OB Module 2

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hoving22
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133837
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OB Module 2
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2012-02-15 15:14:28
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3612 OB module
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Mostly vocab and info from slides
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  1. a disturbance or conflict in which the individual cannot maintain a state of equilibrium
    crisis

    Maturational crisis- pregnancy
  2. neutral attitude toward pregnancy

    is it normal?
    ambivalence

    yes, expected finding
  3. key psychological task of the mother during pregnancy
    ensuring safe passage through pregnancy, labor and birth
  4. fathers attitude during the first trimester
    excited
  5. fathers attitude during the second trimester
    involvement increases
  6. fathers attitude during the third trimester
    anticipation, roles more defined
  7. signify transition to fatherhood in ancient times

    or

    physical symptoms of pregnancy (wt gain, nausea) in father
    couvade syndrome
  8. 1st trimester
    1-13 weeks
  9. 2nd trimester
    14-26 weeks
  10. 3rd trimester
    27-40 weeks
  11. before deliverty; pregnant not in labor
    antepartum
  12. in labor
    intrapartum
  13. time period following the delivery of the baby
    postpartum
  14. any pregnancy that does not maintain viability beyond 20 weeks
    abortion
  15. refers to the total number of pregnancies a woman has had, regardless of outcome, and including current pregnancy
    gravidity
  16. refers to the outcome of a pregnancy
    parity
  17. a woman who has never been pregnant
    nulligravida
  18. a woman who is pregnant for the first time
    primigravida
  19. a woman who has had many pregnancies
    multigravida
  20. EDC, EDD, EDB
    expected date of birth etc. due date
  21. nagels rule
    First day of LMP-3months+7days=EDB
  22. reasons nagels rule may be inaccurate
    • irregular menses
    • ovulating with amenorrhea
    • abortion
    • d/c of contraceptives
  23. occurs with each visit and should correspond to # of weeks gestation
    uterine assessment
  24. at ___wks the uterus can be palpated
    10-12 wks
  25. fundal height =
    cm from symphysis pubis to the top (fundus) of uterus
  26. position for measuring fundal height
    supine with legs straight out
  27. quickening occurs at __ wks
    16-20 wks
  28. Fetal heart beat can be auscultated externally with a doppler at ___ wks
    10-12 wks
  29. fetal heart activity can be seen on ultrasound at __ wks
    6-7 wks
  30. determines adequacy of the pelvic measurements for delivery
    pelvimetry
  31. most conducive pelvis shape to vaginal delivery
    gynecoid pelvis
  32. prenatal visit schedule

    every ___ through ___
    every ___ through ___
    every ___
    • 4 wks through 28 wks
    • 2 wks through 36 wks
    • every week until delivery
  33. every prenatal visits include:
    • weight
    • VS
    • fundal height
    • FHTs
    • labs as indicated
    • psychosocial assessments
    • urine dip (ketones, protein, infection)
  34. increases for about 90 days, should double q48 hrs; during the 1st trimester
    quantitative HCG
  35. decreased levels of ______ may indicate impending abortion during the 1st trimester
    progesterone level
  36. used to determine viability or establishment of a EDC/ validates LMP in the 1st trimester
    ultrasound
  37. Amniocentesis

    results may take up to ___

    pt should be on bed rest with no lifting for __
    2 weeks

    24-48 hours
  38. chorionic villus sampling is performed at ___ weeks for earlier detection of fetal anomalies
    10-12 weeks
  39. may indicate down's syndrome
    decreased MSAFP
  40. may indicate NTD
    increased MSAFP
  41. "Triple screen" tests for
    • MSAFP
    • estriol
    • hCG
  42. "Quad screen" tests
    • MSAFP
    • estriol
    • hCG
    • inhibin A
  43. desired number of fetal kick count per hour
    3-4
  44. Non stress test
    box 19-7 p. 576
  45. signs of pregnancy felt by the woman are ____

    and a few examples
    presumptive signs

    • amenorrhea
    • N&V
    • fatigue
    • breast changes
  46. signs of pregnancy noted by the examiner
    Hegar's sign

    Chadwick's sign

    Braxton Hicks ctx

    pregnancy tests
  47. softening of the isthmus (area btwn the cx and the body of the uterus)
    Hegar's sign
  48. bluish discoloration of the cervix
    Chadwicks sign
  49. signs of pregnancy attributable only to the fetus (100% certain)
    positive signs
  50. examples of positive signs of pregnancy
    fetal heartbeat (10-12 wks)

    fetal movement palpated (19-22 wks)

    visualization of fetus
  51. practice contractions that stimulate blood flow through the placenta

    usually painless and intermittent and occur after the 4th month
    Braxton hicks contractions
  52. opening to the womb
    cervix
  53. estrogen stimulates the glandular tissue, resulting in ____ which leads to ____ and ____
    increased circulation

    • leads to goodells sign (softening)
    • chadwicks sign (blue coloring)
  54. meaning bleeds easily; due to increased vascularity
    friable
  55. small, yellow body that develpos within the ruptured ovarian follicle
    corpus luteum
  56. breast changes by the end of the 2nd month
    increased size

    veins visible

    pigmentation darkers

    tissue is more erectile
  57. inhibited until a decrease in estrogen occurs at birth
    lactation
  58. antibody-rich, yellow secretion expressed as early as the 4th month
    colostrum
  59. by the end of the 2nd trimester blood volume with increase ___
    45%
  60. cardiac output increases by ___ by 5 months gestation
    50%
  61. pulse rate increases by __-__ bpm during pregnancy
    10-15 bpm
  62. BP ___ up to 2nd trimester and ___ in 3rd trimester
    decreases

    increases
  63. due to enlarged uterus pressing down v. cava when supine
    venal caval syndrome (supine hypotensive syndrome)
  64. venal caval syndrome is corrected by ___
    lying on LEFT side, with a pillow under back
  65. Lab values
    focus on Hgb/Hct, WBC's, Platelets and blood glucose levels

    table 6-3 pg 180

    non pregnant vs pregnant
  66. an epidural will not be applied if plateles fall below ___
    100,000
  67. plasma volume increases at a more rapid rate than the RBC production, and hemodilution occurs

    lowered hematocrit
    physiologic anemia of pregnancy
  68. amt of air inspired with normal resp

    increased __-__ during pregnancy to meet the needs of the fetus
    tidal volume

    30-40%
  69. estrogen induced vascular congestion
    epistaxis (nosebleeds)
  70. typically effects cheeks, forehead and nose. a normal finding during preg, also called "mask of preg''
    chloasma
  71. a result of seperation of abdominal m.
    diastasis recti
  72. when a mother may have difficulty with memory or concentration
    placental steal
  73. does not cross the placenta
    insulin
  74. antagonist to insulin
    hPL(human placental lactogen)
  75. secreted by the trophoblast 10-14 days after first missed period. stimulates the corpus luteum to secrete progesterone and estrogen
    hCG
  76. promotes the uterus and breast tissue
    estrogen
  77. plays the greatest role in promoting preg
    progesterone
  78. causes softening of cervix, loosening of pelvis, inhibits contractility of the uterus
    relaxin
  79. weight gain during preg

    normal BMI
    above normal BMI
    below normal BMI
    • normal- 25-35
    • above normal- 15-25
    • below normal- 25-35
  80. generally, wt gain throughout pregnancy is __ the first 12 weeks and __ per week the remainder of pregnancy
    5lbs

    1lb
  81. As far as pregnant mothers are concerned the only increase in food pyramid recommendation is ___ products
    milk and milk products
  82. recommend to prevent neural tube defects
    folic acid
  83. recommended amount of folic acid during preg
    600mcg/day

    4mg if the mother has delivered a child with NTD
  84. assists with tissue formation and enhances absorption of iron
    vit c
  85. the practice of consuming non-food items such as starch, clay, dirt, ice
    PICA
  86. Allowed immunizations during preg
    • tetanus
    • diptheria
    • rembinant Hep B
    • Rabies
    • H1N1 injectable
  87. Whites classification of diabetes in preg
    the longer the individual has had diabetes, the more effects
  88. insulin dependent or non insulin dependent prior to preg
    pregestational diabetes
  89. can't meet insulin demands leading to hyperglycemia of the mother and fetus
    gestational diabetes
  90. results of pregestational diabetes on the fetus
    small for gestational age
  91. results of gestational diabetes
    LGA
  92. O'sullivan test
    1 hr glucose tolerance test perfored around 28 weeks
  93. O'sullivan test perameters
    do not have to be NPO

    any time of day

    drink 50g oral glucose, blood draw 1 hr later

    glucose>140mg/dl a 3hr is performed
  94. 3 hr GTT diagnostic perameters
    if any 2 values are elevated, it is diagnostic of GDM

    fasting should be 65-105

    1 hr post-prandials <130-140
  95. ranges from no limitations to inability to carry out any phyiscal activity

    NY heart assoc. classification
    class 1-4
  96. stress on the cardiovascular system in the preg mother is greatest at ___
    28-32 wks
  97. main dx of a cardiovascular disorder in preg
    altered tissue perfusion r/t cardiac decompensation
  98. Education for a preg mother regarding cardiovascular disorders
    report sx of chest discomfort or productive cough IMMEDIATELY
  99. most common medical disorder of preg (up to 60% of preg woman will develop it)
    Anemia
  100. normal Hct in non preg women
    37-47%
  101. considered normal level of Hct during preg
    33%
  102. as a result of physiologic anemia of preg Hgb can be as low as ___
    10.5g/dl
  103. take ___ to enhance the absorption of iron
    vit c
  104. a recessive autosomal disorder in which normal adult Hgb is abnormally formed. prone to clogging the cappilaries
    sickle cell hemoglobinopathy
  105. recurring episodes of tissue, joint and abdominal pain. SEVER FATIGUE
    s/s of sickle cell hemoglobinopathy
  106. HIV/AIDS exposure to the fetus occurs
    in utero

    during labor as a result of inoculation or ingestion of infected fluids

    through breast milk
  107. classifications of HTN
    table 21-1 p.625
  108. development of mild HTN during preg, w/o proteinuria or excessive edema, after 20 wks. usually resolves PP
    Gestational HTN
  109. HTN antepartum/before 20 weeks, or which continues 6 wks PP
    Chronic HTN
  110. increased BP, w/ proteinuria, in previously normotensive, preg woman, after 20 wks
    preeclampsia
  111. preeclampsia is characterized by a BP of ___ or an increase of ___ systolic or ___ diastolic
    >140/90

    • 30mm/Hg systolic
    • 15mm/Hg diastolic
  112. preeclampsia is characterized by proteinuria by a collection of a 24 hr urine with a concentration of ____
    >300 mg/24
  113. severe preeclampsia is characterized by a BP of ___

    proteinuria ___

    ___-reflexia
    bp>160/110

    proteinuria >5 gm

    hyper-reflexia
  114. main risk factors for preeclampsia/eclampsia
    ___gravida

    age ___ or ____

    race
    primigravida

    <17 or >35

    african american
  115. severe preeclampsia that involves hepatic dysfunction
    HELLP syndrome
  116. H.E.L.L.P. abbreviation
    Hemolysis-decreased Hct

    Elevated Liver enzymes- 2x normal

    Low Platelets- <100,000
  117. given to prevent seizures
    mag sulfate
  118. antidote of mag sulfate
    calcium gluconate
  119. mag sulfate loading dose of __ IV

    maintenance dose of ___ /hr
    4-6gmIV

    2gm/hr
  120. mag sulfate therapeutic level is ___mEq/L
    4-7mEq/L drawn daily
  121. Assessments for mag sulfate
    • urine output via catheter
    • moniter resp
    • BP
    • reflexes every hr
    • clonus
  122. side effects of mag sulfate include
    • hypotension
    • resp depression
    • flushing
  123. care of the pt recieving mag sulfate
    p. 637 box 21-4
  124. includes wt loss of 5%, dehydration, ketonuria, e- imbalance
    hyperemisis
  125. Treatment for hyperemesis in order includes
    IV LR

    NPO

    TPN last resort
  126. terms
    table 21-6 p. 645
  127. cervix has dilated prematurely
    imcompetent cervix
  128. "ties" the cervix closed
    cerclage
  129. implantation of a fertilized ovum in a site other than the endometrial lining
    ectopic pregnancy
  130. classic signs of an ectopic pregnancy
    ACUTE ONE SIDED PELVIC PAIN

    REFERRED SHOULDER PAIN
  131. condition in which abnormal development of the placenta occurs, resulting in fluid filled grape-like clusters and trophoblastic tissue proliferates
    hydatidiform mole (molar pregnancy)
  132. occurs when a sperm fertilizes an "empty" ovum- results in proliferation of a homozygous diploid
    complete hydatidiform mole (molar pregnancy)
  133. occurs when 2 sperm fertilize an ovum- resulting in fetal parts and an aminiotic sace
    partial hydatidiform mole (molar pregnancy)
  134. placenta previa vs. abruption
    table 21-7 p 653
  135. placenta implants over the cervical os, partial or complete
    placenta previa
  136. classic s/s of placenta previa are
    painless vag bleeding- bright red
  137. mgmt of placental previa

    main thing to remember
    NO DIGITAL EXAMS, FHT'S
  138. premature seperation of the placenta, partially or completely from the insertion site
    placental abruption
  139. s/s of placental abruption
    SEVERE ABDOMINAL PAIN

    vag bleeding

    hypovolemia

    "board-like" abdomen
  140. trapped blood in the myometrium may lead to ____ ____, a purple and copper color
    couvelaire uterus
  141. results from an antigen antibody immunologic rx to Rh+ fetal cells

    treatment?
    Rh sensitization

    treat with RhoGAM every pregnancy
  142. RhoGAM is given at ___ wks pregnancy and within ___ hrs of delivery and ___ bleeding epidsode
    28 wks

    72 hrs

    EVERY
  143. contracted by undercooked meat, drinking unpasteurized goat's milk, or coming in contact with cat feces

    if contracted during 1st trimester of pregnancy, could lead to abortion
    toxoplasmosis
  144. a type of measels infection (MMR)
    rubella
  145. ALL women who are ages 13 through childbearing years should be immunized for _____ if not immune

    if immunized, must wait ____ before conceiving
    rubella

    3 months
  146. most common cause of intrauterine infection as it can be found in body fluids and is easily transmitted

    part of the HSV group
    cytomegalovirus
  147. bacterial infection of the lower GI or GU tract

    carriers may be asymptomatic, routinely checked for during antepartum care
    Group B strep

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