Exam 9: Exam Block Review
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| What is gametogenesis? | production of gametes i.e. sperm and ovum
23 chromosomes
24 hours ovum
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| How long can the ovum and sperm survive in the reproductive tract? | 5 days
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| zygote | formed at conception 0-2 weeks
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| Embryo | 2-8 weeks
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| Fetus | 9 weeks to term
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| Where does fertilization usually occur? | Outer 1/3 of the fallopian tubes.
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| What is implantation bleeding? | occurs when the blastocyst begins to burrow into the decidua or “implants” May be mistaken for a light period.
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| How long can the ovum and sperm survive in the reproductive tract? | 5 days sperm
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| zygote | what is formed at conception 0-2 weeks
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| What is the age of viability? | 20 weeks is the age of “legal” viability (need a death certificate for fetus)
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| Embryo | 2-8 weeks
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| Fetus | 9 weeks to term
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| Where does fertilization usually occur? | Outer 1/3 of the fallopian tubes.
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| What is implantation bleeding? | occurs when the blastocyst begins to burrow into the decidua or “implants” May be mistaken for a light period.
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| Which two can re-open after birth if certain congenital defects are present? | Ductus Venosis and foramen ovale.
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| How many vessels are there in the umbilical cord? | Three vessels; two arteries one vein. Arteries carry deoxygenated blood back to placenta. Vein carries oxygenated blood to fetus.
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| What happens at 28 weeks that increases the premature infant’s chances of survival? | Increased production of surfactant
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| Name three functions of the amniotic fluid. | Provides cushion to protect infant from trauma; maintains constant temperature, allows symmetrical growth, allows buoyancy and fetal movement.
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| Name the three fetal circulatory shunts. | Ductus venosus shunts blood away from liver to inferior vena cava foramen
ovale shunts blood from right atrium to left atrium
ductus arteriosus shunts blood from pulmonary artery to aorta bypassing the lungs and the left side of the heart
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| What is the function of the placenta? |
Site of exchange of nutrients and oxygen for waste products and carbon dioxide.
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| Which twins originate with one fertilized ovum? | Identical twins
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| Describe changes in fetal heart at birth. | First big breath > fluid in lungs and lung expansion. O2 ↑. arterioles dilate ↓ resistance pulmonary vascular bed and on the r sid eof <3. DA closes. Cord clamped the systemic BP ↑ leading to ↑ pressure on the left <3 closure of the foramen ovale.
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| Name three of the possible complications from a multi-gestational pregnancy? | SAB, chromosomal anomalies, pre-term delivery, growth restriction, congenital defects, fetal death, pre-eclampsia.
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| What does gravida mean? | Gravid means pregnant (a twin gestation only counts as one under Gs and one under Ps)
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| What is the function of the placenta? |
Site of exchange of nutrients and oxygen for waste products and carbon dioxide.
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| What does para mean? | Para is the # of pregnancies that last at least 20 weeks even if baby is not born alive.
Term, Pre-term, Abortions, Living
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| Which twins originate with one fertilized ovum? | Identical twins
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| Name 3 presumptive signs of pregnancy. | Presumptive: amenorrhea, n/v, urinary frequency, breast tenderness, pigmentation changes, fatigue, quickening.
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| Name 2 positive signs of pregnancy | visual verification by ultrasound. Fetal movement detected by an examiner other than the mother herself, auscultation of fetal heart sounds.
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| What is amenorrhea? | Lack of menstruation
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| What hormone is the basis for pregnancy tests? | HCG
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| What does para mean? | Para is the # of pregnancies that last at least 20 weeks even if baby is not born alive.
Term, Pre-term, Abortions, Living
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| What test is the most accurate to determine pregnancy? Blood or urine? | BLOOD
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| What is amenorrhea? | Lack of menstruation
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| What is quickening? | Mother feels the baby move for the first time
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| What is the usual schedule for prenatal care visits? | One visit a month through the 7th month, then every two weeks a month and then weekly until delivery.
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| What advice about working would you give to a pregnant active duty soldier. | should address working conditions such as limits on lifting, long periods of time standing or sitting. Work should not lead to undue fatigue. Frequent rest periods. Exposures to hazardous chemicals need to be avoided.
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| What hormone is the basis for pregnancy tests? | HCG
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| What test is the most accurate to determine pregnancy? Blood or urine? | BLOOD
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| What would you say to the patient who is worried that her parents do not seem to be excited about this baby? | Your parents may have some ambivalence about becoming grandparents or may not be as excited as they were for their first grandchild.
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| What is the significance of a pregnant woman’s rubella titre? | DETERMINES IF SHE IS IMMUNE TO THE DISEASE OR NOT RUBELLA IS A TERATOGENIC DISEASE. IF SHE IS NON-IMMUNE WE NEED TO VACCINATE HER AFTER DELIVERY SO SHE WILL BE IMMUNE BEFORE ANY SUBSEQUENT PREGNANCY OCCURS.
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| What is the significance of a pregnant woman’s RH status? | Rh factor protein marker on exterior of RBC. RH negative Mom (does not carry marker protein) & baby is RH positive, possible antibodies to baby’s blood type that can cross placenta & hemolyze the baby’s RBCs leading to severe fetal anemia
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| Name four complications associated with smoking in pregnancy. | SAB, PTL, ABRUPTION, PREVIA, IUGR
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| What is FAS? | FETAL ALCOHOL SYNDROME. CHARACTERIZED BY FLAT FACE, THIN UPPER LIP, SMALL EYES AND SMALL CHIN. ASSOCIATED WITH MENTAL RETARDATION AND OTHER CONGENITAL DEFECTS.
MOST DRUGS CAN CROSS THE PLACENTA AND SOME MAY BE TERATOGENIC.
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| Why do we discourage taking drugs and most medications during pregnancy? | FEW CONTROLLED STUDIES ARE AVAILABLE.
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| two nursing interventions Nausea | eat small frequent meals, separate fluid intake from meals, eat bland starchy foods and avoid spicy foods.
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| two nursing interventions Heartburn | eat small frequent meals. Do not eat for two hours before bed time., elevate HOB, use TUMS prn
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| Prenatal Care Constipation | Increase fluid and fiber intake, eat high fiber breads and cereals, fresh fruit and veggies, increase fluid intake to at least 8 full glasses/day.
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| Prenatal Care Back ache | pelvic rocks, heat, massage, sleep with pillow between legs and under pregnant tummy for support. Low healed shoes, stretching exercises.
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| Name two food sources each for protein, calcium, iron and folic acid. | Protein: meat, poultry, dairy, bean, nuts
Calcium: dairy, soy, green leafy vegetables
Folic Acid: liver, lean beef, kidney beans.
Iron: red meats, organ meats, molasses, whole grains, dark green leafy veg and dried fruit.
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| What is the recommended daily allowance for calcium in pregnancy? | 1200mg
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| What color does iron turn your stool? | Black tarry stools
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| What special dietary considerations are there for adolescent pregnancies? | Need to provide adeq calories and nutrition to meet Mom’s developmental needs as well as the fetus’s.
Pica is eating non-food substances
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| How much weight should a normal weight woman gain during pregnancy? | 25-35 lbs. NORMAL WT.
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| How much weight should an obese woman gain during pregnancy? | 15-25 LBS FOR OBESE WOMAN.
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| How can you best communicate with a patient who does not speak your language? | Obtain a medically trained interpreter. Avoid family, friends and children if possible.
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| How can you verify that a woman or her family understands what the nurse has told her? |
Ask the patient to restate what you told her in her own words or give you a return demonstration of a skill.
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| Name eight danger signs in pregnancy. | Gush of fluid
Vaginal bleeding,
Fever
Dysuria
Epigastric pain
Visual changes, edema above the waist, persistant HA unrelieved by tylenol
Decreased fetal movement.
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| Name three uses of ultrasound in pregnancy. | DETERMINE VIABILITY (CARDIAC ACTIVITY); DETERMINE DUE DATE, MEASURE AMNIOTIC FLUID, SCAN FOR CONGENITAL DEFECTS, PERFORM BIOPHYSICAL PROFILE, ESTIMATE GROWTH THROUGH SERIAL SCANS TO CHECK FOR IUGR. DOPPLER US TO MEASURE BLOOD FLOW THROUGH THE PLACENTA.
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| What is the rationale for having a full bladder for U/S in the second trimester? |
A full bladder elevates the uterus out of the pelvis for better visualization. Instruct the patient to drink several glasses of water an hour before the procedure.
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| Name two purposes of amniocentesis testing. | CHECK FOR FETAL LUNG MATURITY, INFECTION OR CHROMOSOMAL ABNORMALITIES.
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| Define a reactive non-stress test. | TWO ACCELERATIONS WTIHIN A 20 MINUTE WINDOW WITH A BASELINE FHR WNL.
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| Define an SAB | spontaneous loss of a pregnancy before 20 weeks.
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| More than half of all SABs are caused by | Chromosomal abnormalities or congenital defects incompatible with life.
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| What is the difference between a threatened abortion and an inevitable abortion? | THREATENED ABORTION = CRAMPING AND BLEEDING.
INEVITABLE ABORTION=CERVICAL DILATION, ROM AND/OR DEATH OF FETUS.
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| What are your priority nursing assessments for the woman with an ectopic pregnancy or SAB? | VS, I&O, ASSESS FOR SIGNS OF SHOCK, OR SUDDEN CHANGES IN THE QUALITY OF THE PAIN, ASSESS AMOUNT OF BLEEDING, ASSESS H/H.
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| What is a missed abortion? | FETAL DEMISE WITHOUT SPONTANEOUS EVACUATION OF THE PRODUCTS OF CONCEPTION BY THE BODY.
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| Define ectopic pregnancy | IMPLANTED EMBRYO OUTSIDE THE UTERUS
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| What are the s/sx of ectopic pregnancy? | VAGINAL BLEEDING, ABDOMINAL PAIN, AMENORRHEA OR ‘MISSED PERIOD’
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| What is Rhogam? | RHOGAM=ANTIBODIES TO RH FACTOR FROM POOLED DONOR SERUM TO PREVENT RH SENSITIZATION IN RH NEGATIVE MOTHERS
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| When should pregnant women get Rhogam? | 28 WEEKS AND POSTPARTUM (IF BABY IS RH +) and after SABs or invasive obstetric procedures like a CVS or amniocentesis.
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| What is erythroblastosis fetalis? | MASSIVE LYSIS OF RBCS DUE TO BLOOD INCOMPATIBILITY, USUALLY RH, BETWEEN MOTHER AND FETUS.
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| What are s/sx of placenta previa vs. placental abruption. | PREVIA = PAINLESS VAGINAL BLEEDING USUALLY STARTING IN SECOND TRIMESTER
ABRUPTION = ABDOMINAL PAIN WITH BLEEDING IN 2ND OR 3RD TRIMESTER
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| Define gestational hypertension (GHTN). | PIH = PREGNANCY INDUCED HYPERTENSION, HTN DIAGNOSED AFTER 20 WEEKS OF PREGNANCY. AKA Gestational hypertension.
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| Define pre-eclampsia | PRE-ECLAMPSIA = HTN + PROTEINURIA
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| Deine eclampsia | SEIZURES in pregnancy
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| What pathophysiologic change underlies all the symptoms/issues associated with pre-eclampsia. | Vasospasm
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| What is the priority of care for the patient with pre-eclampsia? | Improve placental perfusion and fetal oxygenation and prevent seizures and other complications r/t pre-e such as stroke.
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| How often should you check DTRs on the patient on magnesium sulfate? | Triceps, biceps, achilles and patellar reflexes should be checked q one hour. Diminishing or absent reflexes may indicate magnesium toxicity and should be reported to hcp promptly.
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| The criteria for proteinuria in pre-eclampsia is ___ milligrams in 24 hours? | >300 mg/24 hours or a random urine dipstick of > 1+
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| What is HELLP syndrome? | HEMOLYSIS.
ELEVATED LIVER ENZYMES.
LOW PLATELETS.
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| What is the role of magnesium sulfate in the treatment of pre-eclampsia? | Prevention of seizures.
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| What should you teach the woman with mild pre-eclampsia who is being managed as an outpatient? | Check her BP 2-4x/day, to rest frequently during the day and in the lateral position for at least 1.5 hours/day. and to report sx that suggest worsening pre-e such as visual disturbance, severe HA or epigastric pain or decreased fetal activity.
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| How often should a diabetic pregnant woman check her blood glucose? | CHECK BLOOD GLUCOSE 5-6 OR MORE TIMES/DAY INITIALLY
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| How many meals and snacks should she have a day? | 3MEALS AND 3 SNACKS.
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| When do insulin needs increase the most? | Insulin requirements increase the most in the second trimester.
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| What risks of pregnancy are increased in a pregnant woman with pre-existing diabetes? | They are at an increased risk for hypo and hyperglycemia, pre-eclampsia, UTIs, PROM, polyhydramnios and C/S.
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| What are some of the potential fetal and neo-natal effects on infants of diabetic mothers? | LGA OR MACROSOMIA, HYPOGLYCEMIA, HYPOCALCEMIA AND JAUNDICE, INCREASED RISK FOR LUNG IMMATURITY.
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| What topics should you cover in the teaching of a diabetic pregnant woman? | Diet, (exchanges or carb counting) how to self administer insulin, s/sx and treatment for hypo and hyperglycemia, potential complications related to poor glucose control for both her and the baby.
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| What should the FBS be for pregnant women with gestational diabetes? | <95
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| How much does blood volume increase during pregnancy? How does this impact the woman with heart disease? | 40-50% INCREASES WORK LOAD ON THE HEART;
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| Name 4 signs of CHF in a pregnant woman. | Dyspnea, chest pain, hemoptysis, peripheral edema, sudden weight gain.
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| Your textbook defines anemia in pregnancy as a hct/hgb of: | Riskiest time for acute CHF is during labor and immediately after delivery
Anemia is h/h < 32% or hgb < 11 g/dL
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| Why does the risk of DVT increase in pregnancy? | INCREASED ESTROGEN > INCREASED CLOTTING FACTORS, DECREASED ACTIVITY AND DILATION OF BLOOD VESSELS PROMOTES VENOUS STASIS.
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| What are the signs of excessive anti-coagulation? | BRUISING, BLEEDING GUMS, BLOOD IN URINE OR STOOL, NOSE BLEEDS.
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| Folic acid deficiency is associated with what birth defect? | OPEN NEURAL TUBE DEFECTS.
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| What ethnic population is at highest risk for sickle cell disease? | African Americans
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| How many parents must carry sickle cell trait for the child to have the disease? | Both
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| What is Cooley's anemia? | Thalassemia major.
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| What foods aid absorption of iron? | ACIDIC FOODS LIKE CITRUS.
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| What foods inhibit the absorption of iron? | Dairy, tanins (like tea or coffee) antacids and high fiber grains may block absorption
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| List the TORCH infections. | TOXOPLASMOSIS, OTHER, RUBELLA, CMV, HERPES/HEPATITIS B
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| Name the most common side effects associated with TORCH infections in pregnancy. | SAB, CONGENITAL DEFECTS
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| What is your priority of care for the pregnant woman with traumatic life threatening injuries? | ALL HANDS GO DOWN WITH THE SHIP, STABILIZE MOM FIRST THEN WORRY ABOUT BABY.
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| Name the three leading causes of traumatic death in women during the child bearing years. | MVA, HOMICIDE, SUICIDE
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| Name three ways to prevent traumatic injuries to pregnant women. | Seat belts, sensible shoes, steps to avoid falls, high index of suspicion for domestic abuse
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| What nursing interventions are important after a cord prolapse? | Turn mom to side with hips elevated on pillows, in knee chest position, or in trendelenberg and use a hand in the vagina to push the baby up off the cord. Call the OR team STAT for an emergency C/S delivery.
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| When dealing with patients from different cultures what is the most important thing to keep in mind? | Each person is an individual and not necessarily a representative of an entire culture. Ask them about their preferences and do not assume that you know.
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| Name one advantage and one disadvantage of delivering in hospitals or at home. | Delivering in a non-hospital is lower $ & increased freedom of movement &autonomy. Hospital immediate access to emergency facility & an OR. Disadvantage of home birth longer access emergency services. Disadvantage of hospital care is increased cost
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| Describe when laboring women should come into the hospital. | Primigravida go to hospital when contractions consistently no more than 5 mins apart for 1 hr & can no longer walk or talk through contractions or SROM.
Or for Bleeding other than bloody show. , decreased fetal movement or any other concern.
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| Why should a woman with SROM go to the hospital even if she is not contracting? | Risk for infection increased over time with ROM and she is also at risk for cord prolapse if the baby is not well engaged in the pelvis.
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| What is the difference between true and false labor? How does the nursing care differ? | In true labor the cervix makes change i.e. dilates and or/effaces. In false labor the cervix does not change.
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| Define effacement and dilation. | Effacement is the thinning and shortening of the cervix from approx 3.4 cm to 0 cm.
Dilation is the opening up of the cervical os from a closed position to 10 cm.
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| What is the difference between latent labor and active labor? | Latent labor contractions are mild & irregular & cervical change is slow.
Active labor contractions strong, regular, speed of cervical dilation usually increases to approx 1.2 cm/hr for a nullipara and 1.5 cm/ hr for a multipara.
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| Hypertonic labor: | frequent painful contractions without cervical change (very similar to false labor) encourage rest and offer pain relief.
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| Hypotonic labor dysfunction: | Labor starts normally and then stalls out after 4 cm. NI: stimulate labor, AROM, Pitocin, ambulation.
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| Name one risk factor for dysfunctional labor | The most common risk factor for dysfunctional labor is hyperdistension of the uterus ie. Twins, polyhydamnios, macrosomia.
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| What part of the skull is used to describe the infant’s “position” in the pelvis during labor? | The occiput.
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| What does LOA mean? | Left occiput anterior
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| What does ROP stand for? | right occiput posterior
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| What are the four P’s? | The 4 Ps are the Powers, the Passage, the Passenger and the Psyche.
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| What is a breech presentation and why is it potentially dangerous? | Breech presentations may be frank breech, full breech and footing breeching. Problem with breech is risk of head entrapment with cord compression with part of cord outside of mother’s body. Footing breech also has an increased risk for cord prolapse.
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| What causes labor pain? | Labor pain is caused by stretching of the cervix, vagina and perineum.
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| What is the most important assessment immediately after ROM? | FHR for at least 60 seconds.
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| What are the three phases of the first stage of labor? | Early/latent, active and transition
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| Describe signs of imminent delivery. | Feeling like you need to have a BM (rectal pressure), involuntary grunting or the urge to bear down during contractions. Patients who can’t sit flat on their bottom but keep twisting to keep one buttock off the bed.
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| What drug is usually given first to help the uterus contract? | Pitocin
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| What is the most likely cause of hemorrhage post partum? | Uterine atony (boggy uterus)
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| Name three risk factors for postpartum hemorrhage. | Obesity, use of pitocin for induction or augmentation of labor, prolonged labor, previous history of PPH, pre-eclampsia, multiple pregnancy, polyhydramnios, macrosomia or anything associated with uterine hyperdistension during pregnancy.
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| What role does the bladder play in affecting uterine hemorrhage? | A full bladder may lift the uterus out of the pelvis and cause uterine atony > hemorrhage
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| What should you assess after ROM? | FHR, color, amount and odor of fluid.
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| What are two signs of maternal infection during labor. | Maternal fever > 100.4, abdominal tenderness (btn contractions) fetal tachycardia, foul smelling amniotic fluid.
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| Name 3 potential maternal complications from a precipitous labor. Fetal complications? | Cervical, vaginal, vulval lacerations or hematomas. Uterine rupture and an increased risk of PPH. Fetal trauma: PIVH (esp. premies), hematomas, bruising and nerve damage.
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| What is your priority nursing intervention for a boggy uterus? | Massage the fundus.
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| What are your priority nursing interventions after a pre-eclampsia seizure? | Turn pt to side to prevent aspiration, have suction immediately available tq the bedside if needed, apply O2 at 8-10L/sfm, put up side rails and pad to prevent injury in the event of another seizure. Administer Mg Sulfate per orders.
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| Name 5 signs of magnesium sulfate toxicity | Early signs include excessive thirst and flushing, later signs include absent DTRs, decreased LOC, decreased UO, RR< 12/min.
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| What electrolytes should you monitor in the patient on pitocin and why? | Na and Cl due to fluid retention from pitocin’s ADH like side effects.
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| What risks does pitocin pose for the fetus? | Pitocin may cause uterine hyperstimulation leading to fetal hypoxia or intolerance to labor
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| What is the most common side effect associated with terbutaline? | Tachycardia and palpitations (heart pounding in her chest). Other common SEs include insomnia, anxiety and HA
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| drug that is Class B in pregnancy | animal studies have shown no risk to the fetus. No well controlled studies have been done on pregnant women.
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| drug that is Class C in pregnancy | Animal reproduction studies have shown an adverse effect on the fetus but no adequate, well controlled studies have been done on humans.
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| drug that is Class D in pregnancy | There is positive evidence of human fetal risk based on adverse reaction data, but in some cases potential benefits may warrant the use of the drug despite fetal risk. No safer alternative to the drug is available.
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| drug that is Class X in pregnancy | There is positive evidence of human fetal risk and the risk of using these drugs clearly outweighs any benefits.
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