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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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Family Nurse Practitioner (FNP) flashcards
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
Q

health education for pregnancy

A

folic acid 400mcg (start 3 months before conception)
avoid soft cheese (blue/brie)
no hot tubs

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26
Q

pregnancy weight gain for obese pt

A

11-20lb

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27
Q

when is fetal heart tones heard

A

10-12 weeks by doppler ( end of 1st tri)

20 by fetascope

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28
Q

“probable” pregnancy signs

A 
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
Q

positive pregnancy sign (for sure)

A

palpation of fetus
ultrasound
fetal heart sounds

10-12 weeks by doppler ( end of 1st tri)
20 by fetascope

30
Q

palpation of fetal mvt (quickening) is what kind of sign

A

“probable”, NOT positive (positive, is actual palpation of the fetus body)

31
Q

hog blood test what kind of sign

A

probable. HcG also present in molar pregnancy, ovarian cancer

32
Q

when is FHT heard by dopper

A

10-12 wk s

33
Q

20 wks

A

fhb heard by stethoscope

fundus @ umbilicus

34
Q

size and date discrepancy

A

if >2cm order ultrasound for further evaluation

35
Q

heart position and heart changes during pregnancy

A

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
Q

htn medication used during pregnancy

A

methylodopa (aldomet) alpha-adrenergic antagonist

labetolol ( normodyne) BB

37
Q

heart sounds during pregnancy (later) dt > blood volume

A

systolic ejection murmur (SEM)

mammary souffle- bilateral murmur in mammary vesseles

38
Q

vena cava during pregnancy

A

compression by uterus causes hypotension, lay on left

39
Q

lung changes

A

uterus pushes UP the diaphragm, diameter of the thorax is increased

40
Q

hemoglobin during pregnancy

A

decreases due to hemodilution ( more fluid in the body)

HH: ranges from 9.5-10 is NORMAL ( normal is 12-14)

41
Q

thyroid during pregnancy

A

increase, 15% larger

free t3 mildly elevated

42
Q

renal system during pregnancy

A

kidneys increase in size
GFR increases dt >cardio output/renal blood flow

normal GFR: >90

43
Q

Naegele’s rule

A

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
Q

placenta previa vc abruptio ( uterus)

A

previa: BRIGHT RED vaginal bleeding, PAINLESS, without a tender uterus
abruptio: Hypertonic, HARD uterus

45
Q

who should be screened for tay sachs

A

askenazi (euro) jew

46
Q

GPA for pregnancy

A

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
Q

when to give rhogam

A

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
Q

coombs test (direct vs indirect)

A

direct- done on infancy
indirect- done on mom

detects Rh antibodies in the MOTHER

49
Q

when is rhogam given

A

2 times!

300mcg IM @ 28 wks
2nd dose within 72 hours ( or sooner) AFTER delivery

50
Q

what does rhogam do?

A

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
Q

risk factors for gestational DM mom

A

obesity, baby >albs, previous GDM.

52
Q

screening fo GDM

A

28 wks

75g 2 hour glucose tolerance test (OGTT)

53
Q

GDM treatment

A

LIFESTYLE first! diet and exercise
monitor 4-6x/day
insulin if can’t be controlled
NO ORAL medication

54
Q

asymptomatic bacteriuria

tx

A

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
Q

risk of macrobid and sulfa during pregnancy

A

nitrofurantoin ( macrobid) causes hemolysis if mom has g6pd anemia.

56
Q

UTI during pregnancy

A

100,000 colony forming units (UTI) or 10 to the 5th power

57
Q

1st line for UTI during pregnancy

A

nitrofurantoin ( macrobid). AVOID during 3rd trimester

58
Q

spontaneous abortion

A

aka “miscarriage”, loss of fetus

59
Q

threatened abortion

A

vaginal bleeding, bur cervical os is closed

60
Q

incomplete abortion

A

vaginal bleeding with cramping, placental products remain. cervical os dilated, foul smelling ( BV)
tx: dilations with curettage (D&C) and antibiotics

61
Q

eclampsia

A

dsg if SEIZURES

62
Q

preelampsia ( pregnancy induced HTN)

A

can occur late 3rd trimester OR 4 wks postpartum

s/s: headache, blurry vision, right upper quadrant pain

63
Q

triad for preeclampsia

A

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
Q

previous HTN during pregnancy

A

stop if on ace/arb

most moms can stop during first and 2nd trimester due to less peripheral vascular resistance

65
Q

placenta abruptio

defintion, controllable risk factors, s/s

A

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
Q

placenta previa s/s and tx

A

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
Q

how often will newborns nurse 24 hour period

A

10-12 ( every 2 hours)

68
Q

medication for BF mastitis

A

dicloxacillin 500mg or cephalexin (keflex)

mrsa risk: bactrim (trimesthorpim-sulfamethoxazole) or clindaymycin

CONTINUE BF

69
Q

chlamydia during pregnancy

A

treat to

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