TEST 1 Flashcards
1
Q
Three phases of the ovarian menstrual cycle?
A
- follicular phase
2.ovulation
3.luteal phase
2
Q
Hypothalamus secretes _____ that causes the pituitary gland to release _______.
A
GrNH, FSH
3
Q
Adenomyosis
A
endometrial tissue exists within and grows into the uterine wall
4
Q
4 stages of fetal development
A
1.zygotic
2.blastocyst
3.embryonic
4.fetal
5
Q
Where does fertilization occur?
A
In the outer 3rd of the fallopian tube (5 hour long process that ends in pregnancy)
6
Q
The ovum’s “thick outer layer” that the sperm penetrates to begin pregnancy
A
zona pellucida
7
Q
Where do you want the fertilized egg to attach?
A
the upper portion of the posterior uterine wall
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
9
Q
How many chromosomes does each partner give?
A
the male and female both give 23 chromosomes
10
Q
When is viability for a fetus?
A
20 weeks (only because lungs are developed at this point)
11
Q
what happens at the 4th week of fetal development?
A
heart begins to beat
12
Q
what happens at the 8th week of fetal development?
A
all body organs are formed
13
Q
what happens at 12 weeks of fetal development?
A
sex of fetus can be determined and kidneys are able to secrete urine
14
Q
what happens at 16 weeks of fetal development?
A
face looks like a human
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
16
Q
what happens at 24 weeks of fetal development?
A
lecitin begins to appear in amniotic fluid and they can begin to hear
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
18
Q
what happens at 32 weeks of fetal development?
A
subcutaneous fat
19
Q
what happens at 38 weeks of fetal development?
A
skin is pink, fetus receives antibodies from mom
20
Q
how long and wide is the umbilical cord?
A
22inches long 1in wide
21
Q
what is AVA in relation to the umbilical cord?
A
means the umbilical cord has two arteries and a vein
22
Q
what are the 4 hormones the placenta produces?
A
progesterone, estrogen, HCG and hPL
23
Q
How do you screen for syphillis?
A
with rapid plasma regain (RPR) an venereal disease research laboratory (VDRL)
24
Q
What will a positive pregnancy test show to determine its positive?
A
High levels of HCG
25
What are the 4 phases of the endometrial (uterine) cycle?
1. proliferation
2.secretory
3.ischemic
4.menstrual
26
What are the early signs of complications of oral contraceptives?
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
27
What are the early signs of complications of intrauterine devices?
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)
28
What are presumptive signs of pregnancy?
(subjective)
-amenorrhea
-fatigue
-urinary frequency
-breast changes
-uterine enlargement
-quickening (movement)
29
What are probable signs of pregnancy?
(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
30
Progesterone
"hormone of pregnancy"
-Produced by corpus luteum until about 12 weeks then produced by the placenta
-can be used to prolong pregnancy
31
Nagele's Rule
LMP minus 3 months and add 7 days
32
LMP
last menstrual period
33
EDD
estimated date of delivery
34
EDC
estimated date of confinement
35
nulligravid
never pregnant
36
primigravid
one pregnancy
37
multigravid
more than one pregnancy
38
nulliparous
women who has not have a pregnancy beyond 20 weeks
39
primiparous
woman who has given birth once after a pregnancy of atleast 20 weeks
40
multiparous
woman who has had two or more births after a pregnancy of atleast 20 weeks
41
GTPAL
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)
42
Scheduled visits for an uncomplicated pregnancy
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
43
When should you give rhogam?
Rhogam at 28 weeks if mother is Rh negative and FOB is positive or unknown
44
Why is a RBC antibody screen used in early pregnancy, at 28 weeks and again at time of delivery during pregnancy?
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).
45
If there are no Rh antibodies present at 28 weeks what happens?
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.
46
What are the danger signs in pregnancy?
-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
47
what is the indirect coombs test check ?
determines whether or not there are antibodies to the Rh factor in the mothers blood;
48
what is the purpose of an ultrasound?
useful to screen for ectopic pregnancies and anomalies
49
what does an ultrasound measure?
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
50
when is the screening ultrasound usually done and what does it examine?
18-20 weeks; heart, brain & spinal column. can determine sex
51
Describe a chorionic villus test (CVS)
-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
52
what 3 genetic diseases does a CVS test for?
sickle cell, tay-sachs, and hemophilia
53
describe amniocentesis
-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
54
amenorrhea vs dysmenorrhea
amenorrhea-absence of menses
dysmenorrhea- painful menses
55
what happens in endometriosis
tissue grows outside of the uterus
56
what are fibroids (leiomyomas)
noncancerous growths
57
what medications are used to treat polycystic ovary syndrome? (3)
-metformin
-spironolactone
-contraceptives
58
what should women who are Rh negative receive regarding an abortion?
Rhogam
59
describe progesterone only pills
works by thickening cervical mucus & making endometrium unfavorable for implantation
60
who should not take estrogen and progesterone pills
women over 35 yrs of age and smoke; or have a hx of DVT
61
when is the TDaP vaccine offered?
32 weeks
62
describe screening for gestational diabetes
@ 28 weeks ALL non diabetic pregnant women drink 50 gram glucose drink
63
what happens at each prenatal visit
-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
64
when do you do an early glucose screening?
for women with a BMI greater than 30
65
how is fundal height measured?
in centimeters from the pubic symphysis to the top most portion of the uterus
66
what are the functions of the amniotic fluid?
-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
67
what labs are done at the first prenatal visit
-CBC w differential (look at MCV)
-platelets
-blood type and antibody screen
-hep b&c antibody virus
-rubella status
-syphilis status
-HIV
-urine
68
what are the 3 primary germ layers?
Ectoderm- outer layer
mesoderm- middle layer
endoderm-lining of tract
69
at what age can you see the forebrain and heart?
4 weeks
70
where is follicle stimulating hormone produced?
anterior pituitary gland
71
target organ of FSH?
ovaries
72
function of FSH?
responsible for maturation of the ovarian follicle- highest during follicular phase of reproductive cycle
73
What are the 3 types of estrogen?
estradiol- most common during child bearing age;
estriol- main estrogen during pregnancy;
estrone- the only estrogen produced after menopause
74
estrogen is secreted from what organ?
ovaries
75
target organ of estrogen?
ovaries; endometrial lining; multiple organs
76
function of estrogen?
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.
77
target organ of progesterone?
uterus
78
function of progesterone?
Levels increase just before ovulation. Reduces uterine contractions allowing the pregnancy to continue. (Called the hormone of pregnancy due to it’s calming effect).
79
hPL is secreted from where?
placenta
80
target organ of hPL?
maternal pancreas
81
function of hPL?
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.
82
hPL (human placental lactogen) is also known as?
hCS- human chorionic somatomammotropin
83
where is relaxin secreted from?
placenta and corpus luteum
84
target organ of relaxin?
uterus an ligaments of the pelvis
85
function of relaxin?
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.
86
where is oxytocin secreted from?
posterior pituitary gland
87
target organ of oxytocin?
uterus and breasts
88
function of oxytocin?
Stimulates contraction of the uterus and milk ducts of the breasts.
89
where is prolactin secreted from?
anterior pituitary gland
90
target organ of prolactin?
breasts
91
function of prolactin?
promotes production of breast milk
92
what is hCG?
hormone that is measured for pregnancy testing; maintains maternal corpus luteum which secretes progesterone and estrogen
93
when do hCG levels peak?
60-70 days, then decrease until 100-130 days, then will remain at that lower level for the duration of pregnancy
94
What is zygotic stage?
fertilization of sperm and egg through 2nd week
95
What is blastocyst?
zygote divides into a solid ball of cells which attaches to the uterus
96
What is the embryonic stage?
major organs and structures begin to emerge by the end of 2nd week and through the 8th week
97
What is the fetal stage?
differentiation and structures specialize by end of 8th week until birth
98
What are the 3 germ layers?
ectoderm, mesoderm, endoderm (zygote in blastocyst stage transforms into there 3 layers)
99
responsibilities of ectoderm?
outer layer of skin, oil glands of hair follicles and skin, nails and hair, external sense organs, mucous membrane of mouth and anus
100
responsibilities of mesoderm?
true skin, skeleton, bone and cartilage, connective tissue, muscles, blood and blood vessels, kidneys and gonads
101
responsibilities of endoderm?
lining of trachea, pharynx, and bronchi; lining of digestive tract; lining of bladder and urethra
102
What is the the yolk sac?
a cavity that develops on the 9th day after fertilization which functions only during embryonic life
103
what does the yolk sac do?
initiates production of RBCs, continues until fetal liver takes over at about 6 weeks; the umbilical cord encompasses the yolk sac which then degenerates
104
What does the umbilical cord do?
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
105
What covers and cushions cord vessels?
wharton's jelly
106
What is the placenta?
organ for fetal respiration, nutrition, and excretion
107
recommended weight gain for underweight women?
28-40 pounds
108
recommended weight gain for normal weight women?
25-35 pounds
109
recommended weight gain for overweight women?
15-25 pounds
110
recommended weight gain for obese women?
11-20 pounds
111
What foods to avoid while pregnant?
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
how many more calories do pregnant people need a day?
300 (last trimester)
113
how many more calories a day do nursing women need?
500
114
what is the recommendation for folic acid?
400mcg per day pre pregnancy; 800-1000mcg per day when pregnant
115
what is the intracellular parasite the causes chlamydia?
chlamydia trachomatis
116
what 2 vaccines can you get while pregnant?
flu and TDaP
117
What does the assessment of fetal well-being biophysical profile look at
-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
what are the components of the biophysical profile?
fetal movement
fetal tone
fetal breathing movement
amniotic fluid volume
non stress test
(each category is worth 2 points)
119
definition of fetal movement in regards to BPP
3 body or limb movements
120
definition of fetal tone in regards to BPP
1 episode of active extension&flexion of the limbs; opening and closing of hand
121
definition of fetal breathing movement in regards to BPP
episode of >or = 30 seconds in 30 minutes; hiccups are considered breathing activity
122
definition of amniotic fluid volume in regards to BPP
single 2 cm X 2cm pocket is considered adequate
123
definition of non stress test in regards to BPP
2 accelerations > 15 bpm of at least 15 sec durations
124
what is a normal BPP score?
8/10
125
what is a suspicious BPP score?
6 or below
126
What is the most reported STI in the US that is also the most common cause of infertility worldwide?
chlamydia
127
chlamydia may be....?
asymptomatic
128
major sx of chlamydia?
men- urethritis; women- cervicitis, PID, ectopic pregnancy, urinary frequency, dysuria, spotting, vulvar itching, gray-white discharge
129
can chlamydia be passed from mother to newborn during birth?
yes
130
rx tx for chlamydia?
doxycycline (cat x) or azithromycin
131
gonorrhea is caused by what bacteria?
neisseria gonorrhea
132
gonorrhea infects what?
the mucous membranes of the reproductive tract, mouth, throat, eyes, and rectum
133
can gonorrhea be transmitted at birth?
yes, in the form of ophthalmia neonatorum (newborns treated with prophylactic erythryomycin within one hour of birth)
134
When should pregnant women be screened for gonorrhea?
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
what is tx for gonorrhea?
azithryomycin and ceftriaxone (dual therapy)
136
what is HSV-1?
cold sores on lips, eyes, and face
137
what is HSV-2?
genital herpes
138
is there a cure for HSV?
no
139
tx for genital herpes?
anti-virals for acute phase or daily for tx of suppression
140
can mom have vaginal birth with an active herpes outbreak at time of delivery?
no- C section only
141
what is prescribed to pregnant women at 36 weeks with herpes?
acyclovir as suppression therapy to prevent outbreak
142
how many stages of syphilis?
3- primary, secondary, and tertiary
143
syphilis is caused by what?
treponema pallidum
144
every women is screened for syphilis at first prenatal visit because...?
syphilis can kill developing baby
145
what does primary syphilis look like?
single chancre at site of infection that lasts 1-6 weeks
146
what is secondary syphilis?
appears 2 to 6 months after initial exposure and lasts about 2 years;
flu like sx, maculopapular rash on trunk, palms, and soles
147
what is the latency stage of syphilis?
begins after second stage has ended and can last as long as 20 years, no sx but serology tests will be positive
148
what is tertiary syphilis?
life threatening- heart disease and neuro disease that slowly destroy heart, eyes, brain, CNS, skin (gummas)
149
what are gummatas?
growths of pink, fleshy tissue that contain syphilis bacteria; may appear as nodules or ulcers or become masses that are like tumors
150
common sites for gummatas?
skin, mucous membranes, bones, eyes, resp. system, GI system
151
tx of syphilis?
benzathine penicillin G intramuscularly
152
what is congenital syphilis?
passed to the newborn which can lead to spontaneous abortion, low birth weight, fetal growth restriction, prematurity, stillbirth, multisystem failure, mental retardation
153
what is the cause of essentially all cases of cervical, vulvar, vaginal, penile, anal, oropharyngeal cancers?
HPV
154
genital warts are caused by which types of HPV?
6 and 11
155
HPV prevention?
gardasil vaccine
156
what is a non stress test
-indirect measurement of uteroplacental function
-observe for signs of fetal activity w/ a concurrent acceleration of the fetal heart rate
157
what does reactive mean in regards to a non stress test
at least 2 accelerations above baseline of at least 15 bpm for 15 sec in 20 min
158
when it comes to kick counting how much do you count
until you feel up to 10 kicks within a 2 hour time period
159
when is kick counting most often used?
high risk pregnancies
160
what is a contraction stress test?
A noninvasive test that measures fetal heart rate in response to uterine contractions
161
what should happen to an uncompromised fetus during a contraction stress test?
no deceleration of the fetal heart rate during the period of the contraction even though the contraction represents a period of reduced oxygenation
163
in utero, who is more likely to be affected by teratogens?
females
164
what is gestational trophoblastic disease?
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
What is a complete mole (GTD)?
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
manifestations of complete mole?
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
what do you do after a complete mole?
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
what is a partial mole?
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
risk factors for GTD?
previous molar pregnancy, age older than 35 or younger than 20, southeast asian ethnicity, carotene deficiency
170
tx for GTD?
D&C, emotional support, education regarding risk of cancer and strict follow up program, avoid pregnancy for 1 year, rhogam may be needed
171
what is cervical insufficiency?
a condition that occurs when weak cervical tissue causes or contributes to premature birth or the loss of an otherwise healthy pregnancy
172
tx for cervical insufficiency?
progesterone, cerclage placement prior to rupture of membranes, bed rest
173
risk factors for cervical insufficiency?
cervical trauma for surgery, congenital defect or trauma from previous birth, hx of second trimester birth
174
assessment for cervical insufficiency?
painless bleeding, gush or dribbles of fluid (amniotic), contractions
175
when is cerclage removed?
36 weeks
176
what is placenta previa?
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
what is important to remember with previa?
NO cervical exams
178
risk factors for placenta previa?
previous placenta previa, uterine scarring from surgery or infection, advanced maternal age, multifetal gestation, closely spaced pregnancies, smoking
179
manifestations of placenta previa?
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
Nifedipine use
used to reduce high blood pressure, and relax uterine contractions and postpone a preterm birth.
181
betamethosone use
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
nursing interventions for previa?
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
What is placental abruption?
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
risk factors for placental abruption?
maternal HTN, blunt force trauma, cocaine use, smoking, folate deficiency, premature rupture of membranes, multifetal gestation
185
What is preterm labor?
regular contractions of uterus resulting in cervical changes that start before 37 weeks of pregnancy (between 20 and 36)
186
s/s of preterm labor?
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
s/s of preterm labor?
change in vaginal discharge, increase in discharge amount, pelvic or lower abdominal pressure, constant low dull back pain
188
indomethacin use
often prescribed to pregnant women presenting with preterm labor or shortened cervix, which places them at risk for preterm labor and delivery. helps
189
how is preterm labor diagnosed?
pelvic exam, vaginal culture, contraction monitoring, transvaginal ultrasound to measure cervix length, biophysical profile or nonstress test to determine fetal well being
190
what protein is linked to preterm birth?
fetal fibronectin
191
nursing care for preterm labor?
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
when do you give betamethasone and why?
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
what is hyperemesis gravidarum
excessive n/v, dehydration, electrolyte imbalance, nutritional deficiencies, reduced delivery of blood o2 and nutrients to the fetus
194
group B strep
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
testing for rubella
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
should rubella vaccine be given during pregnancy?
NO. It should be given a month or more before pregnancy if a pregnant person didn't get the vaccine as a child.
197
what is terbutaline?
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
What is magnesium sulfate?
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
what do you monitor for with magnesium sulfate?
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
antidote for magnesium sulfate?
calcium gluconate or calcium chloride
201
first line tx for gestational diabetes?
insulin- short acting/ short acting with intermediate acting insulin; insulin does not cross placenta
202
medication for eclampsia?
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
medication for pre-eclampsia/ gestational HTN?
methyldopa (aldomet); nifedipine (procardia); hydralazine (apresoline); labetalol (trandate)
204
why is iron important?
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
HELLP syndrome
hypertension in pregnancy as well as Hemolysis, Elevated Liver enzymes, Low Platelets
206
Difference between pre-eclampsia and eclampsia
Eclampsia has seizures
207
risk factors for hyperemesis gravidarum
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
what are assessment findings of hyperemesis gravidarum
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
what meds are used to treat hyperemesis gravidarum
-pyridoxine
-antiemetics
-corticosteroids
-may require enteral feeding via tube feeding or tpn
210
in true gestational diabetes when does glucose usually return to normal
by 6 weeks postpartum
211
what is gestational diabetes
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
maternal effects of gestational diabetes mellitus
spontaneous abortion, gestational hypertension, preeclampsia, preterm labor and PROM, hydramnios, vaginitis, uti, ketoacidosis,c section, and postpartum hemorrhage
213
fetal and neonatal effects of gestational diabetes mellitus
congenital abnormalities, macrosmia, IUGR, birth injury, delayed lung maturation, neonatal hypo/hyperglycemia, hyperbilirubinemia polycythemia, perinatal death
214
when is the glucose tolerance test done
24-28 weeks gestation
215
gestational hypertension
BP is 140/90 in normotensive woman after 20 weeks gestation on two occasions and without proteinuria
216
when does bp return to normal after gestational hypertension
12 weeks postpartum
217
severe preeclampsia consists of bp greater than what?
160/110 along with more severe symptoms
218
what does HELLP syndrome stand for
hemolysis, elevated liver enzymes, low platelets
219
risk factors for gestational hypertension
-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
what manifestations are seen with preeclampsia
-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
what is eclampsia
severe preeclampsia manifestations with the onset of siezure activity
222
manifestations of severe preeclampsia
-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
what is the cure for gestational diabetes
birth
224
what is the deep tendon reflex rating scale for preeclampsia/eclampsia assessment
4+ hyperactive, very brisk, clonic response abnormal
3+ brisker than average
2+ average response, normal
1+ diminished response, low normal
0 no response
225
what do you monitor for with magnesium sulfate?
BP, HR, RR, deep tendon relfexes, LOC, urinary output (foley); presence of headache, visual disturbances, epigastric pain, uterine contractions, FHR an acitivity
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what is spontaneous abortion?
nonintentional
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what is threatened abortion?
cramping with light spotting; cervix is closed and no fetal tissue is passed
228
what is inevitable abortion?
increased bleeding and cramping and the cervix dilates leading to eventual miscarriage
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what is incomplete abortion?
spontaneous abortion where some of the tissue is not expelled
230
what is complete abortion?
passage of all products of conception; cervix closes; bleeding stops
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what is missed abortion?
fetus dies in utero but is not expelled; sepsis can occur
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what is recurrent abortion?
two or more consecutive spontaneous abortions usually caused by incompetent cervix or inadequate progesterone levels
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therapeutic vs elective induced abortions?
therapeutic is intentional termination to preserve mothers health and elective is intentional for reasons other than mothers health
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risk factors for spontaneous abortion?
chromosomal abnormalities, maternal illness, advanced maternal age, maternal infection, trauma, anomalies of fetus, substance abuse, antiphospholipid syndrome
235
plan of care for spontaneous abortion in first trimester?
watchful waiting, D&C, misoprostol
236
plan of care for spontaneous abortion in second trimester?
bedrest if pregnancy is viable, initiate labor if membranes ruptured, surgery if moms life in danger
237
plan of care for spontaneous abortion in third trimester?
bedrest if pregnancy not in immediate danger, delivery with newborn resuscitation and NICU stay or delivery with grief and loss care
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what is an ectopic pregnancy?
abnormal implantation of fertilized ovum outside the uterine cavity, usually the fallopian tube
239
risks for ectopic pregnancy?
history of STI, history of PID, tubal surgery or previous ectopic, IUD
240
tx for ectopic pregnancy?
no action; tx with methotrexate IM to inhibit cell division; or surgery to removal pregnancy from tube by either saving or removing tube
241
s/s of ectopic pregnancy?
abdominal pain (unilateral), spotting at 6-8 weeks, faintness, dizziness
242
Physiological changes in pregnancy:
Gastrointestinal
• 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
Physiological changes in pregnancy:
Musculoskeletal
• Changes in gait and posture
• Relaxation of joints under
the influence of
progesterone and relaxin
• Postural changes in
pregnancy (lordosis)
244
Physiological changes in pregnancy:
Skin
• 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
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Physiological changes in pregnancy:
Endocrine
• 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
when can Rh incompatibility occur
ONLY if the woman is Rh neg and the fetus is Rh pos
247
Rh positive blood is a _____ trait
dominant
248
Rh negative blood is a ____trait
recessive
249
what can decrease absorption of folate from meals
anticonvulsants, oral contraceptives, sulfa drugs, and alcohol
250
what do you advance to if oral iron does not work
liquid iron
251
lack of folic acid may result in
spina bifida
252
do not take antacids with
iron
253
do not take iron supplements at the same time as
drinking milk
254
who is more than twice as likely to develop gestational hypertension
women with multiple fetus
255
what are the TORCH viruses
Toxoplasmosis
Other (syphillis, varicella-zoster, Zika)
Rubella
Cytomegalovirus
Herpes
256
what is toxoplasmosis
-a parasite acquired by contact with cat feces or raw meat
-transmitted through placenta
257
congenital toxoplasmosis includes the following possible signs
-low birth weight
-enlarged liver and spleen
-jaundice
-anemia
-inflammation of eye structures
-neurological damage
258
what is the treatment for toxoplasmosis
therapeutic abortion
259
how can rubella effect a developing fetus
early in pregnancy- disrupt formation of major body systems
later in pregnancy- damage to already formed organs
260
why cant you receive a rubella vaccine while pregnant
its a live virus
261
how long should a woman wait to get pregnant after receiving a rubella vaccine
at least3 months
262
what are rubellas effects on embryo or fetus
microcephaly
mental retardation
congenital cataracts
deafness
cardiac effects
IUGR
263
what has prenatal zika virus lead to?
linked to adverse pregnancy and birth outcomes, most notably microcephaly and other serious brain abnormalities
264
CDC guidelines for Zika?
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
infected infants with cytomegalovirus may have what?
mental retardation, seizures, blindness, deafness, dental abnormalities, petechiae
266
tx for cytomegalovirus?
no effective tx is known, therapeutic abortion may be offered if CMV infection is discovered early in pregnancy
267
initial herpes infection during first half of pregnancy can cause what?
spontaneous abortion, IUGR, and preterm labor
268
how can infants be infected with herpes?
virus ascends into the uterus after membrane rupture or infant has direct contact with lesions during vaginal delivery
