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NP 2- TOP 8 > GROWING FETUS > Flashcards

GROWING FETUS Flashcards

1
Q

Month 1

A

-all systems in rudimentary form
-heart chambers formed
-heart is beating (14 days)
-begins formation of eyes, ears, nose
-with arms & leg buds

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2
Q

PRIMARY GERM LAYER

ECTODERM
-ECsternal

A

Skin, Epidermis, Sweat glands, hair follicles, Sense organs, tooth enamel, mucus membranes of the mouth, anus, and nose, pituitary glands, peripheral nervous system

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3
Q

CNS is developed in what germ layer?

A

ECTODERM

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4
Q

PRIMARY GERM LAYER

MESODERM <3

A

Reproductive system
Musculoskeletal system
Cardiovascular system
kidney, ureter
spleen, bone marrow, blood cells
connective tissues (bones, cartilage, muscle, ligaments, tendons)
lymph, vessels, walls of digestive tract

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5
Q

PRIMARY GERM LAYER

ENDODERM
“ay”

A

Respiratory tract (lungs)
pharynx, tongue, tonsils, thyroid, parathyroid,thymus, liver, pancreas, lining of GI tract.
Lower urinary system (urethra & urinary bladder)

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6
Q

MONTH 2

A

-head is large in proportion to the rest of the body
-rapid brain development
-neural tube (brain, spinal cord) is well formed
-external genitalia if formed
-sonogram shows gestational sac (6 weeks)
-by the end of 2nd month 8th week “ORGANOGENESIS” is complete.
-by the end of 2nd month: fetus is about 1 inch long & weighs 20g

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7
Q

AFP Alpha-Feto Protein studies through amniocentesis (16-20 weeks)

A

-Discard the first few drops
-AFP done with bloody tap = False High
-AFP done after 20 weeks= False High
Results:
↑AFP= Neural Tube defects
↓ AFP= down syndrome

**do not heck AFP after >20 weeks, should be 16-18 weeks

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8
Q

1st functional organ in fetus?

A

Fetal heart: can be heard as early as 14 days

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9
Q

when will the head and chest become equal in size?

A

10-12 months of infancy

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10
Q

when will chest become larger than head?

A

2 years old

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11
Q

GTK

A

All neural tube defects delivered in CS

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12
Q

Organogenesis starts by what week?

A

starts by 2nd weeks; ends by 8th weeks

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13
Q

3 MONTH

A

-Placenta is complete
-FHT is audible by Echo Doppler (8-12)
-sex is distinguishable by outward appearance
-fetus begins to swallow
-kidney begins to excrete urine
-liver produces bile
-all organs & limbs are present
-by the end of 3rd month
Fetus: 4 inches long
: 45 grams (weight)

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14
Q

4 MONTH

A

-Quickening: 1st fetal moth
(MULTIGRAVIDA)
(fluttering sensation)
-formed eyes, ears,nose
-scalp hair develops
-FHT is audible by fetoscope
-Lanugo begins to appear
*-Meconium in bowel
*-by the end of 4th month
fetus: 6 inches long
: 55-120 gram

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15
Q

GTK

A

-absence of meconium stools for 1st 24 hours of life
-imperforated anus: no hole= ↓ peristalsis
-Hirschsprung disease: Intestinal nerve cells (ganglion cells) don’t develop properly
-Cystic fibrosis: due to meconium/ ↓pancreatic enzyme trypsin

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16
Q

5 MONTHS

A

-Lanugo completely appears: protect fetal skin
-Lanugo: Transparent, Fine downy hair
-Quickening (Primigravida)
-FHT: stethoscope (bell)
-Bones Hardening
-Nipple appear over the mammary gland
-Fetus Actively swallow (600mL/ day)
-Age of viability “V”
-End of 5th month
Fetus: 25 cm (long)
435-465 g (Wt)

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17
Q

6 MONTHS

A

-Body well proportioned
-Skin is red & wrinkled
-Eyebrows & eyelashes are well defined
-Eyelids are open
*-The skin is covered by vernix caseosa (Thermoregulator)
*-Hearing is established
Fetus: 28-36 cm long
Weight: 780g

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18
Q

7 MONTH

A

-Surfactant can be demonstrated in the amniotic fluid
-body is less wrinkled
-hearing is fully developed
-testes begins to descend in scrotal sac
-blood vessels in the retina are thin
(be careful in O2 oxygenation)
-Fetus: 35-38 cm (long)
weight: 1200 grams
-Daily counting of fetal movement the “cardiff- count-to-ten” method starting on 27th week
*Normal count: 10 FMS in 10 hours
Report:
1.) if no Fetal movement in 10 hours
2.)<10 Fetal movement in 2 consecutive days

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19
Q

pre-term or post-term ?

A

-Abundant hair in scalp= Post-term
-Lots of lanugo= Pre-term
-Little lanugo= Term
-Absent Lanugo = Post-Term

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20
Q

GTK

A

-Meconium staining early excretion of meconium
-Meconium staining is sign of fetal distress except for “breech presentation” which is normal, other presentation is reportable.

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21
Q

Signs of fetal distress

A

-Fetal tachycardia: FHB >160bpm
-↑ peristalsis; ↓sphincter = release of meconium
-Meconium stained + Pink Skin = acute hypoxia

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22
Q

Fetal distress

A

FETAL DISTRESS
↓
↑FETAL HEART RATE (FETAL TACHYCARDIA 160 bpm)
↓
↑PERISTALSIS
↓
RELAXATION OF ANAL SPHINCTER
↓
RELEASE OF MECONIUM
↓
MECONIUM STAINING

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23
Q

Exposure of fetus to meconium strained amniotic fluid for >4 hours would lead to?

A

Green fetal skin
↓
CHRONIC HYPOXIA

*can be seen to post-term babies
*Placental insufficiency is seen in post-term
“wear and tear theory” ↓36 weeks
*After several days the meconium turns into Yellow

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24
Q

GTK

A

No meconium by 24 hours after delivery would mean imperforated anus
(+) reportable is wink reflex is absent
(+) imperforated anus
Common: Boys

Nursing Assessment:
-Check genitals if green urine excretion; (+) Fistula.

**Imperforated anus/ Hirschprungs dse
Aganglionic Megacolon
Cystic Fibrosis
↓peristalsis

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25
Q

8 MONTH

A

-Subcutaneous fats begins to deposit
-Fetal storage: Iron deposit; calcium deposit
-Skin is smooth & Pink
-Fingernails grow
-Birth position assumes
-CNS has matured enough (29-32 weeks)
-Active Moro reflex is present (Embracing Motion)
-Fetus: 38cm long
weight: 1600 grams

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26
Q

In Giving Iron Supplement

A

-Baby’s delivered > 1 month early, starts iron at “6weeks until 6 months”
-Baby’s delivered >2 months early, starts iron at 2 weeks-6months

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27
Q

Manuever/ method to used to check fetal position

A

Leopold’s Maneuver: To check for position
F-U-P-P
1st: FUNDAL GRIP: Presentation
2nd: UMBILICAL/LATERAL GRIP: Fetal back
3rd: PAWLIK’S GRIP: Engagement
4th: PELVIC GRIP: Flexion or extension
/Attitude/ location
of cephalic prominence

*4th grip is only applicable to cephalic presentation

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28
Q

9 MONTH

A

-Nails are firm
-with definite sleep & wake pattern
-lanugo disappearing
-95% most babies turns into vertex position
-Fetus: 42-48 cm long; 2700 grams
*-Lung maturity:
a) Lecithin & Sphingomyelin Ratio (L&S Ratio)
2:1 at 35 weeks
DM Mother: 3:1 or 5:1 L&S ratio

b) Presence of phosphatidylglycerol at 36 weeks
DM mother: appears at 38 weeks: hypersecretion of insulin delays insulin

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29
Q

Best indicator of lung maturity

A

Phosphatidylglycerol

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30
Q

what to focus on 3rd trimester?

A

Fetal weight gaining

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31
Q

WHAT TO FOCUS ON 1st TRIMESTER

A

ORGANOGENESIS

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32
Q

WHAT TO FOCUS ON 2ND TRIMESTER

A

FETAL LENGTH

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33
Q

GTK about brown fat

A

Brown fat Metabolism: Heat production

Fat utilization: ketones
↓
ACIDOSIS

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34
Q

COLD STRESS

A

BROWN FAT METABOLSIM
↓
↑O2 consumption
↓
RDS

BROWN FAT METABOLSIM
↓
↑ Glucose utilization
↓
HYPOGLYCEMIA

**By product of ketones: Acidosis

35
Q

temperature in DR

A

25-28 DEGREES CELSIUS

36
Q

LOTS OF VERNIX CASEOSA

A

Pre-term

37
Q

ABSENT VERNIX CASEOSA

A

Post-term

38
Q

VERNIX CASEOSA

A

-do not remove vernix earlier <6 hours
-bathe; 6-8 hours
-we don’t bathe LBW & VLBW
-we only clean with dump cloth after 24 hours

39
Q

How to check Fetal movement

A

-day time hours
-Stimulate by sounds/noise (6 months)
-Eating (glucose) stimulates movement
-Activity
-Massage: Daytime Hours

40
Q

THE UMBILICUS

A

Below 95% CEPHALIC
Above 4% BREECH
Near 1% Shoulder/ Transverse

*Point of maximum impulse: Fetal Back

41
Q

memorize pls!!!!

A

LOA: Left Occiput Anterior
PMI: Below Umbilicus Left sid e

RSA: Right Sacral(breech) Anterior
PMI: Above Umbilicus Right Side

Occuput: Cephalic
Sacral: Breech

42
Q

10 MONTHS

A

-little lanugo
-testes have descended
*-with good muscle tone & reflexes
-fetal kicks active
-fingernails extended over the fingertips
-creases on the soles of the feet covering at least 2/3 of the surface
*-lightening occurs 2 weeks before labor Primigravida
(1 day before labor: Multigravida)
-FETUS: 48-52 cm long
Weight: 3000 grams

43
Q

AMNIOTIC FLUIDS

A

-Alkaline
-Ph: 7-7.25
-Color: Clear/ Lightest yellow/ Amber
-Abnormal color: Green (except post-term)

NORMAL VOLUME:
10 weeks: 30 ml
20 weeks: 350 ml
after 20 weeks: 500-1000 ml

44
Q

<500 ml= Amniotic fluid after 20 weeks

A

<500 ml= Amniotic fluid after 20 weeks
(Oligohydramnios)
INDICATIONS:
=Fetal Kidney Malfunction (Renal Agenesis)

45
Q

> 1500 ml amniotic fluid after 20 weeks

A

Polyhydramnios: Risk for preterm birth
INDICATIONS:
-TreachoEsophageal Atresia Fistula (TEF):
3C’S OF TEF: Coughing, Choking, Cyanotic
-Multifetal pregnancy
-DM during pregnancy

46
Q

3C’S of Esophageal Atresia Fistula (TEF):

A

Coughing, Choking, Cyanotic

47
Q

GIVING OF RHOGAM

A

Prevents antibody function; Temporary
-28 weeks
-within 72 hours after delivery
-if abortion occurs. give rhogam after evacuation
-if Chorionic Vili Sampling+Amniocentesis are done, give Rhogam

48
Q

Indirect Coomb’s test

A

(-) result: No antibody formation yet
Give Rhogram

(+) result: with antibody formation
Dont give, too late

***Indirect’s coombs test after delivery to protect the next fetus.

49
Q

FUNCTIONS OF AMNIOTIC FLUID

A

-shield against pressure or blow the maternal abdomen
-maintain temperature
-muscular development
-protect umbilical cord pressure
-helps in delivery

50
Q

external version

A

-Term bby
-Floating not engaged
-We need consent because there is risk
-Breech to Cephalic

51
Q

Pre-term babies

A

-Lack reflexes
-Smooth nails
-Lots of lanugo
-Lots of vernix caseosa

52
Q

TOCOLYTICS

A

-Muscle Relaxants/ Relaxes Contractions

Contraindicated to:
-Fetal distress
-Maternal tachycardia/ Cardiac Dse
-Abruptio Placenta
-Cervical Dilatation
-PROM
-Chorioamnionitis

53
Q

TYPES OF TOCOLYTICS
Its-Not-Yet-My-Time

A

-Indomethacin: Least used
-Nifedipine (Procardia)
-Yutopar (Ritodrine)
-MgSO4
-Terbutaline (Brethine)

Fetal risk:
Closes Ductus Arteriosus

54
Q

POSITION OF CHOICE FOR PREMATURE RUPTURE OF MEMBRANE

A

-Knee chest
-Trendelenburg
-Put Pillow at back

55
Q

What causes Pathologic Jaundice

A

Erythroblastocyst Fetalis
-Occurs due to RH incompatibility between mother and fetus, resulting in severe anemia and sometimes death of fetus.
-Rh incompatibility
-ABO incompatibility
-Subgroup Incompatibility

56
Q

Umbilicus cord/ Funis

A

Average Length: 50-55 cm
<35 cm= at risk for abruptio
>70cm = cord proplaprse, Cord Coil, Knot, Compression

-AVA
-No nerve supply
-Wharton’s jelly

57
Q

<35 cm of umbilical cord risk for?

A

at risk for abruptio

58
Q

> 70 cm of umbilical cord risk for?

A

cord proplaprse, Cord Coil, Knot, Compression

59
Q

GTK

A

we dont do I.E. in placenta previa pregnant woman

60
Q

What protects the vessels in umbilical cord

A

Wharton’s jelly

61
Q

FETAL CIRCULATION

A

OXYGENATED BLOOD FROM PLACENTA
↓
UMBILICAL VEIN
↓
DUCTUS VENOSUS
↓
INFERIOR VENA CAVA
↓
RIGHT ATRIUM
↓
FORAMEN OVALE
↓
LEFT ATRIUM
↓
LEFT VENTRICLE
↓
ASCENDING AORTA
↓
UPPER AND LOWER PARTS OF THE BABY

62
Q

BLOOD RETURNING TO HEART

A

RIGHT ATRIUM
↓
RIGHT VENTRICLE
↓
PULMONARY ARTERY
↓
DUCTUS ARTERIOSUS
↓
DESCENDING AORTA
↓
UMBILICAL ARTERIES
↓
PLACENTA
↓
MATERNAL CIRCULATION

63
Q

failure of foramen ovale to close

A

Arterial Septal Defect (ASD)
Acyanotic: Left-To-Right Shunt

64
Q

Failure of ductus arteriosus to close

A

Patent Ductus Arteriosus
Acyanotic: Left-right- shunt

65
Q

DOC:
PATENT DUCTUS ARTERIOSUS

A
  1. DOC: Indomethacin
    -Prostaglandin inhibitor
    -closes PDA
  2. Ibuprofen (NSAID)
66
Q

In fetal circulation what is powerful side?

A

Right side is powerful than left side.

67
Q

No.1/ common cause of heart defect?

A

PREMATURITY

68
Q

PLACENTA

A

Weight at term: 500-600 grams
↑ blood supply: 500-600 ml/min at term

69
Q

PLACENTAL HORMONES

A
  1. HCG
  2. HPL/HCS (human chorionic somatomammotropin)
  3. Lactogenic hormones
  4. estrogen
  5. progesterone
70
Q

-anti-insulin hormone
-effect: diabetogenic
-begins to produce at 6 weeks at peak after 20 weeks
-screening for GDM = Between 24-28 weeks

A

HPL/HCS (human chorionic somatomammotropin)

71
Q

HORMONE THAT CAUSES:
A.) Vascularization: chadwicks sign
B) ↑ Blood volume
C) Enlargement of uterus

A

estrogen

72
Q

Chadwick’s sign

A

-6th week
-Probable sign
-↑ estrogen
-Nasal congestion
-softening of gums
-palmar erythema

73
Q

enlargement of uterus

A

Non-Pregnancy shape: Pear
Non preg weight: 50-60 g

Pregnancy shape: Ovoid
preg weight:1000-1100 g

after delivery: 1000-1100 g
after 2 weeks: 500 g
3-4 week: 300g
5-6 weeks: 50-60 g

74
Q

Return of uterus to non-pregnancy state for 6 weeks

A

Uterine Involution

75
Q

Incomplete return of uterus at 6 weeks
cause: Uterine Infection

A

Sub-Involution

76
Q

Secretions

A

-leukorrhea
-operculum (mucus plug): Bacteriostatic affect
-Ptyalism: ↑ excessive salivation
Management: mouth wash

77
Q

Hormone that is:
-Muscle relaxant
-↓ peristalsis
-Fluid retaining hormone
-↑ BBT
-Mammary Gland-Lactation

A

PROGESTERONE

78
Q

Colostrum production starts at what month?

A

-4th month of pregnancy

79
Q

estrogen & progesterone level during pregnancy

A

1st trimester: ↑E↑P
2nd trimester: ↑E↑P
3rd trimester: ↑E↓P - decrease slowly in prep for labor

80
Q

TYPE OF C.S.

A

Classical: Fundus; for E.R.

Transverse: Isthmus; “Bikini Line”

81
Q

VBAC (Vaginal birth after cesarean section )

A

Allowed only for transverse CS after 2 years

82
Q

hormone that initiate labor

A

ESTROGEN

83
Q
A

NP 2- TOP 8 (12 decks)

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