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161 Cards in this Set
- Front
- Back
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Passed from mother with a yeast infection.
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Baby Thrush
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For vaginalitis, also good for swelling/hemmorhoids
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Sitz Bath
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To treat 2nd trimester headaches
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Cold packs, massages
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Occurs as a result of lack of protein/albumin. Ask if it is occuring anywhere else.
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Dependent edema
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Offer dry crackers, ginger, mint. Suggest not drinking with meals
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Nausea/Vomiting
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Ask about burning and or pain
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Urinary freuqency
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Cheesy discharge r/t change in PH
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Candidiasis
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Recommend elevating legs, support hose (before getting OOB), exercise
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Varicose veins
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For dizziness when lying on back
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Turn on side, elevate head at night
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For leg cramps (r/t calcium deficiency)
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Dorsiflex foot
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Glucose in urine specimen?
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Re-do first thing in morning
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Phase of the ovarian cycle lasting from day 5-14
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Follicular phase (estrogen released)
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Phase of the ovarian cycle lasting from day 1-5
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Menses
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Hormones influencing the ovarian cycle
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FSH & LH (secreted by pituitary)
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Meds with clearly documented risks to fetus
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X meds
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Sex OK?
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Yes - but less so with history of abortions/pre-term labor
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Can cause infertility
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PID (Pelvic Inflammatory Disease)
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Days during which implantation (nidation) occurs (spotting possible)
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7-10 days after conception
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Hair on back and shoulders of preemies
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Lanugo
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Stimulates ovarian follicles to grow and produce estrogen (begins during Follicular Phase of Ovarian Cycle)
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FSH
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Secreted by all growing follicles, but mostly by the dominant (graafian) follicle
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Estrogen
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Suppresses the lesser follicles while causing the graafian follicle to mature
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LH
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Day on which a peak of LH causes the ovum to burst from the ovary (ovulation)
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Day 14
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Days duruing which implantation occurs (spotting possible)
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7-10 Days
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Occurs with the follicular phase, uterine endomitrium grows and is reconstructed in preparation for ovulation and possible conception
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Proliferative phase
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Child birth usually occurs about (length of time)
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38 weeks from fertilization
40 weeks from start of last menstruation |
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Life span of egg
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24-36 hrs
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Days 15-28
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Luteal Phase
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Esttrogen levels decrease early. Rise in progesterone (from corpus luteum) causes sharp decrease in LH
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Luteal phase
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Thick cervical mucus, Low spinnbarkeit (mucus stretchability)
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Follicular & luteal phases
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For heartburn
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Small frequent meals
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Bathtub OK - UNLESS
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Ruptured membranes/dilated
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Douching OK?
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NO
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Immunizations OK?
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Killed virus only
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Meds with clearly documented risks to fetus
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X meds
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Glucose in urine specimen?
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Re-do first thing in morning
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Thin cervical mucus, high spinnbarkeit (mucus strechability)
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Ovulation
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Normal Fetal Heart Rate
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110-160 BPM
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Average amount of amniotic fluid
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1000 cc
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How to tell if amniotic sac has ruptured
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Vaginal pH becomes more alkaline (elevated pH)
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During the luteal phase, this counteracts the effects of estrogen and suppresses new follicular growth
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Progesterone
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Begins its decline about 10 days after ovulation if fertilization does not occur
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Corpus Luteum
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Hormone needed to maintain the pregnancy
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Progesterone
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Occurs with the luteal phase to provide support for early embryonic growth (7 days of preparation for implantation)
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Secretary phase
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Death of the corpus luteum when conception does not occur
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Ischemic phase
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Fertilization and zygote formation occurs here (day one of the preembrionic period)
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Ampulla of fallopian tube
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Genetics
Egg contributes: |
22 and an X chromosome
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Genetics
Sperm contributes: |
22 and an X or Y chromosome
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Genetics
XX = |
Female
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Genetics
XY = |
Male
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The endomitrium is called this during pregnancy (after implantation)
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Decidua
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When cast off after pregnancy, the decidua is called this
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Lochia
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The most critical tme in fetal development (Rapid growth, tissue differentiation, formation of all major organs)
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Embryonic Period, First trimester (Weeks 3-8)
Potential for major congenital malformations if exposed to teratogens |
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Process by which a bilaminar embryo becomes a trilaminar embryo
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Gastrulation
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Forms skin, hair, nails, nervous system (incl. brain and spinal cord), tooth enamel
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Ectoderm
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Forms skeleton, muscles, connective tissue, blood and vascular system, teeth (except enamel) kidneys, spleen, reproductive organs, GI tract
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Mesoderm
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Forms epithelial lining of most internal organs
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Endoderm
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When does the umbilical cord form and what does it contain?
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Week 5 (CR length 8mm)
Contains two arteries and one vein |
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When does lanugo appear?
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At 18 weeks (on back and shoulders)
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What is the position of optimal circulation (for function of the placenta?)
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Lying on left side
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What prevents kinking of the umbillical cord?
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Wharton's Jelly
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When do you take your basal body temp?
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First thing in the morning (continued elevation > 2 wks. may mean pregnancy)
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The two umbillical arteries...
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carry deoxygenated blood away from the fetus to the placenta.
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Surfactants from lungs mix with amniotic fluid and can be used to tell lung maturity
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L/H ratio (2:1 = Mature)
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The umbillical vein...
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carries oxygenated blood to the fetus.
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What about fetal Hgb?
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It can carry 20-30% more oxygen than mom's
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When does a woman who is Rh- need isoimmunization (Rogam)?
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After each pregnancy lasting 6 weeks or longer
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When can you hear the FHT with doppler?
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At 12 weeks - menstrual age
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When is the fetus' anus open with meconium in the bowel?
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At week 14
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When are the fetal movements strong enough for mom to feel and the fetal heart can be heard with a fetescope?
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At 18 weeks
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Fetal Circulation
Leaving the placenta, oxygenated blood enters the... |
Umbilical vein
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Fetal Circulation
Leaving the umbilical vein, blood enters the... |
Ductus venosus (virtually all blood bypasses the liver)
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Fetal Circulation
Leaving the ductus venosus, blood enters the... |
Inferior vena cava
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Fetal Circulation
Leaving the inferior vena cava, blood enters the... |
Right atrium
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Fetal Circulation
Leaving the right atrium, most blood enters the... |
Foramen ovale (hole between R & L atria)
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Fetal Circulation
Leaving the right atrium, a little blood enters the... |
Right ventricle
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Fetal Circulation
Leaving the foramen ovale, blood enters the... |
Left atrium
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Fetal Circulation
Leaving the left atrium, blood enters the... |
Left ventricle
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Fetal Circulation
Leaving the left ventricle, blood enters the... |
Aorta
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Fetal Circulation
Leaving the aorta, blood enters the... |
Systemic circulation
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Fetal Circulation
Leaving the right ventricle, a small amount of blood enters the... |
Pulmonary trunk (then to the lungs and pulmonary veins - ending up in the left atrium)
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Fetal Circulation
Leaving the right ventricle, MOST of the blood enters the... |
Ductus arteriosis (bypassing the lungs, it connects the pulmonary trunk with the aorta)
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Fetal Circulation
Leaving the systemic circulation, the blood enters the... |
Umbilical arteries (deoxygenated blood)
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What's the formula for calculating a due date?
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Naegele's Rule:
Due Date = LMP + 7 days - 3 mos. + 1 year |
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When the consistency of the cervix changes from earlobe-like (early and mid-pregnancy) to lip-like or butter -ripe (for delivery)
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Goodell's sign (probable sign)
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Thinning of the cervix at term
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Effacement (happens along with dilation)
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By eight weeks vaginal color changes fron pink to purplish due to increased vascularity
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Chadwick's sign (Chadwick's = C for color) (probable sign)
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Fetal Circulation
Leaving the right ventricle, a small amount of blood enters the... |
Pulmonary trunk (then to the lungs and pulmonary veins - ending up in the left atrium)
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Fetal Circulation
Leaving the right ventricle, MOST of the blood enters the... |
Ductus arteriosis (bypassing the lungs, it connects the pulmonary trunk with the aorta)
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Fetal Circulation
Leaving the systemic circulation, the blood enters the... |
Umbilical arteries (deoxygenated blood)
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During pregnancy, vaginal secretions become less acidic, with a pH of...
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5.6 - 6.5
Resistant to bacterial invasion, but favoring Candida growth (yeast infection.) Eating large amts. of sugar also increases chance of a yeast infection) |
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During pregnancy, the uterus softens.
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Hegar's sign (probable sign)
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The uterus is the size of a grapefruit at __ weeks
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12
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At 12-16 weeks the uterus can be palpated...
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above the symphysis pubis
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At 20-24 weeks the uterus can be palpated...
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at the umbillicus
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At 36 weeks the uterus can be palpated...
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at the zyphoid process (makes breathing difficult)
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The fetal head settles in the pelvis (uterus returns to 32 week height) at this time...
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Prim-ips: 2 weeks before term
Multip: with onset of labor |
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A precursor of breast milk
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Colostrum (a thin, high-protein secretion)
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How early can colostrum be expressed?
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10-16 weeks
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How does the mother's blood volume change during pregnancy?
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It increases 30-50% (to 1500 ml)
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Average blood loss during delivery
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250-300 ml
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Cardiac output during pregnancy
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Increases 30-50%
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Apical pulse during pregnancy
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Increases 10 beats/minute
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To predict potential hypertensive problems...
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Roll Over Test: BP on side, BP on back, Wait 5 min. BP again. Increase of 20 diastolic from side to back = positive roll test (60% chance that PT will develop PIH - pregnancy induced HTN)
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RBC production during pregnancy...
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Increases 30-33% (adequate Iron necessary) *RBCs are not produced fast enough to keep up with increased plasma volume - Pseudo-anemia is often the result.
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Indicator of true anemia (as opposed to pseudo-anemia)
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HCT of 30 or Hgb of 10 or below
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Folic acid insufficiency
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Neural Tube Defect (need 400 mcg Folic Acid daily)
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Basal Metabolic rate during pregnancy
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Increases
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Striae Gravidarum
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Stretch marks
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Hyperpigmentation (ie. Linea nigra, Cholasma AKA "mask of pregnancy") is due to...
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MSH (Melanocyte stimulating hormone)
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N/V due to presence of...
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HCG (Human chorionic gonadotropin) increased estrogen, decreased blood sugar
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Craving for non-food substances (ie. Laundry starch)
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Pica
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When do you take your basal body temp?
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First thing in the morning (continued elevation > 2 wks. may mean pregnancy)
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Surfactants from lungs mix with amniotic fluid and can be used to tell lung maturity
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L/H ratio (2:1 = Mature)
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BUN and creatinine during pregnancy...
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Should decrease because of increased GFR
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If acetone (ketones) appear in urine...
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check nutritional status - indicates starvation
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Weight gain during pregnancy
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Should gain 25-35 lbs. (2-4 lbs first trimester, 1 lb. per week second and third trimesters)
*Obese should not diet. |
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Best position to assess fundal height
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Supine, knees bent, head and shoulders slightly elevated
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Fundal height/gestational age relationship
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Fundal height in cm often equals weeks of gestation +/- 2 cm
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What is lightening?
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The movement of the baby down into the pelvis (occurs toward the end of pregnancy)
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Fetal heart beat heard with doppler at...
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12 weeks
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Fetal heart beat heard with fetoscope at...
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20 weeks
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The first fetal movements are called...
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Quickening
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Quickening (presumptive sign of pregnancy - could be gas) is often first felt at...
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20 weeks
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"Kick counts" (fetal movements) should happen this many times an hour
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Three
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Steroid precursor produced by the fetal adrenal glands is synthesized by the placenta into...
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Estriol
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Estriol levels tell...
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Fetal well being
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Estriol production gradually rises during pregnancy and reaches a plateau at...
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40-41 weeks - and decreases slowly thereafter
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High estriol levels =
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Good fetal prognosis
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Decreasing estriol levels =
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Fetal problems ie. IUGR (intra uterine growth retardation) or fetal death
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Estriol level test done on...
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a 24 hr. urine specimen
*start with an empty bladder, discard first specimen |
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Attaching a fetal monitor after mother has eaten, and observing FHR when baby moves (mom lets tester know when) is a...
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Nonstress test
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During a nonstress test, if there are 2 or more increases in FHR of 15 BPM lasting 15 sec. or more in a 20 min. period, the test is deemed...
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Reactive
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During a nonstress test, if the FHR does not increase, the test is deemed...
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Nonreactive - need to repeat or do CST (contraction stress test)
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How to stimulate contractions for a CST
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Warm washcloth to breasts, PT rolls one nipple for 10 min, if no contractions, roll both nipples for 10 min. (alternatively, dilute pitocin IV)
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Danger with nipple stimulation...
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hard to control oxytocin dosage, risk for hyperstimulation
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Target response in a CST
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3 contractions lasting 40-60 seconds in a 10 min. period.
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Comparing response of FHR to contractions...
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Don't want to see late decelerations
Negative CST if no late decelerations Positive CST if late decels > 1/2 contractions Suspicious CST if late decels < 1/2 contractions |
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McDonalds sign
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Fundus can be easily flexed on cervix (probable sign)
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Practice contractions beginning as early as 3 months, but usually not noticed till 6 mos. (Stronger late pregnancy) Help to thin and soften cervix
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Braxton-Hicks contractions
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Amenorrhea
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Lack of period (presumptive sign of pregnancy) Could be stress, menopause or illness
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Positive pregnancy test - presumptive sign, probable sign or positive sign of pregnancy?
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Probable sign
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Tampons ok?
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NO
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Pre-eclampsia
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Pregnancy-induced hypertension
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Danger signals of pre-eclampsia
(Call MD - doesn't mean something has happened, but something MAY happen) |
Swelling of hands or face
Severe continuous headache Flashes of light, double vision, blurred vision *headache and vision changes means cerebral edema or acute HTN |
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Developmental task - First Trimester
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Accepting the pregnancy (telling friends she's pregnant)
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Initial prenatal visit - Parts of an interview
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Introduction, Chief Concern, Psychosocial & Family, Medical History, Families Illnesses, Gynecological History, Previous Pregnancies
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Number of children delivered after age of viability whether alive or not at birth (20 weeks or 400 Gm)
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Para
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Number of times pregnant incuding this one
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Gravida
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Pregnant for first time
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Primigravida
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Woman pregnant before
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Multigravida
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Had two or more deliveries reach age of viability
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Multipara
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5 Digit System
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G - Gravida
T - Term P - Premature A - Abortions (induced or miscarriage L - Living Children |
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Nutrition and pregnancy - What do you do before teaching?
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Find out how much the mother knows
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Sources of protein
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Beans, nuts, wheat germ, meats, poultry, fish, yogurt, eggs, milk
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Good sources of Folic Acid(400 mcg /day)
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Dark, green leafy vegetables
(risk neural tube defect if deficient) |
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Good sources of Iron
(30-60 mg /day) |
Liver, wheat germ, egg yolk, dried fruit
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What do you need to take with Iron?
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Take with juice (vitamin C needed for iron absorption)
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Restrict Salt?
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NO (decreased intake causes decreased circulating blood vol. = decreased O2 & nutrients to fetus)
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Pregnant adolescents often have...
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Iron deficiency anemia
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Pregnant adolescents need even more of this mineral (they are still growing.)
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Calcium
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