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Physical Assesment 2023 > Exam Of The Obstetric Patient > Flashcards

Exam Of The Obstetric Patient Flashcards

1
Q

During pregnancy what hormonal changes happen

A

There will be increase in levels of estradiol, progesterone and the pregnancy hormones especially HCG
*these hormones will drive many of the pregnancy related endocrine and metabolic changes

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2
Q

What are the cardiovascular changes during pregnancy

A
  1. Increase in plasma volume
  2. Increase in cardiac output (beginning) then decrease late in pregnancy
  3. Decrease in systemic vascular resistance and pressure
  4. Increase in heart position and hyper trophy
  5. Systolic murmurs
  6. Increase in fibrinogen
    *hypercoagulable state
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3
Q

What happens to the blood pressure during pregnancy

A
  1. Diastolic decreases beginning in the 7th week
  2. Maximum decline of 10mmHG from 24 to 32 weeks
  3. Returns to non-pregnant values by term
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4
Q

What is supine hypotensive syndrome

A
  1. Uterus is putting pressure on the vena cava and reduces the venous return to the heart
  2. Causes a drop in BP and uterine blood flow
    *try to sleep on left side
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5
Q

What are the changes of the respiratory system during pregnancy

A
  1. Diaphragmatic elevation 4cm by late pregnancy
    *results in 20% reduction in residual volume and functional residual capacity
    *5% reduction in total lung volume.
  2. Respiratory alkalosis
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6
Q

What are the musculoskeletal changes during pregnancy

A
  1. Lumbar lordosis
  2. Ligamentous laxity in the SI joints and pubic symphysis
  3. Exacerbation of hernia defects
  4. Weight gain from hormone relaxin
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7
Q

What are the breast changes during pregnancy

A
  1. Enlarge
    *by hormone stimulation
    *increase vascularity
    *hyperplasia of glandular tissue
  2. More nodular by 3rd month of pregnancy
  3. Mid to late pregnancy
    *colostrum
    *montogomerys glands are more pronounced
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8
Q

What are the uterine changes during pregnancy

A
  1. Easily palpable beyond 12 to 14 weeks when it straightens and rises up out of the pelvis
  2. When the uterus enlarges it rotates to the right to accommodate the rectosigmoid on the left side of the pelvis
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9
Q

What are the vaginal changes during pregnancy

A
  1. Walls appear thicker and deeply rugated
  2. Vaginal secretions are thick, white, and more profuse
    *luekorrhea of pregnancy
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10
Q

What are the cervical changes during pregnancy

A
  1. Chadwick’s sign
    *purpleish cervix due to increase in vascularity
  2. Mucous plug
    * if the plug isn’t there anymore labor is coming soon
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11
Q

What are the changes to the ovaries during pregnancy

A
  1. Generally not noticeable
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12
Q

What does SAB and TAB mean when relating to abortions

A

SAB: spontaneous abortion
TAB: therapeutic abortion

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13
Q

What does preception/prenatal mean

A

Before birth

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14
Q

What does antepartum mean

A

Between conception and the onset of labor

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15
Q

What does intrapartum mean

A

Happening during childbirth

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16
Q

What does postpartum mean

A

Occurring after birth

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17
Q

What does puerperium mean?

A

6-8n week period following birth
*reproductive tract nd rest of the body return to nonpregnant state

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18
Q

What is an embryo, fetus, perinatal period, neonatal period

A

E: time of fertilization thru 10 weeks of gestation
F: > 10 weeks of gestation thru delivery
PP: >28 weeks gestation thru the first 7 days of life
NP: birth thru 28 days of life

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19
Q

What are the presumptive signs of pregnancy

A

Physiologic changes experienced by the patient
1. Absence of menses
2. Breast fullness or tenderness
3. Nausea or vomiting
4. Fatigue
5. Urinary frequency
6. Skin changes

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20
Q

What are the probable signs of pregnancy

A

Signs noted by examiner
1. Chadwicks signs
2. Leukorrhea
3. Hegars sign
*softening of the cervix
4. Uterine enlargement
5. Uterine contractions

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21
Q

What are the positive signs of pregnancy

A
  1. Fetal heart tones
    *ultrasound: 10 weeks
    *doppler: 10-12 weeks
    *Fetoscope: 18-20 weeks
  2. Palpation of fetal parts
    *fetal movements at 18 weeks (quickening)
    *fetal outline at 22 weeks
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22
Q

How can the EDD (expected date of delivery) be established

A
  1. Doppler (positive at 10 to 12 weeks)
  2. Fetoscope (heard at 18 weeks)
  3. Fetal movement (quickening) 18 to 24 week
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23
Q

How can the ultrasound help determine the EDD

A
  1. Gestational sac 5 to 6 weeks
  2. Cardiac activity 5-6 weeks
  3. Crown rump length
    *based on the size they’ll come up with the gestational age
24
Q

What are the first and second trimester

A

First: initial conception through 12 completed weeks
Second trimester: 13 to 28 weeks

25
Q

What are the third trimester and post dates

A

Third: 28 to 40 weeks
Post dates: >42 weeks

26
Q

What is chronic hypertension and gestational hypertension

A

CH: >140 / >90 before 20 weeks gestation
GH: >140 / 90 after 20 weeks gestation

27
Q

What is preeclampsia and eclampsia

A

P: >140 / 90 after 20 weeks gestation with protein in the urine
E: >140 / 90 after 20 weeks gestation, proteinuria, seizures

28
Q

If someone is normal weight before pregnancy what is the recommend weight gain during pregnancy

A
  1. 25-35 lbs
29
Q

During examination of a pregnant woman what are some things you may find

A
  1. Periodontal disease
  2. Listen for venous hums which are common
30
Q

During the abdominal exam what may you find

A
  1. Striae, linea nigra
  2. Diastasis recti
  3. Fetal movements at 24 weeks
  4. Contractions can be palpated by the examiner
31
Q

How to exam the fundal height

A
  1. Measure the fundal height from the superior portion of the pubis symphysis to the top of the fundus
  2. From 20 weeks to 32 weeks the fundal height in cm should approximate the number of weeks of gestation
32
Q

At 20 weeks of pregnancy where should the fundal height be

A

At the umbilicus

33
Q

What will you find while auscultating

A
  1. Use the Doppler to auscultate the fetal heart from 10 to 12 weeks of the Fetoscope from 18 weeks
    *normal fetal HR is 110 to 160
34
Q

What is the leopolds maneuver (first maneuver)

A
  1. Stand at the patients side facing her head
  2. Keep fingers of the hands together and gently palpate with the fingertips the upper pole of the uterine fundus
    *use to determine what part of the fetus is there
35
Q

What is the leopolds maneuver (second maneuver)

A
  1. Place one hand on each side of the woman’s abdomen, capturing the fetus between the hands
  2. Use one hand to steady the fetus while the other feels for parts
    *back, elbow, knees, arms, legs
36
Q

What is the leopolds maneuver (third maneuver)

A
  1. Face the patients feet, use the flat surface of the fingers of tooth hands to palpate the area just above the pubic symphysis
    *note if the hands stay together or come apart with downward pressure
37
Q

If the hands diverge during the third maneuver what does that mean

A

The presenting part has descended into the pelvis

38
Q

If the hands stay together during the third maneuver what does that mean

A

The presenting part is above the pelvis

39
Q

What is the leopolds maneuver (fourth maneuver)

A
  1. With you dominant hand, grasp the part of the fetus in the lower pole and with your non-dominant hand grasp the part of the fetus in the upper pole
    *will be able to distinguish between a breech and vertex presentation
40
Q

What is goodells sign or Hager sign

A

Cervix consistency is soft

41
Q

What is cervical effacement

A

Thinning of the cervix
1. Cervix will be fully dilated to 10cm

42
Q

What is the station

A
  1. How inferior the presenting part is compared to the ischial spines
43
Q

What initial lab testing will be completed

A
  1. CBC
  2. Blood typing
  3. Hepatitis panel
  4. HIV testing
  5. Syphilis testing
  6. Urine analysis
  7. Rubella titers
  8. Varicella titer
  9. C + G cultures
44
Q

After the initial lab work up what other lab test are needed for consequent visits

A
  1. Glucose
  2. Protein
  3. White blood cells
45
Q

When can free or total H\hCG + PAPP-A (genetic testing) be done

A

10 to 13 weeks
*down syndrome

46
Q

When can nuchal transparency (genetic testing) be done

A

10 to 14 weeks
*Down syndrome

47
Q

When can CVS testing be done (genetic testing)

A
  1. 10 to 13 weeks
    *Down syndrome, tay-sachs, hemophilia
48
Q

When can a quad screen be done (genetic testing)

A

15 to 20 weeks
*Down syndrome, trisomy 18

49
Q

When can aminocentesis be done (genetic testing)

A

15 to 20 weeks

50
Q

When is diabetes screening done

A

24 to 28 weeks

51
Q

When is group b streps screening done

A

35-37 weeks
*group b strep is the number one cause of neonatal meningitis

52
Q

How many visits are needed during the first trimester

A

One
*for full history and physical with lab work

53
Q

How many visits are needed for the second and third trimester (until 32 weeks)

A

Every 4 weeks

54
Q

From 32-36 weeks how many visits are needed

A

Every 2 weeks

55
Q

From 36 weeks until delivery how many visits are needed

A

The patient is seen weekly

Physical Assesment 2023 (20 decks)

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