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NURS 372 > Week 2: Antenatal Care > Flashcards

Week 2: Antenatal Care Flashcards

1
Q

nausea/vomiting is a ______ sign of preg

A

presumptive

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2
Q

this is morgan’s second pregnancy (GA 13 wks). her 1st preg ended in a spontaneous abortion at 8 weeks. whats correct?
1) G2T0P1A0L0
2)G1T0P1A1L0
3)G2T0P1A0L0
4)G2T0P01L0

is she a primigravisa
is she a primipara

A

G2T0P0A1L1
so 2

she is not a primigravida
she is no a primipara

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3
Q

during preg do u get cardiac hypertrophy

A

yes, slightly

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4
Q

during preg what happens to HR

A

increases by 10-15bpm

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5
Q

what happens to the positioning of the heart during preg

A

enlarged uterus displaces diaphragm, elevating heart slightly and rotates to the left

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6
Q

what happens to blood volume during preg

A

increases by 1500 mL or 40-50% above pre-preg levels

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7
Q

what happens to RBC’s during preg

A

mass increase

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8
Q

what happens to hemoglobin and hematocrit during preg

A

decreases resulting in a state of hemodilution (physiological anemia)

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9
Q

what happens to WBC during 2nd and 3rd trimester

A

increase, peaking in 3rd

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10
Q

what happens to cardiac output during preg

A

increases by 30-50%

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11
Q

what happens to systolic BP during preg and for diastolic

A

systolic: has slight or no decreases from pre-preg levels
diastolic: has slight decrease mid preg (24-32 weeks) returning to norm by end of preg

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12
Q

what are some physical changes + risk in CVS during preg

A
  • dependent edema
  • varicose veins and hemorrhoids develop as part of compression of the iliac vein and inferior vena cava
  • increased risk of blood clots due to increased clotting factors
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13
Q

describe supine hypotensive syndrome

A

during second half of preg, clients lying on back will cause compression of the vena cava
can decrease systolic bp
reflex bradycardia
cardiac output decreases

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14
Q

supine hypotensive syndrome s/s

A

pallor, dizziness, faintness, breathlessness, tachycardia, nausea, clammy, diaphoretic

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15
Q

interventions for supine hypotensive syndrome

A

position client on their left side until s/s go away and vitals stable

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16
Q

how does o2 consumption change in preg

A

by 20-40%

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17
Q

how does RR change in preg

A

unchanged or slight increase

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18
Q

what happens to chest expansion during preg

A

increased

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19
Q

what happens to tidal volume during preg

A

increased by 30-40%

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20
Q

what happens to congestion and vascularity of Upper resp tract

A

increased
(nasal stiffness, nosebleeds, sense of fullness in ears)

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21
Q

what happens to renal pelvis and ureters during preg

A

dilate

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22
Q

what happens w urinary stasis or stagnation

A

increased risk of UTIs

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23
Q

what happens w urinary frequency during preg

A

increased due to increased bladder sensitivity and compression on bladder

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24
Q

what happens to bladder tone during preg

A

may decrease

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25
Q

what happens to GFR and renal plasma flow

A

increase in early preg

  • physiological or dependent edema results from decreased renal blood flow and GFR near end of preg
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26
Q

what happens to nipples, areola, axillae, vulva during preg

A

darkens

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27
Q

what is chloasma

A

called the mask of preg

causes blotchy, brownish hyperpigmentation in cheeks, nose, and forehead

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28
Q

what is linea nigra

A

pigmented line extending from symphysis pubis to top of fundus

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29
Q

what is striae gravidarum

A

stretch marks
appear in 50-90% of preg women

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30
Q

what happens to ur nail and hair growth during preg

A

increased

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31
Q

name 7 things that change to breasts during preg

  1. to estrogen and progesterone
  2. to blood vessels
  3. to nipples and areola
  4. to nipples
  5. to montgomery tubercles
    6: what happens to the breastfeeding ducts
  6. colostrum
A
  1. increase resulting in fullness and sensitivity
  2. become more visible
  3. become more pigmented
  4. become more erectile
  5. sebaceous glands that secrete lubrication and anti-infective substances to help protect nipples and areola during breastfeeding
  6. creamy, white to orange premilk fluid may be expressed from nipples
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32
Q

what happens to the uterus overall in preg

A

changes in size, shape, position due to estrogen and progesterone levels

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33
Q

what happens to the uterus btwn 12-14 weeks

A

palpable above symphysis pubis

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34
Q

what happens to the uterus at 20-22 wks

A

rises gradually to level of umbilicus

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35
Q

what is Hegar sign

A

softening and compressibility of lower uterine segment

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36
Q

after 4 months of preg _____________ can be felt thru abdomen

A

braxton hicks

irreg and intermittent contractions to facilitate uterine blood flow thru placenta and promote O2 delivery

not painful, do not increase in intensity or cause cervical dilation

37
Q

goodell sign

A

softening of cervical tip

38
Q

what happens to the friability of the vagina after a exam

A

increases and slight bleeding can occur

39
Q

what does the cervix of the nullpara look like

A

is round
after birth, cervix becomes oval in horizontal plane and external os appears as a transverse slit

40
Q

chadwick sign

A

increased vascularity resulting in a violet-bluish colour of the vaginal mucosa and cervix

41
Q

leukorrhea

A

white or slightly grey mucoid discharge w faint musty odour in response to increased estrogen and progesterone

42
Q

what happens to the pH of vaginal secretions

A

changes in thickness and pH of vaginal secretions acts as a barrier against some organisms (bacteria, yeast)

43
Q

why is nausea/vomiting common in early preg

A

in response to hCG and altered carbohydrate metabolism

44
Q

what happens to the gums in preg

A

increasingly swollen and vascular c/o excessive saliva

45
Q

what are poor dental health/gingivitis risk factors

A

preterm birth, LBW, pre-eclampsia

46
Q

why is it possible to get carpal tunnel syndrome in preg

A

caused by edema that compresses the median nerve

47
Q

other changes in relation to neuro for preg

A

numbness of hands
tension headaches
faintness or syncope

48
Q

acroesthesia

A

numbness of hands

49
Q

9 things in routine antenatal assessment

A
  • confirm gestation age
  • current weight + BMI
  • bp
  • urinalysis
  • symphysis fundal height in cm
  • fetal pres
  • fetal HR
  • fetal movement
  • health teaching discussion
50
Q

what is fundal height, what is it an indicator of

A

distance from symphysis pubic bone to top of uterus measured in cm, shows fetal growth

51
Q

from gestational weeks 18 fundal height should be…

A

equal to gestational age (+/- 2cm)

52
Q

prior to assessment what should u ask pt to do

A

pee as a full bladder can cause variations

53
Q

what can cause variation in fundal height measurement

A
  • position of the fundus
  • position of fetus
  • variations in the amount of amniotic fluid
  • presence of more than one fetus
  • maternal obesity
  • variation in examiner technique
54
Q

when is leopold’s maneuver

A
  • completed in 3rd trimester to assess for fetal lie, presentation, attitude, position, and engagement
55
Q

what should fetal HR be

A

btwn 110-160/min

56
Q

1.when do some women feel movement
2.by 24 wks what should you feel
3.why are baby kicks important/minimum amount/2hrs

A

1.as early as 13-16 wks
2. you should feel kicks in a predictable way
3. daily kick counts are recommended in high risk pregnancies, count baby’s movements in 2 hrs, minimum of 6 movements in 2 hours

57
Q

what classifies a baby as having LBW

A

2500g or less

58
Q

what is the recommended weight gain during pregnancy for someone w a BMI of 21

A

25-35 lbs

59
Q

what does a test for hemoglobin look at

A

Hb screens for anemia

60
Q

what does a ABO/Rh(D) test look for

A

refers to major blood types
Rh neg status is important to note as immune globulin is required

61
Q

what does an antibody screen look at

A

any circulating antibody measured by indirect Coombs

+‘ve screen warrants additional testing in order to identify specific antibody as some will have implications for fetus

62
Q

MCV test

A

any abnormality in red cell volume
low MCV may indicate iron deficiency or thalassemia

63
Q

why do we check platelets

A

thrombocytopenia is common in preg and may represent benign or pathological conditions which require diagnosis and follow up

64
Q

rubella, varicella, parvovirus B19 titre

A

determines immunity to rubella, chicken pox, and parvovirus

65
Q

what does the HBsAg test look for

A

presence of Hep B surface antigen indicates prior Hep B infection and carrier status

66
Q

Syphilis, gonnorhea, chlamydia, HPV

A

screen everyone. consider rescreening those at risk of acquiring during each trimester

67
Q

HIV

A

offer screening to everyone
consider rescreening those at risk of acquiring HIV during preg in each trimester

68
Q

urine c&s

A

screen everyone for asympt bacteriuria preferable in 1st trimester or at 1st presentation and treat if positive

69
Q

what are immunizations that are recommended for pregnant clients

A
  1. tetanus, diphtheria, pertussis (Tdap) vaccine (21-32 weeks gestation)
  2. influenza (flu) vaccine
  3. COVID vaccine
  4. Respiratory syncytial virus (RSV) vaccine (32 and 36 weeks gestation)
70
Q

what is included in fetal assessment (7 things)

A

prenatal screening
CVS/amniocentesis
ultrasounds
SFH monitoring growth
fetal health surveillance
fetal movement counting
biophysical profile

71
Q

major uses of ultrasound

A
  • confirm preg and viability
  • determine gestational age
  • prenatal screening
  • assess level of amniotic fluid
  • detect fetal growth/position
  • detect placental previa or abruption
72
Q

is prenatal screening mandatory

A

all optional
screening is not diagnostic
does not test for everything
all preg ppl have chance for trisomy 21, 18, and 13

73
Q

3 prenatal screenings that are noninvasive

A
  1. enhanced 1st trimester (eFTS)
  2. second trimester serum
  3. integrated prenatal (IPS)
74
Q

non-invasive prenatal testing (NIPT)

A
  • screens method for prenatal genetic material using cell-free DNA
  • performed anytime after 9-10 wks until the end of preg
  • high detection rates Down Syndrome, trisomy 13, trisomy 18
  • screens for sex chromosome disorders
  • maternal venipuncture and results available in about 10 days
  • provincial OHIP coverage for this test is currently limited to specific clinical circumstances
75
Q

what is amniocentesis and when is it done, indications

A

GA>15 weeks

used for genetic information, fetal maturity, fetal hemolytic disease

76
Q

when is chorionic villus sampling done

A

GA 10-13 wks

77
Q

with risk of fetomaternal hemorrhage, Rh what should happen

A

pts should recieve Rh immune globulins (Winrho) to avoid isoimmunization

78
Q

amniocentesis maternal risks

A

hemorrhage, fetomaternal hemorrhage, infection, labour, abruptio placentae, damage to intestines or bladder, amniotic fluid embolism

79
Q

amniocentesis fetal risks

A

dealth, hemorrhage, infection, injury from needle, miscarriage or preterm labour, leakage of amniotic fluid

80
Q

what are the 5 discrete biophysical variables

A

fetal movement, fetal tone, fetal breathing movements, amniotic fluid volume, FHR

81
Q

normal/abnormal for NST/reactive FHR

A

norm (2 points): at least 2 accelerations in 20 min
abnorm (0 points): less than 2 accelerations to satisfy test in 20 min

82
Q

normal/abnormal for US: fetal breathing movements

A

Norm: min one episode of >30 sec in 30 min
abnorm: none or less than 30 sec in 30 min

83
Q

normal/abnormal for US: fetal activity/gross body movements

A

norm: at least 3 movements of torso or limbs
abnorm: less than 3 movements

84
Q

normal/abnormal for US: fetal tone

A

norm: at least 1 episode of active bending and straightening of limb or trunk
abnorm: no movements or movements slow and incomplete

85
Q

normal/abnormal for US: qualitative AFV/AFI

A

norm: at least 1 vertical pocket > 2cm or more in the vertical axis
abnorm: largest vertical pocket </=2cm

86
Q

lily has a BPP at 38 wks gestation. FHR was 140 with 2 spontaneous accelerations. fetus has 2 episodes a practice breathing for 35 seconds. fetus was well flexed and moved actively throughout the assessment. amniotic fluid largest vertical fluid pocket was 0.75cm. whats the BPP score?

A

8

87
Q

what blood test indicates further follow up related to potential development of erythroblastosis fetalis

A

RH neg

88
Q

@ 26wks gestation how many cm should fundal ht be

A

26 cm +/- 2cm

89
Q

@26 wks gestation, expected fetal HR is

A

110-160

NURS 372 (6 decks)

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