endometrium of uterus that grows thicker and vascular to support pregnancy

-deciduas basalis: directly under embryo

-deciduas capsulari: surrounds embryonic sac

outer membrane of the embryo

chorionic villi-"fingers" of connective tissue that contain fetal capillaries at core

-extend into the endometrium

-instrumental in production of placental hormones such as hCG, hPL 9human placental lactogen), estrogen and progesterone

-forms the fetal portion of the placenta

what makes up the umbilical cord?

made from the amnion and chorion (inner and outer fetal membranes)

-one vein:oxygenated blood from the placental villi to the fetus

-two arteries:carry deoxygenated blood from the fetus back to the placental villi

-filled with Wharton's jelly: protects vessels and prevents compression

how often is amniotic fluid being made?

and what is it made by?

pupose?

constantly being made, by the amniotic membrane.

cushions embryo, controls temp, permit symmetric growth and development, prevent adherence of fetus to the amnion and allow freedom of movement, and cushions cord.

normal amount of amniotic fluid?

to much?

to little?

800-1200mL

Hydramnios: too much fluid (more than 2000mL), unknown cause.

Oligohydramnios: too little fluid (less than 400mL) cause by a disturbance in kidney function.

maternal portion (outside) consists of deciduas basalis and its circulation, surface appears red and flesh-like.

fetal portion (inside) consists of the chorionic villi and their circulation, covered by the amnion, appears shiny and gray.

lack of conception despite unprotected sexual intercourse for at least 12 months.

Basal body temp- every morning upon awakening record body temp for 3-4 months

Ovulation method- assess the cervical mucus changes.  follicular phase mucus is thick, white, sticky and not safe for sperm.  during ovulation it is clear, watery and stretchable (spinnbarkheit. egg white appearanc)

Calendar rhythm- record menstral cycle for 6 months, assume that ovulation occurs 14 days before the start of the next menstrual period

Symptothermal method- recording various indicators of fertility like:cycle length; frequency and timing of coitus; cervical mucus changes; secondary signs of ovulation such as increased libido, abdominal bloating, mittelschmerz; and changes in BBT.

Standard days method-for women with regular cycles

Lactational amenorrhea- high levels of prolactin released during breastfeeding should prevent ovulation.

pharmacological agents for endometriosis r/t infertility

Danazol (Danocrine)

Oral contraceptives

Ovulation-induction agents (clomid)

Seraphene

Human Menopausal Gonadotropin (HMG)

Bromocriptine (Parlodel)

Clomiphene Citrate: anovulatory fertility agent

Drug action: stimulates release of FSH and LH

Side effects: hot flashes, breast discomfort, headache and insomnia

route and dose: PO, 50-200 mg/day from cycle 3-7

problems with karyotypes?

trisomies, monosomies, mosaicism.

example:trisomy 21 (down syndrome), trisomy 18, trisomy 13, defects in sex chromosomes like Turner syndrome in girls, X. or Klinefelter's syndrom in boys, XXY.

single gene inheritance.

if a gene is autosomal dominant there is a ____% chance of passing the trait?

if autosomal recessive, ___% chance of affecing the child, and ___% chance the child will be a carrier?

50%

25%

50%

no male to male transmission

50% chance carrier mom passes to son who will be affected.

50% chance carrier mom passess to daughters who become carriers.

dad cannot pass to son, but all daughters will be carriers.

extremely rare

Fragile X syndrome

no male to male transmission

heterozygous females may be affected

affected fathers will ahve affected daughters, but no affected sons.

ultrasound is best when?

used for what?

18-20 weeks

detect head and craniospinal defects, GI malformations, renal malformations, skeletal malformations, and fetal nuchal translucency

AFP (alpha-fetoprotein) done at 15-22 weeks of pregnancy.

detects 85-90% neural tube defects & 80% Downs syndrome

reproductive: amenorrhea

uterus: increased blood flow (1/6 of total maternal blood volume), Braxton Hicks, increase weight, strength, elasticity, and vascularity, increased amounts of estrogen and growing fetus.

cervix: increased estrogen levels, Goodell's sign (softening), Chadwick's sign (blue color), mucorrhea (increased discharge), hyperplasia, formation of mucous plug seals endocervical canal

pseudoanemia

Hgb <11, Hematocrit <30%

cardiac output during pregnancy?

HR?

increases 30-50%

increases 15-20%

increased volume of air.

decreased airway resistance

increased anteroposterior diameter

thoracic breathing occurs as uterus enlarges

incraesed levels of progesterone effects the GI system how?

delayed gastric emptying

decreased peristalsis

N/V, increased saliva, smoothe muscle relaxation causes peristalsis to slow, desplacement of intestines and stomach which causes heartburn, bloating, and constipation

renal tubular reabsortion increases

increased GFR and reanl plasma flow, frequency, nocturia

UTI's are common (can cause PTL, pre term labor)

musculoskeletal during pregnancy

recommended 25-35 lbs

if overweight, recommended gain is 15-25 lbs.

if underweight, gain weight as needed to reach ideal weight plus 25-35 lbs.

increased thyroid/BMR (basal metabolic rate)

pancreas: increased insulin

amenorrhea

nausea and vomiting

fatigue

urinary frequency

breast changes

quickening

Goodell's and Chadwick's sign

Hegar's (softening of the uterine tissue between the body of the uterus and the cervix) and McDonald's sign (flexability of the uterus at the junction between the cervix and body of uterus)

Enlargement of the abdomen

Braxton Hicks contractions

Uterine souffle (soft blowing sound auscultated in uterus)

Skin pigmentation changes

Pregnancy tests

Fetal heartbeat

Fetal movement

Visualization of the fetus

Hemagglutination-inhibition test

Latex agglutination test

or detect hCG during early pregnancy

(the first two are done on first early morning urine specimen)

positive within 10-14 days after the first missed period

Serum tests for pregnancy

Beta subunit radioimmunoassay:positive a few days after presumed implantation

Immunoradiometric assay (IRMA): takes 30 min to perform

Enzyme-linked immunosorbent assay (ELISA): detects hCG levels as early as 7-9 days after ovulation and conception, 5 days before the first missed period

Fluoroimmunoassay (FIA): takes about 2-3 hours to perform

1st: disbelief and ambivalence (love/hate)

2nd: quickening, helps mother to view fetus as separate from herself

3rd: anxiety about labor and birth; nesting occurs(bursts of energy)

1 ensuring safe passage through pregnancy, labor, and birth

2 seeking acceptance of this child by others

3 seeking commitment and acceptance of herself as mother to infant; attatchment formed

4 learning to give oneself on behalf of one's child

1st may feel left out, disbelief, may be confused by his partner's mood changes, might resent the attention she receives

2nd begins to decide which behaviors of own father he wants to imitate or discard

3rd anxiety about labor and birth

complications of pregnancy

vaginal bleeding, with or without discomfort

rupture of membranes

swelling of the fingers, puffiness of the face or around the eyes

continuous, pounding headache

visual disturbances (blurred vision, dimness, spots)

persistent or severe abdominal pain

chills or fever

painful urination

persistent vomiting

changes in frequency or strength of fetal movements

Danger signs in pregnancy?

C A B S

C-chills and fever/cerebral disturbances

A-abdominal pain

B-blurred vision/bleeding/BP

S-swelling/sudden escape of fluid

birth after 20 weeks gestation

(before is abortion)

T P A L

T-#of term infants born (37 wks +)

P-# of preterm infants (>20 <37 wks)

A-# of pregnancies ending in SAB/TAB

L-# of currently living children

susie smart is pregnant.  she has four sons at home: twins born in 1996 at 34 weeks, then singletons born in 1998, and 2001.  She had 1 miscarriage in 2000.  what is her gravida/para?

vs her GTPAL?

G=5

P=3

G=5

T=2

P=2

A=1

L=4

1 lb/week

or 12 lbs/trimester

maternal nutrition

increase caloric intake by how much/day?

protein increase?

about 300 calories/day additonal for a total of 2500/daily

up to 60g/day

Morning sickness caused by?

fixed or curved by?

high levels of hCG, est., and/or prog. levels

lowered maternal blood sugar

lack of vitamin B6

diminished gastric motility

affects 50% of pregnant women

not waiting longer than 12 hrs between meals

eat small frequent meals

snack at bedtime and delay eating in AM

Call MD if not eating more than 24hrs

PICA can lead to?

apparently common enough to mention. crazy toilet paper, dirt eaters.

bright red at birth

Rubra- dark red

Serosa- pink

Alba- white

Clear

menstruation returns when, after birth, in the nonlactating mother?

ovulation returns when?

6-10 weeks

6 months

return of ovulation and menstruation in breastfeeding mother is prolonged related to length of breastfeeding continues

after delivery, spontaneous BM may not occur till?

lingering effects of prog. and decreased muscle tone.

elimination will return to normal within one week.

bladder distention

if bladder is in center, and uterus is in center, why is it pushed to the SIDE?  whatever!

1-2 days after delivery.

mother is passive and somewhat dependent as she sorts reality from fantasy in birth experience.

food and sleep are major needs.

2-3 days after delivery.

mother ready to resume control over her life.

she is focused on baby and may need reassurance.

anticipatory stage- during pregnancy

formal stage- when baby is born

informal stage

personal stage

transient period of depression occurs when?

what may the mother experience?

first few days after delivery

mother may experience tearfulness, anorexia, difficulty sleeping, feeling of letdown

usually resolves within 10-14 days

acquaintance phase- fingertip exploration, en face position, responds verbally to sounds of infant

phase of mutual regulation- adjustment between needs of mother and needs of infant

reciprocity- mutually gratifying interaction among mother, infant, and father

preeclampsia

diabetes

cardiac disease

cesarean birth

overdistention of uterus

abruptio placentae or placenta previa

precipitous labor

prolonged labor

difficult birth

extended period of time in stirrups at birth

retained placenta

Breast

Uterus

Bladder

Bowel

Lochia

Episiotomy

Homan's Sign

Edema

Emotional

Rhogam

Bubble heer

Breast

Bubble heer

Uterus

Bubble heer

Bladder

Bubble heer

Bowel

Bubble heer

Lochia

Bubble heer

Episiotomy

Bubble heer

Homan's sign

Bubble heer

Edema

Bubble heer

Emotional

Bubble heer

Rhogam

Redness

Edema

Ecchymosis (bruising basically)

Discharge/Drainage

Approximation

Lochia volume assessment.

4 different assessment amounts.

in order from least to most

-Scant

-Light

-Moderate

-Heavy

-OMG (just kidding for this one of course)

when is a vaginal birth mother discharged?

cesarean birth?

48 hrs

96 hrs

include physical exam, discharge teaching, rubella vaccine, and Rhogam

Constipation related to fear of tearing stitches or pain.

Acute pain related to perineal edema or epsiotomy from birth.

Impaired skin/tissue integrity related to tearing/shearing forces or surgical intervention.

Impaired urinary elimination.

Risk for infection.

ice packs

topical agents

perineal care

sitz bath

topical anesthetic ointments-dermaplast

rectal suppositories

witch hazel pads

-wear supportive bra within 6 hrs after birth for 5-7 days.  only remove when showering.

-begin after birth: ice packs applied over axillary area of each breast for 20 min. 4xdaily.

-avoid stimulation of the breasts

-avoid heat on breasts, face away from the shower water.

gradually increase activities and ambulation after birth.

avoid heavy lifting, excessive stair climbing, and strenuous activity.

delay returning to work until after 6 weeks postpartum examination.

resume all activities by 4-5 weeks when lockia flow stops.

yes, mothers should be given acvailable options.

(whatever those are)

within 24-72 hours

allows her to become more mobile and active

when to anticipate cord will fall off

information about tub baths and immunizations

feeding and handling infant

safety concerns

PICA

internet- actually any vitamin or mineral deficiency can cause this, but most commonly it is iron.  often a person will crave/eat the things that contain the vitamin they are lacking.

pregnant mothers can eat up to how much fish?

what element are we being cautious of?

what types of fish have high levels of this?

12oz/wk

mercury

swordfish, tilefish, and mackerel

how many calorie increase in second and third trimester?

during lactation?

300kcal/day

200kcal/day

which food groups are we concerned with?

how much of each should mothers eat/day?

grains, vegetables, fruits, milk, meat/beans

grains 6oz/day, vegetables 2 1/2cups/day, fruits 2cups/day, milk 3cups/day, meat and beans 5 1/2oz/day.

use fats oils and sweets sparingly

place infant on back?

"Back to Sleep"

the caring theory

5 attributes of caregiver?

Knowing

Being with

Doing for

Enabling

Maintaining belief

traditional burial via funeral home

cremation at funeral home

hospital disposition

one friggin third! thats 1/3rd!!!

adolescent developmental stages

early?

middle?

late?

early(14 and under)-confomity to peer group

middle(15-17)-seeks independence, turns increasingly to peer groups

late(18-19)-understands and accepts consiquences for behavior

Sexually transmitted infections (STIs)

active outreach activities

health education and sex education

counseling

family planning services

promotion of abstinence or regular use of effective birth control

focus on reducing specific sexual risk taking behaviors