Pregnancy Flashcards
All women of reproductive age should be taking
Folic acid
Prenatal care should be initiated by how many weeks
10 weeks
What do all pregnant patients need to be assessed for
Domestic violence
Qualitative pregnancy test
Yes or no
Quantitative pregnancy test
Amount of HCG
If a pregnant patient is not immune to rubella, when do they get vaccinated
After delivery and they are to avoid infected people
Tight lower quadrant
Appendix
What immunizations should be given during pregnancy
Influenza
TDap in 3rd trimester 27-36 weeks
What immunizations should be avoided in pregnancy?
MMR
Varicella
Live attenuated vaccines
When should pregnant patients be screened for gestational diabetes
24-28 weeks
What can cause preeclampsia, hydramnios, macrosomia, fetal organomegaly, maternal/infant trauma, or perinatal mortality
Gestational diabetes
Diabetes diagnosed at initial visit is called
Overt diabetes
Diabetes diagnosed during pregnancy is called
Gestational diabetes
What is the fasting blood glucose for diabetes
> =126
What is the A1C for diabetes
> =6.5
A pregnant woman is RH negative. When should she receive RhoGam
About 28 weeks
Within 72 hours of delivery
A pregnant woman is Rh negative and has had a miscarriage. What does she need?
RhoGam immediately after miscarriage
When do you test a pregnant patient for Group B strep
35-37 weeks
Vaginal and rectal swabs
Is inhaled budesonide (Pulmicort) safe to use in a pregnant asthma patient
Yes
Is levofloxacin, trimethoprim sulfamethoxazole, or doxycycline safe in pregnancy
No
Setraline (Zoloft) is pregnancy category
C
Painless vaginal bleeding at the end of the second trimester is associated with
Placenta previa
Abrupt onset of vaginal bleeding
Abdominal and or back pain
Scant bloody vaginal discharge
May occur in the second or third trimester
Abruptio placenta
At 20 weeks, where should the uterus measure
At the level of the umbilicus
What is the age of a neonate
0 to 28 days
What is the age of an infant
The whole first year of life
What is the age of a toddler
Ages 1 to 2 years old
What is the age of a preschooler
Ages 3 to 4 years old
What is the age of a school age child
Ages 5 to 12 years old
What is a neonates best vision range
8 to 12 inches away from the caregivers face
In what position should a newborn sleep
The newborn baby should sleep in a face up position
When should tummy time start after birth
Start immediately post birth, building up slowly to a total of 30 minutes per day until such time as child easily turn tummy to back, back to tummy without assistance
When does jaundice start in a newborn
After 24 hours of life
When should all newborns be back up to birthweight
2 to 4 weeks
What ocular prophylaxis do all newborns receive
Gonococal conjunctivitis
How do you treat chlamydial conjunctivitis in a newborn
It is treated with oral erythromycin for two weeks due to pneumonia risk
What does immune globulin do
It provides passive immunity and will protect the patient today
What does an immunization do
It provides active immunity and protects the baby in the future
Turning of the head and sucking when cheek is stroked. No longer seen by 6 to 12 months
Rooting reflex
Throwing out arms and legs followed by pulling them back to the body following a sudden movement or a loud noise. No longer seen by 16 weeks
Moro reflex
Arching of back and head raises when placed on stomach. Lasts until about 12 months
Parachute reflex
When stimulating the back, the trunk and hips move toward the side of the stimulus. No longer seen by nine months.
Tonic neck reflex
When is the most important time to screen for hearing defects
In the first days of life
At what age can a baby move from Tommy and lift themselves up onto arms, respond to sounds, smiles when smile too.
Two months
At what age can a baby reach for a toy or other object, smile for fun spontaneously with no trigger needed, roll from tummy to back.
Four months old
At what age does a baby look like the number six when sitting up, rolls from back to tummy and back.
Six months old
At what age can a child sit up and transfer objects from one hand to the other with ease
Eight months old
At what age can a child stand tall like the number one and walk on two legs
12 months old or one year old
At what age can a child name a single word objects, act like an 18-year-old by copying work that adults do, says no a lot also like an 18-year-old.
18 months old
At what age can a child speak into word sentences, follow two-step commands, can walk up to the second floor with help, and build a two block tower with ease.
Two years old
At what age can a child draw a circle, speak in three word sentences, ride a tricycle, and build a three block tower with ease.
Three years old
At what age can a child draw a cross, build a four block tower with ease, and speak in four word sentences.
Four years old
At 12 weeks just station where would the uterus measure
Just rising above the supra pubic bone
What medication for diabetes must be taken daily at breakfast with a meal and must be avoided with class III and IV heart disease, and heart failure
TZDs
-glitazone
What kind of insulin covers one meal at a time
Rapid acting insulin
What type of insulin last from meal to meal
Regular insulin
What type of insulin last from breakfast to dinner
NPH insulin
What type of insulin is once a day
Lantus
What type of insulin is our use mostly by type one diabetic’s before each meal
Rapid acting insulin i.e. Humalog (insulin lispro)
Premixed insulins are used mostly by
Type two diabetic
What is the starting dose of Metformin
500 mg daily BID
If Metformin Dose is at maximum and A-1 C and blood sugar are still high what should be added
Sulfonylurea
If blood sugar or A1 C is still elevated and patient is on both Metformin and sulfonylurea consider starting patient on
Basal insulin (Lantus SC once daily)
If patient with use of insulin, other options are
TZDs such as -glitazones
What diabetic medications cause weight loss
Metformin
What diabetic medications cause weight gain
Sulfonylurea, TZDs, insulin
What diabetic medication is weight neutral
Meglitanides
-glinide
Balanitis is a possible complication of
Diabetes which is a candlidal infection of the glans penis
Moderate to severe heart disease or heart failure is a contraindication of which drug
TZDs -glitazone Because they cause water the retention which may precipitate CHF
Are diabetics at higher risk for cataracts and glaucoma
Yes
A positive Coombs test in an Rh negative pregnant woman means
The mother has autoantibodies against Rh positive red blood cells
HCG is produced by the
Placenta
Serum alpha fetoprotein is produced by the
Fetal liver
The classic triad of symptoms for this disorder includes hypertension, edema i.e. weight gain, and proteinuria
Pregnancy induced hypertension or pre-eclampsia
Positive signs of pregnancy include
Palpation of the fetus and auscultation of the fetal heart tones by the nurse practitioner
Pregnant woman who is in the late third trimester of pregnancy complains of sudden onset of vaginal bleeding accompanied by a contracted uterus that feels hard (hypertonic) and is very painful. Associated with a sudden onset of dark red colored vaginal bleeding. Up to 20% of women do not have vaginal bleeding. If mild blood is reabsorbed and affected area re-implants. Severe cases cause hemorrhage. Fetus must be delivered to save mother’s life. High-risk in females with hypertension, preeclampsia/eclampsia, cocaine use
Abtuptio placentae
A multi para who is in the late 2nd to 3rd trimester complains of new onset of painless vaginal bleeding that is worsened by intercourse. Blood is bright red in color. Uterus is soft and nontender. If cervix is not dilated, treatment is strict bedrest. Intravenous magnesium sulfate if there is uterine cramping. Uterus will usually reimplanted self if mild. Any vaginal or rectal insertion or stimulation is an absolute contraindication. If cervix is dilated or hemorrhaging, fetus is delivered by C-section. Severe cases cause hemorrhage, fetus must be delivered to save the mothers life
Placenta previa
A primigravida Who is in the late third trimester of pregnancy are usually more than 34 weeks complains of sudden onset of severe recurrent headaches, visual abnormalities i.e. blurred vision, scotomas and pitting edema. Edema easily seen on the face and eyes and fingers. Sudden rapid weight gain within 1 to 2 days. New onset of right upper quadrant abdominal pain. Blood pressure more than 140/90. Urine protein oneplus or higher. Sudden decrease in urine output (oliguria). Nausea and vomiting is a worry some sign (encephalopathy). Only known cure is delivery of fetus/baby
Severe preeclampsia
Serious but rare complication of preeclampsia. Classic patient is multi para older than 25 years old who is in the third trimester of pregnancy. Presence of the signs and symptoms of preeclampsia that is accompanied by right upper quadrant pain or mid epigastric abdominal pain with nausea/vomiting and malaise. Symptoms can present suddenly. Lab abnormalities are elevation of the AST, ALT, total Bilirubin, lactate dehydrogenase with decreased number of platelets and hemoglobin and hematocrit.
HELLP (Hemolysis, Elevated Liver Enzymes, and Low Platelets) Syndrome
When should a urinalysis be performed for pregnant women
Obtain midstream urine before gynecologic exam (minimizes contamination from vaginal discharge)
Protein: trace and from 1+ to 4+ is abnormal
If 20 weeks or more to rule out preeclampsia
If proteinuria present, order 24 hour urine for protein and creatinine clearance
Do any of the liver function test enzymes increase in Pregnancy
Yes alkaline phosphatase
Do white blood cells count increase in pregnancy
Yes the white blood cell count is elevated throughout pregnancy especially during the third trimester. Leukocytosis with neutrophilia is normal during pregnancy if it is not accompanied by signs of infection. The white blood cell count may climb as high as 16 mm.
Does hemoglobin and hematocrit increase or decrease during pregnancy
Both values go down during pregnancy due to hemodilution. Physiologic anemia of pregnancy is most obvious during the 2nd to 3rd trimesters. The hemoglobin value may be as low as 9.5 and the hematocrit value may go down to 28 by the third trimester
Does ESR increase or decrease during pregnancy
Increase
What thyroid function test hormones increase during pregnancy
Total T3 and total T4 are higher during pregnancy due to increased levels of thyroid binding globulin. The TSH, free T-3 and free T4 results remain unchanged.
Where does serum alpha-fetoprotein come from
Manufactured by the liver of the fetus and mother. Majority of maternal AFP comes from the fetus (liver, fetal yolk sac, GI tract)
Is the lipid profile increase or decrease during pregnancy
Total cholesterol, LDL, HDL, and triglycerides are all elevated during pregnancy. Wait for to six weeks after pregnancy to check lipids
Is the GFR from Renal functioning testing increase or decrease during pregnancy
Increase however there are no changes to the serum creatinine
What does it mean if there is a low AFP result
Mature maternal age is the most common risk factor for downs syndrome age 35 and over has a one out of 200 chance. If AFP is low, order the triple screen test of AFP, hCG, and estriol. Or the quadruple screen test of AFP, hCG, estradiol, inhibin-A to evaluate for down syndrome which is trisomy 21
What does it mean if a patient has a high AFP
Rule out neural tube defect’s or multiple gestation. Most common reason for a high AFP is pregnancy dating error. If AFP is high, order the triple screen or the quad screen test and sonogram to rule out neural tube abnormalities. Prevention of neural tube defect’s: folic acid 400 µg per day which is found in green leafy vegetables and fortified cereals. Advise to take prenatal vitamins when planning to become pregnant to reduce risk.
What is the triple screen test
The triple screen test combine the AFP, beta hCG, and estriol serum level values. The hormone level results are use in a formula to figure out the risk of a down syndrome infant. Diagnostic test for genetic anomalies is chromosome testing
What is a quadruple screen test
Combination of the triple screen hormones plus inhibin-A which is hormone released by the placenta. The triple or quadruple screen tests are more sensitive than the AFP alone but have a higher rate of false positives. Gold standard test for genetic disorders is testing of fetal chromosomes/DNA
Who should be screened for Tay-Sachs disease
Jewish decscent
Who should be tested for cystic fibrosis
White/Caucasians
Who should be tested for sickle cell anemia
African Americans
What is a fatal neurological disease with no known cure and is common among Eastern Europeans of Jewish dissent
Tay-Sachs disease
When our group B strep vaginal culture was taken from the patient
At 35 to 37 weeks. Swab vaginal introitus and rectum and insert up to anal sphincter for culture and sensitivity it. If positive, treat with penicillin 2.5 million units IV. If penicillin allergic, use clindamycin or erythromycin instead
What STDs are screened in pregnant women
Hepatitis B, hepatitis C, HIV, gonorrhea, chlamydia, syphilis, herpes virus type one and two
What titers should be checked and pregnant women
Check rubella titer. Check varicella titers if no proof of infection.
Most drugs used in pregnancy are category
B
What antibiotics can pregnant women use that are category B
Penicillins, cephalosporins, macrolides (except for clarithromycin (Biaxin)and erythromycin estolate (EES) which can cause hepatotoxicity in pregnant 🤰 women), and nitrofurantoin (do not use with glucose 6 phosphate dehydrogenase deficiency G6PD anemia since it will cause hemolysis (anemia, jaundice, dark urine)
What antihypertensives are used in pregnant women with pre-existing hypertension or for moderate to severe preeclampsia or eclampsia
Methyldopa (Aldomet)
Hydralazine (Apresoline)
Labetalol (Normodyne)
What drugs are category C in Pregnancy
Sulfa drugs in the third trimester because it can cause hyperbilirubinemia. Sulfa drugs displace Bilirubin from albumin. High levels of unconjugated Bilirubin can cross the blood brain barrier and cause brain damage i.e. mental retardation, seizures, deafness. Clarithromycin (Biaxin) is the only category C macrolide antibiotic. Avoid in pregnant women. NSAIDs avoid using in the third trimester especially the last two weeks because it blocks prostaglandins. Ibuprofen is category B for first and second trimester and category D for third trimester.
What are category D drugs in pregnancy
ACE inhibitors, ARBs which cause fetal renal abnormalities, renal failure, and hypotension. Fluoroquinolones affects fetal cartilage development. A rare side effect is Achilles tendon rupture in athletes. Contraindicated in pregnant or lactating women and children younger than 18 years. Tetracycline stains growing teeth enamel. Avoid in the third trimester. NSAIDS block prostaglandins and may cause premature labor avoid especially in the last two weeks of pregnancy. Sulfa drugs increased riskOf hyperBilirubinemia. Sulfa drugs displace Bilirubin from albumin. High levels of unconjugated Bilirubin will cross the blood brain barrier and cause brain damage i.e. mental retardation, seizures, deafness.
What drugs are category X for pregnancy
Accutane as it is highly teratogenic. Methotrexate, proscar which is used for BPH and prostate cancer, misoprostol which is used as one of the drugs and medical abortion, Evista which is used for treating osteoporosis, all hormonal drugs natural or synthetic are category X in pregnancy all forms of estrogen’s, progesterone, testosterone, and mefiristone. Any drug that blocks hormone synthesis or binding. Depo Lupron is Used for infertility, hormone dependent cancer, and endometriosis.
What vaccines are contraindicated in pregnancy
All live vaccines such as MMR, oral polio, varicella, and flu mist
When can flu mist be used
Only for healthy nonpregnant person’s age 2 Mo to 49 years with no nasal abnormalities. Avoid use if person has close contact with immunocompromise or with pregnant women
What consideration must be given to reproductive aged women After al live virus vaccine is given
After a live virus vaccine, advise reproductive age women to not get pregnant and use reliable birth control in the next four weeks after MMR or three months after varicella vaccine
What are teratogens in pregnancy
Alcohol: fetal alcohol syndrome, aminoglycosides: deafness, cigarettes: intrauterine growth retardation, prematurity, cocaine: CVAs, mental retardation, abruptio placentae, Isotretinoin or Accutane: central nervous system/cranial facial/ear/cardiovascular defects, lithium: cardiac defects (Ebstein’s anomalies)
Chronic hyperglycemia during pregnancy (poorly controlled diabetes or gestational diabetes mellitus. It increases the risk of neural tube defects and craniofacial defects.
What is the required health education for a pregnant patient
Prenatal vitamins with 400 µg of folic acid daily starting three months before conception, always wear a seatbelt what the lapbelt below the uterine fundus, avoid soft cheeses such as blue cheese and brie, uncooked meats, raw milk due to listeria bacteria, sex is safe except for for during vaginal bleeding, incompetent cervix, placenta previa or preterm labor. Cat litter or raw beef can cause toxoplasmosis which is a congenital infection, no raw shellfish or raw oysters due to vibrio vulnificus infection, careful with cold cuts, uncooked hot dogs and deli meat due to listeria bacteria. Pregnant women are 20 times more likely to become infected with a listeria monocytogenes. Smoking can cause intrauterine growth retardation, alcohol can cause fetal alcohol syndrome. Regular coffee 8 ounces a day is OK. No excessive caffeine because it can cause preterm labor. No hot tubs, saunas or excessive heat.
When is most weight gained in pregnancy
Most weight gained in the third trimester about 1 to 2 pounds per week
What is the recommended amount of weight to gain in pregnancy
Best weight gain is 25 to 35 pounds it’s healthy weight before pregnancy
What is the recommended weight gain for underweight patients in pregnancy
28 to 40 pounds
What is the recommended weight gain for obese patients
11 to 20 pounds
How much weight do you lose after delivery
Will lose up to 15 to 20 pounds in the first few weeks
What is the expected weight gain with twins
Weight gain increases 37 to 54 pounds but it is not doubled
What are positive signs of pregnancy
Palpation of the fetus By health provider, ultrasound and visualization of fetus, fetal heart tones auscultated By health provider. 10 to 12 weeks by Doppler and 20 weeks by fetoscope/stethoscope
What are probable signs of pregnancy
Goodell’s sign at four weeks which is cervical softening. Chadwicks sign at 6 to 8 weeks which is blue coloration of the cervix and vagina. Hegar’s sign 6 to 8 weeks softening of the urine isthmus. Enlarged uterus. Ballottement seen in midpregnancy when the fetus is pushed, it can be felt to bounce back by tap tapping the palpating fingers inside the vagina. Urine or blood pregnancy test beta hCG. Quickening: the mother feels The babies movements for the first time. Starts at 16 weeks
What are presumptive signs of pregnancy
Amenorrhea. Nausea/vomiting most common in first trimester in the morning, usually disappears by the second trimester. Breast changes i.e. swollen and tender. Fatigue. Urinary frequency. Slight increase in body temperature.
Palpation of fetal movements or quickening by the mother is considered what sign of pregnancy
Probable sign
Medical softening is called what sign
Goodell’s sign
Blue coloration of the cervix and vagina is called what sign
Chadwick’s sign
Softening uterine isthmus is what sign
Hegar’s sign
Urine/serum pregnancy tests are considered what sign of pregnancy
Probable sign
Does hCG present in ovarian cancer
Yes
What are the three positive signs of pregnancy
Palpation of fetus by health provider, ultrasound and visualization of fetus, and fetal heart tones auscultated by health provider at 10 to 12 weeks my doppler and 20 weeks by fetoscope/stethoscope
What is the fundal height at 12 weeks of pregnancy
Uterine fundus first rises above symphysis pubis. Fetal heart tones heard by Doppler by 10 to 12 weeks.
Where is the Fundal height measured at 16 weeks
Uterine fundus between symphysis pubis and the umbilicus
Where is the fundus measured at 20 weeks
Uterine fundus at level of the umbilicus. Fetal heart tones heard with fetoscope or stethoscope by 20 weeks
What is the fundal height from 20 to 35 weeks of gestation
Fundal height in centimeters equals number of weeks gestation. For example, a 24 week gestation fetus should have fundal height between 23 and 25 cm.
If there is a size and date discrepancy in uterine size from the number of weeks of gestation what must be ordered
U/S
Where is the heart during pregnancy
Pregnancy causes the heart to be displaced into a horizontal position by the larger uterus. It causes the heart to lie in horizontal position and to rotate to the left thus increasing the transverse diameter
By how much does cardiac output increased in pregnancy
30 to 50% and peaks at 24 weeks
What percent is plasma volume increase in Pregnancy
Increases by 30 to 50% by the end of the third trimester
How much does a heart rate increase during pregnancy
15 to 20 bpm
How do you determine Nagel’s rule
Subtract three months from the month of the last menstrual period. Then add seven days to the day of last menstrual period.
When does a heart murmur in pregnancy occur
During systolic flow
What causes cholasma/melasma during pregnancy
Hi estrogen level
In pregnancy what is vaginal bleeding that is bright red without a hypertonic tender uterus
Placenta previa
In pregnancy what is vaginal bleeding that is intermittent one hypertonic, hard and tender uterus
Placenta abruptio
Where is the fundus at 12 weeks gestation
Above symphis pubis
Where is the fundus at 16 weeks gestation
Between the symphisis pubis and the umbilicus
Where is the fundus at 20 weeks gestation
At the umbilicus
Ashkenazi Jews should be screened for
Tay-Sachs disease
Gravida means
Number of pregnancies of the mother no matter what the outcome
Para means
The number of births more than 20 weeks no matter what the outcome. Twins and multiples are counted as one pregnancy.
Abortus or A means
The number of pregnancies that were lost more than 20 weeks includes both induced and spontaneous abortion
What happens with RH negative mothers that have Rh positive fetuses
The maternal immune system develop antibodies against Rh positive blood if not given RhoGam. Give RhoGAM for all pregnancies of Rh negative mothers even if they terminate in miscarriages, abortions, or tubal pregnancies.
What is the Coombs test
Detects presence of Rh antibodies in the mother (indirect Coombs test) and infant 👶🏻 (direct Coombs test). This test is done as part of the labs done in early pregnancy.
When is RhoGAM given
300 µg IM first dose is at 28 weeks. Give second Dose within 72 hours or sooner after delivery.
If a patient has risk factors for gestational diabetes, when should they be screened
Consider screening earlier than 24 weeks if at high-risk for gestational diabetes and have a presence of risk factors. Screen at 24 to 28 weeks of pregnancy via t oral glucose tolerance test. Screen earlier if risk factors are present.
What is the diagnostic criteria for gestational diabetes
Fasting: equal or greater than 92 mg, one hour: equal or greater than 180 mg, two hours: equal or greater than 153 mg.
What is the treatment plan for gestational diabetes
First line treatment is lifestyle. Eat three meals per day +2 to 3 snacks and limit carbohydrates. Exercise 30 minutes per day at least five days a week. Low impact exercises such as walking and swimming preferred. Frequent home glucose monitoring 4-6 times per day. Insulin injections if Not able to control blood glucose by diet and exercise. No oral Anti-diabetics drugs are approved for use in pregnancy by the FDA.
How often do you test for gestational diabetes postpartum
Test for gestational diabetes 6 to 12 weeks postpartum and at least every three years after words in the future
What is overt diabetes
Gestational diabetes
How many grams of glucose is used for the oral glucose tolerance test
75 g
What are the risk factors for gestational diabetes
Obesity, macrosomic infant greater than 9 pounds, and history of previous gestational diabetes
Pregnant women with asymptomatic bacteria are always Treated because they are at high-risk for
Acute Pyelonephritis
How do you diagnose asymptomatic bacteruria
Midstream urine culture and sensitivity results
How do you treat a symptomatic bacteruria in a pregnant woman
Nitrofurantoin BID for 5 days Avoid using in the last trimester Augmentin b.i.d. 3 to 7 days Amoxicillin b.i.d. for 3 to 7 days Cephalexin b.i.d. for 3 to 7 days Increase fluids Pre & post treatment urine c&s
What is the most common urinary tract pathogen in pregnant women
E. coli.
What is a risk for women that are pregnant with urinary tract infections
Higher risk for preterm birth and low birth rate
If the Bactrim or nitrofurantoin are used near the term delivery date or the third trimester what is the baby at risk for. What is the mother at risk for
It causes hyperbilirubinemia in babies. Causes Hemolysis if the mother or mother and baby has G6PD anemia
If a patient woman has asymptomatic bacteria when should you order a post treatment culture and sensitivity
One week after completing antibiotic therapy
If pyelonephritis is suspected in a pregnant woman what should be done
Refer to ED
Can you give nitrofurantoin and sulfa drugs to a Neo Nate less than four weeks of age
No because it can cause hyperbilirubinemia
What is a complication of hyperbilirubinemia that leads to serious North/brain damage
Kernicterus
Can you use sulfa drugs or nitrofurantoin in a patient with G6PD anemia
No because it causes Hemolysis
Pulmonary reactions such as interstitial pneumonitis, pulmonary fibrosis, hepatotoxicity, neuropathy are all adverse effects of
Sulfa drugs and nitrofurantoin
Is a UTI in a pregnant woman considered complicated or uncomplicated
Complicated
UTI is defined as how many colony forming units
100,000
For this exam, how do you treat a UTI in a pregnant woman
Nitrofurantoin
What is the other name for miscarriage and the loss of a fetus before it is viable less than 20 weeks old
Spontaneous abortion
Vaginal bleeding occurs but cervical os remains close. Most of the cases will result in an ongoing pregnancy.
Threatened abortion
Cervix is dilated and unable to stop process. Fetus will be aborted
In evitable abortion
Vaginal bleeding with cramping. Placenta and fetus or expelled completely. Cervical os will close and bleeding stops.
Complete abortion
Vaginal bleeding with cramping. Placental products remain in the uterus. Cervical os remains dilated and bleeding persists, pieces of tissue may be seen at the cervical os. Foul smelling vaginal discharge (BV)
Treatment is dilation with curettage and antibiotics.
Incomplete abortion
When does most cases of preeclampsia occur
Late third trimester around 34 weeks of gesstation or later
Can preeclampsia occur after childbirth
Yes it can occur after four weeks after childbirth in the postpartum period.
Headaches, blurred vision, and right upper quadrant abdominal pain are all symptoms of
Preclampsia
This condition can cause multi organ damage such as the brain i.e. stroke, kidneys i.e. acute renal failure or, lungs i.e. pulmonary edema, liver i.e. hepatic lecture, DIC and fetal and or maternal death. The exact etiology is unknown.
Preeclampsia
What are risk factors for preeclampsia
Primigravida, multi para, older than 35 years of age, obesity, prior history of preeclampsia, hypertension, or kidney disease.
What is the classic triad of symptoms that occur after 20 weeks of gestation in order to diagnose preeclampsia
Hypertension, proteinuria , and Edema that occur. Take at least two separate blood pressure readings at least six months apart. Systolic blood pressure will be greater than 140 mmHg and Diastolic blood-pressure will be greater than 90 mmHg. Protein urea will be greater than 0.3 g of protein in a 24 hour urine specimen. Protein urea ranges from trace to 1+4+. Rapid weight gain of from 2 to 5 pounds per week. The Edema is Is most obvious in the face, around the eyes, and the hands.
How do you treat preeclampsia
Refer to obstetrician for management. The only definitive cure for preeclampsia and eclampsia is the delivery of the placenta/Fetus
If a patient was preeclampsia and has seizures what will they be diagnosed with
Eclampsia
Can a patient take an ACE or angiotensin receptor blocker while pregnant
No
Premature partial to complete separation of a normally implanted placenta from the uterine bed. Rupture of the maternal blood vessels from the decidua basalis. Bleeding ranges from mild to hemorrhage.
Placenta abruptio
What are controllable risk factors for placenta abruptio
Smoking, cocaine use, hypertension and seatbelt use
Sudden onset of vaginal bleeding mild to hemorrhage with abdominal and or back pain. Painful uterine contractions. Uterus is rigid or hypertonic and very tender.
Placenta abruptio
How do you treat placenta abruptio
Refer to ED. Initial ED labs are CBC, PT/PTT, blood type, crossmatch, Rh factor, and So on. Abdominal ultrasound. Possible blood transfusion. If mild contractions give magnesium sulfate IV. Strict bedrest. Deliver fetus by C-section if mothers life is threatened. Give steroids if fetus is viable.
An abnormally implanted placenta. The placenta implants too low on top of the cervix or on the cervical isthmus/neck. Most cases get better spontaneously and will re-implant itself. Some cases are asymptomatic. Higher risk his previous history of placenta previa or C-section, multiparas, older age, smoking, fibroids, or cocaine use.
Placenta previa
A woman who is a multi para who is at the late 2nd to 3rd trimester of pregnancy complains of the sudden onset of bright red vaginal bleeding accompanied by mild contractions. The uterus feel soft and is not tender.
Placenta previa
What is the treatment plan for placenta previa
Refer to ED. Avoid bimanual examination since palpation of the uterus may cause severe hemorrhage. Abdominal ultrasound only. No intravaginal ultrasound. No rectal exams. Avoid any vaginal/rectal sexual intercourse. Bedrest. Close fetal and maternal monitoring. If contractions, give magnesium sulfate IV. If mild cases, pregnancy can be salvaged and the placenta will be implant. Perform C-section if mother’s life is in danger.
When is colostrum produced
Day 1 to 3
What type of vitamin do all breast-fed infants need
Vitamin D supplementation needs to be started within the first few days.
What kind of formula should infants be given who are formula fed
Iron fortified formula
How often well newborns nurse for 24 hours
10 to 12 times
What should you use on your nipple after nursing to protect it from skin breakdown
Lanolin or breast milk
If a mother who is breast-feeding complains of pain and sore nipples what should be recommended for her
She should be advised to continue breast-feeding and that this is a common problem that will resolve
Most common in the first two months of breast-feeding. Skin fissures on the nipple allow bacterial entry. Most common organism is Staphylococcus aureus. Consider MRSA bacterial infection. If severe or toxic, refer to ED or admit to the hospital.
Breast feeding mastitis
How do you prevent breast-feeding mastitis
Frequent and complete emptying of breast and proper breast-feeding technic. breast engorgement and poor technique increases risk of mastitis
Patient who is breast-feeding complains of the sudden onset of a red, firm, and tender area i.e. induration on one breast. May also have fever/chills and malaise i.e. flu like symptoms. May have adenopathy on the axilla by the affected breast.
Breast-feeding mastitis
Are labs indicated for breast-feeding mastitis
Usually not. A clinical diagnosis. CBC shows leukocytosis. Order C&S of milk if hospital acquired, severe, or not responding to antibiotic treatment.
If low risk for MRSA what is the antibiotic therapy recommended for breast-feeding mastitis
Dicloxacillin 500 mg PO QID or Keflex 500 mg PO QID for 10 to 14 days
If at high-risk for MRSA what antibiotics and meds is given
Bactrim 1 to 2 tabs PO BID for 10 to 14 days or clindamycin 300 mg PO QID for 10 to 14 days. Continue to breast-feed on affected breast during antibiotic treatment. If unable to breast-feed, pump milk from infected breast and discard to prevent engorgement. If breast abscess is suspected, order and ultrasound and refer for incision and drainage. Ibuprofen for pain as needed. Cold compresses on indurated breast area. Refer to lactation consultant if suspect poor breast-feeding technique.
How do you treat uncomplicated chlamydia infection in a pregnant woman
Azithromycin 1g orally. Alternative is amoxicillin 500 mg PO TID times seven days.
What are the labs for uncomplicated chlamydia infection
NAAT such as the gen probe. Gen-Probe can only be used on the cervix and urethra. Do not use to collect specimens from the eyes. Test of cure in three weeks after completing treatment.
How do you treat a sexual partner for an uncomplicated case of chlamydia
First line is azithromycin in 1 g orAlly single dose. Doxycycline 100 mg PO bID for seven days. Avoid sexual activity for seven days. Avoid unprotected intercourse until both partners are treated. Test for other STDs such as gonorrhea, syphilis, and HIV.
ACOG recommends that prenatal care be initiated by how many weeks?
10 weeks
MCV <80 in the absence of age deficiency anemia suggests
Thalassemia
Diabetes diagnosed at initial visit is called
Overt diabetes
Diabetes diagnosed during pregnancy is called
Gestational diabetes
If a patient is diagnosed with gestational diabetes what should be done
Referral to registered dietitian. Three small to moderate size the meals with 2-4 snacks, but needs individual adjustment by registered dietitian. Insulin if you needed. Oral diabetic medication not recommended in the 1st trimester, but Glyburide and Metformin are ok in 2nd & 3rd trimester
A pregnant mother is RH negative. When should she receive RhoGAM
About 28 weeks. If abnormal bleeding, give RhoGAM
Untreated asymptomatic bacteriuria can lead to
Pyelonephritis
When should maternal assessment of fetal kick counts be assessed
28 weeks. Patient lies on her left side 30 minutes after eating. She records the time she starts the test and notes each time the baby moves or kicks. Findings a healthy fetus should move 3 to 5 times within one hour. Most to move a lot more than this
When should group B strep screening take place
35 to 37 weeks. Vaginal and rectal swab’s are performed. This is a common cause of neonatal sepsis and can lead to morbidity and mortality
Is Zoloft (Setraline) ok in pregnancy
Yes. Category C. It may be safe
Is Paxil or Prozac ok to give in pregnancy 🤰
No
Are inhaled corticosteroid’s OK to use in pregnancy
Yes
Is doxycycline OK to use in pregnancy and what category is it
No. It is category D
How do you test for premature rupture of membranes
Fern test. Fluid is taken from the posterior vaginal Fornix swabbed on a slide, allowed to dry for greater than 10 minutes. Amnionic fluid fluid has a delicate for ferning pattern. Nitrazine testing is also done and the pH of amniotic fluid would be between 7.0 to 7.7 and turn the paper blue. Normal vaginal pH would be 3.8 to 4.2 and turn the paper yellow.
If placenta Previa is suspected should a vaginal examination be done
No
Symptoms of pregnancy that are felt by the woman are called
Probable sign
A 28-year-old pregnant patient gives a history of smoking one pack of cigarettes per day. The nurse practitioner is accurate when she tells the patients that smoking cigarettes is associated with
A small for gestational age fetus
What parameters should be used to assess a breast-fed infants adequate nutrition
The infant should have at least six wet diapers per day
A 16-year-old sexually active female presents to the clinic. She has never had a vaccination for hepatitis a or B, she has had one MMR immunization, and her last tetanus vaccination was four years ago. Which vaccination would be contra indicated without further testing and why
MMR because it is contra indicated during pregnancy. A pregnancy test would be needed to rule out pregnancy before giving MMR.
Ideally, antepartum care should begin
With pre-conception counseling
If a patient is pregnant with twins and has an elevated maternal serum alpha fetal protein test what does this mean
This is an expected finding due to multiple gestation
A 37-year-old female is found to have a negative rubella titer. How long after immunization should she avoid pregnancy?
28 days
When counseling a woman who is breast-feeding her six month old infant, the nurse practitioner should recommend a caloric intake over her pre-pregnancy requirements of
500 cal per day
It’s 24-year-old female is pregnant with twins. You would recommend how much of iron requirement for her
60 to 100 mg
