Maternity Sem Flashcards

0
Q

What is the human genome project

A

is an international scientific research with the goal of determining the sequence of chemical base pairs which make up the human DNA, and identifying and mapping all genes of the human genome from both a physical and functional standpoint

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1
Q

Understand the growth and progress of a fertilized egg from conception to implantation onto the uterine wall

A

Ovum’s cell membrane surrounded by two layers, closest layer called zona pellucida, the outer layer, corona radiata.

These cells are held together by hyaluronic acid.
High estrogen increases peristalsis which helps move the ovum

-fertilization takes place in the ampulla of the fallopian tube
-prostaglandin in semen may increase uterine smooth muscle contractions
-Sperm must undergo capacitation and acrosomal reaction before fertilization takes place
Capacitation - removal of the plasma membrane
Acrosomal reaction breaks down the hyaluronic acid in the ovum

True moment of fertilization occurs as the nuclei unite
chromosomes pair up to produce the diploid zygote
another moment of fertilization is when the sex of the zygote is determined

First 14 days is called the preembryonic stage. Development after this consist of two phases: cellular multiplication and cellular differentiation

  • as the zygote enters the period of rapid mitotic division called cleavage, in which these cells are called blastomeres.
    0the blastomeres are held together by zona pellucida, which is under the corona radiata. Eventually becoming morula
  • Inside the layer of the blastomere is the blastocyst and the outer layer is called the trophoblast (zona pellucida), eventually becoming the chorion
  • the blastocyst becomes the embryonic disc
  • the trophoblast implants at the endometrium
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2
Q

Explore the common chromosomal anomalies

A

Klinefelter syndrome - M and extra X
Turner syndrome - F, a missing x
XXY syndrome - M, above average height
PKU - metabolic disorder , mental retardation
Sickle-cell - blood disorder that limits supply of oxygen because of shape
Down syndrome - both, extra or altered 21st chromosome

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3
Q

Primary cell layers

A
ECTODERM
epidermis
sweat glands
sebaceous glands
nails
hair follicles
lens of eyes
sensory epithelium of intern and external ear, nose, mouth, anal
cns and pns
nasal cavity
oral glands and tooth enamel
pituitary and mammary gland
MESODERM
dermis
wall of digestive tract
kid and ureter
reproductive organ
connective tissue
skeleton
muscle
cardiovascular system
pleura
lymphatic tissue
spleen
ENDODERM
respiratory tract
epithelium, pharynx, tongue, tonsils, thyroid
lining of digestive tract
primary tissue of liver and pancreas
urethra
bladder
vagina
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4
Q

Identify prenatal diagnostic testing

A

Serum intergrated prenatal screening (sips) 10-13
-2 blood test

If risk of down’s or twins or HIV -> integrated prenatal screen (IPS) which includes SIPS and Nuchal translucency (NT ultrasound) 11-13

QUAD at 15
Hemoglobin - initially and 36 weeks

Rubella
STS
HIV
Group B at 35-37w
Urinalysis 
CBG - 24-28w
Blood type
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5
Q

What are some assisted reproductive technologies

A

In Vitro Fertilization - egg and sperm are extracted, placed in tube

Gamete intrafertilization - eggs are removed and is placed in the Fallopian tube along with the sperm

Intrauterine insemination - intro of semen into the females vagina without sex

Zygote intrafallopian transfer - used when fallopian is blocked

intracytoplasmic sperm injection - when sperm is injected directly into an egg

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6
Q

Signs that women describe as subjective and objective on pregnancy

A
loss of period
N&V
tiredness
frequent urination
breast changes
movement in abdomen

Goodwell’s sign -softening of cervis
chadwick’s sign - bluish purple discoloration of vagina
hegar’s sign - softening of isthmus
mcdonald’s sign - ease of flexing the body of the uterus against the cervix
Braxton hicks - false labour
uterine souffle - soft blowing sound

DIAGNOSTIC

  • FHR (10-12)
  • FETAL MOVEMENT (20w)
  • U/S (4-5 w)
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7
Q

ESTIMATED BIRTH DAY EQUATION

A

last mentrual period - 3 months + 7 days

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8
Q

Why is prenatal care important and how often should a pregnant women have this care

A

To assess the women’s needs of risk of pregnancy’s psychological, emotional status. Should be assessed every 4 weeks for the first 28 weeks, every two weeks until 36, then every week until child birth

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10
Q

Describe the layers of the uterus and their purpose

A

Outermost layer is the perimetrium

middle layer is the myometrium

  • consist of 3 distinct layers of involuntary muscles
  • outer consist of longitudinal muscles that opens cervical effacement and expel fetus
  • the middle layer is made up of interlacing muscle fibers in figure-eight patterns (stops bleeding)
  • the inner muscle form the spincter at the fallopian tube an internal os
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11
Q

Describe the four classic types of the pelvis

A

Gynecoid - favorable for birth
anthropoid - favorable

android - non
platypelloid - non

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12
Q

Name the two portion of the pelvic cavity and describe their purpose

A

False pelvis - serves to support the weight of enlarged uterus

True pelvis - The relationship of the true pelvis and fetal head is of paramount importance. The size and shape of the true pelvis must be adequate for normal fetal passage

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13
Q

What bones are not fused on the fetus’s head

A

two frontal
two parietal
occipital bone

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14
Q

Molding

A

when cranial bones overlaps under pressure

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15
Q

When do fontanelles close

A

posterior - 8 to 12 weeks

anterior - after 18 months

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16
Q

Locate the sutures and fontanelles

A

Coronal - between the frontal and parietal
frontal - between the two frontal
sagittal - between the parietal

17
Q

Fetal landmark

A

Mentum - chin
sinciput - eyebrow
bregma - diamond shaped anterior fontanelle

18
Q

Distinguish between cephalohematoma and caput succedaneum

A

Cephalohematoma is the collection of blood resulting from ruptured blood vessels between the surface of a cranial bone. Last for 2 weeks to 3 months

Caput Succedaneum is localized, easily identifiable area on the scalp, resulting from long and difficult labor. Compression of blood vessels and venous returned is slow. Edema, swelling and bleeding. Crosses suture line
-last for 12h to few days

19
Q

Describe the common theories explaining the onset of labor

A
  • Mechanical stretch releases prostaglandin
  • neurological pressure on cervix releases oxytocin
  • increase estrogen stimulates contractions
  • prostaglandin hypothesis
  • corticotrophin releasing hormone hypothesis
20
Q

Stages of labor

A

1st Onset of reg.contractions to full dilation (includes latent, active & transition)

2nd Full dilation until birth of baby (includes latent/passive, decent/active & transition

3rd Birth of babe until delivery of placenta

4th First 1-4 hours after birth

21
Q

Five factors in Labor 5 Ps

A

Passage (pelvis & soft tissue)
Passenger (lie, attitude, presentation, presenting part, position)
R/S between the passage & passenger
Physiologic forces (contractions & pushing)
Psychosocial-

22
Q

Describe the mechanism of labor

A

1st stage - decent and flexion

2nd stage -
internal rotation (fetal ead must rotate to fit the diameter of the pelvic)
extension
restitution (shoulders of the fetus enter the pelvis inlet)
external rotation
expulsion

3rd stage placenta separation & expulsion
Signs of separation
Expulsion “Dirty” Duncan (maternal) or “Shiny” Schultz
Control of Bleeding

4th stage (close monitoring, attachment/BF time)

23
Q

Nursing care during the stages of labor

A

(1) First phase–latent. Offer support and explanations. Instruct or reinforce breathing techniques (breathe slowly and deeply and use deep chest or abdominal breathing). Remind the patient to not push down during the first stage since it could causes cervical edema. It could also cause cervical lacerations and fetal hypoxia.
(2) Second phase–active. Continue to give support, offer encouragement, and give explanations. Include significant other in these procedures. Reinforce breathing and relaxation techniques. Accelerated shallow panting may be used, and also, effleurage (stroking movement used in massage, usually of the abdomen).
(3) Third phase–transition. Encouragement is especially important now since the patient is most likely losing control at this point. She may be nauseated or flushed and may vomit. Assist the patient to turn on her side or to sit up to prevent aspiration. Wipe her face and mouth with a cool cloth. Be aware that the patient may want to be left alone, but don’t leave; stay and support her. Remind the patient that this is the shortest stage and that the baby will be born soon. Encourage her to concentrate on relaxation and breathing techniques. Use more intensive breathing techniques (high chest, pant-blow). Make sure to give instructions in short, simple phrases. Remind the patient that she still can’t push even though she may have a strong urge to do so.

Third stage
Continue observation. Following delivery of the placenta, continue in your observation of the fundus. Ensure that the fundus remains contracted. Retention of the tissues in the uterus can lead to uterine atony and cause hemorrhage. Massaging the fundus gently will ensure that it remains contracted.

b. Allow the mother to bond with the infant. Show the infant to the mother and allow her to hold the infant.

24
Q

Initial care of the newborn

A
Neck checked for cord
Kept at level of vagina/head down
Cord clamped & cut
Dried & placed under radiant heater
Apgar score performed at 1 & 5 mins
Cord blood obtained for blood gases, group, type & possible stem cells PRN
Reassure parents of babe’s well-being