Exam 1 Flashcards
Gonadal hormones
Estrogen, progesterone, testosterone
Menstrual cycle is mediated through which structures of the body
Hypothalamus, anterior pituitary gland, ovaries
What gland is responsible for stimulating the anterior pituitary gland to produce gonadotropin
Hypothalamus
What gland is responsible for stimulating the anterior pituitary gland to produce gonadotropin
Hypothalamus
Follicle-stimulating hormone
released by anterior pituitary gland
Function of FSH
stimulates growth and development of the Graafian follicle-which secretes estrogen
What hormone does the Graafian follicle secrete
estrogen
When does the anterior pituitary gland secrete luteinizing hormone (LH) and what does it stimulate?
It secretes LH before ovulation to stimulate the development of the corpus luteum
When does the anterior pituitary gland secrete luteinizing hormone (LH) and what does it stimulate?
It secretes LH after ovulation to stimulate the development of the corpus luteum
What hormone is responsible for maintaining pregnancy
Progesterone
Where is progesterone secreted from
Corpus luteum
What happens to the levels of estrogen and progesterone when pregnancy does not occur
They decline because the corpus luteum degenerates
What happens as a result of decreased levels of estrogen and progesterone
The uterus sheds its lining (period)
What is estrogen responsible for
development of secondary sex characteristics and deposition of fat in the buttocks and mon pubis
What does estrogen help regulate
Menstrual cycle by stimulating proliferation of the endometrial lining in preparation for pregnancy
What is the role of progesterone
Regulates menstrual cycle by decreasing uterine motility and contractility (which is caused by estrogen)
-“prolife” hormone because it helps pregnancy remain viable
-readies breasts for lactation
Where is human chorionic gonadotropin (hCG) produced
trophoblast (outermost layer of developing blastocyte)
What is the function of hCG
maintains corpus luteum by keeping levels of progesterone and estrogen elevated until the placenta takes over
-used to measure pregnancy
Menstrual phase
time of vaginal bleeding
signals beginning of follicular phase of ovarian cycle
What triggers the menstrual phase
Declining levels of estrogen and progesterone->poor endometrial support and constriction of endometrial blood vessels-> decreased O2 and nutrients to endometrium-> lining of uterus sheds
What is the role of prostaglandins
cause contractions of smooth muscle and decrease risk of hemorrhage
When does the proliferative phase begin
End of menses through ovulation (appx. days 7-14)
Characteristics of the proliferative phase
-gradually increasing levels of estrogen
-enlarging endometrial glands
-growth of uterine smooth muscle
When does the secretory phase occur
time of ovulation to period just before menses
Characteristics of the secretory phase
increasing amounts of progesterone which cause enlarged breasts, thinning of vaginal mucosa, and increased thickness and stickiness of cervical mucus
When does the ischemic phase occur
end of secretory phase to onset of menstruation (appx days 27-28)
How can toxoplasmosis occur
eating raw or undercooked meat; cleaning cats litter box (cat feces), transplacental
Rh factor concerns
if Mom is Rh- and baby is Rh+, moms body will react and will make antibodies against babies blood cells. Tx w/ Rhogam shot. If left untx, will effect later pregnancies
RPR
rapid plasma reagin during 1st prenatal visit, 3rd trimester, and at birth if high risk
What can untx UTIs cause
Preterm labor
Items considered PICA
ice, dirt, worms, laundry detergent
Reason for need of folic acid/iron in pregnancy
needed to meet demands of increased blood supply and fetus
presumptive signs of pregnancy
-breast changes
-amenorrhea
-N/V
-urinary frequency
-fatigue
-quickening (starts to feel movement)
probable signs of pregnancy
-goodell sign
-chadwick sign
-hegar sign
-positive hCG
-braxton hicks contractions
-ballottement
positive signs of pregnancy
-visualization of fetus by US
-FHT detected by US
-visual of fetus via radiographic study
-FHT detected by doppler, stethoscope
-fetal movements palpated and visible
expected maternal anatomic adaptations to pregnancy
-uterine change in size, shape, position
-enlarged breasts
-increased vaginal secretions
-nipples and areolas darken
-stretch marks
-superficial veins become prominent
expected CV changes in pregnancy
-increase in blood volume
-CO increases 25-50%
-clotting factors increase– hypercoagulable state
-O2 consumption increases by 15-20%
-breathing changes from thoracic to diaphragmatic
-SOB
-greater diaphragm excursions
-nasal congestion
-epistaxis
expected basal metabolism and acid-base balance changes in pregnancy
-BMR increases 10-20% by term
-respiratory alkalosis compensated by mild metabolic acidosis
what causes respiratory alkalosis in pregnancy
O2 consumption increases->diaphragm elevated by enlarging uterus->thoracic cage widens->hyperventilation->decreased CO2 levels-> alkalosis
expected renal system changes in pregnancy
-increased urinary frequency
-higher risk for UTIS
expected skin changes in pregnancy
-linea nigra
-stretch marks r/t stretching of connective tissue
-chloasma
-palmar erythema r/t hyperemia
expected musculoskeletal changes in pregnancy
-lumbar lordosis r/t center of gravity shifted forward
-lumber and dorsal curves more prominent-> lower back pain
-“waddling gait” d/t relaxin hormone that relaxes pelvic points
-muscle cramps r/t hypocalcemia, hypokalemia or hypomagnesia
expected neurological changes in pregnancy
-changes in sensorium r/t postural hypotension/hypoglycemia
-carpal tunnel, edema and compression of median nerve in wrist
-lordosis (back sway)
one major cause of cramps and tetany
hypocalcemia
common GI changes in pregnancy
-N/V
-reflux and constipation r/t relaxation of smooth muscle of esophagus, stomach and intestines
-pyrosis
-hemorrhoids
-gallbladder sluggish
-pica
how many weeks is a fetus considered viable
20 weeks
ballottement
passive movement of fetus
how would the provider assess the patient for ballottement
provider taps on cervix-> fetus rises-> may feel on abdomen
how would the provider assess for quickening
tap cervix gently and palpates fetal rebound in amniotic fluid
-usually present about 16 wks
what is hegar’s sign
softening and thinning of lower segment of uterus around the 6th week
what is lightening
fundal height decreases as fetus descends into pelvis in preparation for delivery (38-40 weeks)
goodell sign
velvety appearance of cervix due to increase vascularity and hypertrophy and hyperplasia of cervix
chadwick sign
violet-blue vaginal mucosa and cervix
normal AFI
> 10 cm
oligohydramnios
<5cm
polyhydramnios
> 25 cm
biophysical profile
looking for total score of 10
-normal: score of 2 per area
-abnormal = 0
bpp acronym
B-breathing movement of fetus
A-amniotic fluid volume
T-tone of fetus
M-movement of fetus
a-and
N-non stress test
fetal milestones in 3rd wk
heart starts beating and blood circulates
fetal milestones in 4th wk
-heart becomes 4 chambers from 2
-respiratory system changes
fetal milestones in 5th wk
umbilical cord developed
fetal milestones in 8th wk
gender distinguishable
fetal milestones at 9th wk
fingers, toes, eyelids, nose and jaw evident
fetal milestones at 12th wk
-placenta complete
-organ systems complete
-thumb sucking
-fetus urinates in AF
fetal milestones in 20th wk
-hearing
-quickening
-lanugo covers baby
-wake/sleep cycle evident
fetal milestones in 24th wk
-circulation visible
-rapid brain growth
-hiccups
-vernix caseosa thick
-lecithin present
fetal milestones in 28th wk
-eyes open and close
-process sights and sounds
-taste buds developing
-hair on head
fetal milestones in 32nd wk
-nails (finger and toes) present
-fingerprints
-subcut fat
-rapid fetal movement
-L/S ratio= 1: 2: 1 (lung maturity =2:1)
fetal milestones in 36th wk
-lanugo disappearing
-AF decrease
-L/S ratio > 2:1
function of ductus venosus
shunts around liver
what organ does the work of the liver
PLACENTA
function of foramen ovale
right to left atria shunt
function of ductus arteriosus
shunts around lung; pulmonary artery to aorta
first organ system to develop in fetus
respiratory
fetal lungs do not function for gas exchange-> ductus arteriosus does this
normal fetal heart rate
110-160
timeframe of ovum
conception to day 14
timeframe of embryo
day 15 to 8 weeks
-organs forming; GREATEST VULNERABILITY!!!!!
timeframe of fetus
8 wks to birth
examples of teratogens
-cocaine
-alcohol
-accutane
-lithium
-Mercury
-syphilis
-ACES
what is an important measure of fetal well being?
fundal height
what is the importance of fundal height measurement?
helps to estimate gestational age of fetus
fundal height during 2nd and 3rd trimesters (18-30 wks)
fundal height in cm appx = fetal age in wks +/- 2cm
where is the height of the fundus at 16 wks
halfway bw symphysis pubis and umbilicus
where is the height of the fundus at 20-22 wks
appx at umbilicus
what STDs increase the risk of corneal scarring of infant during vaginal birth
gonorrhea and chlamydia
what type of delivery is always indicated in an active HSV mom? why?
c-section
-organism may cross placenta and contaminate fetus or in contact with vagina during delivery
absolute BP for preeclampsia
140/90
OR
sys: 30 mmHg over baseline and dias: 15 mmHg over baseline
if a BP of 140/90 is seen, what is the next action?
look for protein in urine
what side should the nurse position the pregnant patient on? why?
side-lying postion
-improves urinary output and helps decrease edema
complication of lying in supine position
compromises renal, cardiac and uterine flow
-vena cava syndrome
what hormone is responsible for chloasma
estrogen
patient education on correct exercises for cramps
knee extended while another person dorsiflexes foot
or
stand and lean forward while dorsiflexing foot
patient education to avoid GI discomfort during pregnancy
sit up for 30 min- 1 hour after eating
maternal weight gain recommendation
total: 25-35 lbs
- 2 to 4 lbs (1st tri)
-1 lb/wk (2nd and 3rd)
adequate fluid intake
3L/day
8-10 glasses/day (4 to 6 of which should be water)
when pregnant, how many more calories should the pregnant patient consume
300
when breastfeeding, how many more calories should the patient consume
450-500 cal/day
foods that help avoid constipation
raw fruits, veggies, cereals, bran
complications overweight pregnant patient
-gestational diabetes
-preeclampsia
-late fetal death
-emergency c/s
-infxn
maternal variables assoc w HRP
-age <17
-high parity (>5)
-HTN/preeclampsia
-rH incompatibility
-malnutrition
-height </= 5 ft
maternal variables assoc w HRP
-age <17
-high parity (>5)
-HTN/preeclampsia
-rH incompatibility
-malnutrition
-height </= 5 ft
warning signs during 1st trim
-severe vomiting
-chills, fever
-dysuria
-diarrhea
-abd cramping
-vaginal bleeding
warning signs during 2nd and 3rd trims
-persistent, severe vomiting
-vaginal bleeding/flank pain
-change in fetal movements
-glycosuria
-swelling of face, fingers or sacrum
-visual disturbances
what is hyperemesis gravidarum? what are its effects on the fetus?
excessive vomiting that persists beyond 1st trimester
-leads to dehydration, electrolyte imbalances and weight loss
timeframe of 1st trimester
wks 1-13
timeframe of 2nd trimester
wks 14-26
timeframe of 3rd trimester
wks 27-40
how many weeks is considered term
beginning of week 38 or completion of week 37 (37.6 weeks)
how many weeks is considered preterm
37.6 wks or less
how many weeks is considered post-term
> 42 wks
what hormone is responsible for milk letdown
oxytocin
what hormone is responsible for production
prolactin
what hormone becomes dominant when the placenta is delivered
prolactin
benefits of colostrum
high in protein and immune properties
The amniotic fluid is composed of
maternal blood by diffusion and fluid secreted by respiratory and GI tracts of fetus
How much AF is indicative of fetal well being
700-1000mL/term
Functions of amniotic fluid
-thermoregulation
-infection barrier
-helps fetal lung development
-cushions
-a source of oral fluids and repository for wastes
Varicella zoster (chicken pox) effects/management
Effects: PTL, encephalitis, varicella pneumonia, IUGR, cataracts
Mgmt: immune globulin for susceptible pts; baby born to mom w active infxn-> give immune globulin w/i 72 hrs
Rubella effects/mgmt
Effects: rash, fever, malaise, spont. abortion during 1st trim., deafness, IUGR, cardiac defects, microcephaly
Mgmt: prevent by MMR vax in childhood
Which TORCH infxn has no effective tx? What are its serious effects?
Cytomegalovirus
Effects: fetal/neonatal death, hemolytic anemia. jaundice, hydro/microcephaly
BRAIDED
B-benefits
R-risks
A-alternatives
I-inquires
D-decisions
E-explanations
D-documentation
barrier methods of contraception
condom
diaphragm
hormonal methods of contraception
oral pills
transdermal patch
IUD
characteristics of contraction stress test (CST)
-fhr baseline for 10 to 20 min
-3 contractions in 10 min
how to induce contractions during CST
-nipple stimulation
-IV pitocin/oxytocin
how are CST findings labeled
negative= no late decels
positive= late decels
equivocal
characteristics of non-stress test (NST)
fetal monitoring for 20-30 min
findings are reactive or nonreactive
reactive findings of NST
normal FHR baseline w/ fetal movement
alpha-fetoprotein
low levels may indicate down syndrome or trisomy 18
elevated levels may indicate NTD (neural tube defects)
1st prenatal visit w/i 12 weeks
hCG, CBC w/diff, blood type & rH, RPR, HIV, HgB, A1C, UA, cervical exam, pap smear
prenatal visit 1x/mo for wks 12-28
UA, TB skin test, rubella titer, Hep B test, triple screen and MSAFP, US, 1hr glucola
prenatal visits Q2wks for wks 29-36
UA, US if not done, type & rH
weekly visits for wks 36-delivery
GBS, HIV, poss. U/S for presentation
structure/function of umbilical cord
connects embryo to yolk sac
2 arteries; 1 vein
whartons jelly-surrounds 2 arteries and 1 vein
function of whartons jelly
protect the umbilical cord from compression
maternal blood flow (short version)
through uterine arteries and into intervillous spaces of placenta-> blood returns through uterine veins and into fetal circulation
what cells does the placenta form from
trophoblasts
function of placenta
transfer of nutrients and O2 to fetus and removal of waste products from fetus
During which developmental stage is a fetus most susceptible to teratogens?
embryonic stage
wks 3-8
