Developmental Self-Care Requirement
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| 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
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| Blastocyst | Embryoblast- inner layer forms: Embryo/amnion
Trophoblast- Outter layer forms: Chorion/placenta
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| Childbearing Patient Components | 1. Anterpartum
2. Intrapartum
3. Postpartum
4. Neonate
5. Family
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| 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
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| Maternal/Fetal Heart Rates | -Funic Soufflé - fetal heart rate (110-160 is normal)
-Uterine Soufflé - mothers blood flow
-distinguish the above by the rate
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| Endocrine Function of the Placenta | Human Chorionic Gonadotropin (HCG)
Human Placental (hPL)
Progesterone
Estrogen
Relaxin
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| 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
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| 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
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| 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
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| TORCH | T- taxoplasmosis
O- Other (gonorrhea, syphilis, Hep B, HIV)
R- Rubella (German Measels)
C- Cytomegalovirus
H- Herpes Symplex
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| 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
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| Taxoplasmosis | -Caused by taxoplasmosis gondii by eating raw or undercooked meat, unpasturized milk, contact with infected cat feces.
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| Rubella aka German Measels | Get maternal blood screened, get vaccinated, MMR vaccine postpartum.
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| 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
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| Progesterone | Keeps endometrium healthy and prevents contraction.
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| Estrogen | For uterine and breast enlargement (for breast feeding).
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| Relaxin | Permits pelvis to expan, relaxes muscles in pelvic, helps with cervical softening, works with progesterone to help maintain the pregnancy.
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| 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
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| 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)
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| Safe Vaccines during pregnancy | Hep A & B
Influenza (inactivated) IM
Pneumonococcal (inactivated)
Tdap
Meningococcal
Rabies
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| Contraindicated Vaccines during pregnancy | MMR
Influenza (live)
Varicella
BCG
Meningococcal
Typhoid
HPV
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| Neonate Abstinence Score (NAS) | GI: Poor feeding, excessive sucking, diarrhea.
CNS: Hypertonicity, excoriation, tremors, inconsolability.
Other: Nasal congestion, sneezing, sweating, fever, tachypnea.
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| Nursing Care for Neonatal Abstinence | -Review maternal history
-Toxicology screening for newborn
-Assessment for signs of withdrawal
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| 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.
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| Karyotype | Pictoral analysis of chromosomes
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| Genotype | Genetic make-up of gene pairs
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| Phenotype | Visible expression of genes (eye color, hair color, height, etc.)
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| 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)
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| Autosome Abnormalities | Down Syndrom-Trisomy 21
Edwards' Syndrom-Trisomy 18
Patau's Syndrom-Trisomy 13
Abnormal Structure- Cri Du Chat (translocation, addition, deletion)
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| Sex Chromosome Abnormalities | Turner Syndrom-femals, Monosomy X
Kleinfelter's Syndrom- Males, Trisomy XXY
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| 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.
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| Assessment for fetal well being-genetic screening | Amniocentesis and Chorionic villi sampling
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| 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
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| 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.
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| 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
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| Substance Abuse as Teratogen: Neonatal Effects | Methadone-more severe than heroin withdrawal, usually within 96 hours of birth
Methamphetamine-often abuse of other substances
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| Chromosomes | Made of DNA, carry Genes
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| Genes | made of DNA, coded info
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| Human Cells | 23 pairs-homologous, matched
22 pairs of autosomes
1 pair sex chromosomes
xx female
xy male
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| Translocation | Pieces of chromosomes break off and attach to another chromosome somewhere in a person's genome: Burkitt's lymphoma, CML
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| Deletion | Portion of one chromosome deleted and added to another
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| Abnormality of Chromosome Structure Cri Du Chat | Missing piece in short arm of chromosome 5
Effectes 50-60 children yearly
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| Patterns of Genetic Transmission-Multifactorial | Combination of genetics/environment, mild to severe, familial (cleft lip/palate, pyloric stenosis, neural tube defects).
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| Patterns of Genetic Transmission-Unifactorial Mendelian | Single gene defect
-autosomal dominant
-autosomal recessive
-x-linked recessive
-x-linked dominant
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| 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.
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| 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
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| 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
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| 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
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| 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
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| Couples Risks Continued... | Abnormal MSAFP
Women with teratogenic risk
Maternal pre-existing medical conditions
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| 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
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| 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
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| 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
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