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202A > Test #1 Wks 1 and part of 2 > Flashcards

Test #1 Wks 1 and part of 2 Flashcards

1
Q

What are the 3 P’s of labor

A 
Passageway
passenger
powers
position
psyche
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2
Q

What is the purpose of the amniotic fluid

A

Protection- cushions the fetus
temp control- acts as insulation
facilitates movement & growth-

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3
Q

what facilitates the volume change of the amniotic fluid

A

the baby swallow it so the amount lessens

The baby urinates & fluid from the maternal blood crosses the placenta thus the amount increases

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4
Q

How much amniotic fluid is there at term

A

1 L on average

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5
Q

what would cause too much fluid in the amniotic sac

A

the fetus may not be swallowing thus revealing a possible GI problem or malformations of the gi tract, neural tube defects,
maternal problems such as maternal diabetes can lead to polyhydraminios

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6
Q

what are 1st trimester discomforts

A
  • urinary frequency/ incontinence- increased fetus growth pressing on bladder
  • fatigue d/t physical changes
  • N&V- d/t possible increase in estrogen progesterone and hcg
  • Breast tenderness- d/t increased estrogen and progesterone
  • constipation- d/t increased progesterone(decreases gi contractility)
  • nasal stuffiness, bleeding gums, epistaxis- increased estrogen causing edema
  • cravings
  • leukorrhea
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7
Q

what is the amnion and the chorion

A

the amnion is the inner layer of the amniotic sac that holds the amniotic fluid
the chorion is the outer sac next to the uterine wall

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8
Q

what can be the cause of oligohydramnios

A

fluid retention in the fetus- can indicate renal problems.
also
uterus placental insufficiency (the placenta is not doing its job-inadequate blood flow through the placental spacing not allowing enough nutrition to the fetus)

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9
Q

complications of oligohydramnios

A

low birth weight, increases risk for c-section which can cause fetal distress

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10
Q

complications of polyhydramnios

A

excess pressure which can lead to premature rupture of the amniotic sac increasing the risk for infection
complications, c-sections, low birth rate, premature baby

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11
Q

what is Whartons jelly

A

a specialized connective tissue surrounding the 2 arteries and vein to prevent compression.

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12
Q

after the umbilical cord is cut what should you check for

A

always check for the 3 vessels.

a lack of artery can be associated with fetal renal or GI issues.

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13
Q

what is the average length of the umbilical cord at term

A

22 inches

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14
Q

purpose of the placenta

A

fetal gas exchange
nutrition
excretion,
hormone production

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15
Q

once the placenta is delivered what needs to be checked and why

A

you need to check if the placenta is in tact. If there is a piece of the placenta left inside the mother it can cause a hemorrhage

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16
Q

what are the 3 fetal shunts

A
  • Ductus venosus- connects the umbilical vein to the inferior vena cava. allows blood to bypass the liver except for the amount to nourish the tissues
  • Ductus arteriosus- connects the main pulmonary artery to the aorta- allows blood to bypass the lungs
  • Foramen Ovale- opening btw rt and lt atrium- blood coming into rt side of heart already oxygenated thus blood bypasses lungs going to lt atrium to lt ventricle
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17
Q

what is angels rule

A

estimating the date of delivery
subtract 3 months to LMP and add 7 days
so if a woman LMP was 1-20-17 her due date would be
10-27-17

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18
Q

what are ways to estimate due date

A

Nageles rule
measure the fundal height
ultrasound

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19
Q

what are presumptive signs of pregnancy

A

subjective signs & symptoms:

amenorrhea, n&v, fatigue, urinary frequency, breast changes, quickening (baby moving)

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20
Q

what are probable signs of pregnancy

A

Objective signs noticed by the examiner:
Hegars sign- softening of the uterine segment
Chadwicks sign-bluish color of the vaginal mucosa
Goodells sign-“good and soft” softening of the cervix
Braxton hicks ctonractions
positive pregnancy test
abdominal enlargement

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21
Q

how early can hcg levels be detected

A

1 week after conception

hcg levels in normal pregnancy usually double every 48-72 hours until they peak approx 60-70 days after fertilization.

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22
Q

Positive signs of pregnancy

A

HEAR the baby- auscultate heart beat
SEE the baby- u/s
FEEL the baby- palpate fetal movement

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23
Q

how long is the uterus in the pelvic cavity before ascending into the abdominal cavity

A

the uterus is in the pelvic cavity for the first 3 months and then ascends into abdominal cavity

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24
Q

If a patient has increased vaginal secretions should she be worried

A

no. vaginal mucosa thickens and connective tissue begins to loosen. this all results in an increase in a whitish vaginal discharge (leukorrhea) which is totally normal.
UNLESS it is accompanied by itching and irritation. this can be the result of vaginitis.

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25
Q

what hormones cause the breasts to become tender and enlarged

A

Progesterone and estrogen

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26
Q

how much does blood volume increase by wk 30 gestation

A

it increases 50%
related to fetal weight- the increase in blood volume is needed to provide adequate hydration of fetal and maternal tissues and to have a reserve for blood loss during birth.

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27
Q

what is the heart rate for a pregnant woman

A

the heart rate increases 10-15 bpm

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28
Q

why would BP drop for a pregnant woman

A

due to peripheral vasodilation caused by progesterone.

it decreases 5-10mmhg during the second trimester and returns to prepregnancy levels at 3rd trimester

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29
Q

as the uterus shifts upward towards the diaphragm what happens to the lungs

A

The lung housing gets smaller and the chest circumference widens to make room and allowing more space for deep breathing and increased tidal volume to compensate for the increased oxygen demands

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30
Q

what respiratory changes occur during pregnancy

A

maternal hyperventilation and hypocapnia(decreased co2 d/t rapid breathing) and her breathing becomes more diaphragmatic than abdominal

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31
Q

what is considered within normal limits of HCT and HgB

A 
HCT= greater than or equal to 35
HgB = greater than or equal to 10
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32
Q

what is the cause of physiologic anemia of pregnancy

A

there is a plasma increase d/t the hormonal factors and sodium and water retention and because this plasma increase exceeds the increase of RBCs HgB and HCT decrease from hemodilution

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33
Q

what is round ligament pain

A

an intense grabbing sensation in the abdomen. the ligaments supporting the uterus are being pulled as the uterus grows

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34
Q

what can you advise a pregnant woman to do to minimize morning sickness

A

encourage woman to stay hydrated, avoid bad smells, eat smaller meals, take ginger and drink carbonated beverages

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35
Q

why do pregnant women get heartburn

A

d/t the increased smooth muscle relaxation from the progesterone and relaxin. This causes a relaxation of the pyloric sphincter resulting in acid reflux

36
Q

what can you teach a woman on how to relieve heartburn

A

chew papaya enzymes prior to eating a meal.

37
Q

What are changed in renal structure caused from

A
  • Estrogen and progesterone
  • Pressure from an enlarging uterus
  • Increase in maternal blood volume
38
Q

What happens to the GFR during pregnancy

A

It increases in the second trimester d/t the increases cardiac output and the relaxin

39
Q

What is a complication from the renal pelvis and ureters relaxing

A

Urine retention and UTIs which can increase the chance of preterm labor

40
Q

What position will better help urine flow in a pregnant woman

A

A side lying position because it takes pressure off of the vena cava and allows better blood flow through

41
Q

What are the hormones in pregnancy

A 
HCG
Human placental lactogen
Estrogen 
Progesterone
Relaxin
Prolactin
Oxytocin 
Cortisol
42
Q

What does HPL do

Human placental lactogen

A

Released by the placenta, promotes lipolysis so it can be used by the mother for energy
Also acts as an insulin antagonist this having an increase in glucose in the bloodstream. This will allow the baby to have enough energy to grow

43
Q

What is estrogen responsible for

A

Increased vascularity as well as the relaxation of ligaments and joints. Especially the pelvis

44
Q

What is progesterone responsible for

A

Facilitates fat deposits to act as energy packs for the mother for lipolysis
Also decreases uterine contractility

45
Q

What is prolactin for

A

Initial lactation.
Estrogen and progesterone suppress the action until after placenta is detached and those levels drop. Then prolactin can begin to work

46
Q

What is cortisol used for

A

Stimulates increased insulin production by the pancreas.

47
Q

If you are traveling what precautions should you take

A

Walk q2h
Wear lap belt under abdomen
Drink plenty of fluids

48
Q

What can happen if mothers weight gain gets too high

A

She had an increase risk of high birth weight baby and ceohalopelvic disproportion this risking inhibition of vaginal birth

49
Q

What can happen if the mother doesn’t gain enough weight

A

Malnourishment and low birth weight baby

50
Q

What are nutritional needs influenced by

A

Pre pregnancy weight and age

Teens need more calories because they are still growing themselves

51
Q

What types of things need to be increased in a pregnant woman’s diet

A

-calories
-protein
-iron
-vitamin a and c
-folate
6-8 glasses of fluids per day

52
Q

What should a pregnant woman avoid eating

A

Fish at the top of the food chain such as shark,swordfish,ahi tuna, macral
And do not eat fish more than twice a week
Avoid raw or undercooked meats or fish
Avoid bacon, hot dogs and deli meats b/c of the risk of listeria
And unpasteurized cheeses such as blue Brie and feta

53
Q

What can vegans eat to get the nutrients they need

A

Protein: soy foods, beans, lentils, nuts, grains, seeds
Iron: meat alternatives and foods rich in vitamin c
Calcium: soy, calcium fortified OJ, tofu
Vitamin b12: fortified soy foods, b12 supplement

54
Q

What may pica indicate

A

An underlying health problem…Nutritional deficiency

Anemia

55
Q

Gravida
Parity
GTPAL

A 
Gravida is how many pregnancies
Para is how many births after 20 wks
Gravida 
Term-37-42 weeks delivered
Preterm-20-36 6/7 weeks delivered 
Abortion- pregnancy ending before 20 weeks
L- current # of living children
56
Q

How often are prenatal visits

A

First 28 weeks : q4weeks
28-36weeks; q2weeks
37 to birth: weekly

57
Q

What is the typical kick count protocol

A

10 movements in 2 hours

58
Q

When and how is AFP tested

A

At about 16-18 weeks

Done on maternal blood

59
Q

what do low AFP levels indicate

A

Down sydnrome

60
Q

what do increased AFP levels indicate

A

neural tube defects such as spina bifida

61
Q

what should you do if AFP is abnormal

A

repeat blood test
obtain a high level U/S
amniocentesis

62
Q

what are the indications for amniocentesis

A
  • assess for genetic defects in the 2nd trimester
  • assess for fetal lung maturity in the 3rd semester
  • check for uterine infection
  • monitor maternal Rh sensitization in Rh neg woman
63
Q

what is RhoGAM and why its given

A

a globulin- the antibody a woman would naturally make if they were sensitized
this causes the body to relax and stop making the Rh antibody. the body metabolizes the RhoGAM and excretes it.
its to ensure the woman does not become sensitized to the Rh antigen if she is Rh neg and the baby is Rh positive

64
Q

how long should the mother be monitored after an amniocentesis

A

20 minutes to ensure the procedure did not put her into early labor

65
Q

when is a NST a valid test

A

at or after 28 weeks

66
Q

what is a normal FHR

A

120-160 bpm

67
Q

what is the purpose of a NST

A

-to evaluate FHR in response to its movement
(it should increase 2 accelerations-15bpm)
and should stay accelerated for at least 15 seconds

68
Q

what could a non reactive NST be a result of

A

fetal acidosis or the fetal sleep cycle.

the test should be repeated

69
Q

what is the BPP

A

biophysical profile- done with real time ultrasound

-evaluates the NST, fetal breathing movements, fetal body movements, fetal tone and amniotic fluid volume`

70
Q

why is the BPP done

A 
for someone who had a non reactive NST. 
will score them as:
8-10- normal
6-equivicol- hospitalization or monitoring and repeat tests required
<4 further tests or delivery ASAP
71
Q

when does the anterior fontonale close

A

up to 18 months to close

72
Q

when does the posterior fontonale close

A

up to 6 weeks

73
Q

what are the fetal attitudes

A

the way the baby is sitting in the uterus

  • flexion-chin to chest
  • military-chin at 90 deg angle to chest
  • extension- chin tilting away from chest
  • hyperextension- face presentation
74
Q

what are the pelvis shapes

A

gynecoid- most favorable for birth
anthropoid
android
platypelloid

75
Q

when is the head said to be engaged

A

when it is at zero station

at the ischial spines

76
Q

what is floating

A

when engagement has not yet occurred and the fetus presenting part is freely moving above the pelvic inlet

77
Q

what can happen if you begin pushing while there is still cerivx left

A

the remaining cervix can become edematous and increase labor time.

78
Q

what are the primary and secondary forces of labor

A

primary- involuntary uterine contractions

secondary- voluntary use of abdominal muscles during second stage of labor

79
Q

what are contractions responsible for

A

thinning and dilating the cervix

thrusting the presenting part toward the lower uterine segment

80
Q

how are frequency of contractions monitored

A

the time from the ONSET of one to the ONSET of the next

81
Q

what will walking and changing position facilitate in labor

A

it affects the pelvic joints which can facilitate fetal descent and rotation

82
Q

what does squatting facilitate in labor

A

it enlarges the pelvic inlet and outlet diameters

83
Q

how do you know a woman is in labor

A
  • lightening- the baby moves down and it is easier to breathe but more pressure on bladder and LE edema w/ lower fundal height
  • bloody show
  • cervical ripening (goodells sign)
  • stronger braxton hix
  • energy burst(nesting)
  • spontaneous rupture of membrane(water breaks)
84
Q

how to tell if pt is having braxton hix

A

they are felt in the abdomen and groin
last about 30 seconds
relieved by walking, voiding, eating, increasing fluid
changing positions

85
Q

where are true labor contractions felt

A

in the lower back

202A (5 decks)

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