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Maternal Exam 2 > Normal Pregnancy Part 2 > Flashcards

Normal Pregnancy Part 2 Flashcards

1
Q

What positioning can help with venous stasis?

A

Since venous stasis is due to pressure from the the uterus

  • side lying
  • put feet up
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2
Q

What type of muscular skeletal changes occur with PG?

A 
Waddling gait
Pelvic presure
Lordosis
Gravity shift
Diastasis recti
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3
Q

What happens that creates the waddling gait in PG women?

A

Pelvic joints relax to prepare for labor and delivery.

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4
Q

What hormones give you the waddling gait in PG? What else?

Which of too much hormone can cause your symphis to separate? Who is it more common in: small weighted women or big weighted?

A

Progesterone & Relaxin but also weight gain

Too much relaxin due to it only being collagen.
Women with bigger babies have separation occur more.

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5
Q

Why is waddling called the pride of PG walk?

A

The hip change will make you walk with shoulders back with your head up and feet far apart. It just makes you look prideful. Really it just keeps you from falling over.
- altered center of gravity

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6
Q

What actions cause pain with the separated symphis?

What do we recommend to help relieve pain?

When will the pain go away?

A

Actions like walking and stepping hurt it.

A tummy hugger; has lots of straps to help support your belly

Pain will only go away after your deliver

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7
Q

Why would pelvic pressure increase to causes musculature changes?

A

The growing uterus will put pressure on the nerves making it feel like more pressure

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8
Q

What is Lordosis & why does it occur in PG?

What does this feel like?

A

Lordosis is the increased lumbar curve

Feels like backache

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9
Q

What is Diastasis Recti? Treatment?

What is the risk with this?

A

Diastasis Recti is when the rectal band splits into two. Need surgery

Risk of umbilical hernia & your abdomen may protrude after PG

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10
Q

Explain the rib cage change

What causes dyspnea?

A

The rib cage will flare

Dyspnea caused by diaphragm shifting up

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11
Q

What happens to oxygen consumption in PG?

A

You will consume more bc you are breathing for two now

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12
Q

Where will you breath in PG?

A

Thoracic breathing

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13
Q

Will PG causes respiratory acidosis or respiratory alkalosis?

How much should mom be breathing while in labor?

A

Respiratory alkalosis due to hyperventilation that you might have to do to get the oxygen

Labor should be 20-22 times
- if goes into alkalosis will be pale and tingled

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14
Q

What happens to your voice in PG? And why?

A

The voice changes due to vascular congestion

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15
Q

Epistaxis increases in PG. What does it mean

Why might you want a soft bristle tooth brush?

A

Nose bleeding

So your gums dont bleed either

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16
Q

Does PG help or hurt hearing? Why?

A

Hurts hearing. Due to membrane swelling

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17
Q

What hormone is responsible for the n/v that occurs with pregnancy?

A

HCG

- starts 6 weeks, peaks 12 weeks and then goes away

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18
Q

Pytalism meaning

What can help?

A

Increased saliva gland activity that causes you to have to swallow more or chew gum

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19
Q

Why does constipation occur in PG?

How to manage this?
Med?

A

Constipation occurs due to decreased peristalsis due to Progesterone hormone

Need to drink fluids, take in more fiber, and more activity

Colace med/stool softener

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20
Q

What happens to the cardiac sphincter in PG?

How to manage the pyrosis?

A

Cardiac sphincter will relax and cause pyrosis.

Manage with eating small, frequent meals and staying sat up instead of laying down. Don’t eat close to bed time

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21
Q

What does increased venous pressure do to the anal region?

A

Causes hemorrhoids. Try to avoid constipation

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22
Q

Pica?

A

Only really happens in PG

herbivores and noncaucasian women have highest risk but can happen for any any age group

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23
Q

How does PG affect the gallbladder?

Why?

A

Can cause more gallstones due to progesterone. Can even occur after PG.

Lack of muscle tone
Prolonged emptying time
Increased cholesterol in bile
Retention of bile salts - causes itching

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24
Q

If you have a history of gastric ulcers will PG make them worse?

A

Actually no! The acidity of the stomach decreases in PG and it may help

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25
Q

Why does mom have delayed gastric emptying in PG?

A

It is so her intestines have more time to absorb stuff

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26
Q

What does the relaxation of the cardiac sphincter cause

A

n/v
heartburn
bloating

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27
Q

How can the appendix be affecte by PG?

A

Become displaced much higher than normal - and if you have appendix, it will be way higher than other people having appendix.

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28
Q

Why does GFR and renal plasma flow of kidneys increase?

How is BUN when pregnant?
And creatine?
What if you see these as normal?

A

To keep up with demands of PG and the increased waste products

Bun lowered
Creatine lowered
If either of these are seen as normal , it actually means they are elevated technically due to lower in PG

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29
Q

What do serum sodium levels look like?

Does this mean we should eat or avoid sodium?

A

decrease - which causes the edema

Depends on the person. it is very individualized

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30
Q

What happens to glucose in PG?

A

May see spilling of glucose in last month of PG but only a trace amount.
- should never be more than 1+

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31
Q

Why is there an increased risk of UTI in PG?

What happens to kidneys ?

A

Due to pressure

Kidneys and uterers enlarge and dialate . May see hydronephrosis on right (but depends where baby is)

32
Q

What happens to ureters in pregnancy?

A

Dilate as well but then become compressed due to uterus pressure

33
Q

What happens to to pH in pregnancy?

A

Increases - which puts you at higher risk of uti

34
Q

How does urinary present?

A

It comes on , leaves, and then comes back due to lightening

- early & late. no sign of infection or anythign either

35
Q

Neuro

headache

cramps

Acrothesia

Fainting concern?

A

Tension headache

Muscle cramps due to imbalance of calcium and phosphors and circulatory stasis
- do get moving to prevent and elevate legs

Acrothesia: numbness of stooped shoulders due to weight of breasts that puts pressure on brachial plexus
- get them in a better bra & improve postuer. no guarantee of improvement

If a young woman says she fainted at work, they will do a PG test. But first need to rule out..

  • vasomator instability
  • hypotension
  • hypoglycema
36
Q

Carpal tunnel syndrome cause

Symptoms

What can exaggerates symptoms

After PG - will it go away?

A

Median nerve pressure from fluid/edema

Pain, tingling, weakness in hand to elbow in dominant hand usually (but can affect both)

Smoking and alcohol

Can persist after delivery in some. will need to have procedures

37
Q

What does the pancreas need to do in PG? And what if it can’t do this?

A

Increase insulin demand to meet needs of PG

Diabetes mellitus

38
Q

How much does the thyroid enlarge?

A

25% due to metabolism going up in PG

39
Q

What does anterior pituitary release?

A

FSH, LH, and Prolactin hormones for PG

40
Q

What does posterior pituitary release?

A

Oxytocin and vasopressin (ADH)

41
Q

Adrenal gland releases?

A

estrogen increases cortisol

Aldosterone sodium retention

42
Q

Initial visit history check?

A

Review of all systems
Family Hx
Personal health hx (so her) - wt, meds, allergies, diseases, illnesses, surgeries
Psychosocial hx - depression, anxiety
Gyn hx - menarche, infections, BC
Pregnancy hx - LMP, GTLA
Religious preference - jewish circumcision done by rabbi
Ethnicity & cultural practices - men not involved example. Ask them what they want!!!
Occupational hx
Person - education, housing, insurance, support
Birth plan
Feeding plans
Circumcision

43
Q

Does everyone have a birth plan?

Do we welcome birth plan?

A

No - but some do. It allows for mothers to choose what they want to happen. It is a sign they are committed and educated

44
Q

What is involved in physical exam?

A

Baseline vitals
Systems assessment
Fundal height - need empty bladder
FHR - at appropriate time

45
Q

When will they do the risk assessment?

A

Will do it first and every visit too. It is just checking on the mom’s subjective symptoms.

46
Q

How often should a mom get a urine analysis?

If there is a concern?

A

Every visit . Can take it home and bring it with them right before she leaves home due to shy bladder

pH, SG, glucose, protein, leukocytes, blood

If there is a concern with the UA will order a renal function test (BUN, creatinine, electrolytes)

47
Q

Why does everyone receive a CBC

HGB levels that indicate anemia?

HCT?

A

To get a read on H&H and check for anemia

hemoglobin anemia- less than 11

hematrocrit anemia - less than 30

48
Q

Why do we want her blood type ?

A

Check for rh factor

- done twice tho. once now and once upon admission to hospital for delivery

49
Q

What do we check for immunizations

A

Rubella titer
Heb B screening or C depending on hx
HIV
TB if not done within last 6 motns

50
Q

What stds will they check for?

A 
Syphillis screening 
Gonorrhea
Chlamydia 
HPV if not done in 6 months
Herpes - only if hx or lesions
HIV
51
Q

What if mom doesn’t report her drug using?

A

Some people will call and report

Or if she triggers protocol checking like missing appt, not doing prenatal care, etc

52
Q

When is Penta Marker done?

A

15-17 weeks

53
Q

When do they do glucose screening?

A

First visit

And then do it 24-28 weeks

54
Q

When will they do GBS screening?

A

36 weeks or late pregnancy but treated in labor

55
Q

Formula used for calculation of due date?

A

Naegele’s rule where you take first day of LMP & write out its date. Subtract 3 months. Then add 7 days.
- based off lunar months

56
Q

What if they have no idea when the last period was?

A

Check ultrasound . Earlier it is, more accurate
Pregnancy wheel on last period & go around 40 weeks
Web apps

57
Q

When do mom and baby need to have first visit?

A

Miss 2 periods ideally. Between 8-12 weeks in first trimester

58
Q

How often does mom need to come in during second trimester?

How often does she need to come back in third trimester?

A

Every 2 weeks in second trimester

Every week in third trimester

.. in normal pregnancies

59
Q

Red flag for drug screening?

A

Late prenatal care

Missing appointmens

60
Q

Who assesses moms anatomy?

pelvic inlet

midpelvis

pelvic outlet

A

Physician

first plane of pelvis

mid plane

outlet plane

you only have 3. They can tell pretty early on if you can delivery vaginally

61
Q

Danger signs of Pregnancy

Gush of fluid

bleeding where?

pain where?

fever of what?

Pre-eclampsia symptoms

vomiting?

severe headache?

edema?

muscle behavior?

epigastric pain?

Oliguria

Dysuria

change in fetal movement

A

Gush means rupture

Vaginal bleeding

abdominal pain

101 or 104.. call doctor

BP going up causing dizzy and blurry vision, spots, headache

vomiting persistently tho. Not just morning sickness

headache that isn’t going away with Tylenol

edema above the knee is not normal

muscle irritability - jerking, seizures (eclamptic)

epigastric pain could mean liver issue

no pee - oliguria , preeclampsia

more pee - dysuria. UTI or gestational diabetes

typically decreased . people will come in for a check

62
Q

Can you give a live virus in PG?

Which live vaccinations should we never give?

A

No do not give a live virus.

MMR
Varicella
Polio
Yellow fever
Smallpox
63
Q

Can you give flu, rabies, hep a, enhanced polio?

A

Yes because they are inactivated

64
Q

Can you give immunoglobulins to PG mom?

A

Yes - but they are weight based.

65
Q

First Trimester Complaints

N/V

Urinary frequency

Fatigue

Breast tenderness

Increased vaginal discharge

Nasal stuffiness & nose bleeding

Pytelism (excessive salivation)

A

N/V - due to increased HCG and metabolism. Avoid causative factors. Eat crackers. Small frequent meals. Avoid greasy or seasoned food. Eat dry meals with fluids in between. Drink carbonated beverages

Urinary frequency - due to pressure. Void often, drink plenty still in day but decrease in evening only

Fatigue - plan time for your nap or go to bed sooner. ask family to help you out sometimes w responsibilities

Breast tenderness - increased estrogen and progesterone is the cause. wear a well fitting bra

increases vaginal discharge - due to estrogen. bathe daily . wear cotton

Pytelism - chew gum or candy. astringent mouthwashes

66
Q

Second Trimester complaints

fainting

dyspnea

flatulence

carpal tunnel

A

fainting - changing position so avoid prolonged standing in warm or stuffy environments

dyspnea - pressure on diaphragm . use proper posture and sleep propped up w pillow

flatulence - avoid gassy foods. chew food. daily exercise. normal bowel habits

carpal tunnel - avoid aggravating hands. use splint. elevate arm

67
Q

Second and Third trimester

heartburn

anke edema

varicose veins

hemorrhoids

constipation

backache

leg cramps

A

heartburn f- rom cardiac sphincter relaxing . eat small frequent meals. no fatty or fried foods. don’t lay down after eating

ankle edema - dorsiflexion, prolonged sitting or standing. elevate legs when sitting. avoid tight stuff

varicose veins - elevate legs , wear hose, avoid crossing legs,

hemorrhoids- avoid constipation, apply ice, ointments, do warm soaks

constipation - increase fluids if possible. fiber in diet. develop regular bowel habits.

backache - avoid uncomfortable working heights, high heeled shoes, lifting heavy loads, and fatigue

leg cramps - imbalance of phosphorus and calcium. so do dorsiflexion to stretch. and evaluate diet . maybe apply heat or start getting up slowly.

68
Q

Breast Care

What should your bra be like?

How should you clean your breasts?

How to avoid cracking of breasts/nipples?

What are breast shields?

What if you see your nipples are flat?

What should clothing be like?

A

A well fitted bra for your changing body.

Hygiene is important with but no soap when you breast feed. It can dry you out and get rid of natural emollient.

You can moisturize with lotion and colostrum.

Erects flat nipple. Influences collagen.

If nipples are flat - you need to treat before delivery if you want to breast feed.

Clothing should be loose but still supportive bra

69
Q

Cleanliness

How often should mom bathe?

Temp?

A

Bathe daily but not tub baths!!! DUe to vaginal bleeding or ROM

Hyperthermia risk if too hot of water

70
Q

Can pregnant women be employed?

A

Yes employment is fine. May be at risk of preterm tho if standing for more than 3 hrs

71
Q

Is it ok for PG women to travel?

A

No restrictions unless there are complications . But ask physicians really

Some reasons not to go would be if near preterm labor, bleeding, preeclampsia, or multiple births

72
Q

What should be done when traveling in the car?

A

Take breaks, no caffeine, drink fluids, wear seat belt

73
Q

Can you fly in PG?

A

Depends on the airline .

74
Q

pregnancy exercises (4)

A

pelvic tilt to promote flexibility and reduce back pain
abdominal exercises
kegels for pelvic floor
tailer sit stretch for inner thigh muscles

75
Q

Trimester responses to getting PG in mom

A

1st - im pregnant (self centered)

2nd - I am gong to have a baby (fetus is seperate frmo baby)

3rd - I am going to be a mother

76
Q

PG response of father?

What is it called when men experience a set of behaviors specific to the mom being PG?

A

By 3rd trimester - should be feeling like the father

Couvade

  • weight gain
  • headaches
  • tend to be very involved tho
77
Q

How to prepare siblings?

A

Let them know they’re still loved
Involve them based on their age
Reassure them
Gift to the baby for acceptance

If they aren’t handling it well, a toddler may regress. Potty accidents, sucking on thumb or pacifier ,etc.
- if you give positive reinforcement , this should pass

Maternal Exam 2 (10 decks)

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