Term
|
Definition
Used for the treatment of preeclampsia
Bolus of 6g magnesium sulfate is administered IV over 20-30 minutes to prevent seizure
Ad additional bolus of 2g of magnesium over 5-10 minutes can be given |
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Term
| Antidote to Magnesium Sulfate |
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Definition
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Term
| Side effects of Loading dose of Magnesium Sulfate |
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Definition
| Warmth, headache, nystagmus, nausea, dry mouth, dizziness, lethargy, risk of pulmonary edema |
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Term
| Fetal Side effects of Magnesium Sulfate |
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Definition
| Hypotonia, lethargy, hypoglycemia, hypocalcemia |
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Term
| Management of Magnesium Sulfate |
|
Definition
Monitor serum levels as ordered, monitor respirations (should not be below 12/min), monitor BP, assess DTR, monotor Urine output (no less than 30 mls an hour)
Monitor fetal heart tones continously
Monitor neuro status |
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Term
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Definition
| pregnancy termination priorto 20 weeks or with a fetus weighing less than 500 grams. Abortion can be spontaneous or induced. Miscarriage is another term for a spontaneous abortion. |
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Term
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Definition
| Unexplained bleeding cramping, backache that indicates that the fetus may be in jeopardy. |
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Term
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Definition
| Bleeding or cramping increases and the internal cervical os dilates or membranes may rupture. |
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Term
|
Definition
| All the products of conception are expelled. |
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Term
|
Definition
| The fetus dies in the utero but is not expelled- give methergine or methotextrate for induction |
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Term
| Treatment for spontaneous abortion |
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Definition
| Bed rest, abstinence from coitus, D&C or suction evacuation, Rh immune globulin because don't want Inti D antigen to attack next pregnancy. |
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Term
| Spontaneous abortion nursing care |
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Definition
| Assess the amount and appearance of any vaginal bleeding, monitor vital signs and degree of discomfort, assess need for RH immune globulin, assess fetal heart rate, assess the responses and coping of the woman and her family |
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Term
|
Definition
| Bleeding due to placenta detaching from the wall, cramping for 1-2 weeks, vaginl rest for 1 week, monitor temp. BID 100.4 too high, follow up in 2 weeks |
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Term
| Premature dilation of the cervix |
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Definition
Painless dilation before pregnancy comes to term leading to early expulsion of fetus, congenital, acquired, biockemical, hormonal, DES, anatomical.
S&S- advanced cervical dilation, low abd pressure, bloody show, urinary frequency, fetus could have some lightening |
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Term
| Cervical Incompetence Treatment |
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Definition
| Serial cervical ultrasound assessments, bed rest, progesterone supplementations (inhibits myometrial contractions), antibiotics, anti-inflammatory drugs, cerclage procedure |
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Term
|
Definition
Suture remaed at term (37 weeks) or may leave in place and have C/S if planning future pregnancies.
Should not have beeding after procedure
Report signs of infection or pain |
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Term
|
Definition
| Implantation of zygote in other than the endometrial lining of uterus, risk factors: tubal damage, scarring, endometriosis, previous ectopic, IUD, PID, tube anomalies, smoking, ovulation inducing drugs, advanced maternal age, douching |
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Term
| Symptoms of an Ectopic Pregnancy |
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Definition
| Amenorrhea, breast tenderness, nausea, presence of hCG, slowly incresing B-hCG levels, Fainting/Dizziness with rupture, referred right shoulder pain, Low Hct/Hgb, increased leukocytes, no gestational sac on US |
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Term
| Treatment of Ectopic Pregnancy |
|
Definition
Methotrexate may be used if extopic pregnancy is unruptured and of 3.5cm size or less
Methotrexate is a folicacid antagonist
Alternate dose of methotrexate or leucovorin
Surgery (removal of tube may be indicated)
Rh immune globlin |
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Term
| Management of Ectopic Pregnancy |
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Definition
| Assess for signs of shock, increased HR, hypotention, Pallor, decreased Urinary output, Assess vaginal bleeding, pain, I/O, emotional status, post-op care |
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Term
| Gestational Tropoblastic Disease (Hydatiform Mole) |
|
Definition
Complete mole- fetilization of egg with no nucleus- looks like white grapes
Results in nucleus of sperm duplicating itself, or 2 sperm fertilize ovum with no nucleus. No fetus, placenta, amniotic membranes, no placenta to recieve maternal blood so hemorrhage into uterine cavity and bag. bleeding occurs.
Partial mole- 2 sperm fertilize one ovum
Gestational trophoblastic neoplasia- 20% choriocarcinoma--- heta Hcg levels do not fall chemotherapy is required |
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Term
| Gestational trophoblastic disease symptoms |
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Definition
| Vaginal bleeding (looks like prune juice), cramping, passing of hydropic vesicles, uterine enlargement greater than expected for gestational age, uterine enlargement greater than expected for gestational age, absence of fetal heart sounds, higher than anticipated hCG levels, increased nausea and vomiting. |
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Term
| Gestationald Trophoblastic disease treatment |
|
Definition
| Immediate evacuation of mole, follow up HCG levels for at least 6 months to detect trophoblastic peoplasia,careful follow up, no pregnancy for one year. |
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Term
| Gestational Trophoblastic disease nursing care |
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Definition
| Monitor vital signs, monitor vaginal bleeding, assess abdominal pain, assess the woman's emotional state and coping ablity, risk for hypovolemic shock |
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Term
|
Definition
Presents with severe nausea and vomiting such that it affects nutirtional status and hydration (losing weight)
Risks- dehydration, electrolyte imbalance, acidosis, weight loss, ketonuria, and hepatic or renal damage
Prevalence- nulliparous women, adolescents, multiple gestation, increased body weight, gestational trophoblastic disesase. |
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Term
| Hyperemesis Gravidarum Treatment |
|
Definition
Obscure etiology due to high levels of hCG
Treatment- Control vomitting, IV therapy to prevent dehydration (dextrose solution), resotre electrolyte imbalanace, maintain adequate nutrition, eat small meals throughout the day.
Pyridoxine (Vitamin B6) PO 10mg-25mg three times a day
Phenergan IM
Reglan
Zofran |
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Term
|
Definition
| Preeclampsia-eclampsia, Chronic hypertension, chronic hypertension with superimposed preeclampsia, Gestational hypertension |
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Term
|
Definition
| Defined as an increase in blood pressure after 20 weeks gestation, accompaned by proteinuria, occurs in a previously normotensive women |
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Term
|
Definition
| The occurrence of a seizure in a woman with preeclampsia who has no other cause for seizure |
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Term
| Preeclampsia Disease Theories |
|
Definition
Impaired trophoblast differentiation and invasion, placental and edotheilial dysfunction, an immune reaction to paternal antigens, exaggerated systemic inflammatory response, may be related to an imbalance between circulating angiogenesis related factors.
The placental plays a central role in the development of the disease and the only known cure isthe birth of the fetus and removal of the placenta. |
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Term
| Characteristics of Preeclampsia |
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Definition
| Maternal vasospasm resulting in decreased perfusion to all organs including the placenta, decrease in plasma volume, activation fot eh coagulation cascade, alteration in glomerular capillary endothelium |
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Term
| Pathophysiology of Preeclampsia |
|
Definition
Maternal vasospasm, decreased perfusion to virtually all organs
Renal- glomerular endotheilial damage, fibrin depsots leading to ischemia leading to decreased GFR. Protein is excreted in the urine, uric acid, creatinine, andcalcium clearance are decreased, Oliguria develops as condition worsens.
Hepatic- increased microvascular fat deposits in the liver, may cause epigastric pain, liver damage may be mild or may leat to HELLP
May have periportal hemorrhagic necrosis which can lead to subscapsular hematoma (RUQ pain) |
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Term
| Pathophysiology of Preeclampsia |
|
Definition
Leakage of serum protein into extracellular spaces and into urine results in creased serum lbumin and tissue edema.
Neurological- endothelial damage to brain results in fibrin deposition, edema, cerebral hemorrhage, may lead to hyperfexia and severe headaches.
Retinal- arteriospasms may cause blurring or double vision, photophobia, or scotoma.
Coagulation- Activated in preeclampsi, thrombocytopenia- 2/2 increased platelet aggergation and deposits at sites of endolthelial damage, activating the clotting cascade |
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Term
| Assessment findings of preeclampsia |
|
Definition
HTN >140/90
Proteinuria 1+ or greater
Brisk DTR, Clonus
HA unrelieved by Tylenol, visual changes, epigastric pain, edema |
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Term
| Management of Severe Preeeclampsia |
|
Definition
| Bed Rest, treatment with magnesium sulfate, corticosteroids, fluid and electrolyte replacement, antihypertensive therapy (Hydralizine), Delivery |
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Term
| Home management of preeclampsia |
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Definition
| Monitor for signs and symptoms of worsening condition, fetal movement counts, frequent rest in the left lateral position, monitoring of blood pressure, weight, and urine protein daily, NST, laboratory testing |
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Term
| Signs and Symptoms of eclampsia |
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Definition
| Seizure, severe persistent HA, epigastric pain, N/V, hyperflexia with clonus, restlessness thought to be triggered by cerebral vasospasm, cerebral hemorrhage, cerebral ischemia, cerebral edema |
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Term
|
Definition
| Remain with patient, call for help, safety- assess airway and breathing, lower HOB and turn head to side if possible, anticipate the need to suction, Record time, length, type or seizure activity, notify physician, prevent maternal injury (padded side rails) |
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Term
|
Definition
| Assess characteristics of seizure, assess status of the fetus, assess for signs of placental abruption, maintain airway and oxygenation, position on side to avoid aspiration, suction to keep the airway clear, administer magnesium sulfate |
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Term
|
Definition
Hemolysis, elevated liver enzymes, and low platelet count
Associated with severe preeclampsia
Hypertension and proteinuria may be absent
90% of women present with symptoms before 36 weeks
25% first demonstrate the disease in the PP period |
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Term
| HELLP syndrome pathophysiology |
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Definition
Microangiopathic hemolytic anemia- RBC are distored or fragmented during passage through small damaged vessels.
Vascular damage is associated with vasospasm and platelets aggregate at sites of camage, resulting in low platelet count.
Elevated liver enzymes occur from blood flow that is obstructed due to fibrin deposits.
Epigastric pain due to the increase in hepatic pressure causes swelling of the liver.
Hyperbilirubinemia and jaundice may occur.
Liver may rupture. |
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Term
|
Definition
| Hemolysis, elevated liver enzymes, low platelets- thrombocytopenia, N/V, epigastric pain |
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Term
|
Definition
Chronic hypertension exists when the blood pressure is 140/90 or higher before pregnancy or before the 20th week of gestation.
Persists 42 days following childbirth |
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Term
| Chronic Hypertension Management |
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Definition
| Nutrition, bed rest, medications, prenatal visits, blood pressure monitoring, fetal surveillance |
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Term
|
Definition
Exitsts when transient elevation of blood pressure occurs for the first time after midpregnancy witout proteinuria or other signs of preeclampsia.
If preeclampsia does not occur and if BP returns to normal 12 weeks PP it is diagnosed to be gestaional hypertension. |
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Term
|
Definition
Rh-negative person is exposed to a Rh-positive blood an antigen-antibody response occurs.
Antibodies are formed, person can be sensitized.
Antigens in the D group are usually involved with incompatiblity between the mother and the fetus.
6 in every 1000 live births is complicated by maternal sensitization to the D red cell antigen.
Screenin for the D antigen is recommended. |
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Term
|
Definition
Resulted in a marked decrease in prevalence of alloimmunization to the RhD in pregnancy.
During pregnancy small amounts of fetal blood may cross he placenta.
Rh-negative mother whose fetus is Rh-positive my develop anti-D antibodies.
During delivery larger amounts of fetal blood can enter the mom's body.
After exposure to the Rh-positive antigen the primary immune response is the development of immunoglobulin M (IgM) antibodies.
The primary response develops slowly over several weeks with a detectable titer developing over 5 to 16 weeks after the sensitizing event.
IgM antibodies do not cross the placenta.
Once antibodies are developed, the Mom is immunized for life. |
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Term
| Isoimmunization: Rh Negative |
|
Definition
Aslo known as D or Du negative.
Rh (D) negtive mother with D+ baby
In 40% of pregnancies fetal blood passess to maternal.
Mother first forms IgM antibodies, too big to pass to baby.
Then forms IgG can cross placenta, destroys D+ blood.
Antibody formation called maternal sensitization.
"Memore" increases antibody production with next pregnancy. |
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Term
|
Definition
| Severe anemia from hemolysis, large numbers of immature erythrocytes, erythroblastosis fetalis, hydrops fetalis (cardiac decompensation), hypoxia from anemia, death. |
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Term
|
Definition
Monder: Indirect coombs- anti-D antibodies are unbound, absorbed only to red cells of fetus, If + identify as IgG and quantify critical titer 1:16 or >
Fetus: direct coombs |
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Term
| Treatment for Neaonate Rh |
|
Definition
Blood type, Rh, Hgb, Direct Coombs
Transfuse for severe anemia and or hyperblirubinemia, itrauterine exchange transfusion o negative blood, crossmatch with mom, early delivery, phototherapy for mild jaundice |
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Term
|
Definition
Problem possibly- A potential problem exists when and Rh-negative mother and an Rh-positive father conceive a child who is Rh positive.
A mothe rmay become sensitized or produce antibodies to her fetus's Rh-positive blood.
Indirect coombs test doen on the mothers blood to measure the number of Rh-positive antibodies.
Direct coombs test done on the nfants blood to detect antibody coated Rh positive RBCs. |
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Term
| When to give Rhogam in 72 hours |
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Definition
| Indirect coombs test is negative and the infants direct coombs test is negative (sensitization has not occured) |
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Term
|
Definition
| Indirect coombs test is positive and Th positive infant has a positive direct coombs test rhogam is not given, the infant should be monitored for hemolytic disease. It is recommended the Rhogam be given at 28 weeks. |
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Term
| Management of Rh incompatibility Prenatal Prevention |
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Definition
| Rhogam at 28 weeks for unsensitized women |
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Term
| Managment of Rh incompatibility Postpartum |
|
Definition
Check direct coombs test
Rhogam to mom if baby is Rh+ within 72 hours of birth |
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Term
| Administration of Rh Immune Globulin |
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Definition
| After birth of an Rh+ infant, After spontaneous or induced abortion, after ectopic pregnancy, after invasive procedures during pregnancy, after maternal trauma, must be within 72 hours. |
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Term
|
Definition
Type O mothers with a Type A or B fetus
Group O infants because they have no antigenic sites o the RBCs are never affected regardless of the mothers blood type
Once women becomes pregnanct anti-A and anti-B antibodies cross the placenta and can produce hemolysis of fetal RBCs. |
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Term
| Group B streptococcus Infection |
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Definition
Group B strep is a bacterial infection found in the lower GI or urogenital tract.
GBS may be transmitted to the fetus in utero during childbirth.
Responsible for maternal morbidity:
pyelonephritis, chorioamnionitis, PP endometritis, sepsis, meningitis |
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|
Term
|
Definition
may result in still births, transmission from mother when fetus passes through the birth canal.
Risk factors:
Prematurity, maternal intrapartum fever, membranes ruptured for longer than 18 hours, previously infected infant, GBS baceriuria in current pregnancy, young maternal age, african american or hispanic |
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Term
| GBS manifestation in Newborn |
|
Definition
| Respiratory distress, pneumonia, apnea, shock, meningitis, neurologic damage |
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Term
| Disorders of Amniotic Fluid |
|
Definition
Polyhydraminos- S/S uterine distention, dyspnea, edema of lower extremities- Treatment therapeutic amniocentesis
Oligohydramnios- Risks- Cord compression, musculoskeletal deformities, pulmonary hypoplasia Treatment- amnioinfusion |
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Term
|
Definition
| amniotic fluid >2000 mls caused by abnormal or excessive fetal urination; frequently found in pregnancies with maternal diabetes, multiple gestation and isoimmunization. Can result in maternal respiratory compromise, fetal malpresentation and cord prelapse; managed by amniocentesis or amniotomy. |
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Term
|
Definition
| amniotic fluid <500mls in second or third trimester caused by any conditio the blocks production of urine or from getting it into amniotic sac. Can result in fetal cord compression, intolerance to labor, negative fetal outcomes. Found in pregnancies with fetal anomalies, maternal hypertension and post dates. |
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Term
|
Definition
Menopause is defined as the absence of menstruation for 1 full year
Occurs around 50 to 51 years of age
Perimenopause-the time before menopause during which the woman moves from ovulatiory cycles to cessation of menses
Perimenopause may last from 2 to 8 years |
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Term
| Physical aspects of menopause |
|
Definition
Anovulation
Reduced fertility
Decreased or increased menstrual flow
Menstrual cycle irregularities
Amenorrhea
( |
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Term
|
Definition
Decrease in bone strength related to dimished bone desity and bone quality.
Estrogen regulates weight and fat metabolism during menopause.
Fat accumulation may occur in the trunk region. |
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Term
| Osteoporosis risk factors |
|
Definition
Presonal hx of fracture after age 50
Current low bone mass
female
weight less than 127
Family history
anorxia
low lifetime of calcium
vitamin D deficiency
Inactive lifestyle
Deficiency in estrogen |
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Term
|
Definition
Family planning may be acceptable following the churches teaching
All family planning or contraceptive use needs to meet an individuals need |
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Term
|
Definition
| Progestin only, syntheic form of progesterone, combination of estrogen and progestin, combination of estrogen and progestin is highly successful, inhibit the release of an ovum by creating and atrophic enometrium and by maintaining thick cervical mucus which slows/inhibits the transport of sperm. |
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Term
| Hormonal contraceptives II |
|
Definition
Combined oral contraceptives are on of the most popular options (combined estrogen and progestin)
Safe, highly effective, and rapidly reversible, taken 21 to 28 days, seasonale and seasonique extended use of estrogen and progestin are taken for 84 days and then followed by a blank pill for 7 days. May have bleeding four times a year. |
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Term
| Extended use of Hormonal contraceptives may reduce the following side effects |
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Definition
| Bloating, headache, breast tenderness, cramping, swelling |
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Term
|
Definition
| A hormone proudced by the avaries that helps prepare the uterus for pregnancy. It is first produced by the corpus luteum in the ovaries and later is maintained by the placenta. |
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Term
| What does progesterone do |
|
Definition
| Helps to regulate the menstrual cycle, prepares the lining of the uterus for implantation, keeps the lining of the uterus thick which is necessary for a successful pregnancy, produces a rise in temperature after ovulation which remains until mentruation occurs, creates a nutrient rich environment for the baby by increasing glycogen and arterial blood to the lining of the uterus, keeps the uterus from having contractions, causes the cervix to thicken and create a mucous plug which prevents bacteria from enterin the uterus. |
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Term
|
Definition
| Fertility awareness based methods documenting changes in the women's menstrual cycle. Life san of sperm 2-7 days, ovum 1-3 days, maximum fertility occurs approximately 5 days before ovulation and decreases rapidly the day after, couple abstains from intercourse. |
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Term
| Basal body temperature Method |
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Definition
| Detects fertility due to temperature change, take temperature every morning for 3-4 months of recording cycle, temperature changes may indicate women is fertile, temperature may riske after ovulation and remain elevated due to the increase in progesterone. Women abstains from intercourse day the temperature rises until 3 days later. If the temperature is a straight line, not ovulating. |
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Term
| Situational contraceptives |
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Definition
| abstinence, coitus interupptus, douching |
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Term
|
Definition
| When contraception is used there is lower incidence sexually transmitted diseases including HIV, fewer unwanted pregnancies |
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Term
| Barrier Methods of Contraception |
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Definition
| Male Condom, femal condom, diaphragm, cervical caps, vaginal sponge, intrauterine devices, male condome is the safest means to protect an individual from contracting HIV or other STI. |
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Term
|
Definition
| Steel band that forms a rings and is covered with latex or silicone so that when the diaphragm is inserted, the ring lodges high in the vagina with the latex or silicone covering of the cervix. |
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Term
|
Definition
| Must be inserted before intercourse with one teaspoon of spermicidal jelly placed around its rim and in the cup. The diaphragm is inserted through the vaginal and covers the cervix. Push the diaphragm under the symphysis pubis, should not cause discomfort. If more than 6 hours lapse, should be reinserted. Should be left in for 6-8 hours after intercourse. |
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Term
|
Definition
| Inserted in the uterus, copper may be left for 10 years, mirena left for 5. May be used to prevent the implantation of the ovum, mirena produces thick cervical mucus which inhibits the entry of sperm, releases levonorgestrel on a daily baiss. |
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Term
| Complications of non hormonal IUD |
|
Definition
| Increased bleeding, increased cramping, increased of pilvic infection following insertion, abnormal bleeding, dysmenorrhea |
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Term
| Hormonal contraceptive contraindications |
|
Definition
Current pregnancy
Hx of thrombophlebitis
Hx of thromboembolic diesease
Acute or chronic liver disease
Estrogen dependent carcinomas
Undiagnosed uterine bleeding
Heavy smoking
Migraines
Diabetes
Amenorrhea |
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Term
| Hormonal contraceptive indications |
|
Definition
Diminished menstrual cramps
Diminished or decreased menstrual flow
Reduction in the incident of ovarian cancer, ovarian cancer, endometrial cancer, colorectal cancer
Reduction in migraines
May improve bone density
May decrease hot flashes |
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|
Term
When taking hormonal contraceptive
Women should contact physician immediately for the following: |
|
Definition
Abdominal pain
Severe chest pain
Shortness of breath
Headache
Dizziness
Severe leg pain!!!!Combination Oral contraceptives may be altered due to Abx, over the counter medications, or herbal supplements |
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Term
| Transdermal hormonal change |
|
Definition
Contraceptive skin patch (Ortho EVera)
Combined hormonal contraception
Applied weekly for 3 weeks
Fourth week it is taken off
Patch is applied the first day of menses
Cannot use if weigh over 198 lbs |
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Term
|
Definition
Vaginal Contraceptive Ring
Low dose sustained release
Ring is left in place for 21 days and then removed for 7 days
Contraindicated with a previous vaginal prolapse |
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Term
|
Definition
Minipill (progestin only)
Used for breastfeeding Mom’s
Used by women who have a contraindication to the estrogen component such as thrombophlebitis or hypertension
Progestin may cause amenorrhea or irregular bleeding |
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Term
| Adaptations to pregnancy reproductive system- UTERUS |
|
Definition
Physiologic changes- increase levels of estrogen/progesterone, enlargement of the uterus, expanded circulatroy volume leading to increased vascular congestions, Acid pH o f vagina
Clinical signs/symptoms- hypertrophy of uterine wall, softening of vaginal muscle and connective tissue, increased uterine contractility (estrogen) leading to braxton hicks, hypertophy of cervical glands leading to mucous plug, increased vaginal glands leading to increased leukorrhea, cessagtion of menstruation/ ovulation. Increat to 20x that of nonpregnant uterus, weight increases from 70-1000g.
Blood flow to the uterus is 500-600mL at term, goodell's sign-cervical tip softens around 6 weeks. Hegar's sign- softening of the lower uterine segment, chadwick's sign-bluish coloration of cervix, mucosa and vulva.
Inhibits grwoth of bacteria, increased growth of candida albicans, leading to increased risk of candidasis. |
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Term
| Adaptations to pregnancy reproductive system- Breasts |
|
Definition
Physiologic changes- increase of estrogen and progesteron levels,initially produced by corpus luteum then by the placenta.
Increase of prolactin produced in the anterior pituitary.
Clincial S/S
Tenderness, fullness, tingling sensation, increase in weight by 400g, enlargement of breasts, nipples, areola, nipples become more erect, areolae become darker, glandular hyperplasia, and hypertrophy of montgomery tubercles, stria, prominent veins d/t a twofold increase in blood flow, increased growth of mammary glands, increase in lactiferous ducts and alveolar system, production of colorstrum by end of 16th week. |
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Term
| Adaptations to pregnancy- cardiovascular |
|
Definition
Physioloic changes- decrease in peripheral vascular systm, increase in blood volume by 40-50%, Increase in cardiac output by 30-50%, Increase in RBC count by 30%, increase in RBC volume by 17-30%, Increase in WBC cound, increased demand for iron in fetal development, hypercoagulability, growing uterus displaces the heart upward and to the left, decrease in systemic and pulmonary vascular resistance, increased venous pressure and decreased blood flow to extremities 2/2 compression of iliac veins and inferior vena cava.
Clinical s/s- decreased BP, hypervolemia of pregnancy, increased HR 15-20BPM, exchange of nutrients, oxygen and waste products within the placenta, needs of expanded maternal tissue, reserve blood loss at birth, increased stroke volume of 30%, systolic murmurs, increase in heart size.
Physiological anemia of pregnancy, hemodiultion caused by increased plasma volume being relatively larger than the increase in RBC leading to decreased hemoglobin and decreased hematocrit.
Up to 15,000 WBC in the absence of infxn, iron-deficiency anemia: HgB <11g/dL and Hct <33%
Plasma fibrin increase of 40%
Fibrinogen increase of 50%
Decrease in coagulation inhibiting factors
Protective of inevitable blood loss during birth
May see a change in location of heart when auscultating heart sounds
BP does not increase due to the decreased resistance in the bessels
Edema of the lower extremities, varicosities in legs and vulva, hemorrhoids. |
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|
Term
| Adaptations to Pregnancy- Respiratory |
|
Definition
Physiological changes- Hormones stimulate the respiratory center and act on lung tissue to increase and enhance respiratory function.
Increase of oxygen consumtpion by 20%
Estrogen, progesterone, and prostaglandin cause vascular engorgement and smooth muscle relaxation, upward displacement of diaphragm by englarging uterus
Estrogen causes a relaxation of the ligaments and joints of the ribs
Clinical S/S- Increase in tidal volume by 30-40%, Slight increase in respiratory rate, increase in inspiratory capacity, decrease in expiratoryvolume, slight hyperventilation, slight respiratory alkalosis, dyspnea,
Nasal and sinus congestion, epistaxis,
shift from abdominal to thoracic breathing, chest and thorax expand to accomodate thoracic breathing and upward displacement of the diaphragm.
Slight decrease in lung capacity. |
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|
Term
| Adaptations to Pregnancy- Renal |
|
Definition
Physiologic changes- Increased progesterone levels leading to relaxations of smooth muscle, pressure of enlargin uterus on renal structures, alterations in CV system lead to increased renal blood flow of 50-80% in 1st trimester then decreases
Decreased renal flow in third trimester
Increased vascularity
Excretion of waste for mom and fetus
Clinical S/S- Dilation of renal pelvis and ureters leading to increased risk of UTI
Ureters become elongated with decreased motility leading to increased risk of UTI.
Decreased bladder tone with increased bladder capacity leading to frequency and incontinence and increased risk of UTI.
Displacement of bladder in 3rd trimester leads to urinary frequency and nocturia.
Increased GFR leads to inreased urinary output.
Increased GFR leads to increased renal excretion of glucose and protein leading to glucosuria and proteinuria.
Dependent edema
Hyperemia of bladder and urethra, increased frequency |
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|
Term
| Adaptations to pregnancy- Gastrointestinal |
|
Definition
Physiological changes-
Increased levels of hCG and altered carbohydrate metabolism, increased progesterone levels lead to decreased muscle tone and slowing of digestive process
Increased progesterone leads to decreased muscle tone of gallbladder leads to prolonged emptying time
Changes in senses of taste or smell
Displacement of intestines by uterus
Increased levels of estrogen lead to increased vascular congestion of mucosa
Clinical S/S-
Nausea and vomiting in early pregnancy, constipation, straining may lead to hemorrhoids, delayed gastric emptying lead to heartburn (pyrosis)
Increased risk of gallston fotmation and cholestasis, increase or decrease in appetite, retention of bile salts which can lead to itching, nausea, Pica, flatulence, abdominal distention, abdomincal cramping, and pelvic heaviness. Gingitis, bleeding gums, increased risk of periodontal disease. |
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|
Term
| Adaptations to pregnancy- musculoskeletal |
|
Definition
Physiological changes-
Increased progesteron and relxin levels lead to softening of joints and increased joint mobility leading to widening and increased mobility of scroiliac and symphysis pubis
Distention of abdomen 2/2 to uterus, reduced abdominal tone, increased breast size, increased estrogen and relxin levels lead to increased elasticity and relaxation of ligaments, abdominal muscles stretch due to enlarging uterus, Human Placental Lactogen (HPL) produced by placenta increases insulin resistance by altering glucose metabolism.
Clinical S/S-
Atered gait- waddling, facilitates birthing process, Pelvis tilts forward leading to shifting of center of gravity leading to change in posture and walking style increasing lordosis. Round ligament spasm, increased risk of joint pain and injury, diastasis recti, gestational diabetes. |
|
|
Term
| Adaptations to pregnancy- Integumentary |
|
Definition
Physiological changes- Estrogen and progesterone levels stimulate increased melanin deposition leading to light brown to dark brown pigmentation, Increased blood flow increased BMR, progesterone induced increase in body temperature, and vasomotor instability, increased action of adrenocorticosteroids lead to cutaneous elastic tissues becoming fragile, increased estrogen levels lead to color and vascular changes, increasedandrogens lead to increased in sebaceous glands
Clinical S/S- linea nigra, melasma, darkening of nipples, areola, vulva, scars and moles. Hot flashes, facial flushing, alternating sensations of hot and cold, increased perspiration, stria gravidarum on abdomen, thighs, breasts and buttock, angiomas, plamar erythema, pinking mottling over palms of handes increased oiliness of skin and increase of acne. |
|
|
Term
Adaptations of pregnancy- Hormones
Decreased follicle stimulating hormone |
|
Definition
|
|
Term
|
Definition
| Maintains pregnancy by relaxation of smooth muscle |
|
|
Term
|
Definition
Decreased GI motility
Facilitates uterine and breast development
Facilitates increases in vascularity
Hyperpigmentation
Alters metabolic processes and fluid and electrolyte balance |
|
|
Term
|
Definition
|
|
Term
|
Definition
Stimulates uterine contractions
Stimulates the milk let-down reflex in response to breastfeeding |
|
|
Term
|
Definition
Facilitates breast development
Alters carb, protein, and fat metabolism
Faciliatates fetal growth by altering maternal metabolism; acts as an insulin atagonist |
|
|
Term
| Hyperplasia and increased vascularity of thyroid |
|
Definition
Enlargement of thyroid
Heat intolerance and fatigue |
|
|
Term
| Increased human chorionic gonadotropin (hCG) |
|
Definition
| Maintenance of corpus luteum until placenta is full functional |
|
|
Term
| Increased BMR related to fetal meatbolic activity |
|
Definition
| Depletion of maternal glucose stores leads to increased risk of maternal hypoglycemia, increased production of insulin, increase in maternal resistance to insulin leads to increased risk of hyperglycemia |
|
|
Term
| Which medications are used to induce labor? |
|
Definition
Pitocin/Oxytocin
Cytotec/Misoprostil
Dinoprostone/Prepidil |
|
|
Term
Used as a tocolytic medicine to slow uterine contractions during preterm labor.
Also used to stop or prevent convulsions of eclampsia. |
|
Definition
|
|
Term
| Antidote for Magnesium Sulfate |
|
Definition
|
|
Term
| Beta agonist used to stop contractions |
|
Definition
|
|
Term
| Used to stimulate fetal lung maturation |
|
Definition
|
|
Term
| What is the route/routes that Misoprostil (Cytotec) can be given? |
|
Definition
Vaginally (may be 25-200 mcg)
Rectally (800mcg-1000mcg)
Orally |
|
|
Term
| Can Tylenol and Motrin be given at the same time Postpartum? |
|
Definition
|
|
Term
| What is procardia used for |
|
Definition
| Use of nifedipine or procardia for the treatment of preterm labor is an unlabeled use of the drug. Nifedipine, a calcium channel blocker, is more commonly used to treat high blood pressure and heart disease. |
|
|
Term
| Which PPH medication is contraindicated with high blood pressure? |
|
Definition
|
|
Term
| When should Simethicone be given? |
|
Definition
| Typically for a c-section patient. After each meal and at bedtime. |
|
|
Term
| Should the infant be left alone in the room when a Mom is given Ambien? |
|
Definition
|
|
Term
| What is Lanolin used for and when should it be applied? |
|
Definition
| After breastfeedings and do not wipe off in between feedings! |
|
|
Term
| Which products are comfort products for the perineum? |
|
Definition
Tucks
Epifoam
Americaine Spray
Ice pack
Sitz bath |
|
|
Term
| Which medications are used to treat/prevent nausea vomiting? |
|
Definition
Phenergan
Zofran
Reglan
Vistaril
Scopolamine patch |
|
|
Term
| If a patient becomes hypotensive after the placement of an epidural, which medications might be used? |
|
Definition
IV Bolus
Hespan (hetastarch) (volume expander)
Ephedrine (stimulant) |
|
|
Term
| Which medications could be used for a Gravid hypertensive patient? |
|
Definition
Hydralazine
Labetalol HCL
Nifedipine
Methyldopa (wishing to breastfeed) |
|
|
Term
| What medications might be used to treat a PPH? |
|
Definition
Oxytocin
Cytotec (prostaglandin)
Methergine (ergot alkaloids)
Hemabate (prostaglandin) |
|
|
Term
| Can Percocet and Tylenol be given together? |
|
Definition
|
|
Term
| How soon should Rhogam be given after delivery is the Mom is sensitized? |
|
Definition
|
|
Term
|
Definition
| Infections acquired in utero or during the birth process are a significant cause of fetal and neonatal mortality and an important contributor to early and later childhood morbidity |
|
|
Term
|
Definition
Toxoplasmosis
Other Infections (syphilis)
Rubella
Cytomegalovirus (CMV)
Herpes simplex virus (HSV) |
|
|
Term
|
Definition
Toxoplasmosis is an infection due to the parasite Toxoplasma gondii
Caused by animals (cats, birds), undercooked meat, contaminated soil
Toxoplasmosis in the uterus often have no symptoms at birth, but will later develop serious complications such as mental retardation and blindness. Some may have eye or brain damage at birth.
Bactrim of the abx of choice for treatment
The risks to the baby are the greatest if infection occurs during the first trimester. Infection with toxoplasmosis can also cause miscarriage, intrauterine growth retardation and preterm labor
Detected through a blood test |
|
|
Term
|
Definition
Chronic infection caused by the spirochete
Acquired through vaginal, oral, anal intercourse
Transplacental congenital transmission may occur
Incubation period of 10-90 days
Detected through a blood test
Primary stage-chancre (painless ulcer), mild fever, loss of weight
Secondary-skin eruptions called condylomata lata which resemble wart like…may present on the vulva, arthritis, enlargement of the liver and spleen
May be transferred via the placenta, may cause stillbirth, IUGR, preterm birth
Treated with PCN-G |
|
|
Term
|
Definition
Can have teratogenic effects on the fetus during the first trimester
May cause congenital cataracts, deafness, heart defects, or mental retardation
Infants should be isolated (IgM antibody is found) |
|
|
Term
|
Definition
Cytomegalovirus is related to the viruses that cause chickenpox and herpes simplex
Once you're infected with CMV, the virus remains with you for life, but it's not always active. CMV may cycle through periods during which it lies dormant and then reactivates. If you're healthy, it mainly stays dormant (content provided by the MayoClinic, 2011)
Most babies who are infected before they're born appear healthy at birth, but a few develop signs over time —sometimes not for months or years after birth. The most common of these late-occurring signs is hearing loss. A small number may develop vision impairment as well
Babies with congenital CMV who are affected at birth tend to be very sick. Signs and symptoms include:
Yellow skin and eyes (jaundice)
Purple skin splotches or a rash or both
Small size at birth (or low birth weight)
Enlarged spleen
Enlarged and poorly functioning liver
Pneumonia
Seizures
4/7/201215
Touching your eyes or the inside of your nose or mouthafter coming into contact with the body fluids of an infected person. This is the most common way CMV is spread because it's absorbed through the mucous membranes.
Through sexual contactwith an infected person.
Through the breast milkof an infected mother.
Through organ transplantationor blood transfusions.
Through the placenta,from an infected mother to her unborn child,or during birth.
Treatment is an antiviral…no cure!
No evidenced base therapy exists |
|
|
Term
|
Definition
1 and 6 people between the ages of 14-49 are infected with herpes simplex
HSV-I and HSV-II-can cause painful lesions in the genital area or the cervix
Presence of lesions may effect the fetus
Spontaneous abortion (if in first trimester)
Pre-term labor
IUGR
Sx’s up to 4 weeks after birth include fever, jaundice, seizures, poor feeding
MOC should be treated with acyclovir at 36 weeks or have a C/S |
|
|
Term
|
Definition
HPV-genital warts is caused by the HPV virus
May be gray like cauliflower lesions
May contribute to cervical dysplasia
Should have frequent pap smears to monitor cervical dysplasia
|
|
|
Term
|
Definition
Inflammatory process of the liver caused by an infection of A,B, C, D, E
A, B, C are caused by blood born pathogens
If MOC is Hepatitis B positive HBIG may be given up to 12 hours
It is encouraged that ALL newborns get the Hepatitis B immunization |
|
|
Term
| Amniotic fluid infections |
|
Definition
PROM
Positive Nitrizine Test
Copious fluid leaking into the introitus
Monitor time, color, and smell
Continue to monitor temperature every 4 hours
If ruptured over 24 hours…patient is at risk of infection
|
|
|
Term
|
Definition
Mammogram is a soft tissue x-ray image of the breast taken without the injection using contrast
It can detect lesions in the breast before they are palpated
Recommended for all women over the age of 40 to do self exams
Self breast exams should be done each month (see page 119-120)
Don’t forget to remind your loved ones (including yourself) to perform this test each month!!!! |
|
|
Term
|
Definition
Chromosomes-composed of deoxyribonucleic acid (DNA) and protein
Chromosome resembles an X (centromere, short arm, and long arm) |
|
|
Term
|
Definition
Regions in DNA strands that contain coded information used to determine the unique characteristics or traits of an individual
Genes in the autosomes determine hair color or blood type
Genes in the sex chromosomes determine gender |
|
|
Term
|
Definition
Each human begins life as a single cell called fertilized ovum or zygote
Cells are reproduced by mitosis or meiosis |
|
|
Term
|
Definition
| Process of cell division that results in daughter cells that are exact copies of the original cell |
|
|
Term
|
Definition
Meiosis is the type of cell division which give rise to gametes
When fertilization occurs the normal diploid number is restored |
|
|
Term
|
Definition
Meiosis occurs during gametogenesis
Oogenesis is the process that produces the female gamete called the ovum (egg) and the male gamete called the sperm
The ovum and the sperm unite to form the zygote |
|
|
Term
|
Definition
Is the process that produces the female gamete called an ovum (egg)
Ovary gives rise to oogonial cells which develop into oocytes
Meiosis begins and stops before birth.
Cell division resumes at puberty.
Development of Graafian follicle |
|
|
Term
|
Definition
Production of sperm
First meiotic division:
Primary spermatocyte replicates and divides.
Second meiotic division:
Secondary spermatocytes replicate and divide.
Produce four spermatids |
|
|
Term
|
Definition
When the sperm and Ovum unite.
New cell has 23 chromosomes from the ova and 23 from the sperm returning to diploid number of chromosomes.
Formation of gametes
gametogenesis |
|
|
Term
|
Definition
Zone pellucida blocks additional sperm from entering
Secondary oocyte completes second meiotic division
Forms nucleus of ovum
Nuclei of ovum and sperm unite
Membranes disappear
Chromosomes pair up |
|
|
Term
| Tubal transport of the zygote |
|
Definition
Zygote is formed by the union of the sperm and ovum.
Transported to the Uterus by the fallopian tubes
During transport the zygote undergoes rapid mitotic division or cleavage |
|
|
Term
|
Definition
Enters the uterus on day 3 and floats around for another 2-4 days.
Cells form a cavity and two distinct layers evolve.
Inner layer
Blastocyst
Outer layer
Trophoblast |
|
|
Term
|
Definition
| Develops into the embryo and embryonic membranes |
|
|
Term
|
Definition
Develops into an embryonic membrane called the Chorion
Chorionic villi
Amnion
Yolk sac |
|
|
Term
|
Definition
7-10 days after conception
Trophoblast burrows into the endometrium until the blastocyst is covered
Endometrium is now called decidua
Chorionic Villa develop from the trophoblast and extend into endometrium
These villi obtain oxygen and nutrients and dispose of carbon dioxide |
|
|
Term
|
Definition
Chorion
Developed by the trophoblast and envelops the amnion, embryo and yolk sac
Has villi projections that extend into the uterine wall and form the embryonic/fetal portion of the placenta
Amnion
Second thin membrane
Envelops the embryo and protects it
The Chorion and Amnion together form the amniotic sac filled with fluid. |
|
|
Term
|
Definition
Protection
Maintains an even temperature
Prevents the amniotic sac from adhering to the fetal skin.
Allows symmetrical growth
Provides a positive pressure environment for fetal lung development |
|
|
Term
|
Definition
9thday the yolk sac develops
Functions only during embryonic life
Initiates the production of red blood cells until about 6 weeks when the liver takes over
The umbilical cord than encompasses the yolk sac and it degenerates |
|
|
Term
|
Definition
After implantation the embryonic disks transforms into three primary germ layers
Ectoderm
Mesoderm
Endoderm |
|
|
Term
|
Definition
Outer layer of skin
Hair follicles
Nails and hair
External sense organs
Mucous membranes |
|
|
Term
|
Definition
True skin
Skeleton
Bone and Cartilage
Connective Tissue
Muscles
Blood and blood vessels
Kidneys and gonads |
|
|
Term
|
Definition
Lining of trachea, pharynx, and bronchi
Lining of digestive tract
Lining of bladder and urethra |
|
|
Term
|
Definition
Metabolic and nutrient exchange
Maternal portion:
Decidua
Fetal portion:
Chorionic villi
Fetal surface covered by amnion |
|
|
Term
|
Definition
Chorionic villi form spaces in decidua basalis
Spaces fill with maternal blood.
Chorionic villi differentiate:
Syncytium: outer layer
Cytotrophoblast: inner layer
Anchoring villi form septa |
|
|
Term
|
Definition
Nutrition
Excretion
Fetal respiration
Production of fetal nutrients
Production of hormones |
|
|
Term
|
Definition
Organ for fetal respiration, nutrition, and excretion
Only temporary organ
Produces four hormones
Progesterone -decreases myometrial activity
Estrogen-increases myometrial activity
Human chorionic gonadotropin (hCG)-maintains corpus luteum
Human placental lactogen (hPL)-promotes fetal growth; regulates glucose availability for the fetus as an insulin antagonist |
|
|
Term
|
Definition
Body stalk fuses with embryonic portion of the placenta
Provides circulatory pathway from chorionic villi to embryo. Delivers oxygenated blood:
One vein
Delivers deoxygenated blood from fetus:
Two arteries
Develops with the placenta and fetal blood vessels
Two arteries carry blood away from fetus
One vein carries blood to fetus
Normal length is 55 cm
Wharton’s Jelly protects cord
Cord is coiled for protection |
|
|
Term
|
Definition
After the fourth week of gestation, circulation to the fetus is well established.
Fetus does not breathe oxygen
Liver does not process waste products (placenta does)
Fetus has three shunts to promote circulation |
|
|
Term
|
Definition
Foramen ovale
Opening into the left atrium
Mixes with small amount of deozygenated blood returning from the fetal lungs through the pulmonary veins
Ductus venosus
Mixes w/ deoxygentated blood from legs and abdomen on way to right atrium
Ductus arteriosus
Bypasses lungs |
|
|
Term
| Three stages of prenatal development |
|
Definition
Zygote: cell formed by union of sperm and ovum
Embryo: 2nd to 8th week of development
Fetus: 9th week until birth |
|
|
Term
|
Definition
Trachea is developed
Liver produces blood cells
Trunk is straighter
Digits develop
Tail begins to recede |
|
|
Term
| Fetal development week 12 |
|
Definition
Eyelids are closed
Tooth buds appear
Fetal heart tones can be heard
Genitals are well-differentiated
Urine is produced
Spontaneous movement occurs |
|
|
Term
| Fetal development week 16 |
|
Definition
Lanugo begins to develop
Blood vessels are clearly developed
Active movements are present
Fetus makes sucking motions
Swallows amniotic fluid
Produces meconium |
|
|
Term
| Fetal development week 20 |
|
Definition
Subcutaneous brown fat appears
Quickening is felt by mother
Nipples appear over mammary glands
Fetal heartbeat is heard by fetoscope |
|
|
Term
| Fetal development week 24 |
|
Definition
Eyes are structurally complete
Vernix caseosa covers skin
Alveoli are beginning to form |
|
|
Term
| Fetal development week 28 |
|
Definition
Testes begin to descend
Lungs are structurally mature |
|
|
Term
| Fetal development week 32 |
|
Definition
Rhythmic breathing movements
Ability to partially control temperature
Bones are fully developed but soft and flexible |
|
|
Term
| Fetal development week 36 |
|
Definition
Increase in subcutaneous fat
Lanugo begins to disappear |
|
|
Term
| Fetal development week 38 |
|
Definition
Skin appears polished
Lanugo has disappeared except in upper arms and shoulders
Hair is now coarse and approximately 1 inch in length
Fetus is flexed |
|
|
Term
| Factors influencing development |
|
Definition
Quality of sperm or ovum
Genetic code
Adequacy of intrauterine environment
Teratogens |
|
|
Term
|
Definition
25-35 lbs for normal weight
15 -20 lbs for overweight
Up to 40lbs for underweight |
|
|
Term
|
Definition
| Combination of presumptive, probable, and positive changes/signs of pregnancy. This information is obtained through history, physical, pelvic examination, laboratory, and diagnostic studies. |
|
|
Term
|
Definition
Presumptive/Subjective
Amenorrhea
Nausea and vomiting
Urinary frequency
Quickening
Objective (probable signs:
Hegars sign
McDonald’s sign
Braxton Hicks
Skin hyperpigmentation
Uterine souffle
Striae/pigmentation
Linea Nigrea |
|
|
Term
| Positive changes of pregnancy |
|
Definition
Fetal heartbeat
Fetal movement
Visualization of the fetus |
|
|
Term
|
Definition
Pre-pregnancy: pear shaped and small (60g)2 ounces
End of pregnancy: greater than 5 times larger (60g)2.5 lbs
Initial changes are stimulated by increased estrogen and progesterone levelsThe circulatory requirement increases as the fetus grows and the placenta develops
Blood increases
Lymphatic vessels within the uterine layers increase
1/6 of maternal blood volume is contained within the vasculature of the uterus
Shape
›Upside down pear at conception
›Becomes more elastic and global
›Grows out of a pelvic cavity organ into the abdominal cavity
Non pregnant size of a plum
7 weeks size of an egg
10 weeks size of an orange
After the 4thmonth contractions can be felt
Placenta perfusion depends on the maternal blood flow to the uterus, blood flow increases as the uterus enlarges
Braxton Hicks
Placenta
Placenta takes up ½ of the uterus (20 weeks)
Placenta-after 20 weeks becomes thicker (not wider) |
|
|
Term
|
Definition
Nullipara
›Round
Multipara
›Enlongated
Mucous plug
Goodell’s sign
Chadwick’s sign |
|
|
Term
|
Definition
Ovaries cease ovum production during pregnancy.
Early pregnancy the human chorionic gonadotropin (hCG) maintains the corpus luteum
Corpus luteum secretes progesterone until the placenta produces enough progesterone to maintain the pregnancy |
|
|
Term
|
Definition
Pregnancy prepares the vagina to stretch
›Walls thicken
›Connective tissue loosens
›Smooth muscle hypertrophies (due to estrogen)
›Vaginal vault elongates
Changes in vagina are estrogen induced
Increase in vaginal secretions to prevent infections
By the end of pregnancy, the vaginal wall and perineal body have become sufficiently relaxed to permit distention and passage of the infant |
|
|
Term
|
Definition
Estrogen and progesterone induce changes in the mammary glands
Striae
Colosturm |
|
|
Term
|
Definition
Pregnancy may produce hyperventilation
Tidal volume may increase (30% to 40% rise)
Oxygen consumption
Vital capacity and inspiratory reserve volume are unchanged
Expiratory reserve volume falls by 20%
The volume of lung is decreased
Diaphragm is elevated and subcostal angle is decreased
Risk for lung disease may increase due to the increased need for oxygen
Rhinitis of pregnancy
Epistaxis |
|
|
Term
|
Definition
Heart may be pushed upward and to the left
Systolic murmur may be auscultated
Blood volume increases up to 34 weeks
Vena Cava Sydrome
Cardiac output increases
Organs systems receive additional blood flow
Pulse rate may increase during pregnancy
Blood pressure may decrease during
2ndtrimester but increase 3rdtrimester
Pulse may increase
Femoral venous pressure slowly rises
Orthostatic hypotension
›Cardiac output suddenly decreases d/t venous return from the lower body falls
Palpatations
›Increases in thoracic pressure w/ sudden movement
Pseudoanemia
›Fluid part of blood increases more than the erythrocyte component gives a false dilutional anemia |
|
|
Term
| Supine Hypotention/ Vena Cava syndrome |
|
Definition
Weight of the uterus compresses the vena cava, reducing the amount of blood returned to her heart
›Faintness
›Lightheadedness
›Agitation
›Dizziness |
|
|
Term
|
Definition
Nausea and vomiting (first trimester)
Ptyalism
Bleeding gums
Gastric tone and mobility decrease
Pyrosis
Uterus enlarges displacing the stomach and intestines toward the back slowing mobility
Pruritus
Gallstones
Liver function |
|
|
Term
| Mothers response to pregnancy |
|
Definition
Ambivalence
Acceptance
Introversion
Mood swings
Changes in body image |
|
|
Term
|
Definition
Difficult believing pregnancy
›Unwanted pregnancy
›Unplanned pregnancy
›Difficulty getting pregnant
Conflicting feelings
›Ambivalence
Emotional swings |
|
|
Term
|
Definition
Fetus becomes more real
Stable time for the pregnancy
“Tries on” the role of motherhood
Body changes are more evident |
|
|
Term
|
Definition
Body changes are more dramatic
Begins to separate herself from the pregnancy, commits to take care of the baby
Minor discomforts become more tiresome |
|
|
Term
|
Definition
Fathers go through similar phases
Ambivalence is typical
Development stages
›Announcement
›Adjustment
›Focus |
|
|
Term
| Father's response to pregnancy |
|
Definition
Confused by partner’s mood changes
Feels left out of pregnancy
Resents attention given to the woman
Resents changes in their relationship
Needs to resolve conflicts about fathering
Couvade
Siblings:
›Rivalry
›Fear of changing parent relationships
Grandparents:
›Closer relationship with expectant couple
›Increasing support of couple |
|
|
Term
|
Definition
Identify beliefs, values, and behaviors:
›Ethnic background
›Patterns of decision making
›Religious preferences, language, communication style
›Common etiquette practices
›Expectations of healthcare system |
|
|
Term
|
Definition
Ensure a safe birth for mother and baby by promoting good health habits and reducing risk factors
Teach health habits that may be continued after pregnancy
Educate in self-care for pregnancy
Provide physical care
Prepare patients for the responsibilities of parenthood |
|
|
Term
|
Definition
Assessment of current and past pregnancies
Gynecologic history
Current and past medical history
Family medical history
Religious, cultural, and occupational history
Partner history |
|
|
Term
|
Definition
Ideally healthcare begins before conception.
Genetic counseling if necessary
Nutritional status
Folic acid
Immunizations
Prenatal visits should begin as soon as a woman suspects she is pregnant |
|
|
Term
|
Definition
History and Physical Assessment
Lab/Diagnostic Studies
Comprehensive health and risk assessment
Current pregnancy history
Complete physical and pelvic exam
Determine EDD
Nutrition assessment including 24 hr diet recall
Psychosocial assessment
Assessment for Intimate Partner Violence
See page 345-351 in your book
•Blood Type and Rh Factor
•Antibody Screen
•CBC
•HIV Screen
•Hepatitis B surface antigen
•RPR, VDRL (syphilis serology)
•Genetic screening based on family history, racial/ethnic background
•Rubella Titer
•PPD
•Urinalysis
•Urine culture and sensitivity
•Pap Smear
•Gonorrhea and Chlamydia cultures
•Ultrasound-depending on gestation |
|
|
Term
|
Definition
History of emotional or physical abuse
History of emotional problems:
Depression and anxiety in general
Postpartum depression
Support systems
Overuse or underuse of healthcare system
Acceptance of pregnancy, intended or unintended
Personal preferences about the birth
Plans for care of child following birth
Feeding preference for the baby |
|
|
Term
| Factors related to fathers health |
|
Definition
Family history of genetic conditions
Age
Significant health problems
Previous or present alcohol intake
Drug and tobacco use
Blood type and Rh factor
Occupation
Educational level
Methods by which he learns best
Attitude toward the pregnancy |
|
|
Term
| Danger signs of pregnancy |
|
Definition
Gush of fluid from vagina
Vaginal bleeding
Abdominal pain
Fever and chills
Dizziness, blurred vision, spots before eyes
Persistent vomiting
Pretibial Edema
Muscular irritability or convulsions
Epigastric pain (RUQ pain)
Headaches unrelieved by Tylenol
Oliguria
Dysuria
Decrease or absence of fetal movement |
|
|
Term
|
Definition
Ultrasound
Doppler ultrasound flow assessment
Alpha-fetoprotein screening
Chorionic Villus sampling
Amniocentesis
Percutaneous Umbilical blood sampling
Non stress test
Contraction stress test
Biophysical profile
Fetal movement assessment
Triple Screen-Quad Test |
|
|
Term
| Assessment of Fetal Well Being |
|
Definition
Ultrasound
Sonograms
Three dimensional ultrasound
Limited ultrasound
Standard ultrasound
Transabominal ultrasound
Transvaginal ultrasound |
|
|
Term
|
Definition
| a cone shaped indentation in the cervical osindicating cervical incompetence or risk of preterm labor |
|
|
Term
|
Definition
Estimation of gestational age
Evaluation of cervical insufficiency
Evaluation of fetal growth
Evaluation of vaginal bleeding
Fetal presentation
Suspected multiple gestation
Hydatidiform mole
Fetal death
Placenta previa
Chromosomal anomalies
Fetal anomolies
Uterine size and clinical dates
Premature rupture of membranes
Ectopic pregnancy |
|
|
Term
| Doppler Ultrasound Blood Flow Assessment |
|
Definition
Description-ultrasound measures rate and volume of blood flow and pressure through placenta and umbilical cord vessels
Purpose-to determine abnormality in the fetal cardiovascular system
Procedure-”Doptone” fetal pulse detector to assess blood flow and flow velocity waveforms available for analysis
Advantages-non invasive
Disadvantages-none |
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Term
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Definition
Urine test does not determine viability
Bleeding (1 in 4 woman will have bleeding during pregnancy)
Bleeding may indicate an unviable pregnancy |
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Term
| NuchalTranslucency Testing |
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Definition
A combination of an ultra sound and a maternal serum test that is used to screen fetuses between 11 weeks and 1 day and 13 weeks and 6 days to determine if a fetus is at risk for a chromosomal disorder such as Down syndrome (trisomy 21), trisomy 13, and trisomy 18
Risks-no maternal or fetal risks |
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Term
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Definition
Performed between 8 to 10 weeks gestation
Involves aspirating the chorionic villi from the placenta for prenatal diagnosis of genetic disorders
Procedure-placental tissue sample obtained transabdominally or transcervically and grown out for karyotype
Advantages-quicker results (7-10 days after procedure); can be performed earlier than amniocentesis
Disadvantages and risks-7% fetal loss rate due to bleeding, infection, and ROM; fetal limb abnormalities; tests for metabolic disorders such as Cystic Fibrosis but does not test for NTD’s |
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Term
| Multiple Marker Screening |
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Definition
Triple marker screening combines 3 chemical markers: AFP, hCG, and estriollevels with maternal age to detect some trisomiesand NTD’s
Quad screen adds inhibinA to increase detection of Trisomy 21 to 80%
Description-screening for fetal protein components; multiple pregnancy
Purpose-detect open neural tube defects-spinabifida, anencephaly: Down Syndrome, Rh disease,
Procedure-sample of maternal blood
Advantages-can detect possibility of open neural tube defects, one marker for Down Syndrome, Trisomy 18 etc.
Limitations-gestational age must be exact; can be falsely elevated for variety of reasons; screening test to be used with other tests such as US
Interpretation-
↓MSAFP and ↓unconjugatedestriollevel suggests abnormality
hCGand inhibin-A levels are twice as high in Trisomy 21
↓estriollevels indicate NTD’s |
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Term
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Definition
Maternal
Prenatal conditions
Hypertensive disorder
Type 1 diabetes mellitus
Chronic renal disease
Preeclampsia
Decreased fetal movement
IUGR
Previous fetal demise
Known fetal anomaly |
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Term
| AntepartumFetal Surveillance |
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Definition
Goals-identify risk factors for fetus in third trimester
Methods-fetal movement assessment; non stress test; contraction stress test; biophysical profile |
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Term
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Definition
Description-assessment of FHR accelerations, fetal breathing, fetal movements, fetal tone, amniotic fluid volume
Purpose-useful evaluation of decreased fetal movement, suspected IUGR, preterm labor, gestational diabetes, post term pregnancy, premature rupture of membranes
Procedure-ultrasound NST and amniotic fluid index
Interpretation-normal score for each indices is 2; abnormal score is 0; score 8/10 or 10/10 indicates healthy nonasphyxiated fetus if fluid is adequate; 6/10 indicates possible fetal asphyxia
Advantages-non invasive
Disadvantages-labor intensive and expensive, requires trained examiner with excellent interpretive skills |
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Term
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Definition
Description-electronic fetal monitor tracing to observe acceleration of the FHR in relation to fetal movement
Procedure-FHR monitored electronically with accompanied tocodynamometer assessment of fetal movement; monitored for 20 minutes or longer
Interpretation-
Reactive if 2 or more accelerations 15bpmx15seconds in 20 minutes
Non reactive –lacks insufficient FHR accelerations over 40 minute period
Advantages-non invasive; can be repeated serially; reliable indicator of fetal well-being |
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Term
| Maternal Assessment of Fetal Movement |
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Definition
Description-assessment of indirect fetal central nervous system integrity and function
Procedure-pregnant woman counts daily fetal movements for specified period of time ( 30 in one hour is norm)
Advantages-non invasive, cost effective
Disadvantages-requires good education for mother; increased anxiety; substances such as caffeine, tobacco smoke, drugs, alcohol interfere with fetal movements |
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Term
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Definition
Purpose-evaluate the respiratory function of the placenta and identify fetus at risk for intrauterine asphyxia by observing the response of the FHR to the stress of uterine contractions
Procedure-stimulation by oxytocin of at least 3 uterine contractions of 40 seconds duration in 10 minutes. FHR monitor is attached as well as uterine contraction monitor (toco). Baseline assessment performed before addition of IV oxytocin or nipple stimulation
Interpretation-absence of late or significant variable decelerations is considered reassuring sign and test is NEGATIVE
the presence of late decelerations following 50% or more uterine contractions, even if fewer than 3 in 10 minutes is a sign of utero/placental insufficiency and is termed POSITIVE and indicates fetus is not obtaining sufficient oxygen
Equivocal or suspicious test –intermittent late decelerations or significant variable decelerations merit follow up testing
Equivocal-hyperstimulatory-decelerations occurring in the presence of UC that occur more frequently than 2 minutes or lasting longer than 90 seconds. Repeat test
Testing done in hospital setting; if POSITIVE CST and nonreactive NST, fetus should be sectioned if greater than 32 weeks |
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Term
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Definition
Pregnant women who are 35 years old or greater
Couples who have had a child with a birth defect
Pregnant women with other abnormal test results
Description-fluid component analysis for fetal cells, fetal lung maturity
Purpose-chromosome analysis and AFP follow up; assessment of fetal lung surfactant components (lecithin and spingomyelin)
Procedure-sample of amniotic fluid withdrawn through needle inserted to uterus through the abdominal wall. US done prior to locate fetus and placenta
Advantages-can grow out fetal cells for analysis; can determine fetal lung maturity
Disadvantages-need enough fluid to obtain sample size; done after 14 weeks; 14-20 weeks for fetal diagnosis
Risks-loss of pregnancy 0.5%; Rh sensitization; infection |
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