Maternity Exam 1 Flashcards
(179 cards)
1
Q
making everyone fit the same cultural pattern and excluding those who don’t fit- forced assimilation. (emphasis on difference as barriers)
A
cultural destructivness
2
Q
do not see or believe there are cultural differences among people. everyones the same
A
cultural blindness
3
Q
being aware that we all live and function within a culture of our own and that our identity is shaped by it
A
cultural awareness
4
Q
understanding and accepting different cultural values, attitudes, behaviors
A
cultural sensitivity
5
Q
capacity to work effectively with people, integrating elements of their culture- vocab, values, attitudes, rules, norms. translate knowledge into their care
A
cultural competence
6
Q
lifelong process of self-reflection and self-critique that begins, not with an assessment of a cultures belief but rather assessment on own
A
cultural humility
7
Q
the average cost of a vaginal birth
A
$32,093
8
Q
average cost of c section
A
$50,373
9
Q
for younger people, those who are under or uninsured
A
medicaid
10
Q
infant mortality rate
A
6 out of 1,000
11
Q
medicaid is funded by ???
- determined by each state, but must meet federal minimal requirements (income, household size, state of pregnancy)
A
federal and state monies
12
Q
The Affordable Care Act gave states the option of extending Medicaid eligibility to people living at or below ___% of the
federal poverty level.
A
133%
13
Q
with medicaid, women are covered through the month in which their 60 -day ________ period ends
A
postpartum
14
Q
t/f: Health outcomes improve with the amount of money spent on care.
A
false
15
Q
full labor- period spent actually birthing baby
A
intrapartum
16
Q
only __% of women in US report receiving preconception care
A
31%
17
Q
what part of pregnancy is most crucial?
A
first few weeks
18
Q
reason for taking folic acid during pregnancy, how much?
A
prevents neural tube defects, 1mg
19
Q
Pregnancies after age 35 are considered high risk due to:
A
- dimished egg quality
-increased risk for preg- related complications - increased risk of preexisting health conditions
20
Q
adolescent pregnancy under age of ___ are considered high risk due to socioeconomic status
A
20
21
Q
35 and older is
A
advanced maternal age
22
Q
gynecological history includes:
A
-age of menarche (menses)
-LMP date (last menstrual period)
-cycle length/regularity
-STI’s
-gynecological conditions/surgeries
23
Q
obstetric history includes:
A
- prior delivery dates
- gestational age at deliveries
-mode of delivery
-delivery location
-anesthesia type
-pregnancy outcome - sex of child
-length of labor
-birth weight/ percentile according to gestational age
-past pregnancy complications
24
Q
GTPAL stands for: (each letter)
A
G- number of pregs in their lifetime
T- number of pregnancies ended at term
P- number of pregnancies ended at preterm
A- spontaneous elective abortion (before wk 20)
L- number of living children
25
GP stands for: (each letter)
G- number of pregs they have had in their lifetime
P- number of pregs carried to viable gestational age (usually 20-24 wks)
26
holistic health history interview:
-sexual history
-self-care/healthy behaviors
-systems review
-biographic data
-allergies
-diet
-sleep patterns
-immuns
-workplace/environmental patterns
-eating habits
-fam history
27
Interactions between the ovaries, anterior pituitary, and the
hypothalamus regulate the ________ ________ _____
female reproductive cycle
28
When estrogen and progesterone levels are low, the hypothalamus is stimulated to produce _______ ________ ______
gonadotropin-releasing hormone (GnRH).
29
In response to GnRH, the anterior pituitary releases _______ and _________
follicle-stimulated hormone (FSH) and luteinizing hormone (LH)
30
this is responsible for maturation of ovarian follicles that will release eggs for fertilization.
FSH
31
___ levels peak approximately 14 days before menses to cause ovulation.
LH
32
After ovulation, the ovarian follicle is called a
corpus luteum
33
first day/onset of bleeding to the start of next bleed
cycle length
34
first day to last day of bleeding
duration
35
The corpus luteum produces large amounts of __________ and a smaller amount of _______, which maintain the uterine lining for implantation.
progesterone, estrogen
36
If implantation does not occur, the corpus luteum begins to lose its secretory function after about ______
a week
37
Progesterone and estrogen levels are decreased causing the hypothalamus to produce ____.
GnRH
38
Menstrual cycle occurs when an ovum is ___ _________ and typically
begins __ to __ days after ovulation.
not fertilized, 12 - 14
39
The first half of the menstrual cycle is known as the
follicular phase.
40
ovaries are stimulated to mature follicles and their associated oocytes. At the same time, the uterine lining
begins to proliferate.
follicular stage
41
ends with: one mature follicle (graafian
follicle) ruptures and expels an ovum (ovulation).
end of follicular stage
42
The second half of the menstrual cycle is called the
secretory phase.
43
the corpus luteum secretes estrogen
and progesterone to maintain the uterine lining for implantation.
secretory phase
44
full term is
37 weeks and beyond
45
preterm is
20 weeks to 36.6 (36 weeks and 6 days)
46
19 weeks its considered ______
once you hit 20 weeks, its considered _____
abortion, preterm
47
the creation of gametes (ova and sperm) through meiosis.
gametogenesis
48
Females are born with ___ to __ _________ oocytes in their ovaries.
1 to 2 million
49
in the female, one ovum and three polar bodies are formed
through ______.
oogenesis
50
In males, spermatogenesis does not begin until _______
puberty
51
in spermatogenesis, one spermatogonium gives rise to ____
spermatozoa.
four
52
Presumptive symptoms of pregnancy include
* Amenorrhea
* Breast tenderness
* Nausea
53
estrogen makes things _____
grow
54
Probable signs of pregnancy include:
-Braxton Hicks contractions
-Positive pregnancy test
-Softening of the cervix (Goodell’s sign)
-Bluish discoloration of the female genitalia (Chadwick’s sign)
55
Positive signs of pregnancy include:
- Fetal heartbeat obtained
- Fetus visualized on ultrasound
56
______ produced at the time of implantation.
hCG
57
____ doubles in early pregnancy approximately every 48 to 72 hours.
hCG
58
Home pregnancy tests detect ___ in the urine
hCG
59
calculating estimated date of delivery by last menstrual period using what?
naegeles rule
60
example of naegeles rule"
- first day of LMP: June 6
- Subtract 3 months: March 6th
Add 7 days: = EDD = __??
EDD= March 12th
61
Fertilized ovum becomes a morula and then blastocyst before entering the uterus
preembryonic stage
62
embryonic stage is what weeks?
weeks 2-8
63
embryonic stage:
implantation occurs by the end of week __
2
64
embryonic stage:
Neural tube fuses at the center and tubular heart
begins to beat in week __
3
65
embryonic stage:
Respiratory and digestive tracts begin to form
and the neural tube fusion is complete in week __
4
66
embryonic stage:
Limb buds appear in week __
5
67
embryonic stage:
the heart is in its final form in week __
6
68
embryonic stage:
the first brain waves are detectable in week __
8
69
fetal stage is what weeks?
weeks 9-38 +
70
fetal movement begins, kidneys begin to function, genitalia fully differentiated in weeks __ to __
weeks 9-12
71
oogenesis established in females, blood vessels visible under the skin, ridges that will form fingers and toe prints are present in weeks __ to __
weeks 13 to 16
72
fetal swallowing is present and insulin production begins. Lanugo and vernix caseosa cover the body by the end of week __
20
73
**lungs begin to form surfactant by what week?
24th week (surfactant- help to breath)
74
testes descend in males, the fetus often moves to a head down position, and blood is produced in the bone marrow by week __
week 28
75
subcutaneous fat is deposited and the fetal heart rate variability is more pronounced due to central nervous system maturity by weeks __ to __
weeks 29 to 34
76
visual acuity is 20/600, vernix caseosa is visible in skin creases, and lanugo only on back and shoulders. The lungs and central nervous system mature while the fetus continues to grow and
gain weight by weeks __ to ___
weeks 33 to 38
77
A patient is 37 weeks pregnant and exposed to a
teratogen that can impede neural tube fusion. The
nurse understands that:
There is little risk because neural tube fusion is
complete in the embryonic stage.
78
A circulatory interface between the mother and the
embryo/fetus
placenta
79
placenta forms at the site of ________ _________
blastocyst implantation
80
placenta attaches with finger-like projections known as ____ ____
chorionic villi
81
placenta expands over the inner surface of the uterus until about ___ weeks gestation
20
82
*what 3 primary functions from placenta:
circulation, protection, hormone production (secretes hormones to *support pregnancy*)
83
how big is placenta when fully developed?
approx. 2.5-3cm thick and 38-51 cm in diameter
84
placenta: fetal surface is smooth and translucent called
shiny Schultze (baby is shiny and new, shiny schultze touches baby)
85
placenta: maternal side has red, meaty appearance called
dirty duncan (dirty side touches us)
86
hormones that tells us were pregnant
hCG, found in urine
87
hPO and hCS
interchangable
88
the umbilical cord has how many arteries and veins?
2 arteries and 1 vein (AVA)
89
umbilical arises from _____ side of placenta
fetal
90
umbilical cord fn:
serves as conduit for blood traveling to and from embryo/fetus
91
large vein carries ________ blood to embryo/fetus and 2 smaller arteries that carry ________ blood to placenta
oxygenated, deoxygenated
92
stretch marks, often genetic, common on breasts, abdomen, thighs
- may appear dark and red then become paler and silvery over time
striae gravidarum
93
a dark line from the pubic symphysis to the fundus, is more often found in women with darker skin and gradually disappears after pregnancy
linea nigra
94
mask of pregnancy, darkens with sun exposure and disappears after pregnancy
chloasma
95
Hair grows longer and thicker in pregnancy due to
estrogen stimulating the hair follicles; Hair growth returns to normal during the first 4
months after delivery.
96
caused by increased blood flow and is harmless and painless.
palmar erythema
97
Blood vessels dilate and become more prominent
in early pregnancy due to
increased estrogen levels.
98
Mother supplies thyroid hormones to the fetus until the ___ week of pregnancy when the fetus can produce on its own.
12th; thyroid hormones is critical to fetal neurologic development and often increase during pregnancy
99
Insulin needs increase steadily beginning when?
the second half of pregnancy.
100
Women whose pancreases cannot keep up with increased insulin demands develop
gestational diabetes
101
Cortisol levels increase in the ______ trimester of pregnancy and may promote lung and neurologic development.
second
102
Oxytocin is produced by the _______ _______ and has a role in producing contractions, postpartum uterine contraction, and milk ejection.
posterior pituitary
103
Oxygen consumption increases __% to __% during pregnancy.
15-20%
104
Mild hyperventilation and sense of dyspnea results in a state of physiologic ??
respiratory alkalosis
105
frequent nose bleeds d/t
engorged capillaries (from congestion from increased estrogen)
106
cardiac output increases by as much as __%
50%
107
Total blood volume increases by 40% to 50% while red blood cell count increases by 30%. Result is
physiological anemia
108
Rise in fibrinogen and other clotting factors thought to prevent excessive postpartum bleeding puts women at risk for blood clots, which could lead to
pulmonary embolism or stroke.
109
hemoglobin stays around 10-10.1 with _______ anemia, no treatment needed is asymptomatic
physiologic; need to treat psychologic
110
GFR increases about __%
50
111
More salt and water is reabsorbed in pregnant women than nonpregnant women. (Water gain is approximately _____)
1.6 L
112
a yellowish form of early milk, is produced and may leak from the nipple.
colostrum
113
Between the ___ and ___th week of pregnancy, the size of the uterus (in centimeters) from the symphysis pubis to the fundus equals the number of weeks’ gestation.
16 and 36th
114
forms inside the cervical canal to create a barrier against pathogens.
mucus plug (operculum)
115
fundus levels:
12 weeks-
level of symphysis
116
fundus levels:
16 weeks-
halfway between symphysis and umbilicus
117
fundus levels:
20 weeks-
level of umbilicus
118
fundus levels:
24 weeks
2 fingers above umbilicus
119
fundus levels:
30 weeks
midway between umbilicus and xiphoid process
120
fundus levels:
36 weeks
level of xiphoid process
121
fundus levels: 40 weeks
2 fingers below the xiphoid process, drops at 34 weeks level because of lightening
122
an exaggerated curve to the lumbar spine, causes shift to the mother’s center of gravity and increases the risk of falls.
lordosis
123
_______ and ______ increases mobility of pelvis for delivery but makes joints less stable.
relaxin and progesterone
124
______ ________ which position and stabilize the uterus, can stretch
and cause pain.
round ligaments
125
Abdominal walls separate at the midline
diastasis recti
126
increased calcium reabsorption due to
increased parathyroid hormone
127
Reduced peristalsis in gastrointestinal tract causes delayed stomach emptying and results in
heartburn, constipation, gallstones
128
t/f: A nurse expects a patient’s hemoglobin and
hematocrit to be lower at the end of pregnancy
than they were at her initial prenatal visit.
true
129
Headaches are common during pregnancy, but may be a sign of preeclampsia and should be evaluated after ____ weeks gestation
20
130
craving nonfood items and may be associated with nutritional deficits.
pica
131
increased saliva
ptyalism
132
Nausea and vomiting is common in the first trimester and likely caused by increased
hCG levels
133
things to avoid with heartburn:
avoid fatty foods and excess liquids with meals, avoid lying down after eating, avoid eating 3 hours before sleep
134
things to increase with constipation
dietary fiber, fluids, light exercise
135
Prenatal care appointments should be every __ weeks until week __.
4, 28
136
Appointments should be every __ weeks between 28 and 36 weeks’ gestation.
2
137
After 36 weeks’ gestation, patients should be seen ______ for prenatal care.
weekly
138
Women should drink approximately ???? cups of fluids that are mostly water each day.
8-10
139
march of dimes caffeine reccomendation:
200mg/day (12 oz cup of coffee)
140
normal weight gain during 1st trimester
1 to 4 lbs (second and third depend on BMI)
141
involuntary uterine contractions (Ferguson relfex), occurs in upper 2/3 of uterus
primary powers
142
voluntary action of pushing
secondary powers
143
reflex to push
Ferguson reflex
144
_________ can be administered to augment strength and frequency of contractions
oxytocin (pitocin)
145
stimulated when presenting part of fetus
reaches pelvic floor
Ferguson reflex
146
time from complete dilation of cervix
(10cm) to birth of fetus
2nd stage of labor
147
Voluntary bearing down efforts of laboring woman
-increases intraabdominal pressure → potentiates contractions
secondary powers
148
Anatomy of the bony pelvis and soft tissue of
the pelvic floor muscles, vaginal canal & introitus (vaginal opening). (depends on ability of soft tissue to stretch)
passageway
149
_______ pelvis shape provides most ideal passageway
gynecoid
150
The relationship between the fetal presenting part and the pelvis is assessed by
fetal station
151
The level of the ischial spines is referred to as
zero station
152
Fetus is engaged when the presenting part has
reached ??
zero station
153
The part of the fetus that enters the pelvis 1st
fetal presentation (presenting part)
154
Majority of fetuses enter pelvis head first –
cephalic presentation
155
buttocks or feet & shoulder presentation
breech
156
Position of fetal body parts in relationship to one another (flexion/extension)
fetal attitude
157
Relationship of the long axis of the fetus to the long axis of the mother
fetal lie
158
The relationship of the presenting part to the maternal pelvis
fetal position
159
a womans ____ can impact labor; anxiety, stress, fear, pain tolerance can all delay labor progress
psyche
160
Contractions are generally more effective when a woman is
upright and ambulating
161
The angle of the pelvis is most conducive to birth when a woman’s hips are sharply flexed →
squatting
162
signs of impending labor: contractions become regular =
q 4 mins x 1 min x 1 hour (411)
163
signs of impending labor: Descent of the fetus into the birth canal
lightening
164
signs of impending labor; GI distress such as
heartburn, nausea, diarrhea
165
signs of impending labor; weight loss just before onset of labor of how many lbs?
1-3
166
regular contractions that cause progressive dilation and effacement of the cervix (longest stage – divided into 3 phases)
first stage
167
primigravida
having first baby
168
multigravida
has had baby before
169
3 phases of first stage
latent, active, transition
170
latent phase dilation
0-3 cm
171
active phase dilation
4-7 cm
172
transition phase dilation
8-10 cm
173
starts with complete dilation of cervix, pushing,
and ends with the birth of the baby
second stage
174
begins just after the birth of the baby and ends with delivery of the placenta
third stage
175
begins just after the delivery of the placenta and ends after 4 hours or when the mother becomes clinically stable
fourth stage
176
After delivery of the placenta, the uterus continues to contract to “pinch” or close the open blood vessels in the decidua to prevent
maternal hemorrhage; failure to contract = _________; primary cause of postpartum hemorrhage
uterine atony
177
Assessment of uterine contractions looks at the number of contractions during a __ ______ window, averaged over ___ ______
10-minute, 30 mins
178
normal uterine contractions
< or equal to 5 contractions in 10 mins
179
tachysystole uterine contractions
> 5 contractions in 10 mins
