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nu 305 - maternity > test 2 - antepartum through fetal circulation > Flashcards

test 2 - antepartum through fetal circulation Flashcards

1
Q

ambivalence is related to this trimester

A

1st trimester

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2
Q

what is ambivalence and what are some possible causes

A

mixed or contradictory feelings towards the pregnancy; planned/unplanned, finances, ability to care for the child

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3
Q

acceptance is related to this trimester

A

2nd trimester

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4
Q

what are some hallmarks of the 2nd trimester

A

morning sickness, beginning to wear maternity clothes, thinking about nursery, baby becomes “real” to mom, seeks out other pregnant women or mothers for advice/comparison, quickening

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5
Q

introversion is related to this trimester

A

3rd trimester

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6
Q

what are some hallmarks of the 3rd trimester

A

strong emotion and attachment to baby, reality of labor kicks in (may feel anxiety about this), discomfort, burst of nesting energy

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7
Q

when may mom experience labile emotions and body image issues (vulnerable/sensitive)

A

throughout pregnancy

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8
Q

what is Rubin’s 1st psychological task in pregnancy

A

pregnancy validation

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9
Q

what can we see as part of pregnancy validation

A

incorporation of fetus into body image (fetal embodiment)

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10
Q

what is Rubin’s 2nd psychological task in pregnancy

A

fetal distinction

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11
Q

what can we see as part of fetal distinction

A

mom views fetus as an individual being,
develops unique mothering identity, accepts body image,
becomes more dependent on support system

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12
Q

what is Rubin’s 3rd psychological task in pregnancyp

A

role transition

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13
Q

what can be seen during role transition

A

mom prepares to give up the fetus in the L&D experience,
anxiety (r/t child birth)
nesting

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14
Q

what type of pregnancy symptoms are subjective

A

presumptive signs

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15
Q

what are the presumptive signs of pregnancy

A
  • amenorrhea
  • N/V (morning sickness)
  • breast changes
  • urinary frequency
  • quickening
  • fatigue
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16
Q

when does N/V typically appear and peak

A

~6-12wks
peaks at ~10wks

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17
Q

what are some breast changes that may occur

A

fullness, tenderness, tingles, increased areola pigmentation

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18
Q

what causes amenorrhea during pregnancy

A

increased HCG and metabolism changes

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19
Q

what type of pregnancy symptoms are objective (diagnostic but not definitive)

A
  • changes in cervix
  • changes in uterine size, shape, consistency
  • uterine souffle
  • braxton hicks ctxn
  • (+) pregnancy test
  • changes in skin pigmentation
  • ballottement
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20
Q

what are the 3 cervical change signs

A

Goodells - softening
Chadwicks - increased pigmentation (deep red/purple)
Hagars - (soft spongy area ~6-8wks)

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21
Q

when should the fundus be above the symphysis pubis

A

10-12wks

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22
Q

when should the fundus be at the umbilicus

A

20-22wks

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23
Q

what is Braun Von Fernald’s sign and when does it occur

A

softening and enlargement of uterus at implantation site; occurs at ~5-8wks

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24
Q

what is Ladin’s sign, when does it occur, and how is it tested

A

softening in the anterior midline of the uterus; ~6wks; manual exam

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25
Q

what is McDonald’s sign, and what does it evaluate

A

body of uterus can be flexed against cervix; baby growth and amniotic fluid

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26
Q

when should baby’s height be equal to gestational age

A

16-32wks

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27
Q

what is Piscaceks sign

A

tumor-like enlargement of uterus at site of implantation

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28
Q

what is uterine souffle

A

soft, blowing sound of the blood through the placenta – goes at the same rate as moms HR

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29
Q

when can mom expect to feel braxton hicks and how are they distinguished from real contractions

A

~28wks; painless and irregular, and goes away with activity

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30
Q

what is ballottement

A

passive fetal movement away from tapping stimulation towards teh lower area of the abd

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31
Q

what are some skin pigmentation changes mom could expect to see

A

abdominal striae - stretch marks
linea nigra - dark line down middle of abd
facial melasma (chloasma) - darkening of the skin on the forehead and around eyes (~16wks)

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32
Q

what type of pregnancy symptoms are diagnostic

A

positive signs

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33
Q

what are the positive signs of pregnancy

A

FHTs (12-20wks)
vaginal U/S
fetal movements (18-20wks)

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34
Q

what can be seen on a vaginal U/S from 4-6wks

A

gestational sac

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35
Q

what can be seen on a vaginal U/S from 8-10wks

A

fetal parts/heart movement

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36
Q

what can be seen on a vaginal U/S from 10-12wks

A

movement

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37
Q

how early can the beta-subunit radio immunoassay (RIA) test show a positive and how long does it take to perform

A

2-8 days after implantation
a few hours

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38
Q

what is the RIA test used to dx

A

ectopic pregnancy or trophoblastic dz

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39
Q

how does the immunoradiometric assay (IRMA) test work and how long does it take

A

detects low levels of HCG with radioactive antibodies;
about 30 mins

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40
Q

how early can the enzyme-linked immunosorbent assay (ELISA) test detect a positive

A

as early as 7-9 days after conception or 5 days before first missed period

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41
Q

how does the ELISA test work and how long does it take

A

substance that results in color change after binding; quick and sensitive

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42
Q

what does the direct ELISA test for

A

antigens

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43
Q

what does the fluoroimmunoassay (FIA) test identify and how long does it take to perform

A

identify and follows HCG concentration; takes 2-3 hours; extremely sensitive

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44
Q

what does the indirect ELISA test for

A

antibodies

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45
Q

what kind of test is given OTC and how does it work

A

enzyme immunoassay; sensitive to low levels of HCG in the urine

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46
Q

what is uterine growth during pregnancy due to

A

hypertrophy (muscle fibers become 7-11x longer and 2-7x weaker) and
hyperplasia (new muscle fibers)

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47
Q

what is the blood volume that the uterus contains at birth compared to usually

A

10mL -> 5,000mL (1/6 of total volume)

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48
Q

how are the ovaries affected in pregnancy

A

decreased FSH and increased estrogen and progesterone secretion

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49
Q

how is the vagina physically effected in pregnancy

A

increased blood supply and relaxed connective tissue (d/t inc estrogen)

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50
Q

how is the vagina chemically affected in pregnancy

A

increased pH to inhibit bacteria (pH 3.5-3.6)

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51
Q

what does discharge look like d/t inc pH in the vagina

A

thick and white

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52
Q

how are the kidneys affected in pregnancy

A

increased GFR, tubular resorption, renal plasma flow, excretion of drugs - d/t increased blood flow and waste
decreased BUN and absorption of glucose - d/t increased filtering of urea

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52
Q

how are the breasts affected in pregnancy

A

hyperplasia of areola tissue
hypertrophy of Montgomery follicles
(d/t inc estrogen and progesterone)

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53
Q

when does the bladder receive the most pressure in pregnancy

A

1st and 3rd trimester

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54
Q

what organ has the most increased vasculature in pregnancy

A

the bladder

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55
Q

how are the ureters affected in pregnancy and what risk factors are there as a result of these changes

A

dilated and elongated and inc risk of UTI d/t sag and stasis of urine

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56
Q

how does inc progesterone affect the GI system

A

relaxation of smooth muscle -> constipation, flatulence, bloating

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57
Q

increased venous pressure and decreased tone in the GI system during pregnancy can lead to what

A

hemorrhoids

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58
Q

increased estrogen causes what effects in the endocrine system

A

increased: thyroxine (T4), BMR
decreased: TSH

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59
Q

how is the parathyroid affected by pregnancy

A

increased activity parallels fetal Ca++ requirements - doubles at 15-32wks mirroring fetal bone development

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60
Q

what role does the anterior pituitary play in pregnancy

A

FSH & LH - make pregnancy possible
thyroptopin: stimulates thyroid and ACTH
ACTH: controls release of cortisol affecting BP, inflammation, and metabolism

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61
Q

what gland secretes prolactin and what role does prolactin play

A

secreted by anterior pituitary and initiates milk production and lactation

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62
Q

what does the posterior pituitary secrete and what roles do they play in pregnancy

A

ocytocin: stimulates contractions and milk let down
vasopressin (ADH): increase BP by vasoconstriction

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63
Q

what role do the adrenals play in pregnancy

A

estrogen causes hypertophy of the adrenals causes inc coritco-steroid and aldosterone secretion (which increases Na+ resorption by kidneys)

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64
Q

what hormones does the placenta secrete and what are they responsible for

A

relaxin - soften cervix and inhibit uterine activity
estrogen - growth and development of fetus
progesterone - (dec) inhibit uterine ctxn and menses causing hormones
HCG
HPL (human placental lactogen) - inc fatty acids in maternal circulation

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65
Q

what effects does HPL have during pregnancy

A
  • inc fatty acids in maternal circulation -> dec metabolism of glucose
  • prepares body for BF and regulates metabolism
  • promotes breast growth and differentiation
  • regulate insulin sensitivity
66
Q

when is HPL detectable and when does it peak

A

detectable ~6wks and peaks at 30wks

67
Q

when does diabetogenesis occur

A

late pregnancy

68
Q

what occurs that triggers diabetogenesis

A

insulin becomes more protein bound and is less reactive – insulin also destroyed in the placenta

69
Q

when does CO peak during pregnancy

A

increases 30-50% and peaks at 25-30wks and remains high

70
Q

plasma and RBCs increase up to ___

A

1.5L

71
Q

what is hydremia of pregnancy

A

the ability to withstand bloodloss d/t disproportional blood volume increase of RBCs

72
Q

hydremia of pregnancy increases the bodies need for ____

A

iron

73
Q

what lab values related to the blood are increased in pregnancy

A

absolute RBC, Hgb, plasma fibrinogen, clotting factors, WBC, ESR,

74
Q

what lab values related to the blood are decreased during pregnancy

A

albumin, Hct

75
Q

decreased Hct causes what kind of anemia in pregnancy

A

pseudo-anemia d/t dilution of hct

76
Q

HCT changes during pregnancy

A

32-42% - decreased

77
Q

Hgb level changes during pregnancy

A

10-14g/dL - increased

78
Q

PLT level changes during pregnancy

A

increase from 150,000 3-5 days pp

79
Q

PTT changes during pregnancy

A

slightly decreased from 12-14sec

80
Q

fibrinogen levels during pregnancy

A

2.3-6.2g/dL - increased

81
Q

WBC levels during pregnancy

A

5,000-15,000/mm3

82
Q

progesterone has what effects on the respiratory system during pregnancy

A

decreases airway resistance, CO2 levels
increases O2 consumption and tidal volume

83
Q

what PO2 level does the fetus need to survive in mom

A

62

84
Q

estrogen causes what respiratory effects in pregnancy

A

increased vascular congestion of nasal mucosa -> rhinitis, nasal stuffiness, epistaxis (nose bleeds)

85
Q

what integumentary changes occur in pregnancy

A

estrogen and progesterone increase MSH from 2nd month forward causing increased pigmentation on abd and face

86
Q

musculoskeletal effects of pregnancy

A

increased need for Ca++, relaxin and progesterone cause waddling gate, symphysis pubis spread

87
Q

what is diastasis recti

A

when the abd muscles split in pregnancy

88
Q

how many calories should be consumed /day during pregnancy

A

2300-2400 cal/day

89
Q

how much iron should be consumed /day during pregnancy

A

30mg

90
Q

where does the fetus store extra iron

A

in the liver for after birth

91
Q

what are good food sources of iron

A

organ meats, dried fruits, green leafy veggies, eggs, fortified cereals

92
Q

what should be taken with iron to aid in utilization

A

vitamin C

93
Q

how much protein should be consumed /day during pregnancy

A

60-65mg/day

94
Q

what leads to inc pro needs

A

increased GFR => increased amino acid loss => inc need for pro

95
Q

food sources of protein

A

meats, eggs, legumes, dairy

96
Q

what is the total weight gain that can be seen in pregnancy

A

25-35lb

97
Q

how much weight is gained in the first trimester

A

2-4lb

98
Q

how much weight is gained in the 2nd and 3rd trimesters

A

1lb/week

99
Q

when do we primarily see gain in mom

A

second trimester

100
Q

when do we primarily see gain in baby

A

3rd trimester

101
Q

what is considered inadequate weight gain

A

<2.2lb/month in 2&3 trimesters

102
Q

what is considered excessive weight gain

A

≥6.6lb/month

103
Q

when is the first trimester

A

LMP - 13wks

104
Q

when is the second trimester

A

14-26wks

105
Q

when is the third trimester

A

27-40wks

106
Q

what vitamins are not stored in the body and must be taken daily

A

water soluble vitamins C and B

107
Q

what vitamin prevents macrolytic megoblastic anemias and neural tube defects

A

folic acid

108
Q

what B vitamins are needed for DNA and RBC production

A

B9 and B12

109
Q

what is anecephaly

A

missing or incomplete skull bones and underdeveloped brain

110
Q

what is spina bifida occulta

A

very minor, characterized by a dimple above the buttocks

111
Q

what is spina bifida menignocele

A

meninges and CSF are presenting outside the body, WITHOUT NEURAL ELEMENTS

112
Q

what is spina bifida myelomeningocele

A

meninges and CSF are presenting outside the body WITH NEURAL ELEMENTS such as the spinal cord

113
Q

what is the RDA of folic acid when pregnant and lactating

A

600mcg/day when pregnant and 500mcg/day when lactating

114
Q

what is the RDA of folic acid if there is a family hx of neural tube defects

A

1000mcg/day

115
Q

what is the RDA of calcium for <19yo

A

~1300 mg/day

116
Q

what is the RDA of calcium for >19yo

A

~1000 mg/day

117
Q

what does EDC stand for

A

estimated date of confinement

118
Q

what does EDD stand for

A

estimated date of deliver

119
Q

what does EDB stand for

A

estimated date of birth

120
Q

what is Negeles rule

A

first day of LMP - 3mo + 7days + 1 year = EDD

121
Q

when is Negeles rule not accurate

A

irregular periods/amenorrhea, ovulating during BF, oral contraception, previous miscarriage/abortion

122
Q

how accurate is the height of the fundus method for estimating gestation

A

+/- 2 weeks

123
Q

when is estimating gestation by the height of the fundus inaccurate

A

late in pregnancy, obesity, presence of uterine fibroids or hydramnios

124
Q

where should the fundus be at 10wks

A

symphysis pubis

125
Q

where should the fundus be at 20 wks

A

umbilicus (20cm)

126
Q

where should the fundus be at 26wks

A

26cm

127
Q

where should the fundus be at 8mo

A

xyphoid process

128
Q

what happens with the fundus at 9mo

A

it drops – referred to as the lightening

129
Q

what is McDonalds rule of estimating gestation of ≤20 wks

A

if ≤20 wks: height of fundus in cm x 8/7 = # of weeks

130
Q

what is McDonalds rule of estimating gestation if >20wks

A

fundal height in cm correlates with gestation

131
Q

what tests does the biophysical profile (BPP) consist of

A

ultrasound and a non-stress test

132
Q

what are the scores for the BPP

A

8-10 = normal
6 = borderline
4 = bad

133
Q

how long does the BPP take

A

30-70 mins

134
Q

what are the 5 variables measured in BPP

A
  • breathing movements (≥1 ep of ≥30 dec in ≥30 mins)
  • gross body movements (≥3 in 30 mins)
  • fetal tone (≥1 ep of active extention with return to flexion)
  • qualitative amniotic fluid volume (≥1 pocket at least 2cm)
  • reactive NST or FHR
135
Q

what is the oxytocin challenge test (OCT)/contraction stress test (CST)

A

toco monitor is applied and records baseline vitals for 15 mins, then oxytocin is administered IV to simulate a ctxn and analyzing how the fetus withstands a ctxn

136
Q

what is measured during the OCT/CST

A

O2 from placenta and FHR

137
Q

when is the OCT/CST done

A

if the non-stress test was inconclusive/didn’t work

138
Q

what is the OCT/CST contraindication

A
  • premature rupture of membranes
  • incompetent cervix/cerclage
  • multiple gestation
139
Q

what are the indications for an OCT/CST

A

IUGR, gestational diabetes, post term (≥42wks), non-reactive NST, abnl/suspicious BPP

140
Q

what does a negative OCT/CST mean

A

good – no late decels

141
Q

what does a positive OCT/CST mean

A

bad – late decels with 2/3 ctxn

142
Q

what is positive OCT/CST associated with and possibly require

A

insufficient placental respiratory reserve - associated with IUFD, fetal distress, or poor condition at birth – may require CS asap

143
Q

what does a suspicious OCT/CST mean

A

1 late decel or questionable results – test rescheduled

144
Q

how is the NST (non-stress test) conducted

A

TOCO applied to monitor FHR and uterine activity - mom pushes a button when movement is felt & look for accelerations with movement

145
Q

when is the NST administered

A

begin after 30wks and 2x/wk

146
Q

what is a reactive NST

A

good – two true accelerations of 15BPM inc lasting 15+ seconds with fetal movement in 20 mins

147
Q

what is a non-reactive NST

A

reactive criteria not met – may admin glucose to wake up baby or admin VST, FAS, and BPP

148
Q

what is an unsatisfactory NST

A

inconclusive

149
Q

what is the antepartum fetal well-being test

A

fetal movement is recorded in 1h segments over 24hw

150
Q

what is normal for the fetal well-being test

A

10 movements in 3h – avg of 3/h

151
Q

what is the cardiff test

A

counts 10 fetal movements in 10h on 2 consecutive days

152
Q

what is considered a failed cardiff test

A

<10 movements in 10h on 2 consecutive days or no movements in 10h on any single day

153
Q

what is tested for fetal lung maturity

A

L/S ration, PG level, and lamellar body counts

154
Q

what is L/S

A

lecithin/sphingomyelin - surfactant which lowers surface tension of the alveoli during expiration

155
Q

what are the pregnancy ratios of L/S

A

30-32wks => L/S are equal
35wks => L/S = 2:1

156
Q

when are the lungs considered mature

A

L/S ration ≥ 2:1

157
Q

when is the L/S ration not accurate

A

meconium/blood in AF
mom is diabetic

158
Q

what can accelerate lung maturity

A

chronic stress

159
Q

what can occur as a result of immature lungs at birth

A

respiratory distress syndrome (RDS)

160
Q

what is the PG level

A

phospholipid present at 36wks and inc until term
(+) result = good

161
Q

when is testing the PG levels indicated

A

contaminated specimens and to confirm L/S ratio

162
Q

what is the LBC test

A

tests phospholipid lamellar body counts
- accurate with DM

163
Q

how is LBC tested

A

testing in amniotic fluid – should be >50,000

nu 305 - maternity (1 decks)

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