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NSG 322 Med Surge I > Exam 2 OB > Flashcards

Exam 2 OB Flashcards

1
Q

what do you need to know to determine estimated date of birth?

A

need to know LMP

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2
Q

if mom doesn’t know first day of LMP, how is EDB estimated?

A
  • uterine size
  • auscultating fetal HR ~ 12-14 weeks
  • US is most accurate
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3
Q

nagele’s rule

A

begin with first day of LMP, subtract 3 months, add 7 days

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4
Q

1st trimester typical emotional responses

A
  • disbelief
  • ambbivalence
  • baby doesn’t seem real
  • focus is on herself and her symptoms and may feel hostility toward pregnancy and unborn child
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5
Q

2nd semester emotional responses

A
  • quickening occurs and mom starts to think of baby as a separate person
  • feel more excited
  • feel best physically
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6
Q

3rd trimester emotional responses

A
  • pride
  • anxious about labor and birth
  • eager for pregnancy to end
  • concerned about health and safety of herself and baby
  • begins “nest-building”
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7
Q

Couvade syndrome

A

some men experience pregnancy-like symptoms (N/V, backaches) and this is a healthy response and signifies acceptance

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8
Q

how often are prenatal visits done?

A

once a month until week 28 then every 2 weeks, then weekley

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9
Q

2 categories of pregnancy at risk

A
  • pre-existing conditions
  • gestational onset
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10
Q

what can pregnancy at risk lead to?

A
  • complication for fetus
  • uteroplacental insufficiency (UPI)
  • decreased oxygenation and nutrients to fetus
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11
Q

what happens with BP during pregnancy?

A

should NOT increase ~ BP over 140/90 needs further investigation

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12
Q

daily fetal movement counts

A
  • called “kick counts”
  • count for 1 hour
  • fetal movement is reassuring sign of fetal health
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13
Q

what are some results with the kick count test?

A
  • need to further investigate if only 2 kicks felt in 1 hours
  • no movement for 12 hours is called “fetal alarm sign”
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14
Q

what should we educate a mom about kick counts?

A
  • they decrease when fetus is sleeping
  • can be affected by diet/nutrition (good to do after eating)
  • will decrease if mom is taking antidepressant medication or other CNS depressants
  • will decrease with alcohol intake and smoking
  • obese women have a decreased ability to sense movement
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15
Q

how can an ultrasound be conducted?

A

abdominally or transvaginally

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16
Q

why would a transvaginal ultrasound be good?

A

allows pelvic anatomic features to be evaluated in greater detail and pregnancy can be detected earlier

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17
Q

what trimester is transvaginal US done in and why?

A
  • 1st trimester
  • detects ectopic pregnancy
  • identify abnormalities
  • gestational age by measuring crown to rump length
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18
Q

when is abdominal US conducted and why?

A

after 1st trimester when uterus is in the abdominal cavity

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19
Q

what would you want to tell a pregnant mom who is getting an abdominal US?

A

they need a full bladder to displace uterus upward

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20
Q

oligohydramnios

A

decreased amniotic fluid ~ congenital anomalies (kidney problem), growth restriction)

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21
Q

polyhydramnios

A

increased amniotic fluid ~ neural tube disorders, obstructed fetal GI tract, fetal hydrops, multiple fetuses

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22
Q

Biophysical profile (BPP)

A
  • comprehensive test to evaluate health of fetus
  • combined test using US and NST
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23
Q

what does BPP score on?

A
  1. amniotic fluid volume (AFV)
  2. fetal breathing movements (FBM)
  3. fetal movements
  4. fetal tone
  5. reactive NST
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24
Q

what do scores mean on BPP?

A
  • each variable receives maximum of 2
  • 8-10 = normal
  • 6 = equivocal (suspicious)
  • <4 = abnormal
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25
Q

how early can a cell free fetal DNA test be performed?

A

as early as 10 weeks

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26
Q

amniocentesis

A
  • obtains a sample of amniotic fluid that contains fetal cells
  • needle inserted trans-abdominally into uterus with guidance from US
  • possible after 14 weeks of pregnancy so the uterus is big enough
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27
Q

why would an amniocentesis be done?

A
  • genetic testing
  • fetal lung disease
  • diagnosis of fetal infections
  • treatment
  • paternity testing
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28
Q

risks of amniocentesis

A
  • very rare (<1%)
  • maternal risks: hemorrhage, infection, miscarriage or preterm labor, abruptio placenta, amniotic fluid embolism, leaking amniotic fluid
  • fetal risks: hemorrhage, infection, direct injury from needle, leakage of amniotic fluid, death
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29
Q

three maternal serum markers

A
  1. maternal serum alpha-fetoprotein
  2. unconjugated estriol
  3. hCG
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30
Q

what does maternal serum alpha-fetoprotein test for?

A

neural tube disorders

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31
Q

when is glucose tolerance tested in pregnant women?

A

24-28 weeks

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32
Q

why are electronic fetal monitoring (EFM) assessments done?

A

to determine fetal wellbeing

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33
Q

examples of EFM

A
  • nonstress test (NST)
  • contraction stress test or oxytocin challenge test (CST)
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34
Q

nonstress test (NST)

A
  • most widely used fetal assessment test
  • non-invasive and inexpensive
  • looks at HR in relation to fetal movement
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35
Q

top vs. bottom of NST strips

A
  • top = uterus
  • bottom = fetal HR
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36
Q

test results of NST and are they good or bad?

A
  • tests are either reactive or nonreactive
  • reactive is good
  • nonreactive is bad
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37
Q

what would a reactive NST look like?

A

at least 2 accelerations in 20-minute period

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38
Q

accelerations

A

at least 15 seconds long and peaking at least 15 BPM above baseline

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39
Q

what would a NST look like with someone before 32 weeks gestation?

A

increase of at least 10 BPM and lasting at least 10 seconds

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40
Q

variability

A

able to see accelerations

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41
Q

nonreactive stress test

A

a test that does not produce 2 or more qualifying accelerations in a 20 minute period

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42
Q

what would need to happen if NST is nonreactive?

A

further intervention or evaluation: vibroacoustic stimulation, hydrate mom, BPP

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43
Q

contraction stress test

A
  • identifies fetal wellbeing in response to stress
  • IV infusion of oxytocin
  • administer until 3 uterine contractions, of good quality, lasting 40-60 seconds, in a 10 minutes period occur
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44
Q

how are the results in a CST?

A

either positive or negative

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45
Q

test results of CST and are they good or bad?

A
  • positive or negative
  • negative is good
  • positive is bad
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46
Q

negative CST

A
  • at least 3 uterine contractions occur in 10 minute period, with no late or significant variable decelerations
  • implies that fetus can handle stress of contractions
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47
Q

positive CST

A
  • implies that fetus cannot handle stress of uterine contractions
  • late decelerations occur with 50% or more of contractions
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48
Q

why is folic acid recommended in pregnant women?

A

it can prevent neural tube defects

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49
Q

folic acid recommendation

A

all women capable of becoming pregnant need 400 mcg daily

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50
Q

those underweight prior to conception risks

A
  • preterm labor
  • LBW infants
  • IUGR infants
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51
Q

those overweight prior to conception risks

A
  • macrosomic infants
  • fetopelvic disproportion
  • emergency c-sections
  • postpartum hemorrhages
  • birth trauma
  • late fetal deaths
  • gestational diabetes
  • gestational HTN
  • cephalopelvic disproportion
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52
Q

recommended weight gain for normal weight before pregnancy

A

25-35 lbs

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53
Q

recommended weight gain for overweight before pregnancy

A

15-25 lbs

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54
Q

recommended weight gain for underweight before pregnancy

A

should reach their ideal weight, then gain 25-35 lbs

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55
Q

energy needs are met by eating what types of foods during pregnancy?

A
  • carbs
  • fat
  • proteins
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56
Q

protein

A

the nutritional element basic to growth

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57
Q

daily recommendation of protein

A
  • 3 or more serving of milk, yogurt, or cheese
  • 6 oz of meat, poultry, or fish
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58
Q

fluids are essential for…

A

the exchange of nutrients and waste products

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59
Q

recommended daily intake of fluids

A

8-10 glasses or 1500-2000 mL

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60
Q

what might inadequate fluid increase the risk of?

A

cramping, contractions, preterm labor

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61
Q

can caffeine be consumed during pregnancy?

A
  • in small amounts, has not been proven to cause adverse effects
  • greater than 3 cups of coffee may increase risk of miscarriage and IUGR infants
  • recommendation is to avoid caffeine or consume in limited quantities
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62
Q

why is iron good during pregnancy?

A

necessary to allow transfer of iron to the fetus and to support expansion of the maternal RBC mass

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63
Q

recommended intake of iron

A

30 mg daily starting by 12 weeks gestation

64
Q

what could iron cause that you would want to educate the patient on?

A

can cause constipation, so educate them about increasing fiber and fluids

65
Q

pica

A

practice of consuming nonfood substances such as clay, dirt, laundry, starch, baking powder, corn starch, baking soda, ice ~ influenced by cultural background

66
Q

risks associated with pica

A
  • lower Hgb (pregnancy already causes lower H&H)
  • malnutrition
  • electrolyte imbalances
  • acid base imbalances
  • rhabdomyolysis
67
Q

what might those who eat vegetarian diets lack?

A

vitamin B12 - must supplement

68
Q

how might nutrient needs during lactation change from pregnancy?

A
  • it is similar but iron and folic acid needs are lower
  • needs for energy calories (protein) are higher
  • fluid intake must be adequate
  • calcium intake needs to be adequate and may have to supplement with 600 mg Ca
69
Q

dangers during pregnancy

A
  • limit caffeine
  • quit smoking/tobacco
  • alcohol
  • toxoplasmosis (from raw/undercooked meats or litter of infected cats)
  • lunch meats (rish of listeria); fish (mercury risk)
70
Q

what does use of tobacco affect with pregnancy?

A
  • causes vasoconstriction
  • higher incidence of low birth weight babies
  • higher incidence of preterm birth, PROM, placenta previa, abruptio placenta, SIDS, lower IQ learning problems
71
Q

hyperemesis gravidarum

A
  • extreme N/V
  • severed enough to cause weight loss, electrolyte imbalance, nutritional deficiencies, and ketonuria
  • may occur in any trimester
  • may cause maternal hepatic and renal damage
72
Q

what effects does diabetes have during pregnancy?

A
  • inc. risk of pre-eclampsia, HTN
  • inc. risk infections, i.e. pyelonephritis, monilial vaginitis
  • inc. polyhydramnios and malpresentation
  • inc. macrosomia, LGA, shoulder dystocia, C/S
  • neonatal complications
  • IUGR and stillbirth
  • congenital anomalies
73
Q

concerns for the pregnant diabetic mother

A
  1. maintain mom’s BG - insulin control!!!!
  2. protect fetus in utero from the fluctuation in BG levels
  3. protect NB the first 24 hours until insulin-glucose regulatory mechanism is stable
74
Q

what hypoglycemic agents have teratogenic effects?

A

sulfonylureas (glyburide)

75
Q

how is glycemic control in first trimester?

A
  • it is improved
  • risk for hypoglycemia
  • reduction in insulin dose
76
Q

how is glycemic control in second and third trimester?

A
  • insulin requirements slowly increase
  • doses must be adjusted daily
  • insulin may double or quadruple by the end of pregnancy
  • requirements will level off at 36 weeks
77
Q

what occurs with insulin requirements post partum?

A

expulsion of the placenta dec. the levels of placental hormones and maternal insulin requirements dec.

78
Q

how many days postpartum with insulin requirements return to pre-pregnancy requirements?

A

7-10 days

79
Q

how does breastfeeding affect insulin requirements?

A

will be lower than pre-pregnancy requirements because breastfeeding utilizes glucose more effectively

80
Q

does a fetus make its own insulin?

A

yes, by 10-14 weeks; fetus just depends on mother for glucose

81
Q

fetus glucose levels in relation to mom’s glucose levels

A

they are proportional

82
Q

macrosomia

A

LGA infants (>90th percentile); high glucose levels lead to this (glucose acts as GH)

83
Q

complications of macrosomia

A
  • cephalopelvic disproportion or should dystocia (fractured clavicle, liver or spleen laceration, brachial plexus injury, facial palsy, subdural hemorrhage)
  • increased rate of c-section
84
Q

ketoacidosis in pregnancy

A
  • most common during 2nd and 3rd trimester
  • more prevalent if the pregnancy is stressed by an illness or infection
85
Q

what does terbutaline do in terms of DKA?

A

increases risk of DKA; used to stop contractions

86
Q

when does ketoacidosis occur in pregnant women?

A

with blood sugars @ 200 mg/dL

87
Q

what increases the risk of sudden and unexplained stillbirth?

A

women with vascular disease and poor glycemic control. may be associate with DKA, preeclampsia, polyhydramnios, macrosomia

88
Q

who are IUGR seen in?

A

with women who have vascular disease due to their diabetes; related to compromised uteroplacental circulation

89
Q

treatment goal for pregestational diabetic pregnant women

A
  • maintain glucose level between 65-95 preprandially and 130-140 postprandially
  • diet
  • exercise
  • frequent BG monitoring
  • insulin/glucose medication
  • consistency of activities
  • close fetal monitoring
90
Q

how would we assess a patient with diabetes before delivery?

A
  • DFM counts
  • frequent US
  • NST
  • 1-2 times/week BPP, amino for lung maturity
91
Q

how would we assess a patient with diabetes during and after delivery?

A
  • C/S for macrosomia
  • glucose levels every 1-2 hours
  • insulin drip to keep BG 70-120
  • frequent monitoring; usually stabilizes in 2-3 days
92
Q

what can maternal hyperglycemia lead to?

A

fetal hyperglycemia, hyperinsulinemia, macrosomia, RDS, hypoglycemia, hypocalcemia, stillbirth, polycythemia, hyperbilirubinemia

93
Q

neonatal hypoglycemia

A

term: <40 mg/dL
preterm: <25 mg/dL
signs: hypothermia, tremors, jitteriness, weak cry, floppy, lethargic, convulsions

94
Q

treatment of neonatal hypoglycemia

A

primary: feed or glucose IV

95
Q

CV changes during pregnancy

A
  • vast increase in BV
  • heart murmurs
  • heart palpitations
96
Q

how do you treat CV disease?

A
  • reduce stress of heart by eliminating anemia, stress, hypertension, constipation, hyperthyroidism, obesity
97
Q

class I heart disease

A
  • cardiac with no limitations
  • absence of symptoms, generally few problems
  • encourage plenty of rest
    *won’t do too much
98
Q

class II heart disease

A
  • slight limitation
  • comfortable at rest
  • experience fatigue, palpitations, dyspnea, or angina with ordinary activity
  • may need O2 in labor and delivery
99
Q

class III heart disease

A
  • moderate to marked limitation of physical activity
  • comfortable at rest
  • symptomatic with less than normal activity
  • often advised against pregnancy
  • often bedrest much of pregnancy
  • breastfeeding contraindicated
100
Q

class IV heart disease

A
  • unable to perform normal ADL without discomfort
  • angina
  • maternal mortality high
  • postpartum period is hazardous
  • delivery is very risk
101
Q

signs of cardiac decompensation

A
  • increase in fatigue
  • inc. in difficulty breathing
  • tachypnea
  • frequent, moist cough
  • palpitations
  • generalized edema
  • irregular, weak rapid pulse
  • crackles
  • orthopnea
102
Q

treatment of asthma with pregnancy

A

terbutaline and albuterol: they will reduce/stop uterine contractions due to their beta 2 action ~ goal is to maintain adequate O2 for the fetus

103
Q

can epilepsy be treated during pregnancy?

A

most meds are contraindicated so risk vs. benefit: especially carbamazepine (tegretol) and valproate (depakote)

104
Q

how much does maternal insulin demand increase during the 2nd half of pregnancy?

A

3x

105
Q

how do we screen for gestational diabetes?

A

glucola: 50 g of PO glucose, then a BG test 1 hour later

106
Q

when are diabetes tests done?

A

24-28 weeks gestation

107
Q

what is a positive score in diabetes and what does it mean?

A

130-140 is considered positive: double check with 3 hr OGTT and try to maintain normal levels

108
Q

levels of hypertension in pregnancy

A
  • gestational HTN
  • preeclampsia
  • eclampsia
  • HELLP syndrome
109
Q

diagnosis of gestational HTN

A
  • without proteinuria
  • after 20 weeks pregnancy
  • BP greater than 140/90 in someone who is normotensive
110
Q

what is preeclampsia caused by?

A

vasospasm

111
Q

is preeclampsia a problem with BP?

A

no, all symptoms stem from arterial vasospasms (pinching off arteries)

112
Q

characteristics of mild preeclampsia

A
  • HTN after 20 weeks gestation
  • proteinuria
  • edema
113
Q

characteristics of severe preeclampsia

A
  • HTN (greater than 160/110)
  • proteinuria
  • oliguria
  • cerebral or visual disturbances
  • hepatic involvement
  • reflexes (hyperreflexia)
  • thrombocytopenia
114
Q

HELLP syndrome diagnosis

A

*based on a group of lab findings
- H = hemolysis (wiping our RBC leading to inc. bilirubin or burr cells)
- EL = elevated liver enzymes
- LP = low platelets (less than 100,000

115
Q

eclampsia

A

preeclampsia symptoms with onset of seizure or coma; can develop during pregnancy, labor, or postpartum

116
Q

if pregnancy is past 37 weeks in someone with HTN, what usually happens?

A

induction

117
Q

magnesium sulfate

A
  • commonly prescribed to prevent seizures
  • since it relaxes smooth muscle, may not be able to do a vaginal delivery
118
Q

goal of using magnesium sulfate

A

to maintain a therapeutic serum Mg level of 4-7 mg/dL
*make sure to draw levels frequently

119
Q

symptoms of mag toxicity

A
  • nausea
  • feeling of warmth
  • flushing of skin
  • dec. reflexes
  • slurred speech
  • muscle weakness
  • hyporeflexia and absent reflexes
  • RR less than 12/min.
  • significant drop in maternal pulse and BP
  • urine output less than 30 mL/hr
  • levels greater than 9.6
  • fetal tachycardia or bradycardia
120
Q

interventions for mag toxicity

A
  • stop magnesium infusion
  • call provider
  • administer antidote: calcium gluconate
  • monitor patient status
  • monitor mag levels and sulfate levels
121
Q

early pregnancy bleeding possiblities

A
  • miscarriage
  • premature dilation of the cervix
  • ectopic pregnancy
  • hydatidiform mole
122
Q

late pregnancy bleeding possibilities

A
  • placenta previa
  • placenta abruption
  • variations in the insertion of the cord
123
Q

threatened miscarriage s/s

A
  • spotting
  • no or mild cramping
  • closed cervix
    *has not happened: a threat for one
124
Q

inevitable miscarriage s/s

A
  • moderate/heavy bleeding
  • open cervical os
  • mild/severe cramping
  • may have ruptured membranes
    *already happening
125
Q

incomplete miscarriage s/s

A
  • expulsion of the fetus with retention of the placenta
  • moderate/heavy amount of bleeding and cramping
    *not everything expells out
126
Q

complete miscarriage s/s

A
  • all tissue and fetus is passed
  • milk bleeding and cramping
127
Q

missed miscarriage s/s

A

fetus has died, but expulsion does not occur

128
Q

how do Hcg levels change with a miscarriage?

A

they might stay the same or dec.

129
Q

cervical cerclage

A

sutures to close cervix to maintain pregnancy

130
Q

ectopic pregnancy

A
  • fertilized ovum is implanted outside the uterus
  • maternal mortality
  • leading cause of infertility
131
Q

3 classic symptoms of ectopic pregnancy

A
  1. abdominal pain
  2. amenorrhea
  3. abnormal vaginal bleeding
132
Q

how do we treat tubal ectopic pregnancy?

A
  • methotrexate before rupture if possible
  • salpingostomy before rupture if possible: remove the pregnancy and use methotrexate for the remaining tissue
  • laparotomy for ruptured ectopic pregnancy to remove conceptus
133
Q

what would you do if the placenta is attached to a vital organ during an ectopic pregnancy?

A

it is left in place and usually absorbed by the body without complication ~ methotrexate may be given

134
Q

symptoms of ruptured fallopian tube

A
  • sharp stabbing pain
  • referred shoulder pain
  • signs of shock
  • cullen sign: blueness around umbilicus
135
Q

if a ruptured fallopian tube is in the interstitial portions of the tube, where the tube is connected to the uterus, how much bleeding will there be?

A

profuse blood loss due to the great blood supply

136
Q

if a ruptured fallopian tube is in the distal third, how much bleeding will there be?

A

less bleeding due to decrease blood supply there; this is where most ectopics are

137
Q

two types of hydatidiform

A
  • complete or classic mole
  • partial mole
138
Q

complete molar pregnancy

A
  • fertilization of an ovum that is “empty”
  • embryoblast becomes fluid filled and embryo does not form
  • no fetal blood is present
  • all of the trophoblast villi become like a “cluster of grapes”
139
Q

complete molar pregnancy

A
  • fertilization of an ovum that is “empty”
  • embryoblast becomes fluid filled and embryo does not form
  • no fetal blood is present
  • all of the trophoblast villi become like a “cluster of grapes”
140
Q

how does HCG change in a complete molar pregnancy?

A

they will be extremely high

141
Q

clinical manifestations of complete molar pregnancy

A
  • uterus expands faster than in normal pregnancy
  • no fetal HR
  • blood/urine test for HCG is strongly positive
  • N/V are present and are worse than with a normal pregnancy
142
Q

when do symptoms of HTN, edema, and proteinuria occur in a molar pregnancy?

A

before the 20th week, usually between 9-12 weeks

143
Q

what might bleeding look like with a molar pregnancy?

A

prune juice

144
Q

what kind of cancer might moms get as a result of a molar pregnancy?

A

choriocarcinoma

145
Q

what precautions do we take to assess for choriocarcinoma?

A
  • serum HCG levels are monitored monthly for six months, then every 2 months for the next 6 months (1 year total)
  • avoid pregnancy for 1 year to avoid confusing pregnancy with it
146
Q

placenta previa

A

low implantation of the placenta in the uterus

147
Q

three degrees of placenta previa

A
  • complete
  • marginal
  • low-lying
148
Q

manifestations of placenta previa

A
  • painless vaginal bleeding
  • placenta doesn’t stretch
  • initial bleeding is usually a small amount of bright red blood
  • bleeding will recur at various times
  • soft, relaxed, non-tender uterus
  • baby might be in transverse position
149
Q

what should be avoided in moms with placenta previa?

A
  • never perform sterile/vaginal exams until after 34 weeks
  • avoid intercourse
150
Q

how will delivery be done in placenta previa?

A

c-section because you can’t deliver the placenta first

151
Q

placenta abruptio

A

detachment of part of all of the placenta from its implantation site

152
Q

when does placenta abruptio occur?

A

usually after 20 weeks, if it occurs before it will be considered SAB

153
Q

risk factors for placenta abruptio

A
  • maternal HTN
  • direct abdominal trauma
  • smoking/cocaine
  • previous abruptions
  • preterm rupture of membranes
154
Q

manifestations of placenta abruptio

A
  • vaginal bleeding (mild or severe)
  • abdominal pain (located high in the uterine fundus)
  • uterine tenderness upon palpation
  • hypertonicity of uterus
155
Q

what should we always suspect in a woman who has sudden onset of localized fundal pain with or without bleeding?

A

abruption

156
Q

how would be position mom who has an abruption?

A

laterally

157
Q

in a patient brought in with a trauma, what do we want to do first?

A

stabilize mom first as if she were not pregnant

NSG 322 Med Surge I (5 decks)

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