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Reproductive Health > Exam Number 1 Study Guide > Flashcards

Exam Number 1 Study Guide Flashcards

1
Q

Nagele’s Rule

A

LMP - 3 months + 7 days

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2
Q

Presumptive signs of pregnancy

A 
amenorrhea
nausea/vomiting
fatigue
urinary frequency
breast changes
quickening
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3
Q

Probable signs of pregnancy

A 
Changes in pelvic organs/vascular congestion
Abdominal enlargement
Braxton hicks contractions
Skin pigmentation changes
Uterine soufflé
Fetal outline
Pregnancy test
Ballottement (sharp push against uterine wall)
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4
Q

Positive/diagnostic signs of pregnancy

A

FHT
Fetal movement
Visualization in ultrasound

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5
Q

purpose of hCG in pregnancy

A

maintains corpus luteum, maintains pregnancy until placenta is developed

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6
Q

hPL in pregnancy

A

antagonist to insulin, breaks down fats to feed baby

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7
Q

estrogen in pregancny

A

stimulates uterine development, develops ductal system in breast

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8
Q

progesterone in pregnancy

A

secreted until placental production is sufficient, maintains pregnancy, develops acini and lobes of breast

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9
Q

relaxin

A

inhibits uterine activity, relaxes pelvic ligaments

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10
Q

vaccines in pregnancy

A

no attenuted live viruses due to possible teratogenic effects.
pertussis vacc in third trimester

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11
Q

first trimester screenings

A

ultrasound for nuchal translucency

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12
Q

second trimester screenings (6)

A 
gestational diabetes
HGB and HCT
Amnio if advanced maternal age
US
Rhogam
Vaccinate for pertussis (third)
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13
Q

Third trimester

A

strep b

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14
Q

Chadwick’s sign

A

bluish coloring of cervix

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15
Q

Goodell’s sign

A

softening of cervix

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16
Q

respiratory changes in pregnancy

A

thoracic breathing

nasal stuffiness

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17
Q

CV changes in pregnancy

A

blood volume increases, pulse increases 10-15 BPM, BP decreases slightly

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18
Q

skin and hair changes in pregnancy

A

Linea nigra, hyperactive sweat and sebaceous glands, significant hair shedding

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19
Q

Metabolic changes in pregnancy

A

Gain of 25-35 points, water retention, need for carbs increases in 2nd and 3rd trimester

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20
Q

Additional calorie intake in pregnancy

A

300 kcal/day

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21
Q

Protein intake in pregnancy

A

add 60g/day

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22
Q

Micronutrient needs in pregnancy

A

increase calcium, iron, zinc, B12, D

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23
Q

Recommended weight gain in pregnancy for normal, overweight, obese, and underweight mothers

A

Normal: 25-35lbs
overweight: 15-25 lbs
Obese: 11-20 lbs
Underweight: 28-40lbs

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24
Q

Folic acid supplements in pregnancy

A

.4mg/day, >.4mg/day if previous child had neural tube defects

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25
Q

Frequency of contractions

A

determined from beginning of one contraction to the beginning of the next

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26
Q

FHR assessment frequency during second stage

A

q5-15 minutes

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27
Q

What types of fetal lie are there? Which is most favorable?

A

Longitudinal- most favorable and common

Transverse- oblique and horizontal

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28
Q

Fetal presentation types

A

Cephalic: head. Occiput (best), brow
Breech: buttocks first
Shoulder

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29
Q

engagement

A

largest part of the presenting part reaches/passes through the pelvic inlet

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30
Q

station

A

where the presenting part is in relation to the ischial spines. From -3 to +3, with 0 being at the ischial spine.

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31
Q

Fetal position designation

A

R/L
O/M/S/A
A/P/T

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32
Q

effacement

A

thinning of the cervix

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33
Q

secondary force of labor

A

the use of the abdominal muscles

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34
Q

acme

A

peak of contraction

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35
Q

decrement

A

relaxation of a contraction

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36
Q

contractions are stimulated by

A

oxytocin

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37
Q

Cause of cervical dilation

A

fetal head pushing against cervix

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38
Q

lightening

A

indicates engagement, fetus settling into pelvic inlet. decreased SOB and increased urinary frequency

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39
Q

False labor pains

A

relieved by ambulation, bath, rest, mainly in lower abdomen and groin

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40
Q

4 Stages of labor

A
  1. onset of labor -> full dilation
  2. complete dilation -> birth
  3. birth of newborn -> birth of placenta
  4. delivery of placent -> 1-4 hrs PP, uterus contractions for bleeding control
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41
Q

First stage of labor latent phase

A

Beginning of regular contractions -> 4cm dilation
~8 hours nulliparous
~5 hours multiparous

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42
Q

First stage of labor active phase

A

4-> 7cm dilation, fetal descent. Cervical dilation 1.2-1.5cm/hour

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43
Q

First stage of labor transition phase: how long?

A

Cervical dilation from 8cm-> complete. 1 hour for multip, 3 hours for nullip.

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44
Q

Second stage of labor—description and length

A

Pushing phase- 10cm-> birth. 15 minutes multips, 2 hours for nullips. 3 Hours wth epidural.

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45
Q

Third stage of labor

A

30 minutes
Placenta separates.
Placenta examined after delivery for vessels and fetal (Schultze) and maternal (Duncan) sides to ensure no retained parts.

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46
Q

Fourth stage of labor

A

1-4 hrs after birth
250-500ml blood loss is normal, blood is redistributed
Fundus should be massaged and midway between SP and umbilicus.
BP lowered, tachy

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47
Q

Nursing interventions fourth stage of labor

A

Check lochia
Check UT firmness q15 x 4 hours
check for hemmorhoids
vital signs q5-15

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48
Q

Early decelerations FHR

A

normal, positive sign. Indicates head compression

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49
Q

Contraction pattern: latent phase

A

q10-30min -> q5-7

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50
Q

Contraction pattern: active phase

A

q2-5 -> q40-60s

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51
Q

Contraction pattern: transition phase

A

q1.5-2min, -> 60s-90s strong

52
Q

FHR assessment intervals

A

first stage of labor: q30 min low risk, q15 minute high risk
2nd stage: q15 minutes low risk, q5 minutes high risk
Before or following AROM, ambulation, med administration, abnormal UC pattern, VE

53
Q

FHR accelerations

A

Transient increase in FHR, sign of fetal well-being and oxygenation

54
Q

Normal FHR

A

110-160 bpm

55
Q

Baseline FHR

A

average rounded to increments of 5 BPM during a 10 minute period

56
Q

absent FHR variability

A

no detectable amplitude

57
Q

minimal FHR variability

A

detectable but less than 5 BPM

58
Q

moderate FHR variability

A

6-25 BPM, normal

59
Q

marked FHR variability

A

> 25 bpm

60
Q

best predictor for fetal compromise

A

reduced variability

61
Q

late decelerations

A

uteroplacental insufficiency in bloodflow due to maternal hypo or hypertension, uterine tachysystole, diabetes, placental abruption- nonreassuring.

62
Q

Interventions for late decelerations

A

continuous monitoring, immediate intervention

63
Q

variable FHR decelerations

A

umbilical cord compression. Abrupt, V shaped decelerations.

64
Q

Catergory I FHR

A 
110-160 BPM
Moderate variability
No variable/late decels
Early decels may be present or absent
No action required
65
Q

Category II FHR

A 
Bradycardia or tachycardia
BSL changes in variability
No accels
Episodic decels or variable decels
Rx: evaluation, surveillance, reevaluation
66
Q

Category III FHR

A 
Absent variability
Recurrent late decels or variable decels
bradycardia
Sinusoidal FHR patterns—may be due to fetal anemia, infx, drug response, cardiac issues
Requires prompt eval, delivery ASAP
67
Q

Fetal tachycardia

A

If accompanied by late decels, severe variable decels, decreased variability— ominous sign
If maternal fever, antipyretics/antibiotics.

68
Q

interventions for late decels

A 
L lateral position until FHR improves or stabilizes
increase fluids
O2 via mask 7-10LPM
Alert provider
Provide explanation and support
D/C oxytocin
Monitor BP and HR
Assess cervix
Prepare for possible C-section
doc interventions
69
Q

Variable decels nursing intervention

A

Position changes to relieve pressure on cord
O2 7-10L/min
Notify provider
Possible amnioinfusion if oligohydramnios present or decels persist
possible c-section
explanation to woman & partner

70
Q

interventions for prolonged decels

A 
Vaginal examination for prolapsed cord
Change maternal position
D/C oxytocin
Notify provider
Support
Increase IV fluids
Administer tocolytic if tachysystole is occurring
Anticipate provider intervention
71
Q

APGAR Scoring (5 variables)

A

HR >100
Respirations- good with crying
Tone- active extremity movement
reflex- cry, cough, sneeze, pulls away when touched
skin color- pink body and extremities (acrocyanosis=pink body with blue extremities)
≥7/10 indicates good condition

72
Q

RR in newborn

A

30-60 RPM

73
Q

Signs of imminent placental separation

A

Uterus rises upward in the abdomen
Umbilical cord lengthens
Sudden trickle or spurt of blood appears
Shape of uterus changes from disk to globe

74
Q

What is administered after delivery of the placenta?

A

10-20units of IV pitocin, or 10 units IM

75
Q

BP and pulse monitoring during 4th stage

A

monitored q5-10 minutes

76
Q

Treating epidural hypotension

A

IV ephedrine, hydration (LR bolus prior to insertion and more for bradycardia). Maternal repositioning, 10L O2, leg elevation

77
Q

Epidural nursing interventions

A

continuous fetal monitoring
IV infusion in place prior to epidural
Indwelling catheter if epidural in place for prolonged period
Assist mom in side lying or sitting for administration

78
Q

Epidural documentation

A

“Black tip visualized”—ensure no part remains inside

79
Q

Contraindications for an epidural

A 
Coagulation deficiencies
Hx of back injuries, back surgery
Allergies
Skin issues at epidural site
Obesity- may complicate insertion
80
Q

General anesthesia

A

rarely used, except for emergency c-section
Fetal depression and maternal intubation issues, blood loss, vomiting/aspiration, amnesia. Prophylactic antacid therapy for mom

81
Q

conception occurs ___ after LMP

A

2 weeks

82
Q

ovaries during pregnancy

A

cease ovum production
hCG matains corpus luteum
secrete progesterone until placental production is sufficient

83
Q

maternal O2 requirements increase by _____% a minute

A

30-40%

84
Q

breathing becomes ____ during pregnancy

A

thoracic

85
Q

Blood volume increases by up to ____ % by ___ weeks

A

50% by 34 weeks

86
Q

pulses increase ______ bpm

A

10-15

87
Q

BP is lowest in the ____ trimester

A

2nd

88
Q

What causes N/V in pregnancy?

A

elevated hCG and altered carbohydrate metabolism

89
Q

What causes bloating and constipation in pregnancy?

A

delayed gastric emptying, decreased peristalsis due to progesterone

90
Q

BMR increases by

A

20-25%

91
Q

GPTPAL

A

gravida: # pregnancies
parity: # babies >20 weeks
T= term infants
P= infants from 20 weeks -> 36.6 weeks
A= number of pregnancies ending in spontaneous or induced abortions
L= number of current living children

92
Q

Fundal height measurement: how is it done and when?

A

Tape measure measures from symphysis pubis to top of uterus. Used after 22 weeks to assess grown.

93
Q

When does quickening occur?

A

between 16-22 weeks

94
Q

When can fetal heart tones be detected?

A

between 8-12 weeks

95
Q

When can US detect gestational sac?

A

4-5 weeks

96
Q

Women with abnormal screening results are offered:

A

genetic counseling, CVS, and amniocentesis

97
Q

Gestational diabetes screening is done when?

A

between 24 and 28 weeks

98
Q

Second trimester nursing interventions

A

administer RhoGam

Educate on pertussus, administer vaccine each pregnancy.

99
Q

Vegan diets during pregnancy require a supplement of ____

A

4mg of B12, along with calcium and vitamin D if no soy milk is consumed.

100
Q

Danger signs of pregnancy (12)

A 
Gush of fluid from vagina
Vaginal bleeding
Abdominal pain
Fever about 38.3°C with chills
dizziness, blurred vision, seeing spots
persistent vomiting
Edema
Muscular irritability, convulsions
Epigastric pain
Oliguria
Dysuria
Absence of fetal movement
101
Q

Frequency of PNC visits

A

Every 4 weeks for the first 28 weeks
Ever 2 weeks until 36 weeks
Weekly from 36-40 weeks
Biweekly with NST after 40 weeks

102
Q

Frequency of fetal kicks

A

10x/hour is normal. Call provider if <10 movements within 3 hours

103
Q

Amniotic fluid index. Normal amount?

A

Indicator of how much fluid is present. 5-20 cm is normal

104
Q

quad screen

A

for AFP, hCG, UE and inhibin A (chromosomal disorders)—abnormal results lead to an amniocentesis. Occurs during second trimester

105
Q

How often to check uterine firmness in the fourth stage of labor

A

q15 for the first 4 hours

106
Q

Normal blood loss in 4th stage of childbirth

A

250-500mL

107
Q

Mechanisms of birth

A 
Descent
Engagement
Flexion
Internal rotation
Extension
Restitution
External rotation
Expuulsion
108
Q

Vital sign checks during the latent stage

A

Q1 vitals

Q4 temp

109
Q

UC and FHR checks during latent stage

A

q30min

110
Q

How often do you palpate UCs during the transition phase?

A

Q15 min

111
Q

Labor support during childbirth reduces…

A 
Use of pain meds
Operative delivery
Length of labor
Low Apgar scores
PP Depression
Breastfeeding failure
112
Q

BP and pulse monitoring frequency in the 4th stage

A

q5-15

113
Q

When can an epidural be started?

A

As soon as active labor is established

114
Q

ova are fertile for ___ hours

A

12-24

115
Q

sperm are fertile for ___ hours

A

72

116
Q

nidation

A

implantation—occurs 7-10 days after fertilzation

117
Q

maternal portion of the placenta

A

decidua

118
Q

fetal portion of the placenta

A

chorionic villi

119
Q

when can fetal heart tones be heard?

A

12 weeks

120
Q

when does spontaneous movement occur?

A

12 weeks

121
Q

when is fetal movement felt by mother?

A

20 weeks (earlier if you are multiparous)

122
Q

when is considered full term?

A

38 weeks

123
Q

when do alveoli begin to form?

A

24 weeks

124
Q

when does the heart first begin to beat?

A

4 weeks

125
Q

Most significant time in the development of organs and main external features

A

embryonic period 15 days-8 weeks

Reproductive Health (4 decks)

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