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Maternity Test 1

Certified Nurse Midwife has post graduate training in the care of normal pregnancy and childbirth and is certified by ACNM.
Doula a birth assistant who provides emotional, physical, and educational support to the woman and family during childbirth and the postpartum period.
Family-centered care the delivery of safe, satisfying, high-quality health care that focuses on and adapts to the physical and psycho-social needs of the family.
What are the basic principles of family-centered care? (1)childbirth is considered a normal, healthy event int he life of a family. (2)childbirth affects the entire family,relationships will change. (3)families are capable of making decisions about care if given adequate information and professional support.
Which of the following is a cost-effective strategy to provide more efficient and effective services to clients extending from acute care to outpatient settings? (A)cost containment, (B)continuum of care, (C)consumer empowerment, (D)preventive care (B)continuum of care; A continuum of care provides cost-effective continuity of care from the acute care setting, such as a hospital, to outpatient settings, such as rehabilitative units.
Maternal mortality ratio the annual number of female deaths from any cause related to or aggravated by pregnancy or its management during pregnancy and childbirth or within 42 days of termination of pregnancy
fetal mortality rate refers to the intrauterine death of a fetus at 20 weeks or more gestation per 1,000 live births.
neonatal mortality rate the number of infant deaths occurring int he first 28 days of life per 1,000 live births.
infant mortality rate the number of deaths occurring in the first 12 months of life.
What is the number one cause of death in women, regardless of racial or ethnic group? Cardiovascular disease
What is considered the basic social unit of our society? the family
At what time in life is nutrition the most important? during fetal development and infancy. Adequate nutrition is essential for tissue formation, neurological development, and bone growth.
Types of nursing support in family centered care: (1)informational, (2)emotional, (3)appraisal (esteem), (4)instrumental
What does the philosophy of family-centered care recognize as the constant? The family is the constant. The health of all the family members and their functional abilities influence the health of the client and other members of the family.
Using a family-centered approach is associated with what positive outcomes? decreased anxiety, improved pain management, shorter recovery times, and enhanced confidence and problem-solving skills.
What is a maternity specific example of primary prevention? Encouraging the use of folic acid supplements in pregnancy to prevent NTD (neural tube defects).
What is the mainstay of secondary prevention? health screenings such as pregnancy testing, blood pressure evaluations, breast exams, pap smears
What is the purpose of tertiary prevention? to restore individuals to their maximum potential. Takes place only if the condition results in a permanent disability.
What are some examples of tertiary prevention? minimizing and managing the effects o a chronic illness such as cerebrovascular disease or chronic effects of STDs
What are the most frequently used CAM methods during pregnancy? massage, acupuncture, vitamins, and herbs
What are some basic components of prenatal care? early and continuing risk assessment, health promotion, medical and psychosocial interventions, and follow-up
What is a birthing center? a cross between a home birth setting and a hospital. offer a home-like setting but with proximity to a hospital in case of complications.
Who is often the sole care providers in a birthing center? midwives. may have an obstetrician as backup in case of emergencies
What is the normal discharge time in birthing centers after childbirth? 4-24 hours
When a home birth is planned what is the most important thing to establish? a backup plan for a health care provider and nearby hospital on standby in case of emergency
External female reproductive organs: mons pubis, labia majora/minora, clitoris, prepuce, vestibule, perineum
What is the site for female circumcision that is still practiced in some cultures? the prepuce, the hood-like covering over the clitoris
Internal female reproductive organs: vagina, uterus, fallopian tubes, and ovaries
What is the pH of the vagina? an acidic environment
Layers of the uterus: endometrium (innermost layer that sheds when implantation does not occur which causes bleeding resulting in the monthly period), myometrium (muscular middle layer), perimetrium (outer layer that covers the body of the uterus)
What are the primary functions of the ovaries? the development and release of the ovum and the secretion of the hormones estrogen and progesterone
What are the accessory organs of the female reproductive system? the mammary glands or breasts
What happens to the breasts during pregnancy? placental estrogen and progesterone stimulate the development of the mammary glands. The breasts may double in size. Glandular tissue replaces adipose tissue.
What is the hormone that stimulates production of milk within a few days after childbirth? Prolactin
Colostrum: the dark yellow fluid that occurs before breast milk comes in. Contains more minerals and protein but less sugar and fat than mature breast milk. Rich in maternal antibodies, especially IgA.
How long can colostrum production continue? approximately a week after childbirth.
What hormones must be adequate for the brain to sense incoming arousal stimuli? estrogen and testosterone
What stimulates sexual desire in women? testosterone
What marks the beginning and end of the monthly cycle? menstruation
Menarche: the start of menstruation in females (average age is 12.8 yrs)
What is the most important factor in determining the age at which menarche starts? genetics, but can also be affected by nutrition, geographic location, cultural and social practices, education level, attitude, family environment, and beliefs
Order of events of female puberty: thelarche (development of breast buds), adrenarche (pubic and then axillary hair), growth spurt, and then menarche
What is the normal cycle length of menstruation? 21-36 days
What two cycles occur simultaneously in the female reproductive cycle? ovarian cycle (when ovulation occurs) and the endometrial cycle (when menstruation occurs) These cycles are divided by ovulation
Follicle-stimulating hormone (FSH) is released by what and stimulates? released by the pituitary gland and stimulates the ovary to produce 5 to 20 immature follices. The follicle that is targeted to mature fully will soon rupture and expel a mature oocyte in the process of ovulation
What is luteinizing hormone (LH) responsible for? affecting the final development and subsequent rupture of the mature follicle.
What day during the cycle is the mature oocyte usually released? Day 14 in a 28 day cycle
What are the predominant menstrual cycle hormones? gonadotropin-releasing hormone, FSH, LH, estrogen, progesterone, and prostaglandins
Physical changes associated with decreasing estrogen levels during perimenopause (2-8 yrs prior to menopause) hot flashes, irregular menstrual cycles, sleep disruptions, forgetfulness, irritability, mood disturbances, decreased vaginal lubrication, night sweats, fatigue, vaginal atrophy, and depression
external male reproductive organs: penis and scrotum
Internal male reproductive organs: testes, the ductal system, and accessory glands
What are the functions of the testes? producing sperm and synthesizing testosterone
Where is sperm collected and matured? the epididymis
Which duct carries sperm from the epididymis? vas deferens
What is the pH of seminal fluid? alkaline
How long does the average pregnancy last? 280 days or 40 weeks from the LMP, but fertilization usually occurs 14 days after the last period which makes the actual duration of the pregnancy 266 days
What are the three stages of fetal development? (1)preembryonic stage (fertilization through second week), (2)embryonic stage (end of second week through the eighth week), (3) fetal stage (end of the eighth week through birth)
Where does fertilization occur? The outer third of the ampulla of the fallopian tube
During the embryonic stage, which structures are formed? basic structures of all major body organs and the main external features are completed including internal organs
What glands secrete mucus to protect the vaginal opening? Bartholin's and Skene's glands; they can become infected and very painful
What med can stimulate the production of breast milk? Reglan
What is the first line treatment for hot flashes? Evening primrose oil
What med can help severe hot flashes? Clonodine
Fertility awareness: any natural contraceptive method that does not require hormones, pharmaceutical compounds, physical barriers, or surgery to prevent pregnancy.
techniques used to determine fertility? cervical mucus ovulation method, basal body temperature method, symptothermal method, standard days method, and two-day method
What is the basis of pregnancy testing? HcG
foramen ovale separates the left and right atrium
ductus venosus links the inferior vena cava and the umbilical vein
ductus arteriosus connects the pulmonary artery to the aorta
What is gene testing in the first trimester looking for? disorders such as cystic fibrosis
When is amniocentesis usually done? 14-16 weeks, but can be seen in L&D especially if woman comes in with no prior care
What are some complications that can occur with amniocentesis? maternal: hemorrhage, infection, labor, abruptio placentae, inadvertent damage to intestines or bladder, amniotic leakage or embolism fetal: death, hemorrhage, infection, direct injury from needle
Indications for amniocentesis: family history of genetic problems, women aged 35 years or older, assurance of lung maturity
What might have to be administered after the amniocentesis procedure? RhoGam if mother is Rh negative
What is collected during amniocentesis? 15-20 mL of amniotic fluid
What is collected during chorionic villi sampling? a small specimen of placental tissue
How man chorionic sampling be completed? transcervically or transabdominally
When can chorionic villi sampling be done? 10-12 weeks
When is the use of chorionic villi sampling indicated? women who are 35 years or older, women who have had frequent spontaneous abortions, women who have a genetic defect
Percutaneous umbilical blood sampling a diagnostic procedure in which a doctor extracts a sample of fetal blood from the vein in the umbilical cord.
What can PUBS detect? chromosomal abnormalities, blood disorders such as anemia, some metabolic disorders, toxoplasmosis, rubella, causes of Intrauterine growth restriction, can be used to perform blood transfusions to the fetus and administer meds directly to the fetus.
When is PUBS used for a chromosome analysis known as a karyotype? important when parents are trying to make a decision about whether to have an abortion and their fetus' gestational age is close to the legal limit.
Risks associated with PUBS 2% miscarriage rate, infection, cramping, and bleeding
L/S Ratio used to assess fetal lung maturity; a ratio of 2:1 or greater indicated probable lung maturity
Phosphatidylglycerol a phospholipid found in pulmonary surfactant. in amniotic fluid it indicates fetal lung maturity
What else can be determined from a karyotype? gender of the fetus
What can be assessed by measuring bilirubin pigment in amniotic fluid? Rh isoimmunization status and severity of hemolytic anemia
Alpha-fetoproteins a fetal antigen leaked into amniotic fluid and absorbed into the maternal circulation. Used as a screening tool for neural tube defects. Quadruple screen measured at 14-20 weeks. has a high false positive rate
what does elevated AFP levels indicate? neural tube or body wall defects; multiple gestation or a later gestational age than is currently estimated.
What does low AFP levels indicate? increased risk of trisomy 18 or trisomy 21.
What factors are indicative of a greater risk of down syndrome ? elevated hCG, elevated inhibin_A, low AFP, low UE
Follow-up of quadruple screen: a need for repeated test, ultrasound, or amniocentesis. These people are usually referred to a larger facility that does 3D ultrasounds.
GTT used to screen pregnant clients for gestational diabetes. standard for all clients
When is GTT completed? normally between 24-28 weeks, but can be used earlier if client has a hx of gestational diabetes or is overweight
Findings of GTT: a level greater than 140mg/dl indicated need for further testing
How to prepare for GTT: Client eats a conventional diet unrestricted with at least 150 grams of CHO per day for 3 days before the test and then the day of the test fast for 8 hours.
Procedure for GTT: Fasting serum glucose is obtained; pt drinks 100 grams of oral glucose and glucose is measured at 1, 2, and 3 hours.
Hemoglobin testing in pregnancy: assessed monthly to monitor for iron deficiency anemia. Normal is (12-16)
Indicated of hemoglobin testing: if level is less than 12 client should have nutritional counseling, if level is less than 11 client should have iron supplements
What does clean catch urine specimens screen for? glucose, protein, nitrites, and leukocytes
abnormal results of clean catch: diabetes, gestational hypertension, preeclampsia, or infection.
Normal protein in urine in pregnant client: +1, increased protein may indicated gestational hypertension or preeclampsia
What does WBCs or nitrites indicate in a urine culture? UTI; places client at risk for preterm labor
Fetal nuchal translucency (FNT): an intravaginal ultrasound that measures fluid collection in the subcutaneous space between the skin and the cervical spine of the fetus
When is FNT testing indicated? to identify fetal anomalies; abnormal fluid collection (greater than 2.5 mm) can be associated with trisomies 13, 18, and 21, turner syndrome, cardiac deformities, and/or physical anomalies
When is FNT completed? 10-14 weeks
What side should a woman lay on while pregnant? Left side
Routine testing during pregnancy? Rubella titer, CBC, blood typing and Rh immunity
What are some probable signs of pregnancy? positive pregnancy test, abdominal enlargement, ballottement, Goodell's sign (softening of cervix), Chadwick's sign (bluish-purple coloration of the vaginal mucosa and cervix), Hegar's sign (softening of the lower uterine segment or isthmus)
What are some positive signs of pregnancy? ultrasound verification of fetus, fetal movement felt by clinician, auscultation of fetal heart tones via doppler
When does the fundus reach it's highest level? 36 weeks at the xiphoid process
When does the fundus usually reach the level of the umbilicus? approx. 20 weeks
Ptyalism: excessive salivation
How are insulin needs affected during pregnancy? insulin needs are increased.
What hormone is responsible for uterine contractions? oxytocin
What hormones increase late in pregnancy that decreases effectiveness of insulin? cortisol and hPL
What fish are high in mercury? shark, swordfish, king mackerel, orange roughy, ahi tuna, and tilefish
What is the main vitamin that is deficient in vegetarians? B12
Pica: compulsive ingestion of nonfood substances; usually it is soil or clay, ice, or laundry starch
Who was Riva Rubin? identified maternal tasks that a woman must accomplish to incorporate the maternal role into her personality.
What are the maternal role tasks? ensuring safe passage throughout pregnancy and birth, seeking acceptance of infant by others, seeking acceptance of self in maternal role to infant, learning to give of oneself
couvade syndrome: partner experiences things the expectant mother is going through. usually includes minor weight gain, morning nausea, disturbed sleep patterns, altered hormone levels. More extreme cases include labor pains, postpartum depression, and nosebleeds
Coombs test: indirect coombs test is used in prenatal testing, detects antibodies against RBCs in patients blood serum, a blood sample is taken and then the serum is extracted from that.
What does a positive coombs test indicate? IgG antibodies that are likely to pass through the placenta into the fetal blood and cause haemolytic disease of the newborn.
Nagele's rule can be used to establish EDB. subtract 3 months from month of LMP, then add 7 days to the first day of LMP. Then correct the year by adding 1 to it where necessary.
Gravida: how many times a woman has been pregnant. gravida I during first pregnancy, gravida II during second and so on
Para: the number of deliveries at 20 weeks or greater
Primip a woman who has given birth once after a pregnancy of at least 20 weeks.
Multip a woman who has had two or more pregnancies resulting in viable offspring
Nullipara a woman who has not produced a viable offspring
TPAL: T=term births, P=number of preterm pregnancies, A=abortions, L=living children (Box 12.3 gives example)
Why should you check deep tendon reflexes? to rule out preeclampsia
Which pelvic shape is best for a natural delivery? gynecoid
true (obstetric) conjugate: measurement from the anterior surface of the sacral prominence to the posterior surface of the inferior margin of the symphysis pubis.
What is the average true conjugate diameter? 11.5 cm, it is important because it is the smallest front to back diameter through which the fetal head must pass when moving through the pelvic inlet.
recommended follow up schedule for healthy woman: every 4 weeks up to 28 weeks, every 2 weeks from 29-36 weeks, every week from 37 weeks to birth
Which type of decelerations are the worst? late decels
When a pregnant woman has problems with bloating what foods should the nurse instruct her to avoid? gas forming foods such as beans, cabbage, and onions as well as foods that have a high content of white sugar
vaccines that should be considered during pregnancy hep b, influenza (inactivated), tdap, meningococcal, rabies
vaccines contraindicated during pregnancy: any live vaccines
Created by: mcguirex3