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Patient Assessment > Pregnancy > Flashcards

Pregnancy Flashcards

1
Q

stretch marks is aka

A

Striae gravidarum

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2
Q

a brownish black pigment vertical strip along the midline skin of abdomen may appear is known as

A

linea nigra

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3
Q

what is diastasis recti

A

separation of the rectus abdominis muscles at the midline due to tension on the abdominal with advancing pregnacy

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4
Q

what weeks is the first trimester of pregnancy

A

weeks 1-end of week 12

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5
Q

what does the uterus look like in the pelvis during the first trimester

A

uterus is enlarged but is confined to pelvis and retains a pre-pregnancy position

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6
Q

when does the uterus become palpable just above the pelvic rom

A

week 12-14

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7
Q

what weeks is the second trimester

A

weeks 13-end of 26

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8
Q

what is the uterus position in second trimester

A

uterus is in the aneverted position that pushes on the bladder
-slight uterine dextrorotation to accomodate rectosigmoid structures

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9
Q

when does round ligament pain start? where does it cause pain?

A

second trimester
-pain in the lower quadrants

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10
Q

where is the fundal height at 12-14 weeks

A

pelvic rim

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11
Q

where is the fundal height at 16 weeks

A

between the pelvic rim and the umbillicus

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12
Q

where is the fundal height at 20 weeks

A

at the umbillicus

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13
Q

where is the fundal height at 24-32 weeks

A

below the xiphoid process

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14
Q

where is the fundal height at 36 weeks

A

right beneath the 36

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15
Q

what sign is bluish color of the vagina and cervix due to increased vascularity of the pelvis

A

chadwick’s sign

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16
Q

what sign indicates normal vaginal secretions that are thick, white, or more profuse

A

Leukorrhea of pregnancy

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17
Q

what sign indicates softening of the cervical isthmus

A

Hegar Sign

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18
Q

when does the fundal height drop

A

after 38 weeks- head is getting ready for delivery

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19
Q

what is expelled as a bloody show at delivery

A

the mucus plug; protects the uterine environment from outside pathogens

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20
Q

where is Adenexae palpable

A

at the corpus luteum

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21
Q

what is a small nodule on an ovary in early pregnancy that disappears by mid pregnancy

A

Adnexae

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22
Q

what gland in your breast becomes more prominent?

A

montgomery glands

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23
Q

when do women secrete colostrum

A

2nd and 3rd trimester

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24
Q

what are normal changes to the breast

A
  1. enlargement
  2. darker areola
  3. nipples become larger and more erectile
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25
Q

What three things confirm pregnancy

A
  1. urine pregnancy test
  2. LMP
  3. ultrasound to confirm dates
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26
Q
A
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27
Q

what are irregular and unpredictable uterine contractions in the 3rd trimester that is RARELY associated with labor

A

braxton hicks contractions

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28
Q

what is vomiting with >5% loss of pre-pregnancy weight

A

hyperemesis gravidarum

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29
Q

what is the menstrual age aka? how is it calculated

A

gestational age
count the # of weeks and days from the first day of the LMP

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30
Q

Conception age is aka? how is it calculated

A

Fetal age
2 weeks less than the gestational age

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31
Q

what is conception age indicated for?

A

IVF conceptions

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32
Q

how is expected delivery date calculated?

EDD

A

40 wks from the first day of LMP

estimated date of confinement

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33
Q

how long is the pregnancy according to gestational age?

A

40 weeks

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34
Q

how long is the lengthh of pregnancy according to fetal age

A

38 weeks

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35
Q

what is Naegele rule to calculated EDD

A
  1. begin on first day of LMP
  2. subtract 3 months
  3. add 7 days
  4. add 1 year
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36
Q

why is gestational age 2 weeks longer?

A

accomodates for 2 weeks of when the women is not pregnant

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37
Q

Gravidity

A

number of times that a women has been pregnant

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38
Q

parity

A

number of times that a women has given birth >24, regardless if the child was born alive or stillborn

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39
Q

how does multiple gestation change G0P000

A

it is counted as 1 pregnancy, one birth but 2 children

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40
Q

What are risk factors for maternal and fetal health

for the women and baby

A
  • tobacco, etoh, drug use
  • RX meds and OTC med use
  • adequate nutritional intake or risk for diabetes
  • intimate partner violence
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41
Q

what family history should be obtained?

A
  • ethnic background of parents
  • history of genetic disease
  • congenital problems in babies
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42
Q

what 3 plans should be established at the inital prenatal visots

A
  • plans for genetic testing
  • plans for breastfeeding
  • plans for postpartum contraception
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43
Q

what history should be obtained each visit after the initial

A
  • fetal movement felt by the patient
  • contractions
  • leakage of fluid
  • vaginal bleeding
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44
Q
A
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45
Q

what is quickening?

A

the first fetal movement felt around 18-24 weeks earlier in parous women

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46
Q

what does quickening feel like? when is it felt?

A

sit feels like fluttering wings
18-24 weeks

47
Q

when are kicks felt? in weeks

A

18-25 weeks

48
Q

when are hiccups felt

A

18-24 weeks

49
Q

when are pokes felt

A

29 weeks

50
Q

when are jabs felt

A

36 weeks

51
Q

what physical exam should be conducted at each subsequent visit?

A
  • vital signs (BP and weight)
  • fundal height
  • verification of fetal heart rate (FHR)
  • fetal position
52
Q

what components should be tested of the urine at each subsequent visit

A
  • infection
  • glucose
  • protein
53
Q

what position should the pt be in during early pregnancy

A

supine position

54
Q

what position should the pt be in during late pregnancy for physical exam

A

semi-sitting with knees bent

55
Q

When do you assess fetal heart tones?

A

after 10-12 weeks

56
Q

when do you begin measuring the uterus?

A

after 20 weeks

57
Q

why don’t you want pts laying on their back late in pregnancy

A

compression on the aorta

58
Q

when does blood pressure normally drop during pregnancy?

A

2nd trimester

59
Q

what is melasma

A

mask of pregnancy
dark spots along the face or neck

60
Q

what vital sign should be monitored prior to pregnancy

A

blood pressure

61
Q

what is melasma aka

A

cholasma

62
Q

what is a normal lung finding in a pregnant female? when is it seen

A

diaphragmatic elevation
can be seen as early as the first trimester

63
Q

where does the apical impulse go?

A

rotated upward and toward the left 4ICS

64
Q

What is the murmur that is heard over the breasts due to increased blood flow and vasculature? when in pregnancy is heard?

A

Mammary souffle
late pregnancy or during lactation

65
Q

where is a mammary murmur heard best at?

A

2nd and 3rd ICS at bilateral sternal borders

66
Q

what type of murmur is a mammary souffle murmur?

A

systolic and diastolic but only heard in systolic

67
Q

what murmur is NEVER normal?

A

diastolic murmur

68
Q

how should you investigate discrepancy between measured fundal height and expected fundal height?

A

ultrasound

69
Q

what difference in expected vs measured fundal height is concerning

A

> 4cm larger than expected or smaller than expected (+/-4cm)

70
Q

when can fetal movement be felt by examiner?

A

24 weeks

71
Q

when do you start measuring the fundal height

A

> 20 weeks gestation

72
Q

where do you measure the fundal height on the belly?

A

from the pubic symphysis to the top of uterine fundus

73
Q

what should the fundal height measurement (in cm) match?

A

Roughly the weeks pregnant

74
Q

what can cause a larger fundal height?

A
  1. multiple gestation
  2. large baby
  3. extra amniotic fluid
  4. uterine leiomyoma
75
Q

what can cause low fundal height

A
  1. small baby (interuterine growth retardation)
  2. low amniotic fluid
  3. missed abortion
  4. fetal anomaly
76
Q

when can you auscultate fetal heart tones?

A

10-12 weeks with a doppler fetal monitor

77
Q

where should you listen to the heart for 10-18 weeks gestation

A

along the midline of the lower abdomen

78
Q

where should you listen to the FHR for 18+ weeks gestation

A

depends on fetal position

79
Q

what is the normal FHR

A

110-160

80
Q

how should FHR vary from second to second

A

10-15bpm

81
Q

when is there increased variability in FHR

A

late pregnancy >32weeks

82
Q

what is cervical ectropion

A

the columnar cells of the inner portion of the cervix migrates to ectocervix and appears as friable darker pin or red

83
Q

what does adnexal tenderness or masses early in pregnancy possibly indicate?

A

ectopic pregnancy
REQUIRED US TO RULE OUT

84
Q

what should be examined for the anus during physical exam

A

external hemorrhoids

85
Q

what should be examined for extremities physical exam

A
  • varicositites
  • edema
86
Q

what are the leopold maneuvars used to determine?

A

fetal position beginning in the first trimester and readiness for vaginal delivery

87
Q

First maneuvar

A
  • hands on both sides of baby
  • determines fetal part is located at the fundus, the upper fetal pole
88
Q

second maneuver

A

hands on both sides but lower
* determines the direction the fetal bac kis facing

89
Q
A
90
Q

third maneuver

A
  • hand on the top and bottom of belly
  • determines what part of the fetus is at the lower fetal pole and descents into the pelvis
91
Q

fourth maneuver

A
  • hands on both sides at the lwoer end
  • determines the direction and degree of flexion of the head
92
Q

what is cephalic position

A

head down, facing into the vaginal canal

93
Q
A
94
Q

what is the breech position

A

butt down facing the vaginal canal

95
Q

what is oblique fetal position

A

head down but kind of sideways

96
Q

what is transverse fetal positon

A

baby is laying sideways

97
Q

Hypertensive moms love Nifedipine

A
  • hydralazine
  • labetolol
  • alpha-methldopa
  • nifedipine
98
Q

what is the frank breech position

A

both hips are flexed and both knees are extended

99
Q

what is the complete breech position

A

both hips and knees are flexed

100
Q

what is footling breech

A

one or both legs are extended below the buttocks

101
Q

what are the 2 things required for pre-eclampsia diagnosis (way 1)

A
  1. SBP >140 or DBP >90 after 20 weeeks on 2 occasions 4 hrs apart OR BP >160/110 within minutes
  2. proteinurira >300mg/24 hours or protein:Cr >0.3 OR dipstick 1+ prtotein
102
Q

what is the classification for diagnosing preeclampsia (second way)

A

new onset HTN without proteinurira but one+ of:
* thrombocytopenia
* impared liver function
* new renal insufficiency
* pulmonary edema
* new onset cerebral or visual symptoms

103
Q

what is chronic HTN in pregnancy

A

SBP >140 or DBP >90
present before conception OR diagnosed before week 20

104
Q

what is gestational HTN

A

SBP >140 or DBP>90
* first documented after 20 weeks
* without proteinuria or end-organ dysfunction

105
Q

when does gestational HTN resolve by

A

12 weeks postpartum

106
Q

what does HELLP syndrome stand for

A

H-hemolysis
E-elevated
L-Liver enzymes
L-Low
P-platelets
hemolysis, elevated liver enzymes, low platelets

107
Q

what is the treatment of preeclampsia

A

delivery

108
Q

why does preeclampsia show proteinuria

A

damaged placenta releases proinflammatory proteins into the circulation

108
Q
A
109
Q

what is the treatment of ectopic pregnancy

A

methotrexate or surgical resection

110
Q

what is ectopic pregnancy?

A

implantation that occurs outside of the uterus

111
Q

where do ectopic pregnancies most commonly occur

A

fallopian tube

112
Q

what are some symptoms of ectopic pregnancy

A
  • syncope
  • hemorrhagic shock (if ruptured)
113
Q

what is the way you can diagnose an ectopic pregnacy

A

-serum HCG is postive
-urine HCG is negative

Patient Assessment (20 decks)

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