Exam 2 Flashcards
1
Q
Stages of Embryonic Development
A
Pre-Embryonic
Embryonic
Fetal
2
Q
Pre-Embryonic Stage (duration; key developments)
A
Duration: Conception - Week 3
Key Developments Zygote implants on uterine wall with 3 layers Endoderm Mesoderm Ectoderm
3
Q
What does the endoderm of the zygote develop into
A
Respiratory system
Digestive system
Liver
Pancreas
4
Q
What does the mesoderm of the zygote develop into
A
Skeleton Connective tissue Cartilage Muscles Circulatory system Lymph system Reproductive system Urinary system
5
Q
What does the ectoderm of the zygote develop into
A
Brain
spinal cord
Nervous system
Outer body parts (hair, skin, nails)
6
Q
Embryonic stage (duration, key developments)
A
Duration: Weeks 4-8
Developments
Rapid developments –> all basic organs are established by the end of this stage
** Most vulnerable period to any factor that may cause congenital anomalies ** (i.e. alcohol, tobacco)
7
Q
Fetal stage (duration, key developments for each trimester)
A
Duration: Week 9-Birth
By 12 weeks gestation (end of T1)
- Some reflexes* present
- Fetal heartbeat can be heard by Doppler (between 10-12 weeks)
- Sex* is distinguishable by appearance
- Kidney* secretions begin
By 24 weeks gestation (end of T2)
- fetal heart tones*
- Lung surfactant* produced (but alveoli not yet formed)
- Liver & pancreas* functioning
- Sleep-wake patterns* established
- Eyelids open*
- Hair forms*
By 40 weeks gestation (end of T3/pregnancy)
- Lung alveoli are formed and considered mature
- testes descend
- subcutaneous fat is deposited
8
Q
Steps of conception
A
- ovum (egg) released from ovary and travels down fallopian tube
- sperm meets the ovum at the outer most portion of the fallopian tube = fertilization
- when sperm penetrates ovum, pregancy begins and ovum becomes a zygote
9
Q
Placenta (what is it, when it forms, functions)
A
The placenta is the interface/pass-through between the mom and fetus
Begins forming at end of 2nd week
Functions
- supplies nutrients and oxygen
- removes waste products from the fetus to be excreted by the mom
- protects baby from mom’s immune attacks
- produces hormones that mature into fetal organs
10
Q
Placental hormones & functions
A
- hCG
- “pregnancy” hormone; the hormone tested for in urine pregnancy tests
- functions: produces progesterone to maintain the uterine lining rather than shedding it
- 2 tests: quantitative (results with amount of hCG to dtmn gestation) and qualitative (yes or no pregnant)
- hPL
- Manages mom and fetus metabolism
- Develops breasts for lactation
- Lowers mom’s insulin sensitivity to increase the number of nutrients available for the fetus
- Estrogen
- Develops breasts, uterus and external genitalia
- Stimulates myometrial contractions during labor
- Progesterone
- Maintains endometrial lining
- Decreases uterine contractility
- Stimulates mom’s metabolism and breast development
- Provides early fetal nourishment during conception phase
- Relaxin
- Maintains the pregnancy
- Softens the cervix before birth
11
Q
Umbilical cord (development, formed from, functions, contents, size)
A
Develops with placenta ~end of 2nd week
Formed from amnion (innermost layer of embryo enclosure)
Function: lifeline between mom and embryo
Contents (AVA)
- 1 large vein
- 2 large arteries
- Wharton’s jelly within to prevent compression of blood vessels
Average size
- Length: 22-in
- Width: 1-in
12
Q
Amniotic fluid (composition, functions)
A
Fluid surrounding baby in the uterus
Composition = mom’s blood + baby’s urine
- amount of amniotic fluid increases as pregnancy progresses
- ~1L at full term
Functions
- Helps maintain body temp for fetus
- Permits symmetric growth & development
- Cushions the fetus
- Prevents umbilical cord compression
- Promotes fetal movement to enhances musculoskeletal development
13
Q
Fetal circulation (purpose) and fetal shunts
A
Fetal lungs are not fully developed so shunting the oxygenated blood from mom away from the lungs and directly to the systemic circulation helps to provide adequate oxygenation in utero
Ductus venosus
- Connects umbilical vein to fetus’ inferior vena cava
Ductus arteriosus
- Connects the fetus’ main pulmonary artery to the aorta
Foramen ovale
- An anatomic opening between the fetus’ right and left atrium
14
Q
Human genome project (goal)
A
an international effort to map, sequence and determine the function of all human genes to allow for early detection of anomalies
15
Q
Genome determines what?
A
Genome = a person’s genetic blueprint
Determines genotype and phenotype
16
Q
Genotype
A
Genes inherited from parents
17
Q
Phenotype
A
the observed outward characteristics of the genotype and its interactions with the environment
18
Q
Genes (definition, makeup, function)
A
Genes = individual units of heredity of all traits
Made of long segments of DNA that occupy specific locations on a chromosome
Function to determine a particular characteristic of an organism
19
Q
Karyotype
A
a pictorial analysis of the number, form and size of chromosomes
22 pairs of autosomes with 1 pair of sex chromosomes
Chromosomes are numbered from largest to smallest (1-22) with sex chromosomes designated by X and Y
XX = female, XY = male
20
Q
Types of Mendelian/Monogenic Disorders
A
Autosomal dominant Autosomal recessive X-linked inheritance -- X-linked recessive -- X-linked dominant
21
Q
Define the following Allele Phenotype Homozygous Heterozygous
A
Allele - any variations that exist for a gene
Phenotype - the outward characteristics of a gene
Homozygous - inherited genes from mom and dad are the same allele
Heterozygous - different alleles are inherited from parents and the dominant allele is the phenotype
22
Q
Autosomal dominant disorders (define, chances of impacted offspring, common disorders)
A
A single gene in a heterozygous state produces the phenotype
If a normal mom and affected dad produce offspring…
- 50% chance unaffected offspring
- 50% chance of heterozygous offspring with disordered phenotype
Common disorders
- Huntington’s
- Polycystic Kidney Disease
23
Q
Autosomal recessive disorders (define, chances of impacted offspring, common disorders)
A
2 copies of affected genes in a homozygous state are needed to cause the disorder
Both parents must be heterozygous carriers to produce affected children
If both parents are heterozygous carriers…
- 25% chance of a homozygous “normal” child
- 50% chance of heterozygous carriers
- 25% chance of heterozygous affected genotype –> disordered phenotype
Common disorders
- Cystic Fibrosis
- Phenylketonuria
- Tay-Sachs
- Sickle cell disease
24
Q
X-Linked Recessive Disorders (define, chances of impacted offspring, common disorders)
A
Disorders are associated with an abnormal gene on the X chromosome
- Since males have only 1 X chromosome, they are more likely to be affected
– males do not pass along their X
chromosomes, these always come
from mom
- Since females have 2 X chromosomes, they can have hetero- or homozygous chromosomes –> similar to autosomal recessive inheritance
If mom is a carrier and dad has a normal X chromosome…
- 25% chance of normal male
- 25% chance of normal female
- 25% chance of carrier female
- 25% chance of affected male
Common disorders
- Hemophilia
- Color blindness
- DMD
25
X-linked dominance (define, chances of impacted offspring, Common disorders)
Rare disorders in which dad has an abnormal X OR mom has at least 1 abnormal X
If dad has affected X --> all females have the condition and NO MALES have the condition
If mom has affected X --> 50% chance female offspring have condition and 50% chance male offspring have condition
Common disorders
- Fragile X Syndrome
26
Genetic evaluation and counseling (when is it most effective to discuss; who may benefit most from it?)
Most ideal time to discuss genetic counseling is pre-conception
Those who may benefit most...
- Mom's 35+ yo when baby is born
- Dads 50+ yo
- Incestual relationships
- Exposure to drugs, medications, radiations, chemicals, or infection
- Teratogen exposure or risk
- Concerns about genetic defects that occur frequently in ethnic or racial group (i.e. Black persons are more at risk for sickle cell anemia)
27
Alpha-fetoprotein test (description, indication and timing)
Description
- a prenatal test drawn from mom's blood to evaluate plasma protein that is produced by the fetus and crosses from amniotic sac into mom's blood)
Indications of increased levels
- Neural tube defects
- Turner syndrome
- Tetralogy of Fallot
- Multiple Gestation
Indications of decreased levels
- Down syndrome
- Trisomy 18
Timing
- Performed between 15-18 weeks gestation
28
Chorionic villus sampling (description, complications, indications and timing)
Description = INVASIVE
- a prenatal test in which a small tissue portion of the fetal side of the placenta is removed to test the fetal genetic makeup
Complications
- Riskier px d/t testing in utero
- Severe transverse limb defects
- Spontaneous pregnancy loss
Indications
- Fetal karyotyping
- detects ...
- - sickle cell anemia
- - Phenylketonuria
- - Down syndrome
- - DMD
Timing
- performed between 10-12 weeks gestation
- Results available in < 1 week
29
Nursing Roles & Responsibilities during Genetic Counseling
- Take a family history
- Answer family questions and concerns
- Discuss costs, benefits and risks of using health insurance, and note potential risk of discrimination d/t genetic testing results
- Understand ethical, legal and social issues
- PRIVACY and CONFIDENTIALITY
- Monitor family's emotional reactions
- Offer emotional support
- Referrals to support groups prn
30
Preconception care goals
- promote the health and well-being of a woman and her partner before pregnancy
- identify and modify biomedical, behavioral and social risks to a woman's health or pregnancy outcome
- CDC guidelines (10)
1. each couple should be encouraged to have a reproductive life plan
2. increase public awareness of the importance of preconception health behaviors and care
3. provide preconception risk assessments and health promotion activities at all primary care visits for women of childbearing age
4. intervene and follow-up for families with identified risks
5. provide interconception care by offering additional interventions to women who have had a previous pregnancy with an adverse outcome
6. prepregnancy checkups for persons planning pregnancy
7. increase health insurance coverage for women and couples with low incomes
8. integrate preconception health into public health programs
9. increase EBP to improve preconception care
10. monitor improvements in preconception care
31
What are key components to address in preconception care
- Immunization status of mom
- Underlying medical conditions
- Reproductive health practices
- Sexuality and sexual practices
- Nutrition
- Lifestyle practices
- Psychosocial issues
- Medication and drug/alcohol use
- Support systems
32
Common risk factors for adverse pregnancy outcomes
*** FETUS IS MOST SUSCEPTIBLE FROM DAYS 17-56 GESTATION ***
Isotrentins (Accutane)
- R/o: congenital malformations of craniofacial, cardiac and central nervous systems
Alcohol
- @ no time during pregnancy is it safe to drink alcohol
- R/o: fetal alcohol syndrome, intellectual disabilities
Antiepileptic drugs
- some are known teratogens
- common for women who are contemplating pregnancy to be rx'd a lower dose
Pre-conception Diabetes
- R/o birth defects
- Good glucose control and diabetes mgmt during pregnancy can substantially reduce risk of defects
Folic acid deficiency
- R/o neural tube defects
- Tx: daily vitamin supplements with at least 400 mcg of folic acid
Hepatitis B
- R/o hepatic failure, liver carcinoma, cirrhosis & death
- Vaccine recommended to couples at risk of acquiring HBV
HIV/AIDS
- R/o passing virus to fetus
- Tx: timely antiretroviral therapy
Smoking
- R/o preterm birth, low birth weight, fetal nicotine addition
- Best way to reduce risk of adverse outcomes is to stop smoking before or during early pregnancy
33
Nursing goals at the first prenatal visit
- establish a trusting relationship
- focus on wellness education
- detect potential problems and risk factors and offer prevention strategies
- conduct the following...
- - health history
- - physical exam
- - lab tests
34
Prenatal health history components
Reason for seeking care
- Suspicion of pregnancy
- Date of LMP
- S&S of pregnancy
- Urine/blood test of hCG
Past medical and surgical hx
Personal hx
- Occupation and occupational hazard exposure
- Exercise and nutritional habits
- Recreational habits (alcohol, tobacco and drug use)
- Use of any alternative/complementary therapies
- Sleep habits
Reproductive history
- Menstrual cycles
- Obstetric (GTPAL)
- Gynecologic hx
35
Nagele's Rule
1. Use 1st day of LMP
2. Subtract 3 from number of months
3. Add 7 to number of days
4. Adjust year by adding 1 year
5. Estimated due date (+/- 2 weeks)
i.e. LMP = 4/23/2020
1/30/2021 = EDD +/- 2 weeks
36
Gravida
of pregnancies a woman has experienced
```
Primigravida = first pregnancy
Multigravida = 2+ pregnancies
```
37
Parity
= number of pregnancies carried to 20+ weeks that have produced a viable offspring
```
Primipara = one birth after a pregnancy of 20+ weeks
Multipara = 2+ births after a pregnancy of 20+ weeks
Nullipara = no viable offspring
```
38
GTPAL
```
G = gravida = # pregnancies
T = term = # pregnancies ending >37 weeks gestation
P = preterm = # pregnancies >20 weeks but ending before completion of 37th week
A = abortions/miscarriages = # pregnancies ending before 20 weeks
L = living children = # of children currently living
```
39
GxPx
Gravida (x = # of pregnancies) P (x = # pregnancies carried to at least 20 weeks that have produced a viable offspring)
40
Prenatal Visit: Physical Exam components
**1st ask mom to change into a hospital gown and get a clean catch urine sample
Get baseline VS and height & weight
Head-to-toe assessment
- head and neck
- - lymph nodes --> any swelling is abnormal
- - nasal and gingival mucosa --> mild inflammation d/t inc estrogen is normal
- - thyroid --> slight enlargement is okay, but f/u needed if thyroid is tender or very enlarged
- Chest
- - check heart & lung sounds --> inc in blood volume may produce a slight systolic murmur; otherwise, should be clear
- - slight increase in HR and RR normal
- - breasts --> look and palpate for symmetry and color
- -- appear more full and nodular, with increased sensitivity
- -- blood vessels are prominent and striae/stretch marks common
- -- enlargement of Montgomery glands
- -- colostrum (yellowish secretion) may be excreted in 3rd T
- Abdomen
- - linea nigra = normal finding running from symphysis pubis to umbilicus
- - check fundus (top of uterus) height
- -- @ 12 weeks --> @ symphysis pubis
- -- @ 16 weeks --> between symphysis pubis and umbilicus
- -- @ 20 weeks --> @ umbilicus
- -- 21+ weeks --> cm above symphysis pubis = gestational week
- -- @ 36-38 weeks --> fundus just under sternum
- -- @ 40 weeks --> fundus drops as lightening occurs
- Extremeties
- - edema
- -- dependent edema in feet in 3rd T is common
- -- edema early in pregnancy may indicate gestational HTN
- - pedal pulses
- - varicose veins
- - calf pain --> abnormal and may indicate DVT risk
- Pelvic Exam
- - internal and external exams performed
- - measure pelvic size
41
Why is urinalysis performed at every prenatal visit?
Goals
- determine if infection is present (CDC)
- test glucose to determine gestational DM
- test proteins for kidney changes or HTN
- identifying dehydration
42
Common lab tests at prenatal visits
CBC --> detects anemia, infection, platelets/clotting factors
Blood typing --> determines mom's blood type and Rh status to rule out early Rh incompatibility
- Rh negative moms are given RhoGAM @ 28 weeks and again with 72 hours post-childbirth
Rubella & Hep B testing
HIV testing
Other STI testing
Cervical smears (Pap, group B strep)
43
Diagnosing overt or gestational diabetes during pregnancy
@ 1st prenatal visit test 1 of the following:
- fasting plasma glucose (ODM >125)
- HbA1c (ODM >6.5%)
- random plasma glucose (ODM >199)
if no overt DM at 1st prenatal visit, test for gestational DM between 24-28 weeks gestation with...
- 2-hour 75-g oral glucose tolerance test
44
Rh Status (definition, interventions)
Rh = protein found on RBCs that can cause blood incompatibilities between mom and fetus
IF MOM is Rh negative
- RhoGAM admin @ 28 weeks gestation
- RhoGAM admin w/in 72 hours of birth
RhoGAM = blood product that prevents Rh antibody development in mom post-exposure to fetal blood
45
Prenatal visit cadence after 1st prenatal visit
q4 weeks until 28 weeks
q2 weeks from 29-36 weeks
q1 week from 37 weeks - delivery
46
Assessments at each prenatal visit
Vitals & weight compared to baseline
Urine testing
Fundal height
Quickening/fetal movement
Fetal HR
Review danger signs by trimester
47
1st Trimester Danger Signs
Spotting or bleeding
- I: miscarriage)
Painful urination
- I: infection
Severe, persistent vomiting
- I: Hyperemesis gravidum
Fever > 100F + lower abdominal pain + dizziness + shoulder pain
- I: ruptured ectopic pregnancy
48
2nd Trimester Danger Signs
Regular uterine contractions unrelieved by walking
- I: preterm labor
Pain in calf, increased with foot flexion
- I: DVT
Sudden gush or leakage of fluid from vagina
- I: Premature Rupture of Membranes (PROM)
Absence of fetal movement for >12 hours
-I: fetal distress or demise
49
3rd Trimester Danger Signs
Sudden weight gain + periorbital or facial edema + severe abd pain + headache with visual changes
- I: gestational HTN or preeclampsia
Decrease in fetal movement for >24 hours
- I: possible demise
50
Nonstress test (define, when to perform, test components, test results, nursing interventions)
Definition = a noninvasive test used to assess fetal wellbeing
- not a routine test --> done for those @ increased risk or when a decrease in fetal movement is ID'd
Test components
- an external monitor assesses fetal HR in relation to fetal movement
- expected findings: fetal HR accelerations during movement
Test results
- reactive = 2+ fetal HR accelerations of 15+ bpm for 15+ seconds within 20 minutes
- nonreactive = <2 fetal HR accelerations of 15+ bpm for 15+ seconds within 20 mins
- - requires additional testing like a biophysical profile
Nursing Interventions/Patient edu
- Procedure is noninvasive
- Mom should be in semi-Fowlers, or L lateral recumbant to prevent supine HTN
- mom holds clicker and clicks when she feels fetal movement
- mom should eat before to stimulate fetal activity
51
Biophysical profile (define, goals, nursing interventions)
# Define = a 2nd line test done post-nonreactive nonstress test OR abnormal ultrasound
Goals
- Assess fetal wellbeing
- Identify fetal abnormalities
- Detect early hypoxia
Nursing Interventions/Pt Edu
- support mom and answer Qs
- encourage mom to eat right before px to stimulate fetal activity
- place mom in L lateral recumbant position to avoid supine HTN syndrome
- mom holds clicker and IDs when baby moves --> expecting accelerations with movement
52
Ultrasounds (when are they performed, why)
1st US --> performed in early pregnancy to determine gestational age
~18-20 weeks for anatomy scan
- IDing congential abnormalities
- Verifying healthy fetal growth
~34-37 weeks
- Determine fetal size/growth
- Verifying placental position (we don't want placenta previa!)
53
1st Trimester Common Discomforts with NIs
- urinary frequency or incontinence
- fatigue
- nausea and vomiting
- - NI: avoid empty stomach by eating a small amount of food before getting out of bed (i.e. saltines); eat small frequent meals; avoid brushing teeth after eating; accupuncture wrist bands; ginger; drink between meals, not with meals to avoid empty stomach; avoid smelly, greasy or fried foods
- constipation
- - NI: drink lots of H20 ~6-8 glasses/day; increase intake of fiber, fresh fruit; regular exercise; pelvic floor exercises; eat small, regular meals; no cheese!; warm fluids on waking up
- nasal stuffiness & epistaxis
- - NI: hydrate; saline sprays; humidifier; good oral hygiene; no decongestants
- Leukorrhea = normal increase of vaginal discharge
- Cravings
- - NI: almost all cravings are normal, but watch for pica = craving to eat dirt, hair, feces, etc.
54
2nd Trimester Discomforts and NIs
- Backaches
- - NI: good posture
- Variscosities of vulva and legs --> leg cramping
- - NI: elevate legs
- Hemorrhoids
- - NIs: hydrate and increase fiber; minimize straining (may be rx'd a stool softener)
- Flatulence with bloating
55
3rd Trimester Discomforts and NIs
- fatigue and n/v return :(
- SOB
- Heartburn and indigestion d/t stomach regurg from uterus displacement
- Dependent edema
- - NI: elevate feet, where compression stockings
- Braxton Hicks Contractions = painless, irregular contractions that occur without dilation; occur thruout pregnancy but are more prevalent in 3T
- - NI: educate that these are normal; educate on differences between true and false labor; encourage mom to lie on L side and deploy Lamaze techniques as practice for true labor
56
Promoting self-care during pregnancy
*** pregnancy is not an illness state ***
Personal hygiene = daily showers
Avoid hot tubs and saunas --> may lead to fetal tachycardia, plus unhygenic
Exercise --> good thruout, unless...
- Contraindications
- -preterm labor
- - poor weight gain
- - anemia
- - HTN
- - pain
- - facial or periorbital edema
- - threatened abortion
- - dizziness and SOB
- - multiple gestation
- - decreased fetal activity
- - heart disease or palpitations
Sleep!!!
- NIs
- - promote a regular sleep scheduled with time to unwind and relax (bedtime routine)
- - decrease intake of caffeine
- - cool, dark room
Sex --> will not harm the fetus; desires fluctuate and that's normal
- Contraindications
- - vaginal bleeding
- - placenta previa
- - preterm labor
- - cervical insufficiency
- - PROM
- - infection
57
Medications during pregnancy
Not all drugs are tested or classified as safe/unsafe for use during pregnancy
- FDA Category X: known teratogens
To avoid risks, best to take 0 medications during pregnancy
However! meds treating maternal diagnoses like seizures, HTN, asthma and depression are often more beneficial to mom than the risk to the fetus
58
Vaccines OK during pregnancy
```
HBV
Flu IJ
Tdap
Meningococcal
Rabies
```
59
Vaccines contraindicated during pregnancy
*** NO LIVE VACCINES ***
```
Flu nasal spray
MMR
Varicella
BCG (TB)
Meningococcal (live)
Typhoid
```
60
Lamaze method (define, breathing techniques, nursing considerations)
= psychoprophylactic method to prepare for labor & delivery
- relaxes body to increase focus on delivery and decrease focus on pain
Techniques
- paced breathing (slow-paced, modified-paced, patterned-paced)
- Focal points
- Guided imagery
- Massage
Nursing Considerations
- remain quiet to allow mom to concentrate on breathing techniques
61
Breastfeeding (benefits, recommendations, patient edu)
Benefits = improved outcomes for moms and babies
- increased bonding
- decreased risk of ovarian and breast cancer in mom
- promotes weightloss without dieting
- increased vitamin absorption to baby
- promotes baby's immune system development
- decreases likelihood of...
- - otitis media
- - constipation
- - upper respiratory infections
- - adult obesity
- cost effective
- composition evolves as baby ages and needs change
Recommendations
- exclusive breastfeeding until 6 months at least, and continuing if possible to 1 year
Patient Edu
- breast feeding is not a birth control method
62
Bottle-feeding (cons, patient edu)
Cons
- increased incidence of OM, DM, asthma, atopic dermatitis, reflux & diarrhea in baby
Pt edu
- types of formula
- how to position the baby to promote bonding while bottle-feeding
63
Placenta previa (define, causes, signs & symptoms, associated risks, risk factors, nursing assessments, nursing mgmt, nursing interventions)
= when the placenta implants and covers the cervical os (either partially or completely)
Causes --> exact cause unknown
- possibly r/t scarring i.e. previous C-sections
Signs & Symptoms
- painless, bright-red bleeding, often in last 2T
- Ultrasound findings confirm dx by locating position of placenta
Risks = high morbidity and mortality for mom and baby
Risk Factors
- Advanced maternal age (>35yo)
- Previous c-sections
- Multiparity
- Previous myomectomy to remove hemorrhoids/fibroids
- HTN or DM
Nursing assessments
- assess for uterine contractions
- palpate uterus (normal = soft and nontender)
- auscultate fetal HR (normal expected, between 110-160 bpm)
Nursing Mgmt (depends on severity of bleeding and extent os is blocked)
- if mom and fetus are stable --> wait and watch, possible activity restriction and hoping for resolution without intervention
- monitor the following...
- - Degree of vaginal bleeding (use peripad count)
- - Mom's VS and uterine contractility via pain scale
- - Fetal HR
- - Cardiopulmonary status
- - Edu that most women require a c-section
Nursing Interventions
- active/excessive bleeding --> place large bore IV for fluid and blood products
- obtain labs (CDC, coag, Rh status)
- RhoGAM @ 28 weeks
- Administer tocolytic meds to stop contractions prn
- O2 at bedside
- *** AVOID INTERNAL VAGINAL EXAMS AS THESE MAY DISPLACE THE PLACENTA AND CAUSE HEMORRHAGE)
64
Ectopic Pregnancy (patho, s&s, interventions)
Patho = any pregnancy where the gestational sac implants outside of the uterus (almost always in the fallopian tubes)
Signs & symptoms
- lower abdominal pain
- delayed menses
- abnormal vaginal bleeding
- if ruptured...
- - Cullen sign = ecchymotic-bluish color of mom's umbilicus
- - Hypovolemic shock
- - Referred shoulder pain
Nursing interventions
- in the event of shock...
- - Montior BP, HR and O2
- Methotrexate
- - I: unruptured ectomic pregnancy
- - MOA: therapeutic abortion
- Surgery (salpingostomy)
- - I: removal of an ectopic pregnancy to prevent tubal rupture
- RhoGAM Administration
- - I: mom is Rh negative with ectopic pregnancy
- - moa: prevents antibody creation to fetal blood in case of rupture or miscarriage
65
Fetal Accelerations vs. Decellerations (what are they, pneumonic)
= variations of fetal HR from baseline correlated with mom's contractions (periodic) or independent of contractions (episodic)
VEAL CHOP
- V = variable caused by --> C = cord compression
- E = early caused by --> H = head compression
- A = accelerations --> O = okay/expected with contractions
- L = late caused by --> P = placental insufficiency
66
Variable Decelerations (define, cause, duration, tx if any)
= abrupt decrease in fetal heart rate below baseline with onset to lowest HR in less than 30 seconds
Caused by: cord compression
Duration ~ 15+ seconds
Usually transient and treatable
67
Early decelerations (define, cause, duration, tx if any)
= gradual decrease of fetal heart rate (takes 30+ seconds to reach nadir) with return to baseline associated with contraction
Caused by: head compression
- contractions
- vaginal exams
- fundal pressure
- internal monitor placement
Tx --> considered normal finding with continuous monitoring
68
Accelerations (define, cause)
= increased fetal heart rate by 15+ bpm above baseline that start and peak within 30 seconds
Caused by: fetal movement --> used as indicator of fetal-wellbeing
69
Late decelerations (define, cause)
= gradual decrease and return to baseline fetal heart rate during the contraction, with the nadir occurring after peak contraction
Caused by: placental insufficiency = insufficient oxygenation between placenta and fetus
- uterine tachysystole (>5 contractions in 10 minutes)
- maternal supine HTN
- placenta previa
- HTN & DM
- intrauterine growth restriction
- epidural
70
Oxytocin/ptiocin (I, MOA, SEs, CIs, NCs)
Indications
- labor induction after cervical ripening
- initiation of milk ejection from nipple
- postpartum hemorrhage control
Mechanism of Action
- begins and increases the strength of uterine contractions by stimulating uterine muscle wall
Side Effects
- Uterine rupture (risk increased with multiparity >5; previous scarring/c-sections)
- Water intoxication d/t anti-diuretic effects
Contraindications
- Fetal lung abnormality (< 20 weeks or aeb lab tests)
- Unripened cervix
- Active genital herpes --> requires C-section to prevent TORCH infection in baby
Nursing Considerations
- use the lowest dose possible to prevent SEs
- Use IV pump only --> drug is inactivated if it passes thru GI system
- Monitor urine output to assess for water intoxication
71
True Labor
Regular, strong contractions
- walking increases intensity
- occur closer and closer together
- felt in low back --> low abdomen
Progressive cervical ripening
- effacement = thinning and shortening of cervix
- dilation = widening of cervix
- aeb bloody show = expulsion of cervical mucus (pinkish color)
Engagement of presenting part
- engagement = fetal passing down into pelvic inlet
72
False Labor
Irregular contractions
- eased and stop with walking
- felt in upper abdomen or back
- irregular intervals
Soft cervix with no effacement or dilation
No fetal engagement
73
Prolapsed Umbilical Cord (patho, risk factors, signs & symptoms, interventions)
Patho
= when umbilical cord comes out before the presenting part of the fetus d/t gravity pushing out the cord with amniotic fluids
Risk factors
- long cord
- breech or transverse lie of fetus
- sudden rupture of membranes
- small fetus
Signs & symptoms
- visualization of the cord (but may be hidden throughout labor)
- monitor fetus for prolonged or variable decelerations during contractions
Interventions
- elevate hips in modified sims or knees to chest
- - moa: relieves compression of cord
- insert 2 fingers into vagina
- - I: visible cord
- - moa: place one finger on either side of cord, or 2 on same side of cord to exert upward pressure on baby's presenting part to prevent compression
- saline towel on cord
- - I: visible cord to prevent infection
- oxygen via nonrebreather mask @ 8-10 L/min
74
Group B Strep (patho, risk factors, signs & symptoms, tx)
patho = GBS acquired in utero or through the passage of the birth canal
risk factors
- preterm birth (< 37 weeks)
- mom with hx of delivery of newborn with GBS sepsis
- mom with temp of 100.4 F during labor
- ROM >18 hours pre-delivery OR PROM
- use of intrauterine monitoring during labor
Signs/symptoms
- cyanosis
- tachypnea and flaring nostrils
- lethargy and pallor
* ** leading cause of neonatal sepsis ***
Tx
- antibiotics
- respiratory support
- IV fluids
- seizure control
75
Shoulder dystocia (patho, risk factors, treatment)
patho = fetal shoulders remain in the anterior-posterior position during descent, causing should impaction
risk factors
macrosomia (aka increased birth weight)
treatment (HELPERR)
*** McRoberts Maneuver = push mom's thighs up onto abdomen to flex and abduct the hips
76
Preterm labor
= regular contractions resulting in effacement and dilation between 20-37 weeks
77
Most important fetal adaptation to extrauterine life
Respiratory and circulatory adjustments (d/t shutting of shunts and lungs beginning to oxygenate)
78
When and by which technology can fetal heart rate be detected
@ 12 weeks/end of T1 --> heard by Doppler
@ 24 weeks/end of T2 --> heard by stethoscope
