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6-26-10 OB MT Sess 1

6-26-10 OB Mid Sess 1 Barry

How many kgs of weight gain does the parturient gain 12 kg (or 17%)
How many kgs of weight gain does the uterus contribute at term 1 kg
How many kgs of weight gain does the amniotic fluid account for at term 1 kg
How many kgs of weight gain does the interstitial fluid account for at term 2 kg
How many kgs of weight gain does the blood volume account for at term 2 kg
How many kgs of weight gain does the new fat and protein account for at term 4 kg
How many kgs of weight gain does the fetus/placenta account for at term 4 kg
What major anatomical changes happen during pregnancy with: Pulmonary (4 things) Diaphram elevation, reduced functional residual capacity, capillary engorgement, progesterone induced tracheal and bronchial dilation
What major anatomical changes happen during pregnancy with: Cardiovascular (2 things) Biventricular hypertrophy, heart elevation and leftward rotation
What major anatomical changes happen during pregnancy with: Gastrointestinal (2 things) Reduced cardioesophagus sphincter tone and horizonial gastric axis (stomach moves horizonally)
What major anatomical changes happen during pregnancy with: Urogenital (4 things) Hydronephrosis, Hydroureter, Increased bladder capacity, and urine stasis
What major anatomical changes happen during pregnancy with: Circulatory (2 things) Aorticcaval compression and lower body venous stasis
T/F: As gestation continues onward from 12 weeks to delivery the following all increase - Alveolar ventilation, minute ventilation, tidal volume, and respiratory rate False - respiratory rate does not change after 12 wks(per slide 33)FYI- tidal volume does increase
What respiratory variables have decreased at a term pregnancy (10 of them)(slide 35) Residual volume, expiratory reserve volume, functional residual volume, total lung capacity, sodium bicarbonate, arterial PCO2, chest wall compliance (alone), total compliance, pulmonary resistance, and airway resistance
Which way does the oxyhemoglobin curve shift in pregnancy to the Right
In there HYPO or HYPER ventilation DURINIG labor Slide says HYPO
During LABOR, which of the following go UP and which go DOWN: PaO2, PaCO2, TV, MV, Resp rate UP = RR, TV, MV, DOWN = PaCO2, PaO2 (note: PaO2 rises during preg but decrease with labor)
What is a normal BiCarb level for 3rd trimester 20 mEq/L
List from least to most - the time it takes to desaturate: Normal adult, Obese adult (>127kg), normal child, and Mod. ill adult (Sats < 90%)= 1st Obese, 2nd Child, 3rd Mod. ill, and last norm. adult
Maternal hyperventilation cause what fetal effects (4 of them) Constriction of umbilical and uterine arteries, fetal acidosis, hypocarnia, shift to the left for maternal hemoglobin dissociation curve (= metabolic alkalosis)
Cardiac output increases in pregnancy related to Increased stroke volume in 1st 1/2 of pregnancy and increase in stroke volume and HR in 2nd 1/2 of pregnancy (actually SVR also decreases...so..CO = HR x SVR)
Does SVR increase or decrease during pregnancy Decreases
Why does SVR decrease during pregnancy (4 of them) Increase in prostacyclin, progesterone, low resistance pilacental circulation, and blood viscosity
What % of blood volume change occurs in pregnancy Goes up 35% (about the same as the stroke volume goes up = 30%)
How much (%) does the peripheral resistance, MAP, systolic, and and diastolic decrease by during pregnancy They all decrease by 15% each
How many mls of blood in non pregnant and pregnant non = 4000ml, preg = 5700 (400ml more RBC and 1300ml more of plasma)
Since blood plasma increases by up to 50% and RBCs increases to 45 %, what is happening to the viscosity - what is that called Blood viscosity is thinner, called "Physiologic Anemia of Pregnancy" (lower count of RBCs to total volmue)
In the late 3rd trimester what happens with RBCs and blood plasma RBCs continue to increase while plasma starts to decrease
Hemaglobin concentration should remain above what % in mom 12 g%
Since RBCs #s are increasing rapidly, are they microcytic or macrocytic Macrocytic because of O2 demand("increasing" has nothing to do with it)
Average mls blood loss for C section 500-1000 mls
Average mls blood loss for vaginal delivery 300-500 mls
When in 2nd stage (lithotomy position) and contracting, what happens to CO and stroke volume They decrease (stroke volume decreases significantly)
What ECGs changes happen during pregnancy Since the heart move up and rotates left, the axis changes to the left (also non specific ST, T and Q wave changes and minor arrythmias
What are the two most common ectopies in pregnancy PACs and PVCs
What are the causes for PACs and PVCs (aka most common ectopies)in pregnancy (4 of them) Changes in cardiac ion channel conduction, Increase in cardiac size, changes in autonomic tone, Hormonal fluxes
What is the most significant change that happens during pregnancy There is a baby in the uterus and pastel colors come at you from everywhere
What happens to CVP and CO when supine (in %) Decrease by 25-50%
When supine the fetus compresses the mom's aorta and vena cava against what causing decrease flow The vessle are compressed between the fetus and the bodies of the vertabraes
Name the 2 components of the phenomenon of "Aortocaval Compression" 1)Inferior vena cava compression (after 24 wks causes alternative circulation (= Azygos vein/Paravertebral system) and Compensatory increase in sympathetic tone and HR) and 2) Second component includes: Aortoiliac obstruction, Arterial side compression..
The second component of "Aortocaval Compression" include (congradulations if "1st and 2nd Components" make sence to you) Aortiliac obstruction, Arterial side compression, No maternal symptoms, Placental blood flow decreases, and femoral flow vs brachial flow (?)
Of a 30-60-90 degree triangle wedge jammed under mom to prevent aortocaval compression, which angle always touches the bed 30% ( in summary, thats the angle mom should be tilted when supine)
What role does regional anesthesia have on aortocaval compression syndrome It exaggerates it (so decrease regional dose)
What do epidurals cause with regaurdss to Aortocaval compression Venous engorgement
The hypercoagulable state of blood during pregnancy is related to ALL Blood Factors except which two (per slide 65..66 says diff) XI and XIII (slide 66 says they ARE involved)
In pregnancy is fibrinolysis increased or decreased It is enhanced
Mendelson's Syndrome is also called Pulmonary Aspiration Pneumonitis
Mendelson's Recommendations (regarding aspiration - 5 of them) Witholding food during labor (holding on to fork and knife during contractions not wise), Greater use of regional anesthesia, Administration of antacids, Emptying of stomach prior to general anesthesia, competent general anesthesia administration
Shirley/Roberts defined what risk greater than 25 ml (or 0.4ml/kg) with pH less than 2.5 in the stomach at delivery (and stop calling me Shirley)
In 1980 when Roberts offered Shirley an antacid with particulates what was her responce Shirley told Roberts that not good, she wanted Bicitra (no particulates) and that he needed Binaca
When do GI physiologic and anatomic changes start to take place in pregnancy Mid-first trimester (8wks)
When do GI physiologic and anatomic changes start to return to normal from pregnancy 1 1/2 months after delivery
How do you treat a lady who is 8 wks gestation to 6 wks post partum Hold her with both hand and groan aloud, don't take her swimming, and don't push on her --Treat her like a full stomach
What are the two most important risk factor related to aspiration after 8 wks gestation Delayed gastric emptying (increased gastric content)and increased acidity (lower pH)
What extrogenous nursing actions contribute to delayed gastric emptying Giving narcotics (decreasing peristalsis)
Does pain decrease gastric emptying Yes
Why can't an anatomical displaced, 8 wk gestational lower esophagus pass the CRNA board exam It's Incompetent
What do opioids do to hypoxemia/hypercarbia responces They diminish them
Three agents for aspiration prophylaxis Ranitidine (Zantac), Metoclopromide (Reglan), and Oral sodium citrate (0.3 M Bicitra)
Which of the following should not be utilized in the pregnant patient: RSI with criciod pressure, ETT beyond 8 wks gest., nasal intubation, gastric suctioning prior to emergence, awake extubations, or smaller ETTs All are appropriate except nasal intubation
It happens in 80% of women by mid-pregnancy Hydronephrosis - ureters and renal pelvis dilate starting at 12 wks
What happens to renal blood flow and glomerular filtration during pregnancy Both increase 50% - causing higher albumin, protein, glucose and bicarbonate excretion
An increase in total body sodium and water are because of an increase in aldosterone
In pregnancy, what starts and causes the renal problems Pre-eclampsia
What happens to SGOT & LDH in pregnancy Increase
What happens to hepatic blood flow No changes
What happens to plasma cholinesterase levels Decrease (most in postpartum)
What happens to colloid oncotic pressures Steve must have fell out - slide 82 didn't specify
What happens to coagulation factors Increase
What are a few drugs that may have a prolonged onset if hepatic problems The slide (83) has sux, chloroprocaine, and etomidate (ester metabolism ?)
What causes increased neural sensitivity to local anesthetics Progesterone
STAR!!!(IMPORTANT TEST QUESTION) What decreases epidural and subarachnoid spaces Engorgement of epidural veins
What is associated with pregnancies - Big MACs or small MACs Small MACs - decrease by a quarter - 40 cents (decrease by 25-40%)
What does the black shaded area represent on slide 85 Who the *!%#$@& knows
What does the MAC of inhalation agents, epidural doses, and spinal doses have in common regarding pregnancy The amount are all smaller - They all decrease by 20-30/40%
What risk increases when a normal non-pregnant dose of local is given to a pregnant patient CNS Toxcity
Uterine blood flow increases to ? ml/min 700ml/min
T/F: Uterine blood flow is autoregulated False
Uterine blood flow can decrease because of which one: Arterial or venous Can be arterial or venous or both
How much does a near term gravid uterus weigh 1100 grams
How much blood does a near term uterus receive a minute (ml/min) 500-800 ml/min
How much does a non-pregnant uterus weigh 70 grams
How much blood flow does a nonpregnant uterus receive a minute (ml/min) 50 ml/mi
How many times more blood flow does a pregnant uterus receive over non-pregnant 10 x more
How much more does a pregnant uterus weigh over a nonpregnant uterus Almost 20 times as much (1100g vs 70g)
The ovarian, uterine, and vaginal arteries all come from what artery Hypogastric artery
What artery does the ovarian artey directly branch off of The uterine artery (the uterine artey comes directly off of the hypogastric artery)
What 2 arteries precede the Azygos artery Uterine artery than hypogastric artery
In the "steal" phenomenon, what artery has a decrease blood flow in in turns increases the blood flow of the uterine and common iliac arteries External iliac artery is being stolen from
Factors that decrease uterine blood flow (5 of them) Uterine contractions, hypertonus, hypotension, hypertension, vasoconstriction (endogenous and exogenous - most sympathomimetics alpha adrenergic)
Does ephedrine constrict uterine arteries Not in the pregnant uterus, but yes in the non-pregnant uterous (pregnancy releases a uterine artery vasodilator)
What is the mechanism that prevents ephedrine from constricting uterine arteries Estrogen produces the endothelium's ability to synthesize the vasodilator nitric oxide (this does not take place in the peripheral vessels)
A lower pH in the fetus after using ephedrine and not phenylephrin is because of Phenylephrine is only alpha, ephedrine is alpha and beta - beta increases metabolism (increase HR and contraction)
Name the cavities and tissue layers from the fetus to the outer wall of the uterus Amniotic cavity, Amnion, Placenta, Chorion, Uterine cavity,Lining of the uterus (endometrium), and Muscle layer of the uterine wall
Name three major functions of the placenta Produces hormones to sustain pregnancy, protects the fetus from the maternal immune system, allows for active and passive transport of nutrients and metabolites
Name four types fo transport mechanisms through a membrane Passive, active, Facilitated and pinocytosis
Which of the following are important pharmacokinetics regarding fetal effects: Synergistic effects of drugs, level of fetal development at time of drug exposure, distribution in fetal tissue, duration of exposure to drug, rate crosses placenta All of them - plus physiochemical properties of the drug
Name the 9 most important drug characteristics regarding placental transfer Lipid solubility, ionization, molecular weight, concentration gradient, surface area, membrane thickness, protein binding, injection related to contraction time and metabolism
Created by: smorrissey1