Introduction to Women's Health and Maternal-Newborn Nursing Flashcards
Exam 1
What is the discipline of obstetrics and gynecology dedicated to?
Obstetrics and gynecology is a discipline dedicated to the broad, integrated medical and surgical care of women’s health throughout the lifespan.
The discipline of obstetrics and gynecology requires extensive study and understanding of what?
reproductive physiology;
the physiologic, social, cultural, environmental, and genetic factors that influence disease in women.
What are integral parts of the practice of obstetricians and gynecologists?
Preventive counseling and health education are integral parts of the practice of obstetricians and gynecologists
True or False?
There is not much that can significantly affect the first weeks of pregnancy. Since it is so early on, it has little impact on the developing embryo.
Why?
False;
The first weeks of pregnancy can be the most critical.
When does a woman typically find our when they are pregnant?
A women typically finds out about 6-8 weeks after pregnancy.
By the time a woman realizes she is pregnant, what develops?
By the time a women finds out she’s pregnant, brain and spinal cord are developing.
When does brain and neural tube development occur in a fetus?
Brain and neural tube develop 3-4 weeks.
True or False:
1 in 5 people who are pregnant in the United States report receiving preconception care.
True;
What is critical in ensuring healthy outcomes for all pregnant women?
Prenatal care is critical in ensuring healthy outcomes for all
How does infants born to women with prenatal care compare to infants born to women who do not receive prenatal care?
Compared with infants born to mothers who received prenatal care:
infants whose mothers did not receive prenatal care are three times more likely to have a low birth weight
and are five times more likely to die in infancy
Women without prenatal care are also three to four times more likely to die from pregnancy-related complications than those who do receive care
According to the WHO, what is defined as a low birth weight?
A weight less than 5.5 pounds
Why are adolescents considered high risk pregnancies?
Largely due to socioeconomic conditions.
Why are pregnancies 35 and older considered high risk?
Potential for diminished egg quality
Increased risk of pregnancy-related complications
Increased risk of preexisting health conditions
The Health History: The interview to learn about a patient includes: list first 6 things
Sexual history
Questions about self-care and health promotion
Review of systems
Biographic data
Allergies
Diet
The Health History: The interview to learn about a patient includes: list last 6 things
Sleep patterns
Immunizations
Workplace and environmental habits
Eating habits
Family history
Teratogens
a substance that can cause or increase the risk of birth defects in a baby if a mother is exposed to it during pregnancy.
Health History:Gynecological history includes
Age of menarche (menses)
Date of last menstrual period (LMP)
Cycle length and regularity
STIs
Gynecological surgeries
Gynecological conditions
Health History:Obstetric history includes (list first 6 things)
Dates of prior births
Gestational age at births
Mode of birth
Type of anesthesia
Location of birth
Pregnancy outcome
Health History:Obstetric history includes (list last 6 things)
Sex of the child
Length of labor
Birth weight and percentile according to gestational age
Length of labor
Complications
What is the normal gestational age?
40 weeks
What are examples of three modes of birth?
- Vaginal delivery
- Vaginally assisted delivery
- C-section
Gravidity
The number of pregnancies a person has had in their lifetime
What is important to know about gravidity?
Outcome is irrelevant
Include current pregnancy
Multiple babies count as one pregnancy
Parity
The number of pregnancies carried to viable gestational age (20-24 weeks gestation)
What is important to know about parity?
This includes alive or stillborn
Prefixes of understanding gravidity and parity?
Nulli: Never or None
Primi: First
Multi: Multiple
Nulli
Never
Primi
First
Multi
Multiple
Nulligravida
Never pregnant
Primigravida
A patient who is pregnant for the first time
Multigravida
Woman who has been pregnant multiple times
or is experiencing their second pregnancy.
Nullipara
A patient who has never carried a pregnancy beyond the 20th week of gestation or carried a fetus weighing more than 500g
Primipara
A patient who has been or is currently pregnant for the first time past the 20th week of gestation
Multipara
A patient who has carried a pregnancy past the 20th week gestation or delivered an infant weighing more than 500g more than once.
What does GTPAL stand for?
Gravida
Term
Preterm
Abortions
Living
G: Gravida
G: The number of pregnancies a person has had in their lifetime
T: Term
T: The number of pregnancies that have ended at term (37 weeks gestation or more)
P: Preterm
P: The number of pregnancies that have ended preterm (20-37 weeks gestation)
A: Abortion
A: The number of pregnancies that end by spontaneous (miscarriage) or elective abortion before 20 weeks.
A patient with a pregnancy history of one spontaneous abortion and one elective abortion might have 1/1 or 2 depending on system used
L: Living
L: The number of living children
Female Reproductive Hormones:
Estrogen
Progesterone
Luteinizing Hormone (LH)
Follicle Stimulating Hormone (FSH)
Cycle of Female Reproductive Hormones
- In response to GnRH, the anterior pituitary releases lutenizing hormone (LH) and follicle-stimulated hormone (FSH)
- Interactions between the ovaries, anterior pituitary and hypothalamus regulate the female reproductive cycle
- When estrogen and progesterone levels are low, the hypothalamus is stimulated to produce gonadotropin-releasing hormone (GnRH)
and cycles again. (positive feedback loop)
In response to GnRH, what does the anterior pituitary do?
In response to GnRH, the anterior pituitary releases lutenizing hormone (LH) and follicle-stimulated hormone (FSH)
What do interactions between the ovaries, anterior pituitary and hypothalamus do?
Interactions between the ovaries, anterior pituitary and hypothalamus regulate the female reproductive cycle
When estrogen and progesterone are low, what happens?
When estrogen and progesterone levels are low, the hypothalamus is stimulated to produce gonadotropin-releasing hormone (GnRH)
Female Reproductive System
After ovulation (follicle rupture), the ovarian follicle is called a corpus luteum.
The corpus luteum produces large amounts of progesterone and a smaller amount of estrogen, which maintain the uterine lining for implantation.
If implantation does not occur, the corpus luteum begins to lose its secretory function after about a week.
Progesterone and estrogen levels are decreased causing the hypothalamus to produce GnRH
Female Reproductive System: After ovulation, what is the ovarian follicle called?
After ovulation (follicle rupture), the ovarian follicle is called a corpus luteum.
What does the corpus luteum produce? What does this do?
The corpus luteum produces large amounts of progesterone and a smaller amount of estrogen, which maintain the uterine lining for implantation.
Female Reproductive System: What happens if implantation does not occur?
If implantation does not occur, the corpus luteum begins to lose its secretory function after about a week.
Female Reproductive System: What happens when the progesterone and estrogen levels are decreased?
Progesterone and estrogen levels are decreased causing the hypothalamus to produce GnRH
Phases of the Reproductive Cycle: When does the menstrual cycle occur? When does it begin?
Menstrual cycle occurs when an ovum is not fertilized,
and typically begins 12 to 14 days after ovulation.
Phases of the Reproductive Cycle: How are the phases divided?
First and second half
Phases of the Reproductive Cycle: What is the first half of the menstrual cycle known as?
The first half of the menstrual cycle is known as the Follicular phase.
Phases of the Reproductive Cycle: What occurs during the follicular phase?
During the follicular phase, ovaries are stimulated to mature follicles and their associated oocytes. At the same time, the uterine lining begins to proliferate.
Phases of the Reproductive Cycle: What occurs at the end of the follicular phase?
At the end of the follicular phase, one mature follicle (graafian follicle) ruptures and expels an ovum (ovulation).
Phases of the Reproductive Cycle: What is the second half of the menstrual cycle called?
The second half of the menstrual cycle is called the Secretory phase.
Phases of the Reproductive Cycle: What is occurs during the secretory phase?
During the secretory phase, the corpus luteum secretes estrogenand progesterone to maintain the uterine lining for implantation.
Fertilization: After ovulation, how long are ova viable for fertilization for?
After ovulation, ova are viable for fertilization for 6 to 24 hours.
Fertilization: how long is sperm capable of fertilizing an egg?
Sperm may be capable of fertilizing an egg for as long as 5 days.
Fertilization: Where does fertilization most often occur?
Fertilization most often occurs in the fallopian tube.
Fertilization: What happens to additional sperm when a sperm fertilizes an egg?
When a sperm fertilizes the egg, additional sperm are blocked from penetration through a process called a cortical reaction.
Fertilization: What occurs after conception?
After conception, the 23 chromosomes of the sperm unite with the 23 remaining chromosomes of the ovum, creating a diploid zygote with 46 chromosomes.
Presumptive symptoms in pregnancy include:
Amenorrhea
Breast tenderness
Nausea
Probable signs of pregnancy include:
Braxton Hicks contractions
Positive pregnancy test
Softening of the cervix (Goodell sign)
Bluish discoloration of the female genitalia (Chadwick sign)
Goodell sign
Softening of the cervix (Goodell sign)
Chadwick sign
Bluish discoloration of the female genitalia (Chadwick sign)
Positive signs of pregnancy include:
Fetal heartbeat obtained
Fetus visualized on ultrasound
Confirming Pregnancy: What is produced at the time of implantation?
Human chorionic gonadotrophin (hCG) is produced at the time of implantation.
What happens to hCG in early pregnancy?
hCG doubles in early pregnancy approximately every 48 to 72 hours.
What do home pregnancy tests do?
Home pregnancy tests detect hCG in the urine.
What can occur with home pregnancy tests?
False negatives can occur.
If the patient thinks there is the possibility of pregnancy, but the patient’s urine test was negative, what should they do?
The patient should repeat the test in 3 to 7 days.
What may cause false positives in a at home pregnancy test?
False positive tests are usually caused by user error (reading the test late) but
could be caused by other issues such as a recent pregnancy loss or fertility treatments.
Cultural competence
Cultural competence is recognizing and respecting culture and integrating aspects important to the individual into care.
What does culture include: (First Four things)
Religion
Language
Profession
Age
What does culture include: (Last Five things)
Gender identity
Disability
Sexual orientation
Beliefs
Tradition
What is the key to cultural competence:
Good communication and
an open mind
Cultural Destructiveness
Making everyone fir the same cultural pattern and excluding those who don’t fit- forced assimilation
Cultural Destructiveness emphasizes what?
Emphasis on differences as barriers
Cultural blindness
Do not see or believe there are cultural differences among people.
Everyone is the same
Cultural awareness
Being aware that we all live and function within a culture of our own and that our identity is shaped by it
Cultural sensitivity
Understanding and accepting different cultural values, attitudes, and behaviors.
Cultural competence
The capacity to work effectively and with people, integrating elements of their culture- vocabulary, values, attitudes, rules, and norms.
Translation of knowledge into action
Cultural humility
The lifelong process of self -reflection and self-critique that begins, not with an assessment of client’s belief but an assessment of your own.
Health disparities are also called:
Health inequities
Health disparities
are differences in health provision and/or healthcare outcomes that are not driven by patient choice.
Reasons for Health disparities:
Reasons for differences include geography, socioeconomic differences, variations in education, religion, race and ethnicity, gender identity, sex, sexual orientation, immigration status, language proficiency, and others.
Factors that influence and perpetuate health disparities are:
Factors that influence and perpetuate health disparities are individual, interpersonal, societal, and community in nature.
Implicit bias
Implicit bias is an unconscious prejudice for or against something and can cause an individual to think and behave in such a way that can harm others.
What can implicit bias cause?
can cause an individual to think and behave in such a way that can harm others.
What else (having to do with healthcare providers) can contribute to health disparities?
The attitudes and behaviors of healthcare providers can contribute to health disparities.
What (by healthcare providers) needs to be done to reduce health disparities?
Nurses need to be aware of and identify their own biases so that change can be implemented.
What percent of babies in the US are born to parents who are not married?
39.9%
What percent of female same sex couples in the US are raising children? What percent of male couples?
24%- female
8% -males
What kind of couples are more likely to be raising an adopted or foster child? By what percent? What are the couples at risk of feeling?
Same-sex couples (21%) are more likely to be raising an adopted or foster child and are at risk for feeling judged or marginalized.
What percent of children in the US are being raised in a blended family?
As of 2015, 22% of children in the United States are being raised in blended families.
What percent of children in the US are being raised without parents?
About 4% to 5% of children in the United States are being raised without parents.
Family structure is NOT indicative of what?
Family structure is not indicative of available support.
What is the average cost of a vaginal birth and cesarian birth?
The average cost of a vaginal birth is $23,148 while a cesarean birth costs $43,774.
Percents of people with insurance and stuff
Study slide 28 is you have time
What country spends more on health care than any other country? How are the outcomes for them?
US; outcomes are not always better
What was the infant mortality rate in the US in 2019? What was the infant mortality rate in the European Union?
In 2019, the infant mortality rate in the United States was 6 out of every 1,000 births
while the rate in the European Union was 3 out of every 1,000 births.
What is Medicaid funded by?
Medicaid is funded by state federal and monies.
Who/What determines eligibility for Medicaid? What must it meet?
Eligibility for Medicaid is determined by each state, but must meet minimal federal requirements.
Eligibility for medicaid depends on what?
Income
Household size
In some states, stage of pregnancy
What does the Affordable Care Act do?
The Affordable Care Act gave states the option of extending Medicaid eligibility to people living at or below 133% of the federal poverty level.
Depending on the state, how is medicaid?
Medicaid coverage may be comprehensive or narrow, depending on the state.
How are pregnant people covered under Medicaid?
People who are pregnant are covered through the month in which their 60-day postpartum period ends.
Preexisting conditions: (first 5)
Asthma
Epilepsy
Thyroid Conditions
Pregestational Diabetes
Systemic Lupus Erythematosus (SLE)
Preexisting conditions: (middle 5)
Multiple Sclerosis (MS)
Cardiovascular Disease
Hypertension
Obesity
Eating Disorders
Preexisting conditions: (last 5)
Iron Deficiency Anemia
Intimate Partner Violence
Substance Abuse
Depression
Anxiety
In what percent of pregnancies does asthma cause complications?
Asthma complicates 3% to 8% of pregnancies.
How are asthma symptoms in pregnant women?
Some females experience worsening of their symptoms while others see improvements.
What are 4 complications from asthma while pregnant:
Antepartum and postpartum hemorrhage
Preeclampsia
Preterm birth
Low birth weight
What are last 3 complications from asthma while pregnant:
Pulmonary embolism
Miscarriage
Cesarean birth
What are the treatment goals for asthmatic pregnant women?
*Treatment goals in pregnancy are to optimize control and limit exacerbations.
What should nurses encourage pregnant asthmatic patients to do?
Nurses should encourage patients to take their asthma medications, stop smoking, and evaluate asthma exacerbations with continuous pulse oximetry.
What type of breathing is common in pregnancy?
While dyspnea is common in pregnancy,
How might asthma exacerbations be recognized in pregnant women?
an asthma exacerbation may be recognized by dyspnea with wheezing or cough.
What are exacerbations in pregnancy that do not respond to rescue medications known as?
Exacerbations in pregnancy that do not respond fully to rescue medications are medical emergencies.
What percent of the population in the US has epilepsy?
About 1.2% of the total population in the United States have epilepsy.
Children of patients with epilepsy are at an increased risk of what?
Children of patients with epilepsy are at increased risk for developing neurological problems and congenital malformations.
Complications due to epilepsy include:
While most pregnancies are uneventful, complications due to epilepsy include preeclampsia, hemorrhage, preterm labor, placental abruption, fetal growth restriction, fetal demise and death.
What should nurses teach pregnant epileptic patients to do?
Nurses should teach patients to take antiseizure medications despite risks to fetus and to avoid individual seizure triggers.
What should pregnant patients on antiseizure medications take? Beginning when and how long?
Patients on antiseizure medications should take 4 mg folic acid daily, beginning 3 months before conception and at least one month after birth.
Infants of patients who take antiseizure meds are at risk for what?
Infants of patients who take antiseizure medications are at increased risk for bleeding.
Hypothyroidism can cause:
infertility, preeclampsia, gestational hypertension, postpartum hemorrhage, low birth weight, preterm birth, placental abruption, and early pregnancy loss.
What is the treatment for hypothyroidism?
Treatment includes levothyroxine (a T4 replacement), adjusted based on TSH levels every 4 weeks to 3 months.
When are medication dose adjustments for hypothyroidism needed during pregnancy?
Medication dose adjustments are typically required more frequently in early pregnancy than in later pregnancy.
When should pregnant women be taking levothyroxine (for hypothyroidism)?
Patients should be taught to take levothyroxine first thing in the morning and on an empty stomach with no further oral intake for one hour.
What can hyperthyroidism lead to?
Hyperthyroidism may cause pregnancy loss, low birth weight, preterm labor, preeclampsia, and maternal heart failure.
What occurs in hyperthyroidism during pregnancy?
Thioamides cross the placenta, suppress fetal thyroid hormone synthesis, and have been associated with fetal anomalies.
What is the goal of treatment of hyperthyroidism in pregnancy?
Goal is to maintain mild hyperthyroidism and avoid hypothyroidism in the fetus.
What does treatment of hyperthyroidism involve?
Treatment involves the suppression of thyroid hormone synthesis with a class of medications called thioamides.
For a pregnant patient with hyperthyroidism, what should the nurse encourage?
The nurse should encourage consistent medication use.
What should patient with pregestational diabetes (preexisting diabetes) do if they are pregnant or planning to be pregnant?
Ideally, patients with pregestational diabetes should receive preconception care and achieve excellent glycemic control prior to attempting pregnancy.
Pregestational diabetes risks include:
Preeclampsia
Perinatal death
Macrosomia of the fetus
Congenital anomalies
Polyhydramnios
Fetal loss
Preterm birth
Pregestational Diabetes: First Trimester Assessments:
Hemoglobin A1C
Patients with diabetes will have an evaluation of baseline kidney function with a 24-hour urine collection.
The patient may also have a screening of the thyroid, heart, and eyes during the first trimester.
Pregestational Diabetes: Second and third Trimester Assessments:
Vasculopathy may be evidenced by fetal growth restriction.
Antepartum testing for fetal well-being usually begins between 32 and 34 weeks gestation
Second and Third Semester Assessments for Pregestational Diabetes:
Antepartum testing for fetal well-being usually begins between 32 and 34 weeks gestation and may include:
Nonstress test
Biophysical profiles
Fetal movement tests
Contraction stress tests
Pregestational Diabetes: Birth considerations
Vaginal birth is not contraindicated, although some providers recommend a cesarean birth for fetal macrosomia diagnosed by ultrasound.
When is labor often induced in women with pregestational diabetes with large babies?
Labor often induced between 39 and 40 weeks.
Care considerations for pregestational diabetic women:
Diet, exercise, and medications are important care components that should be closely monitored.
LOOK AT SLIDE 38- lot of words…
For patients with Systemic Lupus Erythematosus, when is it the safest to attempt pregnancy?
It is safest to attempt pregnancy when systemic lupus erythematosus (SLE) has been in remission for at least 6 months.
Patients with SLE have what likelihood of pregnancy complications?
Patients who have SLE have 2 to 7 times the risk of pregnancy complications.
Complications associated with SLE while pregnant
Complications include preeclampsia (low-dose aspirin therapy) and intrauterine growth restriction (fetus will be closely monitored).
Ideally, patient with SLE should be evaluated for what before pregnancy?
Ideally patients should be evaluated for disease status and functioning of target organs before pregnancy.
What are some tests done for pregnant SLE patients?
Patients will require additional laboratory tests to monitor kidney function, complete blood count, and disease activity as indicated by clinical presentation.
How are SLE meds viewed?
Some SLE medications are considered safe while others are contraindicated.
MS
MS is a chronic immune-modulated demyelinating disease of the central nervous system that often includes relapses and remissions.
How is MS during pregnancy?
Pregnancy is often a time of disease remission, while postpartum is a significant time for relapse.
In pregnancy, what can MS lead to?
In pregnancy, MS may lead to preterm labor, infection, cardiovascular disease, anemia, and neurological complications.
How are the medications for MS?
Some medications for MS are teratogenic and contraindicated.
Others have limited information available.
MS and breastfeeding?
Breastfeeding is not contraindicated, but the medications used to treat MS may not be safe for a breastfeeding infant.
Patients may choose not to take MS medications while breastfeeding.
