NM702 MOD 5 EXAM QUESTIONS AND ANSWERS WITH
COMPLETE SOLUTIONS VERIFIED GRADED A++
OLDCARTS review - what does it stand for?
Onet
Location
Duration
Character
Alleviating/aggravating/associated
Radiation
Timing
Severity
The good and the bad of hematologic changes in pregnancy
Good: protect mother during pregnancy and at delivery; decreased viscosity reduces
resistance to flow
Bad: increase risks for VTE, anemia, coagulopathy
Reasons for hematologic change in pregnancy
-meet demands for larger maternal organs
-tolerate blood loss at delivery
-reduce supine hypotension syndrome
,-enhance nutrient and gas exchange
-assists with heat dissipation through skin (increases 4-7x)
Blood and plasma volume
-Hypervolemia (incr ~1.5L)
-plasma increases early (6-8 wks), peaks at 32 weeks
-produces hemodilution
What decreases venous tone and reduces vascular resistence?
progesterone
helps to dilate and accommodate all of the extra blood volume
These hormones influence RAAS and cause increased sodium, therefore water,
retention
estrogen and progesterone
How to RBCs change in pregnancy? Why?
RBC vilume increases ~25%
Does this to meet extra oxygen demands
happens slower than plasma volume increase, resulting in physiologic anemia
maximum hemodilution at 28-32 weeks
How do hemoglobin and blood plasma increase in relation to each other?
,hemoglobin increases at a slower rate than the plasma
causes decrease in net Hg volumes
When do we check for anemia?
At the first OB appt
and
28 weeks with GDM screening
2nd check bc this is when the maximum dilution will occur and we can catch if she's
anemic
How does oxygen usage in the body change?
There is a decreased affinity of Hg for oxygen, therefore more is available peripherally
(aka to the fetus via IVS in placenta)
How do hematologic changes impact VTE risk?
Decreases this risk by decreasing blood viscosity and increasing perfusion
What is the most common anemia in pregnancy?
IDA
decrease: serum iron, serum ferritin, iron-binding capacity, MCV, MCHV
What are normal Hg levels during pregnancy?
1st and 2nd: >11
3rd >10.5
How do WBCs change in pregnancy?
, these increase slightly
neutrophil increase until ~30 weeks then level until term
How do platelets, plasma, and lipids change in pregnancy?
platelets: stay the same (150k-400k is normal)
plasma: proteins increase but not as much as other components, so there is a relative
decrease; decrease electrolytes; protein binding capacity is altered (affects drugs,
calcium, anesthetics, etc)
lipids: marked increase in cholesterol
What is significance of pregnancy being a hypercoagulable state?
Increased risk for clotting, DIC
increased procoagulation proteins, decreased factors to prevent coagulation =>
thrombin promotes clot formation and stability
Half of the total increase
8 weeks gestation
Cardiac output increases by how much when on left side?
25%
Where does excess blood go?
-uteroplacental circuit
-other organs like skin, kidneys
COMPLETE SOLUTIONS VERIFIED GRADED A++
OLDCARTS review - what does it stand for?
Onet
Location
Duration
Character
Alleviating/aggravating/associated
Radiation
Timing
Severity
The good and the bad of hematologic changes in pregnancy
Good: protect mother during pregnancy and at delivery; decreased viscosity reduces
resistance to flow
Bad: increase risks for VTE, anemia, coagulopathy
Reasons for hematologic change in pregnancy
-meet demands for larger maternal organs
-tolerate blood loss at delivery
-reduce supine hypotension syndrome
,-enhance nutrient and gas exchange
-assists with heat dissipation through skin (increases 4-7x)
Blood and plasma volume
-Hypervolemia (incr ~1.5L)
-plasma increases early (6-8 wks), peaks at 32 weeks
-produces hemodilution
What decreases venous tone and reduces vascular resistence?
progesterone
helps to dilate and accommodate all of the extra blood volume
These hormones influence RAAS and cause increased sodium, therefore water,
retention
estrogen and progesterone
How to RBCs change in pregnancy? Why?
RBC vilume increases ~25%
Does this to meet extra oxygen demands
happens slower than plasma volume increase, resulting in physiologic anemia
maximum hemodilution at 28-32 weeks
How do hemoglobin and blood plasma increase in relation to each other?
,hemoglobin increases at a slower rate than the plasma
causes decrease in net Hg volumes
When do we check for anemia?
At the first OB appt
and
28 weeks with GDM screening
2nd check bc this is when the maximum dilution will occur and we can catch if she's
anemic
How does oxygen usage in the body change?
There is a decreased affinity of Hg for oxygen, therefore more is available peripherally
(aka to the fetus via IVS in placenta)
How do hematologic changes impact VTE risk?
Decreases this risk by decreasing blood viscosity and increasing perfusion
What is the most common anemia in pregnancy?
IDA
decrease: serum iron, serum ferritin, iron-binding capacity, MCV, MCHV
What are normal Hg levels during pregnancy?
1st and 2nd: >11
3rd >10.5
How do WBCs change in pregnancy?
, these increase slightly
neutrophil increase until ~30 weeks then level until term
How do platelets, plasma, and lipids change in pregnancy?
platelets: stay the same (150k-400k is normal)
plasma: proteins increase but not as much as other components, so there is a relative
decrease; decrease electrolytes; protein binding capacity is altered (affects drugs,
calcium, anesthetics, etc)
lipids: marked increase in cholesterol
What is significance of pregnancy being a hypercoagulable state?
Increased risk for clotting, DIC
increased procoagulation proteins, decreased factors to prevent coagulation =>
thrombin promotes clot formation and stability
Half of the total increase
8 weeks gestation
Cardiac output increases by how much when on left side?
25%
Where does excess blood go?
-uteroplacental circuit
-other organs like skin, kidneys
