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What are some physiological adaptations during pregnancy?
- Hyperdynamic State, Hypermetabolic, Hypervolemic, Hypercoaguable, Low resistance
- Compensatory Respiratory Alkalemia, Diabetiogenic
- N/V, back ache, leg craps, variscosisites, hemorrhoids, consitpation, braxton-hicks, Heartburn, indigestion
- Nasal stuffiness, Bleeding gums, epitaxis, (due to increased estrogen-- advise to increase fluid, warm saline mouthwash to relieve discomfort)
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What are some cardiac related Physiologic changes?
- -An increased workload on the heart plus an increased metabolic rate leads to an increase in maternal oxygen consumption. Underlying cardiac dysfunction may be masked, especially in early pregnancy (<30 wk). Cardiac intolerance to pregnancy is typically evident during the second trimester.
- -The increase in oxygen consumption secondary to an increase in metabolic rate, fetal demands, and labor and birth lends to an increased metabolic state and risk of decompensation. Decompensation may be evident by labored breathing (dyspnea), venous engorgement, and/or edema. As a result, there may be less oxygen available for the fetus.
- -A rise in blood volume occurs secondary to the 2–3 L increase in plasma volume. Pathologic alterations may negatively influence the perfusion needs of pregnancy and blood loss at the time of delivery. Normal adaptations of pregnancy may lead to a false sense of normalcy during a state of blood loss or hemorrhage. A pregnant woman may lose up to 35% (approximately 2500 mL3) of her blood volume before showing signs of hypovolemia.
- - Pregnancy promotes procoagulant activity (i.e., a cause to clot) and decreased fibrinolytic activity (i.e., a decreased ability to dissolve a clot) in order to compensate for blood loss at delivery. Pregnancy itself or a history of a clotting disorder (previous deep vein thrombosis, pulmonary embolism, Factor V Leiden disorder, or antiphospholipid antibody syndrome) may increase risk of disseminated intravascular coagulopathy.
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What is the intervention if FHR is havbing late decels?
Stop pitocin, increase fluids, turn mom on side, Apply oxygen
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What are the adverse reactions of Magnesium Sulfate?
Tetany, muscle twitching, arrythmias, seizure
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If given at the wrong time this drug can cause premature labor:
Magnesium Sulfate (but used in preterm labor)
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What are the four pelvic shapes?
- gynecoid (Best for birth)Anthropoid-long, narrow ovalAndroid—usually indicative
- of male anatomyPlatypelloid—flat, transverse oval shape. Not favorable for
- childbirth
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What are common assessments during labor?
Dilation, effacement, FHR, Fetal descent, fetal positioning, Stength, intensity, and frequency of contractions. Evidence of choreo, temparature, onset of labor,
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What station is baby at when in line with ischial spine of the pelvis?
0
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Where would the baby be at -2 station?
Symphasis pubis
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What are the 3 divisions of the first stage (dilation) of labor?
- Latent (1-4 cm)
- Active (4-7cm)
- Transition (7-10 cm)
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What is the second stage of labor?
Expulsion; dilation to birth of infant
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What is the third stage of labor?
Birth of placenta
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What is the fourth stage of labor?
Immediate post recovery period
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Postpartum assessment:
- Breast
- Uterus-Fundal check (at umbilicus at delivery) U-1 at 24H, at day 6 should be between Umbilicus and pubic symphasis.
- Bowel
- Bladder
- Lochia
- Eisotomy
- Homan's Sign
- Emotions
- Pain
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What does the APGAR measure on a new born infant?
- Appearance
- Pulse
- Grimace
- Activity
- Respiration
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What are probable signs of pregnancy? (pg 290)
- Hagar's (softening of lower uterine segment)
- goodell's (softening of the cervix)
- Chadwick's (bluish tint to cervix)
- Braxton-Hicks
- Positive pregnancy test
- Ballotement
- abdominal Enlargement
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What are positive signs of pregnancy? (pg 290)
Ultrasound for visualizationauscultation for fetal heartbeatpalpation of fetal movement (Advance practice)
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How do you differentiate between Braxton-Hicks and True contractions?
Braxton-Hicks are relieved by walking and increased fluid intake
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What are common Lab prenatal tests?
- Ultrasound AFP- (12-14 weeks)congenital or neural tube defect
- Amniocentesis- (15-17 weeks) chromosomal
- abnormalities, fetal blood incompatibility, hereditary metabollic defects
- Fetal lung maturity- L/S ratio and presence of
- phosphatidylglycerolChorionic Villi Sampling- (10-13 weeks gestation)
- identify chromosomal abnormalities
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What are common Diagnostic tests?
- Non-Stress Test- reactive (no further testing) non-reactive (preform CST) evaluate FHR with electronic fetal monitor. Document accelerations
- Contraction Stress Test- Stimulate mild uterine
- contractions. Watch effect on FHR with electronic fetal monitoring. allows practioner to know if fetus can handle mild periods of mild hypoxia during
- labor contractions
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What is the expected weight gain?
- 3.5 lbs in first trimester, then 1 Lb/week.
- normal weight 25-35 lbs
- underweight 28-40 lbs
- overweight 15-25 lbs
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By how much should a female increase her daily caloric intake by?
300 calories
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What types of nutrients should a pregnant female have?
- Protien- cell development and repair
- Calcium- for mom, baby takes it
- Folic Acid B9- Neural tube defect prevention
- Prenatanl Vitamin
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Why does a pregnant female require sodium?
To maintain fluid volume in vascular space and prevent edema in tissue
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When does rapid brain development occur?
17-20 weeks
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When do the lungs begin to produce surfactant?
21-24 weeks
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When does the fetus have hand grasp and startle reflex?
21-24 weeks
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When does the fetus begin to store its own iron, calcium, and phospherus?
29-32 weeks
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What weeks does the mother begin to supply the fetus with antibodies?
33-38 weeks
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What is the prostoglandin inhibitor commonly used to close the foreman ovale?
Indomethacin
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This shunt involved in fetal circulation diverts the blood from the liver directly to the heart and connects the umbilical vein to the inferior vena cava:
Ductus venosis
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This shunt involved in fetal circulation diverts blood from the right atrium to the left atrium rather than going to the lungs for oxygen
Foreman Ovale
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This shunt involved in fetal circulation diverts blood from the pulmonary artery to the descending aorta, rather than going to the lungs for oxygen.
Ductus arteriosis
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What is considered routine care throughout the pregnancy?
- Office visits Q4weeks up to 28 weeks
- Q2wks 29 weeks to 36 weeks
- Qweek 37 weeks through delivery
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First prenatal visit will consist of?
Date of first day of menstrual period (LMP), Date pregnancy (EDC), Hx of previous pregnancy, Medical Hx, Psychosocial Hx, Weight, VS, Especially BP, Pelvic Exam, FHT, Baseline lab work
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At each visit after the first one each of these will be reassessed?
VS, Weight, urine, Fundal height, FHT, Assessment of fetal movement
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