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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.

Corpus Luteum

Graafian follicle cells remaining after ovulation that produce estrogen and progesterone

Fertilized Age

prenatal age of developing baby-calculated from date of conception

Gestational Age

Prenatal age of developing baby-calculated from date of women's LMP

Lanugo

Fine, downy hair covering fetus in utero-develops by 20 wks and should begins to thin at week 35-36

Lightening

descent of fetus lower into the pelvis before labor


starts around 38-39 weeks

Nagelle's Rule

Standard way of calculating due date -3 months +7 days

Quickening

movements from fetus felt by mom around wk 20

Trimester

1/3 of pregnancy or 13 weeks

Vernix

cheesy covering on baby that protects it's skin from amniotic fluids

Wharton's Jelly

Gelatinous substance found within the umbilical cord and around eyes - supports arteries and veins from collapsing in umbilical cord



mitosis

exact copy 1:1 ratio


meosis

2 1/2 copies 1:2 ration

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

Hormones necessary for pregnancy?


Produced?

Estrogen and Progesterone-Corpus Luteum

What are the periods of pregnancy/

Pre-Embryonic, Embryonic and Fetal

Pre-embryonic period consists of?

1st week after conception- Egg Fertilized, blastocyst forms and implantation occurs

Embryonic period consists of?

week 3-week 8- major organs in place, most vulnerable to teratogens, most don't recognize they are pregnant

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

Monozygotic twins

1 sperm:1 egg divide into 2


same sex and same genetics


2 placentas/2 chorions



Dizygotic twins

2 sperm:2 eggs


not genetically alike


may be same or different sex


separate chorions/separate placentas


Increased chance with infertility txs



3 Bypasses?

ductus venous


ductus arterious


foramen ovale

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

where does fertilization occur?

Ampula; the furtherest part of the fallopian tube



purpose of seminal fluid?

protect the sperm from the acidic ph of the vagina, nourishes sperm and assists in motility



zygote

fertilized ovum

morula

original cells divided into 16 cells/copies



blastocyst

original cells divided into 100 cells/copies- looks like uncooked egg with yolk/divided into membranes fluid and mass

blastocyst outer membrane develops...

into placenta and fetal membranes

blastocyst inner mass develops...

into fetus

implantation occurs when?

blastocyst reaches 100 cells or 7-10 days after fertilization

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

decidua

name of endometrium of uterus once blastocyst implants



hCG is?

Human Chorionic Gonadotropin - produce estrogen and progesterone- keeps embryo and membranes alive



week 4 milestones

heart starts beating at 28 days


neural tube coses


extremeties are buds

week 6 milestones

heart has developed 4 chambers


fetal circulation establishment

week 8 milestones

definite human forms


heartbeat detectable by US


digits form



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

week 13-16 milestones

period of paid growth


face looks human


skin transparent-blood vessels visible


active movements


skeletal ossification identifiable

week 20 milestones

lanugo and vernix present


eyebrows and head hair appear


brown fat develops


heartbeat detected by fetoscope


quickening

week 24 milestones

minimal subq fat


skin red and translucent


fetal resp movements starting


surfactant starts producing


alveoli forming

week 25-26 milestones

eyes reopen


lungs begin gas exchange



placenta

thick, disk shaped organ/gland which is the means of metabolic and nutrient exchange between fetal and maternal circulation



maternal side

side of the placenta closest to the mother-rough looking

fetal side

side of the placenta surrounding fetus-smooth looking



blood exchange

maternal and fetal blood do not mix


blood flow is controlled by fetal heart beat


blood washed over chorionic villi

placental functions

transfer of nutrients


transfer of antibodies


waste removal


gas exchange


endocrine functions

complications of implantation

placenta previa


placental abrutption


placenta acreta

placents previa is...

covers the cervical opening

c-section always unless implantation has moved from growth from cervix





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

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

fetal membranes

amnion and chorion-together make the sac around the fetus-are separate membranes



amnion membrane...

inner membrane touches amniotic fluid

chorionic membrane...

outer membrane touches uterus



amniotic fluid

derived from fetal urine and fluid from maternal blood-alkaline



amniotic fluid consists of...

albumin, urea, uric acid, creatinine, lecithin, sphingomyelin(sutfactant from fetus), bilirubin, fat, vernix, lanugo, leukocytes, protein, fructose

fluid volume in amniotic sac

700-1,000 ml



oligohydramnios

<400 ml -need to check fetus kidneys

polyhydramnios

>2000 ml



functions of amniotic fluid

medium of movement

functions of amniotic fluid

protection

functions of amniotic fluid

temp regulation

functions of amniotic fluid

prevents the sac from adhering to the fetus and causing deformities



Ductus venosus bypasses what?

LIVER


Ductus arteriosis bypasses what?

OPENING NEAR AORTA

Foramen ovale bypasses what?

HOLE BETWEEN R&L ATRIUM


week 27 IMPORTANT milestone

babies are more likely able to survive at this point



week 29-32 milestones

skin pigmented according to race


finernails and toenails present


chances of survival good





week 35-36 milestones

lungs become mature


appearance -plump, pink and fat


vernix remains in major creases


lanugo begins to disappear



week 37-40 milestones

considered full-term


lightening occurs



subjective/presumptive signs

amenorrhea

subjective/presumptive signs

nausea and vomitting

subjective/presumptive signs

breast tenderness

subjective/presumptive signs

increased vaginal discharge

subjective/presumptive signs

fatigue

subjective/presumptive signs

quickening

objective/probable signs

uterine enlargement/ abdomen enlargement

objective/probable signs

ballotement

objective/probable signs

chadwick's sign- cervix blue

objective/probable signs

hegar's sign-press on cervix-soft

objective/probable signs

braxton-hicks contractions

positive changes

fetal heart rate

fetal movements by practitioner


visualization of fetus by US


mucous plug formed?

increase in vascularization in cervix, hyperactive

granular tissue and hyperplasia of cervical glands which harden and form plug





1st trimester GI sx N/V

Increase in hCG secretion and change in carbohydrate metabolism

1st trimester GI sx mouth

increased saliva production

1st trimester GI sx mouth

increase in vascularity-gums might bleed

1st trimester GU sx

increased urinary frequency due to pressure of uterus



braxton hicks contractions "false labor"

irregular and painless


starts in front


begins in 2nd trimester


facilitates blood movement in and out of placenta

what prepares the uterus for labor contractions starting the 2nd trimester?

braxton hicks contractions

2nd trimester breats

increase in size/nodularity



colostrum

1st milk products

stimulation of the nipples causes release of what hormone?

oxytocin- which causes contractions- too soon of this can cause preterm labor=NO SEX

decrease in vascular resistance is due to release of what hormone?

progesterone-smooth muscle relaxant

fx of progesterone on the cardiovascular system?

relax the smooth muscle of the arteries to handle the extra blood volume for the fetus

varicose veins

increased venous pressure due to edema in lower extremities

what changes occur to plasma during pregnancy?

blood volume increases more than erythrocytes causing a decrease in hct

supine hypotension syndrome

pressure from uterus on vena cava when lying down causing drop in bp

tx for supine hypotension syndrome

lay pt on left side

2nd trimester breathing

never tachypnea or dyspnea


resp alkalosis norm


diaphragm elevates 3rd trimester

2nd trimester breathing

epistaxis normal-pinch and lean forward

decrease in airway resistance r/t increase progesterone


exsisting lung disease may be exacerbated





2nd trimester blood

fibrinogen increases 50%

hyper coagulability state= increase in blood clots




2nd trimester GI

heartburn(pyrosis) caused by relaxation of cardiac sphincter caused by progesterone

2nd Trimester GI

hemorrhoids caused by constipation

2nd Trimester GI

bloating and constipation-caused by slowed gastric emptying and decreased motility -caused by progesterone

2nd trimester LIVER

minor changes


delayed emptying of gall bladder-gallstone formation


parities from bile salts-itching

2nd Trimester GI

urinary frequency normal

Complaints of increased urinary frequency in 2nd trimester?

not normal; need a UA

oh she's got the "GLOW"

bile salts from gall bladder

2nd trimester GI

increase in gfr-spills glucose



2nd trimester skin

increase in melanocyte stim hormone- which increases pigmentation



linea nigra

line on belly

facial cholasma

"mask of pregnancy"


stay out of sun-sunscreen


goes away after a year

vascular spider nevi

"spider veins" -from weight of pregnancy

2nd trimester hair

hair growth decreases

2nd trimester glands

sweat and sebaceous glands hyperactive-may get acne

2nd trimester mobility

pelvis tilts forward


waddling gait begins


lordosis is present from weight


parethesia's of extremities

pregestational diabetes

need counseling


need to stabilize blood sugar


low a1c over 3 mo less than 7

tx of gestational diabetes

stable bs


fbs<95


2 hr PP <120

Risk for fetus-pregestational diabetes

4x higher congenital malformations


IUGR-because of vasoconstriction

insulin therapy-pregestational

increase insulin at 20th week


hormones antagonistic



gestational diabetes

tested if


AMA >40


hx of diabetes


prior LGA or stillborn


obese


pcos



dx with gestational if...

FBS>126 x2 occasions

when do you test for gestational diabetes?

24-28 weeks

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

tx for gestational diabetes

start with diet


glucose monitoring



fetal risk factors-gestational diabetes

macrosomia=BIG baby


hypoglycemia post delivery=jittery and unstable temps

starvation ketoacidosis

body breaks down fat and protein because mom lacks glucose stores-"low blood sugar"

tx for starvation ketoacidosis

FEED PT!!! or iv fluids=LR



pts at risk for starvation ketoacidosis?

teens

diabetic ketoacidosis

breakdown of fats



tx for diabetic ketoacidosis

give INSULIN and fluids



NPH INSULIN onset

1 HR

NPH INSULIN peak

4-12 HR may need snacks

NPH INSULIN duration

24 HR

REGULAR INSULIN onset

30min-1HR give at meals

REGULAR INSULIN peak

2-3 HR



REGULAR INSULIN duration

6-12 HR give snacks



s/sx of hypoglycemia/hyperglycemia

shaky

s/sx of hypoglycemia/hyperglycemia

weakness/fatigue

s/sx of hypoglycemia/hyperglycemia

irritable

s/sx of hypoglycemia/hyperglycemia

sweating

s/sx of hypoglycemia/hyperglycemia

blurry vision

tx for hypoglycemia

give milk then wait 15-check sugars again

neonatal risks for ketoacidosis

resp distress syndrome


polyhydramnios


perinatal death

human placental lactogen

destroys insulin

tx for low progesterone

give progesterone suppositories up to 12 weeks

tx for low progesterone after 12 weeks

1 shot once a week until end of pregnancy

fx of estrogen

stimulates uterine enviroment to maintain fetus

fx of estrogen

develops ductal system in breast for lactation

fx of prestigladin

causes stimulation of contractions

good oral care prevents

preterm labor- prostagladin found in plaque on teeth

3rd trimester cardio

blood volume increases to peak at 28-32 weeks

3rd trimester cardio

heart beat increases 10-15 beats - never should tachycardic

hgb level

10 is normal for pregnancy



prophylaxis for cardiac disease during pregnancy

restrict activity


elastic stockings


correct anemia 12 or better



cardiac disease- fetal surveillance begins at ...

32 weeks weekly

1st sign of CHF

fatigue

if on heparin...

need to take off and switch to coumadin

s/sx of CHF

C


F


R


E


D


P


SOB

if mom develops chf...

need heart transplant


must wait 2 years after transplant to have another baby

3rd trimester GU

Increased urinary frequency

sensitization

mom rh- and fetus rh+ antibody response can form and attack baby



indirect coombs

1:8 norm range = mom not sensitized

starvation ketoacidosis

ketones and NO glucose in urine
diabetic ketoacidosis

ketones and SOME glucose in urine
rh- newborn

no rhogam necessary

mom needs rhogam what time frame after birth?

72 HRS

striate gravidarum


"stretch marks"


no tx


will fade

pre-eclampsia s/sx
edema

pre-eclampsia s/sx

epigastric pain
pre-eclampsia s/sx

visual disturbances/pounding headache

danger signs of pregnancy
rupture of membranes

danger signs of pregnancy

vaginal bleeding w/wo discomfort
danger signs of pregnancy

signs of preterm labor-pelvic pressure, constant back pain, cramps
danger signs of pregnancy

chills/fever

1st trimester education

traveling-stop 1-2 hrs


exercise okay


sex OK


comfortable clothing


no hot tubs


breast care



2nd trimester education

traveling-stop EVERY hr


exercise ok


sex OK


low heels


no hot tubs


breast care

3rd trimester education


traveling-stop EVERY hr


sex OK


no yoga/yoga


low heels


no hot tubs


breast care

psych 1st trimester
introversion begins

mood swings become exaggerated

intendedness

wether the pregnancy was intended, planned


*can be unintended but still wanted!



ambivalence

state of having simultaneous conflicting reactions, beliefs, or feelings towards pregnancy

psych 1st trimester

many may not believe until seen on US

pregnant women are at risk for what kind of violence?

intimate partner violence

taking-on

mimicry "copying other moms"


role playing



taking-in

introjection


projection



letting-go

grief work-sad giving up old role

toddlers and new babies

don't tell too early


may regress-wait to train until after baby



school age and new babies

FAMILY AFFAIR


dont lie-tell truth

couvade

"transition into fatherhood"


may experience physiological symptoms simultaneously

adolescent pregnancy risk factors

preterm birth, low birth weight, pre-eclampsia anemia and cephlo-pelvic disproportion



adolescent pregnancy factors

don't seek care


don't follow directions for prenatals


may smoke


may be exposed to STI


won't gain weight

nursing care for adolescents

LISTEN MORE TALK LESS


dont assume


don't be vague


teach at their level



nutrition in adolescents

may need to gain more weight


inadequate iron/calcium


*may need a food diary*



education for adolescents

newborn care


weight gain and nutrition


sexuality


relationships


baby care

1st prenatal visit

preg HX


med HX


substance HX


nutrition assessment


physical exam


labs



labs on 1st prenatal visit

CBC


RUBELLA


BLOOD TYPE/RH FACTOR


INDIRECT COOMBS


RPR/VDRL/SERLOGY


STI CULTURES


HIV HEP PAP UA

1ST trimester procedures

estimate gestation age

nuchal trans


viabillity


nuchal translucency test

11wk-13wk6days

>3mm=increased incidence of down's

nuchal translucency

amniocentesis

15-20wks

10-15 wks if AMA, abnorm AFP

amniocentesis risks

sab, club foot, fetal puncture, hemmhorage

nursing care for amniocentesis

empty bladder

sign consent


chorionic villous sampling

9-12 wks

*VERY HIGH RISK OF SAB*


Alpha-fetoprotein

15-22 wks

low levels=downs


high levels=ntd


triple marker test

only makes AFP more reliable

fundal height

1cm=1wk +/- 2wks

NST before 32 wks

10x10

NST after 32wks

15x15

CST

done if NST not REACTIVE

CST RESULTS

negative=good no lates


positive=BAD lates present

contrast to CST

risk for preterm labor

prom


multiple gestation


placenta previa



BPP

do this when NST is not reactive FIRST


8=norm


6=equivocal need CST


always EVEN #s

kick counts

movement is good


pick a time everyday and count for amount of time




*if less than norm, fetal distress, call DR STAT*

GBS

in NORM flora


35-37 wks by swab





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



L/S ratio

determines amount of maturity in lungs


diabetic=2.5:1


nondiabetic=2:1

HGB

10-14, if low rx iron starting in 2nd tri

HCT

32-42

RBC

4.2-5.8 mil

WBC

5-15,000

platelets

150-350

rubella titer

1:8

VDR/RPR/SEROLOGY

1st and 36th wks