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high risk OB > physiologic foundations > Flashcards

physiologic foundations Flashcards

1
Q

biggest change for cardiovascular system

A

high flow (increased blood volume and cardiac output)
low resistance (vasodilation)

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2
Q

hematocrit levels for nonpregnant woman?
pregnant woman?

A

nonpregnant: Hct 38
pregnant: 34.7

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3
Q

what are Hgb and Hct levels for diagnosis of anemia during pregnancy

A

Hct <33
Hgb: <11

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4
Q

what masks the signs of hemorrhage during pregnancy

A

extra blood volume
*assess fetal HR first

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5
Q

most important assessment of CV system in pregnancy

A

cardiac output
-maintains moms bp and ensures profusion to placenta

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6
Q

baseline cardiac output L/min

A

6-7 L/min

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7
Q

what factors affect (increase) cardiac output

A

-b agonist drugs (terbutaline)
-twins
-sepsis
-labor
-exercise
-position (knee-chest and R are highest)

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8
Q

what is frank starlings law

A

-greater ventricles are stretched during diastole, the stronger the force of contraction during systole
(decreases cardiac output)

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9
Q

optimal HR range during pregnancy

A

40-140 bpm

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10
Q

3 determinants stroke volume

A

preload
afterload
contractility

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11
Q

volume; amount of blood in ventricle at end of diastole

A

preload

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12
Q

pressure; resistance that opposes ejection of blood from ventricles

A

afterload

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13
Q

how does pregnancy affect preload, afterload, contractility

A

preload: higher volume and flow
afterload: lower resistance
contractility:

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14
Q

sympathetic response to falling BP

A

-compensatory tachycardia
-vasoconstriction
-conservation blood volume (shunting)
-hyperglycemia

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15
Q

force of contraction of heart

A

contractility

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16
Q

how to increase preload

A

IV fluid bolus
positioning: keep her off back

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17
Q

how to decrease afterload

A

vasodilator/bp med if too high
positioning: keep her off back

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18
Q

how to increase contractility

A

increase preload

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19
Q

noninvasive assessment of cardiac output

A

-BP
-pulses
-breath sounds
-urine output
-heart sounds
-SaO2
-skin color, turgor
-temp
-LOC
-neck veins
-mucous membranes

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20
Q

meds that affect HR

A

chronotropes

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21
Q

meds that affect preload

A

diuretics (decreases)
volume expanders (increases)

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22
Q

meds that affect afterload

A

vasodilators (decreases)
vasoconstrictors (increases)

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23
Q

meds that affect contractility

A

inotropes (digoxin)

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24
Q

pulmonary physiologic alteration with pregnancy

A

compensated resp alk

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25
Q

if mom needs to be intubated what size would she need and why

A

6.5-7.0
because of edema and airway swelling with pregnancy

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26
Q

functional changes in oxygen with pregnant mom

A

-increased O2 consumption because increased metabolic rate
-increased tidal volume (how much you breathe in and out with breath)
-decreased functional residual capacity (amount air left in lungs after breathe out)

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27
Q

amount of air left in lungs after breathing out

A

functional residual capacity

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28
Q

how much you breathe in and out with each breath

A

tidal volume

29
Q

nonpregnant blood gases (pH, O2, CO2, HCO3, b.d.)

A

pH: 7.35-7.45
O2: 90-100
CO2: 35-45
HCO3: 22-26
b.d.: -2

30
Q

pregnant blood gases (pH, O2, CO2, HCO3, b.d.)

A

pH: 7.40-7.45
O2: 104-108
CO2: 27-32
HCO3: 18-22
b.d.: -3 to -4

31
Q

what is SaO2 measuring
how is it measured

A

% hemoglobin molecules saturated by oxygen
pulse ox

32
Q

what is PaO2 measuring
how is it measured

A

total oxygen content of blood
mmHg, blood gas

33
Q

binding and unbinding of oxygen to Hgb

A

oxygen affinity (oxygen magnet)
(98-99% O2 bound to Hgb)
*ability of O2 to bind to and release from Hgb
*fetal oxygen affinity is greater than mom

34
Q

product of PaO2 and cardiac output; oxygen sent to tissues

A

oxygen delivery

35
Q

how does pregnancy affect oxygen dissociation curve

A

shifts right
*oxygen released more quickly from Hgb
*you always want fetal Hgb to be left of mom

36
Q

how to assess oxygenation of baby during pregnancy

A

fetal heart rate patterns

37
Q

major affect of renal system during pregnancy (2)

A

increased filtration
decreased reabsorption

38
Q

anatomic changes renal system during pregnancy

A

-possible obstruction due to enlarging uterus
-dilation of urinary collection system (hydronephrosis, hydroureter)
-displacement bladder at term
-hyperemic (more blood flow)

39
Q

normal glucose in urine during pregnancy

A

+1

40
Q

possible complications renal system with pregnancy

A

-increased risk UTI
-increased risk pyelonephritis
-increased risk traumatic injury

41
Q

functional changes renal system during pregnancy

A

-increased renal perfusion and GFR
-decreased reabsorption
-decreased: Cr, BUN, uric acid
-trace protein and +1 glucose in urine

42
Q

what pulls fluid into blood vessels

A

colloid osmotic pressure (oncotic)
decreases with pregnancy

43
Q

what pushes fluid out of blood vessels

A

hydrostatic pressure
increases with pregnancy
*causes edema

44
Q

possible complication with fluid balance (r/t colloid osmotic pressure)

A

decreased colloid osmotic pressure
*increases risk pulmonary edema (especially postpartum, preeclampsia)

45
Q

normal prepregnancy colloid osmotic pressure

A

COP = 25

46
Q

major hematologic alteration in pregnancy

A

hypercoagulability

47
Q

what causes hypercoagulability during pregnancy

A

increases clotting factors
decreased fibrinolytics

48
Q

possible complication due to hypercoagulability with pregnancy

A

increased risk clot formation

49
Q

triad of factors that increases risk clot formation

A

-venous stasis
-hypercoagulable blood
-endothelial injury (stirrups)

50
Q

DVT prophylaxis

A

leg exercises
compression stockings
maybe use heparin

51
Q

why is warfarin contraindicated during pregnancy

A

teratogenic

52
Q

biggest risk with GI system alterations during pregnancy

A

increased risk aspiration
(stomach displaced, gastric emptying delayed, gastric secretions increased, lower esophageal sphincter tone)

53
Q

causes interference with placental function (4)

A

-constriction spiral arteries (HTN)
-failure spiral arteries to dilate (preeclampsia)
-disruption intervillous space (abruption)
-compression spiral arteries (contractions)

54
Q

effects of poorly perfused placentas

A

-IUGR (malnutrition)
-oxygen problems

55
Q

assessment of placenta

A

-sonogram
-MRI (less common)
-(indirect) fetal HR monitoring
-doppler blood flow (umbilical artery)
-amniotic fluid index/volume

56
Q

doppler blood flow assessment of umbilical artery indicating poor placental perfusion

A

absent/reverse diastolic blood flow

57
Q

Dx of genetics anomalies

A

amniocentesis
chorionic villi sampling
percutaneous umbilical blood sampling

58
Q

fetal assessments of oxygen during pregnancy

A

-sonogram: BPP, growth
-FHR

59
Q

intrinsic mechanisms FHR

A

-CNS
-heart
-hormonal

60
Q

how does sympathetic nervous system affect FHR

A

speeds up (“sympa = speedy”)

61
Q

how does parasympathetic nervous system affect FHR

A

slows down (“para = pokey”)

62
Q

receptors that take autonomic nervous system impulses to brain

A

-chemoreceptors
-baroreceptors

63
Q

effects of stimulation of chemoreceptors on FHR

A

-increased FHR
-severe = bradycardia

64
Q

effects of stimulation of baroreceptors on FHR

A

(responds to pressure)
-increase bp = rapid decrease FHR
-decrease bp = rapid increase FHR

65
Q

what causes FHR variability

A

interplay between sympathetic and parasympathetic firing

66
Q

affects of catecholamines on FHR

A

-shunts blood flow to vital organs (from GI and renal to brain, heart, adrenal)

67
Q

sign of placental insufficiency
result from shunting of blood flow to vital organs

A

asymmetrical IUGR
(normal head growth, smaller chest/abdomen)

68
Q

causes symmetric IUGR

A

-genetics
-problems early in pregnancy (TORCH infection, substance abuse)

high risk OB (14 decks)

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