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NCTC Maternity 1
NCTC Maternity Unit 1
| Question | Answer |
|---|---|
| Obstetrics | derived from Latin term for “stand by” Pertains to care of women during pregnancy, childbirth, and postpartum (puerperium) Maternity nursing is the care given by nurses to the expectant family before, during, and following the birth |
| Obstetrician | is the physician who specializes in the care if women during pregnancy, labor and delivery, and the postpartum period |
| Pediatrics | derived from Greek for "child cure" Is a branch of medicine that deals with development and care of children and the treatment of diseases of childhood |
| Family-centered care | involves the focusing of the strength and integrity of the family in the planning and decision-making of obstetrics and pediatrics through empowerment (maintaining control over health care decisions) |
| Ignaz Semmelweis (1818-1865) | instituted the practice of hand washing Discovered the relationship between incidence of "puerperal fever" and examination of new mothers by student doctors who had just returned, unwashed, from dissecting cadavers |
| Karl Crede (1819-1892) | first to instill silver nitrate into newborn eyes to prevent blindness resulting from gonorrheal infections, a practice which is still used today |
| Louis Pasteur (1822-1895) | a French chemist, confirmed that puerperal fever was indeed caused by bacteria spread by unwashed hands and contact with contaminated objects, which proved Semmelweis' theory |
| Hand washing | remains to this day the single most important means of preventing the spread of microorganisms |
| Joseph Lister (1827-1912) | a British surgeon influenced by Pasteur, experimented with chemical means of preventing infection and revolutionized surgical practice by introducing antiseptic (Listerine) surgery |
| AWHONN | Assoc of Women's Health, Obstetric, and Neonatal Nurses |
| Middle ages 1000-1500 | Concept of childhood did not exist |
| The Children's Bureau - Established by Lillian Wald | to care for the children of America in 1903 Children's Bureau formed by Congress "to investigate and report upon all matters pertaining to the welfare of children and child life among all classes of people" in 1912 |
| Lillian Wald | Found that health and nutrition of children throughout the US was declining As a result, hot lunch programs were established in many schools |
| 1938 Fair Labor Standards Act | established general minimum working age of 16 and minimum age of 18 for hazardous jobs Provided means to establish minimum child labor standards and a means of enforcement |
| Alternative birth centers | provide comprehensive care including antepartum, labor-delivery, postpartum, mother's classes, lactation classes, and follow-up family planning |
| Nursing Practice Act | Tells you what your scope and practice is. |
| Cross-cultural considerations | Diverse cultures come with heritage of beliefs, customs, religions, and health practices |
| Boys (10-13 but not outwardly manifested until 13-16) | Testostrone Shoulders broaden and become muscular Genitals increase in size Facial, pubic, and axillary hair - varies in distribution among races Voice changes - characterized by cracks and squeaks until final pitch Erections and nocturnal emissions |
| Girls (9-11) | Breast tissue increases are first outward change of puberty Menarche occurs about 2 - 2½ years after breast changes Hips broaden - curves begin to appear from adipose tissue deposition -fat redistribution Pubic and axillary hair - varies with race |
| Scrotum is the protective sac of the testes | Suspended from the perineum Keeps testes away from body to lower their temperature rugae- muscles that tighten up and loosen up to keep the correct temperature. Cooling is necessary for spermatogenesis |
| Vagina -Self-cleansing | Beyond the hymen, a tube-like structure made of muscle and membrane tissue that connects the external genitalia to the mid-pelvis Stretching of the vagina is possible by rugae or ridges of mucous membrane lining |
| Don't wear tampons | if you insist on wearing one change every four hours 24/7 that includes at night! Interferes with the natural cleansing mechanism. |
| eggs (oocytes) | Each girl has all the eggs (oocytes) that will be available during herproductive years (approximately 2 million) |
| Chromosomes | All gametes have 23 chromosomes - women's eggs have 46 until fertilization when the final myotic division occurs |
| Gynecoid (typical female pelvis) | most favorable for vaginal birth |
| Android | typical male pelvis |
| Anthropoid | long, narrow oval (result in occiput posterior (face-up) delivery of infant) |
| Platypelloid | flat, transverse oval (encourages transverse lie for the fetus and is poor risk for vaginal delivery |
| Obstetric conjugate | determines if the fetus can pass through the birth canal - found on the ultrasound. |
| Breasts (mammary glands) | Accessory organs of reproduction -all women can breast feed |
| Two types of cell division | Mitosis Meiosis |
| Mitosis | Occurs in body cells Responsible for body growth, development, and replenishment Contains 46 chromosomes (diploid number of 23 pairs) 46 pairs then separate into two daughter cells Each daughter has same genetic material as the parent cell |
| Meiosis | Occurs only in sex cells during gametogenesis Results in haploid number of cells 23 chromosomes per cell Cells called gametes Male: sperm Female: ovum |
| Life span of gamites | Ovum survives from 1-24 hours after ovulation Sperm viable for up to 5 days after ejaculation into area of cervix |
| FERTILIZATION - | Fertilization takes place in the outer third of the fallopian tube (closest to ovary). |
| Sex determination | Sperm carry either larger X or smaller Y and therefore determines the sex |
| Fertilized ovum (zygote) | Transport through tube takes 7 days with rapid mitotic divisions (cleavage) Eight cells (blastomere) Cluster (morula) - size has not increased but the many cells get smaller |
| Ectopic pregnancy | Occasionally the zygote becomes implanted in the tube resulting in ectopic pregnancy |
| Chorion -outer layer | Develops from the trophoblast Envelopes the amnion, embryo, and yolk sac Thick membrane with villi on outer surface Villi form the embryonic portion of the placenta |
| Amnion - inner layer | Thin membrane that envelopes and protects the embryo Forms the outer boundaries of the amniotic cavity Join with chorion to form fluid-filled sac that permits the embryo to float |
| Yolk sac | works till liver functions then is absorbed into the umbilical cord |
| Zygote | Primary stage that begins when the ovum is fertilized |
| Embryo | 4 weeks 4 chambered pumping heart that beats Begins at 3 weeks and continues until end of the 8th week of gestation |
| Fetus - | Begins at week 9 and continues throughout the rest of the 40 weeks of gestation |
| Fetoscope - | used to listen to baby heartbeat 16-20 weeks fundus should be at the level of the umbilicus. |
| 10-12 weeks | should be able to hear the baby's heartbeat with a fetal doppler.(landmark event) Continued growth of organs and body parts External genitalia are identifiable by ultrasound by 10th week By 14 weeks, fetus moves to external stimulus |
| By 20 weeks | fetal lungs can support life Called “age of viability” Will require care in NICU if born this early and survives |
| 25 weeks | lanugo hair should be abundant protective covering vernix caseosa( thick waxy substance that protects the skin from moisture) should also be abundant decreases until closer to the time of birth approx 40 weeks. |
| Abortion - | before 20 weeks termination of pregnancy whether asked for or spontaneous. |
| Fetal demise | after 20 weeks |
| Placental transfer | Thin membrane separates maternal and fetal blood so they do not mix Placental separation during birth may allow bloods to mix |
| Progesterone-first produced by the corpus luteum until placenta takes over its production | Maintains uterine lining for implantation of the zygote Causes the mom's body to relax - ligaments, uterus( has to relax or would expel the fetus.) Increased skin pigmentation (mask) increased salivation, linea nigra (black line) |
| Estrogens | Stimulates uterine growth Increases blood flow to uterine vessels Stimulates development of breast ducts to prepare for lactation |
| Human chorionic gonadotropin (hCG) | Secreted immediately after fertilization (signal the corpus luteum that conception has taken place Is detectable in maternal blood as soon as implantation occurs usually 7-9 days after fertilization – make pregnancy tests positive |
| Human placental lactogen (hPL) | AKA human chorionic somatomammotropin (hCS) Stimulates adjustments in mom's metabolism so adequate protein, glucose, and minerals are available for fetus |
| Umbilical cord - AVA- artery, vein, artery | Lifeline between mom and fetus In early embryonic stage, the body stalk which contains blood vessels, elongates to become the cord One artery and one vein associated with congenital anomalies Wharton's jelly keeps vessils separated |
| Ductus venosus - before birth | diverts most of blood from fetal liver branch carries most of the blood directly to the inferior vena cava - eventually becomes a ligament to help hold the liver. |
| Foramen ovale -before birth | diverts most of blood from right atrium away from lungs to left atrium. |
| Ductus arteriosus -before birth | diverts most blood from pulmonary artery into aorta |
| 2/3 dizygotic (fraternal) | Two ova are fertilized at the same time by two separate sperm Always have two amnions, two chorions, and two placentas Placentas may fuse if they implant close to each other |
| 1/3 are monozygomatic (genetically identical) | Have the same sex and look alike Physical differences are caused by prenatal environmental factors Will normally have two amnions May be conjoined if embryonic disc does not divide completely - more likely if only have one amnion. |
| Prenatal visits | Should begin as soon as woman discovers she is pregnant |
| Scheduled visits | Q 4 weeks - conception to 28 weeks Q 2-3 weeks - 29-36 weeks Q week - 37 weeks to birth More frequently if problems arise |
| Routine assessments made at each visit: | Review of risk factors and assessments for new ones, VS, weight gain, fundal height, FHR, urinalysis for glucose and protein, Leopold's maneuvers, review of nutrition, discomforts or problems that have arisen. |
| Bacteria vaginosis | is most common cause of vaginal discharge Has been associated with preterm labor Treatment with metronidazole or clindamycin between 12-20 weeks |
| Sensitivity for cultural beliefs: | Asian - women will nod head as a sign of respect that does not necessarily mean she understands important teaching don't be overly concerned with lack of eye contact; it is just a way of being non confrontational. |
| GRAVIDA: | any pregnancy |
| ANTE: | before |
| ANTEPARTUM: | before delivery |
| NULLIGRAVIDA: | one who has never been pregnant |
| PRIMIGRAVIDA: | pregnant for the first time |
| MULTIGRAVIDA: | one who was previously pregnant |
| PARA: | one who has delivered a child who reached the age of viability (20 wks); this does not include the number of fetuses delivered |
| PRIMIPARA: | one who has given birth to her first child who reached viability, regardless of whether the child was born alive or dead |
| MULTIPARA: | one who has given birth to 2 or more children past the point of viability |
| NULLIPARA: | one who has not delivered a child who reached the age of viability |
| ABORTION: | ermination of a pregnancy before 20 weeks |
| GESTATIONAL AGE: | the number of completed weeks of fetal development calculated in weeks from the first day of the last period |
| G TPAL | Gravida increases with number of pregnancies Para increases only when delivers a fetus 20 weeks or older T = # of term infants born (=37 weeks) P = # premature infants born (>20<37 weeks) A = # abortions whether elective or not L = # living children |
| Determining the estimated date of delivery (EDD) | Due date is 40 weeks past the first day of the last period +/- 2 weeks Nagele's Rule for determining EDC Count backwards 3 months Add 7 days Pregnancy is divided into trimesters of 13 weeks |
| Presumptive signs of Pregnancy(- Subjective signs from which a definite diagnosis cannot be made as the signs may result from illness or other changes | Amenorrhea Nausea and vomiting (morning sickness) Breast changes Pigmentation changes Urinary disturbances Fatigue and drowsiness Quickening |
| Probable signs - Objective signs that are observed by MD or CNM during exam, but may also be caused by other conditions such as tumors, myomas, or obesity | Goodell's sign Chadwick's sign Hegar's sign McDonald's sign Abdominal and uterine enlargement Braxton Hicks contractions Ballotment Fetal outline Abdominal striae (stretch marks) Pregnancy tests |
| Positive signs – also called diagnostic signs and are the only absolute indicators of a developing fetus | FHR Fetal movements Identification of the embryo or fetus |
| Uterus | Small pear-shaped pelvic organ gradually increases by increasing the size of the individual cells of the myometrium Capacity increases from 10 ml to 5 liters or more |
| Cervix | Color and consistency change beginning immediately after conception with Chadwick's and Goodell's sign |
| Ovaries | Cease to produce ova during pregnancy Corpus luteum produces progesterone during first 10-12 weeks until placenta takes over |
| Vagina | Vascularization increases and Chadwick's sign appears Estrogen levels increase to prepare vagina for passage of the fetus At term, vaginal wall and perineum relax for delivery |
| Breasts | High levels of estrogen and progesterone prepare breasts for lactation Montgomery nodules become prominent Striae and deeper pigmentation appear Colostrum may be expressed late in pregnancy Important to provide maternal antibodies |
| Respiratory system | breathe more deeply and slightly more rapidly to allow for increased exchange of O2 and CO2 Increased progesterone relaxes ligaments to allow chest to more readily expand |
| Cardiovascular system | Hypervolemia begins with the first trimester to 45% by 32-36 weeks for: Adequate exchange of nutrients, O2, and waste products in the placenta Pulse rate increases by 10-15 bpm to accommodate increase in volume |
| Heart may appear enlarged on x-ray | due to upward left displacement from enlarging uterus |
| Pulse rate increases by 10-15 bpm | to accommodate increase in volume Blood pressure should not increase above normal due to compensation of increased heart rate for increased volume |
| Enlarging uterus puts pressure on vessels of the lower body | Pooling of blood occurs with edema and varicosities Lying flat so uterus is on the vena cava may cause supine hypotension syndrome (dizzy, clammy, pale, hypotension) so use left side-lying position and raise HOB |
| Palpitations may occur from increases in thoracic pressure | Orthostatic hypotension may result in faintness and lightheartedness Results from reduced venous return from the lower body |
| RBCs increase slightly | but there is more fluid than RBC increase in the total volume increase which results in pseudoanemia As a result hct level may fall and should be watched carefully |
| Hypercoagulability in 2nd and 3rd trimesters | to prevent hemorrhage after placental separation Increases risk of blood clots in postpartum period |
| Gastrointestinal system | Stomach and intestines displaced to back and sides Increased hCG levels cause N/V Increased salivation (ptyalism) may affect smell and taste from increased estrogen levels Gums become tender and bleed Fetal demand increase appetite and thirst |
| Acidity of gastric secretions decrease and motility is slower | May result in bloating, constipation, and hemorrhoids Heartburn (pyrosis) is caused by relaxation of cardiac sphincter which permits reflux |
| GFR of the kidneys rises and renal tubules increase reabsorption | Water is retained to dilute excess fetal wastes |
| Diameter of uterus and bladder increases due to relaxing effects of progesterone | Renal pelvis and ureters loose tone so there is decreased peristalsis and stasis of urine leading to increased incidence of UTI |
| Fluid and electrolyte balance | Sodium retention leads to maternal edema, especially of dependent limbs Oxytocin (Pitocin) used in labor is antidiuretic Can lead to water intoxication |
| Integumentary and skeletal systems | Posture changes are usually temporary More noticeable curve in dorsal lumbar spine-low back aches Rounding of shoulders with aching in cervical spine and upper extremities Joints of pelvis relax so there may be a "waddling gait" |
| Weight gain | 28-40 for underweight women 25-35 for normal weight women 15-25 for overweight women Multiple fetuses should gain more weight Little if any weight gain is expected in first trimester due to N/V |
| Nutritional requirements - | Requires additional 300 cal/day during pregnancy Protein 60 gm/d Calcium 1200mg/d Iron 30 mg/d Folic acid 400µg Fluids – need 8-10 glasses (8 oz) Avoid caffeinated and high-sugar drinks |
| Pregnant teenager | Gynecologic age is the number of years from the onset of menses and the date of conception Younger gynecologic age has higher nutritional requirements |
| Pica | Craving for and ingestion of non-food substances Difficult habit to break and requires good teaching |
| Nutrition during lactation | Breastfeeding promotes health and growth of infant during first year of life Calorie intake should be 500 more during lactation than in nonpregnant time Protein intake should increase during lactation |
| EXERCISE DURING PREGNANCY | Mild exercise is beneficial in health and fitness maintenance Vigorous exercise should be avoided |
| Elevate temp | decreases fetal circulation and cardiac function Sauna and hot tubs elevate temp above 100° Exercise-induced elevations are tolerated due to physiology of blood flow |
| Hypotension | Lying flat compresses inferior vena cava – reduces blood return to heart Reduces blood flow to fetus |
| Air travel is generally safe | Avoid long periods of sitting due to increased clotting factors during pregnancy Avoid areas where there is high risk of exposure to infectious diseases |
| Nausea -Caused by hormone level increases | Treated by: Dry toast or crackers before getting out of bed in the morning Drink fluids between meals instead of with meals Eat small, frequent meals Avoid fried, greasy, or spicy foods and foods with strong odors such as cabbage or onions |
| Vaginal discharge-Caused by increased blood supply to the pelvis | If accompanied by odor, itching, inflammation, need to be treated by MD DO NOT DOUCHE (May disturb the mucus plug) Wear loose, cotton panties Bathe or shower regularly Wipe front to back after toileting |
| Fatigue-Caused by use of tremendous amount of energy to support growing fetus | 8-10 hours sleep q noc Nap during day if possible Relaxation techniques Meditation Usually relieved during second trimester May feel tired again during last 4-6 weeks before delivery Naps and restful sleep provide energy needed for labor |
| Backache-Caused by spinal adaptation to pregnancy | Good posture Sensible footwear Positioning with pillows Exercises: tailor sitting, shoulder circling, pelvic rocking Bending from knees instead of waist |
| Constipation-Caused by slowing of GI peristalsis, iron supplements, and intestinal pressure | Increased fluid intake Recommended stool softener (avoid anything not prescribed by healthcare provider) Regular exercise Increasing dietary fiber (limit cheese intake and sweets) Responding to urge to defecate |
| Varicose veins- Caused by decreased venous return from lower extremities | Avoiding constrictive clothing and crossing legs Elevate legs above hip level when resting Support hosiery applied before rising Regular exercise, especially walking Avoid standing in one position for long periods of time Rest on left side when lying |
| Hemorrhoids-Caused by pressure, constipation, and descent of head into pelvis | Anesthetic ointments and pads Sitz baths Measures to prevent constipation |
| Heartburn-Caused by hormonal influence on gastric reflux | Frequent, small meals Avoiding smoking, caffeine, spicy foods Deep breathing and sips of water Raising HOB when lying down Antacids with MD approval |
| Nasal stuffiness | Saline drips Humidifier |
| Dyspnea-Caused by pressure on the diaphragm | Resting with HOB elevated Lightening Avoid exertion |
| Leg cramps-Causes: increased uterine weight, increased circulatory load, inadequate rest, imbalance of calcium-to-phosphorus ratio | Not drinking milk in excess Stretching and dorsiflexion exercise of affected leg Elevate legs periodically during day |
| Edema of lower extremities-Caused by increased circulatory load and slower venous return | Elevating legs when lying or sitting Avoiding tight, restrictive clothing |
| 1st trimester:mental | Has ambivalent feelings about pregnancy Hormones cause labile emotions Sonography helps confirm the reality of the pregnancy Sono pictures are shown to all Woman focuses on herself at this time |
| mental 2nd trimester: | Fantasizes about what baby will look like and what gender it will be boody changes ma alter sexual relationship for "fear of harming the baby" |
| 3rd trimester:mental | Feelings alternate between "beautiful" to "big as a house" Becomes more introspective about the impending labor and outcome of delivery Moods become more labile again preparations for the baby's arrival are made Common discomforts have become tiresome |
| Impact on the father | Usually go through same ambivalence and self-questioning as the mother Question their readiness for fatherhood Important for the nurse to recognized hesitancy and investigate the source Culture and personal values may influence degree of participation |
| Impact on the adolescent | Conflict with how to tell parents and father Denial until late in pregnancy is common May include alcoholism and substance abuse Educational level and support system Age of adolescence Importance stressed on education and prenatal classes |
| PRENATAL EDUCATION | Assess history and cultural needs Diagnose the knowledge deficit Plan the goals and priorities Teach the facts and rationales Evaluate the knowledge gained and the goals achieved |
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