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Maternity nursing 231 > unit 1 > Flashcards

unit 1 Flashcards

1
Q

ovarian cycle phases

A

follicular
ovulatory
luteal

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2
Q

follicular phase main hormone

A

estrogen (increases) and produces LH surge at the end: ovulation
usually 14 days (varies)

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3
Q

Ovulatory phase
mucus
S&S

A

cervical mucus: thin, watery and alkaline (helps sperm)
SPINBARKHEIT MUCUS
fertile for 24 hrs
midcycle pain/spotting

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4
Q

Luteal Phase

A

always 14 days (doesn’t vary)
old graafian follicle persists as corpus luteum. which secretes Estrogen and high progesterone to prep. uterus for implantation and preg.
Ovum fertilized-secretes HcG
not fertilized-estrogen and progesterone go down, endometrial lining falls and menses begins

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5
Q

Endometrial cycle phase

A

Proliferative (cells multiply and form tissue: follicular phase of other)
Secretory (begins with ovulation-lutel phase. endometriu, thickens)
Menstrual phase: at end of luteal phase. vasospasm/ischemia and necrosis if not fertilized.

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6
Q

Pelvic types

A

Gynecoid (great)
Anthropoid (ok. posterior position. cone head baby)
Platypelloid (narrow from side to side: poor)
Anthroid (heart. poor)

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7
Q

amnion/chorion membranes

A

inner/outer

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8
Q

amniotic fluid

A

Cushions
Maintains temperature
Allows movement
Prevents adherence

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9
Q

Olihydramnios/polyhydramnios

A

2000 ml

poor lung development/due to Gest.diabetes.multifetal

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10
Q

Placenta

sides

A

Maternal side: from Decidua (protects mother) basilis. ROUGH

Fetal side: from chorionic vili. SMOOTH

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11
Q

Placenta functions

A

-metabolic: produces glycogen, cholesterol, fatty acids.
-Transfer functions: Gas exchange by diffusion; nutrient transfer across placenta- glucose, electrolytes pass through placenta to nourish the baby; removal of wastes (urea, uric acid, carbon dioxide, billirubin)
-Transfer of Antibodies.
Want women in 9th week of pregnancy to be vaccinated against Pertussis → so baby will get pertussis antibody

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12
Q

Placental endocrine function

A 
secretes:
HCG (human chorionic gonadotropin)
Estrogen
Progesterone
Human Placental Lactogen
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13
Q

fertilization (conception)

A

ovum and sperm unite and form a zygote

baby’s sex is determined at that point

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14
Q

preembryonic period

A

first 14 days after conception

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15
Q

morula
1.outside cells (throphoblast)
2,Inside cells (blastocysts)

A

implants into the uterus: nidation (can cause spotting/bleeding a bit, woman thinks is period)

  1. chorion
  2. fetus and amnion
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16
Q

Ductus Venosus

A

Connects umbilical vein to the inferior vena cava.

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17
Q

Forman Ovale:

A

Opening b/w right & left atrium in heart.

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18
Q

Ductus Arteriosus

A

Connects pulmonary artery to the aorta

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19
Q

Decidua capsulais

A

covers the morula (outside of morula; the outer capsule)

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20
Q

Decidua basalis:

A

underneath/below the morula. Maternal portion of placenta develops from the decidua basalis.

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21
Q

Decidua vera :

A

the rest of the uterine cavity.

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22
Q

what do they measure with an ultrasound for age
1 trimester
2nd and 3rd

A
  1. Crown Rump (head to buttocks)
  2. Bi-Parietal diameter (head circumference)
    and femur leg length
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23
Q

First heart beat detectable

A

4-5 weeks with transvaginal sonogram/ultrasound

8-12 weeks with a doppler

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24
Q

uterine sizing

A 
bimanual exam one hand on vagina and the other one on uterus to feel for uterus
non preg: plum size
6 weeks: egg, pear
8 week: small orange
10 week: large orange
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25
Presumptive signs of preg.
``` Pt tells you Amenorrhea N/V Urinary frequency Breast and skin changes ```
26
Probable signs of preg.
``` signs that examiner can detect Chadwick's sign Hegar's sign Godell's sign Ballotment Uterine souffle Fetus souffle and enlargement braxton hick contractions ```
27
Positive signs (definite)
auscultation of fetal heart sounds fetal movements detected by examiner visualization of the embryo or fetus
28
skin changes during pregnancy
increased pigmentation linea nigra strae gravidarum thicker hair chloasma (mask of pregnancy) pruritus (due to gall bladder delayed emptying) PUPPP (pruritic urticarial papules and plaques in pregnancy) itchy red bumps on abdomen. take oatmeal baths
29
Musculoskeletal changes
-increased relaxin and progesterone (ligaments more relaxed) -duck-waddle gait (pubic symphysis widens) -lumbar lordosis (no heels, do pelvic exercises) goes away -paresthesias of extremities (put legs up) -Diasis recti (pt laying down/supine, ask pt to lift shoulders up → may see abdominal muscles separate.) leg cramps (calcium-phosphorus imbalance) teens -Round ligament pain (put knees to chest, abd. support) -varicosities (elevate legs, no constrictive clothing) -fatigue
30
Reproductive system changes
-uterus: increases in size (20 weeks: at umbilicus). Hegar -Cervix: chadwick, godell. mucus plug -vagina: chadwick, leukorrhea (C&S,wear liner,no douching, hygiene) braxton hick contractions: not in preterm labor, painless irregular. -ovulation ceases -breast enlarge, sensitive, montgomery glands, darker, colostrum
31
Cardiovascular system changes
- heart pushed upward to left. increased muscle. abn sounds - blood volume increases: diluted blood (less clots) - HR Accelerates by 10-15 bpm - clotting factors increase (fibrinogen) (walk postpartum) - BP decreases 1st and 2nd trimester. Nrmal in 3rd - vena cava syndrome - physiological anemia and leukocytosis
32
Respiratory changes in preg
- elevated diaphragm (thoracic breathing) - O2 consumption increases - dyspnea (goes away in 3rd trimester) sleep with pillows - rhinitis (due to estrogen) use cool air vaporizer - epistaxis (due to estrogen)
33
GI changes in preg
- N/V - Hyperemia (gingivitis, bleeding gums, epulis-hypertrophy of gums) - delayed gallbladder/stomach emptying - ptyalism (gum, decrease starch intake, mouthwash) - increased appetite - Pyrosis (dont overeat, dont lie down BC, Maalox) - constipation (due to iron, maalox, delayed emptying) - Hemorrhoids
34
Urinary tract changes in preg
- urinary frequency (first and 3rd trimester) empty q2h, increase fluids, do kegel exercises - more prone to UTI (C&S if urinary frequency) - increased GFR (leads to GLYCOSURIA, r/o diabetes first)
35
Endocrine system changes
- thyroid gland increases - cortisol and aldosterone hormones increase - pituitary gland increases - LH and FSH disappear almost (cause ovulation) - parathyroid hormone is normal (for calcium important)
36
estrogen effects
by placenta - hyperpigmentation of skin - stimulates breasts and uterus to get bigger
37
progesterone
``` by corpus luteum and then placenta VITAL! Relaxes uterus preparation of lactation decrease in 9th month ```
38
HPL hormone
human placental lactogen anti-insuling a lot in week 22
39
HCG hormone
human chorionic gonadotropin secreted by throphoblast to maintain corpus luteum detectable in urine at 8 days after conception
40
Relaxin hormone
by corpus luteum and then placenta relaxes muscles, joints softens the cervix makes shoe size increases
41
oxytocin hormone
produced by hypothalamus and released by ant. pituitary. causes uterine contractions let down reflex low during preg, high during labor
42
Prolactin hormones
10x greater in preen | milk production
43
Prostaglandin
low prostaglandin levels: preeclampsia | starts labor
44
Initial prenatal visit | Complete Health Hx
``` Current pregnancy Obstetric Hx GYN Hx Medical Hx Surgical Occupational Religion/culture meds allergies Substance and exposure Nutrition immunization Abuse baby daddy's Hx ```
45
Initial physical exam
``` VS Ht & Wt Neck Breast (self exam?) Fundus Reflexes (preeclampsia) Pelvic exam Rectal exam (hemorrhoids) uterine size ```
46
Initial lab work
``` Antibody screen Blood type/Rh factor CBC (anemia) hepatitis (TORCH PANNEL) Rubella (not given in preg) VDRL Pap smear (Gon/Chlam) PPD Urinalysis (glucose and protein) Iron (start in 2nd trimester unless hgb <11) ```
47
Subsequent visits nursing care
- Wt gain (25-35 lbs total if normal, 28-40 lbs if underweight, 15-25 if overweight, 11-20 lbs if morbidly obese) 2-5 lbs in first trimester, then 1 lbs a week - VS - Urinalysis (protein, urine, ketones, nitrates-UTI) - FHR - Rhogam (28 wks) - Blood test (glucose screening at 24-28 wks) - HIV and VDRL in 3rd trimester - sonogram - intimate partner violence - danger signs of pregnancy - preg education - 9th moth: pelvic exam, GBS culture, chlamydia, gn. - Pertussis vaccine at 26-36 weeks gestation
48
Danger signs of preg
``` vaginal bleeding visual disturbances fever intractable vomiting epigastric pain fluid from vagina ```
49
First Maneuver
facing the mom palpate fundus hard: babes head soft: babys butt
50
3rd maneuver
try to grab babys head at pubic symphysis if you can grab it: not engaged it not: engaged
51
4th maneuver
tells you if baby is flexed or not.
52
TORCH Pannel
``` Toxoplasmosis Other (syphilis) Rubella cytomegalovirus Herpes ```
53
Nuchal transulency
11 weeks Down Syndrome nuchal fold
54
triple screen screening test
2nd trimester (16-20 weeks) AFP Estriol HCG levels
55
Quad screen screening test
Inhibin A added
56
Down syndrome baby
``` Fat on back of baby's neck Low-set ears (below level of eyes) Muscle hypotonia / hypotonic muscles = reduced/low muscle tone Only 1 crease in hand (normal = 3 creases) Protruding tongue / thick tongue Hyper reflexes / hyperreflexia Short, stubby fingers ```
57
CVS
10-13 weeks need consent tells you metabolic disorders, DNA problems, NT defects NI: document FHR before and after rest for 24 hrs after procedure report any bleeding, small spotting is ok 3 hrs or 1 week
58
Amniocentesis
``` may feel abdominal cramping, pressure during procedure monitor FHR and VS of mother Resume activities in 24 hrs Report bleeding, cramping result 1 week ```
59
NST
20-40 minutes Reactive: 2 FHR accelerations 15 bpm for 15 secs in a 20 minute period Nonreactive: no reactive in 40 minutes NI; -tell them to come the next day and repeat -Do a BPP -Eat or Vibroacoustic Stimulation
60
BPP 5 parameters
``` Fetal breathing Fetal tone Fetal movement Amniotic fluid NST 8-10 normal 6-repeat test or deliver 0-4 abnormal: deliver baby right there and then ```
61
kick counts
10 kicks in 2 hours good | 10 kicks in 5 minutes is ok, just stop counting
62
16 weeks development
fetus can swallow, quickening
63
24 weeks development
surfactant production starts
64
26-28 weeks development
testes in scrotum. eyelids not fused
65
32 weeks development
surfactant near mature level
66
Fetal attitude
``` relationship of fetal parts to one another flexion moderate flexion moderate extension extension ```
67
Anterior Fontanelle (DIamond shaped)
18 months
68
Posterior fontanelle (triangle shaped)
2 months
69
Fetal lie
longitudinal | transverse
70
Fetal position
cephalic position: occiput, chin, brown Breech: complete, frank, footling shoulder: complete, frank, footling
71
Midline episiotomy
``` minimal blood loss little scarring less postop pain more complications can lacerate/tear to rectum ```
72
Mediolateral episiotomy
``` less complications will not tear/lacerate into rectum more painful blood loss more scarring prone to have painful sex/intercouse ```
73
FHR HEARD
3-4 weeks ultrasound transvaginal | 8-12 Doppler
74
12 weeks fetal development
Suck reflex Lanugo Sex distinguishable by sonogram
75
16 weeks fetal development
Swallowing Urination Quickening
76
18-20 weeks fetal development
Vernix | FHR by fetoscope
77
24 weeks fetal development
Surfactant | Active fetus
78
26-28 weeks fetal development
Testes go down | Eyelids no longer fused
79
32 weeks fetal development
Surfactant mature

Maternity nursing 231 (5 decks)

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