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lp4 stuff Flashcards

1
Q

Gravida

para term

parapre term

abortion

living children

primapara
multipara

A

Gravida: # of preg including current

Para Term: # of births that reached 37 weeks (born alive or dead)

Para Pre-term: # of births that reached 20 weeks, but before 36 weeks (born alive or dead)

Abortion: # of preg that end (spontaneous or elective-before 20 weeks)

Living children: # of children currently alive

Primipara – first birth; Multipara – second or subsequent birth

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2
Q

Pregnancy Effect on Body Systems

due to
perceived
increased
increased

A

Mostly due to hormonal influences needed to maintain pregnancy

May be perceived negatively

↑ vascularity r/t estrogen-inc blood

↑ muscle relaxation r/t progesterone & relaxin

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3
Q

Primigravida

Multigravida

A

P – woman pregnant with her first child

M– woman pregnant for the second or subsequent time

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4
Q

Presumptive (Subjective) signs of pregnancy
week+s/s
2
3
12
18
24

A

2 Breast changes /NV/ amenorrhea

3 frequent urination

12 fatigue/uterine involvement

18 quickening

24 linea nigra /melasma /straia gravidarum

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5
Q

probable signs of pregnancy weeks
1
6
16
20

A

1-HCG//pregnacny test

6-chadwick, hager, goodell, sonogragy

16-ballotmetn

20-braxton hicks contractions, fetal outline felt

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6
Q

Probable (Objective Signs of pregnancy

Lab tests
how accurate
24-48
7-9
60-80

A

hcg/if non-pregnant=no hcg

//95-98% accurate.

24-48hrs-trace amounts

7-9days-5MIU

60-80days=100,000 miu after this will decline 2000-50000 miu/ml

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7
Q

Probable (Objective Signs of pregnancy

pregnancy tests
how accurate
read
if negative
do

A

97-99% accurate

check exp date/ read instruction including time to read/ concentrated urine works best-do in morning/read results at exa t time//

//if negative wait one week and try again, if neg again check for amenorrhea/

/do prenatal care asap

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8
Q

Positive signs of pregnancy

Demonstration of fetal heart separate from pregnact parents

A

Stethoscope can hear in 18-20 weeks

Ecocardiography can hear in 5 weeks

Doppler in 10-12 weeks

Fetal HR= 120-160 bpm

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9
Q

Positive signs of pregnancy

fetal movements

A

can be felt as early as 16-20 weeks in person

examiner can feel in 20-24 weeks

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10
Q

positive signs of pregnancy

visualization

A

ultrasound-as early as 4-6 weeks of pregnancy can see charactertic ring and site of impantation/

by 8th week fetal outline can be measured and determine age-clear proof

ultrasound generally at 20 weeks as well-for abnormalities in genetics/working organs

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11
Q

Uterus in pregnancy

increase

blood flow

A

↑ in size, weight, capacity

↑ in blood flow-15-20 ml/min and ends at 500-750 ml/min—75% going to placenta–needs to be circulatory system for placenta

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12
Q

Lightening

12

20

36

38

Uterus in pregnancy

A

– fetus settles into mid pelvis-

12wk ut is lg enough to be felt in abdomen

/20wk level of umbilicus

36 wk- touches xiphoiod

38 wks settles into pelvis

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13
Q

Hegar sign

Uterus in pregnancy

A

–walls of uterus feel thin as tissue paper-

extreme softenin of lower uterine segment

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14
Q

Ballottement

rise in

Uterus in pregnancy

A

-16-20 wks-uterus is tapped sharply and fetus will bounce/\

rise on amniotic fluid agants when the hand placed on abdomen

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15
Q

Braxton Hicks contractions

manifestations
who can see
do not cause

Uterus in pregnancy

A

-uterine contractions as early as 12th week. Present throughout rest of pregnancy.

Waves of hardness/tightening accros abdomen/”practice contractions”

/examiner or electric monitor can see

not causing cervix change

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16
Q

amenorrhea

why occur
why only presumptive sign

could be

A

occurs because of suppression of FSH by rising estrogen levels/

/could be result of things like uterine infection, anxiety, athletes or chronic illness so only presumptive sign

could be spotting

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17
Q

Cervix changes in pregnancy

hyperactivity
mucus plug

A

Hyperactivity of tissue ==mucorrhea

Mucus plug (operculum)-seal out bacteria and help prevent infection in fetus/membranes

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18
Q

Vasculatiry changes in cervix in pregnancy

A

↑ vascularity-inc in fluid between cells can soften consistency from pale pink to violet hue

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19
Q

Vagina changes in pregnancy

thickening
relaxing

A

Thickening of mucosa,

relaxation of connective tissue

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20
Q

increase in

causes a decrease/inc in

vaginal changes in pregnancy

A

↑ in amt & acidity of secretions-

↓ in bacterial infections but ↑ yeast infections

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21
Q

Chadwick’s sign-

vagina changes in pregnancy

A

color of vaginal wall will turn violet hue

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22
Q

Ovaries
reproductive changes in pregnancy

A

Ovulation ends

Corpus luteum (shell of discharged ova) produces necessary hormones @ the beginning of pregnancy-after 16 weeks placenta will take over

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23
Q

goodels sign

A

softening of cervix

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24
Q

Breast changes in pregnancy

may be
colostrum
montogmery

A

May be one of first changes- may notice @6 weeks a feeling of sublt fullness, tingling, ot tenderness that’s caused by high estrogen levels

Colostrum -3rd trimester-“pre milk”-thin watery high protein fluid can be exctreted

Montogmetry tubercles-elargne to stop cracking of nips

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25
Q

changes visual on breast

increase in

str

blue

darkening

A

Enlargement- –dt mammory alveoli and fat deposits-making milk

↑ in size & number of glands

straie-stretch mark

blue veins

Darkening of areola-from3-5 cm

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26
Q

endocrine system changes in pregnancy

placenta

A

Placenta – produces estrogen and progesterone, HCG

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27
Q

endocrine system changes in pregnancy

Pituitary gland

A

Prolactin-milk production

Oxytocin-labor contraction

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28
Q

endocrine system changes in pregnancy

Thyroid

A

↑ BMR by 20%-

emotional liability perspiration and tachycardia

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29
Q

endocrine system changes in pregnancy

Adrenal gland

A

Inhibit Immune response-

inc levels of corticosteroids and aldosterone to prevent rejection of pregnacy

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30
Q

endocrine system changes in pregnancy

Pancreas

A

-inc insulin production but inslin doesn’t work as well d/t estrogen and progest

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31
Q

progesterone

when present

inc in progesterone

A

present in as early as 4 weeks

inc in progesterone reduces contracibiltiy of uterus which prevents premature labor

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32
Q

estrogen

contributes

stimulates

A

contributes to memory gladn development in prep for lactation

stimulates uterine growth to account for developing fetus

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33
Q

human placental lactogen

growth
present
expanding
regulates

A

growth-promoting and lactogenic

present in 6th week

expanding breast growth=lactation

regulates parental glucose, protein , fat levels for adequate nutrients for fetus

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34
Q

hcg

blood serum

failsafe

role

8th week

A

blood serum will be completely negative 1-2 weeks after birth

failsafe measure to ensure that corpus lutetium of ovaries continues to produce progesterone and estrogen

plays role in suppressing maternal immunological response so placental tissue is not detected as foreign object

8th week outer layer of placenta begin developing progesterone, producing corpus lutem

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35
Q

what is N/v caused by

what is increased mucus caused by

A

HCG

estrogen

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36
Q

Gestational diabetes

inc risk

monitor for

lab when

A

inc risk of diabetes and size of baby

monitor bs in baby after birth

lab values @25-28 weeks

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37
Q

what vaccine to never give pregnant women

A

rubella

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38
Q

Integumentary & Hair changes in pregnancy

linea nigra
hyperactive glands
hair changes

A

Linea nigra-narrow brown line on abdomen-fades away

Hyperactive sweat & sebaceous glands-inc perspiration and sweat

Hair thickening, then loss post-partum

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39
Q

Straie gravidarum-

Integumentary & Hair changes in pregnancy

A

see streaks on sides of abdomen and sometomes on thighs

are permanent-will fade

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40
Q

Chloasma(melasma)

Integumentary & Hair changes in pregnancy

A

“mask of pregnancy”- darkened/reddened areas on face across cheeks and nose

fades away

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41
Q

Diastasis

Integumentary & Hair changes in pregnancy

A

-rectus muscles underneath skin will painlessly separate

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42
Q

vascular spiders

A

small fiery red branching spots on skin

thighs/hands//palms

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43
Q

musculoskeletal system changes

softens
changes
possible
inc

A

Pelvic/ligaments + Joints soften
(Helps baby move through pelvis during Childbirf)

Changes to center of gravity.

Possible back/ girdle pain.

inc risk of restless leg syndrome + Carpal tunnel Syndrome

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44
Q

respiratory system in pregnancy

wha looks like
may be
tidal volume
02 consumption
increase
BPM

A

Dyspnea/SOB-d/t fetus on lungs

May be congestion

↑ in tidal volume of air

↑ in O2 consumption causing mild hyperventilation

↑ in thoracic circumference

↑ depth & rate of respiration

18-20 breaths per minute

45
Q

what side to sleep on for resp

A

left sided sims position

46
Q

temperature changes in pregnancy

due to

A

Early pregnancy temp will increase– after 16 weeks temp goes back to nomral

due to progestogen

47
Q

Cardiovascular System in Pregnancy

blood flow
peripheral
postural
supine hypotensive

A

↑ blood flow to uterus & kidneys

peripheral blood flow dec causing edema-goes away at night

postural hypotension

Supine hypotensive syndrome-laying supine compresses vena cava and blood return to heart decreses

48
Q

Cardiac output

Heart rate

Blood presure

Blood volume

changes in Pregnancy

A

↑ in cardiac output,

↑ in HR,

slight ↓ in BP,

25 to 50 % ↑ blood volume

49
Q

Cardiovascular System in Pregnancy

need what for blood
plasma
physiologic anemia
inc

A

need ↑ of Fe and folic acid for inc rBC

50% ↑ in plasma volume

Physiologic Anemia - not having enough healthy red blood cells or hemoglobin to carry oxygen to the body’s tissue-SOB

increase in fibrinogen

50
Q

WBC changes

Clotting changes

Pregnancy changes in heart

A

Slight ↑ of WBC’s until delivery then significant ↑

↑ in clotting factors- ↑ risk of thrombosis

51
Q

what to teach for cardiovascular system

A

elevate legs and use compression sock helps vascolarities and blood flow

folic acid and iron helps enhance pregnancy and getting pregnant

52
Q

Gastrointestinal System in Pregnancy

s/e
peristalsis
gallstone

A

N & V-can be noticed at same time of hcg and progesterone increase- subsides after 3 months

↓ in peristalsis constipation heartburn and flatulence

↑ risk of gallstone formation-may need emergency removal

53
Q

Hemorrhoids
Heartburn
Gi system in pregnancy

A

pressure from uterus on veins and consitpation  Hemorrhoids

Relaxation of cardiac sphincter heartburn

54
Q

Hyper-ptyalism
Gums
Teeth

GI system in pregnancy

A

Hyper-ptyalism-excessive production of saliva

Bleeding gums-estrogen

Increased tooth decay

55
Q

Urinary Tract in Pregnancy

ureters
glom filt rate

A

Elongation & dilation of ureters

↑ in glomerular filtration rate (2nd trimester) and renal function

56
Q

urinary frequency in 1/2/3 trimester

Urinary Tract in Pregnancy

A

Pelvic organ- urinary frequency (1st & 3rd trimester)

Abdominal organ - ↓ urinary frequency (2nd trim)

57
Q

retention
capacity
decrease
reabsorb

bladderchanges in pregnancy

A

increase in fluid retention

increase in bladder capacity

decrease in BUN and creating

sometimes body cant reabsorb all glucose= glycosuria

58
Q

glycosuruia

can lead
inc what

Urinary Tract in Pregnancy

A

Sometimes body can’t reabsorb all glucose filtered

can lead to yeast infection

inc fluids and urination

59
Q

relaxation

Musculoskeletal System in Pregnancy

A

Relaxation of joints waddling gait- walking can be difficult and painful

60
Q

Progressive lordosis
Musculoskeletal System in Pregnancy

A

–shoulders back and abdomen forward

61
Q

Diastasis recti

Musculoskeletal System in Pregnancy

A

separation of rectus abdominis muscl

will not go back to same shape

62
Q

1st trimester changes in mother/father

A

accept reality of pregnacy, feel less pleasure and more anxiety-can be confusing/ once patients know gender they can be more accepting/hearing about prenatal can make feel “more pregnant” and help accepting

can be forgotten, but highly important to be apart of emotional/supportive role. Also feeling of ambivalence. Happy but overwhelmed, takes a lot of thought. May not have anyone to support them

63
Q

2nd trimester changes in mother and father

A

trimester-accept reality of baby-feeling a kick can give sense of a person inside. After quickening(first movement), refer to baby as its own entity. can pinpoint when they wanted the child

Trimester-can be felt left out. some will work more. can have difficulty enjoying pregnancy

64
Q

3rd trimester changes in mother father

A

”nest building activates” – prenatal classes and preparing for childbirth. Childbirth education. Happy time for most parents, but unwanted pregnancy, financial difficulties,

65
Q

sibling changes in pregnancy

A

The emotional upset and disruptive behavior of firstborn children to the arrival of a new sibling is often viewed assibling jealousy

routine is key for toddlers

school age needs reassurance

age appropriate teaching–also sibling classes

make it family affair

66
Q

grandprent changes in pregnancy

A

don’t know their role

can try to step in unnecessarily

can often overstep

tell parents to set boundaries

grandparents can be pushy

67
Q

Determination of due date

A

1st day of LMP

EDB

Subtract 3 months, and add 7 days

ultrasounds can help

68
Q

initial prenatal assessment

determine high risk factors

A

High risk = possible negative outcome

Social and personal

Preexisting medical-diabetes or thyroid may be high risk

Obstetric/GYN considerations
—-previous pregnancys what look like

Full Physical assessment including VS
Labs

69
Q

Laboratory tests
initial prenatal assessment

A

Hgb, Hct, and RBCs
ABO and Rh

WBC and differential

Glucose

Protein

Rubella

Hepatitis B and HIV (if desired)

STDs

Pelvic and Pap

70
Q

Pelvic exam answer

A

gyneocloid

71
Q

initial prenatal assessment

factors

A

Family and support systems-whats going on

Economic and living conditions-resources if needed

Educational needs-what help may need

=any home issues to be aware of

72
Q

Initial Assessment-Cultural Factors

A

Respect and professionalism-integrate practices if possible

Don’t stereotype

Ask, don’t assume

Break down language barriers

Handouts and translation services

73
Q

Subsequent Prenatal Assessments
how often

what looking at

fetal development

A

q 4 wks to week 28

q 2 wks to week 36, then weekly until birth

Health Interview
Weight Gain/VS
Edema
Urine sample
Uterine size-Fundal height

Fetal development
Quickening
Doppler
Ultrasound

74
Q

Special tests

first triemester

A

nuchal translucency testing

looking at neck folds on baby

75
Q

Special tests

2nd trimester

A

Amniocentesis

check for gender or genetic disorder

76
Q

Special tests

15-20 weeks

A

Quad or Pentascreen-

Down syndrome /neural tube defect or any risk

77
Q

Special tests

24-48 weeks

A

glucose tolerance test

and H&H (Glucose test may be done sooner if diabetes suspected)

looking for anemia

78
Q

Special tests

35-37 weeks

A

GBS (Group B streptococcus) screen

if positive given antibotcs during delivery

79
Q

prenatal danger signs

A

Vaginal bleeding
Persistent vomiting
Temp and chills
Gush of fluid
Abdominal pain
Dizziness, blurred vision, spots before eyes
Severe headache
Edema
Muscular irritability or convulsions
Epigastric pain
Oliguria
Dysuria
Absence of fetal movement

80
Q

Fetal activity monitoring

influences on fetal activity

A

mom will track activity-10 an hr

Cigarettes and drugs
Blood glucose
Time of day
Sleep/wake cycles
Sounds

81
Q

discomforts of 1st trimester pregnancy

A

Urinary Frequency

Nausea and vomiting

Fatigue

Breast tenderness

Increased vaginal discharge

Nasal stuffiness

82
Q

discomforts of second/third trimesters

A

Heartburn
Ankle edema
Varicose veins
Flatulence
Hemorrhoids
Constipation
Backache
Leg cramps
Faintness
SOB
Difficulty sleeping
—-Left sided Sims - optimal
Round ligament pain
Carpal tunnel syndrom

83
Q

Breast and Nipple Care

A

Support the breasts with nice bra
Comfort
Prevent back strain

Nipple Care
, don’t wash with soaps or put oil or lotion on the nipples

84
Q

Promotion of Self-care Environmental Factors

A

Employment-some jobs cant do

Travel- dont recommend later in trimester

Clothing and Bathing-loose fitting clothing

Activity and Rest

Teratogenic Substances and Medications-chemicals

85
Q

Environmental Factors-ETOH

A

increases the risk of miscarriage,

premature birth and your baby having a low birthweight

no ridge on nose

can cause neurological damage

NO ACLOHOL

86
Q

Environmental Factors-Tobacco

A

Effects of tobacco use –
increased incidence of:

Fetal growth restriction

Low birth weight - SGA

Stillborn and SIDS risk

87
Q

Pregnancy Nutrition
weight gain

A

Wt gain- 25-35 lbs if normal BMI

11 lb fetus, placenta, fluid
2.5lb uterus

4lb increased blood volume

1.5-3lb breast tissue

7 lb maternal stores-backup

88
Q

Nutritional requirements
pregnancy

A

Calories: 300 extra calories daily in 2&3 trimester.

Carbohydrates-

Proteins-meat, poultry, eggs

Fat-vegetable oils-

Minerals-calcium, Iodine, iron, fluoride, zinc-

Vitamins-CAD, folic acid//fresh fruit, vegtables, milk eggs

Fluid- 8-10 glasses fluid daily
4-6 should be water-2500-3000ml

89
Q

pregnacy nutrition

what to watch for

supplements

A

Watch raw foods and fish sources

Prenatal vitamin-can be taken-wont hurt

Supplements
-Iron: Iron helps make hemoglobin.
-Folic Acid- helps prevent neural tube defects AND helps make red blood cells.

90
Q

Factors affecting nutrition

A

Don’t restrict calories, but make them count = nutritious

Lactose intolerance
Eating disorders
Pica-eat non food items
Discomforts
Cultural, ethnic, and religious
Psychosocial
Socioeconomic

ADOLEctents need even more cals

91
Q

what to teach a new pt that comes in with N/v

A

small frequent meals

increase fluids to 2-3 l

8-10 fluids per day

92
Q

why is calcium so vital

A

calcium makes the baby bones!

if you dont eat calcium, baby will steal the calcium from your bones to create its bones

milk/dairy/leafy greens

93
Q

what occurs in metabolism in pregnancy

A

goes up-300 cals a day

underweight should gain over 35 lbs

normal should gain 25-30

overwiehgt should gain 15-20

94
Q

why no raw fish/deli meats

A

fish-mercury

meats-listeria-can cause still birth

95
Q

supplements

A

prenatal vits can always be taken

iron and folic acid are important to take during

96
Q

when to notify a provider in pregnancy

A

if any bleeding

97
Q

what teaching for urinatiom

A

go to bathroom as often as possible

go on first urge

empty bladder fast

98
Q

pain meds during pregnancy

A

ACETAMINOPHEN only

nothing else

99
Q

back pain help

A

soft shoes

massages

ice

positioning

pillows

100
Q

prevention of varicose veins

A

elevate legs

teds compressions stocking

101
Q

what do if mom is RH negative

A

ROGAM

shot at 28 weeks and 72 hrs after labor

help not trasnfering blood

102
Q

best sleeping position

A

left sided sims

helps dizziness

103
Q

what to do if severe fatigue

A

iron testing and H&H for anemia

104
Q

severe headache and blurred vision help

A

contract provider

NO ER

105
Q

what causes gums to bleed

A

estrogen

106
Q

what helps a baby move

A

ice water

sugary food

move around

call if nothing after 2 hrs

107
Q

when to get strep test

A

NO SOONER THEN 35 WEEKS

108
Q

why do babies kick at random times

A

not on same schedule as mother

kick when they feel like it

109
Q

what do you not take in pregnancy

A

NO mental health drugs

no lithium

antiserzires meds no

d- health alteration lp7 (7 decks)

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