Exam 1 Flashcards
A multiparous woman has been in labor for 8 hours. Her membranes have just ruptured. What should you do first?
- Prepare the woman for labor
- Notify the primary health care provider
- Document the color of the fluid
- Assess fetal heart rate
- Assess fetal heart rate
The nurse expects to administer an oxytocic to a woman after expulsion of her placenta in order to:
Stimulate contractions
A vaginal exam in maternity triage reveals the following information: LOA, -1, 65%, 4cm. An accurate interpretation of this data would include which of the following?
A. Attitude: vertex B. Station: 4 cm below the ischial spines C. Presentation: cephalic D. Lie: longitudinal E. Effacement: 65% complete F. Dilation: 4 cm to reach full dilation G. Position: oblique
A, C, D, E
If baby is LOA, that means the attitude must be ___, the presentation must be ___, and the lie must be ___
attitude: vertex
presentation: cephalic
lie: longitudinal
spermatogenesis
formation of male gametes, or sperm, in the maturing adolescent.
climacteric
transitional period, which starts as female fertility
declines and extends through menopause and the postmenopausal period.
In most women, the climacteric occurs between ages 40 and 50 years.
Maturation of ova and production of ovarian hormones gradually decline.
The external and internal reproductive organs atrophy
somewhat as well.
How is a woman’s breast size related to the amount of milk she can produce?
unrelated
What is the function of Montgomery’s tubercles?
sebaceous glands in the areola.
They are inactive and not obvious except during pregnancy and lactation, when they enlarge and secrete a substance that keeps the nipple soft.
active milk production occurs in response to
the infant’s suckling (not produced automatically)
full term pregnancy ranges from ____ weeks of fertilizations age or ____ weeks from gestational age
Full term ranges from 36 to 40 weeks of fertilization age calculated from date of conception, or 38 to 42 weeks of gestational age (after last menstrual period).
How does Nagele’s rule work? Calculate based off LNMP August 30, 2014
Nagele’s rule is often used to establish the EDD.
subtract 3 months from the date the LNMP began, add 7 days and then correct the year, if appropriate.
For example:
•LNMP: August 30, 2014
•Subtract 3 months: May 30, 2014
•Add 7 days and change the year: June 6, 2015
The average duration of pregnancy from the first day of the LNMP is
40 weeks or 280 days
The abdomen is large enough to contain
all its normal contents by __ weeks
10 weeks
During weeks 9-12, the head is approximately ___ the total length of the fetus
half
Blood formation occurs primarily in the ___ during week 9 but shifts to the ___ by the end of week 12.
liver
spleen
When can fetal gender be established?
By the end of week 12
What is quickening?
During weeks 13-16, fetal movements strengthen, and some
women, particularly those who have been pregnant before, are able to detect them.
Vernix caseosa
a fatty, cheeselike secretion of the fetal sebaceous glands
covers the skin to protect it from constant exposure to amniotic fluid.
diminishes as fetus reaches term
Lanugo
fine, downy hair that covers the fetal body and helps the vernix adhere to the skin.
diminishes as fetus reaches term
When is brown fat deposited, where, and why?
weeks 17-20
a special heat-producing fat that helps the newborn maintain temperature stability after birth. It is located on the back of the neck, behind the sternum, and around the kidneys
To reduce respiratory distress of prematurity, ____ may be given to infants who are at risk for a deficiency because of their immaturity.
artificial surfactant
During early pregnancy the fetus floats freely within the amniotic sac. However, the fetus usually assumes a head-down position during this time for two reasons:
- The uterus is shaped like an inverted egg. The overall shape of the fetus in flexion is similar, with the head being the small pole of the egg shape and the buttocks, flexed legs, and feet being the larger pole.
- The fetal head is heavier than the feet, and gravity causes the head to drift downward in the pool of amniotic fluid. The head-down position is also most favorable for normal birth.
Growth of all body systems continues until birth, but the rate of growth ___ as full term approaches.
slows
At birth, boys are slightly ___ than girls.
heavier
What is surfactant?
a surface-active lipid that makes it easier for the baby to breathe after birth.
Surfactant reduces surface tension in the lung alveoli and prevents them from collapsing with each breath.
placenta, 2 sides, functions
The placenta is a thick, disc-shaped organ.
two components: maternal and fetal
(1) metabolic functions
(2) transfer functions
(3) endocrine functions
The fetal side is smooth, with branching vessels covering the membranecovered surface.
The maternal side is rough where it attaches to the uterus
During early pregnancy, the placenta is ___ than the embryo or fetus.
However, the fetus grows faster than the placenta, so the placenta is approximately ___ the weight of the fetus at the end of a fullterm pregnancy.
larger
one sixth
Maternal and fetal blood normally ___ mix in the placenta, although they flow very close to each
other. Exchange of substances between mother and fetus occurs within the ____of the placenta.
do not
intervillous spaces
The umbilical cord contains the umbilical __ and ___ to transport blood between the fetus and placenta.
arteries (2) and vein (1)
arteries carry deoxygenated blood and waste
veins carry oxygenated blood
The closed fetal circulation is important because the blood types of mother and fetus may not be ___.
compatible
The placenta produces some nutrients needed by the embryo and for placental functions. Substances synthesized include ___, ___, and ____
glycogen, cholesterol, and fatty acids
glucose is major energy source for fetal growth and metabolism
Oxygen and carbon dioxide pass through the placental membrane by ____
simple diffusion.
___ is major energy source for fetal growth and metabolism
Glucose
The preterm infant has little protection from maternal
antibodies because ____.
they are transferred during late pregnancy and are
poorly transferred if placental function is inadequate
Human placental lactogen, also called human chorionic somatomammotropin
promotes normal nutrition and growth of the fetus as
well as maternal breast development for lactation.
This placental hormone decreases maternal insulin sensitivity and glucose use, making more glucose available for fetal nutrition.
Functions of progesterone include the following:
- Causes secretory changes in the endometrium, providing nourishment as the conceptus enters the uterus.
- Causes the changes in endometrial cells that convert them into the larger and thicker cells of the decidua, which characterize pregnancy.
- Reduces muscle contractions of the uterus to prevent spontaneous abortion.
- May induce some immune tolerance in the mother’s body for the conceptus.
- Acts with estrogens and other hormones to cause growth of the breasts, budding of the alveoli that will secrete milk, and development of secretory characteristics in the alveolar cells.
What structure takes over the corpus luteum?
As the placenta develops further, it takes over estrogen
and progesterone production and the corpus luteum regresses.
Amniotic fluid protects the fetus by the following actions:
- Cushioning against impacts to the maternal abdomen
- Maintaining a stable temperature
Amniotic fluid promotes normal prenatal development by the following actions:
- Allowing symmetric development as the major body surfaces fold toward the midline
- Preventing the membranes from adhering to developing fetal parts
- Allowing room and buoyancy for fetal movement
What 2 sources is amniotic fluid derived from?
(1) fetal urine and
(2) fluid transported from the maternal blood across the amnion.
What are two sources for the higher rate of twins in the US?
higher age of maternity
infertility treatments
The two types of twins are
monozygotic and dizygotic
Monozygotic twins
are conceived by the union of a single ovum and
spermatozoon, with later division of the conceptus into two.
Monozygotic twins have identical genetic complements and are the same gender.
However, they may not always look identical at birth because one twin may have grown much larger than the other or one may have a birth defect such as a cleft lip.
Monozygotic twins have a higher rate
of birth defects, preterm births and low birth weight.
Dizygotic twins
arise from two ova that are fertilized by different
sperm.
Dizygotic twins may be the same or different gender, and they may not have similar physical traits.
term
38-42 weeks of gestation
lightening
By 40 weeks, the fetal head descends into the pelvic cavity, and the uterus sinks to a lower level.
This descent of the fetal head is called lightening because it reduces pressure on the diaphragm and makes breathing
easier.
Lightening is more pronounced in first pregnancies.
Braxton Hicks contractions.
Throughout pregnancy, the uterus undergoes irregular contractions called Braxton Hicks contractions.
During the contractions, the uterus temporarily tightens and then returns to its original relaxed state.
During the first two trimesters, the contractions are infrequent and usually not felt by the woman.
Contractions occur more frequently during the third trimester and may cause some discomfort. They are called false labor when they are mistaken for the
onset of early labor.
hyperemia
congestion with blood
Chadwick sign
After conception, increasing levels of estrogen cause
hyperemia (congestion with blood) of the cervix, resulting in the characteristic bluish purple color that extends to include the vagina and the labia.
This discoloration, referred to as the Chadwick sign, is
one of the earliest signs of pregnancy.
Goodell’s sign
Before pregnancy, the cervix has a consistency similar to that of the tip of the nose.
After conception the cervix feels more like the lips or earlobe.
The cervical softening is referred to as the Goodell sign.
colostrum
a thick, yellowish fluid which is
secreted from breasts as early as 16 weeks of gestation
physiologic anemia of pregnancy
dilution of RBC mass during pregnancy causes a decline in maternal hemoglobin and hematocrit.
This condition is frequently called physiologic anemia of pregnancy, or pseudoanemia of pregnancy, because it reflects dilution of RBCs in the expanded plasma volume, rather than an actual decline in the number of RBCs, and
does not indicate true anemia.
During pregnancy, the enlarging uterus lifts the diaphragm about
4 cm
(1.6 inches).
Breathing becomes thoracic rather than abdominal, adding to the dyspnea that as many as 60% to 70% of women experience beginning in the first or second trimester
epulis
highly vascular hypertrophy of the gums
regresses spontaneously after childbirth.
ptyalism
excessive salivation.
The cause of ptyalism may be decreased swallowing associated with nausea or stimulation of the salivary glands by the ingestion of starch
Small, frequent meals and use of chewing
gum and oral lozenges offer limited relief to some women
melasma
Areas of pigmentation include brownish patches called melasma, chloasma, or the “mask of pregnancy.”
Melasma involves the forehead, cheeks, and bridge of the nose and occurs in about 70% of pregnant women
linea nigra
The linea alba—the line that marks the longitudinal division of the midline of the abdomen—darkens to become the linea nigra
striae gravidarum
stretch marks
diastasis recti
The abdominal muscles may be stretched beyond their capacity during the third trimester, causing diastasis recti, separation of the rectus abdominis muscles
Maternal thyroid hormones are important for fetal neurologic function because the fetus does not synthesize thyroid hormones until ____ of gestation
12 weeks
In healthy women, the pancreas produces additional
insulin. In some women, however, insulin production cannot be increased and these women experience periodic ___ or ____
hyperglycemia or gestational diabetes
women of normal prepregnancy weight are encouraged to gain an average of ___ to ___ lbs during pregnancy
11.5 to 16 kg (25 to 35 lb)
Because of hemodilution, colloid osmotic pressure
decreases slightly, which favors the development of ____ during pregnancy.
edema – further increases when weight of uterus compresses the veins of the pelvis
amenorrhea
Absence of menstruation (presumptive sign)
Hegar sign
About 6 to 8 weeks after the last menses, the lower uterine segment is so soft that it can be compressed to the thinness of paper. This is called the Hegar sign (Figure 7-9).
The body of the uterus can be easily flexed against the cervix.
ballottement
midpregnancy, a sudden tap on the cervix during vaginal examination may cause the fetus to rise in the amniotic fluid and then rebound to its original position
uterine souffle
late in pregnancy a soft, blowing sound may be
auscultated over the uterus.
This is the sound of blood circulating through the dilated uterine vessels and it corresponds to the maternal pulse.
funicc souffle
the soft, whistling sound heard over the umbilical cord
and corresponding to the fetal heart rate.
Fetal heart sounds can be heard with a fetoscope by ___ to ___ weeks of gestation
18 to 20
The normal fetal heart rate is ____ bpm in the third
trimester.
110 to 160
folic acid recommendations
400 to 800 micrograms (mcg) (0.4 to 0.8 mg) of folic acid daily for at least 1 month before conception and 2 to 3 months after conception to decrease the risk of neural tube
defects
An intake of 600 mcg (0.6 mg) is recommended for the rest of pregnancy
abortion
spontaneous or elective termination of
pregnancies before the twentieth week of gestation
spontaneous abortion is frequently called miscarriage
gravida
refers to a woman who is or has been pregnant, regardless
of the length of the pregnancy
primigravida
a woman pregnant for the first time
multigravida
has been pregnant more than once.
Para
refers to the number of pregnancies that have ended at 20 or more weeks, regardless of whether the infant was born alive or stillborn
nullipara
a woman who has never been pregnant or has not completed a pregnancy of 20 weeks or more
primipara
has delivered one pregnancy of at least 20 weeks
multipara
has delivered two or more pregnancies of at least 20 weeks.
GTPAL
G = pregnancies or gravida, T = term pregnancies
delivered, P = preterm pregnancies delivered, A = abortions, and
L = living children.
Jennie is 6 months pregnant. She had one spontaneous and one elective abortion in the first trimester. She has a son who was born at 40 weeks of gestation and a daughter who was born at 34 weeks of gestation. What is her GTPAL?
She is gravida 5, para 2, T = 1 (the son born at 40 weeks); P = 1 (the daughter born at 34 weeks), A = 2, L = 2. The two abortions are counted in the gravida but not included in the para because they occurred before 20 weeks
of gestation.
Therefore, Jennie’s GTPAL would be 5-1-1-2-2.
Attitudinal barriers to prenatal care
Women rely on advice from family and friends
Hurried exams perceived as unimportant
Depression from or denial of unintended pregnancy
How should the nurse respond to a newly pregnant patient’s questions, and what specific things should the nurse discuss at each visit?
Anticipatory guidance:
- Gather information
- Establish a therapeutic alliance
- Provide education and guidance
Pertinent to upcoming needs and changes
Prenatal visits schedule
Every 4 weeks for the first 28 weeks’ gestation
Every 2 weeks from 28 weeks’ until 36 weeks’
After week 36, every week until childbirth
Presumptive Indications of Pregnancy
- Amenorrhea (cessation of menstruation)
- Nausea & vomiting
- Fatigue
- Urinary frequency
↑ during 1st trimester (hormonal changes)
↓ in the 2nd trimester (uterus more abdominal)
↑ with 3rd trimester (fetus larger, quickening) - Breast changes
- Perceived Fetal movement (quickening)
- Skin changes
Probable Indications of Pregnancy
- Abdominal enlargement
- Cervical softening (Goodell’s sign)
- Flexion and softening of uterus against cervix (Hegar’s sign)
- Fetus pushes away from examiner’s fingers (Ballotment)
apparent at the 16th week of pregnancy - Irregular painless contractions (Braxton Hicks)
- Blood flow through the placenta (Uterine Souffle)
- HCG in urine
Blood flow through the placenta is called
Uterine Souffle
Irregular painless contractions are called
Braxton Hicks
Cervical softening is known as
Goodell’s sign
Flexion and softening of uterus against cervix
Hegar’s sign
Fetus pushes away from examiner’s fingers
Allotment (apparent at the 16th week of pregnancy)
Positive Indications of Pregnancy
- Auscultation of fetal heart sounds (starting at 6 weeks gestation)
- Fetal movements by examiner
- Visualization of fetus via ultrasound
Steps of the nursing process
- Assessment
- Diagnosis
- Outcome Identification
- Planning
- Implementation
- Evaluation
reason behind leopold maneuvers is to
identify the baby’s position/ baby’s back so you can get the heartbeat
fundal height at 8 weeks, 20-21 weeks, 30-38 weeks
at 8 weeks, just above the bone
most common at 20-21 weeks at the umbilicus
highest point is 30-38 weeks, and then the head drops
