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S3 1538 > S3 M2 Reproduction > Flashcards

S3 M2 Reproduction Flashcards

1
Q

S/S of pregnancy

subjective

A 
Urinary frequency
N/V
Breast tenderness
Uterine/breast enlargement
Hyperpigmentation of skin
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2
Q

S/S of pregnancy objective

A 
Braxton hicks
Abdominal enlargement
Ballottement
Goodells sign
Chadwicks sign
Hegars sign
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3
Q

Braxton hicks

A

when the womb contracts and relaxes

objective sign of pregnancy

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4
Q

Chadwicks sign

A

Dark blue or purplish red congested appearance of vag mucose

First trimester
Softening of uterus at junction with cervix

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5
Q

Hegars sign

A

First trimester

Softening of uterus at junction with cervix

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6
Q

Goodwells sign

A

Softening and cyanosis of the cervix

At of after 4 weeks

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7
Q

Ladins sign

A

Softening of uterus after 6 weeks

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8
Q

Pregnancy adaptation

Ptyalism

A

overproduction of saliva

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9
Q

GI pregnancy adaptations

A 
Ptyalism
Gingivitis
Decreased peristalsis
Hemorrhoids 
Heartburn
N/V
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10
Q

Cardiovascular pregnancy adaptation

A

50% more blood

^ cardiac output

v blood pressure at first, increase later

^ RBC x2^ plasma causing hemodilution (anemia)

^ in demands for iron, fibrin, and clotting factors leading to hypercoagulable state

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11
Q

Resp pregnancy adaptations

A

Breathing more diaphragmatic

^ in O2 consumption

Congestion secondary to increased vascularity

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12
Q

Renal/urinary pregnancy adaptations

A

Dilation of pelvis and ureters

^ length/weight of kidneys

^ Glomerulofiltration rate (pee more)

^ kidney activity when lying down

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13
Q

Musculoskeletal pregnancy adaptations

A

Softening of sacroiliac ligaments

^swayback and upper spine extension

Lordosis

Waddle gait

Center of gravity shifts forward

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14
Q

Integument pregnancy adaptation

A

Hyperpigmentation

Linea nigra

Varicosities

Decline in hair growth

Increase in nail growth

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15
Q

Thyroid pregnancy adaptation

A

^BMR

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16
Q

Pituitary pregnancy adaptation

A

v TSH GH

inhibition of FSH and LH

^ Prolactin MSH oxytocin

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17
Q

Pancreas pregnancy adaptation

A

Insulin resistance in second half of pregnancy

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18
Q

Adrenal pregnancy adaptation

A

^ Cortisol and aldosterone

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19
Q

What does the placenta secrete

A 
hCG
hPL - insulin inhibitor
relaxin
estrogen
progesterone
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20
Q

Pregnancy insulin and glucose

A

early pregnancy
^ in glucose demand due to baby growth
Fetus must make its own insulin

mid pregnancy
^ in insulin production to work against hPL and extra cortisol which desensitize insulin to give more sugar to baby

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21
Q

Nutrition pregnancy

A

intake IDRECTLY = wellbeing/outcome of birth

Need vitamins and minerals

Avoid mercury fish
Increase protein, iron, folate, and calories
MyPlate

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22
Q

Nutritional sugestion

A 
1/2 plate, fruit and veg
Whole grain
^ Fiber
NO Hydrogenated fats
2 quarts of water daily
2 servings of fish weekly, 1 of them fatty
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23
Q

Bad food during pregnancy

A

NO Artificial sweeteners

NO Mercury fish (king, mackerel, ahi tuna, shark/sword fish) smoked seafood

NO processed meats (lunch meat, hotdogs, spreads)

NO soft cheeses (feta, brie, camembert)

NO unpasteurized milk

NO store made salads

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24
Q

Good fish for pregnancy

A

shrimp
salmon
pollock
catfish

up to 12 ounces

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25
Q

When is the embryo at greatest risk

A

17 to 56 days after conception

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26
Q

First prenatal visit points

A

Establish trust

Educate wellness

Detection/prevention of problems

Comprehensive history/examination/labs

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27
Q

Pregnancy history

A

suspicion of pregnancy

date of last period

s/s

urine or blood test for hCG

past history

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28
Q

what do you test urine and blood for for pregnancy

A

hCG

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29
Q

Gravida

I

II

A

Pregnant woman

first pregnancy

second pregnancy

etc

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30
Q

Para

A

woman who produced VIABLE/OR NOT offspring carrying 20 weeks or more

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31
Q

Primipara (Primip)

Multipara (Multip)

Nullipara (Nullip)

A

One birth after 20 week prego

2 or more pregnancies with viable offspring post 20 weeks

No viable offspring

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31
Q

Primipara

Multipara

Nullipara

A

One birth after 20 week prego

2 or more pregnancies with viable offspring

No viable offspring

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32
Q

GTPAL

A 
Gravida
Term births
Preterm births
Abortions
Living children
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33
Q

Term birth

A

birth with 37 weeks gestation

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34
Q

preterm

A

birth with 20 to 37 weeks gestation

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35
Q

abortion

A

nonviable birth

less than 20 weeks gestation

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36
Q

OB history

A

GTPAL

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37
Q

So Primigravida means

A

first pregnancy

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38
Q

Menstrual history

A 
Age at menarche
Days in cycle
Flow characteristics
Discomforts
Use of contraception
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39
Q

NAGELEs RULE

Calculate expected date of birth

A

Last menstrual period LMP date

LMP - 3 months + 7 days + 1 year

BEST method is ultrasound

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40
Q

Weight gain during pregnancy

A

BMI less than 18 - 28-40lb
BMI more than 25 - 12-25lb
Normal BMI 18 to 25 - 25-35lb

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41
Q

First Prenatal visit focus not sensitized

A

Rh - if negative, repeat at 28 weeks

if still negative give Rh immune Globulin (RhoGAm) to prevent sensitization

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42
Q

First Prenatal visit sensitized

A 
Monitor closely 
blood work check ABX
doppler ultrasound to fetal brain
aminocentesis at 15 weeks to check fetal blood type
Mother will see preinatologist

Rhogam will NOT work if woman is already sensitized

Good for 12 weeks

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43
Q

If mother is Rh sensitized Rhogam will

A

NOT work

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44
Q

Amniocentesis

A

blood type check at 15 weeks

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45
Q

If Rh is sensitized, mother will need to see a

A

perinatologist

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46
Q

Coombs test

A

determines weather mother has developed isoimmunity to the Rh antigen

detects antibodies harmful to fetus

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47
Q

If Coombs test is negative the woman is a candidate for

A

RhoGAM

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48
Q

Current standard of giving RhoGAM

A

between 28 and 32 weeks

again 72 hours after birth

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49
Q

Which Rh destroys Which

A

Rh negative blood will attack Rh positive blood

this is called Sensitization

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50
Q

Why is Rh a problem during second pregnancy

A

Mother and baby blood does not mix until birth, so first baby is good.

Once it mixes, mother develops antibodies, bad for second baby

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51
Q

Rh Sensitization can cause what in baby

A

Anemia
Jaundice
Hemolytic anemia (erythrocytosis fetalis)

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52
Q

Visits for pregnancy

A

Q4 weeks up to 28 weeks
Q2 weeks 29 to 36 weeks
Every week after 37 weeks to birth

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53
Q

What is measured during pregnancy follow ups

A 
Wight and BP
Urine for protein, glucose, ketones, nitrites
Fundal height
Quickening/fetal movement
Fetal HR

Teach danger signs

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54
Q

Measure fundal height

A

Top of uterus to pubic bone

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55
Q

When does fetal movement begin

A

Second trimester

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56
Q

First perception of fetal movement

Range of movement determins

A

“Quickening”

Gentle fluttering

Pregnancy outcome
Good movement = good outcome

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57
Q

Fetal heart rate

A

Women lies down
Use doppler on abdomen

Normal range for fetus 110 to 160 bpm

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58
Q

1st trimester

includes

A

0-13 weeks
History
Lab
First visit

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59
Q

2nd Trimester includes

A 
14-27 weeks
visit every 4 weeks
V/S 
Wt
BP
gluc, prot
FH FHT
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60
Q

3rd trimester includes

A 
28-40 weeks
Visit every 2 weeks till 36 week then Q1 week
V/S
Wt
BP
Gluc Prot
FH FHT
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61
Q

1st trimester lower abdominal pain with dizziness and shoulder pain

spotting and bleeding

severe vomiting

A

ruptured ectopic pregnancy

miscarriage

hyperemesis gravidarum

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62
Q

2nd trimester pain in calf with felxion

2nd trimester absence of fetal movement for 12h

regular contractions

sudden gush or leakage

A

DVT

fetal distress or demise

preterm labor

premature rupture

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63
Q

3rd trimester edema abdominal pain
visual changes and headache

3rd trimester 24h without fetal movement

What else

A

Gestational hypertension or preeclampsia

possible demise

Literally everything from first 2 trimesters

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64
Q

Congenital malformation checks happen at

A

18-20 weeks

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65
Q

Nuchal translucency ?

is done at

A

test for downs

11-14 weeks

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66
Q

Alpha fetoprotein ?

is done at

A

Down

16-18 weeks

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67
Q

Aminocentesis

Chorionic Villus

A

Genetic testing for abnormalities in fetus MOST ACURATE

Less accurate

68
Q

Anemia in fetus

A

Mild more common than normal pregnancy

moderate - may need transfusion or early delivery

severe - hemolytic anemia, WILL need transfusion and early delivery

69
Q

Hemolytic anemia

Erythrocytosis fetalis

A

RBC destroyed faster than produced

No RBC to Oxygen

Breakdown = ^bilirubin = jaundice/brain damage

No Oxygen = ^HR = HF
Hydrops fetalis

70
Q

Labor contractions

A

4-6 min apart
lasting 30-60 sec

Stronger over time
feeling of vaginal pressure

Contractions start in back and radiate to front of abdomen

NO alleviation with positional change

STAY HOME UNTIL contractions are 5min apart lasting 45-60 sec
and conversation is not possible

71
Q

Primary power of labor

A

Uterine contractions which are

involuntary

72
Q

Normal rate of contractions

Tachysystole or hyperstimulation

A

5 or less in 10 min

More than 5 contractions in 10 min

73
Q

Effacement

A

Thinning of the cervix

74
Q

Cervical ripening agents

A

Dinoprostone - vaginal insert
Prepidil gel - must be at room temp
Misoprostol - orab or vag tab

75
Q

Cervical ripening

A

softening and opening the cervix before labor starts

76
Q

Assessment of contractions includes

A

Frequency
Duration
Intensity
Uterine resting tone

77
Q

Intensity of contractions is measured in

A

MVUs

78
Q

What class of drugs is given for analgesia to women in labor

A

Opioids
Antiemetics
Benzodiazepines

narcan if OD

79
Q

Early/Latent phase

A 
Cervical dilation to 3cm
Cervical effacement to 40%
Contractions q5-10min
Contractions last 30-45 sec
Contraction intensity mild
80
Q

Nullipara

Multipara

A

A woman who has never given birth

A woman who has given birth before

81
Q

Phases of 1st stage of labor

A

Latent/early
Active
Transition

82
Q

Active phase

A 
4-7cm dilation
40%-80% effacement
Contractions q2-5min
Contraction duration 45-60sec
Contraction intensity Moderate
83
Q

Transitional phase

A 
8-10cm dilation 
80%-100% effacement
Contractions q1-2min
Contraction duration 60-90sec
Strong intensity
84
Q

Pitocin(oxytocin)

A

used to initiate or improve contractions

used in 3rd stage to CONTROL BLEEDING

given via DRIP

MONITOR uterine activity and FHT fetal heart tone

85
Q

Pitocin(oxytocin) dosing

A

10 units to 1000ml NS

start at 0.5-1 MU/min
increased to 1-2 MU/min until desired contraction pattern

86
Q

FHT

A

Fetal heart tone

87
Q

Document V/S, contractions and fetal well being q_min when giving pitocin(oxytocin)

A

15

88
Q

Fetal Heart Rate

Tachycardia

Bradycardia

A

110-160bmp

greater than 160

less than 110

89
Q

Treatment for variable in FHR baseline

A

FIRST change mothers position
give O2 to mother
give IV fluids

Slow or stop pitocin
Slow or stop pushing

90
Q

Prolapse cord

A

If prolapse cord, push head off cord and DO NOT remove your hand

this is an EMERGENCY requiring IMMEDIATE c-section

91
Q

VEAL CHOP

FHR Decelerations

A

Variable deceleration - Cord compression
Early deceleration - Head compression
Acceleration - Okay
Late deceleration - Placental insufficiency

92
Q

Early deceleration

A

Head compression

Deceleration and contraction mirror one another

lowest point at peak of contraction

40bpm decrease

No intervention required

93
Q

Variable deceleration

A

Cord compression

Abrupt unpredictable decrease

usually good outcome

94
Q

Late decel

A

Placentae insufficiency

occurs AFTER peak of contraction

fetal hypoxia, asphyxia, acidosis, cns depression

Always abnormal

EMERGENCY

95
Q

Conditions that can lead to late decel, placental insufficiency

A

maternal hypotension
gestational hypertension
placental aging due to diabetes
hyperstimulation via oxytocin

96
Q

Late decel
placental insufficiency treatment

AND

Prolonged decel treatment

A

Stop oxytocin

Turn client on side and do knee to chest - increases placental perfusion

Admin O2

^IV rate

Assess

Notify MD

97
Q

Prolonged decel

A

abrupt FHR decline of at least 15bpm that lasts between 2 and 10 min

USUALLY rate drops to less than 90bpm

98
Q

If late or prolonged decel is unresolved

A

immediate c-section

99
Q

Second stage of labor

A

Dilation to birth
Contractions ever 2-3 min
contraction duration 60-90 sec

100
Q

Phases of the second stage of labor

A 
Pelvic phase (fetal descent)
Perineal phase (active pushing)
101
Q

Third stage of labor

A

Delivery of placenta

Gush of blood
Cord lengthening
Globular and firm uterus
Uterus rises anteriorly

Massage uterus until firm to promote constriction of blood vessels

102
Q

Blood loss during birth

A

vaginal 500ml

cesarean 1000ml

blood loss over 1000ml SEVERE

103
Q

Nursing management of hyperstimulation

A 
STOP pitocin
admin O2
Lateral position
Flush IV
Notify MD
104
Q

Forth stage of labor

A

Post partum time
Attachment with baby
fundal massage

Focus is to prevent hemorrhage, urinary distention and venous thrombosis

Monitor mom every 15min

105
Q

Placental function

A

Nutrition to fetus

Pregnancy hormones

Immune protection

Gas exchange for baby

Removes waste

106
Q

Does placenta and mother blood mix

A

NO

all process is done by diffusion

107
Q

Shultz
Duncan
Amniotic sac

A

Fetal side
Maternal side
sac

108
Q

Episiostomy cut made at the opening of the vagina during childbirth healing

REEDA

A 
Redness
Edema
Ecchymosis (bruising)
Discharge
Approximation (closing)
109
Q

Post partum check

BUBBLE-HE

A 
Breasts
Uterus
Bladder
Bowel
Lochia
Episiotomy (perineum)
Homans' sign
Emotions (psych)
110
Q

Uterus descend after birth

A

1cm per a day for 10 days

everything falls back into true pelvis

111
Q

Lochia

A

Rubra

Serosa

Alba

112
Q

Lochia rubra

A

1st stage

Deep red mucus and debris first 3 day

113
Q

Lochia serosa

A

2nd stage

pinkish brown
3 to 10 days

114
Q

Lochia alba

A

Creamy white or light brown

10 days to 6 weeks

115
Q

Normal pregnancy length

A

38-42 weeks

116
Q

Biophysiological risk factors for baby

examples

A

Genetics

Pre-existing conditions

117
Q

Psychosocial risk factors for baby

Examples

A

Poor fam support, abuse, mental health issues

118
Q

Sociodemographic risk factors for baby

A

Single parent, education, age

119
Q

Environmental risk factors for baby

A

lead exposure, viruses

120
Q

Lab diagnostics for preeclampsia

H EL LP

A

H Hemolysis
EL Elevated liver enzymes
LP Low platelet count

121
Q

Vaccines for mothers

TORCH

A 
T-toxoplasmosis 
O-other; hep, hiv varicella
R-rubella
C-cytomegalovirus
H-herpes
122
Q

antithyroid drugs in mom can lead to

hypothyroidism in mom can lead to

A

fetal demise

fetal demise or cretinism

123
Q

Labor and delivery is also called

A

intrapartum

124
Q

False labor

A 
IRREGULAR contractions
NO change in intensity
Discomfort in abdomen NOT back to front
Walking helps
Cervix unchanged
Rest helps
125
Q

In L/D lie means

A

long axis of fetus to long axis of mother

126
Q

In L/D presentation means

A

Part of fetus to first enter pelvis

127
Q

In L/D attitude means

A

Relationship of fetal head to fetal spine

128
Q

in L/D station means

A

fetal head to maternal ischial spine
+5 to -5

+ means BELOW
- means ABOVE
0 means level

129
Q

in L/D Effacement means

A

Shortening/thinning of the cervix

130
Q

in L/D Dilation means

A

Opening of cervix in centimeters

131
Q

Multigravida

Multipara

A

Woman who has multiple pregnancies

Woman who has carried past 20 weeks

132
Q

in L/D lightening means

A

Occurs at 38 week
fetus has settles into pelvis “Dropped”

eases breathing
pressures bladder

133
Q

in L/D bloody show means

A

passing of protective blood stained mucus before birth

134
Q

Vaginal exam is done at

is not done at

A

Admission, client in labor with no contractions

NOT DONE if active bleeding

135
Q

Postpartum time

A

first 6-8 weeks

Mothers body returns to normal

Immediate period during hospital stay within 2-3 days

Assessment

Comfort

Potential complications

136
Q

Interventions for breast pain postpartum

A

Warm compress if lactating

Cold compress if not

137
Q

Interventions for back pain post partum

A

Pelvic tilt, change positions

138
Q

Interventions for perineum pain post partum

A

Ice x24h then sitz bath,
stool softeners
sprays
tucks

139
Q

Interventions for leg pain post partum

A

Assess
NO massage
Walk if no indication of DVT

140
Q

Interventions for bladder pain post partum

A

^fluid
help void
straight cath
antibiotics

141
Q

Position for uterine infection

A

Semi fowler to help drain

142
Q

Ductus venosus

A

a shunt that allows oxygenated blood in the umbilical vein to bypass the liver and is essential for normal fetal circulation

143
Q

Foramen ovale

A

a small opening between the two upper chambers of the heart, the right and the left atrium

144
Q

Ductus arteriosus

A

Helps bypass lungs in fetus as O2 is gotten from placenta

145
Q

Assessment of new born

A

Weight
Head and chest
Gestational aging

146
Q

SGA

LGA

A

Small for gestational age

Large for gestational age

147
Q

Late premature

A

Bork between 34 and 36 weeks

148
Q

Antepartum

A

1st week till birth starts which is called intrapartum

149
Q

Amenorrhea

A

Absence of menstruation

150
Q

Ballottement

A

Objective sign of pregnancy

pressure on one side of belly, baby moves to the other

151
Q

Positive signs of pregnancy

A

Ultrasound
Fetal movement felt by provider
Fetal heart beat

152
Q

What is done at first visit

A 
Rubella
VDRL/RPR
Blood type and Rh
CBC 
UA
Hep B
HIV
TB
V/S
Weight
Height of fundus
FHT's
Blood glucose
Pap
GC
153
Q

how long is RhoGAM good for

A

12 weeks

154
Q

If you are Rh negative then you MUST get

A

RhoGAM

155
Q

Tests for fetal well being

A
156
Q

18-20 and 11-14 week
Doppler flow
Alpha fetoprotein
Triple/quad

screenings for malformities tests are

A

NOT DIFINITIVE

If dates are off of twins = false positive

157
Q

Male pelvic shape

Female pelvic shape

A

Android

Gynecoid

158
Q

Leopold Maneuver

A

Hands at top of fundus looking for butt, we WANT hand to be down

Bring hands down the middle to look for hard surface, that’s the back. THIS IS WHERE WE MEASURE FETAL HEART BEAT
the soft surface is the chest arms and legs aka place to move

Feel lower to find the head, it will be HARD

159
Q

LOA

vs

ROP

A

how the baby lies in relation to mama

Left Occipital Anterior
Babys back is on mothers left leaning to the back

Right Occipital Posterior
Babys back in on mother right leaning to the front

160
Q

You wan the baby to face the _ before birth

A

Anterior

Mothers spine

161
Q

STOP pitocin if

A

Contractions are 90 seconds or less than 2 min apart

More than 5 contractions in 10 min

GIVE O2
Place mother in lateral position

162
Q

Goal of cervical ripening agents

A

To help achieve effacement

163
Q

Sings of 3rd stage that you NEED TO KNOW

A

Gush of blood
Cord lengthening
Globular and firm uterus
Uterus rises anteriorly

164
Q

Where should the fundus be at about 12 weeks of pregnancy

A

at the symphyses pubis

165
Q

Fundus at 20 weeks of pregnancy

A

At about the belly button

166
Q

Fundus location at 36 weeks

A

Xiphoid process

167
Q

fundal location at 37 to 40 weeks

A

Goes DOWN from xiphoid by 4 cm

getting ready to pop

168
Q

Treatment for variable deceleration

A

Change moms position
Cervical exam for CORD
Give O2 and IV fluids
Slow contraction/Stop pitocin

Push every OTHER contraction

S3 1538 (15 decks)

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