MIH #2 Flashcards
1
Q
Alterations in pelvic support
A
Structural Disorders: Uterus and Vagina
2
Q
Benign neoplasms
A
Ovarian cysts, uterine polyps, leiomyomas
3
Q
the uterus tilts posteriorly and cervix rotates anteriorly.
A
Uterine displacement
4
Q
After pregnancy The ligaments go back the normal within 2 months.
A
Uterine displacement
5
Q
Back pain, painful sex, more severe PMS due to alteration of structures.
A
Uterine displacement
6
Q
Can note during labor or post. Can see on ultrasound.
A
Uterine displacement
7
Q
Cystocele-
A
protrusion of the bladder through the vagina causes- childbirth, age, obesity.
8
Q
S/Sx Cystocele-
A
urinary incontinence and sensation of heaviness in the vagina
9
Q
Rectocele-
A
herniation of the anterior rectal wall through vaginal tissue.
10
Q
Genital Fistulas-
A
perforation between genitals and other organs.
11
Q
Genital Fistulas S/Sx;
A
urine, gas, and feces coming out of vagina
12
Q
Urinary Incontinence- occurs in __ of females.
A
75%
13
Q
Urinary Incontinence
A
Involuntary leakage of urine.
14
Q
Urinary Incontinence Risk factors
A
age obesity, smoking, hx of vaginal delivery, increase in carotene (the more pregnancies) the more risk.
15
Q
Uterine prolapse and Genital fistulas Tx:
A
surgical intervention
16
Q
Related to decrease pelvic muscles that is caused by
A
child birth
17
Q
Can be congenital(present at birth)-
A
structural disorders
18
Q
Uterine prolapse-
A
uterus protrudes through the vagina- more serious than uterine displacement. Bc risk for infection- insides are falling out.
19
Q
Ovarian cysts are
A
Dependent on hormonal influences associated with menstrual cycle
20
Q
most common ovarian cysts.
A
Follicular cysts-
21
Q
Occur in normal ovaries of young females.
A
Follicular cysts-
22
Q
Typically are not going to experience any symptoms unless rupture which causes pelvic pain.
A
Follicular cysts-
23
Q
If the cyst does not rupture then it is going to shrink within 2-3 cycles
A
Follicular cysts-
24
Q
Small follicular cysts-Tx:
A
Nsaids,
contraceptives(suppress ovulation, the hormones influence the cyst)
25
Large follicular cysts-Tx:-
surgical removal
26
endocrine imbalance
Polycystic Ovarian Syndrome (PCOS)-
27
Estrogen-elevated
Polycystic Ovarian Syndrome (PCOS)-
28
Testosterone-elevated
Polycystic Ovarian Syndrome (PCOS)-
29
LH-elevated
Polycystic Ovarian Syndrome (PCOS)-
30
FSH- decreased
Polycystic Ovarian Syndrome (PCOS)-
31
Multiple cyst formation, lots of follicular cysts causes increase of estrogen in body
Polycystic Ovarian Syndrome (PCOS)-
32
Polycystic Ovarian Syndrome (PCOS) Clinical manifestations-
can vary.
Obesity, hirsutism- excessive hair growth, irregular menses, infertility, and glucose intolerance (High levels of insulin)
33
Polycystic Ovarian Syndrome (PCOS) Medical management-
managed with oral contraceptives and metformin (type two diabetes tx, glucose)
34
Polycystic Ovarian Syndrome (PCOS) Nursing Interventions-
tx or intervene any physical problem and consider psychological aspects
35
Uterine polyps- Originate in __ and or ____ tissue.
endometrium, cervix
36
Tumors arise from the mucosa of the cervix
Uterine polyps-
37
May be removed surgically.
Uterine polyps-
38
If in the cervix its going to be an outpatient sugery. If endometrium surgery longer stay
Uterine polyps-
39
Most common age group multiparous (multiple pregnancies>2) women >40 years.
Uterine polyps-
40
All polups surgically removed are send to pathology to determine
bengin or malignant
41
Want the pt to be on pelvic rest (no tampons, sex, douching) for one week bc increase risk of infection
Uterine polyps post op
42
If any s/sx of infection or excessive bleeding seek medical attention
Uterine polyps post op
43
AKA fibroid tumors, fibromas, myomas, or fibromyomas
Leiomyomas
44
MOST common type of benign tumor-
Leiomyomas
45
most common in African American women, nulliparous (never been pregnant) women and obese women
Leiomyomas
46
Is it slow growing? Yes
Leiomyomas
47
Originates from the muscle of the Uterus muscle
Leiomyomas
48
Rarely becomes malignant
Leiomyomas
49
Growth is influenced by ovarian hormones.
Leiomyomas
50
Spontaneously shrink after Menopause due to decrease in cirulainting ovarian hormones
Leiomyomas
51
Typically asymptomatic.
Leiomyomas
52
if tumor is big they expense complications.
Leiomyomas
53
Leiomyomas small tumors:
abnormal uterine bleeding- risk for anemia.
54
Leiomyomas Big tumors-
back pain, lower abdominal pressure, interfere with bowel movements- constipation and cause dysmenorrhea.
55
Influenced by estrogen- neoplasms.
Leiomyomas
56
Can effect implantation and the maintance of pregnancy.
Leiomyomas
57
Could be caused by chronic miscarriages or preterm labor.
Leiomyomas
58
Leiomyomas Medical Management
NSAIDs, oral contraception's, Growth Hormone agonist. Help decrease size of the fibroid.
59
Leiomyomas Medical Management Uterine artery embolization performed-
cut off supply to fibroid which causes to shrink
60
Leiomyomas Surgical Management Laser or Operative removal-
smaller fibroids that are easier to destroy.
61
Leiomyomas Surgical Management Surgical intervention-
myomectomy for removing large fibroid. Comparing size to 12 week fetus.
62
considerations when removing entire uterus.
Leiomyomas Surgical Management Hysterectomy-
63
Severe bleeding, risk for infection, pt signed consent.
Leiomyomas Surgical Management Hysterectomy-
64
Stay in hospital for couple days after procedure, manage pain and psychosocial considerations- depressed
Leiomyomas Surgical Management Hysterectomy-
65
If causes excessive bleeding or obstructing other organs causes hysterectomy.
Leiomyomas Surgical Management Hysterectomy-
66
Malignant Neoplasms:
Endometrial Cancer, Ovarian Cancer, Cancer of the Cervix, Cancer of the Vulva, Cancer of the Vagina
67
Slow- growing w/ a good prognosis
Endometrial Cancer
68
Endometrial Cancer MOST SIGNIFICANT risk factor
Obesity, nulliparity, infertility, late onset menopause, diabetes, hypertension, PCOS, Hx of ovarian or breast cancer, hormonal imbalance
69
Endometrial Cancer Cardinal sign of endometrial cancer:
abnormal uterine bleeding!!
70
Endometrial Cancer s/sx:
bloody mucous vaginal discharge, accompanied by lower back pain, abdominal pain
71
Endometrial Cancer Dx studies-
pap, endometrial biopsy, pelvic exam could reveal a mass
72
Most common cancer of reproductive system
Endometrial Cancer
73
Over __ women are diagnosed with some type of gynecological cancer annually
100,000
74
Obesity,- For occurrence of
gynecological cancer
75
Tamoxifen use increase risk for
gynecological cancer
76
Does not spread
Endometrial Cancer
77
Endometrial Cancer TX:
hysterectomy even if caught in early stages. Chemotherapy common tx for advanced stages.
antiestrogen meds.
78
Endometrial Cancer Most significant risk factor-
hormonal imbalance
79
2nd most common reproductive cancer
Ovarian Cancer-
80
Ovarian Cancer- Symptoms are vague-
urinary urgency, frequency, abnormal bloating, and increase in abdominal girth, pelvic abdominal pain. Or when eating feeling fullness quickly.
81
Ovarian Cancer- Definitive screenings/tests do not exist-
when found it is at a very advanced stage.
82
Unknown cause
Ovarian Cancer-
83
Ovarian Cancer- Risk factors:
Nulliparity (no births)
Infertility
Previous breast cancer
Family history
Ethnicity- European Americans higher risk
84
Ovarian Cancer-Treatment
Surgical removal-, cytoreductive surgery- remove some of the masses from big tumor to make smaller,
antineoplastic surgery, chemotherapy, & radiation- 3 used in combination
85
3rd most common type of reproductive cancer.
Cancer of the Cervix
86
begins as lesions to the cervix and spread to vaginal mucosa, pelvic wall, and to bowel or bladder.
Cancer of the Cervix
87
Incidence highest in Hispanic women.
Cancer of the Cervix
88
90% of cervical cancers are caused by
HPV.
89
Cancer of the Cervix Dx:
Reliable method-pap smear, detects 90% of malignancies
Colposcopy- magnified cervix to see abnormal cells
Biopsy- removal of cervical tissue to see if cells are malignant
90
Cancer of the Cervix Medical-surgical management-
radiation, cryosurgery- remove tumor, laser ablation
91
If Cancer of the Cervix is invasive-
hysterectomy indicated.
92
hysterectomy non electively or sooner than women would like-
psychosocial aspects bc cannot have children ever again.
93
Not many symptoms- could experience pain after intercourse, rectal bleeding, hematuria if it is spread, back and leg pain
Cancer of the Cervix
94
Abnormal bleeding leads to anemia
depending on the extent of the cervical cancer
Cancer of the Cervix
95
Combination of radiation and chemotherapy
Cancer of the Cervix
96
4th most common GYN cancer
Cancer of the Vulva
97
Slow growth, metastasize fairly late
Cancer of the Vulva
98
90% survival rate
Cancer of the Vulva
99
Most common site labia majora
Cancer of the Vulva
100
Cancer of the Vulva Treatment:
Laser surgery
Cryosurgery
Electrosurgical excision
Vulvectomy
101
1%-3% of GYN cancer (extremely rare)
Cancer of the Vagina
102
50% of cases occur between the ages of 70-90 years
Cancer of the Vagina
103
Cancer of the Vagina Potential causes:
Vaginal irritation
Vaginal trauma
Genital viruses
104
Occurrence 1 out of 100 women.
Cancer & Pregnancy
105
Cancer during reproductive years is
infrequent.
106
A lot of therapeutic concerns occurs- faces choice with
continuing or terminating pregnancy.
107
Fetus is most at risk for congenital anomalies due to treatment of the cancer during to
1st trimester.
108
Cancer & Pregnancy Therapeutic issues
Continue or terminate the pregnancy
Timing of therapies such as chemo, radiation therapy, and surgery is affected
109
Most frequent types of cancer that occur during pregnancy
breast, cervical, leukemia, Hodgkin disease, melanoma, thyroid, colon
110
Cancer & Pregnancy Treatment options
Chemo or Radiation
111
Pregnancy after cancer treatment
Delay of __ from end of therapy to conception is advised.
2 years
112
If becoming pregnant before 2 years Increasing chance of
miscarriage and teratogenic
113
Cancer & Pregnancy Types of threats to fetus-
risk for death, chemo and radiation- impact growth and development of the fetus.
114
A woman has just been diagnosed with asymptomatic uterine fibroids. The client asks the nurse, “Do I need to have my uterus removed?” Which is the best response by the nurse?
“Your practitioner can help you decide whether you need a hysterectomy.”
not scope of practice.
Depends of severity of the symptoms, age of pt and pt childbearing
115
Intentional prevention of pregnancy.
Contraception-
116
Keeping egg and sperm apart
Contraception-
117
Be aware of own personal beliefs.
Contraception-
118
Before educating make sure no bias.
Contraception-
119
Make sure not imposing own beliefs to clients beliefs.
Contraception-
120
device or practice to decrease the risk of conception
Birth Control-
121
Conscious decisions on when to conceive
Family Planning-
122
Who makes decision to practice contraception-
woman (main) and significant other. Not what the nurse thinks
123
understand pts need for education
Contraception-
124
Informed Consent
BRAIDED
125
B:
benefits
126
R:
risks- adverse effects from meds
127
A:
alternatives-nonpharmacological
128
I:
inquiries: chance to ask questions bc of many types
129
D:
Decisions- pt decides. Provider gives guidance.
130
E:
explanations- we make sure knowledgeable
131
D:
documentation- Education, informed consent, options discussed, rationales why this is the best option for the pt.
132
Half of pregnancies in US are
unplanned.
133
US has highest rate of unintended teen pregnancy.
Bc vary in states, access in contraceptives, abortion clinic access, cultures, stigma of birth control.
134
Public health office-
teen obtaining contraceptives
135
US is on the scale bc it is considered
wealthiest country
136
Speak teens alone, like an adult, giving education of
options/abstinence.
137
STDs/STIs educate S/Sx, condoms, getting tested-
getting over barriers of educating teens
138
Natural Family Planning- considers cultural and religious aspects.
Fertility Awareness Based methods (FABs)-
139
Only type of contraception that is recognized by roman catholic church.
Fertility Awareness Based methods (FABs)-
140
Pts are avoiding intercourse during fetal periods.
Fertility Awareness Based methods (FABs)-
141
Key Components
Avoid Intercourse during fertile periods
Combine charting menstrual cycle with abstinence
Track fertility
142
Approaches to natural family planning
Calendar-based methods
Symptom-based method
Biological Markers
App for fertility based awareness
143
Charting fetal cycles with
abstinence.
144
Vasal temperatures, tracking cycles, discharge, ovulation tests-
knowing fertile period.
145
Calendar based methods, calendar rhythm based on
standard days.
146
Depends on stress diet medications-
calendar based method
147
Assessing cervical mucous-
ovulation and vasal body temperature- symptom based
148
Biological markers utilizing at home-
ovulation tests at home
149
Phone apps-
tracking fertility to know optimal timing to avoid intercourse
150
Women need to know that ovum once it is released it is fertile for
24 hours
151
Methods of Contraception
Spermicides, Barrier Methods
152
Nonoxynol-9 (N-9) reduces sperm motility
Spermicides
153
Typical failure rate in the first year of spermicidal use alone is
29%
154
Barrier Methods
condoms, diaphragm, cervical caps, contraceptive sponge
155
Condoms:
Male & Female (Vaginal sheath)- Barrier methods- male, female condoms
156
4 types of traditional
Diaphragms
157
Is best that the female is formally fitted.
Diaphragms
158
Utilize spermicide and device should stay in place at least 6 hours after intercourse.
Diaphragms
159
Failure rate if used correctly- 14%
Diaphragms
160
FemCap available in U.S.- fit tighter around the cervical opening.
Cervical caps:
161
Is best that the female is formally fitted.
Cervical caps:
162
Utilize spermicide and device should stay in place at least 6 hours after intercourse.
Cervical caps:
163
Failure rate if used correctly- 14%.
Cervical caps:
164
Failure rate is 29% after vaginal birth with caps and diaphragm
Cervical caps and diaphragm
165
Contraceptive sponge
Today Sponge
166
Toxic shock syndrome (TSS) risks are present with
diaphragms, cervical caps and sponges
167
can occur with tampon use and leaving diaphragm, cervical cap and sponges in place for a long amount of time.
Toxic shock syndrome (TSS)
168
Caused by staphylococcus aureus.
Toxic shock syndrome (TSS)
169
Fever, discharge- S/sx of sepsis.
Toxic shock syndrome (TSS)
170
4 types of Diaphragms-
coil spring, arching, flat spring, wide seal rim
171
Hormonal methods
Available in varying formulations and administration
>100 different formulations available
172
Combined Contraceptives
Oral, Injections, Transdermal, Vaginal ring
173
Combined estrogen progestin.
Oral Combined Contraceptives
174
Taken PO.
Oral Combined Contraceptives
175
Easy to take and highly effective if taken correctly.
Oral Combined Contraceptives
176
relatively safe.
Oral Combined Contraceptives
177
Help to inhibit ovulation for hormonal methods.
Oral Combined Contraceptives
178
Suppressing surge of LH.
Oral Combined Contraceptives
179
both estrogen and progestin.
Combined injections-
180
Prevent surge of LH to suppress ovulation.
Combined injections-
181
Patches.
Transdermal
182
Placed weekly for 3 weeks and on 4th week the pt is patch free.
Transdermal
183
Rotating sites every time placing new patch on
Transdermal
184
both estrogen and progestin.
Suppressing surge of LH.
Transdermal
185
Combined inserted first 5 days of a cycle.
Vaginal Ring
186
After insertion pt required to have backup birth control 7 days after.
Vaginal Ring
187
Removed every three weeks. Ring free for 1 week.
Vaginal Ring
188
both estrogen and progestin.
Suppressing surge of LH.
Vaginal Ring
189
When educating s/sx from birth control put emphasis about cardiac problems-
HTN should not have combined contraceptives.
190
Warning signs to teach patients starting or taking combined oral contraceptives (COCs):
ACHES
191
A:
Abdominal pain may indicate a problem with the liver or gallbladder.
192
C:
Chest pain or shortness of breath may indicate possible clot problem within the lungs or heart.
193
H:
Headaches (sudden or persistent) may be caused by cardiovascular accident or hypertension.
194
E:
Eye problems may indicate vascular accident or hypertension.
195
S:
Severe leg pain may indicate a thromboembolic process. Common in patient with nuvaring.
196
combined oral contraceptives (COCs): Other s/sx;
increase risk of stroke, Heart attack, pseudomenstration- vaginal bleeding or spotting.
197
People placed on contra for heavy menstrual periods or excessive bleeding/
common with IUDs
198
Ask patient baseline and follow up with them
combined oral contraceptives (COCs):
199
Oral contraceptives on antibiotics
must need back of contraceptives
200
Too much estrogen impacts Cardiovascular system-
causes dizziness, fluid retention, leg cramps, high blood pressure
201
Progestin-only Contraception
Oral, Injectable, Implantable
202
failure rate it 9%.
Oral
[Minipill]
203
Important for pts to take same time everyday.
Oral
[Minipill]
204
Progestin increase viscosity of the cervical mucous (thick) so sperm cannot move through and make it to the egg.
Oral
[Minipill]
205
Decreases motility of fallopian tubes.
Oral
[Minipill]
206
Also interferes with LH surge.
Oral
[Minipill]
207
Good for breast feeding moms.
Progestin only
Oral
[Minipill]
208
Highly effective. Long acting.
Injectable
[Depo-provera]
209
given every 11-13 weeks.
Injectable
[Depo-provera]
210
More unfavorable side effects- weight gain and depression more than the pill.
Injectable
[Depo-provera]
211
Slows down motility and increase viscosity of cervical mucous.
Injectable
[Depo-provera]
212
Inhibit LH surge but also inhibits FSH.
Progestin only
Injectable
[Depo-provera]
213
Duration: Rod inserted underneath the skin. Lasts three yrs. Progestin only
Implantable
[Nexplanon]
214
Good for Cardiovascular disease pts.
Progestin-only Contraception
215
Safer than combined contraceptives
Progestin-only Contraception
216
Causes S/E- weight gain, depression, acne, increases risk of yeast infections bc of thick cervical mucous.
Progestin-only Contraception
217
Small T-shaped device inserted into the uterine cavity
Intrauterine devices (IUDs)
218
ParaGard Copper T 380A (effective for up to 10 years)
There are four FDA-approved IUDs:
219
Mirena (releases levonorgestrel; effective for up to 5 years)
There are four FDA-approved IUDs:
220
Liletta (releases levonorgestrel; effective for up to 3 years)
There are four FDA-approved IUDs:
221
Skyla (releases levonorgestrel; effective for up to 3 years)
There are four FDA-approved IUDs:
222
The typical failure rate in the first year of use is 0.2%
IUDs
223
Offers no protection against STIs or HIV
IUDs
224
Important client education; signs of potential complications: ACHES
IUDs
225
Lasts from 3 to 10 years.
IUDs
226
Don’t offer protection with STDs.
IUDs
227
Important to educate on the S/E using the ACHES acronym
Abdominal pain
Chest pain
Headaches
Eye problems
Severe leg pain
IUDs
228
Levonorgestrel-
synthetic estrogen
229
Advanced practice or medical provider does this.
IUD
230
Can cause miscarriages, fertility issues
IUD
231
Permanent Sterilization:
surgical procedures intended to render a person infertile
232
Tubule occlusion- most common.
Female Sterilization-
233
Can have Transcervical sterilization and tubule reconstruction.
Female Sterilization-
234
Can grow back and get pregnant again.
Female Sterilization-
235
surgical interruption of a man’s vas deferens.
Male (Vasectomy):
236
Done with local anesthesia. outpatient setting.
Male (Vasectomy):
237
Not as intense procedure.
Male (Vasectomy):
238
Complications with swelling and infection.
Male (Vasectomy):
239
Additional Considerations
Emergency contraception, Start dose, Missed dose, COCs, Lactational Amenorrhea
240
should be taken ASAP after unprotected sex.
Emergency Contraception-
241
Or also Can be effective after 5 days of sexual intercourse.
Emergency Contraception-
242
Different types: most common are plan b. utilize copper IUD.
Emergency Contraception-
243
when pt is going to be contraceptive on the first day they experience bleeding (the first time).
Start Dose-
244
Or can do the quick start method is that they can start anytime but need to have backup birth control for 7 days.
Start Dose-
245
Prior to taking that pill they have to rule out pregnancy
Start Dose-
246
need to take missed tab and the next scheduled tab at the same time.
Missed Dose Combined Oral Contraceptives'
247
If they miss more than 3 doses they need to discontinue the pack allow for withdrawal bleeding and then in 7 days they can start back
Missed Dose Combined Oral Contraceptives'
248
Need to take pill asap and need to have backup for 48 hrs.
Missed Dose Progestin Oral Contraceptives
249
only applicable to women that are breast feeing exclusively bc of hormone stimulation can suppress ovulation.
Lactational Amenorrhea-
250
Can practice this as birth control abd can only be used if actual breast feeding around the clock. Temporary method.
Lactational Amenorrhea-
251
Ovum is released during ovulation -> Sperm enters the female reproductive system -> Sperm and Egg join in the outer 1/3 in the fallopian tube.
Conception
252
Sperm is fertile for __ and ova (eggs) fertile for
48 hrs, 24 hours
253
Occurs 6-10 days after fertilization.
Occurs in the endometrium(inner lining of the uterus)
Implantation
254
When occurs pt can experience Bleeding or spotting
Implantation
255
Chorion
Amnion
Fetal Membranes
256
XX- female
XY-male- which determines sex of the fetus
Chromosomes- determine pts sex
257
Space for movement and protection
Amniotic Fluid
258
Promotes Thermoregulation
Amniotic Fluid
259
Transport Nutrients and fluid
Amniotic Fluid
260
Amniotic Fluid prevents
Adhering of the amnion to the fetus
Umbilical cord compression
261
800-1200mL present at birth
Amniotic Fluid
262
If too much amniotic fluid.
Polyhydramnios
263
Identified if amniotic fluid is>2000mL.
Polyhydramnios
264
It is associated with gastrointestinal malformations of the fetus.
Polyhydramnios
265
Too little amniotic fluid.
Oligohydramnios
266
Identified with volume that is less then 300 mL of amniotic fluid.
Oligohydramnios
267
Connection with renal malformation of the fetus.
Oligohydramnios
268
Interferes with fetal growth and development
Oligohydramnios
269
Lives in this for about 40 weeks
amniotic fluid
270
Fetus has a covering called vernix which protects skin for
maceration from amniotic fluid
271
amniotic fluid is made of up
Albumin, bilirubin, and uric acid
272
Tested for genetic studies-
amniotic fluid
273
Acts as cushion, keeps umbilical cord floating-
amniotic fluid
274
Protected by Wharton’s Jelly
Umbilical Cord
275
No Pain Receptors
Umbilical Cord
276
Umbilical Cord Three vessel cord
2 Arteries- take deoxygenated and bad stuff away from fetus
1 Vein- carries oxygen rich and nutrients to fetus
277
Some babies can be born with
multiple vessel cord
278
Intestines can be in the
umbilical cord
279
Endocrine gland
Placenta
280
Human placental lactogen
Placenta
281
Human chorionic gonadotrophin
Placenta
282
Develops during week 3
Placenta
283
Fully functional by week 12
Placenta
284
Regulates transport of gases, nutrients, and waste products
Placenta
285
Begins to age towards the end of pregnancy and becomes less functional
Placenta
286
Hormone secretion decreases
Placenta
287
Gradually less effective
Placenta
288
41 weeks of gestation can calcifying and be less effective of transporting nutrients/blood.
Placenta
289
Placenta Shiny shults-
fetal side
290
Placenta Dirty duncan-
maternal side
291
Want fetal side to be shiny,
new- membranes
292
Locus birth-
placenta attached to the baby to increase stem cells
293
Conception to day 14
Pre-Embryonic stage
294
Rapid cell division
Pre-Embryonic stage
295
Primary germ layers- tissues and organ form from and the embryonic membranes
Pre-Embryonic stage
296
Day 15 to week 8
Embryonic Stage
297
Structures of major organs are complete
Embryonic Stage
298
Organ systems are complete and functioning
Embryonic Stage
299
Teratogens!!! (3-8 week period)
Embryonic Stage
300
Educate- being aware of what putting in body if childbearing age and risky sex.
Embryonic Stage
301
Red flag weeks- 3-8 weeks more likely to develop
defects
302
MMR vaccine- teratogens.
The rubella can cause negative effects through the vaccine.
303
Education after to avoid pregnancy after 28 days after injection-
MMR
304
Safe for moms to breastfeed but pregnancy is contraindicated in
MMR- subcutaneous injection
305
Chemo, radiation, lead, CMV (cytomegdalo virus)-
can come contact with AC setting
306
1st trimerster
month 1, 2, 3
307
Month 1
1st trimester
308
Limb buds forming
Month 1
309
Hematopoiesis week
3
310
Day _ can hear
25
311
4th week-
GI developing
312
Liver-thyroid-bones-muscles-epidermis forming
Month 1
313
Neural tube-start of CNS.
Month 1
314
Encourage child bearing capabilities to take folic acid bc it helps promote development of
neural tube.
315
Green leafy veggies and orange juice found.
neural tube.
316
1/2inch <1 oz
Month 1
317
Ears, ankles, wrists
Month 2
318
Eyelids-SHUT
Month 2
319
Hematopoiesis continues
Month 2
320
5th week-
swallowing and voiding
321
Brain has 5 lobes
Month 2
322
*Rh FACTOR>
6 weeks
323
rH FACTOR
Proteins found on RBCs.
Second most important component when blood typing. + or -
1st most important- ABO
324
Pancreas and nerve fibers
Month 2
325
1in <1oz
Month 2
326
Fingers and toes
Month 3
327
Soft nails
Month 3
328
“baby teeth”
Month 3
329
Doppler ultrasound to hear HB abdomen
Month 3
330
Renal function
Month 3
331
Moving- feel fetal movement
Month 3
332
Adrenal cortex production hormones
Month 3
333
Sex characteristics
Month 3
334
Lanugo-thin hairs covering babies body.
Falls off at end of pregnancy
Month 3
335
2.5 inches >1oz
Month 3
336
Cardiac system is the first system that fully funcitons
1st Trimester
337
Cardiac anomalies develop first
few weeks of conception
338
White cheesy covering-
vernix
339
2nd trimester
month 4, 5, 6
340
-Moves, kicks, swallows
Month 4
341
-Handprints 16 weeks
Month 4
342
-Forming Meconium- waste product-black thick, tarry waste product. made in intestines.
Month 4
343
Intestines forms meconium at 13-16 week. First 24 hours after birth expelled.
Month 4
344
Can pass meconium during delivery process which can aspirate and cause
respiratory distress and infections.
345
-Placenta is fully formed
Month 4
346
-6-7in 5 oz
Month 4
347
-Sleep/wake intervals
Month 5
348
-Week 20: producing insulin
Month 5
349
-8-12 inches ½-1lb
Month 5
350
-Actively feeling fetal movement by mom
Month 5
351
-Lanugo all over
Month 6
352
-Eyes open
Month 6
353
-11-14 inches (28 cm long)
Month 6
354
1-1.5 lb (600g)
Month 6
355
*24 weeks*- marks period of
viability
356
Viable (better chance of surviving at extra uterine life) at end of
second trimester
357
Period of rapid growth
2nd trimester
358
3RD Trimester
month 7, 8, 9
359
Period of refinement and growth
3rd trimester
360
-Open and close eyes
Month 7
361
-Responds to light and sound
Month 7
362
-Storing fat
Month 7
363
-Testes descend into scrotum
Month 7
364
-15 inches 3 lbs
Month 7
365
-Rapid brain growth
Month 8
366
-Skull is soft/flexible- fit through birth canal and growth
Month 8
367
-Mature GI system
Month 8
368
-Fe (iron) stored
Month 8
369
-18 in 5 lb
Month 8
370
-FULL TERM 37-40 weeks
Month 9
371
-Brain ¼ size of adult
Month 9
372
-Gains ¼-1/2 lb per week
Month 9
373
[6-9 lb19-21 in]- full term infant
Month 9
374
Blood increase to head and placenta and no blood to the
Lungs by the shunt
375
Intrauterine life to extrauterine life shunts
open
376
Bradycardia =
fetal circulation compromised to help turn mom to left side
377
Fetal Heart, Placenta, Fetal tissues
Fetal Circulation
378
Decrease blood flow to fetal lungs
Fetal Circulation
379
Direct blood to placenta
Fetal Circulation
380
Fetus shunts blood to the lungs while in utero
Fetal Circulation
381
After birth--Infant breathes—shunts are no longer needed.
Fetal Circulation
382
Chemoreceptors active closure to shunts
Fetal Circulation
383
increase blood flow to head and decreasing blood to lungs
Fetal Circulation
384
When compromised fetal circulation-
fetal HR dropping.
Turn mom and place on left side lying which enhances fetal circulation.
385
Significantly impacted by maternal help
Respiratory system of the fetus
386
20-24 weeks
Stabilizes Alveoli
Surfactant
387
Alveoli aren’t mature until
35-37 weeks
388
L/S ratio
(lecithin/sphingomyelin)
389
Want it to be: 2:1 ratio indicates lung maturity
L/S ratio
390
Maternal use of steroids can stimulate production.
L/S ratio
391
If mom is (premature) 34 weeks prg and in labor likely to give steroids to enhance or speed up fetal maturity in the fetal respiratory system.
L/S ratio
392
Not given for full term and healthy baby.
L/S ratio, steroids
393
substance in the alveoli to stabilize it for good gas exchange
Surfactant-
394
Reduce surface tension to make it easier to breathe for the baby-
surfactant
395
Amniocentesis test to test the
LS ratio
396
FERTILIZATION OF A SINGLE OVUM BY ONE SPERM
Monozygotic
397
Identical
Monozygotic
398
Monozygotic Risk:
HX of dizygotic twins in Female history
Use of fertility drugs
399
Multifetal Pregnancy Dx:
Polyhydramnios
Asychronous FHR
utilizing an ultrasound to visualize
400
Likelihood of multifetal pregnancy IF
HX of dizygotic twins in Female history
Use of fertility drugs
401
Multifetal Pregnancy Often end in prematurity
Premature rupture of membranes
402
FERTILIZATION OF 2 OVA BY TWO SPERM
Dizygotic
403
FRATERNAL/NONIDENTICAL
Dizygotic
404
Use of fertility drugs increase the risk for
multifetal
405
___ are more likely to use fertility drugs, higher risk for multifetal pregnancy
Older women
406
End in premature rupture in membranes- early labor.
Its considered high risk.
407
GTPAL
Gravidity, Term birth, Preterm, Abortion, Living
408
Gravidity-
a Pregnancy
409
Term Birth-
occurs after 37 weeks.
410
Preterm-
birth from 20-36 weeks and 6 days.
411
Abortion-
medical abortion(therapeutic) or spontaneous abortion.
412
Living-
how many children the woman has alive
413
Nulligravida-
Never been pregnant
414
Primigravida-
Pregnant for the first time
415
Multigravida-
Pregnant at least a second time
416
Five digit System
Gravity, Term, Preterm, Abortion, Living
417
Signs of pregnancy
Probable, Positive, Presumptive
418
observed by the practioner.
Probable
419
Softening of the cervix- assessed as early as five week-Goodell’s sign.
Probable
420
Chadwix sign-bluish purple discoloration to the cervix.
Occurs bc so much blood flow going to the uterus which is bleeding the cervix.
Noted at 6-8 weeks gestation.
Probable
421
Hegar sign- softening of the lower portion of the uterus.
Noted as early as 6-12 weeks gestation.
Probable
422
Positive pregnancy test- test for hormone HCG.
Probable
423
Practitioner taps on cervix and the baby bounced up and down- ballottement.
Fetus haws to be a significant size not performed until 16 weeks gestation.
Probable
424
definitive evidence that fetus present.
Positive-
425
Only be attributed to the presence of a fetus.
Positive-
426
Ultrasound done 5-6 weeks gestation.
Positive-
427
Fetal hr detected around 6 weeks gestation.
Positive-
428
Palpation of the fetus and the outline of the fetus-palpating the abdomen at significant sigh 18-22 weeks.
Positive-
429
subjective signs.
Presumptive-
430
Fatigue, breast changes(heaviness in breast), darkened areola, nausea, increase urinary frequency
Presumptive-
431
quickening- fetal movements ex:gas bubble that is quickening doesn’t occur 16-20 weeks gestation.
Presumptive-
432
Amenorrhea. Is there something other than pregnancy that can cause
Presumptive-
433
important part of pregnancy
Uterus
434
Increases in size and weight.
Uterus
435
12-14 weeks palpating the __ above the symphysis pubis.
Uterus
436
22-24 weeks gestation palpating at the umbilicus.
Uterus
437
As the fetus grow the __ expands.
Uterus
438
Cervix- dilates and allows the passage of the fetus.
Cervix-
439
Increases in vascularity, softens, increase in mucous production which causes mucous plug
Cervix-
440
When closer to labor the mucous plug and come out in a big chunk or little pieces.
MUCOUS PLUG-
440
acts as barrier against infection.
MUCOUS PLUG-
441
Labor is near (within two weeks)-
after mucous plug falls out.
442
Increased in secretions
Leukorrhea
443
Stimulated by hormones to prepare for lactation
444
Perineum-
support pelvic structures.
During child birth it can be lacerated.
445
Intricate system of tissues that manufactures and stores breast milk
Breasts
446
Stimulated by hormones to prepare for lactation
Breasts
447
as early as 16 weeks gestation.
Colostrum-
448
Colostrum can form.
Breasts
449
Not until estrogen levels decrease that complete lactation can occur.
Breasts
450
Can see striae gravidarum (stretch marks) during pregnancy.
Breasts
451
Heart Displaced to the LEFT
Pregnancy
452
Cardiac Output Increases about 30-50%. Increase to provide adequate perfusion due to compensation.
Pregnancy
453
Cardiac Volume increases
Pregnancy
454
Vital signs- HR- increase 10-15 bpm above baseline,
Help maintain cardiac output.
455
__ sometimes increases during first trimester but will go back to normal after.
BP
455
Abnormal finding- increase in BP during pregnancy,
it is scary and often.
456
Increase in fluid and hormonal fluctuations-
increase bp in 1st trimester.
457
Peripheral Changes in pregnancy
Edema, coagulation
458
fluid retention.
EDEMA-
459
Compression of the Iliac veins and inferior vena cava by the by the
uterus.
460
It is important that moms do not lay on back while pregnancy
uterus is growing.
461
Decreases perfusion to the placenta thus decreasing perfusion to the baby.
Compression of the Iliac veins and inferior vena cava by the by the uterus.
462
Coagulation-hypercoagulable state as a protective mechanism
Pregnancy
463
Clotting factors increase-
protective mechanism.
464
During childbirth mom does not excessive bleeding or hemorrhage that leads to death.
coagulation
465
D-Dimer increases in
pregnancy. Increase risk for DVT, hemorrhage.
466
Diaphragm- raise and flare in the ribs..
Pregnancy
467
RR unchanged- may experience SOB with activities
Pregnancy
468
Slight hyperventilation
Pregnancy
469
Oxygen consumption increases- 15%-20%
Pregnancy
470
Dyspnea
Pregnancy
471
Nasal stuffiness + epistaxis(nose bleeds)- estrogen vascularizes more.
Pregnancy
472
Nasal tract vascularization is increased.
Pregnancy
473
Vascular change due to estrogen
Pregnancy
474
Bladder has a reduced capacity- due to
uterus or fetus is taking up more space.
475
Ureters/kidneys increase in size.
Pregnancy
476
Urine formation is slightly increased
Pregnancy
477
Nocturia- increase frequency in urination at night
Pregnancy
478
Bladder becomes more sensitive bc of increase in pressure from the uterus/fetus.
Pregnancy
479
Increase in urinary elimination.
Pregnancy
480
Goes back to non pregnant size (smaller but not the same)-
kidneys, uterus, bladder.
481
Brownish splotchy mask like discoloration.
Melasma-
482
Common in dark complexed females and fades after birth.
Melasma-
483
A hyperpigmented line that is midline down the abdomen will fade after birth. Can take years to fade
Linea Nigra-
484
Striae Gravidarum- stretch marks due to pregnancy.
A reddish, purplish discoloration. Fade after pregnancy.
Striae Gravidarum-
484
pink or reddish discolored palms. Will disappear after birth.
Palmar erythema-
485
Spider veins. Remain after birth. Does not fade or go away
Angiomas-
486
abnormal lumbar curvature gets deeper. Change in center of gravity so the females stance widens.
Exaggerated Lordosis-
487
Hormonal Influences
Pelvic expansion
Increased softening and elasticity of ligaments
Abdominal muscles stretch
488
typically related to electrolyte imbalances.
Muscle cramps-
489
can occur only during pregnancy
Carpel Tunnel-
490
R/t edema pressure on median nerve
Carpel Tunnel-
491
Usually occurs in late third trimester
Carpel Tunnel-
492
Carpel Tunnel s/sx
paresthesia, pain and swelling/edema in upper extremities-wrist area.
493
Swelling can decrease but May need PT even after pregnancy
Carpel Tunnel
494
Concern for the mom hard to hold baby, write etc
Carpel Tunnel
495
Increase salivation
GI pregnancy
496
Increased appetite and thirst
GI pregnancy
497
Nausea and vomiting- occur due to hormonal changes. rarely is n/v harmful to the fetus.
GI pregnancy
497
Delayed gastric emptying and intestinal motility
GI pregnancy
498
GERD- gastroesophageal reflux disease. Due to hormonal changes.
Increase in the softening of the esophagus and is related to increase progesterone.
GI pregnancy
499
Delayed gallbladder emptying
GI pregnancy
500
Pica- non food cravings.
Indicator of anemia-can be underlying cause (dirt, ice-no nutritional value, chalk). Can impact weight gain
GI pregnancy
501
Estrogen- influences changes with the uterus, breast and skin.
Endocrine pregnancy
502
Progesterone- responsible for maintaining pregnancy.
Endocrine pregnancy
503
hCG- responsible for morning sickness- hyperemesisgravaderum.
Endocrine pregnancy
503
Oxytocin- stimulate milk ejection during lactation and uterine contractions.
Endocrine pregnancy
503
Fetus relies on maternal glucose
Pancreas
503
Thyroid gland
Endocrine pregnancy
504
Pulls glucose from maternal supplies
Fetus
504
Depletes maternal stores
Fetus
504
During 1st trimester results in a decrease in maternal
blood glucose (low blood sugar)
505
2nd trimester- maternal tissue sensitivity to insulin begins to
decline
505
If baby is large for gestational age we have to monitor for
hypoglycemia (checking BGL before and after feedings)
506
Only until babies endocrine system kicks in-
dextrose IVs help hypoglycemia.
506
Estimated due Date/Estimated Date of confinement (EDC)
Diagnosis of Pregnancy
506
Period of physical and psychological preparation for birth and parenthood
Prenatal Period
507
Nagaele’s Rule
+7 to 1st day of Last Menstrual Period, -3 month +1 year (if applicable)
507
Most deliver +/- __ from Estimated due Date
2 weeks
507
April 13th 2023 date of LMP.
-3 month= Jan, +7 day= 20th, +1 year= 2024
Jan 20th, 2024
508
9 months span-
pregnancy
509
Holistic-
family centered care
510
Family supports the
patient
511
1 year after birth stops prenatal care
prenatal birth-
before conception
512
Any female of child bearing age-
prenatal care
513
Education to support the
mom.
514
Supports birth
control/contraceptive care.
515
Adaptations to Pregnancy- biggest mile stone if mom
verbalizing pregnancy
516
Normal for mom to have mood swings due to
hormonal changes
517
Paternal Adaptations to Pregnancy
Couvade Syndrome
517
Maternal Adaptations to Pregnancy.
Acceptance of the pregnancy
Identifying as a mother
Establishing personal relationship with the fetus
Preparation for child birth
518
Partner experiences symptoms of the pregnant women like cravings, nausea. Increase of cravings and appetite- pregnancy like symptoms.
Couvade Syndrome
519
depending on the age. Rebel.
Sibling regression
520
May feel the baby is the burden (babysit, cant move in with lives).
Sibling regression
521
Include the siblings in the plan of care no matter the age
Sibling regression
522
Grandparents-
support, role models. Expected role
523
Various stages of accepting the pregnancy-
mom and significant other
524
Health history, Drug use, Family history, History of any type abuse
Prenatal Interview
525
Spinal disorders, sexual abuse, mental disorders, genetic disorders, allergies, experiencing PICA, OTC drugs and illicit drugs, prescribed.
Prenatal Interview
525
Physical Exam (H to T),
Prenatal Interview
525
Lab tests- CBC, UA, Syphilis, gonorrhea, and chlamydia testing. Informed Consent to test for HIV.
Prenatal Interview
526
Group B strep
Prenatal Interview
527
can change with each pregnancy.
Group B strep
527
done between 35-37 weeks gestation, swab from vagina to the rectum.
Group B strep
527
Not an STI.
Group B strep
527
Determines prophylactic tx with antibiotics while in labor.
Group B strep
528
Can be transmitted to baby going through birth canal and become septic.
Group B strep
529
Fundal height (abdomen- determines height of the uterus, top part of uterus (fundus),
Fetal Assessments
530
FHTs(fetal heart tones),
Fetal Assessments
531
EGA(estimated gestational age),
Fetal Assessments
532
Labs- r/t fetus genetic testing.
Fetal Assessments
533
child care, birthing preferences, feeding preferences.
Education
534
Starting discuccion from prenatal care. What are the plans after birth.
Education
535
if decreased fetal moment light red bleeding contact provider immediately,
Education
536
reiterate at every visit.
Education
537
sexual practices- can still get STD (condoms).
Education
538
first trimester- libido
less likely
539
Preterm Labor
Fetal Assessments
540
Hormonal changes- fluctuations in libido
second trimester
541
Normal VS Abnormal discomforts-
as the pregnancy progresses likely to become more uncomfortable due to growing size of the fetus.
542
Normal for
N/V, back pain, hormonal changes.
543
Abnormal-
bright red vaginal bleeding, uterine contractions- preterm (before 37 weeks), any changes in fetal movement.
544
Nutrition- prenatal vitamins daily,
Pregnancy education
545
Hygiene, breastfeeding- education after delivery
Pregnancy education
546
physical activity- no extremely strenuous but still stay active.
Pregnancy education
547
No amount of alcohol is considered safe during pregnancy.
Pregnancy education
548
Mom stay hydrated if not- electrolyte imbalances which causes uterine contractions (prevent preterm contractions)
Pregnancy education
549
Body mechanics, Rest
Pregnancy education
550
Immunizations- no live vaccines. MMR or Varicella
Pregnancy education
551
OKAY to receive during pregnancy: Flu, hep b, TDAP
Pregnancy education
552
not all vitamins, herbal supplements or OTC are safe for pregnancy.
Pregnancy education
553
NSAIDS are not good. Acetaminophen can be good
Pregnancy education
554
Childbirth goals-
support system, medications
555
Cultural Influences-
how they view pregnancy and how the childbirth practices will be
556
Adolescents- pregnant,
less likely to receive prenatal care.
Educate not shaming them.
557
comorbidities, genetic concerns, increase fertility due to taking infertility drugs
Advanced Maternal Age/Delayed Childbearing- older than 35 years old-
558
care for child?, premature births, restructuring their life’s-career, effects other siblings.
Advanced Maternal Age/Delayed Childbearing- older than 35 years old-
559
