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maternity exam 1

powerpoint

QuestionAnswer
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
Created by: lalad13