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74 Cards in this Set

  • Front
  • Back
What is included in a personal health hx?
hx of illnesses, surgeries, allergies, STIs, drug and tabacco use, abuse,
What is included in a menstrual hx?
age of menarche, cycle length, period length, amount of flow, cramps,
What is included in a family hx?
hx of cancer, hypertension, diabetes, major illness, congenital defects, genetic illnesses, ethnic background, mental illnesses.
what is included in a current pregnancy history?
breast changes, syncopy, nausea, vomitting, apatite increase/decrease, visual changes, weight gain/loss,HA, bleeding, discharge, edema, leg cramps, quickening, dysuria, dyspareuniafever, heartburn, shortness of breath
what is an obstetrical hx?
number of pregnancies, number of live births, miscarriages, abortions, number of preterm births, number of stillbirths
SAB
spontaneous abortion
TAB
therapeutic abortion
medical abortion
surgical abortion
Stillbirth
a baby born dead after 20 weeks gestation,
What does the physical exam include?
exam of major body systems, vitals, weight, height, breast exam, pelvic exam, external genital exam
What does a routine prenatal physical exam include?
Vitals, reflexes, urinalysis, fetal heart rate, leopolds, uterine size,
What does routine prenatal counseling include?
psychosocial history, energy level, sleep cycles, diet recall, review resources in community,discomforts of pregnancy,
Normal pregnancy dietary reccomendations
2 green vegetables, one leafy, 2 other vegetables, 2 fruits, 3-4 grains two whole grains, 3-4 servings of protein, 3 servings of calcium rich foods
what are some remedies for constipation
drink plenty of fluids, eat whole grains, increase fruits and vegetables, moderate exercise
Remedies for Nausea
eat small meals, control blood sugar, dry crackers, restrict fats, acupressure wristbands,
what are causes of bleeding 1st trimester
implantation bleeding, threatened abortion, inevitable abortion, idiopathic, STI, R/O SAB
Signs and symptoms of SAB
cramping, bleeding, heavy feeling in the pelvis, cessation of fetal movement.
What hormone are pregnancy tests based on?
hCG, Human chorionic gonadotropin
Where does hCG originate from?
The outer layer of the trophoblast.
When can you detect hCG?
After implantation.
When are quantitative hCG levels clinically significant?
They are unusually low in ectopic pregnancy, and threatened SAB, high with multiple gestation, and molar pregnancy, and choriocarcinoma.
presumptive signs of pregnancy
nausea, breast tenderness,cessation of period, ^urination, montgomerys tubercles, continued elevation of basal body temp, colostrum, quickening
probable signs of pregnancy
Enlargement of abdomen, palpation of fetal outline, Ballottement
positive signs of pregnancy
FHTs, sonogram of fetus, x ray of fetal skeleton (not used),
Gravida
# of times a woman has been pregnant regardless of outcome
Para
# of pregnancies to reach viability
What is considered age of viability?
20 weeks gestations or 500 grams
what does the 5 digit system of counting pregnancy include?
1st # number of term babies ,>36 weeks or 2500 grams
2nd # number of premature babies born, 20 to 36 weeks, 500 to 2499 grams
3rd # of pregnancies ending in either SAB or TAB

4 # of children now alive

5#number of multiple births
EDC, EDB,EDD
estimated date of confinement
Estimated date of birth
Estimated Date of Delivery
Naegles rule
add 7 days to LMP,and subtract three months, adjust year if necessary
When do the vast majority of women deliver?
10 to 14 before or after their due date
Prenatal tests?
Pap smear, GC and Chlamydia, prenatal screen blood work, urinalysis, glucose screen, GBS
What blood work is included in the routine prenatal blood work?
VDRL, CBC, Rubella titer, Hep B, ABO, Rh factor, Antibody screen, hemoglobin, HCT
What other blood work might be done?
Sickle cell or hemoglobin electorphoresis, HIV
What is the maternal triple screen?
Alpha-fetoprotein.
What test may be repeated in early third trimester
Hemoglobin, HCT
Ptyalism
Increased saliva,
Fatigue
normal symptom of pregnancy, review exercise and diet
Upper backache
caused by increased breast size, new well fitting bra, postural exercise
Leukorrhea
profuse thin or thick vaginal discharge, caused by increase in glycogen in vaginal epithelial cells, hygiene, cotton underwear, do not douche
Urinary frequency
uterus putting pressure on uterus, in first or third trimester. no relief measures
Hegars sign
softening of the isthmus
Heartburn
causes
caused by increased progesterone, relaxing sphincters in stomach and by increased pressure on stomach by the uterus
Heartburn
relief
small meals, good posture, avoid fats, avoid beverages with meals, spicy food, very cold food, Try papaya enzyme, probiotic food
Hemerrhoids
causes, progesterone relaxation of veins, and weight of uterus, relief, avoid constipation, straining, try sitz baths, which hazel, ice, replacing hem, analgesic ointments
Dependent edema
caused by pressure on lower extremities, R/O preeclampsia edema, raise legs, abdominal support
Vericosities Treatment?
caused by progesterone relaxation, impaired venous circulation and increased pressure
relief, support hose, avoid constrictive clothes, long periods of standing, try resting, Elevate legs, 45degree, uncross legs, exercise
Dyspareunia
Painful intercourse,may be caused by pelvic congestion, psychosocial, try position changes, discuss w/ clients misconceptions about sex in pregnancy

R/O vaginal infectionsn and STI
Insomnia
May be caused by anxiety, concerns or excitement, try warm bath, warm milk, relaxation techniques
Round ligament pain
flexing knees, bending forward, pelvic tilt, warmth, support
low back pain
caused by postural changes of late pregnacy, try, squat, review body mechanics, low heels, abdominal support, warmth, massage, rest
shortness of breath
presure on lungs, good posture, stretching arms above head, breath awareness and relaxation
supine hypotensive syndrome
low blood pressure. full weight of uterus laying on the inferior vena cava. Side lying or sitting slightly elevated, propped on one side.
Weight gain in pregnacy
Low BMI<19% 28 to 40 lb
Med BMI up to 26% 25 to 35 lb
High bmi > 26% 15 to 25 lbs
Contraceptive hx
Dates, types of BC used, and complications, or difficulties
STD/STI hx
dates, types, tx, resolution, safe sex practices reviewed, HIV, Hep ABC risk assessed
Vaginal Infection hx
dates, types tx, sexual practices reviewed, HIV, Hep B risk assessed
HIV
Risk assessment
multiple partners
partners with unknown sexual hx
blood transfusion
IV drug use
born to a mother who was HIV positive
Hx of abuse
types of abuse, sexual, physical, emotional. refer to therapist for support if necessary, discuss the possibility that feelings may emerge or reemerge during pregnancy, birth or postpartum
Mental health
Risk assessment
review family and personal hx of mental illness, counsel client on the risks associated with history, Make a PP care plan to address mental health
Physical exam
Breast
Review self breast exam, teach breast exam
Fundal height assessment
Woman in supine position, legs uncrossed, locate pubic bone, place end of measuring tape on the upper border and then lay it long the uterus midline, and then with the opposite hand locate the fundus and record the #
Fundal Height
Generally mirrors the number of weeks gestation and should reflect growth from one visit to the next. In late pregnancy there may be a week or two where the fundal height dips as the baby engages in the pelvis.
Leopolds
Have mother, Empty bladder, lie down in supine position, place palms of your hands on
leopolds
1st maneuver
Face womans head, place hands on the side of the fundus, fingers towards head, palpate shape, size and movement
leopolds
1st maneuver
results
head
breech
neither
Leopolds
2nd Maneuver
facing head, bring hands down the sides of the uterus, apply pressure to one side then another
Leopolds
2nd Maneuver results
weight on one side indicates fetal back, small moveable parts indicates arms or legs,
Leopoolds
3rd Maneuver
facing head, mothers knees bent, grasp lower uterine segment above symphysis pubis between thumb and finger, palpate size spape and moveability
leopolds
3rd
results
hard round moveable w/ cephalic prominence head

softer, immovable. or whole body moves, no cephalic prominece
breech
Leopolds
4th
face mothers feet. palpate for cephalic promincence
Locating fetal heart tones
perform leopolds, locate fetal back, and estimate fetal scapula. begin there.
CVAT
Costovertebral Angle Tenderness

sit upright with entire back exposed
make a fist, and using the ulnar side hit her back from scapula to buttucks midline from spine to side. hit CVT angle and look for wincing
CVAT
findings
finding marked tenderness may indicate Peolyonephritis