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Maternity > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Reproductive cycle begins at

A

The moment of conception

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2
Q

Male and female reproductive systems are undifferentiated until about

A

6 weeks of gestation

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3
Q

Differences in internal structures are visible during week ____

A

7

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4
Q

Outer structures begin to change during week ___ of gestation

A

9

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5
Q

Differentiation of the external structures is complete at about week ___

A

12

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6
Q

Female puberty changes

A
  • 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
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7
Q

Primary amenorrhea

A

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

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8
Q

Secondary amenorrhea

A

Absence of menses
- at least 3 cycles after established 6 months of regular cycles

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9
Q

Vagina

A
  • muscular tube of membrane tissue
  • fold, rugae, muscular layers
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10
Q

Uterus

A
  • hollow thick walled muscular organ
  • contracts during labor
  • each month uterus prepares for pregnancy where or not conception occurs
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11
Q

Divisions of the uterus

A
  • corpus (body)
  • isthmus
  • cervix
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12
Q

Layers of the uterus

A

-perimetrium (outer membrane / serous membrane)
-myometrium (middle layer / thick muscle)
-endometrium (inner layer / basal layer)

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13
Q

Fallopian Tubes: 4 divisions

A
  • interstitial
  • isthmus
  • ampulla
  • infundibulum
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14
Q

Where fertilization occurs (Fallopian tubes):

A

Ampulla

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15
Q

Ovaries produce sex hormones _____ and _____

A

Estrogen and progesterone

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16
Q

The hypothalamus secretes _______

A

GnRH

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17
Q

The pituitary gland secretes _____ and _____

A

FSH and LH

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18
Q

The ovaries produce _____ and ______

A

Estrogen and progesterone

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19
Q

The ovarian cycle includes 3 phases including:

A

1) follicular phase
2) ovulatory phase
3) luteal phase

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20
Q

Follicular phase

A
  • begins at first day of menstruation
  • decreased estrogen and progesterone
  • secretion of FSH and LH
  • maturing of the ovarian follicles
  • ENDS DAY 14
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21
Q

Ovulatory phase

A
  • middle of 28-day cycle before ovulation
  • LH rises sharply
  • fall in estrogen, rise in progesterone
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22
Q

Luteal phase

A
  • 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
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23
Q

Endometrial cycle

A
  • menstrual phase (1-5 days)
  • proliferate phase (6-13 days)
  • secretory phase (14-28)
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24
Q

Menopause

A
  • cycles not consistently fertile
  • FSH levels
  • average age 51
  • organs atrophy
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25
Q

Implantation

A
  • between day 6-10 zygote secretes hcG
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26
Q

Organs vulnerable to teratogens during the _______ period

A

Embryonic

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27
Q

All major organ systems are in place by the ____th week:

A

8th

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28
Q

Fetal movements / quickening present during the _____ period

A

Fetal period

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29
Q

Sources of amniotic fluid

A
  • fetal urine
  • fluid from maternal blood
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30
Q

The umbilical cord includes:

A
  • 2 arteries (carry deoxygenated blood away from the fetus)
  • 1 vein (carries oxygenated blood and nutrients to the fetus)
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31
Q

Verifying pregnancy:

A
  • hCG
  • urine or blood
  • # s should double every 48 hrs

Low numbers - possible miscarriage, ectopic
High numbers - possible multi fetal or problems

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32
Q

Calculating delivery date using Nagele’s Rule:

A

First day of last menstrual period, subtract - 3 months + add 7 days

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33
Q

Gravity

A

Number of pregnancies

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34
Q

Parity

A

Number of pregnancies in which fetus reaches 20 weeks

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35
Q

Viability

A

Point where the infant can live outside the uterus

Approx. 22/25 weeks

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36
Q

The 1st trimester of pregnancy includes weeks __ through __

A

1-12 gestation

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37
Q

The 2nd trimester of pregnancy includes weeks __ through __

A

13-27 gestation

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38
Q

The 3rd trimester of pregnancy includes weeks __ through __

A

28-40 gestation

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39
Q

Cervical changes during pregnancy:

A
  • congested with blood (bluish color / CHADWICK’S SIGN)
  • softens (Goodell’s sign)
  • mucous plug
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40
Q

Vaginal changes during pregnancy:

A
  • increased vascularity (bluish)
  • something of connective tissue
  • thickening of mucosa
  • prominence of rugae
  • increased discharge
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41
Q

Ovarian changes during pregnancy:

A

Secretes progesterone for the first 6-7 weeks

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42
Q

Breast changes during pregnancy:

A
  • breasts increase in size and vascularity
  • nipples increase in size, more erect
  • areola, larger and more pigmented
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43
Q

Cardiovascular changes during pregnancy

A
  • blood volume increases
  • plasma volume increases
  • cardiac output increases
  • heart rate increases
  • blood pressure stable
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44
Q

Respiratory changes during pregnancy

A
  • increased oxygen consumption
  • breathe more freely to compensate
  • lung volume decreased
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45
Q

GI system changes during pregnancy:

A
  • esophagus (heartburn)
  • stomach and small intestine (nausea and vomiting)
  • large intestine (constipation)
  • gallbladder (increased risk for gallstones)
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46
Q

Urinary system changes during pregnancy:

A

Bladder:
- frequency
- urgency
-nocturia

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47
Q

Cutaneous vascular changes during pregnancy:

A
  • Spider Nevi
  • palmer erythema
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48
Q

Musculoskeletal system changes during pregnancy:

A
  • softening of the pelvic ligaments causes waddling gait
  • occurs 2nd and 3rd trimester
  • abdominal wall - diastases recti muscles separate
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49
Q

Anterior pituitary gland releases the hormone _____ to promote milk production

A

Prolactin

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50
Q

The posterior pituitary gland releases the hormone ________ to stimulate contractions, stimulate milk production after birth and keep uterus contracted:

A

Oxytocin

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51
Q

Changes in pregnancy 5-8 weeks:

A
  • amenorrhea
  • nausea
  • fatigue
  • urinary frequency / urgency
  • positive Chadwick’s / Goodell’s signs
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52
Q

Changes in pregnancy 9-12 weeks:

A
  • nausea & vomiting decreases after 12 weeks
  • vulval varicosities may appear
  • audible FHR
53
Q

Changes in pregnancy 13-16 weeks:

A
  • fetal movements (quickening)
  • urinary frequency decreases
54
Q

Changes in pregnancy 17-20 weeks:

A
  • Braxton hick’s contractions palpable
  • skin pigmentation increases
  • colostrum may be expressed
55
Q

Changes in pregnancy 21-24 weeks:

A
  • relaxation of smooth muscles of veins and blaster
  • increased chance of varicose veins and UTI
56
Q

Changes in pregnancy 25-28 weeks:

A
  • period of greatest weight gain and lowest hCG level
  • lordosis may cause backache
57
Q

Changes in pregnancy 29-32 weeks:

A
  • heartburn
  • Braxton hick’s contractions more noticeable
  • waddling gait - increased mobility of pelvic joints
58
Q

Changes in pregnancy 33-36 weeks:

A
  • shortness of breath
  • varicosities
  • pedal and ankle edema
  • lightening (fetal part settles into cavity)
  • urinary frequency, urgency, nocturia
59
Q

Changes in pregnancy 37-40 weeks:

A
  • women are uncomfortable, looking forward to birth of baby
60
Q

TORCH infections include:

A
  • Toxoplasmosis
  • rubella
  • cytomegalovirus
  • herpes virus
61
Q

Nonstress test assessment identifies:

A
  • Adequacy of fetal oxygen
  • FHR increases with fetal movements
62
Q

Non stress test (normal fetus):

A

15 beats/min at or above baseline for at least 15 seconds

** 2 ACCELERATIONS WITH THIS CRITERIA IN 20 MINUTE INTERVAL IS CONSIDERED REACTIVE

63
Q

Biophysical Profile (BPP)

A

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

64
Q

Stage 1 of labor:

A

Effacement and dilation: 0cm - 10cm

65
Q

2nd stage of labor:

A

Pushing & expulsion: 10cm/100% effacement to birth

66
Q

3rd stage of labor:

A

Placenta

67
Q

4th stage of labor:

A

Physical recovery and bonding

68
Q

Phase 1 (of Stage 1 of labor):

A

Latent (early labor)
-0-3cm
-longest stage
-longer for primipara

69
Q

Phase 2 (of Stage 1 of labor):

A

Active labor (4-7cm)
-faster phase
-pain management

70
Q

Phase 3 (of Stage 1 of labor):

A

Transition stage of labor (8-10cm)
-short, intense
-pelvic descent
-bloody show

71
Q

4 components of the birth process:

A

-powers
-passage
-passenger
-psyche

72
Q

Early decelerations

A

FHR slowing with start of contraction with return of FHR to baseline at end of contraction

73
Q

Causes/complications — Early Decelerations:

A
  • compression do the fetal head resulting from uterine contractions
  • vaginal exams
  • fundal pressure
74
Q

Late decelerations

A

Slowing of FHR after contraction with return to baseline well after contraction has ended

75
Q

Causes/complications — late decelerations:

A

-uteri placental insuffiency
-hypotension, placenta previa, abruptio placentae, uterine hyper stimulation, oxytocin
-preeclampsia
-late or post term pregnancy
-maternal diabetes

76
Q

Nursing interventions: Late Decelerations

A
  • 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
77
Q

Variable decelerations

A

Transitory, abrupt slowing of FHR less than 110/min
- variable in intensity, duration, and timing

78
Q

Causes/complications — Variable decelerations:

A
  • umbilical cord compression
  • short cord
  • prolapsed cord
  • nuchal cord (around fetal neck)
79
Q

Nursing interventions — Variable decelerations:

A
  • 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
80
Q

Two components of pain

A

Physiologic: reception by sensory nerves and transmission to central nervous system

Psychological: recognizing the sensation, interpreting it as painful, and reacting

81
Q

Adverse effects of excessive pain

A

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

82
Q

Variables in Intrapartum Pain

A

First stage:
- Visceral- slow deep pain, poorly
Second stage :
- Somatic- faster, sharp

83
Q

Sources of pain

A
  1. Tissue ischemia - blood supply to uterus decreased during ctx
  2. Cx dilation
  3. Pressure and pulling on pelvis structures
  4. Distention of vaginal and perineum - burning, tearing, splitting
84
Q

Physical factors influencing pain perception

A
  • intensity of labor
  • cervical readiness
  • fetal position
  • characteristics of the pelvis
  • fatigue and hunger
  • intervention of caregivers
85
Q

Psychological factors influencing pain perception:

A
  • Culture
  • anxiety and fear
  • Previous experiences with pain
  • Childbirth preparation
  • Support system
86
Q

Pain assessment

A
  • pain level
  • Preference for pain management
  • Maternal vital signs/fetal heart rate
  • allergies
  • Oral intake
  • Evidence of pain
  • Labor status
87
Q

Nonpharmacologic Pain Management:

A

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

88
Q

Types of non-pharmacologic pain management:

A
  • relaxation
  • Environment comfort
  • General comfort
  • Reducing anxiety and fear
  • Cutaneous stimulation
  • hydrotherapy
  • Mental stimulation (imagery)
89
Q

Pharmacologic considerations for affects on fetus:

A
  • Cross placenta
  • May harm
  • Maternal hypotension and reduce placental perfusion
90
Q

Pharmacological considerations for affects on mother:

A
  • cardiac changes
  • Respiratory changes
  • nervous system changes
91
Q

Pharmacologic affects on labor process:

A
  • May slow process is given to early
  • May impair urge to push
92
Q

Pharmacologic pain management: opioid analgesics

A
  • Meperidine (Demerol)
  • butorphanol (Stadol)
  • Nalbuohine (Nubain)

** risk for respiratory depression
** reduce pain perception
** small frequent doses

— naloxone (narcan) // reverse effects

93
Q

Regional pain management: epidural block

A
  • 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

94
Q

Regional pain management: adverse effects

A
  • 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
95
Q

Epidural: Nursing Care

A
  • Preload IV fluids
  • assist with initiation
  • maternal VS & FHR
  • watch bladder distention
  • observe and report s/e
96
Q

Epidural: Contraindications

A
  • woman’s refusal
  • coagulation defects
  • uncontrolled hypovolemia
  • infection in the insertion diet or sever systemic infection
  • allergy
  • condition of fetus requiring immediate delivery
97
Q

Nursing care: Maternal hypotension

A

Prevention: infused 500-100 ml warmed IV before block

If hypotension:
- additional IV fluids & IV epinephrine
- postion to prevent portocaval compression

98
Q

Epidural block: Nursing Care

A
  • 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
99
Q

Spinal Block

A
  • 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
100
Q

Spinal block: adverse effects

A
  • maternal hypotension
  • Bladder distention
  • postural puncture headache
101
Q

Spinal block: management

A
  • bedrest
  • hydration
  • caffeine
  • Blood patch
102
Q

Amniotomy: Indications

A
  • induce labor
  • allow for internal fetal monitoring
103
Q

Aminotomy: Risks

A
  • umbilical cord prolapse
  • chorioamnionitis
  • abrupto placenta
104
Q

Amniotomy: Technique

A
  • 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

105
Q

Chorioamnionitis

A

Inflammation of amniotic sac

106
Q

Indications for induction of labor:

A
  • hostile uterine environment
  • SROM without onset of labor
  • postterm gestation
  • chorioamnionitis
  • hypertension
  • abruptio placenta
  • worsening maternal medical conditions
  • fetal death
107
Q

Amniotomy: contraindications

A
  • placenta previa
  • Umbilical cord prolapse
  • Abnormal fetal presentation
  • Fetal presenting part above pelvic inlet
  • Previous classic C-section
108
Q

Criteria for successful induction

A
  • Close to or at term
  • L/S ratio greater than 2:1
  • Bishop cervical assessment score:
    Dilation, effacement, station, consistency, position
109
Q

Oxytocin (Pitocin)

A
  • diluted in physiologic, electrolyte containing fluid
  • Run a secondary infusion
  • Regulate by infusion pump
  • Start slowly, increase gradually
  • Monitor drip rate
110
Q

Oxytocin: Nursing Care

A
  • 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
111
Q

Episiotomy: indications

A
  • conditions that place women at risk for tearing
112
Q

Episiotomy: RIsks

A
  • infection
  • perineal pain
113
Q

Operative Vaginal Birth: Indications — MATERNAL

A
  • exhaustion
  • inability to push
  • cardiac or pulmonary disease
114
Q

Operative Vaginal Birth: Indications — FETAL

A
  • non-reassuring FHR patterns
  • Partial separation of the placenta
  • arrested decent
115
Q

Operative vaginal birth: contraindications

A
  • severe fetal compromise
  • High fetal station
  • Cephalopelvic disproportion
116
Q

Operative vaginal birth: Risks — MATERNAL

A
  • laceration/hematoma
117
Q

Operative vaginal birth: Risks — FETAL

A
  • ecchymosis, facial & scalp lacerations & abrasions
  • facial nerve injury
  • cephalhematoma
  • Intracranial hemorrhage
118
Q

Operative vaginal birth: Technique

A
  • verify presentation, position, station
  • membranes ruptured
  • cervix completely dilated
  • adequate anesthesia
119
Q

Operative vaginal birth: Nursing Care

A
  • have woman empty bladder or catheterize
  • assess FHR continuously
  • assess mother for vaginal/perineal trauma
  • assess newborn for trauma
120
Q

External version

A

Change from breech or transverse presentation to cephalic presentation

121
Q

External version: contraindications

A
  • uterine malformations
  • Previous C-section
  • cephalopelvic disproportion
  • Placenta previa
  • multifetal gestation
  • oligohydramnios, ruptured membranes, nuchal cord
  • uteroplacental insufficiency
  • engagement fetal head
122
Q

External Version: Technique

A
  • Nonstress test or biophysical profile
  • After 37 weeks gestation
  • administer tocolytic drugs
  • U/S to guide manipulation
123
Q

External Version: Risks

A
  • Fetal entanglement in umbilical cord
  • abruptio placenta
  • mixing of fetal and maternal blood
  • C-section births
124
Q

Nursing care: before external version

A
  • NPO
  • IV line
  • Maternal vital signs
  • Fetal heart monitoring
  • Reduce anxiety
125
Q

nursing care: after external version

A
  • d/c tocolytic drugs
  • maternal vital signs
  • signs of labor
  • Persistent pain
  • Reassuring fetal heart rate
  • Review signs of labor
126
Q

Indications: cesarean birth (c-section)

A

-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

127
Q

Cesarean birth: contraindications

A
  • fetal death
  • Fetus too immature to survive
  • Maternal coagulation defects
128
Q

Cesarean birth: risks — maternal

A
  • infection
  • Hemorrhage
  • urinary tract trauma
  • thrombophlebitis, thromboembolism
  • Paralytic ileus
  • Atelectasis
    -Anesthesia complications
129
Q

Cesarean birth: risks — fetal

A
  • inadvertent preterm birth
  • laceration, bruising, trauma

Maternity (1 decks)

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