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FNP 1 > preconception/ Conception > Flashcards

preconception/ Conception Flashcards

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Family Nurse Practitioner (FNP) flashcards
1
Q

what is preconception considered?

A

Primary Care

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2
Q

what age women should receive preconception care?

A

All women ages 15-44

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3
Q

what should you counsel women who have had bariatric surgery?

A

avoid pregnancy for 12 months
Oral contraceptives absorption may be affected by bariatric surgery-> risk of vitamin deficiency. These patients should take two multivitamins daily

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4
Q

how do mood disorders affect preconception counseling?

A

Anticonvulsants and medications for bipolar disorder pose risk to fetus in first trimester

Depression is a/w preterm birth

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5
Q

nutritional deficiencies associated with conception/ preconception

A

Vitamins A, C, B, & E.
Calcium, iron, zinc, magnesium, and folic acid
FOLIC ACID- some contraceptive have added folic acid, however increase risk of blood clots in first year of use

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6
Q

how does being overweight/ obese cause conception difficulty

A

insulin resistance and oligomenorrhea cause conception difficulty

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7
Q

what problems can occur with pregnancy in an underweight mom?

A

preterm birth and low birth weight. Nutrient deficiencies, osteoporosis, amenorrhea, infertility, arrhythmias. Gastroschisis.

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8
Q

what problems can occur with pregnancy in a diabetic mom?

A

increased risk of miscarriage, congenital fetal abnormalities, perinatal death

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9
Q

what problems can occur with pregnancy in a mom with thyroid disease

A

Hypothyroidism in first trimester a/w cognitive impairment. Hyperthyroidism can result in maternal and neonatal morbidity

Increased risk of preterm birth, low birth weight, placental abruption, and fetal death

Thyroid replacement therapy should be increased during pregnancy

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10
Q

what problems can occur with pregnancy in a mom with asthma

A

symptoms worsen during pregnancy if poorly controlled

Risk to fetus: neonatal hypoxia, IUGR, preterm birth, low birth weight, and death

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11
Q

what problems can occur with pregnancy in a mom with thrombophilia

can you take coumadin while pregnant?

A

increased risk of clots during pregnancy; at risk for preeclampsia
Placental infarct, IUGR, placental abruption, recurrent miscarriage, fetal stroke, and fetal death

COUMADIN is teratogenic

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12
Q

can a pregnant woman w/ thrombophilia take coumadin?

A

NO= teratogenic

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13
Q

what problems can occur with pregnancy in a mom with seizure disorder

A

may have more frequent sz during pregnancy. A/w miscarriage, low birth weight, developmental disabilities, microcephaly, and hemorhagic disease of newborn.

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14
Q

what can occur in mom to be taking seizure medication? what to recommend?

A

Increased rates of neural tube defects with antiepileptic drugs
→ increase folic acid supplementation to 4mg daily at least one month prior to conception and continue through first trimester

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15
Q

how does zika virus affect fetus?

A

Passed to fetus→ causes microcephaly and brain development problems
Often asymptomatic
Sx includes mild illness, rash, fever, joint pain, or red eyes. Lasts one week

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16
Q

things to help prevent infirtility in men?

A

Obesity, smoking, T1D, radiation, mumps, hormone replacement, maintain healthy weight

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17
Q

what do males need to remember if exposed to zika virus

A

wait 3 months from initial symptoms or diagnosis -> if no sx wait 3 months regardless
use condoms with sex

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18
Q

what do females need to remember if exposed to zika virus

A

wait 2 months after initial symptoms or diagnosis - if no sx wait 2 months
use a condom with sex

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19
Q

In preconception how much folid acid supplementation should a woman take? why?

A

400mcg daily → reduce risk of neural tube defects

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20
Q

What to counsel women with DM before getting pregnant?

A

importance of glycemic control before conception to reduce risk of congenital abnormalities

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21
Q

what can toxoplasmosis cause?

A

fetal blindness and brain damage

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22
Q

what to counsel men before conceiving?

A

Avoid hot tubs, tight clothing, bike riding, immunizations, mental health, lifestyle

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23
Q

when is HCg test usually postive?

A

one week after missed perioid

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24
Q

when can FHT be ausculatated?

A

10-12 weeks

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25
Q

Rh-D negative woman carrying Rh-D positive child. Give RhoGam at 28 wks and within 72 hours of delivery

A

alloimmunization

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26
Q

screened during first prenatal visit. Do not vaccinate while pregnant, wait until after delivery. Safe during lactation.

A

Rubella

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27
Q

can have sig. Fetal effects. No vaccine while pregnant; avoid exposure and vaccinate postpartum

A

varicella

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28
Q

the ultimate goal of prenatal care?

A

reduce mortality of mom and baby

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29
Q

when to Screen all for bacteriuria? why?

A

b/t 11-16wks and tx → reduce risk of recurrent UTI, pyelonephritis, preterm labor

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30
Q

Nageles Rule

A

LNMP -3 mon + 7 days + 1 year

31
Q

what is prenatal visit schedule?

before 28 weeks:
weeks 28-36:
weeks 36-birth:

A

before 28 weeks: monthly
weeks 28-36: every 2 weeks
weeks 36-birth: weekly

32
Q

when to screen pregnant women for Group Beta strep

A

increased screening 35-37 weeks to decrease neonatal mortality

33
Q

when to screen pregnant women for gestational diabetes?

A

24-28 weeks glucose tolerance test

34
Q

how to tx pregnant woman with HTN?

A

calcium supplementation if low (dietary Ca to reduce risk of preeclampsia 30-50%)

Low-dose ASA 12-36 weeks in women with hx preeclampsia, HTN, diabetes, autoimmune disease, renal disease, or current gestational HTN

35
Q

what is considered preterm birth?

how to prevent it?

A

birth before 37 weeks

Progesterone injections weekly from 16-37 weeks if hx of preterm birth or SROM

36
Q

what needs to be looked at during prenatal visits?

A 
BP 
Weight 
FHT (fetal heart tones) 120-160 bpm 
UA (ketones, glucose, proteins, nitrites) 
Fundal  Height 
GBS Screen 
Vaccines
37
Q

what is recommended for pregnant women regarding vaccines

A

Tdap every pregnancy and flu shot if pregnant during months of nov- march

38
Q

vaccines contraindicated during pregnancy

A

Active Immunizations

- MMR, Varicella, Zoster

39
Q

First trimester tests

  • 8-12 weeks
  • 10 weeks
  • 11-13 weeks
A

ultrasound for size and date (8-12 weeks)
noninvasive prenatal testing (10 weeks)
nuchal translucency (11-13 weeks)
CVS (11-13 weeks)

40
Q

2nd trimester tests

____________(15-18 weeks)
_____________ (15-19 weeks)
_______________________(18-20 weeks)

A

Quad Screening (15-18 weeks)
Amnio (15-19 weeks)
Anatomy scan ultrasound (18-20 weeks)

41
Q

what does quad screen test?

what does it tell us

A

alpha-fetoprotein (AFP) , HCG
estriol, inhibin A
combined with moms age and ethnicity to assess probability of genetic disorders

42
Q

diagnostic tests that will confirm if there’s any genetic abnormalities that are present in the fetus

A

CVS and amniocentesis

43
Q

how to complete oral glucose tolerance

when in pregnancy?

A

24-26 weeks

drink Glucola (50g of glu) -> check serum glu 60 min later 
*if glu >130 mg/dl -> 100g oral glu tolerance test when fasting
44
Q

how much protein should a pregnant mom eat per day?

what else do they need?

A

60-75 g/day
Prenatal vitamin
folic acid, vit b12, Fe, Ca, vit D

45
Q

how to recommend a diet for pregnant women?

A

Dietary recommendations must be personalized to the woman’s age, to her pre-pregnant BMI, and to her rate of weight gain

46
Q

how much folic acid is needed per day for pregnancy?

A

at least 40mcg

400-800 recommended

47
Q

when is the postpartum visit?

A

4-6 weeks after giving birth

  • physical and emotional concerns
  • contraception
  • breastfeeding and infant
48
Q

What laboratory tests were ordered at the initial prenatal visit?

A 
Blood type
Rh
Rubella titer
CBC
UA
RPR
VDRL - Venereal disease research lab (syphillis) 
HBsAg
Varicella titer
HIV
49
Q

what should be included in fetal assessment?

A

fundal height
FHT
kick counts

50
Q

what is considered a high risk pregnancy

A

any maternal condition that increases risk of uteroplacental insufficiency (GDM, HTN)
hx previous stillbirth
advanced maternal age (>35)
SAB risk
genetic abnormalities
nutritional deficiencies
psychosocial concerns (hx substance abuse)

51
Q

examples of high risk pregnancies

A 
multifetal pregnancy 
post-term  pregnancy 
decreased fetal movement
intrauterine growth retardation 
oligohydramnios 
hx congenital abnormalities 
hx chronic disease in mother
52
Q

screening exams for pregnant women deemed high risk

A

Nonstress test (NST)
US biophysical profile
contraction stress test (CST)

53
Q

what is included in US biophysical profile

A

FHR, fetal breathing movements, fetal body movements, fetal muscle tone, amniotic fluid

54
Q

what should you do at preconception visit?

A
  • > Ask about intention to become pregnant. Contraceptive counseling
  • > importance of glycemic control before conception to reduce risk of congenital abnormalities
  • > Check for use of teratogenic meds and ensure pt is on fewest amount of drugs at the lowest doses possible
  • > Screen for STI and communicable diseases
  • > Update hep B, influenza, measles, mumps, rubella, Tdap, varicella as needed
55
Q

how can poor oral health affect a pregnancy?

A

low birth weight and preterm labor

56
Q

total # pregnancies (including current)

A

Gravidity

57
Q

total pregnancies beyond 20 weeks (the time pregnant, not number of fetuses; ie twins, triplets…) does not include current if not born yet

A

Parity

58
Q

Contraindication vaccines during pregnancy:

A 
MMR
Varicella
Herpes Zoster
HPV
Live, attenuated flu → live inactivated flu safe
59
Q

when should mom get Rubella and varicella ?

A

immediately after delivery if not immune

60
Q

What mom should get hep B?

A

if at high risk (STI, risky sexual behaviors)

61
Q

what should be done if irregular menses, if pt is uncertain when LMP was, or discrepancy in size of uterus and gestational age

A

Early Ultrasound

62
Q

what is considered part of initial prenatal/pre-conception H&P

A

Complete H&P including periodontal exam (more acid in mouth d/t changing hormones)

Labs (BHCG, US, Blood type, Rh, Rubella titer, (CBC)Hgb/Hct, UA C/S, pap smear, RPR (syphilis), VDRL, HepBsAg, HIV, Antibody screen, CF screen, Varicella titer, Tb, GC/chlamydia

BP, weight, FHT, UA (check protein), Fundal height, GBS screen, vaccines (flu, Tdap), fasting glucose

Depression, IPV, oral health

63
Q

Weight gain goal for normal BMI during pregnancy

A

25-35 lbs

64
Q

how long does WHO recommend breastfeeding?

A

6 months

65
Q

GDM test

A

BG of 140 after GTT identifies 80% of women with GDM, if BG is 130, catches 90% of people with GDM
Greater than 130, another screening test fast and do 3hr 100gm
If 2 out of 4 blood tests are abnormal they have GDM

66
Q

conditions that increase the risk uteroplacental insufficiency

A

GDM, HTN

67
Q

Nutritional deficiencies that can cause high risk pregnancy

A

(bariatric surgery, celiac, IBD)

68
Q

HCG, estrodial, alpha-feta protein, inhibin a → blood test

A

Quad Screen

69
Q

when should you start screening tests for high risk pregnancy

A

start around 26-34wks

70
Q

FHR will accelerate with movement in fetus; accelerations 15 BPM above baseline for 15 secs in a 20-40 min period considered reactive. Predictor of fetal wellbeing

A

Nonstress Test

71
Q

done when results of nonstress test are concerning

FHR, fetal breathing movements, fetal body movements, fetal muscle tone, amniotic fluid

A

US biophysical profile (BPP) →

72
Q

Diagnostic Tests→ does the fetus have specific disorders?

A

CVS

Amniocentesis

73
Q

(10-13 weeks) sample of tissue taken from placenta

A

CVS

chorianic villi sampling

74
Q

L/S ratio (15-20 wks, or until birth) Amniotic fluid withdrawn under US guidance

A

amniocentesis

FNP 1 (18 decks)

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