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maternity exam 1
powerpoint
| Question | Answer |
|---|---|
| Process that takes place in the seminiferous tubules of the testes | Spermatogenesis: (key word sperm) |
| The process of producing gametes or sex cells(key word: sex cells) | Gametogenesis: |
| Process that gives rise to eggs. Takes place in the ovaries. | Oogenesis:(key word: ovaries) |
| For conception to occur, a(n) _______ must be available and _______ must take place | ovum; ejaculation |
| Sperm anatomy: (3) parts and their relevance | 1. Head=DNA, 2. Mitochondria in mid piece for energy, 3. Tail for movement |
| Maternal Psychological Responses: | First trimester, second trimester, third trimester |
| When does the preembryonic period begin? | 4 days after fertilization |
| What is the preembryonic period? | entry of zygote into uterus |
| During the preembryonic period, implantation occurs in the _____ | decidua |
| *Embryonic Development -Weeks 2 through 8 = -Weeks 8 through 40 = | -Weeks 2 through 8 = embryonic -Weeks 8 through 40 = fetus |
| Until when is baby considered a fetus? | Until the time he takes first breath and is viable. |
| *Fetal Development by Weeks (name what weeks this happens) The most critical part of the fetus is complete. | 9 – 12 weeks |
| *Fetal Development by Weeks (name what weeks this happens) Nearly all structures and organs are formed and begin to function; wt I ~0.25 ounces | 9 – 12 weeks |
| *Fetal Development by Weeks (name what weeks this happens) Only need growth for most structures/organs | 9 – 12 weeks |
| *Fetal Development by Weeks (name what weeks this happens) All nourishment is rec’d from placenta. | Weeks 13-20 |
| Fetal Development by Weeks (name what weeks this happens) Alveoli forming | Weeks 13-20 |
| What is the survival rate at week 20? | 25-35% |
| Weeks 20-30 _____are under production _____ is no longer translucent Infant can ____ mom and dad, recognize voices The _____ has entered rapid-growth stage _____ is starting to breakdown bilirubin | WBC,skin, hear, brain. liver |
| Weeks 20-30 _____ are moving down; testosterone is being produced Blood vessels in _____ develop, lungs secrete surfactant, 1.5 pts of _____ surround her ____ produces RBCs | Testes, amniotic fluid, Bone marrow |
| *What organ matures last? Why? | Lungs mature last=has to do with surfactant production |
| Fetal Development by Weeks (name what weeks this happens) Accumulation of fat is constant | Weeks 31-40 |
| Fetal Development by Weeks (name what weeks this happens) May hear heartbeat @ next appt. | Weeks 13-20 |
| Fetal Development by Weeks (name what weeks this happens) Fluttering movements; | Weeks 13-20 |
| Fetal Development by Weeks (name what weeks this happens) liver is fx; | Weeks 13-20 |
| Fetal Development by Weeks (name what weeks this happens) Sex glands begin to migrate to correct position; | Weeks 13-20 |
| Fetal Development by Weeks (name what weeks this happens) brain is fully developed. | Weeks 13-20 |
| Fetal Development by Weeks (name what weeks this happens) Skeleton is transforming from cartilage to bone. | Weeks 13-20 |
| Fetal Development by Weeks (name what weeks this happens) kidneys making urine. | Weeks 13-20 |
| Fetal Development by Weeks (name what weeks this happens) Immunities being transferred from mom | Weeks 13-20 |
| Fetal Development by Weeks (name what weeks this happens) wt ~ 10.58 oz | Weeks 13-20 |
| **Fetal Development by Weeks (name what weeks this happens) Lungs are ONLY major organ left to mature | Weeks 31-40 |
| Fetal Development by Weeks (name what weeks this happens) Fetus turns towards light outside uterus | Weeks 31-40 |
| Fetal Development by Weeks (name what weeks this happens) Periods of dream sleep (REM) begin | Weeks 31-40 |
| Fetal Development by Weeks (name what weeks this happens) Amniotic fluid is at its highest level | Weeks 31-40 |
| Fetal Development by Weeks (name what weeks this happens) Antibodies are being transferred | Weeks 31-40 |
| Fetal Development by Weeks (name what weeks this happens) All 5 senses are working | Weeks 31-40 |
| The sperm head contains: a. Mitochondria b. Genetic material c. Energy for movement d. Axial filament | b. Genetic material |
| T/F: Weeks 2 through 16 = the embryonic phase? | False. 2-8 weeks |
| T/F: By week 12, nearly all structures and organs are formed and begin to function | True |
| T/F: Kidneys are the last major organ left to mature | False. Lungs |
| Chorionic Villus Sampling: Chorionic villi are microscopic projections that line the chorion – the ____ layer of the embryonic sac.Surgeons sample villi for genetic testing because they contain the _______as the fetus | outermost; same genetic material |
| Two sampling types | trancervical; transabdomenal |
| Fetal Circulation: *Umbilical cord is made up of ________. It aides in the exchange of _____ and ________ blood between _____ and ______Cord is protected by ________ | 2 arteries; 1 vein; nutrient and oxygen-rich blood between embryo and placenta. Wharton’s Jelly |
| Fetal CV system begins to develop toward end of ____ week. *Critical period is days after fertilization. Many critical events occur during cardiac development causing _____. | 3rd; 20-50; congenital heart defects |
| Fetal blood vessel connecting the umbilical vein to the inferior vena cava (IVC) | Ductus Venosus |
| Ductus Venosus is the featal blood vessel that connects the ___ vein to the _____ | umbilical vein to the inferior vena cava (IVC) |
| Protects lungs against circulatory overload. Allows the rt. ventricle to strengthen. Increases pulmonary vascular resistance, decreases pulmonary blood flow. Carries mostly oxygen saturated blood | Ductus Arteriosis |
| Ductus Arteriosis: Protects ___ against circulatory overload. Allows the ____ to strengthen. __ pulmonary vascular resistance, ___ pulmonary blood flow. Carries mostly ___ saturated blood | lungs; rt. ventricle; Increases; decreases; oxygen |
| *Shunts highly oxygenated blood from the rt. atrium to lt. atrium – right to left shunting | Foramen ovale |
| *Foramen ovale:Shunts highly oxygenated blood from the ____ to ____ – | rt. atrium to lt. atrium - right to left shunting |
| Changes at Birth Foramen ovale, ductus arteriosus and ductus venosus and umbilical vessels are ___ | No longer needed |
| Changes at Birth Ductus venosus ____ forcing blood entering the liver to go through _____. Occlusion of the placental circulation causes an immediate fall in ___ in ___ and ___ | Constricts; hepatic sinusoids. BP in IVC; rt. atrium |
| At first breath: Pulmonary alveoli ___. Pressure ___ in pulmonary tissue. Blood from ___ heart rushes to ____ tissue. Pressure in ___ heart ___. Pressure in ___ heart _____ as more blood returns from ___ tissues via ____ veins in _____. | open; decreases; right; alveolar; right heart; decreases; lt; increases; pulmonary; pulmonary veins; lt. atrium |
| *Associated with Rubella infection early in pregnancy | Patent Ductus Arteriosus (PDA) |
| Preterm infants usually have this r/t hypoxia and immaturity Can be surgically closed | PDA |
| Most common form of atrial septal defect (ASD). Hole is between r/l atria. Fails to close at birth. Some people live their whole lives with it. Sends blood around the lungs | Patent Foramen Ovale (PFO) |
| Monozygotic twins means that __ | their was one egg (identical twins) |
| Dizygotic twins means that __ | their are two eggs fertilized (fraternal twins; most common) |
| Colostrum is good because it | nits fibers of intestine, less allergies, less diseases |
| Maternal CV system responds to ___ metabolic demands of mother and fetus. Blood volume ___ beginning 6-8 weeks and continued until 32-34 weeks w/few changes after that. Increase in plasma volume is greater than RBC mass = decrease iron supplies = | Increased; increases; physiological anemia |
| CV System Heart murmur is common R/t blood volume Heart enlarges and is pushed upward to the ___ | increase; left |
| CV System *Peripheral vascular resistance ____ r/t progesterone/ prostaglandins causing smooth muscle relaxation | decreases |
| CV System B/P: Readings remain mostly unchanged r/t _____ PVR Affected by ____. ____ hypotension Mom in ___ (2nd/3rd tri) causing occlusion of vena cava resulting in dizziness, syncope, nausea, agitation. Solution? | decrease; position; Supine; supine,Change mom to rt. lateral position |
| sign of hypoxic patient | restlessness; fixed by switching position |
| T/F. The chorion villi are used for genetic testing because they contain the same genetic material as the mother. | False. Contain same genetic material as the fetus. |
| The normal umbilical cord should have 2 veins and 1 artery | False. 2 arteries and one vein. |
| Wharton jelly protects the mother’s vaginal canal during birth | False. Protects umbilical cord |
| Which shunt protects the lungs against circulatory overload? Ductus arteriosus Patent ductus arteriosus Ductus venosus | ductus arteriosus |
| Supine hypotension is a result of a mother rising too quickly from a sitting position | False. Supine means lying down. |
| Respiratory tract *Increase in hormone levels = capillary engorgement = swelling of ____, _____, _____ & _____ (think: _______) Diaphragm is elevated slightly to accommodate fetus resulting in slight ____ in lung capacity. | nose, oropharynx, larynx & trachea (think: nose bleeds); decrease |
| Respiratory tract O2 demands ___ gradually in response to fetus growth. | increase |
| GI Stomach and intestines are ____ Hormones effect the __________ causing ___ and _____ after morning sickness. *(Don’t really know – think it’s r/t ____). Mouth _____ more likely, r/t _____ levels | displaced; lower esophageal sphincter; heart burn; Appetite; hormones; Gingivitis; estrogen |
| GU _____ urgency 1st/3rd trimesters _____ causes relaxation of ureteral walls Flow of urine is partially blocked _____ pressure r/t size of fetus *Renal blood flow _____ 50-80% during pregnancy | increased; Progesterone; increasing; increases |
| * How much does renal blood flow increase during pregnancy? | 50-80% |
| Skin Hormones sometimes = ____ Hyperpigmentation occurs aka:___ Cutaneous vascular changes Tiny red areas; ____ *red palms aka ____ Connective tissue changes aka _____ | acne; Linea nigra; angiomas; Palmer erythema; Striae gravidarum |
| MSK Where does the fetus get its calcium from? What postural changes do pregnant women experience? | ›Fetus takes from mother’s storage ›Lordosis; “waddle” |
| Endocrine Pancreas blood glucose is ___ 10-20% compared to pre-pregnancy Adrenal glands- Cortisol goes __ during pregnancy. Aldosterone goes ____ slightly. | down; goes up; up |
| Placental Hormones Whats's the role of human chorionic gonadotropin (hCG)? *What are the two major placental hormones? | It protects deterioration of corpus luteum. Estrogen and Progesterone |
| *What's responsible for uterine growth, blood supply, uterine contractions (near term), glands/ducts for breast feeding, hyperpigmentation? | Estrogen |
| *What maintains endometrium for fertilized ovum, *prevents spontaneous abortion? | Progesterone |
| What protects deterioration of corpus luteum? | human chorionic gonadotropin (hCG) |
| *During what weeks is a women is said to have had a spontaneous abortion? | Before 20 weeks |
| What increases availability of glucose for the fetus? | Human placental lactogen (hPL) |
| *What relaxes connective tissue? | Relaxin |
| Name 2 metabolism changes during pregnancy? | Weight gain, edema (water metabolism). |
| Sensory Organs Cornea thickens r/t ____ ____ in estrogen = c/o blocked-ear = Can become mildly hard of hearing | edema; increase |
| Immunity Maternal immune response is _____ to allow fetus not to be rejected ›Auto-immune disorders such as RA get _____, but viral and fungal infections ____ | blunted; better; increase |
| Confirmation of Pregnancy Presumptive, Probable, or Positive indicators? Amenorrhea, N&V, Fatigue, movement, etc. | Presumptive Indicators |
| Confirmation of Pregnancy Presumptive, Probable, or Positive indicators? Abd enlargement, Cervical softening (Goodell sign, r/t vasocongestion) Uterine consistency changes (Hegar sign) | Probable indicators |
| Confirmation of Pregnancy Presumptive, Probable, or Positive indicators? Auscultation of fetal heart tones Fetal movement felt by examiner Visualization of the fetus | Positive indicators (only 3) |
| *What's the proper term for cervical softening and what type of confirmation of pregnancy indicator is it? | Goodell sign; Probable indicator |
| *What's the proper term for uterine consistency changes and what type of confirmation of pregnancy indicator is it? | Hegar sign; Probable indicator |
| Antepartum Assessment & Care | -Preconception visit (hopefully) -Initial antepartum visit HX OB, menstrual, contraceptive, med/surg, family/partner Physical exams VS, Wt, CV, MSK, neuro, UA, endocrine, GI, repro High risk assessment (Table 7-4) |
| Subsequent Visits | VS/wt/UA Fundal ht Leopold maneuvers Fetal heart rate; activity Teaching: Labor Ultrasound Glucose screening Pelvic exam -Multifetal visits Dx Maternal adaption Antepartum care |
| T/F Mothers experience a slight decrease in lunch capacity r/t the diaphragm being displaced by the fetus. | True |
| T/F Maternal renal blood flow decreases during pregnancy in response to the demands of the fetus | False. Increases |
| Palmer Erythema is a common occurrence for pregnant women | True. |
| Oxytocin decreases during pregnancy r/t progesterone levels | True |
| The two major hormonal players during pregnancy are: ________ & ________ | estrogen and progesterone |
| Pregnant women’s complaints about hearing loss are considered normal during pregnancy | True |
| During pregnancy women are more susceptible to viral and fungal infections | True |
| Cervical softening is called Goodell or Hegar sign? | Goodell |
| Specialized Labs***when are they testeed? what is this for? Maternal serum alpha-fetoprotein (MSAFP or AFP), hCG, Estriol | 16 – 18 weeks |
| Interpretation of High Maternal serum alpha-fetoprotein (MSAFP or AFP), hCG, Estriol = | Open neural tube defects; Trisomy 21 (Downs) Ultrasound Further testing is needed |
| During what weeks is the following done? Glucose screening -3 hr oral glucose tolerance Gestational diabetes | 26-28 weeks |
| Concern during week 35-36? | Group Beta streptococcus (GBS) -Can kill infant -antibiotics must be taken when mother goes into labor |
| what should you tell pregnant women about immunization? | NO live viruses- MMR, oral polio, smallpox |
| Maternal Psychological Responses:name the trimester -Uncertainty -Ambivalence (~51% are unintended!!) -Permanent life change -It’s all about ME | First trimester |
| Maternal Psychological Responses:name the trimester Beginning to “show” -Fetus (baby) is primary focus now -Narcissism & introversion | Second trimester |
| Maternal Psychological Responses:name the trimester -Vulnerability -Worry about their child -Fantasies, nightmares -Increasing dependency -Surprising to some partners Concentration trouble Preparation for birth -Fear/dread labor -Nesting about 2 | Third trimester |
| Maternal Role Transition Term Modeling others; wear maternity clothes before necessary; model waddle | Mimicry |
| Maternal Role Transition Term Holding other infants Seeking approval from partner, mother | Role-play |
| Maternal Role Transition Term My baby will never be dirty or bossy or disrespectful | Fantasy |
| Maternal Role Transition Term Observing other mothers “I’ll be like that”/”I’ll never do that” | Search for role fit |
| Maternal Role Transition Term Mourning this life-change Can never go back to “before” | Grief work |
| securing acceptance begins in what trimester? | 1st |
| what trimester does she commit herself to the unknown child? | 2nd sometimes delayed |
| Name the factors that influence psychosocial adaptations? (6). | Age, Multiparity,Social support, absence of partner, abnormal situation, socioeconomic status |
| Name Barriers to Prenatal Care** (8) | -Financial -Systemic -Attitudinal -Inability to pay -Don’t want to know -Lack of child care -Loss of wages -Lack of transportation |
| T/F A high MSAFP indicates multiple births. | False. It indicates Open neural tube defects; Trisomy 21 (Downs) Ultrasound Further testing is needed |
| T/F Sexual intercourse can continue up until a women goes into labor | True |
| Name an immunization not recommended for a pregnant woman. | NO live viruses- MMR, oral polio, smallpox |
| Some women go through a period of grief when they find out they’re pregnant | True |
| Name 3 barriers to obtaining prenatal care | -Financial -Systemic -Attitudinal -Inability to pay -Don’t want to know -Lack of child care -Loss of wages -Lack of transportation |
| Culturally competent care will combine _______ with _______ | assessment with negotiation |
| Name Application of the Nursing Process: Psychosocial Concerns | -Assessment – Is family adapting? -Analysis – Look at your data with fresh eyes -Planning – What are your expected outcomes? -Intervention – Give them information with participatory guidance |
| What is the folic acid intake recommendation for women and why | 0.4 mg in fortified foods recommended Neural tube defects can occur with poor intake |
| Patterns of gaining weight | ◦~1 – 4 lbs, 1st trimester; ◦ then ~ 1 lb/weekly |
| Name Nutritional Risk Factors ****On exam as fill in the blank (12) | SES, adolescence, vegetarianism, lactose intolerance, nausea and vomiting of pregnancy, anemia, eating disorders, food cravings and aversions,abnormal pregnancy weight, substance abuse, multiparity and multifetal pregnancy, other risk factors |
| Nutrition After Birth **How many cal/day should lactating mothers consume? what else should they do? | 300-500 cal/day Adequate fluid intake Avoid smoking, alcohol, and excessive caffeine Irritating foods to baby |
| Nutrition After Birth what does a nonlactating mother's nutrition consist of? | Return to pre-pregnancy diet. Multi-vitamin |
| *Pyrosis is related to what in pregnancy? | Heart burn |
| ** Verbalize: Types to prevent N/V (name 2 out of 10) | Don’t skip meals and become hungry,Get out of bed slowly—eat starchy food before getting up,Avoid fluids early in morning (watch out for coffee!),Avoid sudden movements, Avoid fat/fried foods, Cool temp foods – No aroma, |
| ** Verbalize: Types to prevent N/V (name 2 out of 10) (cont.) | Don’t brush teeth immediately after eating (gag reflex),Salty/tart foods are best, Exercise/fiber good for constipation (too much can prevent calcium absorption), Pyrosis Eat small, frequent meals) |
| *When do we treat anemia in pregnant women? | Hgb level is <11g/dl during 1st/3rd Tris <10.5g/dl during 2nd Tri |
| T/F The Nursing Process in OB is: Assessment, Diagnosis, Planning, Intervention & Evaluation | False. Analysis after assessment |
| Women should plan on gaining 2 lbs/weekly after the first trimester | False. 1 lb |
| Name 3 tips for preventing N&V | Don’t skip meals and become hungry,Get out of bed slowly—eat starchy food before getting up,Avoid fluids early in morning (watch out for coffee!),Avoid sudden movements, Avoid fat/fried foods, Cool temp foods – No aroma, |
| Anemia during the 1st & 3rd trimesters is defined as a Hgb level <11g/dl | True |
| Lactating mothers should consume how many extra calories a day? | 300-500 cal/day |
| What is considered a pre term pregnancy? | 20-36 weeks |
| What is considered wnl pregnancy? | 37 weeks |
| What is considered a late preterm infant? | 37-38 weeks |
| *Term for time between conception and onset of (true) labor | Antepartum |
| *Term for time from onset of labor until the birth of the infant and placenta | Intrapartum |
| *Term for Time from birth until the woman’s body (uterus*) returns to essentially pre-pregnant condition (size*) | Postpartum |
| *Term for the number of weeks since the first day of the LMP | Gestation |
| *Term for birth that occurs *before 20 weeks* gestation or birth of fetus-neonate weighing *less than 500 grams* | Abortion |
| *Term for normal duration of pregnancy 38-42 weeks | Term |
| *Term for *after 20 weeks* BUT *before 37 weeks* | Preterm/premature labor |
| *Term for any pregnancy regardless of duration including current pregnancy | *Gravida |
| Term for a woman who has never been pregnant | Nulligravida |
| Term for first time pregnant | Primigravida |
| Term for birth after *20 weeks* gestation, regardless of whether infant is born alive or dead | Para |
| Term for a woman who has *not* given birth at more than 20 weeks | Nullipara |
| Term for one who has had *one* birth at more than 20 weeks | Primipara |
| Term for a woman who has had *two or more* births at more than 20 weeks | Multipara |
| Term for fetus born dead *after 20 weeks* gestation | Still birth |
| Components Labor- The 4 "P"s | Passage, passenger, power, psyche |
| *Which one is the narrowest in the pelvic inlet? | AP |
| *Which is the narrowest in pelvis outlet? | Transverse |
| *What is the best shape for vaginal birth? | Gynecoid |
| Relationship of fetal parts to one another | Attitude |
| **Point on fetal part in relation to MOM's pelvis | Position |
| The overlap of these vault cranial bones during the powers of labor | Molding |
| **What shape is the anterior fontanelle? | Diamond shaped (2-3cm) |
| **What shape is the posterior fontanelle? | Smaller triangle shape |
| *The area *between* the anterior and posterior fontanelles | Vertex |
| The area of the fetal skull occupied by the occipital bone, beneath the posterior fontanelle | Occciput |
| **Best, safest, fastest birth position | Vertex presentation, complete flexion |
| What part is born last in breech presentation? | Head |
| What diameter is baby at if the baby is located at the mom's spine? | 0 |
| What diameter is baby at if the baby is crowning? | +3 |
| **Two major factors that we think help initiate labor | Fall in progesterone levels, increase in prostagladins |
| **Fetal role: Increase in ______ from fetal membranes. Large amts of ___ from fetus | Prostaglandins; cortisol |
| Compare and contrast true vs false labor. List true labor | -Regular contractions; getting closer together -CTX begin in back; radiate around abd -Increased intensity with walking -Progressive dilation & effacement -Persistent contractions even with rest or warm bath |
| Compare and contrast true vs false labor. List false labor | =Irregular contractions -No Δ in interval/ duration -Sensation in abdomen -Walking has no effect -No dilation/ effacement -Rest and baths lessen ctx |
| *Main Premonitory Sign of Labor | Braxton hicks contractions |
| When does preterm labor occur? | Prior to 37 (completed) weeks gestation |
| **Mechanisms of Labor – Adaptation of fetus to maternal pelvis- ) | Fetal positional changes- Flexion of head, Descent, Engagement, Flexion, Internal rotation, Extension, External rotation, Expulsion |
| The 4 Ps of labor are: | Passage, Passenger, Power, Psych (presentation- tired; not right state of mind ) |
| T/F The True Pelvis is the best measurement for pelvic girth | True? |
| T/F Anthropoid is the best pelvic type for a vaginal birth | False. Gynocoid |
| T/F The anterior fontanelles is diamond shaped | True |
| Molding of the fetus’s head during birth will go away on its own | True |
| A Frank Breech presents with the legs crossed and tucked under the buttocks | False |
| In false labor contractions increase with walking | False. They go away |
| **Physiologic Maternal Effects CV: Blood flow to placenta ______ with contraction, maternal blood vol _____. Supine hypotension. Resp system: Rate and depth ___ Gastrointestinal system: ___ gastric motility. | decreases; increases; increase; Decreased; |
| Hematopoietic system ___mL normal blood loss for vaginal delivery___ml for c-section | ≤ 500 ml; ≤ 1000 ml |
| Stages of Labor and Birth | =First stage = longest -Latent phase (1-3 cm dilation) -Active phase (4-7cm dilation) -Transition phase (8-10 cm dilation) AFTER transition comes Stage 2 =Second stage – Birth =Third stage - Placenta delivered =Fourth stage - Hemodynamic changes |
| **When is stage 4 of labor? | from delivery of the placenta through the first 1-4 hrs after birth |
| T/F Blood flow to the placenta decreases with contractions | True |
| T/F Maternal blood flow increases during contractions | True |
| What blood loss is considered normal for a vaginal delivery?For a C-section delivery? | ≤ 500 ml (or less) normal blood loss for vaginal delivery ≤ 1000 ml for c-section |
| The stages of labor are: | =First stage = longest Latent phase (1-3 cm dilation) Active phase (4-7cm dilation) Transition phase (8-10 cm dilation) AFTER transition comes Stage 2 =Second stage – Birth =Third stage - Placenta delivered =Fourth stage - Hemodynamic changes |
| Active phase is in which stage? | First Stage |
| Transition phase results in the cervix being totally dilated | True |
| During stage 4, the placenta is delivered | False. Third stage |
| Stage 2 begins when the cervix is completely dilated | True |
| The fetal side of the placenta is called “Shiny” Schultze | True |
| Uterine contractions can continue after the third stage of labor | True |
| During the 4th stage of labor the uterus can be palpated at the level of the umbilicus | True |
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lalad13
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