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167 Cards in this Set

  • Front
  • Back
Childbearing years?
age of woman from 1st menstral cycle until menopause
Gravida?
# of pregnancies the woman has had
Para?
# of pregnancies delivered after age of viability(whether born alive or dead 24 weeks or more)
What urine/serum levels are tested when determining probable pregnancy?
Human chorionic gonadotropin (hCG)
Where is hCG secreted from?
chorionic villi of the placenta
When is hCG's level lowest during pregnancy?
100-130 days into the pregnancy and remains constant until birth
What kinds of medications can give false positives and false negatives on a pregnancy test?
false positives- anticonvulsants and tranquilizers
false negatives- anti-nausea (like compezine) and diuretics
If a womans last menstral period was dec24 2007-dec31 when is her EDC? use nagele's rule
dec 31 2007 - 3 mnths (12-3)=9 or september 31 (or oct 1st) + 7days = around october 8 2008
how many parity does a woman have is she has been pregnant 4 times and has delivered a set of twins, a boy of 38 weeks gestation, a girl at 30 weeks and an abortion at 18 weeks?
twins = 1 parity
boy = 1 parity
girl @ 30 weeks = 1 parity
abortion before 24 weeks = 0 parity
total 3 parity
Give the GTPAL for a woman that has been pregnant 5 times. currently has 1 adopted girl of 12 years, 1 boy born at 35 weeks gestation, 1 girl born at 38 weeks gestation, 2 spontaneous abortions at 20 weeks and 1 still birth at 26 weeks.
G-5
T-full term deliveries - 1
P- preterm - 4
A - spontaneous abortions - 0
L - # of living children - 3
In the first trimester how often are your prenatal visits?
q 4-5 weeks (or about q 1 mnth)
In the 2nd trimester how often are your prenatal visits?
q 2-3 weeks (2 q mnth)
In the 3rd trimester how often are your prenatal visits?
q 1-2 weeks
A 4 mth pregnant woman is in the clinic and asks when she should come back for a follow up, what is your best response?
2nd trimester - in about 2 weeks
what is the best description of conception?
union of sperm and ovum
when is ideal fertilization?
48 hrs before or 24 hours after ovulation
when is menstration
14 days after ovulation
What and where is the cervix?
lower cylindrical portion of the uterus and it is the portion of the uterus that dilates and effaces during labor
What is the false pelvis?
portion above the pelvis brim or linea terminalis
what is the true pelvis?
is the portion that lies below the linea terminalis
Which type of pelivis is most/least favorable for a vaginal birth
most- gynecoid
least- android
which hormone prepares the breast for lactation?
progesterone
where is progreterone secreted?
corpus leuteum
which hormone inhibits FSH production and stimulates LH production?
Estrogen
Average length of the menstrual cycle?
28 days
what role does prostaglandins have in conception?
Increased motility of intrauterine muscles, aids sperm transport to uterus and tubes
where does fertilization take place
fallopian tubes
what marks the begining of pregnancy
fertilization
when does most organogenesis occur?
day 5-8 weeks after conception
when is the fetus most vulnerable to malformations?
during organogenesis or day5-week8
by full term, how much amniotic fluid is contained in the placenta
800-1200cc
What function does the amniotic fluid serve?
-protection from trauma and heat loss
-facilitates musculoskeletal development by allowing movement
-facilitates symmetric growth and development
-source of oral fluid for fetus
-secretion of waste products
when is the umbilical cord formed?
5th week
How many arteries and vein does the cord have?
2 arteries 1 vein
In the umbilical cord which vessels carry oxygenated blood to baby?
umbilical vein
when does maternal and embryonic circulation begin
day 17
What does progesterone do during pregnancy?
preserves/maintains endometrium, decreases contractility of uterus and stimulates breast development and maternal metabolism
What does estrogen do duing pregnancy?
stimulates uterine growth and uteroplacental blood flow
increases glandular breast tissue
stimulates myometrial cntactions
when is a fetus viable outside the uterus?
23-24 weeks gestation
when is a heartbeat detected BY ULTRAsound?
end of 8th week
When is the heartbeat detected by doppler?
end of 12 weeks gestation
when is the sex of the fetus determined?
end of 16th week
when are fetal movements felt by the mother?
20 weeks getation for 1st time pregnancy
16-18 weeks for multiple pregnant woman
when do the fetal lungs start to mature?
end of the 28th week
When are the fetal lungs mature?
at the end of 36 weeks
When is the fetus full term?
end of 40 weeks
when is a baby considered pre-term?
20-37 weeks gestation
when is a baby considered post-term?
more than 42 weeks
what are the presumptive or subjective signs of pregnancy?
-amenorrhea
-n/v
-fatigue
-urinary fequency
-breast enlargement and tenderness
-quickening
what is quickening?
first fetal movement
what are the objective or probable signs of pregnancy?
-Goodell's sign
-chadwicks sign
-hegar's sign
-positive preg. test (hCG)
What is Goodell's sign?
softening of the cervix (usually happens at the begining of the 3rd month)
What is Chadwick's sign?
Bluish color of the cervix r/t increase in blood volume and increase in pelvic congestion
what is Hegar's sign
softening of the isthms of uterus around the 6th week of preg.
What are the 3 positive signs of pregnancy?
fetal heart tones by doppler @ 8-10 weeks
-fetal movement felt by mom and examiner
-ultrasound visualizes fetus
What needs to be done before a sonogram is performed?
woman must fill bladder by drinking lots of fluid
What is the normal fetal heart rate?
120-160 beats/min
at 12 weeks what is the fudus location?
at symphysis pubis (low)
At 16-20 weeks where is the fundus?
midway (umbilicus)
after 20 weeks where is the fundus?
after 20 weeks the fundus starts to move higher up depending on gestational age w/in 2 cm, for example a woman at 32 weeks gestation would have a fundal height of about 30cm. at full term the fundus will drop a few cm.
What is ceasing a womans menstuation during pregnancy?
supression of FSH by estrogen
What is Braxton Hicks contractions?
Painless contractions occuring at irregular periods throughout pregnancy; felt most after 28 weeks
What happens in the blood that causes physiologic anemia in pregnant women?
plasma volume increases and "dilutes" red blood cells causing hemoglobin to drop up to 2 mg/dl.
what is the maximum normal decrease in hemoglobin?
2 mg/dl hgb is less than 10.5
A pregnant woman is in a prenatal visit and the doctor is auscultating her heart sounds, a murmur is detected, what do you expect the doctor to say to the woman?
this a normal finding
What are two discomforts the preg. woman might experience in relation to the respiratory system?
dyspnea because diaphram is getting pressure from fetus
and nasal congestion because of elevated levels of estrogen which cause edema of nasal passageways
What is ptyalism?
a common normal discomfort sometimes experienced by a preg. woman in which there is excessive bitter salivation
what does progesterone do in the GI tract that causes a very common discomfort during pregnancy?
relaxes cardiac sphincter in espophagus which causes acid reflux and heartburn
Why are pregnant women constipated?
slowing of peristalsis, delayed stomach emptying
What happens to a preg. woman's Basal metabolic rate?
increases by 25%
What hormone produces insulin resistance in preg. woman and why?
human placental lactogen (HPL) because adequate glucose must be available to fetus to meet it;s growth needs
What is the average weight gain of a preg. woman
25-25 lbs.
What kind of medication is reccomended for a preg; woman that has constipation?
stool softener NOT LAXAtives
What symptoms is accompained by urinary frequency need to be reported to health care provider during pregnancy?
burning and pain upon urination
What is the total amount of calories needed a day for a preg. woman?
2500
Name the 2 phases of menstration.
Follicular
Luteal
What happens during the follicular phase of menstration.
1 to 14 days long
-menstral phase:one week long in which endometrium sheds
-proliferative phase - endometrial thickening
What happens during the luteal phase of menstration
15-28 days
-secretroy phase: plush endometrium secretes glycogen in prep. for implantation of fertilized ovum
-Ischemic phase - begining of breakdown of endometrium when fertilization has not occured.
What happens to the levels of progesterone and estrogen when the ovum is not fertilized
they drop which causes the sloghing of endometrium
when does the fetal heart begin to beat?
4 weeks gestation.
At 16 weeks gestation, what is the approximate fundal height or location?
halfway between the pubic symphysis and umbilicus
At 24 weeks gestation, what is the approximate fundal height?
approximately 24 cm (should be the same as getational age)
When is AFP screened for and what does it screen?
screen for neural tube defects assessed at 16 to 18 weeks
When is the mother;s glucose tested, why and what hormone causes change?
assessed at 24 to 28 weeks because there is an increase in insulin resistance due to HPL.
What is the pH of the vagina during pregnancy?
3.6 to 6.0 to prevent bacterial or viral infections.
When is screening for STDs and the Rh factor done?
1st prenatal visit.
What is the psychological goal in the 1st trimester?
for the mother to accept the pregnancy
what is psychological goal in the 3rd trimester?
preparation of having a baby
how much does the blood volume increase during the 1st and 2nd trimester of pregnancy?
40-50%
What type of murmur is normal in pregnancy?
systolic heart murmur
What is avg. normal weight gain?
25-35 lbs depending on maternal pre-pregnancy weight
what is the minimum amount of weight gain?
15 lbs.
What nutrients are included in prenatal vitamins that are essential to the fetus?
folic acid, iron, calcium
Why is folic acid so important and when is it vital to the fetus?
aids in neural tube development - vital within the first 8 weeks when the organs are developing. lack of folic acid can lead to neural tube defects
what does adequate calcium intake prevent?
muscle cramps especially in the legs
By how many calories must a woman increase daily?
300 for a total of 2500
What is the psychological goal for the 2nd trimester?
accepting the baby
What is lightening?
droping of the fetus - increases urinary frequency often say its easier to breathe.
What are the preliminary signs of labor?
-lightening
-increase in activity - instinctual (nesting)
-braxton-hicks contrations- false labor - no dilatation of cervix irregular painless contrations
-cervix ripens, becomes soft, partly effaced and may begin to dilate and thin.
-uterine contrations
-show - brownish tinged blood -cervical mucus plugs passed
-ruputure of the membranes - not always a sign of labor
What is the Bishop score used for?
used to score the cervix to see whether the cervix is ready for labor. score of 6 ore more indicates readiness for labor and induction.
What are the components of labor?
-Passageways - refers to the maternal bony pelvis comprised of the two innominate bones.
-Passenger - refers to the fetus
-Powers - include the primary and secondary forces of labor
---primary - consist of the involuntary contractions of the uterine muscle fibers
-----secondary - consist of the voluntary use of abdominal muscles during the second stage of labor to facilitate fetal descent and delivery
-Psyche - represents the psychological component of childbearing; excitement, fear, perceived loss of control, and anxiety are common emotions during the labor and birth process.
What is the lie of the passenger?
is the relationship of the longitudinal axis of the fetus to the longitudinal axis of the mother; vertex (head first), breech (buttocks first), transverse (laterally across the uterus), and oblique (diagonally across the uterus)
What is the presentation of the passenger?
refers to the fetal part entering the pelvis first; most common is cephalic, but breech and shoulder can also occur
what is the position of the passenger?
is the relationship of the fetal presenting part to the maternal pelvis; a three letter notation is used to describe fetal position (3 letters)
when describing a fetal position the nurse describes it as RSA what does this mean?
Right sacrum anterior
fetal presenting part is on the right side of the mother the sacrum is the presenting part (breech) and it is facing her anterior portion (facing out not toward back)
When does engagement occur?
occurs when the largest diameter of the presenting part reaches the pelvic inlet, and can be detected by vaginal examination.
When is it ok to induce labor by rupturing membranes?
when the fetus is engaged or when the fetus has reached the 0 station.
where do uterine contrations originate?
fundus
When are uterine contrations measured in mm Hg?
when mom has a internal uterine contraction monitor
What are the 3 contaction phases?
Increment
acme
decrement
how do you time a contraction?
begining of the first until the begining of the next.
What happens in the 1st stage of labor
extends from the onset of true labor to complete dilatation of the cervix and is divided into three phases
what happens during the latent phase of labor?
0-3 cm dilated, little descent occurs; contractions usually begin irregularly and become more regular, with frequency.
What happens during the active pahse of labor?
4 to 7 cm dilated, progressive effacement and descent, contractions usually every 2-3 minutes, 60 seconds in duration and moderate to strong in intensity.
What happens in the trasition phae of labor?
8 to 10 cm dilated, effacement is completed, and descent increases; contractions every 1.5 to 2 minutes lasting 60 to 90 seconds, strong intensity
what are some interventions in preparing the women in the first stage of labor?
-frequent position changes
-encourage ambulation
-encourage voiding q 2h
-provide ice-chips
-no eating
what happens in the 2nd stage of labor?
extends from complete dilatation of cervix to delivery of fetus; accompanied by involuntary efforts to expel fetus characterized by low pitched, guttural, grunting sounds; many women initally feel renewed energy because they can voluntarily work with the contractions to push out the fetus; overtime can be exhausting work;
What are the cardinal movements?
-Descent of the fetus into the pelvis
-Flexion of the fetal head
-internal rotation of the fetal head must take place to accommodate the maternal pelvis and occurs so that the largest diameter of the fetus, aligns with the anterior-posterior dimension of the maternal pelvis
-Extension of the fetal head occurs as it is comes under maternal symphysis pubis and emerges from the vagina
-External Rotation is viewed as the head turns an additional 45 degrees as the shoulders, rotates into alignment with the maternal pelvis
-Expulsion occurs as the anterior shoulder slips beneath the symphysis pubis to facilitate delivery of the body.
DFIEEE
what can hyperactivity of the fetus signal?
hypoxia
What is variability?
the amount of variablility of the fetal heart rate from the baseline.
-absent variability-undetectable amplitude
-minimal variability-<5bpm
-moderate variability- amplitude 6-25bpm
marked variability - amplitude > 25 bpm
what is the normal fetal heart rate?
110-160 bpm
decreased variability is defined how and what are there significance?
when the baby's heart rate does no deviate from the baseline. sign that the baby is not doing well, may also indicate a sleeping baby or may happen when pain meds are given.
What are early decelerations?
decrease in fetal heart rate beginning at the onset of a contraction and return to baseline by the end of the contraction with the nadir at the acme.
what happens during early decelerations, are they a normal finding?
head compression; yes
what happens during late decelerations, are they a normal finding?
uteroplacental insuffficiency; no. need to stop pitocin, place in left lateral position, place on o2 face mask, @8L/min, increase unmedicated fluids, notify provider
What are variable deceleration? Are they normal? are they periodic (happening with contractions) or episodic (spontaneous)
abrupt decrease in fetal heart rate, can be periodic or episodic, happens with cord compression. may be u-v-w shaped. .
interventions:
change position
o2 via mask @8L/min
increase fluids
may need to stop pitocin
may require amnioinfusion
what is amnioinfusion and what is it used for?
the instillation of warmed normal saline through an intrauterine pressure catheter, may be used to recreate the cushioning effect on the umbilical cord during contractions that is normally provided by amniotic fluid. used with variable decelerations when cord is compressed.
what are Leopold's maneuvers?
method to determine position, presentation, and engagement.
what are accelerations? are they normal?
yes; increase in fetal heart rate in response to movement or being startled.
What is sinusoidal baseline and what does it mean?
a smooth, wave like pattern of regular frequency and amplitude, no a good sign, usually means there is a problem with nervous system, need to get the baby out. probably requires recusitation
What medication can cause sinusoidal baselines?
NuBane - expected side effect. need to monitor but no interventions necessary at that time.
When is a Amniotomy contraindicated?
the fetus has no entered engagement or hasn't entered 0 station.
what is the usual position for birth?
lithotomy
when is local anesthesia given during episiotomy?
given when episiotomy is expected, to repair it
A 1st degree episiotomy?
laceration of skin and mucosa usually does not require repair unless bleeding present
A 2nd degree episiotomy?
laceration of muscles of perineal body and skin and mucosa requires repair
A 3rd degree episiotomy?
laceration of skin, mucosa, muscles, and rectal sphincter, requires repair
A 4th degree episiotomy? complication?
laceration of skin, mucosa, muscles, rectal sphincter, and rectal mucosa must be repaired may lead to fistula if not repaired properly.
3rd stage of delivery?
delivery of the placenta
what must happen first after birth of baby, in order for placenta to be delivered?
seperation of the placental from uterus wall.
Why is methergine given after labor and what is one of it's side effect?
control bleeding, can cause a raise in blood pressure
Most common substance abuse in pregnant women?
alcohol
what are the s & S of fetal alcohol syndrome?
developmental delays, small stature, small brain, facial features are distinct
If a mother is taking heroin while pregnancy what risk factors does she acquire?
IVGR (small size baby)
induced hypertension
powerful cns depression
what is the most successful program with alcoholic mothers?
longterm treatment
what is one of the most imortant thing to remember when teaching pregnant women about substance abuse?
DOCUMENT teachings and outcomes
The Victims of domestic violence have ______ esteem.
low
The batterer in domestic violence have a ________ esteem
low
Abusers have a sense of ______ control
no
Which phase of the abuse pattern keeps victims from reporting their abusers and returning to the abusive environment?
honeymoon phase
what is learned helplessness?
regardless of behavior outcome is always unpredictable and could be unfavorable.
why do the victims of abuse stay in relationship?
fear
what is a consequence of abuse during the prenatal period?
decreased bonding between mom and baby
Primary nursing goal with abuse victims?
safety - #1
psych treatment -#2
Signs of physical abuse
different stages of bruises
broken bones in different stages of healing
story doesn't match injury
types of neglect include:
not sending child to school
not providing health care
not providing adequate nutrition
not providing with love and affection
Primary intervention of abuse is ___________
prevention, by educating
what is the munchausen syndrome by proxy?
fabrication of signs and symptoms of a health condition of a child. mother is usual perpetrator
where is the pain located (in spinal landmark terms) during the 1st stage of labor
T10-T12 and L1
Where is the pain located during a cesarian section?
T6-T8
Where is the pain located during a vaginal delivery?
perineum, pudendal nerve, S2,S3, and S4
What is the etiology of labor pain?
Constiction of vessels which lead to ischemia.
what medication is given with most pain medications, that potentiates their effects, what function does it have?
fenergan - relieves N/V
what medication reverses the effects of cns depressants (most pain meds in pregnancy)?
narcan
when is a spinal anesthetic usually used ?
for a cessarian
when is an epidural usually used?
vaginal delivery
What are some Adverse reactions to anesthesia?
HYPOTENSION (must give fluids before administration to prevent hypotension)
accidental IV administration which would make its effects systemic
anaphylactic reactions (why a test dose is given before full dose is started)
itching (very common) usually standing order for anti-itch is written