question

conception

answer

sperm penetrates egg

question

sperm life

answer

72 hours

question

ovum life

answer

24 hours

question

if egg is unfertilized

answer

degenerates and absorbs back into lining

question

cervical conditions

answer

-acidic ->> sperm survival -thin secretions -> motility

question

ampula

answer

fertilization hapens here

question

implantation

answer

fertilized egg attaches to endometrium 6- 10 days after conception -cells divide

question

estrogen

answer

secreted by corpus gluteum stops menstruation start producing 7 w increases uterine/placenta BF stimulates breasat glandular tissue increases amount at end of pregnancy decreases amount at end of pregnancy to increase contractions -respiration, nutrition, sec, storage if placenta doesn't have enough-> takes it from mom

question

length of pregnancy

answer

10 lunar months 280 days 9 months from the day of the last menstrual period

question

LMP

answer

last menstrual period

question

3 stages of intrauterine development

answer

1) ovum / preembryotic 2) Embryo 3) Fetus

question

*ovum / preembryotic stage*

answer

conception until day 14 -cellular replication -blastocyst formation -initial development of embryonic membranes -establishment of primary germ layers

question

*embryo stage*

answer

day 15-8th week -every organ system is present

question

*fetus stage*

answer

8th week -9 1/2 lunar month -refines structures and perfects the systems

question

3rd week

answer

3 germ layers form -endoderm -mesoderm -ectoderm

question

*endoderm*

answer

epithelial lining that becomes respiratory and digestive tracts oropharynx, urethra, bladder, vagina, pancreas -from yolk sac

question

*mesoderm*

answer

bones, teeth, muscles and smooth cardiac, dermis connect, cardiac system, spleen and urogenital

question

*ectoderm*

answer

gives rise to epidermis glands eye lens, tooth enamel, hair, epidermis glands, central and peripheral nervous system

question

development of embryo

answer

day 15-8weeks (3 cm) crown->: rump -most critical time of development of organ systems and main external features *vulnerable to teratogens* -all organ systems are present

question

*chorion*

answer

1st membrane forms -outermost membrane -fetal side of placenta -chorionic villi

question

chorionic villi

answer

-becomes placenta -burrow in endometrium

question

*amnion*

answer

innermost membrane -contains embryo and amniotic fluid -oxygen and nutrients -disposes of CO2 (acts as a filter)

question

*hCG* human chorionic gonadotropin

answer

earliest biochemical marker of prengancy (7-8 days) mom makes hormone 1 week after conception *pregnancy tests* detected 1 week after impolantation ovarium corpus gluteum

question

*amniotic fluid*

answer

700 mL - 1000 mL present at birth -volume changes constantly -clear fluid, mostly water -no foul smell

question

11 w

answer

fetus urinates, ^ amniotic fluid ^ fluid = ^ kidney fcn

question

*amniotic fluid functions*

answer

-cushion -maintain body temperature -prevents fetus from tangling in cord -volume -maintains WEAB -acts as a wedge in labor -allows freedom for movement/growth -barrier to infection -allows fetal lung development -metric growth

question

*yolk sac*

answer

-becomes primitive digestive system -provides embryo with nutrients /02

question

*placenta*

answer

-begins dev at 3 w completed at 3 mon -weighs 400-600 g (14-21 lbs) -1-1 1/2 in thick -6-8 in diameter -allows for diffusion across membranes

question

*umbilical cord*

answer

attaches fetus to placenta -2 arteries -- from fetus to mom (deoxygen blood) -1 vein -- from mom to fetus (oxygen blood) a) wartons jelly -keeps cord from pinching 2 cm diameter 30 cm length -no pain receptors

question

*placenta maternal side* "dirty duncan" side

answer

endometrium side red, fleshlike divided into segments (cotyledons) - lead to heavy bleeding

question

*placenta fetal side * "shiny shultz" side

answer

chorionic villi smooth surface, glistening grey, covered by amnion

question

*placenta fcn* (endocrine gland)

answer

hCG hCS / hPL progesterone estrogen

question

hCS / hPL (human placental lactogen)

answer

somatomatotropin

question

somatomatotropin

answer

human placenta lactogen -growth hormone increase growth, regulates glucose levels

question

progesterone

answer

maintains pregnancy maintains endometrium decreases uterine contractions stimulates maternal metabolism, increases breast dev helps egg stay in uterus uterus becomes thicker once produced

question

placenta storage

answer

iron calcium carbohydrates glucose (less in fetus)

question

factors affect placenta fcning

answer

-viruses, bacteria, protozoa -teratogens (toxins) -Rh neg mother / Rh pos fetus (isoimmunization) -maternal BP a) vasoconstriction diminishes uterine BF i) hypertension ii) smoking iii) cocaine iv) laying on back ( pinching off baby's vena cava dec. BF ) v) braxton hicks

question

*braxton hicks contractions*

answer

false labor pains / practice contractions

question

*viability*

answer

capability of fetus to survive outside uterus limitations based on CNS fcn and oxygenation capatbility of lungs *can survive on own outside of mother* 22-25 weeks

question

fetal circulatory system

answer

-maintains BF to the placenta -Provedes fetus with O2 and nutrients -removes CO2 and other wastes *most blood bypasses fetal lungs*

question

3 w

answer

blood cell formation begins 2 tubes pulse

question

4-5 w

answer

4 chambers blood detected from heart

question

why doesn't blood pass through fetal lungs

answer

blood doesn't carry out gas exhange in fetal lungs

question

fetal circulation

answer

most umbilical veins -->> ductus venosus foramen ovale closes after baby is delivered pulmonary artery and ductus arteriosis - most blood closes after delivery bc of pressure

question

smoking

answer

vasoconstrictor

question

1-2 w

answer

conception cell division

question

3-4 w

answer

looking to "land" GI starts dev. heart begins (4) resp system bones, muscles, hormones

question

6-7 w (resembles a baby baluga whale)

answer

hematopoesis bones, shoulders, arms -no joins sex organs visible

question

*hematopoiesis*

answer

formation of blood cells

question

8 w

answer

stem cells bone marrow react to env - swims, moves hands and legs

question

9 w

answer

"fetus"

question

10-11 w

answer

heart almost completely dev and can be heard outside of teh doppler RBC - liver, fingers, nails, kidneys produce urine, testes produce testosterone

question

14 w

answer

brain fully developed suchs, swallows, irregular breath movement, feel pain, transparent skin, eyebrows/lashes/lid and ears

question

18-20 w

answer

peristalsis - GI produce insulin lecithin - movement (butterflies) fingernails harden langua-hair recognize mom's voice, clear sex organs

question

24 w

answer

fur respons to sound, sugar shallow, faster heart beat react to temp practices breathing REM vernix

question

vernix

answer

covers skin- protects skin from fluid (similar to us getting wrinkly in water)

question

25-28 w

answer

stores brown fat for stressful times and thermal regulation

question

28 w

answer

testes descend NS control some body fcn eyelids open and close 26% survival

question

32 w

answer

95% survival fetus sleeps 90-95% rhythmic breaths

question

34 w

answer

full term

question

35 w

answer

L - S sufficient

question

36 w

answer

GI system matures digestive enzymes not amylase (starch) and lipase (fats) yet

question

maconium

answer

baby's first stool tarry, black/green, stretchy passes within first 24 hrs after birth

question

antepartum

answer

prenatal period -begins with conception -ends with onset of labor

question

*gravida*

answer

woman who is pregannt

question

*gravidity*

answer

pregnancy

question

*primigravida*

answer

woman who is pregnant for the first time p

question

*multigravida*

answer

woman who has had 2 or more pregnancies p(2 /+)

question

*nulligravida*

answer

woman who has never been pregnant p 0

question

*parity*

answer

number of pregnancies (stillborn/alive) after fetus has reached viability p (->v)

question

*primapara*

answer

woman who has completed one pregnancy that has reached the stage of viability p (1->v)

question

*multipara*

answer

woman who has completed two or more pregnancies to viability stage p (2/+ ->v)

question

*nullipara*

answer

woman who has not completed a pregnancy with fetus or fetuses who have reached stage of fetal viability p0 (2/+ ->v)

question

*preterm*

answer

pregnancy 20-37 w

question

*post date / post term*

answer

pregnancy 42 w +

question

*term*

answer

pregnancy 38-42 w

question

GPTAL

answer

Gravidity Term Preterm Abortions (/miscarriages) Living children

question

pregnancy tests

answer

ELISA

question

ELISA

answer

Enzyme- Linked Immuno- Sorbent Assay

question

*presumptive signs of pregnancy*

answer

amenorrhea nausea and vomiting excessive fatigue urinary frequency changes in breasts quickening (indigestion)

question

*amenorrhea*

answer

lack of menstrual cycle

question

nausea and vomiting

answer

morning sickness 2-12 weeks

question

*probable signs of pregnancy*

answer

changes in pelvic organs enlargement of abdomen hyper-pigmentation of skin ballottement positive pregnancy tests goodells sign chadwick's sign hegar's sign

question

*goodell's sign*

answer

soften tip of cervix leukaria

question

*chadwick's sign*

answer

cervix is light blue/violet color vaginal exam (finger = 3 in)

question

*hegar's sign*

answer

soft of lower segment of uterus

question

positive pregnancy tests

answer

clinical pregnancy tests over- the- counter pregnancy tests

question

*ballottement*

answer

push up on cervix - rebound

question

*leukaria*

answer

vaginal discharge white/yellow acidic - acts as a barrier to keep pathogens out and bacterial infections away

question

A & P changes of pregnancy areas

answer

reproductive cardiovascular/circulatory respiratory system renal system GI MS integument endocrine

question

reproductive changes in pregnancy

answer

uterus : a) changes in shape, size, position (prominent) b) changes in contractility (movement) c) uteroplacental BF d) cervical changes e) changes related to the presence of the fetus ((ballottement and quickening)) f) vaginal secretions

question

fun fact: uterus weight

answer

before birth : 2 oz after birth : 2 1/2 lbs

question

cardiovascular and circulatory system changes in pregnancy

answer

^ BF to uterus, placenta and breasts ^ BVol to (RBC and plasma) ^ cardiac output, pressure on BVes ^ HR (10-15 bpm at term) dec BP (lowest in 2nd trimester) dependent edema varicose veins hemorrhoids postural hypotension supine hypotensive syndrome

question

^ BV RBC and plasma

answer

1500 cc/mL (40-50x normal) hypobolemia of pregnancy peaks at 42 weeks

question

respiratory changes in pregnancy

answer

O2 needs ^ (maternal and fetal blood) growing uterus presses on diaphragm (abdominal -> chest breathing) vascular engorgement smooth muscle relaxation chest c avity doesn't return to normal, but diaphragm does nasal stuffines/epitaxis

question

epitaxis

answer

bloddy nose

question

metabolism changes during pregnancy

answer

basal metabolic rate ^ by 10-20 % peripheral vasodilation and acceleration of sweat gland activity water retention -edema

question

renal system changes during pregnancy

answer

^ pressure on bladder e dec bladder capacity ^ renal plasma flow ureters elongate and dilate muscle tone relaxes urinary frequency UTI's hyperemia glycosuria

question

renal system changes during pregnancy UTI's

answer

pooling of fluid urinary stasis

question

hyperemia

answer

blood in urine

question

glycosuria

answer

tubular reabsorption

question

integumentary system changes during pregnancy

answer

^ pigmentation, subcutaneous BF dec connective tissue strength, rate of hair growth linea nigra mask of pregnancy striae varicosities (spider nevi)

question

linea nigra

answer

under belly button skin discoloration fades after birth

question

mask of pregnancy melasma / cholasma

answer

16 w ? 50-70 % of pregnancies red/flush/"glow" around eyes, on cheeks

question

palmar erythema

answer

red palms due to ^ estrogen

question

striae

answer

stretch marks

question

varicosities

answer

varicose veins

question

musculoskeletal system changes during pregnancy

answer

pelvic joints relax lumbar curve accentuates rectus abdominus muscle may separate waddling gait posture changes - lordosis diastasis recti

question

diastasis recti

answer

abdominal muscles separate

question

neurologic changes during pregnancy

answer

compression of pelvic nerves -legs dorsolumbar lordosis -back peripheral edema -carpal tunnel acroesthesia - hand/fingers tension headaches vascular instability - dizziness, hypotension, light headednesss hypocalcaemia -muscle cramp

question

acroesthesia

answer

hand/finger numbness

question

GI system changes during pregnancy

answer

smooth muscles relax displacement of stomach, intestines, liver, appendix nausea and vomitting bloating and constipation heartburn d/t reflux prone to gallstones weight gain itchy skin

question

GI changes during pregnancy smooth muscles relax

answer

delayed gastric emptying dec in paralysis cardiac sphincter relaxes gallbladder empties slower

question

itchy skin during pregnancy (GI)

answer

gallbladder -delay emptying

question

endocrine system changes during pregnancy

answer

^ need for insulin ^ in hCG level, estrogen, progesterone, hPL, relaxin

question

relaxin

answer

joint and back pain hormone

question

immune system changes in pregnancy

answer

maternal immune system becoming tolerant of foreign body (fetus)

question

multifetal pregnancy - twinning

answer

dizygotic monozygotic conjoined

question

dizygotic twins

answer

2 egg, fertilized 2 placentas

question

monozygotic twins

answer

1 identical egg division into 2 embryos - day 8

question

conjoined twins

answer

monozygotic incomplete division day 13-15

question

complications with age

answer

35 ^ fert. drugs

question

underweight pregnancy

answer

BMI < 19.8

question

average weight for pregnancy

answer

BMI 19.8-26.0

question

overweight for pregnancy

answer

BMI 26.1-29

question

obese pregnancy

answer

MBI > 29.0

question

Prenatal weight gain

answer

underweight 28-40 lbs ave 25-35 lbs overweight 15-25 lbs obese 15 lbs

question

maternal obesity ^ risk for medical and pregnancy related complications

answer

spontaneous aboriton (miscarriage) gestational diabetes preeclampsia labor induction prolonged labor cesarean birth poor wound healing

question

preeclampsia

answer

rise in maternal BP

question

NURSING INTERVENTIONS

answer

Acknowledge Discuss Assist Provide Encourage

question

Nursing care during pregnancy prenatal period

answer

-period of physical and psychologic preparation for birth and parent hood -opportunity for nurses and members of HC team to influence family health -healthy women seek care and guidance -health promotion interventions can affect well-being of woman, child and rest of family

question

first trimester

answer

- first day of LMP - 13 completed weeks counseling / fetal dev

question

second trimester

answer

- 14 weeks through 26 completed weeks add breastfeeding consultant

question

third trimester

answer

- 27 weeks through 40 completed weeks childbirth classes

question

determining the estimated date of birth

answer

nagele's rule fundal height quickening fetal heart beat ultrasound

question

nagele's rule

answer

-1st day of LMP - 3 mon and 7 days = EDB -add 7 days to 9 mon -most women give brith from 7 days before to 7 days after EDB

question

EDB

answer

estimated date of birth

question

determining the EDB with fundal height

answer

correlates with weeks of gestation

question

determining the EDB with quickening

answer

20 weeks gestation

question

determing the EDB with fetal heartbeat

answer

8-12 weeks gestation using doppler

question

determing the EDB with ultrasound

answer

fetal sac 5-6 weeks fetal heart activity 6-7 weeks BPD measurements at 12-13 weeks

question

maternal factors affecting adaptation

answer

psychological physical social *pregnancy becomes a part of the mother's identity* 1 accept the pregnancy 2 ID with the mother role 3 reordering personal relationships 4 establishing a relationship with fetus (emotional attachment) 5 preparing for childbirth

question

ADAPTATION TO PREGNANCY 1 acceptance of pregnancy

answer

emotional responses : -emotional lability (instability) -ambivalence (wanted child for a long time)

question

lability

answer

instability

question

ADAPTATION TO PREGNANCY 2 motherhood role

answer

-ID with motherhood role (influenced by how she was mothered) -cultural and social groups acceptance -did they want to become a mother

question

ADAPTATION TO PREGNANCY 3 reordering personal relationships

answer

a) close relationships can change i) mother -availability - rxns - respect for autonomy - willingness to reminisce ii) partner - changes bond - maturing effect - sexual desire / expression may change

question

ADAPTATION TO PREGNANCY 4 establishing a relationship with the fetus and preparing for childbirth

answer

-emotional attachment -fantasize and daydream about baby/motherhood -interaction with fetus HELPS -attends childbirth classes -reads books -imagines and dreams about labor/birth -nesting

question

ADAPTATION TO PREGNANCY 5 paternal adaptation during pregnancy

answer

-accepting the pregnancy (3 phases) -ID with father role - reordering personal relationships - establishing relationship with fetus -preparing for childbirth

question

couvade syndrome

answer

men may experience pregnancy symptoms and discomforts similar to their pregnant partner -nausea -weight gain -abdominal pains -ritual couvade CARES FOR BABY AS MOTHER WOULD

question

developmental tasks of fathers: (AMF)

answer

-announcement phase -moratorium phase -focusing phase

question

prenatal nursing care / preventative care

answer

goal of prenatal care is to promote health and well-being of pregnant woman, the fetus, the newborn and family (as a whole unit) emphasis on preventative care and optimal self care sought out by women of middle or high socioeconomic status

question

prenatal / preventative nursing care

answer

-women in poverty of lacking health insurance may not have access to public or private care -barriers to obtaining prenatal care -effectiveness of home visiting by nursing by pregnancy has been validated

question

women in poverty or lacking health insurance may not have access to public or private care

answer

-lack of culturally sensitive care and communication interferes with access to care -immigrant women may not seek prenatal care -birth outcomes are less positive, with higher rates of maternal and newborn complications -problems with low birth rate and infant mortality associated with inadequate prenatal care

question

barriers to obtaining prenatal care include

answer

-lack of motivation to seek care (not getting it bc don't like the workers, faculty, hours or can't find child care) -inadequate finances -lack of transportation -unpleasant clinic personnel -unpleasant facilities or procedures -inconvenient clinic hours -problems with child care -personal and cultural attitudes

question

effectiveness of home visiting by nurses during pregnancy has been validated

answer

-fewer visits for women at low risk for complications health care assessment education peer support

question

prenatal care initial visit : interview

answer

reason for seeking care (1st child/think are pregnant) current pregnancy childbearing and reproductive history health history history of drug use and herbal preparations family hx social, experienctial and occupational hx history of physical abuse review of systems

question

prenatal care initial visit : physical examination

answer

VS ht, wt, BMI routine physical exam fetal heart sounds pelvic exam (not a lot to reduce risks of pathogens)

question

prenatal care initial visit : laboratory tests

answer

variety of labs throughout pregnancy CBC (learn a lot) H%H (can see if anemic) blood type and Rh factor Rubella titer (German measles) Urinalysis HIV Glucose tolerance

question

prenatal care follow up visits

answer

interview phys exam fetal assessment a) fundal height b) gestational age c) health status d) lab tests i) multiple-marker or triple-screen blood test ii) other blood tests (RPR/VDRL, CBC, anti-Rh) iii) ultrasonography and amniocentesis

question

prenatal collaborative care

answer

edu for self-management -med and herbal prep -immunizations -alcohol, smoke, caffeine, and drugs -normal discomforts -recognizing potential complications -recognizing preterm labor sex counseling -using the hx -countering misinfo -suggesting alternative behaviors psychosocial support everything has the potential to become a teratogen

question

variations in prenatal care

answer

cultural influences -emo response -clothing (modest) -phys activity and rest (excessive amounts of sleep or excercise) -sex activity (prohibited) -nutrition (hot / cold foods) -age differences -multifetal pregnancy

question

culturally competent nursing - prenatal care things to consider with practices, beliefs, culture conflict

answer

*is the practice safe* is it feasible is it important to the woman

question

prenatal care cultural assessmetn

answer

-woman's predominant culture -styles of nonverbal communication (eye contact / touching) -cultural influences about pregnancy and childbirth -cultural prescriptions -how does the culture interpret and respond to experiences of pain

question

age differences - variations in prenatal care

answer

adolescents : less likely to receive adequate prenatal care -don't want people knowing women older than 35 yrs old : multiparous / nulliparous women - ^ risk chromosome abnormality -dec birth weight

question

multifetal pregnancy - variations in prenatal care

answer

-twin pregnancies often end in prematurity -rupture of membranes before term common -congenital malformations twice as common in monozygotic twins as in singletons -no increase in incidence of congenital anomalies in dizygotic twins MULTIFETAL PREGNANCY PROBABILITY INCREASED BY -hx of dizygous twins in female lineage -use of fertility drugs -rapid uterine growth for weeks of gestation -polyhydramnios (lot of fluid) -palpatoins of more small or large parts than expected -asynchronous fetal heartbeats or more than one fetal electrocardiographic tracing -ultrasonographic evidence of more than one fetus

question

childbirth and perinatal education goals

answer

--assist individuals and fam to make informed, safe decisions about childbirth --assist to comprehend the long-lasting effects of an empowering birth experience can have -ideally - begins in preconception period

question

prenatal education classes

answer

adolescent parenting classes breastfeeding programs sibling classes (3-4 yrs) grandparent classes c/section classes

question

CHILDBIRTH AND PERINATAL EDUCATION components of early pregnancy classes

answer

a) early fetal growth and development b) physiologic and emotional changes of pregnancy c) human sexuality d) nutritional needs of the mother and fetus e) env and workplace hazards f) management of discomfort in labor g) relaxation h) breathing techniques i) imagery and visualization j) biofeedback k) pharmacologic interventions (IV med / epidurals)

question

CHILDBIRTH AND PERINATAL EDUCATION perinatal care choices

answer

physicians nurse-midwives (holistic) direct-entry midwives (outside of US) independent midwives (Amish) doulas birth plans -- flexible

question

doulas

answer

person supporting mother emotionally, physically, mentally goes to dr visits with them

question

CHILDBIRTH AND PERINATAL EDUCATION birth setting choices

answer

labor, delivery, recovery, postpartum (birthing) rooms birth centers home birth -factors increasing the safety of birth at home --attendance by a registered midwife --plan in place in need of transfer to a hospital

question

nurse-midwives views

answer

holistic view

question

direct - entry midwife

answer

outside of US

question

independent midwives

answer

not certified d 151 amish

question

announcement phase (development of fathers) 1

answer

1st suspicion and confirmation desired pregnancy,psychological denial

question

moratorium phase (development of fathers) 2

answer

char by man's distance, not involved to work through ambivilance

question

focusing phase (development of fathers) 3

answer

on pregnancy itself and change attitude

question

assessment of high risk pregnancy factors

answer

biophysical psychosocial sociodemographic environmental

question

biophysical risks

answer

genetic disorders nutritional and gen healt status med or obstetric relatedillness (poorly controlled diabetes mellitus and hypertensive disorders)

question

psychosocial risks

answer

disturbed interpersonal relationships emotional distress inadequate social support unsafe cultural practices substance abuse

question

sociodemographic risks

answer

low income lack of prenatal care age parit marital status ethnicit

question

env factors

answer

hazards in teh work place (chemicals, anesthetic gases, radiation) infection drugs env pollutants

question

psychologicalconciderations labl of high-risk preg may result in

answer

increased sense of vulnerability stress r/t dx ambivalence regarding teh pregnancy inability to accomplish the tasks of parenthood fearful for well-being of the mother

question

nurse's role in antepartal tests

answer

to provide info regarding teh test provide comfort reassure the woman and her partner provide psyhological support to woman and her partner document woman's response and the restults of tests (no false reassurance- honest, supportive)

question

daily fetal movement count

answer

average should be 30 movements / hour basic, easy and can be done on own after 28 weeks

question

ultrasonography

answer

-intermittent high frequency sound waves transmitted by alternating current to a transducer -elevates structures/fcns (breathing, cardiac activity, limb movements) -painless, noninvasive, nonradiating -transabdominal/transvaginal aproaches -no significant risks to fetus / mom

question

transabdominal / transvaginal approaches to ultrasonograpy

answer

20-60 min need full bladder transabd. dec risk of infection

question

2 D ultrasonography

answer

-standard, 2 Dim. black white grey standard

question

3 D ultrasonography

answer

-diagnostic and enjoyment purposes -sepia basic

question

4 D ultrasonography

answer

-adds time -images are produced, recorded and played back specialized

question

indications for use of ultrasonography

answer

-confirm pregnancy -fetal heart activity -gestational age -fetal growth -fetal anatomy -fetal genetic disorders and physical anomalies -placental position and function -adjunct to other invasive tests -fetal well being

question

nursing care client prep for an ultrasound

answer

a) explain what will happen b) advise what need to do c) assist / position

question

umbilical artery doppler flow

answer

noninvasive assesses placental perfusion commonly used to assess fetal status in IUGR fetuses no risk factors

question

AFI

answer

amniotic fluid index

question

amniotic fluid index

answer

-based directly on fetal urina production -directly dependent on renal perfusion -measurement of amniotic fluid

question

oligohydramnios

answer

not enough amniotic fluid

question

polyhydramnios

answer

too much amniotic fluid

question

BPP

answer

biophysical profile

question

biophysical profile

answer

ultrasonography -fetal well being a) doppler blood flow analysis b) amniotic fluid volume c) biophysical profile d) modified biophysical profile -nursing role : counseling and educating regarding to procedure (look at movements, breathing, fetal heart tones, heart rate, and amount of amniotic fluid)

question

MRI

answer

used to visualize maternal and or fetal structures very detailed useful for brain and other complex abnormalities no known harmful effects

question

amniocentesis

answer

-amniotic fluid withdrawn from the uterus via a needle inserted through the maternal abdomen -evaluates: chrom. abnorm, Rh sensitization, fetal lung maturity, fetal maturity if early termination of pregnancy needed (done at 14-20 week gestation) *risk miscarriage, infection* prep: take care of any discomfort check CBC lab need full bladder deep breathing excercises RISK PLACENTA RUPTURE/DETATCH/EMBOLISM

question

amniocentesis for fetal lung maturity

answer

-lecithin/sphingomyelin (L/S) ratio 2:1 indicates fetal lung maturity -presence of phosphatidylglycerol (PG) absense of PG is associated with respiratory distress

question

CVS

answer

choronic villi sampling

question

choronic villi sampling

answer

earlier diagnosis and rapid results performed between 10-13w removal of small tissue specimen from fetal portion of placenta (choronic villi originate in zygote- tissue reflects genetic make up of fetus)

question

AFP

answer

alpha-fetoprotein

question

MSAFP

answer

maternal serum alpha-fetoprotein

question

biochemical assessments maternal assays AFP / MSAFP

answer

-maternal blood drawn 16-18 w gestation -^ levels (associate with neural tube defects, anencephaly, gastroschisis or omphalocele) - decrease levels associated with trisomy 21 (down syndrome) -abnormal findings indicate need for further testing

question

biochemical assessment for high risk patients maternal assays

answer

-multiple marker screens -coomb's test -cell free dna in maternal blood (screening for fetal Rh status, gender)

question

biochemical assessment multiple marker screens

answer

- detects chromosomal abnormalities -increased risk for trisomy 21

question

coomb's test

answer

Rh incompatability -detects other antibodies for incompatibility with maternal antigens

question

estriol

answer

protein made by fetus placenta

question

inhibin A

answer

made by ovaries and placenta

question

quad marker screen hormones biochemical assessment for risk

answer

hCG AFP estriol inhibin A

question

NST

answer

Non Stress Test

question

nonstress test for risk pregnancies

answer

-evaluates FHR in relation to fetal movement a) easy to perform b) noninvasive c) inexpensive d) easy to interpret e) can be done in health care provider's office procedure : 2 belts on woman's abdomen (FHR and urine activity)

question

FHR

answer

Fetal Heart Rate

question

reactive NST

answer

2 / + accelerations of 15 beats above baseline and lasting 15 sec or more within 20 min -indicates intact CNS affected by hypoxia -fetuses < 32 (10x10) in 20 min

question

nonreactive NST

answer

indicates need for further testing ; fetus may be sleeping or sick -may use fetal acoustic stimulation test or vibroacoustic test

question

VST (vibration and sound) / FAST (sound) non reactive NST

answer

VibroAcoustic Stimulation test / Fetal Acoustic Stimulation Test

question

CST

answer

Contraction Stress Test

question

Contraction Stress Test

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a way of evaluating placental respiratory fcn (O2 and CO2 exchange) -during contraction, intrauterine pressure is ^ --> blood flow to intervillous space is momentarily dec --> dec Ox transport to fetus

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healthy fetus tolerates decrease of blood supply during CST

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by maintaining a steady heart rate if insufficient : -fetal hypoxia -depression of myocardium -decrease in FHR need uterine contractions (spontaneous or stim) -stim by oxytocin or breast self stim (20 min recording of uterine activity and FHR)

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CST interpretation negative

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shows 3 contractions lasting 40 or more seconds in 10 min w/o decelerations (( GOOD ))

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CST interpretation positive

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shows persistent/repetitive late decelerations with more than 50% of the contraction (( BAD )) --- if there is a + non reactive non stress test -- the fetus will not likely stand the stress of labor (BPP to verify)

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nursing role in antepartal assessment for risk pregnancies

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-education -support system -assist physician with procedures -performs non-stress tests, contraction stress tests, BPPs -initial assessment

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tests of fetal status and fetal well being

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-daily fetal movement count (kick counts) -NonStress Test -VibroAcoustic Stimulation -Contraction Stress Test -amniotic fluid index -Biophysical profile

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high risk pre-existing conditions

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metabolic disorders cardiovascular disorders respiratory, GI, integumentary and CNS disorders autoimmune disorders substance abuse

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preexisting metabolic disorders

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diabetes mellitus thyroid disorders

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diabetes mellitus

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most common endocrine disorder associated with pregnancy - 4-14 % -pregnancy complicated by diabetes considered high risk -diabetes can be successfully managed with a multidisciplinary approach -key to an optimal outcome is strict maternal glucose control (go to an endocrinologist or natalist-- 1 out of every 3 people) - metabolic changes associated with pregnancy -progestational diabetes mellitus a) occurs in women who have pre-existing diseases (vascular disease)

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diabetes mellitus pathogenesis

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-group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action or both -diabetes may be caused by either or both a) impaired insulin secretion b) inadequate insulin action in target issues

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diabetes mellitus classifications type 1

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-autoimmunity of beta cells in pancreas -absolute insulin deficiency (no insulin) -managed with insulin

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diabetes mellitus type 2

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-Insulin resistance and inadequate insulin production (most common) -most common form -rates are increasing *linked to increasing rates of obesity* -managed with diet, exercise and generally oral glycemic meds (insulin)

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pregestational diabetes mellitus

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-occurs in women who have pre-existing disease -can have significant implications

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maternal insulin in diabetes mellitus

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-does not cross placenta -by 12 weeks fetus makes own insulin -doesn't lower their blood glucose level (whatever mom has the baby sucks up)

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diabetes mellitus 1st trimester

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fetus draws large amounts of glucose for control -maternal need goes way down (may not even need insulin)

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diabetes mellitus 2nd trimester

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hPL and other hormones secreted by the placenta have insulin effect -after 18th week the need for insulin will increase

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maternal risks for pregestational diabetes

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-HTN, preeclampsia -preterm labor -spontaneous abortion (hypertension) -polyhydramanioa / oligohydramnios -c section -infection -hypoglycemia / hyperglycemia -induction of labor

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neonatal risks for pregestational diabetes

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-hypoglycemia -hypoglycalemia/hypomegnesmia -IUGR (not growing as they should be ) -RDS -polycythemia (red/ruddy) -hyperbilirubinemia -prematurity -congenital defects (baby could have cardiac defect at risk --> stillborn) -cardiomyopathy -macrosomia (big babies, lots of glucose) -stillbirth

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maternal diabetes management

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screening labs antepartal management of DM a) DM edu / consult b)dietary reulation -dietary consult c) glucose monitoring d) insulin administration

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fetus diabetes management

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fetal eval -AFP -Ultrasounds a) BPP -NSTs

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intrapartal diabetes management

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timing of birth a) spontaneous birth -sometimes induction b) c section if non reassuring fetal status -macrosomia labor management a) diabetes protocol -maintaining maternal glucose levels -IV

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postpartal diabetes management

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generally maternal insulin requirements fall significantly a) sometimes followed by sliding scale first 24 hrs postpartum antihyperglycemics contraindicated during breastfeeding GDM -seldom need insulin postpartum

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thyroid disorders high risk prenatal

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hyperthyroidism -graves disease 90-95% of cases -rarre in pregnancy *heat loses, fatigue and irritability* hypothyroidism -if untreated at risk for infertility and miscarriage

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maternal phynylketonuria

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1) recognized cause of mental retardation c aused by deficiency in enzyme phynylalanine hydrolase 2) toxic accumulation of phenylalanine in blood interferes with brain dev and fcn 3) key to prevention is ID of women with disorder in their repro years 4) should be advised against breastfeeding

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high risk preg cardiovascular disorders

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major cardiovascular changes during pregnancy with or without cardiac disease are : a) increased intravascular volume b) decreased systematic vascular resistance c) cardiac output changes during labor and birth d) intravascular volume changes that occur just after child birth

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cardiovascular disorders high risk pregnancies classification

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a) class 1 : asymptomatic without limitation of physical activity b) class 2 : asymptomatic with slight limitation of activity (know what mom can/cant do) c) class 3 : symptomatic with marked limitation of activity d) class 4 : symptomatic with inability to carry on any physical activity without discomfort (neonate at risk with cardiac)

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antepartum assessment for high risk preg

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listen to heart

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plan of care and implementation of high risk preg

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-therapy focused on minimizing stress on heart -signs and symptoms of cardiac decompensation (if issue causes bleeding, decrease the stress on heart) -bed rest (deconditioning anticoagulant) -nutrition counseling -cardiac meds prn

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iron deficiency anemia risk factors

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-less than 2 years between preg -heavy menses -diet low in iron -multifetal gestation -vomiting frequently due to morning sickness

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iron deficiency anemia expected finding s

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-fatigue and weakness -irritability -headache -feeling dizzy or light headed -shortness of breath with exertion -palpations -craving unusual foods -pallor -brittle nails -shortness of breath

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iron deficiency anemia lab results

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Hemoglobin less than 11 mg/dL in the first and third trimester less than 10.5 mg/dL in the second semester hematocrit (Hct) less than 30%

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medications for iron deficiency anemia

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ferrous sulfate iron supplements

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folic acid deficiency anemia

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in dark green leafies, eggs, legumes, citrus fruits a) folic acid supplement helps prevent spinobifida

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pulmonary disorders

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asthma cystic fibrosis

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high risk pregnancies pulmonary disorders : asthma (b/c diaphragm is pushed up)

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-exacerbations and remissions -hyperactive airways -effective preg unpredictable a) at ^ risk for postpartum hemorrhage

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high risk pregnancies pulmonary disorders : cystic fibrosis

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-exocrine glands produce excessive viscous secretions -problems with respiratory and digestive systems -infants of mothers with cystic fibrosis will be carriers of genes -with severe disease, pregnancy is often complicated by chronic hypoxia and frequent pulmonary infections

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integumentary disorders induced by pregnancy

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-malama (cholasma) -vascular "spiders" -palmar erythema -straie gravidarum

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melisma (cloasma)

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glow mask

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vacular spiders

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varicose veins

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palmar erythema

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red hands

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straie gravidarum

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line

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skin problems aggravated by preg

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-acne vulgaris (in first trimester) -neurofibromatosis (von Recklinghausen disease) -prurtic urticarial papules and plaques -intra hepatic cholestasis

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High risk pregnancies Neurological disorders

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Epilepsy MS Bell palsy

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Epilepsy High risk pregnancies

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Failure to take med is a common factors -should receive preconceptual counseling -at risk of congenital anomalies I mother is taking anticonvulsant

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MS High risk pregnancies

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Bed rest send steroids to treat acute exacerbations r

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Bell palsy High risk pregnancies

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Acute facial paralysis

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Autoimmune disorders Systemic lupus erythematosus

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-autoimmune antibody productin affects skin, joints, kid, lungs, CNS, liver and other body organs - immunosuppressive Meds not recommended during pregnancy -efforts are aimed at reducing the risk of infections

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Myasthenia Gravis MG Autoimmune disorders

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Autoimmune motor (muscle) endpapers disorder -muscle weakness in the eyes, face, neck, limbs, and respiratory muscles -women with MG normally tolerate labor well - may require forceps or cavuum delivery (can't ouch baby on own)

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High risk pregnancies substance abuse

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-the car tinted use of substances despite tested problems in ohysical, social, or interpersonal areas - dual diagnosis A) substance abuse plus another psychiatric disorder -damaging effects on the fetus are well documented -barriers to treatment A) women fear losing custody of child a criminal prosecution. (Urine test) B) less than 10% of preg women receive treatment C) substance abuse treatment programs designed not address issues affecting pregnant women D) long waiting lists and lack of health insuring present further barriers to treatment

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High risk pregnancies Care management for substance abuse

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-breastfeeding (contraindicated) - substance abusers difficult to care for partially during intra part um and postpartum periods -substance abuse is an illness; women deserve to be treated with patience, kindness, consistency and firmness -before discharge A) home situation must be assessed for safe environment B) someone available to meet infants needs if mother is unavailable C) fam members or friends should become actively involved with mother before discharge -if infants wellbeing is questionable case will be referred to cps

Fundamentals of Nursing Maternity day one full lecture notes – Flashcards

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