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Obstetrical nursing > infertility, conception through pregnancy > Flashcards

infertility, conception through pregnancy Flashcards

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1
Q

FSH: follicle stimulating hormone

A

Stimulates the follicle (which houses the eggs) to grow and mature

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2
Q

LH-luteinizing hormone

A

After ovulation, converts the empty follicle into the corpus luteum and supports this structure(which in turn supports an early pregnancy until the placenta forms)

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3
Q

estrogen

A

stimulates uterine growth and uteroplacental blood flow, cases a proliferation of the breast glandular tissue and stimulates myometrial contractility (at term)

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4
Q

progesterone

A

The hormone of pregnancy-

  • maintains the endometrium
  • decreases the contractility of the uterus
  • stimulates maternal metabolism and development of breast alveoli
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5
Q

relaxin

A

relaxes the ligaments in the pelvis and softens and widens the cervix.

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6
Q

prostaglandins

A

PGE: vasodilatory; smooth muscle relaxant (for uterine growth)
PGF: vasoconstrictive; smooth muscle contractor (for labor)

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7
Q

GnRH

A
  • what shows up on pregnancy test

- once egg is fertilized in uterine linning

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8
Q

human chorionic gonadotropin

A
  • high levels at beg of preg
  • lower at end
  • HCG starts being produced after implantation
  • Remains low for duration of pregnancy
  • Levels can be checked to evaluate state of pregnancy
  • This is the hormone pregnancy tests test for
  • HCG can also be tested by blood test, certain levels (amounts) correspond to weeks of gestation.
  • If someone is miscarrying or having a pregnancy abnormality (ectopic preg, hydatidiform mole, genetic abnormality) then levels would be off what they should be at that gestation. - Multifetal pregnancies may cause increased levels of HCG
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9
Q

HCG peaks at

A

60-70 days of gestation (weeks 8-10)

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10
Q

hcg declines at

A

100-130 days of pregnancy (14- 19 weeks)

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11
Q

infertility

A

inability to get preg for <12m

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12
Q

reasons for infertility

A
  • decrease sperm
  • endometriosis
  • ovulation disorders
  • tubal occlusion
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13
Q

intrauterine insemination

A

procedure use to place prepared sperm in the uterus at the time of ovulation

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14
Q

in vitro fertiliation- embryo transfer

A

procedure of collecting clients eggs from the ovaries, fertiliizing the eggs in the labatory with sperm, and transfering the embryo to the uterus

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15
Q

gamete intrafallopian transfer

A
  • oocytes are retrieved and immediately placed with prepared motile sperm. both are placed together into a thin flexible tube. gametes are than injected into the fallopian tubes using surgical labroscopy
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16
Q

donor oocyte

A

donated eggs are collected from a donor by IVF. eggs are inseminated. embroyos are placed in a recipents uterus. prior to implantation, the recipient undergoes hormonal therapy to prepare the uterus

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17
Q

donor embryo

A

donated embryo is placed in the recipients uterus, which is hormonally prepared

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18
Q

gestational carrier

A

couple completes the process fo IVF with the embryo placed in aother person, who will carry the preg. this is a contract agreement with the carrier having no genetic investment with the embryo

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19
Q

surrogate mother

A

person is inseminated with semen and carries the fetus untill birth

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20
Q

therapeutic donor insemination

A

donor sperm is used to inseminate a person

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21
Q

embryonic development

A

The embryonic stage lasts from day 15 after fertilization until 8 weeks. All organ systems and external features are developing during this time. This is the most critical time, where the embryo is most vulnerable to malformations caused by environmental teratogens.
- happens after fertilization

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22
Q

embryoblast

A

becomes baby

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23
Q

blastocyst

A

embrotic cavity

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24
Q

trophoblast

A

membrane and placenta

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25
Q

Fetal heart beat should be SEEN on US

A

after 6 weeks

26
Q

fetal heart beat should be heard

A

via doppler after 10 weeks

Assessed at each prenatal visit

27
Q

fetal movement should be felt

A

around 16-20 weeks

Maternal education and “fetal kick counts” in 3rd trimester

28
Q

what week does fetal stage start

A

9 weeks

29
Q

what day does fetal heart start beating

A

17 days

30
Q

embryo weeks

A

0-9w

31
Q

first 8 weeks

A

most major organ develop

- most dangerous time, at risk for chemicals, diseases, toxins

32
Q

20 w skin

A

downy hair (lenuva), vernex white waxy lotion, protect skin

33
Q

full term

A

40 w

10m

34
Q

presumptive

A 
fatigue 
breast tenderness
neausea and vomiting 
amenorrhea
urinary freqeuncy 
hyperpigmentation 
fetal movements
uterine enlargement 
breast enlargement
35
Q

probable

A 
braxton hicks contractions 
postive pregnancy test 
abdominal enlargement
ballottement 
goodell's sign 
chadwicks sign 
hegars sign
36
Q

positive

A
  • ultrasound verification
    embryo or fetus
  • fetal movement felt by experienced clinician
  • auscultation of fetal heart tones via doppler
37
Q

calculating due date

A

1 year - 3 months + 7 days

38
Q

uterus changes

A
  • increase size
  • increase weight
  • increase fibrous connective tissue
  • braxton hicks
  • cervical softening
  • mucus plug
39
Q

endocrine

placenta
thyroid
pituitary

A

placenta

  • produces HCB, HPL
  • nutrients to fetus
  • waste away from fetus

thryoid

  • increase size and activity
  • increase basal metabolic rate
  • increase parathyroid activity

pituitary

  • enlarges 9th month
  • produces fsh, lh, thyrodtropin, andrenotropin and prolactin
40
Q

cardio vascular changes

A
  • increase blood volume (30-40%)
  • increase hr
  • increase cardiac palpitations
  • heart enlargement
  • murmurs
  • pseudoanemia: more plasma volume less rbc
41
Q

musculoskeletal changes

A
  • increase lumbosacral curve
  • altered center of gravity
  • duck waddling gait- gooy ligaments
42
Q

gastrointestimal

A

N/V normal with hormonal changes, constipation is very common due to intestines being displaced by enlarged uterus, GI motility is decreased for increased absorption

43
Q

skin changes

A

Chloasma- increased in pigmentation on the face (‘the mask of pregnancy’), linea nigra- dark line of pigmentation from the umbilicus to pubic area, striae gravidarum- stretch marks on abd and thighs, Spider nevi (spider veins) and palmar erythema due to progesterone

44
Q

fundus hight

12
20
after 20 
36
40
A

12 weeks: fundus just above pubic bone

20w: at belly botton hole

after 20w: 1cm per week above umbillical cord

36w: at level of ziphoid process

40 w: uterus comes down

45
Q

vena cava syndrome

A
  • enlarged uterus compress the inferior vena cava and the lower aorta when pt. is supine
  • reduced venois return to heart
  • symtoms include decreased BP, light headedness, syncope, racing hert, sweating, fetal heart rate changes

** turn on left side laterally- blood flow back

46
Q

healthy weight to gain

A

25-35lbs

47
Q

nutritional needs

A
  • Increase in protein (basic growth),
  • iron (increase maternal RBCs, 2x pre-preg recommendation),
  • folate 600mcg/day (prevent neural tube defects),
  • calcium 1000 mg/day
  • Increase of 340- 452 calories / day
    Fluid- 8-10 glasses (2.3 L)/ day (water, fruit juice, milk)
48
Q

iron

A
  • Double amt recommended pre-pregnancy-(anemia is very common in pregnancy)
  • best absorbed between meals and when given with Vit C.
  • Milk and caffeine interfere with absorption.
  • Food sources- beef liver, read meats, fish, poultry, dried peas, beans, fortified cereals and breads. Iron supplements can cause constipation- stool softener may be needed
49
Q

nutrition avoid

A
  • Limit caffeine (no more than 200mg/day)
  • No alcohol
  • Pica- craving to eat nonfood substances, like chalk, dirt, red clay. CALL DOC
50
Q

TORCH

A

“TORCH”- acronym for the following infections:

  • Toxoplasmosis
  • Other: Varicella, Parvovirus,
  • Syphilis, Listeria, & Coxsackie Virus, Zika
  • Rubella
  • Cytomegalovirus (CMV)
  • Herpes Simplex Virus (HSV)
  • All are associated with potential for significant negative fetal outcomes including fetal death if infection occurs during pregnancy
  • Often mild or even NO symptoms in mother
  • Often limited or no treatment available
  • *PREVENTION, PREVENTION, PREVENTION!!!!!!!

Toxoplasmosis
- Avoid eating raw or undercooked meat, avoid contact with feces of infected cats

Parvovirus (Fifth’s disease),
- Coxsackie (Hand, Foot & Mouth), CMV
Check status of those with high exposure risks-day care workers, etc. Precautions if non-immune.

Listeria
- Avoid eating unpasteurized cheeses (cantaloupe outbreak in 2011)

Rubella, Varicella
- Immunization available but not given during pregnancy – check status, precautions if non-immune, immunize postpartum.

Syphilis, Herpes
- Safe sex practices (condoms), suppressive therapy for HSV in the weeks before labor to prevent an active outbreak and transmission to baby.

Zika
- Avoid travel to high risk countries, use bug sprays/clothes to prevent mosquito bites, avoid contact with infected individuals

51
Q

health promotion (X)

A
  • No over the counter meds unless OBGYN/CNM ok’d
  • No Alcohol (birth defects) or Tobacco (low birth weight)
  • No Substance use
  • No undercooked meat/poultry/eggs, sushi, soft cheeses(unpasteurized), seafood high in mercury, unwashed fruits/veggies, wet paint, kitty litter
  • No hot tubs/saunas
52
Q

health promotion (y)

A 
Exercise good- ~ 30min moderate daily if not contraindicated
Avoid TORCH infections
Hair dye, massages, mani/pedi
Sexual intercourse 
Travel
53
Q

common discomforts of preg

A

Nursing Implications:

  • N/V- 1st trimester dry crackers/toast before rising in the morning, small meals, avoid spicy, greasy, or gas-forming foods, encourage fluids in-between meals
  • Constipation- 2nd/3rd trimesters, encourage plenty of fluids, high fiber diet, exercise regularly
  • Breast tenderness- 1st trimester most freq, supportive bra needed
  • Urinary freq- 1st/3rd trimesters, empty bladder freq, decrease fluid before bed, Kegels
  • UTIs- common during preg, proper wiping, no bubble baths, use cotton underwear, looser pants, increase water intake, urinate before/after intercourse, don’t hold it, notify provider if urine is foul-smelling, bloody, or cloudy
  • Fatigue- normal, freq rest
  • Headaches- only normal in 1st trimester, hormonal/stress/lack of sleep, balanced diet, plenty of water, rest freq
  • Heartburn- small freq meals, check with provider about over the counter antacids
  • Hemorrhoids- 2nd/3rd trimesters, warm sitz bath, witch hazel pads (TUCKS), topical ointments
  • Backaches- 2nd/3rd trimesters, exercise regularly, pelvic tilt exercises, proper body mechanics, side lying position
  • SOB- mild common during 3rd trimester, maintain good posture, sleep with extra pillows, notify provider if worsening
  • Leg cramps- 3rd trimester, extend affending leg, dorsiflex, heat over muscle or foot massage (not the calf!)
  • Varicose veins/ edema- 2nd/3rd trimesters, rest with legs elevated, avoid constricting clothing, support hose, avoid sitting/standing in one position for too long, freq walking
  • Gingivitis, nasal, epistaxis- due to estrogen levels, brush teeth gently, use humidifier, saline nose drops/spray
  • Braxton Hicks- practice contraction, common during 3rd trimester, if it goes away with walking or change in position, not true labor. Your uterus is just practicing for the real thing
  • Supine hypotension- lie on your side or semi-sitting with keens slightly flexed
54
Q

initial labs

A 
CBC (hgb/hct/plt)	
Blood Type, Rh, ABS
Syphilis (RPR/VDRL
Rubella status
Hepatitis
HIV
Urinalysis/Urine culture
Gonorrhea & Chlamydia
Pap smear 
*cystic fibrosis carrier screen
*TB testing
*varicella
55
Q

28 week labs

A
  • CBC
  • Glucose tolerance test: greater than 140 FAIL
  • ABS (if Rh negative)
56
Q

35-37 week

A

GBS testing

retest sugar

1 Hr Glucose Tolerance Test- >140 mg/dL fail= needs further follow-up with 3 hr test
3Hr Glucose Tolerance Test- fasting, 1 hr, 2hr, and 3rd later (95, 180, 155, 140~ respectively. If 2 or more values are off= diagnosed with Gestational Diabetes

57
Q

other optional test

A 
Antenatal screening (Maternal alpha-fetoprotein or QUAD screening testing for genetic abnormalities)
Hep C (waterbirth)
TORCH
58
Q

recommended immunizations

A

Tdap

Influenza

59
Q

not during preg immunizations

A

No Live vaccines!

*Rubella (MMR)- wait until postpartum!!!
HPV
Varicella
TB
Zoster
60
Q

RH-

A

receive rogam

61
Q

first semester danger signs

A
  • Burning on urination (infection)
  • Severe vomiting (Hyperemesis gravidarum)
  • Diarrhea (infection)
  • Fever/Chills (infection)
  • Abd cramping/ vaginal bleeding (miscarriage, ectopic pregnancy)
62
Q

2nd and 3rd

A
  • Gush of vaginal fluid (not urine, rupture of membranes)
  • Vag bleeding (placenta problems)
  • Abd pain ( preterm labor, placental issue, ectopic preg)
  • Change in fetal movements (may be fetal distress)
    Persistent vomiting (hyperemesis)
  • Severe headaches/blurred vision/edema of face or hands/ epigastric pain (pre eclampsia)
  • Fever (infection)
  • Dysuria (UTI)
  • Flushed, dry skin, fruity breath, rapid breathing, increased thirst/urination, headache (hyperglycemia)
  • Clammy pale skin, weakness, tremors, irritability, lightheadedness (hypoglycemia)

Obstetrical nursing (8 decks)

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