Shared Flashcard Set

Details

Labor & Delivery/Genetics
Exam 2
300
Nursing
09/26/2012

Additional Nursing Flashcards

 


 

Cards

Term
What are the the 5 Ps of labor?
Definition

Passenger - Fetus and placenta

 

Passageway - Birth Canal

 

Powers - Contractions

 

Position - Maternal Position

 

Psychological

Term
Lightening
Definition
The fetal presenting part and uterus move downward in the maternal pelvis
Term
Anterior Fontanel
Definition

Larger

 

Diamond Shaped

 

3 cm x 2 cm

 

Closes by 18 months after birth

Term
Posterior Fontanel
Definition

Smaller

 

Triangular

 

1 cm x 2 cm

 

Closes by 6-8 weeks after birth

Term

When does fundal heigh drop?

 

Lightening

Definition
Fundal Height drops around 38 and 40 weeks
Term
Presenting Part
Definition
Part of the fetal body first felt by the examiner during a vaginal examination
Term
Presenting part - Occiput
Definition

Cephalic

 

Head first

Term
Presenting part - Sacrum
Definition

Breech

 

Buttocks or feet first

Term
Presenting part - Scapula
Definition

Shoulder

 

Shoulder first

Term
Vertex Presentation
Definition

Vertex

 

When the presenting part is the occiput

 

Most wanted

Term
Fetal Lie
Definition
Relation of the long axis (spine) of the fetus to the long axis (spine) of the mother
Term
Fetal Lie - Longitudinal
Definition
Cephalic or breech
Term
Fetal Lie- Vertical
Definition

Transverse

 

unable to deliver vaginally

Term
Fetal Lie - Oblique
Definition
Uncommon, typically converts to a longitudinal or transverse lie during labor
Term
Fetal Attitude
Definition
Relationship of the fetal body parts to each other
Term
General Flexion (want this)
Definition

Back of the fetus is rounded so the chin is flexed on the chest, the thighs are flexed on the abdomen, and the legs are flexed at the knees, arms are crossed over the thorax and the umbilical cord lies between the arms and legs

 

Deviations from normal flexion may cause difficulty in childbirth

Term
Biparietal diameter
Definition

Largest transverse diameter - indicator of fetal head size

 

In well-flexed cephalic presentation, the biparietal diameter will be the widest part of the head entering the pelvic inlet

Term
Fetal Position
Definition

Relationship of the presenting part to the four quadrants of the mother's pelvis

 

Term

Fetal Position

 

1st letter- location of the presenting part to the maternal pelvis

Definition

R - Right

 

L - Light

Term

Fetal Position

 

2nd letter - presenting part of the fetus

Definition

O - Occiput

 

S - Sacrum

 

M - Mentum (chin)

 

Sc - Scapula (shoulder)

Term

Fetal Position

 

3rd letter - location of the presenting part in relation to the maternal pelvis

Definition

A - Anterior (face toward spine)

 

P - Posterior (face toward pubic)

 

T - Transverse

Term
ROA
Definition
Occiput is the presenting part, located in the right quadrant of the maternal pelvis
Term
Fetal Station
Definition
Relationship of the presenting part of the fetus to an imaginary line drawn between the maternal ischial spines
Term
How do you determine fetal station?
Definition

Measure the degree of descent of the presenting part of the fetus through the birth canal

 

Measured in centimeters

If 1 cm above the ischial spines minus 1 (-1)

Level of the ischial spines zero (0)

If 1 cm below the ischial spines plus 1 (+1)

Birth is imminent when station is +4/+5

Term
Engagement
Definition
Indicates that the largest transverse diameter of the presenting part has passed through the maternal pelvis inlet into the true pelvis and usually corresponds with 0 station
Term
Passageway Pelvic types
Definition

Gynecoid - classic femal type

(most common easiest for baby to get out)

Android - resembles the male pelvis

Anthropoid - resembling the pelvis of anthropoid apes

Platypelliod - flat pelvis

Term
Primary Powers
Definition
Involuntary uterine contractions
Term
Secondary powers
Definition
Bearing down and pusing of the woman with a fully dilated cervix
Term
Doula
Definition

A woman who has received training and whose sole objective is to provide supportive care to women in labor

(massage, breathing, talk, hand on comfort tech)

Term
Contractions move downward over the uterus in waves
Definition
Term
Frequency
Definition
Time from the beginning of one contraction to the beginning of the next
Term
Duration
Definition
Length of contraction from the beginning to the end
Term
Definition
Term
Intensity
Definition
Strength of the contraction
Term

Intensity Maternal Perception

 

Mild

Definition

Feels like touching end of nose

 

Uterus is easy to indent at peak of contraction

Term

Intensity Maternal Perception

 

Moderate

Definition

Feels like touch to the chin

 

Uterus is firm at peak of contraction

Term

Intensity

 

Maternal perception

 

Strong

Definition

Feels like a touch to the forehead

 

Uterus is hard at peak of contraction - it cannot be dented

Term
Intrauterine Pressure Catheter (IUPC)
Definition

Membranes must be ruptured to use

 

 

Term
Adequate uterine pressure
Definition
50-75 mmHg
Term
Resting tone of uterus
Definition

Soft uterus, using palpation

 

<10 mmHg using IUPC

Term
Relaxation Period
Definition
Should be at least 30 seconds for re-establishment of maternal blood flow to intervillous spaces thereby restoring oxygen to fetus
Term
Placenta
Definition

If intrauterine pressure is greater than 50-70 mmHg, the maternal blood flow to the placenta (intervillous spaces) is stopped

 

If IUPC is 30 mmHg, the maternal blood flow from the placenta (intervillous spaces) is stopped

Term
Effective Contraction Pattern
Definition

Interval - every 2 minutes

 

Duration - 90 seconds or less

 

Intensity - moderate to strong

 

Relaxation period - at least 30 seconds

 

Resting tone - 10 mmHg or less and uterus is soft to palpation

 

Term

Primary Powers

 

Cervical dilatation

Effacement

Station (descent)

Definition

Cervical dilatation 0-10cm

 

Effacement 0-100%

 

Station (descent) -4 to +4

 

Engaged = 0 station

Term
Effacement
Definition

Shortening and thinning of the cervix during the first stage of labor

 

Cervix is typically 2-3 cm long and 1 cm thick

 

Only a thin edge of the cervix can be palpated once effacement is complete

 

Measured in percentage 0% - 100%

 

100% fully effaced

Term
Dilation
Definition

Enlargement or widening of the cervical opening

 

Diameter of the cervix increase from less than 1 cm to full dilation, 10 cm

 

When the cervix is fully dilated, it can no longer be palpated

 

Full cervical dilation marks the end of the first stage of labor

Term
Secondary Powers
Definition

When the presenting part reaches the pelvic floor, the contractions change in character to expulsive

 

Laboring woman feels an involuntary urge to push

 

She should only begin pusing when she feels the urge to push (Labor Down)

Term
Position
Definition

Frequent changes in position relieve fatigue, increase comfort, and improve circulation

 

Upright - good for gravity

walking and dance of labor

 

Squatting - open pelvis

Sidelying

Support of birthing ball - open pelvis

Term
Fear tension pain triangle
Definition

Treat with

 

Support

 

Education

 

Anesthesia/analgesia

Term
Labor
Definition
Labor is the process in which fetus, placenta, and membranes are expelled spontaneously
Term

Signs of Labor

 

Premonitory signs of labor (8)

Definition

Lightening

Return of urinary frequency

Backache

Stronger Braxton-Hicks contractions

Bloddy show-increased  vaginal discharge

Spontaneous rupture of membranes

Surge of energy

Weight loss

 

Term
When should you tell a woman to go to the hospital
Definition
Tell patient to come to the hospital when she is having trouble walking and talking during contractions
Term

1st Stage of Labor

 

Latent phase

Definition

0-3 cm

 

0-2+

 

Contraction every 5-10 min, mild intensity, lasting 30-45 seconds

Term

1st Stage of Labor

 

Active Phase

Definition

4-7 cm

Average dilation 1.2 cm/hr

40-80% effacement

Fetal descent 2+-4+

Intense contraction q 2-2.5 mins

lasting 40-60 sec

Increase in pain

Term

1st Stage of Labor

 

Transition phase

Definition

8-10 cm

100% effacement

Contractions intense

q 1-2 min lasting 60-90 sec

Feels exhausted

Bloody show

N/V, backache, diaphoresis, and trembling

Term

1st Stage Nursing Care

Latent Phase

Definition

Assess for progress on admission

Rest

Walk

Assessment: BP, P, R - 30-60 mins

Temp - 2-4 hours (Assess every 2 hrs w/ROM)

Uterine activity and FHR - 30-60 mins

Emotional support (Dad and Family)

Teach about what to expect

Physical Support: Comfort measures, ice chips, popsicles, empty bladder every 2 hrs

 

Term

1st Stage Nursing Care

Active Phase

Definition

4-7 cm

BP, P, R - every 30 minutes

Temperature every 2 hours

Uterine activity and FHR - every 15-30 minutes

Term
Definition
Term

1st Stage Nursing Care

Transition Phase

Definition

BP, P, R - every 15-30 minutes

Temperature - every 2 hours

Uterine activity - every 10-15 minutes

FHR - every 15-30 minutes

Presence: Do not leave patient alone

Positive words and actions

Communicate with calm short directions

Expect some N&V

Expect irritability

Notify doctor of progress

Term

Rupture of Membranes

AROM

Definition
Artificial Rupture of Membranes
Term

Rupture of Membranes

SROM

Definition
Spontaneous Rupture of Membranes
Term

Rupture of Membranes

PROM

Definition
Premature Rupture of Membranes
Term
What is the hazards of Prolonged ROM?
Definition
Increases infection rates in the mother and fetus
Term
Describe next actions after ROM (AROM or SROM)
Definition

First assess FHR

What color is fluid?

If meconium stained/note that

If blood tinged/monitor mom closely could be placenta pulling away

Do not do a lot of physical exams

 

May notice lanugo and fetal squamous cells

At risk for prolapsed cord

Term

Labor Pain-Physiology

Visceral

Definition

1st stage of labor

Lower abdomen related to contractions

Term

Labor Pain - Physiology

Somatic

Definition

2nd Stage

Vagina and perineum

Term
Pain during labor may result due to the following factors (3):

Definition

Decreased blood supply to uterus

Increased pressure and stretching of the pelvic structures

Cervical dilatation and stretching

Term
Definition
Term
Intradermal Water Block
Definition

Injection of small amounts of sterile water with a fine needle into four locations on the lower back to relieve back pain

Effective in early labor

Singing will occur for 20 to 30 seconds

Treatment can be repeated

Term

Pharmacologic Management

Systemic Analgesics

Definition

Demerol, stadol, nubain, fentanyl

Crosses the fetal blood-brain barrier

Newborn effects: Respiratory depression, decreased alertness, delayed sucking

Term

Pharmacologic Management

 

Opiod Antagonist

Definition

Narcan

 

Reverses the opioid-induced respiratory depression in the mother or the newborn

Term

Pharmacologic Management

 

Pudenal Nerve Block

Definition

Administered late in the 2nd stage of labor

 

Used with episiotomy or forceps

Term

Pharmacologic Management

 

Spinal Anesthesia

Definition

Utilized in cesarean births

 

Provides anesthesia from the nipple line to the feet

Term

Pharmacologic Management

 

Epidural Anesthesia

Definition

Most effective pharmacologic pain relief mehod for labor that is currently available

 

Relief of pain from uterine contractions and birth

 

Local anesthetic: bupivacaine

Opiod analgesic: fentanyl/sufentanil

Injection is between L4 & L5

Term
Epidural Side Effects
Definition

Hypotension                                  Assymetrical block

Local anesthetic toxicity*                Fever

*Lightheadedness                          Urinary retention

*Dizziness                                    Pruritis

*Tinnitus                                      Limited movement

*Metallic taste                              Longer 2nd stage of labor

*Numbness of the tongue or mouth   Increased use of Pitocin

*Bizarre behavior                           Increased likelihood of medically

*Slurred speech                            assisted birth

*Convulsions

*Loss of consciousness

High or total anesthesia

Term
Nursing Care for Epidural
Definition

Monitor B/P - Hypotension likely (to counteract trendelenberg position - head lwr)

Maintain IV - Bolus of 500-1000 ml prior

Continuous fetal monitoring

Assess for bladder fullness - empty q 2 hrs

Unable to bear weight

Reposition on bed-many possible positions

Term
What does the anesthesiologist use for a spinal headache?
Definition
Blood patch
Term

Occiput Posterior (OP)

 

Position

Definition

Back labor

Dx by vaginal exam-palpating suture lines

Research indicates that dx by by Ultrasound is promising and leads to earlier dx, therefore nursing interventions can be initiated earlier leading to OA position

 

Sims posture on the same side as the fetal spine facilitated the fetus' rotation to OA

 

If fetus is LOP - turn mother to left side

ROP - turn mother to right side

 

Term

2nd Stage of Labor

 

 

Definition

Expulsion

 

Ctx q 2-3 min

Term
Definition
Term

2nd Stage of Labor

 

Phase 1 Early

Definition
Physiologic Lull- REST
Term

2nd Stage of Labor

 

Phase 2 active

Definition

Increased intensity of ctx

Descent-passive (laboring down)

push only when feel urge

Urge to push present as fetal head reaches perineal floor

Term

2nd Stage of Labor

 

Phase 3 transition

Definition
Overwhelmingly strong, expulsive ctx
Term
2nd Stage of Labor Assessment
Definition

Complete dilatation

Sudden burst of energy

Shorter duration with multips than primips

Intense ctx q 2 min, lasting 60-90 sec

Increase in bloody show

Perineum flattens w/bulging rectum and vagina

Urge to push

Involuntary bearing down

Shaking of extremities

Increased restlessness

Term

2nd Stage of Labor

 

Early Phase

Definition

Lasts 20-30 min

 

Rest

 

Recover from transition

 

Ice chips

Term
Definition
Term

2nd Stage of Labor

 

Active Phase

 

Definition

Laboring down or delayed pushing

Intensity increases

Bear down with the urge to push

(For 6 to 8 seconds)

(3 bearing down efforts per contraction)

(Exhale while bearing down)

Open glottis

Term

2nd Stage of Labor

 

Transition Phase

Definition

Uncontrollable urge to push

 

Crowning of head

 

Burning sensation

 

Provide continuous suppor and encouragement

 

Asssess FHR, turn on warmer (when crowning)

Term
Positions for 2nd Stage
Definition

Position is semi-fowlers with a wedge behind back

Change position every 30 min

No stirrups

Throne position of bed

Birthing ball

Pull on towel or tug toy on squatting bar

Do not encourage

(breath holding, counting, pulling knees back, valsalva, or closed glottis)

Term
What are the cardinal movements of Labor? (7)
Definition

Engagement

Descent

Flexion

Internal Rotation

Extension

External Rotation

Expulsion

Term
Apgar Scoring (0-2 points each)
Definition

HR/Assessed by auscultation or palpating umbilical cord

RR rate/effort - auscultated or by observed movement of respiratory effort

Muscle tone/based on degree of flexion and movement of extremities

Reflex irritability (response to stimulation)/based on response to bulb syringe

Color/Based on observation of pallor, cyanotic, or pink

Scored at 1 and 5 minutes of life receiving scores of 8/10 or 9/10-scores of 7/10 and above are "normal"

Most have one point taken off for color acrocyanosis: blue color of hands and feet

Term

Apgar Scoring Table (0-2 pts each)

 

Used as a tool to evaluate newborn's transtition to extrautuerine life

Definition

Sign                         0                    1                    2

 

Heart rate           Absent         Slow (<100)              >100

Respiratory rate   Absent         Slow, weak cry        Good Cry

Muscle tone         Flaccid         Some flexion of          Well flexed

                                   extremities

Reflex irritability    No response  Grimace                Cry

Color                  Blue, pale      Body pink                  Completely pink

                                    extremties blue

Term

3rd Stage of Labor

 

After birth to delivery of placenta

Definition

placenta

about 30 minutes after delivery

signs placental separation has occured (uterine shape changes from disc to globe, small gush of blood, apparent lengthening of umbilical cord, sesation of fullness in vagina, uterine fundus at umbilicus)

Sometimes manual removal is required

Term
4th Stage of Labor
Definition

First 1-2 hours after birth

Recovery

Assess for hemorrhage

Promote bonding

Assist with first breastfeeding

Postpartum assessment every 15 minutes

Term
Latent phase of labor is indicated by:
Definition
Cervix 0-3 cm dilated w/ctx every 5-10 min, of mild intensity, lasting 30-45 sec.
Term
Active phase of labor is indicated by:
Definition
Average dilation 1.2 cm/hr, dilation progresses 4-7 cm
Term
Transition phase of labor is indicated by:
Definition
Dilation from 8-10 cm, ctx intense every 1-2 min, lasting 60-90 sec
Term
Cesarean Birth
Definition

The birth of a fetus through a trans-abdominal incision in the uterus

 

Can be elective, scheduled, unplanned or emergent

 

Purpose:  preserve the life or health of the mother and her fetus

Term
Factors related to increased C-Section
Definition

Fetal macrosomia, advanced maternal age, obesity, gestational diabetes, and multifetal pregnancy

 

fewer VBAC

Term
What have studies shown that reduces c-section rates?
Definition
The one-on-one support of the laboring woman by another woman such as a nurse, nurse midwife, or doula
Term
Elective Cesarean Birth
Definition

Cesearean on request or demand

 

A primary cesarean birth w/out a medical or obstetric indication

 

Many women belief that it will prevent future problems w/pelvic support or sexual dysfunction

Evidence is insufficient to support these claims

 

 

Term
What is the ACOG recommendation for elective Cesarean Sections?
Definition
ACOG recommends that elective cesarean not be performed unless a gestational age of 39 weeks has been determined
Term
Maternal Indications for C-Section
Definition
Specific cardiac disease, specific respiratory disease, conditions related to increased intracranial pressure, mechanical obstruction of lower uterine segment, mechanical vulvar obstruction, history of previous C-section
Term
Fetal indications for C-Section
Definition
Non-reassuring fetal status, malpresentation, active maternal herpes lesions, maternal HIV virus, congenital anomalies
Term
Maternal-Fetal indications of C-Section
Definition
Dystocia, placental abruption, placenta previa, elective C-section
Term
C-Section Pre-op Care
Definition

Blood tests-CBC, blood type, Rh status, maternal VS, FHR, informed consent, ensure NPO status

 

IV and fluids are started to prevent maternal hypotension

SCDs, Foley catheter, shave pubic hair

 

Support person: surgical scrubs, booties, hair cover, and mask. Support person will typically be allowed into the OR once spinal anesthesia has been completed

Term

C-Section Risks

 

Maternal

Definition
Aspiration, hemorrhage, atelectasis, endometritis, abdominal wound dehiscence or infection, urinary tract infection, injuries to the bladder or bowel, and complications related to anesthesia
Term

C-Section Risks

 

Fetal

Definition
Premature birth if gestational age calculation incorrect, fetal asphyxia related to maternal hypotension, fetal injuries
Term
C-Section Anesthesia
Definition

Epidural - usually because laboring epidural

(more sensory less motor, increase meds)

 

Spinal - most common

(motor/sensory block, decrease meds)

 

Combination

 

General - seldom used unless crash, significant fetal distress, prolapsed cord)

Term
C-Section Intraoperative Care
Definition

Woman is positioned so that her uterus is displaced laterally to prevent compression of the inferior vena cava (wedge or tilting table to one side)

The woman may feel cold beta dyne cleaning solution, but should not feel sharp pain

 

She may feel pressure as the baby is born

Term
Types of Uterine Incisions
Definition

Vertical - extending from near the umbilicus to mons pubis

 

Transverse - In lower abdomen

Term
C-Section Immediate Post-Op Care
Definition

Transferred to the recovery room

Transient tachypnea of the newborn common

Keep warm by skin to skin w/Dad in full view of Mom

Frequent VS, pain control, airway patency, and postpartum care, fundus, bleeding, return of sensation

 

Discharged to postpartum care once she is alert, oriented, and able to move all her extremities

Term
C-Section Post-Op and Postpartum Care
Definition

Pain management for incisional and gas pain (Diet progression per nurse assessment)

Duramorph (synthetic morphine), Benadryl or small doses of Narcan (itching)

First 24 hours will have pain relief from spinal opioids, IV medications/PCA

After 24 hrs:

D/C Foley-measure first void (6-8 hrs)

Ambulate (sit, march, walk) in hall

PO pain medications

Nurse montiros dressing/drainage til removal

Shower after dressing removed (physician removes)

Term
Incisional Pain Management
Definition

Splint incision when moving or coughing

 

Use relaxing techniques

 

Apply ice for the first 24 hours (even after), then heat as necessary

Term
Gas Pain Management
Definition

Walk

Do not eat or drink gas-forming items

Do not use straws increases gas

chew simethicone as prescribed

Lie on the left side

Rock in a rocking chair

Term
Dystocia
Definition

A long, difficult, or abnormal labor is known as dysfunctional labor, or dystocia.

 

 

Term
What is the second most common indication for cesarean birth after previous cesarean birth?
Definition
Dystocia
Term
When is Dystocia suspected?
Definition
When the characteristics of uterine contractions are altered or when progress in the rate of cervical cilation or progress in fetal descent and expulsion is lacking or failure to descend, not progressing as think she should
Term

Dystocia Causes

 

Powers

Definition
Ineffective uterine contractions or maternal bearing down efforts (most common cause of dystocia)
Term

Dystocia Causes

 

Passage

Definition

Alterations in the pelvic structure

 

HPV-genital warts blocking vagina

Obesity

Term

Dystocia Causes

 

Passenger

Definition

Fetal causes that include abnormal presentation or position, anomalies, excessive size, and number of fetuses

 

Ascynclitic (head not in correct position)

(OP) - occiputposterior - back labor

Term

Dystocia Causes

 

Position

Definition

Maternal position during labor and birth

(way she lies)

Term

Dystocia Causes

 

Psychological

Definition

Responses of the mother to labor related to past experiences, preparation, culture, heritage, and support systems

 

Not pusing, total anxiety, abuse issues

Term
Tachysystole
Definition

Hypertonic uterine dysfunction

defined as uncoordinated uterine activity

Term
Risk factors for Tachysystole
Definition
Augmented (stimulated) labor
Term
Definition
Term

Tachysystole Management

 

with reassuring FHR

Definition

Reposition to side lying

IV fluid bolus-500 ml

If uterine activity not returned to normal after 10 minutes, decrease Pitocin

Term

Tachysystole Management

 

with non-reassuring FHR

Definition

D/C Pitocin immediately

Reposition to side lying

IV fluid bolus - 500 ml

Oxygen 10L per nonrebreather

0.25 mg Terbutaline SQ (not used that often-smooth muscle relaxant-short acting)

Notify physician

Term
Hypotonic Uterine Dysfunction
Definition

The woman initially makes normal progress into the active phase of labor; then the contractions become weak and inefficient or stop altogether

 

Occurs when the pressure of the UC is insufficient (<25 mmHg) to promote cervical dilation and effacement

 

IUPC inserted to monitor strength of contractions

 

 

 

 

Term
Augmentation methods
Definition

Pitocin

Amniotomy (Break bag of waters)

Term
What are some non-invasive methods of augmenting labor?
Definition

Empty bladder (urinate frequently)

 

Ambulation

 

Position changes

 

Hydration

 

The presence of a personal nurse who provides constant emotional and physical support is the only component associated with shorter labors and lower rates of C-section.

Term
What is precipitous labor?
Definition

Labor that lasts less than 3 hours from the onset of contractions to the time of birth

 

 

Women report feeling frustrated when nurses did not believe them when they reported their readiness to push

Term
What conditions are associated with Precipitous labor?
Definition
Placental abruption (detaches from uterine wall), an excessive number of uterine contractions, and recent cocaine use
Term
What are the maternal complications for precipitous labor?
Definition

Uterine rupture

Lacerations of birth canal

Amniotic fluid embolism (relatively rare)

Post partum hemorrhage (more common)

Term
What are the fetal complications of precipitous labor?
Definition

Hypoxia, caused by decreased periods of uterine relaxation, or rarely, intracranial trauma related to the rapid birth

Facial bruising

Term
When do inadequate expulsive forces occur?
Definition
Occurs in the second stage of labor when the woman is not able to push or bear-down
Term
What are the risk factors for inadequate expulsive forces?
Definition

Analgesics

Exhaustion

Inadequate hydration or food intake

Term
Medical management for inadequate expulsive forces?
Definition

Augmentation with Pitocin

AROM

Assisted vaginal birth

Term
Nursing Actions for inadequate expulsive forces
Definition

Positioning

 

Ambulation

Term
Causes of Fetal Dystocia
Definition

Fetal dystocia may be caused by excessive fetal size (macrosomic)

Malpresentation (OP, Asynclitic, face presentation)

Multifetal pregnancy

Fetal anomalies

Term
Fetal Dystocia complications
Definition

Neonatal asphyxia

Fetal injuries or fractures

Maternal vaginal laceration

Can cause post partum hemorrhage

Assisted vaginal birth often necessary

Term
What is cephalopelvic disproportion?
Definition

Disproportion between the size of the fetus and the size of the mother's pelvis

 

Fetus can not fit through the maternal pelvis to be born vaginally

Term
What are the factors of cephalopelvic disproportion?
Definition

Fetal size (macrosomia-4000g or more)

Presentation and position (malposition of the presenting part)

Size and shape of the maternal pelvis

Quality of the uterine contractions

Term

Cephalic Disproportion

 

Fetal macrosomia risk factors

 

Definition

Maternal diabetes

Obesity

Multiparity

Large size of one or both parents

Term

Cephalopelvic Disproportion

 

Assessment findings

Definition

Malposition found during vaginal examination

 

Is not accurately predicted

Term

Cephalopelvic Disproportion

 

Medical Management

Definition

Facilitating rotation of fetal head

Hands and knees, squatting, pelvic rocking, stair climbing, lateral position (lie toward the side in which the fetus should turn)

Lunges

Term
Pelvic Dystocia
Definition

Related to the contraction of one or more of the three planes of the pevis

 

 

Term
What are the three contractions of the pelvic planes?
Definition

Inlet contraction

Mid-pelvis contraction

Outlet contraction

or any combination of these planes

Term
What causes pelvic dystocia?
Definition

Caused by congenital abnormalities

Maternal malnutrition

Neoplasms

Lower spinal disorders

 

An immature pelvic size redisposes some adolescent mothers to pelvic dystocia

 

Uniqueness of pelvic shape not very common

Term

Shoulder Dystocia

 

 

Definition

Condition in which the head is born, but the anterior shoulder cannot pass under the pubic arch

 

(Dread)

 

 

Term

What are the risk factors for shoulder dystocia?

 

Read pre-natal hx look for risk factors

Definition

Excessive fetal size

Maternal pelvic abnormalities

Maternal diabetes

Hx of shoulder dystocia with another pregnancy

Prolonged second stage of labor (not going as predicted)

Term
Warning Sign of Shoulder Dystocia?
Definition
Retraction of the fetal head against the perineum immediately after emergence (turtle sign)
Term

Shoulder Dystocia Complications

 

Fetal

Definition

Fetal injuries are usually caused by asphyxia related to the delay in completing the birth or by trauma from the maneuvers used to accomplish the birth

 

Brachial plexus (Erbs palsy)(if recognized and treated early 80-90% heal completely)

Phrenic nerve injuries

Fracture of humerus or clavicle (asymmetrical movement)

 

Term

Shoulder Dystocia Complications

 

Maternal

Definition

Postpartum hemorrhage

 

Rectal Injuries

Term

Shoulder Dystocia Management

 

Definition

1. Supra pubic pressure (attempting to push the anterior shoulder under the symphysis pubis, do not push top of fundus down)

2. McRoberts manueuver (pt pull legs back)

3.  Maternal position changes (hands and knees, squatting position, lateral recumbant)

Term

Nursing Actions for

Shoulder Dystocia Management

Definition

Call for additional assistance

Apply supra pubic pressure

Assist mother with position changes

Term
Labor Induction
Definition

Chemical or mechanical initiation (AROM or stretching cervical os with foley bulb) of uterine contractions before their spontaneous onset for the purpose of bringing about birth

 

Elective or Medically

Term

Labor Induction

 

Factors to Consider

Definition

Parity

Status of membranes: ruptured or intact (deliver with in 24 hrs of rupture)

Status of the cervix: favorable or unfavorable

Hx of previous cesarean births

Not before 39 weeks

Continuous fetal monitoring

Cervial ripening with Prostin (Prostaglandin) "Cervidil"

Amniotomy-breaking "the bag of waters" (needs some dilation)

Pitocin administration (now getting earlier than 3-4 cm)

Term
Bishop Score
Definition

A rating system to evaluate indicibility

When the Bishop score is ≥8, induction is typically successful

 

                                          Score                                  

                              0                1               2                3          

Dilation (cm)                0                1-2          3-4              ≥5

Effacement (%)            0-30           40-50        60-70           ≥80

Station (cm)                -3                -2            -1,0             +1, +2

Cervical consistency      Firm            Medium      Soft             Soft

Cervix position           Posterior     Mid-positon  Anterior       Anterior 

Term
Indications for Labor Induction
Definition

Hypertensive complications of pregnancy

Fetal death

Chorioamnionitis

Diabetes Mellitus

Postterm pregnancy (+42 weeks)

IUGR (Intrauterine Growth Restriction)

Premature rupture of membranes with established fetal maturity

Term
Contraindications to Labor Induction
Definition

Acute, severe fetal distress

Should presentation

Transverse lie, breech

Floating fetal presenting part (moves up/dwn, not engaged)

Uncontrolled hemorrhage

Placenta previa (covering cervical os)

Previous uterine incision that prohibits a trial of labor

 

Term
Relative contraindications to Labor Induction
Definition

Grand multiparity (+5 babies)

Multiple gestation

Suspected cephalopelvic disproportion

Breech presentation

Term
Cervical Ripening
Definition
Cervical ripening is the process of physical softening and opening of the cervix in preparation for labor and birth
Term
Cervical Ripening Methods
Definition

Chemical: Prostaglandin E1 (Cytotec) - tablet intravaginally PO 50 mcg or Vaginally 25 mcg q 4 hrs

 

Prostaglandin E2 (Cervidil) - insert into posterior fornix of vagina - romove after 12 hours

 

Mechanical: Balloon catheter-Releases endogenous prostaglandins

Hydroscopic dilators-absorb fluid and dilate the cervix

 

Other methods: Nipple stimulation, sexual intercourse, castor oil, stripping membranes

The digital separation of the chrionic membrane from the wall of the cervix and lower uterine segment during a vaginal exam done by a primary care provider to stimulate labor

Term
Amniotomy
Definition

AROM during a vaginal examination with amnihook

Only perform when cervix is ripe and presenting part is engaged or cord prolapse possible

Assess FHR during and after procedure

Monitor temperature at least every hour

Term
Oxytocin
Definition
A hormone normally produced by the posterior pituitary gland that stimulates uterine contractions and aids in milk let-down
Term
Maternal hazards of Oxytocin Use
Definition

Pain

Abruptio placentae

Uterine rupture

Unecessary cesarean birth caused by non-reassuring FHR, postpartum hemorrhage, and infection

Term
Fetal Hazards of Oxytocin Use
Definition
If contractions are too frequent or prolonged-hypoxemia and acidemia; resulting in late decelerations and minimal or absent baseline variability
Term
Oxytocin Goal
Definition
To produce contractions of normal intensity and duration while using the lowest dose of medication possible
Term
Common Interventions with Labor Induction
Definition

Intravenous (IV) fluids

Bed rest

Continuous electronic monitoring

Increase pain medication use and epidural anesthesia

Amniomoty

Prolonged stay in labor unit

Term
Example Pitocin Protocol
Definition

IV Pitocin administered piggyback to main IV placed on a pump

Ice chips only (monitor I&O)

No supine position

Continuous fetal monitoring

Assess FHR and B/P prior to increasing Pitocin

Increase by 1 mU every 30 minutes (or what is ordered) to q 20 minutes

Term

Operative Vaginal Delivery

Vacuum-assisted delivery

Definition

Attachment of a vacuum cup to the fetal head, using negative pressure to assist in the birth of the head

 

Encourage the woman to still push during the contraction

Term
Fetal Risks for Vacuum-assisted delivery
Definition

Caput

Cephalhematoma

Scalp lacerations

Subdural hematoma

Term
Maternal Risks for vacuum-assisted delivery
Definition

Perneal, vaginal, or cervical lacerations

Soft-tissue hematomas (won't see a drop of blood but can have PPH with these)

Term

Operative Vaginal Delivery

 

Forceps-assisted delivery

Definition

An instrument with 2 curved blades is used to assist in the birth of the fetal head

woman's cervix should be fully dilated, presenting part must be engaged, and membranes must be ruptured

 

blades are positioned by the physician with the blades placed in front of the baby's ears

Term

Vaginal Birth after Cesarean (VBAC)

 

Benefits and Risks

Definition

Success rate 70-80%

 

Benefits: shorter maternal hospital stay, less blood loss, fewer infections, and fewer thomboembolic events

 

Risks:  uterine rupture, hysterectomy, operative injury, post partum hemorrhage, and neonatal morbidity (injury)

 

Term
Selection criteria for VBAC
Definition

One previous low-transverse cesarean birth

Clinically adequate pelvis

No other uterine scars or history of previous rupture

Physician immediately available to perform emergency cesarean (rupture of uterine scar)

Availability of anesthesia and personnel for emergency cesarean birth

Term
Definition
Term
Post-term pregnancy
Definition
Pregnancy that extends beyond the end of week 42 gestation
Term
Problems associated with post-term pregnancy include:
Definition

Induction of labor with an unfavorable cervix

Cesarean section

Prolonged labor

Postpartum hemorrhage d/t distension of uterus

Traumatic birth

Term
Risk factors associated with post term
Definition

Macrosomia

Aging of placenta

Oligohydraminos

Meconium stained fluid

 

Term
Assessment findings of post term newborn
Definition

Dysmaturity syndrome: dry, cracked, peeling skin

long nails

meconium staining of the skin, nails and umbilical cord

Term
Risk factors for preterm labor
Definition

Previous preterm labor

Multiple fetuses

Socioeconomic level, education, nutrition, age >17 or <35, race, infection <2 losses in 2nd trimester

Term
If risk factors present for preterm labor can test
Definition

Saliva test for increased estrogen

Fetal fibronectin (protein in cervical mucous)

Absence is reasurring

Performed at 24-34 weeks

90-95% accurate if don't see

Presence doesn't necessarily mean anything

Term
Signs and Symptoms of Preterm Labor
Definition

Uterine contractions q 10 min or more

Continuing for 1 hr or more

May or may not be painful

Back pain

Lower abdominal cramping w/wo diarrhea

Suprapubic pain or pressure

Pelvic pressure

Urinary frequency (Sudden change or increase in freq)

Contractions in thighs

Vaginal discharge changes (increased amt, may be thicker, may be watery, bloody, or brown)

ROM

Term

Preterm Labor Education

S/Sx taught at every prenatal visit

Self Care: for an hour

Definition

Rest on side for 1 hr

Time contractions

Drink 2-4 cups of water

Relaxation/breathing techniques

Call Dr. or Midwife

If contractions subside, rest

Do not return to work

If longer than 1 hr <6 in 1 hr

note: dehydration causes uterine irritability, make sure hint of yellow

 

Term
Medications to Suppress Contractions
Definition

Magnesium Sulfate (smooth muscle relaxer)

Terbutaline (Brethine)

Calcium Channel Blockers such as Procardia (blocks Ca+ so muscle can't contract, can use at home and long term)

Term
Prolapsed Cord
Definition

Prolapse of the umbilical cord is when the cord lies belowthe presenting part of the fetus

 

THIS IS AN OBSTETRICAL EMERGENCY

 

Most common: Frank (visible) prolapse immediately after ROM (can be occult, hidden)

Term
Contributing Factors for Prolapsed Cord
Definition

Long Cord

Malpresentation

Unengaged presenting part

Term
Warning signs of prolapsed cord
Definition

Variable or prolonged deceleration during uterine contraction

Woman reports feeling the cord after membranes rupture

Sense of fullness

Cord is seen or felt in or protruding from the vagina

 

 

*Monitor FHR after ROM

Term
Prolapsed Cord Management
Definition

Relieve pressure on the cord by putting a sterile, gloved hand into the vagina and holding the presenting part off of the umbilical cord

 

Assist woman into a Trendelenburg or knee-chest position so gravity can assist keeping pressure off of the umbilical cord

Term
Uterine Rupture
Definition
Complete nonsurgical disruption of all uterine layers
Term
Major risk factors for uterine rupture
Definition

TOL for attempted VBAC

Classic Incision (need transverse incision and cephalic presentation)

Labor Induction (Can rupture w/Pitocin stress can rupture)

Multiple prior cesarean births

Multiparity

Trauma

 

Term

Common interventions for a patient having an induction include all except:

 

Intermittent FHR Monitoring

Bedrest

IV fluids

Increased pain meds or epidural

Definition
Intermittent FHR Monitoring
Term

Labor that lasts less than 3 hours from onset of labor to birth is categorized as:

 

Turmultuous labor

Emergency labor

Precipitous labor

Abruptio labor

Definition
Precipitous labor
Term

Fetal dystocia may be caused by excessive:

 

Uterine activity

Fetal size or malpresentation

Dilatation or malpresentation

Uterine distention because of fetal anomalies

Definition
Fetal size or malpresentation
Term
Auscultation FHR
Definition

Detect baseline rhythm and increase or decrease in FHR

 

Full min after UC ends

Term

Fetal Assessment

 

Intermitten fetal heart rate auscultation

Definition

Take maternal pulse simultaneously to decerease confusion between maternal and fetal heart rates

Baseline rate

Rhythm

Increases

Decreases

Term
Research FHR
Definition
Continuous electronic FHR monitoring has not improved the outcome for the fetus over the use of intermittent auscultation yet
Term
Palpation of contractions
Definition

The frequency, duration, tone, and intensity of contractions can be assessed by palpation:

 

Mild or 1+ (easily dented) nose

Moderate or 2+ (can slightly indent) chin

Strong or 3+ (cannot indent uterus) forehead

 

Know feel before (resting tone)

Term

Assessment Frequency

 

Low Risk

Definition

Intermittent FHR auscultation

Immediately after contractions

Every 30 min in active first stage labor

Every 15 min in second stage

Contractions are palpated

Term

Assessment Frequency

 

High Risk

 

HTN, Pitocin, Epidural HTN, Diabetes, Pre-existing pathology-disease or infection

Definition

Continous electronic fetal monitoring

Document every 15 min in active phase 1st stage

Document every 5 min in 2nd stage

 

Internal monitoring on people on Pitocin to detrmine sufficient pressure

Term
Influences on Fetal Heart
Definition

Utero-placental unit

Autonomic nervous system (stimulus)

Position, Epidural & Pitocin

Baroreceptors

Central nervous System

Chemoreceptor

Acidodic

Hormonal Regulation

Utero-placental Insufficiency

Head compression

Term

FHR Categories

Category I

Definition

Normal

Strongly predictive of normal fetal acid-base balance. They may be followed in a routine manner and no action is required.

Term

FHR Categories

Category II

Definition
FHR tracings are indeterminate. They are not predictive of abnormal fetal acid-base status, yet there is not adequate evidence to classify them as category I or III. They require evaluation and continued surveillance and reevaluation in the context of the clinical circumstances
Term

FHR Categories

Category III

Definition

FHR tracings are abnormal. They are predictive of abnormal fetal acid-base status and require prompt evaluation.

Depending on the clinical situation intrauterine resuscitation should be initiated.

 

Minimum or absent variability

Term

Category I FHR tracings include all of the following:

 

Normal

Definition

Baseline rate 110-160 bpm

Baseline variability moderate

Late or variable deceleration absent

Early decelerations absent or present

Term

Category II - Indeterminate

FHR tracings include all FHR tracings not categorized as category I or III

They include any of the following:

Definition

Bradycardia not accompanied by absent variability

Tachycardia

Minimal baseline variability

Absent baseline variability not accompanied by recurrent decelerations

Marked baseline variability

Absence of induced accelerations

Recurrent variable decelerations with minimal or moderate variability

Prolonged decelerations

Recurrent late decerlations with moderate variability

Variable decelerations with other characteristics

Term
Definition
Term

Category III - Abnormal (non-reassuring)

FHR tracings are either

Definition

Absent variability with any of the following:

recurrent late decelerations

recurrent variable decelerations

bradycardia

sinusoidal pattern

 

Term

FHR pattern Interpretation

 

Definition

Interpretation of baseline variability

Interpretation of periodic and episodic changes: Decelerations

Early, variable, late

 

Term
FHR Variability
Definition

No distinction between long and short-term

Variability is measured from the peak to the trough of FHR fluctuation of baseline

Document present or absent

Absent, Minimal, Moderate, Marked

Term

Absent Variability

Causes of Absent/Minimal Variability

Definition

Congenital anomalies

Preexisting neurological injury

CNS depressant medications

Tachycardia

Extreme prematurity

Fetus is in sleep state

Term

Moderate Variability

 

Definition

Amplitude range of 6-25 bpm

Considered normal

Indicates normal fetal acid-base balance

Term
Marked Variability
Definition

Amplitude range is greater than 25 bpm

Unclear as to the significance of marked variability at this time

Don't want for very long

Not always indicative of problem but needs watching

 

Term

Reassuring FHR Parameters

 

Definition

Baseline:  110-160 bpm

Variability: moderate

Accelerations: present

Periodic changes:

Early decelerations

Accelerations with contractions

Variable decelerations lasting no more than 30-45 sec. with normal baseline, variability and shoulders

Term
Baseline FHR
Definition
FHR that occurs when there is no labor or between contractions during labor
Term
Definition
Term
Changes that occur in baseline without contractions
Definition
Episodic
Term
Changes that occur with contractions
Definition
Periodic
Term
Mean FHR
Definition
Rounded to increments of 5 beats during a 10 min segment. One number (not a range is documented) 140, not 135-145
Term
Normal baseline FHR
Definition
110-160 bpm average = 14-
Term
Tachycardia
Definition
Above 160 bpm for 10 min or longer
Term
Bradycardia
Definition
below 110 bpm for 10 minutes or longer
Term
Baseline FHR Variability
Definition

Reflects normal, irregular changes/fluctuations in FHR baseline related to autonomic/cerebral and brain stem function and indicates:

A mature fetal neuological system

A measure of fetal reserve

Adequate oxygen perfusion to brain stem

Does not include accelerations or declerations

Term
Sinusoidal FHR Pattern
Definition

A regular, smooth, undulating wavelike pattern

Occurs with severe fetal anemia

Not good

Term
Accelerations
Definition

Presence is highly indicative of Normal fetal acid-base balance, significant of fetal well-being

Document present or absent

 

Term
What denotes an acceleration?
Definition
The abrupt increase in FHR with 15 bpm above baseline lasting for at least 15 seconds and less than 2 minutes from onset to return to baseline
Term
What causes accelerations?
Definition
Caused by increase in sympathetic nervous system
Term
What denotes acceleration in fetuses under 32 weeks?
Definition
An abrupt increase of 10 bpm for 10 seconds is considered an acceleration
Term
What are accelerations of FHR for more than 10 minutes?
Definition
A change in baseline rate
Term
Accelerations may be periodic or episodic and occur in association with fetal movement or spontaneously
Definition
Term
Stimulating Accelerations
Definition
If accelerations do not occur spontaneously, they can be elicited by fetal scalp stimulation or vibroaccoustic stimulation
Term

Decelerations

Categorized as:

Definition
Early, late, variable, or prolonged
Term
Early decelerations
Definition

related to head compression

A gradual decrease in associated with uterine contraction, the onset, nadir (lowest point), and recovery are coincident with the beginning, peak, and ending of the contraction

A mirror image

Considered benign

Term

Early Decelerations

Caused by:

Definition

Head compression resulting from:

Uterine contractions

Vaginal examination

Fundal pressure

Placement of internal mode of monitoring

Significance: Normal pattern, no intervention req'd

Term
Late Deceleration
Definition

Related to uteroplacental insufficiency

A gradual decrease (defined as onset of deceleration to the nadir in 30 or greater seconds); associated with uterine contraction delayed in timing, with the nadir of the decleration occuring after the peak of contraction

Begins after the contraction has started

Does not return to baseline until after the contraction is over

Ominous sign if uncorrectable or associated with absent or minimal variability or tachycardia

Term

Late Decelerations

Uteroplacental Insufficiency

Definition

Persistent and repetitive late decelerations indicate the presence of fetal hypoxemia stemming from insufficient placental perfusion during uterine contractions

If recurrent and sustained, can lead to metabolic acidosis

Term
Causes of Late Decelerations
Definition

Uteroplacental Insufficiency caused by:

Uterine tachysystole

Maternal supine hypotension

Epidural or spinal anesthesia

Placenta previa

Abruptio placentae

Hypertensive disorders

Postmaturity

IUGR

Diabetes mellitus

Intraamniotic infection

Term
Late Deceleration Significance
Definition
Abnormal pattern associated with fetal hypoxemia, acidemia, and low Apgar scores
Term
Late Deceleration Interventions
Definition

Change maternal position

Correct hypotension

Increase rate of IV

Palpate uterus for tachysystole

Discontinue Pitocin

Oxygen at 10L by nonrebreather

Notify physician or midwife

LION PIT

Term

Variable Deceleration

 

Definition

Related to umbilical cord compression

Variable waveform usually with rapid onset and offset; decrease below baseline at least 15 bpm, lasting at least 15 sec and no longer than 2 min from onset to return

May occur during, after, in-between contractions

Nadir and duration varies, but usually related to strength and duration of contraction

A "typica" variable maintains baseline, variability and is preceded and followed by brief accelerations/shoulds

U, V, or W shaped

May be preceded or followed by brief accelerations of the FHR known as shoulders to compensate

Term
Variable Deceleration Causes
Definition

Umbilical cord compression caused by the

following:

Maternal position with cord between fetus and maternal pelvis

Cord around fetal neck, arm, leg, or other body part

Short cord

Knot in cord

Prolapsed cord (depending on placement)

Term

Variable Deceleration

Occur in 50% of all labors and usually are transient and correctable

Interventions:

Definition

Change position

D/C position

O2 at 10L nonrebreather

Notify physician or midwife

Assist with vaginal or speculum examination to assess for cord prolapse

Assist with amnioinfusion if ordered

Term
Prolonged Deceleration
Definition
Decrease in FHR below the baseline 15 bpm or greater, lasting at least 2 min but less than 10 min from onset back to baseline
Term
Prolonged Deceleration causes:
Definition

Caused by a disruption in fetal oxygen supply

Prolonged cord compression, profound uteroplacental insufficiency, sustained head compression

The presence and degree of hypoxia are thought to correlate with the depth and duration of the deceleration, how abruptly it returns to baseline, and how much variability is lost during the deceleration

Term
Non-reassuring (abnormal) FHR patterns
Definition

Tachycardia, bradycardia, or unidentifiable/wandering

Absent variability

Absence of accelerations

Late decelerations

Fetal pulse-oximetry is not effective in determining fetal outcome-no change in C/S rate

Term
Intrauterine Resuscitation
Definition

Interventions for nonreassuring FHR patterns

 

LION PIT

 

These interventions maximize intravascular volume, uterine perfusion, placental exchange, and oxygen delivery to the fetus

Term

Intrauterine Resuscitation

When a nonreassuring FHR pattern is identified, assessment may include:

Definition

Cervical exam to assess for:

Umbilical cord prolapse

Rapid cervical dilation

Rapid descent of fetal head

Assess uterine activity for uterine tachysystole

Assess maternal VS, especially:

Maternal temperature for maternal fever

Maternal blood pressure for hypotension

Term
Intrauterine Resuscitation Management
Definition

Change maternal position (left or right lateral) to minimize or correct cord compression, decrease frequency of UCs and improve uterine blood flow

Administer IV bolus of fluid to maximize intravascular volume and improve uteroplacental perfusion

Administer O2 at 10 L/min via face mask to improve fetal oxygen status. Reduce uterine activity if UCs are too frequent because there may be insufficient time for blood to perfuse placenta

Term
Amnioinfusion (Intrauterine Resuscitation)
Definition

Infusion of room-temperature isotonic fluid into the uterine cavity if the volume of amniotic fluid is low

Amnioinfusion has been used to resolve variable FHR deceleration by correcting umbilical cord compression as a result of oligoydraminos

Intensity and frequency of uterine contractions should be continually assessed during the procedure

Term
Intrauterine Resuscitation Management
Definition

Alter pushing efforts, or stop the woman from pushing, or having woman push with every other or every third UC to provide time for fetus to recover when FHR is nonreassuring during the second stage

Support woman and family to decrease anxiety or pain, and improve uterine blood flow and maximize oxygenation to fetus

Ominous FHR patterns are associated with fetal acidemia

The presence of one of the ominous patterns warrants immediate bedside evaluation by a physician who can initiate a cesarean birth

Term

Nursing Interventions for non-reassuring (abnormal) FHR

 

Definition

Position changes

Oxygen administration 8-10 L/min by nonrebreather mask

Increase IV fluids

D/C Pitocin if running

Terbutaline may be ordered to quiet uterus

Continue to assess and document

Notify physician, nurse midwife, NICU, anesthesia

Prepare for amniinfusion when variable decelerations are present

Term
Genetics
Definition

The study of a single gene or gene sequences and their effects on living organisms

Is a contributing factor in virtually all human illness

Term
Genome
Definition
Complete copy of genetic material in an organism
Term
Genomics
Definition

The study of the entire DNA structure of all of an organism's genes, including functions and interactions of genes

Broad categorization of all that influences the genome

Compare this concept to the Information Technology concept tht includes all those things that influence the transmission of information using technology

Term
Another definition of Genomics
Definition
Study of the functions and interactions of all the genetic material in the genome, including interactions with each other, the environment, & other psychosocial & cultural factors
Term
Where are genes located?
Definition
DNA
Term
Do genes act in isolation?
Definition
No. They never act in isolation they always interact with other genes and the environment
Term
Approximately 62% of miscarriages and 10% of still births and perinatal death are caused by what?
Definition
Chromosomal abnormalities
Term
Genotype
Definition

Genetic make-up of an individual

This is what you are made of

Term
Phenotype
Definition

Observable expression of the individuals genotype

This is what you see

Term
Karyotype
Definition

Schematic arrangements of the chromosomes within a cell to demonstrate their numbers and morphologic features

Determine the number and structure of chromosomes

Term
Tay-Sachs
Definition
Ashkenazi Jews, French Canadians in Quebec, Cajuns from Louisiana, Amish in Pennsylvania
Term
Beta-thalassemia
Definition
Mediterranean, Middle Eastern, Transcaucasus, Central Asian, Indian, Far Eastern, African
Term
Sickle cell anemia
Definition
African-American
Term
Alpha thalassemia
Definition
Southeast Asia, South China, Philippine Islands, Thailand, Greece, Cyprus
Term
Lactase Deficiency
Definition
Chinese, Thailand
Term
Neural Tube Defects
Definition
Irish, Scottish, Welsh
Term
PKU
Definition
Irish, Scottish, Scandinavian
Term
Cystic Fibrosis
Definition
Caucasians, Ashkenazi Jews, Hispanics
Term
Niemann-Pick disease type A
Definition
Ashkenazi Jew
Term
What are some diseases that have both a genetic and environmental component?
Definition

Lung Cancer                  Smoking

Skin Cancer                   Sun exposure

Diabetes                        Obesity

Heart disease                 Diet

Alzheimers                     No longer learning

Term
Human Genome Project
Definition

Map the complete set of instructions for genes within the cell nucleus

Completed by both public and private scientists in 2000

National and International effort

Francis Collins led the Human Genome Project

Term

Outcomes of the Human Genome Project

Key findings:

Definition

All humans are 99.9% identical at the DNA level

30,000-40,000 genes make up the human genome

Assumption was that humans were more evolved with approximately 80,000-150,000 genens

Term
More than 100 genes involved in diseases identified including:
Definition

Huntington disease

Breast cancer

Colon cancer

Alzheimer disease

Achondroplasia

Cystic fibrosis

Genetic tests for 1672 inherited conditions are commercially available

Term

The use of genetic information to individualize drug therapy

To reduce adverse drug reactions

P450

Definition

A family of genes that control how fast an oral med is metabolized

Rapid metabolizers-don't keep the drug in their system very long therefore it may be less effective and it will have fewer adverse effects

Term
P450 Poor Metabolizers
Definition

The drug is poorly metaboized therefore it stays in the system longer and can lead to more adverse effects and even toxic effects

An individual may need a smaller dose which will still be effective, and not lead to toxic levels

 

Example: Gleevac is a drug used to treat chronic myeloid leukemia (CML). Caused by a translocation between chromosome 9 and 22 creating an oncogene

CML develops

This drug blocks the new protein produced by this oncogene-remission occurs in 90% of patients with CML

Term
What Nurses need to know about Genetics & Genomics
Definition

Basic genetic concepts and principles

Clinical presentations tht may indicate a genetic condition

Common genetic conditions

Availability of genetic services

Informed decision making about genetic testing and therapeutic options

Risks for discrimination, stigmatization, altered self-esteem, and altered family dynamics associated with diagnosis of genetic condition or a genotype for adult onset disorders

How to obtain a 3 generation family history and construct the corresponding pedigree

Term
Chromosomal Abnormalities
Definition

Trisomies-non-disjunction

Downs Syndrome

Term
Single gene diseases
Definition

Newborn screening-almost all of the inborn errors of metabolism are autosomal recessive

Cystic Fibrosis

Term

Single Gene Disorders

Potential patterns of inheritance for single-gene disorders

Definition

Autosomal dominant

Autosomal recessive

X-linked dominant (fragile X)

X-linked recessive (color blind, hemophilia)

Term
Multifactorial Genetic Disorders
Definition

Combination of genetic and environmental factors

Congenital malformations:

Cleft lip and palate

Neural tube defects

Cancer

Diabetes

Heart Disease

Alzheimer's disease

Most other diseases

Term
**Autosomal Dominant
Definition

Only one copy of a variant allele is needed for phenotypic expression

Vertical pattern of inheritance is seen (does not skip a generation)

Males and females are equally affected

Examples: Marfan syndrome, neurofibromatosis, myotonic dystrophy, Stickler syndrome, Treacher Collins syndrome, achondroplasia

Term
**Autosomal Recessive
Definition

Both genes of a pair must be abnormal for the disorder to be expressed (trait is expressed when two carriers each contribute a variant allele to the offspring)

Heterozygous individuals have only one variant allele and are unaffected (known as carriers)

Chance of a trait occurring is 25%

Horizontal pattern of inheritance

Usually observed in one or more siblings, but not in earlier generations

Males and females are equally affected

Examples: IEM (inborn error of metabolism): PKU, galactosemia, maple syrup urine disease.

Tay-Sachs disease, sickle cell anemia, CF

Term
**X-Linked Dominant
Definition

Occur in males and heterozygous females

X-inactivation-affected females are usually less severely affected compared to males

Females are more likely to transmit the affected allele to their offspring

Heterozygous females have a 50% chance of transmitting the variant allele to each offspring

May be lethal in males

Examples: Vitamin D- resistant rickets, fragile X syndrome

Few X-linked dominant disorders identified d/t lethality

Term
**X-Linked Recessive
Definition

Carried on the X chromosome

Females may be heterozygous or homozygous for traits

Males are hemizygous since they only have 1 X chromosome, with no alleles on the Y chromosome

Most often occur in male offspring

Male receives the disease-associated allele from his carrier mother

Female carriers have a 50% probability of transmitting the disease-associated allele to offspring

An affected male can pass the disease associated allele to daughters, not sons

The daughter will be a carrier if they receive a normal X from their mother

The daughter will only be affected if they receive a disease-associated allele on the X chromosome from both their mother and father

Examples: Hemophilia, color blindness, Duchenne muscular dystrophy

Term
Genetic Counselors
Definition

Provide non-directional (gives just facts & statistics but not what means) counseling about genetic testing

Provide information on risk for the future

Cancer predisposition

Prenatal

Especially age-related risk for chromosomal abnormalities

Prepared with a Master's degree in gentic counseling

Term
Genetic Evaluation
Definition

Diagnosis of a genetic condition

Family history

Physical exam looking for dysmorphology or other clues

Geneticists are physicians with fellow-ships in gentics

Term
Family history
Definition

At least 3 generations

Record current and past health status

Include mental illness (depression)

Pregnancy losses (miscarriage)

In addition to ones suggested

Term
Genetic Testing
Definition

Informed decision making

Non-directional counseling (give no opinion only info)

Term

Family Genes

Refer when 2+ are present

Definition

F family characteristics are obvious

G groups of anomalies (3 or more)

E extreme presentation (early onset or abnormally severe)

N neurologic abnormalities

E exceptional pathology (rare findings)

S surprising lab values (hypocalcemia, chromosomes, etc)

Term
Types of Genetic Testing
Definition

Diagnostic Testing-do I have the gene?

Carrier testing-do I carry the gene but my other gene prevents me from having the disease

Predictive testing-what are my chances of getting the disease

Pre-symptomatic testing-do I have the gene but it's just not affecting me yet, but certainly will (Huntington disease)

Predisposition testing-if the test is positive, it is not 100% that I will get the disease (BRCA 1)

Term
Nurse Role in Genetics
Definition

Provide emotional support to families during the genetic counseling process

Provide basic info about patterns of inheritance

Identify patients who might benefit from genetic information/services

Provide accurate information about what is involved in genetic evaluation/counseling before referral is made

Find accurate, current information about gentic information for the patient and family

Access to Credible Genetics Resources Network

Identify patient's current knowledge and find out what they need to know first and find it

Identify community resources for the patient and family

Maintain confidentiality

Protect privacy

Term
Effective Communication
Definition

Use child first language:

The child with Down syndrome

Not A Down's child

 

Use neutral words

Use gene alteration or gene mutation

NOT defective or mutant

Down syndrome NOT Down's Syndrome

Term
ELSI: Ethics, Legal, Social Implications
Definition

http://agree.mc.duke.edu/index.html

Accessible genetics research ethics education

Family impact

Target screening for populations with increased incidence of a particular genetic condition

Term

Discrimination

GINA

Definition

G genetic

I information

N non-discrimination

A act

Term
GINA Federal Legislation
Definition

This legislation would prohibit discrimination on the basis of genetic information with respect to health insurance and employment

GINA provides strong, enforceable protections against the misuse of genetic information-the definition of which includes family health history-in both health insurance coverage and employement decisions

Term
Equal Access for Genetic Services
Definition

Informed consent necessary prior to blood being drawn for testing

Target populations where a gentic disease has an increased incidence so that early screening and treatment can occur.

Term
Advocate for Insurance Coverage
Definition

Generally most insurance underwriters approve payment on a case by case basis

Encourage patients to contest a decline of coverage