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74 Cards in this Set
- Front
- Back
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What is included in a personal health hx?
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hx of illnesses, surgeries, allergies, STIs, drug and tabacco use, abuse,
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What is included in a menstrual hx?
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age of menarche, cycle length, period length, amount of flow, cramps,
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What is included in a family hx?
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hx of cancer, hypertension, diabetes, major illness, congenital defects, genetic illnesses, ethnic background, mental illnesses.
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what is included in a current pregnancy history?
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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
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what is an obstetrical hx?
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number of pregnancies, number of live births, miscarriages, abortions, number of preterm births, number of stillbirths
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SAB
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spontaneous abortion
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TAB
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therapeutic abortion
medical abortion surgical abortion |
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Stillbirth
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a baby born dead after 20 weeks gestation,
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What does the physical exam include?
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exam of major body systems, vitals, weight, height, breast exam, pelvic exam, external genital exam
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What does a routine prenatal physical exam include?
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Vitals, reflexes, urinalysis, fetal heart rate, leopolds, uterine size,
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What does routine prenatal counseling include?
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psychosocial history, energy level, sleep cycles, diet recall, review resources in community,discomforts of pregnancy,
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Normal pregnancy dietary reccomendations
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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
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what are some remedies for constipation
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drink plenty of fluids, eat whole grains, increase fruits and vegetables, moderate exercise
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Remedies for Nausea
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eat small meals, control blood sugar, dry crackers, restrict fats, acupressure wristbands,
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what are causes of bleeding 1st trimester
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implantation bleeding, threatened abortion, inevitable abortion, idiopathic, STI, R/O SAB
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Signs and symptoms of SAB
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cramping, bleeding, heavy feeling in the pelvis, cessation of fetal movement.
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What hormone are pregnancy tests based on?
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hCG, Human chorionic gonadotropin
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Where does hCG originate from?
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The outer layer of the trophoblast.
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When can you detect hCG?
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After implantation.
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When are quantitative hCG levels clinically significant?
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They are unusually low in ectopic pregnancy, and threatened SAB, high with multiple gestation, and molar pregnancy, and choriocarcinoma.
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presumptive signs of pregnancy
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nausea, breast tenderness,cessation of period, ^urination, montgomerys tubercles, continued elevation of basal body temp, colostrum, quickening
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probable signs of pregnancy
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Enlargement of abdomen, palpation of fetal outline, Ballottement
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positive signs of pregnancy
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FHTs, sonogram of fetus, x ray of fetal skeleton (not used),
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Gravida
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# of times a woman has been pregnant regardless of outcome
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Para
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# of pregnancies to reach viability
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What is considered age of viability?
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20 weeks gestations or 500 grams
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what does the 5 digit system of counting pregnancy include?
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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 |
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EDC, EDB,EDD
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estimated date of confinement
Estimated date of birth Estimated Date of Delivery |
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Naegles rule
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add 7 days to LMP,and subtract three months, adjust year if necessary
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When do the vast majority of women deliver?
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10 to 14 before or after their due date
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Prenatal tests?
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Pap smear, GC and Chlamydia, prenatal screen blood work, urinalysis, glucose screen, GBS
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What blood work is included in the routine prenatal blood work?
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VDRL, CBC, Rubella titer, Hep B, ABO, Rh factor, Antibody screen, hemoglobin, HCT
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What other blood work might be done?
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Sickle cell or hemoglobin electorphoresis, HIV
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What is the maternal triple screen?
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Alpha-fetoprotein.
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What test may be repeated in early third trimester
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Hemoglobin, HCT
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Ptyalism
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Increased saliva,
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Fatigue
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normal symptom of pregnancy, review exercise and diet
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Upper backache
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caused by increased breast size, new well fitting bra, postural exercise
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Leukorrhea
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profuse thin or thick vaginal discharge, caused by increase in glycogen in vaginal epithelial cells, hygiene, cotton underwear, do not douche
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Urinary frequency
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uterus putting pressure on uterus, in first or third trimester. no relief measures
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Hegars sign
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softening of the isthmus
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Heartburn
causes |
caused by increased progesterone, relaxing sphincters in stomach and by increased pressure on stomach by the uterus
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Heartburn
relief |
small meals, good posture, avoid fats, avoid beverages with meals, spicy food, very cold food, Try papaya enzyme, probiotic food
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Hemerrhoids
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causes, progesterone relaxation of veins, and weight of uterus, relief, avoid constipation, straining, try sitz baths, which hazel, ice, replacing hem, analgesic ointments
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Dependent edema
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caused by pressure on lower extremities, R/O preeclampsia edema, raise legs, abdominal support
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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
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Dyspareunia
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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 |
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Insomnia
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May be caused by anxiety, concerns or excitement, try warm bath, warm milk, relaxation techniques
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Round ligament pain
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flexing knees, bending forward, pelvic tilt, warmth, support
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low back pain
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caused by postural changes of late pregnacy, try, squat, review body mechanics, low heels, abdominal support, warmth, massage, rest
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shortness of breath
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presure on lungs, good posture, stretching arms above head, breath awareness and relaxation
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supine hypotensive syndrome
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low blood pressure. full weight of uterus laying on the inferior vena cava. Side lying or sitting slightly elevated, propped on one side.
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Weight gain in pregnacy
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Low BMI<19% 28 to 40 lb
Med BMI up to 26% 25 to 35 lb High bmi > 26% 15 to 25 lbs |
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Contraceptive hx
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Dates, types of BC used, and complications, or difficulties
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STD/STI hx
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dates, types, tx, resolution, safe sex practices reviewed, HIV, Hep ABC risk assessed
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Vaginal Infection hx
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dates, types tx, sexual practices reviewed, HIV, Hep B risk assessed
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HIV
Risk assessment |
multiple partners
partners with unknown sexual hx blood transfusion IV drug use born to a mother who was HIV positive |
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Hx of abuse
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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
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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
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Physical exam
Breast |
Review self breast exam, teach breast exam
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Fundal height assessment
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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 #
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Fundal Height
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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.
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Leopolds
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Have mother, Empty bladder, lie down in supine position, place palms of your hands on
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leopolds
1st maneuver |
Face womans head, place hands on the side of the fundus, fingers towards head, palpate shape, size and movement
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leopolds
1st maneuver results |
head
breech neither |
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Leopolds
2nd Maneuver |
facing head, bring hands down the sides of the uterus, apply pressure to one side then another
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Leopolds
2nd Maneuver results |
weight on one side indicates fetal back, small moveable parts indicates arms or legs,
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Leopoolds
3rd Maneuver |
facing head, mothers knees bent, grasp lower uterine segment above symphysis pubis between thumb and finger, palpate size spape and moveability
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leopolds
3rd results |
hard round moveable w/ cephalic prominence head
softer, immovable. or whole body moves, no cephalic prominece breech |
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Leopolds
4th |
face mothers feet. palpate for cephalic promincence
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Locating fetal heart tones
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perform leopolds, locate fetal back, and estimate fetal scapula. begin there.
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CVAT
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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 |
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CVAT
findings |
finding marked tenderness may indicate Peolyonephritis
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