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105 Cards in this Set

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*Psychological/ Psychosocial adaptation to pregnancy:
1st TRIMESTER?
*Accepting the PREGNANCY* (most important step, if parents dont accept the 1st trimester they will not accept the 2nd trimester)
-"I/We are pregnant"
-recovering from shock
-ambivalence (mixed feelings)
-feelings of both pleased & not pleased
*Psychological/ Psychosocial adaptation to pregnancy:
2nd TRIMESTER?
*Accepting the BABY* (baby is the focus)
-Narcissism: self-centeredness
-Introversion: concentrate on self & one's body
-role playing and dreaming what it will feeel like to be a parent
-behavior changes: ie. if smokes mom will stop or cut back on smoking
*Psychological/ Psychosocial adaptation to pregnancy
3rd TRIMESTER?
*Role TRansition*
-"Get ready for a change & be a parent" (decide if they are going to be good or bad parents)
-parents grow impatient as they ready themselves
-baby's room preparation
QUICKENING:
-the first moment a woman feels fetal movement
- woman accepts she is having a baby at quickening (2nd trimester)
What is a good way to measure the level of a woman's acceptance of the coming baby?
to measure how well she follows prenatal instructions.
What trimester do these psychological task/changes happen?
-stress r/t financial changes, physical & hormone changes that could lead to postartum depression emotional stress
2nd trimester
Narcissism?
self-centeredness
an early reaction to pregnancy
-feel you are the most important 1 & that you need all the attention
-ie. becomes more concerned about how she dresses,
-may lose interest in job
-makes a ceremony out of fixing her meals
Consumer Product Safety Commission
Health and safety of consumers in and around home.
External Environment: Legal
Body image and Body Boundary:
BODY IMAGE (the way your body appears to yourself) and BODY BOUNDARY (a zone of separation you perceive between yourself and objects or other people) change during pregnancy as a woman begins to envision herself as a mother
Couvade Syndrome:
-men experience physical sx such a N/V and backache as their partner during pregnancy
-sx result from stress, anxiety & empathy for the pregnant woman
-ie. as the women abdomen begins to grow, the partner may perceive himself as growing larger too
Mood changes occur frequently in a pregnant woman, partly as a manifestation of _________ & partly b/c of hormonal changes (estrogen & progesterone)
Narcissism: her feelings are easily hurt by remarks that would have been laughed off before
What age group may need to be reassured periodically during pregnancy that a new baby will be an addition to the family and will not replace them in their parents' affection.
preschool and
school-age children
-but they will be very helpful when baby comes along with feedings and diaper changes
-teenagers rather go out with friends or on a date than babysit new sister or brother
Ways to reduce Mood Swings:
-avoid fatigue
-reduce stress, set priorities
-Don't let little things grow into big ones
-view situations from other's perspective
-let others know you are aware you are having trouble with emotions
Presumptive (subjective) signs of pregnancy:
-breast changes -N/V
-Fatigue -amenorrhea
-frequent urination
-Quickening:fetal mvmt felt
-Linea Nigra: line of dark pigment on the abd
Melasma: dark pigment on face
-Striae Gravidarum: red streaks on abd
Probable signs of Pregnancy are OBJECTIVE: name examples of signs seen by a health care provider:
-Chadwicks sign: color change of the vagina from pink to violet
-Goodell's Sign: softening of the cervix, low
-Hegar's Sign: softening of the lower wall of uterus(use bimanual exam tech)
-Ballottement: When lower uterine segment is tapped on a bimanual exam, the fetus can be felt to rise against abdominal wall.
-Braxton Hicks: uterine tightening (gas)
-hCG test
a hormone created by the chorionic villi of the placenta, in the urine or blood serum of the pregnant woman
hCG
hCG appear in the serum as early as
-24 to 48 hours after implantation
What will cause false-positive results on pregnancy tests?
-psychotropic drugs: anti-anxiety drugs
-oral contraceptives
-proteinuria
-postmenopausal
-hyperthyroid disease
What is the 1st step after a positivegnancy test?
-arrange for prenatal care
Advise a woman who thinks she might be pregnant but gets a negative result from a home pregnancy test to do what next?
-repeat test 1 week later if still experiencing amenorrhea
-if sx persist after 2 tests, call md (possible ovarian tumor)
What are the only 3 POSITIVE signs of pregnancy?
-Demonstration of a fetal heart separate from the mother's (10th to 12th week via doppler)
-Fetal movements felt by an examiner (20-24 wks)
-Visualization of the fetus by ultrasound
(Skeleton outline, auscult FHR, fetal mvmts, gestational sac ring)
Doppler Tech can detect Fetal heart sounds as early as ?
10 to 12 weeks

-ECG: FHR at 5 weeks
-Ultrasound: FHR 6-7 week
FHR audible by auscultation of the abdomen with a stethoscope at ___ weeks?
18 to 20 wks
When does the fetal heart been to beat?
24th day after conception
Normal FHR?
120 to 160
What are 2 reasons why a Fetal heart sound would be difficult to hear?
-woman's abd has a great deal of subcutaneous fat or
-a larger than normal amt of amniotic fluid is present (hydramnios).
A larger than normal amount of amniotic fluid is present?
hydramnios
When is fetal mvmt felt by the mother?
-16 to 20 wks
-mvmt felt by the MD is more reliable b/c woman could mistake mvmt for Gas!
When can fetal mvt be felt by the MD?
20 to 24 weeks
If a woman is pregnant, a characteristic ring, indicating the ________ ____, will be revealed on an oscilloscope screen as early as the 4th to 6th wk
Gestational sac
(a positive sign of pregnancy)
The most obvious alteration in a woman's body during pregnancy is?
the increase in the size of the uterus to accommodate the growing fetus
A woman becomes aware of her growing uterus early in pregnancy; by the end of the ___ wk?
12th week,
Amt of Blood perfusing in the uterus?
> 500-750mL/min
Primigravida:
woman in her 1st pregnancy
Multipara:
a woman who has had one or more children
Uterine growth is only a presumptive sign (subjective) of pregnancy. T/F?
True b/c a uterine tumor could mimic this steady growth
"practice contractions"
-mistaken for labor contractions (false labor)
-probable sign of pregnancy
-BRAXTON HICKS COntraction: differentiated from true labor contractions b/c they do not cause cervical dilation
Reasons for Amenorrhea:
-menopause
-uterine infection
-worry/stress
-severe anemia
-athletes (long-distance runners)
-PRESUMPTIVE sign of pregn
What are the Cervical Changes during pregnancy?
-Operculum:tenacious coating of mucus that fills the cervical canal,acts to seal out bacteria during pregnancy and helps prevent infection in the fetus and membranes.
-Goodell's Sign: Softening of the cervix in pregnancy (probable sign of pregn)
What are the Vaginal changes during pregnancy?
-pH 4 to 5 (acidic) prone to infections: Candida albicans
-Chadwicks Sign:increase in circulation changes the color of the vaginal walls from the normal light pink to a deep violet (probable sign of pregnancy)
What are the Ovarian changes during pregnancy?
-ovulation stops b/c of the active feedback mechanism of estrogen and progesterone produced by the corpus luteum early in pregnancy and by the placenta later in pregnancy. This feedback causes the pituitary gland to halt production of FSH and luteinizing hormone (LH).
-without stimulation from FSH and LH, ovulation does not occur.
Changes in Breast?
-16th week, colostrum, the thin, watery, high-protein fluid that is the precursor of breast milk, can be expelled from the nipples
-Montgomery's tubercles: sebaceous glands of the areola, enlarge & become protuberant
-vascularity of the breasts increases, blue veins
-areola of the nipple darkens
Very high in antibodies, baby will get passive immunity(protection is temporary)
-Colustrum (before milk)
What are the INTEGMENTARY system changes during pregnancy?
1.striae gravidarum: stretch marks
2. Linea Nigra: brown line, from umbilicus to symphysis pubis & separating the abd from R & L hemispheres
3. Melasma (chloasma): darkened areas on cheek & nose "mask of pregnancy"
4. Vascular spiders or telangiectases (small, fiery-red star like bld vessels)
5. Palmar erythema (redness & itching) on the hands from increased estrogen level.
6.Hyperactive sweat glands:
LIGHTENING:
-fetal head settles into the pelvis to prepare for birth & uterus returns to the ht it was at 36 wks, this is termed lightening b/c a woman's breathing is much easier it seems to lighten a women's load
What are the respiratory changes?
1. Respiratory Alkalosis: develops b/c of hyperventilation) (ph up , PaCO2 down)
2. Plasma PaCO2 27-32
3. SOB (pressure on the Diaphragm/xiphoid process)until lightening or Dropping at 40wks
4. congestion: response to increased estrogen levels (nasal stuffiness" is normal)
5. hyperventilation : to blow off excess CO2
How does the kidneys compensate for Respiratory alkalosis?
kidneys excrete bicarbonate in urine, causing increased urination, Polyuria (early sign of pregnancy)
What are the changes of Body temperature?
-increases b/c of the secretion of progesterone from the corpus luteum
-returns to normal at 16 wks
-women mistakenly assume that this slight rise in temp (99.6° F O), assoc. w/ pregnancy-related nasal congestion, is a sure sign of a cold, & may think meds are needed
What are the Cardiovascular changes during pregnancy?
-Blood Volume: increases
-Plasma Volume: Increases
-Cardiac Output: Increases
-Circulating Volume Increases
(most during the 2nd trimester)
Cardiovascular changes
Pseudoanemia:
B/c the plasma volume increases faster than RBC production, the concentration of Hbg and erythrocytes may decline, giving a woman a PSEUDOANEMIA(false anemia) early in pregnancy
The increases in the mother's circulatory red blood cell mass requires?
an additional 400 mg of IRON.
Cardiovascular System:

TRUE ANEMIA?
Either a hgb concentration of less than 11 g/100 mL or a hematocrit value below 33% in the first or third trimester of pregnancy or
-a hgb concentration of less than 10.5 g/dL (hct <32%) in the second trimester
Cardiovascular System:

What happens if there is not enough Folic Acid intake during pregnancy?
-Megalohemoglobinemia (large, nonfunctioning RBC) will result
Cardiovascular System:

Inadequate Folic Acid intake during pregnancy, could cause what d/o in the Fetus?
-Neural Tube d/o
Cardiovascular System:

What foods are high in Folic Acid?
spinach
asparagus
legumes
Cardiovascular System:
What is the HR during pregnancy?
Increases by 10 beats
-80-90 bpm
Cardiovascular System:

What is the position of the heart in a pregnant woman?
-heart is shifted to a more transverse position in the chest cavity, a position that may make it appear enlarged on x-ray examination
Cardiovascular System:

Palpitations of the heart are not uncommon during pregnancy, particularly on quick motion. T/F?
True
-Palpitations in the early months of pregnancy are probably caused by sympathetic nervous system stimulation
Cardiovascular System:
What is the B/P during pregnancy?
-2nd Trimester: decreases slightly
3rd Trimester:b/p rises again to 1st- trimester levels
Cardiovascular System:
During the 3rd trimester blood flow to the lower extremities is impaired, why? b/c the pressure of the expanding uterus on veins and arteries.
b/c of the pressure of the expanding uterus on veins and arteries.
-can lead to Edema and Varicosities
-if traveling get out of the car every few hours to prevent DVT (blood clots) & Don't Cross Legs
Cardiovascular System:
What causes MSHS (maternal Supine HYPOtension syndrome)?
the wt of the uterus presses the Vena Cava against the vertebrae, obstructing bld flow from the lower extremities, Causing a decrease in blood return to the heart & decreased CO and hypotension
Cardiovascular System:

What are the S/S experiened with MSHS?
-lightheadedness
-faintness
-palpitations
*Cardiovascular System*
MSHS condition is potentially dangerous, Why?
because it can cause Fetal Hypoxia
*Cardiovascular System*
What causes MSHS?
-caused by poor venous return to the heart & lack of blood supply to the upper extremities and brain
-poor venous return to the heart
*Cardiovascular System*
How can MSHS be corrected?
-have woman turn onto her LEFT side, so that blood flow through the VC increases again
-TEACH women Always to rest on the Left side rather than back, leads to hypotension
*Cardiovascular System*
Which one INcreases or Decreases?
1. Fibrinogen (for clotting)
2. WBC
3. Blood Lipid/ Cholesterol
4. Plt count
5. Protein
1. increases b/c of increase level of estrogen
2. Increases up to 20,000, protective mechanism and as a reflection of a woman's increased total blood volume
3. Increase:
4. Increases
5. Decreases
*Cardiovascular System*
What causes MSHS?
-caused by poor venous return to the heart & lack of blood supply to the upper extremities and brain
-poor venous return to the heart
*Cardiovascular System*
How can MSHS be corrected?
-have woman turn onto her LEFT side, so that blood flow through the VC increases again
-TEACH women Always to rest on the Left side rather than back, leads to hypotension
*Cardiovascular System*
Which one INcreases or Decreases?
1. Fibrinogen (for clotting)
2. WBC
3. Blood Lipid/ Cholesterol
4. Plt count
5. Protein
1. increases b/c of increase level of estrogen
2. Increases up to 20,000, protective mechanism and as a reflection of a woman's increased total blood volume
3. Increase:
4. Increases
5. Decreases
*Gastrointestinal System*

What hormones contribute to the cause of morning sickness & N/V?
-hCG
-progesterone
(more freq in women who smoke cigs)
*Gastrointestinal System*
What is the end result of Decreased Peristalsis and gastric emptying?
-reflux
-N/V
-Constipation
-Heartburn
-flatulence
*Urinary System*
Why is water retained during pregnancy?
to aid in the increase in in blood volume
*Urinary System*
Trace of Glucose in urine is Normal? T/F
True
-anything > than a trace is abnormal: b/c it can be a sign of gestional diabetes
*Urinary System*
GFR and Renal plasma flow increase?
-to meet the increased needs of the circulatory system
-high GFR = Low SG
-High SG = Dehydration
*Urinary System*
Ureters increase in diameter and the bladder capacity increases. T/F
True
*Urinary System*
Pressure on the urethra may lead to por bladder emptying and bladder infection. T/F
True
*Urinary System*
An oral antibiotic will not treat a bad kidney infection, instead it will cause?
pre-term labor
*Urinary System*
Inflammation/infection of the bladder?
cystitis
*Urinary System*
An infection of the kidney and the ureters?
Pyelonephritis
UTI are associated with ?
preterm labor
*Muscoskeletal System*
What hormone causes the softening & relaxing of a woman's pelvic ligament & joints to create pliability & to facitlitate passage of baby through pelvis?
-Relaxin and placental progesterone
*Muscoskeletal System*
How does a pregn woman change her center of gravity and make ambulation easier?
stand straighter and taller than usual= "Pride of Pregnancy"
-shoulders back and the abdomen forward, creates a Lordosis (forward curve of the lumbar spine), which may lead to Backache
*Endocrine system*
What cells produce Insulin?
Beta cells of the Islet of Langerhan
*Endocrine system*
Insulin production in the 1st trimester is LOW, why?
b/c of the heavy demand of glucose by the fetus
b/c the mother is sick and not eating therefore she is not getting any glucose from food
*Endocrine system*
________ increases production of insulin in response to the higher levels of glucocorticoid produced by the adrenal glands
Pancreas
*Endocrine system*
Why will insulin production be HIGH after the 1st trimester?
-b/c of the insulin antagonist properties of 3 hormones(blocks insulin):
1. hPL: human placental lactogen
2. estrogen
3. progesterone
*Endocrine system*
What hormones blocks Insulin or makes the cells very resistance to Insulin, so mother has to produce more insulin if not the mother will develop diabetes?
hPL: human placental lactogen
progesterone
estrogen
*Endocrine system*
"Master Gland" and stimulates the release of FSH and LH
-Pituitary Gland
*Endocrine system*
How is the Pituitary Gland affected by pregnancy?
there is No FSH and LH production
*Endocrine system*
Late in pregnancy, the posterior pituitary begins to produce Oxytocin, why?.
-Prolactin production begins late in pregnancy, why?.
Oxytocin: aids in labor
Prolactin: breast prepare for lactation
*Endocrine system*
an endocrine organ that produces large amounts of estrogen, progesterone, hCG, human placental lactogen (hPL), relaxin, and prostaglandins?
-Placenta
*Endocrine system*
Produces hPL?
-Placenta
-placenta has endocrine functions
*Endocrine system*
Thyroid and Parathyroid glands and Adrenal glands increase in size during pregnancy?
True
become hyperactive
*Immune System*
What immunoglobulin production is decreased during pregnancy?
IgG, making a woman more prone to infections
-High risk for infections:do not expose to rubella, Hiv, Hep b or any other type of infectious disease
What is the Terrible 2 Toddlers psychological response to a new baby?
-regress, jealous, clingy
-feel left out
What is Pre-school/school age kids psychological response to new baby?
-inquistivie
How a sibling response to a new baby depends on ?
1. how much attention is given to the new baby
2. how much attention the older child receives
3. how well the parents handle regressive and agressive behavior
What is the function of the uterus?
holds the baby
The diagnosis of pregnancy is based on what three types of findings?
presumptive (subjective), probable (objective), and positive (documented)
What physiologic changes during pregnancy,does the urinary system undergoes?
include alterations in
-fluid retention and
-renal, ureter, and bladder function.
The changes in the urinary system is result from?
1. Effects of high estrogen and progesterone levels
2. Compression of the bladder and ureters by the growing uterus
3. Increased blood volume
4.Postural influences
What are the urinary tract changes during pregnancy?
-GFR -Increased by 50%
-Renal plasma flow: Increased
-BUN: Decreased by 25%
- creatinine level Decreased
-Renal threshold for sugar
Decreased to slight spillage
-Bladder capacity- Increased
-Diameter of ureters- Increased
-Frequency of urination
Increased first trimester, last 2 weeks of pregnancy to 10-12 times/day
________ causes ureters to dilate.
Progesterone, this is Normal
If you have a high GFR=
you have a Low SG
-dehydrated = High SG
*urinary system*
increase blood volume, Increase cardiac output, blood goes where?
kidney