exam 1 Flashcards
(227 cards)
1
Q
conception refers to the
A
union of sperm and egg
this would be the zygotic stage
2
Q
stages of featal development
A
- blastocyst stage
- embryonic stage
- featl stage
3
Q
blastocyst stage
A
zygote divide into solid ball of cells and attaches to uterus
4
Q
embryonic stage
A
end of 2nd week through 8th week where basic structures of major body organs and main external features
5
Q
fetal stage
A
differentiation of structures specialize by end of their week until birth
6
Q
breasts are made up
A
lymph nodes
alveoli
ducts
areola
nipple
7
Q
menstruation
A
release of an unfertilized egg causing shedding of endometrial lining inducing monthly bleeding
8
Q
ovarian cycle
A
- follicular phase (days 1 through ovulation, abt 10-14 days)
- ovulation (day 14 of a 28 day cycle)
- luteal phase (day 15-28)
9
Q
endometrial cycle
A
- proliferative phase
- secretory phase
- ischemic phase
- menstrual phase
10
Q
menstrual cycle hormones
A
- GnRH
- Follicle-stimualting hormone (FSH)
- Luteinizing hormone (LH)
- estrogen
- progesterone
- prostaglandins
11
Q
hormones and menstruation
A
- 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
12
Q
function of the placenta
A
- 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
13
Q
fetal circulation
A
- 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
14
Q
umbilical cord
A
- 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
15
Q
role of amniotic fluid
A
- 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
16
Q
how is pregnancy confirmed
A
- assumed on presence of S/S
- either presumptive, probable, or positive
17
Q
presumptive signs
A
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
18
Q
probable (objective) signs
A
- chadwick’s sign
- goodell’s sign
- hegar’s sign
- positive pregnancy test
- ballotement
- braxton hicks
- abdominal enlargement
- change in size and shape of uterus
19
Q
chadwick’s sign
A
bluish purple coloration of vaginal mucosa and cervix (6-8 wks)
20
Q
goodell’s sign
A
softening of cervix (5wks)
21
Q
hegar’s sign
A
softening of lower uterine segment or isthmus (6-12 wks)
22
Q
ballotement
A
can push cervix and feel a rebound from floating fetus (16-28 wwks)
23
Q
what to pregnancy tests measure
A
- 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
24
Q
positive signs of pregnancy
A
- fetal heart sounds
- fetal movement by HCP
- ultrasound visualization of fetus
25
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
26
cervical adaptations
- softening (goodell's sign)
- mucous plug formation
- increased vascularization (Chadwick Sign)
- ripening about 4 wks before birth
27
vaginal adaptation
- increased vascularity with thickening
- lengthening of vaginal vault
- secretions more acidic, white, and thick; leukorrhea
28
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
29
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
30
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
31
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
32
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)
33
maternal weight gain for healthy BMI
- health weight BMI: 25-35
- first trimester weight gain: 3.5-5lb
- second and third trimester: 1lb/wk
34
maternal weight gain for BMI <19.8
- 28-40 lbs overall
- first trimester: 5 lb
- second and third: +1lb/wk
35
BMI >25 maternal weight gain
- 15-25 lbs
- first trimester: 2lb
- second and third trimester: 2/3 lbs/week
36
maternal emotional response
- ambivalence: conflicting feelings
- introversion: focusing on oneself
- acceptance: fetus as separate individual
- mood swings
37
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
38
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
39
primipara
woman who has given birth once after pregnancy
40
multipara
woman who has had two or more pregnancies of at least 20 weeks
41
GTPAL
G= gravida (# of confirmed pregnancies)
T= term births
P= preterm births
A= # of births ending before 20 wks
L= # of children currently living
42
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
43
how to estimate delivery date (EDD)
- nagel's rule
- use first day of LMP
- subtract 3 months
- add 7 days
- add 1 year
44
labs during first prenatal vist
- CBC
- urinalysis
- STI testing (VDRL or RPR)
- Pap Smear
- blood type (including Rh factor)
- rubella
- HIV
45
ultrasound is used during first prenatal visit to
confirm pregnancy, site of implantation, and gestational age
46
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
47
follow up visits for pregnancies
- q4weeks up to 28 wks
- q2weeks from 29-36 wks
- q1week from 37 wks to birth
48
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
49
teaching during follow up appointments is to
educate on danger signs
50
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
51
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
52
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
53
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
54
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
55
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
56
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
57
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
58
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
59
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
60
reactive nonstress test
normal FHR normal rate moderate variability, accelerates (by >15 bpm for >15 second) >2x in 20 minutes
61
non-reactive nonstress test
abnormal FHR which doesn't accelerate sufficiently with fetal movement further testing done
62
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
63
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
64
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)
65
unpleasant side effects of pregnancy
- congestion
- constipation
- epistaxis
- fatigue
- gingivits
- heartburn
- hemorrhoids
- n/v
- urinary frequency
- varicose veins
- backaches
- breast tenderness
- cramps
- edema
66
congestion
use normal saline spray, certain antihistamines appropriate (Zyrtec)
67
constipation
increase fluid and fiber
68
epistaxis
use humidifer
69
fatigue
take frequent naps or rests
70
gingivitis
practice good dental hygeine, brush with soft toothbrush , floss daily
71
heart burn
eat small frequent meals, avoid laying down after meals, avoid spicy and greasy foods
72
hemorrhoids
use warm sitz bath and witch hazel pads, avoid straining during bowel movements
73
nausea/vomiting
eat crackers before getting out of bed in am, eat small/frequent meals and bland foods
74
urinary frequency
empty bladder often, kegel exercises help decrease stress incotinence
75
varicose veins
elevate legs, wear compression socks and stokcing, walk often, and avoid prolonged standing
76
chadwick's sign
bluish pruple color of vaginal mucosa and cervix
77
goodell's sign
softening of the cervix
78
hegar's sign
softening of the lower uterine segment/isthmus
79
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
80
highest risk in pregnancy
hemorrhage
81
conditions associated with early bleeding
- occur in 1st trimester
- spontaneous abortion, fibroids, ectopic, cervical insufficiency, trophoblastic
82
conditions associate with later bleeding
- occur after 20th week
- previa, abruption, accreta
83
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)
84
spontaneous abortion in 1st trimester is usually due to
fetal congenital abnormality
85
spontaneous abortion in 3rd trimester is usually due to
something maternal
86
labs for abortions
- WBCs
- Hgb/Hct
- blood type and Rh factor
- hCG levels
87
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
88
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
89
nursing assessment for spontaenous abortion
- vaginal bleeding
- cramping or contractions
- vital signs, pain level
- client's understanding
90
threatened abortion
- slight bleeding
- no cervical changes
- mild cramping
- no passage of fetal tissue
91
inevitable abortion
- moderate bleeding
- cervical dilation
- rupture of membranes
- strong cramping
- no passage of fetal tissue
92
incomplete abortion
- heavy bleeding, cervical dilation, severe cramping, passage of some fetal tissue
93
complete abortion
- decrease in pain and bleeding after passage of all fetal tissue
94
missed abortion
- spotting
- no cervical dilation
- no cramping
- non-viable embryo retained in uterus
95
nursing management of abortions
- continued monitoring of vaginal bleeding, pad count, passage of products of conception, pain level, preparation for procedures, meds
- support physical and emotional; stress that woman is not the cause of the loss, verbalization of feelings, grief support, referral to community support group
96
misoprostol (Cytotec)
- stimulates uterine contraction to terminate pregnancy and evacuate uterus after abortion to ensure passage of all products
- nursing: monitor s/e like diarrhea, abdominal pain, n/v, dyspepsia, vaginal bleeding and increased pain fever, monitor for signs and symptoms of shock, such as tachycardia, hypotension, and anxiety
97
mifepristone
- acuts as progesterone antagonist allowing prostaglandins to stimulate uterine contractions cause sloguh
- monitor for headache n/v and heavy bleeding
- anticipate admin of antiemetic prior to use
- encourage use of acetaminophen to reduce discomfort
98
dinoprostone
- stimulates uterine contractions causing expulsion of uterine contents
- bring gel to room temp
- avoid contact with skin
- use sterile technique
- keep client supine for 30 minutes
- document time of insertion and dosing intervals
- remove insert with retrieval system after 12 hrs or at onset of labor
- explain purpose
99
Rh immumoglobin
supresses immune response of nonsensitized Rh- blood to prevent isoimmunization in Rh-negative women exposed to Rh-positive blood after abortions, misarriages, and pregnancy
- admin IM
- only give microhgam for abortions and miscarriages
- educate she will need again after delievery
100
ectopic pregnancy
any pregnancy in which the ovum implants outside uterine cavity which can be a medical emergency if rupture or hemorrhage
101
nursing assessment for ectopic pregnancy
hallmark sign: lower abdominal pain (unilateral stabbing pain felt) with spotting (dark brown or red) within 6 to 8 weeks after missed meses
can also see s/s of hemorrhage (hypotension, tachycardia, pallor)
102
diagnosing ectopic pregnancy
- serum quantitative b-hCG
- progesterone
- CBC
- blood type and Rh
- transvaginal ultrasound
103
management of unruptured ectopic pregnancy
- meds: methotrexate, prostaglandins, misoprostol, and actinomycin, Rhogam
- given to dissolve pregnancy and save fallopian tube
104
methotrexate
folic acid antagonist that inhibits cell division in developing embryo
adverse effects: n/v, stomatitis, diarrhea, gastric upset, increased abdominal pain, dizziness
IM admin
105
surgical management of ectopic pregnancy
- depends on location, extent of tissue involvement, and woman's desire for future pregnancies
- salpingostomy (tubal incison to remove pregnancy)
- salpingectomy (removal of fallopian tube)
- beta HcG levels monitored until all tissue is gone
106
nursing management of ectopic pregnancy
- admin analgesics for pain and meds as ordered
- monitor VS
- educate about meds, s/e, adverse effects, s/s of rupture (severe, sharp stabbing pain, vertigo/faintaing, hypotension, and increased pulse)
- if surgery monitor vitals, bleeding, and pain status
- provide emotional support
107
hydatidiform mole (MOLAR pregnancy)
- exact cause unknown
- some point in pregnancy, trophoblastic cells normally would form placenta but instead proliferate and chorionic villi becomes enlarge and form grape-like structures
- two types: partial (embryonic tissue present) or complete (embryonic tissue absent)
108
s/s of hydatidiform mole
- dark brown vaginal bleeding (prune juice appearance)
- larger uterus/fundal height than expected for gestational age
- cramping
- persistent n/v
- early signs of preeclampsia
- expulsion of grape like vesicles
109
diagnosing hydatidiform mole
serum hCG levels
ultrasound
110
management of hydatidiform mole
immediate d&c, long term followup and serial hCG levels
111
nursing management of hydatidiform mole
- prepare for d&c
- emotional support
- provide them with factual information
- educate on phases of treatment, need for hCG, serum monitoring levels for 6 months, possible admin of methotrexate prophylactically, need to avoid pregnancy for 1 year
112
cervical insufficiency
- premature dilation of cervix
- cause unknown: possibly due to cervical damage
113
s/s of cervical insufficiency
- pelvic pressure
- vaginal bleeding or pink tinged discharge
- rush of fluids from vagina
- cervical dilation
114
diagnosis of cervical insufficiency
transvaginal ultrasound to assess cervical length
115
treatment of cervical insufficiency
cervical cerclage; bedrest avoidance of heavy lifting
116
musing management of cervical insufficiency
- monitor for s/s of preterm labor
- backache
- increased baginal discharge
- ROM
- uterine contractions
- emotional support
- preop teaching, s/s of preterm labor, reporting of changes, reinforce activity restrictions and follow ups
117
placenta previa
unknown cause
placenta implants over cervical os
two types: low-lying <2cm from internal os but doesn't cover and complete covering
118
s/s of placenta previa
- painless bright red bleeding during second half of pregnancy
- FHR reassuring
- uterus soft and non-tender
- VS normal
119
diagnosis of placenta previa
transvaginal ultrasound
120
therapuetic management of placenta previa
- dependent on bleeding and amount of placenta covering os, fetal development and position, maternal parity, labor s/s
- if stable w/ no active bleeding and reliable transportation, bed rest at home
- if continuous care needed hospitalized
- C-section at 36-37 weeks or immediate delivery for excessive bleeding
121
nursing management of placenta previa
- monitor maternal and fetal vitals
- monitor vaginal bleeding and pad count
- avoid vaginal exams
- monitor uterine contracts
- insert IV and admin IVF as ordered
- obtain and monitor labs (CBC, coag, type and xmatch)
- support and education (fetal mvmnts, effects of prolonged bed rest); s/s to report
- preparation for possible c-section
122
placental abruption
premature separation of the implanted placenta from the uterus after 20 weeks gestation leading to compromised fetal blood supply and high maternal and fetal morbidity/mortality
unknown cause
123
types of abruption
- partial with concealed hemorrhage
- partial with hemorrhage
- complete with concealed hemorrhage
124
s/s of placental abruption
- dark red bleeding
- severe abdominal pain
- rigid "board like abdomen
- fetal distress
125
diagnosing placental abruption
- CBC
- fibrinogen levels
- PT/aPTT
- type and cross match
- nonstress test
- biophysical profile
126
therapuetic management of placental abruption
- assessment
- control and restoration of blood loss
- positive outcome
- prevention of DIC
- emergency c-section
127
management of abruptio placentae
- start 2 large bore IVs and infuse NS or LR
- obtain labs
- maintain strict bedrest
- place in left lateral position
- administer o2 via nasal canula
- monitor vs and amount and quality of bleeding q15min
- insert foley
- assess fundal height
- s/s of DIC (bleeding gums, tachycardia, oozing from IV, petechiae)
- admin blood products
- initiate cFM
- report HCP for increased tenderness or rigidity
- uterine contractions
- NO VAGINAL EXAMS
128
previa vs abruption
- previa is insidious while absurption is sudden
- previa shows visible light bleeding that progresses while placental abruption can be conealed or visible
- blood is bright red with previa and dark with abruption
- no pain with previa, contstant pain with uterine tenderness for abruption
- uterus is soft and relaxed vs firm to rigid
- FHR in normal range, fetal distress or absent FHR
- may be breech or transverse lie; engagement is absent vs. no relationship
129
hyperemesis gravidarum
- severe n/v that extends beyond first trimester of pregnancy
- hCG levels higher and extend beyond first trimester
130
labs for hyperemesis gravidarum
- liver enzymes
- CBC
- BUN
- electrolytes
- urine
- specific gravity
- ultrasound
131
s/s of hyperemesis gravidarum
- n/v
- dehydration
- metabolic acidosis
- alkalosis and hypokalemia
- weight loss >5% prepreganancy weight
132
management of hyperemesis gravidarum
- conservative (diet and lifestyle changes)
- hospitalization with parenteral therapy
133
nursing assessment and management of hyperemesis gravidarum
- assess frequency, severity, duration of vomiting and diet hx
- monitor VS, I&Os, weight
- admin IVF and electrolytes as ordered
- admin antiemetics as ordered
- encourage small/frequent meals, dry/bland foods when resumation of eating
- provide emotional support
134
promethazine (Phenergan)
diminishes vestibular stimulates and acts on chemoreceptor trigger zone to relieve n/v and motion sickness
nursing: be alert for urinary retention, dizziness, hypotension, and involuntary movements, institute safety measures to prevent injury secondary to sedative effects, offer heard candy and frequent rinsing of mouth for dryness
135
pyridoxine and doxylamine
- delyaed releasse containing a combo of antihistamine and vitamin B6 to relive nausea and vomiting
- be alert for drowsiness, dizziness, headache, and irritability
- do not admin with CNS depressants or sleeping meds
- must be taken daily
- empty stomach with full glass of water
136
ondansetron (zofran)
- blocks serotonin release which stimulates vagal afferent neurons stimulating vomiting reflex
- monitor for s/e (diarrhea, constiaption, abdominal pain, headache, dizziness, drowsiness, and fatigue), liver function studies as ordered
137
hypertensive disorders of pregnancy
- chronic hypertension
- gestational hypertension
- preeclampsia/eclampsia/HELLP
- chronic hypertension with superimposed preeclampsia
138
preeclampsia
- leading cause of death and severe maternal morbidity worldwide
- unknown etiology
- risk factors: primigravida, multiple gestation, IVF, family hx, african american, obesity, hx in previous pregnancy, use of ovulation drugs, lower socioeconomic status, hx of diabetes
139
labs for preeclampsia
- CBC
- BUN/creatinine
- hepatic enzymes
- ruine for protein
- 24 hr urine collection
140
management of mild preeclampsia
- bed rest
- daily BP monitoring
- fetal movement counts
- hospitalization: IV magnesium, sulfate during labor
141
management of severe preeclampsia
- hospitalization
- oxytocin and magnesium sulfate
- preparation for birth
142
eclampsia management
- seizure mangement
- magnesium sulfate
- antihypertensive agents
- birth once seizures controlled
143
nursing assessment and management for preeclampsia
- assess for risk factors
- monitor VS frequently
- assess edema
- obtain lab tests as ordered and monitor
- monitor I&Os and weight
- bedrest with left side-lying position
- administer hypertensive medications as ordered
- monitor fetus
- maintain quiet environment to prevent seizures
144
magnesium sulfate
- blocks neuromuscular transmission to prevent eclamptic seizures
- monitor levels
- assess DTRs and ankle clonus
- calcium gluconate available in case of toxicity
- monior for hypotension, cardiac and CNS depression, sweating
- monitor for s/s of toxciity (decreased DTR, urine output <30mL/hr, respirations <12/min, decreased LOC)
145
hydralazine hydrochrlodie
reduces BP
146
labetalol hydrochloride
alpha 1 and beta blocker
reduces BP
147
nifedipine
calcium channel blocker
reduces blood pressure and stops preterm albor
148
sodium nitroprusside
rapid vsodilation to reduce severe hypertension requiring reduction in BP
149
furosemide
diuretic
pulmonary edema reduction
150
gestational diabetes
- impaired glucose tolerance during pregnancy
- risks: obesity, HTN, family hx of diabetes, previous GDM in previous pregnancy
151
s/s of gestational diabetes
usually asymptomatic
152
diagnosing gestational diabetes
1hr/3hr glucose tolerance test
153
treatment of gestational diabetes
- diet modification
- exercise
- blood glucose monitoring
154
complications of gestational diabetes
- fetal macrosomia
- neonatal hypoglycemia
- birth trauma
- c-section and diabetes following pregnancy
155
glucose tolerance test
blood sugar equal to or less than 140mg/dL 1 hr after drinking the glucose solution
at 2 hrs blood sugar <140 is normal
three hours after drinking glucose solution, normal blood glucose is lower than 140
156
gestational diabetes nursing management
- education: blood glucose first thing in the morning and 2 hrs after each meal, fetal kick count, s/s of hypo or hyperglycemia s/s of ketoacidosis
- intrapartum: establish IV access, monitor FHR, monitor glucose, prepare for complications
- postpartum: monitor glucose, monitor complications, encourage breastfeeding, emphasize need for follow up
157
blood incompatiablity
- ABO incomatibility; type O mothers and fetuses with type A or B blood (less severe than Rh)
- Rh incompatiability: exposure of Rh- negative mother to Rh+ fetal blood; sensitization; antibody production; risk increases with each subsequent pregnancy and fetus with Rh+ blood
158
nursing assessment for blood
maternal blood type and Rh status
159
nursing management
Rhogam at 28 wks
160
hydraminos (polyhydraminos)
amniotic fluid >2,000mL between 32-36 weeks
161
management of hydraminos (polyhydraminos)
- close monitoring
- removal of fluid
- indomethacin (decreases fluid by decreasing fetal urinary output)
162
nursing assessment for hydraminos (polyhydraminos)
- risk factors
- fundal height
- abdominal discomfort
- difficulty palpating fetal parts
- obtaining FHR
163
nursing management of hydraminos (polyhydraminos)
- ongoing assessment and monitoring
- assisting with therapuetic amniocentesis
164
oligiohydraminos
amniotic fluid <500 mL between 32-36 wks
165
therapuetic management of oligiohydraminos
- serial monitoring
- amnioinfusion and birth for fetal compromise
166
nursing assessments for oligiohydraminos
- risk factors
- fluid leaking from vagina
167
nursing management of oligiohydraminos
- continuous fetal surveillance
- assistance with amnioinfusion
- comfort measures
- position chaneges
- moniotr VS, contractions, and FHR
168
multiple gestation
- any pregnancy with 2+ babies
- rate has increased due to technology
- multiple gestation has higher risks for mothers and babies (ie, miscarriage, gestational diabetes, hypertension, HELP syndrome, preterm labor, PPROM)
169
goals of medical care for multiple gestation
- promote normal fetal development
- prevent maternal complications
- prevent preterm birth
- minimize fetal trauma during labor
170
nursing care for multiple gestation prenatally
- hx taking
- measuring fundal height
- palpate uterus
- determine family's level of preparation for integrating multipels
171
intrapartum nursing care of multiples
- large bore needle IV
- anesthesia and x-match need to be available
- monitor FHR of all fetuses
- prep for additional documentation and equipment
- have addtional staff on hand for delivery
- c/s performed if presenting twin is not in vertex position (preferred method fro 3+)
- first newborn is ID'd as A then B, etc.
172
premature rupture of membranes
- PROM = women beyond 37 wks gestation
- PPROM = women less than 37 wks gestation
- treatment: dependent on gestational age, no unsterile digital cervical exams until woman in active labor, expectant management if fetal lungs immature
173
nursing care for PROM
- asktime of initial loss and if continuous, note color, consistency, amount, and odor
- check fluid with nitrazine paper
- perform a fern test
- obtain CBC and urinalysis
- perform NST and biophysical profile
- place pt on bedrst and encourage to lay on L or R side
- monitor maternal VS q4hr
- ensure hydration
- admin antibiotics as ordered
- admin corticosteroids as ordered
- limit vaginal exams
- keep her and significant other informed
174
labor
between 37 and 42 weeks
causes are not fully understood
175
factors influencing onset of labor
- uterine stretch
- progesterone withdrawal
- increased oxytocin sensitivity
- increased release of prostaglandins
176
premonitory signs of labor
- lightening
- bloody show and/or increased vaginal discharge
- backache
- return of urinary frequency
- stronger braxton hick's contrations
- cervical ripening
- surge of energy
- weight loss 0.5-1.5kg
- nesting
- possible rupture of membranes
- GI upset: n/v, diarrhea, indigestion all without other causes
- increased vaginal secretions
177
true vs false labor
- contraction timing
- contraction strength
- contraction discomfort
- change in contraction activity
178
true labor vs false labor
true labor: regular contractions gradually coming closer together usually about 4-6 minutes apart lasting 30-60 seconds, getting stronger with time, vaginal pressure is felt, starts in back and radiates around in front, contractions continue no matter what position, stay home until contraction are 5 minutes apart and lasting 45-60 seconds and are strong enough so that conversation during one is not possible
false labor: irregular and not occuring close together, frequently weka not getting stronger or alternating contractions, usually felt in front of abdomen, contractions may stop or slow down with walking or making a position change, drink fluids, and walk
179
five P's of labor
- passageway (birth canal: pelvis and soft tissues)
- passenger (fetus and placenta)
- powers (contractions)
- position (maternal)
- psychological response
180
5 additional P's
- philosophy (low tech, high touch)
- partner (support caregivers)
- patience (natural timing)
- patient (preparation - education)
- pain management (comfort measures)
181
passageway
refers to the bony pelvis including the inlet, midpelvis, and outlet and soft tissues including cervix, pelvic floor muscles, vagina, and perineum
182
most favorable pelvis
gynecoid
183
anthropod pelvis
oval shaped
184
android pelvis
alient like shape, difficult for birth
185
plattypelloid pelvis
flat shaped, difficult for birth
186
passenger
refers to fetal head, presentation, lie, attitude and position
all aspects of the fetus inside the womb
187
fetal skull
referance to the fetus' fontanelles and sutures the skull molds to the sutures and fontanelles merge together
188
fetal attitude
referes to whether the baby is flexed or extented
189
fetal lie
relationship of fetus to inlet of pelvis
longitudonal, transverse
190
fetal presentation
presenting part of fetus to the inlet of pelvis, back of head, front of face, feet, buttocks, etc.
191
fetal position
relationship of the reference point on presenting part of fetus to the four quadrants of mother's pelvis
first letter = right or left
middle letter = presenting part
third letter = location in regards to pelvis
192
breech
position of baby where position isn't ideal for birth and is not head first
193
passageway and passenger relationship
- engagement
- station
- position
194
process of engagement
- floating
- entering the inlet
195
fetal station/engagement
refers to how far down the head is in relation to ischial spine
196
cradinal movements
- engagement
- descent
- flexion
- internal rotation
- extension
- restitution and external rotation
- expulsion
197
powers
- primary power: uterine contractions
- secondary: maternal pushing efforts
- understanding of parameters of uterine contraction in reference to frequency, duration, and intensity
198
contractions
- rhythmic tightening of uterus
- muscle fibers squeeze the baby down and out while pulling cervix back to open it
- muscle at top of uterus push down to push baby out
- in early stage labor, contractions feel like hardening or tightening of the belly and cramping
- as labor progresses contractions become longer, closer, and stronger
- in active labor, uterine contraction builds up and peaks
199
cervical effacement
- no changes to cervix = 0% effaced
- cervix is half of normal thickness = 50% effaced
- cervix is completely thinned = 100% effaced
200
cervical dilation
opening of cervix to allow space for baby to be expelled
201
cervical assessment
- dilation and effacement
- fetal station
- membrane status
- fetal position
202
determining fetal position
on vaginal assessment you may see fontanelle's of baby
leopolds manuever
203
lamaze healthy birth practices 2 and 5
walk, move around, and change postion throughout labor
avoid giving birth on back and follow body's urge to push
204
lamaze healthy birth practice I
let labor begin on its own, medical interventions are last resort
205
hormones of labor
- oxytocin
- endorphins
- cathecholomine (adrenaline)
- prolactin
206
oxytocin
- stimulates the calm and connection
- released in response to tocuh, security, pleasant sounds, good food, positive thoughts
207
endorphins
- morphine like painkillers
- reduces brain perception, helps give focus
- release in response to touch, deep breathing, rhythmic movement and visualization
- increase in pregnancy, rise in labor and birth
208
cathecholomine (adrenaline)
- stress hormone
- pupils dilate, and breathing quickens, muscles ready to move
- increases in second stage of labor
209
prolactin
- milk producing/mothering hormone
- thought to be important along with catecholamine's in fetal lung development
210
lamaze healthy birth practice 4
avoid interventions that are not medically necessary
211
indications of induction of labor
- post-term pregnancy
- PROM
- gestational hypertension/preeclampsia
- diabetes
- maternal medical condition (cardiac disease, renal disease)
- chorioamnionitis
- intrauterine fetal demise
212
amniotic membrane rupture
- "water breaking"
- high leak: trickle of fluid
- low break: gush of fluid
213
physiological responses to labor
- increased HR, CO, and BP (during contractions)
- increased WBCs
- increased RR and oxygen consumption
- decreased gastric motility and food absorption
- decreased gastric emptying and gastric pH
- slight temp elevation
- mucles aches
- increased BMR
- decreased blood glucose levels
214
fetal response to labor
- periodic HR accelerations and slight decelerations
- decrease in circulation and perfusion
- increase in arterial carbon dioxide pressure
- decrease in fetal breathtaking movements
- decrease in fetal oxygen pressure, and partial pressure of oxygen
215
maternal response to second stage of labor
- urge to push
- fear of tearing
- increased energy and control
- crowning: visible head within the introitus
216
labor stages
first stage: effacement and dialtion (early labor/latent phase 0-6cm, active labor/active phase 6-10cm)
second stage: expulsion or pushing (full dilation until birth of baby)
third stage: separation and delivery of the placenta
217
early labor/latent labor
- contractions are 30-40sec/q5-20 min
- fatigue sets in, conserve energy, can last up to 20 hours
- dilation 0-6cm
- effacement 0-100%
218
active labor
- cervix has thinned out and opening up
- baby's head is facing mother's side
- effacement in active labor is 100%
- contractions are 45-60sec/q2-5 minutes
- moderate to palpation
- 0.5cm-1cm/hr
- progressive fetal descent
219
recommendations from experts about pushing
- labor down until she feels urge to push
- follow spontaneous urges
- directing a woman should be reserved
- shouldn't be directed to push longer than 8 seconds with each push
220
how positioning can help push
- push in upright position
- increases pelvic diameter 28-30%
- decreases duration of 2nd stage
- decreased intensity of pain
- decreased incidence of perineal trauma
221
third stage of labor
- expulsion of placenta
- may be very happy or very tired
- involved with how baby is doing; asking questions about baby's well being
- slowing of contractions
- shrinking of uterus to grapefruit size; found at level of umbilicus
222
fetal adaptation to labor
- FHR: accelerations and slight decels
- fetal circulation: uterine contractions may decrease circulation: watch for cord compression
- fetal lung fluid is cleared from passages as infant passes through birth canal during labor and birth. process of labor contributes to absorption of some of lung fluid
- fetal O2 pressure decreases
- arterial carbon dioxide increases
- arterial pH decreases
- bicarbonate levels decrease
- fetal respiratory movements decrease during labor
223
maternal adapations to labor
- increase in CO
- increase in systolic and diastolic BP during contractions; baseline in between
- increase HR
- increase WBC
- increase RR and O2 consumption
- proteinuria
- perineal stretching
- euphoria, amensida
- stomach empyting slower, nausea
224
fetal assessment during labor and birth
- true labor contraction
- false labor contractions
- FHR patterns (baseline, variablity, periodic changes, assessment methods, fetal scalp sampling, pulse ox, stimualtio
225
factors for proper oxygenation of fetus
- normal maternal BF and volume to placenta
- normal oxygen saturation in maternal blood
- adequate exchange of O2 and CO2
- open circulatory path between placenta and fetus through vessels in umbilical cord
- if not maintained can lead to fetal hypoxia
226
amniotic fluid allows for
- proper bone growth
- lungs to develop properly
- prevents pressure on umbilical cord
- keeps constant temperature
- cushions fetus from sudden blows or movement
227
characteristics of amniotic fluid
- color: clear (if colored with green it means meconium indicating fetal distress)
- odor: should be odorless (if foul smelling, may indicate infection)
- amount: scant: gross scant: high leak: gross: forwaters
- time: note time leak is first observed
