placental abruption (use acronym - DETACHED)

A 
Dark red bleeding 
Extended fundal height
Tender, firm uterus 
Abdominal pain
Concealed bleeding
Hard abdomen
Experience DIC
Distressed fetus (Decels)
95
Q

SUDDEN, INTENSE, LOCALIZED uterine pain is often associated with which complication in pregnancy?

A

placental abruption

96
Q

what are some risk factors for placental abruption? (4)

A
  1. HTN
  2. trauma
  3. multifetal pregnancy
  4. substance use
97
Q

what condition is described as HTN after 20 weeks w/ protein in the urine ?

A

preeclampsia

98
Q

diagnostic BP of preeclampsia (values)

A

140/90 2x or more, 4 hours apart

99
Q

risk factors for preeclampsia (8)

A
  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
Q

s+s of preeclampsia (4)

A
  1. elevated BP
  2. HA
  3. irritability
  4. edema
101
Q

severe preeclampsia is associated with damage to what?

A

organs

102
Q

s+s of severe preeclampsia (11)

A
  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
  8. proteinuria
  9. elevated creatinine
  10. oliguria
  11. hyperreflexia w/ankle clonus (3+ or 4+)
103
Q

what 2 things should we ALWAYS ask in assessment with pre eclamptic patients?

A
  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
Q

if someone is in hospital for preeclampsia, what precautions should they be on? what does this include?

A

seizure precautions:

suction, O2, airway kit, IV access, padded bed rails, low stimulus

105
Q

if preeclamptic patient is in active seizure, what care do we provide?

A 
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
Q

re: fetal heart rate, at what rate are we worried that the fetus isn’t doing well?

A

<110

107
Q

re: eclampsia + mag sulfate, which antihypertensive should not be given with mag. why?

A

NO nifedipine - can cause cardiopulmonary arrest

108
Q

re: eclampsia, which drug class should not be given with asthmatic patients? (b/c of bronchoconstriction)

A

LOLs / beta blockers

ex: labetolol

109
Q

MOA of mag sulfate. why do we give this drug?

A

MOA: suppress CNS

use: seizure prevention

110
Q

what s+s should we teach our clients to expect with mag sulfate administration? (5) think of MOA

A
  1. hot
  2. flushing
  3. sedation
  4. N/V
  5. weakness
111
Q

what baseline measurement should we give before administering mag sulfate?

A

baseline respiratory status

112
Q

how often should respiratory rate be assessed with mag sulfate administration?

KNOW

A

q 15-30 min

113
Q

how often should neuro assessments happen with mag sulfate administration?

KNOW

A

at least hourly

114
Q

therapeutic level for mag sulfate

A

4-7

115
Q

toxic level for mag sulfate

A

> 7

116
Q

s+s of mag sulfate toxicity (5)

A
  1. absent DTR
  2. respiratory depression
  3. bradycardia
  4. sudden drop in BP
  5. oliguria
117
Q

what antidote can we administer for mag sulfate toxicity?

A

calcium gluconate

118
Q

what is HELLP syndrome? (think of acronym)

A

Hemolysis of RBCs –> anemia + jaundice
Elevated Liver enzymes
Low Platelets

119
Q

re: HELLP syndrome, what s+s would go along with elevated liver enzymes?

A

epigastric pain

N/V

120
Q

tx for HELLP syndrome

A

fresh frozen plasma or platelets

121
Q

impaired glucose tolerance that BEGINS during pregnancy

A

gestational diabetes

122
Q

ideal blood glucose range (pregnant person)

A

70-110

123
Q

when should the glucose tolerance test occur?

A

24-28 weeks

124
Q

re: gestational diabetes, describe the 1 hr test 1 hr test:

A

no prep needed. drink 50g glucose + test 1 hr later

125
Q

re: glucose tolerance test, what’s a positive result? and if they get a positive result, what happens next?

KNOW

A

130 or greater

next step: 3 hr test

126
Q

protocols/steps/rules for 3 hr glucose tolerance test (3)

A
  1. fasting
  2. avoid caffeine
  3. avoid tobacco
127
Q

what is the only antidiabetic med approved for use during pregnancy ?

A

Glyburide

128
Q

ectopic pregnancy

A

when fertilized egg implants in site other than uterus (usually fallopian tube)

129
Q

1 s+s of ectopic pregnancy

A

unilateral stabbing pain in lower abdomen

130
Q

what is sign of ruptured ectopic pregnancy?

A

cullen’s sign (bluish tint around the belly button)

131
Q

what is Hydatidiform mole?

A

abnormal tumor forming in uterus where placenta should be - excessive tissue growth

132
Q

what is hallmark sign of hydatidiform mole? and 2 others?

A
  1. Hallmark: rapidly growing uterus **
  2. High hCG
  3. Extreme N/V
133
Q

when is the rh factor relevant in pregnancy?

A

when pregnant person is rh negative + fetus is rh positive

134
Q

when is rho gam administered?

A

@ 28 weeks and then within 72 hrs after birth

135
Q

how long should we monitor patient after administration of rho gam?

A

20 mins to watch for allergic rxn

136
Q

the purpose of this test in pregnancy is to detect antibodies (both maternal + fetal)

A

coombs test

137
Q

what is indirect coombs test?

A

testing maternal blood for rh + antibodies

138
Q

what is direct coombs test?

A

testing fetal blood for maternal antibodies

139
Q

what happens if you get a positive coombs test?

A

more frequent monitoring

140
Q

what is the term for excessive N/V for prolonged period (beyond 16 weeks)?

A

hyperemesis gravidarum

141
Q

interventions for hyperemesis gravidarum (5)

A
  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
Q

WHEN + HOW do we diagnose group B step in pregnant person?

A

vaginal + rectal culture @ 35-38 weeks

143
Q

tx for group B strep in pregnancy

A

PCN or ampicillin during labor

NSG412 OB/Peds (5 decks)

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