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NSG 122 > Sexuality and Reproduction > Flashcards

Sexuality and Reproduction Flashcards

1
Q

pre-embryonic

A

fertilization-2nd week-implantation occurs 6-10 days after conception-zygote

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2
Q

embryonic

A

2-8th week MOST CRITICAL time for development (teratogens) most women do not know they are pregnant yet, umbilical cord (AVA) day 14. placenta day 17-embryo

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3
Q

fetal

A

end of 8th wee-birth-fetus

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4
Q

gastrula

A

2nd layer and 3rd layer structure which results from indentation (gastrulation) of one side of the blastula

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5
Q

endoderm

A

inner layer-resp. system, liver, pancreas, digestive system

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6
Q

mesoderm

A

middle layer, skeletal, urinary, circulatory, and reproductive organs

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7
Q

ectoderm

A

outer layer-CNS, sensory organs, skins and glands

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8
Q

amniotic sac

A

• Embryonic membranes form around the time of implantation forming sac- upper uterus
• About 1 liter at full term (37-40 wks)
• 2 sources- fetal urine, fluids from mom’s blood-plasma
• Volume changes constantly as fetus voids and swallows
Maintains a constant body temperature, cushions fetus, allows cord to be free from compression, promotes movement

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9
Q

amniotic fluid

A

• Less 500cc at term- oligohydramnios (too low amniotic fluid)- associated with uteroplacental insufficiency and fetal renal problems
Greater than 2000cc polyhydramnios (too much amniotic fluid)- associated with maternal diabetes, chromosomal deviations and malformations of CNS/GI- may lead to premature rupture of membranes due to overdistension of the uterus

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10
Q

umbilical cord

A

• Fetal lifeline
• AVA- 1 larger vein, 2 smaller arteries
• Wharton’s jelly ( connective tissue) surrounds to prevent compression
• Max length at 30 wks- determine by genetics, intrauterine space, fetal activity
Average length 22 inches long 1 inch wide

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11
Q

placenta

A

• Blastocyst cells make human chorionic gonadotropin(hCG) hormone three days after conception to make sure endometrial lining will be receptive to implantation
• Protects fetus from immune attack from mom
• Removes fetal waste products
• Induces mom to increase blood supply to placenta
• Produces hormones to prepare fetal organs
• Function depends on maternal blood pressure supplying circulation- interference with blood flow to placenta is threatening to fetus
• At no time during pregnancy does maternal blood mix with fetal blood
• Placenta barrier
• Materials exchange through diffusion
• Maternal arteries bring in glucose and o2 veins carry wastes away
• Structure complete by week 12
Produces hormones- hCG- preserves corpus luteum & its progesterone production so uterine lining is maintained- basis for pregnancy tests

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12
Q

Hegar’s sign

A

Isthmus of uterus softens

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13
Q

Goodell’s sign

A

cervix softens

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14
Q

Chadwick’s sign

A

vagina increases in vascularity -bluish increase circulation

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15
Q

CA system

A

• related to cardiac enlargement
• vasodilation
• increase blood volume- hemodilution
• increase cardiac output 30-50%
• Physologic anemia- not true anemia will revert after birth
• Heart gets bigger
Plasma increases- everything else gets more dilute

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16
Q

variations in lab results**

A

• Hemoglobin stays about the same 12-16g/dl
• Hemacrit- 37% decreases- hemodilution- increase on 1500 cc over 1000 cc is plasma
RBC- 5.7 million increase of 17%

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17
Q

resp. system

A

• Thoracic cage is pushed upward and the diaphragm is elevated as uterus enlarges
• Oxygen consumption increases to support fetus
Lower thoracic cage widens to increase tidal volume

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18
Q

elimination system

A 
N/V-increased levels of Hcg,
fatigue.changes in CHO metabolism
nursing care
	• Avoid offending odors
	• Eat dry CHO(crackers) upon wakening
	• Eat 5-6- small meals per day
	• Avoid spicy, gas forming foods
Drink carbonated beverages
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19
Q

skin changes

A 
• Increased pigmentation -r/t increased production of melanotropin
	• Face- chloasma
	• Breasts- areola darkens
	• Abdomen- linea nigra
	• Spider nevi on face and upper trunk
Striae gravidarum- stretch marks
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20
Q

urinary system

A 
Renal changes
Related to:
	• Kidneys enlarged in size and weight due to increased filtration needs
	• Enlarges uterus presses on kidneys and ureters reducing effective flow
	• Ureters dilate
	• Urinary stasis occurs
Urinary frequency and urgency
Related to: pressure of uterus on bladder first and last trimester
Nursing care:
	• Kegel's exercises
	• Limit fluid intake before bedtime
Report dysuria or burning
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21
Q

avoid live vaccines

A

MMR and varicella

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22
Q

nutrition and weight gain

A

• Total weight gain 25-35 pounds recommended
• Overweight 15-25
• Underweight 35-45
• Low birth weight correlates with birth defects
• First trimester 12/13 wks - 2-4 pounds
• Second and third trimester 13 wks-birth- 1 pound a week
• Weight gain pattern significant
Fundal height- top of uterus at umbilicus at 20wks

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23
Q

disadvantages of home preg. test

A

• Must be able to follow directions as described or can lead to improper results
• False positives results- anticonvulsants( seizure meds ), aspirin, tranquilizers, marijuana
False negative results- diuretics, promethazine

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24
Q

health hx nurse needs from patient

A

• Obstetrics history- current and past pregnancies
• Menstrual history
• Family history- genetic and environmental factors that affect health
Medical history

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25
Q

gravida and parity**

A

• Gravida- number of times pregnant- regardless of duration or outcome

Parity- number of deliveries after the age of viability (20 weeks)

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26
Q

calculations of gravida and parity**

A 
T= term
P= preterm- less than 37 weeks 20-36 weeks
A= abortions- elective or miscarriage- before 20 weeks
L= Living children
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27
Q

Nagele’s rule **

A

• First day of last menstrual
• Go back 3 months
Add 7 days

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28
Q

Example- Mrs. Andrew tells you her last menstrual period began on July 18?

A

April 25 – knuckle rule for # of days in the month

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29
Q

Mcdonald’s rule**

A

• Use fundal height measurement, measure from the symphysis to top of the fundus
• Months= measure cm times 2 divide by 7
• Weeks= measure cm times 8 divide by 7
• Mrs. Andrews fundal height is 7cm. How far along is she?
• months7x2/7=2
Weeks 7x8/7=8

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30
Q

danger signals

A 
• Vaginal bleeding
	• Fluid from vagina
	• Abdominal pain
	• Increased temperature
	• Dizziness, blurred vision or double vision
	• Persistent vomiting
	• Edema
	• Headache
	• Dysuria
Absence of movement of the baby
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31
Q

first trimester

A

major feelings

-Disbelief/ uncertainty- much time is devoted to the attempt to determine for sure whether she is pregnant

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32
Q

second trimester

A

• Woman feels well and good about herself
• Concerned with producing a healthy baby
• Self-centered and introverted
• Visualizes the infant as a separate being
• Views body image changes as positive sign that the baby is doing ok
Babymoon

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33
Q

third trimester

A

Ways in which the health care workers can assist the woman to adjust
• Assure her of the baby’s well- being
• Be a good listener
• Nurture her
• Provide with information about childbirth classes
Assist her with the contacting appropriate agencies that may assist in caring for the infant after birth

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34
Q

factors that affect psychosocial adaptations

A 
• Age
	• Multiparity
	• Social support
	• Absence of a partner
	• Socioeconomic status
Abnormal situations
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35
Q

Nurses role is to provide information about the tests

A

NEVER TALK ABOUT THE TEST RESULTS

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36
Q

admission to labor and delivery

A 
• Vital signs
	• Physical exam with a vaginal exam
	• Contraction pattern
	• Membrane status
	• Fetal status
	• Psychosocial assessment, cultural assessment
Preparation of labor and delivery
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37
Q

assessment of contractions

A

• Palpation
• Electronic monitoring
Vaginal examination

38
Q

vaginal examination

A 
• Presentation
	• Position
	• Condition of membranes
	• Dilation- enlargement and widening of os (CM)
	• Effacement- thinning of the cervix %
	• Station
Engagement
39
Q

Fetal oxygenation- main assessments related to fetal well-being are:

A

• Fetal heart rate
• Contractions
• Characteristics of amniotic fluid
Maternal vital signs

40
Q

passenger-baby

A
  • Fetal head- cephalic
    • Bones
    • Sutures
    • Fontanelles- anterior- diamond shaped, posterior- triangular shaped smaller
    • Presentation- occiput- head down, breech- butt down
    • Position-loa, lop ,roa, rop- angle in the womb
    • Molding- fetal head changes shape
    • Flexion- normal attitude- chin tucked
    • Fetal lie- longitudinal
    • Version- Dr. physically moves fetus around in womb in hopes of baby getting into correct position. Can be dangerous because of umbilical cord
41
Q

passageway-bony pelvis

A

• Station- level of ishial spines -1-2-3 above spines, +1+2+3 below spines
- moving forward, moving out
Engagement- 0 station at the level of ishial spines

42
Q

powers-how hard she is pushing

A

• Primary powers- uterine contractions- frequency- how often? Beginning to beginning
• Duration low long does the contraction last? beginning to end
• Intensity- strength or quality by palpation
mild-nose,
moderate- chin,
strong - forehead
• Secondary powers- mother’s voluntary pushing efforts
• Ripening- softening
• Dilation- open
Effacement- shorten and thin

43
Q

psyche- emotional state

A

All components must interrelate for a successful vaginal birth or c/s

44
Q

stage 1-long stage

A

• Bladder acts as soft tissue obstruction. Keep bladder empty.. Foley
• Spiral arteries- open and closing increasing and decreasing cbv
• Scant pinkish discharge, bloody show
• Mother surge of energy
Best time to do teaching- anxiety low

45
Q

stage 1-latent

A

sociable, contractions every 10-30 mins progressing to every 5-7 for 30-40 seconds, dilate 0-3 cm

46
Q

stage 1-active

A

serious.. Best time for med- every 2-5 mins for 40 secs- 60 moderate to strong- dilate 4-7 cm

47
Q

stage 1-transition

A

irritable- pukes- every 1.5 -2 mins 60-90 sec strong, Stage of dilation 7-10 cm urge to push

48
Q

stage 2-pushing stage

A

• 10 cm dilated, 100% effaced
• Expulsion of baby- can be up to 3 hours
Signs and symptoms- increase in bloody show, sudden sweat on upper lips, an episode of vomiting, shaking extremities, increased restlessness, pressure on rectum; involuntary bearing down, bulging of perineum

49
Q

stage 3-delivery of placenta

A

5-10 mins after baby
• Cord lengthening
• Retained placenta
• Initiate contact with baby may allow to breast feed.

50
Q

stage 4-recovery stage

A

2 hours in L&D-uterine tones and vtials

51
Q

cord circulation

A
  • cord circulation is opposite of mom’s
    • Red (vein) from placenta to baby has O2 (big cord in the umbilical cord)

blue (Arteries) waste Away from baby to placenta

52
Q

plancent-schultz mechanism

A

shiny(fetal) side -covered in membrane

53
Q

duncan mechanism

A

rough (maternal) side-like pulling off velcro

54
Q

spiral arteries

A
  • Placental circulation (between contractions)

* O2, nutrients, and waste b/c mother/baby occurs in intervillious («i></i>

55
Q

nursing intervention- left side positioning

A

(vena cava syndrome) -when mom is distressed nursing intervention**need blood flow back up to heart b/c baby is blocking it when mom is on back

56
Q

fetal monitor readings

A

○ Measure peak to peak
Early- head compression
Variable-cord compression
Late- uteroplacental insufficiency

57
Q

early deceleration

A 
-head compression increase ^ICP-> vagus nerve slows heart rate 
		○ Occur with contractions 
		○ Not associated with fetal compromise
		○ Consistent, uniform, subtle 
		○ Mirror the contraction 
Intervention=none
58
Q

VEAL CHOP

A

Variable
Early decels
Acelerations
Late decel

Cord compression
Head compression
Ok
Placenta pooped

59
Q

variable decelerations

A

○ Etiology- cord compression
○ No uniform appearance
○ Appear sharp in decent
○ May see shoulders
○ Rise and fall abruptly decrease flow through cord
***Intervention -reposition (left side pref.)

60
Q

late decelerations

A

○ Etiology- uteroplacental insufficiency
○ Non-reassuring pattern of delayed decelerations
○ Fetus has reduced reserve to tolerate decreased O2
○ Shifted to the right
○ Begin at peak and return to baseline after contraction ends
***Interventions -prepare patient for C/S this is bad

61
Q

uterine atony

A

uterus fails to contract after childbirth; can lead to postpartum hemorrhage

62
Q

pain in labor stage 1

A

§ Stretching of cervix during dilation & effacement
§ Uterine anoxia (no O2 in cells)
Stretching of the uterine ligaments

63
Q

pain in labor stage 2

A

§ Distension of the vagina and perineum
§ Compression of the nerve ganglia in cervix & lower uterus
§ Pressure on urethra, bladder, rectum during fetal descent
Traction on and stretching of the perineum (can tear)

64
Q

pain relief during labor

A

• Criteria for administering an analgesic :
Needs to be in ACTIVE PHASE of labor (if given in latent phase it may slow labor; if given in transition phase can lead to neonatal RESP. DEPRESSION)

65
Q

nubain

A

over 3 contractions, 10mg/IV
do NOT give to opiate dependent client-can precipitate withdrawal
-decrease neonatal resp. depression

66
Q

Stadol (butorphanoltartate)

A

○ Decreases neonatal resp. depression
○ Therapeutic use -pain, itching
○ Dosage- 1mg or 2mg IM
**administer IVP over 3 contractions

67
Q

nursing care: epidural

A

○ Preparation -assess platelet count (MUST be normal), empty bladder, assess VS for baseline, IV fluids

Following-Assess VS (espec. BP for hypotension which is main side effect), rotate position between right and left side-lying, assess bladder and catheterize as needed, assess for other side effects and intervene

68
Q

pudenal anesthesia

A

in the pudenal nerve like novocaine at the dentist

69
Q

BUBBLE HE

A

B-breasts - use back of your hand, ask questions about feeling milk let down- tingling, pain
U-uterus - down a finger each day from the umbilicus
B-bladder- ask her to empty bladder- ask about urine characteristics
B-bowels- ask about last bm.
L-lochia- bleeding- clots need to look up colors
E-episiotomy - assess for hemorrhoids at the same time - discharge, healing, sutures
H-Homan’s sign - lift leg flex foot while holding the calf assess for pain
E-emotional-

70
Q

protein material catabolism

A

Release of proteolytic enzyme into the endometrium and myometrium to break down the hypertrophied cells so the uterine muscle will decrease in size as the size of the cells grow smaller

71
Q

regeneration of endometrium

A

• Placenta heals in about 6 weeks, heals by exfoliation rather than forming scar tissue( aka primary intention) for subsequent pregnancies
The endometrium will grow from the margins of the placental site and from the fundi of the endometrial glands in the basal layer of the placental site

72
Q

uterine changes

A

Placement and size -immediately after delivery it needs to be at the belly button and every 2 hours it needs to drop a finger size down the belly
• It is important to get report from previous nurse (but STILL MAKE OWN ASSESSMENTS)
• Important nursing intervention prior to assessing fundus is to make the patient gets up and pees. If it still doesn’t go down massage fundus and look for gushes of blood.
Normal tone of fundus? -feeling for a rubber bouncy ball. Make sure to not be shy and press down

73
Q

postpartum medications

A
  • Pitocin 1st line-administered to all -treats uterine atony
    • Methergine 2nd line-check BP before administration; given if Pitocin does not work

Hemabate 3rd line- when not controlled by other methods; last resort

74
Q

lochia

A

• Lochia rubra-dark red and consists mainly of blood. Occurs day 1-3
• Lochia serosa- pinkish serum with mucus and debris usually occurs on day 3-10
Lochia alba- creamy yellowish brownish. Occurs after day 10

75
Q

perineum

A 
• Assess: the episiotomy -while patient is lying on their side, lift up butt cheek then check lochia while there
		○ R- redness 
		○ E- edema or swelling 
		○ E-ecchymosis or bruising 
		○ D-drainage
A-approximated
76
Q

process of lactation

A

sucking of infant stimulate hypothalamus
• Hypothalamus sends messages to the pituitary gland
○ Anterior pituitary -stimulates Prolactin to be released which is the ultimate stimulation for milk production

Posterior pituitary -releases oxytocin which stimulates the contraction of the cells around the alveoli in the mammary glands. This causes milk to be propelled through the duct system to the infant. “LET DOWN” reflex. Felt as a tingling sensation (contract uterus as well-cramps)

77
Q

CA changes postpartum

A

• Blood volume
○ Increase for the about 24-48 hours after delivery
○ Increase in blood flow back to the heart when blood from the placenta unit returns to central circulation
○ Extravascular interstitial fluid is moved into the vascular system (intravascular)
Leads to increased cardiac output mainly RT increase stroke volume

78
Q

blood values postpartum

A

WBC-increased leukocytosis is common with values of 25,000-30,000 RT increased neutrophils

RBC-return to normal

Hgb- normal to see a drop of about 1 gram

Hct-normal to see a drop of 2-4 points and then a rise RT> loss of plasma than RBC death

Platelets- drop and gradually rise

79
Q

blood values pregnancy

A

WBC-elevated slightly to about 12,000

RBC-increase slightly to about 10 million

Hemoglobin-stays about normal at =12g
Below 10g=anemia

Hematocrit-lowers 33-39% RT hemodilution. If drops below 32-35%=anemia

80
Q

VS after delivery

A

• Temperature -a slight elevation of up to 100.4 may occur related to dehydration and increase basal body metabolism from exertion of labor and delivery
○ After 24 hours, temp should be normal
○ Greater than 100.4 suggests infection
• Blood pressure-should remain stable
○ Hypovolemia can indicate postpartum hemorrhage
○ Hypervolemia could indicate preeclampsia
• Pulse -bradycardia of 50-70 bpm is normal
○ Tachycardia is not considered normal could indicate excessive blood loss
Respirations -should remain stable and within normal range

81
Q

CA changes in baby

A

• Oxygen enters the lungs and pulmonary alveoli expand
• Oxygen lowers resistance in the pulmonary vessels allowing blood to flow more freely to and from the lungs
• Pressure in the right atrium decreases because of flow of blood to the lungs
• Pressure in the left atrium increases because of flow of blood from the lungs
• With oxygenation, the ductus arteriosus begins to constrict, becoming functionally closed
As pressure in the left side of the heart begins to exceed that in the right side, the foramen ovale becomes closed

82
Q

conjugation of bilirubin

A

Unconjugated bilirubin (fat soluble)- is breakdown product derived from Hgb that is released from destroyed RBCs. It is not excretable so it is a potential toxin. MUST be conjugated (made water soluble) in order to be excreted from the body

83
Q

physiological jaundice

A

• About 50% of all infants exhibit signs in 2-3 days after birth
• Bilirubin levels at birth are about 3mg/dl and should not exceed 12 mg
• Nursing care:
○ keep well hydrated and promote elimination
early feedings tend to keep bilirubin levels down by stimulating intestinal activity removing the contents and not allowing reabsorption

84
Q

non-shivering thermogenesis

A

-unique to newborns. Uses infant stores of brown fat

Brown fat is in midscapular, around neck, in axillas, around trachea, kidneys, and adrenal glands

85
Q

non-shivering thermogenesis

A
  1. Skin receptors perceive a drop in environmental temperature
    1. Transmit impulses to the central nervous system
    2. Which stimulates the sympathetic nervous system
    3. Norepinephrine is released at local nerve endings in the brown
    4. Metabolism of brown fat
    5. Release of fatty acids
      Release of HEAT
86
Q

temp of baby

A

Normal- 97.7-99.5 or 36.5-37.5

87
Q

normal glucose of baby

A

> 45

88
Q

vitamin K for baby

A

Dose-1.0mg (0.5ml) IM in vastus lateralis muscle
newborns lack intestinal flora necessary for vitamin k production
prevents or treats hemorrhagic disease in newborns

89
Q

postpartum phases of rubin: Taking in

A

1-3 days postpartum
○ Marked by a period of being dependent and passive behavior
○ Mother’s primary needs are her own-food and sleep
○ Mother is talkative about labor and delivery experience
Main nursing job is to listen and help mom interpret events of delivery to make them more meaningful and clarify misconceptions

90
Q

postpartum phases of rubin: Taking hold

A

3-2 weeks postpartum
○ Ready to deal with present
○ More in control -takes on role of “mothering”
○ *BEST time for teaching–but already home at this time
Lots of repetition and education before d/c home

91
Q

postpartum phases of rubin: Letting go

A

○ Mother may feel deep loss over separation of baby from part of her body and may grieve this loss
Common for postpartum blues to occur during this time

NSG 122 (4 decks)

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