Maternal health exam 2

Genetics Review(:

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Infertility, Genetics, and fetal development (:

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antepartum (:

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Additional prenatal lab work:

glucose, chlamydia, gonorrhea, UA, drug screening

genograms

¡A tool used to trace characteristics through multiple generations ¡Helpful for a nurse or provider when looking at specific genetic characteristics

Potential for abuse

¡Employers and insurers are using results of genetic tests to discriminate based on perceptions of long-term health risk. ¡The American Council of Life Insurance has lobbied to use cancer predisposition information in underwriting. ¡Gene patenting has restricted use to those who can afford to pay.

Non-medical PGD uses

¡Genes have been identified that control or enhance intelligence, musical ability, and endurance.

Ethical and social implications of genetic counseling --autonomy

¡Information must be presented in a neutral and non-judgmental manner. ¡The person/family makes the decisions, not the counselor. ¡Testing is voluntary.

Ethical and social implications of genetic counseling --justice

¡refers to fairness or equal access to genetic services. ¡What if the person lives in a rural area and does not have access to testing? ¡What if the person is uninsured and unable to pay for testing?

Ethical and social implications of genetic counseling --beneficence and nonmaleficence

¡the tenets to attempt to do good and to avoid harm ¡What happens if the test proves non-paternity? ¡What if the results will affect employability or insurability?

Significance of cervical mucus consistency

-If the cervical mucus is too thick, it will not be sperm friendly and allow for implantation -If too thick, sperm cannot swim through to be fertilized (hostile mucus) -Mucus needs to be thin so sperm can swim through

Significance of FSH and LH levels

-LH and FSH are the hormones that encourage ovulation. Both LH and FSH are secreted by the pituitary gland in the brain. If not high enough, can't ovulate and therefore cannot reproduce -LH = luteinizing hormone -FSH = follicle stimulating hormone -FSH has to peak to get follicle to develop -LH needs to spike when egg is being released -Cycles last 28 days. Start day 1 at first bleeding day

Primary infertility interventions (prevent infertility problems)

-Preconception counseling -Well balanced diet -Non-smoker -Boxer shorts (lower temperature from core body, don't want to eat it up) -Exercise -Monitoring ovulation by body temp -Cervical mucus monitoring --Thicker and more viscous when not supposed to be pregnant (beginning and end of cycle) --Thinner when fertile, allowing sperm to swim through -Basal body temp --Temp rises at ovulation --Check temp every morning before getting up --See a thermal shift right before ovulation --Have to use basal body temperature

Clomiphene citrate (clomid) education

-This is an ovulation induction drug -Estrogen-like hormone drug -Increases LSH and LH levels to stimulate ovulation -Must have an infertility evaluation before starting this fertility treatment -Usually started on day 3, 4, or 5 of menstrual cycle -First day of bleeding is day 1 -Risks are increased risk for multiple babies -Impacts hormone levels 50/50 chance of this working -Less chance for multiples as in vitro fertilization -Have intercourse every other day around ovulation (to allow sperm to regenerate)

Applications for PGD use

-¡Sex selection has been used by carriers of Duchenne type Muscular Dystrophy --¡Only female embryos were implanted to avoid having an affected son --¡Sex selection has also been used for gender balancing in families -¡A couple who were both congenitally deaf used PGD to select an embryo with the gene for deafness; embryos with the gene for hearing were destroyed --¡Deafness was a desired characteristic for this family, not a defect -¡Cystic fibrosis carriers used PGD to avoid having a child with the disease --¡One of the embryos had an extra chromosome 21 --¡The couple insisted 2 embryos be implanted at random and the others frozen for future use, rather than destroy the defective embryo -¡A 30 year old female used PGD to select an embryo free of early onset Alzheimer's disease, which was predicted to cause full blown disease in the mother by age 40 -¡Scientists have identified genes which control genetic predisposition for future diseases such as: obesity, heart disease, diabetes, and certain cancers -Designer babies?

Genetic disorders

-¡Single Gene Disorders --lAutosomal dominant --lAutosomal recessive --lX-linked ¡-Polygenic multifocal l--Multiple genetic and environmental factors -There are three types of single gene disorders. -Single gene disorders are associated with a fixed rate of occurrence. -Polygenic multifocal disorders have a genetic component, but are caused by a variety of genes and environmental factors may also play a part. -Recurrence risk is usually 3-5% after 1 affected child. Risk varies depending on the relationship to the affected family member, severity of the case, sex of the affected family member, number of children or relatives showing the disorder, race or ethnic group, geographic location and maternal/paternal age.

Lab test: hematocrit Pt results: 35% 1. significance of finding?: 2. Why is it important to monitor?

1. Low end of normal; low hct r/t anemia 2. Low hct can indicate anemia and high hct can indicate dehydration or other complications. Low hct can cause preeclampsia or PROM;

Lab test: hemoglobin Pt results: 10.2 g/dL 1. significance of finding?: 2. Why is it important to monitor?

1. Low; can be low r/t anemia; volume of plasma higher than that of RBCs. if baby is positive, mom will need rhogam at delivery 2. Mom's blood volume will increase with pregnancy; need to make sure mom has hgb so she can carry O2 and get it to baby; prevent hemorrhage; low hgb during 1st half of pg. associated with preeclampsia, low levels during 2ndhalf pg. assoc. with risk of preerm premature ROM; decreased oxygen to fetus

Lab test: HIV Screen Pt results: neg 1. significance of finding?: 2. Why is it important to monitor?

1. Mom does not have HIV 2. Baby is not at risk for HIV transfer in utero

Lab test: Hepatitis B Pt results: neg 1. significance of finding?: 2. Why is it important to monitor?

1. Mom does not have hep B 2. Baby is not at risk for hep B transfer in utero

Lab test: VDRL Pt results: neg 1. significance of finding?: 2. Why is it important to monitor?

1. Mom does not have syphilis 2. Baby is not at risk for syphilis transfer in utero

Lab test: papanicolaou test Pt results: neg 1. significance of finding?: 2. Why is it important to monitor?

1. No cervical abnormalities 2. Baby is not at risk for complications r/t cervical abnormalities

Lab test: rubella titer Pt results: 1:5 1. significance of finding?: 2. Why is it important to monitor?

1. Not rubella immune 2. Mom cannot receive immunization while pregnant-risk to mom and baby of acquiring infection

presumptive signs of pregnancy

1. Presumptive (client can see themselves): amenorrhea, nausea, vomiting, fatigue, poor sleep, diarrhea, breast enlargement, fatigue, increased urination, breast changes, quickening, increased pigmentation

Lab test: blood grouping Pt results: A- 1. significance of finding?: 2. Why is it important to monitor?

1. Rh negative 2. Will have to test baby PP to see if Rh+ or -; mom will need Rhogam shot PP

Lab test: WBC Pt results: 9.3 1. significance of finding?: 2. Why is it important to monitor?

1. WNL 2. Monitor during pg. for signs of infection. Treat quickly to prevent transfer of illness to fetus

**nausea and vomitint what trimester is the symptom in? 1. cause: 2. patient teaching?

1st 1. High levels of hormone human chorionic gonadotropin 2. Avoid overeating, avoid triggers such as heat, odors, and excessive exercise, brush teeth after vomiting to prevent future vomiting

**urinary frequency what trimester is the symptom in? 1. cause: 2. patient teaching?

1st and returns in 3rd 1. Increase of the hormones progesterone and human chorionic gonadotropin 2. Wear a pad, don't hold it in (may cause UTI), usually resolves after giving birth, exercise such as kegels may help

probable signs of pregnancy

2. Probable (what provider can see): increased frequency of urination, positive pregnancy test, enlarged ABD, hegar's sign (softening of uterus), goodell's sign (softening of cervical lip), ballottement(fetus rebound), palpable fetus outline, braxton-hicks contractions

A male client has green color blindness, an X-linked recessive disorder. His wife has no affected genes. Which statement by the nurse is true regarding the couple's potential for having a child who is color blind? 1."All male children will be carriers for colorblindness." 2."All female children will be carriers for colorblindness." 3."All male children will be color blind." 4."All female children will be color blind."

2."All female children will be carriers for colorblindness."

Expectant parents ask the nurse when the major organs are present. How should the nurse reply? 1."At 4 weeks." 2."At 8 weeks." 3."At 12 weeks." 4."At 16 weeks."

2."At 8 weeks."

A client's amniocentesis results were reported as 46, XY. Her health care provider informed her that everything looked fine. Shortly after birth the baby was diagnosed with cerebral palsy. Which response by the nurse will best explain this result? 1."It is likely that you received the wrong amniocentesis results." 2."Cerebral palsy is not a genetic disorder." 3."The genes responsible for cerebral palsy have not been discovered yet." 4."The lab did not test for cerebral palsy."

2."Cerebral palsy is not a genetic disorder."

How should the nurse describe the function of amniotic fluid? 1."It helps reduce excess fetal movement." 2."It allows exchange of oxygen, nutrients, and waste products." 3."It promotes adherence of the placenta to the uterus." 4."It helps maintain a constant fetal body temperature."

2."It allows exchange of oxygen, nutrients, and waste products."

How would the nurse explain the composition of the umbilical cord to expectant parents? 1."It has one artery and one vein." 2."It has two arteries and one vein." 3."It has two arteries and two veins." 4."It has two veins and one artery."

2."It has two arteries and one vein."

The nurse is counseling a pregnant couple who are both carriers for phenylketonuria (PKU), an autosomal recessive disease. Which comment by the nurse is most appropriate. 1."Congratulations! You must be relieved that the odds of having a sick child are so small." 2."There is a 50% chance that your child will be a carrier for PKU." 3."I wish I could give you good news. Because this is your first pregnancy, your child will definitely have PKU." 4."There is a 50% chance that your child will have PKU."

2."There is a 50% chance that your child will be a carrier for PKU."

•The nurse is working with a couple who have been trying to conceive. The nurse formulates a diagnosis of Knowledge Deficit related to ovulation and fertility management. What is most important for the nurse to include in the teaching plan? 1.The ovum survives for 96 hours after ovulation, making conception possible during this time. 2.Ovulation usually occurs on day 14, following the onset of the menstrual cycle. 3.Most women can tell they have ovulated because they have thick, scant cervical mucus at this time. 4.The basal body temperature will fall after ovulation has occurred.

2.Ovulation usually occurs on day 14, following the onset of the menstrual cycle.

**constipation what trimester is the symptom in? 1. cause: 2. patient teaching?

2nd 1. Growing baby causing body changes, hormone levels 2. High fiber diet, avoid holding bowel movements, drink plenty of water, exercise regularly

**varicosities what trimester is the symptom in? 1. cause: 2. patient teaching?

2nd 1. Increase in the blood volume to the pelvic region during pregnancy 2. Get a support garment, change positions, avoid standing or sitting for long periods of time, elevate your legs, apply cold compresses to your vulva

**round ligament pain what trimester is the symptom in? 1. cause: 2. patient teaching?

2nd 1. Round ligament stretches as baby and womb grow making it more likely to be strained 2. Elevate legs, wear a belly band or belly belt, avoid sudden movements, decrease intensity of workouts

**shortness of breath what trimester is the symptom in? 1. cause: 2. patient teaching?

2nd and 3rd 1. growing uterus 2. Practice good posture, sleep with pillows supporting the upper back, practice deep breathing

positive signs of pregnancy

3. Positive: fetal heart sounds, fetal movement, fetal skeleton on x-ray, fetal sonography

**ankle edema what trimester is the symptom in? 1. cause: 2. patient teaching?

3rd 1. Additional blood and fluids 2. Eat foods high in potassium and avoid caffeine. Avoid standing for long periods. Minimize outdoor time when it is hot. Rest with your feet elevated Dependent edema normal Nondependent edema (in face) not normal

**hemorrhoids what trimester is the symptom in? 1. cause: 2. patient teaching?

3rd 1. Enlarged uterus puts pressure on the veins 2. To prevent, avoid constipation. Eat lots of fiber. Drink plenty of fluids. Use the toilet as soon as you feel the urge. Avoid sitting or standing for long periods of time

**leg cramps what trimester is the symptom in? 1. cause: 2. patient teaching?

3rd 1. Fatigue, the uterus pressing on certain nerves, or decreased circulation in the legs 2. Massage calf in the midst of a spasm, flex your foot, avoid pointing your toes, drink lots of water

**heartburn what trimester is the symptom in? 1. cause: 2. patient teaching?

3rd 1. Growing uterus puts pressure on the intestines and the stomach 2. Preventing is the best way to deal with heartburn. Eat 5-6 smaller meals throughout the day, wait an hour after eating to lie down, avoid spicy/greasy/fatty food, zantac, tums

The genetic counselor informs a couple that they have a 25% probability of having a child with a severe genetic disease. The couple asks the nurse exactly what this means. Which response by the nurse is appropriate? 1."If you have 4 children, only one will be affected." 2."Only your firstborn child will be affected." 3."Your fourth child will have the disease." 4."Whenever you get pregnant, there is a 1 in 4 chance that the child will have the disease."

4."Whenever you get pregnant, there is a 1 in 4 chance that the child will have the disease."

•When is gender determined?

At fertilization/conception

Percentage of risk for transmission

Autosomal recessive: 25% to giving it to offspring dominant disorder: 50% chance Males XY Females XX Males exhibit disorders with X link Females are carriers of disorders with X link 46 chromosomes, 23 pairs

Infertility therapy lifestyle changes to avoid fetal exposure to teratogens

Avoidance of teratogens (hazardous chemicals, chemo) Well balanced diet Exercise Avoid excessive quantities of vitamins, especially A and D Take folic acid supplements Avoid alcohol and drugs Smoking cessation Check with physician regarding prescription meds, OTC meds, and herbals

A woman comes to the clinic for pregnancy testing. Her last menstrual period was 6 weeks ago. She states she has experienced no problems and has decided she will not return for prenatal care unless she needs it. How should the nurse respond? A. "We recommend that all clients come in as frequently as the insurance provider will allow." B. "You are coming in earlier than normal. Most clients don't realize they are pregnant for at least 20 weeks." C. "The first three months of pregnancy are the most critical time in fetal development." A. "We recommend that all clients come in as frequently as the insurance provider will allow." B. "You are coming in earlier than normal. Most clients don't realize they are pregnant for at least 20 weeks." C. "The first three months of pregnancy are the most critical time in fetal development." D. "Your healthcare provider will want to meet with you at least every other week."

C. "The first three months of pregnancy are the most critical time in fetal development."

ALWAYS START WITH LESS INVASIVE AND MOVE TO MORE INVASIVE.

Check ovulation Check sperm eval Mucus eval

infertility risk factors

Chemo (occupation) Birth control/oral contraceptives for prolonged period NOT A RISK FACTOR! Age (especially advanced maternal age) Also increases risk for fetal problems Hormonal dysfunction/imbalance Ovulation problems r/t body temp Endocrine disorders Rubella non-immune

examples of genetic disorders

Cleft lip and palate Neural tube defects Pyloric stenosis Heart defects Dislocated hips Club foot

Monozygotic twins (identical twins)

Come from one egg

Dizygotic twins (fraternal twins)

Come from separate eggs

Environmental agents that may affect fertility

First trimester is most vulnerable for the fetus -Develop everything! Body, appendages, head, etc Second trimester is development of brain Third trimester is development of other organs

3 phases

Follicular phase -Day 1-12 of cycle Ovulatory phase -Days 13-15 of cycle Luteal phase -Days 16-28 of cycle

autosomal recessive

Genetic carrier mother (Rr) Genetic carrier father (Rr) ¼ (25%) noncarrier (RR) 2/4 (50%) genetic carrier (Rr) ¼ (25%) affected (rr)

Secondary infertility interventions

Infertility testing for male and female Prenatal vitamin (4-6 months before they conceive is best) Folic acid!

Hormones needed for ovulation

LH FSH Estrogen Progesterone - secreted from placenta to maintain pregnancy

Intrauterine insemination (IUI)

Less likely to have multiples One egg

Preimplantation genetic diagnosis (PGD)

Now that all the chromosomes have been mapped, PGD has surfaced as a possible solution to the genetic transmission of disease and disability. ¡3,000 to 4,000 diseases are now linked to genetic mutation

Determining your risk

Patterns in a family health history that indicate a higher risk are: More than one blood relative with a particular disease Diagnosis at an earlier age than expected Diseases that are rare in a certain gender (ex: a male with breast cancer) Recurring combinations of diseases (ex: diabetes and heart disease)

risk factors that put patient or fetus at risk for complications

Smoker, alcohol use, husband in a dangerous job, first pregnancy, lack of education

roles of the nurse

The terms "genetics" and "genomics" may conjure images of rare genetic disorders and specific tests ordered by experts. But a new era of genetic medicine has emerged. ¡Providing basic genetics information to patients and families ¡Identifying individuals who may benefit from genetic services ¡Recognizing historical and physical features of common genetic conditions ¡Monitoring the health of individuals with a genetic disorder ¡Providing a medical home ¡Recognizing the special psychosocial issues ¡Possessing knowledge of how to access the full range of genetics services from which patients might benefit ¡Appropriately referring patients ¡Facilitating the use of genetics services.

autosomal dominant

Unaffected mother (dd) Affected or predisposed father with autosomal dominant faulty gene (Dd) 50% offspring unaffected (dd) 50% offspring affected or predisposed (Dd)

In vitro fertilization process

Used as a remedy for infertility, a woman's egg cells are combined with a man's sperm cells outside the uterus. The fertilized egg is then implanted in the woman's uterus and, if successful, begin the pregnancy cycle. 1. The woman is given hormone treatments to stimulate egg production 2. Multiple eggs are taken from the woman's ovaries 3. In the lab, the eggs are mixed with the man's sperm cells in a culture dish to become fertilized 4. The fertilized eggs or embryos are placed in an incubator for about 48 hours 5. Embryos are implanted in the woman's uterus or frozen for future implanting More likely to have multiples Implant multiple eggs

Inheritance of X-linked recessive trait through affected father -legend

Xr = recessive faulty gene on X chromosome X = working gene copy Non carrier mother (XX) Affected father with x-linked recessive faulty gene (XrY) GIRLS: 50% changes genetic carrier XrX or XXr BOYS: 50% non-carrier XY

Which of the following is considered a positive sign of pregnancy that could be present at this point in Susan's pregnancy (eight weeks gestation)? a. Fetal cardiac activity or body movement noted on ultrasound. b. Palpation of fetal movements by an examiner. c. Ballottement noted on vaginal examination. d. Uterine soufflé auscultated with Doppler.

a. Fetal cardiac activity or body movement noted on ultrasound.

A prenatal client tearfully states that she used drugs before she knew she was pregnant. The nurse should understand which fact about the effects of teratogens in pregnancy? a.Drug use in the first trimester always causes congenital defects. b.Drug use before implantation has a smaller incidence of teratogenic effect. c.It is only important to avoid drug use during the period of organ formation, weeks 3 to 10. d.Selected drug use is not harmful in pregnancy.

a.Drug use in the first trimester always causes congenital defects.

Primary Interventions- for infertility --· Lifestyle considerations (i.e. prior to conception):

aims to prevent disease or injury before it ever occurs o Avoidance of teratogens o Well-balanced diet, exercise o Avoid excessive quantities of vitamins (i.e. especially A and D) o Take supplements of folic acid o Avoid alcohol and drug ingestion o Smoking cessation o Check with your physician regarding use of prescription medications, over-the-counter medications and herbals [FDA Drug Categories A through D, and X; no FDA regulation of botanical products]

Primary Interventions- for infertility --· Suggestions for improving fertility [males]:

aims to prevent disease or injury before it ever occurs o STI prevention o Avoid exposure to toxins, such as lead pesticides or other chemicals o Avoid high temperatures (i.e. hot tubs, saunas, sitting for prolonged periods) o Decrease alcohol intake; discontinue use of illicit drugs o Talk with physician regarding therapeutic treatments, such as antihypertensive medications, antineoplastic drugs or radiation for cancer o Condom use for immune reactions to sperm

Primary Interventions- for infertility --· Suggestions for improving fertility [females]:

aims to prevent disease or injury before it ever occurs o STI prevention o Use only water soluble lubricants o Decrease stress level o Healthy BMI o Stabilize chronic health conditions (i.e. diabetes) o Monitor basal body temperature o Monitor cervical mucus changes

Secondary Interventions for infertility

aims to reduce the impact of a disease or injury that has already occurred. Goals: detect/treat problems & encourage strategies to prevent continued problems; implement solutions to return people to their original health and function

A client's father has Huntington's disease and the client is now also exhibiting mild symptoms of the disorder. The client and his wife decide to visit a genetic counselor to discuss the risk of having a baby with this disease. What should the counselor tell the couple about this autosomal dominant disorder? a.There is no possibility of transmission from the father because this abnormal gene is carried by the mother. b.There is approximately a 25% chance that the abnormal gene will be passed on to offspring. c.There is a 50% chance that the abnormal gene will be passed on to offspring. d.There is a 100% chance that the affected parent will transmit the normal gene to the offspring.

c.There is a 50% chance that the abnormal gene will be passed on to offspring.

functions of amniotic fluid

comes from fetus urinating amniotic fluid •Function of amniotic fluid: cushion, provide movement, allow for symmetrical growth, prevent trauma, provides adequate temp, fetus practices respirations by breathing in amniotic fluid so muscles know how to breath (promoting lung development)

infertility

defined as a lack of conception despite unprotected sex for at least 12 months

postcoital test

o Evaluates characteristics of cervical mucus and sperm function within that mucus at the time of ovulation (i.e. test is performed 6-12 hours after intercourse)

secondary infertility

previous pregnancy, but now no conception after 12 months; inability to maintain pregnancy

sperm penetration assay

secondary intervention Evaluates fertilizing ability of sperm § Female

hysterosalpingogram

secondary intervention o Evaluates patency of uterus and fallopian tubes

ultrasound

secondary intervention o Evaluates the structure of prostate gland, seminal vesicles, and ejaculatory ducts o Evaluates structure of pelvic organs; cyclic endometrial changes; ovarian follicles and release of ova at ovulation

semen analysis

secondary intervention o Evaluates structure and function of sperm and composition of seminal fluid

ovulation prediction

secondary intervention o Commercial ovulation predictor kits o Cervical mucous assessment o Basal body temperature monitoring

testicular biopsy

secondary intervention o Identifies pathology and obstructions

infertility subjetive patient history

secondary intervention § The woman's age at menarche and menstrual characteristics (frequency, regularity, duration, amount of flow, presence of pain) § Any pregnancies, complications, and their outcomes (GTPAL) § Contraceptive methods, past and present § Previous fertility of the man or woman with other partners § Previous surgeries, infections (including childhood infections, pelvic inflammatory disease, STIs, abnormal Pap tests and treatments, serious illness) § Pattern of intercourse in relation to the woman's cycles § Length of time the couple has had intercourse without contraception § Exposure to possible toxins, prescribed and over-the-counter medications § Family history of multiple pregnancy losses, birth defects, intellectual disabilities § Any home tests the couple has used, such as over-the-counter ovulation predictor kits § Detailed personal and family histories of each partner

Multifetal pregnancy:

twins

primary infertility

women who have never conceived

therapies to facilitate pregnancy- o Infertility pharmacologic and non-pharmacological therapy and treatment

§ Medications § Surgical Procedures- to correct obstructions § Therapeutic insemination- Intrauterine Insemination (IUI) § Egg donation § Surrogate parenting § Assisted Reproductive Technology (ART) uses medical, surgical, laboratory, or micromanipulation techniques to handle ovum and sperm

Factors contributing to repeated pregnancy loss

· Abnormalities in fetal chromosomes · Abnormalities of the cervix or uterus (i.e. bicornuate uterus; incompetent cervix) · Endocrine abnormalities · Immunologic factors · Environmental agents

Factors in female fertility

· Disorders of ovulation (i.e. altered secretion of hormones and/or altered ovarian response) · Age (i.e. ovulation and menstruation are more erratic; pool of ova diminishes) · Obesity · Anorexia · PCOS · Blocked fallopian tubes · Cervix (i.e. hostile mucus; obstruction)

Therapies to facilitate pregnancy

· In Vitro Fertilization (IVF) · Gamete Intrafallopian Transfer (GIFT) · Zygote Intrafallopian Transfer (ZIFT) · Intracytoplasmic Sperm Injection (ICSI)

Factors in male fertility

· Sperm (impaired number, structure or function) · Abnormal erections · Ejaculation problems · Seminal fluid (abnormal amount, consistency or chemical composition) Antibodies to partner

umbilical cord

•2 arteries, 1 vein (reversed in what they carry)

Key points

•Avoid excessive quantities of vitamins, especially A and D •Take supplements of folic acid prior to pregnancy •Avoid alcohol and drug ingestion, including OTC and herbals •Correct nutritional excesses/deficiencies prior to becoming pregnant •Teratogens

placenta

•Function: provides oxygen, excretion (normalizing and cleaning out blood), provides nutrients,provides immunity, endocrine function (placenta is an organ and releases hormones) •Maternal and fetal blood never mix •Drugs cross placenta •Insulin does not cross placenta

•Embryo Developmental Milestones:

•Implantation to 8 weeks after conception •Most critical time in development of organ systems and external features •All organs formed by 8 weeks •Heart begins beating by 4 weeks •Unmistakably human appearance by week 8 •After 8 weeks, it is considered a fetus •Gender determined at fertilization, but can see it confidently at 20 weeks Fetuses can hear at 18 weeks Fetus starts respiration at 24 weeks

what info should you collect for a genogram

•Information depends on the context and reason for collecting it •Collect 3 generations of information •For each person: •Gender •Date of birth (or age) •If deceased, age and cause of death •Diseases or other medical conditions •Age of onset of the disease •Ancestry

oligohydramnios

•No enough amniotic fluid •Related to kidney development •1 kidney baby, baby with another congenital/chromosomal anomaly •Concerned about hearing cause ears developed at same time •Can cause clubfoot

•Hydramnios (a.k.a. polyhydramnios)

•Too much amniotic fluid •Related to kidney development •Diabetic mom increases blood sugar, babies urinate out more frequently to get rid of glucose and increase amniotic fluid •Concerned about hearing cause ears developed at same time