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NSG 309 OBNB
Quiz 1+2 Study Guide
| Question | Answer |
|---|---|
| Family planning | any educational/social/healthcare intervention to allow reproduction planning for contraception, abortion, infertility |
| Sterilization contraceptive | - Permanent contraceptive (surgical) - Tubal ligation - Vasectomy |
| Long acting contraceptive | - Reversible, invasive - IUD - Implants (Nexplanon) - Shots (- Depo-Provera LAI) |
| Short acting contraceptive | - Contraceptive pills/patches/shots/rings |
| Barrier contraceptive | - Condoms - Diaphragm - Sponges - Cervical caps |
| Natural Rhythm method contraceptives | - Natural family planning - Withdrawal/abstinence |
| ACHES Signs | - Warning sign for oral contraceptive - A: Abdominal pain (liver/pancreas/GB disease) - C: Chest pain/SOB (PE/MI) - H: Headaches (HTN/migraine/impending CVA) - E: Eye/Visual change (HTN/CVA) - S: Severe leg pain (DVT/thromboembolic event) |
| Nonhormonal Intrauterine contraception (IUC/IUD) | - Copper - Inhibit/kills sperm - 10-12 yr lifespan - Emergency contraception within 5-7 days post-coitus S/S: heavier periods, increase cramping |
| Hormonal IUC/IUD | - Progestin (Mirena/Kyleena/Liletta) - inhospitable change to cervical mucus + endometrial atrophy - Variable effect on ovulation - 3-8 yr effectiveness S/S: reduce menstrual bleed |
| Emergency Contraception | - Plan B (Levonorgestrel) - 72 hr window + OTC - Ella (Ulipristal acetate) - 120 hr window + prescription - Copper IUD - 5-7 day window + prescription |
| Surgical Abortions | - 1st trimester: Vacuum aspiration - 2nd trimester: D&E (dilation/evacuation) |
| Medical Abortions | - Mifepristone + Misoprostol (FDA approve up to 10 weeks) - Methotrexate + Misoprostol (alternative + less common abortion) - F/U Needed to confirm completion |
| GTPAL | G - Gravida (total pregnancies) T - Term (births after 37 wks) P - Preterm (births 20-36 weeks) A - Abortions (losses) L - Living children - Twins count as 1 pregnancy - Stillbirths at term count for T |
| Preconception Care Considerations | - Pregnancies 20-34 y.o safe (socioeconomic instability vs older age complications) - Discuss optimal nutrition, fertility, management of concurrent health problems |
| GP | Gravidity: number of pregnancies in lifetime Parity: Number of pregnancies to viable gestational age (20-24 week gestation) |
| GnRH | Gonadotrophin releasing hormone - Hypothalamus origin - Stimulate anterior pituitary to release LH/FSH |
| GnRH-FSH-LH pathway | - Regulate female reproductive cycle - GnRH release by hypothalamus (@ low estrogen/progestogen level) -> stimulate anterior pituitary - Anterior pituitary release LH/FSH -> female reproductive cycle |
| LH | - Lutienizing hormone - Stimulate ovulation (peak @ 12-24 hr prior to ovulation) |
| FSH | Follicle stimulating hormone - Stimulate maturation of ovarian follicles for egg release |
| Menstrual Cycle | - Starts 12-14 days after ovulation - Follicular phase: ovaries stimulated to mature follicles/oocytes + uterine lining proliferation -> mature follicle rupture and expel ovum at end - Secretory phase: corpus luteum secretes estrogen/progesterone (maintain uterine lining for implantation) |
| Ovum/Ova | singular vs plural name for egg cell |
| Normal Gametogenesis Considerations | - females born with 1-2 million oocytes in ovaries - spermatogenesis starts at puberty - Meiosis reduce diploid to haploid chromosome (46 pairs -> 23 single) |
| Fertilization | - Ovum viable for 6-24 hrs; sperm 5 days - Cortical reaction: egg blocks additional sperm fertilization - 23 chromosomes (male) + 23 chromosomes (female) = 46 chromosome diploid zygote |
| Nageles Rule | Calculate estimated date of delivery (EDD) - (1st day LMP + 7 days) - 3 months = EDD |
| Probable Signs of Pregnancy | - Early: Amenorrhea, breast tenderness, N/V (4-14 wks), abd enlargement (14 wks) - Braxton-Hicks contractions, positive pregnancy test, softening of cervix (Goodell sign), cervical bluish discoloration (Chadwick sign), uterine enlargement - b-hCG production @ implantation (doubles every 48-72 hr in early pregnancy) |
| Chadwicks Sign | - Bluish discoloration of cervix/vagina/vulva @ 6-8 weeks - Sign of pregnancy |
| Goodell's Sign | Softening of cervix @ 5 weeks - Sign of pregnancy |
| Positive Sign of Pregnancy | - FHR via doppler US (10-12 weeks) - Fetus visualization on US (4-6 weeks) - Fetal movement felt by HCP (20 weeks) |
| Pregnancy Tests Considerations | - detect urine or serum HCG (level double Q2-3 days in early pregnancy) - Retest if in 3-7 days if suspect pregnancy - False positive d/t recent pregnancy loss vs fertility tx |
| Fetal Development Timeline | - Heart (3-8 weeks) - Limbs (4-8 weeks) - Palate (7-9 weeks) -> cleft lip defect @ 5-6 weeks - Ear (4-16 weeks) - CNS (3-38 weeks) -> neural tube defects @ 5-6 weeks - Eyes (4-38 weeks) - Genitalia (7-38 weeks) - Teeth (7-38 weeks) |
| Embryonic stage | Week 2: Implantation Week 3: Neural tube fusion, tubular heart starts beating Week 4: Resp/digestive tract start forming, neural tube fusion complete Week 5: Limb buds appear Week 6: heart final form Week 8: brain wave detectable (end embryonic stage) |
| Fetal stage | - Week 9-12: fetal movement, kidneys start functioning, genitalia differentiated - Week 13-16: oogenesis established, blood vessel visible, finger/footprint form - Week 20: fetal swallowing, insulin production, lanugo/vernix caseosa cover body - Week 24: lung produce surfactant (viability milestone) - Week 28-34: testes descend, SQ fat deposit, CNS maturation inc HR - Week 33-38: vision 20/600, lung/CNS mature, weight gain, fetus prepare for birth |
| Lanugo | soft hair covering fetus in gestation |
| Vernix caseosa | white cheesy substance covering infant during 3rd trimester + birth |
| Placenta | - Function for circulation + protection + hormone production - Form @ blastocyte implantation -> expand over uterine surface until 20 weeks - Attach via chorionic villi - Shiny schultz (fetus side, smooth/translucent) vs dirty duncan (mother side, red/meaty) - Approximately 2.5-3 cm x 38-51 cm - Secrete hCS, progesterone, estriol |
| Umbilical Cord | - Umbilical vein (oxygenated) + 2x umbilical arteries (deoxygenated) - Approx 55 cm x 2 cm on average - Wharton jelly: supports + protects umbilical cord |
| Vulnerable populations | Groups at higher risk for poor physical/psychological/social health d/t socioeconomic, political or environmental factors |
| IPV | actual or threatened psychological, sexual or physical abuse of current/former partner - Power/control over partner - Victim usually knows + trust abuser - Safety planning essential - Assess SAFELY |
| Sexual Assault Considerations | - HIV PEP within 4 hours optimally (not 72) - SANE exam within 72 hours - Emergency contraceptive ASAP (Plan B, Ella, copper IUD) - STI testing (CT/NG, HBV, HIV, RPR) @ 4-6 weeks and 3 months post assault |
| Human trafficking | Transportation/transfer of people via force/fraud/deception for exploitation (labor/sex) - Controlled by trafficker (3rd party) - Victim often does not self identify as trafficking victim - Someone speaks for them + lacks control of money/location/ID |
| Anorexia nervosa vs Bulimia | Anorexia: Calorie restriction below requirement Bulimia: Binge eating + inappropriate compensatory behavior (eg. purging) - PTSD, borderline personality, mood disorder, substance abuse associated Tx: psychotherapy, nutritional rehab, SSRI for bulimia |
| Striae gravidarum | Stretch marks |
| Linea Nigra | dark line from pubic symphysis to fundus - normal pregnancy change, fade postpartum - more common in darker skin tone |
| Chloasma | "mask of pregnancy" - worse with UV exposure (SPF 30+) - resolve postpartum |
| Normal Skin Change in Pregnancy | Pigment change: Striae gravidarum, linea nigra, chloasma, nevi, freckles, darker areolae Vascular: prominent blood vessels, palmar erythema Hair/Nail: Longer thicker hair, nail hardness/brittle changes |
| Thyroid Change in Pregnancy | - Fetal thyroid hormone production @ 12 weeks - Thyroid levels may increase during pregnancy -> euthyroid state optimal - Thyroid hormone critical for fetal neuro development |
| Insulin Change in Pregnancy | - Insulin need increase 2nd trimester - Insufficiency -> gestational DM Screening: 1 hr GCT @ 24-28 weeks -> 3 hr GTT to confirm |
| Adrenal/Posterior Pituitary Change in Pregnancy | - Increase cortisol level in 2nd trimester -> promote fetal lung/neuro maturation - Oxytocin (posterior pituitary) -> drive contraction, postpartum uterine involution, milk ejection |
| Respiratory Changes in Pregnancy | - Increased O2 consumption (15-20%) + increased tidal volume (40-50%) - Diaphragm elevates 5 cm + rib expand and widened subcostal angle - Mild hyperventilation = physiological resp alkalosis -> mother blowing off CO2 = increased fetal CO2/O2 transfer - Increased estrogen = mucus membrane congestion + nosebleed risk |
| Cardiovascular Changes in Pregnancy | - RBC 30% increase + total blood volume 40-45% increase = physiological anemia (expected) -> peak 1500 mL above baseline @ 3rd trimester - Increased fibrinogen + clotting factors = DVT/PE risk - Temporary benign heart murmur common BP: slight decrease at 2nd trimester, otherwise at pre-pregnancy levels HR: +10-15 BPM @ 2nd/3rd trimester Cardiac output: 30-50% increase CO @ 2nd/3rd trimester |
| Supine Hypotension Syndrome | - Gravid uterus compress ICV @ supine position = decrease venous return + hypotension S/S: dizziness, diaphoresis, pallor, nausea during supine Tx: Left lateral decubitus position Teach: avoid lying supine especially @ 2nd/3rd trimester |
| Renal/GU changes in pregnancy | - 80% increased renal blood flow - 50% increase in GFR -> lowered thirst/ADH release threshold - Small urine glucose/protein normal - Higher salt/H2O reabsorption = 1.6 L additional water gain - Proteinuria >300mg/24hr abnormal after 20 weeks (preeclampsia) - Stress incontinence (kegel exercise) + nocturia common |
| Reproductive Changes in Pregnancy | - Fundal height in cm = weeks of gestation between 16-36 weeks - Breast change for lactation/feeding (supportive bra) - Colostrum production - Breast tenderness (common 1st trimester) - Increased vascularity of vagina |
| Braxton Hicks | Irregular contractions that do not change cervix (practice contractions) - Relief via rest/hydration - Differentiate btwn true labor (regular, progressive, + cervical dilation, effaces) |
| Operculum | Mucus plug -> barrier against pathogens - lost w/ cervical ripening |
| Breast Changes in Pregnancy | - Duct/lobule/alveoli grow - Fuller breast + darker nipple/areolae - Colostrum production - Milk leaking (supportive bra tx) - Breast tenderness (1st trimester most common) |
| Vaginal Changes in Pregnancy | - Increase vascularity of vulva/vagina/cervix - Leukorrhea - normal white/clear discharge (mild odor) - more acidic vaginal pH - Monitor: foul odor, color change, itching/burning (BV, candida, trichomonas, etc) |
| MSK changes in Pregnancy | - Lordosis - Relaxin + progesterone -> increase pelvic mobility but less stable joint - Round ligament pain -> sharp/stretching sensation w/ positional change - Diastasis recti = abdominal wall separation at midline - Increased PTH = increase calcium reabsorption -> leg cramp |
| GI changes in pregnancy | - Decrease peristalsis -> delay gastric emptying = GERD, constipation, gallstone - Progesterone relax lower esophageal sphincter (GERD) - Increase metabolic rate 10-20% (+350 kcal 2nd trimester, +450 kcal 3rd trimester) - N/V (hyperemesis) -> hCG driven - Hemorrhoids from pelvic PSI + constipation |
| Weight Gain Recommendations | - Underweight <18.5 BMI = 28-40 lb - Healthy weight 18.5-24.9 BMI = 25-35 lb* - Overweight 25-29.9 BMI = 15-25 lb - Obese 30+ BMI = 11-20 lb |
| Key Gestational Nutritional Intake | - Folic acid = 400 mcg/daily from preconception -> 1st trimester (neural tube defects) - Iron = increase maternal RBC production (increase absorption w/ vitamin C) - Calcium = fetal bone development + prevent maternal bone loss - Protein = fetal/uterine/placental development |
| Foods to Avoid in Pregnancy | - EtOH (teratogen) - high mercury fish (shark, king mackerel, swordfish) - Soft cheese/Unpasteurized milk/Deli meat/Raw sprout (Listeria risk) - Caffeine limitation ( <200mg/daily) |
| Nausea/Vomiting interventions | - small frequent meals - bland foods - Ginger - Vitamin B6 - Avoid triggers |
| Acne/Skin Interventions (Pregnancy) | - Gentle cleanser - Avoid retinoids (teratogen) |
| Nasal Congestion/Nosebleed intervention (pregnancy) | - saline spray - Humidifier - Direct pressure for nosebleed |
| Hyperemesis Gravidarum | - hCG driven (resolve by 1st trimester) - Ketosis risk - Classical Sx: persistent vomiting + >5% pre-pregnancy weight loss + ketonuria + dehydration - Tx: NPO status (to break vomiting chain) IV hydration, antiemetics, ?hospitalization |
| Common 1st/2nd trimester discomforts | - Fatigue - N/V - Breast tenderness - Urinary frequency/Leukorrhea - Nasal congestion/epistaxis - Headache/lightheadedness - Acne/skin change - Increase salivation |
| Common 3rd trimester discomforts | - GERD/Constipation/hemorrhoids - Low back pain - LE edema - Varicose veins - Carpal tunnel syndrome (self limiting post pregnancy) - Dyspnea - Braxton hicks |
| Abnormal signs in Pregnancy | - Sudden generalized edema (facial/hand) - Severe headache after 20 weeks (possible preeclampsia) - Flashing lights/blind spot/double vision (preeclampsia) - Hyperemesis gravidarum Sx - Sudden severe SOB/CP (possible PE) - Regular contractions before 37 weeks (preterm labor) - Rupture of membranes/bloody show/foul smelling discharge - Decrease/absent fetal movement (start NST) |
| First GYN visit Labs/Education | - Blood type/Rh, CBC, rubella, HBV, HIV, RPR, urine GC/CT, U/A + culture - If due/indicated: pap smear, TB screen, genetic carrier screening - Education: danger signs to report, nutrition, medications to avoid, activity |
| Prenatal Care Checkup Scheduling | - <28 weeks: Q4 weeks (VS, weight, FHR, fundal height (after 16 wk), urine dipstick, education - 28-36 weeks: Q2 weeks (+GBS Cx @35-37 weeks, GDM screen @ 24-28 weeks) - 36+ weeks: + cervical assessment, NST/BPP if indicated, birth planning discussion |
| First GYN visit H&P | - Complete H/P - Determine EDD (Nagele's Rule/US) - Medication/Supplement review - Assess psychological response to pregnancy (depression/anxiety screening) - Assess FHx (eval genetic risk factor) - Screen for IPV (always in PRIVATE) |
| Dizygotic Twins | - Fraternal twins (2 eggs fertilized by 2 sperm) - NOT identical - Dichorionic-diamniotic (both have chorion + amnion) - Risk factors: fertility drugs, older maternal age, certain ethnicities, FHx |
| Monozygotic Twins | - Identical twins (1 egg splits after fertilization = random event) - early cleavage = more separate structures = less shared features/risk |
| Maternal/Fetal Risk of Multiple Gestation | - GDM, HTN, preeclampsia, PE, IUGR, placenta previa, fetal anomalies, early pregnancy loss/stillbirth/preterm birth, twin-twin transfusion syndrome (TTTS) |
| Miscarriage Pathophysiology | - Spontaneous abortion (pregnancy loss before 20 weeks) - 20% mothers w/ vaginal bleeding - RhoGAM admin for Rh (-) - Emotional support S/Sx: vaginal bleeding, cramping, passage of tissue Dx: serial b-hCG + transvaginal US Intervention: assess VS/bleeding/pain, monitor for sign of shock |
| Rh Isoimmunization | - Occur when Rh (-) mother w/ Rh (+) fetus - Safe in 1st pregnancy (Ab formation) -> subsequent pregnancies maternal Ab attack Rh(+) fetal RBC = hemolytic disease - For delivery, miscarriage, ectopic preg, amniocentesis, abdominal trauma Tx: RhoGAM @ 28 weeks + within 72 hours of delivery |
| Ectopic Pregnancy | - Pregnancy implanted outside uterus (fallopian tube common) - LIFE THREATENING - Risk factor: prior PID/ectopic, infertility/fertility tx, smoking, IUD, advance age S/Sx: unilateral pelvic pain, pain referred to shoulder (diaphram irritation), vaginal bleeding, dizziness Dx: serial b-hCG (fails to double) + transvaginal US Tx: methotrexate (if stable), salpingectomy/salpingostomy Nursing: monitor for rupture sign (sudden severe pain, hypotension, rigid abdomen) |
| Gestational Trophoblastic Disease Pathophysiology | - Nonviable mass of trophoblastic tissue w/o viable fetus - Abnormal uterine growth + abnormally HIGH b-HCG level - Invasion beyond uterus = invasive mole vs choriocarcinoma Dx: US (snowstorm appearance), serum b-HCG level Tx: D&C, hysterectomy, possible chemotherapy ppx, RhoGAM (if Rh negative) - Need 6-12 month b-HCG monitoring post tx + avoid pregnancies for 1 year |
| Preeclampsia Pathophysiology | - Renal (oliguria, proteinuria, renal failure) - Liver (elevated AST/ALT, RUQ/epigastric pain, subcapsular hematoma) - CNS (cerebral edema, severe HA, visual disturbance, seizure) - Hematologic (thrombocytopenia + DIC risk) - Pulmonary (PE) - Uteroplacental (IGUR, oligohydramnios, placental abruption) Tx: HTN meds for >160/110 (IV labetalol/hydralazine or PO nifedipine), ASA ppx @12-16 weeks, Mag sulfate IV (4g loading 10-15 mins, 1-3g/hr maintenance), steroids if 34+ weeks, DELIVERY only cure |
| Preeclampsia Nursing Interventions | - Continuous maternal/fetal monitoring - BP when seated @ arm level Q1-4 hours - Assess DTR + clonus with BP - Urine output (30+ mL/hr), urine dipstick (24h urine if positive) - Assess neuro status/LOC (HA, visual, alertness/orientation) - Fetal monitoring: FHR, kick count, NST/BPP, fundal height Labs: CBC, BMP, uric acid, coagulation study |
| Preeclampsia danger signs | - Severe HA: indicate cerebrovascular edema (unrelieved by tylenol) - Visual disturbances: blurry vision, blind spot (scotomata), photophobia, diplopia - RUQ/epigastric pain: liver capsule distension (HELLP sign) - BP >160/110 (BP meds within 30-60 mins, CVA risk) - Altered LOC: confusion, agitation, decrease responsiveness |
| Magnesium Sulfate | Used to decrease seizure risk - Loading dose IV 4-6g/15-30 mins - Maintenance 1-3g/hr (4-7 mEq/L range) - Monitor for DTR, RR 12+, urine output 25+ mL/hr (check before each dose) - Tx: STOP IV infusion, calcium gluconate 1g IV slow push |
| Gestational DM (GDM) Risk factors/Complications | Poor maternal glucose metabolism during gestation - Risk factors: overweight/obesity, prior GDM/macrosomic infant/fetal demise/infant anomalies, FHx DMT2, maternal age 40+, chronic HTN, ethnicity (Black, Native American, Asian/PI) - Fetal: macrosomia, stillbirth, fetal anomalies, shoulder dystocia - Maternal: postpartum hemorrhage, inc cesarean risk - 50% maternal risk of DMT2 in 10 years |
| Gestational DM (GDM) Screening | - Screening @24-28 weeks - 1st line: 1 hr 50g nonfasting glucose challenge test - 2nd line: 3 hr 100g fasting glucose tolerance test (positive @ fasting 95+, 1 hr 180+, 2 hr 155+, 3 hr 140+ mg/dL) |
| Fetal Surveillance for GDM | - Daily fetal kick counts** - Weekly NST/BBP @36 weeks - Growth US (monitor macrosomia) - Vaginal birth preferred -> induction @39-40 weeks to prevent stillbirth - Cesarean if macrosomia dx by US or suboptimal glucose |
| GDM treatment | - Nutritional management (carb restriction + protein/fiber increase) - Exercise (150 min/weekly moderate) - Insulin preferred (does not cross placental barrier) - Metformin offlabel (may cross placental barrier) |
| TORCH infections | T= Toxoplasmosis O = Other (syphilis, zika, varicella, listeria) R = Rubella (check immunity 1st visit, live vaccine postpartum only) C = cytomegalovirus (often asymptomatic, hand hygiene) H = Herpes (HSV1/2) |
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sleepingbear