unit 1 Flashcards
ovarian cycle phases
follicular
ovulatory
luteal
follicular phase main hormone
estrogen (increases) and produces LH surge at the end: ovulation
usually 14 days (varies)
Ovulatory phase
mucus
S&S
cervical mucus: thin, watery and alkaline (helps sperm)
SPINBARKHEIT MUCUS
fertile for 24 hrs
midcycle pain/spotting
Luteal Phase
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
Endometrial cycle phase
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.
Pelvic types
Gynecoid (great)
Anthropoid (ok. posterior position. cone head baby)
Platypelloid (narrow from side to side: poor)
Anthroid (heart. poor)
amnion/chorion membranes
inner/outer
amniotic fluid
Cushions
Maintains temperature
Allows movement
Prevents adherence
Olihydramnios/polyhydramnios
2000 ml
poor lung development/due to Gest.diabetes.multifetal
Placenta
sides
Maternal side: from Decidua (protects mother) basilis. ROUGH
Fetal side: from chorionic vili. SMOOTH
Placenta functions
-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
Placental endocrine function
secretes: HCG (human chorionic gonadotropin) Estrogen Progesterone Human Placental Lactogen
fertilization (conception)
ovum and sperm unite and form a zygote
baby’s sex is determined at that point
preembryonic period
first 14 days after conception
morula
1.outside cells (throphoblast)
2,Inside cells (blastocysts)
implants into the uterus: nidation (can cause spotting/bleeding a bit, woman thinks is period)
- chorion
- fetus and amnion
Ductus Venosus
Connects umbilical vein to the inferior vena cava.
Forman Ovale:
Opening b/w right & left atrium in heart.
Ductus Arteriosus
Connects pulmonary artery to the aorta
Decidua capsulais
covers the morula (outside of morula; the outer capsule)
Decidua basalis:
underneath/below the morula. Maternal portion of placenta develops from the decidua basalis.
Decidua vera :
the rest of the uterine cavity.
what do they measure with an ultrasound for age
1 trimester
2nd and 3rd
- Crown Rump (head to buttocks)
- Bi-Parietal diameter (head circumference)
and femur leg length
First heart beat detectable
4-5 weeks with transvaginal sonogram/ultrasound
8-12 weeks with a doppler
uterine sizing
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
Presumptive signs of preg.
Pt tells you Amenorrhea N/V Urinary frequency Breast and skin changes
Probable signs of preg.
signs that examiner can detect Chadwick's sign Hegar's sign Godell's sign Ballotment Uterine souffle Fetus souffle and enlargement braxton hick contractions
Positive signs (definite)
auscultation of fetal heart sounds
fetal movements detected by examiner
visualization of the embryo or fetus
skin changes during pregnancy
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
Musculoskeletal changes
-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
Reproductive system changes
-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
Cardiovascular system changes
- 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
Respiratory changes in preg
- 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)
GI changes in preg
- 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
Urinary tract changes in preg
- 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)
Endocrine system changes
- 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)
estrogen effects
by placenta
- hyperpigmentation of skin
- stimulates breasts and uterus to get bigger
progesterone
by corpus luteum and then placenta VITAL! Relaxes uterus preparation of lactation decrease in 9th month
HPL hormone
human placental lactogen
anti-insuling
a lot in week 22
HCG hormone
human chorionic gonadotropin
secreted by throphoblast to maintain corpus luteum
detectable in urine at 8 days after conception
Relaxin hormone
by corpus luteum and then placenta
relaxes muscles, joints
softens the cervix
makes shoe size increases
oxytocin hormone
produced by hypothalamus and released by ant. pituitary.
causes uterine contractions
let down reflex
low during preg, high during labor
Prolactin hormones
10x greater in preen
milk production
Prostaglandin
low prostaglandin levels: preeclampsia
starts labor
Initial prenatal visit
Complete Health Hx
Current pregnancy Obstetric Hx GYN Hx Medical Hx Surgical Occupational Religion/culture meds allergies Substance and exposure Nutrition immunization Abuse baby daddy's Hx
Initial physical exam
VS Ht & Wt Neck Breast (self exam?) Fundus Reflexes (preeclampsia) Pelvic exam Rectal exam (hemorrhoids) uterine size
Initial lab work
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)
Subsequent visits nursing care
- 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
Danger signs of preg
vaginal bleeding visual disturbances fever intractable vomiting epigastric pain fluid from vagina
First Maneuver
facing the mom
palpate fundus
hard: babes head
soft: babys butt
3rd maneuver
try to grab babys head at pubic symphysis
if you can grab it: not engaged
it not: engaged
4th maneuver
tells you if baby is flexed or not.
TORCH Pannel
Toxoplasmosis Other (syphilis) Rubella cytomegalovirus Herpes
Nuchal transulency
11 weeks
Down Syndrome
nuchal fold
triple screen screening test
2nd trimester (16-20 weeks)
AFP
Estriol
HCG levels
Quad screen screening test
Inhibin A added
Down syndrome baby
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
CVS
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
Amniocentesis
may feel abdominal cramping, pressure during procedure monitor FHR and VS of mother Resume activities in 24 hrs Report bleeding, cramping result 1 week
NST
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
BPP 5 parameters
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
kick counts
10 kicks in 2 hours good
10 kicks in 5 minutes is ok, just stop counting
16 weeks development
fetus can swallow, quickening
24 weeks development
surfactant production starts
26-28 weeks development
testes in scrotum. eyelids not fused
32 weeks development
surfactant near mature level
Fetal attitude
relationship of fetal parts to one another flexion moderate flexion moderate extension extension
Anterior Fontanelle (DIamond shaped)
18 months
Posterior fontanelle (triangle shaped)
2 months
Fetal lie
longitudinal
transverse
Fetal position
cephalic position: occiput, chin, brown
Breech: complete, frank, footling
shoulder: complete, frank, footling
Midline episiotomy
minimal blood loss little scarring less postop pain more complications can lacerate/tear to rectum
Mediolateral episiotomy
less complications will not tear/lacerate into rectum more painful blood loss more scarring prone to have painful sex/intercouse
FHR HEARD
3-4 weeks ultrasound transvaginal
8-12 Doppler
12 weeks fetal development
Suck reflex
Lanugo
Sex distinguishable by sonogram
16 weeks fetal development
Swallowing
Urination
Quickening
18-20 weeks fetal development
Vernix
FHR by fetoscope
24 weeks fetal development
Surfactant
Active fetus
26-28 weeks fetal development
Testes go down
Eyelids no longer fused
32 weeks fetal development
Surfactant mature
