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Women and Families > Women and Families > Flashcards

Women and Families Flashcards

1
Q

Non-stress test

A

measures fetal well-being; started around 34 weeks for normal risk pregnancy; accelerations in response to fetal movement; 2 or more accelerations in 20 minutes

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2
Q

contraction stress test

A

looks for decelerations of baby HR in response to contractions; do not want decelerations in relation to contraction; want a negative test = no decels

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3
Q

prolactin

A

hormone that stimulates milk production

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4
Q

Let down reflex

A

stimulation of the nipple by babies sucking; hypothalamus stimulates posterior pituitary to release oxytocin and anterior pituitary to release prolactin;

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5
Q

oxytocin

A

stimulates release of milk from the breast; can contribute to afterpains

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6
Q

BUBBLEHEB

A

postpartum focused exam: breasts, uterus, bladder, bowel, lochia, episiotomy, homans, emotional, bonding

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7
Q

breast assessment

A

inspect size, contour, asymmetry, and engorgement; note reddened, tender, engorgement, warmth; check nipples for cracks, redness, fissures; note if nipples are flat, erect, or inverted; educate women to wear supportive bra 24 hrs; assess correct latch if breast feeding

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8
Q

if women is non-lactating/breast-feeding

A

avoid stimulation, ice packs or cabbage leaves, mild analgesic for pain

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9
Q

Uterus assessment

A

assess women lying flat after void; support bottom of uterus during assessment (prevent prolapse); note firm vs boggy, midline vs. deviated; any lac/hematoma to vagina

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10
Q

bladder assessment

A

monitor output/assess for retention, postpartum diuresis, void within 4 hours after birth (catheterize if unable), ambulate early, assess for UTIs, auscultate bowels prior to assessing uterus

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11
Q

Lochia assessment

A

educate on stages of lochia; increase in amount, foul smell, or return to rubra is not normal; change peri pad frequently; peri care after each void if lac/episiotomy; weigh pas to get accurate blood loss volume

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12
Q

Episiotomy assessment

A

use REEDA, midline or mediolateral

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13
Q

peri care

A

peri bottls, ice packs (first 24 hours), Sitz bath (after 24 hours), topical meds (witch hazel, dibucaine, dermoplast, epifoam), pat dry front to back

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14
Q

1st degree lac

A

perineal and subcutaneous skin and vaginal epithelium

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15
Q

2nd degree lac

A

includes skin, mucous membranes, and fascia of perineal body

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16
Q

3rd degree lac

A

skin, mucous membranes, and muscle of perineal body, extends into but not through rectal sphincter

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17
Q

4th degree lac

A

extends through anterior rectal mucosa exposing rectal lumen

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18
Q

hemorrhoids assessment

A

assess for appearance and number

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19
Q

emotional adaptation

A

post partum blues (appears few days after delivery) symptoms: sadness, anger, anxiety, unable to self care or care for infant, reject infant; 10-20% of all postpartum pt; post partum psychosis can occur (hallucinations, delusions, bizarre behavior)

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20
Q

Bonding

A

determine moms phase of adjustment; take culture into account; describe level of attachment

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21
Q

antepartum

A

pregnant women before onset of labor

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22
Q

intrapartum

A

time of labor and childbirth

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23
Q

postpartum

A

6-8 week time after delivery of baby and placenta; return to non-pregnant state

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24
Q

involution

A

pelvic reproductive organs returning to approximate pre-pregnant size, position, and function

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25
Q

normal rate of involution

A

fundus/uterus descends 1cm (or fingerbreadth) per day from umbilicus

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26
Q

lochia rubra

A

first 1-3 days (bright red bleeding); shedding 9 months of accumulated substance

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27
Q

lochia serosa

A

3-10 day, pale, serosanguinous (pale red) to light brown

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28
Q

lochia alba

A

10-14 days; creamy, yellow, white (usually gone in 2 week but can last up to 6)

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29
Q

critical bleeding after delivery

A

saturating peri pad in 15 minutes or less or pooling of blood under butt

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30
Q

Rhogam

A

mother Rh -, infant Rh +; mothers antibodies attack babies; leads to complications for subsequent pregnancies; if baby is + then administer 300 mcg rhogam within 72 hours postpartum

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31
Q

discharge/going home

A

provides minimum stay; 48 hours after uncomplicated vaginal birth; 96 hours after uncomplicated cesarean birth

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32
Q

menstrual cycle step 1

A

hypothalamus releases GnRH causes anterior lobe cells to secrete FSH and LH

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33
Q

menstrual cycle step 2

A

FSH and LH promote follicle growth and maturation of oocyte, estrogen production, endometrium priming, all in ovary

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34
Q

menstrual cycle step 3

A

blood level estrogen rises stimulating surge in LH secretion

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35
Q

menstrual cycle step 4

A

surge of LH midcycle triggers ovulation and formation of corpus luteum

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36
Q

menstrual cycle step 5

A

progesterone & estrogen secreted by corpus luteum maintains endometrium if pregnancy occurs

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37
Q

menstrual cycle step 6

A

rises in progesterone and estrogen in blood inhibit FSH and LH during last phase of cycle

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38
Q

when does corpus luteum deteriorate

A

when ovum is not fertilized

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39
Q

conception

A

union of male and female ovum

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40
Q

sperm survival time

A

48-72 hours

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41
Q

ova fertility time

A

12-24 hours

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42
Q

fertilization

A

penetration of sperm into ovum

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43
Q

location of fertilization

A

ampulla in fallopian tube

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44
Q

capacitation

A

sperms ability to penetrate ovum

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45
Q

fertilization factors

A

maturation of sperm and ovum (sperm must wait 4-6 hours in female to undergo capacitation), sperms ability to reach ovum, sperms ability to penetrate ovum

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46
Q

zygote

A

fertilized sperm and ovum combined; contains all genetic material; secretes human chorionic gonadotropin

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47
Q

placental functions

A

transport & exchange: serves as lungs, kidneys, liver, GI tract, and serves as passive immunity; Hormone secretion: secretes hCG, estrogen, progesterone, hPL (human placental lactogen)

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48
Q

progesterone function

A

smooth muscle relaxant; stops women from early birth and contractions

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49
Q

umbilical cord

A

how baby is connected to mother; 2 arteries and 1 vein

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50
Q

embryonic period

A

development of 3 germ layers, development of embyonic membranes: chorion, amnion, umbilical cord, placenta

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51
Q

chorion

A

outermost layer of fetal membrane

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52
Q

amnion

A

amniotic fluid-buoyant temperature controlled environment (acts as a cushion)

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53
Q

umbilical cord artery/vein purpose

A

2 arteries carry deoxygenated blood from fetus to placenta; 1 vein supplies oxygen and nutrients to fetus; surrounded by wartons jelly

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54
Q

first trimester characteristics of fetus

A

face becomes more human; reflex activity, spontaneous movement, heart begins to beat, weighs 45g at end and is 3.5 in long, very susceptible to teratogens, organ development, fetal circulation established, sex identified

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55
Q

second trimester characteristics

A

very active (feel movement), lanugo present, vernix caseosa coats skin, brown fat forms, lungs form alveoli and surfactant, eyes open (sensitive to light and sound), weigh 700-800g and 10 in long

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56
Q

first trimester timeline

A

conception - end of week 12

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57
Q

second trimester timeline

A

week 13-end of week 26

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58
Q

third trimester characteristics

A

subcutaneous fat increases (chubby), bones soft and flexible, increase in muscle, resp. and circ. system functions, lanugo and vernix start to disappear, maternal antibodies transferred, usually positioned head down ()

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59
Q

third trimester timeline

A

27 weeks - birth

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60
Q

estrogen secreted from

A

secreted from placenta and ovaries

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61
Q

estrogen affects

A

increase uterine growth, increase breast development, increase uterine blood flow, prevents follicular development during pregnancy

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62
Q

progesterone secreted where

A

corpus luteum first then placenta

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63
Q

progesterone affects

A

relaxes smooth muscle decreasing vascular resistance, supports and maintains uterine lining for implant and development, decreases prostaglandin production

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64
Q

prolactin secreted where

A

anterior pituitary

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65
Q

prolactin affects

A

promotes development of breasts and supports lactation, release and stimulate milk production after birth

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66
Q

oxytocin secreted where

A

posterior pituitary

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67
Q

oxytocin affects

A

stimulates uterine contractions and stimulates milk ejection reflex

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68
Q

hCG secreted where

A

cells of developing placenta

69
Q

hCG affects

A

prevents involution of corpus luteum, peaks at weeks 9-10 and decreases as pregnancy progresses; measured in urine for tests

70
Q

hPL secreted where

A

placenta

71
Q

hPL affects

A

makes glucose available for developing fetus, growth promoting and milk producing, promotes relative insulin resistance later in preg.

72
Q

LH secreted where

A

anterior pituitary

73
Q

LH affects

A

stimulates ovulation of mature ovum in nonpregnant state

74
Q

McDonalds rule

A

fundal height in cm = gestational age from 22-34 weeks

75
Q

physical changes of reproductive system

A

uterus, cervix, vagina, ovaries, breasts

76
Q

physical changes of uterus

A

hegers sign and braxton hicks contractions

77
Q

hegers sign

A

softening of lower portion of uterus (as early as 7 weeks); common sign of pregnancy but not definite sign; can cuase painless contractions

78
Q

braxton hicks contractions

A

irregular intermittent painful contractions

79
Q

physical changes of cervix

A

goodells sign and mucus plug; cervix becomes more vascular and ededemous (a good and soft purple chadwick)

80
Q

goodells sign

A

softening of cervix

81
Q

mucous plug

A

operculum; seals uterus and ruptures during labor (the boody show)

82
Q

changes of the vagina

A

chadwicks sign and leukorrhea

83
Q

chadwicks sign

A

purple color

84
Q

leukorrhea

A

vaginal secretion

85
Q

changes of the ovaries

A

ovulation stopped from corpus luteum producing estrogen/progesterone (negative feedback on FSH and LH which inhibits ovulation)

86
Q

changes in breasts

A

growth d/t hormones; may feel tingling/tenderness from high estrogen; vascularity increases, hyperplasia, colostrum (around 12 weeks), areola darkens

87
Q

cardiovascular changes during pregnancy

A

blood, BP, edema, varicosities

88
Q

blood changes in pregnancy

A

volume increases progressively, RBCs increase (20-30%), coagulation increases (increase in fibrinogen), WBCs increase (6000-30000), pulse increases d/t increased CO, hematocrit decreases d/t increase in plasma

89
Q

BP changes

A

decreases d/t decreased systemic vascular resistance and then steadily increases until normal level at term

90
Q

edema and varicosities in pregnancy

A

legs, vulva, rectum (hemorrhoids)

91
Q

supine hypotensive syndrome

A

when pregnant mom lies flat, fetus presses on inferior vena cava decreasing blood return; should sleep on side

92
Q

physical changes of respiratory system

A

epistaxis, thoracic breathing vs abdominal breathing, increase in need for O2 (CO2 sensitive)

93
Q

physical changes in GI system

A

N/V (subside by end of 1st tri), acid reflux (cardiac sphincter), constipation, gallstones, Ptyalism (excessive salivation), PICA, acute sense of smell

94
Q

physical changes of renal system during pregnancy

A

kidney increase in size, increase risk of UTI (d/t stagnant urine), increase urinary frequency, increase GFR (glomerular filtration), dilated renal pelves and ureters

95
Q

changes in musculoskeletal system during pregnancy

A

carpel tunnel syndrome, lordosis, relaxin allows for more pelvic flexibility, hypercalcemia can cause muscle aches

96
Q

lordosis

A

increased curvature of lower spine d/t rectus abdominis separating

97
Q

changes in endoctine system during pregnancy

A

increase in basal metabolic rate, increase in thyroid function, increase in aldosterone and insulin

98
Q

increase in hair and skin during pregnancy, formation of central line and other lines

A

melasma/cholasma, linea nigra, striae (stretch marks), increase in hair thickness (oestrogen)

99
Q

hyperemesis gravidarum

A

extreme N/V leading to dehydration and fluid/electrolyte imbalances

100
Q

gestational diabetes

A

carb/glucose intolerance onset during pregnancy

101
Q

development tasks of pregnancy (psychological)

A

acceptance of pregnancy, identifying with role of mother, eval. relationships between self and mother and self and partner, ensuring safe passage of self and baby through whole process, prenatal fear of loss of control during labor (self-esteem)

102
Q

maternal role attainment

A

interaction and developmental process occurring over time where mother becomes attched to infant, competence in care-taking, express gratification and pleasure of role

103
Q

psychologic adaptation 1st trimester

A

AACEPTANCE OF PREGNANCY; tests reality; signs of ambivalence (disbelief); normal adjustment “ I am Pregnant”

104
Q

teaching during first trimester

A

body changes upcoming, nutrition, healthy lifestyle, PNC

105
Q

psychological adaptations of 2nd trimester

A

DIFFERENTIATION; discomfors ease (not as sick); focus shifts to baby; perceives fetus as separate; normal adjustment “I am going to have a baby”

106
Q

teaching during 2nd trimester

A

newborn care, breast-feeding, parenting, fetal development

107
Q

psychological adaptations of 3rd trimester

A

SEPARATION; prep for end; ambivalence returns (fear returning is normal); anxiety (normal sign); finding out meaning of mothering and fathering; normal adjustment “I am going to be a mother”

108
Q

teaching during 3rd trimester

A

infant care, self care, preparing of L & D, birth plan, pain management, when to go to hospital, what to loo for in terms of contractions

109
Q

presumptive (subjective) signs of pregnancy

A

N/V, amenorrhea, fatigue, urination, quickening, breast changes

110
Q

Positive signs of pregnancy

A

audible fetal HR, palpable fetal movement by examiner, US visualization of fetus

111
Q

Ballottment

A

tip of forefinger in vagina, tap against lower segment of uterus; present fetus tossed upward and finger is kept in place where it will feel strike of fetus against wall as it falls back down

112
Q

ways to determine due date

A

Ultrasound, nageles rule, gestational wheel, McDonalds rule (22-34 weeks)

113
Q

ultrasound (in terms of frequency)

A

high risk= more ultrasounds and starts early on; most accurate in first trimester

114
Q

ultrasound measurement 1st trimester

A

crown to rump length 7-13 weeks (head to butt)

115
Q

ultrasound measurements2nd trimester

A

biparietal diameter >13 weeks (parietal bone to parietal bone); femur length >13 weeks

116
Q

Nageles Rule

A

take the 1st day of menstrual period subtract 3 months and add 7 days

117
Q

Gravida

A

of pregnancies

118
Q

Para

A

of delveries to viable babies

119
Q

primigravida

A

pregnant for fist time

120
Q

nulligravida

A

never been pregnant

121
Q

primipara

A

completed 1 pregnancy to stage of viability

122
Q

viability age

A

22-24 weeks or >500g

123
Q

mulitpara

A

completed 2+ pregnancies to stage of viability

124
Q

extra calorie consumption for pregnancy

A

~300 calories

125
Q

First prenatal visit obtaining history

A

family medical history, PMH, gynecologic history, OB history, Social history, infections/teratogens/genetic problems, nutritional status, immunizations/illness/risk factors

126
Q

first prenatal visit exam

A

full physical, pelvic exam (sizing and intrauterine US to see if cervix is closed), labs

127
Q

prenatal labs consist of

A

blood type and Rh status, HIV, rubella, VDRL (syphilis), CBC, HbSAg, pap test, STI, TB test, auscultate fetal HR (8-12 weeks)

128
Q

prenatal visit counseling

A

what to expect, risk factors, interventions for discomforts, nutrition, exercise, work, sexual activity

129
Q

warning signs of pregnancy

A

gush/rupture of amniotic fluid prior to 37 weeks; vaginal bleeding (abruptio or previa), ABD pain (premature labor, abruptio, ectopic) changes in fetal movement, persistent vomiting, severe headaches, elevated temp (infect.), dysuria (painful/blood = UTI), blurred vison (HTN), edema of hands/face (HTN), epigastric pain (HTN), signs of hyperglycemia, signs of hypoglycemia

130
Q

signs of hyperglycemia

A

flushed dry skin, fruity breath (ketones), rapid breathing, increased thirst/urination, headache

131
Q

signs of hypoglycemia

A

clammy pale skin, weakness, tremors, irritability, lightheadedness

132
Q

folic acid needs

A

600mcg (avoid neural tube defects)

133
Q

iron

A

need more iron for increased RBC

134
Q

calcium and vitamin D

A

develop bones, teeth, skin, eyesight

135
Q

needed vitamins (PNV)

A

folic acid, iron, calcium, vitamin, D, omega 3s

136
Q

substances to avoid

A

caffeine (less than 200mg), mercury (can cause BD), alcohol (no safe amount)

137
Q

listeriosis

A

food-borne illness from bacteria ta causes flu-like symptoms and can cause miscarriage

138
Q

fetal alcohol syndrome

A

small head, short eyelid opening, flat midface, smooth philtrum, underdeveloped jaw, low nasal bridge, epicanthal folds, short nose, thin upper lip

139
Q

routine PNC

A

weight/vitals; fundal height/leopolds maneuver; FHR and movement/ urine for protein, glucose, ketones; 1 hr glucose tolerance test (24-28 weeks), Rhogam, rectal swab for GBS (36 weeks)

140
Q

fetal diagnostic tests

A

US, CVS, amniocentesis, quad screen/maternal AFP, NST, CST, biophysical profile, doppler flow studies, fetal lung maturity, fetal movement/kick count

141
Q

ultrasound types

A

transabdominally(need full bladder) or intrauterine (birth acknowledged earlier) detects multiple babies, abnormalities, size

142
Q

New born vaccines

A

hep B recommended

143
Q

amniocentesis

A

invasive procedure to determine fetal lung maturity (injection through abdomen into amniotic sac); measures surfactant lecithin and sphingomyelin (want 2:1 ratio); can predict fetal viability; AFP present at high levels can indicate spina bifida

144
Q

CVS

A

chronic villus sampling; tissue sample from placenta; can be done earlier than amniocentesis; diagnoses fetal chromosomal abnormalities (cannot detect neural tube defects)

145
Q

biophysical profile

A

conducted around 18 weks and end of pregnancy; scored like apgar; rates fetal HR, breathing, body movements, tone (flexion), volume of amniotic fluid, placental grading

146
Q

disadvantages of CVS

A

fetal limb reduction, membrane rupture, spontaneous abortion (1%), risk of blood mixing, cannot detect neural tube defects

147
Q

mastitis

A

inflammation or infection of the breast tissue usually from staphylococcus aureus from breast feeding in the babies mouth; very tender, engorged, hard, erythematous breasts (usually unilateral); keep breast feeding to speed up process and is safe for baby

148
Q

US 1st trimester

A

determine viability, gestational age, cause of vaginal bleeding, visualize for CVS

149
Q

US 2nd trimester

A

detect polyhydraminos/oligos, visualize amniocentesis

150
Q

US 3rd trimester

A

determine placental insufficiency, intrauterine growth restriction, cogenital abnormalities, biophysical profile

151
Q

Quad marker screening

A

Maternal serum alpha-fetoprotein, free beta hCG (high levels can indicate down syndrome), unconjugated estradiol (lower can indicate down syndrome/edwards syndrome), plasma protein A (ins. growth factor bioavailability test)

152
Q

MSAFP

A

tool for neural tube defects (high levels); 16-18 weeks; low levels = potential for down syndrome

153
Q

amniocentesis disadvantages

A

1% chance of miscarriage within 24 hours; no specifications after 24 hour period

154
Q

firm or boggy uterus?

A

need firm

155
Q

boggy uterus =

A

risk for hemorrhage

156
Q

Rubins restorative phases

A

taking in (dependent), taking hold (independent), letting go (interdependent)

157
Q

Rubella (MMR) vaccine

A

admin to non-immune mother, safe for nursing, live vaccine, avoid pregnancy for 1 month

158
Q

attachment psychological adaptation

A

touching, holding, kissing, cuddling, singing, “en face” position; mal-attachment is refusing to look at infant no touching or holding

159
Q

interventions to assist with bonding

A

rooming in, skin to skin, praisr support and reassurance

160
Q

baby blues

A

peaks 3-5 days after delivery, d/t changes in hormones, up to 80% of women

161
Q

REEDA

A

redness, edema, ecchymosis, discharge, and approximation

162
Q

SIDS

A

sudden infant death syndrome; unexplained cause of death younger than 1 year

163
Q

shaken baby syndrome

A

shaking of the baby causes injury to skull or intracranial injuries that can lead to defects or death

164
Q

menstrual cycle

A

ovarian cycle and uterine cycle

165
Q

ovarian cycle

A

production and release of eggs and release of progesterone and estrogen; follicular phase, ovulation, luteal phase

166
Q

uterine cycle

A

preparation and maintenance of uterus lining for receiving of embryo; menstrual phase, proliferative phase, ovulation, secretory phase, ischemic phase

167
Q

Probable (objective) signs of pregnancy

A

serum lab test (hCG), chadwicks sign,goddells sign, hegars sign, fetal outline by examiner, ballottment

168
Q

1 gram weight =

A

1 mL of blood

169
Q

Bowel assessment

A

anatomy returns to normal, relaxin depresses bowel motility, intraabdominal pain decrease, icontinence = lacerated sphincter, spontaneous bowel mvmt 2-3 days post-partum, 6-8 glasses water/juice, stool softener (and laxative), SITZ for comfort, meds for hemorrhoids

Women and Families (4 decks)

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