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Simmons NURP 501 Exam 2 > Sprang Key Points > Flashcards

Sprang Key Points Flashcards

1
Q

Name the presumptive signs of pregnancy.

A 
NV
Breast tenderness
Quickening
Amenorrhea
Excessive fatigue
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2
Q

Name the probable signs of pregnancy.

A 
Goodell sign
Chadwick sign
Hegar's sign
Braxton-Hicks
Positive pregnancy test
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3
Q

Name the positive signs of pregnancy.

A

Fetal heart tones

See baby kicking / movement after 20 weeks

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4
Q

When is most likely time to get positive pregnancy test?

A

14 days after fertilization. This is approximately 4 weeks after LMP. And for most, that will mean their period a few days late.

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5
Q

When can you get FHTs on US, Doppler, and fetoscope?

A

US visible cardiac activity as early as 6-8 weeks. Doppler at 10-12 weeks. Fetoscope at 17-20 weeks.

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6
Q

What do GP and GTPAL stand for?

A

Gravidity: Number of times pregnant (including current pregnancy)
Parity: Number of times given birth (not number of babies)
Term: 37+ weeks
Preterm: 20-36.6 weeks
Abortions: Spontaneous or induced prior to 20 weeks
Living children

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7
Q

How are twins counted in the GTPAL system?

A 
They count as 1 birth, but 2 living children (if they are both still living). So, a primip with twins born at 38 weeks would be:
G1
T1
P0
A0
L2
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8
Q

What cardiac changes occur in pregnancy?

A

Cardiac output increases 30-50%.
Volume of S1 possibly increased with splitting.
S3 may be detected.
Systolic murmurs possible.
Blood volume increases.
Clotting factors increase (causes clotting risk during pregnancy).

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9
Q

When would you send a pregnant pt with a systolic murmur for a cardiac workup?

A

If the murmur is loud (grade 3 or 4) or if it has other s/s such as SOB or cough.

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10
Q

What causes anemia of pregnancy?

A

Hemodilution d/t increased blood volume.

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11
Q

When do you start pregnant patients on iron pills?

A

Usually when hemoglobin is 11 or lower.

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12
Q

What happens to the thyroid during pregnancy?

A

Can be enlarged.

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13
Q

When would you be concerned about an enlarged thyroid in pregnancy?

A

If asymmetrical

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14
Q

What GI changes occur in pregnancy?

A 
Peristalsis decreased (constipation).
Bowel sounds can be diminished.
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15
Q

What kidney changes occur during pregnancy?

A

Urinary frequency.
Kidneys increase in size and are displaced.
Uretal dilatation causes urine reflux. Higher risk for UTIs.
Bladder tone decreased.

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16
Q

What skin changes occur during pregnancy?

A

Linea nigra, darken nipples/areolas, chloasma gravidium

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17
Q

Where would you expect to find the fundus at:
12 weeks?
16 weeks?
20 weeks?

A

12 - symphysis pubis
16 - midway between symphysis pubis and umbilicus
20 - umbilicus

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18
Q

What happens to vaginal discharge during pregnancy?

A

Increased mucus and vaginal discharge. Leukorrhea is normal.

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19
Q

T/F Only at risk patients are tested for toxoplasmosis.

A

True

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20
Q

Name the routine tests for 1st prenatal visit.

A

Urine: culture, gonorrhea, chlamydia.
Blood: CBC, H/H, blood type, Rh factor, syphilis, HIV, rubella titer, Hep B,

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21
Q

Name the routine tests for 1st prenatal visit.

A

Urine: culture, gonorrhea, chlamydia.
Blood: CBC, H/H, blood type, Rh factor, syphilis, HIV, rubella titer, Hep B.

22
Q

What is Rhogam and why is it given?

A

If the mom is Rh negative and the baby could be Rh positive, then Rhogam is given to prevent isoimmunization.

23
Q

In isoimmunization, the _____ blood breaks down the _____ blood.

A

In isoimmunization, the MOM’S blood breaks down the FETUS’ blood.

24
Q

Risk factors for genetic anomalies.

A
  1. Maternal age >35
  2. High-risk racial/ethnic groups
  3. Mother and father related by blood
  4. Genetic conditions
  5. Congenital malformations of any body part
  6. Congenital blindness/deafness
  7. Stature disorders (very tall/short)
  8. Developmental delays and mental retardation
  9. Maternal exposure to toxins
  10. Unexplained maternal/paternal infertility
25
Q 
Name the appropriate weight gain:
BMI <18.5 (underweight)?
BMI 18.5-24.9 (normal)?
BMI 25-29.9 (overweight)?
BMI 30+ (obese)?
A

BMI <18.5 (underweight): 28-40 lbs
BMI 18.5-24.9 (normal): 25-35 lbs
BMI 25-29.9 (overweight): 15-25 lbs
BMI 30+ (obese): 11-20 lbs

26
Q

In general, what should be done at the 1st prenatal visit?

A 
Know the tests.
Pregnancy test
EDD
PNVs
GTPAL
27
Q

When is IPV screened?

A

At 1st prenatal visit and each trimester after.

28
Q

What are signs of IPV on the physical exam?

A

Unexplained bruises (esp abdomen or arms / legs)

29
Q

Name some risk factors for IPV.

A
  1. Pregnancy
  2. Substance abuse
  3. History of depression
  4. Low self esteem
  5. Younger age (college age esp)
  6. Raised in violent family
  7. Past history of violence
  8. Lower educational levels
  9. Poverty
  10. Unemployed
  11. Alcohol, drugs
  12. Unhealthy family situations (family drama, unhealthy family relationships)
  13. Adolescents who have poor parenting
30
Q

When and how is glucose testing usually done in pregnancy?

A

GTT at 24-28 weeks. 50-gram 1-hour GTT. If fail (130-140+) then 75- or 100-gram 3-hour test. Need 2 elevated numbers for diagnosis.

31
Q

Which vaccines are and are not recommended in pregnancy?

A

TDaP, flu shot are recommended. NO LIVE VACCINES (MMR, varicella, yellow fever).

32
Q

Why and when is TDaP given in pregnancy?

A

TDaP between 27 and 36 weeks for EACH pregnancy to prevent pertussis (whooping cough). Infants are at increased risk of death. Entirely dependent on passive immunity until first vaccine at 2 months.

33
Q

What is the timing of prenatal visits?

A

< 28 weeks q monthly
28-36 weeks q 2 weeks
36+ q weekly

34
Q

Name the early signs of preterm labor.

A
  1. Cramping
  2. Fluid leaking
  3. Backache
  4. Contractions less than 10 minutes apart
  5. Increased pressure
  6. Increased vaginal discharge
  7. Vaginal bleeding
35
Q

What bloodwork / testing is NOT collected at the 1st visit?

A

GTT at 24-28 weeks
GBS at 35-37 weeks
Quad screen at 15-22 weeks

36
Q

What is the timing of morning sickness?

A

Typically begins before 9 weeks, peaks at 12 weeks, and subsides by 20 weeks

37
Q

What can help with N/V in pregnancy?

A

5-6 small meals.
Bland, lukewarm, cold foods.
Protein or carbs before getting out of bed.
Eliminating PNV (iron) and taking only folic acid.
Sea bands.
Ginger (1,000 mg max daily)

38
Q

What is the treatment for hyperemesis gravidarum?

A

Diclegis is the only FDA-approved med.

39
Q

When would you diagnose hyperemesis instead of N/V in pregnancy?

A

When signs of dehydration are present: weight loss, ketones in urine.

40
Q

When is fatigue most common in pregnancy?

A

Peaks around 9-12 weeks. Early sign of pregnancy.

41
Q

Name differential diagnoses for fatigue.

A
  1. Thyroid disease (hypothyroidism: fatigue, cold sensitivity, dry skin, weight gain, thinning hair).
  2. Anemia (check cap refill).
  3. Cardiac (SOB, cough).
42
Q

When are carrier tests done during pregnancy?

A

Anytime

43
Q

When are screening tests (trisomies and genetic anomalies) done during pregnancy?

A

Around 1st and 2nd trimesters.

44
Q

What is the most common genetic screening test and when is it done?

A

Quad screen.

15-22 weeks.

45
Q

Who especially should have a quad screen?

A

Older age

Past/family hx of trisomies or fetal abnormalities

46
Q

What does quad screen test?

A

AFP
Inhibin A
hCG
Estriol

47
Q

What test is used to look at amniotic fluid levels?

A

Anatomy US (18+ weeks)

48
Q

If quad screen comes back abnormal, what is a good 2nd screening test?

A

Anatomy US (18+ weeks)

49
Q

Who should be offered noninvasive prenatal testing?

A

High risk only

50
Q

When is noninvasive prenatal testing done and what does it test?

A

10 or more weeks.

Screens aneuploidy and trisomies 13, 18, 21.

51
Q

Which is more accurate for trisomies, quad screening or noninvasive prenatal testing?

A

Noninvasive prenatal testing is a little more accurate.

52
Q

Which carrier screenings should be offered and which populations are high risk?

A
  1. Tay-Sachs – Anaschazi Jews
  2. Cystic Fibrosis – Caucasians (European descent)
  3. Sickle Cell – African descent

Simmons NURP 501 Exam 2 (48 decks)

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