Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
49 Cards in this Set
- Front
- Back
|
What countries have the lowest infant mortality rate?
|
Singapore
Hong Kong Japan Sweden Norway Finland Spain |
|
|
Higher infant mortality rates exist for mothers who are:
|
Teens
Over 35 Unmarried African American (4x as high) |
|
|
What is a high risk pregnancy?
|
a condition, pre-existing or not, that exists jeopardizes the health of the mother baby or both
|
|
|
Why is pregnancy considered a maturational crisis?
|
its a normal part of growth and development, one needs to resolve issues and move on
|
|
|
Why is high risk pregnancy considered a situational crisis?
|
when stressful events threaten a persons biophysical integrity and creates a disequilibreum
|
|
|
What are the goals of assessing risk in pregnancy?
|
early detection
early intervention prevention |
|
|
What is the role of the provider during antepartum assessments?
|
monitor progression of pregnancy
perform necessary screening and intervention Educate and reassure the mother detect complication and intervene appropriately |
|
|
What are the assessment components?
|
Hx: health, reproductive, risk assessment
Physical Exam Diagnostic Studies Labs: Blood (type H&H STD rubella glucose), urine, BP, PAP, GC |
|
|
What are the Biophysical Risk factors?
|
Genetic/Chromosomal
Multiple Gestation/ Large baby Pre-existing Condition Preeclampsia/GDM ABO incompatibility Incompetent Cervix Placental Abnormality Over/Under nutrition |
|
|
What are the psychosocial risk factors?
|
Smoking
Caffeine ETOH Drugs Situational Crisis Violence Unsafe Cultural Practices |
|
|
What are the sociodemographic risk factors?
|
Poverty
Lack of prenatal care Age (<15->35) Parity (first or >5) Marital Status Access to care Ethnicity (inc for nonwhite) |
|
|
What are the environmental risk factors?
|
Radiation
Pesticides Infections Drugs Pollutants Second Hand Smoke Stress |
|
|
When is an ultra sound used?
|
during each trimester but best after the first trimester
|
|
|
What do US detect in the first trimester?
|
PEGMACB
Pregnancy Confirmation Ectopic pregnancy (r/o) Gestational Age (determine) Multiple Gestations (ID) maternal Abnormalities CVS visualization ID cause of Vaginal Bleeding |
|
|
What do US detect in the second trimester?
|
PAIDC
assess Placental Placement Amniocentesis visualization Intrauterine Growth restriction Detection confirm Dates Congenital Anomalies |
|
|
What do US detect in the third trimester?
|
Confirm Gestational age
detect macrosomia Detect congenital anomalies Detect IUGR Determine fetal position Detect placenta previa Amniocentesis visualization Biophysical profile Amniotic Fluid Volume assessment Doppler Flow Studies Detect placental maturity |
|
|
When should the bladder be empty and full?
|
Empty: Transvaginal and 1st Trimester
Full: Abdominal and 2nd Trimester |
|
|
What position should a woman be in during abdominal and transvaginal US?
|
Abdominal: pillows under knees and head (gel or mineral oil used)
Transvaginal: lithotomy or elevated with pillows |
|
|
What is Chorionic Villi Sampling?
|
a biopsy of cells from the chorionic villi
|
|
|
Why is CVS done?
|
to detect chromosomal, metabolic, and DNA disorders
|
|
|
When is a CVS done?
|
10-13 weeks
|
|
|
Who would get a CVS done?
|
women at risk for DS or other genetic diseases
>35 US suggested birth defect CAN"T DETECT NTD |
|
|
What is the nursing care for CVS?
|
position varies (abd or cervical)
Asepsis (check for STD if cervical) For Rh- mother, give Rhogam Monitor FHT Explain to watch fever cramping bleeding No strenuous activity for 48hrs |
|
|
What do Multiple Markers screen for?
|
AFT (MSAFT)
hCG Estriol Inhibin A (<35) |
|
|
What is MSAFP tested for?
|
NTD in 15-20weeks, usually need more testing after that (amnio and US)
|
|
|
Why would someone want to get a multiple marker test?
|
abnormalities can indicate high risks for NTD and chromosomal disorders but has a lot of false negatives
accuracy varies for trisomy 21 |
|
|
When are MM tests done?
|
16-18 weeks
|
|
|
Who would be recommended the MM test?
|
those who have Family Hx
>35 Used harmful medications/drugs during pregnancy DM and use insulin Viral infection during pregnancy Exposed to high levels of radiation |
|
|
What can cause false negatives in MM?
|
gestational age
multiple gestations maternal weight DM normal does not mean healthy baby |
|
|
What does the amniotic fluid assess for?
|
Genetic
NTD Abdominal Wall Anomalies Fetal hemolytic disease Fetal Lung Maturity (L/S 2:1) during 3rd T |
|
|
When is the Amniotic Fluid Assessment done?
|
after 14 weeks
|
|
|
What are the risks for the AFA?
|
Informed consent required because of:
Possible trauma to baby, cord, or maternal structures Infection PROM |
|
|
What are the pre-procedure care for AFA?
|
Preterm Labor position (towel under one buttock)
Empty Bladder Fetal monitor strip before and after If Rh -, give Rhogam |
|
|
What are the post-procedure care for AFA?
|
Maternal VS and FHT q15m x 1hr
Observe puncture site Educate to rest at home and report leaking, bleeding, cramping Normal activity at 24hrs, no strenuous activity (jogging) for 48hrs |
|
|
When is a Percutaneous Umbilical Blood Sampling Done?
|
>17weeks because veins are fragile lasting 45mins and healed in 72hrs
|
|
|
Why is a UBS done?
|
to detect chromosomal and metabolic abnormalities
blood disorders infections structural problems Manage Rh disease detect abnormal clotting determine acid/base balance |
|
|
What is the FHR?
|
110-160
|
|
|
What are the risks associated with UBS?
|
Maternal or fetal infection
injury PROM Blood sensitization Cord Cx: cord laceration or hematoma, thrombosis or thromboembolism preterm labor: bleeding from cord, fetal bradycardia ONLY DONE IN SEVERE SITUATIONS |
|
|
What is a non-stress test?
|
normal fetal heart rate patterns response to fetal movement
|
|
|
What are the interpretations of NST?
|
Reactive Test (+): 2 accelerations in a 20min period, each lasting 15secs and peaking at least 15 beats above the base line HR
NonReactive Test: does not produce 2 or more required accelerations above the baseline |
|
|
What is the biophysical profile?
|
a detailed assessment utilizing US that is a reliable predictor or fetal well being
|
|
|
What does the biophysical profile measure?
|
Fetal breathing movements: at least one episode in >30secs
Gross Body Movements: 3 discrete body/limb movements Fetal Tone: 1 episode of active extension with return of flexion of fetal limbs Amniotic Fluid Volume: 1 pocket of AF measuring 2 cm in two perpendicular planes Fetal Heart Reactivity (NST) Score 2 for each normal variable |
|
|
What is the scoring of Biophysical profile
|
10-8 Normal Infant, low risk of asphyzia
4-6 Suspect Asphyxia 0-2 Strongly suspect Asphyxia |
|
|
What does the Contraction Stress Test measure?
|
Identifys fetal compromise because during contraction uterine blood flow and placental perfusion is decreased that could lead to hypoxia (which is portrayed through deceleration of FHR)
|
|
|
How is the Contraction Stress Test Conducted?
|
Fetal monitor is observed for 10-20 mins for baseline HR
Uterine Contractions are stimulated (at least 3 contractions lasting 40-60 sec within a 10min period) |
|
|
How are contractions stimulated in the Contraction Stress Test?
|
Nipple Stimulated: placing warm compress on nipple or massaging nipple
Oxytocin |
|
|
What is the interpretation of the Contraction Stress Test?
|
Negative (good): at least 3 uterine contractions in 10 min with no late of significant deceleration
Positive (Bad): Late decelerations with 50% or more Contractions Equivocol: hyperstimulation with nonrepetitive decelerations Unsatisfactory Tracing: not enough info |
|
|
What is the Fetal Movement Count
|
Done in the 3rd Trimester
Count once a day for 60mins: should be atleast 3 fetal movements within an hour Count three times daily for 60 mins * Omnious (no movement in 12hrs) |
|
|
What can be done to arouse fetus in Nonstress test?
|
give orange juice
wake up mother |
