exam 1 Flashcards
Four goals when providing care for infertility
Provide couple with accurate information
Assist in identifying cause
Provide emotional support
Guide and educate about treatment options
What classifies someone as infertile
If under 35 and have unsuccessfully been trying for 1 year
If over 35 and unsuccessfully been trying for 6 months
What can increase chance of infertility
obesity and hypothyroidism
Semen analysis
Gold standard test for men
Assess ability of sperm to move around and number of sperm ejaculated
Hormone analysis for men
Must abstain from sex for 2-3 days prior
Clomiphene/Clomid
Increase release of the egg
Increase chance of multiple fetuses
When taken with Metformin increases effectiveness
In vitro fertilization- embryo transfer
Woman’s eggs collected from ovaries, fertilized in lab and transferred to uterus
Gamete intrafallopian transfer (GIFT)
Oocytes retrieved from ovary, placed in catheter with washed sperm and transferred to end of uterine tube.
Fertilization occurs in uterine tube.
Therapeutic donor insemination (TDI)
Donor sperm used for inseminate female
Intracytoplasmic sperm injection
One sperm cell is injected directly into egg used with IVF
Cryopreservation of human embryos
Can freeze embryos and still be viable many years later
Contraception
Intentional prevention of pregnancy
May still be at risk for pregnancy
Peak fertility days
days 8-19
1 week before and 24 hours after ovulation
Coitus interruptus
withdrawal/pullout method
Fertility awareness methods (FAMs)
rely on avoidance of intercourse during fertile periods
Calendar method
11 days from longest cycle
18 days from shortest cycle
longest is 34 days - 11 = 23
shortest is 28 days - 18 = 10
need to be careful during days 10-23
Cervical mucus ovulation detection method
Cervical mucus will change
Prior to ovulation discharge is egg white and stretchy, then becomes watery, followed by thicker mucus that would accompany a pregnancy
Breastfeeding and contraception
inhibits estrogen levels and prevents ovulation, causes dry vaginal canal
Should prevent pregnancy for at least 6 months
Diaphragm
Barrier method
reusable.
Clean after each use.
Check for proper fit after pregnancy or weight changes
Cervical cap
Barrier method
More of a one size fits all diaphragm
Contraceptive sponge
Barrier method
Can be left in 24 hours but longer increase risk for toxic shock syndrome
Condoms
Petroleum jelly can cause condom to break
Hormonal methods
increase risk for cerebrovascular and vascular issues
Increase risk of DVT (increase when over 35 and smokers)
Progestin-only contraceptives
mini pill, injectables, implantable- Nexplinon)
Used for postpartum
Shot good for 3 months
Emergency contraceptives
Used within 72 hours
Plan B most readily available- increase progesterone- blocks ovulation
Copper IUD- need in provider office within 100 hours of intercourse
Emergency contraceptives
Used within 72 hours
Plan B most readily available- increase progesterone- blocks ovulation
Copper IUD- need in provider office within 100 hours of intercourse
IUDs
Small T shaped device inserted into uterus
Mirena loaded with pregestational agent
Copper is only nonhormonal IUD
Common complications with abortion
infection
retained products of conception
excessive vaginal bleeding
Gravidity
of pregnancies
Gravida
Woman who is pregnant
Nulligravida
Woman who has never been pregnant
Primigravida
Woman pregnant for the first time
Multigravida
Woman who has had 2 or more prgnancies
Parity
of pregnancies that reached 20 weeks
Nullipara
Woman who has not completed a pregnancy that reached 20 weeks
Primipara
Woman who has had 1 pregnancy reach 20 weeks
Multipara
Woman who has had 2 or more pregnancies reach 20 weeks
Preterm
20 weeks to 36 weeks 6 days
Early preterm
20 weeks to 33 weeks 6 days
Late preterm
34 weeks to 36 weeks 6 days
Early term
37 weeks to 38 weeks 6 days
Full term
39 weeks to 40 weeks 6 days
Late term
41 weeks to 41 weeks 6 days
Post term
42 weeks and beyond
Viability
Capacity to live outside uterus
22 weeks to 25 weeks
Two digit summarizing obstetric hx
GP
gravida para
Five digit summarizing obstetric hx
GTPAL
Gravidity, term, preterm, abortion, living children
hCG
Earliest biochemical marker of pregnancy
Can be detected as early as 7 to 8 days after ovulation
ELISA
Basis for most OTC home pregnancy test
Medication use, hormone-based tumors, or improper collection cause inaccurate results
Signs of pregnancy
Presumptive- changes felt by the woman
Probable- changes observed by examiner
Positive- attributed only by presence of fetus (heart tones, US, movement)
Factors affecting labor
Five P’s
Passenger (fetus and placenta
Passageway (birth canal)
Powers (contractions)
Position of mother
Psychologic response
Elements about passenger that affect birth
Size of fetal head
Fetal presentation
Fetal lie
Fetal attitude
Fetal position
Molding
bones shift to fit through birth canal
Fontanels
Soft spots
Triangle- anterior
Circle- posterior
Bulging fontanels could indicate increase intracranial pressure
Vertex or cephalic
Head down
Breech
Head up
Transverse
side to side
Occipitoanterior
Fetus has neck flexed and the occiput of head is facing anterior aspect of pelvis
Also called OA, can be right or left
Occipitoposterior
Fetus neck extended and occiput is facing posterior pelvis.
Also called OP or sunny side up
Takes longer to deliver and cause more back pain
Frank breech
Sacrum presenting and legs are straight up by head
Complete breech
Sacrum and feet presenting
Single footling breech
1 leg is extended down
Vertex presentation
Chin all the way to chest
Presents smallest part of head
Most ideal
Sinciput presentation
Chin tucked some
Military position
Brow presentation
Neck flexed
Delays labor and delivery is more difficult
Fully engaged or zero station
baby head positioned at ischial spine
Start actively pushing at what station
+1 or +2
Station of crowning
+5
Gyneocoid pelvis
most desired
More traditional size pelvis
Cephalopelvis disproportion
Pelvis is too small for larger size of head
Powers
Primary powers (uterus contractions)
Secondary powers (maternal efforts- can be affected by epidural, fatigue, and lack of glucose)
Position of laboring woman
Widen the pelvis and relax muscles
If baby in OP place mom on hands and knees in hope to turn the baby
Effacement
Thinning of cervix
Fingertip length is no thinning
0-100%
Dilation
0-10
10 can not feel any cervix
Labor
Process of moving fetus, placenta and membranes out of uterus and through birth canal
Signs preceding labor
lightening or dropping
bloody show
braxton hicks
mucus plug
nesting
diarrhea
water break- true sign of labor
Stages of labor
1st stage- onset of contractions to full dilation
2nd stage- full dilation to birth
3rd stage- birth of fetus to delivery of placenta
4th stage- 2 hours post delivery of placenta (recovery)
7 cardinal movements of labor
engagement
descent
flexion
internal rotation
extension
restitution (external rotation)
expulsion (birth)
Normal fetal HR
110-160
Nursing care focus during labor and birth
assessment
support
best possible outcome
Role is mostly assessment
First stage of labor
Begins with onset of regular uterine contractions
Ends with full effacement and dilation
Three stages of the first stage of labor
Latent phase
Active phase
Transition phase
Latent phase
first stage of labor
Up to 3 cm
Longest phase
Cervix is thinning and dilating
Mothers alter/happy/anxious
Active phase
first stage of labor
4 to 7 cm
Stronger and closer contractions
Mothers can only answer questions between contractions
Transition phase
first stage of labor
8 to 10 cm
Hardest spot of labor
Contractions are strongest and longest
Mothers less interactive
True labor
Must have cervical change, rupture of membranes, stronger and closer contractions, back contractions
False labor
Contractions irregular and do not get stronger or closer together, braxton hicks, 1 sided contractions
EMTALA
Emergency medical treatment and active labor act
Ensures women receive emergency treatment or labor care
Must check every woman who comes in to make sure they are not in labor
Prenatal data
assessment
Due dates
Blood type
Any titers they have done
Anatomy scan
Low or high risk pregnancy
Admission data
assessment
Update all questions and info
Ensure all info is correct
# of pregnancies
Psychosocial factors
assessment
Exposure to smoking
Use of drugs
Abuse hx
Labor plan
assessment
Epidural
Support team
How they react to pain
Comfort measure preference
Cultural factors
assessment
Any ritual or practices
Need for translator
Physical exam
assessment
Head to tie
Fetal heart tones (should be below belly button)
VS (closely watch BP)
Leopold maneuver (find fetal position)
Vaginal exam (cervix, discharge, leaking fluids)
Contraction duration
How long takes to reach peak then go back to normal
Frequency of contraction
Start of one contraction to start of another
Amniotic fluid
Should be clear and odorless
Yellow- infection
Green- baby had BM in womb
Second stage of labor
Infant is born
Begins with full dilation and effacement
Ends with baby’s birth
Usually 3 hours for first time moms and 2 hours for second time moms
Two phases of second stage of labor
Latent phase- laboring down. allowing contractions to move baby down birth canal
Descent phase- Active pushing and urge to bear down. baby’s head is molding
Supplies needed for second stage of labor
2 clamps
suction bulb
scissors
blanket
placenta bucket
sterile gloves
towels
gauze
gown
Crowning
largest part of head is through
Episiotomy
purposeful cuts to allow extra room
1st degree- through first layer of skin
2nd degree- extend through muscle of peritoneum
3rd degree- extend through anal sphincter
4th degree- extend through rectal mucous. Rectum exposed to vagina
Third stage of labor
Baby has been born, waiting on placenta
Umbilical cord will change color
Once placenta releases will be gush of blood, pt then gibes small push
Fourth stage of labor
VS and fundal massage every 15 minutes for first 2 hours
VS and assessment on baby every 30 minutes
Skin to skin!!!
Trimesters
First- week 1 through 13
Second- week 14 through 26
Third- week 27 through 40
Nagele rule
Determine first day of LMP subtract 3 months add 7 days plus 1 year
Alternatively add 7 days to LMP and count forward 9 months
Maternal adaptations of pregnancy
Accepting the pregnancy
Identifying with mother role
Reordering personal relationships
Establishing relationship with fetus
Preparing for childbirth
Paternal adaptations of pregnancy
Accepting the pregnancy
Identifying with father role
Reordering personal relationship
Establishing relationship with fetus
Preparing for childbirth
Barriers to obtaining prenatal care
Lack of motivation to seek care
Inadequate finances
Lack of transportation
Inconvenient clinical hours
Problems with child care
Initial Prenatal visit
Reason for seeking care
Current pregnancy
Obstetric and gynecologic hx
Health hx
Nutrition hx
drug use and herbal preparations
Family hx
Mental health screening
Intimate partner violence
Physical exam
Lab test
Follow-up prenatal visits
Physical exam
Fetal assessment- fundal height, fetal heart tones, gestational age, health status
Clean catch urine
Group B strep test between 35 and 37 weeks
Components of early pregnancy classes
Early fetal growth and development
Physiologic and emotional changes of pregnancy
Human sexuality
Nutritional needs
Environmental and workplace hazards
Components of late pregnancy classes
Management of discomfort in labor
Relaxation
Breathing techniques
Imagery and visualization
IV meds and epidurals
Nutrient needs before conception
Healthful diet before conception ensures adequate nutrients are available for developing fetus
Folate or folic acid intake is important
Factors that contribute to increase in nutrient need during pregnancy
Development of uterine-placental-fetal unit
Increase maternal blood volume and constituents
Maternal mammary development
Increased metabolic rate
Nutrition issues during pregnancy
Alcohol
Caffeine
Artificial sweeteners
PICA
Food cravings
Adolescent pregnancy needs
Nurses work to-
Improve nutritional health by focusing on knowledge and planning of meals
Promote access to prenatal care
Develop nutrition interventions and educational programs effective with adolescents
Understand factors that create barriers to change in adolescent population
Preeclampsia
Cause still unknown
Speculation that poor intake of specific nutrients may be contributing factor
Adequate diet best means of prevention
Physical activity during pregnancy
Moderate exercise improves muscle tone, shortening course of labor
Liberal amounts of fluid before, during and after
Sufficient calorie intake for pregnancy and exercise
Nutrient needs during lactation
Similar to during pregnancy
Calorie intake increase of 330 kcal
Increase maternal weight loss during lactation
Smoking, alcohol, and excessive caffeine should be avoided
Nutrition care and teaching
Components of adequate diet
Individualizing diet related to needs, culture, finances
Coping with nutritional-related discomforts
Use nutrition supplements appropriately
Consult or refer to other professional
