OB Test 1 Flashcards
What do the words prenatal and antepartum relate to?
pregnancy
intrapartum
child birth
postpartum
first 6 weeks after birth
perinatal
Relating to the period before birth and immediately following
What does women’s health nursing focus on?
the special physical, psychological, and social needs of women throughout their life spans
What does maternity nursing encompass?
care of childbearing women, neonates, and their families through all stages of pregnancy, childbirth, and the first 6 weeks after birth.
What are some factors that affect women’s health?
age race violence human trafficking poverty rape incest
What does Canada and the U.S. rank among industrialized nations in infant mortality rates?
Canada 29th U.S. 31st
What is emphasized in current women’s health practice?
- Evidence-based practice 2. outcomes orientation
What factors improve quality of care?
- risk management 2. learning from sentinel events
What chronic medical conditions contribute to to increasing maternal mortality rates in the U.S.?
heart disease diabetes obesity
What are some of the Healthy People 2020 objectives relating to maternal and infant health?
- Reduce the rate of fetal and infant deaths 2. reduce the rate of maternal mortality 3. reduce preterm births 4. reduce cesarean births among low-risk women
What has helped make the health system more responsive to women’s needs?
Nurses caring for women have been critically important in developing strategies to improve the well-being of women and their infants.
What does the Interprofessional Education Collaborative practice competency domain include?
- values/ethics for inter professional practice 2. roles/responsibilities 3. interprofessional communication 4. teams and teamwork
What does SBAR stand for?
Situation Background Assessment Recommendation
How is the SBAR used to promote communication?
The SBAR utilizes critical thinking skills to: 1. prioritize info 2. relate facts to other facts (remember: review the test before you take a test)
What are the four Serious Reportable Events related to maternity and newborn care?
- maternal death or serious injury associated with labor or birth in a low-risk pregnancy while being cared for in a healthcare setting 2. Death or serious injury of a neonate associated with labor or birth in a low risk pregnancy. 3. Artificial insemination with the wrong donor sperm or wrong egg 4. abduction of a client/resident of any age
What is the most significant barrier to women’s health care access?
the inability to pay
What perinatal events are considered sentinel events?
A perinatal event involving the need to receive 4 or more units of blood and/or admission to the ICU. (ex. Kernicterus is a rare form of brain damage that can occur with jaundice and may require four or more blood transfusions.
What type of ethical concerns have arisen in perinatal care due to increasing use of technology and scientific advances?
- reproductive technology assisting in pregnancies for older woman 2. reproductive services for HIV positive women 3. third party payers assume the cost of services such as induced ovulation and in vitro fertilizations 4. multiple pregnancies and multifetal pregnancies due to in vitro fertilization 5. multifetal pregnancy reduction (selectively terminating one or more fetuses).
menarche
a girl’s first mestruation
menstruation
the periodic uterine bleeding that begins approximately 14 days after ovulation
What are the three cycles of menstruation?
- endometrial 2. hypothalamic-pituitary 3. ovarian
climacteric
a transitional phase during which ovarian function and hormone production decline. (spans the years from onset of perimenopausal ovarian decline to postmenopausal time when symptoms stop)
menopause
refers only to the last menstrual period - can be dated with certainty only 1 year after menstruation ceases.
perimenopause
a period preceding menopause that lasts about 4 years during which ovarian function declines (normal developmental phase during which a woman passes from the reproductive to the non reproductive stage.
What are the four phases of sexual response?
excitement phase plateau phase orgasmic phase resolution phase
What are the top 5 leading causes of death in women in the United states?
- heart disease/cardiovascular disease 2. cancer 3. chronic lower respiratory disease 4. stroke 5. Alzheimer’s disease
What is a health risk associated with adolescent women?
teen pregnancy
What is a health risk associated with young and middle adulthood women?
parenthood after 35 years of age
What is a health risk associated with late adulthood women?
breast disease or ovarian cancer
BMI
Body Mass Index - a measure of an adult’s weight in relation to his or her height
What are the risk factors associated with women’s health?
Substance use and abuse Nutritional problems and eating disorders Eating disorders Lack of exercise Stress Depression, anxiety, mental health Sleep disorders Risky Sexual Practices Environmental and workplace hazards Medical conditions Gynecologic conditions Female genital mutilation Human trafficking Violence against women
What are the 4 C’s of cultural competence?
- Call - what do you call your problem? 2. Cause - What do you think caused your problem? 3. Cope - How do you cope with your condition? 4. Concerns - What are your concerns regarding your condition?
How often should women have their blood cholesterol tested?
Every 5 years beginning at age 45
how often should women get a Papanicolaou (Pap) test?
Between the ages of 21-65: every 3 yrs Between the ages of 30-65: every 5 years (if HPV test is also done) After 65 and 3 negative tests and no risks: women choose to stop screening
How often should women get a mammogram?
every 1-2 years between the ages 40-49 annually after age 40 annually after age 50 biennially ages 50-74
What is the recommended exercise amount per week?
150 moderate per week 75 vigorous per week
What should a nurse do when obtaining a reproductive health history from a woman?
explain the purpose for the questions asked and how the information will be used.
primary amenorrhea
absence of both menarche and secondary sexual characteristics by age 13; absence of menses by age 15 regardless, regardless of the presence of normal growth and development (Myra lecture said 14 and 16)
secondary amenorrhea
a 3-6 month absence of menses after a period of menstruation
dysmenorrhea
pain during or shortly before menstruation in the suprapubic area or lower abdomen
cyclic perimenstrual pain and discomfort (CPPD)
term used to describe women’s symptoms of discomfort during the menstrual cycle
primary dysmenorrhea
a condition associated with the ovulatory cycle; usually appears 6-24 most after menarche; results in ischemia and cyclic lower abdominal cramps.
What is one of the most common gynecologic problems in women?
dysmenorrhea
What are the preferred pharmaceutical therapies used to treat dysmenorrhea?
Primary dysmenorrhea: NSAIDs (prostaglandin synthesis inhibitors) - examples include Diclofenac, ibuprofen, ketoprofen, naproxen. Less severe primary dysmenorrhea: oral contraceptives (OCPs)
what are some common causes of amenorrhea?
- PREGNANCY (most common) - low body weight - common in athletes due to delay or hormonal imbalance - type 1 diabetes - drug abuse - OCP use - endocrine dysfunction
secondary dysmenorrhea
menstrual pain that develops later in life than with primary dysmenorrhea (typically after the age of 25); associated with pelvic pathology such as adenomyosis, endometriosis, pelvic inflammatory disease, endometrial polyps or sub mucous or fibroids)
Premenstrual syndrome (PMS)
Physical and psychological symptoms beginning in the luteal phase of the menstrual cycle and end with the onset of menses.
premenstrual dysphoric disorder (PMDD)
a more severe variant of PMS in which women have marked irritability, dysphoria, mood lability, anxiety fatigue, appetite changes, and a sense of feeling overwhelmed.
What pharmaceutical therapies are used to treat PMS and PMDD?
NSAIDs OCPs SSRIs (Prozac, Zoloft, Celexa, Lexapro, Paxil CR)
Endometriosis
the presence and growth of endometrial tissue outside of the uterus.
What are the signs and symptoms of endometriosis?
Major symptoms: secondary dysmenorrhea, deep pelvic dyspareunia (painful intercourse), abnormal bleeding, infertility. Additional symptoms: chronic pelvic pain, pelvic heaviness, or pain radiating into the thighs; bowel symptoms such as diarrhea, pain with defecation, and constipation; pain during exercise.
What is the overall incidences of endometriosis in reproductive-age women, infertile women, and women with chronic pelvic pain?
Reproductive-age: 5-15% Infertile: 30-45% chronic pelvic pain: 33%
What non-pharmaceutical measures are used to treat dysmenorrhea?
- application of heat - aerobic exercise - relaxation training - dietary changes (decreased intake of salt and refined sugar 7-10 days before expected menses - natural diuretics
oligomenorrhea
decreased menstruation, either in amount, duration, or both. (infrequent menstruation)
hypomenorrhea
light menstruation
metrorrhagia
intermenstrual bleeding; any episode of bleeding, whether spotting, menses, or hemorrhage, that occurs at a time other than the normal menses.
menorrhagia
(hypermenorrhea) excessive menstrual bleeding, in either duration or amount
abnormal uterine bleeding (AUB)
any form of uterine bleeding that is irregular in amount, duration , or timing and is not related to regular menstrual bleeding.
What symptoms do perimenopausal women seek care for?
- bleeding - changes in menstruation 2. genital changes - vaginal dryness, painful intercoarse, frequent urination, incontinence 3. vasomotor instability - hotflashes, flushing, night sweats 4. fatigue 5. changes related to sexuality
osteoporosis
a progressive loss of bone mass that results from decreasing levels of estrogen after menopause
What are the major health risks of perimenopausal women?
osteoporosis coronary heart disease (due to changes in lipid metabolism)
what are the two types of menopausal hormonal therapy (MHT)
- estrogen therapy (ET) - a woman takes only estrogen 2. HT - a woman takes both estrogen and progestins
What are the risks associated with the long-term use of estrogen-progesterone therapy? What usage of ET is suggested to reduce this risk?
stroke, venous thromboembolism, coronary heart disease, and dementia. The North American Menopause Society (NAMS) supports the use of ET before the age of 60 years and within 10 years after menopause at the LOWEST EFFECTIVE DOSE FOR THE SHORTEST POSSIBLE TIME.
What factors in addition to menopause, increase your risk of osteoporosis?
- obesity - smoking - inadequate calcium intake - disruption of calcium intake (excessive caffeine, alcohol, soft drink consumption) - steroid therapy - disorders such as hypogonadism, hyperthyroidism, and diabetes mellitus
What are alternative therapies used to relieve discomforts associated with menopause?
- homeopathic remedies - acupuncture - herbal therapies - self-management
What are some herbal therapies used to treat symptoms of menopause?
- ginseng (hot flashes) - oriental teas composed of licorice, ginseng, coatis, red raspberry leaf, and chinese rhubarb (hot flashes) - plant foods containing phytoestrogen (isoflavones) such as red clover, wild yams, dandelion greens, cherries, alfalfa sprouts, black and soy beans - Vit E
What are some self-management suggestions to treat symptoms of menopause?
- layered clothing - ice packs - ice water - fans - avoid caffeine, alcohol, or tobacco in the evening - avoid liquids after dinner - kegel exercises - practice yoga, relaxation exercises
genetics
the study of a particular gene
genomics
the study of all the gens in the entire genome
genome
the entire set of genetic instructions found in a cell
genomic medicine
an emerging discipline that involves using genomic information about an individual as part of their clinical care and the health outcomes and political implications of the clinical use.
precision medicine
an emerging approach to preventing and treating illnesses that includes individual variations in genes, environment, and lifestyle
What percentage are human beings identical at the DNA level?
99.9%
What is the human genome project?
a publicly funded international effort coordinated by the NHGRI at the National Institute of Health to map the human genome (the complete set of genetic instructions in the nucleus of each human cell). (Initiated in 1990 with the goal to have a map by 2005 - completed a map in 2003)
What is the key finding from the Human Genome Project?
all human beings are 99.9% identical at a DNA level.
carrier screening
a form of prenatal genetic testing that is used to identify people who carry one copy of a gene mutation that, when present in tow copies, causes a genetic disorder
maternal serum screening
a blood test used to see if a pregnant woman is at increased risk for carrying a fetus with a neural tube defect or a chromosomal abnormality such as DS, Trisomy 13, or trisomy 18
fetal ultrasound/sonogram
an imaging technique using high-frequency sound waves to produce images of the fetus inside the uterus
What are more invasive prenatal tests?
chorionic villus sampling amniocentesis
What are the three main ways that people acquire gene mutations that can lead to cancer?
environmental factors by chance inherited
What is autosomal recessive inheritance?
genetic inheritance of a disorder in which both genes of a pair associated with the disorder must be abnormal for the disorder to be expressed.
If parents have a child with cystic fibrosis, what are the chances that other siblings may have it?
25% chance (1 in 4 chance)
If both parents are a carrier for traits such as sickle cell and cystic fibrosis, and they have a child with the disease, what would be the best test for them to utilize?
recurrence risk
What is a major barrier to genetic testing?
department referrals
Which cancer is being studied as a genetic disorder?
colorectal cancer
What is the occurrence and recurrence risk in an autosomal dominant disorder that subsequent offspring will be affected when one parent is affected and the other is not?
50%
What is the recurrence risk for autosomal recessive disorders if both parents are carriers?
25%
What is the most effective contraceptive method?
long-acting, reversible contraceptive (LARC) methods (ex. IUD)
What is the only contraceptive practices acceptable by the Roman Catholic church?
Fertility awareness-based (FAB/FAM) methods
What are the three phases of the menstrual cycle?
- infertile phase - before ovulation 2. fertile phase - approx. 5-7 days around the middle of the cycle, including several days before and during ovulation and the day afterward 3. infertile phase: after ovulation
The human ovum can be fertilized no later than how long after ovulation?
12-24 hours
What is the FAM method of contraception?
fertility awareness-based method - tracking when a woman is fertile and abstaining during that time.
What are the different techniques used to identify fertile days?
- Calendar-based methods: calendar rhythm method and standard days method. 2. symptoms-based methods: two-day method, cervical mucus ovulations detection method, and basal body temperature method
What term describes the conscious decision concerning when to conceive or avoid pregnancy vs intentional prevention?
family planning
A woman will be taking oral contraceptives using a 28-day pack. What advice should the nurse provide to protect this client from an unintended pregnancy? a. Limit sexual contact for one cycle after starting the pill. b. Use condoms and foam instead of the pill for as long as the client takes an antibiotic. c. Take one pill at the same time every day. d. Throw away the pack and use a backup method if two pills are missed during week 1 of her cycle.
c. take one pill at the same time everyday
What may happen if taking OCPs with other medications such as anti seizure?
the other medications may reduce the effectiveness of the OCP
A woman has just undergone a first trimester abortion and is starting birth control pills, what should she be advised of?
to use a back-up method for the first week
Which client would be an ideal candidate for injectable progestins such as Depo-Provera (DMPA) as a contraceptive choice? a. The ideal candidate for DMPA wants menstrual regularity and predictability. b. The client has a history of thrombotic problems or breast cancer. c. The ideal candidate has difficulty remembering to take oral contraceptives daily. d. The client is homeless or mobile and rarely receives health care.
c. one who had difficulty remembering to take oral contraceptives daily.
Which statement regarding emergency contraception is correct? a. Emergency contraception requires that the first dose be taken within 72 hours of unprotected intercourse. b. Emergency contraception may be taken right after ovulation. c. Emergency contraception has an effectiveness rate in preventing pregnancy of approximately 50%. d. Emergency contraception is commonly associated with the side effect of menorrhagia.
a. to be most effective it should be taken within 72 hours (can be taken up to 120 hours but efficacy goes down)
An unmarried young woman describes her sex life as “active” and involving “many” partners. She wants a contraceptive method that is reliable and does not interfere with sex. She requests an intrauterine device (IUD). Which information is most important for the nurse to share? a. “The IUD does not interfere with sex.” b. “The risk of pelvic inflammatory disease will be higher with the IUD.” c. “The IUD will protect you from sexually transmitted infections.” d. “Pregnancy rates are high with the IUD.”
ANS: B Disadvantages of IUDs include an increased risk of pelvic inflammatory disease (PID) in the first 20 days after insertion, as well as the risks of bacterial vaginosis and uterine perforation. The IUD offers no protection against sexually transmitted infections (STIs) or the human immunodeficiency virus (HIV), as does a barrier method. Because this woman has multiple sex partners, she is at higher risk of developing an STI. Stating that an IUD does not interfere with sex may be correct; however, it is not the most appropriate response. The typical failure rate of the IUD is approximately 1%.
what are the danger signs of toxic shock syndrome?
sudden onset of fever over 38.4 degrees C, hypotension, and a rash
How long after intercourse should a diaphragm be removed
6-8 hours but no longer or could cause TSS
Which nonpharmacologic contraceptive method has a failure rate of less than 25%? a. Standard days’ variation b. Periodic abstinence c. Postovulation d. Coitus interruptus
ANS: A The standard days’ variation on the calendar method has a failure rate of 12% and is a variation of the calendar rhythm method with a fixed number of days for fertility in each cycle. The periodic abstinence method has a failure rate of 25% or higher. The postovulation method has a failure rate of 25% or higher. The coitus interruptus method has a failure rate of 27% or higher.
How long does DMPA (deport-provera) last?
DMPA should be administered every 11-13 weeks
What does BRAIDED stand for in regards to informed consent?
Benefits Risks Alternative Inquiries Decisions Explanations Documentation
induced abortion
purposeful interruption of a pregnancy before 20 weeks of gestation
elective abortion
abortion performed at the woman’s request
therapeutic abortion
an abortion performed for reasons of maternal or fetal health or disease
What are signs of potential complications related to IUDs?
P - period late, abnormal spotting or bleeding A - abdominal pain, pain with intercourse I - infection exposure, abnormal vaginal discharge N - not feeling well, fever or chills S - string missing, shorter or longer
What are options for abortions in the first trimester?
aspiration (most common) can be done in the first 8-12 weeks medical abortion can be done up to 9 weeks after last menstrual period (methotrexate and misopostol or mifepristone and misoprostol)
What abortion option is used in the second trimester?
Dilation and evacuation - can be performed at any point up until 20 weeks of gestation.
infertility
a prolonged time to conceive; the inability to conceive and carry a child to term gestation.
sterility
the inability to conceive
About what percentage of of otherwise healthy adults does infertility affect?
15-18%
infertility increases for a woman after what age?
35-40yrs
About what percentage of infertility cases are unexplained?
20%
Of the 80% of infertility cases in which the cause is known about what percentage is female causes and what percentage is male causes?
40% female 40% male 20% both
What are common etiologic factors of infertility?
decreased sperm production ovulation disorders tubal occlusion endometriosis (obesity and smoking)
what is the main factor affecting low sperm count?
substance abuse, especially tobacco
What fertility data is collected when evaluating a woman?
evaluation of the cervix, uterus, tubes, and peritoneum; detection of ovulation; assessment of immunologic compatibility; and evaluation of psychogenic factors.
What fertility data is collected when evaluating a man?
evaluation of general health, pets, meatus, testes, scrotum, prostate, hair distribution, and breast development.
How is the investigation of infertility conducted?
systematically and simultaneously for male and female partners.
What must be considered in the infertility plan of care?
the couple’s relationship dynamics, sexuality, and ability to cope with the psychologic and emotional effects of diagnostic procedures and treatment of infertility.
What is the care priority for couples seeking fertility treatment?
psychologic support
What lifestyle changes can increase fertility?
diet changes, weight loss
intrauterine insemination (IUI)
prepared sperm is placed in uterus at ovulation
in vitro fertilization (IVF-ET)
eggs are collected from the ovaries, fertilized in the lab with sperm, and transferred to her uterus after normal embryo development has occurred
gamete intrafallopian transfer (GIFT)
oocytes (eggs) are retrieved from the ovary, placed in a catheter with sperm, and immediately transferred into the fimbriated end of the uterine tube; fertilization occurs in the uterine tube.
what is Metrodin?
a gonadotropin used to stimulate follicular development and the induction of ovulation in patients with polycystic ovary syndrome, and infertility, who have failed to respond or conceive following adequate clomiphene citrate therapy. Metrodin and hCG may also be used to stimulate the development of multiple follicles in ovulatory patients undergoing Assisted Reproductive Technologies (ART) such as in vitro fertilization.
how is Metrodin administered?
by injection
zygote intrafallopian transfer (ZIFT)
similar to IVF-ET; after in vitro fertilization the ova are placed in one uterine tube during the zygote stage.
A nurse is providing instruction to a couple undergoing zygote intrafallopian transfer (ZIFT). The nurse is aware that instruction has been effective when the woman states: a.“My egg will be fertilized and then placed into my uterus.” b.“My husband’s sperm will be inserted into my uterus.” c.“My husband’s sperm and my egg will be placed into my fallopian tube.” d.“A fertilized egg will be placed into my fallopian tube.”
answer D: A Incorrect: This procedure is known as in vitro fertilization (IVF). B Incorrect: This procedure is known as artificial insemination (AI). C Incorrect: This is the description for the procedure known as gamete intrafallopian transfer (GIFT). D Correct: A fertilized egg that is placed into the fallopian tube is known as ZIFT.
how long does human gestation last?
approx 280 days after the last menstural period or 266 days after conception
fertilization occurs in the uterine tube within how many hours of ovulation?
24 hours
What happens during fertilization?
the zygote undergoes mitotic divisions, creating a 16-cell morula
how long after fertilization does implantation begin?
6 days after
what are the three stages of intrauterine development?
- ovum or pre-embryonic (conception - day 14) 2. embryo (day 15 until approx 8 weeks) 3. fetus (9-40 weeks)
What do all tissues and organs of the embryo develop from? When does the embryonic disk differentiate into them?
the three primary germ layers differentiates during the third week after conception (embryonic phase)
What are the three primary germ layers and what do they develop into?
- upper layer (ectoderm): epidermis, glands, nails and hair, central and peripheral nervous systems, lens of the eye, tooth enamel and the floor of the amniotic cavity 2. middle layer (mesoderm): bones and teeth, muscles, dermis and connective tissue, cardiovascular system and spleen and the urogenital system 3. lower layer (endoderm): the epithelium lining the respiratory and digestive tracts, and the glandular cells of associated organs, including the oropharynx, liver and pancreas, the urethra, bladder, and vagina.
What is the most critical stage of development in the development of the organ systems and the main external features
the embryonic stage
What is the function of amniotic fluid?
- maintains fetal body temperature - source of oral fluid and a repository for waste - assists in maintenance of fluid and electrolyte homeostasis - allows fetal movement for bone growth - protection of the fetus
What is oligohydramnios and what are the risks associated with it?
having less than 300 mL of amniotic fluid; fetal renal abnormalities
What is the function of the placenta?
the metabolic functions of the placenta are respiration, nutrition, excretion, and storage; This structure provides oxygen and nutrients to your growing baby and removes waste products from your baby’s blood.
What is the placenta rich in?
blood and nutrients
During what stage of development and between what gestational weeks do heart defects (TA, ASD, VSD) occur?
During the embryonic stage between weeks 3-6
During what stage of development and between what gestational weeks do neural defects (neural tube defects NTDs and mental retardation) occur?
During the embryonic and the fetal stage between weeks 3-32
During what stage of development and between what gestational weeks do limb defects (amelia/moromelia) occur?
During the embryonic stage between weeks 4-6
During what stage of development and between what gestational weeks do lip defects (cleft lip) occur?
During the embryonic stage between weeks 5-7
During what stage of development and between what gestational weeks do ear defects (low-set malformed ears and deafness) occur?
During the embryonic and fetal stages between weeks 4-9 (mostly embryonic)
During what stage of development and between what gestational weeks do eye defects (microphthalmia, cataracts, glaucoma) occur?
During the embryonic stage between weeks 4-8
During what stage of development and between what gestational weeks do teeth defects (enamel hypoplasia and staining) occur?
During the embryonic stage between weeks 6-8
During what stage of development and between what gestational weeks do palate defects (cleft palate) occur?
During the embryonic and fetal stages between weeks 6-9 (mostly embryonic)
During what stage of development and between what gestational weeks do genital defects (masculinization of female genitalia) occur?
During the embryonic and fetal stages between weeks 7-apprx 11
How long does it take the ovum to implant into the uterine wall?
6-10 days
When can hCG (human growth hormone) be detected in the maternal serum?
by 8-10 days after conception
What is stored in the placenta to meet the fetal needs?
carbohydrates, proteins, calcium, and iron
what happens if a woman lies on her back during pregnancy?
the pressure of the uterus compresses the vena cava and blood return to the right atrium is diminished.
What is the most critical time in the development of the organ systems and main external features during gestation?
the embryonic stage; approx the first 2-8 weeks
What happens during the fetal stage of pregnancy?
refinement of structure and function; the fetus becomes recognizable as a human being.
Viability
the capability of the fetus to survive outside the uterus; usually defined by fetal weight and pregnancy duration.
What is the standard definition of viability for a fetus?
20 weeks gestation and birth weight of 350-500g (varies by state); With modern technology and advancements in maternal and neonatal care, infants who are 22-25 weeks of gestation are on the threshold of viability.
When does the heart of an embryo begin to beat?
by the end of the third week
what does the embryo look like at 4 weeks of gestation?
body flexed, c-shaped; arm and leg buds present; head at right angles to body
What does the embryo look like at 8 weeks of gestation?
body fairly well formed; nose flat, eyes far apart; digits well formed; head elevating; tail almost disappeared; eyes, ears, and moth recognizable.
What does the fetus look like at 12 weeks of gestation?
nails appearing; resembles a human; head erect but disproportionately large; skin pink, delicate.
What does the fetus look like at 16 weeks of gestation?
head still dominant; face looks human; eyes, ears, an nose approach typical appearance on gross examination; arm/leg ration proportionate; scalp hair appears
What does the fetus look like at 20 weeks of gestation?
vernix caseosa appears; lanugo appears; legs lengthen considerable; sebaceous glands appear.
What does the fetus look like at 24 weeks of gestation?
Body lean but fairly well proportional; skin red and wrinkled; vernix cases present; sweat glands forming
What does the fetus look like at 28 weeks of gestation?
lean body, less wrinkled and red; nails appear
What does the fetus look like at 30-31 weeks of gestation?
subcutaneous fat beginning to collect; more rounded appearance; skin pink and smooth; has assumed birth position
What does the fetus look like at 36-40 weeks of gestation?
36 weeks: skin pink,, body rounded; general lanugo disappearing; body usually plump 40 weeks: skin sooth and pink; scant vernix caseosa; moderate to profuse hair; lanugo on shoulder and upper body only; nasal and alar cartilage apparant
meconium
fetal waste products; dark green to black and tarry; normally passed within 24 hours of birth
When is the embryo and fetus vulnerable to environmental teratogens?
When both cell number and size are increasing; The first 3 months of pregnancy are recognized as the most critical period for embryonic and fetal development. within that period of time, teratogens have the greatest effect during the embryonic period from days 15-60. Brain growth and development continue during the fetal period, and teratogens can severely affect CNS development throughout gestation.
vernix caseosa
a white, cheesy material that protects fetal skin; formed by the superficial layer of the epidermis sloughing and becoming tied with the sebaceous glands secretions.
how does the vernix caseosa protect the fetus?
Because of its lipid content, vernix is hydrophobic and protects the skin from excessive water exposure during the development of the stratum corneum. The vernix caseosa has various functions during fetal transition from an intrauterine to an extrauterine environment, including lubrication of the birth canal during parturition, barrier function to prevent water loss, temperature regulation, for innate immunity and for intestinal development.
teratogens
environmental factors that can produce abnormalities in the embryo or fetus.
What effect do teratogens have during the first 2 weeks of development?
they either have no effect or have effects so severe that they cause miscarriage.
dizygotic twins
When multiple mature ova are produced in one ovarian cycle and fertilized by separate sperm (fraternal twins)
monozygotic twins
develop from one fertilized ovum, which then divides (identical twins)
Gravida
woman who is pregnant
gravidity
pregnancy
multigravida
woman who has had two or more pregnancies
multipara
woman who has completed two or more pregnancies to stage of fetal viability
nulligravida
woman who has never been pregnant
parity
number of pregnancies in which fetus or fetuses have reached the 20 weeks gestation
multipara
a woman who has completed two or more pregnancies to 20 weeks of gestation or more
What is the meaning of the 5 digit term used in hospitals?
G (gravida), T (term births), P (preterm births), A (abortions), L (living children)
What is considered a full term pregnancy?
a pregnancy that has reached between 39 weeks and 0 days and 40 weeks 6 days of gestation
why is colostrum good for the baby?
It’s highly concentrated, full of protein and nutrient-dense
How does a woman’s blood volume and composition change during pregnancy?
it increases significantly during pregnancy by approximately 30-45%
How does a woman’s cardiac output increase during pregnancy?
it increases 30-50% over the standard baseline by the 32nd week of pregnancy then goes down to 20% by 40 weeks
melasma
(chloasma or make of pregnancy) a blotchy , brownish hyper pigmentation of the skin over the cheeks, nose, and forehead, especially in pregnant women with dark complexions.
gestation
duration of pregnancy
What is considered a full gestational period?
40 weeks/280 days 9 calendar months/10 lunar months
What weeks make up the first trimester?
weeks 1-13
What weeks make up the second trimester?
weeks 14-26
What weeks make up the third trimester?
weeks 27-40
What does EDB stand for?
estimated date of birth
How do you use Naegele’s Rule to calculate EDB?
After determining the first day of the last menstrual period, subtract 3 calendar months and then add 7 days. (assumes that the woman has a 28-day cycle and that fertilization occurs on the 14th day)
What are some ways in which women prepare for childbirth?
reading books and info on various websites, watching videos, attending parenting classes, talking with other women
What are some things that cause anxiety for pregnant women?
impending labor, pain, safe delivery of baby
What causes physical discomforts toward the end of the third trimester?
breathing difficulty, sleep disturbances due to fetal movements, backaches, fatigue on exertion, frequency and urgency of urination, constipation, varicose veins, impatience for labor to start
couvade syndrome
the condition in which the partner experiences some of the same symptoms and behavior as the expecting mother such as: nausea and vomiting, weight gain, hormone imbalances, sleep disturbances
What are the three phases characterizing the developmental tasks experienced by expectant fathers?
- Announcement phase: accepting the biologic fact of the pregnancy/reaction to the pregnancy 2. Moratorium phase: accepting the reality of the pregnancy/becoming more introspective 3. Focusing phase: negotiating with his partner the role he is to play in labor and in preparing for parenthood/begins to think of himself as a father
How can nurses facilitate the establishment of a relationship of the partner with the fetus?
asking question such as how they expect the baby to look and act, how they envision life as a parent, how they will be involved, how will a baby affect their relationship with their partner.
What types of topics should be discussed in the prenatal interview?
- reason for seeking care - current pregnancy - childbearing and female reproductive history - health history - nutritional history - history of drug and herbal use - family history - social/occupational history
What BMI is related to an underweight woman and how much weight should she gain during pregnancy?
BMI < 18.5 should gain 28-40lbs
What BMI is related to a normal weight woman and how much weight should she gain during pregnancy?
BMI 18.5-24.9 should gain 25-35lbs
What BMI is related to an overweight woman and how much weight should she gain during pregnancy?
BMI 25-29.9 should gain 15-25lbs
What BMI is related to an obese woman and how much weight should she gain during pregnancy?
BMI >30 should gain 11-20lbs
What is the pattern of healthy weight gain during pregnancy?
1st trimester 2.2-4.4lbs, then 1.1.b/wk
in relation to weight gain, what are teens at an increased risk for?
decreased weight gain and low birth weight
What vitamins and minerals are important during pregnancy?
FOLIC ACID 400-800mcg/day B6 1.9mg/day Iron Calcium 1000mg/day Magnesium 400mg/day B12 2.6mcg
