Unit 1 Flashcards
(153 cards)
1
Q
A nurse is caring for an older client and their family. She decides to approach the family as a component of society. What does that her cares consist of?
A
—Monitors how families interact with other institutions in a community (schools, medical facilities, financial institutions, congregations)
—used to study and implement population-focused interventions (immunization campaigns)
2
Q
What does it mean to care for a family as a system?
A
-studies how interactions among family members affect the whole family function
-used to promote family helath by directing interventions toward the way family members interact with each other
3
Q
What does it mean to care for a family as a client?
A
-Examines the family unit functioning first, then individuals needs next
- used to see how the family health is impacted by each individual’s reaction to a health event
4
Q
What does it mean to care for a family as context`
A
Focuses on an individuals first, and the family next.
Used to promote the health and recovery of an individual, using the family as a resource for service and support.
5
Q
Viewing the client as the focus of care. With the family members viewed as a source of support for the client is an example of which family care approach
A
Family as context
6
Q
Asking the family members how their family function overall has changed following the client’s stroke is an example of which family approach?
A
Family as a client
7
Q
Asking individual family members how their life has changed following a client’s stroke is an example of which family care approach?
A
Family as a system
8
Q
Examining how the family unit interacts with other parts of society, such as medical facilities or financial institutions is an example of which family care approach?
A
Family as a component of society
9
Q
What are ecomaps?
A
Visual diagram of the family unit in relation to other units such as school, work, church, friends( used to understand the relationship among family members and the community
10
Q
What is gravidity
A
Number of pregnancies the pregnant person has had, including the current
11
Q
Primigravida means what
A
First pregnancy
12
Q
What does T mean in GTPAL
A
Term—number of full term births
(Stillborn or living)
13
Q
What is the time frame to be considered pre-term
A
Fetus is greater than 20 weeks but less than 37 weeks
14
Q
What does A mean in GTPAL
A
Number of previous pregnancies that ended in abortion (spontaneous or induced) before 20 weeks
15
Q
A woman is pregnant fore the first time:
G___T___P___A___L___
A
G 1 T 0 P0 A 0 L 0
16
Q
A woman is pregnant for the 4th time. She previously delivered a child at 38 weeks and a child at 28 weeks. She had a spontaneous abortion at 16 weeks
A
G4 T1 P1 A1 L2
17
Q
A woman is pregnant for the second time. Her last pregnancy resulted in the birth of twins at 36 weeks.
A
G 2 T0 P2 A0 L 2
18
Q
What is considered full term pregnancy
A
37 + weeks
19
Q
What does hCG stand for
A
Human chorionic gonadotropin
20
Q
What is nagele’s rule estimate?
A
First day of LMP-3months+7days
21
Q
What are some presumptive signs
A
Subjective
Experienced by the pregnant person
Ammonrrhea( lack of period)
Fatigue
Nausea
Breast changes
Urinary frequency
Quickening (16-20 weeks)
22
Q
What are some probable signs in pregnancy
A
Objective
Observed by examiner
Hegar’s sing
Ballottement
Positive pregnancy test
Chadwick and Goodell signs
23
Q
What are positive pregnancy signs
A
Objective
Auscultation of fetal heart rate
Visualization of fetus
24
Q
What does hCG do
A
Maintains the corpus luteum production of estrogen and progesterone
Prevents menses until placental hormones take over (12-14 weeks)
Produces the trophoblast/chorionic layer
25
What does progesterone do
Promotes relaxation of all smooth muscle throughout the body
Increase basal body temp
Intimates development of milk ducts in breast tissue
26
What does estrogen do
Cause proliferation in the uterus
Causes increases in vascularity, uterine blood flow, and pigmentation
Causes relaxation of pelvic joint and ligaments
27
What are the names of hPL and hCS
They are the same hormone, different names
Human placental lactogen
Human chorionic somatomammotropin
28
What does hPL or hCS do in pregnancy
Increases protein synthesis
Contributes to placental and fetal growth
Aids in colostrum production
Causes creased insulin resistance
Produced by the placenta
29
What does cortisol do to insulin
Cortisol stimulates production of insulin
30
What does PTH do during pregnancy
PTH control calcium and magnesium metabolism
31
what is the general rule of fundus growth
1 cm a week up until 20 weeks
32
Near 20 weeks, where should the uterus be?
Al the level of umbilicus around 20 -22 weeks
33
Where should the uterus be at 12 weeks
Near symphysis around 12 weeks
34
What is hegar’s sign
6 weeks softening and compressibility of the lower uterus segment
35
What is ballottement>
Identifiable between 16-18 weeks; examiner bounces the floating fetus near the cervix
36
What what rate does uterine blood flow
140/650mL/min
37
What is runic soufflé
Sound of blood rushing through the umbilical veins
Should match maternal pulse
38
What are factors the decrease uterine blood flow?
1. Low maternal arterial pressure
2. Contractions of the uterus
3. Maternal supine position
After second trimester, urge not to lay on back
39
What is goodell’s sign>
Softening of the cervical tip around 6 weeks of pregnancy
40
What is Chadwick’s sign?
Violet-blue color of the vaginal mucosa and cervix around 6-8 weeks of pregnancy
41
What is leukorrhea?
Normal during pregnancy
Copious white/gray mucous discharge
42
What is the normal pH of a pregnancy
3.5-6
More susceptible to yeast infections
43
What is operculum?
Thick, jelly like mucus that falls the cervical canal to protect the fetus from infection that forms at 3 week s for gestation
“Mucus plug”
44
When do you see proliferation of milk ducts
2 and 3rd trimester
45
What is lactogensis stage 1 and when does it happen
Prolactin stimulates colostrum production; placental lactogen stimulates colostrum secretion 3rd trimester
46
How does pregnancy affect blood volume
Increases 40-50%
Fluid reserve
47
How does pregnancy affect cardiac output?
Increase 30-50%
48
What is supine hypotension syndrome
Supine hypotension syndrome is when uterus compresss inferior vena cava and aorta, which limits blood flow to fetus and mother
49
How does the structure of heart changes during pregnancy
Heart is elevated upwards and rotated forward to the left due to enlarged uterus
Third heart sound and murmur may be present
50
Potential physiologic anemia due to increased plasma volume T/F
T
51
How much does oxygen consumption increase during pregnancy
20-40%
52
What does progesterone do in the GI system
Pytalism (excessive salivation) and epulis (reddened gum nodules)
Decreases in motility of smooth muscle
Pyrosis (heartburn) and constipation
Gallstones
53
T/F dilation of the right ureter is more common
True
54
What is diastasis recti
Separation of the rectus abdomin is muscles
55
Why is carpal tunnel common in pregnancy
Edema compresses median nerve beneath the carpal tunnel ligament of wrist
56
Why are headaches common in pregnancy
Increased blood volume
Need to rule out hypertension
57
What are the 5 Ps in labor and birth
Passenger
Passageway
Powers
Position (of mother)
Psychological response
58
What are the three types of fetal presentation
Cephalon
Breech
Shoulder
59
What is fetal lie
Relation of the fetal spine to the maternal spine (longitudinal or vertical)
60
What is fetal position
Relationship of reference point on the presenting part of the four quadrants of the mother’s pelvis
61
What is the fetal attitude
Relation of the fetal body parts to one another
62
What is fetal station
Measure of the degree of descent of the presenting part of the fetus through the birth
63
What is engagement
Usually corresponds to 0 and moving steady
64
What is the first stage of labor
Onsent of regular uterine contractions to full dilation of the cervix
65
What is the second stage of labor
Time the cervix is fully dilated to the broth of the infant
66
What is the second stage of labor
Time the cervix is fully dilated to the broth of the infant
67
What is the third stage of labor
Birth of the infant through delivery of the placenta
68
What is the fourth stage of labor
Delivery of the placenta until delivery perosn’s condition is stable (usually an hour after birth)
69
What is the normal bpm of fetus inutero
110-160
70
T/F carbon dioxide increases during labor to initiate a breath
T
71
What is the length of pregnancy?
280 days (40 weeks)
Calculated from the first day of LMP
72
What are the three stages of development and describe them
Germinal (0-2 weeks)—zygote implants in the uterine wall, initial cells divide
Embryonic( week 3-8) embryonic disc differentiates, organs and body structure form
fetal (week 9+) organs and tissues develop, and refinement of structures and function
73
What happens prior to conception
Gametogenesis and fertilization
74
What is gametogenesis
Oogenesis— egg formation, begins during fetal life
Spermatogenesis—sperm formation begins during puberty
75
What is capacitation
Removal of sperm’s protective coating
76
When is conception
When a zygote forms (sperm and egg meet)
77
when does implantation occurs
Blastocyst embeds in the endometrium between days 6-10
78
What are the primary germ layers of the embryonic
Ectoderm—forms the epidermis, different glands, nails, nervous system, parts of eye, teeth enamel, part of the amniotic cavity (surrounds fetus)
Mesodermal— gives rise to bones, teeth, muscles, dermis, connective tissues, cardiovascular system, spleen, and UI tract
Endoderm— epithethial lining of respiratory and digestive tracts, granular cells and those systems (digestive enzymes and surfactant
79
When are teratogens most harmful to fetus
Embryonic stage
80
Where do you measure embryo in embryonic stage
Head to bottom
81
List and describe two fetal membranes
Chorion- becomes the covering of the fetal side of teh placenta, contains umbilical blood vessels and chorionic billiard that degenerates into the smooth membrane
Amnion— thin membrane that covers the umbilical cord and forms a fluid filled sac around teh embryo; fuses with the chorion
82
What does the yolk sac aids in?
Transferring maternal nutrients and oxygen for the first 5-6 weeks
Similar functions to the placenta in early pregnancy
83
What is Wharton’s jelly
Surrounds vessels to prevent compression
84
You can read brain waves at 8 weeks T/F
T
85
When does the placenta start forming
Week 3, formed by 12 weeks
86
What hormones does the placenta produce
HCG
HPL/hCS
Progesterone
Estriol
87
What are the 4 functions of the placenta
Respiration, nutrition, excretion, storage
88
What are the functions of the amniotic fluid
Thermoregualtion for fetus
Source of oral fluid
Repository for waste
Assists with fluid/electrolyte homeostasis
Provides fetal cushioning and aids musculoskeletal development
Antibacterial factors
Provides for auditory stimulation
Facilitates fetal lung development
89
What is it called when there is <300 ml of amniotic fluid
Oligohydramnios
90
What is it called when there is >2 liters of amniotic fluid
polyhydramnios
91
ductus arteriosus
Connection between pulmonic artery and aorta
92
Foramen ovale
Hole between Altria of the heart
93
ductus venous
Connection that allows oxygenated blood to pass the liver and direct to the heart
94
When does the ductuses close
Right after birth
95
T/F fetal hemoglobin affinity is lower than maternal hemoglobin
False fetal oxygen affinity for oxygen 20% to 30% more than maternal hemoglobin
96
When is respiratory fully developed
Surfactant present and functional at 32 weeks
Respiratory system fully developed at 34 weeks
97
when is the GI tract developed
Begins forming in week 4 and matures until 36 weeks
Fetus swallowing in the fifth month
Meconium stool passed in the first 24 hours
98
When is the hepatic system developed
Develops from foregut around 4 weeks
Liver is enlarged between weeks 7-9 weeks d/t hemotpoisesi
Glycogen stored in fetal liver
99
When do kidneys form and function
Kidneys form by week 5 and function by week 9
100
What is cervix caseosa
White, cheesy substance that protects fetal skin; thick around 24 weeks and thin by term
101
What is the definition of the postpartum period
Internal between birth and return of the reporoductive organs to their non pregnant state
Also referred to as fourth trimester
102
What is involution
Return of the uterus to its non pregnant state
Begins after delivery of placenta (oxytocin
Uterus is the same size as 20 weeks gestation by 24 hours after birth
103
What is autolysis
Self-destruction of extra uterine tissue
104
What is subinvolution
Failure of uterus to return to non pregnant state
105
What is lochia?
Uterine discharge that appears after birth
Happens as uterine non lotion and endometrial change occurs
106
What are the different kinds for lochia
Rubra—bright red— 1-3 days==blood from placental site, tissue debris, vernix, lanugo, active bleeding
Serous— pinkish brown—4-10 days==blood, wound, exudate, RBCs, WBCs, cervical mucosa
Alba—white-yellow—10-14 days (can last 3-6 weeks)== wbcs, trophoblastic tissue debris
107
How do viral signs change during postpartum
Temperature may increase to 100.3 within first 24 hours
Pulse, stroke volume, and cardiac output elevated for first hour PP, normal within 48 hours
Blood pressure increases first few days PP, normalizes over weeks-months
108
What is the normal blood loss for vaginal and C section
300-500ml—vaginal
500ml-1000ml—C section
109
What are respiratory changes during postpartum
Decrease in intraabdominal pressure allows more room for diaphragm contraction and lung expansion
Chest wall complicate increases
Pulmonary blood flow decreases
110
What are endocrine changes in postpartum
Decreased progesterone causes increased prolactin, which remain elevated as long as woman is breastfeeding
111
What are some GI changes during postpartum
Peristalsis is slowed during labor
Diarrhea is common in the immediate perinatal period
Dehydration
—stool softeners are needed for he first several days
First stool usually happened 2-3 days PP
112
What is melasma
Freckle like hyperpigmentation during pregnant
113
What is the definition of infertility
Inability of become pregnant after one year of actively trying
114
What is amenorrhea
Defined as the absence of menstrual flow for more than 45 days from first day of LMP
Pregnancy, hypogonadotropin (problems in central hypothalamic-pituitary axis), exercise-associated
Assessment:history, rule out pregnancy, cbc, chemistry, UA, hormone testing
115
Why is dysmenorrhea
Pain shortly before and during menstruation
Primary—associated with ovulation cycle by release of prostaglandins
Secondary —develops later in life associated with pelvic pathology (typically after 25 years old)
116
What is PMS
Complex poorly understood condition includes psychological and behavioral symptoms
Symptoms begin in literal phase
Diet and exercise can manage
117
What is premenstrual dusphoric disorder PMDD
More severe variant of PMS where women have marked irritability, disphora, mood lability, anxiety, fatigue, appetite changes, and sense of feeling overwhelmed
118
What is endometriosis
Defined as the presence and growth of endometrial tissue out of the uterus (5-10% of menstruating women)
Symptoms- dysmenorrhea, deep pelvic pain, painful intercourse, abnormal bleeding
Management- drug therapy (NSAIDs and hormone therapy), and surgical intervention
119
Define menopause
Defined as asmenorrhea for 12 consecutive months, leads to cessation of menses
Usually occurs between ages 40 and 58; average duration is 4-8 years
Characteristics: cycles are irregular, genital atrophy: vaginal dryness, urinary incontinence, recurrent UTIs
Vasomotor instability: hot flashes, night sweats
Increased risk of osteoporosis and coronary heart disease
—hormone therapy is an option for some women
120
What are some pain reliefs for clients with menstrual problems
Heat to lower abdomen
Certain exercises can relieve pelvic congestion
NSAIDs
OCPs if indicated (birth control)
121
What is benign prostatic hyperplasia, incidence, and contributing factors
Condition where prostate gland increases in size, disrupting the outflow of urine from the bladder though the urethra
50% of men will have signs 50 years
>70% of men will have signs by 60-69 years
Does NOT increase risk of prostate cancer
Contributing risk factors—hormonal changes related to aging, obesity, lack of physical activity, diabetes, high intake of red meat and animal fat, alcohol use, smoking, family history
122
What are some symptoms of BPH
Irritating symptoms—nocturnal, urinary frequency, dysuria, incontinence
Obstructive symptoms—difficulty starting stream of urine, weak stream of urine, intermittency, dribbling
Manifestationoccur gradually and worsen as urethra becomes more compressed
123
What are some assessments, treatments, and complications of BPH
Assessments—digitical rectal exam, uroflowmetry, transrectal ultrasound
Treatments—drug therapies, PSA surveillance, prostatectomy, transurthral incision or resection of the prostate
Complications—- acute urinary retention, UTI, pyelonephritis, bladder calculi/stones, sepsis and renal failure
124
Define prostatitis and what are the types
Describes a group of inflammatory and noninflammatory conditions that affect the prostate gland
Incidence: one of teh most common urologic disorders
4 types: acute bacterial prostatitis
Chronic bacterial prostatitis
Chronic prostatitis (non bacterial)
Asymptomatic inflammatory prostatitis (non bacterial
125
What are the signs and symptoms of prostatitis
Acute__ fever, chills, back and perineal pain, rivalry symptoms, acute urinary retention
Chronic— back and perineal pain, ejaculatory pain, recurrent UTIs
Prostate is enlarged, soft, tender
Diagnosis—UA, CBC, PS, MRI/TRUS
Management: antibiotics, pain management, increase fluid intake
Urinary catheter isertion for retention (contraindicated for acute prostatitis)
126
T/F prostate cancer is the first most common cancer among males and leading cause of cancer death
F
Prostate cancer is the second most common cancer among males and second leading cause of cancer death
127
T/F white men are the highest risk of diagnosis/ death
F black men are higher risk
128
What is considered to be the neonatal period
Birth-28 days
129
When is the period of instability of a newborn
6-8 hours
130
What are the three stages of transition and describe them
First- HR increases 160-180bpm until about 30 minutes, respiratory 60-80 (30-60 minutes), altertness (great for skin to skin, ideal meconium stool,
Period of decreased activity: 60-100 minutes after birth, well-circulated, active bowel
Second period of reactivity- brief tachycardia and tachypnea, 2-8 hours after birth, lasts several hours
131
What initiates the first breath
Chemical: increased CO2 present during labor, cord clamping causes buildup of CO2
Mechanical: compression of chest with vaginal delivery and chest expansion once born, crying opens alveoli
Sensory:catecholamine surge shortly before labor stimulates fluid clearance from lungs and increases release of surfactants
132
What are normal findings in the respiratory system
30-60 breaths per minute, shallow and irregular, chest and abdomen rise with inspiration, breath sounds are louder due to thin chest wall, shoulder sound clear over most areas but occasional rakes are common in the first two hours
133
What are sings of respiratory distress
RR greater than 60 (without crying) or less than 30 RR. Diminished breath sounds, wheezes, or crackles after the first hour of life, expiratory grunts, cyanosis (circumoral), retractions, apnea for 20 seconds or more, nasal flaring (after 30 minutes)
134
What are normal findings in newborn during cardiovascular system
-first breath triggers pressure changes that lead to the transition from fetal to neonatal circulation
-clamping of umbilical cord increases systemic pressure and forces flow of blood through the lungs
-murmurs are usually benign
-HR 12-160bpm
Rate is regular, although sinus dysrhythmias are common
135
What are signs of cardiovascular distress
Persistent tachycardia (more than 160bpm)
Persistent bradycardia (less than 80bpm)
Absent pulses in extremities
Difference in BP between upper and lower extremities
Irregular heart rate past the first few hours
Poor feeding, apnea, cyanosis, pallor
136
What is the normal rectal temperature for a newborn
36.5-37.5C (97.8-99.5F)
137
what is the normal newborn BP
Systolic 60-80
Diastolic 40-50
138
What do newborns create heat
Brown fatLconverted in glycogen more easily than white fat, rich vascularity and nerve supply
139
What are characteristics of the hepatic system in a newborn
Iron storage is sufficient for 4-6 months
Serum glucose decreases
Bilirubin regulation: liver is immature and unable to conjugate bilirubin effectively
140
T/F amylase and lipase not functional at birth
T
141
What antibody is passive immunity for first 3 months
IgG
142
When if IgM present
8th week— neonate can respond to new antigens
143
Where does baby get IgA, and what does it do
IgA present in breast milk—helps maintain immune homeostasis
144
What is erythema toxicum?
transient newborn rash that appears in first 24-72 hours of life and last up to 3 weeks of age
145
What is caput succedaneum?
Benign fluid collection cause by pressure on presenting part of scalp during delivery
Edema crosses suture lines, resolves in 3-4 days
146
What is cephalohematoma
Accumulation of blood under scalp, since bleeding is between skill bone and periosteum, doesn’t cross suture lines, resolves in 3-6 weeks
147
What is purple crying?
Development normal cruing that increases to 2.5 hours/day and peaks around second month of life
148
Fluid requirements of infants
2 days—60-80/kg/day
3-7–100-150/kg/day
8-30days—120-180ml/kg/day
149
What are some contraindications to breastfeeding
Galactosemia in infant —(can’t break down glucose)
Maternal T cell luphotropic virus
Material HSV lesions on beast
Maternal HIV
150
What is rich in colostrum
Rich in immunoglobulins, high concentrate of protein and minerals, binds bilirubin
151
What are the formula feeding patterns
24-48 hours: 15-30mL per feeding
By second week: 90-150 mL
Every 3-4 hours thereafter
152
What is the golden hour
Refers to the first hour of life after birth
Baby should be on mom’s chest if both are stable
Priorities: bonding, breastfeeding, identification, cord pH
153
What is the normal infant glucose
40-45 in the first 72 hours
