Test #1 - Prenatal Factors Flashcards
What is defined as the premature separation of the placenta from the uterus. typically present with bleeding, uterine contractions, and fetal distress?
Abruption Placentae
What is an abnormal absence of menstruation?
Amenorrhea
What is painful menstruation, typically involving abdominal cramps?
Dysmenorrhead
What is difficult or painful sexual intercourse?
Dyspareunia
What is the failure to conceive following twelve months of unprotected intercourse?
Infertility
What refers to the poor growth of a baby while in the mother’s womb during pregnancy. Specifically, it means the developing baby weighs less than 90% of other babies at the same gestational age?
Intra-uterine growth retardation (IUGR)
What are birth defects of the brain, spine, or spinal cord. They happen in the first month of pregnancy, often before a woman even knows that she is pregnant. The two most common defects are spina bifida and anencephaly. In spina bifida, the fetal spinal column doesn’t close completely?
Neural Tube Defects
What is an agent or factor that causes malformation of an embryo?
Teratogens
What are some forms of birth controls?
Abstinence
Natural:
Sympothermal Method, Interruptus
Barrier Methods:
Condoms, Diaphragms, Cervical Caps
Medical:
Oral contraceptives, Vaginal Rings, Patches, Injectsions, Implants Intrauterine devices
Sterilization:
Bilateral tubal ligation, Vasectomy
When is infertility diagnosed?
After 12 months of unprotected sex
What days of the cycle are women most fertile?
11-21
What are some signs of ovulation to teach someone being assessed for infertility?
Wet Slippery Discharge
Higher basal temp
How does a female get checked for infertility?
Thyroid
Diabetes check
Hormonal SA’s
Ultrasounds
Profilactin
Hysterosalpingography
-Dye is injected and goes to uterus and fallopian tubes and shows any physical abnormalities
What are some factors of Infertility?
Waiting til later in life
Prolonged use of BC
Diet
How do we check male/female for infertility? Who is checked first?
Women checked 1st
Then Male
What are some treatment options for infertility?
Medications
Surgical
- May be useful in correcting obstructions
- Therapeutic Insemination
- Invitro Fertilization
Psychological Factors
- Ineffective coping, distress, self-esteem
Why is Folic Acid needed?
To Make DNA/RNA
What are some risks of being Folic Acid Deficiency?
Neural Tube Defects
Spina Bifida
Anencephaly
Meningocele
What foods can you get folic acid from?
Enriched Cereals
Pasta
Bread
Fresh Green leafy veggies
Red and Organ Meats
fish
Poultry
What are some Teratogens that can effect the baby during pregnancy?
Pesticides/Chemicals- work hazards
Radiation = x-rays, radioactive iodine, spills
Infections= Rubella, Syphilis, HSV 2, Toxoplasmosis, Cytomegalovirus
Altitude- women who live in higher altitudes may have increased risk of SGA babies
Medications- Most likely OTC meds.
These can be just as dangerous as scripts. May take teratogenic medication before realizes she is pregnant.
• Greatest risk for gross abnormalities in 1st trimester due to fetal organs developing
What are the FDA drug classifications?
A-Very few drugs in this category
B - Penicillin’s fall into this category
C -Many drugs fall into this category
D -But benefits in certain situations outweigh the risks to fetus
Ex. Tetracycline, Lithium
X -Accutane= acne medication which causes many CNS, facial, and cardiovascular anomalies
“If the mother takes a drug in the D or X category she should be informed of the risks with the drug and also be informed of her alternatives.
A mother taking drugs in other safer categories may need reassurance.
Teratogenic effects most crucial in first trimester However they can also occur in the 2nd andjrd.
What are some caffeine consideration and what does it do during pregnancy?
Caffeine
Decreases iron absorption, predisposing to anemia
No significant data links consumption to birth defects however, heavy consumption (>300 mg/day) has been linked to lowered birth weight
Caffeine intake of >6oo mg/day linked to IUGR, Spontaneous abortion, Increased incidence of cleft palate, and other anomalies are suspected
Constant motion in newborn can often be assessed
What are some things that cigarette smoke does during pregnancy?
Cigarette smoke = cyanide gas.
Decreases amount of O2 consumed by mother
Dec. maternal appetite = poor nutrition
Increase risk of abortion, abruptio placentae, preterm labor, and intrauterine growth retardation (IUGR).
Avoid secondary smoke.
Increased risk of SIDS
Increased risk of resp. illness and chronic resp. disease to newborn
What does alcohol do during pregnancy?
Ethanol passes freely through the placenta
Incidence- Highest in ages 20-40 and teenagers
Effect on fetus in each trimester- 1st alters embryonic development. 2nd effects cell division and growth (all) 3rd CNS development altered growth retardation
C. FETAL ALCOHOL SYNDROME- Incidence in 1-2 live births/1000
- Mental retardation, microcephaly, hyperactivity
- Decreased weight, length, head circumference, persistent postnatal growth deficiency, head circumference and linear growth most effected
- Epicanthal folds, broad nasal bridge, short upturned beaklike nose, abnormally small lower jaw, thin upper lip
- Heart, septal and valvular defects, eyes, kidneys, skeletal system especially joints
What does cocaine do to the mother and the fetus?
Affects on mother
AMI’s
Cardiac arrhythmias
Seizures
CVA’s
Sudden death
Affects on fetus
First trimester abortion
Abruptio placentae
Stillbirth
PROM- premature rupture of membranes & premature birth
Low birth weight
Extreme irritability or depression
Increased risk of SIDS
Anomalies- heart & kidney defects, CNS, and limb reduction
Learning disabilities as a child
What are some nursing diagnosis for mother with cocaine use?
Alteration in nutrition
Injury, high risk for
Ineffective family coping
Altered fluid status
Alteration in parenting
Assessment- Patients last drug intake, if intake was close to labor. Increase dose= Increase effect on newborn. This assessment can indicate what effects neonate will exhibit.
Plan- Treatment, psychological support, and interventions to correct health problems.
What are some symptoms of a newborn where the mother did cocaine?
Exaggerated mouthing behaviors (rooting, nonnutritive sucking),
Abdominal distention
Sleeplessness, Excessive arousal states, & Inconsolable crying, Irritable Abnormal reflexes-startle, gag
Hyperactivity with little ability to maintain alertness and attentiveness to environment
Jittery throughout first month of life but may last longer Dependence is physiologic NOT psychologic in the infant
What are some interventions for a baby born from a cocaine mom?
Dimly lit
Cluster care, provide care on infants schedule
avoid overstimulation, calmness imperative to effectiveness of interventions
feeding techniques, comforting measures, recognize newborn cues, appropriate parenting responses
parents can anticipate mild jitteriness and irritability in the newborn persistent up to 8-16 weeks
The nurse should follow up on missed appointments. This can bring parents back into the health care system, which improves overall outcomes
What is PID?
Pelvic Inflammatory Disease (PID)
PATHOPHYSIOLOGY
Infection involving the lining of the uterus, the fallopian tubes(salpingitis), ortheovaries(oophoritis).
The same organisms responsible for bacterial STD’s (such as chlamydia, gonorrhea, staph, strep) cause 90-95% of all cases of PID.
What are some complications of PID?
Pelvic Abscess or generallized peritonitis
Thrombophlebitis
Inc risk for ectopic pregnancy
Infertility risks also increase
How do you prevent PID?
Following safer sex behaviors. Yearly PAP smear.
Following the PCP’s recommendations after gynecological events or procedures
Getting prompt treatment for sexually transmitted diseases
Do not forget the treatment of sexual partners.
what are some assessments of PID?
- Vaginal discharge- abnormal odor, color, or consistency.
- Irregular menstraul bleeding or spotting
- Increased menstraul cramping, lower back pain
- Amenorrhea
- Increased pain during ovulation
- Dyspareunia
- Bleeding after intercourse
- Fever/ Chills /Fatigue/ N/V
What are some diagnostics/labs for PID?
- Abdominal Pain
- WBC , ESR (sed rate)
- A wet prep or wet mount microscopic examination.
- Serum HCG
- C&S -endocervical culture for all organisms
- A laparoscopy may be indicated
What are some nursing care items for PID?
Goal: To prevent the spread and extension of the infection.
Bed rest
Medical asepsis
Provide frequent perineal care
Provide psychological support
• Encourage expression of feelings
Explain factors related to long term management
What are some medications and teachings for PID?
Antibiotics= aimed at removing or destroying the causative organism.
Analgesics
Surgical Treatment-if pharmacologic treatment is not effective
• Teach-
Discuss general hygiene and sexual measures to help prevent new infections.
Emphasize importance of prevention to decrease chances or chronic PID.
What is Cystocele and assessments?
A hernia-like disorder in women that occurs when the wall between the bladder and the vagina weakens, causing the bladder to drop or sag into the vagina.
Assessments:
Stress incontinence, chronic UTI’s
What is Rectocele and assessments?
A bulge of the front wall of the rectum into the vagina.
Assessment findings:
Feeling of heaviness in bowel and bladder, backache.
What are some risk factors for Cystocele and Rectocele?
Obesity
Chronic coughing
Constipation or straining to defecate
Heavy lifting or abdominal straining
Multiple pregnancies-Childbirth
What is some diagnostics for Cystocele/Rectocele?
Bimanual pelvic examination
Incontinence, UTI’s, and urinary retention
Client with may complain of vaginal pressure with or without discomfort.
What is a treatment for Cystocele?
Pessary- pelvic support device or incontinence pessary can help correct a “fallen” bladder, uterus, and urethra by adding support. A doughnut shaped device made of silicone. The pessary is inserted into the vagina and rests against the cervix, similar to a diaphragm used in birth control.
What is a treatment when you have Cystocele and Rectocele?
A&P REPAIR
Anterior vaginal wall repair for surgical treatment of urinary incontinence
Women with this procedure have approx 60% rate of success in relieving symptoms.
Posterior repair corrects rectocele.
A&P- involves both procedures at the same time.
What are some interventions/teachings for cystocele/rectocele surgery?
Ensure client understanding of surgery
Prevent wound infection
Prevent pressure on suture
Instruct importance of perineal cleanliness
Avoid activities that cause straining
Tighten pelvic muscles when coughing/sneezing to support the bladder.
Bowel & Bladder habits
What is Endometriosis?
Occurs when tissue that lines the inside of the uterus grows outside the uterus, usually on the surfaces of organs in the pelvic and abdominal areas.
The tissue growth typically occurs in the pelvic area on the ovaries, bowel, rectum, bladder, and the delicate lining of the pelvis.
The tissue responds to hormonal stimulation by bleeding into
What is the Etiology of Endometriosis?
Unknown etiology
One theory suggests that part of the endometrial tissue flows backwards during menstrual flow into the fallopian tubes and abdomen where it attaches and grows.
Another states that either a presence or absence of unknown substances may stimulate the growth of endometriosis from multi-potential cells.
One final theory is that endometrial tissue may travel to areas outside the uterus through blood vessels or the lymph system.
What are some assessments of Endometriosis?
Dysmenorrhea
Extremely painful menstrual cramps; pain may get worse over time.
Chronic pelvic pain (includes lower back pain)
Pain during or after sex
Intestinal pain
Painful BM’s or painful urination during menstrual periods
Heavy menstrual periods and Infertility
What are some diagnostics of Endometriosis?
Culdoscopy- endoscopic examination, can only look
• Laparoscopy-To remove the diseased tissue
What are some meds and treatment for endometriosis?
NSAIDS
Birth control- Depo-Prevera, Micronor
Danocrine (Danazol) - a synthetic androgen
Gonadotropin- releasing hormone (GNRH) agonist (Lupron)
Surgical:
Panhysterectomy- removal of the uterus, cervix, fallopian tubes, and ovaries and is often referred to as a total abdominal hysterectomy with bilateral salpingoectomy, and oophorectomy (TAH-BSO).
What are some teachings about Endometriosis?
Teach client about disease process.
Assist client to understand the implication of the disease process and measures to maintain health.
Provide emotional reassurance
Initial pre & post op teaching
Hormone replacement therapy **
