Diagnostic Tests

prenatal (antenatal)

pertaining to any event that exist in the embryo or the mother during the period between conception & delivery of the infant.

screening test

any test that separates those who are not, or who would not be, affected by the disease from those who are at risk for it & who will be given further test. A simple ___ for the purpose of uncovering a disease condition that is treatable.

Diagnostic Test (clinical diagnosis)

based on physical examination, & the patients history; does not include laboratory test

laboratory examination

diagnosis arrived after laboratory study of specimens taken from the patient

high risk pregnancy

one in which a concurrent disorder, pregnancy related complication or external factor jeopardizes the health of the mother, fetus or both.

etiology

study of causation/ from the Greek word etio-, which means 'causation' and -ology, which refers to the scientific study of something/ the cause or origin of a disease or abnormal condition

Risk Factor (RF)

a causative factor/ attributes, characteristics or exposures that increase the likelihood of a person for developing a disease or health disorder (age, sex, family health history ----- linked to disability, disease or death)

contributing factor (CF)

the practices and environmental conditions that lead to outbreaks/ preventable causes of outbreaks--- lifestyle, poor health habit

(1) SIgns and (2) Symptoms (S/Sx)

(1) are objective and externally observable (a doctor, or other person, notices)

(1) objective alteration that can be observed or measured by another person; pulse rate, blood pressure, temp., etc.

(2) are a person's reported subjective experiences (an individual experiences)

(2) subjective experiences reported by the person, complains such as pain, nausea, vomiting, etc.

predisposing factors

Factors or areas of susceptibility that promote the risks of the presenting problem

• Ex. exposure to alcohol of the fetus in prenatal life and any genetic predisposition of mental illness

precipitating factors

These are factors, events, or stressors that initiate/ cause/ trigger/precipitate or promote the onset of any illness, disease, accident, or behavioral response (aggressive behavior)---

• Ex. conflict about relationships, transitions, or identity

perpetuating factors

factors that maintain the disabling symptoms. Any condition or factors, either in the family or community that exaggerate the problem rather than solve it

• Ex. lack of education, occupation, or financial stress

protective factors

factors that take into account the person’s skill, competency, talent, or any supportive element that helps the patient in facing and overcoming the predisposing, precipitating, and perpetuating factors

tocolysis

an obstetrical procedure carried out with the use of medications with the purpose of delaying the delivery of a fetus in women presenting preterm contractions.

tocolytics

medications used to suppress premature labor (used to slow or stop the contractions of a woman's uterus during pregnancy; they are typically given to women who are in preterm labor to try to delay birth for 1 to 2 days).

1. “pathos” =

2. “physis” =

3. “logos” =

1. suffering

2. nature, origin

3. the study of

pathophysiology or physiopathology

refers to the study of abnormal changes in body functions that are the causes, consequences, or concomitants of disease processes

• pathophysiology

• risk factors

• clinical manifestation

• diagnostics

• nursing interventions and patient teaching

• medications

• possible complications

the disease process (PRCDNMP)

disease

a condition in which the presence oof an abnormality of the body causes a loss of normal health

• idiopathic

• iatrogenic

• congenital

• acquired

• nosocomial

types of a disease

idiopathic

no identifiable causes

iatrogenic

occurs as a result from medical treatment

congenital

disease existing at birth or before births, involves in the development of fetus

acquired

develops post-fetally

nosocomial

due to being in a hospital environments

pathogenesis

is a mechanism of the disease which etiology operates to produce the pathological and clinical manifestation

• ex: inflammation, degeneration, immune response

complication

is the onset of further diseases in a person who is already suffering from another existing disease

diagnosis

refers to the process of attempting to determine or identify a possible disease of disorder

prognosis

refers to the expected outcome of a disease

clinical manifestation

are the signs and symptoms or evidence of disease

epidemiology

is the study of patterns of disease occurrence and transmission among populations and by geographic areas

incidence of a disease

is the number of new cases occurring in specific time of period

prevalence of a disease

is the number of existing cases within a populations during the specific time of period

cellular adaptation

under normal conditions, cells must constantly adapt to changes in their environment (physiological, pathological)

• atrophy

• hypertrophy

• hyperplasia

• dysplasia

• metaplasia

types of cellular adaptation

atrophy

• the entire tissue or organs diminishes in size and function

• may be due to decrease in workload, lost of nerve stimulating, lack of blood supply, inadequate nutrition, lost of endocrine stimulation and aging process

hypertrophy

• increase the size of the cells and consequently the size of the organs

• increased the synthesis of structural protein and organelles

• can be physiologic and pathologic and adiposity of adipose tissue

hyperplasia

• increase the number of cells in an organ or tissue (increase rate of cellular division)

• hypertrophy and this are closely related

• can be compensatory ___ (exp: liver), hormonal ___ (exp: uterus, breast) and pathological (exp: endometrium)

metaplasia

• is a reversible change in which one adult cell type is replaced by another cell type

• adaptation of cells that sensitive to particular stress to cell types and the adverse of environment

dysplasia

• atypical hyperplasia

• abnormal changes in the size, shape, and organization of mature cells

• strongly associated with common neoplastic growth

1. nonlethal injury

2. lethal injury

types of cell injury:

1. cell degeneration

2. necrosis

cell degeneration (nonlethal injury)

• manifested as an abnormality to biochemical function, structural changes or combination

• its reversible but may become irreversible (necrosis/apoptosis)

• may produce clinical disease

necrosis (lethal injury)

• unprogrammed cell death and living tissues (opposite to apoptosis)

• irreversible

• accompanied with by biochemical and morphological changes

• due to hypoxia, chemical substance, free radical, immunologic response, infections, etc.

• oxygen deprivation

• chemical agents

• infectious agents

• immunologic reactions

• genetic defects

• nutritional imbalances

• physical agents

• aging

causes of cell injury (OCIIGNPA)

hypoxia

oxygen deficiency

• can also occur via:

  • lack of oxygen inside blood

  • reduction in oxygen carrying capacity in RBC (anemia)

  • carbon monoxide poisoning

ischemia

lost/lack of blood supply (due to arterial blockage or reduced venous drainage

oxygen deprivation

can occur via hypoxia or ischemia

chemical agents

1. membrane permeability

2. osmotic hemostasis

3. integrity of an enzyme

• ex: poisons, air pollutants, insecticides, CO, asbestos, ethanol, therapeutic drugs, etc.

• this agents can cause cell death by:

  • (1) altering ____

  • (2) altering ____

  • (3) altering ____

infectious agent

virus, bacteria, fungi, parasites, helminths

immunologic reactions

autoimmune disease- immunity against its own tissues. ex: SLE, Rheumatoid arthritis, etc.

genetic defects

• abnormalities to the genomes - mutation

• this chromosome anomaly is associated with missing, or irregularities or extra in portion of chromosomal DNA

• down syndrome, Alzheimer’s disease, Huntington’s disease, etc.

nutritional imbalance

• (1) kwashiorkor, marasmus

• (2) osteoporosis

• (3) scurvy

• caused directly or indirectly by lack of essential nutrients (malnutrition)

• or it may be related to excessive of food intake (diabetic mellitus)

• ex: protein deficiency - (1) ___, __, calcium deficiency- (2) ___, vitamin c- (3) __

physical agents

trauma, extremes of temperature, radiation, electrical shock all have wide ranging effects on cells

aging

• aged cells become larger, less able to divide and multiply

• lose their ability to function, or function abnormally

• magnesium sulfate

• terbutaline

• nifedipine

• indomethacin

• ketorolac

• sulindac

common tocolytics agents (MTNIKS)

magnesium sulfate

(comments) may cause maternal flushing, lethargy, headache, weakness, dry mouth, pulmonary edema, cardiac arrest; may cause neonatal lethargy, hypotonia, respiratory depression; recommended by ACOG to reduce cerebral palsy risk

terbutaline

(comments) may cause maternal cardiac arrhythmias, pulmonary edema, myocardial ischemia, hypotension, tachycardia, metabolic abnormalities, nausea, vomiting, fever, hallucinations; may cause neonatal tachycardia, hypoglycemia, hypocalcemia, hyperbilirubinemia, hypotension, intraventricular hemorrhage

nifedipine

(comments) may cause maternal flushing, headache, dizziness, nausea, transient hypotension; no fetal or neonatal effects reported

indomethacin

(comments) may cause maternal nausea, heartburn; may cause neonatal constriction of ductus arteriosus, pulmonary hypertension, decreased renal function, intraventricular hemorrhage, hyperbilirubinemia, necrotizing enterocolitis

• ketorolac

• sulindac

(comments) no maternal, fetal, or neonatal effects reported

13 visits:

• 7 in first 7 months

• 2 in 8th month

• 4 in 9th month

the ideal antenatal visits

• 1: as soon as the pregnancy is suspected (for registration & first check-up

• 2: 26 weeks

• 3: 32 weeks

• 4 36 weeks

minimum antenatal visits

1. CBC W/PLT

2. BT, Rh factor determination

3. UA (Benedict's sugar and Acetic Acid Tests-Albumin)

4. STI screening

5. Blood sugar screening (FBS, OGTT, HbA1c)

6. Preg. test, UTZ

7. Cervical CA screening using Acetic acid wash

8. Papanicolau smear

8 laboratory exams

prenatal blood and urine tests

are essential tools during pregnancy, from confirming pregnancy to monitoring fetal development to ruling out pregnancy complications and more

pregnancy urine test

• when: 7 days after missed period

• why: to confirm pregnancy

routine urine tests

• when: all or most visits

• why: to rule out UTIs, gestational diabetes, and preeclampsia

• provides essential clues in terms of her well-being and potential signs of complications

pregnancy blood test

• when: 7 days after missed period

• why: to confirm pregnancy

• detects the presence of hCG to confirm she is pregnant

• it can detect pregnancy sooner than urine tests, they are typically done after a positive urine pregnancy tests, mainly due to their higher cost

1st prenatal visit blood work

• when: after positive urine test

• why: to check mother’s health status

maternal serum screening

• when: at 11-14 weeks & 15-20 weeks

• why: to evaluate risk for chromosomal abnormalities

glucose challenge screening

• when: at 24th & 28th weeks

• why: to rule out gestational diabetes

prenatal urine tests

is a quick and inexpensive way to monitor a woman’s health during pregnancy and catch abnormalities early on; also called urinalysis

• bacteria

• sugar

• protein

a urinalysis will be used to detect the following:

• __ a sign of a UTI

• __ might be a sign of gestational diabetes

• __ might indicate preeclampsia

prenatal blood tests

comes at an even larger variety than prenatal urine tests. they will also be used at specific points throughout gestation or when additional needs arise.

1. maternal blood type

2. Rh factor

3. immunity

4. sexually transmitted disease

5. complete blood count

first prenatal visit blood work is done to comprehensively screen for the following:

1. __ in case a woman should require a blood transfusion

2. __ a protein on the RBC

3. __ to rubella, varicella, and tuberculosis from past disease or vaccination

4. __ syphilis, hep B, HIV, and others, if so instructed by a doctor

5. __ anemia, blood clotting, vitamin deficiencies, and overall health status

at 11-14 weeks (first trimester); nuchal translucency

(what week range) it evaluates the risk for aneuploidy (missing or extra genes), which is done with ultrasound exam called __ as part of the ___

at 15-20 weeks (second trimester)

also called quad screen or multiple marker screen, it screens for both aneuploidy and neural tube defects, alongside an anomaly ultrasound as part of the _____

non-invasive prenatal testing (NIPT)

women at a higher risk for chromosomal problems due to their age or family history or those with abnormal results of the first trimester maternal blood serum might also undergo a ______ around the 10th week — it is a new prenatal blood test that screens mother’s blood for evidence of fetal chromosomal abnormalities

1. qualitative

2. quantitative

pregnancy blood tests comes in 2 varieties: (1) confirm the presence of hCG ____ and those that determine its exact amounts in the blood (2) ___

Ultrasound (UTZ) or transvaginal ultrasound

• it is performed in early pregnancy due to rule out ectopic pregnancy and evaluate the risk of a miscarriage, especially when the results of a blood test are inconclusive or a woman presents with vaginal bleeding or abdominal pain

• used to measure embryo development and rule out complications

1. fetal development

2. within a few minutes

3. dipstick

4. vertical lines

• getting an accurate and reliable pregnancy confirmation in a quick manner can determine subsequent (1) __ and help women get started with prenatal care.

• the results of urine pregnancy tests are available (2)__ . the results can be marked on the (3)__ in a variety of ways, most commonly (4)__; however, some tests use plus and minus signs or “pregnant/not pregnant” labels

positive

(type of UPT test result) pregnant; hCG is present in urine; should confirm with a blood test

negative

(type of UPT test result) not pregnant; no hCG detected in urine

faint positive

(type of UPT test result) most probably pregnant; re-testing is recommended to rule out an error

false positive

(type of UPT test result) not pregnant; positive results might indicate an ectopic pregnancy, miscarriage, or medication side effects

false negative

(type of UPT test result) pregnant; negative results occurred from taking the test too early or incorrectly

1. gestational sac

2. yolk sac

3. fetal pole

4. fetal heartbeat

5. no gestational sac with hCG higher than 1,500 mIU/mL

6. yolk sac present but not fetal pole at 7 weeks

7. fetal pole present but no heartbeat at 7 weeks

transvaginal ultrasound:

1. week 5:

2. week 5 1/2:

3. week 6:

4. week 6-8:

5. evidence of ectopic pregnancy

6. follow up TZ in 1 week; potential error in pregnancy dating; if gestational sac is larger than 16-18 mm with no fetal pole, miscarriage is confirmed

7. follow up UTZ in 1 week; if fetal pole is 5 mm with no heartbeat, miscarriage is confirmed

1. ≥25 mIU/mL

2. 6-24 mIU/mL

3. ≤5 mIU/mL

pregnancy blood test:

1. __: pregnant

2. __: possibly pregnant; re-testing a day or 2 later is recommended

3. __: not pregnant; could mean an early miscarriage. ectopic pregnancy, or medication effects