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N370
OB
76
Nursing
Undergraduate 3
09/14/2011

Additional Nursing Flashcards

 


 

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Term
Conception:
Definition
The union of a single egg and sperm. (Gamete formation, ovulation, fertilization, implantation)
Term
Fertilization:
Definition
Penetration of the ovum by the sperm (with accompanying union of genetic material)
Term
Implantation:
Definition
(nidation) trophoblast secretes enzymes that burrow into the endometrium and bury the blastocyst. (6-10 days after conception)
Term
Chorionic Villi:
Definition
finger-like projections that develop out of the trophoblast to effect exchange of nutrients and O2.
Term
Chorion
Definition
covers the fetal side of placenta and has all the big vessels in it bring fetal blood to the placenta for exchange of nutrients and O2.
Term
Amnion
Definition
eventually surrounds embryo and forms a sac and covers the umbilical cord
Term
Amniotic fluid:
Definition
* initially a filtrate of maternal blood
* serves as cushion
* protects the cord
* maintains body temp
* helps fetus grow symmetrically
* provides testing material for fetal studies
Term
Umbilical cord
Definition
initially the stalk which attaches early embryonic cell mass to the chorionic villi,
has 2 arteries and 1 vein, with an average length of 22 inches at birth.
Wharton’s jelly surrounds vessels.
Term
Placenta
Definition
Organ of metabolic exchange (respiration, nutrition, excretion, storage) and hormone production
Semi-permeable barrier able to keep out many compounds, proteins, bacteria, etc that are of large molecular weight but not many of the deleterious enemies of the fetus fit this description.
Term
The placenta functions by
Definition
simple diffusion
active transport
pinocytosis
Term
Functioning is directly related to maternal circulation. With maternal circulation dependent on
maternal blood pressure
condition of her vessels
maternal position
uterine contractions
Definition
Placenta
Term
Placenta functions as:
Definition
A means of metabolic exchange
Respiration
Nutrition
Excretion
Storage

Endocrine gland producing four hormones to maintain pregnancy
Human chorionic gonadotropin (hCG)
Human chorionic somatomammotropin (hCS) or hPL
Progesterone
Estrogen
Term
Embryo:
Definition
day 15-week 8 after conception
Term
Embryo:
Definition
day 15-week 8 after conception
Term
Embryonic stage
Definition
(day 15 – week 8):
Critical period of development
structures/systems
Stage most susceptible to
teratogens
Term
Fetal stage
Definition
(week 9 – end of pregnancy):
Refinement and maturation
of structures/systems.
Critical period continues for
neurologic development
Cephalocaudal development
Term
Gestation:
Definition
period of intra-uterine development from conception through birth (pregnancy)
Term
Gravida:
Definition
a pregnant woman
Term
Primigravida:
Definition
pregnant for the first time
Term
Multigravida:
Definition
pregnant more than once
Term
Parity:
Definition
the number of pregnancies in which the fetus or fetuses have reached viability ( ~20 weeks)
Term
Nullipara:
Definition
a woman who has not completed a pregnancy to viability
Term
Primipara:
Definition
a woman who has completed one pregnancy to an age of viability
Term
Multipara:
Definition
a woman who has completed more than one pregnancy to viability
Term
Abortion:
Definition
loss of pregnancy prior to the age of viability
Term
Stillbirth:
Definition
fetal loss greater than the age of viability
Term
Term pregnancy:
Definition
38 – 42 weeks gestation
Term
Preterm:
Definition
20 weeks-prior to 37 weeks gestation
Term
Postdate or Postterm:
Definition
after 42 weeks gestation
Term
hCG
Definition
Earliest biochemical marker for pregnancy
Basis of test
Detected 7-10 days after conception
Term
Radioimmunoassay (RIA)
Definition
Blood or urine
Use radioactively labeled marker
Tests for beta subunit of hCG
Term
Radioreceptor (RRA)
Definition
serum
Measures ability to inhibit binding of radio-labeled hCG to receptors
Term
Enzyme-linked immunosorbent assay (ELISA)
Definition
Urine
Most popular
Uses anti-hCG with enzymes to bond with hCG in urine
Term
Changes to reproductive system during pregnancy
Definition
Uterus
• Increases in both numbers and size of cells, increased vascularity, and development of decidua

• Process of enlargement is hormonal in first trimester and mechanical after that.

• Shape of the uterus changes as it rises out of abdomen

• There is a correlation between uterine size and weeks gestation
• Increased uterine blood flow and pelvic congestion produce Chadwick's sign; bluish color to the cervix

• Capacity of the uterus grows 500, even 1000 times

• The round ligaments that help to hold the uterus in place, enlarge and stretch, eventually the intestines are pushed to the side.

• Non-expulsive contractions called Braxton Hicks contractions begin to facilitate blood flow.
Term
Changes to cervix
Definition
• Chadwick's sign.

• Glandular tissue becomes hyperactive and produces a thick tenacious mucous which plugs the cervix.

• Appearance of the cervical os changes with parity.

• In pregnancy there is increased friability
Term
Changes to the vagina
Definition
• Hormones thicken the mucosa, loosen the connective tissue and prepare the vaginal for birth

• Estrogen causes exfoliation of the vaginal mucosa, this rapid shedding of cells coupled with the increased secretion due to the high vascularity create an increase in vaginal discharged called leukorrhea

The pH changes, becoming more acidic
Term
Changes to breasts
Definition
• Can be one of the first things a woman notices when she is pregnant. Fullness, tingling, nipples become very sensitive.

• Increased pigmentation of the nipples and areola

• Increased vascularity is noted by the visibility of blood vessels that create a network visible beneath the skin.

• Montgomery's tubercles, small sebaceous glands in the areolar tissue enlarge produce a natural lubricant
• Striae may appear.

• If a pregnancy ends after 16 weeks the milk will come in

• High levels of estrogen inhibit the milk producing hormone prolactin from being secreted however colostrum is present in the third trimester.
Term
Changes to cardiovascular system
Definition
• Adaptation to meet increased metabolic needs created by pregnancy.

• Mild cardiac hypertrophy secondary to increased blood volume.

• Auscultatory changes: More audible split s1-s2 after 20 weeks and common to have systolic ejection murmurs but not over grade II

• Pulse increases to 10-15 BPM over her norm

• Arterial blood pressure decreases slightly in the first trimester, with a low point in the second trimester and returns to normal by the third trimester.
• Orthostatic hypotension is common as are varicosities and edema.

• Blood volume increases 30 -50% starting around ten weeks.

• Physiologic anemia.

• RBC production is accelerated.

• WBC levels increase then remain stable.

• Cardiac output is greatly increased.

• Function can significantly affected by maternal position and activity

• Coagulation tendencies are increased.
Term
Changes to respiratory System
Definition
• Structural changes occur: rib cage relaxes, there is an increase in the diameter of thoracic cage

• Small degree of pregnancy induced hyperventilation due to progesterones effect on the CNS

• Increase vascularity leads to congestion of upper airways and nasal and sinus stuffiness, epitaxsis and even voice changes.
Term
Metabolic Regulation in pregnancy
Definition
• BMR is increased related to the increased oxygen demands and increased cardiac work. Dissipation of excess heat from this increased BMR is why pregnant women feel so warm and sweat a lot.

• Thyroid function increases in response to higher BMR
Term
Renal system changes in pregnancy
Definition
• Ureters, renal pelvis dilate, smooth muscles like the linings of bladder, uterus and urethra have relaxed tone

• Relaxed tone makes women more susceptible to stagnant urine and infection, especially since the threshold for glucose is lower in pregnancy and glycosuria may be present creating an even more favorable environment for bacteria.
Renal System


• Ureters, renal pelvis dilate, smooth muscles like the linings of bladder, uterus and urethra have relaxed tone

• Relaxed tone makes women more susceptible to stagnant urine and infection, especially since the threshold for glucose is lower in pregnancy and glycosuria may be present creating an even more favorable environment for bacteria.
Renal System


• Ureters, renal pelvis dilate, smooth muscles like the linings of bladder, uterus and urethra have relaxed tone

• Relaxed tone makes women more susceptible to stagnant urine and infection, especially since the threshold for glucose is lower in pregnancy and glycosuria may be present creating an even more favorable environment for bacteria.
• Decreased bladder tone may make the bladder hold far more urine then normal...if the mechanical pressures don't make her void every half-hour.

• GFR is increased due to blood volume and demands for waste excretion are increased with fetal waste present.

• To maintain the blood volume needed, the kidneys increase their ability to retain Na.

• Protein in urine in measurable amounts is abnormal and a sign of renal disease

• The best maternal position for renal function is the left lateral recumbent.
Term
Chloasma
Definition
mask of pregnancy,
fades after pregnancy
Term
Human Chorionic Gonadotropin (HCG):
Definition
Secreted by trophobast in
early pregnancy to stimulate corpus
lutem to continue estrogen and
progesterone production in order
to maintain the pregnancy until
the placenta can assume that function.
Term
Human Placental Lactogen (hPL):
Definition
also called Human Chorionic
Somatomammotropin is an antagonist
of insulin creating increased circulating
free fatty acids and glucose for metabolic
needs.
Term
Estrogen:
Definition
Secreted first from
the corpus luteum by the seventh
week of pregnancy it is mostly a
placental hormone.
It stimulates uterine development
to provide an appropriate
environment for the fetus
It helps to develop the ductal system
of the breast. (tissue building and
increased vascularity)
Term
Progesterone:
Definition
Produced first by the
corpus luteum and then by the placenta
It plays the greatest role in maintenance
of the pregnancy.
It maintains the endometrium and inhibits uterine contractility. (smooth muscle relaxation; uterus, G-I ,vessels)
Term
Relaxin:
Definition
The primary source
is the corpus luteum but some
may come from the placenta or
decidua.
Acts to inhibit uterine contractions
Softens cervix and "remodel collegen"
Term
Prostaglandins:
Definition
Lipid substances
arising from most tissues but
greater concentrations in the female
reproductive tract.
Involved in initiation
of labor. Mechanism unclear.
Term
Presumptive signs of pregnancy
Definition
1. Breast Changes
2. Amenorrhea
3. Nausea, Vomiting
4. Urinary Frequency
5. Fatigue
6. Quickening
Term
Probable signs of pregnancy
Definition
1. Goodell’s sign
2. Chadwick’s sign
3. Hegar’s sign
4. Positive pregnancy test
5. Braxton Hick’s contractions
6. Ballotment
Term
Positive signs of pregnancy
Definition
1. Visualization of fetus
2. FHT’s
3. Fetal movement palpated
Term
Pregnancy assessment
Definition
History: Demographics
Gyn history
Family history
Medical history
OB history (previous pregnancies)
Present pregnancy
LMP vs. LNMP
EDC: Nagele’s Rule
Pregnancy tests
Planned pregnancy and is father supportive?
Problems or events of this pregnancy
Signs and symptoms of pregnancy
Patient preferences: Support persons, birth plans, planned medications, early DC
Term
EDC or EDD:
Definition
expected date of confinement or delivery
266 days from conception
280 days from first day of LMP assuming a 28 day cycle
9 calendar months
10 lunar months (4 week months)
Term
Nagele's rule
Definition
Based on 28 day regular cycle
Add one year
Subtract 3 months and add 7 days to the
first day of the last menstrual cycle.
Term
Physical Exam (initial)
Definition
a complete physical, focusing on the reproductive system.

assessment of the nipples related to breastfeeding

assessment of the fundal height, or assessment of uterine size by bimanual exam.
FHTs

DTRs, edema and varicosities

Measurement of the adequacy of the bony pelvis
Term
Lab work (initial)
Definition
Blood work
type and Rh, antibody screen for Rh
or other blood related antibodies
serology RPR or VDRL
HBsAg
Rubella screen
CBC
Maternal serum AFP/prenatal risk screen between 14-18 weeks. Or earlier if “sequential screening” indicated or requested

HIV screen by inclusion
Cultures:
GC, Chlamydia, Herpes only with lesions or to check for cervical shedding

Urinalysis and culture is necessary

Pap smear

Others as history indicates: Sickle prep, PPD
Term
The return OB visit
Definition
Typically see clients
1x/month till 28 weeks
2x/month 28-36 weeks
1x/week 36-40 weeks
more frequently if go past 40 weeks, at least 2x/week.

client weighs self and checks her urine looking for glycosuria or proteinuria

Midwife or nurse does BP

Chart to compare to norms and observe pattern

Encourage and answer questions.
Anticipatory Guidance
Term
Ongoing lab work
Definition
28, 36 weeks Hct

28 weeks 1 hour post 50gm glucola

28 weeks Rhogam if Rh neg

Cultures as history deems necessary
Term
Continued assessment
Definition
Fundal Height Measurements

Fetal Heart tones: Doptone, Fetascope

Fetal Movement: Quickening, Monitoring

Fetal Position: Leopold maneuvers

Discuss progress of pregnancy
share patterns of growth: weight, fundal height
how new developments such as quickening compare to norms
refer to fetus as a person
Term
1st trimester anticipatory guidance
Definition
Hazards
Radiation
Drugs
Hyperthermia
Infections – viral/bacterial

Danger signals
Severe vomiting [ hyperemesis gravidarum
Chills, fever, burning on urination, diarrhea [ infection
Abdominal cramping; vaginal bleeding [ miscarriage, ectopic pregnancy

Discomforts/relief measures
Nausea and Vomiting
Urinary frequency
Breast tenderness
Increased vaginal discharge (leukorrhea)
Nasal stuffiness and epitaxis
Ptyalism
Mood swings/ambivalence
Term
2nd trimester anticipatory guidance
Definition
Discomforts and Relief Measures:
Pigmentation deepens; acne, oily skin
Spider nevi
Pruritus
Palpitations
Supine hypotension and bradycardia
Faintness
Food cravings
Heartburn
Constipation
Flatulence with bloating/belching
Varicose veins
Headaches
Carpal tunnel syndrome
Periodic numbness, tingling of fingers
Round ligament pain
Join pain, backache, pelvic pressure
Teaching related to Danger Signs For:
Preterm labor
Hypertensive conditions
Term
Third trimester anticipatory guidance
Definition
L&D material
Discomforts / Relief measures
Heartburn
Dependent edema
Varicosities, hemorrhoids
Constipation
Backache
Leg cramps
Faintness
Shortness of breath
Insomnia
Mood swings, ambivalence, increased anxiety
Urinary frequency and urgency
Braxton Hicks uterine contractions
Danger Signals: Decreased Fetal Movements
Term
Preterm Labor
Incidence: 10%
Morbidity and Mortality
83% morbidity
Causes: 50% unknown
Risk factors and Causes
Signs and symptoms:
Definition
Uterine contractions q 10min or more frequent with or without other signs
Menstrual-like cramps felt in lower abdomen constant or intermittent
Low dull backache felt below the waistline either constant or intermittent
Pelvic pressure that feels like the baby is pushing down either constant or intermittent
Abdominal cramping with or without diarrhea
Increase or change in vaginal discharge
Term
Maternal Weight Gain
Definition
Expected pattern is 2-5lbs in the first trimester and about a pound (450g) a week in the second and third trimesters

Poor weight gain is defined as less then 2.2lbs or 1kg per month in the second and third trimesters.
Term
Wt gain in pregnancy
Definition
Baby 7 -8.5 pounds
Amniotic fluid 2
Placenta 2-2.5
Uterus 2
Breasts 1-4
Increased Blood Volume 4-5
Increased Fluid 3-5
Maternal stores 4-6
Term
Energy needs:
Definition
variable but we use 300 calories as the average. For increased BMR, energy needs
Term
Protein:
Definition
60 gms is needed for just about everything...fetal and placental growth, maternal blood volume and constituents, maternal tissues, to maintain colloidal osmotic pressure and store reserves.
Term
Iron:
Definition
30 mg above norm of 15 mg needed. Needed to make RBCs and for fetal stores.
Term
Folic Acid:
Definition
recommended 0.4- 0.8 mg multiple pregnancy. RX prenatal vitamins usually have .08. Needed in DNA synthesis and maternal erythropoiesis.
Term
Calcium:
Definition
1000 -1200mg
Term
Every pregnant women should be on a multivitamin with
Definition
minerals (iron, mag, zinc, cal/pho) and folic acid.
Term
Avoid excess in
Definition
fat soluble vitamins
Term
The Psychological Trimesters of Pregnancy
FIRST TRIMESTER:
Definition
Focus is on self, begins to do "cost Analysis” the benefits vs. the worries...may be unsure and scared...moody. Watches and analyzes every physical change. (Body Image)

Ambivalence is a common trait of early pregnancy even in the most planned pregnancy. Not accepting pregnancy does not mean not accepting the child.
Term
The Psychological Trimesters of Pregnancy
SECOND TRIMESTER:
Definition
Mother feels movement...fetus says "I am!"
Mother is interested in producing a healthy baby and looks to ways to do so...proper eating etc.
This is the time when she feels best. Develops a narcissism love of self...baby and she are one.
May become involved in traditional feminine activities; cooking, crafts.
Tends to seek out other pregnant women or recent mothers.
May increase or renew contact with her own mother.
Begins to question what the baby will be like, sex etc
Increasing feelings of protectiveness towards infant and increasing sense of vulnerability about herself.
Term
The Psychological Trimesters of Pregnancy

THIRD TRIMESTER:
Definition
Increasing intensity in feelings of vulnerability...sees world as hostile, doesn't want to be alone.
Sees herself as alone …no one really cares or understands...may seek additional support
Sees the baby as simultaneously one with her but separate from her
Focus is on labor and delivery
process...fears, unsure.
Wants to hear birth stories.
Childbirth classes to increase
knowledge base.
Increasing discomfort helps
to separate fetus from mother
"I want out of this" tired of pregnancy.
Term
PSYCHOLOGICAL TASKS
Definition
Acceptance of pregnancy
Reordering of relationships
Acceptance of fetus as a separate individual
Acceptance of the mother/father role
Resolution of fears about childbirth
Attachment
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