Maternity/Infant Health (Exam Two) Flashcards
1
Q
What is the most common cause of alterations in pelvic support?
A
Childbirth
2
Q
Involving the uterus and cervix, what occurs during uterine displacement and prolapse?
A
- The uterus tips posteriorly (tip to the back)
- The cervix rotates anteriorly (rotate to the front)
3
Q
What are the signs and symptoms of uterine displacement?
A
- Pelvic pain
- Back pain
- PMS
- Painful intercourse
4
Q
What becomes visible during a uterine prolapse?
A
The uterine will be seen protruding out from the vagina
5
Q
Which condition is more serious, uterine displacement or uterine prolapse?
A
Uterine prolapse
6
Q
What is cystocele?
A
Protrusion of the bladder into the vagina
7
Q
What are the causes of cystocele?
A
- Childbirth
- Obesity
- Age
8
Q
What are the signs and symptoms of cystocele?
A
- Heaviness inside of the vagina
- Urinary incontinence
9
Q
What is rectocele?
A
Herniation of the anterior rectal wall through vaginal tissue
10
Q
What are the management options for both cystocele and rectocele?
A
- Surgical repair
- Pelvic physical therapy
11
Q
What are genital fistulas?
A
Perforations between genital track organs
12
Q
What are the signs and symptoms of genital fistulas?
A
- Depends on location
- Leaking of urine
- Gas
- Feces in vagina
13
Q
What are the treatment options for genital fistulas?
A
-Surgical repair (surgery may not always fix it)
14
Q
What percentage of females experience urinary incontinence? It is common after what procedure in women?
A
- 75% of females
- Vaginal childbirth
15
Q
Urinary incontinence increases with what?
A
- Parity (number of births)
- Age
- Obesity
- Smoking
16
Q
Ovarian cysts are often associated with what?
A
Menstrual cycle
17
Q
What are the two types of ovarian cysts?
A
- Follicular cysts
- Polycystic Ovarian Syndrome (PCOS)
18
Q
Follicular cysts are most common in…
A
Normal ovaries of younger females
19
Q
Follicular cysts generally present with ___________, unless it ________.
A
- No signs or symptoms
- Ruptures
20
Q
If a follicular cyst ruptures, what will the female experience?
A
Pelvic pain
21
Q
What will happen to the follicular cyst if it does not rupture?
A
It will shrink in size after 2 or 3 menstrual cycles
22
Q
What are the treatment options for follicular cysts?
A
- NSAIDS
- Oral contraceptives
- Larger cysts can be surgically removed
23
Q
What is polycystic ovarian syndrome (PCOS)?
A
- Endocrine imbalance
- Multiple follicular cysts due to overproduction of estrogen
24
Q
What hormones will be increased with polycystic ovarian syndrome (PCOS)? Which hormones will be decreased?
A
- Increase in estrogen, testosterone, and luteinizing hormone (LH)
- Decrease in follicle stimulating hormone (FSH)
25
What are the treatment and management options for polycystic ovarian syndrome (PCOS)?
- Encourage diet
- Encourage weight loss
- Oral contraceptives
- Metformin
26
What are the signs and symptoms associated with polycystic ovarian syndrome (PCOS)?
- Obesity
- Hirsutism
- Irregular menstrual cycles
- Infertility
- Glucose intolerance
- Hyperinsulinemia
27
Where do uterine polyps originate?
In the endometrium or the cervix
28
Uterine polyps can be surgically removed in an outpatient setting if they are located where?
In cervical tissue
29
After the removal of a uterine polyp, what education should the nurse provide to the patient?
- No tampons for one week
- No sex for one week
- Signs and symptoms of infection
- Notify HCP if they experience heavy bleeding
30
What age group is most likely to develop uterine polyps?
Multiparous women older than 40
31
What is the most common type of benign tumor?
Fibroid tumors
32
These women are at a higher risk for developing fibroid tumors?
- African Americans
- Nulliparity (no pregnancies)
- Obese
33
What are the signs and symptoms of fibroid tumors? Which of these symptoms are specific to large tumors?
- Typically asymptomatic
- Abnormal uterine bleeding
- Anemia
Specific to large tumors:
- Back pain
- Pressure in lower abdomen
- Constipation
- Dysmenorrhea
34
Fibroid tumors are heavily influenced by what? What will this impact?
-Influenced by estrogen
- Implantation
- Maintenance of pregnancy
35
Regarding pregnancy, fibroid tumors may cause what?
- Miscarriage
- Pre-term labor
- Difficult labor
36
What are the management options for fibroid tumors?
- NSAIDS
- Oral contraceptives
- Growth hormone agonist
- Uterine artery embolization
37
Why would a women with fibroid tumors be prescribed growth hormone agonists?
They will decrease the size of the fibroid
38
What is uterine artery embolization?
Blocks the blood supply (perfusion) to the fibroid tumor causing it to shrink
39
Regarding fibroid tumors, what signs and symptoms would indicates the need for a hysterectomy?
- Very large tumor
- Severe bleeding
- Tumor is obstructing other organs
40
What are the nursing interventions for fibroid tumors?
- Discuss fertility
- Obtain consent
- Discuss childbearing
- Monitor bleeding
41
How long will a patient stay in the hospital after having a hysterectomy?
1 to 2 days
42
What signs and symptoms might the patient experience postop from a hysterectomy? What education should the nurse provide to this patient?
- Pain
- Fatigue
- Depression
- Promote pelvic rest
- Patient can engage in sexual intercourse after healing
43
What is the most common type of reproductive cancer?
Endometrial cancer
44
What are the risk factors for developing endometrial cancer?
- Obesity
- Nulliparity
- Infertility
- Late onset menopause
- Diabetes
- Hypertension
- PCOS
- Family history of ovarian/ breast cancer
- Tamoxifen use
45
What is the MOST significant risk factor for developing endometrial cancer? List other signs and symptoms of endometrial cancer.
*Hormonal imbalance
- Pinkish mucus vaginal discharge
- Lower back pain
- Pelvic pain
46
What is the cardinal sign of endometrial cancer?
Abnormal uterine bleeding
47
How is endometrial cancer diagnosed?
- Pap smear
- Biopsy
- Pelvic exam
48
How many women are diagnosed with endometrial cancer annually? What characteristic do these women have in common?
- Over 100,000
| - Obesity
49
What is the second most common reproductive cancer?
Ovarian cancer
50
The signs and symptoms of ovarian cancer are usually _____.
Vague
51
List the signs and symptoms of ovarian cancer.
- Urinary urgency
- Urinary frequency
- Increased abdominal girth
- Abdominal bloating
- Pelvic pain
- Abdominal pain
- Feeling of fullness quickly after eating
52
How is ovarian cancer diagnosed? Are women who have ovarian cancer usually diagnosed early or late in the disease process?
- Definitive screenings or diagnostic testing does not exist
- The cancer is generally very progressed or in the later stages when found
53
What ethnicity is most at risk for developing ovarian cancer?
- North American
| - European descent
54
What are treatment options for ovarian cancer?
- Surgical removal of ovaries or uterus
- Cyctoreductive surgery
- Antineoplastic surgery
- Chemotherapy
- Radiation
55
What is cyctoreductive surgery?
Debulking (shrinking) of the tumor
56
What treatment options for ovarian cancer are commonly used simultaneously?
- Antineoplastic surgery
- Chemotherapy
- Radiation
57
What is the third most common reproductive cancer?
Cervical cancer
58
What common places does cervical cancer spread?
- Vaginal mucosa
- Pelvic wall
- Bowel
- Bladder
59
The incidence of cervical cancer is highest in what ethnicity?
Hispanic women
60
90% of cervical cancers are caused by what?
Human papilloma virus (HPV)
61
What is the most reliable method for detecting cervical cancer? What percent of malignancies does it detect?
- Pap smear
| - 90%
62
Besides a pap smear, what are other methods used to diagnose cervical cancer?
- Colposcopy
| - Biopsy
63
What are the signs and symptoms of cervical cancer?
- Most often asymptomatic
- Abnormal bleeding after sexual intercourse
- Rectal bleeding
- Hematuria
- Back pain
- Leg pain
- Anemia
64
Abnormal bleeding puts any patient at an increased risk for what?
Anemia
65
If cervical cancer is considered invasive, what method of treatment is commonly used?
Hysterectomy
66
What is the fourth most common gynecological cancer?
Cancer of the vulva
67
What is the most common site for cancer of the vulva?
Labia majora
68
What is contraception?
- Keeping the egg and the sperm apart
| - Intentional prevention of pregnancy during intercourse
69
What is birth control?
Device or practice that decreases the risk for conceiving
70
What is family planning?
Conscious decision on when to conceive throughout the reproductive years
71
The decision to practice conception should be a decision made by who?
- A woman
| - A woman and her significant other
72
What should the nurse consider when looking at fertility awareness based methods (natural family planning) for the patient?
- Cultural beliefs
| - Religious belies
73
How can a women determine when she is fertile or ovulating?
- Fertile test strips
- Basal temperature
- Symptoms (individualized for each woman)
74
Besides decreasing the risk of pregnancy, condoms also aid in preventing what?
Sexually transmitted diseases (STDs)
75
If a patient is using diaphragms, cervical caps, or sponges to prevent pregnancy, the nurse should educate them on what?
Toxic shock syndrome (TSS)
76
What is the point of oral contraceptives?
- To prevent the formation of a follicle, thus prohibiting ovulation
- Suppressing of the surge of the luteinizing hormone (LH)
77
What are the forms of combined estrogen-progestin contraceptives?
- Oral
- Transdermal
- Vaginal rings
78
Describe transdermal patches for contraception.
- A new patch is placed on each week for three weeks
- Patch is removed on the four week
- Placement of the patch should be alternated
79
What method of contraception requires a back-up method for seven days after insertion?
Vaginal ring (i.e. Nuvaring)
80
What are the warning signs to teach patients who are starting or taking COCs?
HINT: ACHES
```
A: abdominal pain
C: chest pain
H: headaches
E: eye problems
S: severe leg pain
```
81
COCs are not recommended for patients with what?
Cardiac issues
82
What side effect is very common with the Nuvaring?
- Severe leg pain
| - Blood clots
83
It is extremely to educate your patient on what regarding oral contraceptives and antibiotics?
- Antibiotics reduce the effectiveness of oral contraception
- Will need a back-up method
84
Side effects for COCs is directly correlated with receiving too much of which hormone?
Estrogen
85
What are the common side effects of progestin-only contraception?
- Irregular bleeding/spotting
- Depression
- Mood changes
- Decreased libido
- Weight gain
- Recurrent yeast infections
- Acne
86
How does progestin-only contraception inhibit conception?
- Increases the viscosity (thickens) of cervical mucus
| - Suppressing of the surge of the luteinizing hormone (LH)
87
Progestin-only contraceptives are a good option for mothers who are what?
Breastfeeding
88
_____ may be delayed after stopping injectable progestins.
Fertility
89
What are implantable progestins? How long can they last?
- Implanted rods located in the upper arm
| - Last up to three years
90
Patients using this method of contraceptive should also be educated on the ACHES side effects.
Intrauterine devices (IUDs)
91
What is a vasectomy?
surgical interruption of the male vas deferens
92
What education should be provided to the patient regarding the oral contraceptive start dose?
It is best started on the first day the female experiences menstrual flow
93
What is a quick-start dose? What education must be included with a quick-start dose?
- Patient can start contraceptive method at anytime
- Pregnancy MUST be ruled out before taking
- Patient must use back-up birth control for seven days
94
If a patient misses one dose of COC, what should they do?
-Take both the missed dose tablet and the next scheduled tablet
95
If a patient misses three or more doses of COC, what should they do?
- Discontinue the pack
- Allow for withdrawal bleeding
- Start a new pack
96
If a patient misses one dose of progestin-only contraceptive, what should they do?
- Take the missed dose tablet as soon as possible
| - Use back-up contraception for 48 hours
97
Where do the sperm and the egg (ovum) join?
In the outer 1/3 of the fallopian tube
98
How many hours are sperm fertile?
48 hours
99
How many hours are ovum fertile?
24 hours
100
How much amniotic fluid should be present at birth?
800 - 1200mL
101
What is polyhydramnios?
- Excessive amount of amniotic fluid
| - Amniotic fluid >2000mL
102
Polyhydramnios may indicate what?
>2000mL of amniotic fluid may indicate GI malformations of the fetus
103
What is oligohydramnios?
- Insufficient amount of amniotic fluid
| - Amniotic fluid <300mL
104
Oligohydramnios may indicate what?
<300mL of amniotic fluid may indicate renal malformations of the fetus
105
What protects the umbilical cord?
Wharton's Jelly
106
What is the umbilical cord comprised of?
- 2 arteries
| - 1 vein
107
The two arteries of the umbilical cord are responsible for what?
Carries deoxygenated blood and waste away from the fetus
108
The one vein of the umbilical cord is responsible for what?
Carries oxygenated and nutrient rich blood to the fetus
109
Where do abdominal organs of the fetus initially develop? Why?
- Inside of the umbilical cord
| - Abdomen of the fetus is too small to house these organs during initial growth
110
The placenta acts as what? Why?
- Endocrine gland
| - Because it secretes hormones
111
What hormones are secreted by the placenta?
- hCG
- HPL
- Estrogen
- Progesterone
112
What is the role of the placenta?
Regulates transport of gases, nutrients, and waste
113
The placenta develops during which week of pregnancy?
Week 3
114
The placenta is fully functional by which week of pregnancy?
Week 12
115
What is the basis for all tissue and organ development?
Germ layers
116
During what stage are defects most likely to occur?
Embryonic stage
117
Describe the pre-embryonic stage.
- Conception to day 14
- Rapid cell division
- Primary germ layers and embryonic membrane form
118
Describe the embryonic stage.
- Day 15 to week 8
- Structures of major organs are complete
- Organ systems are functioning
- Teratogens
119
What is the greatest threat to the fetus during the embryonic stage?
Teratogens
120
List examples of teratogens.
- Radiation
- Lead
- Chemotherapy agents
- CMV
- MMR = Rubella!
121
How long should a woman avoid pregnancy after receiving the MMR vaccine?
28 days
122
Can a woman receive the MMR vaccine if she is breastfeeding?
Yes
123
What is the very first system to fully function within the fetus?
Cardiac system
124
During development of the fetus, malfunctions of the cardiac system can occur as early as...
One month
125
What is the second most component when assessing blood type?
rH Factor
126
When is the rH factor developed during pregnancy?
During Month 2 or >6 weeks
127
The doppler heartbeat can be heard as early as which month?
Month 3
128
What protects the fetus's skin integrity from the amniotic fluid?
- Lanugo
| - Vernix
129
When does the fetus become viable?
24 weeks of gestation
130
During what month is meconium forming in the fetus?
Month 4
131
Ideally, when is meconium expelled from the fetus?
24 hours after birth
132
Regarding meconium, what may occur if the birth is stressful on the fetus?
- The meconium can be passes into the amniotic fluid
| - The fetus may aspirate the amniotic fluid and, in turn, aspirate the meconium
133
When can a fetus be actively felt by the mother?
Week 20
134
The third trimester is a period of _____ and _____.
Refinement and growth
135
What is the average weight and length of a full term fetus?
- 6 to 9 lbs
| - 19 to 21 inches long
136
What are the three structures involved in fetal circulation?
- Fetal heart
- Placenta
- Fetal tissues
137
What are the three purposes of fetal circulation?
- Increase blood flow to head and heart
- Decrease blood flow to the fetal lungs
- Direct blood to the placenta
138
While in utero, will the baby perfuse blood to the lungs?
- No!
| - In utero the fetus shunts blood to the lungs
139
How is effective fetal circulation determined in utero?
By the fetal heart rate
140
How can the fetal heart rate be increased while in utero?
Perform interventions on mom (i.e. turning to one side)
141
When is fetal circulation no longer needed?
When the fetus takes his/her first breath
142
Describe surfactant? How does it work within the lungs?
- Produced within the lungs
- Stabilizes alveoli
- Decreases surface tension within the lungs
- Allows the lungs to inflate which will decrease the effort needed to breath
- Keeps lungs from sticking together when deflated
143
When does the fetus's alveoli become mature?
Between 35 and 37 weeks
144
What is the desired L/S ratio? What does this L/S ratio indicate?
- 2:1 ratio
| - Indicates lung maturity of the fetus
145
What can stimulate the production of L/S?
Maternal use of steroids
146
A multifetal pregnancy is always considered what?
High-risk
147
How are multifetal pregnancies diagnosed?
- Polyhydramnios
- Asynchronous fetal heart rate
- Ultrasound evidence
148
Multifetal pregnancies often end in what?
Prematurity
149
What is monozygotic?
- Fertilization of a single ovum by one sperm
| - Identical twins
150
What is dizygotic?
- Fertilization of two ova by two sperm
| - Fraternal/Nonidentical twins
151
Are congenital malformation most common among monozygotic or dizygotic twins?
Monozygotic
152
What is gravidity?
Number of pregnancies the woman has had regardless of the outcome
153
What is term birth?
A birth that is completed after 37 weeks
154
What is preterm?
A birth prior to 37 weeks
155
What is abortion?
Termination of the fetus, either spontaneous or therapeutic
156
What is a spontaneous abortion?
A miscarriage or stillbirth
157
What is a medical/therapeutic abortion?
An abortion involving a medical procedure or medication
158
What is living?
The number of living children at that very moment
159
What is nulligravida?
Never been pregnant
160
What is primigravida?
First pregnancy
161
What is multigravida?
More than one pregnancy
162
Presumptive pregnancy data is _______ data.
Subjective data
163
List presumptive signs of pregnancy.
- Amenorrhea
- Fatigue
- Breast changes (heaviness, darkened areola)
- Nausea
- Increased urinary frequency
- Quickening between 16 and 20 weeks (fetal movement)
164
Probable pregnancy data is observed by who?
-The examiner:
- OBGYN
- Midwife
- Nurse
165
List probable signs of pregnancy.
- Goodell sign
- Chadwick sign
- Hegar sign
- Uterine fundus will press on bladder
- hCG pregnancy test
- Ballottement
166
What is Goodell's sign?
- Noted as early as 5 weeks after conception
| - Softening of the cervix
167
What is Chadwick's sign?
- Occurs between week 6 to 8
- Bluish-purple discoloration or hue to the cervix
- Noted through the vaginal canal
168
What is Hegar's sign?
- Occurs between week 6 to 12
| - Softening of the lower segment of the uterus
169
What is ballottement?
- Noted between week 16 and 28 of pregnancy
- Examiner gently taps on cervix and feels the bounce of fetus
- Fetus will move up and come back down
170
Explain positive pregnancy data.
- Considered definitive evidence or sign of pregnancy
| - Only attributed to the presence of a fetus
171
List positive signs of pregnancy.
- Ultrasound (as early as 5 to 6 weeks)
- Fetal heart rate (as early as 6 weeks)
- Palpation of fetal movement (as early as 19 to 22 weeks)
172
What is Leopold's maneuver?
Palpating the outline of the fetus
173
Where can the uterus be palpated? During what weeks is the uterus palpable?
- Above the symphysis pubis between 12 to 14 weeks
| - At the umbilicus between 22 and 24 weeks
174
What is the purpose of the mucus plug?
Acts as a barrier against infection for the fetus
175
Loss of the mucus plug _____ for every woman.
Varies
176
What is leukorrhea?
- Response to an increase in estrogen and progesterone
| - Increase in vaginal secretions
177
What is the importance of the perineum?
- Supports the pelvic structures
- Often lacerated during childbirth
- Surgical incision may be utilized to widen the birth canal
178
What is the function of the breasts during pregnancy?
- Manufactures breast milk
| - Stores breast milk
179
What is colostrum?
- Precursor to breast milk
| - Can be noted in the pregnant woman as early as 16 weeks
180
When is complete lactation able to occur?
- After pregnancy
| - Once estrogen levels have declined
181
Striae gravidarum can appear on the _____.
Breasts
182
Why is cardiac output increased during pregnancy?
Ensures the body is able to perfuse and supply the placenta
183
A drop in maternal blood pressure will occur during which week of pregnancy?
Week 20
184
Is an elevated blood pressure normal or abnormal during pregnancy?
Completely abnormal!
185
Regarding hypertension, the nurse should educate the pregnant patient on what signs and symptoms?
- Dizziness
- Headache
- Blurred vision
186
Pregnancy is considered a _____ state.
Hypercoagulable
187
What is a hypercoagulable state?
- Clotting factors are increased
| - Protective mechanism against hemorrhage during childbirth
188
The hypercoagulable state puts the pregnant woman at an increased risk for what?
- Blood stasis
| - Blood clots
189
During pregnancy, the respiratory tract becomes what? What is this in response to?
- Highly vascular
| - In response to estrogen
190
Describe what happens to the renal system during pregnancy.
- Bladder becomes more sensitive
- Uterus presses up against bladder
- Increase is urine frequency
191
What is melasma?
- Blotchy brown mask
- Also known as the mask of pregnancy
- More common in darker complected females
- Fades after childbirth
192
What vascular changes remain after childbirth?
- Striae gravidarum
| - Angiomas
193
What vascular changes fade after childbirth?
- Melasma
- Linea Nigra
- Palmar erythema
194
What is pica?
Non-food cravings
195
Pica cravings often signify what?
Signifies what the woman is lacking in her diet
196
If a woman is craving dirt or ice chips, she may be what?
Anemic
197
Oxytocin is responsible for what?
- Uterine contraction
| - Breast milk production
198
Progesterone is needed to _____ pregnancy.
Maintain
199
Which hormone is responsible for morning sickness?
hCG
200
Why might the pregnant woman have a lower blood sugar during the first trimester?
- Fetus relies on maternal glucose
| - Fetus pulls glucose from maternal supplies
201
What are the two major affects of high blood glucose levels?
- Makes more glucose available for fetal energy needs
| - Stimulates the pancreas of a healthy woman to produce more insulin
202
Discuss the fetal implications of a pregnant woman developing gestational diabetes.
- Fetus becomes accustomed to high levels of glucose in utero
- Once the umbilical cord is cut the high amount of glucose received by the fetus is stopped
- Fetal blood glucose will plummet causing fetus to become hypoglycemic
- Fetus glucose levels will still need to be monitored after birth
203
Women with gestational diabetes often have _____ babies.
Large
204
When does prenatal care begin and end?
- Before conception
| - Up to one year after birth
205
Most women deliver within how many weeks of their estimated due date?
+/- 2 weeks
206
How is an estimated due date determined?
Nagaele's rule
207
Explain Nagaele's rule.
- Assumes every female has a 28 day menstrual cycle
| - Assumes fertilization occurred on day 14
208
How is Nagaele's rule calculated?
- Add 7 to the first day of the last menstrual period (LMP)
- Subtract 3 from the current month
- Add 1 to the year (if applicable)
209
List the maternal stages of transition to parenthood.
- Acceptance of pregnancy
- Identifying as a mother
- Establishing personal relationship with fetus
- Preparation for childbirth
210
What is the biggest maternal milestone?
Verbalizing pregnancy
211
What is couvade syndrome?
Father experiences pregnancy like symptoms (i.e. nausea, cravings, weight gain)
212
List the five screenings done on every single pregnant woman?
- HIV (consent needed)
- Syphilis
- Gonorrhea
- Chlamydia
- Group B Strep (GBS)
213
Describe the Group B Strep (GBS) screening?
- Completed between the 35 and 37 week of pregnancy
- Swab of the vaginal canal to the rectum to detect presence (GBS thrives in this area)
- Can be passed from mother to fetus during childbirth and cause sepsis of the fetus
- Completed on all women regardless of childbirth route
- GBS results can vary with each pregnancy
214
What is included in the fetal assessment?
- Fundal height
- Fetal heart trends
- Estimated gestational age
- Labs (i.e. genetic testing)
- Education
215
After 20 weeks, the pregnant woman should notify her HCP if she notices a decrease in what?
Fetal movement
216
List abnormal pregnancy discomforts.
- Bright red bleeding
- Uterine contractions
- Changes in fetal movement
*Needs to seek medical help
217
List normal pregnancy discomforts.
- Nausea
- Vomiting
- Back pain
218
Libido may increase during which trimester?
Second trimester
219
Pregnant women cannot receive an immunizations that contain what? Give examples.
- Live viruses
- MMR
- Varicella
220
What common OTC medication should be avoided during pregnancy?
Ibuprofen
221
Which vaccines are safe to administer during pregnancy?
- Hep B
- Flu
- Tdap
222
Advanced maternal age is considered what?
35+ years old
