The Obstetric Patient 1 Flashcards
What are early signs of pregnancy?
Extreme fatigue Mood swings Bloating Unusual spotting or light period Subtle motion sickness Frequent mild HAs Sore breasts and nipple darkening Cramps Heightened sense of smell
What does para mean?
number of births, regardless of the number of infants born
What does gravida mean?
number of pregnancies; a woman who has been pregnant, regardless of pregnancy outcome
What ways can you document pregancy/births?
G#P#
4 numbers: #fullterm infants, #preterm infants, #abortions, #children currently alive
What is nullipara?
A woman who has not completed a pregnancy beyond 20 weeks of gestation. She may or may not have been pregnant or have had an abortion or spontaneous miscarriage.
What is primipara?
A woman who has had one delivery beyond 20 weeks of gestation.
What is multipara?
A woman who has delivered two or more pregnancies beyond 20 weeks of gestation; regardless of whether the fetuses were born live or still born (not the number of fetuses delivered).
What is multigravida?
A woman who has had more than one pregnancy, regardless of outcome. The # represents the # of pregnancies.
What is gestation?
Duration of pregnancy, usually 280 days, or 40 weeks, marked from the first day of the last menstrual period
What is a trimester?
Division of weeks of pregnancy
First trimester=1 to 13
Second=14 to 27
Third 28-40
What is preeclampsia?
Sudden increase in BP, usually signals kidney damage-cause is unknown, although may be pressure in placental blood vessels-emergency, signals immediately delivery
What are the sx of preeclampsia?
HA, blurred vision
What are the sx of pregnancy-induced HTN?
HA, blurred vision
What is ectopic pregnancy?
Egg is implanted in the fallopian tube instead of uterus
What are some sx of ectopic pregnancy?
Sever lower abdominal pain, dizziness or lightheadedness, nausea
What is placental abruption?
Placenta peels away from the uterus, may deprive fetus of oxygen, may require early delivery
What are sx of placental abruption?
Severe lower abdominal pain, vaginal bleeding
What are sx of fetal distress or demise?
Decreased fetal movement
What are the sx of osteoporosis of pregnancy?
Pain in the hip/low back, pain with weightbearing
What is placenta previa?
placenta covering cervix; may resolve itself, or may require early delivery
What are the sx of placenta previa?
vaginal bleeding
What are some sx of retained placenta?
Increased post-partum bleeding
What are the sx of mastitis?
Localized breast tenderness
What are the sx of cystitis?
Pain or burning, frequency or urgency of urine, suprapubic pain
What are the sx of acute pyelonephritis?
Flank pain, fever, chills, malaise, may have frequency or urgency
What are the sx of deep venous thrombosis?
Localized calf, popliteal, or anterior thigh or groin pain; calf or lower extremity swelling; pitting edema
What pregnancy conditions require immediate referral?
Pre-eclampsia (can lead to seizure activity) Pregnancy induced HTN (urgent) Ectopic pregnancy Placental Abruption Placental previa Retained placenta Cystitis (urgent) Pyelonephritis (urgent) DVT (urgent/emergent)
What vascular changes occur in pregnancy?
Decreased tone/vasodilation-SVR decreased 20%
Positional effects
Placenta-low resistance shunt
What hematologic changes occur in pregnancy?
Blood volume increases 50-100%
RBC increases 25-40% (causes relative “physiologic” anemia)
Become hypercoagulable-increased risk for thromboemolic disease
Decrease in platelets
Increase in WBC
What cardiac changes occur in pregnancy?
Cardiac axis is displaced cephalad and left, point of maximum impulse lateral and elevated, left axis deviation
Murmurs, virtually all valves
Increased rate
Ventricular distention-25% increase
Rhythm changes-nonspecific ST and T changes, increase in dysrhythmias (physiologic hypokalemia)
LVH and pericardial effusion
Increased and markedly fluctuating output
What is the placenta? What type of nutrients does it receive?
A veritable hormone factory
Receives 20-25% of cardiac output
Uses as much O2 as fetus
What are the s/s of normal pregnancy that may mimic cardiac disease?
Peripheral Edema JVD (venous distention) Reduced exercise tolerance Dyspnea Changes with auscultation Change in heart position and size Increased vascular markings Nonspecific ST-T wave changes Axis deviations LVH
What kidney changes occur with pregnancy?
Renin increased-stimulation by progesterone and made by the placenta–> leads to net absorption of Na+, excretion of K+, and water retention of 6 to 8 L
Increased renal blood flow-50-75% increase
GFR-50% increase
Decreased albumin=lower oncoid oncotic pressure
What is the cycle from angiotensinogen to the distal tubule?
Angiotensinogen-Angiotensin 1-Angiotensin 2-Aldosterone-Distal tubule
What urinary tract changes occur with pregnancy?
Ureteral dilation/hydroureter-smooth muscle relaxation, later exacerbation by uterine obstruction, urinary stasis
Dilation of pelves and calyces
Increased kidney size
What respiratory adaptations occur with pregnancy?
No change in rate or IRV Increased minute ventilation Reduced FRC-20% Increased tidal volume-30 to 40% Compensatory respiratory alkalosis-pH 7.4+, increased oxygen partial pressure, decreased carbon dioxide partial pressure
What gastrointestinal adaptations occur with pregnancy?
Slowed GI motility-constipation, early satiety
Relaxation of LES-GERD
N/V-often proportional to HCG levels
Liver/gallbladder-biliary stasis and cholesterol saturation (more stones), coagulation factors, increased binding proteins (thyroid, steroid, vitamin D)
What other adaptations occur with pregnancy?
Altered center of gravity
Altered gait
Greater joint laxity-widening of pubic symphysis, affects other joints, thorax-widened costovertebral angle
Fatigue/solemnolence
What integumentary changes occur with pregnancy?
Spider angioma and palmar erythema Hair growth (abdomen and face) Mucosal hyperemia Striae gravidarum Hyperpigmentation (esp. linea nigra)-rashes and acne are relatively common
