Ch.26 Health Promotion and Pregnancy

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Probable Signs / objective

- hegar's sign, ballotement, goodell's sign

Self-care in pregnancy

-Diet—eat 300 more calories per day. ---To prevent spinal chord abnormalities, increase folic acid, calcium, protein -Sex—usually safe unless pregnancy is at risk for miscarriage or prematurity. -Environmental hazards—avoid , long soaks in hot tubs, and x-rays.

Chorionic villi

-microscopic fingerlike projections that penetrate the endometrium -develop into the placenta & support maternal-fetal gas exchange

Contraction stress test (CST)

-nipple stimulation or oxytocin stimulation evaluates fetal response to stress -no deceleration with a min of 3 contractions lasting 40-60 seconds in 10 min -done at 32 wks

Respiratory changes in pregnancy

-oxygen consumption increases by 20% -increased tidal volume -increased intra-abdominal pressure due to growing fetus

Taking-in

24-48 hours after birth: dependent, passive; focuses on own needs; excited, talkative

third trimester of pregnancy

28-40 weeks,

Placenta, embryonic membranes, embryo

3 layers differentiate into tissues/layers?

role transitions

3rd tri, prep for baby's arrival, child birth class, birth plans

Fetus

9 weeks to birth

Urinary retention

A client is receiving an epidural anesthetic during labor. Which side effect would the nurse monitor the client for?

Blastocyst

A fluid-filled sphere formed about 5 days after fertilization of an ovum that is made up of an outer ring of cells and inner cell mass. THis is the structure that implants in the endometrium of the uterus. Foundation of placenta

Blastocyst

A fluid-filled sphere formed about 5 days after fertilization of an ovum that is made up of an outer ring of cells and inner cell mass. This is the structure that implants in the endometrium of the uterus.

Syndrome

A group of symptoms or signs of abnormal condition; contribute to behavior pattern due to environment or uncontrolled sugars in diabetic mom or poor nutrition in pregnancy

Lamaze method

A method of "prepared" childbirth involving relaxation and controlled breathing.

Letting-go

A phase of maternal adaptation that involves relinquishment of previous roles and assumption of a new role as a parent.

Morula

A solid ball of cells that makes up an embryo; in humans, this stage occurs within four days of fertilization.

morula

A solid ball of cells that makes up an embryo; in humans, this stage occurs within four days of fertilization. It has about 32 cells

Biophysical profile

A test that assess five variables; fetal breathing, fetal movement, fetal tone, amniotic fluid volume, and fetal reaction

viable

Ability of fetus to survive outside the uterus - 20-24 weeks

Amniotic fluid

Acts as a cushion, helps regulate fetal temperature, allows for fetal growth, it is alkaline,

Attachment

Affectionate tie that occurs over time as a result of parent-infant interaction

Increase fluid intake for natural diuresis, exercise moderately

Ankle edema caused by long periods of standing, walking or sitting, poor posture and hot weather

Biophysical profile (BPP)

Assessment of five variables in the fetus that help to evaluate fetal risk: breathing movement, body movement, tone, amniotic fluid volume, and fetal heart rate reactivity.

Respiratory

At week 23 lungs work but not enough alveoli to function

Musculoskeletal

At week 4 limb buds appear, week 12 skeletal muscles start involuntary movements

Fetal stage - 2nd and 3rd trimester

Begins at 9th week of pregnancy, fetal development systemically, cephalo-caudal is first to develop, proximo-distal and general to specific

Chadwick's sign

Bluish-purple coloration of the vaginal mucosa and cervix

DANGER SIGSN AND SYMPTOMS OF PREGNANCY!

Blurred vision, severe or sudden headaches, peripheral edema, rapid wt gain, signs of infection, vaginal bleeding, absence or decrease fetal movement

Arteries

Carries deoxygenated blood to the placenta, carries wastes away from baby for mom to get rid of

Veins

Carries oxygenated blood to the fetus, delivers nutrients and oxygen to the baby

Genome

Complete set of DNA that is contained in all cells

Drink six to eight glasses of water daily. Increase dietary fiber intake.

Constipation is a frequent symptom as a pregnancy progresses. Which measures should be recommended to the gravid woman?

Bradley method of childbirth

Controls environmental factors, lights, temp, noise to provide calm delivery

cotyledon

Dark red with rough surface, could cause bleeding in mom if rows are not intact

leg cramps in pregnancy

Dorsiflexion can help

En face

Face to face

Toxins

Fetal development can cause abnormalities, illness or miscarriage if exposed to this

Hematologic development

Fetal hemoglobin has attached for oxygen which ensures fetus gets oxygen, blood type is also determined

Gastrointestinal

Fetus begins swallowing around 20 weeks

Antibodies

Fetus receives this from mom and its good for 6 months

Villi

Fingerlike extensions of the intestinal mucosa that increase the surface area for absorption

Cardiovascular

First to function, heartbeat at 21 days,

Dizygotic

Fraternal twins

Cardio changes in pregnancy

HR increases 10-15 bpm, blood volume increase by 40% to 50%, RBC increase 17%, hemoglobin and hematocrit decreases,

HCG, estrogen and progesterone

Hormones that the placenta excret which helps maintain the pregnancy.

It takes 3 or 4 days to enter the uterine cavity

How long does the zygote take to reach the uterine cavity?

12 weeks

How long dos it take for the placenta to fully develop

60 g

How many grams of protein will a nurse instruct a pregnant client to consume when discussing increased daily requirements during pregnancy?

Monozygotic

Identical twins

Genetic code

Info that will determine characteristics newborn

amnion

Inner layer blends with the umbilical cord

Reassurance, promote relaxation,

Insomnia due to fetal movements, muscle cramps, urine frequency, usually occurs at later weeks of pregnancy

Stem cells

It is the purest cell because they can become anything and will form every part of baby

First stage of chorionic villi

It secretes HCG, nourish corpus luteum, produces progesterone, stops ovulation and becomes fetal side of the placenta

Primary villi

It usually appear on surface within 2 to 7 weeks, it transports oxygen and nutrients to embryo until week 8

Yolk sac / innermost layer

Its lined with endoderm, develops lining cavities, passages, covering of most internal organs and supplies nourishment until implantation

Assess for redness, warmth or swelling, poor peripheral circulation

Leg cramps due to compression of nerves supplying lower extremities

Chloasma

Mask of pregnancy, worsens w/ sun exposure

Basic Prenatal Physical Examination

Measurement of vitals, height, and weight assessment of heart, lungs, and reflexes general physical inspection of skin and mobility laboratory studies (hemoglobin, hematocrit, serology, ABO and Rh factor, rubella titer) routine urinalysis for glucose, protein, and ketones pregnancy tests.

Fetal Embodiment - 2nd trimester

Mother incorporates fetus into body image

25-35 lbs, first trimester 3-4 lbs then 1lb/week

Normal weight gain for a pregnant woman?

Chorion

Outer layer of the fetal side of the placenta

Allele

Pairing of genes

Nonstress test (NST)

Performed at 28 weeks - onwards, evaluates FHR to fetal movement, to check for placental insufficiency, to determine how baby will handle the stress during labor

Intrapartal

Period that begins with the onset of labor and ends with the delivery of the placenta; also called perinatal.

When can auscultation occur with a Doppler?

Practitioners can auscultate fetal heart tones between 10 and 12 weeks with Doppler scan

Colostrum

Premilk, developed until mom's milk comes in, low in fat, high in carbs and protein, contains antibodies to provide protection, laxative-like effect

Estrogen

Primary hormone, increased vascularity and needed for developing pregnancy

Kegel exercises, limit fluid intake at bedtime, report to PCP if any pain or burning sensation during urination

Return of urinary urgency and frequency

Advise patient to sleep w/extra pillow, remain good posture, dont eat too much

SOB and dyspnea in pregnant women due to enlarge uterus

Fetal circulation

Shunts blood away from fetal lungs

Hëgar's sign

Softening of the isthmus of the uterine cervix early in gestation; a probable sign of pregnancy.

Abortion

The deliberate termination of a pregnancy by killing the unborn child

Engrossment

The father's or significant other's developing an intense focus on the newborn

Postpartal

The final stage of the maternity cycle

A client making her first prenatal clinic visit asks what immunization can be administered safely to a pregnant woman.

The inactive influenza and diphtheria, tetanus, acellular pertussis (DTaP) immunizations can be safely administered during the first trimester of pregnancy, although DTaP is recommended at 27 to 36 weeks' gestation to provide immunity to the mother and infant.

Human placental lactogen

This hormone promotes insulin resistance by the maternal cells resulting in elevations in serum glucose levels. It affects maternal metabolism, resulting in the maintenance of energy sources for the fetus.

Maternal serum alpha-fetoprotein

This must be offered to all women, document the test was offered, accepted or declined?

Nonstress test.

To use the tocotransducer recording fetal movement and the ultrasound transducer recording the fetal heart rate.

Respiratory status

Which assessment is the nurse's priority when performing a 1-hour postpartum check on a client recovering from a cesarean section delivery under general anesthesia?

Week 12 of pregnancy

Which week does the placenta become fully functional?

Dominant gene

Will overpower a recessive gene most of the time

Fetal distinction

Woman feels fetal movements & begins to daydream about the baby Fetus starts to become distinct & separate from herself

Hydatidiform mole

abnormal growth of a fertilized ovum in which a large vascular mass, but no fetus, develops

Teratogenic agents esp first 3 months

agents that cause damage during embryonic or fetal development Ex: rubella, accutane, thalidomide, alcohol, DES, HIV, illegal drug use

Pica

an abnormal craving or appetite for nonfood substances, such as dirt, paint, or clay that lasts for at least 1 month

Therapy for ptyalism

astringent mouthwash chewing gum sucking on hard candy

Prenatal phase

before birth; most critical period; basic structures develops

embryonic stage

begins with implantation and encompasses approximately the first 8 weeks of pregnancy.

Para

beside, near or living child

Nausea

by increased HCG levels and changes in carbohydrate metabolism is taught to be cause of this

Mutated

changed in form or nature

Surfactant

chemical produced in the lungs to maintain the surface tension of the alveoli and keep them from collapsing, matures at 35-37 weeks

Ultrasonography (ultrasound)

common prenatal test that uses sound waves to create a visual image of a developing fetus

sibling rivalry

competition between siblings, often for parental attention

umbilical cord

connects fetus to placenta, 2 arteries one vein

Hair, nails, skin, nervous system

ectoderm layer becomes

trilaminar embryonic disc

embryonic disc with three layers; 1. ectoderm, 2. mesoderm, and 3. endoderm

Digestive system, liver pancreas, lungs - inner layers

endoderm layer becomes

ELSI

ethical, legal, and social implications associated with the Human Genome project

Hirsutism

excessive hair growth over the body

Gravida

pregnant woman

Implantation

process in which the blastocyst attaches to the wall of the uterus

Spider nevi

red elevations of skin with lines radiating from center

Palmar erythema

reddening of the palms, due to increased blood flow that results in high estrogen

Bonding

refers to a strong emotional tie between parents and the newborn

Antepartal

refers to pregnancy before the onset of labor

Health promotion during pregnancy

regular prenatal checkups, no smoking, no alcohol, no drugs, avoid NSAIDS and OTC, if meds are needed doses must be in lowest form, delay or avoid dental surgery to avoid risk for infection

Fundus

rounded upper portion of the uterus

Weeks 13-27 of pregnancy

second trimester, fetus is developed and waiting for everything to mature, respiratory movements presents, baby can hear sounds

Hyperemesis Gravidarum

severe nausea and vomiting in pregnancy that can cause severe dehydration in the mother and fetus

Goodell's sign

softening of the cervix

human chorionic gonadotropin (hCG)

stimulates corpus luteum in ovary to continue production of estrogens and progesterone to maintain pregnancy

Perinatal

the time and events surrounding birth

gene therapy

the transplantation of normal genes into cells in place of missing or defective ones in order to correct genetic disorders.

Chromosomes

threadlike structures made of DNA molecules that contain the genes; 30,000 genes in genome

virus vector

virus that has the ability to enter specific cells in the body

Desirable outcomes for a Contraction Stress Test?

which means that no change in fetal heart rate occurs with the contractions.

Flagellation

whipping; flogging

Morning Sickness and Hyperemesis alternative therapy

• Acupuncture • Acupressure • Motion sickness bracelets (Sea Bands

Presumptive Signs / subjective

• Amenorrhea: • Nausea and vomiting • Frequent urination • Breast changes: • Quickening: • Chadwick's sign:vulva have purple-ish discoloration

fundus of uterus

Where does implantation usually occur?

Trimesters

a period of three months, especially as a division of the duration of pregnancy.

Progesterone

It enables implantation, maintenance of hormone to normal contractility of uterus

Flagellation

It is how the sperm travels through the mucus of the cervical canal to the uterine chamber and to ampulla

Mesoderm

It is located between the amniotic cavity and yolk sac

trophoblast

Its the outer wall, secretes enzymes that break down protein to allow for implantation

Embryonic stage

Its when implantation ends, cells grows rapidly, all systems are developed/ formed but not fully functioning

Fetal heart rate increases in connection with fetal movement.

A test that may be done in late pregnancy to determine fetal well-being is the nonstress test. This test is based on which phenomenon?

Effleurage

Light, continuous-stroking massage movement applied with fingers and palms in a slow and rhythmic manner.

Fetal stage

Starts in 9th week and embryo is now referred to as fetus

Straie gravidarum

Stretch marks, fades but does not go away

Amniocentesis

needle puncture of the amniotic sac to withdraw amniotic fluid for analysis

Preparing for Ultrasound Scan Examination

Inform the woman that she needs a full bladder for an abdominal ultrasound scan to allow better imaging of the fetus. Position her comfortably, with pillows under her head and knees, while the test is conducted. Apply ultrasonic gel to the abdomen and pass the scanner over it while images are reproduced. The woman and her partner can watch if they wish. The woman should not feel any discomfort. For a transvaginal ultrasound scan, tell the woman that she may either be in a lithotomy position or have her pelvis elevated. These positions are optimal for imaging the pelvic structures. Introduce a transducer with a protective sheath covering into the vagina. If the woman wants to insert it herself, allow her to do so. The angle of the probe or the tilt of the table may be altered during the examination, but the procedure should not be painful.

Illegal drug use

It can cause newborn addiction, preterm labor, intrauterine grown retardation, placental abruption

Chorionic villus sampling

It detects genetic disorder of fetus, it requires small sample of chorion of placenta for genetic testing, it is guided by ultrasound, done at 8-10 weeks gestation, it does not detect NTD or down syndrome, it may be a risk for miscarriage due to invasive procedure

Daily fetal movement count

Measurement of fetal movement as an indicator of fetal health. Advantages of the test include that it is simple, low cost, noninvasive, and fast. Instruct woman to count fetal movements for 1 hour two or three times daily. No exact number of movements has been identified as a "failing test." However, fewer than three fetal movements in a 1-hour period or the absence of fetal movements for 12 hour is an indication for further evaluation

fetal alcohol syndrome

Mental retardation and abnormal facial features due to maternal ingestion of substance such as alcohol during the cell growth of the developing fetus

human placental lactogen (hPL)

Promotes insulin resistance by maternal cells

Improved communication with partner, family and support for mom

Psychosocial responses such as mood swings, increased anxiety due to labor and delivery

Relaxin

Softens the cervix and symphysis pubis, "waddle"

Crown-rump length

The measurement from the top of the fetal head to the buttocks

Fetal membranes, chorion and amnion

Two layers strong enough to support 20 pounds or more

Nuchal translucency screening

Ultrasound screening to measure fetal nuchal folds to assess for potential Down syndrome.

Braxton Hicks contractions

Uterine contractions in prep for labor, for relief- change positions, rest and practice breathing techniques

Leboyer method

Warm water birth to reduce trauma

amniotic cavity and yolk sac

What are the two cavities that develop in the embryo during the first 2 weeks?

Relaxation and Muscle Ache Relief

What can Yoga, Biofeedback, Reflexology , Therapeutic touch, Massage offer to a pregnant woman

Gender

What can be determined by ultrasound at 12 weeks

Structure, physiology and metabolism of fetus, risk for CAD and alter function of organ system being developed

What can change if a fetus gets inadequate nutrition during pregnancy

It suggests neural tube defects

What does elevated alpha-fetoprotein indicate?

It indicates down syndrome / trisomy 21

What does low levels of alpha-feta protein indicate?

Albumin, urea, uric acid, creatinine, bilirubin, lecithin/indirect surfactant, sphingomyelin, fructose, fat, leukocytes, proteins, epithelial cells, enzymes, strands of lanugo

What does the amniotic fluid contain?

44 autosomes and 2 sex chromosomes

What does zygote carries?

A positive test is when the fetal heart rate declines with the contractions. It indicates placental insufficiency and fetal hypoxia.. Late decelerations are decline in FHR,considered an ominous sign. The fetus may be at risk during labor and c-section may occur

What is the Nondesirable outcomes for a Contraction Stress Test?

Explain procedure, no discomfort for pt, allow her to verbalize fears and concerns, patient should have empty bladder, in sims position

What is the patient teaching for a Non stress test

Blood pressure WNL - hypertension systolic 30 over, diastolic 15 over baseline, uterine size in cm = weeks, edema, fetal position, FHR

What must be followed up and monitored during prenatal visits

After applying external fetal monitor to pts abdomen, observe for increase FHR with fetal movement and stimulate fetal activity if the fetus remains quiet for more than 20 mins

What will be observed during the non stress test?

ultrasound scan at 6 weeks; Doppler at 10 to 12 weeks stethoscope at 18 to 20 weeks.

When can fetal heart activity be detected?

Week 12, genitourinary

When does the fetus begin to produce urine

16-18 weeks

When is internal ballotement usually occur?

Implantation

When zygote moves through fallopian tue via cilia and irregular peristaltic activity? It takes about 3-4 days to uterine cavtity

in the ampulla of the fallopian tube.

Where does The process of fertilization usually takes place

Amniocentesis

needle puncture of the amniotic sac to withdraw amniotic fluid for analysis, detects biochemical, chromosomal abnormalities, fetal lung maturity, and sex determination, can be done at 14-16 weeks onwards of gestation

human chorionic gonadotropin (HCG),

a hormone that stimulates the continued production of progesterone and estrogen by the corpus luteum, which is the reason ovulation and menstruation cease during pregnancy and secreted by chorionic villi

Chloasma

a pigmentation disorder characterized by brownish spots on the face

Ballottement

a sharp upward pushing against the uterine wall with a finger inserted into the vagina for diagnosing pregnancy by feeling the return impact of the displaced fetus

Apgar scale

a system of rating the physical condition of a newborn baby -taken in 1 min and 5 min after birth

Placenta / flat plate

organ that nourishes the fetus, only present during pregnancy, weighs about 1 pound, 8in x 1in thick in diameter, it is assessed and examined for intactness after delivery

Ectoderm

outermost germ layer; produces sense organs, nerves, and outer layer of skin

Neonatal

pertaining to newborn

Where is the Doppler positioned to auscultate fetal heart rate?

place the instrument in the midline, just above the symphysis pubis, and apply firm pressure.

Chorionic villus sampling

sampling of placental tissue for microscopic and chemical examination to detect fetal abnormalities

Shiny schultze

shiny fetal surface of placenta

Ampulla

site of fertilization, sperm and ovum meet

Zygote

the fertilized egg; it enters a 2-week period of rapid cell division and develops into an embryo

Zygote

the fertilized egg; it enters a 2-week period of rapid cell division and develops into an embryo.

Quickening

the first movement of the fetus in the uterus that can be felt by the mother, occurs at 16-20 weeks

Umbilical cord

connects fetus to placenta, it has no pain receptors, it has 2 arteries and 1 vein

Ptyalism

excessive salivation

Pregnancy validation

feelings of uncertainty and ambivalence. Accepts pregnancy.

Gestation.

fetal life

Lanugo

fine downy hair of newborn infant, appears at 20 weeks

Lanugo

fine, downy, unpigmented hair that appears on the fetus in the last 3 months of development

Meconium

first stool of the newborn, it forms around 16 week

Dick-Read Method

focuses on fear reduction and abdominal breathing, avoid analgesics

Genetic counseling

guidance for prospective parents on the likelihood of genetic disorders in their future children

Ectopic Pregnancy

implantation of the fertilized egg in any site other than the normal uterine location

Ectopic pregnancy

implantation of the fertilized egg in any site other than the normal uterine location

Endoderm

innermost germ layer; develops into the linings of the digestive tract and much of the respiratory system

Alpha-fetoprotein

is a protein produced by the fetal yoke sac and liver.

Dirty Duncan

maternal side of placenta

Circulatory system, lungs - epithelial layers, skeletal system, muscular system

mesoderm layer becomes

Mesoderm

middle germ layer; develops into muscles, and much of the circulatory, reproductive, and excretory systems

Taking-hold

mother begins to initiate action and becomes interested in caring for infant

Wharton's jelly

mucoid connective tissue that surrounds the vessels within the umbilical cord

Guidelines for Counting Fetal Movements (Kick Counts)

• Kick count monitoring should begin at 28 weeks' gestation. •pick a time during the day lie down in left side-lying position • Each fetal movement or kick should be counted. The goal is to experience 10 to 12 movements/kicks in a 1-to 2-hour period.

Gynecologic Examination

• Palpation and auscultation of the abdomen • Visualization of the cervix and vagina • Evaluation of the bony pelvis • Palpation of the uterus externally or bimanually • Examination of the vulva, the perineum, the anus, and the rectum • Pap smear (done at the beginning of the examination)

Positive Signs of Pregnancy

• Visualization of fetus via ultrasound • Fetal movement detected by PCP • Auscultation of fetal heart tone


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