Exam 1 Review Concepts Flashcards
No pap screening before age…
21
Age 21-24 USPSTF pap screening
pap test every 3 years
Age 21-24 ACS pap screening
no test
Age 21-24 ACOG pap screening
pap test alone every 3 years
Age 25-29 USPSTF pap screening
pap test every 3 years
Age 25-29 ACS pap screening
HPV every 5 years - preferred
HPV + pap every 5 - acceptable
Pap every 3 years - acceptable
Age 25-29 ACOG pap screening
Pap alone every 3 yrs
HPV alone can be considered but pap preferred
Age 30-65 USPSTF pap screening
Pap every 3
HPV every 5
Or HPV+Pap every 5
Age 30-65 ACS pap screening
HPV every 5 - preferred
HPV+Pap every 5- acceptable
Pap every 3 - acceptable
Age 30-65 ACOG screening
Any of the three:
Pap+HPV every 5
Pap alone every 3
HPV alone every 5
Pap screening over age 65
No screening unless previous abnormal
Pap screening for post-hysterectomy
No screening unless it was done for cervical cancer changes
Age to start mammograms
40-50
When to stop mammograms
Less than 10 years life expectancy
Age 75 or higher
Frequency of mammograms
Annual or biannual
Every 2 years after age 55
Are 3d mammograms beneficial?
Inconclusive or yes, reduces risk for cancer
There is little evidence that self breast exams reduce risk of breast cancer…
IF THE WOMAN IS GETTING MAMMOGRAMS
Pallor, dizziness, breathlessness, tachycardia, nausea, diaphoresis, clammy skin, are all signs of…
supine hypotension or vena cava syndrome
Intervention for supine hypotension
Position woman on her left side (lateral decubitus)
If dental procedure place pillow under 1 hip
Semi-sitting with knees slightly flexed
A woman is at higher risk for supine hypotension if she is…
obese, dehydrated, or hypovolemic, or large uterus
Sign of pregnancy: fatigue
presumptive
Sign of pregnancy: breast tenderness
presumptive
Sign of pregnancy: nausea/vomiting
presumptive
Sign of pregnancy: amenorrhea
presumptive
Sign of pregnancy: urinary frequency
presumptive
Sign of pregnancy: quickening
presumptive
Sign of pregnancy: Goodell sign
probable
Sign of pregnancy: Chadwick’s sign
probable
Sign of pregnancy: Hegar’s sign
probable
Sign of pregnancy: Positive pregnancy test
probable
Sign of pregnancy: Braxton Hicks contractions
probable
Sign of pregnancy: Ballottement
probable
Sign of pregnancy: Quickening
probable
Quickening def
feeling baby move
Goodell sign
softening of cervix, at 6 weeks, increased vascularity and hypertrophy/hyperplasia
Probable signs are
OBJECTIVE by the provider
Chadwick sign
6-8 weeks of pregnancy, bluish color of cervix by increased vascularity
Hegar sign
4-6 weeks, softening of lower uterus (isthmus)
Ballottement
Passive movement of unengaged fetus, press on cervix, 16th-18th week
Sign of pregnancy: ultrasound visualization
positive
Sign of pregnancy: fetal heart tones
positive
Sign of pregnancy: xray visualization
positive
Sign of pregnancy: fetal movements palpated or visualized by examiner
positive
Recommended weight gain: BMI under 18.5
28-40
Recommended weight gain: BMI 18.5-24.9
25-35
Recommended weight gain: BMI 25-29.9
15-25
Recommended weight gain: BMI 30 or greater
11-20
How to calculate bmi
kg/m2 or weight/inches2 * 703
Live vaccines contraindicated:
Varicella
Measles
Poliomyelitis
Recomb Hep B is OK
TDAP (for pertussis) should be administered…
27-36 weeks gestation
If not, then immediately post partum
Friends/fam should be immunized too
Flu vaccine
Offered to all pregnant patients
Intranasal flu vaccine contraindicated
Prenatal appointment schedules
First visit within the first trimester (12 weeks)
Monthly visits weeks 16 through 28
Every 2 weeks from weeks 29 to 36
Weekly visits week 36 to birth
GPTPAL
Gravita - number of pregnancies Para - number of births Term - 37 and above Preterm - Under 37 Abortion - under 20 wks Living - number of living children
late preterm
34-36 6/7
early term
37 - 38 6/7
late term
41 -41 6/7
post term
42 and above
How much folic acid
0.4 mg
How much calcium
1000 mg
How much caffeine
200 mg or less
Limit
artifical sweeteners
Vegan mothers need…
4 mg b12
1200 mg calcium
10 mg vit d
Contraindicated foods in pregnancy
Alcohol Homemade dressings Anything unpasteurized Processed meats Soft cheeses such as brie High mercury fish (shark, swordfish, king, tuna) Raw fish or meat Organ meat Raw eggs Raw sprouts and unwashed produce
White tuna (albacore) no more than…
6 oz a week
27-30 mg recommended at 12 weeks
iron supplement
What is the EDD for LMP July 6, 2022
April 13th, 2023
Vegan pregnant woman considerations
Refer to dietitian, preferably preconception
May need additional DHA
What is fundal height
measurement of the height of the uterus above the symphysis pubis
How to measure fundal height
A disposable paper metric tape measure is preferred for measuring fundal height
The tape can be placed in the middle of the woman’s abdomen and the measurement made from the upper border of the symphysis pubis to the upper border of the fundus, with the tape measure held in contact with the skin for the entire length of the uterus
What should be noted in measuring fundal height
Conditions under which the measurements are taken can also be described in the woman’s records, including whether the bladder was empty and whether the uterus was relaxed or contracted at the time of measurement.
Leopold’s Maneuver: Step 1
Fundal grip: fundus palpated, determine which part feeling, head is hard and breech is nodular mass
Leopold’s Maneuver: Step 2
Umbilical grip: Around sides of belly, level of umbilicus, which side is fetal back?
fetal back is hard convex, and small structures are nodular
Leopold’s Maneuver: Step 3
Pawlick’s grip: Pubic symphysis, thumb and fingers to determine baby presentation
If fetus not engaged a moveable structure can be palpated
Leopold’s Maneuver: Step 4
Pelvic grip: Lower quadrants to determine engagement of fetal presenting part
Fetal development milestone: 4 weeks
Heart begins beating
Fetal development milestone: 12 weeks
Resembles human
Fetal development milestone: 20 weeks
Fetal movements strong enough for mother to feel, vernix caseosa and lanugo appear
Fetal development milestone: 24 weeks
Alveolar ducts and sacs appear, lecithin beings to appear in amniotic fluid, potentially viable, red skin wrinkles, body lean
Fetal development milestone: 30-31 weeks
Subq fat forming, L/S ratio 1.2 : 1
Fetal development milestone: 36-40 weeks
Lanugo and vernix disappear, L/S 2:1, definite sleep wake cycles, testes descended, labia majora well developed
maternal blood pressure remains the same or decreases slightly because…
reduced systemic vascular resistance caused primarily by the vasodilatory effects of progesterone, prostaglandins, and relaxin
Factors that influence maternal BP
age, activity level, presence of health problems, circadian rhythm, alcohol consumption, smoking, anxiety, and pain
Explain rubella titer and vaccine during pregnancy
Measures immunity to rubella
a subcutaneous injection of rubella vaccine is recommended in the postpartum period prior to hospital discharge to prevent the possibility of contracting rubella in future pregnancies
Rubella vaccine considerations
Women are cautioned to avoid becoming pregnant for 28 days after receiving the rubella vaccine because of the potential teratogenic risk to the fetus. The live attenuated rubella virus is not communicable in breast milk; therefore breastfeeding mothers can be vaccinated
What is rhogam and when is it given?
within 72 hours after birth prevents sensitization in the Rh-negative woman who has had a fetomaternal transfusion of Rh-positive fetal red blood cells
or 28 week mark
Why is rhogam given?
Administration of Rh immune globulin is intended to prevent problems in future pregnancies should the Rh-negative woman have an Rh-positive fetus
Normal H&H in pregnancy
Hemoglobin: greater than 11 g/dL
HCT: greater than 33%
Low = anemia
Hemoglobin 1st trimester
11-14
Hemoglobin 2nd trimester
10-13
Hemoglobin 3rd trimester
10-14
HCT 1st trimester
31-41
HCT 1st trimester
30-38
HCT 1st trimester
32-41
When is GBS tested
36 wks
1 hr gtt abn
greater than 140
Explain organogenesis. What is it? When is it complete?
Embryonic stage, day 15-8 weeks, period of organogenesis and the most critical time in the development of the organ systems and the main external features
At the end of the eighth week, all organ systems and external structures are present, and the embryo is unmistakably human
What is included in the initial prenatal visit?
Prenatal interview Reason for seeking care Current pregnancy Childbearing and reproductive system history Health history
What is included in the prenatal interview?
Nutrition Meds/Supp/Herbs Family and social history Substance abuse screening IPV screening
Define an acceleration
visually apparent, abrupt (onset to peak less than 30 seconds) increase in FHR above the baseline rate
The peak is at least 15 beats/min above the baseline, and the acceleration lasts 15 seconds or more, with the return to baseline less than 2 minutes from the beginning of the acceleration. If before 32 weeks, changes to 10
Accelerations are a…
GOOD THING!
Fetal tachycardia
Greater than 160 for 10 mins or longer
What does fetal tachycardia indicate?
Early sign of fetal hypoxemia, especially with minimal or absent variability or late decelerations
Causes of fetal tachycardia
Maternal fever
Maternal infection
Maternal hyperthyroidism
Or in response to drugs such as… Brethine, atropine, cocaine
What is the nursing intervention for fetal tachycardia?
Depends on cause. Notify HCP. Tylenol for fever and o2 at 10L non rebreather face mask
What is fetal bradycardia?
HR less than 110 for 10 mins or longer
Nursing intervention for fetal bradycardia?
Notify HCP
Causes of fetal bradycardia
Fetal heart defects
Fetal viral infection (CMV)
Maternal hypoglycemia
Maternal hyperthermia
Late decelerations and then prolonged bradycardia (minimal variation) might indicate…
Uterine rupture (need emergency C section)
What are the nursing interventions if the nurse suspects uterine rupture?
NOTIFY HCP. Turn to left side, o2 10L NRB face mask, prepare for emergency c section
What are the nursing interventions for prolonged decelerations?
NOTIFY HCP. Turn to left side, o2 10L NRB face mask, prepare for emergency c section
What is a prolonged deceleration?
Greater than 2 mins
What causes absent variability?
CNS depressants Fetal sleep cycle Neuro injury Congenital abnormalities Extreme premature Fetal hypoxemia Fetal metabolic acidosis
Minimal variability
<5 bpm
Moderate variability
6-25 bpm
Marked variability
> 25 bpm
What is the significance of marked variability?
Unclear, may be normal, may be early sign of hypoxemia
What is the only accurate way to determine variability?
Intrauterine monitoring
What causes early decelerations?
Head compression, considered normal
What causes variable decelerations?
Cord compression, not normal
What causes late decelerations?
Placental insufficiency, onset to nadir greater than 30 seconds
Define a variable deceleration
Sharp decline to nadir, less than 30 seconds, with drop of 15 bpm or more, less than 2 mins duration. Not related to contractions
Variable deceleration intervention
Dx pitocin/oxytocin if infusing Repostion side to site or knees to chest O2 10LNRB Notify HCP Vaginal exam for prolapsed cord Amniocentesis may be needed, assist Vacuum or forceps assisted birth, or c section
What is a common cause of variable decelerations?
Baby is a negative station, amniotic fluid drains and allows cord to come with it, then baby comes out pressing on cord
What causes placental insufficiency?
HTN, hypotension, hypovolemia, hemorrhage, severe anemia, uterine hypertonus, DM, infection, IUGR, placental separation
What is uterine hypertonus and what causes it?
Sustained contraction due to excessive pitocin
Late deceleration nursing interventions
Dx Pitocin Side lying position 10L O2 NRB Correct hypotension by elevating legs, increase maintenance fluids Palpate uterus to assess for too fast of contractions Notify HCP Internal monitoring Assist with birth
Active labor normal contraction frequency
2-5 every 10 mins, most frequent in second stage
Active labor normal contraction duration
No longer than 90 seconds
Relaxation time between contractions
60 seconds or more in 1st stage
45 seconds or more in 2nd stage
Normal resting tone
Avg 10 mmhm, should be soft to palpation, never more than 20
When is acoustic sound contraindicated?
decals or bradycardia
Ductus arteriosus shunts blood away from…
liver
When do fetal shunts close
Immediately after birth
What type of vessels are in the umbilical cord?
2 arteries and 1 vein
What is the umbilical cord surrounded by?
Wharton’s Jelly
When does fundal height measurement start?
20 weeks, it should be at the umbilicus at 20 weeks. Measure from symphysis pubis to funds of uterus
What is the fundal height threshold?
Plus or minus two
Multigravita may feel quickening at…
16 weeks
Rubella titer levels
less than 1:8 not immune, greater than 1:10 is immune
What is lightning?
Dropping of baby into the pelvis (process of moving down)
Engagement
at the level is ischial spine
What to assess for ruptured membranes
clear or blood tinged, odor
What tests determine if membranes are actually ruptured
Amnisure, should be positive if ruptured
If membranes are ruptured can mother walk?
Only if the baby is engaged, if still up in the uterus then cord could prolapse
What types of anesthesia are used for labor?
Epidural
Pain meds
Spinal block
What type of anesthesia is used for c sections?
Spinal
What are we concerned about with anesthesia and pregnancy?
CNS depression Prolonged labor Hypotension Bleeding Spinal headaches Bladder distention
What lab work is important for epidural?
Platelets
What do platelets need to be for an epidural?
Over 100,000
Which pelvis shape causes the most concern for delivery and most often results in c section?
Platypelloid
Shapes of pelvis
Platypelloid, gynecoid, arthoropoid, android
Platypelloid shape
short and normal width
gynecoid
round and wide
arthropoid
normal width but long height
Android
heart shaped
True labor
Cervical changes, contractions become longer, and closer together and more intense, starts in lower back to abdomen
False labor
Contractions are irregular, get better with comfort measures, starts upper back stays at naval level
Cardinal movements in order
Even Diana feels insecure every event
Engagement Descent Flexion Internal rotation External rotation Expulsion
