Exam 1 Flashcards
Reproductive cycle begins at
The moment of conception
Male and female reproductive systems are undifferentiated until about
6 weeks of gestation
Differences in internal structures are visible during week ____
7
Outer structures begin to change during week ___ of gestation
9
Differentiation of the external structures is complete at about week ___
12
Female puberty changes
- breast changes: enlargement of nipples, growth of tissue, fat deposits
- body contour: pelvis widens, fat deposits
- skeletal growth: growth spurt in response to estrogen ~ 1 year after initial breast development
- enlargement of female genitalia: enlargement of vagina, uterus, fallopian tubes
Primary amenorrhea
Delayed onset of 1st mentrual period
If not occurred by:
- 2 years after onset of breast development
- By age 16
- more than 1 year older than mother or sister when their menarche occurred
Secondary amenorrhea
Absence of menses
- at least 3 cycles after established 6 months of regular cycles
Vagina
- muscular tube of membrane tissue
- fold, rugae, muscular layers
Uterus
- hollow thick walled muscular organ
- contracts during labor
- each month uterus prepares for pregnancy where or not conception occurs
Divisions of the uterus
- corpus (body)
- isthmus
- cervix
Layers of the uterus
-perimetrium (outer membrane / serous membrane)
-myometrium (middle layer / thick muscle)
-endometrium (inner layer / basal layer)
Fallopian Tubes: 4 divisions
- interstitial
- isthmus
- ampulla
- infundibulum
Where fertilization occurs (Fallopian tubes):
Ampulla
Ovaries produce sex hormones _____ and _____
Estrogen and progesterone
The hypothalamus secretes _______
GnRH
The pituitary gland secretes _____ and _____
FSH and LH
The ovaries produce _____ and ______
Estrogen and progesterone
The ovarian cycle includes 3 phases including:
1) follicular phase
2) ovulatory phase
3) luteal phase
Follicular phase
- begins at first day of menstruation
- decreased estrogen and progesterone
- secretion of FSH and LH
- maturing of the ovarian follicles
- ENDS DAY 14
Ovulatory phase
- middle of 28-day cycle before ovulation
- LH rises sharply
- fall in estrogen, rise in progesterone
Luteal phase
- remaining cells of old follicle persist for 12 days (corpus luteum)
- preparing endometrium for fertilized ovum
- if ovum is not fertilized FSH and LH fall, corpus luteum regresses
- menstruation occurs
Endometrial cycle
- menstrual phase (1-5 days)
- proliferate phase (6-13 days)
- secretory phase (14-28)
Menopause
- cycles not consistently fertile
- FSH levels
- average age 51
- organs atrophy
Implantation
- between day 6-10 zygote secretes hcG
Organs vulnerable to teratogens during the _______ period
Embryonic
All major organ systems are in place by the ____th week:
8th
Fetal movements / quickening present during the _____ period
Fetal period
Sources of amniotic fluid
- fetal urine
- fluid from maternal blood
The umbilical cord includes:
- 2 arteries (carry deoxygenated blood away from the fetus)
- 1 vein (carries oxygenated blood and nutrients to the fetus)
Verifying pregnancy:
- hCG
- urine or blood
- # s should double every 48 hrs
Low numbers - possible miscarriage, ectopic
High numbers - possible multi fetal or problems
Calculating delivery date using Nagele’s Rule:
First day of last menstrual period, subtract - 3 months + add 7 days
Gravity
Number of pregnancies
Parity
Number of pregnancies in which fetus reaches 20 weeks
Viability
Point where the infant can live outside the uterus
Approx. 22/25 weeks
The 1st trimester of pregnancy includes weeks __ through __
1-12 gestation
The 2nd trimester of pregnancy includes weeks __ through __
13-27 gestation
The 3rd trimester of pregnancy includes weeks __ through __
28-40 gestation
Cervical changes during pregnancy:
- congested with blood (bluish color / CHADWICK’S SIGN)
- softens (Goodell’s sign)
- mucous plug
Vaginal changes during pregnancy:
- increased vascularity (bluish)
- something of connective tissue
- thickening of mucosa
- prominence of rugae
- increased discharge
Ovarian changes during pregnancy:
Secretes progesterone for the first 6-7 weeks
Breast changes during pregnancy:
- breasts increase in size and vascularity
- nipples increase in size, more erect
- areola, larger and more pigmented
Cardiovascular changes during pregnancy
- blood volume increases
- plasma volume increases
- cardiac output increases
- heart rate increases
- blood pressure stable
Respiratory changes during pregnancy
- increased oxygen consumption
- breathe more freely to compensate
- lung volume decreased
GI system changes during pregnancy:
- esophagus (heartburn)
- stomach and small intestine (nausea and vomiting)
- large intestine (constipation)
- gallbladder (increased risk for gallstones)
Urinary system changes during pregnancy:
Bladder:
- frequency
- urgency
-nocturia
Cutaneous vascular changes during pregnancy:
- Spider Nevi
- palmer erythema
Musculoskeletal system changes during pregnancy:
- softening of the pelvic ligaments causes waddling gait
- occurs 2nd and 3rd trimester
- abdominal wall - diastases recti muscles separate
Anterior pituitary gland releases the hormone _____ to promote milk production
Prolactin
The posterior pituitary gland releases the hormone ________ to stimulate contractions, stimulate milk production after birth and keep uterus contracted:
Oxytocin
Changes in pregnancy 5-8 weeks:
- amenorrhea
- nausea
- fatigue
- urinary frequency / urgency
- positive Chadwick’s / Goodell’s signs
Changes in pregnancy 9-12 weeks:
- nausea & vomiting decreases after 12 weeks
- vulval varicosities may appear
- audible FHR
Changes in pregnancy 13-16 weeks:
- fetal movements (quickening)
- urinary frequency decreases
Changes in pregnancy 17-20 weeks:
- Braxton hick’s contractions palpable
- skin pigmentation increases
- colostrum may be expressed
Changes in pregnancy 21-24 weeks:
- relaxation of smooth muscles of veins and blaster
- increased chance of varicose veins and UTI
Changes in pregnancy 25-28 weeks:
- period of greatest weight gain and lowest hCG level
- lordosis may cause backache
Changes in pregnancy 29-32 weeks:
- heartburn
- Braxton hick’s contractions more noticeable
- waddling gait - increased mobility of pelvic joints
Changes in pregnancy 33-36 weeks:
- shortness of breath
- varicosities
- pedal and ankle edema
- lightening (fetal part settles into cavity)
- urinary frequency, urgency, nocturia
Changes in pregnancy 37-40 weeks:
- women are uncomfortable, looking forward to birth of baby
TORCH infections include:
- Toxoplasmosis
- rubella
- cytomegalovirus
- herpes virus
Nonstress test assessment identifies:
- Adequacy of fetal oxygen
- FHR increases with fetal movements
Non stress test (normal fetus):
15 beats/min at or above baseline for at least 15 seconds
** 2 ACCELERATIONS WITH THIS CRITERIA IN 20 MINUTE INTERVAL IS CONSIDERED REACTIVE
Biophysical Profile (BPP)
Markers for fetal well being
Score out of 8:
- fetal breathing movements 2
- gross fetal movements 2
- fetal muscle tones 2
- amniotic fluid volume (AFV) 2
Stage 1 of labor:
Effacement and dilation: 0cm - 10cm
2nd stage of labor:
Pushing & expulsion: 10cm/100% effacement to birth
3rd stage of labor:
Placenta
4th stage of labor:
Physical recovery and bonding
Phase 1 (of Stage 1 of labor):
Latent (early labor)
-0-3cm
-longest stage
-longer for primipara
Phase 2 (of Stage 1 of labor):
Active labor (4-7cm)
-faster phase
-pain management
Phase 3 (of Stage 1 of labor):
Transition stage of labor (8-10cm)
-short, intense
-pelvic descent
-bloody show
4 components of the birth process:
-powers
-passage
-passenger
-psyche
Early decelerations
FHR slowing with start of contraction with return of FHR to baseline at end of contraction
Causes/complications — Early Decelerations:
- compression do the fetal head resulting from uterine contractions
- vaginal exams
- fundal pressure
Late decelerations
Slowing of FHR after contraction with return to baseline well after contraction has ended
Causes/complications — late decelerations:
-uteri placental insuffiency
-hypotension, placenta previa, abruptio placentae, uterine hyper stimulation, oxytocin
-preeclampsia
-late or post term pregnancy
-maternal diabetes
Nursing interventions: Late Decelerations
- place client in side lying position
- insert IV catheter for IV fluid administration
- discontinue oxytocin
- oxygen mask
- elevate legs
- notify provider
-prepare for assisted vaginal birth or c-section
Variable decelerations
Transitory, abrupt slowing of FHR less than 110/min
- variable in intensity, duration, and timing
Causes/complications — Variable decelerations:
- umbilical cord compression
- short cord
- prolapsed cord
- nuchal cord (around fetal neck)
Nursing interventions — Variable decelerations:
- reposition patient side-to-side or knee-to-chest
- insert IV catheter for IV fluid administration
- discontinue oxytocin
- oxygen mask
- elevate legs
- notify provider
-prepare for assisted vaginal birth or c-section
Two components of pain
Physiologic: reception by sensory nerves and transmission to central nervous system
Psychological: recognizing the sensation, interpreting it as painful, and reacting
Adverse effects of excessive pain
Physiological effects:
- Fear and anxiety
- Reduces uterine and placental blood flow
- Reduces effectiveness of uterine contractions
- Increases maternal metabolic and respiratory rate
Psychological :
- Poorly relieved pain lessens the pleasure great event
Variables in Intrapartum Pain
First stage:
- Visceral- slow deep pain, poorly
Second stage :
- Somatic- faster, sharp
Sources of pain
- Tissue ischemia - blood supply to uterus decreased during ctx
- Cx dilation
- Pressure and pulling on pelvis structures
- Distention of vaginal and perineum - burning, tearing, splitting
Physical factors influencing pain perception
- intensity of labor
- cervical readiness
- fetal position
- characteristics of the pelvis
- fatigue and hunger
- intervention of caregivers
Psychological factors influencing pain perception:
- Culture
- anxiety and fear
- Previous experiences with pain
- Childbirth preparation
- Support system
Pain assessment
- pain level
- Preference for pain management
- Maternal vital signs/fetal heart rate
- allergies
- Oral intake
- Evidence of pain
- Labor status
Nonpharmacologic Pain Management:
PROS:
- Does not slow labor
- no s/e
- alternative and adjunct to drugs
CONS:
- Not always give a total pain control
- Still may need pharmacologic methods
Types of non-pharmacologic pain management:
- relaxation
- Environment comfort
- General comfort
- Reducing anxiety and fear
- Cutaneous stimulation
- hydrotherapy
- Mental stimulation (imagery)
Pharmacologic considerations for affects on fetus:
- Cross placenta
- May harm
- Maternal hypotension and reduce placental perfusion
Pharmacological considerations for affects on mother:
- cardiac changes
- Respiratory changes
- nervous system changes
Pharmacologic affects on labor process:
- May slow process is given to early
- May impair urge to push
Pharmacologic pain management: opioid analgesics
- Meperidine (Demerol)
- butorphanol (Stadol)
- Nalbuohine (Nubain)
** risk for respiratory depression
** reduce pain perception
** small frequent doses
— naloxone (narcan) // reverse effects
Regional pain management: epidural block
- Relief for labor and birth
- Start after labor is established
- Continuous or intermittent
- Dural puncture can result in a spine h/a
** blood patch may be necessary // 15 ML of patient’s blood is injected by anesthesia into epidural space // seal is formed stopping leakage of spinal fluid
Regional pain management: adverse effects
- maternal hypotension
- Bladder distention
- provolone second stage- what’s urge to push
- Catheter migration
- c/s birth
- Maternal fever
- nausea / vomiting
- Pruritis
- Delayed respiratory depression — up to 24 hours
Epidural: Nursing Care
- Preload IV fluids
- assist with initiation
- maternal VS & FHR
- watch bladder distention
- observe and report s/e
Epidural: Contraindications
- woman’s refusal
- coagulation defects
- uncontrolled hypovolemia
- infection in the insertion diet or sever systemic infection
- allergy
- condition of fetus requiring immediate delivery
Nursing care: Maternal hypotension
Prevention: infused 500-100 ml warmed IV before block
If hypotension:
- additional IV fluids & IV epinephrine
- postion to prevent portocaval compression
Epidural block: Nursing Care
- assist woman:
during administration of the block, assist pushing if pt cant feel the urge to push - assess:
VS and FHR every 5 min during the first 15 min, degree of block & sensations and bladder frequently
Spinal Block
- local anesthetic with opioid
- Subarachnoid space
- Maybe done when a quick C-section is needed // no epidural catheters in
- Loss of sensory and motor function below the level of the block
Spinal block: adverse effects
- maternal hypotension
- Bladder distention
- postural puncture headache
Spinal block: management
- bedrest
- hydration
- caffeine
- Blood patch
Amniotomy: Indications
- induce labor
- allow for internal fetal monitoring
Aminotomy: Risks
- umbilical cord prolapse
- chorioamnionitis
- abrupto placenta
Amniotomy: Technique
- disposable plastic hook to preferate amniotic sac
- done after vaginal exam to determine dilation, effacement, and presenting part
** if fetal presenting part is high or position not cephalic, Amniotomy not done
Chorioamnionitis
Inflammation of amniotic sac
Indications for induction of labor:
- hostile uterine environment
- SROM without onset of labor
- postterm gestation
- chorioamnionitis
- hypertension
- abruptio placenta
- worsening maternal medical conditions
- fetal death
Amniotomy: contraindications
- placenta previa
- Umbilical cord prolapse
- Abnormal fetal presentation
- Fetal presenting part above pelvic inlet
- Previous classic C-section
Criteria for successful induction
- Close to or at term
- L/S ratio greater than 2:1
- Bishop cervical assessment score:
Dilation, effacement, station, consistency, position
Oxytocin (Pitocin)
- diluted in physiologic, electrolyte containing fluid
- Run a secondary infusion
- Regulate by infusion pump
- Start slowly, increase gradually
- Monitor drip rate
Oxytocin: Nursing Care
- Assess fetal response:
- if non-reassuring patterns are present or hypertonic contractions
- reduce or stop oxytocin increase primary not additive solution
- keep a woman and lateral position
- give 100% 02
- notify DR/CNM
- Assess maternal response:
- hypertonic uterine activity
-BP, P, T - I & O
- pain control
- postpartum, uterine atony
- corrective actions: same as for non-reassuring, fetal heart rate
Episiotomy: indications
- conditions that place women at risk for tearing
Episiotomy: RIsks
- infection
- perineal pain
Operative Vaginal Birth: Indications — MATERNAL
- exhaustion
- inability to push
- cardiac or pulmonary disease
Operative Vaginal Birth: Indications — FETAL
- non-reassuring FHR patterns
- Partial separation of the placenta
- arrested decent
Operative vaginal birth: contraindications
- severe fetal compromise
- High fetal station
- Cephalopelvic disproportion
Operative vaginal birth: Risks — MATERNAL
- laceration/hematoma
Operative vaginal birth: Risks — FETAL
- ecchymosis, facial & scalp lacerations & abrasions
- facial nerve injury
- cephalhematoma
- Intracranial hemorrhage
Operative vaginal birth: Technique
- verify presentation, position, station
- membranes ruptured
- cervix completely dilated
- adequate anesthesia
Operative vaginal birth: Nursing Care
- have woman empty bladder or catheterize
- assess FHR continuously
- assess mother for vaginal/perineal trauma
- assess newborn for trauma
External version
Change from breech or transverse presentation to cephalic presentation
External version: contraindications
- uterine malformations
- Previous C-section
- cephalopelvic disproportion
- Placenta previa
- multifetal gestation
- oligohydramnios, ruptured membranes, nuchal cord
- uteroplacental insufficiency
- engagement fetal head
External Version: Technique
- Nonstress test or biophysical profile
- After 37 weeks gestation
- administer tocolytic drugs
- U/S to guide manipulation
External Version: Risks
- Fetal entanglement in umbilical cord
- abruptio placenta
- mixing of fetal and maternal blood
- C-section births
Nursing care: before external version
- NPO
- IV line
- Maternal vital signs
- Fetal heart monitoring
- Reduce anxiety
nursing care: after external version
- d/c tocolytic drugs
- maternal vital signs
- signs of labor
- Persistent pain
- Reassuring fetal heart rate
- Review signs of labor
Indications: cesarean birth (c-section)
-dystocia
- cephalopelvic disproportion
- PIH
- maternal diseases
- active genital herpes
- Previous uterine surgical procedures
- Persistent non-reassuring fetal heart rate patterns
- prolapsed umbilical cord
- Fetal malpresentations
- Hemorrhagic conditions
Cesarean birth: contraindications
- fetal death
- Fetus too immature to survive
- Maternal coagulation defects
Cesarean birth: risks — maternal
- infection
- Hemorrhage
- urinary tract trauma
- thrombophlebitis, thromboembolism
- Paralytic ileus
- Atelectasis
-Anesthesia complications
Cesarean birth: risks — fetal
- inadvertent preterm birth
- laceration, bruising, trauma
