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ob/peds > exam 1 study guide > Flashcards

exam 1 study guide Flashcards

1
Q

what is sexual assault

A
  • does not have to include penetration
  • sexual act that is forced or coerced without concent
  • rape and sexual assaukr are not sexually motivated acts
  • MOTIVATED BY AGE, RAGE, AGGRESSION AND THE MOTIVATION TO DOMINATE ANOTHER HUMAN BEING*
  • more likely to report to the police if the assailant is a stranger than a partner -
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2
Q

Pre-embryonic development process

A
  • fertilization takes place in the fallopian tube
  • union of eggs and ovum forms a zygote ( 46 chromosomes)
  • cleaves division continues to form a MORULA (mass of 16 cells)

INNER CELL = blastocyst = EMBRYO AND AMNION
OUTTER CELL = trophoblast = PLACENTA AND CHORION

CHORION: outter most covwr of the embryo (amnion fluid)

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3
Q

what is the pre-embryonic/ embryonic/ fetal stages

A
  • pre embryonic: fertilization through 2nd week
  • embryonic: end of 2nd week through 8th week
  • fetal stage: end of 8th until birth

MOST CRITICAL TIME: embryonic stage bc during this is when basic structures of major body organs and main external features beguns ti form

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4
Q

how long is the gestation period

A
  • 280 days
  • 10 lunar months
  • 9 calendar months

NORMAL WEEKS: 37 - 42 weeks

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5
Q

what is the naegle’s rule

A

last mentrual period + 7 days - 3 months PLUS 1 year = Estimated Due Date

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6
Q

birth defects

A
  • neural tube defects: 6 weeks
  • cleft lip: 5-6 weeks

HEART DEVELOPS: 3-8 weeks

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7
Q

functions of the placenta

A

PLACENTA TAKES OVER THE FUNCTIONS OF LUNGS, KIDNEYS DURING FETAL LIFE ( as a result, large volumes of oxygens are not need by the fetal )

  • metabolic function of respiration, nutrition, excretion, storage of nutrients
  • makes hormones to contril the physiologic of the mother
  • INDUCES THE MOTHER TO BRING MORE FOOD INTO THE PLACENTA
  • removing waste products from the fetus
  • protection of the fetys from immune attack from the mother
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8
Q

fucntion of Human chorionic gonadotropin ( hCG )

A
  • produced by the placenta during pregnancy
  • preserves the corpeus luteum and it’s progesterone prodcution so that the ENDOMETRIAL lining of the uterus is maintained
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9
Q

function of the human placental lactogen ( hPL ) or human chorionic somatomammotropin ( hCS )

A
  • fetal and maternal metabolism
  • participates the development of maternal breast for lactatin
  • DECREASES MATERNAL INSULIN SENSITIVITY to INCREASE its availability for fetal nutrition
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10
Q

function of the estrogen (estriol)

A
  • stimulates myometrial contractility
  • INCREASES THE STASIS OF BILE SALT ( cholestasis of pregnancy ) = pruitis and icterus
  • causes blood flow to mouth (blood vessel procreation) = gums more friable and increasea risk of gingivitis
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11
Q

function of progesterone ( progestin )

A
  • smooth muscle relaxation
  • causes relaxation of the stomach content. as a result, it causes DECREASE IN MOTILITY AND INCREASE IN ABSORPTION OF MINERALS, NUTRIENTS AND DRUGS = CONSTIPATION
  • maintains endometrium
  • decreases contractility of the uterus
  • stimulates maternal metabolism and breast development
  • provides nourishment for early conception
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12
Q

fucntion of the relaxin hormone

A
  • acts with progesterone to maintain pregnancy
  • causes relaxation of the PELVIC LIGAMENTS
  • softens the CERVIX in preparation for birth
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13
Q

function of the umbilical cord ( A-V-A )

A
  • formed from the amnion
  • originates from a connecting stalk
  • at WEEK 5, stalk is compressed and forms the narrow part of the umbilical cord*

VEINS: oxygen blood to the fetus
ARTERY: deoxygenated to the placenta

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14
Q

function of the Amniotic Fluid ( 700 - 1000mL )

A
  • too low: oligohydramnios
  • too high: hydramnion
  • BARRIER TO INFECTION
  • maintains constant body temperature
  • permits symmetric growth and development
  • cushion from trauma
  • allows umbilical cord to be free of compression
  • promotes fetal movemnt to enhance musculoskeletal development
  • INITIALLY DERIVES FROM THE DIFFUSION FROM MATERNAL BLOOD
  • large part of this fluid is urine so that can be used to judge the fetal renal function
  • fluids from the respiratory and GI tract of the fetus can also enter the amniotic cavity
  • the fetus swallows fluid and fluid flows in and out of fetal lungs

BY 11th week: fluid urine into the fluid increasing its volume

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15
Q

Fetal circulation process ( placenta-baby-placenta )

A

1) the umbilical VEIN carries OXYGENATED blood from placenta to the liver through DUCTUS VENOSUS
2) liver then carries it to the INFERIOR VENA CAVA TO THE RIGHT ATRIUM
3) some of the blood is shunted through the FORAMEN OVALE to the left side of the heart TO THE BRAIN AND UPPER EXTREMITIES
4) rest of the blood travels doen the right ventricle through pulmonary artery
5) small portion of the blood travels to the nonfucntionimg lungs whiles remaining is shunted through the ductus arterious into the AORTA to supply to the rest of the body

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16
Q

3 shunts during fetal life

A
  • DUCTUS VENOSUS: connects umbilical cord to the inferior vena cava
  • DUCTUS ARTERIOUSUS: connects main pulmonary ARTERY TO AORTA
  • FORAMEN OVALE: anatomic opening between the right left atrium

OXYGENATED BLOOD IS SENT TO VITAL BODY AREAS (heart and brain) whiles first shunting it from less important ones (lungs, liver)

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17
Q

pulse rate and blood pressure changes in pregnancy

A
  • pulse rate increases to 10-15 bpm
  • 1st trimester: blood pressure at pre pregnancy levels
  • 2nd trimester: DECREASES 5-10 mm Hg
  • 3rd semester: returns to pre pregnancy levels

MOST WOMEN ENTER PREGNANCY WITH INSUFFICIENT IRON STORES SO THEY NEED EXTRA DEMANDS

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18
Q

blood volume during pregnancy

A

INCREASES 1500 mL
- 40-50% abobe pre preg

  • RBC: increases to transport the additional oxygen required during pregnancy
  • hemoglobin/hematocrit = DECREASES
  • WBC: INCREASES in 2nd to 3rd trimesyer
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19
Q

NEWBORN normal pulse and respiration

A

Pulse: 100-60
respiration: 30-60

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20
Q

infant ( 1-11 months ) pulse and respirations

A

pulse: 100-150
respirations: 25-35

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21
Q

Toddler ( 1-3 years) ) pulse and respirations

A

pulse: 80-130
resporations: 20-30

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22
Q

pre schooler (3-5 years) pulse and respiration

A

pulse: 80-120
reapirations: 20-25

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23
Q

school aged ( 6-10 years ) pulse and resporations

A

pulse: 70-110
respirations: 18-22

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24
Q

adolescent ( 10-16 years ) pulse and respirations

A

pulse: 60-90
respirations: 16-20

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25
Q

what is reyes syndrome ( aspirin )

A

acute illness causinf infliteation of fat in the liver

  • HYPERAMMONE
  • ENCEPHALOPATHY
  • INCREASED INTRACRANIAL PRESSURE ( ICP )
  • damaged haptic mitochondria disrupt the urea cycle with changes AMMONIA to UREA for excretion
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26
Q

what people does reye syndrome normally affects

A

children 2-12 yrs

  • sequence and lenth of time between stages can vary from hours to days
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27
Q

5 stages (risk) of reye syndrome

A
  • viral illness ( ESPECIALLY FLU )

- chicken pox with aspirin or SALICYLATE USE

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28
Q

sign and symptoms of reye syndrome

A

BRIEF RECOVERY

  • intractable vomiting
  • lethargry
  • chnages in mental status
  • INCREASING BP, RESPIRATIONS, PULSE
  • hyperactive reflexes

COMA

  • coma deepens
  • seizures
  • decreases tendon reflexes
  • respiratory failure
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29
Q

diagnosis of reyes syndrome

A

ELEVATED

  • liver enzymes ( WITHOUT sign of jaundice )
  • AST ( asparate amimotransferase )
  • ALT ( alanine amninotransferase )
  • serum ammonia levels
  • PROLONGED PROTHROMBIN TIME
  • liver biopsy SHOWS fat deposits
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30
Q

treatment of reyes syndrome

A
  • supportive care
  • assisted ventilation if comma
  • assesment of ICP
  • glasgow coma scale = score of 7,8 or less = coma
  • IV GLUCOSE FOR HYPOGLYCEMIA

LABS: blood chemistries, electrolytes, pH, PT

    • most important role is parent education. NO ASA (aspirin)
  • if they must be on ASA for medical reasons, educate them about reyes syndrome -
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31
Q

MUMPS (paroitis) ISOLATION

A

Droplet Precaution: continue for 24 hours after start of antibiotic therapy

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32
Q

ISOLATION TYPES

A

BACTERIAL

  • droplet spread precautions
  • comtinue for 24 hours after start of antibiotic therapy

VIRAL

  • contact (enteric) precautions
  • continue for 7 days after onset
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33
Q

complications of mumps (parotiitis)

A
  • sensorineural deafness = PERMANENT
  • epdidyomo-orchitis = usually unilateral to make after puberty = STERILITY

inability to produce or store sperm

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34
Q

Rubeola ( MEASLES ) incubation/ communicability

A

AIRBORNE

INCUBATION: 10-20 days
- communicable/contagious ~ 4 days before the appearance of the rash to 5 days after the appearance of the ras ( CATARRAHAL STAGE )

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35
Q

measles (rubeola) complication

A

encephalitis

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36
Q

sign and symptoms of measles (rubeola)

A

-koplik spots = irregular red spots with tiny bluish white center seen in buccal mucosa OPPOSITE MOLARS ABOUT 2 DAYS BEFORE RASH

  • photophobia
  • full stage: RASH
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37
Q

treatment/enhancement of measles

A

vitamin A

  • DIM LIGHTS IF PHOTOPHOBIA
  • keep eyes clean
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38
Q

varicella (chicken pox) incubation/communicability

A

INCUBATION TIME: 2-3 weeks

communicable/contagious ~ 1 day bedore eruption of lesions to ~ 6 days after first crop of vesicle crust

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39
Q

isolations of varicella (chicken pox)

A
  • strict in hospitals ( airborne + contact )

- HOME: 1 week after onset of disease ( vesicles crusted, dry )

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40
Q

complications of varicella (chicken pox)

A

NO ASPIRIN!!!

  • secondary reyes syndrome
  • reactivated herpes zoster later in life (SHINGLES)
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41
Q

meningitis are caused by

A

DROPLET PRECAUTIONS

  • HIB = haemophilus influenza type B
  • Nesisseria meningitidis (meningococcal)
  • cephalosporin therapy
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42
Q

sign and symptoms of meningitis in older children

A
  • postive brudzinski’s sign = patients hips and knees flexes when neck is flexed (stiff neck)
  • positve kernig sign = when laying flat on back and the knee is being EXTENDED

Resistance, pain, or an inability to extend the knee is indicative of a positive Kernig’s sign.

  • opisthotonos= spasm of the muscles causing backward arching of the head, neck, and spine
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43
Q

other sign and symptoms of meningitis

A
  • papilledema ( edema and inflammation of optic nerce at its point of entrance into the eyeball
  • photophobia
  • nuchal rigidity (cannot flex neck- stiff neck)
  • seizure
  • irritable
  • severe headache
  • high fever
  • behavior changes
  • anorexic
  • meningococcal meningitis
  • septic shock
  • meningococcal rash (petechial)
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44
Q

Lumbar Puncture ( diagnostic of mengitis )

A
  • must be done before antibiotic therapy ( cephalosporin )
  • sterile procedure done in treatment room
  • nurse holds child flexed postion
  • pressure can be measured = CSF PRESSURE ELEVATED
  • keep flat after procedure to prevebt headache
  • band aid to the site
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45
Q

what 3 test tubes should be collected during lumbar punchture

A
  • cell count
  • chemistries
  • gram stain
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46
Q

BACTERIAL CELLS LUMBAR PUNCTURE

A
  • nutrophils and protein INCREASE
  • glucose decrease = bacterial be eating up the glucose
  • CSF is cloudy
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47
Q

VIRAL CELLS LUMBAR PUNCTURE

A
  • lymphocytes INCREASE
  • glucose is NORMAL
  • CSF is clear
  • protein is normal to slight increase

if glucose is normal = CSF is clear

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48
Q

tretament of meningitis

A
  • IV antibioic therapy = 10-14 days
  • HIGH END DOSE = meningitic and MUST CROSS BLOOD BRAIN BARRIER

ANTIBIOTICS USED

  • ampicillin
  • cefotaximine
  • ceftriaxone
  • penincillum G ( pneumococcal or meningococcal )
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49
Q

assement of meningitis

A
  • frontanel
  • head circumference
  • high pitched cry
  • seizures
  • loss of conciousness
  • setting sun sign of eyes
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50
Q

some changes associated with INCREASED ICP

A
  • INCREASED BP
  • DECREASED pulse
  • DECREASE LOC

known as the cushing triad

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51
Q

motor skill of 1 month infant

A

lift head while in prone

52
Q

motor skill in 2 month old infant

A

raises head and chest

53
Q

motor skill in 3 month old infant

A

hold open hands to face

54
Q

motor skill in 4 month old infant

A

rolls prone to supine

55
Q

motor skill in 5 month old infant

A

grasps rattle or toy

56
Q

motor skill in 6 month old infant

A

tripot sit

57
Q

moro reflex

A
  • arm extension and abduction

- spreads arm

58
Q

root reflex

A

search for mouth when the corner of the mouth is stroked or touched

59
Q

suck reflex

A

when you touch the roof of the mouth of the infant and they begin to suck. BREASTFEEDING

60
Q

plantat and palmas grasp reflex

A

when you put a finger in palm and they automatically grasp

- same for the foot

61
Q

asymmetric tonic neck reflex

A

fencing position

62
Q

step reflex

A

when you put them on their feet wnd tehy try to walk

63
Q

babinski reflex

A

hypertension of the feet = normal in kids

abnormal in adults

64
Q

parachute reflex

A

preparijg to carch yourself when youre falling

  • not primitive cus it still happen in adults
65
Q

erikson theory of a newborn/infant

A

TRUST VS MISTRUST

  • creatinf sense of trust with the people around them
  • they develop trust with their caretaker
66
Q

erikson theory of toddler (1-3 years)

A

INDEPENDENCE, autonomy vrs shame
- like to do things on their own and self control

  • always say NO!! even when they mean to say yes. its a very normal and healthy part of development

50 vocabs by 2 years

67
Q

emotional and social development of a toddler

A
  • FOCUS (speartion): seeing themselves as separter from the parent
  • INDIVIDUALIZATION: forming a sense of self and learning
  • EGOCENTRIC: always focus on self
68
Q

erikson theory for preschooler (3-5 yrs)

A

initiative vs guilt

ACCOMPLISHMENT

  • inquisitive, eagered to know everythin
  • ask alot of question
  • feels sense of accomplishnent by succeeding in activities
  • learning new things
  • feeling pride in achievements stimulayes initiative

OVEREXTENDING SELF CAN RESULT IN GUILT
- superego (concious development)

69
Q

erikson theory for school aged ( 6-12 yrs )

A

INDUSTRY VS INFERIORITY

  • developing social skills
  • interested in how things are made

INFERIORITY: occurs with repeated failures with little support or trust from ppl close to the child

70
Q

erikson theory for adolescent ( 13-18 yrs )

A

IDENTITY VS ROLE CONFUSION

  • dveloping their own sense of identity by revisiting previus stages
71
Q

gross motor skills in toddlers

A
  • running
  • climbing
  • jumping
  • pushing or pulling a toy
  • throwing a ball
  • pedaling a tricycle
72
Q

motor skills in infants

A
  • FINE SKILLS (proximal distal) - involves had to hand acorss the chest
  • GROSS (cephalocaudal/head to toe)
73
Q

cardiovascular changes in pregnancy

A
  • cardiac ouput INCREASES (product of stroke and heart rate)

- cardiac HYPERteophy

74
Q

gastrointestinal changes during pregnancy

A
  • saliva is more acidic

- the fetus gets calcium from the maternal stores NOT FROM HER TEETH

75
Q

unchanged respiratory during respiratory

A
  • resporatory rate
  • vital capacity
  • lung capacity
76
Q

increased respiratory changes during pregnancy

A

TIPOB

  • tidal volume
  • inspiratory capacity
  • O2 consumption
  • BMR
  • PH

ALKALOSIS

77
Q

decreased reapiratory chnages during pregnancy

A

PERR

  • PCO2
  • expiratory volume
  • residual volume
  • residual air
78
Q

renal chnages during pregnancy

A
  • renals becomes dialated
  • urethras especiallt the right becomes more elongated, widens and becomes more curved
  • GFR INCREASES
  • BLADDER CAPACITY INCREASES

CREATINE DECREASES!!!!

glucoseurea in 20% of pregnant women

79
Q

musculoskeletal chnages during pregnancy

A
  • calcium changes
  • abdominal wall
  • postural changes
  • due to chnage in center of gravity
  • shoes can make a difference in balance. AVOID BAREFOOT
  • balance issues due to anemia and medications

COUNSEL WOMNE ABOUT SHOES, POSTURE AND GOOD BODY MECHANICS

80
Q

integumentary system changes

A

INCREASES IN

  • skin thickness
  • hair and nails
  • sweat and sebaceous
  • FRAGILITY OF ELASTIC TISSUE = straie stretch marks
  • varicose veins are commin as a result of distention, instability and poor circulation
    = WEAR SUPPORT HOSE

ENCOURAGE IN LEFT LATERAL POSITION

81
Q

GTPAL

A

Gravida
- the number if times the patient has been preggo wherher successfull or not

Term = full term

Para ( pre term)
- births greater than or equal to 20 weeks but less than 37 weeks

Abortion/ miscarriage
- ending before 20 weeks

Living

82
Q

what is spontaneous abortion

A
  • also known as abortion. usually less than 20 weeks.
  • increases with increased mayernal age
    EXACT CAUSES UNKNOWN
  • can be related to genetic abnormalities, maternal medical conditions, infections, drug use

LOSS OF BABY UNDER 20 WEEKS = miscarriage
LOSS OF BABY AFTER 20 WEEKS = stillbirth

83
Q

sign and symptoms of spontaneous abortion

A

80% occurs during the 1st trimester

  • baginal bleeding
  • cramps
  • passinf products of conception
84
Q

managements of spontaneous abortion

A
  • assess maternal bleeding
  • assess cramping
  • assess state of mind

CONTINUED MONITORING
- provide supooet and be aware of grieving process that may occur

85
Q

Rh factor (incompatibility)

A
  • wgen the mother is Rh negative and the father and child is Rh positve
  • DOES NOT HAPPEN WITH FIRST PREGNANCY = it happens in subsequent pregnancies due to formation of antibodies

during pregnancy, a smal amount of blood enters the mothers bloodstream. The mothers body then recognizes the fetus blood as a foreign object and start developing antibodies to the against the childs Rh antigen. AS A RESULT, when mother becomes pregnant again, she pass it on.

86
Q

Rh factor prevention

A

RHOGAM
- given at 26 weeks of gestation within 72 hours hours of dekivery to reduce the possibility

if woman refuses, you need to have another nurse sign off before giving since its a blood product

87
Q

effect of Rh factor incompatibility on children

A
  • heart problems
  • breathing difficulties
  • jaundice
  • anemia (hemolytic)
88
Q

vaccinations to avoid during pregnancy

A

virus vaccinations MMR and Varicella
- avoid during and a month within pregnancy

vaccines to be considered

  • hepatitis
  • influenza (INACTIVATED)
  • tetanus/diphtheria tDap
  • meningococcal
  • rvaies
89
Q

ectopic pregnancy

A
  • any preg in which fertilized ovum implants out the UTERINE
  • can lead to massive hemorrhage, infertility or death
  • EARLY DIAGNOSIS IS DIFFICULT CUS WOMAN IS GEN ASSYMPTOMATIC BEFORE RUPTURE OCCURS
    MED= methotrexate vs surgery
90
Q

hallmark of ectopic pregnancy

A
  • abdominal pain with spotting within 6-8 weeks afer missed period
  • SEEK PARENTAL CARE EARLY TO CONFIRM LOCATION OF PREGNANCY
91
Q

what is gestational trophoblastic

A
  • abnormal olacental development that result in production if fluid filled grapes
  • INCREASED HCP
  • HYPERPROLIFERATION OF TROPHOBLASTIC CELLS
92
Q

two types of gestational trophoblastic

A
  1. hydratidiform mole: no fetal tissue. devlops from empty egg = COMPLETE
    - partial: contains abnormal fetal parts. normal ovum fertilzed by 2 ovum
  2. CHORIOCARCINOMA
93
Q

manifestations/ assessments if gestational trophoblastic

A
  • vaginal bleed ( dark brown like prune juice )
  • anemia
  • nausea/vomiting
  • cramping
  • preeclampsia prior to week 24
  • RAPID GROWTH OF UTERINE
94
Q

placenta previa

A
  • whe the placenta implants over cervical ox or protrude theough it
  • can be partial or completely
  • bleedinf that occurs during last trimesters of pregnancy
  • MORE RISKY IN SUBSEQUENT C SECTIONS
95
Q

placenta previa assessment

A
  • hypertension
  • MULTIPLE GESTATION
  • uterine insult or injury
  • cocaine use
  • previous c section birth
    ADVANCED AGED 35 yrs over
96
Q

placenta abruption

A

medical emergency!!

  • separation of the placenta from the womb wall after 20 weeks of gestation
  • hemorrhage DARK RED
  • HIGHER RISK IN REOCCURRENCE IN SUBSEQUENT PREGNANCY ( between 24 and 26 weeks )
  • mother vital signs can be in normal range even with significant blood loss up to 40% of her blood total volume without showing sign of shock
97
Q

nursing managemnt of gestational trophoblastic

A
  • preoperative preparation
  • rhogan expulsion if Rh negative
  • hCG monitoring
  • prophylactic chemotherapy

AVOID PREGGO IN A YEAR

98
Q

cervical insufficiency

A
  • premature dilation of the cervix
  • assess vaginal discharge
  • assess pelvic presure ans contraction
    AVOID HEAVY LIFTING
99
Q

first priority during hyperemeis gravidarum

A

stop all food intake!!!

  • IV fluids may be required for rehydration

due to the excess loss of fluid causing dehydration, RBC and hematocrit GOES UP

100
Q

what is preeclampsia

A
  • vasospasm and hypofusion
  • PRESENCE OF HYPERTENSION AND PROTEINURIA AND EDEMA

ECLAMPSIA: onset seizure

101
Q

stages of preeclampsia

A

1ST STAGE

  • widespread vasospasm
  • endothelial injury occurs
  • PRESENCE OF SCHISTOCYTES (fragments of an erythrocyte)
  • leading to platelet adherence
  • fibrin deposition

2ND STAGE
- hypertension
- proteinuria
-

102
Q

sign and symptoms of preeclampsia

A
  • systolic BP greater than or equal to 140 mm Hg
  • diastolic BP greater than or equal to 90 mm Hg
  • protein uria
  • pathologic edema ( first starts as weight gain to generalized edema. from ankle to face )
  • muscle twitching
  • abdominal pain
  • seizures and coma
  • blurred vission, headache, irritability

DEEP TENDON REFLEXES may be brisk with clonus = cerebral irritability due to decreased brain circulation and edema

LABS: show liver and renal dysfunctions, coagulopathies

103
Q

management goal for preeclmaptic

A
  • goal is to improve placental blood flow
  • fetal O2
  • prevent seizures and maternal complications

MILD - managed at home with frequent visits from home care nurse

SEVERE: potential for HELLP syndrome

  • most seizures occurs 24 hrs after delivery
  • even though edema us not a cardinal sign, weight should be monitored frequently
104
Q

preeclampsia assessement

A
  • CBC
  • electrolytes
  • BUN creatine
  • liver enzyme
  • check urine for protein
  • DTR and vital signs
  • allert and orientated
105
Q

HELLP syndrome

A

H - hemolysis resulting anemia and jaundice
EL - elevated liver enzyme leading to INCREASED amninotranferase ALT or asportate transaminase AST, epigastric pain, nausea and vomiting
LP - low platelets ( < 100k )

106
Q

treatment of HELLP syndrome

A
  • treat BP
  • control seizures
  • deliver fetus
  • lower BP ( hydralazine or labetol )
  • preventing seizure ( mag sulfate )
  • blood components ( fresh frozen plasma, packed RBC, plateles )
  • deliver baby ASAP (steriods for fetal, lung maturity)
107
Q

gestational diabetes

A
  • impaired tolerance to glucose with firsy oneet recognition during pregnancy
  • obesity, maternal age over 25
  • family history of DM
  • previous delivery of large infant/still born
108
Q

woman with type 1 DM triangle

A
  • fetal surveillance
  • diet ( exercise appropriate)
  • insulin therapy
109
Q

woman with gestational diabetes mellitus

A
  • fetal syndrome
  • sometimes insulin, exercise
  • diet
110
Q

anemia VS hemoglobin, hematocrit and blood plasma during pregnancy

A

pregancy causes decrease in hemoglobin and hematocrit in response to BLOOD PLASMA

BLOOD PLASMA GOES UP,
HEMOGLOBIN AND HEMATOCRIT GOES DOWN but does not indicate decrease in oxygen carrying capacity or true anemia

H/H leves BELOW 11 or hemat less than 35%

  • avoid iron supp with coffee, tea, chocolate and high fiber foods
  • for best absorption, take non supplements between meals and vitamin C, miss a dose, take it ASAP
111
Q

thalassemia

A

group of hereditary anemias in which one or both chains of hemoglobin molecule ( alpha and beta ) is DEFECTIVE - microlytic

SICKLE CELL: hemoglobin S replaces HbA and HbG causing sickling of theRBC
- trauma, hypoxia, infection and cold tem

112
Q

food recommendations for anemia

A
  • meats
  • green leafy
  • veggies
  • legumes
  • dried fruits
  • whole grains
113
Q

chorionic villus Sampling ( CVS )

A

10-13 weeks after LMP

  • invasive procedure where needle stick is push through catheter
  • full bladder is needed for better visualization
  • ultrasound will be done first to locate embryo
  • assess detal heart rate and administer RhoGAM to an insensitized Rh negative after a procedure
  • used to obtain smaple of chorionic villi from the planceta to test for DOWN SYNDROME, CYSTIC FIBROSIS, ENZYME DEFICIENCIES, FETAL GENDER DETERMINATION, SEX LINKED DISORDERS, HEMOPHILIA, SICKLE CELL ANEMIA, TAY SACHS DISEASE

-

114
Q

Nonstress Test ( NST )

A
  • recommended twice weekly after 28 weeks
  • non invasive
  • acceleration of fetak heart in healthy kids
  • HAVE AN EMPTY BLADDER

REACTIVE: presence of two fetal heart rate accelerations

NON REACTIVE: absence of fetal heart acceleration over 40 mins. offer fluid and allow them to use the restroom after

115
Q

Amniocentesis

A
  • 15-20 weeks
  • 2nd trimester
  • obtain amnion fluid to test for CHROMOSOMES ABNORMALITIES
  • early asscoiated with MISCARRIAGE
  • EMPTY BLADDER TO PREVENT CHANCE OF BLOOD PUNCTURE
116
Q

Biophysical Profile ( BPP )

A
  • fetal well being that are sensitive to hypoxia
  • ultrasound monitoring detal movements ( 3 or more limbs mov )
  • fetal tone and fetal breathing
    ULTRASOUND OF AMNIOTIC FLUID VOLUME
  • reduce stillbirth and hypoxia

A SCORE LESS THAN 6 = suspicious

  • do NST test before BPP
117
Q

endocrine system changes during pregnancy

A
  • hCG
  • posterior pituitary gland = oxytocin
  • anterior pituary gland = prolactin
  • ovaries, uterus, placenta = relaxin
118
Q

glucose during pregnancy

A

glucose decreases levels because of heavy fetal demand glucose.

  • the fetus must produce its own insulin in order for glucose to enter its cells
  • mothers glucose drivert across the placenta to embryo hence why mother glucose can be low to the point of HYPOGLYCEMIA
  • INSULIN ( pancreas ), glueoce and other nutrients can enter the placenta but INSULIN DOES NOT!!
  • THE FETUS IS DRAWING AMINO ACIDS AND LIPIDS FROM THE MOTHER WHICH DECREASES THE MOTHERS ABILITY TO SYNTHESIZE GLUCOSE

AMINO ACID & LIPIDS = DECREASE GLUCOSE SYNTHESIS

119
Q

goodells sign

A

indication of pregnancy where cervix and vagina softens

120
Q

hegar’s sign

A

non sensitive indication
- softening of the uterus
- features of the cervix and uterine isthmus
ITS ABSENCE DOES NOT EXCLUDE PREGNANCY

121
Q

chadwicks sign

A
  • early sign of pregnancy
  • INCREASE BLOOD flow to the vagina and cervix around week 4.

tissue becomes purplish-red

122
Q

ballotment sign

A

when the examiner taps inside of the cervix of the baby causing the baby to float upward then sinks back and gentle tap is felt on the finger

123
Q

braxton hicks sign

A

spontaneous, irrugal, painless contraction

124
Q

oligohydramnios

A
  • associates with uteroplacental insufficiency

- rebal abnormalities

125
Q

polyhydramnios

A
  • maternal diabetes
  • neural tube defects
  • malformations of the gastrointestinal tract
    and CNS

ob/peds (4 decks)

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