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Franqui

Antaenatal Screening

QuestionAnswer
What is the name of the equation used to calculate EDD? Naegele's Rule
How does Naegele's Rule work? 28 Day Cycle - Subtract three months from the first day of the LMP and add seven days to that date
How does Naegele's Rule work on a 24 Day Cycle? LMP date - 3 months + 7 days LESS 4 days from EDD date given
How does Naegele's Rule work on a 30 Day Cycle? LMP date - 3 months + 7 Days PLUS 2 days
Jane telephones you as she suspects she is pregnant. Discuss your response... Why?? - Amenorrhoea - When was her LMP? - Any pregnancy symptoms? - Length of cycle - Conception/Contraception - Has she done a pregnancy test? - Ask if this is her first pregnancy - ?? Primip/Multip = Organise an appt + DOCUMENT
What is Amenorrhoea? The absence of a menstrual period in a woman of reproductive age
What are some reasons for Amenorrhoea? - Pregnancy - Contraception - BF - Stress - Medication - Hormone imbalance - Low weight - Thyroid malfunction - Ovarian insufficency - Uterine scaring
Ways for a MW to confirm pregnancy - Blood Test - Urine Test - USS
Symptoms of early pregnancy - Nausea - Sore breasts - increased micturition (urine) - tiredness
Routine antenatal bloods - Blood Group + rhesus factor - Rhesus antibodies - FBC - Syphilis - Hep B - Rubella antibodies - HIV (with consent) - Hb (haemoglobin)
What does a urine test screen for? PROTEINURIA - marker for pre-eclampsia + UTI, GLYCOSURIA - marker for gestational diabetes
Why use a MSU? All hypertensive pregnant women with positive proteinuria should do a MSU confirm pre-eclampsia and to exclude a UTI
What does an MSU test for? - Blood - Protein - Nitrites - Leukocytes
Sue is 15/40 and would like to book you as her LMC. What is your PHYSICAL ASSESSMENT? - Weight + Height = BMI - Basic Obs = BP + Pulse - Urinalysis = MSU (asymptomatic bacteria) - Bloods = FBC, Blood Group, + Antibodies, Rubella, Heb B, Haemoglobin, Syphylis, HIV (w consent) - Palpate = Observe scars, Fundal height, FHR - DOCUMENT
Routine antenatal bloods - Blood Group + rhesus factor - Rhesus antibodies - FBC - Syphilis - Hep B - Rubella antibodies - HIV (with consent) - Hb (haemoglobin)
What does a urine test screen for? PROTEINURIA - marker for pre-eclampsia + UTI, GLYCOSURIA - marker for gestational diabetes
Why use a MSU? All hypertensive pregnant women with positive proteinuria should do a MSU confirm pre-eclampsia and to exclude a UTI
What does an MSU test for? - Blood - Protein - Nitrites - Leukocytes
Sue is 15/40 and would like to book you as her LMC. What is your PHYSICAL ASSESSMENT? - Weight + Height = BMI - Basic Obs = BP + Pulse - Urinalysis = MSU (asymptomatic bacteria) - Bloods = FBC, Blood Group, + Antibodies, Rubella, Heb B, Haemoglobin, Syphylis, HIV (w consent) - Palpate = Observe scars, Fundal height, FHR - DOCUMENT
Sue is 36/40 this visit. What assessments will you make? Discuss physiological changes
What are some CIRCULATORY physiological changes of pregnancy? CIRCULATORY - Oedema, Carpal Tunnel, Fainting + Dizziness, Palpatations, Varicose Veins (leg, vulval, anal), bleeding gums or nose.
What are some MUSCLE + LIGAMENT physiological changes of pregnancy? MUSCLE + LIGAMENT - Leg Cramps, Abdominal Pain, Back Pain, Sciatica, Symphysis Pubis Dysfunction, Incontinence, Uterine Cramps (braxton hicks)
What are some DIGESTIVE physiological changes of pregnancy? DIGESTIVE - Nausea + Vomiting. Constipation, Heartburn + Indigestion, Ptyalism, Bloating + excessive wind, Diarrhoea
Breast changes during pregnancy - tenderness - growth - colour+size of areola - leaking
Vagina changes during pregnancy - increased discharge - pH (thrush susceptibility)
Urinary changes during pregnancy - Frequency - UT Dilation + Shortening (increased UTI susceptibility)
Sleep changes during pregnancy - pattern - insomnia - nature - dreams
Nose changed during pregnancy - congestion - bleeds - hay fever
Hair changes during pregnancy - growth on skin (abdomen + face) - loss from head
Skin changes during pregnancy - itching - pregnancy rash (PUPP) - acne - chloasma, - linea nigra - stretch marks
Dietary changes during pregnancy Hypersensitivity to smell, taste, pica, appetite and metabolism changes
Sexuality changes during pregnancy Libido changes
Emotional changes during pregnancy Volatility and mood swings
Tiredness and fatigue increase 1st and 3rd trimesters
Ways to reduce morning sickness - increase rest periods - eat carbs 20min b4 getting out of bed - eat protein before bed or during night - low energy/impact exercise after eating - avoid refined/fried/spicy foods - eat food rich in B group vit - increase fluids - reduce coffee/te
MW skills for antenatal care - establish EDD - Abdominal Palp - BP - Routine blood + urine screening - nature + significance of fetal movements - physiological changes associated with pregnancy + issues + management - antenatal education
What history do you take at a clinical booking? - Medical - Surgical - Obstetric - Social - Gravida/Parity - LMP + EDD - Previous labour outcomes - Breastfeeding
Examples of MEDICAL Hx - Cardiac - Hypertension - Epilepsy - Bleeding disorders - Asthma - Current meds
Examples of SURGICAL Hx - Previous gynaecological surgery - Prev GA
Examples of SOCIAL Hx - Mental health - Family Violence - Smoking/drugs - Relationship/whanau - Diet/nutrition
38+/40 risk markers - fresh blood loss - Reduced FM - Signs of pre-eclampsia - Rupture of membranes without contractions - Meconium stained liquor
Fundal Assessment - 5 Stages - Initial visual (observe) - Fundal assessment - Lateral assessment - Pelvic assessment - Listening or auscultation
In a Visual Assessment, we look for - initial impression of progress - physiological changes (linea nigra, stretch marks - size, shape, contours in relation to gestation/presentation/position - surgical scars - bruising or other signs of FV
In a Fundal Assessment, we look for - upper most part of fundus - Lie (position of babes spine relative to mum) - Presentation - Landmark of fundal height re gestation - Measurement of fundal height
Reasons for discrepancies with fundal height and gestation are - large/small baby - multiple preg - molar preg - poly/oligohydramnios - errors in gestational age estimation - oblique or transverse lie
In a Lateral Assessment, we look for - confirms lie+presentation with orientation of baby - identifies position (anterior, posterior, lateral) - identifies denominator in relation to points of the pelvis
In a Pelvic Palpation, we look for - presenting part - descent into womens pelvis
Cephalo Pelvic Disproportion (CPD) should be considered if the babies head is not engaged at 40 weeks gestation
The purpose of Auscultation is to Listen to baby's FHR, to confirm baby is alive
The FHR is audible with a dopplar at 12 weeks
The FHR can be heard with a pinard at 24-28/40
Fetal movement can be felt from around 18/40
Most women will feel fetal movements by 22-24/40
Created by: boylan.r@gmail.com on 2010-06-04



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