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Maternity nursing 231 > unit 1 > Flashcards

unit 1 Flashcards

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1
Q

ovarian cycle phases

A

follicular
ovulatory
luteal

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2
Q

follicular phase main hormone

A

estrogen (increases) and produces LH surge at the end: ovulation
usually 14 days (varies)

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3
Q

Ovulatory phase
mucus
S&S

A

cervical mucus: thin, watery and alkaline (helps sperm)
SPINBARKHEIT MUCUS
fertile for 24 hrs
midcycle pain/spotting

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4
Q

Luteal Phase

A

always 14 days (doesn’t vary)
old graafian follicle persists as corpus luteum. which secretes Estrogen and high progesterone to prep. uterus for implantation and preg.
Ovum fertilized-secretes HcG
not fertilized-estrogen and progesterone go down, endometrial lining falls and menses begins

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5
Q

Endometrial cycle phase

A

Proliferative (cells multiply and form tissue: follicular phase of other)
Secretory (begins with ovulation-lutel phase. endometriu, thickens)
Menstrual phase: at end of luteal phase. vasospasm/ischemia and necrosis if not fertilized.

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6
Q

Pelvic types

A

Gynecoid (great)
Anthropoid (ok. posterior position. cone head baby)
Platypelloid (narrow from side to side: poor)
Anthroid (heart. poor)

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7
Q

amnion/chorion membranes

A

inner/outer

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8
Q

amniotic fluid

A

Cushions
Maintains temperature
Allows movement
Prevents adherence

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9
Q

Olihydramnios/polyhydramnios

A

2000 ml

poor lung development/due to Gest.diabetes.multifetal

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10
Q

Placenta

sides

A

Maternal side: from Decidua (protects mother) basilis. ROUGH

Fetal side: from chorionic vili. SMOOTH

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11
Q

Placenta functions

A

-metabolic: produces glycogen, cholesterol, fatty acids.
-Transfer functions: Gas exchange by diffusion; nutrient transfer across placenta- glucose, electrolytes pass through placenta to nourish the baby; removal of wastes (urea, uric acid, carbon dioxide, billirubin)
-Transfer of Antibodies.
Want women in 9th week of pregnancy to be vaccinated against Pertussis → so baby will get pertussis antibody

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12
Q

Placental endocrine function

A 
secretes:
HCG (human chorionic gonadotropin)
Estrogen
Progesterone
Human Placental Lactogen
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13
Q

fertilization (conception)

A

ovum and sperm unite and form a zygote

baby’s sex is determined at that point

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14
Q

preembryonic period

A

first 14 days after conception

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15
Q

morula
1.outside cells (throphoblast)
2,Inside cells (blastocysts)

A

implants into the uterus: nidation (can cause spotting/bleeding a bit, woman thinks is period)

  1. chorion
  2. fetus and amnion
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16
Q

Ductus Venosus

A

Connects umbilical vein to the inferior vena cava.

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17
Q

Forman Ovale:

A

Opening b/w right & left atrium in heart.

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18
Q

Ductus Arteriosus

A

Connects pulmonary artery to the aorta

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19
Q

Decidua capsulais

A

covers the morula (outside of morula; the outer capsule)

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20
Q

Decidua basalis:

A

underneath/below the morula. Maternal portion of placenta develops from the decidua basalis.

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21
Q

Decidua vera :

A

the rest of the uterine cavity.

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22
Q

what do they measure with an ultrasound for age
1 trimester
2nd and 3rd

A
  1. Crown Rump (head to buttocks)
  2. Bi-Parietal diameter (head circumference)
    and femur leg length
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23
Q

First heart beat detectable

A

4-5 weeks with transvaginal sonogram/ultrasound

8-12 weeks with a doppler

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24
Q

uterine sizing

A 
bimanual exam one hand on vagina and the other one on uterus to feel for uterus
non preg: plum size
6 weeks: egg, pear
8 week: small orange
10 week: large orange
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25
Q

Presumptive signs of preg.

A 
Pt tells you
Amenorrhea
N/V
Urinary frequency
Breast and skin changes
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26
Q

Probable signs of preg.

A 
signs that examiner can detect
Chadwick's sign
Hegar's sign
Godell's sign
Ballotment
Uterine souffle
Fetus souffle
and enlargement
braxton hick contractions
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27
Q

Positive signs (definite)

A

auscultation of fetal heart sounds
fetal movements detected by examiner
visualization of the embryo or fetus

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28
Q

skin changes during pregnancy

A

increased pigmentation
linea nigra
strae gravidarum
thicker hair
chloasma (mask of pregnancy)
pruritus (due to gall bladder delayed emptying)
PUPPP (pruritic urticarial papules and plaques in pregnancy) itchy red bumps on abdomen. take oatmeal baths

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29
Q

Musculoskeletal changes

A

-increased relaxin and progesterone (ligaments more relaxed)
-duck-waddle gait (pubic symphysis widens)
-lumbar lordosis (no heels, do pelvic exercises) goes away
-paresthesias of extremities (put legs up)
-Diasis recti (pt laying down/supine, ask pt to lift shoulders up → may see abdominal muscles separate.)
leg cramps (calcium-phosphorus imbalance) teens
-Round ligament pain (put knees to chest, abd. support)
-varicosities (elevate legs, no constrictive clothing)
-fatigue

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30
Q

Reproductive system changes

A

-uterus: increases in size (20 weeks: at umbilicus). Hegar
-Cervix: chadwick, godell. mucus plug
-vagina: chadwick, leukorrhea (C&S,wear liner,no douching, hygiene)
braxton hick contractions: not in preterm labor, painless irregular.
-ovulation ceases
-breast enlarge, sensitive, montgomery glands, darker, colostrum

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31
Q

Cardiovascular system changes

A
  • heart pushed upward to left. increased muscle. abn sounds
  • blood volume increases: diluted blood (less clots)
  • HR Accelerates by 10-15 bpm
  • clotting factors increase (fibrinogen) (walk postpartum)
  • BP decreases 1st and 2nd trimester. Nrmal in 3rd
  • vena cava syndrome
  • physiological anemia and leukocytosis
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32
Q

Respiratory changes in preg

A
  • elevated diaphragm (thoracic breathing)
  • O2 consumption increases
  • dyspnea (goes away in 3rd trimester) sleep with pillows
  • rhinitis (due to estrogen) use cool air vaporizer
  • epistaxis (due to estrogen)
33
Q

GI changes in preg

A
  • N/V
  • Hyperemia (gingivitis, bleeding gums, epulis-hypertrophy of gums)
  • delayed gallbladder/stomach emptying
  • ptyalism (gum, decrease starch intake, mouthwash)
  • increased appetite
  • Pyrosis (dont overeat, dont lie down BC, Maalox)
  • constipation (due to iron, maalox, delayed emptying)
  • Hemorrhoids
34
Q

Urinary tract changes in preg

A
  • urinary frequency (first and 3rd trimester) empty q2h, increase fluids, do kegel exercises
  • more prone to UTI (C&S if urinary frequency)
  • increased GFR (leads to GLYCOSURIA, r/o diabetes first)
35
Q

Endocrine system changes

A
  • thyroid gland increases
  • cortisol and aldosterone hormones increase
  • pituitary gland increases
  • LH and FSH disappear almost (cause ovulation)
  • parathyroid hormone is normal (for calcium important)
36
Q

estrogen effects

A

by placenta

  • hyperpigmentation of skin
  • stimulates breasts and uterus to get bigger
37
Q

progesterone

A 
by corpus luteum and then placenta
VITAL!
Relaxes uterus
preparation of lactation
decrease in 9th month
38
Q

HPL hormone

A

human placental lactogen
anti-insuling
a lot in week 22

39
Q

HCG hormone

A

human chorionic gonadotropin
secreted by throphoblast to maintain corpus luteum
detectable in urine at 8 days after conception

40
Q

Relaxin hormone

A

by corpus luteum and then placenta
relaxes muscles, joints
softens the cervix
makes shoe size increases

41
Q

oxytocin hormone

A

produced by hypothalamus and released by ant. pituitary.
causes uterine contractions
let down reflex
low during preg, high during labor

42
Q

Prolactin hormones

A

10x greater in preen

milk production

43
Q

Prostaglandin

A

low prostaglandin levels: preeclampsia

starts labor

44
Q

Initial prenatal visit

Complete Health Hx

A 
Current pregnancy
Obstetric Hx
GYN Hx
Medical Hx
Surgical
Occupational
Religion/culture
meds
allergies
Substance and exposure
Nutrition 
immunization
Abuse
baby daddy's Hx
45
Q

Initial physical exam

A 
VS
Ht & Wt
Neck
Breast (self exam?)
Fundus
Reflexes (preeclampsia)
Pelvic exam
Rectal exam (hemorrhoids)
uterine size
46
Q

Initial lab work

A 
Antibody screen
Blood type/Rh factor
CBC (anemia)
hepatitis (TORCH PANNEL)
Rubella (not given in preg)
VDRL
Pap smear (Gon/Chlam)
PPD
Urinalysis (glucose and protein)
Iron (start in 2nd trimester unless hgb <11)
47
Q

Subsequent visits nursing care

A
  • Wt gain (25-35 lbs total if normal, 28-40 lbs if underweight, 15-25 if overweight, 11-20 lbs if morbidly obese) 2-5 lbs in first trimester, then 1 lbs a week
  • VS
  • Urinalysis (protein, urine, ketones, nitrates-UTI)
  • FHR
  • Rhogam (28 wks)
  • Blood test (glucose screening at 24-28 wks)
  • HIV and VDRL in 3rd trimester
  • sonogram
  • intimate partner violence
  • danger signs of pregnancy
  • preg education
  • 9th moth: pelvic exam, GBS culture, chlamydia, gn.
  • Pertussis vaccine at 26-36 weeks gestation
48
Q

Danger signs of preg

A 
vaginal bleeding
visual disturbances
fever
intractable vomiting
epigastric pain
fluid from vagina
49
Q

First Maneuver

A

facing the mom
palpate fundus
hard: babes head
soft: babys butt

50
Q

3rd maneuver

A

try to grab babys head at pubic symphysis
if you can grab it: not engaged
it not: engaged

51
Q

4th maneuver

A

tells you if baby is flexed or not.

52
Q

TORCH Pannel

A 
Toxoplasmosis 
Other (syphilis) 
Rubella
cytomegalovirus
Herpes
53
Q

Nuchal transulency

A

11 weeks
Down Syndrome
nuchal fold

54
Q

triple screen screening test

A

2nd trimester (16-20 weeks)
AFP
Estriol
HCG levels

55
Q

Quad screen screening test

A

Inhibin A added

56
Q

Down syndrome baby

A 
Fat on back of baby's neck
Low-set ears (below level of eyes)
Muscle hypotonia / hypotonic muscles = reduced/low muscle tone Only 1 crease in hand (normal = 3 creases)
Protruding tongue / thick tongue
Hyper reflexes / hyperreflexia
Short, stubby fingers
57
Q

CVS

A

10-13 weeks
need consent
tells you metabolic disorders, DNA problems, NT defects
NI: document FHR before and after
rest for 24 hrs after procedure
report any bleeding, small spotting is ok
3 hrs or 1 week

58
Q

Amniocentesis

A 
may feel abdominal cramping, pressure during procedure
monitor FHR and VS of mother
Resume activities in 24 hrs
Report bleeding, cramping
result 1 week
59
Q

NST

A

20-40 minutes
Reactive: 2 FHR accelerations 15 bpm for 15 secs in a 20 minute period
Nonreactive: no reactive in 40 minutes
NI;
-tell them to come the next day and repeat
-Do a BPP
-Eat or Vibroacoustic Stimulation

60
Q

BPP 5 parameters

A 
Fetal breathing
Fetal tone
Fetal movement
Amniotic fluid
NST
8-10 normal
6-repeat test or deliver
0-4 abnormal: deliver baby right there and then
61
Q

kick counts

A

10 kicks in 2 hours good

10 kicks in 5 minutes is ok, just stop counting

62
Q

16 weeks development

A

fetus can swallow, quickening

63
Q

24 weeks development

A

surfactant production starts

64
Q

26-28 weeks development

A

testes in scrotum. eyelids not fused

65
Q

32 weeks development

A

surfactant near mature level

66
Q

Fetal attitude

A 
relationship of fetal parts to one another
flexion
moderate flexion
moderate extension
extension
67
Q

Anterior Fontanelle (DIamond shaped)

A

18 months

68
Q

Posterior fontanelle (triangle shaped)

A

2 months

69
Q

Fetal lie

A

longitudinal

transverse

70
Q

Fetal position

A

cephalic position: occiput, chin, brown
Breech: complete, frank, footling
shoulder: complete, frank, footling

71
Q

Midline episiotomy

A 
minimal blood loss
little scarring 
less postop pain
more complications
can lacerate/tear to rectum
72
Q

Mediolateral episiotomy

A 
less complications
will not tear/lacerate into rectum
more painful
blood loss
more scarring
prone to have painful sex/intercouse
73
Q

FHR HEARD

A

3-4 weeks ultrasound transvaginal

8-12 Doppler

74
Q

12 weeks fetal development

A

Suck reflex
Lanugo
Sex distinguishable by sonogram

75
Q

16 weeks fetal development

A

Swallowing
Urination
Quickening

76
Q

18-20 weeks fetal development

A

Vernix

FHR by fetoscope

77
Q

24 weeks fetal development

A

Surfactant

Active fetus

78
Q

26-28 weeks fetal development

A

Testes go down

Eyelids no longer fused

79
Q

32 weeks fetal development

A

Surfactant mature

Maternity nursing 231 (5 decks)

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