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Childbearing Patient
Developmental Self-Care Requirement
| Question | Answer |
|---|---|
| Implantation | 1. Blastocyst embeds into endometrium 2. Usually in upper/posterior uterine wall 3. 5-6 days 4. Chronic villi, finger like projections 5. Embryo 6. Germ cell layers developed (ectoderm, mesoderm, endoderm |
| Blastocyst | Embryoblast- inner layer forms: Embryo/amnion Trophoblast- Outter layer forms: Chorion/placenta |
| Childbearing Patient Components | 1. Anterpartum 2. Intrapartum 3. Postpartum 4. Neonate 5. Family |
| Multifetal Pregnancies | Twins: 1 in 43 pregnancies Dizygotic - Fraternal (2 mature ova fertilized by 2 seperate sperm) Monozygotic - Identical (1 fertilized ova splits) Multifetal - usually due to infertility drugs |
| Maternal/Fetal Heart Rates | -Funic Soufflé - fetal heart rate (110-160 is normal) -Uterine Soufflé - mothers blood flow -distinguish the above by the rate |
| Endocrine Function of the Placenta | Human Chorionic Gonadotropin (HCG) Human Placental (hPL) Progesterone Estrogen Relaxin |
| Umbilical Cord | Formed from Amnion Cord's blood is baby's blood (If there is only 1 vein and 1 artery in cord this can indicate cardiac abnormalities that would need to be ruled out.) Normally has 3 vessels (AVA - two arteries and one vein) Wharton's Jelly |
| Preconception Counseling | Physical Exam Dental Exam-women with poor dental hygiene are at higher risk for preterm labor. Nutrition-Should take 400mcg/day of Folic Acid before and during pregnancy. Exercise-continue what you are used to. Teaching |
| Factors that effect embryonic/fetal development | Environmental Teratogens -Maternal health, behaviors -Infectious Agents-TORCH -Chemical, meds, drugs, radiation Chromosomal or genetic -Chromosomal abnormalities -Single Gene Disorder |
| TORCH | T- taxoplasmosis O- Other (gonorrhea, syphilis, Hep B, HIV) R- Rubella (German Measels) C- Cytomegalovirus H- Herpes Symplex |
| Germ Cell Layers | Germ cell layers developed 1. Ectoderm (placenta, nervous system, pituitary). 2. Mesoderm (muscles, bones) 3. Endoderm (Respiratory, digestion, asophogus, lungs, liver, bowel, bladder |
| Taxoplasmosis | -Caused by taxoplasmosis gondii by eating raw or undercooked meat, unpasturized milk, contact with infected cat feces. |
| Rubella aka German Measels | Get maternal blood screened, get vaccinated, MMR vaccine postpartum. |
| Herpes Simplex Virus | Transmitted to baby during vaginal delivery (40% develope HSV within 2-12 days, half of 40% will die). Treatments- Valtrex PO and Acyclivor IV |
| Progesterone | Keeps endometrium healthy and prevents contraction. |
| Estrogen | For uterine and breast enlargement (for breast feeding). |
| Relaxin | Permits pelvis to expan, relaxes muscles in pelvic, helps with cervical softening, works with progesterone to help maintain the pregnancy. |
| GBS Infection | -Bacterial infection colinized in the vagina and rectum. -Screened at 35-37 weeks -GBS + -IV Antibiotics (PCN) at least 4 hours before delivery -Failure to treat can result in sepsis or death Baby needs to be Max: 18 hours after membrane rupt |
| Stages of Development | Pre-embryonic-0-15 days Embryonic- 15 days to 8 weeks Fetal - 9 weeks to delivery (0-8 weeks is most critical) |
| Safe Vaccines during pregnancy | Hep A & B Influenza (inactivated) IM Pneumonococcal (inactivated) Tdap Meningococcal Rabies |
| Contraindicated Vaccines during pregnancy | MMR Influenza (live) Varicella BCG Meningococcal Typhoid HPV |
| Neonate Abstinence Score (NAS) | GI: Poor feeding, excessive sucking, diarrhea. CNS: Hypertonicity, excoriation, tremors, inconsolability. Other: Nasal congestion, sneezing, sweating, fever, tachypnea. |
| Nursing Care for Neonatal Abstinence | -Review maternal history -Toxicology screening for newborn -Assessment for signs of withdrawal |
| Supportive Newborn Care for Neonatal Absitnence | Low stimulus environment Nutritional support Swaddling Non-nutritive sucking Skin Care Pharmocologic treatment based on severity of withdrawal symptoms. |
| Karyotype | Pictoral analysis of chromosomes |
| Genotype | Genetic make-up of gene pairs |
| Phenotype | Visible expression of genes (eye color, hair color, height, etc.) |
| FDA Classification for Pregnancy | Classification A-Vit C B-Penicillin, acetaminophen C-Heparin, Zidovudine, Orinase D-Tetracycline, Lithium, Streptomycin X-Coumadin, Diethylstilbestrol (DES), Accutane (Never give these) |
| Autosome Abnormalities | Down Syndrom-Trisomy 21 Edwards' Syndrom-Trisomy 18 Patau's Syndrom-Trisomy 13 Abnormal Structure- Cri Du Chat (translocation, addition, deletion) |
| Sex Chromosome Abnormalities | Turner Syndrom-femals, Monosomy X Kleinfelter's Syndrom- Males, Trisomy XXY |
| Autosomal Dominant Inheritance | Affected individual has affected parent 50% chance of passing on the gene Males and Femals equally affected Ex: Huntington's Disease, polycystic kidney disease, neurofibromatosis, Achondroplastic dwarfism. |
| Assessment for fetal well being-genetic screening | Amniocentesis and Chorionic villi sampling |
| Developmental Milestones Embryo/Fetus | 4- heart begins to beat 8-body organs and eyes/ears/nose/mouth/digits well-formed 12-sex recognizable 16-mother feels quickening 20-lanugo and vernix appear 24-hearing 28-weak cry/suck reflex; lecithin forms 36-plump/surfactant/myelination of brain |
| Teratogen | Any subs., organism, physical agent of defici. state present during gestation that is capable of inducing abno. postnatal structure or func. interfering with normal embryonic and fetal develop. -greatest effect during embryonic period-16-60 days concept. |
| Substance Abuse as Teratogen: Neonatal Effects | Alcohol-Craniofacial features, developmental delays, cognitive delays Tobacco-LBW, learning problems, SIDS Heroin-withdrawal within 24-72hrs after birth Cocaine-fetal effects are 2nd to maternal effects, growth restriction, behav. issuses, hypertonicit |
| Substance Abuse as Teratogen: Neonatal Effects | Methadone-more severe than heroin withdrawal, usually within 96 hours of birth Methamphetamine-often abuse of other substances |
| Chromosomes | Made of DNA, carry Genes |
| Genes | made of DNA, coded info |
| Human Cells | 23 pairs-homologous, matched 22 pairs of autosomes 1 pair sex chromosomes xx female xy male |
| Translocation | Pieces of chromosomes break off and attach to another chromosome somewhere in a person's genome: Burkitt's lymphoma, CML |
| Deletion | Portion of one chromosome deleted and added to another |
| Abnormality of Chromosome Structure Cri Du Chat | Missing piece in short arm of chromosome 5 Effectes 50-60 children yearly |
| Patterns of Genetic Transmission-Multifactorial | Combination of genetics/environment, mild to severe, familial (cleft lip/palate, pyloric stenosis, neural tube defects). |
| Patterns of Genetic Transmission-Unifactorial Mendelian | Single gene defect -autosomal dominant -autosomal recessive -x-linked recessive -x-linked dominant |
| Autosomal Dominant Inheritance | Affected individual has an affected parent 50% chance of passing on the gene Males and females equally affected Ex: huntington's disease, polycystic kidney disease, neurofibromatosis, achondroplastic dwarfism. |
| Autosomal Recessive Inheritance | Both parents are carriers 25% of passing on abnormal gene 25% of an affected child with each pregnancy 50% chance of having carrier child Males and females equally affected Ex: CF, Tay-Sachs, Sickle Cell, Inborn Errors Metabolism: PKU, Galactosemia |
| X-Linked Dominant Inheritance | Rare, occur in males/heterozygous females, affected females have normal gene, affected males transmit abnormal gene only to their daughters on X chromosome Ex: fragile X syndrome, vitamin D-resistant rickets |
| X-Linked Recessive Inheritance | Abnormal gene carried on X Female carries the abn. gene on one of her two X chromosomes A single abnormal copy of the recessive gene will cause the disease in a male. 50% pass to son affected 50% pass to daughter carrier Ex: Hemophilia, color blindne |
| Couples Risks Factors | Maternal age > 35 + family hx, cpl w/chrom abn. cpl w/a balanced translocation, Fam. hx of known or suspec. Mendelian (single gene) genetic disorder,previous child w/chromo. anomaly or metab.disorder, 2 + 1st tri spont. abortions, ethic groups at ^ r |
| Couples Risks Continued... | Abnormal MSAFP Women with teratogenic risk Maternal pre-existing medical conditions |
| Promotion of Normalcy Nursing Care: Educative/Supportive Nursing System | Prenatal care and teaching Anticipatory guidance emotional support identifies ethical, cultural, legal, and fiscal issues related to genetics Teach about teratogens and genetics and the impact of fetal well-being Support pt/fam in making informed dec |
| Promotion of Normalcy Nursing Care: Partially Compensatory Nursing System | Assist w/prenatal/postnatal diagnostic testing Monitor newborn for deviations-behavior changes, temperature instability, feeding difficulties, respiratory changes Encourage parent-newborn interaction Teach Re: modifications for newborn care, followup c |
| Promotion of Normalcy for Fetal Development | Nursing Dx -risk for disturbed maternal/fetal dyad -risk for impaired parenting Outcomes -verbalize factors that impact fetal well-being -demonstrate behaviors that reduce risk to fetus -participate in screening procedures as indicated |
Created by:
nglidden
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