Exam #1 Flashcards
What is true labor?
cervical changes with rhythmic contractions
When should the 1st prenantal visit occur?
within 12 weeks
What labs are taken at 1st prenatal visit?
HGC
CBC
Type & Rh
RPR
HIV
Hemoglobin
Electrophoresis
(check anemias),
A1C
UA
cervical
exam
pap
smear,
How often should prental visits be between 12-28 weeks?
Once a month
What labs are taken at the monthly visits 12-28 weeks?
- UA at every visit
- TB skin test,
Rubella titer, Hep
B test, Triple
Screen & MSAFP - Ultrasound
- 1hr glucola (24-28
weeks)
How often should prenatal visits be between 29-36 weeks?
Every 2 weeks
What labs are drawn every 2 week at 29-36 weeks?
- UA at every visit
- Ultrasound if not
done before - Type & Rh
How often should prenatal visits be from 36 weeks-delivery?
weekly
What labs will be drawn from 36 weeks-delivery?
- GBS, HIV
- Possible U/S for
presentation
What are warning signs during first trimester of pregnancy that the doctor may follow-up on?
-severe vomiting
-chills, fever
-dysuria
-diarrhea
-abdominal cramping
-vaginal bleeding
How does the menstrual cycle correlate with getting pregnant or not?
A woman is most fertile during the ovulation period (12-14 days before next cycle) of the menstrual cycle, and is the time where a woman is most likely to get pregnant
What are examples of barrier method contraceptives?
spermicides, condoms, diaphragms, cervical caps, contraceptive sponge
When should a female obstain from intercourse using cervical mucus method?
when cervical mucus is wet, clear, and stretchable
What is education concerning barrier method contraception?
use in conjunction with spermicidal foam to increase effectiveness, recommended to prevent STDs
What is an important education about spermicidal method?
not effective when a
highly reliable contraceptive method is sought
What are important things to note about diaphragm method?
- Round flexible device that covers the cervix
- Must be fitted for size by health care provider
- Inserted into the vagina up to 6 hours before
intercourse - Used with spermicidal jelly or cream
- Must remain in place for 6-8 hours after
intercourse - Increases risk of urinary tract infections
- Return to health care provider for size
refitting if weight fluctuates up or down - Does not prevent STD
What is the teaching when a birth control pill is missed and its been <12 hours?
Take 1 pill immediately and
take the rest of the pack at the
usual time
No backup method needed
No Emergency
Contraceptive needed
What is the teaching when a birth control pill is missed and its been over 12 hours?
Take pill as soon as
remembered and continue the
rest of the pack at the usual
time
Use EC if had unprotected
intercourse in the past 7
days
Use condoms or abstinence
for the next 7 days
What are serious side effects for oral contraceptives?
- A = abdominal pain
- C = chest pain or shortness of breath
- H = severe headache
- E = Eye problems such as vision loss, dizziness
or blurring of vision - S = Severe leg pain or swelling
What is the education needed for transdermal contraception patch?
- Contains a combination of estrogen and
progestin - Patch placed on abdomen, buttocks, upper
outer arm or torso BUT NOT THE BREAST - Replaced each week for 3 weeks
- Not used for 1 week to allow for
menstruation
What is the education needed for vaginal ring?
- Small flexible ring inserted deep into the
vagina for 3 out of every 4 weeks - A new ring is used for each 4-week cycle
- Delivers continuous levels of progestin &
ethinyl estradiol
What is the education needed for depo-provera?
- Given every 11-13 weeks
- Suppresses ovulation and produces thick cervical mucus that decreases sperm motility
- Effective, convenient, inexpensive compared to other methods
- Menstrual bleeding is diminished or absent
- May be a delay in fertility for up to 18 months when discontinued
What are side effects of IUD?
Side Effects: include irregular
menstrual cycles and increased bleeding
and cramping during menstruation
What are serious side effects of an IUD?
- P = Period late abnormal spotting or bleeding
- A = Abdominal pain; pain during intercourse
- I = Infection exposure; STD’s
- N = Not feeling well; fever and chills
- S = String missing; shorter or longer
When is a IUD contraindicated?
- Not recommended for women who have not
had children - Not recommended for women with history of
Pelvic Inflammatory Disease (PID) - If pregnancy occurs with IUD in place,
increased risk for miscarriage and premature
labor
What is the process of fertilization and implantation?
During fertilization, the sperm and egg unite in one of the fallopian tubes to form a zygote. Then the zygote travels down the fallopian tube, where it becomes a morula (3 days). Once it reaches the uterus, the morula becomes a blastocyst (4 days). The blastocyst then burrows into the uterine lining — a process called implantation. (6 days)
What is the structure of the placenta?
-Flat, disk shaped
-Structure composed of 15 to 20 lobes called cotyledons
What is the function of the placenta?
o Provides nutrients (O2) and removes waste (CO2)o Metabolizes drugs and other substances
o Produces hormones estrogen/progesterone for maintenance of pregnancy
§ Estrogen stimulates uterine development to provide environment for baby
§ Progesterone relaxes uterine muscle to prevent spontaneous abortion
o When Human Chorionic Gonadotropin is released it produces the placenta and begins to grow. An increase in HCG levels =indication of pregnancy
o Corpus luteum main source of estrogen and progesterone until month 3. After that the placenta is in charge.
What is the structure of the umbilical chord?
-Structure that connects the developing baby to the placenta
-Contains two arteries and one vein in utero
What is the function of the umbilical chord?
o Transport O2 and nutrients from Mom to baby and waste back to maternal blood
o Permits free movement for baby within the membranes
o arteries carry deoxygenated blood while veins carry oxygenated blood (when cord is cut those will close and switch functions)
What kind of blood do the arteries carry?
deoxygenated blood
What kind of blood do the veins carry?
oxygenated
What are the three fetal valves called in fetal circulation?
ductus arteriosis, foramen ovale, and ductus venosus
What is ductus arteriosis?
Valve that
shunts blood
around the
lung. (Just
enough to
keep lungs
viable)
What is foramen ovale?
Valve
allowing
blood to flow
directly from
right to left
atrium
What is ductus venosus?
Valve that
shunts
around the
liver
When does hematopoesis begin?
week 6
Why is it important to know about RBCs forming early in gestation?
It’s important to know if you have any RBC antibodies early in your pregnancy to help your baby avoid problems like anemia or jaundice.
What are presumptive signs of pregnancy?
breast changes, amennorrhea, N/V, urinary frequency, fatigue, quickening
What are probable signs of pregnancy?
Goodell sign, chadwick sign, hegar sign, positive pregnancy test, braxton hicks contractions, ballottment
What are positive signs of pregnancy?
Visualization of fetus by real-time ultrasound, fetal movements palpated, fetal movements visible,fetal heart tones detected by fetal stethoscope, FHTs detected by ultrasound, visualization of fetus by radiographic study
What are expected findings of pregnant woman?
-increase in estrogen and progesterone levels
-uterus changes in size, shape, and position
-increase uterine blood flow and stronger muscles for birth process
-vaginal secretions increase
-expansion of vascular volume 45-50%
-cardiac output increase 25-50%
-clotting factors increased
-oxygen consumption increased 15-20%
-breathing changes from thoracic to diaphragmatic
-basal metabolic rate increases 10-20%
-linea nigra
-striae gravidarum
-chloasma
-palmar erythema
When is hyperemesis gravidarum seen?
can start at 2 weeks and lasts until 20 weeks (first trimester)
What is hyperemesis gravidarum?
Abnormal condition of pregnancy characterized by vomiting excessive enough to cause weight loss( > 5%), electrolyte imbalance, nutritional deficiencies, and ketonuria, and dehydration. Moms don’t eat because they’re throwing up: nutritional deficiencies.
What is education for clients about IPV?
Abuse is a violation of rights
Facilitation of access to protective
and legal services is first step
Support and community resources.
What is a normal total weight gain during pregnancy?
25-35 lbs
What is a normal weight gain during 1st trimester?
2-4 lbs
What is a normal weight gain during 2nd and 3rd trimester?
1 lb/week
What is folic acid used for in pregnancy?
help meet demands of increased blood supply and fetus
What are items that would be considered PICA?
- Clay, soil
- Laundry starch
- Cornstarch
- Ice
- Freezer frost
- Baking powder
- Raw rice
- flour
What are maternal characteristics that may cause a high risk pregnancy diagnosis?
-Biophysical-genetic considerations, nutritional status, medical and obstetric disorders
-Psychosocial-smoking, caffeine, alcohol, drugs, psychological status
-Sociodemographic-low income, lack of prenatal care, age, adolescents, mature mothers, parity, marital status, social determinants of health, ethnicity
-Environmental-infections, radiation, chemicals such as mercury and lead, therapeutic drugs, illicit drugs, industrial pollutants, cigarette smoke, stress, and diet.
What are warning signs second/third trimester?
-persistent, severe vomiting
-sudden discharge of fluid from vagina <37 wks
-vaginal bleeding, severe abdominal pain
-severe backache/flank pain
-change in fetal movements
-contractions; pressure; cramping <37 weeks
-visual disturbances: blurring/double vision/spots
-face/fingers/sacrum swelling
-headaches; severe/frequent or continuous
-muscular irritability or convulsions
-epigastric/abd pain (heartburn/severe stomach ache)
-glycosuria, +GTT reaction
When does advanced maternal age for pregnancy start?
35
What are the maternal and fetal effects from toxoplasmosis?
o Maternal effects
§ Influenza- like aching
§ Lymphadenopathy
§ Spontaneous abortion
o Fetal effects
§ Congenital toxoplasmosis, LBW, hepatosplenomegaly c, jaundice and anemia
What are maternal and fetal effects from “other” (AIDS, GBS)?
o Aids maternal effects
§ Antepartum – An increased incidence of other STD’s. Offered the option of ZDV.
§ Intrapartum – External EFM preferred. Avoid use of fetal scalp electrodes or blood sampling.
§ Postpartum – breastfeeding contraindicated. Universal precautions
o Aids fetal effects
§ If the mother is HIV+ the newborn is given an ELISA test for presence of HIV antibodies. If positive but asymptomatic at birth, s/s usually become evident during 1st year of life. FTT, liver and spleen involvement,bacterial
o GBS maternal effects
§ none
o GBS fetal effects
§ Sepsis, pneumonia or meningitis within 7 days of birth. Meningitis is the most common clinical symptom. Early (1st week of life, or late onset). May have permanent neurologic deficits
What are materal and fetus effects from rubella?
o Maternal effects
§ Rash, fever, malaise
§ Spontaneous ab during 1st trimester or pregnancy
o Fetal effects
§ Deafness, MR, IUGR, cardiac defects and microcephaly
What are maternal and fetal effects from Cytomegalovirus?
o Maternal effects
§ Flu-like symptoms; cervical discharge
o Fetal effects
§ Fetal or neonatal death; severe generalized disease c hemolytic anemia, jaundice, hydrocephaly or microcephaly
What are maternal and fetal effects of hep b?
o Maternal effects
§ Fever, rash, arthralgia, abdominal pain, liver enlarged and tender
o Fetal effects
§ Prematurity; LBW
§ Development of acute infection at birth and perhaps neonatal death
When is syphilis tested and how?
Screened at first prenatal
visit VDRL or RPR
serology and again in 3rd
trimester and at time of
birth if they are high risk.
What are effects of syphillis on fetus?
Pregnancy: May result in
spontaneous abortion or PTL.
Transmitted across
placenta after approximately
18 weeks gestation.
Newborn: Congenital anomalies
and/or congenital syphilis
Congenital syphilis. (Test on
cord blood).
What does the hypothalamus secrete?
gonadotropin releasing hormone
What does the anterior pituitary secrete?
follicle-stimulating hormone
What does the posterior pituitary secrete?
lutenizing hormone
what does the follicular phase do to the follicle?
changes the primary follice to the graafian follicle, which stimulates ovulation (egg formation)
What does the luteal phase do
turns the egg into the corpus luteum and degeneratin corpus luteum
What does the graafian follicle produce?
grows and releases steady amounts of estrogen
What does the corpus luteum produce?
progesterone
What are the phases of the menstrual cycle?
menstruation, proliferative phase, ovulation, secretory phase, ischemic phase, back to menstruation
How long is the follicular phase?
cycle days 1-13
How long is ovulation?
cycle day 14
How long is the luteal phase?
cycle day 15-28
What is the role of GnRH?
stimulates the pituitary release of FSH and LH when hormone levels are low
What is the role of FSH?
stimulates development of Graafian follicles and production of estrogen
What is the role of LH?
trigger explosion of ovum from Graafian follicle and the formation of corpus luteum
What is the role of estrogen?
stimulates thickening of the endometrium prior to ovulation an after menstration
What is the role of progesterone?
prepares endometrium for a fertilized ovum should it occur
What is the role of prostaglandins?
fatty acid classified as a hormone that affect ovulation, smooth muscle contractility, fertility, menstruation, and hormone activity.
What is Hegar’s sign?
Softening and thinning of lower
segment of uterus – about the 6th week
What is lightening?
fundal height decreases as fetus
descends into the pelvis in preparation for delivery (38
– 40 weeks)
What is bellotement?
passive movement of fetus
What is quickening?
Maternal observation of fetal movement
18-20 weeks gestation (nulliparous) or 14-16 weeks
(multiparous).
What is Chadwick’s sign?
bluish color of cervix
What is Goodell sign?
Softening of cervical tip in a
normal unscarred cervix
What BP is a danger sign in pregnancy?
140/90
When are pregnant clients screened for gestational diabetes?
24-28 weeks
What are cardinal signs of Preeclampsia?
PROTEINURIA
EDEMA
ELEVATED BP
HEADACHES OR DIZZINESS
BLURRED VISION
people eat every hot balloon
What is the structure of amniotic fluid?
derives from maternal fluid by diffusion
Volume serves as indicator of fetal well-being
What is the normal volume for amniotic fluid?
700-1000mL-term)
What are the functions of amniotic fluid?
-maintain body temp
-barrier to infection
-allows lung development
-freedom of movement
-MS development
-cushion to outside forces
-symmetrical growth
-source for oral fluids and repository for waste
What happens at 3 weeks of fetal development?
Heart starts beating & blood circulates
What happens at 4 weeks of development?
■ 2- chamber forms a 4- chamber heart
■ Respiratory system begins
What happens at 5 weeks of development?
Umbilical cord developed
What happens at 8 weeks of development?
Gender distinguishable
What happens at 12 weeks of development?
■ Placenta complete
-organ system complete
■ Thumb sucking
■ Fetus urinates in amniotic fluid-11
What happens at 16 weeks of development?
meconium in bowel
What happens at 20 weeks of development?
Quickening (Mom feels movement)
■ Lanugo covers the body
What happens at 24 weeks of development?
vernix caseosa is thick
lecithin present
What happens at 32 weeks of development?
L/S ratio 1.2:1 (lung maturity 2:1)
What happens at 36 weeks of development?
lanugo disappears
L/S ratio >2:1
What are major characteristics of viability?
CNS function and O2 capability of the lungs. weight of 500g, 20 weeks past conception (22 since LMP)
What happens at 34 weeks of development?
lungs fully mature
