Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

HR will increase by

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

When ventricular walls thicken,

A

systolic murmurs not uncommon

diastolic murmurs and cardiac enlargement pathologic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe dilutional anemia

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Normal blood loss for a vaginal delivery is

A

500 mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Normal blood loss for Cesarean section is

A

800-1000 mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

A decrease in SVR results in

A

venous pooling

decrease in diastolic blood pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Aortocaval compression results from

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Aortocaval compression is more severe in

A

polydraminos and multiple gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

With aortocaval compression, hypotension can occur

A

immediately

-usually 10 minutes to develop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Aortocaval compression is relieved by

A

left uterine displacement

-optimal angle is 15 degrees

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Hematologic changes to the mother include

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe what makes the parturient hypercoagulable.

A

clotting factors VII-IX increased

fibrinogen increased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

One of the leading causes of maternal mortality is

A

thromboembolic events

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Airway swelling during labor results from

A

capillary engorgement resulting in

  • narrowed glottic opening
  • oral & nasal pharynx edema
  • laryngeal edema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Describe the increase in oxygen consumption.

A

33% at rest

100% during labor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Describe the rise in minute ventilation.

A

increase in TV>RR

PaCO2 decreases slightly- compensatory decrease in HCO3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Upward pressure of the diaphragm results in

A

decrease in FRC, less residual volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

In the apneic mother,

A

there is RAPID DESATURATION

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Describe changes to the nervous system.

A

Increased sensitivity to anesthetic gases & LAs

increased block height

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Describe why there is increased block height for the parturient.

A

engorged epidural veins

increased intra-abdominal pressure- decrease in epidural & SAH spaces

26
Q

Describe the gastrointestinal changes to the parturient.

A

increased risk for regurgitation and aspiration

  • increased levels of gastrin
  • upward displacement- mechanical obstruction
  • Labor further reduces gastric emptying
27
Q

Prior to cesarean section for GI reasons, give the mother

A

nonparticulate antacid
H2 receptor blocker
prokinetic

28
Q

Describe the hepatic changes to the parturient.

A

decrease in serum albumin

-increase in free-fraction of highly protein bound drugs

29
Q

Describe the renal changes for the parturient.

A 
-Increased GFR
   BUN & creatinine decrease 
-glucose excreted in urine
   high GFR
   reduced renal absorption 
-protein excretion elevated
30
Q

At term, uterine blood flow increases to a maximum of

A

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
Q

Uterine blood flow allows for exchanges of

A

nutrients, respiratory gases, and waster

  • oxygen & CO2 are “perfusion limited”
  • fetal transfer dependent on perfusion, not gases rate of diffusion
32
Q

The fetus sends oxygen-poor blood to

A

the placenta

  • two umbilical arteries
  • perfuse capillary networks of the placental villi
33
Q

Most _____ are transferred via diffusion

A

drugs

34
Q

Placental transfer of drugs is dependent upon

A 
concentration gradient
molecular weight (<500 daltons cross easily)
lipid solubility
state of ionization
protein binding
35
Q

Fetal effects of placental drug transfer are minimized by

A

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
Q

_______ may affect drug accumulation for the fetus

A

acid-base status

-“ion-trapping”

37
Q

One-fifth of fetal cardiac output returns

A

directly back to placenta

-shunt flow from foramen ovale & ductus arteriosus

38
Q

Labor is a progressive

A

dilation of the cervix in response to uterine contractions

39
Q

Describe the stages of labor.

A

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
Q

Describe the latent versus active stage of stage I labor

A

latent: onset of labor to point of rapid cervix dilation
active: cervix dilation 2 cm to full dilation (10 cm)

41
Q

Describe pain in the first stage of labor.

A

non-localized aching or cramping

T10-12 & L1

42
Q

Describe pain in the second stage of labor.

A

cervical dilation complete and presenting part descends into the pelvis
S2-S4

43
Q

Pain during labor is accentuated by

A

fear of the unknown

44
Q

Pain is highly _____ and varies

A

individualized and varies widely among patients

45
Q

Four factors critical to a woman’s childbirth experience include

A

personal expectations
amount of support from caregivers
quality of patient-caregiver relationship
-patient’s involvement in decision making

46
Q

Fetal heart rate monitoring is

A

not a specific predictor
most readily available method to determine fetal condition
allows you to relate FHR to uterine activity

47
Q

Describe the two methods for fetal evaluation.

A

external- doppler placed on maternal abdomen

internal- electrode placed in fetal scalp

48
Q

The two channel format of fetal heart rate monitoring monitors

A

FHR

uterine contractions

49
Q

Normal FHR is

A

110-160 BPM***

50
Q

When examining changes in fetal heart rate, we are looking at

A

variability

accelerations

51
Q

Describe accelerations

A

results from fetal movement & adequate oxygenation

52
Q

The single best indicator of fetal well-being is

A

variability

  • indicates fetal oxygen reserve
    • -hypoxia (CNS depression) decreases it
  • interaction in autonomic nervous sytem
53
Q

Describe the types of decelerations.

A

early
variable
late

54
Q

Early decelerations occur in

A

concert with uterine contractions
consistent with each
decrease in FHR approximately 20 bpm

55
Q

Variable decelerations are an

A

abrupt decrease in FHR irrespective of contractions

Baroreflex-mediated response to umbilical cord compression

56
Q

Describe late decelerations.

A

non-reassuring!

  • lowest point of deceleration occurs after peak contraction
  • represents uteroplacental insufficiency
57
Q

Categories for FHR evaluation include

A 
Category I (normal)
Category 2 (continue to observe)
Category 3 (intervene)
58
Q

Describe category one for FHR evaluation.

A

normal baseline HR & moderate variability with NO variable or late decels

59
Q

Describe category II for FHR evaluation.

A

all tracings not included in I or III
do not indicate acid-base imbalance
-warrant continued observations

60
Q

Describe category III.

A

fetal bradycardia and absent variability with variable or late decels
warrants prompt intervention

Advanced Principles 2 (42 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions