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Advanced Principles 2 > Obstetric Patient Part 1 > Flashcards

Obstetric Patient Part 1 Flashcards

1
Q

Changes during pregnancy include

A 
CV
hematologic
respiratory
nervous
GI
hepatic
Renal
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2
Q

Describe the main changes to the CV system of the pregnant woman.

A 
Increased HR
Increased CO
Ventricular walls thicken
Dilutional anemia
Decrease in SVR
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3
Q

HR will increase by

A

20-30% by term for the parturient (peaks at 32 weeks)

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4
Q

Cardiac output will increase by _______

A

40% over non-pregnant values

  • stroke volume contributes to a great extent
  • 10% perfuses the uterus
  • increase by 80% immediately following delivery
  • returns to baseline in 14 days
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5
Q

When ventricular walls thicken,

A

systolic murmurs not uncommon

diastolic murmurs and cardiac enlargement pathologic

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6
Q

Describe dilutional anemia

A

there is a large increase in plasma volume more than RBC volume

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7
Q

Normal blood loss for a vaginal delivery is

A

500 mL

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8
Q

Normal blood loss for Cesarean section is

A

800-1000 mL

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9
Q

A decrease in SVR results in

A

venous pooling

decrease in diastolic blood pressure

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10
Q

Aortocaval compression results from

A

compression of aorta and vena cava by gravid uterus leading to supine hypotension

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11
Q

Aortocaval compression is more severe in

A

polydraminos and multiple gestation

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12
Q

With aortocaval compression, hypotension can occur

A

immediately

-usually 10 minutes to develop

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13
Q

Aortocaval compression is relieved by

A

left uterine displacement

-optimal angle is 15 degrees

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14
Q

Hematologic changes to the mother include

A

“hypercoagulable”
increased risk for thromboembolic events
platelet count decreases slightly
WBC count rises

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15
Q

Describe what makes the parturient hypercoagulable.

A

clotting factors VII-IX increased

fibrinogen increased

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16
Q

One of the leading causes of maternal mortality is

A

thromboembolic events

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17
Q

Describe respiratory changes for the pregnant woman.

A

airway swelling during labor
increase in O2 consumption
minute ventilation increases
upward pressure of diaphragm

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18
Q

Airway swelling during labor results from

A

capillary engorgement resulting in

  • narrowed glottic opening
  • oral & nasal pharynx edema
  • laryngeal edema
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19
Q

Describe airway considerations for the parturient.

A

avoid nasal intubation
short handle on laryngoscope
intubation with a smaller tube 6.5 mm cuffed endotracheal tube

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20
Q

Describe the increase in oxygen consumption.

A

33% at rest

100% during labor

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21
Q

Describe the rise in minute ventilation.

A

increase in TV>RR

PaCO2 decreases slightly- compensatory decrease in HCO3

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22
Q

Upward pressure of the diaphragm results in

A

decrease in FRC, less residual volume

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23
Q

In the apneic mother,

A

there is RAPID DESATURATION

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24
Q

Describe changes to the nervous system.

A

Increased sensitivity to anesthetic gases & LAs

increased block height

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25
Describe why there is increased block height for the parturient.
engorged epidural veins | increased intra-abdominal pressure- decrease in epidural & SAH spaces
26
Describe the gastrointestinal changes to the parturient.
increased risk for regurgitation and aspiration - increased levels of gastrin - upward displacement- mechanical obstruction - Labor further reduces gastric emptying
27
Prior to cesarean section for GI reasons, give the mother
nonparticulate antacid H2 receptor blocker prokinetic
28
Describe the hepatic changes to the parturient.
decrease in serum albumin | -increase in free-fraction of highly protein bound drugs
29
Describe the renal changes for the parturient.
``` -Increased GFR BUN & creatinine decrease -glucose excreted in urine high GFR reduced renal absorption -protein excretion elevated ```
30
At term, uterine blood flow increases to a maximum of
800 mL/min. - 10% of CO - 150 mL/min supplies nutrients to the myometrium - 100 mL/min flow to the decidua basalis (maternal part of placenta)
31
Uterine blood flow allows for exchanges of
nutrients, respiratory gases, and waster - oxygen & CO2 are "perfusion limited" - fetal transfer dependent on perfusion, not gases rate of diffusion
32
The fetus sends oxygen-poor blood to
the placenta - two umbilical arteries - perfuse capillary networks of the placental villi
33
Most _____ are transferred via diffusion
drugs
34
Placental transfer of drugs is dependent upon
``` concentration gradient molecular weight (<500 daltons cross easily) lipid solubility state of ionization protein binding ```
35
Fetal effects of placental drug transfer are minimized by
dilution with intervillous blood redistributed once in the fetus umbilical blood passes through liver (first pass effect) increase in maternal hepatic enzymes decrease serum drug levels
36
_______ may affect drug accumulation for the fetus
acid-base status | -"ion-trapping"
37
One-fifth of fetal cardiac output returns
directly back to placenta | -shunt flow from foramen ovale & ductus arteriosus
38
Labor is a progressive
dilation of the cervix in response to uterine contractions
39
Describe the stages of labor.
stage 1: effacement & dilation of the cervix Stage II: cervix 10 cm dilation to delivery of the fetus (active pushing) Stage III: delivery of the placenta
40
Describe the latent versus active stage of stage I labor
latent: onset of labor to point of rapid cervix dilation active: cervix dilation 2 cm to full dilation (10 cm)
41
Describe pain in the first stage of labor.
non-localized aching or cramping | T10-12 & L1
42
Describe pain in the second stage of labor.
cervical dilation complete and presenting part descends into the pelvis S2-S4
43
Pain during labor is accentuated by
fear of the unknown
44
Pain is highly _____ and varies
individualized and varies widely among patients
45
Four factors critical to a woman's childbirth experience include
personal expectations amount of support from caregivers quality of patient-caregiver relationship -patient's involvement in decision making
46
Fetal heart rate monitoring is
not a specific predictor most readily available method to determine fetal condition allows you to relate FHR to uterine activity
47
Describe the two methods for fetal evaluation.
external- doppler placed on maternal abdomen | internal- electrode placed in fetal scalp
48
The two channel format of fetal heart rate monitoring monitors
FHR | uterine contractions
49
Normal FHR is
110-160 BPM***********
50
When examining changes in fetal heart rate, we are looking at
variability | accelerations
51
Describe accelerations
results from fetal movement & adequate oxygenation
52
The single best indicator of fetal well-being is
variability - indicates fetal oxygen reserve - -hypoxia (CNS depression) decreases it - interaction in autonomic nervous sytem
53
Describe the types of decelerations.
early variable late
54
Early decelerations occur in
concert with uterine contractions consistent with each decrease in FHR approximately 20 bpm
55
Variable decelerations are an
abrupt decrease in FHR irrespective of contractions | Baroreflex-mediated response to umbilical cord compression
56
Describe late decelerations.
non-reassuring! - lowest point of deceleration occurs after peak contraction - represents uteroplacental insufficiency
57
Categories for FHR evaluation include
``` Category I (normal) Category 2 (continue to observe) Category 3 (intervene) ```
58
Describe category one for FHR evaluation.
normal baseline HR & moderate variability with NO variable or late decels
59
Describe category II for FHR evaluation.
all tracings not included in I or III do not indicate acid-base imbalance -warrant continued observations
60
Describe category III.
fetal bradycardia and absent variability with variable or late decels warrants prompt intervention

Advanced Principles 2 (42 decks)

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