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3rd Semester Nursing > OB Test 4 > Flashcards

OB Test 4 Flashcards

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1
Q

An abortion is any fetal loss before ___

A

The third trimester

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2
Q

What screenings are done at the first visit?

A 
H&H
Blood type, Rh type and antibody screen
HCG levels
STIs (including HIV)
Cervical cancer screen
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3
Q

What are the numbers for healthy fetal kick counts?

A

Up to 10/hr during 7th month… slows slightly towards 38-40 weeks (10 in 2h?)

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4
Q

How often are antepartum visits?

A

Once a month until 28 weeks.
Twice a month until 36 weeks.
Four times a month (weekly) until delivery.

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5
Q

What is an operculum?

A

Mucus plug - seals cervical canal during pregnancy.

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6
Q

When does quickening occur?

A

Primips: 18-20w
Multips: 16+ weeks

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7
Q

How to figure out fundal height?

A

Correlates with weeks of gestation (cm above pubis) between 22-34 weeks (fetal weight variations change it after that).

VOID before measuring. Same person, same position each time.

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8
Q

How early can colostrum be expressed?

A

As early as 16 weeks

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9
Q

Respiratory system changes

A

Tidal volume increases (increases hyperventilation) which causes respiratory alkalosis.

Vital capacity increases slightly; compliance and pulmonary diffusion stay the same.

Flared rib cage, increased chest circumference, thoracic breathing.

Nasal stuffiness (“rhinitis of pregnancy”)

Nosebleeds (vascular congestion/edema of nasal mucosa r/t estrogen).

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10
Q

True or false: pregnancy can cause a) estrogen-induced edema, b) hypersecretion of mucus, and c) vascular congestion of the nasal mucosa?

A

True

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11
Q

True or false: pregnancy can cause a) a change in white blood cell production, b) reduction in total fluid volume

A

False

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12
Q

When will shortness of breathing related to pregnancy improve?

A

The last few weeks, as lightening occurs.

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13
Q

Changes to the cardiovascular system

A
  • Blood volume increases (plasma and erythrocytes)
  • cardiac output increases
  • pulse rate can increase up to 15bpm.
  • blood pressure decreases. (Lowest point = 2nd trimester).
  • Orthostatic hypotension d/t multiple factors (including lower albumin, increased femoral venous pressure and dependent edema
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14
Q

What is supine hypotensive syndrome (vena cava syndrome)?

A

Decrease in BP; pallor, dizziness, clamminess that occurs as a result of pregnant woman lying on back.

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15
Q

What is the ‘physiologic anemia of pregnancy’?

A

As plasma volume increases, hematocrit decreases (relative)

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16
Q

What happens with leukocyte production in pregnancy?

A

Increases - during labor and postpartum, can raise to 25k.

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17
Q

What happens to fibrin levels during pregnancy? Why is this a problem?

A

Fibrin levels increase during pregnancy.

DVT risk

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18
Q

What hormone causes nausea/vomiting during first trimester?

A

HCG

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19
Q

What happens to gums in pregnancy?

A

They can also get increased blood flow and be prone to bleeding

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20
Q

What are common GI symptoms in pregnancy?

A
  • Excessive salivation
  • Heartburn (d/t displacement of stomach/intestines)
  • hemorrhoids
  • GALLbladder stasis (gallstone formation)
  • Bloating (stasis d/t progesterone = smooth muscle relaxation)
  • constipation (Stasis d/t progesterone = smooth muscle relaxation)
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21
Q

What is the normal temp range during pregnancy?

A

97-99.6

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22
Q

What are normal urinary changes during pregnancy

A

Increased need to urinate in 1st and 3rd trimesters

  • UTIs (increased amino acids and glucose in urine + urethral atonía + ureter stasis)
  • possible glycosuria (should still check it out, but not uncommon).
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23
Q

What causes increased skin pigmentation?

A

Increased levels of estrogen and progesterone increase alpha-melanocytes.

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24
Q

What does relaxin and progesterone do to the joints? Which joints?

A

Sacroiliac, sacrococcygeal, pubic joints - relax in the later part of pregnancy. Leads to waddling gait.

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25
Q

Why does carpal tunnel syndrome happen in pregnancy?

A

Because there’s pressure/edema on peripheral nerves

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26
Q

What is acrothesia?

A

Numbness and tingling of the hands (normal in pregnancy)

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27
Q

Why do muscle cramps/tetany happen in pregnancy?

A

Low levels of calcium

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28
Q

What does FSH do and what produces it?

A

Pituitary gland: stimulates the growth of the egg in the follicle

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29
Q

What does LH do and what produces it?

A

Pituitary: stimulates the release of the egg

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30
Q

What does prolactin do and what produces it?

A

Pituitary: stimulates initial lactation

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31
Q

What does the corpus luteum do?

A

Releases progesterone to maintain the endometrial lining in case implantation occurs.

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32
Q

What does the posterior pituitary secrete during pregnancy

A

ADH/vasopressin: causes vasoconstriction and helps water balance

Oxytocin: promotes uterine contractility & letdown reflex

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33
Q

What is hPL and who produces it?

A

Human chorionic somatomamatropin…. ie human placental lactogen. Produced by the placental lining (synctiotrophoblast).

Antagonizes insulin.
Increases glucose (for fetal growth)
Increases fatty acids circulating.
p. 160

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34
Q

What happens to the thyroid in pregnancy?

A

Gets bigger and more active
T4 increases
TSH decreases.

Increases basal metabolic rate
Increases protein-bound iodine.
Returns to normal a few weeks after birth.

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35
Q

Endocrine changes

A

BMR increased
Concentration of parathyroid hormone increased
Parathyroid gland size increases
Increases removal of calcium from the bones to balance babies removal
Adrenal glands increase cortisol and aldosterone levels

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36
Q

Nutrition requirements during pregnancy

A 
300 more calories per day
60g of protein per day
1.2g of calcium per day
0.4mg of folic acid per day
Iron: 30-60mg supplementation last 3-4 months
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37
Q

How much weight should a low weight (19.8 BMI or less) mom gain during pregnancy?

A

28-40 lbs

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38
Q

How much weight should a normal weight (19.8-26.0) mom gain during pregnancy?

A

25-35lbs

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39
Q

How much weight should a high weight (26-29 BMI) mom gain during pregnancy?

A

25-35lbs

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40
Q

How much weight should an obese (29+ BMI) mom gain during pregnancy?

A

15+ lbs.

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41
Q

What are the consequences of low and high pre-pregnancy BMI?

A

Can increase risk for severe maternal morbidity/mortality.

Obesity: Larger babies = increased complication risk; increased risk of eclampsia, kidney failure, sepsis, hemorrhage, resp problems.

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42
Q

Recommendations for Nausea/Vomiting

A
  • eat dry crackers before getting up
  • small frequent meals
  • drink between meals
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43
Q

Recommendations for urinary frequency in pregnancy

A

Normal during 1st & 3rd trimester

  • what to look for with bladder infection
  • drink min 2000L/day
  • empty bladder Q2h
  • get rid of fluid after dinner.
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44
Q

Epistaxis or rhinitis

A

Cool air vaporizers
Normal saline nasal sprays
(Can grow used to other sprays)

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45
Q

Ptyalism - what is it?

A

Bitter taste in mouth. Can be excessive amount of saliva.

46
Q

Recommendations for heartburn

A 
Low-sodium liquid antacid
Avoid aluminum (constipation)
Avoid magnesium (diarrhea)
Avoid sodium (electrolyte imbalance)

If not relieved by antacids, can get a prescription for an H2 blocker.

47
Q

Recommendation for varicose veins

A

Side-lying position during rest and sleep.

Surgery not recommended until after delivery.

48
Q

Recommendations for constipation

A

Increase fiber in diet
Increase fluid intake
Increase exercise

If preexisting, the HCP can recommend stool softeners, laxative, suppositories.

49
Q

Body mechanics for back pain

A

Legs 12-18” apart

Bend at knees to lift objects

50
Q

Recommendations for leg cramps

A

Increase calcium intake
Increase phosphorus intake
Stretch
Avoid extension of foot.

51
Q

Round ligament pain - recommendations

A

Described as a “grabbing” pain in abdomen.

Apply heating pad to the abdomen once medical complications have been ruled out.

52
Q

Do you need to worry about edema in the hands and face in the morning?

A

Yes. Danger sign during pregnancy.

53
Q

Do you need to worry about epigastric pain during pregnancy?

A

Yes - sign of preeclampsia and HELLP syndrome.

54
Q

What are the first two uterine phases of the menstrual cycle

A 
Menstrual phase
Proliferative phase (estrogen rises)
55
Q

When doe the luteal phase begin and what hormones are associated with it?

A 
Begins after ovulation
Progesterone increases (secreted by the corpus luteum)
56
Q

What are the three phases that the uterus goes through during the luteal phase?

A

Secretory phase (epithelial cells plump up and secrete endometrial fluid)

Ischemic phase (if not fertilized, corpus luteum degenerates, estrogen and progesterone fall)

Menstrual phase

57
Q

What OTC medications for headache can you take in pregnancy?

A

Acetaminophen

(NOT aspirin or ibuprofen).

58
Q

When do you take the OGTT and if you have to repeat it, what are the criteria for a diagnosis?

A

24-28 weeks

For 3h OGTT, two or more of the following:

  • fasting 95+
  • 1h 180+
  • 2h 155+
  • 3h 140+
59
Q

What pharmaceutical treatments for diabetes are used during pregnancy

A

Insulin or glyburide

60
Q

When do you perform ultrasounds for diabetic moms.

A

Week 24 and every 4 weeks after.

61
Q

When do you perform Non-Stress Tests for diabetic moms?

A

At 28 weeks and every week afterwards.

62
Q

What are some newborn complications of gestational diabetes

A 
Hypoglycemia
LGA
Large head/shoulders
Premature births 
Polyhydramnios
Decreased surfactant / resp distress
Meconium - poop in the soup
Placental insufficiency to fetus
63
Q

In TORCH, what does the “o” encompass?

A

Other: hepatitis B, syphilis, herpes zoster

64
Q

What is the Kleihauer-Betke test for?

A

Done after trauma to see how much fetal blood is in maternal circulation.
(Can also assess for pre-term labor)

65
Q

Do all women who get help have preeclampsia?

A

No - they may not have BP problems or proteinuria.

66
Q

What are the criteria for preeclampsia?

A

BP over 140/90 + proteinuria.

67
Q

When do you start doing kick counts?

A

After 27 weeks

68
Q

What does NIPT test for and at how many weeks?

A

Tests for trisomy disorders (and gender) at 10-20 weeks.

69
Q

Guidelines for fetal kick counts

A

Lie on L side
20-30m each time
You want 10 fetal movements in 3 hours

(If you have less than 8, tell provider)

70
Q

What is percutaneous umbilical blood sampling for?

A

To determine genetic anomalies. Can do after 18 weeks gestation.

71
Q

What is chorionic villi sampling for and when can you do it?

A

Take a small sample of cells from where the placenta attaches to the uterus. Can be done after 9 weeks. Detects genetic diseases and some birth defects.

72
Q

What are the rules for getting an abdominal ultrasound done?

A

Have 1-2Q of fluid to drink beforehand so you have a full bladder.
Wedge under the right hip, leaning to the left.

73
Q

What does ultrasound screen for?

A

Nuchal translucency of 3mm or greater (trisomy 13, 18, 21)

Can help guide needle for chorionic villus sampling.

74
Q

At how many weeks does a NST switch from 10/10 to 15/15

A

At 32 weeks.

75
Q

What does the biophysical profile entail?

A 
NST (2pt)
Fetal breathing (2pt)
Fetal tone (2pt)
Fetal movements (2pt)
Amniotic fluid (2pt). 
8-10= normal. Less than 6, notify provider.
76
Q

How to set up contraction stress test?

A

Obtain 15m baseline on FHR
Then, Pitocin or nipple stim
Want 3 contractions that last for 40-60s in 10m.

If late decels (50% or more), Positive result. Can’t withstand stress of labor.
If non-persistent late decels, Equivocal result. Might need BPP.
If negative, baby is good to go.

77
Q

Amniocentesis procedures

A

Consent
Give RhoGAM (if Rh -)
Empty bladder (dont’ want to puncture it)
Monitor VS and FHR
Tell mom to notify if she feels decreased fetal movement, uterine contractions, fever/chills.

Take more fluids over the next 24h and rest.

78
Q

What does amniocentesis do?

A

Extracts amniotic fluid for genetic testing. (Diagnoses Down syndrome, can diagnose fetal lung maturity). 99% accurate.

79
Q

What is AFP?

A

Alpha feto protein. Produced by the placenta until 6w, then by the fetal liver after 6w.

Can show up in amniotic fluid or maternal blood (15-20w).

80
Q

High AFP can signify

A

Neural tube defects
Omphalocele (organs outside of belly button)
Anencephaly (born without parts of brain)
Multiples

81
Q

Low AFP can signify

A

Down’s syndrome

Hydatidiform mole

82
Q

What does the Quad Screen contain

A

-AFP test (neural tube defects (H), Down syndrome (L), hydatidiform mole (L))
-hCG (molar pregnancy)
-Unconjugated estriol (tests for multiple anomalies)
-Diameric Inhibin A (Down’s syndrome marker)
Just a blood test (15-20w).

83
Q

Why does hyperemesis gravidarum cause ketonuria

A

If not enough nutrients, body will break down muscle/fat.

84
Q

Will dehydration lead to acidosis or alkalosis

A

Acidosis

85
Q

With a molar pregnancy, will the fundus be higher or lower?

A

Higher

86
Q

Why is anemia a risk of molar pregnancies?

A

D/t bleeding.

87
Q

What’s the benefit of a progesterone injection if you have a short cervix?

A

Can decrease the risk fo preterm labor by 1/3

88
Q

If pre-term labor is likely, how long to you want steroids to be in the system? How much earlier can you give them?

A

Want steroids in the system for 48h prior to delivery

Can be up to 7 days earlier.

89
Q

What is fetal fibronectin test for? Is it accurate?

A

It’s to determine the likelihood of labor. Swab of tissue at cervix.

If negative, good chance mom won’t deliver in 2w.
If positive, doesn’t really mean much.

90
Q

Why would you want an ultrasound to measure cervical length?

A

To see the risk for preterm labor (shorter cervix - more likely labor)

91
Q

Aside from fetal lung maturity, what else do corticosteroid injections help with? When would you want to give them?

A

Intraventricular hemorrhage, necrotizing enterocolitis, and respiratory distress syndrome.

Give if PPROM at < 32w.
Actively in preterm labor
delivery is anticipated in 7d and mom is 24-34w.

92
Q

What are some tocolytics we mentioned?

A

Cox inhibitors
Calcium channel blockers (nifedipine)
Calcium antagonists (mag sulfate) in conjunction with something else
Terbutaline (oral or subQ)

93
Q

What other benefit does mag sulfate have in a premature delivery?

A

Can reduce the risk of cerebral palsy.

94
Q

How do insulin needs vary in pregnancy if a person has type 2 diabetes?

A

Insulin needs decrease in the 1st trimester

Increase in the 3rd trimester

Decrease after placental delivery

95
Q

Is Trichomonas a bacteria, parasite or virus?

A

Parasite. Spread by sex.

96
Q

Is vaginosis d/t a parasite, virus, or bacteria?

A

A bacteria

97
Q

What are the paternal stages?

A

Announcement (excitement)
Moratorium (doesn’t feel real, on hold)
Focusing (can see, feel baby move)

98
Q

What are adolescent moms more at risk for?

A

Anemia
Preeclampsia
Gestational diabetes

99
Q

How long should sperm be in the body before ovulation?

A

9-12 hours, ideally.

100
Q

What are the s/s if chlamydia is symptomatic?

A

Pain: urination, abdominal, during sex.
Discharge: anal, penile, vaginal
Swollen testes
Bleeding.

101
Q

What are the medications for chlamydia?

A

Ezithromycin, Doxycycline. Treat in pregnancy.

102
Q

What can chlamydia and gonorrhea cause (later complications)

A

PID
Infertility
Chronic joint pain
Ectopic pregnancy

103
Q

What are the s/s if gonorrhea is symptomatic?

A

Pain: urination, abdomen, pooping.
discharge (yellow, white, green)
Bleeding
Cluster of fluid-filled blisters

104
Q

What are the medications for gonorrhea?

A

1 shot of ceftriaxone, 1 dose of oral ezithromycin

105
Q

What conditions can chlamydia cause in newborns

A

Conjunctivitis

Pneumonia

106
Q

What conditions can gonorrhea cause in newborns?

A

Ophthalmia neonatorium (reason for eye ointment)

107
Q

Syphilis, s/s early

A

Chancre @ entry site, 1st 4 weeks.

  • weight loss
  • malaise
  • Slight fever
108
Q

Syphilis s/s late

A

Wart-like plaques (infectious), rash on palms

109
Q

What problems can result from syphilis (baby?

A

Miscarriage, stillbirth, neuro issues, birth defects, infant death.

110
Q

How is an HSV CNS infection diagnosed?

A

PCR assay

111
Q

When do you start to get HIV symptoms?

A

About 2-4 weeks after infection (feverish, achy, sick)

Unlikely to show up until after 18m if baby

112
Q

Can you deliver vaginally with HIV?

A

Yes, if viral load is undetectable. C/s if detectable viral load.

3rd Semester Nursing (5 decks)

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