Pregnant Patient PE Quiz Flashcards
What should be addressed at the initial prenatal care visit?
- confirm pregnancy with lab tests (urine or blood)
- assess health status of the mother
- counsel mother to ensure a healthy pregnancy
How to confirm pregnancy at initial prenatal care visit?
lab tests ( urine or blood)
What should be addressed at subsequent prenatal care visits (NOT initial)
- assess health of mother
- assess fetus
- educate to ensure a healthy pregnancy
During weeks 4-28 a woman should get a prenatal checkup every [] weeks
4/ once a month
During weeks 28-36 a woman should get a prenatal check up every [] weeks
2/ twice a month
during weeks 36-birth a woman should get a prenatal check up every [] weeks
once a week until baby is born
When is it best to do genetic screening?
15-18 weeks
when it is best to do in depth US
20 weeks
when is it best to screen for gestational diabetes
24-28 weeks
[] is the number one cause of neonatal meningitis
group B strep
when should group B testing be done
36-39 weeks
What initial labs should you draw on your pregnant patient
- CBC
- blood type
- hepatitis panel
- HIV testing
- syphilis testing
- UA and culture
- pap smear
- chalmydia
- gonorrhea cultures
What subsequent lab tests should be ran on your pregnant patient
- urine for glucose (GDM)
- protein in urine (preeclampsia)
- WBC (infection)
glucose in urine can be indicative of []
gestational diabetes
protein in urine can be indicative of
preeclampsia
WBC in urine can be indicative of
infection
hormonal changes lead to extensive [1] and [2] changes in [3]
- anatomical
- physiological
- every major body system
what hormones are most responsible for pregnancy related endocrine and metabolic changes
- estradiol
- progesterone
- pregnancy hormones (HCG)
erythrocyte mass and plasma volume [] during pregnancy
increase
cardiac output [] during pregnancy
increase
system vascular resistance and pressure [] during pregnancy
fall
musculoskeletal changes occur from [] and []
- weight gain
2. relaxin hormone
what happens to the spine during pregnancy?
lumbar lordosis
[] and [] ligaments relax during pregnancy
- SI joints
2. pubic symphyses
Describe some breast changes in pregnancy
- enlarge moderately
- become more nodular by 3rd month of pregnancy
- clostridium expression
- areolae darken
- venous pattern becomes more visible
what causes breasts to enlarge moderately during pregnancy
- hormone secretion
- increased vascularity
- hyperplasia of glandular tissue
what 4 breast changes occur in late pregnancy
- colostrum may be expressed
- areolae darken
- montgomery’s glands are more pronounced
- venous pattern increasingly visible
when is the uterus most easily palpable
12-14 weeks as it straightens from anteverted position and rises up out of pelvis
as uterus enlarges is rotates to the [] to accommodate for []
- right
2. rectosigmoid structures on the left side of pelvis
describe changes to the vaginal during pregnancy
- walls appear thicker and deeply rugated
2. vaginal secretions are thick, white, and more profuse
describe Chadwick’s sign
bluish discoloration of the cervix, vagina and labia from increased blood flow
[] is a bluish discoloration of cervix, vagina, and labia from increased blood flow
Chadwick’s sign
describe cervical changes during pregnancy
- Chadwick’s sign
2. mucous plug
describe changes to ovaries during PE
cadges generally not noticeable on PE
What symptoms of pregnancy should you address with your patients
- absence of menses
- breast tenderness
- N/V
- fatigue
- increased frequency urination
what are 6 important history taking points to talk about with your pregnant patient
- symptoms pregnancy
- maternal concerns/attitude about pregnancy
- current state of health
- obstetrical hx
- past medical hx
- family hx congenital disease
how should you assess maternal concerns and attitude about pregnancy with your patient
- how does she feel?
- was is planned?
- is it desired?
- does she plan to continue to term?
how should you asses the current state of health of the patient
- review nutrition and exercise
- obtain smoking/alochol/and drug hx
- obtain occupational hx, look for workplace hazards
- assess social support and finances
what symptoms of pregnancy typically only occur in the 1st trimester
- nausea
- breast tenderness
- weight loss
- edema
How would you assess past obstetrical history with your patient?
- past pregnancy
- prenatal/labor issues - review birth weight of prior pregnancies
- review any miscarriages and fetal demise
how would you asses past medical history
review for any systemic diseases that would affect pregnancy
how would you assess family hx of congenital disease
investigate for sickle cell/cystic fibrosis/etc.
every exam during prenatal time is an excellent opportunity for []
emphasizing healthy habits
- nutrition
- weight gain
- exercise
- smoking/alcohol/illicit drug use
- screen for DV
- immunization
How you do establish estimated date of delivery
Naegle’s Rule
first date of LMP + 1 week - 3 months + 1 year
Describe Neaegle’s Rule
way to determine EDD
first date of LMP + 1 week -3 months + 1 year
how can you verify the EDD?
- doptone (+ 10-12 weeks)
- fetoscope (heard at 18 weeks)
- fetal movement (18-24 weeks)
- US
a doptone might be positive at [] week
10-12
a fetoscope can be heard at []
18 weeks
fetal movement may occur at [] weeks
18-24 weeks
General inspection of pregnant patient should include
- overall health status
- emotional state
- nutritional status
[] is very important in establishing if a patient becomes hypertensive during pregnancy
BP
What vital sign is especially important to asses in pregnancy women and why?
BP
to monitor hypertension during pregnancy
> 140/90 before 20 weeks indicates []
chronic hypertension
what value would point to chronic hypertension in pregnancy
> 140/90 before 20 weeks
> 140/90 after 20 weeks indicates []
gestational hypertension
what indicates gestational hypertension
> 140/90 after 20 weeks
> 140/90 after 20 weeks with protein in urine indicates
preeclampsia
what BP state indicates preeclampsia
> 140/90 after 20 weeks with protein in urine
why is weight and BMP important to discuss with patients
important to educate patient on proper weight gain and nutrition
for a low BMI of [] a [] lb gain is recommended
- > 19.8
2. 28-40 pound weigh gain
for a normal BMI of [], a [] lb gain is recommended
- 19.9-26
2. 25-35 lb gain
for a high BMI of [] and [] lb weight gain is recommended
- 26.1-29
2. 15-25 lb gain
for an obese bmi [] a [] weight gain
- > 29
2. <15 lb
what signs on patient’s head are common in pregnancy
- mask of pregnancy/cholasma
2. edema
what signs on patients hair indicate pregnancy
often dry and thinning
what signs on eyes indicate pregnancy
- pallor of conjunctiva can mean anema
what signs on nose indicate pregnancy
edema with congestion normal
what should you note on inspecting patients mouth
note gums and teeth, periodontal disease common
patients often complain of [] in thorax during pregnancy
shortness of breath
[] are common in pregnancy when listening to heart
venous hums
what should you be inspecting in patients breasts
- symmetry
- color
- veins often prominent
describe chloasma
melanoma of pregnancy, dark, blotchy, brown, confetti-like patches of skin on forehead, upper lip, cheeks
What should you inspect on you pregnant patient’s abdominal exam
- scars from earlier c section
- striae
- linea nigra
- palpate abdominal organs for masses
- palpate uterus
- fetal movement at 24 weeks
- contractions can be felts
[] can be palpated at 24 weeks on patients abdomen
fetal movement
[] dark vertical line that appears on the abdomen
linea nigra
[] a gap of roughly 1 inch or greater between 2 sides of rectus abdominis muscle
diastasic recti
describe distasis recti
a gap of roughly 1 niche or greater between 2 sides of rectus abdominis mucle
describe striae
stretch marks
fundal height is measured from the [] to the []
- superior portion of pubic symphysis
2. top of fundus
superior portion of pubic symphyses -> top of fundus
fundal height
from [] gestation, the fundal height in cm should approximate the number of weeks gestation
20-32 weeks
at 20-32 weeks gestation, fundal height in cm should approximate []
number of weeks gestation
how can fetal heart rate be assessed
- doptone (10 weeks)
2. fetoscope (18 weeks)
fetal heart rate should be [] in the first weeks for pregnancy
150s - 160s
fetal heart rate should be [] by term
120s - 140s
if the fetal heart rate is around 150-160 BPM what can you conclude?
the woman is a few weeks along
if the fetal heart rate is 120-140 what can you conclude?
the pregnancy is almost to term/to term
what should you assess on your pregnancy patient’s genitals
- episiotomy scars
2. perineal lacerations from prior delivery
what should you asses on your patients anus
- hemorrhoids
- fissures
- warts
*have patient bear down to rectoceles or cystoceles
gravid cervix appears [] on speculum exam
bluish (chadwick’s sign)
the cervix appears soft on speculum exam, this is know as [] sign
Hegar’s
describe Hegar’s sign
soft cervix on speculum exam
What 3 things should you note on your pregnancy patient’s speculum exam regarding the cervix
- color (bluish)
- consistency/soft
- shape
*obtain pap and std culture
Desicribe bimanual exam
- with 2 fingers in vagina palpate cervix, uterus, and adnexal areas
- assess length of cervix
- assess if externa/internal os is open or closed
- if term, assess station of presenting part
why is it important to asses the length of the cervix on bimanual exam
so thinning of cervix can be estimated during delivery
what is important to note on bimanual exam of a patient at term
station of presenting part
-i.e. how inferior presenting part is to ischial spine
what should you note on your pregnancy patient’s extremities
- varicose veins
- edema
- reflexes
