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Maternity > Exam 1 - week 8 > Flashcards

Exam 1 - week 8 Flashcards

1
Q

prenatal care is routinely sought by what types of women?

A

women of middle or high socioeconomic status

• Women in poverty or lacking health insurance may not have access to public or private care

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2
Q

why is it important we test the mother’s blood type and Rh?

A

-we worry if the mother is Rh NEGATIVE bc if the baby is Rh POSITIVE the mothers antibodies could attack the baby’s blood

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3
Q

what is a coombs test?

A

antibody screen (tests whether Rh negative mother has been exposed to Rh POSITIVE antibodies)

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4
Q

If Rh neg mother (who has NOT ever been exposed to Rh pos antiboides) gets pregnant, what drug can be given to prevent formation of Rh positive antibodies?

A

rhogam

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5
Q

Can rhogam be given to Rh negative pregnant women who have already been exposed to Rh positiive antibodies?

A

no

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6
Q

What is the standard protocol for when to give rhogam these days?

A

to Rh negative women, in 28 week of pregnancy, who have NOT yet been exposed to Rh positive antibodiies

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7
Q

what are routine lab tests done for pregnant women?

A

• CBC
• Blood Type, Rh, Antibody Screen
o Sickle cell, HIV, Hep B, syphilis, varicella, GC/Chlamydia, TB, Thalassemia screens
• Rubella Titer
o Pap
o Genetic Panel
o Standard vs. increased based on history

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8
Q

what is the standard visit schedule for a NORMAL pregnancy?

A

o 1st Trimester: monthly
o 2nd Trimester: Q2 to Q3 weeks
o 3rd Trimester: Q 2 weeks
o weekly in the last month

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9
Q

what is “quickening” and when does it usu happen?

A

1st awareness of fetal movement detected by mother: appx 20 wks

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10
Q

what are 3 symptoms we might see that are signs of preterm labor?

A

cramping (important to distinguish preterm contractions from braxton hicks contractions)
pressure
backache

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11
Q

what is the difference between preterm contractions and braxton hicks contractions?

A
  • preterm: feels more like menstral cramping. Usu worsens with activity
  • braxton hicks: cramps are more on the sides moving inwards, usu lessens with walking
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12
Q

four potential tests during pregnancy

A

o Nuchal Translucency Screening
o Chorionic Villus Sampling
o Amniocentesis
o AFP / Quad Screen

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13
Q

what is Nuchal Translucency Screening? Why and how is it done?

A

o To identify risk for Down’s Syndrome
o Sonogram of back of neck at 10-14 wks combined with blood test
o Combined result is 82-87% accurate

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14
Q

When and how is chorionic villus sampling performed?

A

o Transabdominal or transvaginal
o 10-12 wks
-checks for congenital problems (more definitive than nuchal translucency screening)

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15
Q

When and how is amniocentesis performed?

A

o 14+ wks

o chromosome karyotype

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16
Q

What is the Alpha fetoprotein analysis (AFP)/Quad screen prenatal test? when is it done?

A

o looks for neural tube defects
o done at 15-22 wks
 If AFP is increased: risk of NTD, multiple fetuses, oligohydramnios
 Decreased: risk of Down’s, fetal death, increased maternal weight

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17
Q

what is the glucose tolerance test and when is it performed?

A
  • screens for gestational diabetes

- done between 24-28 weeks

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18
Q

When during prenatal testing do we test for fetal structures?

A

18-20 weeks

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19
Q

When are pregnant women typically tested for group B strep?

A

35-57 weeks

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20
Q

What are common discomforts during the 1st trimester?

A 
o	nausea and vomiting
o	urinary frequency
o	fatigue
o	breast tenderness
o	increased vaginal discharge
o	nasal stuffiness and nosebleeds – d/t increased vascularity, increase in hormones
o	ptyalism
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21
Q

what is ptyalism?

A

excessive salivation

-commonly occurs during 1st trimester

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22
Q

Patient teaching for common discomforts of 1st trimester?

A

o for N/V: dry crackers, small frequent meals (high carb and protein); herbal teas; accupressure; 250mg ginger 4x daily
o Rest when tired!
o Cool mist humidifier -helps with dry/stuffy nose
o Pytalism: decreased starch intake and increased astringent (ie mouthwash)

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23
Q

common discomforts during the 2nd trimester?

A 
o	Heartburn
o	Ankle edema
o	Varicose veins
o	Hemorrhoids
o	Backache
24
Q

what is a hemorrhoid?

A

Swollen and inflamed veins in the rectum and anus that cause discomfort and bleeding.

25
Q

common discomforts during 3rd trimester?

A 
o	Constipation
o	Backache
o	Leg cramps
o	Faintness
o	Dyspnea
o	Carpal tunnel syndrome
o	Braxton-Hicks contractions
26
Q

what is carpal tunnel syndrome

A

A numbness and tingling in the hand and arm caused by a pinched nerve in the wrist.

27
Q

Pt teaching/management of symptoms in 2nd and 3rd trimester?

A 
o	supportive shoes / stockings
o	back support / good posture / body mechanics
o	exercise / dorsiflexion of foot
o	diet modification
o	Tums 
o	stool softener
o	avoid supine positioning if possible
o	monitor for preterm labor
28
Q

Warning signs (tell your DOC!) during pregnancy

A

o Gush of fluid from vagina (rupture of membranes)
o Vaginal bleeding
o Abdominal pain
o Fever (infection)
o Dizziness, blurred vision, spots before eyes – could indicate HTN/pre-ecclampsia
o Persistent headache
o Persistent vomiting
o Edema: facial (Dependent edema is OK but we worry about facial edema)
o Significant weight gain (2 Kg 1 week)
o Muscular irritability or convulsions
o Epigastric pain- (can be a late sign of pre-ecclampsia, happens d/t liver enlargement)
o Oliguria or dysuria-bladder infection
o Absence of fetal movement

29
Q

what are some risks associated with LBW and VLBW babies?

A

o Neonatal death rates for moderate LBW are five times higher than babies >2500 g
o The risk for VLBW is 100 times higher

30
Q

how much folic acid is recommended for pregnant women?

A

400mcg/day

31
Q

normal weight gain pattern for pregnancy?

A

25-35 lbs total

32
Q

how much weight gain is normal in 1st trimester?

A

1-4.4lbs (0.5-2kg)

33
Q

What’s the average gain per week during the last two trimesters

A

of 0.45 kg (1 lb) per week

34
Q

how much water should a woman be drinking during pregnancy?

A

8-10 glasses/day

35
Q

what are the 5 fishes with higher-than-normal mercury levels to avoid during pregnancy?

A

Tilefish, shark, swordfish, mackerel, tuna

36
Q

what should we advise to pregnant women who have cats?

A

change cat litter often d/t risk of toxosplasmosis

37
Q

Normal hematocrit range

A

Male: 38.8-50 percent
Female: 34.9-44.5 percent

38
Q

normal hemoglobin

A

Male: 13.5-17.5 grams/dL***
(135-175 grams/L)
Female: 12-15.5 grams/dL
(120-155 grams/L)

39
Q

the glucose challenge test is performed at or after 24 weeks gestation to assess for the maternal physiological response to which pregnancy hormone?

a. estrogen
b. progesterone
c. human placental lactogen
d. human chorionic gonadotropin

A

c. human placental lactogen (HPL) - bc hpl is an insulin antagonist

40
Q

why is there such a high increase in blood volume during pregnancy?

A

in order to adequately perfuse the placenta

41
Q

nursing education for a pt with ptyalism?

A
  • decreased starch intake and increased astringent (ie mouthwash)
  • encourage woman to brush her teeth carefully
  • women with ptyalism are also more susceptible to gingivitis, N/V
42
Q

why does ptyalism occur during pregnancy?

A

-Ptyalism is r/t the increase in vascular congestion of mucous membranes from increased estrogen production

43
Q

which of the following foods could be recommended to a pregnant woman suffering from constipation?

a. bananas
b. rice
c. yogurt
d. celery

A

celery (high in fiber)

44
Q

what foods (other than dairy products) have high amts of calcium?

A

-turnip greens, dark leafy vegetables (spinach, kale, collards), small fish (sardines)

45
Q

Food high in folic acid?

A
  • liver and green leafy veggies (best source)

- oranges and orange juice (also good)

46
Q

Iron is highest in which foods

A

-animal products (seafood, meats, eggs) [but NOT MILK)

47
Q

Foods that are high in vitamin C are:

A
  • citrus fruits
  • strawberries, blueberries, kiwis
  • potatoes
  • zucchini
  • green peas, lentils
  • green beans
48
Q

what is considered the lifeline between mother and embryo?

A

umbilical cord

49
Q

at full term, how long is the average umbilical cord?

A

22 inches

50
Q

where does the placenta most commonly develop?

A

at top of uterus (fundus)

51
Q

when is the structure of the placenta usually completed?

A

12 weeks

52
Q

What hormones are produced by the placenta?

A
  • HCG
  • human placental lactogen (HPL)
  • estrogen
  • progesterone
  • relaxin
53
Q

Function of hPL (human placental lactogen)

A

modulates fetal and maternal metabolism

  • participates in development of maternal breast for lactation
  • decreases maternal glucose utilization (to increase glucose availability to the fetus)
54
Q

Function of relaxin hormone

A

acts synergistically with progesterone to maintain pregnancy

  • causes relaxation of pelvic ligaments
  • softens cervix in prep for birth
55
Q

Function of the placenta?

A 
-protects the fetus from immune attack
by the mother, 
-removes waste products from the
fetus, 
-induces the mother to bring more food to the placenta
-produces hormones
56
Q

what is the purpose of fetal circulation?

A

to carry highly oxygenated blood to vital organs (heart/brain) while first shunting it away from less vital ones (lung/liver)

Maternity (6 decks)

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