Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clin Skills > the pregnant woman > Flashcards

the pregnant woman Flashcards

1
Q

what does estrogen do? (3)

A
  1. Endometrial growth supports early pregnancy
  2. Stimulates prolactin from anterior pituitary: readies breast tissue for lactation
  3. Contributes to a hypercoagulable state that increases risk of thromboembolic events
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

which hormone dominates the beginning of the menstrual cycle?

A

estrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what does progesterone do? (3)

A
  1. Increase tidal volume and alveolar minute ventilation; leads to resp. alkalosis and SOB sensation
  2. Esophageal sphincter tone decreases: gastroesophageal reflux— ( works with estradiol)
  3. Relaxes tone in ureters and bladder: hydronephrosis and risk of bacteruria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what does HCG do?

A

Produced by the placenta supports progesterone synthesis in corpus luteum preventing the early embryo being lost to menstruation
- (AKA supports pregnancy until the pregnancy can support itself- keeps placental supported by progesterone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

***what hormone is implicated in the insulin resistance and hyperglycemia associated with gestational diabetes?

A

human placental lactogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

***___ of all women with GDM will go on to have _____ ______ _____ in their lifetime

A

half

type 2 DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

if a woman has GDM in first pregnancy? will she likely have it in her second? what are the babies like?

A

yes!

babies are big

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

how do thyroid hormones (T3, T4, TSH) levels change in pregnancy?

A

fluctuate, usually normal ranges, due to HCG’s stimulation of TSH receptor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what secretes relaxin? what does it do?

A

Secreted by corpus luteum and placenta

- Promotes ligamentous laxity in the SI joints and pubic symphysis in preparation for passage of the fetus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

when does erythropoeitin levels increase? what does this do?

A

Increases during pregnancy raising erythrocyte mass

  • Plasma volume increases causing relative hemodilution and physiologic anemia
  • CO increases but systemic vascular resistance decreases: net decrease in BP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what anatomic changes happen to the breast in pregnancy? (4)

A
  1. Moderate enlargement due to hormonal stimulation increased vascularity and glandular hyperplasia
  2. Nipples larger and more erectile, darker areola and pronounced Montgomery glands
  3. Increased venous pattern
  4. 2nd and 3rd trimester colostrum secretion; a nutrient rich precursor to milk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what anatomic changes happen to the uterus in pregnancy? (3)

A
  1. increases in size: Muscle cell hypertrophy
  2. Increase in fibrous and elastic tissue
  3. Development of blood vessels and lymphatic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

in the ___ trimester, Uterus confined to pelvis

and Retains prior position

A

first

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what happens to the uterus/ b/c of the uterus in the second trimester ? (4)

A
  1. 12-14 weeks uterus becomes externally palpable above pelvic brim
  2. Starts to invade space for bladder
  3. Intestines are displaced laterally
  4. Stretching of round ligaments- mostly on the right side
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

___ wks the uterus is at the umbilicus level (to of the fundus palpable here)

A

20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

___ wks the uterus is just above the pelvic brim (tops of fundus palpable here)

A

12 - 14

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what are the breakdown of wks between first, second, and third trimester?

A

first: 0-12 wks
second: 13-28 wks
third: 29-40 wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what anatomic changes happen to the vagina in pregnancy? (3)

A
  1. Chadwick’s sign
  2. Vaginal walls become more deeply rugated due to thickening of mucosa and loosening of connective tissue and hypertrophy of muscle cells
  3. Increase in glycogen stores in epithelium = proliferation of Lactobacillus acidophilus –> decrease vaginal pH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

***what is chadwick’s sign ?

A
  • increased vascularity leads to a bluish color of vaginal walls and cervix
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what happens to the cervix in pregnancy?

A
  1. Chadwick’s sign- appears cyanotic
  2. Hegar’s sign
  3. Mucus plug fills the cervical canal to protect from
    outside influence (protect from bacteria)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

***what is hegar’s sign?

A

palpable softening of the cervical isthmus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is the first thing “to go” in delivery?

A

mucus plug of the cervical canal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

might be able to feel ______ ______ as a small nodule that then disappears by _________

A

Might be able to feel corpus luteum as a small nodule then disappears by mid-pregnancy
(changes in the adnexae in pregnancy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what happens to the external abdomen in pregnancy?

A
  1. Stria gravidarum (stretch marks)
  2. Linea nigra- a brownish black line along the midline
  3. Diastasis recti- rectus abdominis muscles may separate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what is the cervical isthmus? (kinda weeds)

A

the uterine isthmus is the inferior-posterior part of uterus, on its cervical end — here the uterine muscle (myometrium) is narrower and thinner. It connects superiorly-anteriorly to the complementary parts of the uterus: the body and the fundus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what is the adnexae?

A

The appendages to the uterus are known as the adnexa uteri. The parts of the adnexa uteri are the fallopian tubes, ovaries, and ligaments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

looking at a quantitative HCG: know where they should be (baseline) based on what?

A

dates of last menstrual cycle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

if HCG higher than what you expect, what does this mean?

A

they have twins or they further along in the pregnancy than they thought they were (a month or so earlier)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

if pregnancy is viable, what number do we want to go up?

A

HCG hormone levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what test do we do to confirm pregnancy?

A

urine HCG (maybe blood HCG but not really necessary)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

health history for pregnancy (6)

A
  1. Current state of health
  2. Past obstetric history
  3. Past medical history
  4. Family history
  5. Expected weeks of gestation (first day of LMP- last menstrual period)
  6. Expected date of delivery (Naegele’s rule)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

acute/chronic issues that effect pregnancy (weeds)

A 
Abdominal surgeries
Hypertension
Diabetes
Cardiac conditions
Asthma
Hypercoagulability states
Mental health disorders
HIV/STIs
Abnormal Pap smear
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

how do you ask for the expected weeks of gestation?

A

first day of LMP (last menstrual period)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what is “ G” (gravida)?

A

how many prior pregnancies you have had

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what is the “P” (para/ parity) ?

A

how many labors you have had. includes term deliveries, preterm, spontaneous/therapeutic abortions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what are pregnancy complications that you may ask history about? (4)

A

DM, HTN, preeclampsia, preterm labor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what are labor or delivery complications that you may ask history about? (3)

A

Large babies, fetal distress, emergency interventions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what are risks to maternal and fetal health? (weeds)

A

Tobacco, alcohol, illicit drugs
Medications, OTC medications, Herbal
Toxic exposures at home or work? (Cat litter)
Nutritional intake
Adequate social support and financial support
Stress at home or work
Physical abuse or domestic violence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what does “TPAL” stand for?

A

T- term (to 20 wks)
P- preterm
A- abortion (spontaneous or therapeutics)
L- living

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

***what is naegele’s rule?

A 
Estimated Date of Delivery (EDD): 
Add seven (7) days to first day of LMP
Subtract three (3) months
Add one (1) year
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

for family history, how far along in the family tree do you ask about?

A

2 generations up and 2 generations down

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

if there is a congenital problem/anomaly in the first child is it more likely that their second will have it?

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

what do babies get from breastmilk that they can’t with formula?

A

Passive immunity from certain infectious diseases until their own immunity is functional at 3-4 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

gestational age is used to establish timeframe of the pregnancy. what information is this useful for? (5)

A
  1. For normal progress
  2. Establishing paternity
  3. Timing screening tests
  4. Tracking fetal growth
  5. Effective preterm and postdates labor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

breastfeeding may suppress _______, but don’t rely on it for ________

A

ovulation, birth control !

46
Q

if baby has a fever… what do you need to do?

A

COMPLETE and THOROUGH workup !

47
Q

limitation to naegele’s rule for determining EDD?

A

Shorter or longer than 28 day cycles ( Irregular menstrual cycles)

48
Q

EDD, you use Naegele’s rule OR add ____ wks to first day of LMP. but most of the time a _____ _____ is done to confirm.

A

40

-dating US

49
Q

how frequent are checkups during pregnancy? (3 parts)

A
  1. Usually once a month until 30 weeks gestation
  2. Then every two weeks until 36 weeks
  3. Then every week until delivery
50
Q

***what is important to document with each checkup for a pregnant woman? (6)

A
  1. History
  2. fetal movement felt by patient
  3. contractions
  4. leakage of fluid
  5. vaginal bleeding
  6. PE- Vital signs (BP and weight), fundal height, verification of fetal HR, determination of fetal position and activity
51
Q

***what is important to document from the PE of pregnant checkup? (4)

A
  1. Vital signs (BP and weight)
  2. fundal height
  3. verification of fetal HR
  4. determination of fetal position and activity
52
Q

health promotion and counseling (7parts)

A 
Nutrition
Weight gain
Exercise
Substance abuse
Domestic violence
Prenatal laboratory screening
Immunizations
53
Q

nutrition for pregnancy, what multivitamin should she take?

A

Multivitamin

With 0.4 to 0.8 mg of folic acid and 30 mg or iron

54
Q

nutrition: what to avoid in pregnancy? (4)

A

Excess amounts of Vitamin A (can become toxic)
Fish with mercury (shark, swordfish, some canned tuna
Unpasteurized dairy products
Undercooked meats

55
Q

nutrition: only increase by _____ calories a day if pregnant

A

Should only increase by 300 calories a day

56
Q

______ and _________ are associated with poor birth outcomes

A

Excessive and inadequate weight gain

57
Q

rules for exercise in pregnancy? specifically after the 1st trimester? what about in the 3rd trimester? what to do if fatigued/uncomfortable?

A
  • mild to moderate exercise, short periods (30min+), 3 or more times a week
  • After 1st trimester avoid exercise in supine position (compress inferior vena cava decreasing blood flow to placenta)
  • 3rd trimester no exercise that might cause loss of balance
  • STOP if fatigued/uncomfortable
58
Q

_______ ______ _______is the leading cause of preventable mental retardation in the U.S.

A

Fetal alcohol syndrome is the leading cause of preventable mental retardation in the U.S.

59
Q

what amount of alcohol is safe to drink when pregnant?

A

There is no known “safe dose” so abstinence is best

60
Q

__________ Accounts for about 1/3rd of low-birth-weight babies and many other poor pregnancy outcomes like placental abruption, and preterm labor

A

tobacco

61
Q

what two vaccines should pregnant women get?

A

Tetanus (Tdap) and flu

62
Q

what three vaccines are safe for pregnant women?

A

Pneumococcal
Meningococcal
Hepatitis B

63
Q

what three vaccines are unsafe in pregnancy?

A

measles/mumps/rubella
Polio
Varicella

64
Q

what do you give a woman who is Rh negative woman? (if dad might be Rh positive?.. ) how often does she get this?

A

Rho (D) immunoglobulin or RhoGam should be given to all Rh-negative women at 28 weeks gestation and again within 3 days of delivery to prevent sensitization to an Rh-positive infant

65
Q

what are included in initial screenings ? (weeds)

A 
Blood type and Rh
Antibody screen
CBC- especially hematocrit and platelet count
Rubella titer
Syphilis test
Hepatitis B surface antigen
HIV test
STI screening for GC and Chlamydia
UA with culture
66
Q

what are two “timed screenings” for prenatal visit?

A
  1. Oral glucose tolerance test for Gestational diabetes around 24 weeks
  2. Vaginal swab for group B strep between 35-37 weeks
67
Q

what do you need to check for each prenatal visit? (maybe weeds)

A 
Evaluate blood pressure
Weight
Urine protein and glucose
Uterine size for progressive growth
Fetal heart rate
68
Q

After patient reports __________ she should be asked about it at every visit

A

After patient reports “quickening” (fetal movement) she should be asked about it at every visit

69
Q

Between ___ -____ weeks patient should be taught warning signs of preterm labor

A

24-34 weeks

70
Q

4 signs of preterm labor

A

Uterine contractions
Leakage of fluid
Vaginal bleeding
Low pelvic pressure low back pain

71
Q

Beginning in the _______patient should be taught to recognize the warning signs of preeclampsia

A

2nd trimester

72
Q

what are the 4 warning signs of preclampsia?

A

Headache
Visual changes
Hand or facial swelling
Epigastric or RUQ pain

73
Q

At 28 weeks systemic examination of the abdomen is carried out to identify what 3 things?

A
  1. The lie (eg., longitudinal, transverse, oblique)
  2. The presentation (eg., vertex, breech, shoulder)
  3. The position (eg., flexion, extension, or rotation of the occiput)
74
Q

how many maneuvers of leopold are there?

A

4 (upper pole, sides abd, lower pole, flexion of fetal head )

75
Q

1st maneuver of leopold

A

UPPER POLE
Women’s side facing her head
Fingers together palpate gently to determine what part is in the upper pole (usually buttocks feel firm but irregular. Head feels firm round, smooth)

76
Q

2nd maneuver of leopold

A

SIDES OF MATERNAL ABD
Facing patients head, one hand each side of abdomen trying to capture body of fetus
One hand steadies, the other palpates for the position of the back vs. the extremities
The hand on back feels smooth, firm surface length of hand; hand on arms and legs feels irregular bumps, and maybe kicking

77
Q

3rd maneuver of leopold

A

LOWER POLE
Face patient’s feet, fingertips touching together, palpate just above symphysis pubis
Palpate to see if head (smooth, firm, rounded) or buttocks (firm but irregular
Judge the descent or engagement of the presenting part into the maternal pelvis

78
Q

4th maneuver of leopold

A

FLEXION OF FETAL HEAD
This assumes the head is the presenting part in the pelvis
Face the patient’s feet, place hands on either side of the uterus and determine the fetal front and back side.
Using one hand at a time run it down each side of the fetal body until you run into the “cephalic prominence”.
If the prominence is on the back of the body the head is extended and the face is presenting
If it is on the front side of the body the head is flexed and the top of its head is presenting

79
Q

Most comfortable positions for patient will be ______ or _________

A

Most comfortable positions for patient will be sitting or left-side-lying position

80
Q

hyperreflexive on genital exam may be a sign of what?

A

preclampsia

81
Q

what do you check in the supine part of the exam?

A

Uterine palpation, fetal heart tones, pelvic exam

  • As quickly/efficiently as possible
  • Semi-sitting with knees bent
82
Q

what is expected of the thyroid on exam?

A

Thyroid – modest symmetric enlargement expected

83
Q

Wt loss greater than ___% during first trimester may be due to ______

A

5%

hyperemesis

84
Q

what constitutes preclampsia?

A

SBP > 140 and DBP > 90 after week 20 and proteinuria

85
Q

what is chloasma?

A

on HENT of pregnant woman: chloasma (mask of pregnancy, irregular brownish patches around forehead, cheeks, nose, or jaw)

86
Q

how can the hair present on a pregnant woman?

A
  • dry or oily

- sometimes generalized hair loss or mild hirsutism

87
Q

why would you check the eyes of a pregnant woman?

A

look at conjunctiva- check for anemia sign

88
Q

nose exam for pregnant woman, what are some common things?

A

nasal congestion and nose bleeds are both common

89
Q

in the mouth of a pregnant woman, it is common to see ____ enlargement

A

gingival

90
Q

thorax and lung exam of a pregnant woman may show what two things? why might they have respiratory alkalosis ?

A

elevated diaphragm & increased chest diameter

* May have resp. alkalosis – TV and Alveolar minute ventilation increase but resp rate constant

91
Q

heart exam of pregnant woman: ____ elevated in late pregnancy. what might you also hear? why?

A

PMI elevated late in pregnancy (4th ICS).

- Venous hum and systolic or continuous mammary souffle (pronounced soo-fl)

92
Q

souffle (soo-fl) ? when and where do you find this?

A

when: late pregnancy or during lactation
where: heard 2nd or 3rd ICS. systolic > diastolic

93
Q

what is souffle (soo-fl)? where does it come from? (maybe weeds)

A

murmur with blowing quality: due to increased blood flow in normal vessels.

94
Q

breast of pregnant woman may present how?

A

venous pattern noticeable, nipples and areolae dark, prominent Montgomery glands; more tender and nodular; colostrum expression from nipples

95
Q

when are fetal movements felt by mother? by others?

A

18-20wks (mom)

24wks (someone touching her stomach)

96
Q

**regular contractions before ___wks with or without pain or bleeding = ABNORMAL

A

37

97
Q

when do you assess fundal height? from where to where do you measure?

A

20 wks

Measure top of symphysis pubis to uterine fundus in the midline. measure in cm

98
Q

fundal height: should roughly equal weeks of gestation from wk ___ - ____. deviation from expected: if its >4cm or <4cm; what is the significance?

A

wk 20-32

99
Q

if fundal height is >4cm from the expected value, what might that mean?

A

> 4cm = mult. Gestation, large fetus, extra amniotic fluid, uterine leiomyoma

100
Q

if the fundal height is <4cm than the expected value, what might that mean?

A

<4cm = missed abortion, transverse lie, growth retardation, false pregnancy

101
Q

avg fetal HR is around what?

A

160 but slows to 140-120 near end of term

102
Q

when and where can you find fetal HR? (weeds)

A

Doppler ~ 10 weeks
12-18 weeks heard midline lower abdomen
Fetoscope – 18 wks
>28 weeks heard over fetal back or chest

103
Q

genitalia and rectal exam (weeds)

A

Labia and clitoris enlargement is normal
Note scars, perineal incisions and introitus relaxation in multiparous women
Palpate Bartholin’s and Skene’s gland for tenderness
Check for cystocele or rectocele
Note hemorrhoids
Speculum exam – cervix color, shape, healed lacs
If PAP is done use wooden spatula or cotton tip applicator

104
Q

bimanual exam of cervix, os, uterus and adnexa (weeds)

A

Usually easier in pregnancy due to relaxation
Cervix softer
Cervical os – nulliparous vs multiparous
Cervical length – cervical tip to lateral fornix (1.5-2 cm before 34-36 wks)
Palpate adnexae
Assess pelvic muscle strength

105
Q

extremity exam (3) -( weeds)

A

Note varicose veins
Note edema
Check knee and ankle reflexes

106
Q

common symptoms- 1st trimester

A

N/V, breast tenderness, fatigue

107
Q

common symptoms- 2nd trimester

A

lower abdominal pain and abdominal striae (stretch marks)

108
Q

common symptoms- 3rd trimester

A

fatigue, stretch marks, contractions, loss of mucus plug, edema

109
Q

common symptoms- all trimesters

A

amenorrhea, heartburn, urinary frequency, vaginal discharge, constipation, hemorrhoids, backache

110
Q

vaginal discharge in pregnancy

A

leukorrhea is normal - from increased secretions (vasocongestion and hormonal changes)
- anything foul smelling or with pruritis should be investigated

Clin Skills (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions