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joy's deck for FNP > women's health pregnancy and childbirth > Flashcards

women's health pregnancy and childbirth Flashcards

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1
Q

placenta abrutio

A

PAINFUL
SUDDEN onset of vaginal bleeding with hard (hypertonic) uterus. > risk with HTN, cocaine. if severe, baby must be delivered

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2
Q

placenta previa

A

PAINLESS vaginal bleeding
bright red, uterus SOFT
bed rest, no intercourse
magnesium sulfate if cramping

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3
Q

severe preeclampsia

A 
only cure is delivery
s/s 
lated 3rd trimester
SEVERE sudden headache
edema, weight gain >2lb/week
HIGH blood pressure
protein in urine
  • IF seizure= eclampsia
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4
Q

HELLP syndrome (hemolysis, >liver enzymes, Low platelet)

A

complication of preeclampsia
RIGHT upper quadrant pain, n/v
?ALT
?AST

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5
Q

protein in urine during pregnancy

abnormal labs and what to do

A

check midstream urine
protein from 1+ to 4+ is abnormal
if >20 wks, r/o preeclampsia

ir protein present urder 24 hour urine (for protein and creatinine clearance)

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6
Q

which lab > during pregnancy as normal

A

Alkaline phosphate (ALP) (dt growth of fetal bones)
WBC (up to 16,000) “leukocytosis and neutrophilia” is normal, check s/s
H/H decrease
ESR increase
t3/t4 increase

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7
Q

What is a high neutrophil count?

A

What is a high neutrophil count?
Neutrophil are the primary white blood cells that respond to a bacterial infection, so the most common cause of neutrophilia is a bacterial infection, especially pyogenic infections. Neutrophils are also increased in any acute inflammation, so will be raised after a heart attack, other infarct or burns.

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8
Q

Leukocytosis

A

Leukocytosis is defined as a total WBC value of greater than 11,000/microL in adults

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9
Q

normal ANC

A

norm ANC: 2,500 and 6,000.

The ANC is found by multiplying the WBC count by the percent of neutrophils in the blood

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10
Q

Low AFP results and triple screen

A

risk for down’s dt maternal age >35yo

if APT Is low order triple screen; AFP, HCG, estriol, inhibit A

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11
Q

screen in jewish for which genetic disorder

A

tay-sachs (fatal neurological disease, no cure)

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12
Q

screen in whites for which genetic disorder

A

cystic fibrosis

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13
Q

doubling time

A

doubling of hcg, only good for 1st trimester ONLY

if values lower than normal, r/o ectopic or inevitable abortion

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14
Q

vaginal cultures during pregnancy and tx

A

group B; 35-37wks swab introits and rectum

is positive tx with PCN G IV, or clinda/erythro if allergic

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15
Q

which STD to screen in pregnancy

A 
hiv
hep b, hep c
herpes 1 and 2
gonorrhea/chlamydia
syphilis
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16
Q

titers to check during pregnancy

A

rubella

varicella

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17
Q

most drugs are CATegory B, animal studies show NO risk, no human data available.
cat B drugs

A

antacids (tums, maalox)
colace
analgesics (acetaminiphin)

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18
Q

antibiotics for pregnancy ok / contraindicated

A

cat B:
PCN,cephalosporin, macrobid
macrolides- except CLARITHROMCIN (Biaxin)- category C
nitrofurantoin (furandantin, macrobid)- don’t us in g6pd anemia dt hemolysis (anemia, jaundice, dark urine)

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19
Q

category C

A

septra
nsaids

adverse in animals, no human data

trimethroprim-sulfamethoxazole (bactrim/septra DS)
nsaids (blocks prostaglandins)

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20
Q

what category is ibuprofen/advil during pregnancy

A 
category B (1st and 2nd tri)
category D (3d trimester!)- evidence of fetal risk
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21
Q

category D

A

Acei/arb (ie: capoten/captopril, losartan/hyzaar)

fluroroquinolones (cipro, floxin, levaquin)
* achillis heal rupture/can’t use under 18!

tetracycline- teeth stain (minocycline)

NSAID- premature labor, blocks prostaglandin

SULFa- risk of hyperbilirunemia (neonatal jaundice, kernicterus).

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22
Q

category X

A

proven fetal risk

accutane
methotrexate- anti metabolite (tx for autoimmune; RA, psoriasis,cancers)
proscar (anti androgen)- BPH, prostate cancer
** misoprostol- drugs for abortions
evista (osteoporosis rx)

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23
Q

LIVE vaccines

A

LAIV flu mist (flu injection OK)
varicella
MMR
oral polio

  • note: after LAIV, reproductive femals should use reliable birth control in the next 4 weeks (MMR) or 3 months (varicella)
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24
Q

teratogens - causes structural abnormalities in fetus

A

alcohol
aminoglycosides (“mycin”, gentamycin, neomycin, streptomycin)
lithium
chronic hyperglycemia ( poorly controlled DM) can cause neural tube defects/craniofacial defects

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25
health education for pregnancy
folic acid 400mcg (start 3 months before conception) avoid soft cheese (blue/brie) no hot tubs
26
pregnancy weight gain for obese pt
11-20lb
27
when is fetal heart tones heard
10-12 weeks by doppler ( end of 1st tri) | 20 by fetascope
28
"probable" pregnancy signs
``` goodell's- cervical softening@ 4 wks chadwicks- blue discoloration 6 wks hegar's- softening uterine isthmus 6 wks ballottement urine or blood (hct) test "quickening"- mother feels baby move starting at 16 wks ```
29
positive pregnancy sign (for sure)
palpation of fetus ultrasound fetal heart sounds 10-12 weeks by doppler ( end of 1st tri) 20 by fetascope
30
palpation of fetal mvt (quickening) is what kind of sign
"probable", NOT positive (positive, is actual palpation of the fetus body)
31
hog blood test what kind of sign
probable. HcG also present in molar pregnancy, ovarian cancer
32
when is FHT heard by dopper
10-12 wk s
33
20 wks
fhb heard by stethoscope | fundus @ umbilicus
34
size and date discrepancy
if >2cm order ultrasound for further evaluation
35
heart position and heart changes during pregnancy
heart is displaced horizontal and rotate left (increases the transverse diameter) cardio output, plasma volume, heart rate all INCREASE BP may decrease ( mom can be off htn medication.
36
htn medication used during pregnancy
methylodopa (aldomet) alpha-adrenergic antagonist | labetolol ( normodyne) BB
37
heart sounds during pregnancy (later) dt > blood volume
systolic ejection murmur (SEM) | mammary souffle- bilateral murmur in mammary vesseles
38
vena cava during pregnancy
compression by uterus causes hypotension, lay on left
39
lung changes
uterus pushes UP the diaphragm, diameter of the thorax is increased
40
hemoglobin during pregnancy
decreases due to hemodilution ( more fluid in the body) | HH: ranges from 9.5-10 is NORMAL ( normal is 12-14)
41
thyroid during pregnancy
increase, 15% larger | free t3 mildly elevated
42
renal system during pregnancy
kidneys increase in size GFR increases dt >cardio output/renal blood flow normal GFR: >90
43
Naegele's rule
used to estimate delivery date (EDD) during the first trimester with regular menstrual cycle SUBTRACT 3 months from the month of the last menstrual period and ADD 7 days
44
placenta previa vc abruptio ( uterus)
previa: BRIGHT RED vaginal bleeding, PAINLESS, without a tender uterus abruptio: Hypertonic, HARD uterus
45
who should be screened for tay sachs
askenazi (euro) jew
46
GPA for pregnancy
gravida: number of total pregnancies ( regardless of outcome) para: number of BIRTHS >20 weeks ( no matter outcome). twins count as 1 abortions- lost more > 20 weeks (induced or spontaneous abortion)
47
when to give rhogam
to ALL rh- mothers regardless if they miscarriage, abortion, or ectopic pregnancy aka; anti- D immune globulin (from igG) if NOT given will cause fetal hemolysis/anemia in future pregnancies
48
coombs test (direct vs indirect)
direct- done on infancy indirect- done on mom detects Rh antibodies in the MOTHER
49
when is rhogam given
2 times! 300mcg IM @ 28 wks 2nd dose within 72 hours ( or sooner) AFTER delivery
50
what does rhogam do?
it decreases risk of isoimmunization of the maternal immune system by destroying fetal rh positive RBC that have crossed the placenta doesn't affect current baby, just FUTURE baby
51
risk factors for gestational DM mom
obesity, baby >albs, previous GDM.
52
screening fo GDM
28 wks | 75g 2 hour glucose tolerance test (OGTT)
53
GDM treatment
LIFESTYLE first! diet and exercise monitor 4-6x/day insulin if can't be controlled NO ORAL medication
54
asymptomatic bacteriuria | tx
ALWAYS treat dt risk for pyelonephiritis. tx: antibiotics, fluids, fre/post urine C&S nitrofurantoin (Macrobid) or amoixcillin (augmentin) ** DO NOT USE MACROBID during 3rd trimester dt risk of bilirubinemenia
55
risk of macrobid and sulfa during pregnancy
nitrofurantoin ( macrobid) causes hemolysis if mom has g6pd anemia.
56
UTI during pregnancy
100,000 colony forming units (UTI) or 10 to the 5th power
57
1st line for UTI during pregnancy
nitrofurantoin ( macrobid). AVOID during 3rd trimester
58
spontaneous abortion
aka "miscarriage", loss of fetus
59
threatened abortion
vaginal bleeding, bur cervical os is closed
60
incomplete abortion
vaginal bleeding with cramping, placental products remain. cervical os dilated, foul smelling ( BV) tx: dilations with curettage (D&C) and antibiotics
61
eclampsia
dsg if SEIZURES
62
preelampsia ( pregnancy induced HTN)
can occur late 3rd trimester OR 4 wks postpartum s/s: headache, blurry vision, right upper quadrant pain
63
triad for preeclampsia
1) hypertension 2) protein (>.3g in 24 hour specimen) proteinuria ranges from trace to sever (1+ to 4+. ) look at hands and face. 3) edema (gained 1 plus pound per week)
64
previous HTN during pregnancy
stop if on ace/arb | most moms can stop during first and 2nd trimester due to less peripheral vascular resistance
65
placenta abruptio defintion, controllable risk factors, s/s
partial to complete separation of placenta from the uterine bed controllable risk factors: smoking, cocaine, HTN, "seatbelt" s/s: sudden vaginal bleeding, pain, uterus is "hypertonic/rigid and tender"!
66
placenta previa s/s and tx
uterus is SOFT and NON tender ``` refer to ED NO bimanual exam, Ultrasound only bed rest if contractions, give mgSO4 (mag sulfate) c section prn ```
67
how often will newborns nurse 24 hour period
10-12 ( every 2 hours)
68
medication for BF mastitis
dicloxacillin 500mg or cephalexin (keflex) mrsa risk: bactrim (trimesthorpim-sulfamethoxazole) or clindaymycin CONTINUE BF
69
chlamydia during pregnancy
treat to

joy's deck for FNP (24 decks)

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