Ch.26 Health Promotion and Pregnancy
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