Test #3- Modules 5&6 Flashcards
RBC’s __________ in pregnancy.
increase
Hemoglobin and Hct __________ in pregnancy.
decrease
WBC’s ____________ in pregnancy.
increase
Serum ferritin and serum iron _________ in pregnancy.
decrease
TIBC ______ in pregnancy.
increases
In pregnancy, the rapid increase in _________ volume causes _____________. The increase starts _____ in pregnancy and _____ _______in second trimester. ____ volume increases faster and before ______ volume.
plasma; hemodilution.
early; rapidly increases
Plasma; RBC
Pregnancy is a ___________ state.
hypercoagulable
The relaxing effect of _____________ on vessel walls and valves makes them more pliable, which can lead to the development of varicosities. Another contributing factor is the pressure of the _________ ___________ on pelvic ________ which leads to vein __________.
progesterone.
gravid uterus; vessels; engorgement
Conditions that can predispose a woman to varicosities:
increased age; family hx, obesity, prolonged standing, existing leg trauma
T/F - Varicosities are usually worse in subsequent pregnancies.
True
Symptoms of varicosities _______ as the pregnancy progresses. Symptoms include:
increase.
cosmetic nuisance, but can have constant itching, pigmentation around ankles, ulcerations at ankles, mild swelling of feet, infection
____________ helps prevent varicosities.
Exercise
Treatment measures include:
Rest & compression stockings
T/F - Vulvar varicosities do not usually interfere with vaginal birth.
True
Differential dx for varicosities
DVT, peripheral arterial or venous disease
Physiologic cause of supine hypotension syndrome:
Weight of uterus on vena cava and other vessels causes a reduction in blood return from lower extremities, which decreases cardiac output - arterial hypotension.
Symptoms of supine hypotension:
dizzy, lightheaded
Treatment for supine hypotension
Turn to side or have her sit up
Differential dx for supine hypotension:
seizure, hypoglycemia, postural hypotension
What physiologic factors predispose a woman to dizziness/syncope?
Increased vascular resistance and vasodilation, and venous pooling in the legs. Cardiac output decreases, BP drops, and cerebral blood flow is reduced.
What should you tell the woman who suffers from dizziness/syncope? What info should you gather?
Educate about physiology; arise slowly, reassurance of normalcy.
Description of activity just prior to episode; hot room? Last food/drink? Any other sx - palpitations, headache, vomiting?
Differential dx for syncope/dizziness:
Women with SOB, chest pain or loss of conciousnness resulting in injury need to be further evaluated. Possible maternal cardiac disease is possible if these occurred.
Physiologic cause of palpitations in pregnancy:
Usually normal due to increase in blood volume and heart rate. Usually are pvcs or pacs and may also be related to hormonal changes, fluid and electrolyte imbalance or an active sympathetic nervous system.
When are palpitations most likely to occur in pregnancy?
28-32 weeks, when the heart stroke volume peaks
What subjective and objective info should you obtain for palpitations?
onset, nature, characteristics, caffeine intake, medication hx, anxiety/depression
Note affect and auscultate heart sounds
Treatment for palpitations:
Reassurance. Explanation of normalcy unless accompanied by dizziness, SOB, or hx of cardiac problems.
Differential dx for palpitations:
Thyroid problem, anxiety, undiagnosed cardiac disease or structural defect
RBC’s increase due to erythropoetin stimulated by ________ _______ __________, __________, and __________.
human placetal lactogen, progesterone, and prolactin
WBCs increase due to effect of _______________.
estrogen
Pregnancy is associated with increased ____________ potential, decreased ____________, and decreased _____________.
clotting; anticoagulants; fibrinolysis
____________ consumption is increased due to increased metabolic needs.
Oxygen
_____ percent of the increase in cardiac output occurs by ___ weeks gestation. Increase is related to maternal__________ consumption, not _________ or ___________.
50%; 8 weeks.
increase in maternal oxygen consumption, not metabolic requirements or body mass.
INcreased cardiac output is due to changes in ____ _____ and ___ _____. Changes in these are reported by ___ and ___ weeks respectively.
heart rate and stroke volume
5 weeks and 8 weeks
Stroke volume peaks at _____ to ____ weeks.
16 to 24 weeks
Systemic vascular resistance decreases by ____ weeks and reaches lowest level by _____ to _____ weeks.
5 weeks; 16 to 34 weeks
In pregnancy there is a progressive _______ in resting oxygen consumption.
increase
Physiology behind shortness of breath: Increase in _________________ causes and increase in respiratory ________-, _______ ____________, and __________ ________.
progesterone; respiratory capacity, tidal volume, and respiratory rate.
Lung function is more ______ in pregnancy, but the sensation of SOB can escalate to a _______ felling in some women.
efficient; panic
SOB: subjective data to gather
onset, nature, characteristics, hx of asthma or other respiratory illness
SOB Objective data:
Observation of RR at rest, ausculation and percussion of lung fields as indicated
SOB Treatment
REassurance of normalcy; expalantion, relief trategies to expand lung capacity - good posture, lift arms over head, sleep upright
SOB warning signs
constant coughing, heart palpitations, chest pain, fever, faintness or dizziness
Physiology of edema: total body fluids increase by ____ to __ liters in pregnancy, most of which is _________. Collection of fluid in the __________ space due to impaired __________ ___________ and increased _______ ___________ in the lower extremities.
6 to 8 L; extracellular.
interstitial; venous circulation, venous pressure
Dependent edema is seen in up to ____ % of pregnant women.
75%
Assessment for edema:
Subjective- onset, location, symptom description, diet (especially salt and water intake)
Objective- location, severity, pitting?, blood pressure, urine dip, weight gain pattern.
Treatment for edema:_________ ___________ provides a uniform compression and produces a natural _________ __________. Immersion should last at least ____ minutes and should be at least _________ deep.
Water immersion; pressure gradient.
20minutes; chest.
Warning signs for edema:
rapid onset, sx of preeclampsia
Urinary frequency is urinating more than ___ times during the daytime hours
7
Changes in the renal system are primarily related to the influence of __________ on smooth muscle.
progesterone
The predominant structural change in the renal system is ____________ of the renal pelvis and ________; this happens as early as the ____ week.
dilation; ureters; 7th
Physiologic basis for urinary frequency: primarily due to _______ _________, _____________ and the increased _________ and _____
hormonal changes, hypervolemia, increased renal plasma flow and glomerular filtration rate.
Hematologic changes ________ the mother at ______ and during _______ but increase her risks for ___, ____, and ____________.
protect; delivery; pregnancy; VTE, anemia, and coagulopathy
Cardiac output increases by ____% when positioned on Left side.
25%
Compression of the inferior vena cava causes decreased _____ _______, ________ ___________, and ________ ________.
venous return, stroke volume, and cardiac output.
Heart rate increases by ___ to _________ BPM by week ___.
10 to 20; 32 weeks
Increase in HR is due to effect of ________ on the heart muscle to compensate for the decreased ________ caused by _________.
estrogen; SVR, progesterone.
Heart sounds in pregnancy: Split _____ sound due to ______ valve closure and increased _____ ______ (starts between ___to__ weeks)
_______murmur due to increased cardiovascular load, heard in last ___ __________.
first; earlier; blood flow; 12 to 20
Systolic; two trimesters
_________ & ______________ influence the renin-aldosterone system causing increased _____ (and thus _____) retention.
Estrogen and Progesterone; sodium; water
Hormone changes stimulate ______________ and cause increased RBC production to meet increased _________demands during pregnancy
erythropoetin, oxygen
Maternal oxygen-hemoglobin disassociation curve is shifted to the ____ in pregnancy.
•Leads to a _______ affinity of hemoglobin for oxygen, so more oxygen is available _____________ (including in the IVS for the fetus).
right; decreased; peripherally
The ________ in hemoglobin decreases ___ risk by decreasing _________ and
increasing _______.
decrease; VTE; decreasing viscosity, increasing perfusion
T/F: Serum iron decreases in pregnancy, more so if inadequate iron stores prior to pregnancy.
True
MCV and MCHV _______ in cases of iron deficiency anemia; serum ________ decreases as iron is used for maternal RBC formation and fetal iron uptake.
decrease; ferritin
Desired Hemoglobin levels:
–1st and 2nd trimester >___ –3rd trimester >____
11; 10.5
Plasma:
–Proteins _______ but result in net ______ because
the other components increase more
•Leads to increased _____(less protein in blood leads to decreased _______ pressure)- along with ______ _________ _________ changes.
–Decreased serum ____________(relates to ___________changes)
increase, decrease.
edema; oncotic; venous hydrostatic pressure changes
electrolytes; respiratory (think acid-base balance)
Edema is caused by: Increased capillary ____________, fall in _________ ________ pressure, & increased femoral ________ ___________.
permeability; colloid osmotic; venous pressure
T/F: Women with edema need to decrease fluids and salt intake.
False - do not need to decrease either.
There is a ___% increase in air volume per minute, mild respiratory ___________ (enhances gas exchange across the placenta)
50%; alkalosis
T/F: A woman is more likely to feel SOB during ascent and descent during air travel.
True
Increases in volume of air and gas exchane ocurring each breath to increase _________ of oxygen and ________ of carbon dioxide
availability; removal
Mechanical changes in respiratory function:
1) Uterine enlarge causes a rise in the __________ (up to __cm)
2) Increased _______ circumference
3) Increased ___________ angle
4) Increased rib _________ as ligaments relax (mediated by _________)
•Major work of breathing is accomplished by the ________, not _____ muscles
1) diaphragm; 4cm
2) Thoracic
3) subcostal
4) elasticity; relaxin
5) diaphragm; costal
Respiratory:
Hormones (progesterone, estrogen, prostaglandins)
–Act __________ by stimulating respiratory center or _________ on smooth muscle and lung tissue
centrally, directly
Respiratory (biochemical):
Progesterone:
–Levels ______throughout pregnancy
–Is a respiratory __________
–Increases responses to ______ (increased sensitivity
to carbon dioxide)
–More than ____% of the sensitivity to CO2 occurs by ___weeks gestation
–Decreases airway _________ (facilitates airflow)
increase stimulant hypercapnia 60%; 20wks resistance
Lung volumes ________ and reserve volume __________. This is why asthmatics have a lower threshold for attacks (less reserve) and why we ventilate pregnant women _______ than non-pregnant women.
increase, decreases.
sooner
Respiratory changes start by __ weeks gestation. Pregnant women ___________ in pregnancy due to effects of progesterone on respiratory center.
•Improves alveolar ____ _________.
8; hyperventilate
gas exchange
Decreased affiliation of oxygen for __________ causes more oxygen to be available for the _______.
hemoglobin; fetus
Pregnant women have an ___________ in pH.
increase (alkalotic)
Pregnant women are normally in a state of compensated respiratory ___________ due to effects of _____________ and increased minute volume. _______ is lower then pre-pregnancy (starts in first trimester)
alkalosis; progesterone; PCO2
SOB: Caused by increased progesterone which increases sensitivity to ___and leads to ________ in an attempt to maintain normal PO2 levels; increased respiratory ____ and load, mechanical changes
• Begins in 1st or 2nd trimester, worst at ~_______ weeks, stable or worsens through 3rd trimester
CO2; Hyperventilation
drive
28-30weeks
Bladder tone __________ and capacity _________.
decreases; increases
Renal blood flow and GFR ___________.
increase
GFR increases ~___% in pregnancy
•Begins at ___ weeks, before plasma volume expansion and increased cardiac output
50%; 6wks
Glucose and amino acid excretion is __________ when tubular reabsorption can’t accommodate the ___________ ______.
•Glucose excretion increases soon after ___________and stays higher throughout pregnancy.
•Protein excretion ____________in pregnancy
increased; increased load
conception
increases
Fluid/Electrolyte Balance
•Mediated primarily by changes in _____/______ balance.
•Increased ___ leads to more sodium filtered out, so tubular reabsorption of sodium ________ so the filtered sodium is reabsorbed. This increases net sodium _________.
sodium/water
GFR; increases; retention
T/F: Accumulation of greater than 1 ½ liters of interstitial fluid is associated with edema.
True
Increased ______ leads to larger pituitary gland and changes in morphology.
•Prolactin-producing cells grow from 20% to 60% of the anterior pituitary and bioactive prolactin increases to prepare _________ for ________.
•Prolactin __________ during pregnancy and peaks at ___________.
estrogen;
breasts for lactation.
increases, delivery
Physiologic responses to stress are blunted in pregnancy, due to increased _________ levels.
cortisol
HPT Axis Changes
•Occur mostly in _____ half of pregnancy
first
Thyroid: –TBG levels\_\_\_\_\_\_\_\_\_\_ •\_\_\_\_\_\_\_ levels of free thyroid hormone –hCG stimulates increased \_\_\_ and \_\_\_ Leads to \_\_\_\_\_\_\_\_\_\_ in TSH (especially in weeks \_\_ to \_\_)
- Mimic_____________
- Thyroid hormone changes support altered carbohydrate, protein and lipid metabolism and changes in basal metabolic rate.
increase Decreases T3 and T4 decrease; 8-14 hyperthyroidism
T/F Thyroid function doesn’t change during pregnancy.
True
Total T3 and T4 are _________, but Free T3 and Free T4 are ___________.
increased, decreased
The degree of ________ enlargement is in direct relation to the need for ___________.
thyroid; iodine
Viral infections are more ____________ and more _____________, especially in the _________ and ____ trimesters.
frequent, severe; 2nd and 3rd
Have higher rates of fungal infection (yeast) due to effects of______________ on nutrient availability for growth
estrogen
Cell-mediated immunity is ________ in pregnancy likely to protect the fetus from rejection.
suppressed
__________ enhance antibody-mediated responses and cause a protective function in maternal-fetal immune relationship while ____________ maternal resistance to bacterial and viral infections. If this system is disrupted, inflammatory cytokine production increases and is increased risk for _____, ________, _________, and ___.
Cytokines; decreasing
SAB, preeclampsia, PTL, and FGR
Maternal _____ antibodies cross the placenta, and increase after ___ to ___ wks.
IgG; 20-22
