Term
| What are the 4 factors that effect the initiation of respirations in the neonate? (briefly describe each one) |
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Definition
Mechanical--when the pressure on the neonates chest is released upon birth, recoil draws in air, reducing the amount of negative pressure needed (by baby's muscles) for the first breath.
Chemical--decreased pO2, decreased pH, increased pCO2, affects chemoreceptors in the medulla, diaphragm is stimulated.
Thermal--cold air and touch stimulate skin sensors
Sensory--tactile stimuli and the sounds and lights in delivery may aid in initiating respirations. |
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Term
| 5 major changes to cardiopulmonary adaptation? |
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Definition
1. Increase in blood O2
2. Shifts of pressure in the heart.
3. Clamping of the umbilical cord.
4. Shifts in pressure in pulmonary circulation. (R sided pressure drops.)
5. Shift in pressure in systemic circulation. (Increases) |
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Term
| Neonatal RBC survival time? |
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Definition
| less than an adult, 100 days. |
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Term
| What factors effect neonatal blood volume? |
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Definition
| If the cord isn't clamped immediately, as much as 75 mL of blood goes to the infant. |
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Term
| 4 reasons thermoregulation is difficult for the infant? |
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Definition
1. Evaporation (drying of the skin).
2. Conduction (movement of heat directly from infants skin to an object)
3. Convection (radiation of heat into the air)
4. Radiation (heat transfer to objects not in direct contact with infant) |
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Term
| 2 methods of neonatal thermogenesis |
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Definition
Shivering
Non shivering thermogenesis (oxidation of brown fat) |
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Term
| 3 functions of neonatal liver? |
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Definition
1. maintenance of glucose levels
2. Conjugation of bilirubin
3. Production of coagulation factors, storage of iron, and metabolism of drugs. |
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Term
| 6 factors of physiologic jaundice? |
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Definition
1. excess production of bilirubin
2. rbc's break down faster than adults
3. liver immaturity
4. intestinal factors (establishment of intestinal flora are necessary for conjugated bilirubin to be excreted)
5. delayed feeding (passage of meconium delayed)
6. trauma (increased rbc breakdown)
also: fatty acids |
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Term
| What does it mean to conjugate bilirubin? How does this happen? Why is it important to conjugate bilirubin? |
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Definition
| a. Bilirubin is the product of hemolysized rbc’s. It is increased in unconjugated form (indirect bilirubin) and is not soluble in water. Before excretion, the liver must change it to soluble form by conjugation. Because unconjugated bilirubin is fat soluble, it may be absorbed by subq fat causing jaundice. If enough accumulates in the blood, it can cause kernicterus which is bilirubin encephalopathy, damaging the brain. |
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Term
| What is the priority nursing intervention regarding GI assessment? |
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Definition
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Term
| What is the normal range for vital signs in the newborn? How are each assessed? |
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Definition
Pulse-(which pulses should you include?) HR 120-160 (100 sleeping, 180 crying) brachial, femoral and pedal pulses all present and equal.
Respirations- 30-60 per minute
Temperature- 36.5 to 37.5 ^C (97.7-99.5) axillary
Blood pressure- varies w/size and gestational age |
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Term
| Describe the process of maturation of an ovum including the signs and symptoms of ovulation. What happens to the corpus luteum if pregnancy occurs? What happens to the corpus luteum if pregnancy does not occur? |
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Definition
• Body temp increases .3-.6 ^C. (look for the check mark)
• Mittleschmerz occurs (pain before ovulation, blood in peritoneal cavity
• Cervical mucus changes
o Increases in amount
o Becomes thin, watery, clear (egg whites)
o Ferning (look @ mucus on a slide)
o Stretchable
o Spin market (?)
• Formation of the Corpus Luteum
o The follicle collapses and in about 4 days, cells multiply within the follicle and form a solid mass called the corpus luteum. If fertilization does not occur, it degenerates and becomes the corpus albicans under the influence of the lutenizing hormone. |
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Term
| What is the purpose of the 4 main hormones in the menstrual cycle? |
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Definition
a. FSH (follicle stimulating hormone) stimulates the ovaries to mature an ovum
b. LH (lutenizing hormone) assists in the growth of the fraafian follicle and the surge prior to ovulation, assists in the release of the ovum.
c. Estrogen is responsible for the proliferation of the endometrium
d. Progesterone (pro-gestation) the Corpus Luteum produces progesterone which supplements action of estrogen in proliferation of the endometrium. Causes the thich endometrium to secrete substances that nourish a fertilized ovum. |
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Term
| How long are ovum and sperm viable? |
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Definition
ovum: 12-24 hours
sperm: about 24 hours |
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Term
| What is capacitation (as it relates to normal fertilization)? |
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Definition
| Capacitation: while traveling toward the distal end of the fallopian tube, the sperm undergo capacitation, where a glycoprotein and seminal proteins are removed from the head of the sperm, making them more active. |
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Term
| What is an acrosomal reaction? |
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Definition
| During fertilization, the acrosome reaction is the reaction which occurs in the acrosome of the sperm as it approaches the egg. The acrosome is a cap-like structure over the anterior half of the sperm's head. As the sperm approaches the zona pellucida of the egg, the membrane surrounding the acrosome fuses with the plasma membrane of the sperm, exposing the contents of the acrosome and rendering the sperm capable of fusing with the egg. |
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Term
| Why are BILLIONS AND BILLIONS AND OMG BILLIONS of sperm needed for fertilization? |
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Definition
| The zona pellucida is a glycoprotein membrane surrounding the plasma membrane of an oocyte. Millions of sperm dissolve this layer by the acrosomal reaction, allowing only 1 to fertilize it. |
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Term
| Following conception, the fertilized ovum travels in the fallopian tube toward the uterus – what occurs related to cellular multiplication and division during this travel. How does the fertilized ovum get from the distal end of the fallopian to the uterus? |
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Definition
| It gets there by fallopian peristalsis. During this travel, the zygote undergoes mitosis until it reaches the 16 cell stage. When it forms a solid mass resembling a mulberry it is known as a morula. (Mulberries look like raspberries or blackberries.) |
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Term
| Explain the process of implantation. |
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Definition
| The trophoblast (outer layer of cells of the morula) extends small finger like projections that literally eat a hole into the endometrium by enzymatic action. The endometrium is now called the decidua. This implantation enables the blastocyst (inner layer of cells of the morula) to absorb nutrients from the glands and blood vessels of the decidua. |
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Term
| What are the three types of decidua? Which one is the most important to the process of pregnancy? |
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Definition
• Decidua basalis that portion directly underneath the site of implantation (the most important one because along with the chorionic villi, it forms the placenta)
• Decidua capsularisis the portion that is pushed out by the growing blastocyst and covers the blastocyst
• Decidua vera is the remaining portion of the decudua that lines the uterus. |
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Term
| During cell division, what do the blastocyst and trophoblast develop from? What embryonic and fetal structures do each of these develop into? |
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Definition
• Blastocyst: is the inner layer of solid cells of the morula. It develops into the fetus and inner embryonic membrane called the amnion
• Trophoblast: is formed from the outer layer of solid cells of the morula. It develops into the placenta and embryonic membrane called the chorion |
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Term
| What are the three germ layers and structures that arise from each layer? |
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Definition
• Ectoderm: nervous, skin, hair, nails, sense organs
• Mesoderm: muscle, connective tissue, blood vessels, bone marrow
• Endoderm: digestive, GU, respiratory tract epithelium, trachea, lungs. |
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Term
| What is wharton’s jelly and the purpose. |
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Definition
| Wharton's jelly is a gelatinous substance within the umbilical cord, composed of cells that originate in the original egg and sperm of conception. As a mucous tissue it protects and insulates umbilical blood vessels. Wharton's jelly, when exposed to temperature changes, collapses structures within the umbilical cord and thus will provide a physiological clamping of the cord, an average of 5 minutes after birth. In some cases, such as in water birth with the cord immersed, the Wharton's jelly reaction will occur much later. |
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Term
| What are the 5 main functions of the placenta? |
|
Definition
• Fetal respiration and removal of wastes-gas exchange between fetal and maternal blood system
• Exchange of nutrients and electrolytes
• Production of hormones that are vital to survival
• Barrier to prevent certain substances from entering fetal circulation (big things don’t cross, little things do)
• Transmission of maternal antibodies. |
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Term
| What are the major functions of amniotic fluid? |
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Definition
• Maintains the fetus at an even, stable temperature.
• Cushions the fetus against possible injury
• Provides a space in which the fetus can move
• Prevents the fetus from adhering to surrounding tissues. |
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Term
| What occurs in stage 1 of fetal development? |
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Definition
| Stage 1, 1-3 weeks, Zygote or Ovum stage: implantation occurs. |
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Term
| What occurs in Stage 2 of fetal development? |
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Definition
| Stage 2, 4-8 weeks, Embryonic stage: this is the period of organogenesis. (This stage of growth and development holds the potential for major congenital malformations if exposed to teratogens |
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Term
| What occurs in stage 3 of fetal development? |
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Definition
| Stage 3, 9-40 weeks, Fetal stage: Lots of mitosis, but mostly the cells have already specialized. |
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Term
| What diagnostic tools does the nurse use to confirm pregnancy? These tests measure Human Chorionic Gonadotropin (hCG) , a hormone specific to gestation. |
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Definition
a. Urine hema-agglutination inhibition tests (home pregnancy tests)
b. Radioimmune assay tests
c. Enzyme immunoassays |
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Term
|
Definition
| a number denoting any pregnancy, regardless of duration, including current pregnancy. |
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Term
|
Definition
| A birth after 20 weeks gestation, regardless of whether the infant was born alive. |
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Term
|
Definition
• TPAL: more detailed than paragravida. Gravida keeps it’s meaning but para changes because this system is more detailed, and counts each infant born rather than the # of pregnancies
o Triplets count as one pregnancy, but 3 births (g1p3)
o T is the # of Term infants born after 37 weeks or more
o P is the # of Preterm infants born after 20 weeks but before 37 weeks
o A is the # of pregnancies ending in either spontaneous or therapeutic abortion.
o L is the # of currently living children |
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Term
|
Definition
| 1st day of last menstrual cycle, minus 3 months, add 7 days (estimated date of conception) |
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Term
|
Definition
Measure from symphesis pubis to the top of fundus..
Measure in cm and multiply by 2/7 for months.
Measure in cm and mulitiply by 8/7 for weeks of gestation. |
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Term
| Presumptive signs of pregnancy? |
|
Definition
o Amenorrhea
o N/V
o Breast changes
o Frequent urination
o Quickening—the mother’s perception of fetal movement, occurs 18-20 weeks after last menstrual in 1st time pregnancy, 16 weeks if not first pregnancy.
o Increased pigmentation in skin
o Chadwick’s sign: bluish, purple, or deep red discoloration of the mucous membranes of the cervix, vagina, and vulva (this is under probably signs in book, but presumptive signs in the notes)
o Vaginal changes
o Fatigue |
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Term
|
Definition
o Enlargement of the abdomen
o Hegar’s sign: softening of the isthmus of the uterus, the area between the cervix and the body of the uterus
o Goodell’s sign: softening of the uterus
o Braxton-Hicks contractions—irregular, generally painless contractions of the uterus, intermittent throughout pregnancy
o Ballotment—passive fetal movement elicitied when the examiner inserts two gloved fingers into the vagina and pushes against the uterus
o Positive pregnancy test (not + sign because other conditions can cause elevated hCG levels) |
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Term
|
Definition
o Fetal heartbeat (10-12 weeks)
o Active fetal movement felt by trained person
o US showing fetal outline at 4-5 weeks. |
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Term
| Upon confirmation of the pregnancy, what teaching should the nurse include regarding "danger signals" and when to notify the physician? What might each of them implicate? |
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Definition
a. Vaginal bleeding-abruption placentae, placenta previa; lesions of cervix or vagina, bloody show.
b. Fluid from the vagina-premature rupture of membranes (prom)
c. Abdominal pain-premature labor, abruption placentae
d. Elevated temperature-greater than 101, infection
e. Dizziness, double vision-HTN, preelcampsia
f. Persistent vomiting-hyperemesis gravidarum
g. Edema-preeclampsia
h. Headache-preeclampsia, HTN
i. Dysuria-uti
j. Absence of fetal movement (quickening-when should this first appear?)-maternal medication (18-20 weeks for 1st time, 16 weeks for other than first time) |
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Term
| What is the suggested weight gain for a pregnant woman? |
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Definition
1st Trimester: 3.5-5 lbs
2nd/3rd Trimesters: 1 lb/week |
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Term
| What special instructions regarding calorie and protein intake should the nurse include in teaching the pregnant woman? |
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Definition
Increase protein to 60g/day (14g>than when not pregnant)
Calories, no increase 1st trimester, +300kcal/day in second/third trimesters. |
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Term
| How to determine position? |
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Definition
Step 1, determine presenting part (the landmark on the fetus is the posterior fontanel).
Vertex=Occiput
Face=Mentum
Breech=Sacrum
step 2, divide mom's pelvis into 4 quadrants, where is the landmark pointing? |
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Term
|
Definition
| Lie is the relationship of the midline axis of the fetus to the midline axis of the mother. Longitudinal (optimum) or transverse. |
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Term
|
Definition
| Attitude is the relationship of the fetal body parts to each other. Ovoid is the optimal attitude. |
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Term
| What is fetal presentation? |
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Definition
| Cephalic, breech, vertex, military, brow, face. Cephalic/vertex presentation is optimal (head first, neck flexed to chest) |
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Term
|
Definition
| D: the largest diameter of the presenting part has passed through the pelvic inlet. |
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Term
| What is true labor defined as? |
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Definition
| Regular, increase in intensity with walking, increase in frequency and duration. Discomfort radiates girdle like from back to front of abdomen. The cervix progressively dilates and effaces, with pinkish vaginal discharge. |
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Term
|
Definition
| Irregular contractions, no changes in intensity. Discomfort is in the abdomen or groin, and is relieved with walking. there is no change to the cervix, and there is no discharge. |
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Term
| 26. What portions of the woman's health history represent priority information for the Labor & Delivery nurse? |
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Definition
| Some are, abnormal presentation, multiple gestation, hydramnios, olighydramnios, meconium staining of amniotic fluid, premature ROM, induction of labor, abruptio placentae/placenta previa, failure to progress in labor, precipitous labor (<3 hours), prolapse of umbilical cord, fetal heart aberrations, uterine rupture, postdates (>42 weeks), diaetes, preeclampsia, eclampsia, and AIDS/STI. |
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Term
| Explain the parts of a contraction and the relationship including: |
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Definition
a. Frequency beginning to beginning of a contraction
b. Duration beginning to end of one contraction
c. Intensity depth of contraction (on a sine wave, the height of the wave) |
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Term
| What are the stages of labor? |
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Definition
Stage I, d&e, 0-10cm
Stage II, birth of baby
Stage III, birth of placenta
Stage IV, post partum, recovery, 1-2 hours. |
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Term
| What are the Cardinal Movements of Labor? |
|
Definition
DFIERER
a. Descent: the head enters the inlet
b. Flexion: as the fetal head descends and meets resistance from the soft tissues of the pelvis, the muscles of the pelvic floor, and the cervix. As a result of the resistance, the fetal chin flexes downward onto the chest.
c. Internal rotation the fetal head must rotate to fit the diameter of the pelvic cavity, which results from the fetal head meeting resistance from pelvic muscles.
d. Extension: the resistance of the pelvic floor and the mechanical movement of the vulva opening anteriorly and forward, assist with the extension of the fetal head as it passes under the symphysis pubis. With this positional change, the baby’s brow and face emerge.
e. Restitution: the turning of the baby’s head as the shoulders enter the pelvic inlet, as the head is born, free of that tension, the head turns.
f. External rotation: as the shoulders rotate to the anteroposterior position in the pelvis, the head turns farther to one side.
g. Restitution/Expulsion: anterior shoulder born first, followed by posterior shoulder. The body follows quickly. |
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Term
| What are the signs and symptoms of the woman entering the second stage of labor? |
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Definition
a. Increase in body show
b. Pressure on rectum,
c. Bulging of perineum |
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Term
What is baseline FHT?
What is fetal tachycardia?
What is feal bradycardia? |
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Definition
a. Baseline FHT is the FHR when not in a contraction, and when not in brady or tachycardia. Baseline is the trend of the normal FHR. It is the average of 10 minutes of observation.
Tachy is >160 bpm for 10m or more, marked Tachy is >180.
Brady is <120bpm for 10m or more, <100 is marked brady |
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Term
|
Definition
| a. Variability is the normal irregularity of cardiac rhythm. Good variability on the printed FHR recording is demonstrated by fluctuations of the FHR baseline that cause the printed line to have a rough rather than smooth appearance. Decreased variability is an early warning sign of fetal distress. Decreased variability is exhibited by a smoothing of the line. |
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Term
| Explain a FHT acceleration |
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Definition
| a. A form of periodic change in the FHR, the hr accelerates above the normal baseline. An acceleration of 15bpm for 15s is a healthy sign of fetal alertness and well being. Fetal movement can be observed on the uterine activity panel at the bottom of the strip and can be said to ‘agree’ with the fhr on the to part of the strip. |
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Term
| What are early decelerations? |
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Definition
| i. occur only during contractions. They mirror the contraction. In a deceleration, the fhr drops at the start of the contraction, and returns to normal at the end of the contraction. No intervention is necessary. |
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Term
| What are late decelerations? |
|
Definition
periodic decelerations that begin late in the contraction and recover and return to baseline after the contraction is over. This is a sign of uteroplacental insufficiency. Interventions:
1. reposition, avoiding the supine position
2. 02 via mask at 10-12 lpm
3. Turn off the pitocin
4. Give Terbutaline (tocolytic) sub-q (3&4 are to slow labor)
5. Increase the rate of the main iv
6. Call the md. |
|
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Term
| what are variable decelerations? |
|
Definition
Variable deceleration are periodic decelerations that occur anytime during a uterine contraction. They are related to umbilical cord compression. Variable decelerations indicate fetal distress when there is prolonged or deep decelerations of 80-60 bpm. Interventions:
1. Position changes
2. Amnioinfusion |
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Term
| What is the term used to describe FHT patterns that include decelerations and/or decreased variability? |
|
Definition
|
|
Term
|
Definition
| From delivery to six weeks after. The finalization of childbirth and delivery. |
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Term
|
Definition
| Involution is the process by which the reproductive organs return to their normal, pre-pregnant size and function. |
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Term
|
Definition
| 12-24 hours after delivery. passivity, dependent, talkative, mother’s needs are her own, rest and food. Nurse’s role is to listen, help clarify misconceptions, and help the mother find meaningfulness in the experience. |
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Term
|
Definition
| 'taking in’ up to 2 weeks after delivery. Mother is ready to deal with the present. More ‘in control’. Best time for teaching. |
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Term
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Definition
| 2 weeks post partum. Mother may grieve separation. Common time for post partum blues. |
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Term
| What is the process of progression for infertility treatment? |
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Definition
| The earliest and least invasive infertility testing is done first. |
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Term
| What lab tests would the nurse expect to draw on a woman experiencing infertility? |
|
Definition
• Estrogen levels- measures estriol at midcycle
• Gonadotropin levels (FSH, LH)
o FSH- single most valuable test of ovarian reserve and function
o LH- measured early in cycle to rule out androgen excess disorders; daily sampling at midcycle can detect the LH surge; day of LH surge is day of max fertility
• Progesterone assays
o Furnish the best evidence of ovulation and corpus luteum functioning hormonal assessment may also be conducted for prolactin, thyroid-stimulating hormone, and androgen levels |
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Term
| What information does the nurse include when teaching the client about the administration and side effects of Clomid (clominphine citrate)? |
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Definition
• Induces ovulation in 80% women; 40% will get pregnant; 8% can have multiples (usu twins)
• Assess presence of ovulation by doing BBT and urinary LH tests
• Side effects include
o visual disturbances (flashes, blurring, spots)- avoid bright lighting; will disappear within a few days or weeks after discontinuing therapy
o hot flashes due to antiestrogenic properties of clomid- increase intake of fluids, use fans
o decrease in cervical mucus
o abdominal bloating
o breast tenderness
o N/V
o Ovarian enlargement
• Take the drug for 5 days starting day 5-9 of menstrual cycle
• Have intercourse every other day for 1 week beginning 5 days after last day of meds |
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|
Term
| How does a pt administer Pergonal? |
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Definition
| self administered IM injection. |
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Term
| Female norms (infertility) |
|
Definition
• Favorable cervical mucus
• Clear passage b/t cervix and tubes
• Patent tubes w/ normal motility
• Ovulation and release of ova
• No obstruction b/t ovary and uterus
• Endometrium prepares for implantation |
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Term
|
Definition
• Normal semen analysis
• Unobstructed genital tract
• Normal genital tract secretions
• Ejaculate deposited at cervix |
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Term
|
Definition
| Intra Cytoplasmic sperm injection (ICSI): a microscopic procedure to inject a single sperm into the outer layer of an ovum so that fertilization will occur. |
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Term
| Why is gamete intrafallopian transfer (GIFT) more successful than IVF? |
|
Definition
• Oocytes placed in catheter w/ washed, motile sperm and placed into the fimbriated end of the fallopian tube
• Fertilization occurs in the fallopian tube as w/ normal conception rather than the lab |
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|
Term
| How does the woman calculate her fertile days using the Rhythm or Calendar Method? |
|
Definition
• Ovulation is usually 14 days (+/- 2 days) before start of next menstrual cycle. Sperm are viable for 48-72 hours. Ovum are viable for 24 hours.
• Fertile phase calculated from 18 days before end of shortest recorded cycle through 11 days from end of longest recorded cycle. (e.g. cycle of 24-28 days produces fertile phase of days 6-17.
• Least reliable due to factors that alter time of ovulation |
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|
Term
| What is spinnbarkheit and how does it predict ovulation? |
|
Definition
• Amount and character of cervical mucous
• Mucous is thinner and clearer and more stretchable during ovulation (a quality called spinnbarkheit) shows fern pattern under microscope
• Abastain from intercourse from first time notices clearer mucous until 4 days after last wet mucous day |
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Term
| What specific history findings indicate contraindications to oral contraception? |
|
Definition
• Pregnancy, breast feeding
• Hx of DVT, CAD
• Acute or chronic liver disease of cholestatic type with abnormal function
• Presence of estrogen dependent carcinomas
• Undiagnosed uterine bleeding
• Heavy smoking
• Gallbladder disease
• HTN
• Diabetes
• Hyperlipidemia
• Sickle cell anemia
• Monitor frequency of migraines, epilepsy, depression, oligomenorrhea, amorrhea |
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|
Term
| What signals a man is sterile, post vasectomy? |
|
Definition
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