NR 602 MIDTERM STUDY GUIDE
1. Signs of pregnancy (presumptive, probable, positive)
a. Presumptive: felt by woman, subjective
i. Breast changes, amenorrhea, nausea, vomiting, urine frequency, fatigue,
quickening
b. Probable: observed by examiner, objective
i. Goodall’s sign (softening of cervix)
ii. Chadwick’s sign (bluish cervix 6-8 weeks)
iii. Haegar’s sign (softening and compressibility of lower uterus)
iv. Braxton Hicks contractions
v. Ballottement (sharp upward pushing against the uterine wall with a finger
inserted into the vagina for diagnosing pregnancy by feeling the return impact of
the displaced uterus)
c. Positive: changes attributed to the presence of fetus
i. Visualization of fetus by real time
ii. Ultrasound
iii. Fetal heart tones (doppler 10-12wks or examiner)
1. 17-20 weeks = fetoscope
iv. Fetal movements palpated or visible by examiner
2. Pregnancy and fundal height measurement
a. 12 weeks: uterine fundus first rises above the symphysis pubis
b. 16 weeks: uterine fundus between symphysis pubis and umbilicus
c. 20 weeks: uterine fundus is at the level of umbilicus
d. 25-35 weeks: measure the distance btw upper edge of symphysis pubis and the top of
the uterine fundus with a tape measurer; fundal height in cm = # gestational weeks (plus
or minus 2 cm). For example a 28 week gestation fetus should measure between 26-
30cm
e. Lightening: fetal head goes down; less pressure on diaphragm 38 weeks for prima but
may not occur for multi
3. Naegele’s rule
a. Estimated DOB for women with 28 day cycles = +7days, -3months, +1year
b. ADD 7 DAYS TO LMP
c. SUBTRACT 3 months
d. Add one year
4. Hematological changes during pregnancy
a. Heart displaced upward
i. Uterus pressure on diaphragm
b. Risk for inferior vena cava and aortic compression leading to supine hypotension
c. LIE IN LEFT LATERAL POSITION just like colonoscopy
d. Cardiac output in pregnancy increases by 30-50%
i. Peaks in early third trimester
ii. Maintained until birth
e. Stroke volume increases 20-30%
i. 30% increase in oxygen consumption
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https://www.coursehero.com/file/96258047/Midterm-Study-Guidedocx/
, f.
Heart rate and sounds change
g.
Volume of first heart sound increased with splitting
3rd heart sound may be detected
h.
i.
Systolic murmors may be detected
j.
Increases 15-20bpm
i. By 32 weeks gestation
k. BP decreases by 5-15mm/Hg due to peripheral vascular resistance
l. 75% increase in blood volume is plasma
i. Hemodilution = ANEMIA
m. Clotting factors increase creating a risk for clotting
5. Indications and contraindications for prescribing combined estrogen vs. progesterone-only
birth control
a. Combine estrogen
i. Take every day; has 7 day non hormone intervals
ii. Safe for healthy women; decrease in the possibility of endometrial or cervical
cancer not found with mini pill or POP
iii. Contraindications: direct effects of the hormonal ingredient as in breast cancer
or thromboembolism
b. Progesterone-only birth control
i. Mini pill: must take every day at same time and there are no hormone free
intervals
ii. These pills ONLY thicken cervical mucus to prevent pregnancy
iii. Make the mucus thick for 22 hours so it needs to be taken constantly to avoid
the mucus to return to regular consistency
iv. INDICATIONS: POP are a safe method for many women who cannot take
estrogen for medical reasons
v. POPs are preferable to COCs for lactating women bc they do not cause adverse
effects on the volume or quality of breastmilk
vi. NO CONTRAS
6. Menstrual cycle physiology
a. Menarche: the initiation of menstruation; between ages 12-15
b. Menstrual cycles that occur during the first 1-1.5 years after menarche may be irregular
due to
i. Frequently irregular due to immaturity of hypothalamic pituitary ovarian axis
ii.
7. Vaccines during pregnancy
a. Women who are pregnant are at increased risk for flu related complications.
i. Any gestation when the injection is available.
b. Tdap
i. After maternal vaccination, antibodies cross the placenta and decrease the risk
of pertussis infection in the newborn
ii. Third trimester – 27-36 weeks gestation
c. Hep B
i. If women is at risk for acquiring hep b she should be vaccinated
This study source was downloaded by 100000839306532 from CourseHero.com on 01-23-2022 04:20:36 GMT -06:00
https://www.coursehero.com/file/96258047/Midterm-Study-Guidedocx/
1. Signs of pregnancy (presumptive, probable, positive)
a. Presumptive: felt by woman, subjective
i. Breast changes, amenorrhea, nausea, vomiting, urine frequency, fatigue,
quickening
b. Probable: observed by examiner, objective
i. Goodall’s sign (softening of cervix)
ii. Chadwick’s sign (bluish cervix 6-8 weeks)
iii. Haegar’s sign (softening and compressibility of lower uterus)
iv. Braxton Hicks contractions
v. Ballottement (sharp upward pushing against the uterine wall with a finger
inserted into the vagina for diagnosing pregnancy by feeling the return impact of
the displaced uterus)
c. Positive: changes attributed to the presence of fetus
i. Visualization of fetus by real time
ii. Ultrasound
iii. Fetal heart tones (doppler 10-12wks or examiner)
1. 17-20 weeks = fetoscope
iv. Fetal movements palpated or visible by examiner
2. Pregnancy and fundal height measurement
a. 12 weeks: uterine fundus first rises above the symphysis pubis
b. 16 weeks: uterine fundus between symphysis pubis and umbilicus
c. 20 weeks: uterine fundus is at the level of umbilicus
d. 25-35 weeks: measure the distance btw upper edge of symphysis pubis and the top of
the uterine fundus with a tape measurer; fundal height in cm = # gestational weeks (plus
or minus 2 cm). For example a 28 week gestation fetus should measure between 26-
30cm
e. Lightening: fetal head goes down; less pressure on diaphragm 38 weeks for prima but
may not occur for multi
3. Naegele’s rule
a. Estimated DOB for women with 28 day cycles = +7days, -3months, +1year
b. ADD 7 DAYS TO LMP
c. SUBTRACT 3 months
d. Add one year
4. Hematological changes during pregnancy
a. Heart displaced upward
i. Uterus pressure on diaphragm
b. Risk for inferior vena cava and aortic compression leading to supine hypotension
c. LIE IN LEFT LATERAL POSITION just like colonoscopy
d. Cardiac output in pregnancy increases by 30-50%
i. Peaks in early third trimester
ii. Maintained until birth
e. Stroke volume increases 20-30%
i. 30% increase in oxygen consumption
This study source was downloaded by 100000839306532 from CourseHero.com on 01-23-2022 04:20:36 GMT -06:00
https://www.coursehero.com/file/96258047/Midterm-Study-Guidedocx/
, f.
Heart rate and sounds change
g.
Volume of first heart sound increased with splitting
3rd heart sound may be detected
h.
i.
Systolic murmors may be detected
j.
Increases 15-20bpm
i. By 32 weeks gestation
k. BP decreases by 5-15mm/Hg due to peripheral vascular resistance
l. 75% increase in blood volume is plasma
i. Hemodilution = ANEMIA
m. Clotting factors increase creating a risk for clotting
5. Indications and contraindications for prescribing combined estrogen vs. progesterone-only
birth control
a. Combine estrogen
i. Take every day; has 7 day non hormone intervals
ii. Safe for healthy women; decrease in the possibility of endometrial or cervical
cancer not found with mini pill or POP
iii. Contraindications: direct effects of the hormonal ingredient as in breast cancer
or thromboembolism
b. Progesterone-only birth control
i. Mini pill: must take every day at same time and there are no hormone free
intervals
ii. These pills ONLY thicken cervical mucus to prevent pregnancy
iii. Make the mucus thick for 22 hours so it needs to be taken constantly to avoid
the mucus to return to regular consistency
iv. INDICATIONS: POP are a safe method for many women who cannot take
estrogen for medical reasons
v. POPs are preferable to COCs for lactating women bc they do not cause adverse
effects on the volume or quality of breastmilk
vi. NO CONTRAS
6. Menstrual cycle physiology
a. Menarche: the initiation of menstruation; between ages 12-15
b. Menstrual cycles that occur during the first 1-1.5 years after menarche may be irregular
due to
i. Frequently irregular due to immaturity of hypothalamic pituitary ovarian axis
ii.
7. Vaccines during pregnancy
a. Women who are pregnant are at increased risk for flu related complications.
i. Any gestation when the injection is available.
b. Tdap
i. After maternal vaccination, antibodies cross the placenta and decrease the risk
of pertussis infection in the newborn
ii. Third trimester – 27-36 weeks gestation
c. Hep B
i. If women is at risk for acquiring hep b she should be vaccinated
This study source was downloaded by 100000839306532 from CourseHero.com on 01-23-2022 04:20:36 GMT -06:00
https://www.coursehero.com/file/96258047/Midterm-Study-Guidedocx/
