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ME 536- Patient Care II > The Pregnant Patient > Flashcards

The Pregnant Patient Flashcards

1
Q

Things to note on breast exam documentation

A

symmetry
tenderness
masses
skin changes
nipple changes
axillary and lymph node exam

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2
Q

Quadrants of the breast

A

Upper outer quadrant
upper inner quadrant
lower outer quadrant
lower inner quadrant

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3
Q

Gravida

A

a woman who is or has been pregnant (regardless of outcome of pregnancy)

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4
Q

Nulligravida

A

a woman who has never been pregnant and is not currently pregnant

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5
Q

Primigravida

A

woman who is pregnant for the first time or has been pregnant once

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6
Q

Multigravida

A

woman who has been pregnant more than once

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7
Q

Nullipara

A

A woman who has never given birth or never had a pregnancy beyond 20 weeks

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8
Q

Primipara

A

woman who has given birth only 1 time (one delivery of a fetus born alive or dead with a gestation of 20 weeks or more)

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9
Q

Multipara

A

A woman who has given birth 2 or more times (past 20 weeks)

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10
Q

What is the marker for para designation

A

20 weeks

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11
Q

What does primigravida and nullipara mean

A

A woman who was pregnant but the baby did not reach 20 weeks gestation

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12
Q

What does G stand for?

A

Gravida: # of pregnancies

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13
Q

What does P stand for?

A

P: Para # of births after 20 weeks

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14
Q

GTPAL

A

Gravida
Term deliveries (after 37 weeks)
Preterm
Abortions (spontaneous/therapeutic < than 20 weeks or <500 grams)
L: number of living children

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15
Q

What does G2P2002 mean

A

2 pregnancies, 2 term deliveries (after 20 weeks), no abortions, no preterm, 2 living children

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16
Q

What are the 3Ps for sign of pregnancy

A

Presumptive (better not tell you now)
Probable (most likely)
Positive (without a doubt)

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17
Q

Presumptive signs of pregnancy are

A

Subjective, a patient describes to the provider, may not be due to pregnancy

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18
Q

What are examples of presumptive signs of pregnancy

A

missed or unusual bleeding pattern
nausea/vomiting
breast changes, size, tenderness, increased sensation
increased urinary frequency

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19
Q

What are examples of probably signs of pregnancy

A

enlargement of uterus
Hegar’s sign
Chadwick’s sign
Goodell’s sign
Piskacek’s sign
Positive UPT
Melasma

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20
Q

When do presumptive signs of pregnancy come into play?

A

women who are multipara

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21
Q

Hegar’s sign

A

softening of the uterine isthmus

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22
Q

Chadwick’s sign

A

Bluish or cyanotic appearing cervix and upper vagina due to increased vascularity

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23
Q

Goodell’s sign

A

Softening of the cervix due to increased vascularity

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24
Q

Piskacek’s sign

A

assymmetric bulge or soft prominence of uterus caused by placental development

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25
Q

Positive signs of pregnancy

A

fetus identified by ultrasound
fetal heartbeat detected by doppler or auscultation
objective detection of fetal movement by healthcare provider
DELIVERY OF THE BABY

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26
Q

Symptoms of early pregnancy

A

amenorrhea
early spotting in pregnancy can be confused for menses
N/V
breast enlargement/tenderness
fatigue
urinary frequency
pelvic discomfort/pressure

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27
Q

What physical exam signs can you see at 6+ weeks

A

engagement and softening of uterus

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28
Q

What physical exam signs can you see at 12+ weeks

A

uterus palpable above symphysis pubis in the lower abdomen

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29
Q

Which occurs first? Chadwick’s sign or hears sign?

A

Chadwick’s sign

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30
Q

What lasts longer? Chadwick’s sign or hears sign?

A

Hegar’s sign

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31
Q

When can you detect fetal heart tones?

A

6 weeks fetal cardiac activity detected by ultrasound
12 weeks heart tones detected by Doppler (may be as early as 9 weeks)

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32
Q

When can you detect intra uterine pregnancy on ultrasound?

A

may be as early as 4-5 weeks gestation (gestational sac)

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33
Q

When does fetal quickening occur

A

18-20 weeks in a primigravida
14-18 weeks in multigravida

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34
Q

What are some skin findings of pregnancy

A

mask of pregnancy/melasma (2nd or third trimester)

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35
Q

Linea Nigra

A

darkening of the midline of the abdomen (beginning late 1st trimester)

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36
Q

Pregnancy must be confirmed by

A

testing

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37
Q

What are definitive examples of pregnancy

A

Positive urine or serum hCG
Identification of pregnancy by ultrasound
Detection of fetal heart tones by doppler

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38
Q

What does CRL mean

A

crown to rump length

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39
Q

What kind of test is a UPT?

A

Qualitative, it will say yes or no

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40
Q

What kind of problems happen with UPT?

A

his false negative rate (says negative but the patient is pregnant)

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41
Q

Benefit of serum hCG

A

more sensitive
positive earlier than UPT
qualitative (yes or no) and quantitative (how long?)

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42
Q

what is a quant/qual hCG?

A

serum hCG

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43
Q

How quickly does hCG double in early pregnancy

A

double ever 48-72 hours increases every after 6 weeks double every 96

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44
Q

When does hCG levels peak?

A

first 8-11 weeks of pregnancy and then declines and levels off

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45
Q

of a hCG level peaks before 8 weeks what does that mean?

A

possible ectopic or lost pregnancy

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46
Q

Home pregnancy test should

A

be confirmed in the office

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47
Q

What is menses day 1?

A

first day of bleeding of LMP

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48
Q

How do you estimate gestational age

A

number of weeks since first day of LMP, NOT presumed time of conception

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49
Q

EDD

A

Estimated date of delivery

50
Q

What is the average pregnancy

A

Average is 280 days from first day of LMP

51
Q

What is the other name for EDD?

A

EDC estimated date of confinement

52
Q

Naegele’s Rule

A

Add 7 days to first day of LMP subtract 2 months, add a year

53
Q

What ultrasound is the most accurate in gauging EDC

A

first trimester ultrasound

54
Q

When do you get the first ultrasound?

A

before 22 weeks to confirm dates

55
Q

What is it called if the ultrasound is done after 22 weeks

A

“sub-optimally dated”

56
Q

When is the first prenatal visit done?

A

8 to 10 weeks gestation, ideally 1st trimester

57
Q

What is done at the first prenatal visit?

A

confirm the pregnancy, destine estimated date of delivery and gestational age
determine desire for pregnancy/attitude for pregnancy

58
Q

What are questions to ask about about attitude of pregnancy during 1st prenatal visit

A

how does she feel?
was it planned?
Is it desired?
Does she plan to continue to term?

59
Q

What type of education and counseling is provided at the 1st prenatal visit?

A

scope of care provided in the office and expected schedule of visits
Counseling (risk factors, complications, diagnostics, genetic screening)
Discussion of current symptoms as well as anticipated symptoms
Offer reassurance that most symptoms will improve
health maintenance
barriers to care

60
Q

When do pregnancy symptoms improve

A

usually 2nd trimester when other changes typically reverse by 6 weeks postpartum, some immediately after delivery

61
Q

What are important health maintenance issues for a pregnant person

A

weight gain, nutrition, seat belts, vaccinations

62
Q

How often should prenatal care occur

A

total 14 visits (every 8-10 weeks of pregnancy)
4 weeks during the 1st 28 weeks
2-3 weeks until 36 weeks
every week after 36 weeks

63
Q

What physical exam during 1st prenatal comprehensive visit

A

vitals, especially blood pressure
weight (including BMI)
heart, lung, thyroid, basic neuro
breast pelvic exam
PELVIMETRY
assessment of cervix
uterine size, shape and consistency

64
Q

What is included in pelvimetry measurement

A

public arch, ischial spines, sacrum, diagonal conjugate

65
Q

What is pelvimetry

A

description of bony pelvis adequate for vaginal delivery

66
Q

Size of the uterus at 12 weeks

A

at symphysis pubis

67
Q

Size of the uterus at 16 weeks

A

halfway between pubis and umbilicus

68
Q

Size of the uterus at 20 weeks

A

at umbilicus

69
Q

Size of the uterus after 20 weeks

A

1 cm for every week of gestation

70
Q

Normal pregnancy 10 weeks obstetric findings

A

fetal heart beat detectible by 9-10 weeks via Doppler (often closer to 10-12 weeks)

71
Q

Normal pregnancy 12 weeks obstetric findings

A

Uterus palpable in abdomen by 12 weeks

72
Q

Normal pregnancy 18 weeks obstetric findings

A

fetal movement felt by mom “quickening” between 18-20 weeks

73
Q

Normal pregnancy 20 weeks obstetric findings

A

fundus reaches umbilicus at 20 weeks

74
Q

Normal pregnancy 24 weeks obstetric findings

A

fetal movement observable by examiner/partner after 24 weeks

75
Q

What should BP be like in pregnancy?

A

Low
any high BP during pregnancy is bad

76
Q

Normal pregnancy 36 weeks obstetric findings

A

fundus reaches max height at the level of the xiphoid process around 26 weeks

77
Q

If someone has low BMI how much weight gain is recommended during pregnancy

A

28-40lb gain recommended

78
Q

If someone has normal BMI how much weight gain is recommended during pregnancy

A

25 to 35 lb gain recommended

79
Q

If someone has a high BMI how much weight gain is recommended during pregnancy

A

15-25 lb gain recommended

80
Q

If someone is obese how much weight gain is recommended during pregnancy

A

less than 15 lbs recommended

81
Q

What are routine labs that should be done during the comprehensive 1st prenatal visit

A

ABO, Rh typing, antibody screen
CBC (anemia, platelet count)
Genetic and infectious disease testing (CF, hemoglobinopathy, hereditary diseases)

82
Q

What infectious disease testing is recommended during comprehensive 1st prenatal visit

A

Hepatitis B, Hepatitis C (recommended for each pregnancy)
Rubella, varicella, syphilis and HIV (unless declined)

83
Q

If a patient is high risk

A

includes gonnorrhea and chlamydia

84
Q

What are routine diagnostic studies during comprehensive 1st prenatal visit

A

cervical cancer screening
urine culture and sensitivity
urine dip for protein and glucose
gestational diabetes screening (if high risk)
TSH (if indicated)

85
Q

What is in a prenatal vitamin

A

folic acid (helps prevent neural tube defects)
Vitamin D
iron
Calcium

86
Q

What are foods to avoid during pregnancy d/t risk of listeria

A

Unpasteurized milk/soft cheese
hot dogs/lunch meat (unless they are steamed hot just before eating)
Pate/meat spread
smoked seafood
unwashed raw produce
raw and undercooked seafood/eggs/meat/poultry
DO NOT EAT SUSHI MADE WITH RAW FISH

87
Q

What to know about eating fish in pregnancy

A

mercury

88
Q

What are low mercury seafood?

A

shrimp, salmon, catfish, pollock

89
Q

What are high mercury seafood?

A

shark, swordfish, king mackerel, Marin tilefish
limit white (albacore) tuna to 6oz per week

90
Q

What immunizations do you need before pregnancy

A

Every pregnancy TDAP (27-36 weeks)
Inactivated flu vaccine, one dose annually

91
Q

What are examples of live attenuated vaccines

A

MMR
Varicella
Zostavax
live attenuated flu

92
Q

What vaccines should be delayed in pregnancy?

A

Shingrix
HPV

93
Q

What woman are considered high risk for STI testing in pregnancy?

A

under age 25
sex work
IVDU
multiple partners

94
Q

What should you be doing during every prenatal visit

A

emphasize healthy habits and assess risks

95
Q

Protein in urine can show

A

ecclampsia

96
Q

glucose in urine can show

A

gestational diabetes

97
Q

When does the height of the uterus become unreliable for a measure of gestation

A

36 weeks

98
Q

What are Leopold’s maneuveres

A

helps to determine fundal height

99
Q

Pawlick’s grip

A

both hands on upper and lower poles of fetus to determine presentation- allows estimation of fetal size

100
Q

Leopold’s first maneuver

A

what is in the fundus, what is the height

101
Q

Leopold’s second maneuver

A

where is the back and extremities

102
Q

Leopold’s third maneuver

A

what direction and degree of flexion of the head

103
Q

Leopold’s fourth maneuver

A

what is the presenting part? Has it descended into the pelvis

104
Q

What do you screen for at 24-28 weeks?

A

gestational diabetes
antibody screen Rh negative
repeat H&H

105
Q

How do you test for gestational diabetes

A

50-gram one hour glucose challenge test as a screen (1 hour GTT)
If abnormal: 100 gram 3-hour glucose tolerance test: diagnostic (3hr GTT)

106
Q

What do you screen for at 35-37 weeks

A

screen all women for group B beta hemolytic streptococcus (GBS)

107
Q

Where do you swab for GBS

A

lower vagina and rectum

108
Q

What do you screen for in the 3rd trimester?

A

repeat screening HIV and other STI in patients at increased risk

109
Q

Aneuploidy

A

abnormal number of chromosomes

110
Q

Prenatal screening: What are maternal serum testing

A

hCG, pregnancy-associated plasma protein A, alpha fetoprotein (AFP), fetal ultrasound, carrier testing

111
Q

Prenatal genetic testing: when is carrier testing done

A

done at any time during pregnancy but ideally done before pregnancy
Blood or tissue from inside the cheek

112
Q

Prenatal genetic testing: when do you screen for Down syndrome and trisomy 18

A

weeks 9-12

113
Q

What does integrated screening and sequential screening do

A

10-22 weeks
combines first trimester and second trimester screening test results
Down syndrome, trisomy 18, trisomy 13 and Neural tube defect

114
Q

What does cell-free DNA screening do

A

10 weeks and beyond
blood test
Down syndrome, trisomy 18, trisomy 13

115
Q

When do you do CVS (chorionic villus) screening

A

10-13 weeks
tests fetal cells in a sample of chorionic villi
Detects Down syndrome, trisomy 13, trisomy 18, inherited disorders requested for testing but not neural tube defect

116
Q

What does group B strep cause in infants during vaginal delivery

A

fatal meningitis

117
Q

When do you do an amniocentesis

A

15-20 weeks
tests fetal cells in amniotic fluid
tests for Down syndrome, trisomy 13, trisomy 18, inherited disorders for which you request testing, certain types of neural tube defects

118
Q

When is quad screening performed

A

15-22 weeks
blood test
screens for Down syndrome, trisomy 18, trisomy 18 and neural tube defect

119
Q

When do you perform first-trimester screening

A

10-13 weeks
blood test plus nuchal translucency ultrasound exam
screens for Down syndrome and trisomy 18

120
Q

When do you perform a standard ultrasound exam

A

timing 18-22 weeks
screens for some physical defects

ME 536- Patient Care II (8 decks)

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