First Maternal Nursing Exam

Front 1

Chadwick's sign -- is it a presumptive, probable, or positive sign of pregnancy?

Back 1

probable

Front 2

Hegar's sign -- is it a presumptive, probable, or positive sign of pregnancy?

Back 2

probable

Front 3

Goodwell's sign -- is it a presumptive, probable, or positive sign of pregnancy?

Back 3

probable

Front 4

fetal heart tones -- is it a presumptive, probable, or positive sign of pregnancy?

Back 4

positive

Front 5

positive pregnancy test (peeing on the stick) -- is it a presumptive, probable, or positive sign of pregnancy?

Back 5

probable

Front 6

braxton-hicks contractions -- is it a presumptive, probable, or positive sign of pregnancy?

Back 6

probable

Front 7

fetal outline felt by examiner -- is it a presumptive, probable, or positive sign of pregnancy?

Back 7

positive

Front 8

quickening -- is it a presumptive, probable, or positive sign of pregnancy?

Back 8

presumptive

Front 9

linea nigra -- is it a presumptive, probable, or positive sign of pregnancy?

Back 9

presumptive

Front 10

darkened areola -- is it a presumptive, probable, or positive sign of pregnancy?

Back 10

presumptive

Front 11

striae gravidarum -- is it a presumptive, probable, or positive sign of pregnancy?

Back 11

presumptive

Front 12

chloasma -- is it a presumptive, probable, or positive sign of pregnancy?

Back 12

presumptive

Front 13

amenorrhea -- is it a presumptive, probable, or positive sign of pregnancy?

Back 13

presumptive

Front 14

What's the McDonald method of calculating gestational age?

Back 14

gestational age is approx. equal to the fundal height measured from the symphysis pubis

Front 15

what is gravida?

Back 15

# of pregnancies

Front 16

What's para?

Back 16

# of pregnancies in which the fetus/fetuses reach viability (at least 20 weeks or 500g) regardless of whether the fetus is born alive or not.

Front 17

What's GTPALM?

Back 17

G = gravidity
T = term births (38 wks or more)
P = preterm births (20wks)
A = abortions/miscarriages (before 20 wks)
L = living kids
M = Multiple gestation

Front 18

blood volume increases by how much during pregnancy?

Back 18

35-50%

Front 19

T/F. WBC count decreases during pregnancy.

Back 19

False.
WBC count increases by 10,000/mm^3

Front 20

does maternal pulse rate increase or decrease during pregnancy?

Back 20

increase

Front 21

oxytocin given for induction of labor is always given by which route?

Back 21

IV Piggyback

Front 22

the most noninvasive way to attempt to induce labor is:

Back 22

nipple stimulation -- to trigger the release of endogenous oxytocin

Front 23

what does high levels of Alpha-fetoprotein (AFP) in the amniotic fluid indicate?

Back 23

neural tube defects

Front 24

what does low levels of Alpha-fetoprotein (AFP) in the amniotic fluid indicate?

Back 24

Down syndrome
or
gestational trophoblastic disease (hydatidiform mole)

Front 25

what is the normal fetal HR range?

Back 25

110-160 bpm

Front 26

T/F. Variability of fetal HR is normal.

Back 26

True.

Front 27

What is hyperemesis gravidarum?

Back 27

excessive nausea and vomiting r/t high hCG lvls that is prolonged past 12 weeks of gestation and results in 5% weight loss from pre-pregnancy weight, dehydration, F&E imbalance, etc.

Front 28

What do you look for in the urinalysis of a pt suffering from hyperemesis gravidarum?

Back 28

- ketones and acetones
- increased specific gravity

Front 29

Main difference between placenta abruptio and placenta previa:

Back 29

placenta previa = painless bleeding

placenta abruptio = painful

Front 30

things to monitor for when on mag sulfate:

Back 30

- BP
- UO
- reflexes
- respirations

Front 31

what positions can you place your pt who has a cord prolapse?

Back 31

- trendelenburg
- knee-chest
- side-lying with hips elevated

Front 32

Pt's having preterm labor.
Place in order of priority:
- apply fetal monitor
- infuse prescribed IV tocolytic
- administer betamethisone
- pt teaching regarding bed rest

Back 32

1. infuse IV tocolytic (hydration and medication stops preterm labor)
2. administer betamethisone (to develop fetal lungs in case of early delivery)
3. apply fetal monitor (to monitor contractions and fetal HR)
4. bedrest teaching

Front 33

what's acrocyanosis?

Back 33

pink body with blue extremities

Front 34

what pH is amniotic fluid? and what color would the nitrazine paper turn into?

Back 34

pH 6.5-7.5

bluish-greenish, dark blue

Front 35

when can the sex of the fetus be determined?

Back 35

at 12 weeks (3 months)

Front 36

At which gestational age are all body organs formed?

Back 36

8 weeks (2 months)

Front 37

When does the fetal heart begin the beat? when can you hear it using a Doppler? when can you hear it with a fetoscope?

Back 37

- begins to beat at 4 weeks (1 mo.)
- hear it w/ a Doppler at 8-12 weeks (2-3 mo.)
- hear it w/ a fetoscope at 20 weeks (5 mo.)

Front 38

brown fat present at what gestational age?

Back 38

28 weeks (7 months)

Front 39

Fetus gains ability to hear at what gestational age?

Back 39

24 weeks (6 months)

Front 40

what's the ductus arteriosus?

Back 40

duct that connects the pulmonary artery with the aorta allowing blood to bypass the lungs

Front 41

What's the ductus venosus?

Back 41

shunts blood from the umbilical vein to the inferior vena cava allowing most of the blood to bypass the liver

Front 42

what serves as the respiratory organ for the developing fetus?

Back 42

the placenta

Front 43

T/F. the umbilical vein carries oxygenated blood.

Back 43

True.
It carries oxygenated blood and nutrients from the placenta (maternal supply) to the fetus

Front 44

T/F. Have the pt void before performing an ultrasound.

Back 44

False.
Pts should drink lots of fluids and fill the bladder to stabilize the uterus for an US.

Front 45

T/F. Always have the pt sign a consent form before performing an ultrasound or any other procedure.

Back 45

False.
Pts do not need to sign a consent prior to an US.

Front 46

Define fetal lie:

Back 46

relationship of the mom's spine to the fetal spine.
(transverse or parallel/longitudinal)

Front 47

Define: fetal attitude:

Back 47

relationship of fetal body parts to one another.
(flexion or extension)

Front 48

define fetal presentation:

Back 48

the part of the fetus that enters the pelvic inlet first.
(occiput, mentum, scapula, or sacrum)

Front 49

T/F. Iron needs for lactating women are about the same as non-lactating women.

Back 49

True.

Front 50

a positive contraction stress test indicates a need for what other test?

Back 50

biophysical profile

Front 51

what is done to relieve hydramnios?

Back 51

amniocentesis

Front 52

can oxytocin cause decreased or increased blood pressure in postpartum pts?

Back 52

increased blood pressure

Front 53

T/F. amniocentesis can determine the sex of the fetus.

Back 53

True.

Front 54

can amniocentesis be used to determine fetal lung maturity?

Back 54

yes but only during the last trimester

Front 55

T/F. Amniocentesis is used to diagnose polyhydramnios.

Back 55

False.
ultrasounds are used to diagnose polyhydramnios, but an amniocentesis can be used to relieve it.

Front 56

what are the 3 cardinal signs of an ectopic pregnancy?

Back 56

- abdominal pain
- vaginal bleeding
- a positive pregnancy test

Front 57

T/F. hyperemesis gravidarum is a neurologic disorder.

Back 57

False.
The cause of hyperemesis gravidarum isn't known

Front 58

approximately where is the fundal height at 20 week gestation?

Back 58

at the umbilicus.

Front 59

the uterus deviates to which side in early pregnancy?

Back 59

right side.
(so many women experience RLQ pain/pulling)

Front 60

Adverse reactions to Oxytocin in the mother such as hypertension and fluid overload are due to what effects of drug?

Back 60

due to its antidiuretic effects

Front 61

what are the 5 components of a biophysical profile?

Back 61

- nonstress test
- fetal tone
- fetal breathing
- fetal motion
- quantity of amniotic fluid

Front 62

Conception- definition

Back 62

defines beginning of pregnancy, results from the union of single egg and sperm

Front 63

Sequential process of conception…

Back 63

1. Gamete formation 2. Ovulation 3. Fertilization (in fallopian tube) 4. Implantation (in the uterus)

Front 64

Implantation occurs when…

Back 64

6-10 days after conception

Front 65

Function of chorionic villi

Back 65

develop out of trophoblast and extend into the endometrium. Obtain oxygen and nutrients, dispose of carbon dixide and waste products

Front 66

Edometrium becomes what after implantation

Back 66

It becomes the decida after implantation. The three decida layers become the fetal membranes

Front 67

Pre-embryonic (ovum)

Back 67

conception until day 14. Primary germ layers

Front 68

Embryo

Back 68

day 15 until 8 weeks after conception (or until the crown-rump length 3cm). Stage when cell division is most vulnerable to malformation caused by teratogens. By 8 weeks all organ systems and external structures are present.

Front 69

Fetus

Back 69

stage 9 weeks until pregnancy.

Front 70

Viability

Back 70

capability of the fetus to survive outside the uterus. Previously 28 weeks post conception, now may be 20 weeks. Limitations based upon CNS function and oxygenation capacity of lungs.

Front 71

Fetal membranes

Back 71

Chorion, amnion, amniotic fluid, yolk sac, umbilical cord, placenta

Front 72

Chorion

Back 72

develops from the trophoblast and contains the ______ villi on the surface, becomes the fetal side of the placenta, contains the major umbilical blood vessels, the villi atrophy and degenerate, leaving a smooth ______ membrane

Front 73

Amnion

Back 73

develops from the interior of the blastocyst. Forms on the side of the amniotic cavity opposite the blastocyst. Embryo draws the amnion around itself, forming a fluid-filled sac

Front 74

Amniotic fluid

Back 74

Maintains constant body temp, source of oral fluid, repository for waste, cushioning, freedom of movement (prevents entanglement with membranes) chemical and genetic studies of the fluid provide health information

Front 75

Oligohydramnios

Back 75

too little amniotic fluid. May indicate fetal renal abnormalities (baby not producing urine which

Front 76

Polyhydramnios

Back 76

too much amniotic fluid. May indicate GI or other fetal malformations (baby has a hard time swallowing)

Front 77

Yolk Sac

Back 77

transfers nutrients and oxygen, forms primative blood cells. (Seen with the embryo functions until the placenta can take over)

Front 78

Wharton's jelly

Back 78

connective tissue that prevents compression of the cord

Front 79

Nuchal cord

Back 79

when cord wraps around the fetal neck

Front 80

Battledore placenta

Back 80

when the umbilical cord is located peripherally on the placenta, instead of the usual central insertion. (More risk for compression of the umbilical cord)

Front 81

Placenta

Back 81

begins to form at implantation, divided into 15-20 separate sections (cotyledons), which function as independent units, the whole of which is the ______. Maternal-embryonic circulation is separated by the placenta (the two circulation systems do not mix!) Means of metabolic exchange, produces hormones: 1. Human chorionic ganadotropin (hCG) 2. Human placental lactogen (hPL) 3. Progestrone 4. Estriol

Front 82

Human chrionic gonadotropin (hCG)

Back 82

Its role is to prevent the disintegration of the corpus luteum of the ovary and thereby maintain progesterone production that is critical for a pregnancy in humans.

Front 83

Human placental lactogen (hPL)

Back 83

Produced by the placenta. It modifies the metabolic state of the mother during pregnancy to facilitate the energy supply of the fetus. HPL has anti-insulin properties, which is why some women get gestational diabetes

Front 84

Progesterone

Back 84

"Produced by the placenta. Supports gestation, During implantation and gestation, ___appears to decrease the maternal immune response to allow for the acceptance of the pregnancy, decreases contractility of the uterine smooth muscle (why GI also slows), inhibits lactation during pregnancy. The fall___ levels following delivery is one of the triggers for milk production, a drop in ____levels is possibly one step that facilitates the onset of labor.

Front 85

Estriol

Back 85

Produced by the placenta. Helps maintain placental function

Front 86

Fetal circulation

Back 86

Placenta - ductous venosus - Inferior vena cava (bypassing the liver) - Right atrium - passes through the foramen ovale - left atrium - left ventricle - aorta -

Front 87

Gravidity

Back 87

pregnancy

Front 88

Multigravida

Back 88

woman with two or more pregnancies

Front 89

primigravida

Back 89

women pregnant for the first time

Front 90

nulligravida

Back 90

woman who has never been pregnant

Front 91

Placenta

Back 91

begins to form at implantation, divided into 15-20 separate sections (cotyledons), which function as independent units, the whole of which is the ______. Maternal-embryonic circulation is separated by the placenta (the two circulation systems do not mix!) Means of metabolic exchange, produces hormones: 1. Human chorionic ganadotropin (hCG) 2. Human placental lactogen (hPL) 3. Progestrone 4. Estriol

Front 92

Human chrionic gonadotropin (hCG)

Back 92

produced by the fetus and later the placenta. Levels can first be detected by a blood test about 11 days after conception and about 12 - 14 days after conception by a urine test (?) Its role is to prevent the disintegration of the corpus luteum of the ovary and thereby maintain progesterone production that is critical for a pregnancy in humans.

Front 93

Human placental lactogen (hPL)

Back 93

Produced by the placenta. It modifies the metabolic state of the mother during pregnancy to facilitate the energy supply of the fetus. HPL has anti-insulin properties, which is why some women get gestational diabetes

Front 94

Progesterone

Back 94

"Produced by the placenta. Supports gestation, During implantation and gestation, ___appears to decrease the maternal immune response to allow for the acceptance of the pregnancy, decreases contractility of the uterine smooth muscle (why GI also slows), inhibits lactation during pregnancy. The fall___ levels following delivery is one of the triggers for milk production, a drop in ____levels is possibly one step that facilitates the onset of labor.

Front 95

Estriol

Back 95

Produced by the placenta. Helps maintain placental function

Front 96

Fetal circulation

Back 96

Placenta - ductous venosus - Inferior vena cava (bypassing the liver) - Right atrium - passes through the foramen ovale - left atrium - left ventricle - aorta -

Front 97

Gravidity

Back 97

pregnancy

Front 98

Multigravida

Back 98

woman with two or more pregnancies

Front 99

primigravida

Back 99

women pregnant for the first time

Front 100

nulligravida

Back 100

woman who has never been pregnant

Front 101

parity

Back 101

number of pregnancies where fetus reached viability (not affected by being born alive or stillborn)

Front 102

nullipara

Back 102

woman who has not completed a pregnancy where the fetus reached viability (nullip)

Front 103

primipara

Back 103

woman pregnant for the first time (primip)

Front 104

Multipara

Back 104

woman who has completed two or more pregnancies to viability (multiple)

Front 105

Term

Back 105

a pregnancy from week 38 -42 of gestation

Front 106

Preterm

Back 106

pregnancy between 20 -37 weeks gestation

Front 107

Postdate or post-term

Back 107

pregnancy that goes beyond 42 weeks gestation

Front 108

S Ab

Back 108

Spontaneous abortion

Front 109

T Ab

Back 109

Therapeutic abortion

Front 110

E Ab

Back 110

Elective abortion

Front 111

Pregnancy tests

Back 111

Early detection of hCG, based on beta subunit, urine tests sensitive to 25 mIU/ml. Can pick up about 10-17 days after conception (about the time of the first missed menses) Serum tests may pick up several days earlier

Front 112

Presumptive signs of pregnancy (felt by the woman)

Back 112

Amenorrhea, nausea/vomiting, fatigue, breast changes

Front 113

Probable signs of pregnancy (observed by the examiner)

Back 113

Hegar sign, Ballottement, Pregnancy test

Front 114

Positive signs of pregnancy

Back 114

Hearing fetal heart tones, visualizing fetus (ultrasound), palpating fetal movements

Front 115

Hegar sign

Back 115

softening of lower uterine segment- about 6 weeks of gestation)

Front 116

Ballottement sign

Back 116

passive movement of the floating fetus (about 16-18 weeks)

Front 117

Changes to uterus in pregnancy

Back 117

Fundal height palpable about the symphysis pubis between 12-14 weeks. Level of umbilicus at 20-22 weeks. Reach xiphoid process at term. Begins to drop between 38-40 weeks ("lightening"). Braxton-Hicks sign

Front 118

Braxton- Hicks sign

Back 118

false labor or practice contractions

Front 119

Changes to Cervix in pregnancy

Back 119

Goodell sign- softening of cervical tip (6 weeks)

Front 120

Goodell sign

Back 120

softening of cervical tip (6 weeks)

Front 121

Changes to vagina/ulva in pregnancy

Back 121

Chadwick sign, leukorrhea, mucous plug

Front 122

Chadwick sign

Back 122

deepened color, violet-bluish, as early as 6 weeks.

Front 123

Leukorrhea

Back 123

white or gray vaginal mucous discharge

Front 124

Mucous plug

Back 124

gelatinous mucus in the cervical canal

Front 125

Changes in breasts in pregnancy

Back 125

Increased sensitivity (tingling to sharp pain), nipples and areolae darken, Montgomery's turbercles (hypertrophy of sebaceous glands), visible blood vessels

Front 126

Changes in cardiac in pregnancy

Back 126

more audible S1 and S2, shift in PMI, BP-1st trimester= same as pre-pregnancy, 2nd trimester= decrease in systolic and diastolic by 5-10 mmHg then after 20 weeks slowly increases back to first trimester at term. Blood volume increases by 1500 ml (40-50% above non-preg levels). CO increases 30-50%, WBC count increases in 2nd and 3rd trimesters. Anemia develops because of hemodilution (plasma increases more than RBC production)

Front 127

Hemodilution

Back 127

plasma increases more than RBC production)

Front 128

Changes in respirations in pregnancy

Back 128

progesterone and estrogen increase sensitivity to carbon dioxide, leading to perception of SOB

Front 129

Changes in renal system in pregnancy

Back 129

Dilation of renal pelvis and ureters in response to increase urine volume, secondary to increased blood volume. More susceptibility to UTI.

Front 130

Skin changes in pregnancy

Back 130

Chloasma, linea nigra, striae gravidarum, palmar erythema, gingival hypertrophy.

Front 131

Chloasma

Back 131

mask of pregnancy, tan or dark discoloration

Front 132

Linea Nigra

Back 132

from pubis to the top of the fundus in the midline

Front 133

Striae Gravidarum

Back 133

Stretch marks, caused by collagen separation in the skin- color depends on women's skin color

Front 134

Palmar erythema

Back 134

reddening of the palms at the thenar and hypothenar eminences

Front 135

Changes in musculoskeletal system in pregnancy

Back 135

pelvis tilts forward, increasing lordosis, waddling gait, relaxation and increased mobility of pelvic joints, ligaments, separation of the rectus abdominis layers in 3rd trimester.

Front 136

Changes in neurologic system in pregnancy

Back 136

Carpal tunnel syndrome, pain from lordosis, tension headaches, faintness, occasional syncope, postural hypotension, hypoglycemia

Front 137

Changes in GI in pregnancy

Back 137

Pica, ptyalism, heartburn, constipation, hemorrhoids

Front 138

Pica

Back 138

crave non foods

Front 139

Lordosis

Back 139

inward curvature of back

Front 140

ptyalism

Back 140

excessive saliva

Front 141

Changes in endocrine system in pregnancy

Back 141

Thyroid enlargement due to increased gland activity, pancreas= maternal glucose levels decrease because of fetal demand so insulin production decreases with it, as pregnancy hormones make it more difficult to use insulin and can lead to gestational diabetes.

Front 142

Issues in the response to pregnancy

Back 142

Financial, realities of labor and birth, family dynamics

Front 143

Mother's reactions

Back 143

Intendedness, Ambivalence, Acceptance, Introversion, Mood swings, Changes in body image

Front 144

Couvade

Back 144

traditionally referred to the rituals and taboos by the male to signify transition to father hood. Now term describes the unintended development of the physical symptoms. Tend to have a higher degree of paternal role participation.

Front 145

positive pregnancy Test

Back 145

measures the beta subunit of human chorionic gonadotropin (hCG) hormone in urine or serum.

Front 146

hCG

Back 146

hormone secreted by the trophoblast to encourage progestrone and estrogen production by the luteum to maintain the pregnancy until the placentas fully develops and takes over production

Front 147

elevated hCG commonly causes

Back 147

causes n&v, changes carbohydrate metabolism, triggered by hPL (human placental lactogen)

Front 148

Nausea and vomiting of pregnancy (NVP)

Back 148

known as “morning sickness”, but can occur at any time of day. (most common on empty stomach)

Front 149

“morning sickness”,

Back 149

Related to the high levels of hCG and hPL, but we are still researching other causes and contributing factors. Stress and anxiety seem to exacerbate NPV in some women, and may have a contributing factor.

Front 150

NVP happens when.

Back 150

Usually appears around gestational week 6 and is gone around week 12.

Front 151

Fatigue in pregnancy happens when..

Back 151

Common through the first trimester, and related to the high levels of progesterone secreted by the corpus luteum and then by the placenta.

Front 152

fatigue improves when

Back 152

Generally improves around gestational week 14

Front 153

Breast tenderness

Back 153

Caused by hormonally induced growth of the secretory ductal system.

Front 154

Breast tenderness is common when

Back 154

Common in first trimester, but may persist.

Front 155

2 methods of ultrasound

Back 155

"Transvaginal -used in 1st trimester because it is still small Transabdominal

Front 156

Appropriate uses of ultrasound

Back 156

detect gestational sac at 5 to 6 wks after LMP, detect fetal HR at 6 to7 wks, detect fetal breathing movement 10 to 11 wks of preg.

Front 157

assessment in 1st trimester with ultrasound

Back 157

Nothing can be seen before 4 weeks (before g.sac) Confirm pregnancy and viability. Determine gestational age (by crown-rump length of embryo before 12 wks) Rule out ectopic pregnancy, Detect multiple gestation, Detect maternal abnormalities

Front 158

Second trimester use of ultrasound

Back 158

"Confirm dates, Confirm viability (fetal heart sounds), Detect poly, Detect congential anomalies, Detect IUGR, Confirm placenta placement, Can detect the gender at this time too

Front 159

Daily Fetal Movement Count

Back 159

"""kick counts"" Begin in late second trimester Notify provider if no movement in 12 hours Fewer than 3 movements in one hour warrants further evaluation by non-stress testing or biophysical profile

Front 160

Third trimester use of ultrasound

Back 160

Confirm viability, Detect macrosomia (large birth weight), Detect congenital anomalies- that may not have shown up earlier), Detect IUGR, Determine fetal position, Detect placenta previa or abruption , Biophysical profile (BPP)= Amniotic fluid volume assessment (AFI) , Doppler flow studies, Detect placental maturity Determine gestational age (by crown-rump lentgh of embryo before 12 weeks.

Front 161

high AFP level

Back 161

may indicate fetal neural tube defect, multiple gestation, or preg that is further along than believed.

Front 162

low AFP level

Back 162

risk of Down syndrome, or trisomy 18

Front 163

alpha-fetoprotien (AFP

Back 163

fetal protein that is excreted from the fetal yolk sac during the first 6 wks of pregnancy then production os taken over by the fetal liver.

Front 164

high levels of hCG and inhibin-A and low UE

Back 164

risk of down syndrome

Front 165

AFI index

Back 165

Measure depth of fluid volume in all four quadrants around mother’s umbilicus, and add the measurements together

Front 166

Amniocentesis

Back 166

used for genetic dx, done btwn 15 and 20 wks for NTD, AFP levels, blood type, DNA. Later done btwn 30 to 35 wks dor lung maturity tests

Front 167

Oligohydramnios

Back 167

If less than 5 cm AFI

Front 168

Polyhydramnios

Back 168

If greater than 20 cm AFI

Front 169

Electronic Fetal Monitoring used when..

Back 169

Used to assess women at risk for uteroplacental insufficiency

Front 170

Non-stress test (NST) reactive

Back 170

"2 or more accels of 15 bpm lasting over 15 sec in a 20 minute period. Long-term variability of 10 or more bpm

Front 171

Non-reactive NST

Back 171

if doesn’t meet NST criteria after 40 minutes

Front 172

Contraction Stress test (CST)

Back 172

Fetal monitoring in conjunction with nipple stimulation or oxytocin administration

Front 173

Recommended weight gain in pregnancy, based on maternal BMI:

Back 173

"Low (<18.5) 28-40 lbs.--Normal (18.5-24.9) 25-35 lbs.--High (25-29.9) 15-25 lbs.--Obese (>30) 11-20 lbs.--4 to 6 lbs a month to gain in weight during pregnancy.

Front 174

Obesity complication in preg.

Back 174

"Prematurity, Neural tube defect, Stillbirth, Macrosomia, Wound infection/dehiscence if c-section

Front 175

Prenatal vitamins (PNV)

Back 175

Higher in iron, calcium and folic acid, Lower in Vitamin A,

Front 176

Nagele's rule

Back 176

1st day of LMP, subtract 3 months, and add 7 days

Front 177

Fundal height

Back 177

measures the distance from the top of the symphysis pubis over the curve of the abdomen to the top of the uterine fundus. Correlates with weeks gestation. Ex 26cm=26 weeks gestation

Front 178

Quickening

Back 178

fetal movement felt by the mother indicates 20 weeks gestation or some btwn 16-22.

Front 179

Vibroacoustic Simulation (VAS)

Back 179

application of sound 90db for 1 to 3 secounds to stimulate fetal movement

Front 180

Biophysical Profile (BPP)

Back 180

FHR accleration(done with NST), (rest doen with ultrasound) fetal breathing, fetal movements, fetal tone, amniotic fluid volume. Also, (doppler flow studies and detect placental maturity= placental grading).

Front 181

2 most important parts of the BPP are…

Back 181

NST (reflect intactness of nervous system and AFI (reflects kidney perfusion)

Front 182

Placental maturity grade

Back 182

I - III , III being the most mature can be due to GD, postterm, preclampsia, etc.

Front 183

Chroionic Villus Sampling (CVS)

Back 183

used to detect genetic, metabolic, and DNA abnormalities. Can not detect NTDs can be done btwn 10 to 12 wks

Front 184

Percutaneous umbilical blood sampling (PUBS) or Cordocentesis

Back 184

Cordocentesis

gets pure fetal blood to dx blood disorders, anemia, infection, blood grouping,

Front 185

Omega-3, DHA – essential fatty acids

Back 185

"Good neurological development for fetus, Fish oil capsules or flaxseed oil capsules – 1000 mg a day, Expecta – OTC formula of DHA/EFA, Some PNV include these as part of the packaging (e.g. One-A-Day Prenatal Formula)

Front 186

Iodine

Back 186

normal thyroid function and prevention of impaired brain development

Front 187

Sodium

Back 187

for proper metabolism and fluid balance

Front 188

Magnesium

Back 188

for cellular metabolism and growth

Front 189

physiologic anemia of pregnancy

Back 189

nonpregnant women hmcrit is 38to 47%. When pregnant hematocrit can drop to 34%

Front 190

Vit A

Back 190

Fat soluble V, aids in metabolism of carbs and fats, aids in growth os epithelial cells (skin and GI tract) and develops healthy eyes in fetus. High amounts of this V cause birth defects.

Front 191

Vit D

Back 191

Aids in absorption of calcium and phosphorus

Front 192

Vit E

Back 192

It is an antioxidant.

Front 193

Vit K

Back 193

is an essential factor for synthesis of prothrombin= related to normal blood clotting.

Front 194

Vit C

Back 194

Essential to the formation of collagen, overall aids in the development of connective tissue and the vascualr system,

Front 195

B vitamins (Folic Acid)

Back 195

0.4mg pre-pregnancy, 0.6 during pregnancy, and 0.8

Front 196

Fluids

Back 196

8 to 10 (8oz) glasses a day which 4 to 6 should be water

Front 197

Pattern of Weight Gain During Pregnancy

Back 197

1st Trimester - 1.1- 2.2lbs, 2nd and 3rd Trimester based on weight

Front 198

Calculating BMI

Back 198

WT(KG) DIVIDED BY HT(M2)

Front 199

Caffeine

Back 199

"Eliminate if possible, Vasoconstrictor, increase risk for miscarriage because limits blood flow to developing fetus, Limit to 300 mg daily if desired (one cup of coffee or one can of soda a day).

Front 200

Mercury

Back 200

"Limit fish intake to no more than 12 oz a week. Avoid swordfish, tile fish, king mackerel, large tuna steaks, shark. Fish oil capsules okay. Generally, salmon, shrimp okay; one 6 oz can of chunk light tuna (not albacore or white tuna) a week.

Front 201

Lacto-ovovegetarians

Back 201

include milk, dairy products, and eggs in diet

Front 202

Lactovegetarians

Back 202

include dairy but no eggs

Front 203

Vegans

Back 203

need to supplement with B12 vitamins

Front 204

Foods to avoid in pregnancy

Back 204

No raw meat, poultry, fish or eggs. No uncooked hot dogs or deli meats such as salami, prosciutto, pepperoni, smoked fish (canned smoked fish okay). No unpasteurized dairy or fruit juices. No soft cheeses that have been out of the refrigerator for longer than an hour.

Front 205

Alcohol in pregnancy

Back 205

Advise not to drink alcohol in pregnancy, because we have not been able to establish safety guidelines.

Front 206

Cultural foods

Back 206

generally not an issue, provided the foods follow the guidelines to avoid mercury and bacterial concerns.

Front 207

Exercise restrictions for pregnancy

Back 207

"Do not lift, push or pull more than 20-25 lbs. (harmful to mom), No excessive exertion or over-heating. No spinning classes or Bikram yoga. No hot tubs, saunas, jacuzzis or prolonged hot baths. ( Concerned about raising core body tempture that will affect fetus development). No activities requiring keen balance or coordination (e.g., skiing of any type; roller-blading, mountain biking) preg you are just clumsier!

Front 208

Maximum training heart rate for pregnant mother

Back 208

140 (or 160 if in good condition prior to pregnancy) because of less oxygen available to fetus.

Front 209

Max altitude for pregnancy

Back 209

8000 feet, Limit activities at elevations above 4000 feet no scuba diving

Front 210

Flying restrictions of pregnancy

Back 210

Flying is fine until 34 weeks because pressure changes can rupture amniotic sac. Move legs because of the blood clot risk due to the estrogen.

Front 211

Why heartburn in pregnancy?

Back 211

happens because of displacement of the stomach by enlarging uterus and the increase of progesterone decreases GI motility and relaxes esophageal sphincter.

Front 212

Tx for heartburn

Back 212

Avoid overeating, ingesting fatty and fried foods, and remain upright 30 minutes after eating. Drugs: Antacids (e.g., Tums, Rolaids, Mylanta, Maalox). H-2 blockers (e.g. Zantac 75 or Pepcid AC), Simethicone (e.g. Gas-X), Don't us Tagamat= why?

Front 213

Tx for constipation in pregnancy

Back 213

"Increase fluids (at least 2000ml/day), exercise, fiber in diet, & Stool softeners (docusate sodium, 1-2 times a day), Glycerine suppositories, or Milk of Magnesia if laxative needed

Front 214

Tx of itching, irritation

Back 214

"Lubricating skin creams (e.g., cocoa butter, Eucerin, Aquaphor), Benedryl cream for skin rashes

Front 215

Tx for acne

Back 215

"Facial washes containing salicylic acid (e.g. Neutrogena line), OTC Benzoyl peroxide, See Derm for topical antibiotics if needed. Can not use tetracycline's

Front 216

Skin tx prevention

Back 216

Wear sunscreen!!!

Front 217

Back, ligament and joint pain

Back 217

"Massage, heat (to the back, but not the abdomen), Chiropractic (those who are comfortable dealing with pregnancy), Carpal tunnel wrist braces, Maternity belt/girdle

Front 218

Varicose veins

Back 218

"Support hose, Maternity girdle

Front 219

Headaches

Back 219

"Pre-pregnancy migraines tend to improve in pregnancy, Acetaminophen 650 mg every 4 hours or 1000 mg every 6 hours. Add a caffeine source if needed. Massage to neck; heat or ice. NO ibuprofen or naproxen or aspirin products. NO migraine meds

Front 220

Normal fetal lie

Back 220

Longitudinal (vertica). Longitudinal= fetus spine is parallel to mom's spine.

Front 221

Normal attitude

Back 221

Back rounded, chin flexed on chest, thighs flexed on abdomen, legs flexed at knees, arms crossed over thorax, umbilical cord lies between arms and legs= General Flexion

Front 222

Ideal fetal position

Back 222

occiput anterior

Front 223

The presenting part of fetus O,S,M,Sc stands for what?

Back 223

Occiput, Sacrum, Mentum (chin), Scapula

Front 224

Engagement

Back 224

indicating that the largest transverse diameter of the presenting part (usually the biparietal diameter- BPD) has passed through the maternal pelvic brim or inlet into the true pelvis, and usually correlates with station 0

Front 225

When does engagement occur?

Back 225

"Can happen in several weeks prior to labor for a nullip. May occur before or during labor in a multip. Assessed by either abdominal or vaginal examination

Front 226

Role of soft tissues, lower uterine segment?

Back 226

distends and allows contractions and thickening of the upper uterine segment to push the intrauterine contents down toward the cervix

Front 227

Role of soft tissues, cervix?

Back 227

effaces (thins) and dilates (opens) to allow the first fetal portion to descend into the vagina, drawing up and over the first fetal portion

Front 228

Role of soft tissues, muscle layer of pelvic floor?

Back 228

helps fetus to rotate anteriorly

Front 229

Role of soft tissues, vaginal tissues

Back 229

develop during pregnancy to allow dilation at term, and permitting passage of the fetus

Front 230

Frequency

Back 230

time from beginning of one contraction to beginning of next

Front 231

Duration

Back 231

length of time of contraction

Front 232

Intensity

Back 232

strength of contraction

Front 233

Fundal Hieght

Back 233

Distance from the top of the symphysis pubis to the top of the uterine fundus

Front 234

Preparation for fundal height measurement

Back 234

-Have mom empty bladder
-Pillow under the knee and
- Position mom-partially supine with knee flex

Front 235

`Location of fundal height throughout gestation?

Back 235

-just over the symphysis pubis @ 12wks to 14wks
- at umbilicus @ 20wks
- xiphoid process @ 36wks
- drops 4cm by 40ks of gestation

Front 236

What pregnancy risk factors can be assessed when measuring fundal height?

Back 236

Lo fundal Ht.: miscalculated due date, baby not growing, or small baby for term
Hi fundal Ht.:miscalculated due date, too much amonitic fluid, multiple births, or large baby for term

Front 237

When is fundal height measured?

Back 237

16wks to 38wks

Front 238

What is the purpose of Leopold's Maneuvers?

Back 238

is done to determine the attitude, fetal presentation lie, presenting part, degree
of descent, an estimate of the size, and number of fetuses, position, fetal back &
fetal heart tone; use palm! Warm palm.

Front 239

Preparation for Leopold's Maneuvers?

Back 239

Empty bladder
Position of mom-supine with knee flex, and slightly to the side

Front 240

Leopold's: 1st maneuver

Back 240

Place patient in supine position with knees slightly flexed; Put towel under head
and right hip; With both hands palpate upper abdomen and fundus. Assess size, shape,
movement and firmness of the part. In dorsal recumbent position – to relax the abdominal
muscles. To determine presentation parts.

Front 241

Leopold's: 2nd maneuver

Back 241

with both hands moving down, identify the back of the fetus (to hear fetal heart
sound) where the ball of the stethoscope is placed to determine Fetal Heart Tone. Get Vital
Signs (before 2nd maneuver) Pulse Rate to differentiate fundic soufflé (Fetal Heart Rate) &
uterine soufflé (Maternal Heart Rate). To determine fetal back.

Front 242

Leopold's: 3rd maneuver

Back 242

using the right hand, grasp the symphysis pubis part using thumb and fingers.
To determine degree of engagement. (Assess whether the presenting part is engaged in the
pelvis ) Alert : if the head is engaged it will not be movable.

Front 243

Leopold's: 4th maneuver

Back 243

the Examiner changes the position by facing the patient’s feet. With two hands,
assess the descent of the presenting part by locating the cephalic prominence or brow.
When the brow is on the same side as the back, the head is extended. When the brow is on the
same side as the small parts, the head will be flexed and vertex presenting. To determine
attitude – relationship of fetus to 1 another.
Attitude – refers to the relationship of fetus to each part into one another ( degree of flexion )
Full flexion – when the chin touches the chest

Front 244

What does the Nonstress test determine?

Back 244

determines the response of the fetal heart rate to activity

Front 245

NST Procedure

Back 245

Done within 30 minutes wherein the mother is in semi-fowler’s position (w/ fetal
monitor);external monitor is applied to document fetal activity; mother activates the
“mark button” on the electronic monitor when she feels fetal movement.

Front 246

What is the prembroyic period?

Back 246

The 1st 2wks after conception

Front 247

What is a zygote?

Back 247

A fertilized ovum after the fourth day of conception

Front 248

What is a morula?

Back 248

A zygote that has divided into 16 cells (resembles a mulberry)
The outer cells secret fluids forming a blastocyst

Front 249

What does the blastocyst form?

Back 249

The fetus (inner mass of cells) and the placenta and fetus membranes (outer mass of cells)

Front 250

Describe implantation?

Back 250

-occurs 6 to 9 days after fertilization
-occurs when the blastocyst implants itself in the endometrium of the anterior or posterior fundal region

Front 251

What is the deciduas?

Back 251

The endometrial lining during pregnacy
- Sercetes prolactin, relaxin, and prostaglandin

Front 252

Location of implantation? And 3 reasons why?

Back 252

Upper portion of the uterus more posterior than anterior.
1.rich supply of blood
2. thick muscular wall to prevent placenta from embedding to deep
3. Muscular tone limits blood loss after birth

Front 253

What is the embryonic period?

Back 253

The 3wk to 8wk after conception

Front 254

What are the three germ layers and what do they form ?

Back 254

Ectoderm
Mesoderm
Endoderm
And they form the major organ systems of the body

Front 255

What does the ectoderm form?

Back 255

Brain and Spinal Cord
Peripheral nervous system
Pituitary gland
Sensory epithelium of eye,ear, and nose

Front 256

What does the Mesoderm form?

Back 256

Muscular skeletal system
Heart,blood cells and vessels
Lymphatic system
Endocrine
Reproductive system

Front 257

What does the endoderm?

Back 257

Lining of the GI and Respiratory tract
Tonsils
Thyroid and Parathyroid
Liver
Panceras
Lining of GU

Front 258

Chorion

Back 258

where placenta is developed – outermost membrane of the fetal membrane

Front 259

Trophoblast

Back 259

fingerlike projections covering around the blastocyst that later becomes
placenta and membrane.

Front 260

Amnion

Back 260

innermost layer of the fetal membrane. It is a membrane, continuous with and covering the fetal side of
the placenta that forms the outer surface of the umbilical cord.

Front 261

Amniotic Fluid

Back 261

also known as (BOW) bag of water, clear, odor mousy/musty, with crystallized
forming pattern, slightly alkaline.

Front 262

Function of Amniotic Fluid?

Back 262

1. cushions fetus against sudden blows or trauma
2. facilitates musculo - skeletal development and symmetrical growth
3. maintains temperature
4. prevent cord compression
5. help in delivery process

Front 263

Normal amount of Amniotic Fluid?

Back 263

500 to 1000cc

Front 264

Fetal Period

Back 264

9wks to birth.

Front 265

Placenta Function

Back 265

1. Respiratory System – beginning of lung function after birth of baby.
2. GIT – transport center, glucose transport is facilitated diffusion more rapid from
higher to lower.
3. Excretory System- artery - carries waste products. Liver detoxifies waste products of
the fetus.
4. Circulating system – achieved by selective osmosis
5. Endocrine System – produces hormones

Front 266

What is Placenta Previa

Back 266

it occurs when the placenta is improperly implanted in the lower uterine segment,
sometimes covering the cervical os.

Front 267

S/S of Placenta Previa

Back 267

FRANKBRIGHT RED PLEEDING, PAINLESS BLEEDING

Front 268

Abruptio Placenta

Back 268

it is the premature separation of the placenta form the implantation site.
- It usually occurs after the twentieth week of pregnancy.

Front 269

S/S of Abruptio Placenta

Back 269

dark red, painful bleeding
board like or rigid uterus/abdomen
Severe abdominal pain

Front 270

Placenta succenturiata

Back 270

1 or 2 more lobes connected to the placenta by a blood vessel
which may lead to retained placental fragments if vessel is cut

Front 271

S/S of Placenta incerta

Back 271

deeper attachment of placenta to
myometrium

Front 272

Difference in the placenta on the maternal and fetal sides?

Back 272

Fetal= smooth, with branching vessels covering the surface
Maternal= Rough it attaches to the uterus

Front 273

Placenta Accreta

Back 273

unusual attachment to myometrium

Front 274

Problems with Retained Placental Fragments?

Back 274

Infection

Front 275

Teratogens-

Back 275

any drug, virus or irradiation, the exposure to such may cause damage to the fetus

Front 276

Types of Teratrogens?

Back 276

Streptomycin- Deafness
Tertacycline - inhibit growth of long bone
Viamint K -hemolysis
Iodides
Steriods - Cleft Lip or plate
Thalidomides- Amelia- no extremites
Lithium - congenital extremities
ETOH
Smoking
Caffeine
Cocaine

Front 277

Morning Sickness(1st) Nsg Intervention

Back 277

Eat dry carbohydrate in am; avoid fried,
odorous, and greasy foods; small meals rather
than large; and a protein snack at nite

Front 278

Fatigue(1st) Nsg Intervention

Back 278

Rest frequently, as needed.

Front 279

Urinary frequency (1st and late 3rd) Nsg intervention

Back 279

Kegel exercises, perineal pad for leakage.

Front 280

Heart Burn (2nd and 3rd) Nsg intervention

Back 280

Small meals, bland foods, antacids if ordered.

Front 281

Constipation (2nd and 3rd) Nsg intervention

Back 281

Sufficient fluids, foods high in roughage,
regular bowel habits. No laxatives unless
ordered, including mineral oil.

Front 282

Hemorrhoids (3rd) Nsg Intervention

Back 282

Avoid constipation; promote regular bowel
habits.

Front 283

Hyperemesis Gravidarum Nsg intervention

Back 283

1. Begin NPO and IV fluid and electrolyte replacement. (Correction of
F&E balance will decrease nausea, NPO will rest the stomach)
2. Monitor I&O
3. Gradually re-introduce PO intake, monitor amounts taken and retained
4. Monitor TPN and central line placement if unable to eat.
5. Provide mouth care.

Front 284

Hyperemesis Gravidarum Potential Problems

Back 284

Excess nausea and vomiting of early pregnancy leads to dehydration
and electrolyte disturbances, especially acidosis.

Front 285

What is cotyledons?

Back 285

sections of the placenta
there should be 18-28

Front 286

Abruptio Placentae Nsg

Back 286

1. Ensure bed rest.
2. Check maternal/fetal vital signs frequently.
3. Prepare for IV infusions of fluids/blood as indicated.
4. Monitor urinary output.
5. Anticipate coagulation problems (DIC).
6. Provide support to parents as outlook for fetus is poor.
7. Prepare for emergency surgery as indicated.

Front 287

Umbilical Cord

Back 287

Connecting link between fetus and placenta.

Front 288

Describe the umbilical Cord

Back 288

Contains two arteries and one vein supported by (Wharton's
jelly) to prevent kinking and knotting.

Front 289

Direction of blood flow in the umbilical cord?

Back 289

Arteries- unoxgenated blood flow
Veins- oxygentated blood flow

Front 290

Vilamentous Insertion of cord

Back 290

cord divides into small vessels before it enters the placenta

Front 291

Vasa Previa

Back 291

velamentous insertion of cord has implanted in cervical OS

Front 292

Battledore Placenta

Back 292

cord inserted marginally rather then centrally

Front 293

Cord Prolapse

Back 293

a complication when the umbilical cord falls or is washed through the cervix
into the vagina.

Front 294

Danger Signs of Cord Prolapse

Back 294

* PROM (premature rupture of membrane )
* Presenting part has not yet engaged
* Fetal distress
* Protruding cord form vagina

Front 295

Nursing Care of Cord Prolapse

Back 295

1. Slip cord away from presenting part
2. Count pulsation of cord for Fetal Heart Tone
3. Positioning – trendelenberg or knee chest position
4. Observe for fetal distress
5. provide emotional support
6. Prepare mother for Cesarean Section
· Cover cord with sterile gauze with saline solution - to prevent drying of cord so
cord will remain slippery.
* NOTE: five minutes cord compression

Front 296

Amniocentesis

Back 296

obtain a sample of amniotic fluid by inserting a needle through the abdomen
into the amniotic sac.

Front 297

Amniocentesis preparation

Back 297

empty bladder before performing the procedure.

Front 298

Amniocentesis fluid is tested for?

Back 298

1. Genetic screening / abnormality - maternal serum alpha feto-protein test (MSAFP)
– 1 s t trimester
2. Determination of fetal lung maturity primarily by evaluating factors indicative of
lung maturity – 3 rd trimester
2.1 Testing time – 36 weeks

Front 299

Oxygenation consumption during pregnancy?

Back 299

RV increases 20 to 40 % to provide o2 for fetus, placenta, uterus, and breast and increased maternal respiratory and cardiac demands
Oxygen consumption increases by 15%.

Front 300

Flow is maxminzed in what position during pregnancy?

Back 300

Blood flow to uterus and placenta is maximized by side-lying position.

Front 301

What causes acroesthia?

Back 301

Pressure on sciatic nerve may occur later in pregnancy due to fetal
position.

Front 302

Renal System changes during pregnancy?

Back 302

A. Kidney filtration rate increases as much as 50%.
B. Glucose threshold drops; sodium threshold rises.
C. Water retention increases as pregnancy progresses.
D. Enlarging uterus causes pressure on bladder resulting in frequency of
urination, especially during first trimester; later in pregnancy relaxed
ureters are displaced laterally, increasing possibility of stasis and infection.
E. Presence of protein (not an expected component of maternal urine)
indicates possible renal disease or pregnancy-induced hypertension.

Front 303

Endocrine System changes during pregnancy?

Back 303

A. Pituitary: FSH and LH greatly decreased; oxytocin secreted during labor
and after delivery; prolactin responsible for initiation and continuation of
lactation.
B. Progesterone secreted by corpus luteum until formation of placenta.
C. Principal source of estrogen is placenta, synthesized from fetal precursors.
D. HCS/HPL produced by placenta; similar to growth hormone, it prepares
breasts for lactation; also affects insulin/glucose metabolism. May
overstress maternal pancreas.
E. Ovaries secrete relaxin during pregnancy.
F. Slight increase in thyroid activity and basal metabolic rate (BMR).
G. Pancreas may be stressed due to complex interaction of glucose
metabolism, HCS/HPL, and cortisol, resulting in diminished effectiveness of
insulin, and demand for increased production.