exam 1 Flashcards
conception refers to the
union of sperm and egg
this would be the zygotic stage
stages of featal development
- blastocyst stage
- embryonic stage
- featl stage
blastocyst stage
zygote divide into solid ball of cells and attaches to uterus
embryonic stage
end of 2nd week through 8th week where basic structures of major body organs and main external features
fetal stage
differentiation of structures specialize by end of their week until birth
breasts are made up
lymph nodes
alveoli
ducts
areola
nipple
menstruation
release of an unfertilized egg causing shedding of endometrial lining inducing monthly bleeding
ovarian cycle
- follicular phase (days 1 through ovulation, abt 10-14 days)
- ovulation (day 14 of a 28 day cycle)
- luteal phase (day 15-28)
endometrial cycle
- proliferative phase
- secretory phase
- ischemic phase
- menstrual phase
menstrual cycle hormones
- GnRH
- Follicle-stimualting hormone (FSH)
- Luteinizing hormone (LH)
- estrogen
- progesterone
- prostaglandins
hormones and menstruation
- LH rises and causes follicles of ovary to produce estrogen
- when estrogen levels increase, LH decreases
- ovulation occurs after an LH surge damages the estrogen producing cells causing decline in estrogen
- LH surge results in corpus luteum which produces estrogen and progesterone
- estrogen and progesterone rises suppressing LH output
lack of LH promotes degeneration of corpus luterum - cessation of the corpus luteum means a decline in estrogen and progesterone output
- decline in hormones ends their negative effect on LH output
- LH is release and menstrual cycle begins again
function of the placenta
- serves as interface between the mother and fetus
- masking hormones to control the physiology of the mother to ensure fetus is supplied with nutrients and oxygen needed for growth
- protecting the fetus from immune attack by the mother
- removing waste products from fetus
- inducing the mother to bring more food to the placenta
- producing hormones that mature into fetal organs
fetal circulation
- blood from the placenta to and from the fetus back to the placenta
- ductus venousus, ductus arteriosus, and formen ovale are the shunts during fetal life
- placenta acts like lungs
- arteries typically bring blood into the body but in fetal circulation, arteries are bringing blood to placenta and umbilical vein goes to the heart
umbilical cord
- formed from the amnion
- lifeline from the mother to growing embryo
- contains one large vein and two small arteries
- wharton jelly surrounds the vein and arteries to prevent compression
- at term, average umbilical cord is 22 in long and 1 in wide
role of amniotic fluid
- helps maintain a constant body temperature for the fetus
- permits symmetric growth and development
- cushions the fetus from trauma
- allows the umbilical cord to be relatively free of compression
- promotoes fetal movement to enhance MSK development
how is pregnancy confirmed
- assumed on presence of S/S
- either presumptive, probable, or positive
presumptive signs
can be explained by conditions other than pregnancy and include
- fatigue (12 weeks)
- N/V (4-14 weeks)
- urinary frequency (6-12 wks)
- amenorrhea (4 weeks)
- breast changes 3-8 weeks)
- quickening
probable (objective) signs
- chadwick’s sign
- goodell’s sign
- hegar’s sign
- positive pregnancy test
- ballotement
- braxton hicks
- abdominal enlargement
- change in size and shape of uterus
chadwick’s sign
bluish purple coloration of vaginal mucosa and cervix (6-8 wks)
goodell’s sign
softening of cervix (5wks)
hegar’s sign
softening of lower uterine segment or isthmus (6-12 wks)
ballotement
can push cervix and feel a rebound from floating fetus (16-28 wwks)
what to pregnancy tests measure
- recognition of hCG
- lower than 5mLU/mL negative
- higher than 25 mlU/mL
- levels double q48-72 hrs until peak approximately 60-70 days after fertilization and decrease to a plateau at 100-130 days
positive signs of pregnancy
- fetal heart sounds
- fetal movement by HCP
- ultrasound visualization of fetus
uterine adaptations
- increase in size, weight, length, width, depth, volume and overall capcity
- pear shape to ovoid shape; positive Hegar’s sign
- enhanced uterine contractility; braxton hicks contraction
- ascent into abdomen after first 3 months
- fundal height by 20 weeks at umbilicus level and reliable determination of gestational age
- 24wks = 24 cm
cervical adaptations
- softening (goodell’s sign)
- mucous plug formation
- increased vascularization (Chadwick Sign)
- ripening about 4 wks before birth
vaginal adaptation
- increased vascularity with thickening
- lengthening of vaginal vault
- secretions more acidic, white, and thick; leukorrhea
breast adaptations
- increase in fullness, become larger and tender due to estrogen and progesterone
- become highly vascular and veins become visible
- nipples become larger and more erect
- areola becomes pigmented and tubercles of Montgomery become prominent
GI Adaptations
- Gums: hyperemic, swollen, friable
- Ptyalsim
- gingivitis
- decreased peristalsis and smooth muscle relaxation
- constipation and increased venous pressure + pressure from uterus = hemorrhoids
- slowed gastric emptying (heartburn)
- prolonged gallbladder emptying
- nausea and vomiting
cardiovascular adaptations
- increased BV (50% above pregnancy levels)
- increased CO; increased venous return; increased HR
- slight decline in BP until midpregnancy then returning to prepregnancy levels
- increase number of RBCs; plasma volume >RBC leading to hemodilution (anemia)
- increase in iron demands, fibrin, and plasma fibrinogen levels, and some clotting factors, leading to hypercoaguable state
respiratory adaptation
- breathing more diaphramatic than abdominal due to increase diaphragmatic exursion, chest circumference, and tidal volume
- increase in O2 consumption
- congestion secondary to increased vascularity
nutritional needs of pregnancy
- healthy eating enables optimal gestational weight gain and reduces complications (both associated with positive birth outcomes)
- need for vitamins and mineral supplements
- dietary recommendations include increase in fruit and vegetables choose whole grains, food with a lot of fiber, consuming 3 quarts of water daily, eating two servings of fish weekly (AVOID high mercury)
maternal weight gain for healthy BMI
- health weight BMI: 25-35
- first trimester weight gain: 3.5-5lb
- second and third trimester: 1lb/wk
maternal weight gain for BMI <19.8
- 28-40 lbs overall
- first trimester: 5 lb
- second and third: +1lb/wk
BMI >25 maternal weight gain
- 15-25 lbs
- first trimester: 2lb
- second and third trimester: 2/3 lbs/week
maternal emotional response
- ambivalence: conflicting feelings
- introversion: focusing on oneself
- acceptance: fetus as separate individual
- mood swings
maternal tasks of pregnancy
- ensuring safe passage throughout pregnancy and birth
- seeking acceptance of infant by others
- seeking acceptance of self in maternal roe to infant “binding in”
- learning to give of oneself
first prenatal visit
- establishment of trusting relationship
- focus on education for overall wellness
- detection and prevention of potential problems
- comprehensive health hx, physical exam, and lab tests
- reasons for seeking care: suspicion of pregnancy, date of LMP, S/S of pregnancy, urine or blood test for hCG
primipara
woman who has given birth once after pregnancy
multipara
woman who has had two or more pregnancies of at least 20 weeks
GTPAL
G= gravida (# of confirmed pregnancies)
T= term births
P= preterm births
A= # of births ending before 20 wks
L= # of children currently living
Mary Johnson is pregnant for the 4th time. She had one abortion at 8 wks gestation. She has a daughter who was born at 40 wks gestation & son born at 34 wks. How would this be documented?
G4T2P1A1L2
how to estimate delivery date (EDD)
- nagel’s rule
- use first day of LMP
- subtract 3 months
- add 7 days
- add 1 year
labs during first prenatal vist
- CBC
- urinalysis
- STI testing (VDRL or RPR)
- Pap Smear
- blood type (including Rh factor)
- rubella
- HIV
ultrasound is used during first prenatal visit to
confirm pregnancy, site of implantation, and gestational age
fundal height
- roughly correlates with gestational age
- tape measure used to measure cm between top of symphisis pubis over abdominal curve to uterine fundus (McDonald method)
- usually responds in cm for gestation from 22-34 wks
- +/- cm either way is normal
- if abnormal, ultrasound should be preformed to determine possible cause
follow up visits for pregnancies
- q4weeks up to 28 wks
- q2weeks from 29-36 wks
- q1week from 37 wks to birth
assessments during followup visits
- weight and BP compared to baseline values
- urine testing for protein, glucose, ketones, and nitrates
- fundal height
- quickening/fetal movement
- fetal HR
teaching during follow up appointments is to
educate on danger signs
fetal heart beat
- use of ultrasonic doppler
- may detect at 10-12 weeks gestation
- normal FHT is 110-160bpm
- if FHB cannot be ausculatated get ultrasound
quickening
- fetal movements felt by mother
- may indicate fetus is nearing 20 weeks
- can be felt as early as 16 or as late as 22 weeks
- multiparous women usually report quickening before primigravidas do
fetal kick counts
- being attentive to fetal movement will help patient notice any changes
- pick time of day baby is most active (usually night), have something to eat or drink, lay down, on left side should feel 10 movements within 1 hr
danger signs in pregnancy
- sudden gush of fluid from vagina
- vaginal bleeding
- abdominal pain
- temp >101
- dizziness, blurred/double vision, spots
- presistent n/v
- severe HA
- edema to face, hands, feet, and legs
- epigastric pain
- dysuria
- absence or decreased fetal movement
psychological maladaptation
- increased anxiety
- depression
- inability to communicate
- inappropriate responses/actions
- inability to cope with stress
- indications of substance abuse
- denying pregnancy
- intense preoccupation w/ sex of baby
- failure to acknowledge quickening
- failure to plan/prepare for baby
diagnostic tests: ultrasound
- non-invasive
- transvaginal in first trimester to confirm pregnancy
- second maybe done about 18-20wks for congenital malformations, checking for multiples or to confirm dates
- third may be done at 34 weeks or so to assess fetal growth and verify placental position
- nursing management: education and explanations
alpha fetoprotein analysis (AFP)
- serum AFP increase until about 14-15 weeks
- optimal time to screen is 16-18 weks
- elevated levels indicate could indicate neural tube defects
- nursing management: preparing client, accurate collecting of LMP, explaining will require blood draw
amniocentesis
- transabdominal puncture of amniotic sac to obtain amniotic fluid
- performed between 15-18 weeks gestation
- nursing: explain procedure, encourage to empty bladder, obtain and record baseline vs, monitor vs, provide comfort, after procedure admin Rhogam if needed assess VS q15min, observe puncture site for bleeding, educate on complications
chorionic villus sampling (CVS)
- involve using nan 18-guage needle in abdomen or passage of suction catheter through cervix to obtain sample of chorionic villi from placenta to test for chromosomal abnormalities
- 10-13 weeks
- nursing: explain and inform of risks, provide comfort, assist into sitting position, clean lubricant or secretions, educate on s/s, assess FHR, admin Rhogam
- increased risk of miscarriage
nonstress test
- noninvasive test to determine fetal well being
- FHR recorded for 30 minutes. mom pushes button when she feels movement
- results: normal FHR normal rate moderate variability, accelerates (by >15 bpm for >15 second) >2x in 20 minutes
reactive nonstress test
normal FHR normal rate moderate variability, accelerates (by >15 bpm for >15 second) >2x in 20 minutes
non-reactive nonstress test
abnormal FHR which doesn’t accelerate sufficiently with fetal movement further testing done
nursing responsibilities for NST
- intruct pt ot eat meal before procedure
- position in semi-fowler’s position
- fetal monitor
- document date and time
- VS
- obtain baseline fetal monitor strip over 15-30 minutes
- during procedure observe for signs of fetal activity with concurrent acceleration
- after procedure, assist to sitting position, provide fluids, and assist to restroom, provide teaching on s/s
biophysical profile
- non invasive assessment of fetal well being using ultrasound and NST
- includes u/s moniotring of fetal movement, fetal tone, and fetal breathing and assessment of amniotic fluid volume with or without assesment of FHR
- nursing: offer support, answer questions, inform what wil be done in imaging
biophysical profile scoring
- fetal HR (reactive =2 nonreactive =0)
- fetal breathing (>1 episode of 30 sec. = 2, absent or less than 30sec = 0)
- gross body movements (>3 body/limb movements = 2, <3 movements = 0)
- fetal tone (>1 extension/flexion =2, none or slow movement = 0)
- amniotic fluid volume (>1pocket of fluid >2cm = 2, <2 cm pocket = 0)
unpleasant side effects of pregnancy
- congestion
- constipation
- epistaxis
- fatigue
- gingivits
- heartburn
- hemorrhoids
- n/v
- urinary frequency
- varicose veins
- backaches
- breast tenderness
- cramps
- edema
congestion
use normal saline spray, certain antihistamines appropriate (Zyrtec)
constipation
increase fluid and fiber
epistaxis
use humidifer
fatigue
take frequent naps or rests
gingivitis
practice good dental hygeine, brush with soft toothbrush , floss daily
heart burn
eat small frequent meals, avoid laying down after meals, avoid spicy and greasy foods
hemorrhoids
use warm sitz bath and witch hazel pads, avoid straining during bowel movements
nausea/vomiting
eat crackers before getting out of bed in am, eat small/frequent meals and bland foods
urinary frequency
empty bladder often, kegel exercises help decrease stress incotinence
varicose veins
elevate legs, wear compression socks and stokcing, walk often, and avoid prolonged standing
chadwick’s sign
bluish pruple color of vaginal mucosa and cervix
goodell’s sign
softening of the cervix
hegar’s sign
softening of the lower uterine segment/isthmus
high risk pregnancy
- jeopardy to mother, fetus, or both
- condition due to pregnancy or result of condition present before pregnancy
- higher morbidity and mortality
- risk assessment with first antepartal visit; ongoing
highest risk in pregnancy
hemorrhage
conditions associated with early bleeding
- occur in 1st trimester
- spontaneous abortion, fibroids, ectopic, cervical insufficiency, trophoblastic
conditions associate with later bleeding
- occur after 20th week
- previa, abruption, accreta
spontaneous abortion
- cause unknown and highly variable
- 1st trimester commonly due to fetal genetic abnormalities
- 2nd trimester more likely related to maternal conditions
-S/S: uterine cramping, backache, vaginal pressure, abnormal uterine bleeding (bright red, heavy, and consistent)
spontaneous abortion in 1st trimester is usually due to
fetal congenital abnormality
spontaneous abortion in 3rd trimester is usually due to
something maternal
labs for abortions
- WBCs
- Hgb/Hct
- blood type and Rh factor
- hCG levels
tests and procedures for spontaneous abortions
1st trim.: frequent monitoring of hCG levels to validate conceptive tissue expelled. possible dilation and curettage (D&C)
2nd trim: admitted to hospital for induction of labor
questions to ask for bleeding
- color of blood
- how much soaking of pads/ how frequent
- clots?
- save tissue or clots to see if it is containing fetal parts
- how long
nursing assessment for spontaenous abortion
- vaginal bleeding
- cramping or contractions
- vital signs, pain level
- client’s understanding
threatened abortion
- slight bleeding
- no cervical changes
- mild cramping
- no passage of fetal tissue