Final- Mn- Ch 10 And 30

Front 1

normal functioning of an intact hypothalamic-pituitary-gonadal axis supports gametogenesis, which is?

Back 1

(formation of sperm and ova)

Front 2

-the life span of sperm may remain viable in the females reproductive tract for __hours or more, probably only a few retain fertilization potential for more than ___hours

Back 2

48



24

Front 3

-ova remain viable for about __hours but the optimal time for fertilization may be no more than

Back 3

24


1-2 hrs

Front 4

-in general, about ___% of couples will have unexplained or idiopathic causes of infertility

Back 4

20

Front 5

-among the __% of couples who have an identifiable cause of infertility about __% are related o factors in the female partners and __% are related to factors in the male partner, __% are related to both

Back 5

80


40
40



20

Front 6

-pharmacologic therapy for female infertility is often directed at treating what

Back 6

ovulatory dysfunction either by stimulating ovulation or by enhancing ovulation so that more oocytes mature


-the medications include FSH, hCG, progesterone

Front 7

-the medications include FSH, hCG, progesterone
-these meds are extremely potent and require daily monitoring with ovarian ultasonography and monitoring of estradiol levels to prevent hyperstimulation


-the prevalence of ___________ with the use of these meds is greater than 25%

Back 7

multiple pregnancy

Front 8

what may result from a high stress level or decreased % of body fat as a result of an eating disorder (anorexia nervosa) or excessive exercise

Back 8

-a hypoestrogenic condition

Front 9

In Vitro Fertilization-Embryo transfer is a common approach for woman who experience what?

Back 9

women with blocked or absent uterine tubes
unexplained infertility
for men with very low sperm counts

Front 10

In Vitro Fertilization-Embryo transfer
-how many embryos are transferred?

Back 10

-generally only 3 or fewer embryos are transferred to minimize the risk of multiple pregnancies

Front 11

In Vitro

-couples who have excess embryos frozen or later transfer must be informed before consenting to the procedure to make decisions regarding the disposal of the embryos in the event of

Back 11

1) death
2) divorce
3) decision that they don’t want the embryos later

Front 12

Subfertility:



Sterility:

Back 12

Subfertility: prolonged time to conceive (took 4-5 years to become fertile)


Sterility: inability to conceive

Front 13

Infertility and age?

Back 13

Increases with age, particularly women older than 40 years (more likely to have down syndrome and congenital anomalies)

Front 14

Factors Associated with Infertility -Female infertility

Congenital or developmental factors, such as :

Back 14

External genitals,
internal reproductive tract

Front 15

Factors Associated with Infertility -Female infertility

Hormonal or ovulatory factors, such as:

Back 15

Hypothalamic or adrenal gland

Front 16

Factors Associated with Infertility -Female infertility

Tubal/peritoneal factors

Back 16

STIs adhesions
Some STIs can scar the fallopian tubes

Front 17

Factors Associated with Infertility -Female infertility

Vaginal-cervical factors, such as:

Back 17

Isoimmunization(her body attacks the sperm and they can’t get pregnant),-sperm antibodies

Front 18

Factors Associated with Infertility - male factors

Can be caused by structural and hormonal disorders

Back 18

Undescended testes don’t produce sperm as well
Hypospadias
Varicocele (varicose vein of the scrotum)
Low testosterone levels
Azoospermia: no sperm cells produced
Oligospermia: few sperm cells produced

Front 19

Egg and sperm mixed in a dish, then when an embryo forms, that is put into the woman

Back 19

In vitro fertilization-embryo transfer (IVF-ET)

Front 20

-Preeclampsia parameters

-hypertension that develops when

Back 20

after 20 weeks of gestation in a previously normal woman

Front 21

-Preeclampsia parameters

-characterized by the presence of

Back 21

hypertension and proteinuria

Front 22

-mild preeclampsia

what is present?

Back 22

-with mild preeclampsia, hypertension and proteinuria are present and there is no organ dysfunction

Front 23

-hypertension is defined as systolic = greater than and diastolic = greater than


taken when?

Back 23

140


90


on two separate occasions at least 4-6 hours apart

Front 24

-proteinuria is defined as a concentration of

Back 24

30 or more mg/dl in at least 2 random urine specimens collected at least 6 hours apart with no evidence of a UTI

Front 25

-in a 24 hour specimen, proteinuria is defined as a concentration of

Back 25

300 or more mg

Front 26

HELLP SYNDROME is what

Back 26

-a laboratory diagnosis for a variant of severe preeclampsia that involves hepatic dysfunction

Front 27

HELLP SYNDROME
characterized by what lab tests?

Back 27

-characterized by hemolysis (H), elevated liver enzymes (AST and ALT), and low platelets.

-A woman’s platelet count must be less than 100,000

Front 28

-most commonly, HELLP syndrome is seen in what race?


90% of women report what?

Back 28

older white multiparous women.



-a history of malaise for several days

Front 29

HELLP SYNDROME

-pain is also noted where?
-50% complain of?

Back 29

-epigastric or right upper quadrant pain is noted
-50% complain of n/v

Front 30

-complications with HELLP syndrome include:

Back 30

renal failure,
pulmonary edema,
rupture liver hematoma,
DIC,
placental abruption,
preterm birth

Front 31

Severe Preeclampsia / Hospital Care

-with a gestational age of ____, labor induction is usually performed

Back 31

32-36 weeks

Front 32

Severe Preeclampsia / Hospital Care

vaginal or c-section?

Back 32

-vaginal birth is considered safer than c sections and should be attempted, unless there are indications for a c birth such as unfavorable (uneffaced and undilated) cervix

Front 33

Severe Preeclampsia / Hospital Care

-in pregnancies less than how many weeks, antenatal corticosteroids may be given to promote fetal lung maturity

Back 33

34

Front 34

Severe Preeclampsia / Hospital Care

-nursing care must focus on the mom and the fetus
-what is measured on admission and usually at the same time every day thereafter

Back 34

weight

Front 35

Severe Preeclampsia / Hospital Care

breath sounds are auscultated for crackles or diminished breath sounds, which may indicate

Back 35

pulmonary edema

Front 36

Severe Preeclampsia / Hospital Care


-baseline laboratory assessments are:

Back 36

liver enzyme (ALT, AST, LDH),

CBC w/ platelets,

coagulation profile to assess for DIC,

electrolyte studies for renal functioning

Front 37

Severe Preeclampsia / Hospital Care

-fetus has the potential for _____ r/t:

Back 37

hypoxia related to uteroplacental insufficiency

Front 38

Severe Preeclampsia / Hospital Care

-the woman with severe preeclampsia is maintained on bed rest, and seizure precautions are initiated

true or false

Back 38

true

Front 39

Severe Preeclampsia / Hospital Care


what may be required for accurate fluid monitoring in the presence of pulmonary edema or acute renal failure

Back 39

-measurement of central venous pressure or pulmonary arterial wedge pressure

Front 40

-one of the important goals of care for the woman with severe preeclampsia is

Back 40

prevention or control of convulsions

Front 41

-what is the drug of choice in prevention & treatment of convulsions

Back 41

magnesium sulfate

Front 42

Magnesium Sulfate Section
-initial loading dose of

Back 42

4-6 g of magnesium sulfate, per protocol or docs order, if infused over 15-20 min

Front 43

Magnesium Sulfate
-therapeutic effect is what?

Back 43

-this dose should maintain a therapeutic serum magnesium level of 4-7 mEq/L

Front 44

Magnesium Sulfate Section

after the loading dose, what may happen?

Back 44

there may be a transient lowering of the arterial BP secondary to relaxation of smooth muscle by magnesium sulfate

Front 45

-magnesium sulfate interferes with the release of _____________at the synapses, decreasing neuromuscular irritability, and

Back 45

acetylcholine


depressing cardiac conduction, and decreasing CNS irritability.

Front 46

Magnesium Sulfate

why must the nurse assess for s/s of toxicity?

Back 46

-b/c magnesium sulfate is a CNS depressan

Front 47

Magnesium Sulfate
-early symptoms of toxicity are

Back 47

-early symptoms of toxicity include nausea, feeling of warmth, flushing, muscle weakness, decreased reflexes and slurred speech

Front 48

Magnesium Sulfate

-symptoms of toxicity is detected by

Back 48

-loss of patellar reflexes,
respiratory depression,
oliguria,
-decreased LOC

Front 49

-if magnesium toxicity is suspected, what should the nurse do?

Back 49

The infusion should be discontinued immediately. Calcium gluconate, the antidote for magnesium sulfate may also be ordered and given slowly IV push to avoid undesirable reactions such as arrhythmias, bradycardia, ventricular fibrillation

Front 50

-magnesium sulfate does NOT seem to affect the FHR in a health term fetus


true or false

Back 50

true

Front 51

Magnesium Sulfate
-Neonatal serum levels approximate those levels of the mother.

true or false

Back 51

true

Front 52

Magnesium Sulfate


-toxic levels in the newborn can cause

Back 52

depressed respirations and hyporeflexia at birth

Front 53

Magnesium Sulfate

-because magnesium sulfate is a tocolytic agent, its use may (increase or decrease) the duration of labor.

Back 53

increase

A preeclamptic woman receiving magnesium sulfate may need augmentation with oxytocin during labor.

Front 54

Immediate Care

-eclampsia is preceded by s/s of (3)

Back 54

h/a,
severe epigastric pain,
hyperreflexia.





------ convulsions appear suddenly

Front 55

Immediate Care

-the immediate goal of care during a convulsion is to

Back 55

ensure a patent airway

Front 56

Immediate Care

-when convulsions occur, what do we do?

Back 56

turn ht woman onto her side to prevent aspiration of vomit and supine hypotension syndrome

Front 57

-after the convulsions stop, what do we do?

Back 57

suction food and fluids from the glottis and administer 10 L of oxygen by a facemask

Front 58

-if eclampsia develops after the initiation of magnesium sulfate therapy, what may be given?

Back 58

additional magnesium sulfate or another anticonvulsant (diazepam)

Front 59

-fetal and neonatal effects of diazepam include

Back 59

decreased FHR variability,
neonatal hyotonia,
decreased RR,
depressed sucking reflex

Front 60

-what is the leading cause of maternal morbidity and mortality after eclamptic seizure.

Back 60

aspiration

Front 61

-after the initial stabilization and airway management, the nurse should anticipate orders for what 2 things to rule out aspiration?

Back 61

a chest radiograph and possibly arterial blood gases to rule out aspiration

Front 62

-a rapid assessment of what 3 things is performed after a convulsion

Back 62

uterine activity, cervical status, and fetal status

Front 63

-during the convulsion, membranes may have ruptured, the cervix may have dilated, because the uterus becomes hypercontractile and hypertonic and _____may be imminent

Back 63

birth

Front 64

-the more serious the condition of the woman, the greater the need to proceed to birth
-general anesthesia and regional anesthesia is not recommended
-maternal pain can be controlled with

Back 64

epidural anesthesia or systemic opioids

Front 65

-immediately after a seizure the woman may be confused and combative.
so what do nurses have to do to prevent injury?

Back 65

-pad the side rails to prevent injury
-maintain a quiet dark envt
-it may take several hours for the woman to regain her usually level of mental functioning
-the woman should not be left alone

Front 66

Tonic-clonic convulsion signs

-stages of invasion:

Back 66

2-3 sec, eyes are fixed, twitching of facial muscles occurs

Front 67

Tonic-clonic convulsion signs

-stage of contraction:

Back 67

15-20 sec, eyes protrude and are bloodshot, all body muscles are in tonic contraction

Front 68

Tonic-clonic convulsion signs

-stage of convulsion:

Back 68

muscle relax and contract alternately (clonic); respirations are halted and then begin again with long, deep, stertorous inhalation, coma ensues

Front 69

Intervention during seizures

-keep airway patent: how?

what 3 other things should we do

Back 69

turn head to one side, place pillow under 1 shoulder of back if possible


-call for assistance
-protect with side rails up
-observe and record convulsion activity

Front 70

After convulsion or seizure
-do not leave unattended until when?

Back 70

they are fully alert

Front 71

After convulsion or seizure
-observe for:
-administer what?

Back 71

-observe for postconvulsion coma, incontinence
-use suction as needed
-administer oxygen via face mask at 10 L/min

Front 72

After convulsion or seizure
-start IV fluids and monitor for?
-give what other drug?
-insert?
-monitor what VS?

Back 72

-Start IV fluids and monitor for potential fluid overload
-give magnesium sulfate or anticonvulsant drug as ordered
-insert indwelling urinary catheter
-monitor BP

Front 73

After convulsion or seizure
-monitor status of what 2 things:

-expediate lab work as ordered to monitor what?

Back 73

-monitor fetal and uterine status
- kidney function,
liver function,
coagulation system,
drug levels

Front 74

Magnesium Sulfate

nursing alert
what is the woman at risk for

Back 74

-the woman is at risk for a boggy uterus and a large lochia flow as a result of magnesium sulfate therapy. Uterine tone and lochia flow should be assessed frequently

Front 75

Hypertensive disorders
is defined as:

Back 75

Hypertensive disorders
Systolic BP >140
OR Diastolic BP >90

Front 76

Preeclampsia
-what race is at higher risk?

Back 76

African-American women experience most severe complications and have higher mortality rates (already predisposed to hypertension, limited access to resources)

Front 77

Onset of hypertension without proteinuria after week 20 of pregnancy

Back 77

Gestational hypertension

Front 78

Pregnancy-specific syndrome in which hypertension develops after 20 weeks of gestation in a previously normotensive woman


Hypertension AND proteinuria

Back 78

Preeclampsia

Front 79

Hypertension present before pregnancy or diagnosed before week 20 of gestation

Back 79

chronic hypertension

Front 80

Preeclampsia
-how do you cure it?

Back 80

delivery of fetus and placenta

Front 81

care management for preeclampia, what do we check deep tendon reflexes (DTRs) –

Back 81

To check CNS

Front 82

Magnesium Sulfate monitoring of I&O , why?

how often do we do I&Os?

Back 82

mag sulfate is excreted through the urine and if it is not excreted, they can be become toxic . We need to know if the kidneys are working well enough to excrete this drug.




We are doing hourly I&Os

Front 83

Chronic Hypertension is associated with what bad thing??

Back 83

Abruptio placentae –placenta is leaving the side. The force of the BP is bounding on the placenta and comes away from the side

Front 84

Historic risk factors are associated with a higher incidence of preeclampsia (3)

Back 84

First pregnancy or pregnancy of new genetic makeup

History of vascular disease

Multiple gestation

Front 85

Magnesium sulfate (vasodilates or vasocontricts and helps with convulsions), the anticonvulsive agent of choice for preventing eclampsia, requires careful monitoring of what 3 things?

Back 85

vasodilates


reflexes, respirations, and urinary output

Front 86

Magnesium Sulfate

-whats the antidote?

Back 86

calcium gluconate, should be available at bedside for toxicity, not the seizure