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501 Exam 1, Week 1

NM/WHNP

QuestionAnswer
Nulligravida never been pregnant
Gravida currently pregnant or has been pregnant irregardless of outcome
Parity number of pregnancies carried to VIABLE gestational age
Nullipara first pregnancy and has NOT given birth
Multipara given birth 2+ times
Grand Multipara given birth 5+ times
Primipara given birth ONCE before Pregnant with 2nd child
Multigravida pregnant more than one time
Abortion termination of pregnancy PRIOR to viability
SAB Spontaneous Abortion miscarriage, unintentional expulsion before the 24th week gestation
Lie Normal Lie: Abnormal Lie: Relationship of the fetus to the long axis of the mother spine Normal Lie: longitudinal, cephalic Abnormal Lie: transverse, oblique
Attitude Normal Attitude Abnormal Attitude presenting part Normal Attitude: Fetus in full flexion Abnormal Attitude: Fetal head is extended
Fetal Position position of fetal denominator: Occiput or Vertex
Types of Fetal Presentation LOA LMA LST Cephalic/Vertex presentation- LOA, LOP etc Face Presentation- (mentum), LMT, LMA Breech Presentation- Sacral- LST, LSA
Breech is abnormal after ___ weeks abnormal after 32 weeks
Smallest fetal head diameter: Suboccipitalbregmatic (LOA, LOT, LOP)- all
Largest head diameter: type of presentation body parts in FLEXED POSITION Occipitomental - increases diameter 3 cm over flexed head. May result in failure to progress. (Head extended, not flexed)- Brow presentation
What are some potential causes of FACE PRESENTATION? grand multiparous patients, large fetus and contracted pelvis, neck swelling (thyroid goiter), anencephaly
What is presenting in a Compound Presentation and it is more common in _____ presentation: hand prolapse alongside fetal head. Common in prematurity
Shoulder presentation occurs in what kind of lie? Shoulder presentation occurs in a transverse lie. Nothing will be felt in the inlet.
Demominator the lowest presenting part of the fetus
Engagement at the point when the widest diameter of the presenting part has passed through the pelvic inlet
Station relationship of the lowermost part of the presenting part in the imaginary line drawn between the ischial spines.
Location of - station (-4, -3) High or low high station (above ischial spines)
Location of + station (+4, +3) High or low low station (below ischial spines)
GTPAL 11303 first pregnancy with 3 preterm infants @ 34w, no AB
G- # T- # P-# A-# L-# letter- # pregnancies letter- # delivered after 36 weeks letter-# delivered between 20-36 weeks letter-# delivered before 20 weeks letter -# living
Initial Pregnancy Labs (9) CBC Rpr/VDRL Blood type- RH Rubella HepBsAg GC/CT U/A Urine C & S HIV- offer
Labs of 24-28 weeks CBC GCT or GTT T & S depending on RH status Possibly RPR/VDRL
Labs of 35-37 weeks GBS culture GC/CT if positive earlier in preg or new RF Possibly HIV Possibly Urine Tox
Rx for Pregnant Patients (3) if indicated Prenatal Vitamin, Folic Acid, Iron Supplements
OB visits consist of every 4 weeks until 28 weeks every 2 weeks until 35 weeks every 1 week until delivery
What week do you give GTT/GCT 28 weeks
What week do you perform GBS Screening 35-37 weeks
What week do you administer Rhogham in pregnancy if indicated 28 weeks
Breast size increases during which months? 4th and 5th
Pharm relief measures for nausea in pregnancy Pyridoxine (Vit B6) 25 mg QID or 50 mg BID OTC or Unisom 25mg qhs Combo therapy B6 25mg bid + 50 Unisom or 1/2 tab TID
Ptyalism excessive saliva
Would you Rx Alka-Selzer in pregnancy no, it can cause increased edema- Substitute Maalox, mylanta, MOM,
Why are my gums bleeding now that im in my 2T? Hyperemia
If I am ___ weight, I should gain ___ pounds underweight normal weight overweight obese underweight- 28-40 normal weight-25-35 overweight-15-25 obese-11-20
After 1T how many calories should be increased per day 350 calories
What week do you begin to assess fundal height 20
Patient was Rh -... What is your plan? recheck antibody screen (checking sensitization) and administer Rhogam at 24-28 weeks and again PP.
What week do you screen for GDM? 24-28 weeks
When do you begin assessing fetal position 24-28 weeks
When do you assess for GBS? 35-37 weeks
Pt was + early in pregnancy for GC/CT and or HSV. What is your plan? Test again at 35-37 weeks; if HSV + consider suppression therapy
Examples of Presumptive Pregnacy amenorrhea N/V/increased salvation breast changes urinary frequency increased basal body temp Chadwick sign (blue cervix) Skin changes (cholasma) Quickening (fetal movement)
Examples of Probable Pregnancy abdominal enlargement uterine enlargement palpation of fetus ballottement of fetus Hegar's sign (softening of isthmus) Goodell's sign (softening of cervix) Endocrine pregnancy test (BHCG) + preg test urine or serum
Positive Signs of Pregnancy Fetal Heart tones Palpation of fetal movement, palpation of the fetus Visualization of the fetus on US Delivery XRAY
Serum Beta Hcg you want to see the numbers do what? The levels should double every 48 h (2 days)
T/F: HCG is a protein thus antigenic True
Discuss what happens with immunologic assay of Hcg pregnancy testing when combined with antisera Preg Urine with Hcg neutralizes the Antibodies and INHIBITS agglutination = POSITIVE (NO CLUMPING) Non-preg with no HCG cannot neutralize => AGGLUTINATION = NEGATIVE (CLUMPING)
Chadwicks Sign bluish discoloration of the vulva, vagina and cervix starting at 6 weeks
Goodell's Sign softening of the cervix at 6 weeks (lips vs nose)
Hegar's Sign softening of the uterine isthmus at 6 weeks
Piskacek's Sign 8-10 w of preg, an asymmetrical uterus
FHT should be heard via doppler and fetascope at what weeks doppler- 9-12w fetascope-18-20w
US due date taken during the 1T are more/less accurate than later and the most precise method in 1T. US due date taken during the 1T are MORE accurate than later and the most precise method in 1T.
US discrepancy: # days in 1 T # days from 12-20 weeks # days from 28w+ US discrepancy: 7 days in 1 T 10 days from 12-20 weeks 15.6 days from 28w+ ACOG recommends changing EDD if > above days
Naegele's Rule and what does it depend on and what do you rely on to determine EDD? LMP + 7 days - 3 months Pending cycle length, ability to recall LMP, bleeding, BCP, BF. If the above, do NOT use Rule. Instead rely on US in combo with clinical findings.
Prem's Rule Calculates EDD from conception using basal body temp charts. 1st day of thermal shift - 7 days + 9 months = final EDD
uterine growth in early pregnancy is due to ____, not products of conception hyperplasia
How is the uterine wall strengthened Uterine wall is strengthened by increased number of muscle cells, increased elastic tissue, and accum of fibrous tissue.
Advancing pregnancy stimulates uterine enlargement due to ___ hypertrophy (increase cell size)
Why is gestational dating important important for screening, size estimation, and evaluation of fetal growth
Sensitivity % of AFFECTED individuals WITH the DISEASE who have a POSITIVE result on the screening test
Specificity % of UNAFFECTED individuals, those WITHOUT the disease, who have NEGATIVE results on the screening test.
Screening vs Diagnosing Screening is for asymptomatic pts Diagnosing is for intention of dx
What is your plan if a lab comes back Hbg <10 g/dl? Dx? Iron Deficiency Anemia. begin iron supplementation 300 mg Ferrous sulfate TID and taken with meals, add 1.0 mg of folic acid in cases where folate is low or use Vit C enriched food to aid with absorption
Reasons for high Hgb dehydration, burns, diarrhea
H/H cut off values: 1T, 2T, 3T 1T= 11.0/33.0 2T= 10.5/32.0 3T= 11.0/33.0
What does a "shift to the left" mean? increase in bands or immature neutrophils, indicating response to infection
What is your plan if PLT are <150,000 testing including antiplatelet antibody screening and peripherial smear. Coag studies, Consultation with physician is required for mgt plan. In majority of cases, no tx will be necessary. NO FSE OR VACUUM.
MCV (average size of RBC) is high indicates? Macrocytic Anemia- B12/folate deficiency check serum folate and B12 levels
MCV (average size of RBC) is low indicates? Microcytic Anemia- iron deficiency, thalassemia (confirms iron deficiency if ferritin also low)
What is your FU for Hgb <10? FeSO4 and dietary counseling
Spirochete- Treponema pallidum Syphilis (VDRL/RPR)
Sensitized women (>1:4) who are Rh - develop which kind of antibodies. What can it cause in next pregnancy? Treatment? Refer? anti-D antibodies. Can cause fetal RBC hemolysis, severe anemia, cardiac decompensation, hydrops, fetal or NN death. RhoGAM- ab that prevents isoimmunization 28w and 72h PP, miscarriage, vag bld, trauma. Refer to high risk OB
When can you not receive RhoGAM? if delivered 3 weeks after given or 1 month past delivery
Teaching after administering Rubella vaccination. Lab titer for immune vs non-immune Avoid pregnancy for 4 wks after vaccination Ab titer of 1:10 or higher = IMMUNE Ab titer of 1:64 or higher = acute infection
Give VZIG within 96 hrs of exposure of what?(mom and or baby) Varicella/ Chicken Pox
The antigen is what we screen for in pregnancy is refering to what test? HepBsAg (Hep B Virus Screening)
Flagyl 2g, rpt culture q3m until 37w, risk for PTD,withold BF for 12-24h after last dose- Which STI? Trich
GC/CT Testing: who tested, timing, procedure, FU All preg women, High risk: (new partner, >1), <25yo, hx STI, Timing- NOB, 3T if + Procedure- Gen-Probe- no lube, insert 1 cm 10-30 sec into Os, rotate prior to removal FU-Treat and TOC of +, retest in 3T if +
Discuss GCT 1 hour Glucose Challenge test Timing, Performed, grams, Fasting or not, levels 24-28w 50g glucose loading= serum glucose checked after 1 hr Normal value= below 130-140 FU > 140 = 3 GTT FU > 200 = dx for DM does NOT need GTT
GTT 3 hour Glucose Tolerance Test Diagnostic test FASTING 100g glucose mixture = blood draws at 1 hr, 2 hr and 3 hr Values: 2+ abnormal = GDM 1 abnl=nutritional counseling, rpt 1 month, consider mgt as GDM FASTING > 126 = GDM
Preg HgA1C level is >6.5 interpret Type 2 DM. A1C values are LOWER in pregnancy
T/F: GBS + can cause PTL FALSE: GBS + will NOT cause PTL
Triple Screen includes what 3 -Down Syndrome levels- if +, add what test? -Trisomy 18 levels -NTD levels AFP, Estriol, hCG -Down's: Low AFP, Low Estriol, High hCG. **Quad Screen- adds inhibin A- elevated -Trisomy 18: all low levels -NTD: elevated AFP -NTD levels
CVS performed ___ weeks. What do you administer after procedure 10-12 weeks RhoGAM
Created by: Tiffani McDonald Guymon Tiffani McDonald Guymon on 2013-08-22



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