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NURSING 210 > TEST 1 > Flashcards

TEST 1 Flashcards

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1
Q

Three phases of the ovarian menstrual cycle?

A
  1. follicular phase
    2.ovulation
    3.luteal phase
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2
Q

Hypothalamus secretes _____ that causes the pituitary gland to release _______.

A

GrNH, FSH

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3
Q

Adenomyosis

A

endometrial tissue exists within and grows into the uterine wall

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4
Q

4 stages of fetal development

A

1.zygotic
2.blastocyst
3.embryonic
4.fetal

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5
Q

Where does fertilization occur?

A

In the outer 3rd of the fallopian tube (5 hour long process that ends in pregnancy)

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6
Q

The ovum’s “thick outer layer” that the sperm penetrates to begin pregnancy

A

zona pellucida

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7
Q

Where do you want the fertilized egg to attach?

A

the upper portion of the posterior uterine wall

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8
Q

What is the volume of fluid at 10 weeks, 20 weeks and 37 weeks?

A

30ml @ 10 weeks
350ml @ 20 weeks
~1000 @ 37 weeks

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9
Q

How many chromosomes does each partner give?

A

the male and female both give 23 chromosomes

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10
Q

When is viability for a fetus?

A

20 weeks (only because lungs are developed at this point)

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11
Q

what happens at the 4th week of fetal development?

A

heart begins to beat

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12
Q

what happens at the 8th week of fetal development?

A

all body organs are formed

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13
Q

what happens at 12 weeks of fetal development?

A

sex of fetus can be determined and kidneys are able to secrete urine

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14
Q

what happens at 16 weeks of fetal development?

A

face looks like a human

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15
Q

what happens at 20 weeks of fetal development?

A

primitive respiratory movements begin, heartbeat can be heard on fetoscope and doppler and quickening occurs

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16
Q

what happens at 24 weeks of fetal development?

A

lecitin begins to appear in amniotic fluid and they can begin to hear

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17
Q

what happens at 28 weeks of fetal development?

A

brown fat (for thermoregulation), eyes can open and close and they have a weak suck reflex

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18
Q

what happens at 32 weeks of fetal development?

A

subcutaneous fat

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19
Q

what happens at 38 weeks of fetal development?

A

skin is pink, fetus receives antibodies from mom

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20
Q

how long and wide is the umbilical cord?

A

22inches long 1in wide

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21
Q

what is AVA in relation to the umbilical cord?

A

means the umbilical cord has two arteries and a vein

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22
Q

what are the 4 hormones the placenta produces?

A

progesterone, estrogen, HCG and hPL

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23
Q

How do you screen for syphillis?

A

with rapid plasma regain (RPR) an venereal disease research laboratory (VDRL)

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24
Q

What will a positive pregnancy test show to determine its positive?

A

High levels of HCG

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25
Q

What are the 4 phases of the endometrial (uterine) cycle?

A
  1. proliferation
    2.secretory
    3.ischemic
    4.menstrual
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26
Q

What are the early signs of complications of oral contraceptives?

A

A bdominal pain may indicate liver/gallbladder issues
C hest pain or SOB may indicate pulmonary embolism
H eadaches may indicate increase BP or impending stroke
E ye problems may indicate increase BP or cerebral vascular incident
S evere leg pain may indicate a thromboembolic event

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27
Q

What are the early signs of complications of intrauterine devices?

A

P eriod late/pregnancy/abnormal periods
A bdominal pain/ pain with intercourse
I nfection exposure/abnormal vaginal discharge
N ot feeling well/fever/chills
S tring length (shorter/longer/missing)

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28
Q

What are presumptive signs of pregnancy?

A

(subjective)
-amenorrhea
-fatigue
-urinary frequency
-breast changes
-uterine enlargement
-quickening (movement)

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29
Q

What are probable signs of pregnancy?

A

(objective)
- positive urine pregnancy test
-hegors sign (softening of lower uterus)
-chadwicks sign ( bluish color of cervix)
-goodells sign (softening of cervix)
-ballottement (rebound of unengaged fetus)
-braxton hick contractions
-abdominal enlargement

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30
Q

Progesterone

A

“hormone of pregnancy”
-Produced by corpus luteum until about 12 weeks then produced by the placenta
-can be used to prolong pregnancy

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31
Q

Nagele’s Rule

A

LMP minus 3 months and add 7 days

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32
Q

LMP

A

last menstrual period

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33
Q

EDD

A

estimated date of delivery

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34
Q

EDC

A

estimated date of confinement

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35
Q

nulligravid

A

never pregnant

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36
Q

primigravid

A

one pregnancy

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37
Q

multigravid

A

more than one pregnancy

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38
Q

nulliparous

A

women who has not have a pregnancy beyond 20 weeks

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39
Q

primiparous

A

woman who has given birth once after a pregnancy of atleast 20 weeks

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40
Q

multiparous

A

woman who has had two or more births after a pregnancy of atleast 20 weeks

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41
Q

GTPAL

A

G- gravidity (# of pregnancies)
T-term pregnancies (>37 weeks)
P- preterm birth (24-37weeks)
A-abortions (spontaneous or induced)
L-living (how many living kids do you have)

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42
Q

Scheduled visits for an uncomplicated pregnancy

A

First visit 8 weeks
Second visit 12 weeks
Visits q 4 weeks until 28 weeks
Visits q 2 weeks until 36 weeks
Visits weekly until delivery

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43
Q

When should you give rhogam?

A

Rhogam at 28 weeks if mother is Rh negative and FOB is positive or unknown

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44
Q

Why is a RBC antibody screen used in early pregnancy, at 28 weeks and again at time of delivery during pregnancy?

A

to screen for antibodies in the blood of the mother that might cross the placenta and attack the baby’s red cells, causing hemolytic disease of the newborn (HDN).

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45
Q

If there are no Rh antibodies present at 28 weeks what happens?

A

the woman is given an injection of
Rh immune globulin (Rhogam) to clear
any Rh-positive fetal RBCs that may be
present in her bloodstream to prevent the production of Rh antibodies by the
mother.

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46
Q

What are the danger signs in pregnancy?

A

-sudden gush of fluid
-vaginal bleeding
-abdominal pain
-persistant vomiting
-epigastric pain
-edema of hands and feet
-severe persistent headache
-blurred vision/dizziness
-chills w/ fever over 100.4
-painful urination or decreased urine output

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47
Q

what is the indirect coombs test check ?

A

determines whether or not there are antibodies to the Rh factor in the mothers blood;

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48
Q

what is the purpose of an ultrasound?

A

useful to screen for ectopic pregnancies and anomalies

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49
Q

what does an ultrasound measure?

A

the clear (translucent) space in the tissue at the back of the baby’s neck; babies with abnormalities tend to accumulate more fluid back there

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50
Q

when is the screening ultrasound usually done and what does it examine?

A

18-20 weeks; heart, brain & spinal column. can determine sex

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51
Q

Describe a chorionic villus test (CVS)

A

-done under ultrasound guidance @ 12 weeks
-needle enters placenta to biopsy the cells
-diagnostic
-chromosomes are examined directly; can detect chromosomal abnormalities & test for certain genetic diseases

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52
Q

what 3 genetic diseases does a CVS test for?

A

sickle cell, tay-sachs, and hemophilia

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53
Q

describe amniocentesis

A

-done under ultrasound guidance @ 15-16 weeks
-needle enters placenta to remove fluid surrounding fetus
-diagnostic
-fluid can be sent to screen for neural tube defects such as spina bifida

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54
Q

amenorrhea vs dysmenorrhea

A

amenorrhea-absence of menses
dysmenorrhea- painful menses

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55
Q

what happens in endometriosis

A

tissue grows outside of the uterus

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56
Q

what are fibroids (leiomyomas)

A

noncancerous growths

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57
Q

what medications are used to treat polycystic ovary syndrome? (3)

A

-metformin
-spironolactone
-contraceptives

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58
Q

what should women who are Rh negative receive regarding an abortion?

A

Rhogam

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59
Q

describe progesterone only pills

A

works by thickening cervical mucus & making endometrium unfavorable for implantation

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60
Q

who should not take estrogen and progesterone pills

A

women over 35 yrs of age and smoke; or have a hx of DVT

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61
Q

when is the TDaP vaccine offered?

A

32 weeks

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62
Q

describe screening for gestational diabetes

A

@ 28 weeks ALL non diabetic pregnant women drink 50 gram glucose drink

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63
Q

what happens at each prenatal visit

A

-urine dip for protein&sugar
-weight
-BP
-listen for fetal heart tones after 12 weeks
-measure uterus(cm=weeks after about 20 weeks)
-at end of pregnancy, check fetal position and cervix for dilation and effacement

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64
Q

when do you do an early glucose screening?

A

for women with a BMI greater than 30

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65
Q

how is fundal height measured?

A

in centimeters from the pubic symphysis to the top most portion of the uterus

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66
Q

what are the functions of the amniotic fluid?

A

-maintains temperature for fetus
-allows for symmetric growth of fetus
-allows for buoyancy and movement of fetus
-acts as cushion to protect fetus and umbilical cord from injury

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67
Q

what labs are done at the first prenatal visit

A

-CBC w differential (look at MCV)
-platelets
-blood type and antibody screen
-hep b&c antibody virus
-rubella status
-syphilis status
-HIV
-urine

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68
Q

what are the 3 primary germ layers?

A

Ectoderm- outer layer
mesoderm- middle layer
endoderm-lining of tract

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69
Q

at what age can you see the forebrain and heart?

A

4 weeks

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70
Q

where is follicle stimulating hormone produced?

A

anterior pituitary gland

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71
Q

target organ of FSH?

A

ovaries

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72
Q

function of FSH?

A

responsible for maturation of the ovarian follicle- highest during follicular phase of reproductive cycle

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73
Q

What are the 3 types of estrogen?

A

estradiol- most common during child bearing age;
estriol- main estrogen during pregnancy;
estrone- the only estrogen produced after menopause

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74
Q

estrogen is secreted from what organ?

A

ovaries

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75
Q

target organ of estrogen?

A

ovaries; endometrial lining; multiple organs

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76
Q

function of estrogen?

A

Responsible for development of sex characteristics and reproductive development; promotes increased blood supply of endometrium resulting in a welcoming environment for the zygote, embryo and developing fetus; causes changes during pregnancy including nasal stuffiness, loosens pelvic ligaments and joints, hyperpigmentation and vascular changes in the skin; etc.; protects bone health; stabilizes cholesterol; protects heart, skin, brain, etc.

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77
Q

target organ of progesterone?

A

uterus

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78
Q

function of progesterone?

A

Levels increase just before ovulation. Reduces uterine contractions allowing the pregnancy to continue. (Called the hormone of pregnancy due to it’s calming effect).

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79
Q

hPL is secreted from where?

A

placenta

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80
Q

target organ of hPL?

A

maternal pancreas

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81
Q

function of hPL?

A

Acts as an antagonist against maternal insulin. Makes glucose available for fetal growth by altering maternal CHO, fat, and protein metabolism.
Prepares mammary glands for lactation.

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82
Q

hPL (human placental lactogen) is also known as?

A

hCS- human chorionic somatomammotropin

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83
Q

where is relaxin secreted from?

A

placenta and corpus luteum

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84
Q

target organ of relaxin?

A

uterus an ligaments of the pelvis

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85
Q

function of relaxin?

A

Works with progesterone to maintain pregnancy by suppressing release of oxytocin to delay onset of labor contractions; increase in flexibility of pelvis; works on dilation of cervix.

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86
Q

where is oxytocin secreted from?

A

posterior pituitary gland

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87
Q

target organ of oxytocin?

A

uterus and breasts

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88
Q

function of oxytocin?

A

Stimulates contraction of the uterus and milk ducts of the breasts.

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89
Q

where is prolactin secreted from?

A

anterior pituitary gland

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90
Q

target organ of prolactin?

A

breasts

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91
Q

function of prolactin?

A

promotes production of breast milk

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92
Q

what is hCG?

A

hormone that is measured for pregnancy testing; maintains maternal corpus luteum which secretes progesterone and estrogen

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93
Q

when do hCG levels peak?

A

60-70 days, then decrease until 100-130 days, then will remain at that lower level for the duration of pregnancy

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94
Q

What is zygotic stage?

A

fertilization of sperm and egg through 2nd week

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95
Q

What is blastocyst?

A

zygote divides into a solid ball of cells which attaches to the uterus

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96
Q

What is the embryonic stage?

A

major organs and structures begin to emerge by the end of 2nd week and through the 8th week

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97
Q

What is the fetal stage?

A

differentiation and structures specialize by end of 8th week until birth

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98
Q

What are the 3 germ layers?

A

ectoderm, mesoderm, endoderm (zygote in blastocyst stage transforms into there 3 layers)

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99
Q

responsibilities of ectoderm?

A

outer layer of skin, oil glands of hair follicles and skin, nails and hair, external sense organs, mucous membrane of mouth and anus

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100
Q

responsibilities of mesoderm?

A

true skin, skeleton, bone and cartilage, connective tissue, muscles, blood and blood vessels, kidneys and gonads

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101
Q

responsibilities of endoderm?

A

lining of trachea, pharynx, and bronchi; lining of digestive tract; lining of bladder and urethra

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102
Q

What is the the yolk sac?

A

a cavity that develops on the 9th day after fertilization which functions only during embryonic life

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103
Q

what does the yolk sac do?

A

initiates production of RBCs, continues until fetal liver takes over at about 6 weeks; the umbilical cord encompasses the yolk sac which then degenerates

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104
Q

What does the umbilical cord do?

A

fetal deoxygenated blood (CO2) and waste products leave the fetus through 2 umbilical arteries; oxygenated, nutrient rich blood from mother is transported to the fetus y 1 umbilical vein

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105
Q

What covers and cushions cord vessels?

A

wharton’s jelly

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106
Q

What is the placenta?

A

organ for fetal respiration, nutrition, and excretion

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107
Q

recommended weight gain for underweight women?

A

28-40 pounds

108
Q

recommended weight gain for normal weight women?

A

25-35 pounds

109
Q

recommended weight gain for overweight women?

A

15-25 pounds

110
Q

recommended weight gain for obese women?

A

11-20 pounds

111
Q

What foods to avoid while pregnant?

A

no raw or unpasteurized dairy; no shark, tilefish, king mackerel, or swordfish; limit albacore tuna to 6oz/wk; no raw meat or fish; avoid organ meat; limit caffeine; no alcohol

112
Q

how many more calories do pregnant people need a day?

A

300 (last trimester)

113
Q

how many more calories a day do nursing women need?

A

500

114
Q

what is the recommendation for folic acid?

A

400mcg per day pre pregnancy; 800-1000mcg per day when pregnant

115
Q

what is the intracellular parasite the causes chlamydia?

A

chlamydia trachomatis

116
Q

what 2 vaccines can you get while pregnant?

A

flu and TDaP

117
Q

What does the assessment of fetal well-being biophysical profile look at

A

-ultrasound to assess various parameters of fetal well being
-ultrasound monitoring fetal movements, fetal tone,&fetal breathing as well as ultrasonic measurement of fluid volume
-used to identify infants at risk of a poor outcome

118
Q

what are the components of the biophysical profile?

A

fetal movement
fetal tone
fetal breathing movement
amniotic fluid volume
non stress test
(each category is worth 2 points)

119
Q

definition of fetal movement in regards to BPP

A

3 body or limb movements

120
Q

definition of fetal tone in regards to BPP

A

1 episode of active extension&flexion of the limbs; opening and closing of hand

121
Q

definition of fetal breathing movement in regards to BPP

A

episode of >or = 30 seconds in 30 minutes; hiccups are considered breathing activity

122
Q

definition of amniotic fluid volume in regards to BPP

A

single 2 cm X 2cm pocket is considered adequate

123
Q

definition of non stress test in regards to BPP

A

2 accelerations > 15 bpm of at least 15 sec durations

124
Q

what is a normal BPP score?

A

8/10

125
Q

what is a suspicious BPP score?

A

6 or below

126
Q

What is the most reported STI in the US that is also the most common cause of infertility worldwide?

A

chlamydia

127
Q

chlamydia may be….?

A

asymptomatic

128
Q

major sx of chlamydia?

A

men- urethritis; women- cervicitis, PID, ectopic pregnancy, urinary frequency, dysuria, spotting, vulvar itching, gray-white discharge

129
Q

can chlamydia be passed from mother to newborn during birth?

A

yes

130
Q

rx tx for chlamydia?

A

doxycycline (cat x) or azithromycin

131
Q

gonorrhea is caused by what bacteria?

A

neisseria gonorrhea

132
Q

gonorrhea infects what?

A

the mucous membranes of the reproductive tract, mouth, throat, eyes, and rectum

133
Q

can gonorrhea be transmitted at birth?

A

yes, in the form of ophthalmia neonatorum (newborns treated with prophylactic erythryomycin within one hour of birth)

134
Q

When should pregnant women be screened for gonorrhea?

A

at first prenatal visit and at 36 weeks because gonorrhea is associated with chorioamnionitis, premature labor, premature rupture of amniotic membranes, and postpartum endometritis

135
Q

what is tx for gonorrhea?

A

azithryomycin and ceftriaxone (dual therapy)

136
Q

what is HSV-1?

A

cold sores on lips, eyes, and face

137
Q

what is HSV-2?

A

genital herpes

138
Q

is there a cure for HSV?

A

no

139
Q

tx for genital herpes?

A

anti-virals for acute phase or daily for tx of suppression

140
Q

can mom have vaginal birth with an active herpes outbreak at time of delivery?

A

no- C section only

141
Q

what is prescribed to pregnant women at 36 weeks with herpes?

A

acyclovir as suppression therapy to prevent outbreak

142
Q

how many stages of syphilis?

A

3- primary, secondary, and tertiary

143
Q

syphilis is caused by what?

A

treponema pallidum

144
Q

every women is screened for syphilis at first prenatal visit because…?

A

syphilis can kill developing baby

145
Q

what does primary syphilis look like?

A

single chancre at site of infection that lasts 1-6 weeks

146
Q

what is secondary syphilis?

A

appears 2 to 6 months after initial exposure and lasts about 2 years;
flu like sx, maculopapular rash on trunk, palms, and soles

147
Q

what is the latency stage of syphilis?

A

begins after second stage has ended and can last as long as 20 years, no sx but serology tests will be positive

148
Q

what is tertiary syphilis?

A

life threatening- heart disease and neuro disease that slowly destroy heart, eyes, brain, CNS, skin (gummas)

149
Q

what are gummatas?

A

growths of pink, fleshy tissue that contain syphilis bacteria; may appear as nodules or ulcers or become masses that are like tumors

150
Q

common sites for gummatas?

A

skin, mucous membranes, bones, eyes, resp. system, GI system

151
Q

tx of syphilis?

A

benzathine penicillin G intramuscularly

152
Q

what is congenital syphilis?

A

passed to the newborn which can lead to spontaneous abortion, low birth weight, fetal growth restriction, prematurity, stillbirth, multisystem failure, mental retardation

153
Q

what is the cause of essentially all cases of cervical, vulvar, vaginal, penile, anal, oropharyngeal cancers?

A

HPV

154
Q

genital warts are caused by which types of HPV?

A

6 and 11

155
Q

HPV prevention?

A

gardasil vaccine

156
Q

what is a non stress test

A

-indirect measurement of uteroplacental function
-observe for signs of fetal activity w/ a concurrent acceleration of the fetal heart rate

157
Q

what does reactive mean in regards to a non stress test

A

at least 2 accelerations above baseline of at least 15 bpm for 15 sec in 20 min

158
Q

when it comes to kick counting how much do you count

A

until you feel up to 10 kicks within a 2 hour time period

159
Q

when is kick counting most often used?

A

high risk pregnancies

160
Q

what is a contraction stress test?

A

A noninvasive test that measures fetal heart rate in response to uterine contractions

161
Q

what should happen to an uncompromised fetus during a contraction stress test?

A

no deceleration of the fetal heart rate during the period of the contraction even though the contraction represents a period of reduced oxygenation

163
Q

in utero, who is more likely to be affected by teratogens?

A

females

164
Q

what is gestational trophoblastic disease?

A

molar pregnancy or hydatidiform mole; the embryo fails to develop a primitive state;

GTD is hyperproliferation of trophoblastic cells that would normally develop into the placenta

165
Q

What is a complete mole (GTD)?

A

all genetic material is paternally derived but ovum has no genetic material and molar tissue contains no fetus;

there is no placenta to receive maternal blood so bleeding occurs

166
Q

manifestations of complete mole?

A

bleeding, rapid uterine growth, failure to detect fetal heart activity, signs of hyperemesis gravidarum, unusually early development of gestational HTN, preeclampsia; higher than expected levels of hCG; “snowstorm” pattern on ultrasound

167
Q

what do you do after a complete mole?

A

monitor hCG levels for 1 year;

80% of women will have levels back to normal after 8-12 wks
20% of women will have levels that continue to rise

168
Q

what is a partial mole?

A

genetic material derived maternally and paternally; embryo has 69 chromosomes instead of 46; normal ovum is fertilized by 2 sperm or one sperm where meiosis didnt take place; can contain abnormal embryonic or fetal parts; may present with sx of a missed or incomplete abortion

169
Q

risk factors for GTD?

A

previous molar pregnancy, age older than 35 or younger than 20, southeast asian ethnicity, carotene deficiency

170
Q

tx for GTD?

A

D&C, emotional support, education regarding risk of cancer and strict follow up program, avoid pregnancy for 1 year, rhogam may be needed

171
Q

what is cervical insufficiency?

A

a condition that occurs when weak cervical tissue causes or contributes to premature birth or the loss of an otherwise healthy pregnancy

172
Q

tx for cervical insufficiency?

A

progesterone, cerclage placement prior to rupture of membranes, bed rest

173
Q

risk factors for cervical insufficiency?

A

cervical trauma for surgery, congenital defect or trauma from previous birth, hx of second trimester birth

174
Q

assessment for cervical insufficiency?

A

painless bleeding, gush or dribbles of fluid (amniotic), contractions

175
Q

when is cerclage removed?

A

36 weeks

176
Q

what is placenta previa?

A

when the placenta implants in the lower segment of the uterus near or over the cervical os;

abnormal implantation results in bleeding in the 3rd trimester as cervix begins to dilate and efface

177
Q

what is important to remember with previa?

A

NO cervical exams

178
Q

risk factors for placenta previa?

A

previous placenta previa, uterine scarring from surgery or infection, advanced maternal age, multifetal gestation, closely spaced pregnancies, smoking

179
Q

manifestations of placenta previa?

A

painless, bright red bleeding in 2nd and 3rd trimester; uterus is soft and nontender; FH noted; make sure H and H stable; rhogam if needed; US to diagnose

180
Q

Nifedipine use

A

used to reduce high blood pressure, and relax uterine contractions and postpone a preterm birth.

181
Q

betamethosone use

A

it can help speed up lung development in preterm babies. Betamethasone causes the release of surfactant, a substance that lubricates the lungs so that they do not stick together when the infant breathes.

182
Q

nursing interventions for previa?

A

NO vaginal exams, instruct not to put anything in vagina, bedrest as needed, avoid supine hypotension, fluids and meds, betamethasone for fetal lung maturity, delivery by cesarean only

183
Q

What is placental abruption?

A

premature separation of the placenta from the uterus which can be partial or complete detachment;

significant maternal and fetal morbidity and mortality; leading cause of maternal death

184
Q

risk factors for placental abruption?

A

maternal HTN, blunt force trauma, cocaine use, smoking, folate deficiency, premature rupture of membranes, multifetal gestation

185
Q

What is preterm labor?

A

regular contractions of uterus resulting in cervical changes that start before 37 weeks of pregnancy (between 20 and 36)

186
Q

s/s of preterm labor?

A

change in vaginal discharge, increase in discharge amount, pelvic or lower abdominal pressure, constant low dull back pain, mild abdominal cramping, regular or frequent contractions, ruptured membranes (water breaks)

187
Q

s/s of preterm labor?

A

change in vaginal discharge, increase in discharge amount, pelvic or lower abdominal pressure, constant low dull back pain

188
Q

indomethacin use

A

often prescribed to pregnant women presenting with preterm labor or shortened cervix, which places them at risk for preterm labor and delivery. helps

189
Q

how is preterm labor diagnosed?

A

pelvic exam, vaginal culture, contraction monitoring, transvaginal ultrasound to measure cervix length, biophysical profile or nonstress test to determine fetal well being

190
Q

what protein is linked to preterm birth?

A

fetal fibronectin

191
Q

nursing care for preterm labor?

A

modified bed rest, encourage rest in left lateral position, instruct to not have sex, hydrate, monitor fetal heart rate and contractions, ampicillin to treat any infection, give betamethasone

192
Q

when do you give betamethasone and why?

A

stimulates fetal lung maturation by releasing enzymes to mature/promote surfactant; given IM two injections 24 hour apart- not given if more than 35 weeks

193
Q

what is hyperemesis gravidarum

A

excessive n/v, dehydration, electrolyte imbalance, nutritional deficiencies, reduced delivery of blood o2 and nutrients to the fetus

194
Q

group B strep

A

can cause infection of the urinary tract, placenta, womb, and amniotic fluid. Even if they haven’t had any symptoms of infection, pregnant women can pass the infection to their babies during labor and delivery. Late onset disease can cause meningitis

195
Q

testing for rubella

A

used to check the pregnant person for immunity to rubella. People who are pregnant and become infected with rubella can transmit the infection to their fetus. The risk of transmission is greatest during the first trimester and in the last few weeks of pregnancy.

196
Q

should rubella vaccine be given during pregnancy?

A

NO. It should be given a month or more before pregnancy if a pregnant person didn’t get the vaccine as a child.

197
Q

what is terbutaline?

A

beta-adrenergic agonist used as a tocolytic to relax smooth muscle and inhibit uterine activity; administer SQ, monitor for CNS stimulation (tachycardia, tremors, nervousness, etc)

198
Q

What is magnesium sulfate?

A

tocolytic that is a CNS depressant and relaxes smooth muscles, thus inhibiting uterine activity by suppressing contractions; administered IV; need to monitor mother closely

199
Q

what do you monitor for with magnesium sulfate?

A

magnesium toxicity and discontinue for loss of deep tendon reflexes, urine output less than 30ml/hr, resp rate less than 12, pulmonary edema, severe hypotension, or chest pain

200
Q

antidote for magnesium sulfate?

A

calcium gluconate or calcium chloride

201
Q

first line tx for gestational diabetes?

A

insulin- short acting/ short acting with intermediate acting insulin; insulin does not cross placenta

202
Q

medication for eclampsia?

A

antihypertensives; may need nitroglycerin IV drip to decrease BP; magnesium sulfate IV to prevent seizures and inhibit uterine contractions; maintain calcium gluconate on hand

203
Q

medication for pre-eclampsia/ gestational HTN?

A

methyldopa (aldomet); nifedipine (procardia); hydralazine (apresoline); labetalol (trandate)

204
Q

why is iron important?

A

Iron is essential during pregnancy to support your baby’s developing blood supply, as well as your own. The mineral is so vital for baby’s growth, it is most important in the last 10 weeks of pregnancy

205
Q

HELLP syndrome

A

hypertension in pregnancy as well as Hemolysis, Elevated Liver enzymes, Low Platelets

206
Q

Difference between pre-eclampsia and eclampsia

A

Eclampsia has seizures

207
Q

risk factors for hyperemesis gravidarum

A

Maternal age younger than 30; multifetal gestation; Gestational Trophoblastic Disease; psychosocial issues and high levels of emotional stress; clinical hyperthyroid disorders; diabetes; gastrointestinal disorders; family history of emesis

208
Q

what are assessment findings of hyperemesis gravidarum

A

Persistent N&V; often unable to retain food or fluid
Significant weight loss
Dehydration (dry tongue, mucous membranes, decreased skin turgor, decreased and concentrated urine and a high hematocrit)
Electrolyte and acid-base imbalances
Psychological factors (stress, emotional immaturity, ambivalence)

209
Q

what meds are used to treat hyperemesis gravidarum

A

-pyridoxine
-antiemetics
-corticosteroids
-may require enteral feeding via tube feeding or tpn

210
Q

in true gestational diabetes when does glucose usually return to normal

A

by 6 weeks postpartum

211
Q

what is gestational diabetes

A

impaired tolerance to glucose with first onset or recognition during pregnancy due to release of human placental lactogen and prolactin cause increase in resistance to insulin in the pregnancy

212
Q

maternal effects of gestational diabetes mellitus

A

spontaneous abortion, gestational hypertension, preeclampsia, preterm labor and PROM, hydramnios, vaginitis, uti, ketoacidosis,c section, and postpartum hemorrhage

213
Q

fetal and neonatal effects of gestational diabetes mellitus

A

congenital abnormalities, macrosmia, IUGR, birth injury, delayed lung maturation, neonatal hypo/hyperglycemia, hyperbilirubinemia polycythemia, perinatal death

214
Q

when is the glucose tolerance test done

A

24-28 weeks gestation

215
Q

gestational hypertension

A

BP is 140/90 in normotensive woman after 20 weeks gestation on two occasions and without proteinuria

216
Q

when does bp return to normal after gestational hypertension

A

12 weeks postpartum

217
Q

severe preeclampsia consists of bp greater than what?

A

160/110 along with more severe symptoms

218
Q

what does HELLP syndrome stand for

A

hemolysis, elevated liver enzymes, low platelets

219
Q

risk factors for gestational hypertension

A

-age younger than 19 or over 40
-1st pregnancy
-extreme obesity
-family hx of GH
-multifetal pregnancy
-chronic hypertension
-chronic renal disease
-family hx of preeclampsia
-DM
-rheumatoid arthristis
-systemic lupus erythematosus

220
Q

what manifestations are seen with preeclampsia

A

-Gestational hypertension with the addition of proteinuria of greater than or equal to 1+.
-report of transient headaches may occur along with episodes of irritability
edema can be present

221
Q

what is eclampsia

A

severe preeclampsia manifestations with the onset of siezure activity

222
Q

manifestations of severe preeclampsia

A

-bp 160/110 or greater
-proteinuria greater than 3+
-oliguria
-elevated blood creatinine
-cerebral or visual disturbances
-hyperreflexia
-edema
-hepatic dysfunction
-epigastric pain
-right upper quadrant pain

223
Q

what is the cure for gestational diabetes

A

birth

224
Q

what is the deep tendon reflex rating scale for preeclampsia/eclampsia assessment

A

4+ hyperactive, very brisk, clonic response abnormal
3+ brisker than average
2+ average response, normal
1+ diminished response, low normal
0 no response

225
Q

what do you monitor for with magnesium sulfate?

A

BP, HR, RR, deep tendon relfexes, LOC, urinary output (foley); presence of headache, visual disturbances, epigastric pain, uterine contractions, FHR an acitivity

226
Q

what is spontaneous abortion?

A

nonintentional

227
Q

what is threatened abortion?

A

cramping with light spotting; cervix is closed and no fetal tissue is passed

228
Q

what is inevitable abortion?

A

increased bleeding and cramping and the cervix dilates leading to eventual miscarriage

229
Q

what is incomplete abortion?

A

spontaneous abortion where some of the tissue is not expelled

230
Q

what is complete abortion?

A

passage of all products of conception; cervix closes; bleeding stops

231
Q

what is missed abortion?

A

fetus dies in utero but is not expelled; sepsis can occur

232
Q

what is recurrent abortion?

A

two or more consecutive spontaneous abortions usually caused by incompetent cervix or inadequate progesterone levels

233
Q

therapeutic vs elective induced abortions?

A

therapeutic is intentional termination to preserve mothers health and elective is intentional for reasons other than mothers health

234
Q

risk factors for spontaneous abortion?

A

chromosomal abnormalities, maternal illness, advanced maternal age, maternal infection, trauma, anomalies of fetus, substance abuse, antiphospholipid syndrome

235
Q

plan of care for spontaneous abortion in first trimester?

A

watchful waiting, D&C, misoprostol

236
Q

plan of care for spontaneous abortion in second trimester?

A

bedrest if pregnancy is viable, initiate labor if membranes ruptured, surgery if moms life in danger

237
Q

plan of care for spontaneous abortion in third trimester?

A

bedrest if pregnancy not in immediate danger, delivery with newborn resuscitation and NICU stay or delivery with grief and loss care

238
Q

what is an ectopic pregnancy?

A

abnormal implantation of fertilized ovum outside the uterine cavity, usually the fallopian tube

239
Q

risks for ectopic pregnancy?

A

history of STI, history of PID, tubal surgery or previous ectopic, IUD

240
Q

tx for ectopic pregnancy?

A

no action; tx with methotrexate IM to inhibit cell division; or surgery to removal pregnancy from tube by either saving or removing tube

241
Q

s/s of ectopic pregnancy?

A

abdominal pain (unilateral), spotting at 6-8 weeks, faintness, dizziness

242
Q

Physiological changes in pregnancy:
Gastrointestinal

A

• Gums become hyperemic
• Increased salivation
• Displacement of intraabdominal portion of
esophagus can result in GERD
• Slower gastric emptying can result in
heartburn
• Slower intestinal peristalsis
• Nausea and Vomiting “morning sickness”

243
Q

Physiological changes in pregnancy:
Musculoskeletal

A

• Changes in gait and posture
• Relaxation of joints under
the influence of
progesterone and relaxin
• Postural changes in
pregnancy (lordosis)

244
Q

Physiological changes in pregnancy:
Skin

A

• Chloasma aka facial melasma
aka _____
Pigmentation increases on the face due to estrogen
effect
• Linea nigra
Dark line of pigmentation from the umbilicus extending
to the pubic area
• Striae gravidarum
Stretch marks most notably found on the abdomen and
thighs

245
Q

Physiological changes in pregnancy:
Endocrine

A

• Thyroid- Basal metabolic rate
increases
• Pituitary- Prolactin secreted to
promote breast development and
lactation
• Oxytocin- Responsible for uterine
contractions to bring about
delivery. Also responsible for milk
ejection during breast feeding.

246
Q

when can Rh incompatibility occur

A

ONLY if the woman is Rh neg and the fetus is Rh pos

247
Q

Rh positive blood is a _____ trait

A

dominant

248
Q

Rh negative blood is a ____trait

A

recessive

249
Q

what can decrease absorption of folate from meals

A

anticonvulsants, oral contraceptives, sulfa drugs, and alcohol

250
Q

what do you advance to if oral iron does not work

A

liquid iron

251
Q

lack of folic acid may result in

A

spina bifida

252
Q

do not take antacids with

A

iron

253
Q

do not take iron supplements at the same time as

A

drinking milk

254
Q

who is more than twice as likely to develop gestational hypertension

A

women with multiple fetus

255
Q

what are the TORCH viruses

A

Toxoplasmosis
Other (syphillis, varicella-zoster, Zika)
Rubella
Cytomegalovirus
Herpes

256
Q

what is toxoplasmosis

A

-a parasite acquired by contact with cat feces or raw meat
-transmitted through placenta

257
Q

congenital toxoplasmosis includes the following possible signs

A

-low birth weight
-enlarged liver and spleen
-jaundice
-anemia
-inflammation of eye structures
-neurological damage

258
Q

what is the treatment for toxoplasmosis

A

therapeutic abortion

259
Q

how can rubella effect a developing fetus

A

early in pregnancy- disrupt formation of major body systems
later in pregnancy- damage to already formed organs

260
Q

why cant you receive a rubella vaccine while pregnant

A

its a live virus

261
Q

how long should a woman wait to get pregnant after receiving a rubella vaccine

A

at least3 months

262
Q

what are rubellas effects on embryo or fetus

A

microcephaly
mental retardation
congenital cataracts
deafness
cardiac effects
IUGR

263
Q

what has prenatal zika virus lead to?

A

linked to adverse pregnancy and birth outcomes, most notably microcephaly and other serious brain abnormalities

264
Q

CDC guidelines for Zika?

A

serial US every 3-4 weeks to evaluate fetal anatomy and growth is positive; test cord blood and placenta at birth for Zika; delayed pregnancy for 3 months after exposure for women (2 months for men)

265
Q

infected infants with cytomegalovirus may have what?

A

mental retardation, seizures, blindness, deafness, dental abnormalities, petechiae

266
Q

tx for cytomegalovirus?

A

no effective tx is known, therapeutic abortion may be offered if CMV infection is discovered early in pregnancy

267
Q

initial herpes infection during first half of pregnancy can cause what?

A

spontaneous abortion, IUGR, and preterm labor

268
Q

how can infants be infected with herpes?

A

virus ascends into the uterus after membrane rupture or infant has direct contact with lesions during vaginal delivery

NURSING 210 (5 decks)

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