Term
|
Definition
Sleep apnea
Renovascular disease
Coarctation of the aorta
Drug induced
chronic kidney disease
pheochromocytoma
thyroid or parathyroid disease
primary aldosteronism |
|
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Term
|
Definition
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Term
|
Definition
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|
Term
Prehypertension parameters |
|
Definition
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|
Term
What is the formula to determine MAP? |
|
Definition
|
|
Term
Chronic high BP is associated with ed risk of: |
|
Definition
left ventricular hypertrophy
left-sided heart failure
atherosclerosis |
|
|
Term
Mediators that cause VD and ¯\ BP |
|
Definition
histamine
some PGs
prostacyclin
nitric oxide |
|
|
Term
Mediators that cause VC and \ increase BP |
|
Definition
angiotensin II
vasopressin
endothelin
thromboxane A
Serotonin |
|
|
Term
| What is the major determinant of DP? |
|
Definition
| Systemic vascular resistance (SVR) |
|
|
Term
Passive elastic recoil of the aorta ejects blood into peripheral arteries during diastole so that DP never falls to zero is characterized by? |
|
Definition
|
|
Term
|
Definition
| volume ejected & the compliance of the aorta |
|
|
Term
Pathologic venous conditions are the result of? |
|
Definition
Obstruction to flow (deep vein thrombosis)
Structural alterations (valvular incompetence) |
|
|
Term
a specific term that identifies the arterial inflammatory process as autoimmune in nature is? |
|
Definition
|
|
Term
Inflammation of the intima of a vein is known as? |
|
Definition
|
|
Term
Inflammation of the intima of an artery is known as? |
|
Definition
|
|
Term
What is angina pectoris of a variant form that is characterized by chest pain during rest and by an elevated ST segment during pain. |
|
Definition
|
|
Term
An embolus is an abnormal particle circulating in the blood what types are there? |
|
Definition
fat
air
amniotic fluid
bacteria
cancer cells |
|
|
Term
| Eventually the thrombus may break free from the vessel wall and become an |
|
Definition
|
|
Term
A detached thrombus is a? |
|
Definition
|
|
Term
A thrombus is a _________ blood clot formed within a vessel or heart chamber. |
|
Definition
|
|
Term
In the venous system, obstruction manifests as |
|
Definition
|
|
Term
| In the arterial system, obstruction manifests as |
|
Definition
|
|
Term
|
Definition
pressure upstream
¯ed flow downstream |
|
|
Term
|
Definition
| Most frequently due to the surgical removal of lymph nodes or radiation damage to lymphatic vessels during cancer treatment |
|
|
Term
|
Definition
| Related to a congenital decrease in lymphatics or an obstruction of the thoracic duct. |
|
|
Term
Blood flow through a particular vascular bed is regulated ? |
|
Definition
| centrally by the ANS and locally by the organ or tissue |
|
|
Term
| Main factors affecting resistance to flow |
|
Definition
Radius of vessel (most imp determinant in healthy ind.
Length of vessel
• Blood viscosity
• Turbulence
|
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
increased HPC
increased venous pressure
increased ECF as a result of fluid retention
¯ed pC
increased capillary permeability
¯ed plasma protein [ ]
Primary lymphatic blockage |
|
|
Term
| Thromboangiitis obliterans |
|
Definition
•a chronic, recurring, inflammatory, vascular occlusive disease, chiefly of the peripheral arteries and veins of the extremities.
|
|
|
Term
|
Definition
| primary vasospastic disease of small arteries and arterioles The cause is unknown. There is an exaggerated response of vasomotor controls to cold or emotion. |
|
|
Term
Intermittent Claudication is the hallmark of |
|
Definition
| chronic, stable limb ischemia |
|
|
Term
•Intermittent claudication
|
|
Definition
is leg pain that occurs during exercise.
•It is a cramping pain and weakness in the legs (especially the calves) on walking that disappears after rest. |
|
|
Term
six P’s herald acute limb ischemia |
|
Definition
1.Pulselessness
2.Pain
3.Pallor
4.Polar (cold)
5.Paresthesia
6.Paralysis
|
|
|
Term
|
Definition
a chronic disease of the arterial system characterized by abnormal thickening and hardening of the vessel walls.
|
|
|
Term
|
Definition
a form of arteriosclerosis in which the thickening and hardening of the vessel walls are caused by soft deposits of intra-arterial fat and fibrin that harden over time |
|
|
Term
Hardening leads to decreased _____?______
Thickening leads to increased _____?______
|
|
Definition
|
|
Term
Progression of Atherosclerosis |
|
Definition
|
|
Term
Pathogenesis of Atherosclerosis |
|
Definition
A.1. Endothelial injury
B.2. Influx of lipids
C.3. Accumulation of lipids in vessel wall, proliferation of smooth muscle cells, and accumulation of macrophages
D.4. Atheromas consist of a lipid-rich soft part and a firm fibrous cap
|
|
|
Term
Clinical Manifestations of Atherosclerosis |
|
Definition
increased TPR and ¯ed compliance ® hypertension |
|
|
Term
Modifiable risk factors associated with atherosclerosis
(SEE GOD In Weeks) |
|
Definition
1.Smoking
2.
Elevated cholesterol and LDLs
Elevated blood pressure
3.
Glucose intolerance pressure
Obesity
Decreased physical activity
4.
Ineffective stress management
6.7.Weight fluctuations
8.
5. |
|
|
Term
Coronary heart disease (CHD) is
caused by atherosclerotic obstructions of the vessels and
characterized by |
|
Definition
insufficient delivery of oxygenated blood to the myocardium because of atherosclerotic coronary arteries.
|
|
|
Term
Modifiable Risk Factors for CAD
|
|
Definition
Cigarette smoking
Hypertension
••Hyperhomocysteinemia
Obesity
Psychosocial factors (stress)
Dyslipidemia
Sedentary life style
•
•Atherogenic diet
Lipoprotein a
•
•
•
••
Type 2 diabetes mellitus |
|
|
Term
Pathogenesis of Atherosclerosis |
|
Definition
- Injury to vessel wall
- Lipids accumulate in vascular wall
- Macrophages infiltrate and oxidize lipids
- Inflammation and release of local growth factors (Angiotensin II)
- plaque formation on intimal wall
- Mini thrombi incorporated into plaque ruptures
|
|
|
Term
Plaque formation & progression in a coronary artery |
|
Definition
Type IV, V, and VI lesions predispose to the ischemic syndromes. |
|
|
Term
5 Clinical syndromes of CHD based on severity and onset of clinical symptoms
(MUSIC) |
|
Definition
Myocardial infarction (ACS)
Unstable angina (ACS)
Stable angina pectoris (chronic)
Ischemic cardiomyopathy (chronic)
Cardiac death (sudden) |
|
|
Term
Factors that ¯ myocardial O2 supply |
|
Definition
•Hemodynamic factors
•increased coronary vessel resistance
•Hypotension
•¯ed blood volume
•Cardiac factors
•¯ed diastolic filling time
•increased HR
•Valvular incompetence
•Hematologic factors
•¯ed O2 content of blood
•Systemic disorders that ¯ blood supply/O2 availability
•Shock
|
|
|
Term
|
Definition
•
-Stable angina is generally relieved by rest and nitroglycerin
-•Nitroglycerin is a drug that causes coronary & peripheral vasodilation.
chronic coronary obstruction that results in recurrent, predictable chest pain (also called classic or typical angina) Stenosed arterioles dilate poorly in response to ed myocardial O2 demands |
|
|
Term
|
Definition
•occurs unpredictably, & usually at rest.
•Probable mechanism is vasospasm which explains the responsiveness to treatment with Ca++-channel blocking drugs.
|
|
|
Term
In the treatment of myocardial ischemia,
the factors most amenable to pharmacologic manipulation are: |
|
Definition
•Blood pressure
•Heart rate
•Contractility
•LV volume
|
|
|
Term
| Effects of anti-anginal medications on myoccardial o2 supply and demand |
|
Definition
|
|
Term
•With stable angina, plaque progression is______and collateral circulation has time to develop.
|
|
Definition
|
|
Term
•Acute coronary syndromes are associated with _______ disruption of a vulnerable plaque.
|
|
Definition
|
|
Term
•A sudden coronary obstruction due to thrombus formation over an atherosclerotic plaque produces an _____ ______ _____.
|
|
Definition
|
|
Term
| What acute coronary syndrome causes reversible myocardial ischemia? |
|
Definition
|
|
Term
•
•
What acute coronary syndrome
Causes
Death of myocardial cells?
|
|
Definition
|
|
Term
Pathogenesis of Acute Coronary Syndromes |
|
Definition
-
Plaque disruption or breakdown
-
Tissue thromboplastin exposed
-
Platelet aggregation and clotting cascade activated
-
Thrombus formation
-
Acute ischemia
|
|
|
Term
Classification of Acute Coronary Syndromes |
|
Definition
|
|
Term
Characteristics of 3 ischemic syndromes |
|
Definition
|
|
Term
|
Definition
Subendocardial
•
1.Transmural
•Infarct involves the entire wall thickness
•More common type of infarct
•Symptoms are more severe
Infarct does not affect the entire ventricular wall thickness Less common Less severe symptoms
|
|
|
Term
|
Definition
|
|
Term
|
Definition
an inability of the heart to maintain sufficient cardiac output to optimally meet metabolic demands of tissues and organs.
HF results in inadequate perfusion of body tissues.
|
|
|
Term
|
Definition
•(CAD) is the most common cause of heart failure
•Remember, myocardial ischemia occurs when the heart’s demand for O2 exceeds the ability to supply O2
|
|
|
Term
Hypertension is the 2nd most common cause of ? |
|
Definition
left ventricular dysfunction which leads to heart failure |
|
|
Term
|
Definition
is the 3rd most common cause of left ventricular dysfunction
•Dilated cardiomyopathy is a condition in which the heart becomes weakened and enlarged, and cannot pump blood efficiently |
|
|
Term
Factors that increase myocardial O2 demand |
|
Definition
•High systolic blood pressure
• increased ventricular volume
• increased thickness of the myocardium (LV hypertrophy)
• ed HR resulting from:
•Exercise
•Stress
•Hyperthyroidism
•Anemia
•Hyperviscosity of blood
• Conditions that increase contractility
•i.e. exercise
|
|
|
Term
Left heart failure categorieds based on myocardial fiber impairment |
|
Definition
•Systolic heart failure
•Impaired ability of fibers to contract
•Low ejection fraction (EF)
•Higher EDV
•Diastolic heart failure
•Impaired ability of fibers to relax
•EF is normal
•Lower EDV
•Due to ineffective ventricular filling
|
|
|
Term
Insufficient cardiac pumping is manifested by:
|
|
Definition
¯ed cardiac output,called forward failure
1.congestion of blood behind the pump, called backward failure
|
|
|
Term
1.
causes of heart failure include? (short answer potential)
(More Heartfailure Clients)
|
|
Definition
1.
myocardial ischemia (leading cause)
hypertension (second leading cause)
Cardiomyopathy (3rd leading cause)
|
|
|
Term
Left-sided Heart Failure
Backward/forward effects |
|
Definition
BACKWARD:
Dyspnea and Paroxysmal nocturnal dyspnea
Orthopnea
Cough
Cyanosis
Basilar crackles
FORWARD:
Fatigue/Anxiety/Restlessness/Confusion
Oliguria
increased HR
faint pulses
|
|
|
Term
Right-sided Heart Failure
Backward/forward effects |
|
Definition
BACKWARD:
Hepatomegaly, Ascites, Splenomegaly
Subcutaneous edema
Anorexia
Jugular vein distention
FORWARD:
Increased HR with faint pulses
Oliguria
Fatigue/anxiety/confusion/restlessness
|
|
|
Term
Effect of digoxin on the Na+/K+ pump |
|
Definition
-
Digoxin inhibits the Na+/K+ pump, resulting in accumulation of intracellular Na+ and less efficient Ca++ extrusion.
-
The increased IC Ca++ strengthens myocardial contraction.
-
Digitalis competes with K+ for the K+ binding site on the Na+/K+ pump. Low serum K+ \ potentiates the effect of digitalis.
|
|
|
Term
|
Definition
DIURETICS: (most generic drug names end in "ide")
B-type natriuretic peptide
Loop diuretics
Thiazide and thiazide like
VENODILATORS: (just the two are listed)
Nitroglycerine
Morphine |
|
|
Term
|
Definition
Ca++ channel blockers
Centrally acting anti-adrenergics
Peripherally acting anti-adrenergics
Direct vasodilators
|
|
|
Term
INOTROPIC DRUGS
(Increase contractility) |
|
Definition
Cardiac glycosides
Beta adrenergics
Phosphodiesterase inhibitors
(digoxin, dopamine and isoproterinol are common) |
|
|
Term
NEUROHORMONAL MODULATORS
(think of lol-il-an) |
|
Definition
Beta blockers
Angiotensin-converting enzyme inhibitors
Angiotensin receptor blockers
(many beta blockers end in "lol")
(many ACE inhibitors end in "il")
(many ARBs end in "an") |
|
|
Term
Shock is a life-threatening condition characterized by hypotension and insufficient delivery of oxygenated blood to cells and tissues.
WHAT ARE THE CAUSES? |
|
Definition
•Infections
•Heart disease
•Trauma
•Blood loss
•Anaphylactic reactions
|
|
|
Term
Causes of circulatory shock can be divided into 4 main types: |
|
Definition
•Cardiogenic
•Results from heart disease that has progressed to decompensated heart failure
• Hypovolemic
•Associated with loss of blood volume or excessive loss of EC fluids
• Obstructive
•A circulatory blockage disrupts cardiac output
• Distributive
•Characterized by a greatly expanded vascular space because of inappropriate vasodilation
|
|
|
Term
Excess production of ___ ___ is an important mechanism of vascular failure in shock. |
|
Definition
|
|
Term
|
Definition
¯ed myocardial contractility causes
1.¯ed tissue perfusion
2.pulmonary edema
|
|
|
Term
Differentiation of the acute coronary sydromes |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
SV x HR = CO
(normal= 5-6L/min resting)
(25-30 L/min exercising)
CRAZY!! |
|
|
Term
| Ejection Fraction Formula |
|
Definition
EF=SV/EDV
(70-80ml- should be 60-75%) |
|
|
Term
| Pressure, flow, resistence formula |
|
Definition
Flow (Q)= change in pressure (P)/ Resistence (R)
Also... QxR=change in P |
|
|
Term
|
Definition
Compliance (C)= change in volume (V)/change in pressure (P)
C=V/P |
|
|
Term
|
Definition
MAP=DP+PP/3
MAP is upstream pressure |
|
|
Term
|
Definition
VR=(Pms-RAP)/RvR
VR (venous return)
Pms (mean systemic pressure)
RAP (right atrial pressure)
RvR (resistence to venous return)
|
|
|
Term
F = CO
What parameters do A-E represent?
A=HR
B=SV
C=AL
D=Contractility
E=PL
|
|
Definition
|
|
Term
| general pathophys of hypertension is due to what? |
|
Definition
Increased TPR
Increase in circulating blood volume (BV)
Increase in both TPR and BV |
|
|
Term
| Current theories that explain pathogenesis of HTN |
|
Definition
- overactivity of SNS which causes VasoConstrict. and Increased CO
- Overactivity of RAA system
- Salt and water retention by kidneys
- Hormonal inhibition of Na/K transport across cell membranes increased IC Ca+ therefore VC and increased TPR=HTN
- Insulin resistence and endothelial function interaction
|
|
|
Term
|
Definition
| sustained, primary hypertension that has pathologic effects beyond hemodynamic alterations and fluid and electrolyte imbalances, compromising structure and function of vessels |
|
|
Term
| 2 major mechanisms of hypertension induced tissue damage |
|
Definition
|
|
Term
|
Definition
drop in systolic of 20mmHg or drop of diastolic by 10 mmHg within 3 minutes of standing
This decreases CO |
|
|
Term
| what is the treatment of raynaud DISEASE? |
|
Definition
| Ca++ channel blockers which cause VD by interfering with Ca++ influx into smooth muscle cells |
|
|
Term
| Raynaud phenomenon versus raynaud disease |
|
Definition
|
|
Term
| What happens when myocardial demand exceeds supply? |
|
Definition
| Ischemia in tissue and pain perception in peripheral nerves |
|
|
Term
| decreased compliance and increased TPR lead to? |
|
Definition
|
|
Term
Put the following in order:
___Foam cells release cytokines that encourage atherosclerosis development
___Monocytes differentiate into macrophages
___LDL is oxidized
___LDL causes adhesion and entry of moncytes and T Lymphocytes into endothelium
___Macrophages ingest LDL "clean up" and become foam cells creating fatty streak
___LDL enters intima via endothelium |
|
Definition
- LDL enters intima via endothelium
- LDL is oxidized
- LDL causes adhesion and entry of moncytes and T Lymphocytes into endothelium
- Monocytes differentiate into macrophages
- Macrophages ingest LDL "clean up" and become foam cells creating fatty streak
- Foam cells release cytokines that encourage atherosclerosis development
|
|
|
Term
Diagnosis of ACS is based on 3 primary indicators
(SEE) |
|
Definition
Symptoms
ECG changes
Elevation of cardiac markers in blood |
|
|
Term
1. Patients with chest pain, evidence of acute ischemia and ST elevation ECG changes are cadidates for?
2. Patients with symptoms of unstable angina (no biomarkers) and no ST segment elevation on the ECG may not benefit from the same treatment but rather from this primary choice of treatment |
|
Definition
1. acute reperfusion therapy
2. Antiplatelet drugs |
|
|
Term
| WHat are the cardiac isoenzymes that are biomarkers of an MI? |
|
Definition
CK-MB
troponin-I
troponin-T |
|
|
Term
Subendocardial MI has an ECG finding of?
Transmural MI ECG finding is? |
|
Definition
Subendocardial- ST segment depression, T wave inversion
Transmural- ST segment elevation and Q waves |
|
|
Term
Angiotensin II is released systemically and locally. What are the local effects?
What are the systemic effects? |
|
Definition
Local: coronary artery alterations that affect myocardial O2 supply and coronary arterial spasm leasing to decreased myocardial O2 supply
Systemic: (increased PL and increased AL) systemic artery alterations increase O2 demand increased AL= increased myocardial work and therefore, increased myocardial demand |
|
|
Term
| Mortality from an MI is related to |
|
Definition
|
|
Term
| A drop in CO from an MI triggers a number of compensatory responses mediated by the SNS. Name them... |
|
Definition
Increased HR
Increased Contractility
Increased vasoconstriction
(these increase blood pressure) |
|
|
Term
|
Definition
external compression on the heart from fluid accumulation in the pericardial sack leading to decreased SV.
this manifests as distended neck veins, and pulsus paradoxus= arterial BP during expiration exceeds arterial BP during inspiration by >10mmHg |
|
|
Term
|
Definition
| sticking and rubbing of visceral and parietal pericardial layers. Diagnosable by presence of a friction rub |
|
|
Term
|
Definition
| Inflammatory disorder typically with viral cause characterized by scattered, necrotic and dead heart muscles. Major complication is dilation of the 4 heart chambers with reduced contractility. |
|
|
Term
|
Definition
3 major functional classes:
-
Dialted=enlargement of all 4 chambers and decreased contractility
-
Hypertrophic=primarily affects LV and septum. Conditions that increase contractility such as exhertion cause obstructed ventricular flow and decreased CO
-
Restrictive (constrictive)= stiff, fibrotic left ventricle leading to left HF and decreased CO
|
|
|
Term
| 2 types of valve disorders |
|
Definition
-
stenosis=failure of complete valve opening which increases the pressure work of the heart
-
Regurgitation=inability of the valve to completely close, allowing backflow and increased volume work for the heart
|
|
|
Term
| Systolic versus diastolic heart failure |
|
Definition
systolic= impaired contractility causing low
diastolic=impaired myocardial fiber relaxation causing increased LVEDP."heart failure with a normal EF" *pulmonary congestion/edema |
|
|
Term
| 3 Main compensations for heart failure |
|
Definition
-
SNS activation (increased HR, contractility, arterial vasoconstriction and RAA activation)
-
Increased PL (kidney output reduces increasing volume)
-
Myocardial hypertrophy (increased muscle mass) growth promotion by neurohormones such as angiotensin II and norepinephrine.
|
|
|
Term
|
Definition
| Right ventricle hypertropy and dialtion secondary to diseas of lungs or lung blood vessels |
|
|
Term
|
Definition
| The union of a single egg and sperm. (Gamete formation, ovulation, fertilization, implantation) |
|
|
Term
|
Definition
| Penetration of the ovum by the sperm (with accompanying union of genetic material) |
|
|
Term
|
Definition
| (nidation) trophoblast secretes enzymes that burrow into the endometrium and bury the blastocyst. (6-10 days after conception) |
|
|
Term
|
Definition
| finger-like projections that develop out of the trophoblast to effect exchange of nutrients and O2. |
|
|
Term
|
Definition
| covers the fetal side of placenta and has all the big vessels in it bring fetal blood to the placenta for exchange of nutrients and O2. |
|
|
Term
|
Definition
| eventually surrounds embryo and forms a sac and covers the umbilical cord |
|
|
Term
|
Definition
* initially a filtrate of maternal blood
* serves as cushion
* protects the cord
* maintains body temp
* helps fetus grow symmetrically
* provides testing material for fetal studies |
|
|
Term
|
Definition
initially the stalk which attaches early embryonic cell mass to the chorionic villi,
has 2 arteries and 1 vein, with an average length of 22 inches at birth.
Wharton’s jelly surrounds vessels. |
|
|
Term
|
Definition
Organ of metabolic exchange (respiration, nutrition, excretion, storage) and hormone production
Semi-permeable barrier able to keep out many compounds, proteins, bacteria, etc that are of large molecular weight but not many of the deleterious enemies of the fetus fit this description. |
|
|
Term
| The placenta functions by |
|
Definition
simple diffusion
active transport
pinocytosis |
|
|
Term
Functioning is directly related to maternal circulation. With maternal circulation dependent on
maternal blood pressure
condition of her vessels
maternal position
uterine contractions |
|
Definition
|
|
Term
|
Definition
A means of metabolic exchange
Respiration
Nutrition
Excretion
Storage
Endocrine gland producing four hormones to maintain pregnancy
Human chorionic gonadotropin (hCG)
Human chorionic somatomammotropin (hCS) or hPL
Progesterone
Estrogen |
|
|
Term
|
Definition
| day 15-week 8 after conception |
|
|
Term
|
Definition
| day 15-week 8 after conception |
|
|
Term
|
Definition
(day 15 – week 8):
Critical period of development
structures/systems
Stage most susceptible to
teratogens |
|
|
Term
|
Definition
(week 9 – end of pregnancy):
Refinement and maturation
of structures/systems.
Critical period continues for
neurologic development
Cephalocaudal development |
|
|
Term
|
Definition
| period of intra-uterine development from conception through birth (pregnancy) |
|
|
Term
|
Definition
|
|
Term
|
Definition
| pregnant for the first time |
|
|
Term
|
Definition
|
|
Term
|
Definition
| the number of pregnancies in which the fetus or fetuses have reached viability ( ~20 weeks) |
|
|
Term
|
Definition
| a woman who has not completed a pregnancy to viability |
|
|
Term
|
Definition
| a woman who has completed one pregnancy to an age of viability |
|
|
Term
|
Definition
| a woman who has completed more than one pregnancy to viability |
|
|
Term
|
Definition
| loss of pregnancy prior to the age of viability |
|
|
Term
|
Definition
| fetal loss greater than the age of viability |
|
|
Term
|
Definition
|
|
Term
|
Definition
| 20 weeks-prior to 37 weeks gestation |
|
|
Term
|
Definition
|
|
Term
|
Definition
Earliest biochemical marker for pregnancy
Basis of test
Detected 7-10 days after conception |
|
|
Term
|
Definition
Blood or urine
Use radioactively labeled marker
Tests for beta subunit of hCG |
|
|
Term
|
Definition
serum
Measures ability to inhibit binding of radio-labeled hCG to receptors |
|
|
Term
| Enzyme-linked immunosorbent assay (ELISA) |
|
Definition
Urine
Most popular
Uses anti-hCG with enzymes to bond with hCG in urine |
|
|
Term
| Changes to reproductive system during pregnancy |
|
Definition
Uterus
• Increases in both numbers and size of cells, increased vascularity, and development of decidua
• Process of enlargement is hormonal in first trimester and mechanical after that.
• Shape of the uterus changes as it rises out of abdomen
• There is a correlation between uterine size and weeks gestation
• Increased uterine blood flow and pelvic congestion produce Chadwick's sign; bluish color to the cervix
• Capacity of the uterus grows 500, even 1000 times
• The round ligaments that help to hold the uterus in place, enlarge and stretch, eventually the intestines are pushed to the side.
• Non-expulsive contractions called Braxton Hicks contractions begin to facilitate blood flow. |
|
|
Term
|
Definition
• Chadwick's sign.
• Glandular tissue becomes hyperactive and produces a thick tenacious mucous which plugs the cervix.
• Appearance of the cervical os changes with parity.
• In pregnancy there is increased friability |
|
|
Term
|
Definition
• Hormones thicken the mucosa, loosen the connective tissue and prepare the vaginal for birth
• Estrogen causes exfoliation of the vaginal mucosa, this rapid shedding of cells coupled with the increased secretion due to the high vascularity create an increase in vaginal discharged called leukorrhea
The pH changes, becoming more acidic |
|
|
Term
|
Definition
• Can be one of the first things a woman notices when she is pregnant. Fullness, tingling, nipples become very sensitive.
• Increased pigmentation of the nipples and areola
• Increased vascularity is noted by the visibility of blood vessels that create a network visible beneath the skin.
• Montgomery's tubercles, small sebaceous glands in the areolar tissue enlarge produce a natural lubricant
• Striae may appear.
• If a pregnancy ends after 16 weeks the milk will come in
• High levels of estrogen inhibit the milk producing hormone prolactin from being secreted however colostrum is present in the third trimester. |
|
|
Term
| Changes to cardiovascular system |
|
Definition
• Adaptation to meet increased metabolic needs created by pregnancy.
• Mild cardiac hypertrophy secondary to increased blood volume.
• Auscultatory changes: More audible split s1-s2 after 20 weeks and common to have systolic ejection murmurs but not over grade II
• Pulse increases to 10-15 BPM over her norm
• Arterial blood pressure decreases slightly in the first trimester, with a low point in the second trimester and returns to normal by the third trimester.
• Orthostatic hypotension is common as are varicosities and edema.
• Blood volume increases 30 -50% starting around ten weeks.
• Physiologic anemia.
• RBC production is accelerated.
• WBC levels increase then remain stable.
• Cardiac output is greatly increased.
• Function can significantly affected by maternal position and activity
• Coagulation tendencies are increased. |
|
|
Term
| Changes to respiratory System |
|
Definition
• Structural changes occur: rib cage relaxes, there is an increase in the diameter of thoracic cage
• Small degree of pregnancy induced hyperventilation due to progesterones effect on the CNS
• Increase vascularity leads to congestion of upper airways and nasal and sinus stuffiness, epitaxsis and even voice changes. |
|
|
Term
| Metabolic Regulation in pregnancy |
|
Definition
• BMR is increased related to the increased oxygen demands and increased cardiac work. Dissipation of excess heat from this increased BMR is why pregnant women feel so warm and sweat a lot.
• Thyroid function increases in response to higher BMR |
|
|
Term
| Renal system changes in pregnancy |
|
Definition
• Ureters, renal pelvis dilate, smooth muscles like the linings of bladder, uterus and urethra have relaxed tone
• Relaxed tone makes women more susceptible to stagnant urine and infection, especially since the threshold for glucose is lower in pregnancy and glycosuria may be present creating an even more favorable environment for bacteria.
Renal System
• Ureters, renal pelvis dilate, smooth muscles like the linings of bladder, uterus and urethra have relaxed tone
• Relaxed tone makes women more susceptible to stagnant urine and infection, especially since the threshold for glucose is lower in pregnancy and glycosuria may be present creating an even more favorable environment for bacteria.
Renal System
• Ureters, renal pelvis dilate, smooth muscles like the linings of bladder, uterus and urethra have relaxed tone
• Relaxed tone makes women more susceptible to stagnant urine and infection, especially since the threshold for glucose is lower in pregnancy and glycosuria may be present creating an even more favorable environment for bacteria.
• Decreased bladder tone may make the bladder hold far more urine then normal...if the mechanical pressures don't make her void every half-hour.
• GFR is increased due to blood volume and demands for waste excretion are increased with fetal waste present.
• To maintain the blood volume needed, the kidneys increase their ability to retain Na.
• Protein in urine in measurable amounts is abnormal and a sign of renal disease
• The best maternal position for renal function is the left lateral recumbent. |
|
|
Term
|
Definition
mask of pregnancy,
fades after pregnancy |
|
|
Term
| Human Chorionic Gonadotropin (HCG): |
|
Definition
Secreted by trophobast in
early pregnancy to stimulate corpus
lutem to continue estrogen and
progesterone production in order
to maintain the pregnancy until
the placenta can assume that function. |
|
|
Term
| Human Placental Lactogen (hPL): |
|
Definition
also called Human Chorionic
Somatomammotropin is an antagonist
of insulin creating increased circulating
free fatty acids and glucose for metabolic
needs. |
|
|
Term
|
Definition
Secreted first from
the corpus luteum by the seventh
week of pregnancy it is mostly a
placental hormone.
It stimulates uterine development
to provide an appropriate
environment for the fetus
It helps to develop the ductal system
of the breast. (tissue building and
increased vascularity) |
|
|
Term
|
Definition
Produced first by the
corpus luteum and then by the placenta
It plays the greatest role in maintenance
of the pregnancy.
It maintains the endometrium and inhibits uterine contractility. (smooth muscle relaxation; uterus, G-I ,vessels) |
|
|
Term
|
Definition
The primary source
is the corpus luteum but some
may come from the placenta or
decidua.
Acts to inhibit uterine contractions
Softens cervix and "remodel collegen" |
|
|
Term
|
Definition
Lipid substances
arising from most tissues but
greater concentrations in the female
reproductive tract.
Involved in initiation
of labor. Mechanism unclear. |
|
|
Term
| Presumptive signs of pregnancy |
|
Definition
1. Breast Changes
2. Amenorrhea
3. Nausea, Vomiting
4. Urinary Frequency
5. Fatigue
6. Quickening |
|
|
Term
| Probable signs of pregnancy |
|
Definition
1. Goodell’s sign
2. Chadwick’s sign
3. Hegar’s sign
4. Positive pregnancy test
5. Braxton Hick’s contractions
6. Ballotment |
|
|
Term
| Positive signs of pregnancy |
|
Definition
1. Visualization of fetus
2. FHT’s
3. Fetal movement palpated |
|
|
Term
|
Definition
History: Demographics
Gyn history
Family history
Medical history
OB history (previous pregnancies)
Present pregnancy
LMP vs. LNMP
EDC: Nagele’s Rule
Pregnancy tests
Planned pregnancy and is father supportive?
Problems or events of this pregnancy
Signs and symptoms of pregnancy
Patient preferences: Support persons, birth plans, planned medications, early DC |
|
|
Term
|
Definition
expected date of confinement or delivery
266 days from conception
280 days from first day of LMP assuming a 28 day cycle
9 calendar months
10 lunar months (4 week months) |
|
|
Term
|
Definition
Based on 28 day regular cycle
Add one year
Subtract 3 months and add 7 days to the
first day of the last menstrual cycle. |
|
|
Term
|
Definition
a complete physical, focusing on the reproductive system.
assessment of the nipples related to breastfeeding
assessment of the fundal height, or assessment of uterine size by bimanual exam.
FHTs
DTRs, edema and varicosities
Measurement of the adequacy of the bony pelvis |
|
|
Term
|
Definition
Blood work
type and Rh, antibody screen for Rh
or other blood related antibodies
serology RPR or VDRL
HBsAg
Rubella screen
CBC
Maternal serum AFP/prenatal risk screen between 14-18 weeks. Or earlier if “sequential screening” indicated or requested
HIV screen by inclusion
Cultures:
GC, Chlamydia, Herpes only with lesions or to check for cervical shedding
Urinalysis and culture is necessary
Pap smear
Others as history indicates: Sickle prep, PPD |
|
|
Term
|
Definition
Typically see clients
1x/month till 28 weeks
2x/month 28-36 weeks
1x/week 36-40 weeks
more frequently if go past 40 weeks, at least 2x/week.
client weighs self and checks her urine looking for glycosuria or proteinuria
Midwife or nurse does BP
Chart to compare to norms and observe pattern
Encourage and answer questions.
Anticipatory Guidance |
|
|
Term
|
Definition
28, 36 weeks Hct
28 weeks 1 hour post 50gm glucola
28 weeks Rhogam if Rh neg
Cultures as history deems necessary |
|
|
Term
|
Definition
Fundal Height Measurements
Fetal Heart tones: Doptone, Fetascope
Fetal Movement: Quickening, Monitoring
Fetal Position: Leopold maneuvers
Discuss progress of pregnancy
share patterns of growth: weight, fundal height
how new developments such as quickening compare to norms
refer to fetus as a person |
|
|
Term
| 1st trimester anticipatory guidance |
|
Definition
Hazards
Radiation
Drugs
Hyperthermia
Infections – viral/bacterial
Danger signals
Severe vomiting [ hyperemesis gravidarum
Chills, fever, burning on urination, diarrhea [ infection
Abdominal cramping; vaginal bleeding [ miscarriage, ectopic pregnancy
Discomforts/relief measures
Nausea and Vomiting
Urinary frequency
Breast tenderness
Increased vaginal discharge (leukorrhea)
Nasal stuffiness and epitaxis
Ptyalism
Mood swings/ambivalence |
|
|
Term
| 2nd trimester anticipatory guidance |
|
Definition
Discomforts and Relief Measures:
Pigmentation deepens; acne, oily skin
Spider nevi
Pruritus
Palpitations
Supine hypotension and bradycardia
Faintness
Food cravings
Heartburn
Constipation
Flatulence with bloating/belching
Varicose veins
Headaches
Carpal tunnel syndrome
Periodic numbness, tingling of fingers
Round ligament pain
Join pain, backache, pelvic pressure
Teaching related to Danger Signs For:
Preterm labor
Hypertensive conditions |
|
|
Term
| Third trimester anticipatory guidance |
|
Definition
L&D material
Discomforts / Relief measures
Heartburn
Dependent edema
Varicosities, hemorrhoids
Constipation
Backache
Leg cramps
Faintness
Shortness of breath
Insomnia
Mood swings, ambivalence, increased anxiety
Urinary frequency and urgency
Braxton Hicks uterine contractions
Danger Signals: Decreased Fetal Movements |
|
|
Term
Preterm Labor
Incidence: 10%
Morbidity and Mortality
83% morbidity
Causes: 50% unknown
Risk factors and Causes
Signs and symptoms: |
|
Definition
Uterine contractions q 10min or more frequent with or without other signs
Menstrual-like cramps felt in lower abdomen constant or intermittent
Low dull backache felt below the waistline either constant or intermittent
Pelvic pressure that feels like the baby is pushing down either constant or intermittent
Abdominal cramping with or without diarrhea
Increase or change in vaginal discharge |
|
|
Term
|
Definition
Expected pattern is 2-5lbs in the first trimester and about a pound (450g) a week in the second and third trimesters
Poor weight gain is defined as less then 2.2lbs or 1kg per month in the second and third trimesters. |
|
|
Term
|
Definition
Baby 7 -8.5 pounds
Amniotic fluid 2
Placenta 2-2.5
Uterus 2
Breasts 1-4
Increased Blood Volume 4-5
Increased Fluid 3-5
Maternal stores 4-6 |
|
|
Term
|
Definition
| variable but we use 300 calories as the average. For increased BMR, energy needs |
|
|
Term
|
Definition
| 60 gms is needed for just about everything...fetal and placental growth, maternal blood volume and constituents, maternal tissues, to maintain colloidal osmotic pressure and store reserves. |
|
|
Term
|
Definition
| 30 mg above norm of 15 mg needed. Needed to make RBCs and for fetal stores. |
|
|
Term
|
Definition
| recommended 0.4- 0.8 mg multiple pregnancy. RX prenatal vitamins usually have .08. Needed in DNA synthesis and maternal erythropoiesis. |
|
|
Term
|
Definition
|
|
Term
| Every pregnant women should be on a multivitamin with |
|
Definition
| minerals (iron, mag, zinc, cal/pho) and folic acid. |
|
|
Term
|
Definition
|
|
Term
The Psychological Trimesters of Pregnancy
FIRST TRIMESTER: |
|
Definition
Focus is on self, begins to do "cost Analysis” the benefits vs. the worries...may be unsure and scared...moody. Watches and analyzes every physical change. (Body Image)
Ambivalence is a common trait of early pregnancy even in the most planned pregnancy. Not accepting pregnancy does not mean not accepting the child. |
|
|
Term
The Psychological Trimesters of Pregnancy
SECOND TRIMESTER: |
|
Definition
Mother feels movement...fetus says "I am!"
Mother is interested in producing a healthy baby and looks to ways to do so...proper eating etc.
This is the time when she feels best. Develops a narcissism love of self...baby and she are one.
May become involved in traditional feminine activities; cooking, crafts.
Tends to seek out other pregnant women or recent mothers.
May increase or renew contact with her own mother.
Begins to question what the baby will be like, sex etc
Increasing feelings of protectiveness towards infant and increasing sense of vulnerability about herself. |
|
|
Term
The Psychological Trimesters of Pregnancy
THIRD TRIMESTER: |
|
Definition
Increasing intensity in feelings of vulnerability...sees world as hostile, doesn't want to be alone.
Sees herself as alone …no one really cares or understands...may seek additional support
Sees the baby as simultaneously one with her but separate from her
Focus is on labor and delivery
process...fears, unsure.
Wants to hear birth stories.
Childbirth classes to increase
knowledge base.
Increasing discomfort helps
to separate fetus from mother
"I want out of this" tired of pregnancy. |
|
|
Term
|
Definition
Acceptance of pregnancy
Reordering of relationships
Acceptance of fetus as a separate individual
Acceptance of the mother/father role
Resolution of fears about childbirth
Attachment |
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|
