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HESI - OB > Anatomy and physiologic changes during pregnancy > Flashcards

Anatomy and physiologic changes during pregnancy Flashcards

1
Q

Normal cycle is how many days in length?

A

21 - 45

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2
Q

Mean age for menarche in the U.S.?

A

12.87 y/o

Or 1-3 years after breast budding

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3
Q

4 Phases of menstrual cycle?

A

Menstrual phase
Proliferation (follicular) phase
Secretory (luteal) phase
Ischemic phase

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4
Q

Menstrual phase is day ___ to ___ of cycle?

Characteristics?

A

Days1 to 5

Shedding of endometrium (uterine bleeding)

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5
Q

Proliferation (follicular) phase is day ___ to ____?

Characteristics?

A

Day 5 to ovulation

Endometrium is restored under primary hormone influence of estrogen.
FSH is secreted by the anterior pituitary
Preovulatory surge of LH converts the follicle to a corpus luteum, which produces progesterone

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6
Q

Occurs from ovulation to approx 3 days before menstrual cycle?

A

Secretory (luteal) phase

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7
Q

Estrogen levels off during the _____ phase?

A

Secretory

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8
Q

Progesterone levels increase during the ____ phase?

A

Secretory

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9
Q

Occurs approx 3 days before menstruation to onset of menstruation?

A

Ischemic phase

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10
Q

Ovulation occurs ____ ___before the next menstrual cycle.

A

14 days

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11
Q

Sperm live approx how long?

Eggs live about?

A

SPERM: 3 days (48-72 hr)
EGGS: 24 hr

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12
Q

When MUST a couple avoid unprotected sex to PREVENT pregnancy?

A

Several days before the anticipated ovulation and for 3 days after ovulation

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13
Q

When would a slight drop in temp occurs be expected?

A

1 day prior to ovulation

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14
Q

A rise of 0.5 to 1 F in temp is expected to occur when?

A

At ovulation

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15
Q

How long does temp remain elevated during ovulation?

A

10-12 days

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16
Q

Which characteristics of cervical mucus indicate ovulation?

A

Abundant, watery, clear, and more alkaline

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17
Q

Which characteristics of cervical os indicate ovulation?

A

Cervical os dilates slightly, softens, and rises in the vagina

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18
Q

What is spinnbarkeit?

A

Egg-white stretchiness of cervical mucus

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19
Q

When is spinnbarkeit present?

A

Ovulation

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20
Q

If ______ is seen under microscope, it indicates ovulation?

A

Ferning

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21
Q

Indications of ovulation?

A
  1. Slight drop in temp 1 day prior to ovulation. Rise of 0.5 to 1 F in temp at ovulation ,Temp remains elevated for approx 10-12 days.
  2. Cervical mucus is abundant, watery, clear, and more alkaline.
  3. Cervical os dilates slightly, softens, and rises in the vagina.
  4. Spinnbarkeit (egg-white stretchiness of cervical mucus) is present.
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22
Q

Conditions for fertilization?

A
  1. Postcoital test demonstrates live, motile, normal sperm present in cervical mucus.
  2. Fallopian tubes are patent.
  3. Endometrial BX indicates adequate progesterone and secretory endometrium
  4. Semen is supportive to pregnancy: 2 mL semen; at least 20 million sperm/mL; >60% are normal; and >50% are motile.
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23
Q

____ mL of semen must be present to support pregnancy, with at least _____ sperm/mL; with ___% normal; and ___% motile.

A

20 mL
20 million
>60 %
>50%

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24
Q

Where does fertilization take place?

A

In ampulla (outer third section of fallopian tube

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25
Q

How long does the zygote (fertilized ovum) take to enter the uterus?

A

3 to 4 days

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26
Q

How long does it take to complete the process of nidation (implantation)?

A

7 to 10 days

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27
Q

When does the zygote develop in the fetal development process?

A

12 to 14 days after fertilization

From the time the ovum is fertilized until it is implanted in the uterus

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28
Q

When does the embryo develop?

A

3 to 8 wks after fertilization

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29
Q

The embry is most vulnerable to _______ which can cause major congenital anomalies?

A

Teratogens (viruses, drugs, radiation, or infections)

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30
Q

When does the fetus develop?

A

9 weeks after fertilization to term (38+ wks)

31
Q

Major congenital anomalies from teratogens occur from ____ to _____ weeks of development?

A

3 to 8 (embryonic period)

32
Q

Functional defects and minor anomalies from teratogens occur from ____ to ____ weeks of development?

A

9 to 38 (fetal period_

33
Q

LMP

A

280 days
40 wks
10 lunar months (perfect 28 days mos)
9 calendar months

34
Q

Trimesters (length of each one)

A

FIRST: 1st day of LMP - 13 wks
Second: 14 - 26 weeks
Third: 27 - 40 wks

35
Q

8 weeks gestation - Fetal development

A 
Fetal development:
Rapid
Heart begins pumping
Limp buds well developed
Facial features discernible
Major divisions of brain discernible
Ears develop from skin folds
Tiny muscles formed beneath skin embryo
Wt = 2g
36
Q

What is the approx wt of an 8 wk old embryo?

A

2 g

37
Q

Maternal changes at 8 weeks gestation?

A 
Nausea for up to 12 wk
Uterus changes from pear to globular shape
Hegar sign occurs
Goodell sign occurs
Cervical flexes
leucorrhea increases
Ambivalence about pregnancy may occur.
There is no noticeable Wt gain
Chadwick sign appears as early as 4 weeks
38
Q

What is Hegar sign?When does it occur?

A

Softening of isthmus of cervix

8 wks gestation

39
Q

What is Goodell sign?When does it occur?

A

Softening of cervix

8 wks gestation

40
Q

What is Chadwick sign?When does it occur?

A

Bluing of vagina

As early as 4 weeks

41
Q

8 weeks gestation nursing interventions

A

Teach prevention of nausea
Teach safety
Prepare client for pregnancy

42
Q

What should you teach to prevent nausea in the woman at 8 wks gestation?

A

Eat dry crackers before getting out of bed in the a.m
Eat small, freq meals
Avoid fatty foods
Avoid skipping meals

43
Q

Safety education for women at 8 wks gestation includes?

A

Avoid hot tubs, saunas, and steam rooms throughout pregnancy

44
Q

Why are woman advised to avoid hot tubs, saunas, and steam rooms throughout pregnancy?

A

Increases risk for NTDs in first trimester; Hypotension may cause fainting.

45
Q

At 8 wks gestation how will you prepare the client for pregnancy?

A

Discuss attitudes toward pregnancy
Discuss value of early pregnancy classes
Provide info about child birth prep classes
Include father and family in prep for childbirth

46
Q

Fetal development at 12 weeks gestation?

A 
Embryo becomes fetus
Heart is discernible by U/SLower body develops
Sex is discernible
Kidneys produce urine
Fetus weighs 19-28 g (<1 oz)
47
Q

How much does a fetus way at 12 wks gestation?

A

19-28 g (<1 oz)

48
Q

Maternal changes at 12 wks gestation?

A

Uterus rises above pelvic brim
Braxton Hicks contractions are possible (continue throughout pregnancy)
Potential for UTI increases (exists threw preg)
Wt. gain is 2-4 Lb during first trimester
Placenta is fully functioning & producing hormones

49
Q

12 weeks gestation - Nursing interventions?

A

Teach UTI prevention
Discuss nutrition and exercise
Discuss possible effects of pregnancy on sexual relationship.
Recognize father’s role as he labors to incorporate the parental role into his self identity.

50
Q

How much should a woman increase caloric intake when at 12 wks gestation?

A

300 cals/day

51
Q

Fetal development at 16 wks gestation?

A

Head still dominant
Face looks like human Arm/leg ratio proportionateScalp hairMeconium in bowel, anus openMost bones and joint cavities seen on U/SMuscular mvmts detectedHeart well developedBlood formation active in spleenElastic fibers appear in lungs and terminal; bronichioles appearKidneys in positionCerebral lobes delineated, and cerebellum assumes prominenceGeneral sense organs differentiatedTestes in pos for descent into scrotum/vagina open

52
Q

Maternal changes at 16 wks gestation?

A

Quickening may be noted from 16-20 wks gestColostrum from nipples possible Cholesterol increases from 16-32 wksPlacenta clearly defined by 14-16 wksInsulin resistance begins 14-16 wks of gest and continues to rise until last few wks of pregnancyApprox Wt gain of 1 lb./wk beginning in second trimester and continuing until delivery.

53
Q

Nursing interventions for the client at 16 wks gestation?

A

Explain screeining test and obtain blood sample for MSAFP b/w 15-22 wks of gestationExpalin the multiple marker, or triple screen, blood test, and obtain a specimen for screeinnig b/w 16-18 wks of gestation to measure the MSAFP, hCG, aand unconjugated estriol

54
Q

Elevated MSAFP levels are assoc with?

A

NTDsMultiple gestations

55
Q

Low MSAFP levels are assoc with?

A

Down syndrome

56
Q

Fetal development at 20 weeks?

A

Vernix protects bodylanugo covers body and protects bodyeyebrows, eyelashes, and head hair developfetus sleeps, sucks, kicksWeight 200-400 g (11-14 oz)

57
Q

Fetal Wt at 8 weeks gestation?

A

2 grams

58
Q

Fetal Wt at 12 weeks gestation?

A

19-28 g (< 1 oz)

59
Q

Fetal Wt at 32 weeks gestation?

A

1800-2200 g (4-5 lb)

60
Q

Fetal Wt at 36-40 wks gestation?

A

3200 g (7+ Lb.)

61
Q

Maternal changes - 20 wks gestation?

A

Fundus reaches umbilicusBreasts begin secreting colostrum; areolae darkenAmniotic sac holds approx 400 mL fluidPostural hypotensionQuickening becomes “real”Possible S/S: Nasal stuffiness Leg cramps Varicose veins Constipation

62
Q

Nursing interventions - 20 wks gestation?

A

Comfort measures Remain active Sit w/feet elevated Avoid pressure on lower thighs Use support stockings Dorsiflex foot to relieve leg cramps Cool-air vaporizer/NS nasal spray for stuffinessAvoid Constipation Eat raw fruits, veg’s, bran cereal Drink 3 L fluids/day Exercise frequently

63
Q

Fetal development - 24 weeks gestation

A

Body well proportions; skin red and wrinkledSweat glands formingBlood formation ^ in BM & decreases in liverAlveolar ducts/sacs presentLecithin in amniotic fluid (wks 26-27)Neuronal proliferation in cerebral cortex ends.Can hearTestes at inguinal ring in descent to scrotum

64
Q

Maternal changes - 24 weeks gestation

A

Uterus rises to umbilicusDBP gradually ^ at 24-32 wksSBP remains same as prepregnancy level

65
Q

Nursing interventions - 24 wks gestation?

A

Explain and obtain a blood sample for a glucose challenge that is usually done b/w 24-28 wks gestation.At 24-32 wks gestation, 2-3 U/S measurements may be taken 2 wks apart to compare against standard fetal growth curves.

66
Q

Fetal development at 28 weeks gestation

A

Can breathe, swallow, and regulate temperatureSurfactant forms in lungsCan hearEyelids openPeriod of greatest fetal wt gain beginsFetus weights 1100 g (2.5 lb)

67
Q

Maternal changes at 28 weeks gestation

A

Fundus hallway b/w umbilicus and xiphoidThoracic breathing replaces abd breathingFetal outline palpableWoman become more introspective Heartburn may beginHemorrhoids may develop

68
Q

28 weeks gestation - Nursing interventions

A

Teach TX of hemorrhoids - sitz, topical anesthetics, stool softenersTeach comfort measures - elevate legs when sitting, assume side lying position when resting.Teach measures to avoid heartburn Prepare woman for delivery/parenthood

69
Q

Fetal development at 32 weeks gestation

A

Brown fat deposits dev beneath skin15-17 inches in lengthBegins storing iron, Ca, & phosphorusWeighs 1800-2200 g (4-5 lb)

70
Q

Maternal changes at 32 weeks gestation

A

Fundus reaches xiphoidsBreast full, tenderUrinary freq returnsSwollen ankles may occurSleeping problems may developDyspnea may develop

71
Q

32 weeks gestation - Nursing interventions

A

Teach measures to decrease edemaTeach comfort measures: wear well-fitting supportive bra. use semi-fowler position at night for dyspnea.Prepare woman for childbirth.

72
Q

Fetal development at 36-40 wks gestation

A

Fetus occupies entire uterus; activity restrictedMaternal antibodies transferred to fetus L/S ratio is 2:1 and phosphatidylglycerol is presentFetus weighs 3200 g (7 lb+)

73
Q

Maternal changes at 36-40 wks gestation

A

Lightening occursPlacenta weighs approx 20 oz.Mother is eager for birth, may have energy burstBackaches increaseUrinary freq increasesBraxton Hicks contractions intensify (cervix and lower uterine segment prepare for pregnancy)

74
Q

36-40 wks gestation - Nursing interventions

A

Teach safety measures -wear low heeled shoes/flats -NO heavy lifting -sleep on side to relieve bladder pressureEncourage preparation for delivery -KEGAL exercises -encourage packing suitcase -Encourage couple to tour L&D -Discuss PP circumstances: circumcision, rooming-in, possibility of PP blues, birth control, need for adequate rest, father’s role

HESI - OB (3 decks)

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