Women and Families Flashcards
(169 cards)
1
Q
Non-stress test
A
measures fetal well-being; started around 34 weeks for normal risk pregnancy; accelerations in response to fetal movement; 2 or more accelerations in 20 minutes
2
Q
contraction stress test
A
looks for decelerations of baby HR in response to contractions; do not want decelerations in relation to contraction; want a negative test = no decels
3
Q
prolactin
A
hormone that stimulates milk production
4
Q
Let down reflex
A
stimulation of the nipple by babies sucking; hypothalamus stimulates posterior pituitary to release oxytocin and anterior pituitary to release prolactin;
5
Q
oxytocin
A
stimulates release of milk from the breast; can contribute to afterpains
6
Q
BUBBLEHEB
A
postpartum focused exam: breasts, uterus, bladder, bowel, lochia, episiotomy, homans, emotional, bonding
7
Q
breast assessment
A
inspect size, contour, asymmetry, and engorgement; note reddened, tender, engorgement, warmth; check nipples for cracks, redness, fissures; note if nipples are flat, erect, or inverted; educate women to wear supportive bra 24 hrs; assess correct latch if breast feeding
8
Q
if women is non-lactating/breast-feeding
A
avoid stimulation, ice packs or cabbage leaves, mild analgesic for pain
9
Q
Uterus assessment
A
assess women lying flat after void; support bottom of uterus during assessment (prevent prolapse); note firm vs boggy, midline vs. deviated; any lac/hematoma to vagina
10
Q
bladder assessment
A
monitor output/assess for retention, postpartum diuresis, void within 4 hours after birth (catheterize if unable), ambulate early, assess for UTIs, auscultate bowels prior to assessing uterus
11
Q
Lochia assessment
A
educate on stages of lochia; increase in amount, foul smell, or return to rubra is not normal; change peri pad frequently; peri care after each void if lac/episiotomy; weigh pas to get accurate blood loss volume
12
Q
Episiotomy assessment
A
use REEDA, midline or mediolateral
13
Q
peri care
A
peri bottls, ice packs (first 24 hours), Sitz bath (after 24 hours), topical meds (witch hazel, dibucaine, dermoplast, epifoam), pat dry front to back
14
Q
1st degree lac
A
perineal and subcutaneous skin and vaginal epithelium
15
Q
2nd degree lac
A
includes skin, mucous membranes, and fascia of perineal body
16
Q
3rd degree lac
A
skin, mucous membranes, and muscle of perineal body, extends into but not through rectal sphincter
17
Q
4th degree lac
A
extends through anterior rectal mucosa exposing rectal lumen
18
Q
hemorrhoids assessment
A
assess for appearance and number
19
Q
emotional adaptation
A
post partum blues (appears few days after delivery) symptoms: sadness, anger, anxiety, unable to self care or care for infant, reject infant; 10-20% of all postpartum pt; post partum psychosis can occur (hallucinations, delusions, bizarre behavior)
20
Q
Bonding
A
determine moms phase of adjustment; take culture into account; describe level of attachment
21
Q
antepartum
A
pregnant women before onset of labor
22
Q
intrapartum
A
time of labor and childbirth
23
Q
postpartum
A
6-8 week time after delivery of baby and placenta; return to non-pregnant state
24
Q
involution
A
pelvic reproductive organs returning to approximate pre-pregnant size, position, and function
25
normal rate of involution
fundus/uterus descends 1cm (or fingerbreadth) per day from umbilicus
26
lochia rubra
first 1-3 days (bright red bleeding); shedding 9 months of accumulated substance
27
lochia serosa
3-10 day, pale, serosanguinous (pale red) to light brown
28
lochia alba
10-14 days; creamy, yellow, white (usually gone in 2 week but can last up to 6)
29
critical bleeding after delivery
saturating peri pad in 15 minutes or less or pooling of blood under butt
30
Rhogam
mother Rh -, infant Rh +; mothers antibodies attack babies; leads to complications for subsequent pregnancies; if baby is + then administer 300 mcg rhogam within 72 hours postpartum
31
discharge/going home
provides minimum stay; 48 hours after uncomplicated vaginal birth; 96 hours after uncomplicated cesarean birth
32
menstrual cycle step 1
hypothalamus releases GnRH causes anterior lobe cells to secrete FSH and LH
33
menstrual cycle step 2
FSH and LH promote follicle growth and maturation of oocyte, estrogen production, endometrium priming, all in ovary
34
menstrual cycle step 3
blood level estrogen rises stimulating surge in LH secretion
35
menstrual cycle step 4
surge of LH midcycle triggers ovulation and formation of corpus luteum
36
menstrual cycle step 5
progesterone & estrogen secreted by corpus luteum maintains endometrium if pregnancy occurs
37
menstrual cycle step 6
rises in progesterone and estrogen in blood inhibit FSH and LH during last phase of cycle
38
when does corpus luteum deteriorate
when ovum is not fertilized
39
conception
union of male and female ovum
40
sperm survival time
48-72 hours
41
ova fertility time
12-24 hours
42
fertilization
penetration of sperm into ovum
43
location of fertilization
ampulla in fallopian tube
44
capacitation
sperms ability to penetrate ovum
45
fertilization factors
maturation of sperm and ovum (sperm must wait 4-6 hours in female to undergo capacitation), sperms ability to reach ovum, sperms ability to penetrate ovum
46
zygote
fertilized sperm and ovum combined; contains all genetic material; secretes human chorionic gonadotropin
47
placental functions
transport & exchange: serves as lungs, kidneys, liver, GI tract, and serves as passive immunity; Hormone secretion: secretes hCG, estrogen, progesterone, hPL (human placental lactogen)
48
progesterone function
smooth muscle relaxant; stops women from early birth and contractions
49
umbilical cord
how baby is connected to mother; 2 arteries and 1 vein
50
embryonic period
development of 3 germ layers, development of embyonic membranes: chorion, amnion, umbilical cord, placenta
51
chorion
outermost layer of fetal membrane
52
amnion
amniotic fluid-buoyant temperature controlled environment (acts as a cushion)
53
umbilical cord artery/vein purpose
2 arteries carry deoxygenated blood from fetus to placenta; 1 vein supplies oxygen and nutrients to fetus; surrounded by wartons jelly
54
first trimester characteristics of fetus
face becomes more human; reflex activity, spontaneous movement, heart begins to beat, weighs 45g at end and is 3.5 in long, very susceptible to teratogens, organ development, fetal circulation established, sex identified
55
second trimester characteristics
very active (feel movement), lanugo present, vernix caseosa coats skin, brown fat forms, lungs form alveoli and surfactant, eyes open (sensitive to light and sound), weigh 700-800g and 10 in long
56
first trimester timeline
conception - end of week 12
57
second trimester timeline
week 13-end of week 26
58
third trimester characteristics
subcutaneous fat increases (chubby), bones soft and flexible, increase in muscle, resp. and circ. system functions, lanugo and vernix start to disappear, maternal antibodies transferred, usually positioned head down ()
59
third trimester timeline
27 weeks - birth
60
estrogen secreted from
secreted from placenta and ovaries
61
estrogen affects
increase uterine growth, increase breast development, increase uterine blood flow, prevents follicular development during pregnancy
62
progesterone secreted where
corpus luteum first then placenta
63
progesterone affects
relaxes smooth muscle decreasing vascular resistance, supports and maintains uterine lining for implant and development, decreases prostaglandin production
64
prolactin secreted where
anterior pituitary
65
prolactin affects
promotes development of breasts and supports lactation, release and stimulate milk production after birth
66
oxytocin secreted where
posterior pituitary
67
oxytocin affects
stimulates uterine contractions and stimulates milk ejection reflex
68
hCG secreted where
cells of developing placenta
69
hCG affects
prevents involution of corpus luteum, peaks at weeks 9-10 and decreases as pregnancy progresses; measured in urine for tests
70
hPL secreted where
placenta
71
hPL affects
makes glucose available for developing fetus, growth promoting and milk producing, promotes relative insulin resistance later in preg.
72
LH secreted where
anterior pituitary
73
LH affects
stimulates ovulation of mature ovum in nonpregnant state
74
McDonalds rule
fundal height in cm = gestational age from 22-34 weeks
75
physical changes of reproductive system
uterus, cervix, vagina, ovaries, breasts
76
physical changes of uterus
hegers sign and braxton hicks contractions
77
hegers sign
softening of lower portion of uterus (as early as 7 weeks); common sign of pregnancy but not definite sign; can cuase painless contractions
78
braxton hicks contractions
irregular intermittent painful contractions
79
physical changes of cervix
goodells sign and mucus plug; cervix becomes more vascular and ededemous (a good and soft purple chadwick)
80
goodells sign
softening of cervix
81
mucous plug
operculum; seals uterus and ruptures during labor (the boody show)
82
changes of the vagina
chadwicks sign and leukorrhea
83
chadwicks sign
purple color
84
leukorrhea
vaginal secretion
85
changes of the ovaries
ovulation stopped from corpus luteum producing estrogen/progesterone (negative feedback on FSH and LH which inhibits ovulation)
86
changes in breasts
growth d/t hormones; may feel tingling/tenderness from high estrogen; vascularity increases, hyperplasia, colostrum (around 12 weeks), areola darkens
87
cardiovascular changes during pregnancy
blood, BP, edema, varicosities
88
blood changes in pregnancy
volume increases progressively, RBCs increase (20-30%), coagulation increases (increase in fibrinogen), WBCs increase (6000-30000), pulse increases d/t increased CO, hematocrit decreases d/t increase in plasma
89
BP changes
decreases d/t decreased systemic vascular resistance and then steadily increases until normal level at term
90
edema and varicosities in pregnancy
legs, vulva, rectum (hemorrhoids)
91
supine hypotensive syndrome
when pregnant mom lies flat, fetus presses on inferior vena cava decreasing blood return; should sleep on side
92
physical changes of respiratory system
epistaxis, thoracic breathing vs abdominal breathing, increase in need for O2 (CO2 sensitive)
93
physical changes in GI system
N/V (subside by end of 1st tri), acid reflux (cardiac sphincter), constipation, gallstones, Ptyalism (excessive salivation), PICA, acute sense of smell
94
physical changes of renal system during pregnancy
kidney increase in size, increase risk of UTI (d/t stagnant urine), increase urinary frequency, increase GFR (glomerular filtration), dilated renal pelves and ureters
95
changes in musculoskeletal system during pregnancy
carpel tunnel syndrome, lordosis, relaxin allows for more pelvic flexibility, hypercalcemia can cause muscle aches
96
lordosis
increased curvature of lower spine d/t rectus abdominis separating
97
changes in endoctine system during pregnancy
increase in basal metabolic rate, increase in thyroid function, increase in aldosterone and insulin
98
increase in hair and skin during pregnancy, formation of central line and other lines
melasma/cholasma, linea nigra, striae (stretch marks), increase in hair thickness (oestrogen)
99
hyperemesis gravidarum
extreme N/V leading to dehydration and fluid/electrolyte imbalances
100
gestational diabetes
carb/glucose intolerance onset during pregnancy
101
development tasks of pregnancy (psychological)
acceptance of pregnancy, identifying with role of mother, eval. relationships between self and mother and self and partner, ensuring safe passage of self and baby through whole process, prenatal fear of loss of control during labor (self-esteem)
102
maternal role attainment
interaction and developmental process occurring over time where mother becomes attched to infant, competence in care-taking, express gratification and pleasure of role
103
psychologic adaptation 1st trimester
AACEPTANCE OF PREGNANCY; tests reality; signs of ambivalence (disbelief); normal adjustment " I am Pregnant"
104
teaching during first trimester
body changes upcoming, nutrition, healthy lifestyle, PNC
105
psychological adaptations of 2nd trimester
DIFFERENTIATION; discomfors ease (not as sick); focus shifts to baby; perceives fetus as separate; normal adjustment "I am going to have a baby"
106
teaching during 2nd trimester
newborn care, breast-feeding, parenting, fetal development
107
psychological adaptations of 3rd trimester
SEPARATION; prep for end; ambivalence returns (fear returning is normal); anxiety (normal sign); finding out meaning of mothering and fathering; normal adjustment "I am going to be a mother"
108
teaching during 3rd trimester
infant care, self care, preparing of L & D, birth plan, pain management, when to go to hospital, what to loo for in terms of contractions
109
presumptive (subjective) signs of pregnancy
N/V, amenorrhea, fatigue, urination, quickening, breast changes
110
Positive signs of pregnancy
audible fetal HR, palpable fetal movement by examiner, US visualization of fetus
111
Ballottment
tip of forefinger in vagina, tap against lower segment of uterus; present fetus tossed upward and finger is kept in place where it will feel strike of fetus against wall as it falls back down
112
ways to determine due date
Ultrasound, nageles rule, gestational wheel, McDonalds rule (22-34 weeks)
113
ultrasound (in terms of frequency)
high risk= more ultrasounds and starts early on; most accurate in first trimester
114
ultrasound measurement 1st trimester
crown to rump length 7-13 weeks (head to butt)
115
ultrasound measurements2nd trimester
biparietal diameter >13 weeks (parietal bone to parietal bone); femur length >13 weeks
116
Nageles Rule
take the 1st day of menstrual period subtract 3 months and add 7 days
117
Gravida
of pregnancies
118
Para
of delveries to viable babies
119
primigravida
pregnant for fist time
120
nulligravida
never been pregnant
121
primipara
completed 1 pregnancy to stage of viability
122
viability age
22-24 weeks or >500g
123
mulitpara
completed 2+ pregnancies to stage of viability
124
extra calorie consumption for pregnancy
~300 calories
125
First prenatal visit obtaining history
family medical history, PMH, gynecologic history, OB history, Social history, infections/teratogens/genetic problems, nutritional status, immunizations/illness/risk factors
126
first prenatal visit exam
full physical, pelvic exam (sizing and intrauterine US to see if cervix is closed), labs
127
prenatal labs consist of
blood type and Rh status, HIV, rubella, VDRL (syphilis), CBC, HbSAg, pap test, STI, TB test, auscultate fetal HR (8-12 weeks)
128
prenatal visit counseling
what to expect, risk factors, interventions for discomforts, nutrition, exercise, work, sexual activity
129
warning signs of pregnancy
gush/rupture of amniotic fluid prior to 37 weeks; vaginal bleeding (abruptio or previa), ABD pain (premature labor, abruptio, ectopic) changes in fetal movement, persistent vomiting, severe headaches, elevated temp (infect.), dysuria (painful/blood = UTI), blurred vison (HTN), edema of hands/face (HTN), epigastric pain (HTN), signs of hyperglycemia, signs of hypoglycemia
130
signs of hyperglycemia
flushed dry skin, fruity breath (ketones), rapid breathing, increased thirst/urination, headache
131
signs of hypoglycemia
clammy pale skin, weakness, tremors, irritability, lightheadedness
132
folic acid needs
600mcg (avoid neural tube defects)
133
iron
need more iron for increased RBC
134
calcium and vitamin D
develop bones, teeth, skin, eyesight
135
needed vitamins (PNV)
folic acid, iron, calcium, vitamin, D, omega 3s
136
substances to avoid
caffeine (less than 200mg), mercury (can cause BD), alcohol (no safe amount)
137
listeriosis
food-borne illness from bacteria ta causes flu-like symptoms and can cause miscarriage
138
fetal alcohol syndrome
small head, short eyelid opening, flat midface, smooth philtrum, underdeveloped jaw, low nasal bridge, epicanthal folds, short nose, thin upper lip
139
routine PNC
weight/vitals; fundal height/leopolds maneuver; FHR and movement/ urine for protein, glucose, ketones; 1 hr glucose tolerance test (24-28 weeks), Rhogam, rectal swab for GBS (36 weeks)
140
fetal diagnostic tests
US, CVS, amniocentesis, quad screen/maternal AFP, NST, CST, biophysical profile, doppler flow studies, fetal lung maturity, fetal movement/kick count
141
ultrasound types
transabdominally(need full bladder) or intrauterine (birth acknowledged earlier) detects multiple babies, abnormalities, size
142
New born vaccines
hep B recommended
143
amniocentesis
invasive procedure to determine fetal lung maturity (injection through abdomen into amniotic sac); measures surfactant lecithin and sphingomyelin (want 2:1 ratio); can predict fetal viability; AFP present at high levels can indicate spina bifida
144
CVS
chronic villus sampling; tissue sample from placenta; can be done earlier than amniocentesis; diagnoses fetal chromosomal abnormalities (cannot detect neural tube defects)
145
biophysical profile
conducted around 18 weks and end of pregnancy; scored like apgar; rates fetal HR, breathing, body movements, tone (flexion), volume of amniotic fluid, placental grading
146
disadvantages of CVS
fetal limb reduction, membrane rupture, spontaneous abortion (1%), risk of blood mixing, cannot detect neural tube defects
147
mastitis
inflammation or infection of the breast tissue usually from staphylococcus aureus from breast feeding in the babies mouth; very tender, engorged, hard, erythematous breasts (usually unilateral); keep breast feeding to speed up process and is safe for baby
148
US 1st trimester
determine viability, gestational age, cause of vaginal bleeding, visualize for CVS
149
US 2nd trimester
detect polyhydraminos/oligos, visualize amniocentesis
150
US 3rd trimester
determine placental insufficiency, intrauterine growth restriction, cogenital abnormalities, biophysical profile
151
Quad marker screening
Maternal serum alpha-fetoprotein, free beta hCG (high levels can indicate down syndrome), unconjugated estradiol (lower can indicate down syndrome/edwards syndrome), plasma protein A (ins. growth factor bioavailability test)
152
MSAFP
tool for neural tube defects (high levels); 16-18 weeks; low levels = potential for down syndrome
153
amniocentesis disadvantages
1% chance of miscarriage within 24 hours; no specifications after 24 hour period
154
firm or boggy uterus?
need firm
155
boggy uterus =
risk for hemorrhage
156
Rubins restorative phases
taking in (dependent), taking hold (independent), letting go (interdependent)
157
Rubella (MMR) vaccine
admin to non-immune mother, safe for nursing, live vaccine, avoid pregnancy for 1 month
158
attachment psychological adaptation
touching, holding, kissing, cuddling, singing, "en face" position; mal-attachment is refusing to look at infant no touching or holding
159
interventions to assist with bonding
rooming in, skin to skin, praisr support and reassurance
160
baby blues
peaks 3-5 days after delivery, d/t changes in hormones, up to 80% of women
161
REEDA
redness, edema, ecchymosis, discharge, and approximation
162
SIDS
sudden infant death syndrome; unexplained cause of death younger than 1 year
163
shaken baby syndrome
shaking of the baby causes injury to skull or intracranial injuries that can lead to defects or death
164
menstrual cycle
ovarian cycle and uterine cycle
165
ovarian cycle
production and release of eggs and release of progesterone and estrogen; follicular phase, ovulation, luteal phase
166
uterine cycle
preparation and maintenance of uterus lining for receiving of embryo; menstrual phase, proliferative phase, ovulation, secretory phase, ischemic phase
167
Probable (objective) signs of pregnancy
serum lab test (hCG), chadwicks sign,goddells sign, hegars sign, fetal outline by examiner, ballottment
168
1 gram weight =
1 mL of blood
169
Bowel assessment
anatomy returns to normal, relaxin depresses bowel motility, intraabdominal pain decrease, icontinence = lacerated sphincter, spontaneous bowel mvmt 2-3 days post-partum, 6-8 glasses water/juice, stool softener (and laxative), SITZ for comfort, meds for hemorrhoids
