Nurs 353 test 1 Flashcards
1
Q
Skene glands
A
on either side of the urethra and produces mucus that helps lubricate the vagina
2
Q
bartholin glands
A
for lubrication and produces acidic environment for sperm to travel up
3
Q
no estrogen =
A
menopause
4
Q
when a girl is young estrogen helps
A
create opening, pubic hair, and ovarian functioning
5
Q
cervix
A
bottom of the uterus. not its own organ
6
Q
what holds everything together
A
ligaments
7
Q
are the Fallopian tubes actually attached?
A
no just ligaments holding together and little fingers grab the egg
8
Q
internal stuctures
A
vagina, uterus, cervix, Fallopian tubes, ovaries
9
Q
external structures
A
mons pubis, labia majora, labia minora, clitoris, sienne glands, bartholinites glands
10
Q
rugae
A
allows vagina to stretch for child birth
11
Q
peak of estrogen does what to cervix
A
opens so sperm can fit through
12
Q
thelarche
A
occurs around 9-11 years. signals ovarian function has begun. breast buds, higher estrogen, and growth spurt
13
Q
menarche
A
first menstruation. usually 1 year after thelarche. average 13 years old
14
Q
menstruation is controlled by
A
negative and positive feedback system
15
Q
first day of bleeding is
A
day 1 of cycle
16
Q
menstrual cycle does what to the uterus
A
prepares it for pregnancy
17
Q
typical menstrual cycle is 28-32 days but is can range from
A
21-35 days
18
Q
4 phases of endometrial cycle
A
menstrual phase, proliferative phase, secretory phase, and ischemic phase
19
Q
menstrual phase
A
vasoconstriction and sloughing of endometrial tissue- bleeding
20
Q
proliferative phase
A
ends with ovulation. rapid growth of the endometrium and is restored in 4 days
21
Q
proliferative phase if dependent on
A
estrogen
22
Q
secretory phase
A
day after ovulation. increasing amounts of progesterone thicken and vascularize the endometrium
23
Q
ischemic phase
A
does not occur if you get pregnant. day 27-28. estrogen and progesterone are very low. spiral arteries vasoconstriction and bleeding begins marking day 1 of cycle.
24
Q
what phase is it when the endometrium reaches full thickness
A
secretory phase where it is 10-12 mm thick
25
phase of ovarian cycle
follicular phase, ovulatory phase, and luteal phase
26
follicular phase
before ovulation 1-30 follicles begin to mature. LH affects a single follicle
27
the single follicle that is chosen during the follicular phase is called
Graafian follicle
28
ovulatory phase
estrogen peaks and ends with the release of the egg from the Graafian follicle
29
where is LH released and what stimulates it
estrogen peaks which stimulates the pituitary gland to release LH around day 12
30
what do you need to ovulate
LH and estrogen
31
luteal phase
cells of the follicle form the corpus luteum.
32
if pregnancy occurs the corpus luteum
continues to release progesterone and estrogen until placenta matures
33
if no pregnancy occurs the corpus luteum
degenerates and the decreased progesterone signals the beginning of menstruation
34
what produces hormones to sustain pregnancy
corpus luteum
35
4 major hormones of the menstrual cycle
follicle stimulating hormone (FSH), luteinizing hormone (LH), estrogen, and progesterone
36
follicle-stimulating hormone
stimulates the development of Graafian follicles and therefore estrogen
37
luteinizing hormone
spikes day 12-13 and stimulates the release of the ovum
38
where is estrogen produced
ovaries
39
where is progesterone produced
corpus luteum
40
prostaglandins
oxygenated fatty acids classified as a hormone
41
if you do not have any prostaglandins then
estrogen cannot peak
42
what is considered the essential organ of males
testes because they produce sperm
43
what % of sperm are mobile
40%
44
how many sperm are there per mL of ejaculate
120 mL
45
60% of semen volume is produce in _____ and 30% of semen is produced in ______
60% produced by seminal vesicles and 30% produced by prostate
46
why is the 30% produced in the prostate important
because they are alkaline and it helps protect the sperm from the acidic environment of the vagina
47
conception occurs when
a sperm nucleus enters the nucleus of the egg
48
what account for 60% of miscarriages
chromosomal anomalies and the miscarriage usually occurs within the first 8 weeks
49
once the sperm nucleus and egg nucleus combine what begins
meiosis
50
conception occurs in the
Fallopian tube
51
all cells contain ___ chromosomes and how many pairs are inherited from each parent
46 chromosomes and 23 pairs and inherited
52
mitosis
cell division
53
3 days after fertilization the zygote has how many cells
16 cells
54
5 days after fertilization
blastocyst and now enters the uterus
55
once the blastocyst reaches the uterus us becomes
an embryoblast (embryo) and trophoblast (placenta)
56
implantation should occur ______ days after ovulation
6-10 days
57
where does implantation occur
upper portion of the uterus where it gets buried underneath the endometrial surface
58
most critical time for organ system development
before 8 weeks
59
when are all the organ systems and external structures present
8 weeks
60
stage of the embryo
day 15 until 8 weeks after fertilization
61
amniotic fluid
cushions the fetus and protects against developmental problems
62
when does amniotic fluid appear
about 3 weeks and increases until about 24 weeks
63
yolk sac
has nutrients and oxygen for embryo until placenta transfer can occur
64
when does placenta begin to form and when does the transfer occur
begins to form at implantation and transfer occurs 2-3 weeks gestation
65
what does the yolk sac become
digestive system
66
how many arteries and veins does the umbilical cord have
2 arteries and 1 vein
67
placenta function
passive diffusion to transfer nutrients and oxygen to the fetus and also helps with metabolic function and waste
68
where does passive diffusion of placenta occur
chorionic villi
69
when is the placenta complete and how long does it grow for
complete at 8-10 weeks and grows until 20 weeks
70
can bacteria cross the blood placenta barrier
no most bacteria are too large
71
vaginal secretions are was ph
4-5 so slightly acidic
72
bacterial vaginosis
normal hydrogen peroxide producing lactobacilli are replaced with high concentrations of anaerobic bacteria
73
bacterial vaginosis is associated with
preterm labor
74
common signs and symptoms of bacterial vaginosis
fishy odor
75
screening and management of bacterial vaginosis
gram stain slide and treatment is flagyl (antibiotic)
76
candidiasis
yeast infection
77
symptoms of candidiasis
itching, vaginal dryness, painful urination, discharge is thick
78
trichomoniasis
STI that is cause by parasite
79
trichomoniasis is associated with
preterm delivery
80
screening for trichomoniasis
saline slide (shows white blood protozoa) and examination
81
common symptoms of trichomoniasis
most will be asymptomatic but some will have yellowish/green frothy foul smelling discharge, inflammation, painful urination and intercourse
82
malodorous
foul smelling
83
management of trichomoniasis
flagyl and male partner should receive treatment
84
chlamydia is associated with
preterm birth and blindness in the baby
85
gonorrhea is associate with
miscarriage, preterm birth, low birth weight, infection of fluid that surrounds fetus, blindness of the baby, and premature rupture of the membranes surrounding the fetus
86
syphilis is associated with
preterm birth, stillbirth, and some deaths after birth. untreated infants tend to develop problems because syphilis may pass from infected mother to fetus
87
can antibiotics cross the placenta
yes
88
group B streptococcus
considered normal flora of the vagina and intestines but is a huge factor in neonatal morbidity and mortality
89
screening and management of group B streptococcus
retrovaginal culture screening at 35-37 weeks and treatment is antibiotic prophylactically for the baby
90
embryo vs fetus
embryo until 8 weeks and fetus 9 weeks on until born
91
pregnancy lasts
40 weeks
92
pregnancy is computed by
nagele's rule
93
nagele's rule
LMP subtract 3 months, add 7 days and 1 year
94
how long is each trimester
1st - week 1-13
2nd - week 14-26
3rd - week 27-40
95
viability
refers to capability of the fetus to survive outside the womb
96
age of viability
about 24 weeks gestation when central nervous system functions and lungs of capable of oxygenation
97
before 24 weeks the lungs dont have
enough surfactant to breath on their own
98
when is the fetus less likely to be effected by environmental teratogens
after 9 weeks
99
4th week vs 5th week of a fetus's heart
week 4 - 2 chamber heart
week 5 - beating heart
end of week 5 - 4 chamber heart
100
where does the blood travel in the fetus
it does not need to travel to the lungs so it goes through ductus arteriosus
101
fetal heart rate is
110-160 beats per minute
102
if the neural tube does not close what happens
defects such as spina bifida anencephaly
103
anencephaly
absent brain
104
RBC production in fetus
9 weeks liver serves as major site of RBC production then at 12 weeks blood is formed in bone marrow but it is not until 28 weeks that RBC are made in bone marrow
105
fingernails formed
11 weeks
106
when is sex identifiable
12 weeks but usually not on ultrasound until 18 weeks
107
meconium
first bowel movement starts forming at 16 weeks
108
18 weeks
vocal cords work and quickening occurs
109
quickening
mother starts to feel movement of baby
110
20 weeks
hair on head, nose and ears ossify, weighs one pound, and respiratory movements occur
111
when is the GI system complete
36 weeks
112
when is the respiratory system fully mature
38 weeks but branching only 2-3 complete by birth
113
what hormone helps make the bones in babies head softer
relaxin
114
dizygotic twins
two mature ovum implant. 2 placentas
115
monozygotic twins
one fertilized ovum that divide in two. will always be same sex and same genotype
116
types of monozygotic twin
mono-mono twins and mono-di twins
117
mono-mono twins
one amniotic sac and one placenta - only a 50% survival rate
118
mono-di twins
two amniotic sacs and one placenta
119
gravidity
of pregnancies a woman has had
120
parity
number of pregnancies in which fetus has reached 20 weeks
121
term
of pregnancies that have reached 38-42 weeks (to term)
122
preterm
pregnancy that has reached 20 weeks of gestation but before completion of 37 weeks of gestation
123
two digits
G- gravida
| P- Para
124
5 digits
G-T-P-A-L, Gravidity, Term, Preterm, Abortions, Living, Children
125
biochemical marker of pregnancy
HCG - human chorionic gonadotropin
126
signs and symptoms of pregnancy
presumptive, probable, and positive
127
presumptive symptoms
changes felt by the woman
128
probable symptoms
changes observed by health care provider
129
positive symptoms
signs only by the presence of a fetus such as ultrasound, movement felt by practitioner, doppler of heart beat
130
Goodell sign
increased vascularity and hypertrophy of the cervix
131
luekorrhea
increased discharge due to increased estrogen
132
Chadwicks sign
deepening color of the vulva by 6-8 weeks
133
montgomery tubercles
where milk comes out and are all around the nipples
134
colostrum
thought of as the first vaccine. first form of milk produced immediately following delivery of the newborn. has a lot of antibodies
135
what happens to blood volume during pregnancy
it increases by 1500 mL to support utero-placental circulation
136
what happens with RBC during pregnancy
RBC increase by 20-30% in response to increased O2 requirements
137
what happens to cardiac output during pregnancy
increases by 30-40%
138
breathing during pregnancy
there is a shift from abdominal to thoracic breathing and may be more shallow/short/fast breaths
139
what occurs with the renal system during pregnancy
GFR increases and bladder tone decreases so there may be frequency, urgency, and needing to pee multiple times at night
140
chloasma
mask of pregnancy - brownish pigmentation of skin over cheeks and forehead
141
linea nigra
darkening line of abdomen
142
striae gravidarum
stretch marks
143
palmar erythema
red hands
144
relaxin hormone can do what to joints
cause joint pain because it makes bones softer
145
lordosis
abnormal anterior curvature of the spine
146
diastasis recti
separation of the abdominal muscles
147
PICA
cravings for non-food substances. usually a sign of iron or magnesium deficiency
148
edema of the peripheral nerves can cause
carpal tunnel syndrome
149
what does progesterone do to the GI system
it slows food that is going through the stomach so that more nutrients can be taken in for the baby but this can cause bloating and constipation
150
HCG should be _____ every 72 hours
doubled
151
progesterone is made in
placenta and corpus luteum but if not pregnant than in the ovaries
152
estrogen does what
main thing: decrease contractions so they don't happen too early
153
human placental lactogen
acts as a growth hormone. produced by placenta and helps fetus grow
154
relaxin hormone
decreases contractions early in pregnancy and at the end of pregnancy relaxes the muscles for labor. produced in the corpus luteum and placenta
155
2 major need from the partner
feeling loved and having the child accepted by the partner
156
maternal adaptation to pregnancy includes
accepting the pregnancy, identifying with the mother role, establishing a relationship with the fetus, and preparing for childbirth
157
paternal adaptation to pregnancy
accepting the pregnancy, identifying with father tole, reordering personal relationships, establishing relationship with fetus, and preparing for childbirth
158
sibling adaptation to pregnancy
dependent one child's age and development level but can include encouraging children to participate in care of infant, sibling jealousy, and sometimes regressive behaviors in younger siblings is normal
159
prenatal care is an emphasis on
preventative care and optimal self care
160
inadequate prenatal care is associated with
problems with low birth rate and infant mortality
161
some prenatal care barriers include
lack of motivation, inadequate finances, lack of transportation...
162
traditional model of prenatal care
initial visit, monthly visits through week 28, bi weekly until week 36, then weekly visits until delivery
163
post party follow up
6 week is vaginal birth and 2 weeks in C-section birth
164
what happens during the initial prenatal visit
confirm pregnancy, interview, assessment, medications such as prenatal vitamins
165
lab tests during prenatal visit
HIV testing, blood type, H&H, HCG levels, rubella, Hep B, urinalysis, alpha Fetoprotein
166
alpha Fetoprotein (AFP)
15-20 weeks
if elevated -NTD, anencephaly, omphalocele, gastroschisis
if decreased - trisomy 21
167
what is included in follow up visit
interview, assessment, ultrasound, and Rh(D) immune globulin (RhoGAM)
168
Rh(D) immune globulin (RhoGAM)
300 mcg IM for RH women at 28 weeks
169
amniocentesis
Needle inserted through abdominal wall into the uterine cavity to obtain amniotic fluid sample
indicated for women over 35, history of genetic or hemolytic disorders, or + alpha fetoprotein
170
follow up visit labs
Urine dip stick (glucose, albumin, & ketones)
1hour glucose test (24-28 weeks)
3 hour glucose testing…done if high reading on 1 hour screen
Vag/rectal GBS (35-37 weeks)
H&H (repeated 36 weeks) to check for anemia
171
tests for fetal well being
umbilical artery doppler flow, amniocentesis, chorionic villus sampling, non-stress test, amniotic fluid index, and biophysical profile
172
amniotic fluid index
Measures the volume of amniotic fluid via ultrasound in four quadrants of the uterus. Used to detect fetal hypoxia and kidney function
173
amniotic fluid index levels
normal 8-24 cm
oligohydramnios- less than 5 cm
polyhydramnios- greater than 24
174
Biophysical profile (BPP)
Assessment of fetal breathing movements, gross body movements, fetal tone, amniotic fluid volume, and heart rate activity via ultrasound (2 points each)
175
Biophysical profile (BPP) levels
reassuring - 8-10
score of 6 = delivery depending on gestational age
non-measuring = 4 or less and warrants delivery
176
true labor contractions
are regular, frequent, and hard
177
births settings
hospital, birth centers, and home birth
178
nutrient needs during pregnancy
folate or folic acid and iron supplements
179
when is folic acid important
during pre conceptual period
180
when is iron supplements most important
begin by the 13th week of gestation to prevent anemia and take about 30 mg per day
181
because of mercury content pregnant women should
limit all fish to 12 oz per week
182
food to avoid during pregnancy
unpasteurized dairy, raw cookie dough, certain kids of fish, and raw fish
183
normal weight gains during pregnancy
of you are underweight - 28-40 lbs
if you are average weight - 25-35 lbs
if you are overweight - 15-25 lbs
if you are obese - 11-20 lbs
184
caffeine has been found to increase risk of
miscarriage or IUGR (fetal growth restriction)
185
adolescent pregnancy needs
increased need for calcium, possibly more weight gain, and they may have a smaller pelvis size
186
strict vegetarians who become pregnant may need
so supplement with B12 for healthy pregnancy
187
AMA
advanced maternal age. also called geriatric pregnancy
188
advanced maternal age
any pregnancy that ends when a woman is over 35
189
when risk factors are identified the patient is referred to
a perinatologist
190
risk factors for high risk pregnancies
high or low age, multiple gestation pregnancies, genetic or nutritional considerations, medical disorders, psychosocial factors, socioeconomical factors
191
hyperemesis gravidarum
nausea and vomiting that leads to weight loss, electrolyte imbalance, nutritional deficiency, and ketonuria
192
treatment of hyperemesis gravidarum
IV fluids, combination of pyridoxine (B6) and doxylamine (Unisom), antiemetics, ginger root
193
nursing care for hyperemesis gravidarum
assessment including weight and VS, strict I&O, oral hygiene, small frequent meals with bland food, sipping fluid through a straw, little to no odors
194
PIH
hypertension in pregnancy
195
gestational hypertension
onset of hypertension without proteinuria after 20 weeks
196
chronic hypertension
hypertension that is present before pregnancy, develops before 20 weeks, or persists longer than 12 weeks postpartum
197
preeclampsia
pregnancy specific syndrome in which hypertension and proteinuria develop after 20 weeks of gestation in previously normotensive women
198
signs and symptoms of preeclampsia
elevated BP, epigastric pain that is worse at night, sudden weight gain, peripheral edema, hyperactive DTRs, proteinuria, headaches, heartburn
199
mild to moderate preeclampsia treatment
managed at home- complete partial bedrest, normal diet. will need to do 24 hour urine collection, CBC, liver enzymes, kidney function, and biophysical profile
200
severe preeclampsia treatment
treated in hospital immediately- bedrest, oral antihypertension medication, magnesium sulfate, corticosteroids, possible C-section
201
magnesium sulfate
high risk medication - requires 2 rn check. drug to prevent and manage seizures
202
loading dose vs maintenance dose of magnesium sulfate
loading dose - 4-6 g IV
| maintenance 1-2 g/hr IVPB
203
side effects of magnesium sulfate
may cause relaxation of uterus, diaphoresis. fatigue, weakness, slurred speech
204
if severe toxicity of magnesium sulfate is suspected what do you do
stop infusion and administer calcium gluconate or calcium chloride which are the reversal agents of magnesium sulfate
205
HELLP syndrome
severe preeclampsia. H= hemolysis, EL= elevated liver enzymes, LP= low platelet
206
when does HELLP syndrome usually develop
third trimester or within 48 hours postpartum
207
signs and symptoms of HELLP syndrome
flu-like symptoms, malaise, N/V, HA, shoulder pain, bruising, and hematuria
208
treatment of HELLP syndrome
FFP transfusion, platelet transfusion, PRBC, immediate delivery
209
FFP tranfusion
fresh frozen plasma
210
HA
headache
211
eclampsia
onset of a seizures or coma in a women with preeclampsia with no history of seizure disorder
212
eclampsia treatment
1. airway and safety
2. check fetal heart rate, note duration of seizure
3. side rails up, oral suction, 10L of O2, fetal heart rate tracing
5. if patient is on magnesium need to administer more or start a magnesium infusion
213
placenta previa
the placenta is implanted in the lower uterine segment - can be complete, marginal, partial, or low lying
214
how does placenta previa present
painless, bright red bleeding during the second or third trimester
215
treatment of placenta previa
observe and bed rest. always need a C-section if complete or partial
216
abruptio placentae
the prematures separation of a normally implanted placenta. can be graded 1 (mild), 2 (moderate), 3 (severe)
217
signs and symptoms of abruptio placentae
dark vaginal non-clotting bleeding, severe abdominal pain, uterine tenderness, hypovolemia, abnormal FHR
218
treatment for abruptio placentae
emergency C-section, replace blood loss, O2
219
incompetent cervix
painless cervical dilation in the second trimester that can progress to premature birth
220
incompetent cervix treatment
cerclage, administer tocolytics, monitor mother for infection, vaginal bleeding, and preterm labor
221
cerclage
purse string suture placed in the cervix to reinforce and prevent dilation
222
tocolytics
drugs used to suppresses uterine activity and contractions
223
GDM
gestational diabetes
224
gestational diabetes
metabolic changes during pregnancy lower glucose tolerance so blood glucose levels rise and more insulin is produced
225
how does gestational diabetes effect baby
maternal glucose will cross the placenta but maternal insulin does not. baby tries to compensate by producing its own insulin and when it is born makes too much insulin for glucose amount causes baby to be hypoglycemic and will be a big baby
226
gestational diabetes treatment
self glucose testing, can try to control with diet/exercise, but 40% need to treat with insulin
227
normal fasting glucose levels vs levels after meals for pregnant women
fasting glucose = below 95 mg/dL.
| after meals = 120-135 mg/dL
228
appendicitis and pregnancy
signs are mistaken for pregnancy because during pregnancy the appendix is pushed back
229
how to treat pregnant women who have been through trauma
treat the mother to treat the fetus
230
not accepting pregnancy by third trimester will indicate
conflict in maternal role
231
when does mother/child bond happen
very quickly but especially during the first heart beat
232
dad bounds with baby through
ultrasound and presence of fetus (kicks and movements)
233
fetal heart at 8 weeks
fully formed with all vessels and its beating
234
what age is considered low for pregnancy
19
235
first thing you will do to treat hyperemesis gravidarum
IV fluids
236
why is antiemetics third line treatment for hyperemesis gravidarum
because antiemetics have side effects that will effect the fetus
237
how can hyperemesis gravidarum effect the baby
intrauterin growth restriction - baby undernourished
238
chronic hypertension vs gestational hypertension
chronic - had before 20 weeks
| gestational - got after 20 weeks
239
risk factors of preeclampsia
less than 19 yr old, older than 40, first pregnancy, having preeclampsia before, obesity, and multiple gestations
240
what does corticosteroids do for baby
stimulates surfactant and develops lungs
241
DIC
Disseminated intravascular coagulation. bleed from everywhere because clotting factors all used up from forming little clots
242
indication of magnesium sulfate
HTN, seizes, and preterm labor to stop contractions because it relaxes smooth muscle
243
normal magnesium levels
1.7-2.2
244
what can magnesium sulfate do to fetal heart rate
decrease it
245
therapeutic range of serum magnesium for seizure or HTN patient
4-7 mEq/L
246
why is the blood during placental previa bright red
because it is coming from the maternal side and is oxygenated
247
why is blood during abruptio placentae dark red
it is non oxygenated blood
248
placental previa causes an increase risk for
abruptio placentae
249
common cause of abruptio placentae
drug use or seat belt laceration from car accident
250
when can you test for gestational diabetes
23-24 weeks
251
treatment for appendicitis during pregnancy
ultrasound needed, fluids, and antibiotics. if bad might need a appendectomy
252
treatment of cholelithiasis during pregnancy
fluids, bowel rest, NG tube, and antibiotics
253
effect of trauma on pregnancy influenced by
length of gestation, type and severity of the trauma, degree of disruption to uterine and fetal features
