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;
434 Cards in this Set
- Front
- Back
|
Define sexuality.
|
Sexuality is intrinsic and influences every aspect of a person's life, starts at conception et develops through childhoood. It influences a person's choice of partners, careers, friends and intrests as well as a self perception of self and others.
|
|
|
List the 2 components of the female reproductive cycle and descibe each.
|
1) Ovarian cycle- in each cycle one follice from aprox 40,000 matures into a graafian follicle et ruptures to liberate the ovum inside
2) Menstral cycle- cyclical physiological uterine bleeding that normally bleeding that normally occurs @ approx 4wk intervals in the reproductive female |
|
|
Describe the "climacteric" and list the implications of this event for women.
|
The time that marks the cessation of a womans reproductive function
|
|
|
What has research shown about sexuality among older adults?
|
Older individuals can / do enjoy the pleasures of sexual foreplay / intercourse. The general pattern of sexual behavior is fairly consistent throughout life.
|
|
|
Give 3 risk factors for STIs.
|
1) Sex partner who is allready infected
2) More thanm 1 sex partner 3) Sexual activity during adolescence 4) Drug use 5)Anal et oral sex practices |
|
|
What type of occurences can result in altered sexual activity?
|
1) Altered body image d/t trauma / DZ
2) aging et its natural changes on body functions |
|
|
Explain cultural influences on sexuality and provide examples.
|
Culture defines, evaluates at regulates a person's sexuality, ie: their dress, sopcial responsibilitu, marriage expectations, sex practices, puberty rites, body beautifications et female genitial mutilation (FGM)
|
|
|
Descibe 2 mechanisms through which medications alter libido.
|
Drugs can alter the way sex centers of the brain function or drugs can act on the peripheral nerves or blood vessels of the genitalia
|
|
|
What risk factors are associated with high teen birth rates?
|
1) Poverty
2) Low eeducation 3) Poor self-esteem 4) Family dysfunction 5) High-risk behaviors |
|
|
ID clients who are considered @ risk for sex-related problems.
|
1) Vistims of sexual, physical or psych abuse
2) Persons who have been disfigured 3) Pts on meds that decrease the sex drive 4) Persons w/an altered body image 5) Persons w/a diaability |
|
|
Name two NANDA-1 diagnosis R/T sexuality
|
1) Altered sex pattern (t expresses a concern reguarding sexuality)
2) Sexual dysfunction (pt expresses a concern in regard to sexual functioning) |
|
|
List examples of legal and ethical implications that need to be considered when providing rationales for nursing interventions during the planning phase
|
1) Access to birth control for adolescent
2) Sex ed in schools 3) Access to rape counseling / reporting 4) Pregnancy termination rights |
|
|
ID some of the main reasons for performing a physical exam when assessing a client's sexuality.
|
Dx birthcontrol needs, pregnancy, STD, DZs or answer questions about natural body changes a/o adress concerns
|
|
|
If a client wants to get pregnant what activities should be encouraged?
|
1) Exercise
2) Proper nutrition / hydration 3) Vitamins 4) Physical exam / medical care 5) Genetic counseling PRN |
|
|
If a client wants to get pregnant what activities should she avoid?
|
1) Drinking alcohol
2) Smoking / 2nd hand smoke 3) Illegal drug use 4) monitor prescription meds for safety |
|
|
What are the 3 areas of assessment in the preconception period
|
1) Pt health history
2) Risk assessment 3) Family history |
|
|
What are the factors that put a couple at risk for poor outcome when trying to concieve or achieve a sucessful pregnancy?
|
1) Age
2) Genetic factors 3) Lack of up to date immunizations 4) Infertility 5) Hx of recurrent miscarriages 6) STDs |
|
|
List 2 NANDA-I diagnoses specifically related to the preconception period.
|
1) Readiness for enhanced decision making: A pattern of choosing courses of action that is sufficent for meeting short and long term health related goals and that can be strengthened
2) Health seeking behaviors: Active seeking (by a person in stable health) of ways to alter personal health habits and/or the environment in order to move toward a highr level of health |
|
|
If the goals of the nursing process were not met during the preconception period, what is the next step for the health care team?
|
The team must reevaluate the following;
1) Pt and partner get education to overcome any knowledge deficit? 2) Were the pt and partner tested for STDs / infertility? 3) Did pt and partner understand the careplan? 4) Was the plan of carecompatible wityh the client's lifestyl, religious and cultural beliefs? Anser the above question, reorganize the health care plan as needed and intergrate the new data/treatnment into begin a new course of action / care plan |
|
|
Define- pregnancy
|
Pregnency, divided into 3 phases called trimesters lasting apro 3 months each. A term pregnancy lasts 38-42 weeks.
|
|
|
Define- antepartum period
|
The time of pregnancy between conception and the onset of labor. Also called the prenatal period.
|
|
|
Define- intrapartum period
|
The time of pregnancy from onset of labor to the birth of the infant and placenta.
|
|
|
Define- postpartum period
|
The time of pregnancy from birth of the infant until a woman's body returns to an essentially prepregnant condition.
|
|
|
Give 3 positive signs of pregnancy
|
1) Fetal heartbeat can be detected @ 17-20 weeks (Electronic Doppler can detect FHT @ 10-12 weeks)
2) Fetal movements can be palpated @ 20 wks by HCP 3) Visualization by US; gestional sac @ 4-5wks fetal parts and HB @ 8wks (vaginal probe used to detect gestional sac as early as 10 days after implantation). |
|
|
List 5 maternal physiological changes that occur during pregnancy.
|
1) Maternal weight gain
2) Uterine growth 3) Changes in all systems to include; cardiovascular, respiratory, urinary, gastrointestional and endocrine |
|
|
List some of the common discomforts of pregnancy for which the nurse can teach a woman self-care measures.
|
1) N/V
2) Urinary freq 3) Heartburn 4) Vaginal discharge 5) Constipation 6) Ankle eedema 7) Hemorrhoids 8) Varicose veins 9) Bachache 10) Leg cramps |
|
|
List common pregnacy induced complications taht the health care team should always be aware of and evaluating for.
|
1) HTN
2) Preterm labor 3) Gestional diabetes mellitus- GDM 4) Ectopic pregnancy 5) Spontaneous abortion 6) Placenta previa 7) Incompetent cervix 8) Gestional trohoblastic DZ 9) Rh sensitization |
|
|
Define: TORCH infections.
|
Group of infections that have serious complications with the fetus if the mother contracts them during pregnancy, they include;
Toxoplasmosis Rubella Cytomegalovirus (CMV) Herpes simplex Hepatitis Varicella |
|
|
List some of the common medications used during the antepartal period.
|
1) Prenatal vitamins
2) Iron 3) Folic acid 4) Docusate sodium (Colace) 5) Magnesium sulfate 6) Terbutaline sulfate (Brethine) 7) Ritodrine 8) Betamethasone sodium phosphate (Celestone) |
|
|
Describe the placenta and its function and circulation.
|
The placenta provides metabolic and nutrient exchange between the embryonic and maternal circulation. The placenta develops on the uterine wall where the developing embryo has attached. The embryonic heart starts to function @ approx 17 days completeing the maternal-placental crculation system. The placental is a seperate organ @ approx 14 weeks. The umbilical cord contains 2 arteries and 1 vein.
Blood flows via; 1) maternal arteries thru the intervillous spaces 2) into the umbilical vein and into the fetus 3) returns from the fetus thru the umbilical arteries 4) into the uterine vein 5) into the maternal circulation |
|
|
List available fetal DX tests.
|
Can include but not limited to:
1) Electronic Fetal Monitoring (EFM) 2) Ultrasound 3) Amniocentesis 4) Biophysical profile (BPP) 5) Amniotic Fluid Index (AFI) 6) Alpha-Fetoprotein (AFP) Screening 7) Chorionic Villi Sampling (CVS) 8) Lecithin/Sphingomyelin (L/S) Ratio |
|
|
Describe various methods for determining the estimated date of birth (EDB).
|
1) Nagels Rule- First day of LMP, add 1 year, subtract 3 months then add 7 days= EDC
2) McDonald's Method= measure the fundal height in cm from top of the symphysis pubis to the top of the uterine fundus= between 22-34 weeks gestation the difference in cm correlates with the number of weeks gestation. 3) Validate when quickining occurs = usully occurs at approx 20 weeks 4) FHR can be auscultated with US Doppler by 10-12 weeks 5) Fetal measurements are used during the first trimester and biparietal diameter and femur lengths are used later in pregnancy |
|
|
What is the recomended schedule for prenatal visits?
|
In a normal pregnancy care should be scheduled Q 4 weeks for the first 28 weeks of gestation
then Q 2 weeks until 36 weeks of gestationb and then Q week until delivery |
|
|
What areas should be assessed when obtaining an obsteetical Hx?
|
Areas should include:
1) Current & past pregnancy Hx 2) GYN Hx 3) Current & past medical Hx 4)Family medical Hx 5) Religious and cultural HX 6) Occupational Hx 7) Partner's Hx and personal info |
|
|
List the danger signs of pregnancy about which the nurse should educat ethe pt.
|
1) Vaginal bleeding
2) Persistent or unusual ABD pain 3) Temp above 101F and chills 4) Sudden gush of vaginal fluid before 37 weeks 5)Visual changes; blurriness, double vision, seeing spots 6) Persistant or unusual HA 7) Persistant vomiting 8) Epigastric pain 9) Decreased urinary output 10 Dysuria 11) Decreased or absent fetal movements |
|
|
ID a sample nursing Dx R/T the expectant mother that may be established during the analysis phase of the nursing process.
|
1) Impaired comfort
2) Anxiety 3) Ineffective health maintenance 4) Constipation 5) Fatigue 6) Nausea 7) Altered nutrition 8) Altered sexuality patterns |
|
|
Describe the fetal nursing assessment.
|
!) Eval any DX test results
2) Fundal height and fetal heart rate fetal movement is assessed 3) Viability and gestitational age are determined 4)Beta-HCG is done prn 5) US can show fetus @ 4-5 weeks 6) In the 2nd trimester cardiac activity, fetal #/presentation and fetal anatomy are IDed 7) Amniotis fluid is calculated |
|
|
Describe the analysis phase of the nursing process as it relates to the fetus.
|
The nurse works in collaboration with the pt and other members of the health care team. Actual abd potentail problems for the fetus are IDed and nursing X are noted. Goals and priorities are set based on the nursing DX. Priorities are established with the mother and generally based on Maslow's hierarchy of needs. Cultural variations and the availability of resources should always be considered when developing a Dx.
|
|
|
•Adrenarche
|
Increase in the adrenal gland activity that occurs prior to puberty
|
|
|
•bulbourethral / Cowper’s glands
|
pair of structures lying bilaterally at the urethra, they secrete lubricant into the penile urethra during sexual excitement and neutralize acid to enhance sperm mobility
|
|
|
•climacteric
|
period of time that marks the end of a woman’s reproductive function
|
|
|
•corpus luteum
|
endocrine tissue that develops with luteinizing hormone (LH) and produces high levels of progesterone and low levels of estrogen
|
|
|
•endometrium
|
innermost layer of uterus
|
|
|
•epididymis
|
compact duct behind the testes, becomes the vas deferens after it rises over the testes to the prostate gland
|
|
|
•follicle-stimulating hormone (FSH)
|
causes testes and ovaries to produce hormones
|
|
|
•follicular phase
|
begins immediately after menses and ends during the middle of the uterine cycle, the primordial follicle matures with FSH and LH
|
|
|
•gametes
|
sex cells (ova or sperm)
|
|
|
•gonads
|
where sex cells / gametes are produced
|
|
|
•graafian follicle
|
mature follicle that ruptures to release an ovum / egg from the ovary
|
|
|
•homologous
|
reproductive system fundamentally similar in structure and function of male and female, functioning to produce sex cells and transport the cells to a location where they can unite with each other
|
|
|
•ischemia phase
|
days 27-28 starts tissue breakdown, estrogen & progesterone levels drop, endometrial tissue sheds
|
|
|
•luteal phase
|
begins when the graafian follicle ruptures and the ovum is released
|
|
|
•male climacteric
|
age when testosterone drops in males, happens more gradually than in females, based on male Sx
|
|
|
•menopausal phase
|
second phase of the climacteric, the females last menses
|
|
|
•male menopause
|
age when testosterone drops in males, happens more gradually than in females, based on male Sx
|
|
|
•menarche
|
start of menstruation
|
|
|
•menopause
|
period of time that marks the end of a woman’s reproductive function
|
|
|
•menstrual cycle
|
cyclic, physiological uterine bleeding that normally reoccurs at 4 week intervals in the absence of pregnancy during the reproductive period of the female
|
|
|
•menstrual phase
|
starts on the first day of menstrual flow and last the first 6 days
|
|
|
•myometrium
|
middle layer of uterus, made up of 3 distinct layers of muscle tissue
|
|
|
•ovarian cycle
|
rhythmic cyclic change in the ovaries consisting of 2 phases, the follicular and the luteal phase
|
|
|
•paraurethral glands
|
located at the posterior wall of the urethra near its opening, functions by lubricating the vaginal vestibule during sexual intercourse
|
|
|
•parietal peritoneum
|
thin, slippery outer layer of uterus
|
|
|
•perineal body
|
found between the lower part of the vagina and anal canal, site of episiotomies during childbirth
|
|
|
•postmenopausal phase
|
the years after the last menses
|
|
|
•premenopausal phase
|
abnormal hormone fluctuations that may begin at 36-42 years of age
|
|
|
•proliferative phase
|
from the last day of menses to the beginning of ovulation, days 7-14, endometrial thicken with blood and estrogen peaks just prior to ovulation
|
|
|
•prostate gland
|
lies below the neck of the bladder, secretes thin, milky alkaline fluid that protects the sperm against the acidic environment of the vagina and male urethra. Fluid contains high levels of zinc, calcium, citric acid and acid phosphate.
|
|
|
•secretory phase
|
starts after ovulation, days 15-26, estrogen drops sharply, progesterone stays constant, endometrial cells swell in preparation for fertilization a/o implantation
|
|
|
•Skene’s gland
|
located at the posterior wall of the urethra near its opening, functions by lubricating the vaginal vestibule during sexual intercourse
|
|
|
•spermatogenesis
|
time at puberty when testes start producing gametes / sperm
|
|
|
•wet dreams
|
nocturnal emissions without sexual stimulation
|
|
|
•zygote
|
fertilized egg / ovum
|
|
|
•sexually transmitted DZ (STD) / sexually transmitted infection (STI)
|
specific infections or Sx transmitted primarily via sexual intercourse and are the most common infectious DZs in the US
|
|
|
•mytonia
|
muscle tension an d increased contractibility
|
|
|
•sexual response cycles
|
response to sexual stimulation thorough a cycle of phases; excitement, plateau, orgasm and resolution
|
|
|
•retarded ejaculation
|
delayed or the inability to ejaculate into the vagina, respectively, may have physical or psychological causes
|
|
|
•ejaculatory incompetence
|
delayed or the inability to ejaculate into the vagina, respectively, may have physical or psychological causes
|
|
|
•vaginitis
|
inflammation of the vagina
|
|
|
•urethral / Littre’s gland
|
tiny mucus secreting glands in the male urethra lining, aid in the bulbourethral gland
|
|
|
•sensate exercises
|
learning to enjoy the sensation of touch without sexual intercourse, such as massage
|
|
|
•premature ejaculation
|
when a man is unable to delay ejaculation long enough to satisfy his partner
|
|
|
•frigidity
|
failure of sexual arousal
|
|
|
•excision
|
removal of the clitoris to supposedly reduce sexual desire and temptation
|
|
|
•female genital mutilation (FGM)
|
female circumcision, removal of all or some of the female genitals
|
|
|
•dyspareunia
|
pain experienced by the female during intercourse, can be caused by but not limited to inadequate lubrication, hormone imbalance, scarring, infection
|
|
|
•fourchette
|
area at bottom of the labia minora near the anus
|
|
|
•gonads
|
specialized organs that produce sex cells / gametes
|
|
|
•infibulations
|
sewing the labia majora together to prevent intercourse
|
|
|
•introitus
|
vaginal opening, border between the external and internal genitals
|
|
|
•libido
|
sexual desire and the ability to enjoy intercourse
|
|
|
•excitement
|
1st phase in the sexual response cycle
|
|
|
•orgasm
|
3rd phase in the sexual response cycle
|
|
|
luteinizing hormone (LH)
|
hormone that causes testes to produce testosterone
|
|
|
orgasmic dysfunction
|
the inability to achieve orgasm
|
|
|
plateau
|
2nd phase in the sexual response cycle
|
|
|
hymen
|
collar / semicollar of tissue that surrounds the vaginal opening
|
|
|
rape trauma syndrome
|
cluster of psych Sx following a sexual assault, to include:
acute disorganization phase- initial wide range of emotions, fear, guilt, etc.. outward denial adjustment phase- appears ok but copes by denial and suppression reorganization- may be depressed and wants to talk about assault and the problems resulting from it integration- realizes she is not at fault and blames attacker recovery- level of trust starts to return and she starts to feel safe in her environment |
|
|
•rape
|
forced sexual assault / intercourse that includes both physical force and psychological coercion
|
|
|
•resolution
|
4th phase in the sexual response cycle
|
|
|
•vaginal vestibule
|
boat shaped depression that is enclosed by the labia majora
|
|
|
•vaginismus
|
the irregular and involuntary contraction of the muscles around the outer 3rd of the vagina when sex is attempted
|
|
|
•vas deferens
|
connects the epididymis with the prostate gland an then connects with ducts from the seminal vesicle to become ejaculatory duct
|
|
|
•Infertility
|
unsuccessful trying to conceive for a year
|
|
|
•fundal height
|
distance in cm from the top of the symphysis pubis to the top of the uterine fundus
|
|
|
•vulvodynia
|
a chronic vulvar discomfort or pain
|
|
|
•chronic vilius sampling (CVS)
|
tests for genetic, metabolic and DNA abnormalities, chorionic villi are sampled from the edge of the placenta
|
|
|
•Nagel’s Rule
|
Method of estimating / calculating EDC
oGet the first day of the mothers last menstrual period (LMP) oAdd 1 year oSubtract 3 months oAdd 7 days =EDC |
|
|
•McDonald’s method
|
Method of estimating / calculating EDC in single fetal pregnancy
oObtain fundal height, the difference in cm approximately correlates with the number weeks of gestation |
|
|
•abrupto placenta
|
premature separation of a normally implanted placenta from the uterine wall
|
|
|
•active phase
|
second part of the 1st stage of labor, cervix dilates from 4 to 7 cm
|
|
|
•amnioinfusion
|
warm sterile fluid introduced into the uterus via an intrauterine pressure catheter (IUPC)
|
|
|
•amniotomy
|
artificial rupture of amniotic sac by outside means
|
|
|
•artificial rupture of membranes (AROM)
|
artificial rupture of amniotic sac by outside means
|
|
|
•augmentation of labor
|
used when spontaneous contractions have not advanced labor / changed the cervix to allow labor to continue
|
|
|
•bloody show
|
pinkish discharge that r/f loss of mucus plug, increases with cervical effacement and dilation
|
|
|
•Bradley method
|
Childbirth that uses breathing techniques and body relaxation, natural birthing, breast feedings after birth to promote bonding
|
|
|
•Breech presentation
|
Delivery with fetal buttocks down, 3 types
Frank breech, buttocks first legs out omplete, fetal legs crossed Single or double footling, feet first |
|
|
•caput succedaneum
|
fetal scalp edema & bruising from extended or assisted birth
|
|
|
•cardinal movements
|
movements by the fetus to adapt to the maternal pelvis to allow its passage / birth
|
|
|
•cephalic presentation
|
most common type of delivery, head first (can be vertex, brow, face, military or sinciput)
|
|
|
•cervical ripening
|
softening and effacement of cervix
|
|
|
•cesarean section / C-Section
|
removal of the fetus surgically thru the abdominal wall
|
|
|
•compound presentation
|
two fetal parts present together
|
|
|
•crowning
|
fetal head is encircled by the external opening of the vagina/ introitus, birth is near
|
|
|
•disassociation relaxation
|
pt will isolate a muscle group concentrate on that group and relaxes the rest of the body
|
|
|
•dystocia
|
difficult labor
|
|
|
•early (Type I) decelerations
|
fetal response to head compression, often after ROM during 2nd stage of labor, start & end with contractions, FHR 120-160
|
|
|
•effleurage
|
light stroking over the body with the tips of the fingers, used to relieve mild to moderate pain
|
|
|
•episiotomy
|
surgical incision of the perineal body
|
|
|
•false labor
|
contractions are irregular in intensity, rhythm, and frequency and can be relieved by outside action
|
|
|
•fetal attitude
|
relation of the fetal parts to one another / itself
|
|
|
•fetal endocrine theory
|
the fetus releases a hormone that triggers uterine contractions
|
|
|
•fetal heart rate decelerations
|
may indicate fetal distress, types are
early / Type 1 late / Type 2 variable / Type 3 |
|
|
•fetal lie
|
relation of the long axis of the fetus to that of the mother
|
|
|
•fetal malpositions
|
fetal position other than occiput anterior, most common is occiput posterior position
|
|
|
•fetal position
|
position of fetal presenting part in relation to 4 imaginary quadrants of the maternal pelvis
right anterior left anterior right posterior left posterior |
|
|
•fetal presentation
|
portion of the fetus that is nearest to the cervical os
|
|
|
•forceps
|
surgical instrument, helps to provide traction on the fetal head during labor
|
|
|
•HypnoBirthing method
|
Childbirth where hypnosis with breathing technique and relaxation used to eliminate fear & stress
|
|
|
•Hypotonic uterine dysfunction
|
Uterine contractions are too weak or to infrequent to be effective during labor / post labor
|
|
|
•Kitzinger method
|
Childbirth method that promotes home births for non-high risk pregnancies, encourages informed parental decisions, relies on breathing techniques with ABD relaxation
|
|
|
•Labor induction
|
Stimulation of labor contractions artificially before natural labor starts
|
|
|
•Lamaze method
|
Childbirth that encourages informed parents promoting a medical intervention free delivery by using pain control, breathing & relaxation techniques and positional changes
|
|
|
•Latent phase
|
First part of the 1st stage of labor, starts with regular contractions, approx 8.6hrs (nullipara) to 5.3hrs (multi), should not exceed 20-14hrs
|
|
|
•Late (Type II) decelerations
|
Starts when contraction is @ its peek but does not return to normal until well after contraction has ended (smooth and U shaped), resolves late, FHR stays wnl, usually d/t decreased circulation to placenta, always ominous= find cause & correct STAT
|
|
|
•Lightening
|
Maternal feeling of fetus settling in to the mother’s pelvis
|
|
|
•Mechanisms of labor
|
movements by the fetus to adapt to the maternal pelvis to allow its passage / birth
|
|
|
•Molding
|
Shaping of the fetal head during birth
|
|
|
•Occult cord prolapse
|
Cord lies beside or just ahead of the fetal head
|
|
|
•Oxytocin theory
|
Oxytocin will levels increase near the start of labor
|
|
|
•Placental accrete
|
Chorionic villi attach directly to the uterine muscular wall
|
|
|
•Placental delivery
|
Usually spontaneous, considered retained if not delivered in 30 minutes
|
|
|
•Placental separation
|
Occurs d/t decrease in uterine surface area, usually 5 min after delivery
|
|
|
•Premature rupture of membranes (PROM)
|
Any rupture before the onset of labor
|
|
|
•Primary uterine inertia
|
Failure of cervix to dilate and the uterus is hypotonic / weak
|
|
|
•Progesterone-deprivation theory
|
Onset of labor starts d/t decreasing progesterone levels
|
|
|
•Progressive relaxation
|
Tense then relax 1 muscle group at a time
|
|
|
•Prolapsed cord
|
Umbilical cord presents before a fetal part
|
|
|
•Prostaglandin theory
|
Increased production of prostaglandins start labor
|
|
|
•Rule of 60s
|
Used to determines ominous cord compression / severe deceleration, defined as
FHR @ 60 bpm Decelerations longer than 60 seconds FHR falls below 60 beats below baseline |
|
|
•Relaxin
|
Water soluble protein secreted by corpus luteum, causes relaxation of symphsis and cervical dilation
|
|
|
•Rupture of membranes (ROM)
|
Amniotic sac breaks and fluid leaks out
|
|
|
•Secondary uterine inertia
|
Direct result of dystocia / difficult labor
|
|
|
•Shoulder presentation
|
Delivery with fetal shoulder closest to internal os, hard to deliver vaginally
|
|
|
•Spontaneous rupture of membranes (SROM)
|
Amniotic sac ruptures from intense contraction, no outside action is used
|
|
|
•Spontaneous vertex birth
|
Birth of fetus without complication
|
|
|
•Touch relaxation
|
Emphasizes mother labor coach relationships, partner touches tense muscles reminding mother to relax prn
|
|
|
•Transition phase
|
Third & Last part of the 1st stage of labor, cervical dilates to 10cm
|
|
|
•True labor
|
Contractions become strong, regular and intensify causing cervical change regardless of outside action
|
|
|
•Variable (Type III) decelerations
|
FHR decreases sharply and for a significant amount of seconds then returns to normal just as quickly, repetitive decelerations are serious may indicate fetal hypoxia or fetus is acidotic
|
|
|
•Variable (Type III) decelerations
|
FHR decreases sharply and for a significant amount of seconds then returns to normal just as quickly, repetitive decelerations are serious may indicate fetal hypoxia or fetus is acidotic
|
|
|
•Ventouse
|
Vacuum extraction
|
|
|
•Vertex presentation
|
Delivery with fetal head down pushing on cervix, chin tucked to chest
|
|
|
•Intrauterine pressure catheter (IUPC)
|
Internal monitor records contraction strength
|
|
|
•Tokodynamometer
|
An external monitor places at the top of the fundus, records contraction rhythm and freq but not strength
|
|
|
Short-term variability (STV) or beat-to-beat variability
|
Best indication of fetal oxygenation and O2 reserves, a change in FHR of 2-3 bpm from one beat to the next, can only be accurately assessed via fetal scalp electrode
|
|
|
•Long-term variability (LTV)
|
Rhythmic & cyclic fluctuations of FHR of 3-10 cycles per minute, indicates fetus oxygenation and its adaption to stresses, evaluated via 5-10 minute monitor strip and each facility may have their own perimeters
|
|
|
What are the 4 theories that help explain the onset of labor?
|
1. Fetal endocrine theory
the fetus releases a hormone that triggers uterine contractions 2. Oxytocin theory oxytocin will levels increase near the start of labor 3. Progesterone-deprivation theory onset of labor starts d/t decreasing progesterone levels 4. Prostaglandin theory increased production of prostaglandins start labor |
|
|
Describe the difference between false and true labor.
|
• Braxton-Hick’s contractions / false labor
o contractions are irregular in intensity, rhythm, and frequency and can be relieved by outside action • True labor o Contractions become strong, regular and intensify causing cervical change regardless of outside action |
|
|
What is crowning and in what stage of labor does it occur?
|
fetal head is encircled by the external opening of the vagina/ introitus, birth is near, happens in the second stage of labor
|
|
|
Fetal descent is thought to occur because of what 4 forces of labor?
|
1.amniotic fluid pressure
22. direct pressure of the uterine fundus on the breech of the fetus 3.contraction of ABD muscles 4.extension and lengthening of the fetal body |
|
|
What occurs when the fetal head descends and meets resistance from the soft tissues of the pelvis, musculature of the pelvic floor, and the cervix?
|
Flexion occurs as the fetal head descends and meets resistance from soft pelvic tissue, pelvic floor musculature and the cervix.
|
|
|
What are the signs of placental separation?
|
Approximately 5 minutes after delivery, Sx: sudden rush of blood or trickle of blood, umbilical cord extends further from the vaginal, a globular shaped uterus that rises into the ABD
|
|
|
What are some of the indications for cesarean delivery?
|
1.Delay in labor
2.Abnormal fetal presentation 3.Fetal distress 4.Maternal illness / distress 5.Previous C-Sections but not always |
|
|
What are the most common types of childbirth classes taught in North America?
|
Bradley, Lamaze, Kitizinger and HypnoBirthing classes
|
|
|
Describe at least 3 relaxation techniques for the laboring mother.
|
1.Progressive relaxation tenses and relaxes 1 muscle group at a time
2.Touch relaxation emphasizes mother labor coach relationships, partner touches tense muscles reminding mother to relax prn 3.Disassociation relaxation, the pt will isolate a muscle group concentrate on that group and then relax the rest of the body 4.Effleurage is a light stroking over the body with the tips of the fingers, used to relieve mild to moderate pain |
|
|
Describe the advantages of using the hands-and-knees positions for laboring and birthing.
|
1.increases perineal relaxation
2.increases umbilical and placental circulation 3.improves fetal rotation 4.allows assessment of perineum 5.Easier delivery for fetus with shoulder dystocia 6. Helps mothers who are experiencing back pain |
|
|
Describe the disadvantages of using the hands-and-knees positions for laboring and birthing.
|
Mother is unable to view the birth and she can feel more fatigued
|
|
|
Describe the normal findings of labor.
|
1) Regular contractions
2) Progressive cervical dilation and effacement 3) Progressive decent of the presenting fetal part 4) Possible ROM that is clear w/out odor |
|
|
Describe the abnormal findings of labor
|
1) Irregular or altered contraction pattern
2) Prolonged latent phase 3) Cervical rigidity 4) Failure of fetal descent 5) Discolored a/o foul smelling amniotic fluid ** Poss R/T uterine hypertonicity / hypotonicity, dehydratyion, cervical infection or edema, abnormal fetal presentation, macrosomia, poor pelvic measures, chorioamnionitis and prolonged ROM |
|
|
What are some examples of goals when providing maternal nursing care during the intratal period?
|
1) Pt will choose positions to assist in descent of fetus
2) Pt will verbalize understanding of assessments that the nurse completes 3) The pt will express a decrease in anxiety 4) Pt's family will provide the opportunity for the pt to deal with her situation in her own way |
|
|
Describe the evalation phase of the nursing process in relation to providing maternal care during the intrapartal period.
|
The evaluation phase involves reassessment of pt care and revisions to the care plan as needed.Ex:
Pt is in pain Pain measures given Nurse should/will reassess the pts pain complaint w/in 30 min for eval of relief If pain is not relieved, reevaluate Pt Use a different course of action depending reevaluation |
|
|
What is external monitoring?
|
Noninvasive method of moniroring fetal activity, a tokodynamometer or fetoscope can be used. During labor the results can be affected by maternal obesity, or movements by mom a/o fetus
|
|
|
What is internal monitoring
|
Internal monitoring is invasive, increases the risk of infection to both mom and child, should onky be used when indicated: when mother or fetus are unstable or conditions warrants a closer inspection. Methods used include, scalp electrode for FHR and an intrauterine pressure catheter (IUPC) for monitoring contractions
|
|
|
What type of lab and health data are collected during the intrapartal period to determine fetal health?
|
1) Maternal HIV status
2) Kown congenital anomalies 3) Maternal blood type & Rh factor 4) Fetal positions and presentations are determined by inspection, palpation, vaginal exam and US 5) Plan of care can be alter as more info is available |
|
|
What is the optimal maternal position for fetoplacental blood flow, and when is it used?
|
Left lateral position is optimal for fetoplacental blood flow.
|
|
|
What types of ssessment data is collected in relation to the birthing process.
|
Maternal and fetal/neonatal responses to various medical interventions. APGAR scores provide info on the infant.
|
|
|
NSG DX that may be associated with the birthing process.
|
1) Anxiety R/T fear of the unknown
2) Fatigue R/T childbirth 3) Compromised family coping R/T situational crisis 4) Acute pain R/T uterine contractions 5) Altered family processes R/T lack of family support during labor |
|
|
abortion
|
birth that occurs before 20 weeks gestation
|
|
|
antepartal period / antepartum / prenatal period
|
the time between conception and the onset of labor
|
|
|
blastocyte
|
when the morula has entered the uterus
|
|
|
capacitation
|
the wearing off of the head of a sperm cell exposing the chemicals inside to the ovum allowing it enter
|
|
|
chorion
|
thick membrane with finger-like projections
|
|
|
chorion villi
|
finger-like projections on the surface of the chorion
|
|
|
cleavage
|
rapid mitotic cell division
|
|
|
embryonic membranes
|
trophoblast develops into this
|
|
|
gestation
|
the number of weeks since the first day of the mother’s last menses (LMP)
|
|
|
gravida
|
number of times a female has been pregnant regardless of outcome
|
|
|
intrapartum period
|
time from the start of labor to birth of the placenta
|
|
|
morula
|
a zygot that has reached the 12-16 cell stage
|
|
|
multigravida
|
female pregnant the second / or more times
|
|
|
multipara
|
female who has had 2 or more births at more than 20 weeks gestation
|
|
|
nidation
|
implantation of a blastocyte
|
|
|
nulligravida
|
female that has never been pregnant
|
|
|
para
|
any birth after 20 weeks gestation, regardless if the infant is born alive or dead
|
|
|
postpartal / postpartum period
|
from birth until the female’s body returns to its prepregnancy condition
|
|
|
post term labor
|
occurs after 42 weeks gestation
|
|
|
preterm / premature labor
|
contractions that occur between 20 and 37 weeks gestation
|
|
|
primigravida
|
female pregnant for the first time
|
|
|
quickining
|
fetal movements that are felt by the mother
|
|
|
stillbirth
|
fetus that is born dead after 20 weeks gestation
|
|
|
term pregnancy
|
lasts 38-42 weeks
|
|
|
TPAL method
|
method of data collection for OB Hx
T- term infants born P- preterm infants born A- abortions L- living children mother has given birth to |
|
|
trimesters
|
the phases of pregnancy divided into three 3 month sections
|
|
|
trophoblast
|
outter layer of a blastocyte
|
|
|
zona pellucida
|
ovum's hard outter shell
|
|
|
zygote
|
cell containing 46 chromosomes
|
|
|
APGAR score
|
Method of evaluating an newborns status at 1 and 5 minutes after delivery
Activety Pulse Grimace Appearance Respirations Scored with 0-1 or 2 0-4= newborn needs rescutation 4-7= newborn needs stimulation 8-10= WNL |
|
|
Cardiac decompensation
|
Return of the cardiac / circulatory system to normal following birth d/t decrease in fluid volume and workload. Cardiac workload takes 2-3 weeks to recover from the stresses placed on it’s by the fetus
|
|
|
Methylergonovine Maleate / Methergine
|
Medication used to stimulate uterine contractions, lasts 3 hours, contraindicated in HTN, PIH, cardiac & renal DZ, DO NOT USE during pregnancy or labor
|
|
|
Oxytocin / Pitocin
|
Medication used to contract and maintain the firmness of the uterus after delivery
|
|
|
RhlgG / RhoGAM
|
Medication that prevents Rh sensation from fetal-maternal transfusion of Rh + fetal red blood cells, given w/in 72 hours after delivery if the following are met:
1) Mother is Rh- 2) Mother is not Rh sensitized by an earlier pregnancy 3) 3) Infant isRh+ 4) Direct Coomb’s test is weakly reactive or negative |
|
|
Colostrum
|
Secretions from the breast before onset of true lactation
|
|
|
Diastasis recti abdominis
|
Separation of the rectus abdominis muscles, may happen during pregnancy
|
|
|
Colostrum
|
Secretions from the breast before onset of true lactation
|
|
|
Direct Coomb’s test
|
A test for Rh antibodies performed on the cord blood at delivery
|
|
|
Diastasis recti abdominis
|
Separation of the rectus abdominis muscles, may happen during pregnancy
|
|
|
Fundus
|
Top portion of the uterus
|
|
|
Direct Coomb’s test
|
A test for Rh antibodies performed on the cord blood at delivery
|
|
|
Habituation
|
Adaption of responding to complex stimuli, the newborn response to the same repeated stimuli will diminish over time
|
|
|
Fundus
|
Top portion of the uterus
|
|
|
Involution
|
The rapid reduction in size of the uterus after birth and its return to a condition similar to its prepregnant state
|
|
|
Habituation
|
Adaption of responding to complex stimuli, the newborn response to the same repeated stimuli will diminish over time
|
|
|
Lactation amenorrhea method (LAM)
|
Method of contraception using constant breast feeding to suppress the mothers reproductive cycle, effective for approximately the first 6 months after childbirth
|
|
|
Involution
|
The rapid reduction in size of the uterus after birth and its return to a condition similar to its prepregnant state
|
|
|
Leukocytosis
|
Elevation in WBCs
|
|
|
Lactation amenorrhea method (LAM)
|
Method of contraception using constant breast feeding to suppress the mothers reproductive cycle, effective for approximately the first 6 months after childbirth
|
|
|
Lochia
|
Discharge from birth, has a musty stale odor, not offensive
|
|
|
Leukocytosis
|
Elevation in WBCs
|
|
|
Lochia alba
|
Final uterine discharge
|
|
|
Lochia
|
Discharge from birth, has a musty stale odor, not offensive
|
|
|
Lochia alba
|
Final uterine discharge
|
|
|
Lochia rubra
|
Uterine discharge first 2-3 days after delivery, dark red
|
|
|
Lochia serosa
|
Uterine discharge from 3rd-10th day after delivery, pink to dark brown in color
|
|
|
Mastitis
|
Infection of the connective breast tissue in women who are lactating, breasts become, red, hot and hard
|
|
|
Maternal role attainment
|
The process by which a woman learns mothering/parenting roles and becomes comfortable with her role as a mother
|
|
|
Meconium
|
Dark green or black material present in the large intestine of a full-term infant, contains mostly the newborns waste product
|
|
|
Metritis
|
Infection of the uterus
|
|
|
Physiologic anemia of infancy
|
Decline of Hgb in newborn after its rise the first few days after delivery d/t erythropoietin production stopping
|
|
|
Postpartum blues
|
A transient period of depression that occurs in most women during the first week or two after birth
|
|
|
Postpartum mood disorder / postpartum depression
|
Happens around the 4th week after birth, not associated with depression during pregnancy, requires medication, therapy and possibly help with childcare
|
|
|
Puerperal infection
|
Infection of the maternal reproductive tract within the first 6 weeks of delivery
|
|
|
Self-quieting ability
|
The ability of newborns to sooth themselves through their own behaviors such as thumb sucking
|
|
|
Subinvolution
|
Partial or incomplete involution / reduction in size of the placental site d/t retention of placental tissue
|
|
|
Boggy uterus
|
Uterine fundus feels soft and spongy rather than firm and contracted, can indicate uterine bleeding
|
|
|
Babinski reflex
|
Infants toe is stroked from heel to toe, positive reaction= dorsiflexion of the great toe and extension of the other 4, this reflex SHOULD DISAPEAR by age 2
|
|
|
Cold stress
|
Excessive heat loss in the newborn that causes the infant to use other methods, such as increased respirations, using fat stores, to make up for the temp loss
|
|
|
Large for gestational age (LGA)
|
Any infant whose birth weight is above the 90th percentile
|
|
|
Moro reflex
|
Flexion of newborns thighs and knees accompanied by fingers that fan then clench as the arms are simultaneously thrown out then brought together as if holding something, from tactile stimulation
|
|
|
Palmar grasp
|
An object is placed in the infant’s hand; the fingers will grasp the object
|
|
|
Plantar grasp
|
A finger is placed to the sole of the infant’s foot below the toes, the toes will flex around the finger, this SHOULD DISAPEAR by 10 months
|
|
|
Postmature infant
|
Any infant born after 42 weeks
|
|
|
Preterm / premature infant
|
Infant born @ 20 to 37 weeks gestation
|
|
|
Respiratory distress syndrome (RDS)
|
DZ of the newborn d/t immaturity of the lungs, d/t lack of adequate surfactant production and immature alveoli until about 34-36 weeks gestation
|
|
|
Rooting reflex
|
When the infant is awake, if the cheek is touched the infant will turn toward the touch as if to nurse, this SHOULD DISAPEAR by 6 months
|
|
|
Small for gestational age (SGA)
|
Any infant who weight is below the 10th percentile
|
|
|
Startle reflex
|
Flexion of newborns thighs and knees accompanied by fingers that fan then clench as the arms are simultaneously thrown out then brought together as if holding something from a sudden noise or movement- not tactile stimulation
|
|
|
Stepping reflex
|
Holding the infant upright, one foot touches a firm surface, the leg touching the surfaces extends and the other leg retracts and the infant will appear to take a step
|
|
|
Suck reflex
|
When the infant is awake and a clean nipple or finger is placed in the infant’s mouth they will begin to suck
|
|
|
Swallow and gag reflex
|
The infant can suck and swallow food without distress
|
|
|
Tonic neck / fencing position
|
When a supine newborns head is turned to the side, the arm and leg of that side will extend, and the opposite side retracts
|
|
|
Traction response
|
When one finger is placed in both palms of the infants hand the infant holds onto the fingers and can be pulled up into a sitting position
|
|
|
Erythroblastosis fetalis / Isoimmune hemolytic DZ
|
when Rh- mother is pregnant with an Rh+ child and the transplacental passage of maternal antibodies takes place, maternal antibodies enter the fetal circulation and destroy fetal red blood cells
|
|
|
Hydrops fetalis
|
most severe form of hemolytic DZ, the maternal antibodies attach to the Rh site of the fetal red blood cells causing them to be destroyed
|
|
|
Sepsis neonatorum
|
Infection in the newborn facquired from or during delivery can be up to 1 month of age
|
|
|
Fetal alcohol syndrome (FAS)
|
Neurological disorder that develops in the infant d/t chronic ETOH use during pregnancy
|
|
|
Hyperbilirubinemia
|
Excess levels of bilirubin in the blood and causes jaundice
|
|
|
Hypoglycemia
|
Newborns blood glucose is less than 40mg per deciliter
|
|
|
Neonatal abstinence syndrome (NAS)
|
Similar to FAS, but the mother is using illicit substances during the pregnancy
|
|
|
Phenylketonuria (PKU)
|
Congenital error of metabolism, most common error in amino acid DOs, excessive amounts of phenylalanine build up causing a progressive mental retardation
|
|
|
Persistent pulmonary hypertension of the newborn (PPHN)
|
Failure of the fetal circulatory system to transition into a self contained/supporting system, can be life threatening if not treated
|
|
|
Opthalmia neonatorum
|
Conjunctivitis caused by the Neisseria gonorrhoeae, TX by EMYCIN ophthalmic ointment via OU immediately after birth (Rx is also effective for ophthalmic chlamydial infections)
|
|
|
How does the cervix change after birth?
|
Cervix is flabby formless and may be bruised. The cervix will return to its original shape in a few hours but the os is permanently changed in size/diameter.
|
|
|
From birth to 2 months, how does the bottle fed infant feed? How much does the infant eat?
|
The infant will need to have 6-8 feedings a day, w/ approximately 2-4oz of formula.
|
|
|
How much protein does a lactating woman need?
|
A lactating woman requires 65gm of protein is the RDA for the first 6 months and 62gm for the second 6 months following delivery. An adult non-lactating woman requires 46-50gm of protein a day.
|
|
|
Describe the complications that can result with preterm infants?
|
1)Respiratory Distress Syndrome (RDS) d/t immature lungs and lack f surfactant.
2)Patent Ductus Arteriosus (PDA) cardiac defect when the ductus arteriosus, the shunt between the higher pressure aorta and the pulmonary artery fails to close, allowing oxygenated blood to flow from the left heart back into the lungs 3)Weak or absent reflexes 4)Lack passive immunity 5)Unable to control / regulate vital functions 6)System immaturity 7)Necrotizing Enterocolitis (NEC) 8)Retinopathy Of Prematurity (ROP) 9)Bronchopulmonary Dysplasia (BPD) 10) Intraventricular hemorrhage (IVH) |
|
|
Describe a large for gestational age (LGA) baby.
|
Infant w/a birth weight above the 90th percentile. Maternal diabetes is a major cause.
|
|
|
Describe a small for gestational age (SGA) baby.
|
An infant with a birth weight below the 10th percentile. IUGR can occur d/t maternal HTN, or an acute compromise of uteroplacental blood flow.
|
|
|
Describe the signs of sepsis in an infant.
|
S/Sx are vague and easily missed. Dx can be made w/a “septic workup”= CBC, blood cultures, CXR and possibly a lumbar puncture
|
|
|
What is fetal alcohol syndrome (FAS)?
|
A fetal defect d/t maternal chronic use of ETOH R/I a child w/ developmental delay a/o neurological issues d/t ETOH effect on the developing brain.
|
|
|
What is Hyperbilirubinemia?
|
High levels of bilirubin in the blood causing jaundice. Physiological (after the first 24 hrs) is mild and resolves w/out TX. Pathological jaundice does not resolve on its own.
|
|
|
amnion
|
thin protective membrane that contains the amniotic fluid and fetus/fetal parts
|
|
|
amniotic cavity
|
space between the amniotic membrane and the embryo
|
|
|
amniotic fluid
|
slightly alkaline and contains albumin, urea, uric acid, etc and fetal wastes. It serves as a fetal cushion, controls the embryo temp, aids in symmetrical growth and muscle development
|
|
|
amniotic sac / bag of waters (BOW
|
fluid filled sac that protects the floating embryo/fetus
|
|
|
chorionic villi
|
finger like projections that cover the chorion membrane
|
|
|
couvades
|
fathers attempt to identify w/ mother and will mimic pregnancy S/Sx
|
|
|
crown to rump (C-R) measurement
|
measurement of embryos from the top of the head to the bottom of the buttocks
|
|
|
decidua basalis
|
portion of the uterine wall directly below where the blastocyte implants
|
|
|
decidua capsularis
|
portion of the uterine wall that covers where the blastocyte implanted
|
|
|
decidua vera
|
uterine lining after implantation that surrounds the blastocyte
|
|
|
ectopic pregnancy
|
fetus implants anywhere else but the uterus
|
|
|
embryo
|
2 weeks after fertilization
|
|
|
embryonic disc
|
blastocyte develops into a double layer of cells that will become the embryo
|
|
|
embryonic stage
|
from day 15 to approximately the 8th week
|
|
|
fetal stage
|
from day 15 to approximately the 8th week
|
|
|
fetus
|
fetal stage
|
|
|
Braxton-Hicks contractions
|
irregular contractions of the uterus
|
|
|
human chorionic gonadotropin (HCG)
|
hormone that serves as a messenger to the corpus luteum in the ovaries, aids in the continued production of estrogen and progesterone
|
|
|
macrosomia
|
enlarged fetal head, poss D/T fetal exposure to hyperglycemic environment
|
|
|
maternal hyperthermia
|
use of external heating devices that increase maternal temp, ie hot tubs, sauna, can cause nervous system defects or not allow neural tube closure in the
|
|
|
neonate
|
child from birth to the first 28 days of life
|
|
|
first trimester
|
from conception to the end of the 3rd month
|
|
|
physiologic anemia of pregnancy / pseudoanemia
|
Occurs D/T maternal plasma volume being larger than the erythrocyte volume
|
|
|
placenta
|
site where the transfer of metabolic and nutrient exchange via embryonic and maternal circulation, becomes a discrete organ at 14 weeks
|
|
|
pregnancy
|
condition that physically alters woman’s body as she caries a developing child in preparation for its birth
|
|
|
rhinitis of pregnancy
|
first 14 days of development after the ovum is fertilized
|
|
|
pre-embryonic stage
|
first 14 days of development after the ovum is fertilized
|
|
|
supine hypotensive syndrome / vena cava syndrome / aortocaval compression
|
pressure on the growing uterus pushes against the vena cava when the mom is supine R/I increased drop in maternal blood pressure w/ dizziness, pallor, clamminess
TX= have mom ly on her left side to decrease pressure |
|
|
teratogenic
|
any substance that can R/I damage to an embryo
|
|
|
term pregnancy
|
lasts 38-42 weeks
|
|
|
Wharton’s jelly
|
specialized connective tissue that surrounds the blood vessels in the umbilical cord
|
|
|
ALPROSTADIL
|
Use: erectile dysfunction
Smooth muscle relaxant, injected into base of penis 20 minutes before sex, blood enters and lasts aprox 1 hr |
|
|
VIAGRA
|
Use: Erectile dysfunction
Smooth muscle relaxant, take 1 hr before sex, lasts aprox 1 hr SE: HA, diarrhea CI: severe cardiac conditions, any retinopathy |
|
|
DEPO-PROVERA
|
Injectable birth control, 1 injection Q3 months of hormones
|
|
|
Diaphragm
|
Barrier method of birth control
|
|
|
BSE
|
Breast Self Exam
|
|
|
TSE
|
Testicular Self Exam
|
|
|
Papanicolaou Test / Smear
|
PAP Test / Smear
|
|
|
How much Folic Acid should a female take on a daily basis before she tries to conceive?
|
0.4mg Q Day
|
|
|
How much Folic Acid should a female take on a daily basis if she has a Pregnancy Hx affected by birth defects?
|
4mg Q Day
|
|
|
A prenatal vitamin should contain…
|
Folic acid Vitamin B
Iron Vitamin C Calcium Magnesium Protein |
|
|
What chromosomal abnormalities are more prevalent in women over 35 y/o?
|
Trisomy 13
Trisomy 18 Trisomy 21 XXX and XXY |
|
|
What chromosomal abnormalities are more prevalent in older men when conceiving?
|
Neurofibromatosis
Achondroplasis Marfan syndrome |
|
|
If a man is over 50 y/o at the time of conception there is a risk of what with the fetus?
|
Late fetal death
|
|
|
What are the categories for possible genetic diseases in the newborn?
|
Congenital abnormalities
Familial DO Known inherited DZ Metabolic DO Chromosomal abnormalities |
|
|
Vaccinations that are safe for the pregnant / non-pregnant woman are?
|
Flu and partner should be vaccinated also
Tetanus Hepatitis A & B Pneumonia Polio- if mom is traveling to Africa, India or SE Asia |
|
|
Pregnant should NOT receive what vaccines?
|
Measles
Mumps Rubella |
|
|
How long can a sperm survive in the female body?
|
48 – 72 hours
|
|
|
Where does fertilization usually take place?
|
The outer third of the fallopian tube
|
|
|
The sperm and ovum combine to create a cell that has how many chromosomes?
|
46
|
|
|
What are the 3 positive objective signs of pregnancy?
|
Detected fetal heartbeat
Detectable palpable fetal movements Visualization of fetus via US |
|
|
Fetal heartbeat can be detected with a fetoscope at how many weeks?
|
17 – 20 weeks
|
|
|
Normal fetal rate
|
120 – 160 BPM
|
|
|
Fetal movements can be palpated at how many weeks?
|
20 weeks
|
|
|
Fetal gestational sac can be observed via US at how many weeks?
|
4 – 5 weeks
|
|
|
Fetal heart movement can be observed via US at how many weeks?
|
8 weeks
|
|
|
HCG can be detected how far along in a pregnancy?
|
7 – 14 days
|
|
|
What are some probable signs of pregnancy?
|
Enlarged uterus
Goodell’s sign Hegar’s sign Braxton-Hicks contractions Ballottement |
|
|
What are some presumptive signs of pregnancy?
|
Amenorrhea
Breast changes / enlargement Chadwick’s sign Fatigue N/V Polyuria Quickening |
|
|
Maternal weight gain with a normal BMI is recommended at?
|
25 – 30 pounds / 11.5 – 16 kilograms
|
|
|
What is the recommended pattern of weight gain during pregnancy?
|
1st trimester= 3.5 – 5 lbs total
2nd trimester= 1lb Q wk 3rd trimester= 1lb Q wk |
|
|
Maternal blood volume increases by how much during pregnancy?
|
45%
|
|
|
Maternal cardiac output increases how much during pregnancy?
|
30 – 50%
|
|
|
Maternal erythrocyte volume increases by how much during pregnancy
|
30% w/supplements and only 18% w/out supplements
|
|
|
Maternal plasma volume increases by how much during pregnancy
|
50%
|
|
|
Pyrosis
|
Heartburn
|
|
|
Epistaxis
|
Nosebleed
|
|
|
Progesterone
|
Maintains the endometrium and inhibits spontaneous uterine contractions, helps develop acini and lobules of the breasts to prepare for lactation
|
|
|
Relaxin
|
Inhibits uterine activity, decreases the strength of the contractions, softens the cervix, remodels collagen
|
|
|
The White Classification
|
Categorizes diabetes according to the extent of the disease
|
|
|
Infants born to diabetic mothers are at risk for what?
|
Fetal macrosomia a/o are born large for gestational age (LGA)
Intrauterine growth retardation (IUGR) |
|
|
A fetal HIV test is not truly positive until the child is how old?
|
15 – 18 mo/old
|
|
|
An infant born to an HIV+ mother may test positive after delivery but this may be a false positive, why?
|
The test responds to antibodies and it may be detecting the maternal antibodies that have crossed the placenta and haven’t been cleared from the maternal circulatory system.
|
|
|
The fetal previable period is what, how long?
|
From gestation to 22 weeks, during this time the fetus has little to no chance of survival if delivered
|
|
|
The fetal immature period is what, how long?
|
22 – 28 weeks, the fetus is immature but viable
|
|
|
The fetus is preterm when?
|
28 weeks
|
|
|
The fetus is premature when?
|
28 – 38 weeks
|
|
|
The fetus is considered mature and viable when?
|
38 – 41 weeks
|
|
|
What is the most common disorder of pregnancy?
|
HTN
|
|
|
Preeclampsia is most often seen?
|
In the last 10 weeks of gestation
During labor The first 48 hours after childbirth |
|
|
The goals of management for preeclampsia are:
|
Quick DX
Prevent cerebral hemorrhage Prevent seizure Prevent hematological complications Prevent renal and hepatic DZ Deliver an uncompromised infant as close to term as possible |
|
|
Antepartal TX for mild preeclampsia includes:
|
Bed rest a/o hospitalization
A diet that is mod to high in PRO Freq BP checks (poss QID) CBC w/ PLT count QOD Serum creatinine, LFT and uric acid 1 – 2 X week |
|
|
Antepartal TX for severe preeclampsia is give:
|
Anticonvulsants
Corticosteroids Sedatives Antihypertensive Fluid & electrolyte replacements |
|
|
CVP
|
Central Venous Pressure
|
|
|
PAWP
|
Pulmonary Artery Wedge Pressure
|
|
|
Women with PIH are at greater risk for developing chronic HTN later in life.
|
False
|
|
|
What is the cure for PIH?
|
Birth
|
|
|
What is the TX focus for Gestational Diabetes Mellitus (GDM)?
|
Diet Ty
Insulin Ty when diet is not enough |
|
|
Generally Gestational Diabetes Mellitus (GDM) resolves postpartum w/little alteration in insulin secretory capacity.
|
True
|
|
|
Preterm labor / premature labor
|
Labor between 20 -37 weeks gestation
|
|
|
Some risks for Preterm labor / premature labor are:
|
Multiple gestation
Maternal Diethylstilbestrol (DES) exposure Known cervical incompetence Maternal age less than 18 or greater than 35 y/o |
|
|
No attempt should be made to stop labor if what conditions are present:
|
Severe preeclampsia
Severe eclampsia Hemorrhage or abruptio placenta Maternal cardiac DZ Fetal death Lethal fetal abnormality Poorly controlled HTN Poorly controlled diabetes mellitus Poorly controlled thyrotoxicosis Acute fetal distress |
|
|
What class of medication is used to treat preterm labor?
|
IV tocolytics
|
|
|
What medication is most commonly used to treat preterm labor?
|
Terbutaline sulfate / Brethine
|
|
|
What medication is most commonly used to treat ectopic pregnancy?
|
Methotrexate
|
|
|
The most reliable clinical indicator of a potential spontaneous abortion is?
|
Pelvis cramping and backache
|
|
|
The classic Sx of placenta previa is?
|
Painless vaginal bleeding that occurs after 20 weeks
|
|
|
Alpha-Fetoprotein (AFP) Screening
|
optional test for expectant mothers that may indicate a fetal development problem, it measures the level of alpha-fetoprotein in the blood, abnorm high or low can indicate fetal chromosomal abnorms or other DO assoc w/ brain, spinal or digestive system
|
|
|
amniocentesis
|
15 - 20ml of fluid from amniotic sac is removed via needle and assessed for fetal health and maturity
|
|
|
amniotic fluid index (AFI)
|
obtained by measuring pockets of amniotic fluid in 4 quadrants of the uterus, the measurements are added together to obtain the AFI
|
|
|
ballottement
|
when the uterus is tapped sharply at the 4-5th month the fetus will rise and rebound
|
|
|
Biophysical Profile (BPP)
|
the assessment of 5 fetal biophysical variables
1. Breathing movement 2. Body movement 3. Tone 4. Amniotic fluid volume 5. Fetal heart rate |
|
|
Chadwick's sign
|
violet - bluish color of the vaginal mucosa d/t increased vascularity of the pelvic organs, appears at 8 - 12 weeks into the pregnancy
|
|
|
electronic fetal monitoring (EFM)
|
a visual assessment of fetal heart rate, continuous tracing that allows for monitoring fetal heart characteristics
|
|
|
gestational diabetes mellitus (GDM)
|
Carbohydrate intolerance of variable severity w/onset or 1st recoginition during pregnancy
|
|
|
gestational trophoblast DZ (hydatidiform mole / molar pregnancy)
|
the uterus fills w/small grapelike clusters instead of an embryo or fetus, fetal heart is not detected
|
|
|
(hydatidiform mole / molar pregnancy) gestational trophoblastic DZ
|
the uterus fills w/small grapelike clusters instead of an embryo or fetus, fetal heart is not detected
|
|
|
Goodell's sign
|
cervix softens d/t pelvic congestion, occurs during the 2nd month of pregnancy
|
|
|
Hegar's sign
|
the lower uterine segment feels soft when palpated , appears during the 2nd - 3rd month of pregnancy, indicates hyperemia of the pelvis
|
|
|
hyperplasia
|
increase in cell number
|
|
|
hypertrophy
|
increase in size of an object
|
|
|
incompetent cervix
|
painless dilation of the cervix w/out contractions by the mother
|
|
|
intrauterine growth retardation (IUGR
|
the placenta is poorly perfused and the fetus is compromised, inhibiting its growth
|
|
|
non-stress test (NST)
|
an assessment method by which the reaction / response of the fetal heart rate to fetal movement is measured
|
|
|
preeclampsia
|
progressive PIH disease w/ an increase is systolic BP of 30mm Hg or an increase of diastolic BP 15mm Hg above baseline
|
|
|
Rh sensitization
|
Rh sensitization
|
|
|
Terbutaline pump
|
a portable pump that is programmed to deliver medication or a bolus if contractions occur
|
|
|
tocolysis
|
tocolysis
|
|
|
tocotransducer
|
In-home monitor that the mother uses 2x day for 1 hour intervals and PRN to record contractions then info is sent to MD
|
|
|
TORCH infections
|
a group of infections that can have serious effects on the fetus
Toxoplasmosis Other (hepatitis or varicella) Rubella Cytomegalovirus (CMV) Herpes simplex |
|
|
ultrasonography
|
uses high-frequency sound waves that are directed into the ABD via transducer then reflected, giving a picture of varying densities
|
|
|
Toxoplasmosis
|
caused by a protozoan, transmitted by eating under cooked meat or contact w/cat feces R/I flu -like Sx. Can cause early spontaneous abortion or CNS problems later in the pregnancy
|
|
|
Hepatitis
|
Liver inflamation
Hep A is transmitted via oral-fecal route Hep B is transmitted via blood a/o body fluids |
|
|
Varicella / Chicken pox
|
Congenital anomalies can develop if contracted in the 1st trimester. Fetal mortality risk rises if contracted near delivery. VZIG should be given if mother is not varicella immune and is exposed.
|
|
|
Rubella / German Measles
|
Rubella / German Measles
|
|
|
Rubella titer
|
a titer above 1:10= immunity
a titer of 1:8= minimal or no immunity |
|
|
eclampsia
|
a pregnant woman who has a seizure but has no known Hx of seizure
|
|
|
lecithin / sphingomyelin (L/S) ratio
|
lecithin and sphingomyelin are 2 phospholipids found in surfactant. The ratio of the two changes during the pregnancy and can be measured to determine lung maturity via amniocentesis. When twice the amount of L/S is found in the amniotic fluid the RDS is very unlikely
|
|
|
Cytomegalovirus
|
fetus @ risk for generalized DZ and stillbirth if exposed by droplet nuclei
|
|
|
Herpes simplex (HSV-2)
|
genital herpes, if mother has active herpes infant must be born via C-section to avoid transmission to fetus
|
|
|
placenta previa
|
placenta implants in the lowest part of the uterine segment sometimes over the internal os, as the cervix contracts the placenta will be torn away causing bleeding
|
|
|
Varicella-zoster immune globulin (VZIG)
|
chicken pox vaccine, should be given to a woman who is not immune to varicella and is exposed during pregnancy
|
