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Maternal Newborn

Antepartum Assessment

Timing for prenatal care: 1st visit by ___ months, then how often? First visit by 3 months,Then every 4 weeks until 28 weeks, then every 2 weeks until 36 weeks, then every week until delivery (avg 12-13 visits)
The first prenatal visit - the initial maternal assessment includes... 1. General Health History. 2. Obstetrical history (current & past pregnancies & due date). 3. Physical Exam. 4. Laboratory tests
Terms used for determination of due date include EDC, EDD and EDB what do they stand for? Estimated Date of Confinement, Estimated Date of Delivery, Estimated Date of Birth
Date of Last Normal Menstrual Period (LNMP) is important because It is used to assess due date, as long as it is a normal period and need to assess for presence of spotting or bleeding
How is Nagele's Rule used in determination of due date? Start with First Day of Last Normal Menstral Period (LNMP) and subtract 3 months then add 7 days.
____ is the number of pregnancies regardless of the outcome Gravida
____ is the number of births after 20 weeks of gestation Para - includes stillbirths and live births
____ is any births before 20 weeks of gestation Abortion - elected or spontaneous. Not viable before this stage
Abbreviation for Living Children LC
Another name for spontaneous abortion (SAB) miscarriage
Elective Abortions - EAB, TAB, VIP what do they mean elective AB (EAB), therapeutic AB (TAB), voluntary interruption in pregnancy (VIP)
When doing an OB history and counting the number of Gravida (Gr) don't forget to count the current pregnancy - one Gr for twins, triplets, ect.
How many Para (Pa) for twins? One - Para means birth, one birth for a set of twins, triplets, ect.
When obtaining an OB history, what does TPAL stand for? T-term deliveries (Pa), P-preterm deliveries(B4 37 wks), A-abortions(AB), L-living children (LC)
During the Physical Exam of the initial prenatal visit a pelvic exam is done for what reasons, if indicated. Determine uterine size (assess in relation to gestational date), Pap smear, and cultures for STD's and vaginal infections
Hgb less than ____ = anemia 12
If pregnant woman is Rh-, check for ____ Rh antibodies. If partner is Rh+, discuss need for antibody titers and possibility for Rh immune globulin
urinalysis checks for abnormal color and pH what are they looking for? porphyria, hemoglobinuria, bilirubinemia, alkaline urine, metabolic alkalemia, proteus infection
Rubella titer lab testes for hemagglutination-inhibition (HAI test) what ratio indicates woman is immune HIA titer less than 1:10. If greater than, a immunization will be given postpartum and instruct woman to avoid children who have rubella
A pregnant woman who tests positive for HepB surface antigen (HbsAg), the infant who test positive are given ____ soon after birth followed by first dose of hepB vaccine Hepatitis B immune globulin
T/F only women who are at risk for HIV are encouraged to be screened for HIV True - those who are at risk are ENCOURAGED and those who are not at risk are OFFERED
A client of African descent should be screened for ____ sickle-cell screen, a positive test result would include a description of cells
Weight depends on body build, generally a prepregnant woman under ____ lbs should be evaluated. 100 lbs - needs nutritional counseling
Weight depends on body build, generally a prepregnant weight over ____ lbs should be evaluated over 200 lbs., also evaluate for rapid, sudden weight gain could be signs of preeclampsia at any prepregnancy weight
____ is diagnosed when a pregnant woman over 20 wks develops high blood pressure (two separate readings taken at least 6 hours apart of 140/90 or more)- AND - 300 mg of protein in a 24-hour urine sample (proteinuria), and pitting edema can be significant pre-eclampsia
Normal BP for pregnant women 135/85. BP greater than 140/90 requires immediate consideration
Problems with high BP in pregnancy (over 140/90) include essential hypertension, renal disease, pre-gestational hypertension, apprehension or anxiety assoc with pregnancy, exam, or other crisis. If over 20 wks - considered pre-eclampsia
Glucose in the urine is checked to determine gestational diabetes mellitus (GDM), low renal threshold for glucose, if over 140, check for ketones.
The ultrasonic Doppler devise can detect fetal heartbeat on average at ___ - ____ wks gestation 8-12 weeks from book (notes say 10-12 wks)
____ is fetal movements felt by the mother and may indicate that the fetus is nearing 20 wks gestation. (may be experienced between 16-22 weeks and it is not completely accurate) Quickening
T/F, kick counts is a fetal activity monitoring True
In general, weight gain is between ____ - ____ lbs 25-35 lbs
How is weight distributed by trimester sb gradual - first=0-4lbs, second=12lbs, third=12lbs(l lb per wk)
Sudden, excessive weight gain is a sign of ____, may be brought on by pregnancy induced hypertension (PIH) edema
Most critical vital sign assessment blood pressure
due to physiological changes, BP ____ slightly in the second trimester decreases
Either a BP greater than 140/90 or an increase of ____mm systolic and ____mm diastolic may indicate pregnancy induced hypertension increase of 30mm systolic and 15mm diastolic
T/F episodic glycosuria is uncommon False - it is common. but may also be a sign of gestational diabetes and need to be retested
T/F proteinuria (albuminuria) is a sign of pregnancy induced hypertension True
How soon can fetal heart activity be seen by a sonogram as early as 5 weeks
How soon is quickening felt with multigravida (subsequent pregnancy) 14-16 wks
How soon is quickening felt in a primigravida (first pregnancy) 18-20 weeks
measuring ____ heigth is a validation of estimated due date fundal heigth
____ method is when the fundal heigth correlates with weeks of gestation between 22 to 24 weeks to 34 weeks McDonald's
possible reasons for fundal heigth less than expected intrauterine growth retardation (IUGR) or Fetal demise
Possible reasons for fundal heigth greater than expected Multiple pregnancy, hydraminos (>amniotic fluid) and molar pregnancy (an anomalous growth containing a nonviable embryo which implants and proliferates within the uterus)
normal hematocrit ____ - ____% 38-47%, lower can be marked anemia or blood dyscrasias
The triple screen is performed between weeks ____ and include what between weeks 15-20. maternal serum alpha-fetoprotein, unconjugated estriol, and hCG
what does maternal serum alpha-fetoprotein measure for higher levels = neural tube defect, underestimated gestational age, and multiple gestation. lower levels = Down syndrome and trisomy 18
What does higher than normal hCG measure down syndrome
What does lower than normal unconjugated estriol UE measure down syndrome
What does the 50g, 1hr. glucose screen (between 24-28 wks) measure gestational diabetes melitus (GDM) if plasma glucose level is over 140mg/dL
What is the possible cause of sudden gush of fluid from vagina premature rupture of membranes
what is the possible cause of vaginal bleeding abruptio placentae, placenta previa, lesions of cervix or vagina, or bloody show
What is the possible cause of abdominal pain premature labor, abruptio placentae
possible cause for temp above 101 infection
possible cause for dizziness, blurring of vision, double vision, spots before eyes hypertension, preeclampsia
possible cause for persistent vomiting hyperemesis gravidarum (severe form of morning sickness)
possible cause for severe headache hypertension, preeclampsia
possible cause for edema of hands, face, legs and feet preeclampsia
possible cause for muscular irritability, convulsion preeclampsia, eclampsia
possible causes for epigastric pain preeclampsia, eschemia in major abdominal vessle
possible cause for oliguria renal impairment, decreased fluid intake
possible cause for dysuria urinary tract infection
possible cause for absence of fetal movement maternal medication, obesity, fetal death
administration of ____ prevents Rh sensitization RhoGam (Rh immune globulin)
RhoGam works by preventing ____ immunity by providing passive immunity active immunity
When is Rho Gam given 28 weeks prenatally or within 72 hrs of delivery if baby is Rh+ or after SAB, TAB, ectopic pregnancy or amniocentesis
When to contact the care provider using the kick counts or cardiff count to ten method fewer than 10 in 3hrs after meals, movements slowing and takes longer each day to note ten, no movements in the morning, fewer than 3 in 8 hrs without meals
T/F the ultrasound/sonogram is used as a routine test to determin gender False
A reactive nonstress test will have at least two accelerations of ____ bmp above the baseline lastine how long 15 bpm lasting 15 seconds in a 20 min time period, if nonreactive indicates fetus is at risk or asleep - so stimulate fetus with sound or vibration and feed mother
The biophysical profile (BPP) includes the nonstress test as well as what 4 other things fetal breathing movement, fetal movement of body or limbs, fetal tone by extension and flexion, and amniotic fluid volume
How is the biophysical profile scored? What score indicates a healthy fetus? Each of the 5 measurements has a max score of two, a score of 8-10 indicates a healthy fetus
____ test is a means of evaluating the respiratory function (oxygen and carbon dioxide exchange) of the placenta contraction stress test
The contraction stress test helps ID the fetus at risk for intrauterine ____ by observing the response of the FHR to the stress of contraction asphyxia
A healthy fetus tolorates the reduction in blood flow in the placenta and maintains a steady ____ during the contraction stress test heart rate
____ or breast stimulation is used to stimulate a contraction for the contraction stress test IV pitocin
Amniocentesis provides info about genetic disorders (triple test), fetal health and fetal lung maturity (L/S ratio and PG level)
by ____ weeks gestation, the lecithin/spingomeylin ratio is 2:1 35 weeks, indicates that the risk of respiratory distress syndrome is very low
Presence of ____ (PG) is associated with fetal lung maturity phosphatidylglycerol (PG) found in amniotic fluid at about 35 wks
____ conjugate Distance from the lower posterior border of the symphysis pubis to the sacral promontory; may be obtained by manual measurement. diagonal conjugate
____ is the period of intrauterine development fromm conception through birth; pregnancy gestation
____ a woman who has never been pregnant nulligravida
____ conjugate is the distance from the middle of the sacral promontory to an area approx 1cm below the pubic crest obstetric conjugate
____ inflammation of the parametrial layer of the uterus parametritis
____ is labor that occures after 42 wks gestation postterm labor
____ is a woman who is pregnant for the first time primigravida
____ is a woman who has given birth to her first child (past the point of viability), whether or not the child is living or was alive at birth primipara
____ the normal duration of pregnancy term
____ factors is any findings that suggest the pregnancy may have a negarive outcome, either for the woman or her unborn child risk factors
____ removal of amniotic fluid by insertion of a needle into the amniotic sac; amniotic fluid is used to assess fetal health or maturity amniocentesis
____ villus sampling is a procedure in which a specimen of the chorionic villi is obtained from the edge of the developing placents at about 8 wks gestation, the sample can be used for chromosomal, enzyme, and DNA tests Chorionic villus sampling
____ a technique for directly observing the fetus and obtaining a sample of fetal blood or skin fetoscopy
____ umbilical blood sampling (PUBS's) is a technique used to obtain pure fetal blood from the umbilical cord while the fetus is in utero. Also called cordocentesis percutaneous umbilical blood sampling (PUB's)
____ a surface-active mixture of lipoproteins secreted in the alveoli and air passages that reduces surface tension of pulmonary fluids and contributes to the elasticity of pulmonary tissue surfactant
____ is high-frequency sound waves directed through a transducer. The ultrasonic sound waves reflect underlying structures of varying densities and allow various fetal tissues, bone and fluids to be identified ultrasound
Created by: cgwayland