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223 Cards in this Set
- Front
- Back
Brown Fat |
dark-colored adipose tissue with many blood vessels, involved in the rapid production of heat in babies. |
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Corpus Luteum |
Graafian follicle cells remaining after ovulation that produce estrogen and progesterone |
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Fertilized Age |
prenatal age of developing baby-calculated from date of conception |
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Gestational Age |
Prenatal age of developing baby-calculated from date of women's LMP |
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Lanugo |
Fine, downy hair covering fetus in utero-develops by 20 wks and should begins to thin at week 35-36 |
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Lightening |
descent of fetus lower into the pelvis before labor starts around 38-39 weeks |
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Nagelle's Rule |
Standard way of calculating due date -3 months +7 days |
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Quickening |
movements from fetus felt by mom around wk 20 |
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Trimester |
1/3 of pregnancy or 13 weeks |
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Vernix |
cheesy covering on baby that protects it's skin from amniotic fluids |
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Wharton's Jelly |
Gelatinous substance found within the umbilical cord and around eyes - supports arteries and veins from collapsing in umbilical cord |
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mitosis |
exact copy 1:1 ratio
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meosis |
2 1/2 copies 1:2 ration |
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Best place for Implantation? |
Top of fundus in the uterus because it is richly supplied w/ blood, the lining is thick and limits the blood loss after birth |
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Hormones necessary for pregnancy? Produced? |
Estrogen and Progesterone-Corpus Luteum |
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What are the periods of pregnancy/ |
Pre-Embryonic, Embryonic and Fetal |
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Pre-embryonic period consists of? |
1st week after conception- Egg Fertilized, blastocyst forms and implantation occurs |
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Embryonic period consists of? |
week 3-week 8- major organs in place, most vulnerable to teratogens, most don't recognize they are pregnant |
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Fetal period consists of? |
week 9 to BIRTH all major systems in place, 1st fetal movements, can determine sex of fetus wk 12, heart beat heard by 12 wks, produces urine and excretes in fluids and eyes close at 10 wks |
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Monozygotic twins |
1 sperm:1 egg divide into 2 same sex and same genetics 2 placentas/2 chorions |
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Dizygotic twins |
2 sperm:2 eggs not genetically alike may be same or different sex separate chorions/separate placentas Increased chance with infertility txs |
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3 Bypasses? |
ductus venous ductus arterious foramen ovale |
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Milestones of the heart? |
begins beating-28 days 4 chamber heart-week 6 seen on us-week 8 seen on doppler-week 12 heard on fetoscope-week 20 |
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where does fertilization occur? |
Ampula; the furtherest part of the fallopian tube |
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purpose of seminal fluid? |
protect the sperm from the acidic ph of the vagina, nourishes sperm and assists in motility |
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zygote |
fertilized ovum |
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morula |
original cells divided into 16 cells/copies |
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blastocyst |
original cells divided into 100 cells/copies- looks like uncooked egg with yolk/divided into membranes fluid and mass |
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blastocyst outer membrane develops... |
into placenta and fetal membranes |
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blastocyst inner mass develops... |
into fetus |
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implantation occurs when? |
blastocyst reaches 100 cells or 7-10 days after fertilization |
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what hormone is released by zygote to signal pregnancy has begun? |
hCG-signals corpus luteum to continuing producing estrogen and progesterone causes endometrium to to thicken |
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decidua |
name of endometrium of uterus once blastocyst implants |
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hCG is? |
Human Chorionic Gonadotropin - produce estrogen and progesterone- keeps embryo and membranes alive |
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week 4 milestones |
heart starts beating at 28 days neural tube coses extremeties are buds |
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week 6 milestones |
heart has developed 4 chambers fetal circulation establishment |
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week 8 milestones |
definite human forms heartbeat detectable by US digits form |
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week 9-12 milestones |
all major systems are in place, extremities approach their relative length, first fetal movements, eyes close, begins to produce urine, can determine sex, heart beat heard by doppler |
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week 13-16 milestones |
period of paid growth face looks human skin transparent-blood vessels visible active movements skeletal ossification identifiable |
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week 20 milestones |
lanugo and vernix present eyebrows and head hair appear brown fat develops heartbeat detected by fetoscope quickening |
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week 24 milestones |
minimal subq fat skin red and translucent fetal resp movements starting surfactant starts producing alveoli forming |
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week 25-26 milestones |
eyes reopen lungs begin gas exchange |
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placenta |
thick, disk shaped organ/gland which is the means of metabolic and nutrient exchange between fetal and maternal circulation |
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maternal side |
side of the placenta closest to the mother-rough looking |
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fetal side |
side of the placenta surrounding fetus-smooth looking |
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blood exchange |
maternal and fetal blood do not mix blood flow is controlled by fetal heart beat blood washed over chorionic villi |
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placental functions |
transfer of nutrients transfer of antibodies waste removal gas exchange endocrine functions |
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complications of implantation |
placenta previa placental abrutption placenta acreta |
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placents previa is... |
covers the cervical opening
c-section always unless implantation has moved from growth from cervix |
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placental abrutption is... |
placenta detaches from uterine wall before delivery cutting of blood supply to baby mom can hemorrhage - 10 min to get to OR *DARK,RED BLEEDING IS INDICATOR |
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placenta acreta is... |
placenta attached too firmly to endometrium visible on US-can plan for hysterectomy as needed previous c/s scar tissue can cause NO VAGINAL EXAMS due to bleeding *BRIGHT,RED BLEEDING INDICATOR |
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fetal membranes |
amnion and chorion-together make the sac around the fetus-are separate membranes |
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amnion membrane... |
inner membrane touches amniotic fluid |
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chorionic membrane... |
outer membrane touches uterus |
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amniotic fluid |
derived from fetal urine and fluid from maternal blood-alkaline |
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amniotic fluid consists of... |
albumin, urea, uric acid, creatinine, lecithin, sphingomyelin(sutfactant from fetus), bilirubin, fat, vernix, lanugo, leukocytes, protein, fructose |
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fluid volume in amniotic sac |
700-1,000 ml |
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oligohydramnios |
<400 ml -need to check fetus kidneys |
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polyhydramnios |
>2000 ml |
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functions of amniotic fluid |
medium of movement |
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functions of amniotic fluid |
protection |
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functions of amniotic fluid |
temp regulation |
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functions of amniotic fluid |
prevents the sac from adhering to the fetus and causing deformities |
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Ductus venosus bypasses what? |
LIVER
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Ductus arteriosis bypasses what? |
OPENING NEAR AORTA |
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Foramen ovale bypasses what? |
HOLE BETWEEN R&L ATRIUM
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week 27 IMPORTANT milestone |
babies are more likely able to survive at this point |
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week 29-32 milestones |
skin pigmented according to race finernails and toenails present chances of survival good |
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week 35-36 milestones |
lungs become mature appearance -plump, pink and fat vernix remains in major creases lanugo begins to disappear |
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week 37-40 milestones |
considered full-term lightening occurs |
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subjective/presumptive signs |
amenorrhea |
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subjective/presumptive signs |
nausea and vomitting |
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subjective/presumptive signs |
breast tenderness
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subjective/presumptive signs |
increased vaginal discharge
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subjective/presumptive signs |
fatigue
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subjective/presumptive signs |
quickening
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objective/probable signs |
uterine enlargement/ abdomen enlargement |
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objective/probable signs |
ballotement |
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objective/probable signs |
chadwick's sign- cervix blue |
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objective/probable signs |
hegar's sign-press on cervix-soft |
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objective/probable signs
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braxton-hicks contractions |
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positive changes |
fetal heart rate
fetal movements by practitioner visualization of fetus by US |
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mucous plug formed?
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increase in vascularization in cervix, hyperactive
granular tissue and hyperplasia of cervical glands which harden and form plug |
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1st trimester GI sx N/V |
Increase in hCG secretion and change in carbohydrate metabolism |
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1st trimester GI sx mouth |
increased saliva production |
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1st trimester GI sx mouth |
increase in vascularity-gums might bleed |
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1st trimester GU sx |
increased urinary frequency due to pressure of uterus |
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braxton hicks contractions "false labor" |
irregular and painless starts in front begins in 2nd trimester facilitates blood movement in and out of placenta |
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what prepares the uterus for labor contractions starting the 2nd trimester? |
braxton hicks contractions
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2nd trimester breats |
increase in size/nodularity |
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colostrum |
1st milk products |
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stimulation of the nipples causes release of what hormone? |
oxytocin- which causes contractions- too soon of this can cause preterm labor=NO SEX |
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decrease in vascular resistance is due to release of what hormone? |
progesterone-smooth muscle relaxant |
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fx of progesterone on the cardiovascular system?
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relax the smooth muscle of the arteries to handle the extra blood volume for the fetus |
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varicose veins
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increased venous pressure due to edema in lower extremities |
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what changes occur to plasma during pregnancy?
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blood volume increases more than erythrocytes causing a decrease in hct |
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supine hypotension syndrome
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pressure from uterus on vena cava when lying down causing drop in bp |
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tx for supine hypotension syndrome |
lay pt on left side |
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2nd trimester breathing |
never tachypnea or dyspnea resp alkalosis norm diaphragm elevates 3rd trimester |
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2nd trimester breathing
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epistaxis normal-pinch and lean forward
decrease in airway resistance r/t increase progesterone exsisting lung disease may be exacerbated |
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2nd trimester blood
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fibrinogen increases 50%
hyper coagulability state= increase in blood clots |
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2nd trimester GI |
heartburn(pyrosis) caused by relaxation of cardiac sphincter caused by progesterone |
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2nd Trimester GI |
hemorrhoids caused by constipation |
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2nd Trimester GI |
bloating and constipation-caused by slowed gastric emptying and decreased motility -caused by progesterone |
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2nd trimester LIVER |
minor changes delayed emptying of gall bladder-gallstone formation parities from bile salts-itching |
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2nd Trimester GI |
urinary frequency normal |
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Complaints of increased urinary frequency in 2nd trimester? |
not normal; need a UA |
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oh she's got the "GLOW" |
bile salts from gall bladder |
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2nd trimester GI |
increase in gfr-spills glucose |
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2nd trimester skin |
increase in melanocyte stim hormone- which increases pigmentation |
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linea nigra |
line on belly |
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facial cholasma |
"mask of pregnancy" stay out of sun-sunscreen goes away after a year |
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vascular spider nevi |
"spider veins" -from weight of pregnancy |
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2nd trimester hair |
hair growth decreases |
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2nd trimester glands |
sweat and sebaceous glands hyperactive-may get acne |
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2nd trimester mobility |
pelvis tilts forward waddling gait begins lordosis is present from weight parethesia's of extremities |
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pregestational diabetes |
need counseling need to stabilize blood sugar low a1c over 3 mo less than 7 |
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tx of gestational diabetes |
stable bs fbs<95 2 hr PP <120 |
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Risk for fetus-pregestational diabetes |
4x higher congenital malformations IUGR-because of vasoconstriction |
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insulin therapy-pregestational |
increase insulin at 20th week hormones antagonistic |
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gestational diabetes |
tested if AMA >40 hx of diabetes prior LGA or stillborn obese pcos |
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dx with gestational if... |
FBS>126 x2 occasions |
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when do you test for gestational diabetes? |
24-28 weeks |
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what test is given for dx of gestational diabetes? |
1 hr glucose tolerance test (GTT), if failed 3 hr test given *2 values elevated=gestational diabetic |
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tx for gestational diabetes |
start with diet glucose monitoring |
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fetal risk factors-gestational diabetes |
macrosomia=BIG baby hypoglycemia post delivery=jittery and unstable temps |
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starvation ketoacidosis |
body breaks down fat and protein because mom lacks glucose stores-"low blood sugar" |
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tx for starvation ketoacidosis |
FEED PT!!! or iv fluids=LR |
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pts at risk for starvation ketoacidosis? |
teens |
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diabetic ketoacidosis |
breakdown of fats |
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tx for diabetic ketoacidosis |
give INSULIN and fluids |
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NPH INSULIN onset |
1 HR |
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NPH INSULIN peak |
4-12 HR may need snacks |
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NPH INSULIN duration |
24 HR |
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REGULAR INSULIN onset |
30min-1HR give at meals |
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REGULAR INSULIN peak |
2-3 HR |
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REGULAR INSULIN duration |
6-12 HR give snacks |
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s/sx of hypoglycemia/hyperglycemia |
shaky |
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s/sx of hypoglycemia/hyperglycemia |
weakness/fatigue
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s/sx of hypoglycemia/hyperglycemia |
irritable
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s/sx of hypoglycemia/hyperglycemia |
sweating
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s/sx of hypoglycemia/hyperglycemia
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blurry vision |
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tx for hypoglycemia |
give milk then wait 15-check sugars again |
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neonatal risks for ketoacidosis |
resp distress syndrome polyhydramnios perinatal death |
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human placental lactogen |
destroys insulin |
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tx for low progesterone |
give progesterone suppositories up to 12 weeks |
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tx for low progesterone after 12 weeks |
1 shot once a week until end of pregnancy |
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fx of estrogen |
stimulates uterine enviroment to maintain fetus |
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fx of estrogen |
develops ductal system in breast for lactation |
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fx of prestigladin |
causes stimulation of contractions |
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good oral care prevents |
preterm labor- prostagladin found in plaque on teeth |
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3rd trimester cardio |
blood volume increases to peak at 28-32 weeks |
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3rd trimester cardio |
heart beat increases 10-15 beats - never should tachycardic |
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hgb level |
10 is normal for pregnancy |
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prophylaxis for cardiac disease during pregnancy |
restrict activity elastic stockings correct anemia 12 or better |
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cardiac disease- fetal surveillance begins at ... |
32 weeks weekly |
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1st sign of CHF |
fatigue |
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if on heparin... |
need to take off and switch to coumadin |
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s/sx of CHF |
C F R E D P SOB |
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if mom develops chf... |
need heart transplant must wait 2 years after transplant to have another baby |
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3rd trimester GU |
Increased urinary frequency |
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sensitization |
mom rh- and fetus rh+ antibody response can form and attack baby |
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indirect coombs |
1:8 norm range = mom not sensitized |
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starvation ketoacidosis
|
ketones and NO glucose in urine |
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diabetic ketoacidosis
|
ketones and SOME glucose in urine |
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rh- newborn
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no rhogam necessary |
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mom needs rhogam what time frame after birth? |
72 HRS |
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striate gravidarum |
no tx will fade |
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pre-eclampsia s/sx
|
edema
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pre-eclampsia s/sx |
epigastric pain
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pre-eclampsia s/sx
|
visual disturbances/pounding headache |
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danger signs of pregnancy |
rupture of membranes
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danger signs of pregnancy |
vaginal bleeding w/wo discomfort
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danger signs of pregnancy
|
signs of preterm labor-pelvic pressure, constant back pain, cramps |
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danger signs of pregnancy
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chills/fever |
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1st trimester education |
traveling-stop 1-2 hrs exercise okay sex OK comfortable clothing no hot tubs breast care |
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2nd trimester education
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traveling-stop EVERY hr exercise ok sex OK low heels no hot tubs breast care |
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3rd trimester education
|
sex OK no yoga/yoga low heels no hot tubs breast care |
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psych 1st trimester
|
introversion begins
mood swings become exaggerated |
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intendedness |
wether the pregnancy was intended, planned *can be unintended but still wanted! |
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ambivalence |
state of having simultaneous conflicting reactions, beliefs, or feelings towards pregnancy |
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psych 1st trimester |
many may not believe until seen on US |
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pregnant women are at risk for what kind of violence? |
intimate partner violence |
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taking-on |
mimicry "copying other moms" role playing |
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taking-in |
introjection projection |
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letting-go |
grief work-sad giving up old role |
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toddlers and new babies |
don't tell too early may regress-wait to train until after baby |
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school age and new babies |
FAMILY AFFAIR dont lie-tell truth |
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couvade |
"transition into fatherhood" may experience physiological symptoms simultaneously |
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adolescent pregnancy risk factors |
preterm birth, low birth weight, pre-eclampsia anemia and cephlo-pelvic disproportion |
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adolescent pregnancy factors |
don't seek care don't follow directions for prenatals may smoke may be exposed to STI won't gain weight |
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nursing care for adolescents |
LISTEN MORE TALK LESS dont assume don't be vague teach at their level |
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nutrition in adolescents |
may need to gain more weight inadequate iron/calcium *may need a food diary* |
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education for adolescents |
newborn care weight gain and nutrition sexuality relationships baby care |
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1st prenatal visit |
preg HX med HX substance HX nutrition assessment physical exam labs |
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labs on 1st prenatal visit |
CBC RUBELLA BLOOD TYPE/RH FACTOR INDIRECT COOMBS RPR/VDRL/SERLOGY STI CULTURES HIV HEP PAP UA |
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1ST trimester procedures |
estimate gestation age
nuchal trans viabillity |
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nuchal translucency test |
11wk-13wk6days
|
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>3mm=increased incidence of down's
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nuchal translucency |
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amniocentesis
|
15-20wks
10-15 wks if AMA, abnorm AFP |
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amniocentesis risks |
sab, club foot, fetal puncture, hemmhorage
|
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nursing care for amniocentesis
|
empty bladder
sign consent |
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chorionic villous sampling
|
9-12 wks
*VERY HIGH RISK OF SAB* |
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Alpha-fetoprotein
|
15-22 wks
low levels=downs high levels=ntd |
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triple marker test
|
only makes AFP more reliable
|
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fundal height
|
1cm=1wk +/- 2wks
|
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NST before 32 wks
|
10x10
|
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NST after 32wks
|
15x15
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CST |
done if NST not REACTIVE
|
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CST RESULTS
|
negative=good no lates positive=BAD lates present |
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contrast to CST
|
risk for preterm labor
prom multiple gestation placenta previa |
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BPP |
do this when NST is not reactive FIRST 8=norm 6=equivocal need CST always EVEN #s |
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kick counts |
movement is good pick a time everyday and count for amount of time *if less than norm, fetal distress, call DR STAT* |
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GBS |
in NORM flora 35-37 wks by swab |
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tx for GBS |
early admit before delivery 2 doses Q 4 HRS, at least 20 min before delivery stay 48 hrs penicillin is choice ABX push ABX even if not enough time |
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L/S ratio |
determines amount of maturity in lungs diabetic=2.5:1 nondiabetic=2:1 |
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HGB |
10-14, if low rx iron starting in 2nd tri |
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HCT |
32-42 |
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RBC |
4.2-5.8 mil |
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WBC |
5-15,000 |
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platelets |
150-350 |
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rubella titer |
1:8 |
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VDR/RPR/SEROLOGY |
1st and 36th wks |