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139 Cards in this Set
- Front
- Back
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What are the graafian follicle cells that remain after ovulation?
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The Corpus Luteum
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What does the corpus luteum produce?
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estrogen and progesterone
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When does the ovum typically enter the uterus?
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about three days after it is released from the ovary
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As an ovum is released into the fallopian tube, how long does it remain viable?
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12-24 hours
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Where does fertilization usually occur?
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in the distal third of the fallopian tube
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How long can sperm survive after being ejaculated into the female?
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24-48 hours, possibly as long as 80 hours
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Changes in which layer of the ovum prevent more than one sperm from entering?
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the zona pellucida
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The first two weeks after conception is known as what? What is the fertilized ovum now called?
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The pre-embryonic period.
A zygote |
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What is the true moment of fertilization?
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When the nuclei unite
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The two chromosomes of which pair determine the sex of the new individual?
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The 23rd pair
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When does the conceptus enter the uterus?
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about 3-4 days after conception
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What occurs between 6-10 days after conception?
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implantation of zygote into the decidua (secretory phase)
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Where does a normal implantation occur?
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In the upper uterus (fundus)
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What might occur as the conceptus implants, causing the mother to believe she's not pregnant?
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A small amount of bleeding might occur
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Which period of development begins with the third week, and continues through the eighth week?
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the embryonic period
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In terms of the types of cells, what happens to the embryo during the embyonic period?
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Cells differentiate, i.e., the embryo no longer consists of cells with identical functions. Specialized body cells are formed.
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When does the placenta begin to develop?
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beginning with third week of embryonic development
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What is hCG, and where is it produced?
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human chorionic gonadotropin, produced by the placenta
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What does hCG do?
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causes corpus luteum to persist and continue to secrete estrogens and progesterone for the first 6-8 weeks.
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When does hCG become present in maternal serum?
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8-10 days after fertilization
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What is the hospital slang term for the maternal side of the placenta?
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"dirty duncan"
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What is the fetal side of the placenta known as?
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"shiny shultz"
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The "bag of waters" is made up of which two fetal membranes?
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the amnion (inner membrane) and chorion (outer)
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What is the relative pH of the amniotic fluid?
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slightly alkaline
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True or False...most substances in the maternal blood can be transferred to the fetus.
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True
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What are the two sources of amniotic fluid?
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fetal urine and fluid transported from maternal blood across the amnion
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After 20 weeks, what is the amniotic fluid volume range?
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700-1000ml
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What is the definition of amniotic fluid volume of less than 500ml?
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oligohydramnios
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What is low AF volume associated with?
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poor fetal lung development and malformations due to compression of fetal parts
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What causes low AF volume?
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renal agenesis or dysplastic kidneys, or inadequate placental blood flow
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What is the definition of hydramnios?
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AF volume greater than 2000 ml
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What provides a circulatory pathway between the chorionic villi and the embryo?
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the umbilical cord
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What is the primary function of the ductus venous, ductus arteriosis, and the foramen ovale?
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to divert the majority of the circulating blood away from the lungs and the liver
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How does oxygenated blood enter the fetal body from the placenta?
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through the umbilical vein
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Most blood that enters the right atrium is shunted where? How is this accomplished?
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directly to the left atrium, through the foramen ovale
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Before birth, which ventricle of the fetal heart has thicker walls? Why?
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The right. High resistance to blood flow through the uninflated lungs.
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When does organogenesis primarily occur?
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During the first 12 weeks of fetal development
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Inadequate maternal nutrition during the first twelve weeks can lead to what types of problems?
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abnormal brain development
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During which period of development are the organs especially vulnerable to structural damage from teratogens?
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The embryonic period
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What does FDA pregnancy risk category A denote?
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No evidence of risk to the fetus
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If inadequate studies have been done on pregnant women, and the risks of a drug are essentially unknown, which category would this refer to?
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Category B
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Adverse effects on an animal fetus, but no adequate studies done on humans would put a drug into which category?
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Category C
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What would category D refer to?
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positive evidence of fetal harm in humans, but potential benefits to the pregnant woman
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What is the absolute worst pregnancy risk category rating?
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Category X (risk of using the drug clearly outweighs any potential benefits)
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Adequate amounts of folic acid have been shown to have what effect on the developing fetus?
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reduction in the incidence of neural tube defects
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When does the CNS begin developing in the embryo?
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during the third week
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When does the neural tube complete closure?
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during the fourth week
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When is partitioning of the heart into 4 chambers completed?
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by the end of the sixth week
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What are the primary teratogenic concerns during the first trimester?
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spontaneous abortion, CNS defects, incomplete neural tube closure
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What are the primary concerns regarding maternal substance abuse during the first trimester?
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CNS, anatomical anomalies, IUGR, and pre-term birth
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What are the major developmental milestones that occur by the fourth week?
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brain formed from anterior neural tube, limb buds seen, heart partitions into 4 chambers, GI system begins
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When does the heart first begin beating?
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21-22 days after conception
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What development is achieved during the sixth week?
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Heart reaches final four chambered form, external ears begin to form
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What time frame is defined as the fetal period?
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9 weeks after conception until birth
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What happens to blood formation in the fetus from weeks 9 through 12?
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Blood formation shifts from the liver to the spleen during this time.
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What about external genitalia during 9th through 12th weeks?
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Both sexes look similar until end of 9th week, by end of 12th week fetal sex can be determined by appearance of external genitalia
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The formation of teeth, kidneys assuming shape, presence of meconium in intestines, and presence of hair on the scalp all occur during which time period?
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16 weeks
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At 20 weeks gestation, what development has occured?
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myelination of spinal cord begins, fetus begins suck and swallow responses, lanugo and vernix caseosa cover body
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When does the fetus begin to produce surfactant in the lungs?
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by week 24
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In weeks 25-28, what happens with blood formation?
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shifts from spleen to bone marrow
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How often do spontaneous twins occur?
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once out of every 85 pregnancies
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T or F: Examining the placenta and membranes after birth can always establish whether twins are mono or dizygotic.
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False. Two separate placentas can fuse (along with the membranes) in dizygotic twins, and can appear to be one.
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What is the definition of abortion?
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spontaneous or elective termination of pregnancy before the 20th week of gestation
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A birth after the 20th week and before the start of the 38th week would be called what?
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preterm
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During the first trimester, how does the uterus grow?
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mainly hyperplasia due to stimulation of the myometrium by estrogen and growth factors
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How does the uterus grow during the second and third trimesters?
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hyperplasia and hypertrophy as muscle fibers stretch to accomodate growing fetus
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What are the irregular contractions that occur throughout pregnancy, especially during the third trimester?
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Braxton-Hicks Contractions
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What does estrogen do to the cervix during pregnancy?
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cervix becomes congested with blood resulting in bluish purple color (chadwick's sign)
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Why does the cervix soften during pregnancy?
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decrease in collagen fibers
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What is the term for the softening of the cervix?
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Goodell's sign
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What is a common result of the glycogen rich environment found in the vagina during pregnancy?
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yeast infections (candidiasis)
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What is the "hormone of pregnancy"?
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progesterone
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What is the major function of the ovaries during pregnancy?
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secretion of progesterone for the first 6-7 weeks of pregnancy
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Where is progesterone produced for the remainder of pregnancy?
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the placenta
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How much does tidal volume increase during pregnancy?
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30-40%
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What effects are caused by the increase in the volume of air inspired by the pregnant mother?
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partial pressure of CO2 is lowered, causing respiratory alkalosis. Kidneys excrete bicarbonate to compensate, and lowered PCO2 promotes transfer of CO2 from fetal to maternal circulation
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Which hormone is primarily responsible for respiratory changes in the pregnant female?
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progesterone
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What happens to blood volume during pregnancy?
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increases 30-50%
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Because RBC mass only increases by 20-30%, and the increase occurs later in pregnancy than the increase in plasma volume, what effect does this have?
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physiologic anemia, or pseudoanemia of pregnancy
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What is often prescribed for all pregnant women by the second trimester to prevent anemia?
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Iron supplementation
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How do changes in blood makeup affect clotting in the pregnant female?
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Increased plasma volume may dilute blood to a degree that clotting is somewhat less likely, however, this is offset by an increase in clotting factors (plasma fibrinogen) which produces a hypercoagulable state in the mother
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In what position is blood pressure lowest in the pregnant female?
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lateral recumbent
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What are the symptoms of supine hypotensive syndrome?
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faintness, lightheadedness, dizziness, nausea, agitation, and sometimes syncope
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What is the recommended weight gain during pregnancy for a woman who was at a normal weight before becoming pregnant?
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25-35 lbs
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What are the recommended weight gains for overweight and underweight women during pregnancy?
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overweight women:15-25 lbs
underweight women: 28-40 lbs (or gain enough to reach ideal weight then gain 25-35 lbs) |
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What GI effects are caused by increased estrogen levels during pregnancy?
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nausea, constipation, slowed bowel motility, heartburn, occas. excessive salivation
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What are the most important nursing interventions for N/V?
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smaller, more frequent meals, increase CHOs, no spicy or greasy food, avoid an empty stomach, anti-emetics, heartburn medications
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What is Hegar's sign?
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softening of the uterus during pregnancy
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What are presumptive indications of pregnancy? (give examples)
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subjective changes reported by the women, such as amenorrhea, N/V, fatigue, quickening
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What are some examples of probable (objective) changes?
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abdominal enlargement, goodell's sign, palpation of fetal outline, braxton-hicks contractions, positive pregnancy test.
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What are the positive indications of pregnancy?
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auscultation of fetal heart sounds, fetal movements felt by examiner, visualization of the embryo or fetus (ultrasound for example)
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What is the term for any pregnancy (including current), regardless of outcome?
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Gravida
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Any birth that occurs after 20 weeks of gestation is referred to as what?
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Para
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During pregnancy, a sharp pain in the side or inguinal area (usually right side) is commonly caused by what?
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softening and stretching of the round ligament
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What is Nagele's rule?
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determines EDD. First day of last normal menstrual period, subtract 3 months then add 7 days.
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How often should prenatal visits occur during the first 28-30 weeks of gestation?
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Every 4 weeks
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How often should prenatal visits occur from 30-36 weeks gestation, and then from 36 weeks until birth?
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Every two weeks, then every week...increased frequency for higher risk pregnancies
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When does the production of lung fluid begin to diminish in the fetus?
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2 to 4 days before labor begins
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What is the name of the first breath taken by the newborn?
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the inspiratory gasp
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What triggers the inspiratory gasp in the newborn? (chemical factors)
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a decrease in PO2 and pH, and an increase in PCO2 all trigger chemoreceptors in the the aorta and carotid arteries. This stimulates the respiratory center in the medulla.
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What is non-shivering thermogenesis?
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The metabolism of brown fat to produce heat when thermal receptors in the skin detect a drop in skin temperature.
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What are some of the major symptoms of cold stress?
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Increased respirations, hypoxemia, hypoglycemia, pale, cold, mottled skin.
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What are the four types of heat loss?
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Conduction, convection, evaporation, radiation
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What is the normal heart rate for newborns?
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120-160 BPM
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What is normal BP for a newborn?
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60-80/40-45 mmHg
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The blood volume of the newborn is largely determined by which factor?
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The amount of placental transfusion during expulsion of the placenta
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How long does caput succedaneum usually take to resolve?
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This edematous condition usually resolves within 12 hours to several days after birth.
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How long does cephalhematoma usually take to resolve?
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May take 6-8 weeks to resolve
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When would jaundice normally be noticed in a newborn?
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Abnormal during the first day after birth, but common during the first week
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What is the most common treatment for jaundice?
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phototherapy (bilirubin in the skin absorbs the light and turns into a water soluble product)
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When should newborns generally pass their first stool?
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12-48 hours after birth
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What is the first stool called, and what does it look like?
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Meconium, dark green/black, thick.
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What stool comes after meconium, and when?
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The transitional stool, thin brown to green, about 2 days later
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What does breastfed stool look like?
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Pale yellow to pasty green
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What is initial bladder volume and when should voiding first occur?
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6-44ml of urine, 95% within 24 hours, 100% within 48 hours
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What are the two components of the gestational age assessment?
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neurologic and external physical characteristics
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What are the external physical characteristics?
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skin, lanugo, sole creases, breast tissue, ears, genitals
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How is temperature taken after birth?
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Rectal first, then axillary is the preferred method
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What is the Ortolani maneuver used for?
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To determine the presence of hip dysplasia
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What are the five APGAR assessments?
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1. Heart rate
2. Respiratory effort 3. Muscle tone 4. Reflex response 5. Color |
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When is APGAR assessed and what is considered within normal limits?
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At 1 min and 5 mins, 7 or higher is considered wnl
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Into which muscle is the IM injection of vitamin K given?
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Vastus lateralis
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The return of the uterus to its nonpregnant size and condition is known as what?
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involution
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What is the first step of involution?
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contraction of muscle fibers around area of placental attachment to help stem flow of blood
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How does the placental site heal?
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By the process of exfoliation, may take 6-7 weeks
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Breastfeeding, early ambulation, complete expulsion of placenta, and an uncomplicated birth all help with which process?
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The descent of the uterine fundus
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Where is the uterus within 6-12 hours after childbirth?
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At the level of the umbilicus
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By what measurement does the uterus decrease in size?
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by one finger breadth per day...should return to prepregnant size by 6 weeks
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What are some interventions for postpartum afterpains?
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encourage early ambulation, assess for clots, administer pain meds 1 hour before breastfeeding
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What is the description of lochia that is pink and occurs around days 3-10 after birth?
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Lochia serosa
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How often do you assess the female after giving birth?
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q15min x 1 hr, q30min x 1 hr, qhr x 2 hrs, then q8hr
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How long after birth does the risk of thromboembolism last?
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about 6 weeks
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What is true of 50% of menstrual periods immediately postpartum?
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they are anovulatory
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In the non-breastfeeding mother, when does menstruation usually return?
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about 6-10 weeks after birth
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What is true of heart rate for the first 6-10 days postpartum?
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may lower to 50-70 BPM
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Until ambulating, what should the new mother do every two hours to prevent pooling of secretions in the airways?
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turn, cough, and deep breathe
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How often should Homan's sign be assessed?
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every shift
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When can women generally return to exercise regimen?
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about 6-8 weeks postpartum
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When do postpartum "blues" usually resolve?
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10-14 days
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