Quiz Exam 1.pdf

Exam 1 Review - 70 Questions | 4 Med Calc | 1 Hour Prior when we can Download Question SATA - That every answer is CORRECT (ALL ANSWERS) | SATA (One of them is ALL BUT ONE) 1. Going to be on preeclampsia (Need to know) Body systems AFFECTED by preeclampsia - - When gestational hypertensio...

Exam 1 Review - 70 Questions | 4 Med Calc | 1 Hour Prior when we can Download Question SATA - That every answer is CORRECT (ALL ANSWERS) | SATA (One of them is ALL BUT ONE) 1. Going to be on preeclampsia (Need to know) Body systems AFFECTED by preeclampsia - - When gestational hypertension progresses into preeclampsia, high blood pressure temporarily impairs the kidneys; ability to filter albumin, causing the protein to appear in the urine. - Kidney impairment leads to generalized edema Other systems AFFECTED - - Intravascular volume is reduced as fluid moves out of the vessels (Hemoconcentration - Increased blood viscosity and tissue edema. - Decreased liver perfusion - Impaired liver function and elevated liver enzymes - Hepatic edema causes epigastric or right upper quadrant abdominal pain. - Cerebral edema -Increased CNS irritability, causing headaches, hyperreflexia, Ankle clonus, and seizures. - Decreased blood flow to the retina causes visual disturbances and blurred vision. Characteristics of MILD preeclampsia - - Blood pressure: increases in pregnancy; ≥ 140/90 mm Hg - Edema: face, hands, ankles, periorbital edema (MORE ominous finding) - Weight: 2nd trimester increase; 3 pounds or more per month; 3rd trimester increase 1 pound per week - Urine: 1+ to 2+ protein; output is at least 500 mL/24 h Characteristics of SEVERE preeclampsia - Blood pressure :≥ 160/110 mm Hg x 2 (6 hours apart), even when on bed rest - Edema: MORE obvious - Weight: increases dramatically; 1-2 pounds gained in 3-7 days - Urine: 3+ to 4+ protein; output &lt; 500 mL/24 h - Headache, Blurred vision, and Epigastric discomfort - Hyperreflexia and Clonus (Indicates a seizure is likely to occur Preeclampsia - Develops AFTER 20 weeks - BP elevated on 2 occasions at least 6 hours apart - Associated with Proteinuria and Edema Risk factors of preeclampsia - Nulliparity - Multifetal gestations - Maternal age over 35 - Preeclampsia in a previous pregnancy Chronic hypertension - Pregestational diabetes - Vascular and connective tissue disorders - Nephropathy - Antiphospholipid syndrome - Obesity - African-American race Fetal effects of preeclampsia - Placental abruption - Fetal growth restriction - Oligohydramnios - Fetal distress - Increased perinatal morbidity and mortality Labs and Fetal assessments of preeclampsia - Urine dipstick for protein - 24-hour urine - Discard the first void - Over ice or in the fridge - CBC - Comprehensive metabolic profile - Liver enzymes - Uric acid - Fetal Kick Counts - NST - BPP - Amniocentesis for fetal lung maturity - Steroids if PREMATURE delivery anticipated - Betamethasone was given to mom one time; at 24-34 weeks, lungs mature by 36 Preeclampsia indications for delivery - Worsening BP - A nonreassuring fetal condition - Development of severe PIH - Fetal lung maturity ** Ultimate: Cure is DELIVERY 2. If we have a patient with repetitive UTI (Decrease in her diet) - REDUCE SUGAR 3. When do we give a rubella vaccine if she is NONimmune - 72 Hours AFTER Delivery 4. Hyperemesis Gravidarum Patient Teaching (What to do)- Crackers in the morning, Smaller portions (Bland), NON-Greasy foods, Hydrate (Increase Fluid Intake), Medications if needed -> - Ondansetron - PPIs (Omeprazole) - Antacids (Calcium carbonate) - H2 blockers (Famotidine) - Pyridoxine (Vit B6) - Doxylamine - Metoclopramide 5. Amniocentesis; Do we do an Ultrasound? YES; Why? To GUIDE the NEEDLE Amniocentesis - A needle guided by ultrasound is passed through the abdominal wall into a small pocket of Amniotic fluid, which is removed for testing - Performed BEGINNING from 15-20 or 16-18 weeks gestation and can be USED throughout pregnancy - Evaluate chromosomal and Metabolic abnormalities and Fetal Lung Maturity - 1% RISK of PREGNANCY LOSS -> Report vaginal bleeding, leaking amniotic fluid, abdominal pain, or fever -> Monitor mom and baby for 1 hour, discharged in 2-4 hours if both mom and baby are stable - Rest and Reduce activity for 24-48 hrs 6. BPP - NEED TO KNOW WHAT IT STANDS FOR → Biophysical Profile - FHR: End of the SECOND trimester - Fetal Breathing Movements: 10 weeks - Fetal Muscle Tone: 7-8 weeks of gestation - Amniotic Fluid Volume: 10 weeks - Gross fetal movements: 9 weeks FHR reactivity interpreted from an NST - Other 4 parameters measured by real-time ultrasonography - Each parameter is 0 or 2 point - 10 = PERFECT, 0 = WORST Score - 8-10 Considered NORMAL unless oligohydramnios (Decreased Amniotic Fluid) is present 7. Food HIGH in Calcium - Collard Greens 8. Iron deficiency Anemia Foods: (Double up on iron from vitamins) - Meats - Dark green leafy vegetables - Enriched bread and cereal - Dried fruits - Tofu - Legumes - Nuts - Blackstrap Molasses 9. If we are talking to someone and educating them - We have to make sure they understand what we say (TEACH BACK Method) 10. Vitamins during pregnancy - Fat-soluble: K, A, D, E ** NO supplements - Water soluble: B6, B12, C, Folic acid (400 mg daily), Thiamin, Riboflavin, Niacin - Iron: 1000 mg daily, Calcium, Sodium, Iodine 11. What over-the-counter pain medication can a woman take in her third trimester? ACETAMINOPHEN (Tylenol) 12. Remember looking for Domestic Violence, Some of the CUES (Patient came in, asking questions, what would concern you) - Partner answers the questions instead of the patient (Speaking for the patient) Abused pregnant women percentage - Nearly 20% - Abuse gets WORSE DURING pregnancy - Pregnant Adolescents and UNINTENDED pregnancies at an INCREASED risk 13. Gestational Diabetes What are some of the things we MIGHT SEE during the check- up (Came in for her visit, except to see) - - Increase fundal Height - Glucose in Urine, NEVER Protein in her urine Give Glyburide if she HAS Gestational DM (Oral Hypoglycemic) 14. Talked about the Glucose Test and Challenge Test - Know what is involved One-Hour Glucose Challenge Test (Test Three-Hour Glucose Tolerance Test (Test glucose Level After 1 HOUR) the FASTING BG Level) - Between 24-28 weeks - Between 24-28 weeks - SIMPLE - COMPLEX - NO NEED to FAST - NEED TO FAST - Typically for initial screening - Drink 100G of a glucose solution - Drink 50G of a glucose solution - Test the blood glucose levels 1,2,3 hours - If HIGHER than 140, the client proceeds later to an ORAL glucose tolerance test - Gestational DM is diagnosed if 2 or MORE of the values meet or exceed the following → Fasting Glucose: 95 mg/dL → 1 hour: 180 mg/dL → 2 hours: 155 mg/dL → 3 hours: 140 mg/dL 15. Know the Good/Chadwick Sign (NEED TO KNOW) Vaginal and Cervical changes - Chadwick Sign (Increased vascularity noted upon pelvic exam; pink to blue (Bluish Purple) - Goodell Sign (Cervical softening -> Like a Nose (Becomes Softer) - Hegar's Sign (The lower uterine segment is so SOFT it can be compressed to the thinness of the paper 16. MSAFP - Need to Know Maternal Serum Alpha-Fetoprotein Screening - Initial screening is offered at 16-18 weeks of gestation - Gestational age, Maternal Weight, Multifetal pregnancy, Race, Maternal diabetes, and Ethnicity considered when evaluating levels Low Levels: Chromosomal Abnormalities such as Trisomy 21 High levels: Open Neural Tube defects and Body Wall Defects - Spina Bifida - Anencephaly Abnormal findings prompt MORE testing such as ultrasound (To confirm the birth defects) and Amniocentesis (to confirm the Chromosomal Abnormalities) 17. Know what Social Determinants are (Need to Identify) - H E E N S (Mnemonic) - Healthcare Access and Quality: Factors such as access to health care, health insurance coverage, health literacy, and primary care access - Economic Stability: The ability to access resources that are essential to one's life and well-being - Education Access and Quality  - Neighborhood and built environment - Social and Community Context Some EXAMPLES of SDOH include: - Income and Social Protection - Unemployment and Job insecurity - Working Life Conditions - Food Insecurity - Housing, Basic Amenities, and The Environment 18. Who is at RISK for Gestational Diabetes - Women OVER 25, Obese, Family History of GDiabetes Risk factors for Gestational Diabetes - First-degree relative with diabetes - History of gestational diabetes - High-Risk Ethnic Groups (AA, Hispanics, American Indian, Asian Americans, pacific islander) - Overweight, Obese, Morbidly obese - History of Polycystic ovary syndrome (POS) 19. Talked about the Skin Changes - Dark Areas, Malsma, Linea Negra, Gravidarum (Need to know) Skin changes during pregnancy Linea Nigra: Dark line from the Umbilicus to the Abdomen Striae Gravidarum (Stretch marks) May appear on thighs, abdomen, and breasts -Caused by the Stretching of the skin - Typically fades AFTER delivery Melasma/Chloasma/Mask of pregnancy - Brownish patches involving the forehead, cheeks, and bridge of the nose - Increases with exposure to sunlight - Use sunscreen - Usually resolves AFTER pregnancy but may continue for months or years 20. What blood is a Vein or Artery that gives Oxygen-Rich Blood to the Fetus - V E I N 21. BMI (How much weight a patient should gain) - 25-35 BMI for pregnant women - - Normal BMI = 18.5-24.9 kg (25-35) - Overweight BMI = 25-29.9 kg (15-25) - Obese BMI = 30+ (11-20) Weight gain in Pregnancy - Weight gain is Expected - MOST weight gained in 2nd trimester and going into 3rd 22. What do you do if the patient has a culture that she CAN NOT eat certain foods during pregnancy - Notify the HCP 23. Fundal Measurements (Need to Know) Fundal Height Measurements - 12 weeks: Fundus palpated ABOVE Symphysis Pubis - 16 weeks: Fundus MIDWAY between symphysis pubis and umbilicus - 20 weeks: Located AT Umbilicus - 36 weeks: Fundus reaches HIGHEST level; Xiphoid process - Pushes against diaphragm; mom feels SOB at rest - 40 weeks: Fetal Head DESCENDS into the pelvic cavity and uterus sinks to a lower level; Lightening; Reduces pressure on the diaphragm and makes breathing easier Fundal height: Assess fetal growth and confirm gestational age - Beginning in 2nd Trimester, when the uterus rises into the abdomen, a tape measure is placed from the top of the fundus to the symphysis - 20-32 weeks: Fundal measurement should correspond to the gestational weeks as determined by the due date - Mcdonald's rule to measure the cm length from the top of the fundus to the symphysis - Mom empties bladder and is supine with knees slightly flexed Too high: Excessive amniotic fluid or multiple fetuses Too low: Intrauterine growth restriction - Impacted by maternal obesity, fetal and maternal position, presence of uterine fibroids 24. Once we do an Amniocentesis (Need to Know - But what are we monitoring) - Monitor Heart Tones 25. What can a doula do? Give Emotional Support/Supportive (Main Thing) NO Medical Background (Labor Support ONLY) 26. Know what is going on with the fetus between 16 Weeks, 18 Weeks, and 24 Gestation - LOOK IT UP 16 weeks gestation 18 weeks gestation 24 weeks gestation - Head in an - The cornea iris lens retina and - Structures of the upright ciliary body are formed but inner ear are fully position not fully refined yet formed - Neck more - Eyelids closed - Receptors and fluid- defined - Eyes eyelashes eyebrows and filled ducts for - Taste Buds eyelids continue developing hearing and balance forming until the final trimester make up a  - O2 sat, Vital Signs, BP - Auscultate lungs - Strict I/O (30 ML - If < then SHUT OFF) - LOC - Check that FUNDUS after she delivers (Can get PPH) S/S of being on - N/V, TIred, Hot Flash - Clonus- Pushing foot back and if it has beats when coming back down the pt is hypertensive Magnesium therapeutic level: 6-8 mg/dl Antidote- Calcium Gluconate - 10 ml of 10% solution of calcium gluconate IV over 3-10 minute Toxicity- RR