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Nurs. 314 > Exam 1 > Flashcards

Exam 1 Flashcards

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0
Q

Graviditiy

A

Pregnancy

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1
Q

Gravida

A

A woman who is pregnant

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2
Q

Multigravida

A

A woman who has had two or more pregnancies

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3
Q

Multipara

A

A woman who has completed two or more pregnancies to 20 or more weeks

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5
Q

Nulligravida

A

A woman who has never been pregnant

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6
Q

How long does pregnancy last?

A

Pregnancy lasts about 280 days after the last menstrual period, or 266 days (or 38 weeks) after conception.

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7
Q

How long is the ovum stage?

A

The ovum stage lasts from conception until day 14 and includes the development of the primary germ layers

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8
Q

How long is the embryo stage?

A

The embryo stage lasts from day 15 until about 8 weeks after conception, when the embryo measures 3 cm from crown to rump.
• ♣ This stage is the most critical time in the development of the organ systems and the main external features. Developing areas with rapid cell division are the most vulnerable to malformation caused by environmental teratogens, which are substances or exposures that cause abnormal development.

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9
Q

How long is the fetal stage?

A

The fetal stage lasts from 9 weeks after conception until the pregnancy ends.

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10
Q

When is a fetus considered viable?

A

Viability refers to the ability of the fetus to survive outside the uterus. Infants who are at 22 to 25 weeks of gestation are now considered to be on the threshold of viability.

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11
Q

What are the types of signs a women sees during pregnancy ?

A

Presumptive signs are those noticed by the woman, such as amenorrhea, fatigue, nausea, vomiting, and breast changes.
• o Probable signs are those noted by the examiner, such as Hegar sign, ballottement, and pregnancy tests.
• o Positive signs are those that are attributable only to the fetus, such as hearing fetal heart tones, visualizing the fetus, and palpating fetal movements. Only positive signs can establish the diagnosis of pregnancy.

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12
Q

What changes occur in the uterus/vagina during pregnancy/

A

The uterus enlarges greatly and changes in shape and position.
• ♣ Although the pH of vaginal secretions becomes more acidic, the pregnant woman is more vulnerable to some vaginal infections, especially yeast infections.
• ♣ Increased vascularity and sensitivity of the vagina and other pelvic viscera may lead to a high degree of sexual interest and arousal

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13
Q

What changes occur in the breasts during pregnancy?

A

Fullness, heightened sensitivity, tingling, and heaviness of the breasts begin in the early weeks of gestation. Colostrum may be expressed from the nipples as early as 16 weeks of gestation.

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14
Q

Supplements during pregnancy?

A

Iron supplementation is usually recommended routinely during pregnancy. Other supplements may be recommended when nutritional risk factors are present. Even with supplementation, the woman should consume a nutritious, well-balanced diet.
• o Nutritional needs during lactation are similar to those during pregnancy.
• o Needs for calories, protein, calcium, iodine, zinc, B vitamins, and vitamin C remain greater than nonpregnant needs.
• o However, during lactation the need for iron and folic acid is usually less than that during pregnancy.

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15
Q

What is couvade syndrome?

A

In accepting the pregnancy, some men experience couvade syndrome, developing pregnancy-like symptoms, such as nausea and weight gain.

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16
Q

What is amniocentesis done for?

A

Amniocentesis is performed to obtain amniotic fluid, which contains fetal cells. Indications for amniocentesis include prenatal diagnosis of genetic disorders or congenital anomalies, assessment of pulmonary maturity, and diagnosis of fetal hemolytic disease.
♣ CVS offers earlier diagnosis and fast

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17
Q

CVS

A

CVS offers earlier diagnosis and fast results, which makes it a popular technique for genetic studies in the first and second trimesters. Indications for CVS are similar to those for amniocentesis, except that CVS cannot be used for maternal serum marker screening because it does not obtain fluid.

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18
Q

What is PUBS?

A

PUBS allows direct access to the fetal circulation in the second and third trimesters, and is widely used for fetal blood sampling and transfusion. Indications for PUBS include prenatal diagnosis of inherited blood disorders, karyotyping of malformed fetuses, detection of fetal infection, and assessment and treatment of fetal isoimmunization and thrombocytopenia.

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19
Q

Child vs. adult resp. system

A

Respiratory System:
Cartilage in airway of an infant is soft
The trachea of an infant is 1/3 that of an adult
At birth, there are 25-40 million alveoli and 300-400 million alveoli by age 8-10
The size of alveoli does not change
Children generally have cardiac arrests secondary to primary respiratory arrests

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20
Q

Childs cardiac and neuro system

A

Cardiac System
Heart is fully developed and pumping by week 7
Neurological System
Myelination of neurological system is greatest in the last trimester and the first two years of life

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21
Q

Babys water content

A

Higher Body Water Content
At birth: 90%
Within 24-48 hours: 70%
12 months of age (comparable to that of an adult): 61%

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22
Q

Differences between children and adults

A

Less able to concentrate urine
Increasing risk for fluid imbalance, specifically dehydration which leads to hypovolemia
Lower glycogen stores
Increasing risk for hypoglycemia
Rapid metabolism
Increasing risk for hypoglycemia and hypoxia

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23
Q

Trust vs. Mistrust

A

Erickson: Trust vs. Mistrust
Piaget: 0-2 Years of Age,
Sensorimotor
Development of routines
Transitional items represent absent parents/caregivers
Huge developmental strides
Social skills-cooing, smiling, laughing, verbal

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24
Q

Stranger anxiety

A

Stranger anxiety- peaks 7-8 months and 18-20 months

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25
Gross motor skills
Prefer upright position vs. horizontal Lack of object permanence – what I cannot see is not there Gross motor: creeping by 4-5 months, sitting by 6-8 months, walking by 12-15 month (These are typical times, but there are individual variations)
26
Autonomy vs. shame and doubt
Erickson: Autonomy vs. Shame and doubt Allow to “do it myself” whenever possible Piaget: 2-6: Preoperational Everything is concrete and direct (“little stick in your arm”, “coughing your head off”, “two faced”, etc) Egocentric, inability to delay gratification
27
Intiative vs. guilt
Erickson: 3-6 years (Initiative vs. guilt) Piaget: : 2-6 years (Preoperational) Everything is concrete and direct (“little stick in your arm”, “coughing your head off”, “two faced”, etc) Are magical thinkers Everything that happens is because of this little person, whether it is good or bad
28
Industry vs. inferiority
6-11 years (Industry vs. inferiority) Piaget: 6-11 years (Concrete operational) Want basic explanations and reasons for everything Big learners – interested in the functional aspects of all procedures, objects, and activities Heightened concern about body integrity Regression common in stressful situations
29
Family assessment scale
``` Family APGAR Adaptation Partnership Growth Affection Resolve ```
30
3 basic principles of atraumatic care
Prevent/minimize separation from family Promote child’s sense of control over situations Prevent/minimize bodily pain or injury
31
Infants with a fever
``` Fever: Defined as: Rectal 101.4 or above Oral or tympanic 100.4 or above Axillary 99.4 or above Standing orders for fever reduction ALWAYS recheck temps within ½ hour after treatment if elevated ```
32
Hyperthermia in kids
Hyperthermia: Can be because of fever Can be a result of a traumatic brain injury, brain tumor, or exposure to higher than acceptable external temperatures Will lead to Hypoxia and Increased Intracranial Pressure Can result in damage to the brain and/or death
33
Important levels in infants
Potassium (3.4-5) , sodium (135-145) , chloride (96-111), glucose, and hematocrit (32-42)….IMPORTANT levels in infants
34
Urine output for infants
Urine (1-2cc/kg/hr)
35
Iv maintenance on kids
Check ivs every hour Bag changes every 24 hours Tubing changes every 72 hours
36
Monitoring elimination
Level Of Consciousness Monitoring urine output: 1-2cc/kg/hour Skin Turgor: Skin should not tent Capillary Refill: Under 3 Seconds, but best if under 1 ½ seconds Heart rate will increase with low fluid volume
37
Monitoring elimination cont.
``` Newborns/Infants: wet 6-10 times per day Weigh diapers and record output Zero out weight of diaper 1 gram=1ml Document on computer Stooling patterns vary Breastfed babies often have mustard stool with each diaper change Usually stool at least once every 3 days Significant findings: hard, pebble-like stools ```
38
The trimesters of pregnancy
Pregnancy divided into trimesters: 1st trimester: week 1-13, -embryonic plus 2 weeks as fetus. 2nd trimester : week 14-27 3rd trimester: week 28-40. (end of pregnancy)
39
Pregnancy
Length of pregnancy and development LMP: First day of last menstrual period, Fertile: generally about 2 weeks after first day of LMP (if 4 week cycles) Ovulation and most fertile time: About 14 days before start of next menstrual cycle. Pregnancy considered 40 weeks, but first 2 weeks, not actually pregnant, so pregnancy is actually 38 weeks.
40
Pregnancy development
In that 40 weeks the development is divided into the three stages: Ovum or preembryonic: Conception until day 14 Cellular replication, blastocyst formation, embryonic membranes, primary germ layers Embryo: day 15 -8 weeks after conception (3 cm- 1 inch in length) greatest vulnerability to teratogens-organ systems and external structures are present. Fetus: 9 weeks- end of pregnancy
41
Placenta structure and function
``` Placenta Structure Begins at implantation Maternal/placental/embryo circulation by day 17 Structure complete in first trimester, getting larger through week 20 Placenta Function Endocrine hCG hCS or hPL Progesterone Estrogen Metabolic Oxygen, CO2 Nutrient Stores No blood transport –only nutrients and waste ```
42
Babys endocrine development
``` Endocrine Thyroxine during 8th week Baby must produce own Mental retardation Insulin By week 20 ```
43
Twins
Twins Dizygotic or Monozygotic Twins can either be monozygotic ("identical"), meaning that they develop from one zygote that splits and forms two embryos, or dizygotic ("fraternal"), meaning that they develop from two eggs, each fertilized by separate sperm cells
44
Protein
``` Three servings a day Amino acids Complete proteins Complimentary proteins Fish ```
45
Vitamin and mineral supp.
Iron-supplementation recommended for all women Minimum Hgb: 11g/dl, 10.5 g/dl, 11 g/dl Folic Acid 600 mcg/day through food and/or supplementation for normal pregnancy CDC recommends supplementation of 400 mcg before and during pregnancy. Supplement with 4 mg if history of NTD. Calcium-no increased need!
46
Nursing care for morning sickness
``` Small, frequent meals every 2-3 hours Crackers before getting out of bed Vitamins at night Iron supplements after N and V are over Increased fluid and fiber intake Avoid rich, high fat, and spicy foods Good oral hygiene – soft toothbrush ```
47
Normal heart rate for baby
Normal heart rate is 120-180 for baby
48
Doctors visits
Visits monthly until 28 weeks then 28-36 its every 2 weeks, then its weekly till delivery
49
What are keels for?
Kegel exercises are for strengthening the perineum
50
Medications and pregnancy
A,B,C,D,X A: No problems Folic acid, levothyroxine B: Generally considered safe Zofran, insulin, some antibiotics C: Benefit may outweigh risk or no information (most medications) Zoloft, Albuterol, Diflucan D: May cause harm to baby, but may have reason to use it-for maternal health Paxil, lithium, dilantin, some chemotherapy X: Never use in pregnancy Accutane, thalidomide
51
Potential problems in pregnancy
``` All women should be aware of signs of concern: Vaginal bleeding Pain or bleeding with urination Persistent vomiting: Hyper gravidum Visual disturbance, spots, headaches, swelling of hands and face, epigastric pain Pelvic Pain Change in Fetal movement S/S of PTL ```
52
Abbreviations
Nullipara : never been pregnant Primif: pregant for first time Muiltipara: Pregantn 2nd time Grandmulti: more than 4 pregnancies Elderly grandmultip: over 35
53
Days of cycle
Day 14-Ovulation Day 14-20-Fallopian Tube Day 18-20-Uterus Day 20-24-Implantation
54
True or false
At week 11 baby urinates in amniotic fluid
55
Normal Hgb & Hct findings in a Prenatal assessment?
Hgb: 12-16 g/dl Hct: 38-47%
56
Normal WBC findings in a prenatal assessment
5,000-12,000/microliter
57
What are 3 common procedures a woman will undergo on her first prenatal visit?
1. Inspection, Auscultation, & Palpation of the ABDOMEN 2. Determination of the adequacy of the PELVIS 3. VAGINAL examination
58
Explain how to measure fundal height? | What is this method also known as?
Measured by placing the beginning of measuring tape on top of the symphysis pubis, then stretching up over the abdomen to the top of the uterine fundus. AKA McDonald's Method
59
When does the fundal height measurement best correlate with the gestational age (ie when is it most accurate)?
Between 22-24 weeks through 34 weeks. During this time the fundal height should match up with the weeks of gestation
60
Where would you expect to find the fundus at 12 weeks' gestation?
Slightly above the symphysis pubis
61
Where should the fundus be at 20 weeks' gestation?
At the umbilicus
62
When is the fetal heartbeat usually detected with a Doppler?
Average 10-12 weeks
63
What is Nagele's rule? What is the formula?
Nagele's rule is used to determine EDB. The formula is: You take the first date of woman's LMP, minus 3 months and then add 7 days.
64
If a woman states September 19, 2011 was her LMP, what would be her EDB?
June 26, 2012
65
Dysuria is a common sign of?
UTIs
66
Epigastric pain is a warning sign of what?
Preeclampsia
67
Vaginal bleeding may be a sign of?
Placenta previa
68
List 4 of the more common pregnancy related complications for teens?
1. Iron deficiency anemia 2. Preeclampsia 3. Preterm birth 4. Cephalopelvic disproportion (CPD)
69
In which trimester is there the greatest potential for gross abnormalities in the fetus?
The first trimester when fetal organs are first developing.
70
If a woman HAS to take an anti-coagulant during pregnancy, which one should she take?
Heparin - it does not cross the placenta, it is safer for the fetus than Warfarin or other anti-coag's
71
What maternal risk behavior is highly associated with low-birth weight infants and 3x's the normal risk for SIDS?
Smoking
72
What procedure is routinely offered to all pregnant women over 35 years of age? Why?
An AMNIOCENTESIS; to permite the early detection of several chromosomal abnormalities, including Down Syndrome
73
An Amniocentisis cannot be done until ____ weeks of pregnancy and the chromosomal studies (results) take roughly ____ weeks to complete
14 weeks, 2 weeks
74
What are the 2 most important HORMONES FOR BREASTFEEDING? What do they do?
1. Prolactin-causes milk production | 2. Oxytocin-causes milk-ejection reflex (let down reflex)
75
Normal Temperature Range in initial Newborn Assessment?
97.5 - 99 degrees Fahrenheit
76
Normal RESPIRATION RATE for initial newborn assessment?
30 to 60 breaths per minute
77
Normal BLOOD PRESSURE range for initial newborn assessment?
70 to 50/45 to 30 mm Hg
78
A newborn's head circumference is 34 cm (13.6 in.) and chest circumference is 32 cm (12.5 in.). Which nursing action is appropriate? a) Measure the occipitofrontal circumference daily b) Prepare the mother for the probability that the healthcare provider will want to transilluminate the head. c) Record the findings and take no further action. d) Refer the newborn for evluation for psychomotor delays.
a) Measure the occipitofrontal circumference daily
79
Normal LENGTH range for newborns?
50 cm (20 in.), ranges from 48 to 52 cm (18 to 22 in.)
80
During assessment, the nurse bumps the bassinet and the newborn exhibits extension of the arms, with fingers forming the shape of a "C". What is the reflex known as?
The MORO reflex
81
How should you assess for the BABINSKI REFLEX in a newborn?
Stroke the lateral aspect of the sole from the heel upward and across the ball of the foot
82
Why are newborns' hands/feet often cold? | What is the term for this?
Due to decreased peripheral circulation, which results in vasomotor instability and capillary stasis. Term is ACROCYANOSIS
83
Why does the newborn need an injectiion of Vit. K?
The do not have the normal intestinal bacterial flora needed to synthesize Vit. K. This creates a transient blood coagulation deficiency between the second and fifth day of life. (They can't clot)
84
If a newborn has a Hematocrit value of 68%, this signifies? What would be the priority nursing intervention?
this value signifies POLYCYTHEMIA. The nurse should increase fluid intake
85
If a newborn's BILIRUBIN level is 15 mg/dl, what does this indicate? What is the priority nursing intervention?
This value indicates JAUNDICE. The nurse should ASSESS NEED FOR PHOTOTHERAPY
86
If a newborn has a blood glucose level of less than 45 mg/dl, what does that signify? What are the best nursing interventions?
This signifies HYPOGLYCEMIA The nurse should observe for signs of jitteriness & temperature instability. Additionally, the nurse must initiate early feedings (Breast milk or glucose water)
87
A nurse in mother-baby area (postpartum) must do what four daily assessments on a newborn?
1. Vital signs 2. Stool & voiding patterns 3. Caloric/fluid intake & weight pattern 4. Status of umbilical cord & if necessary (being male & parents opted for it), the status of circumcision
88
When should a newborn have their first stool?
Within 12 - 24 hours or AT LEAST by 48 hours
89
A woman asks how she can affect the number of fetal movements (ie when she is going to perform "kick counts"). What would you tell her?
To eat..eating often stimulates the fetus. Also the woman should be made aware that the fetus will have intermittent sleep periods lasting 20-40 minutes.
90
A patient is opting for a nuchal translucency test vs. an amniocentesis. All of the following are true about a nuchal translucency test except? a) it is a diagnostic test b) it is a screening test c) it screens for trisomies 13, 18, and 21 d) it cannot screen for neural tube defects
a) it is a diagnostic test. This test is a "screen" if abnormal test results are found the woman will then be referred to have a diagnostic test done, such as chorionic villus sampling or amniocentesis
91
Which parameter on a BPP is the FIRST TO DEVELOP and the LAST ACTIVITY to cease during ASPHYXIA? a) FHR accelerations b) Fetal breathing c) Fetal movements d) Fetal tone e) Amniotic fluid volume
d) Fetal Tone
92
Before an AMNIOCENTESIS is initiated (ie before the needle goes in)..What must be done?
The placenta must be located via ultrasound and an appropriate pocket of fluid should be identified.
93
What are the 3 tests used to determine fetal lung materity and/or adequate surfactant amounts in the fetus? In brief, what are the results of each test that are "normal" (good)?
1. L/S (lecithin/sphingomyelin) Ratio - 2:1 ratio 2. Phosphatidyglycerol - Phospatidyglycerol is present in amnio fluid 3. Fluorescence polarization - Values greater than 55 mg/g in a mom w/out diabetes and 70 mg/g in a mom WITH diabetes.
94
How many ounces of breastmilk or formula does a newborn require each day?
19-21 oz.
95
What is the important immunoglobin found in breastmilk? What are it's properties
Secretory IgA | It has antiviral, antibacterial, and antigenic-inhibiting properties
96
What component of breastmilk promotes myelination and neurologic development in infants?
Cholesterol
97
How often should a newborn's vitals be taken in the first 4 hours after birth
Once an hour
98
What are the two categories of the Ballard Assessment tool?
External physical characteristics & | Neurologic characteristics
99
vWhen assessing a newborns temperature, Where should you do it & for how long?
At the axillary site for at least 3 minutes.
100
What is an indicator of Sepsis in an infant?
Fluctuations in temperature
101
When should the first feeding occur?
Within the first hour of lif
102
In the first two days of life, what is acceptable weight loss amounts for a newborn?
5-10% of birthweight
103
What are normal B/P ranges for a newborn?
70-50 Systolic/ 50-45 Diastolic
104
Which type of immunoglobin crosses the placenta?
IgG

Nurs. 314 (5 decks)

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