Unit 1: CARE OF AT-RISK/HIGH RISK AND SICK MOTHER AND CHILD Flashcards
(Nutritional status) A mother’s is at risk when hematocrit value is less than ____
33%
Mother is at risk for pre-term labor if she is younger than _____ or older than ______
16
35
Mother is at risk for pre-term labor if her maternal weight is below ____
50 kg
High caffeine is ___ or more cups of coffee each day
3
To decrease pregnancy complications, a woman should get pregnant ___ years after menarche
6
A DFMC (Daily Fetal Movement Count) is aka
Kick counts
A test done after_____ gestation to identify potentially hypoxic fetuses
28 weeks
DFMC (Daily Fetal Movement Count)
In a DFMC (Daily Fetal Movement Count) if ____ movements can’t be felt within 1 hour, walk around but if still none, you should notify physician
10
A noninvasive test done that monitors the baby’s heartbeat when he is at rest and when he is moving
Non-stress test
Result of the NST (Non-stress Test) : 2 or more accelerations of 15 beats/min lasting 15 seconds or more a in 20 min period
Reactive
Result of the NST (Non-stress Test) : No fetal heart rate acceleration or accelerations less than 15 beats/min
Non reactive
Result of the NST (Non-stress Test) : Fetal heart rate pattern cannot be interpreted
Unsatisfactory
If NST(Non-stress Test) is reactive for _____weekly, the pregnancy is allowed to continue
2x
If the result of the NST (Non-stress Test) is unsatisfactory what would you do? (2)
Repeat NST Do CST (Contraction Stress Test)
A test done on the fetus that utilizes oxytocin given to the mother (IV) or through nipple massage to cause labor contractions and release oxytocin
Contraction Stress Test
During a Contraction Stress Test, what does it imply if the fetal heart rate decelerates after a contraction instead of speeding up?
The baby may have problems with the stress of normal labor
Should the mother eat before undergoing a Contraction Stress Test?
No (NPO for 4-8 hours)
What is the result if CST interpretation is: 3 contractions, 40-60 sec long within 10-min period, no late decelerations
Negative
Fetus may tolerate labor process if it occurs within 1 week
What is the result if CST interpretation is: Persistent/consistent late decelerations with more than 50% of contractions
Positive
Fetus is at risk
What is the result if CST interpretation is: Decelerations in less than 50% of contractions
Suspicious
What is the result if CST interpretation is: Inadequate pattern or poor tracing
Unsatisfactory
In abdominal ultrasound, should the bladder be empty or full?
Full
A test that provides excellent pictures of soft tissues
MRI
The amnion extracted during amniocentesis contains what?
Fetal cells
True anemia (1st and 3rd Trimester) is an Hgb of _____
<11g/dl
True anemia (2nd Trimester) is Hgb of ____
<10. 5 g/dl
True anemia (1st and 3rd Trimester) is Hct of ____
<33%
True anemia (2nd Trimester) is Hct of ____
<32%
Pseudoanemia in pregnancy happens when plasma volume increases by ____ but the RBC count increases by _____
50%
30%
The most common anemia in pregnancy
Iron-deficiency anemia
Iron deficiency anemia is Hgb of __
<12 mg/dl
Iron deficiency anemia is Hct of __
<33%
How many years should a mother become pregnant again to decrease risk of iron deficiency anemia?
at least 2 years
To prevent iron deficiency anemia a mother should take ___ of elemental iron supplements
27 mg
If the mother already has iron-deficiency anemia a dose of _____ elemental iron is given every day
120-200mg
Vitamin C supplies ____ which promotes iron absorption
ascorbic acid
If the mother cannot take iron by mouth what is prescribed?
IM or IV iron dextran
Folic Acid deficiency anemias is seen in __% to ___ %of pregnancies
1-5
It is necessary for the normal formation of RBCs in the mother as well as preventing neural tube defects in the fetus.
Folic Acid or Folacin
A condition where large and immature blood cells are formed
Folic Acid Deficiency Anemia
A condition where RBCs are enlarged
Megaloblastic Anemia
An anticonvulsant agent that interferes with folate absorption
Hydantoin
For expectant mothers, ___ of folic acid is supplemented
400g
For pregnant mothers ____ of folic acid is prescribed
600g
An endocrine disorder in which the pancreas cannot produce adequate insulin to regulate body glucose level.
Diabetes Mellitus
A condition of abnormal glucose metabolism that arises during pregnancy
Gestational Diabetes
4P’s for Assessing Diabetes Mellitus
Polyuria
Polydipsia
Polyphagia
Pound loss
What is OGTT?
Oral glucose tolerance test
Diabetes is diagnosed if the Fasting Blood Sugar is
Equal to or greater than 200mg/dl
A venous blood sample is taken for glucose determination 60 minutes later. If the serum glucose level at 1 hour is more than 140 mg/dl, the woman is scheduled for a 100 mg, 3 -hour fasting glucose tolerance test.
50 mg Oral Glucose Challenge
If two or more of the blood samples collected for this test are abnormal or the fasting value is above 95 mg/dl, a diagnosis for diabetes is made.
100 mg Glucose tolerance test
50 mg Oral Glucose Challenge -a venous blood sample is taken for glucose determination _____ minutes later. If the serum glucose level at ___ minutes is more than ____, the woman is scheduled for a _______
60
60
140 mg/dl
100 mg, 3 -hour fasting glucose tolerance test.
What is the process for an Oral Glucose Tolerance test?
8-12 hour fasting
Test for FBS
Glucose drink
3 blood samples every hour
What is the Normal Glucose level for pregnant women after fasting?
9 mg/dl
What is the Normal Glucose level for pregnant women 1 hour after taking a 100 mg glucose load?
180 mg/dl
What is the Normal Glucose level for pregnant women 2 hours after taking a 100 mg glucose load?
155 mg/dl
What is the Normal Glucose level for pregnant women 3 hours after taking a 100 mg glucose load?
140 mg/dl
How do you know that the pregnant glucose level is abnormal at 1-hour intervals?
If 2 values are exceeded
Why does increased glucose concentration in urine lead to UTI?
Because sugar in urine promotes bacterial growth
The usual regimen recommended for women with gestational diabetes? (calorie diet)
1800-2400 calorie diet divided into 3 meals and 3 snacks
A mother’s insulin requirement is highest during what trimester?
3rd
What type of insulin is chosen during pregnancy?
Humulin
Humulin is administered _____in the morning, ___ at dinner and administered____, ___ minutes before meals
2/3
1/3
SQ
30
Insulin is administered in what route and and angle?
SQ
90 degree angle
What does postprandial mean?
After a meal
Insulin is adjusted to keep the FBS below_____
95-100 mg/dl
Insulin is adjusted to keep the 2-hour post-prandial level below__
120 mg/dl
How does stress affect your blood glucose level?
Stress increases blood glucose levels
Why is human insulin preferred rather than a beef or pork insulin?
Because it has a lesser risk of provoking the antibody response
It utilizes an automatic pump about the size of an mp3 player and implanted into the SQ tissue in the abdomen or thigh
Insulin Pump Therapy
Continuous SQ Insulin Infusion
What is the best predictor of subsequent fetal macrosomia?
Blood glucose level 1 hour after beginning a meal
<120 mg/dl
What does high insulin sensitivity mean?
High insulin sensitivity allows the cells of the body to use blood glucose more effectively
It increases during exercise
What should prenatal vitamins contain to reduce the risk of gestational diabetes mellitus?
Folic Acid
Why is diet/insulin therapy not needed for a woman with gestational diabetes 24 hours after giving birth?
They usually demonstrate normal glucose values in this timeframe
A normal result in this test suggests that the woman’s vascular system is intact because the kidney function is normal
Creatinine clearance test
A healthy fetus makes how many movements per hour?
10
A rock type of methamphetamine that is smoked
Amphetamine
Common name for Amphetamine
Ice
Substances obtained from the hemp plant, cannabis
Marijuana and Hashish
Why can’t women who takes marijuana or hashish breastfeed?
It reduces milk production
Why do women usually use marijuana during early pregnancy?
To counteract nausea
An animal tranquilizer that is frequently used as street drug in polydrug abuse
Phencyclidine (PCP)
How does Phencyclidine (PCP) affect the body? (2)
Increase CO
Sense of euphoria
A substance that has a potential for causing long-term hallucinations (flashback episodes)
Phencyclidine (PCP)
A substance that tends to leave maternal circulation and concentrates in fetal cells, which can injure the fetus
Phencyclidine (PCP)
A substance that can be abused and is used for the treatment of pain (Morphine or meperidine) (Demerol) and cough suppression.
Narcotic agonist
What are the two effects of Narcotic agonists?
Analgesia
Euphoria
Heroin abuse during pregnancy can result in:
severe _____ in the infant after birth
withdrawal symptoms
Refers to the ”sniffing” or “huffing” of aerosol drugs
Inhalants
Airplane glue
Cooking sprays
Computer keyboard cleaner
are abused as _____
Inhalants
The effect of Inhalants in the body is similar to _____
Alcohol abuse
If the baby has characteristics such as:
Small eye openings
Smooth Philtrum
Thin upper lip
it may be indicative of___
Fetal Alcohol Syndrome
An inflammatory connective tissue disease which may develop in untreated group A B-hemolytic streptococcal infections.
Rheumatic Fever
Results when recurrent inflammation from bouts of rheumatic fever causes scarring formation in the valves.
Rheumatic Disease
Failure of the heart valve to open completely
Stenosis
Failure of the valve to close completely or a combination of both thereby increasing the workload of the heart
Regurgitation
Scarring due to Rheumatic fever results in: (2)
Stenosis
Regurgitation
Classify the Functional Capacity Of a Patient With Cardiac Disease:
Asymptomatic.
No limitation of physical activity
Class 1
Classify the Functional Capacity Of a Patient With Cardiac Disease:
-marked limitation of physical activity.
-comfortable at rest but
symptomatic during less than ordinary physical activity
Class 3
Classify the Functional Capacity Of a Patient With Cardiac Disease:
- slight limitation of physical activity
- asymptomatic at rest
- symptoms occur with ordinary physical activity
Class 2
Classify the Functional Capacity Of a Patient With Cardiac Disease:
-inability to carry on any physical activity without discomfort
-discomfort increases with
any physical activity
Class 4
A relatively rare condition of excessive vomiting during pregnancy
Hyperemesis Gravidarum
usually during the 1st 10 weeks of pregnancy
3 Medications given for uncontrolled nausea and vomiting
Pyridoxine (B6) or with doxylamine (Unisom)
Promethazine (Phenergan)
Metoclopramide (Reglan)
Refers to the premature dilatation of the cervix, usually in the 4th or 5th month. Associate w/2nd Trimester abortions
Incompetent cervix
Why does an incompetent cervix open too early?
Due to the pressure exerted by the growing fetus
An incompetent cervix is traditionally managed by a ____ operation
Shirodkar-Barter (Cerclage)
Shirodkar-Barter (Cerclage) Operation is a modification of a ___ operatoin
Mcdonald
Majority of spontaneous abortion are related to ___abnormalities
chromosomal
Most miscarriages occur before the ___week of pregnancy
14th
What type of Abortion?
- embryo or fetus is jeopardized by unexplained bleeding, cramping, and backache.
- Cervix is closed
- bleeding may persist for days
- maybe followed by partial or complete expulsion of the embryo or fetus, placenta, and membranes.
Threatened Abortion
What type of Abortion?
- bleeding and cramping increase
- internal cervical os dilates
- membranes may rupture
Imminent Abortion
What type of Abortion?
-all products of conception are expelled.
Complete Abortion
What type of Abortion?
-the fetus die in utero but was not expelled. Uterine growth ceases, breast changes regress and the woman may report a brownish vaginal discharge.
Missed Abortion
What type of Abortion?
-(formerly called habitual abortion). Abortion occurs consecutively in three or more pregnancies.
Recurrent pregnancy loss
What type of Abortion?
- presence of infection. May occur with prolonged:
- -unrecognized rupture of the membranes
- -pregnancy with intra-uterine device (IUD) in utero
- -attempts of unqualified individuals to terminate a pregnancy.
Septic Abortion
(1st Trimester) Abortion Assessment:
Vaginal spotting, perhaps slight cramping
Threatened Miscarriage
(1st Trimester) Abortion Assessment:
Vaginal spotting, cramping, cervical dilatation
Imminent miscarriage
(1st Trimester) Abortion Assessment:
Vaginal spotting, perhaps slight cramping, no apparent loss of pregnancy
Missed miscarriage
Abortion Assessment:
Vaginal spotting, cramping, cervical dilatation, but incomplete expulsion of uterine contents
Incomplete Miscarriage
Abortion Assessment:
Vaginal spotting, cramping, cervical dilatation, andcomplete expulsion of uterine contents
Complete miscarriage
Assessment:
Sudden unilateral lower abdominal quadrant pain,; minimal vaginal bleeding, possible signs of shock or hemorrhage
Ectopic (tubal pregnancy
Assessment:
Overgrowth of uterus; highly positive human chorionic gonadotropin (hCG) test; no fetus present on sonogram; bleeding from vagina of old or fresh blood accompanied by cyst formation
Hydatidiform Mole (gestational trophoblastic disease)
(2nd Trimester) Assessment:
Painless bleeding leading to expulsion of fetus
Premature Cervical Dilatation
Retained trophoblast tissue can lead to ____
Choriocarcinoma
At 1st trimester when the fetal contents are not expelled within 4-6 weeks what is done?
D&C
At 2nd trimester when the fetal contents are not expelled within 4-6 weeks what is done?
Induction of Labor
The placenta is implanted in the lower uterine segment rather than the upper portion of the uterus.
Placenta previa
What type of Placenta Previa?
the internal os is completely covered
Total
What type of Placenta Previa?
internal os is partially covered
Partial
What type of Placenta Previa?
the edge of the internal os is covered
Marginal
What type of Placenta Previa?
placenta is implanted in the lower uterine segment in close proximity but not covering the os.
Low lying
The premature separation of a normally implanted placenta from the uterine wall.
Abruptio placenta
What type of Abruptio placenta?
-placenta separates at it’s edges, the blood passes between the fetal membranes and the uterine wall, and the blood escapes vaginally (also called marginal sinus rupture)
Marginal
What type of Abruptio placenta?
-the placenta separates centrally and the blood is trapped between placenta and the uterine wall. Entrapment of the blood results in concealed bleeding.
Central
What type of Abruptio placenta?
-massive vaginal bleeding is seen in the presence of total separation.
Complete
The rupture of the amniotic sac and leakage of amniotic fluid beginning at least 1 hour before the onset of labor at any gestational age.
Premature Rupture of membranes (PRoM)
Premature Rupture of membranes (PRoM) is when membranes rupture before ____ weeks gestation
37
Pregnancy in which implantation occurs outside the uterine cavity
Ectopic pregnancy
A red flag for a ruptured ectopic pregnancy
Shoulder pain when lying down
An unruptured ectopic pregnancy is usually treated with ______
methotrexate
A folic acid antagonist chemotherapeutic agent that attacks and destroys fast growing cells, used for ectopic pregnancy
methotrexate
An abortifacient, effective at causing sloughing of the tubal implantation site.
Mifepristone
Therapy for ruptured ectopic pregnancy is ___to ligate the bleeding vessel and to remove or repair the damaged fallopian tube.
laparoscopy
H mole or gestational trophoblastic disease may happen in women with blood type ____ who married men with blood type _____
A
O
What type of Molar growth?
- all trophoblastic villi swell and become cystic.
- if an embryo is formed it dies early at 1-2 mm in size, with no fetal blood present at the villi.
Complete mole
What type of Molar growth?
- some of the villi form normally, however swollen and mishapen.
- a macerated embryo of approximately 9 weeks gestation maybe present in the villi
Partial Mole
H-mole management
After__months, if hCG level are still negative the woman is theoretically free of any malignancy developing.
After __months, the woman can have the 2nd pregnancy.
6
12
The drug of choice for choriocarcinoma.
methotrexate
- the most common medical complication of pregnancy.
- a significant contributor to maternal and perinatal morbidity and mortality
Hypertension
Pregnancy induced hypertension is manifested with a systole elevation of ____ and diastole elevation of _____ or a BP of ______ on 2 consecutive readings at least 6 hours apart
> 30 mm Hg
15 mm Hg
140/90 mm Hg
- onset of HPN without proteinuria after 20 weeks of pregnancy
- development of mild hypertension during pregnancy in previously normotensive women without proteinuria or pathologic edema
Gestational HPN
-development of proteinuria after 20 weeks of gestation in previously non-proteinuric woman without hypertension
Gestational Proteinuria
-development of HPN and proteinuria in previously normotensive woman after 20 weeks of gestation or in an early postpartum period; in presence of trophoblastic disease it can develop before 20 weeks gestation
Preeclampsia
HPN and /or proteinuria in pregnant women prior to 20 weeks gestation and persistent after 12 weeks postpartum.
Chronic Hypertension
-development of preeclampsia or eclampsia in woman with woman with chronic hypertension prior to 20 weeks gestation.
Superimposed preeclampsia or eclampsia
