NS A473 Exam 1 Semester 3

Explain the physiology and management of GDM

Diabetes diagnosed in pregnancy Diagnosed withe glucose challenge test and oral tolerance test Management: Blood glucose monitoring, dietary management, exercise, fetal surveillance

Compare nutrient needs of pregnant and nonpregnant women

FOLIC ACID- 600-800mcg per day Calcium Iron Phosphate Protein Generally need to increase caloric intake to 340-450 calories per day Increase fluid intake to 8-10 cups a day

Fundal height measurement

-after the uterus reaches a position that is palpable above the umbilicus -tape measure is placed with zero mark on the anterior aspect of the symphysis pubis -the measurement is taken at the palpable fundus (top) of the uterus -measurement in centimeters should = approx weeks of pregnancy (plus of minus 2-3 cm) 12 weeks pubis synthesis 20 weeks umbilicus 36 weeks xyphoid process 40 a little bit lower than X process due to lightening

Describe the development and management of hypertensive disorders of pregnancy

1. Chronic Hypertension- no protein in urine and prior to pregnancy 2. Gestational Hypertension- onset after 20 weeks, no protein in urine 3. Preeclampsia- hypertension after 20 weeks with protein in urine. BP >140mmHg systolic or 90>mmHg diastolic of higher 4. HTN withe superimposed preeclampsia 5. Eclampsia- life threatening withe seizure Assess BP and s/s of headache, urine output, edema

Explain the purposes of a birth plan

A brith plan is important for all parents as it established the needs of the mother and baby going into birth. It allows the healthcare team to know what the patient needs and expects from their labor and delivery. It helps the patient and her support system be prepared and informed. It also allows the patient to have a game plan before birth which is one less thing for the patient to be concerned about as making decisions in the moment may be hard. A birth plan set a precedence for the entire healthcare team when making decisions during labor and delivery.

Discuss factors that influence psychological adaptation to pregnancy

Age Multiparity Social support Abnormal situations Absence or presence of partner

Relate chromosomal abnormalities to spontaneous abortion and birth defects in the infant

Birth Defects: Trisomy causes Downs Syndrome, Monosomy causes Turners Syndrome. Spontaneous Abortion: all other monosomy's are not compatible with birth. Over 99% of conceptions with 45XO karyotype are lost in spontaneous abortion

Describe the normal anatomy of the female and male reproductive systems

Female External Anatomy: mons pubis, labia majora and minora, clitoris, perineum, and vestible (structures enclosed by labia minora) Female Internal Anatomy: Vagina, Uterus, Cervix, Fallopain tubes, Ovaries, Male External Anatomy: penis, scrotum Male Internal Anatomy: testes accessory ducts and glands (epididymis, seminiferous tubules, vas deferens, prostate, seminal vesicles, bulbourethral gland)

Explain the normal function of the female and male reproductive systems

Female Reproductive System: The female reproductive system is a group of organs that work together to enable reproduction, pregnancy, and childbirth. It also produces female sex hormones, including estrogen and progesterone. The system consists of organs and tissues inside the body and some that are visible outside the body. A constricted section called the isthmus connects with the uterus. Finally, an intermediate, dilated portion, the ampulla, curves over the ovary. Egg fertilization usually occurs in the ampulla. The eggs then travel through the isthmus into the uterus. Male Reproductive System: the male reproductive system is responsible for repoduction and urination. They produce, maintain and transport sperm (the male reproductive cells) and semen (the protective fluid around sperm). They discharge sperm into the female reproductive tract. They produce and secrete male sex hormones. Sperm cells pass through a series of ducts to reach the outside of the body. After they leave the testes, the sperm passes through the epididymis, ductus deferens, ejaculatory duct, and urethra.

Describe six methods of antepartum fetal testing

Fetal Movement Counting Non-stress Test Contraction Stress Test Biophysical Profile Modified Biophyscial Profile Doppler Flow Studies

Discuss weight gain recommendations for pregnancy

First Trimester up until week 13 weight gain is recommended to be 1.1-4.4 pounds total One pound a week will be roughly gained onwards Someone with a normal BMI should be expected to gain 25-35 pounds during pregnancy

Describe the psychological responses of the expectant mother to pregnancy

First semester: uncertainty, ambivalence, self as primary focus Second trimester: physical evidence of pregnancy, fetus as primary focus, increase libido Third trimester: vulnerability, nesting, increasing dependance, preparation for birth

Compute gravida, para, and estimated date of delivery

GTPAL Method G = Pregnancies T = term deliveries over 37 weeks P = preterm deliveries 20-36 weeks A = Abortions/miscarriage, less than 20 weeks L = Living children Nagels Rule: based on first day of last normal period, subtract 3 months, add 7 days and correct year to get estimated date of delivery Example: Last menstrual period October 3, 2022 October - 3 months =July 3rd + 7 days = July 10th Due date is July 10th, 2023

Describe the effects of pregnancy on glucose metabolism

Glucose metabolism during normal pregnancy is characterized by an impairment in insulin sensitivity, an increase in β-cell secretory response and β-cell mass, a moderate increase in blood glucose levels following the ingestion of a meal, and changes in the levels of circulating free fatty acids and triglycerides

Describe the developmental processes of the transition to the role of father

Grappling with reality Recognition as parents Couvade- similar symtoms as pregnant partner

Discuss the purpose of each screening and diagnostic procedure

HCG Screen- peaks at 8-10 weeks Ultrasound Screen- fetal growth Nuchal Translucency- measure fluid filled space at back of neck Cell Free Fetal DNA Screen- maternal serum screening targets for trisomies Maternal Serum Alpha Feto Protein- MSAFP, protein in fetal urine that crosses the placenta into maternal circulation Chorionic Villi Sampling: contains chromosomal metabolic and genetic material makeup of the fetus DIAGNOSTIC preformed 10-13 weeks to diagnose fetal chromosomal metabolic DNA abnormalities

Identify indications for fetal diagnostic procedures

If the Nuchal Translucency is enlarged on back of the neck, further diagnostic tests will be done If FHR and ultrasound growth is abnormal, diagnostic tests will be done

Discuss the nutritional needs of the postpartum woman who is breastfeeding

Increase caloric intake by 500 calories per day while breastfeeding Avoid large amounts of alcohol and caffeine Wait three months after birth before starting any dieting HYDRATE

Describe the structure and function of normal human genes and chromosomes

Inherited Characteristics are passed from parent to child by the genes in each chromosome Chromosome: a threadlike structure of nucleic acids and protein found in the nucleus of most living cells, carrying genetic information in the form of genes Gene: segments of your DNA, which give you physical characteristics that make you unique

Explain the importance of adequate nutrition and weight gain during pregnancy

It matters significantly, poor nutrition can negatively impact fetal growth and development

Explain implantation and nourishment of the embryo before development of the placenta

Location of implantation: the upper uterus which is supplied with blood for optimal fetal gas exchange, nutrition and waste elimination Implantation or nidation is a gradual process that occurs between days 6 and 10 after conception Primary chorionic villi are tiny projections on the surface of the conceptus extending into the endometrium Chorionic villi make up a significant portion of the placenta and serve primarily to increase the surface area by which products from the maternal blood are made available to the fetus.

Identify the process of maternal role transition

Mimicry, grief work, searching for role fit, role play/fantasy with new child

Explain the mechanisms and trends in multifetal pregnancies

Monozygote: single ovum, single spermatozoom, identical genetics and same sex. Dizygotic: two ova, two spermatazoom, higher inherited tendency, always seperate amnion and chorion, not always identical, two placentas, two sacs

Explain physiology and management of placenta previa and placental abruption

Placenta Previa *implantation of placent in lower uterus *NEVER preform vaginal or cervical exam *Lots and lots of bleeding * 1 in 200 births, male fetus, older mother, prior uterine surgery *Sudden onset of painless bleeding *electronic fetal monitoring *conservative management Placental Abruption *seperation of normally implanted placenta before the fetus is born *caused by any disruption of the endometrium *bleeding, tenderness, abdominal or low back pain *Go to the hospital for evaluation ASAP *conservative management if under 34 weeks

Describe preconception, initial and subsequent antepartum assessments in terms of history, physical examination and risk assessment

Preconception: obtains complete history, and performs regualr physical assessment, assessed for diabetes, hypertension, STDs, harmful habits and social problems that could effect pregnancy Initial Prenatal Visit: obtain obstetric history, menstrual history and estimated date of delivery, gynecologic and contraceptive history, family history, partners health history, psychosocial history Initial Prenatal Assessment: vitals signs, assess cardiovascular system, musculoskeletal system, height and weight, abdomen, neurological system, urinary system, breasts, pelvic measurements, labs, risk assessment, gastrointestinal system, external reproductive organs

Differentiate presumptive, probable and positive signs of pregnancy

Presumptive- subjective Probable- objective only way to confirm pregnancy is through auscultation of heart sounds, ultrasound, and felt via examination

Explain the role of the nurse in caring for individuals or families with concerns about birth defects

Provide counseling after additional education Guide parent/parents though prenatal diagnosis and genetic counseling Supporting parents as they make decisions after receiving abnormal prenatal diagnostic results Helping family deal with the emotional impact of a birth defect Assisting patents to locate resources for support Coordinating services such as physical/occupational therapists, social workers and dietitians Helping families find support groups if needed

Explain the characteristics of multifactorial birth defects

Result from an interaction fo genetic and environmental factors, the genetic tendency toward the disorder is modified by the environment Characteristics: typically present and detectable at brith and isolated defects rather than defects that occur with unrelated abnormalities. A multifactorial defect may cause a secondary defect. EX: infants with spina bifida often have hydrocephalus (abnormal collection of spinal fluid in the brain.) Other Examples: cleft lip, cleft palate, heart defects, neural tube defects, pyloric stenosis

Compare Rh and ABO incompatibility

Rh Incompatibility: mother is Rh negative and fetus is Rh positive. Which means the father of the fetus would need to be Rh postivive. This causes the Rh factor in mothers blood to cross to fetus and destroy its Rh postive erythrocytes. Fetus becomes deficient in RBC's and fetal bilirubin levels increase. ABO Incompatibility: mother is blood type O and fetus is blood type A,B, or AB. Newborn will be carefully screened for jaundice and hyperbilirubinemia

Review the difference between screening and diagnostic tests

Screening tests are not diagnostic. They can provide information regarding the risk of a baby having a certain disorder or condition. Only diagnostic tests are definitive and can identify if a baby does have a birth defect. Screening tests are intended for asymptomatic (showing no or disguised symptoms) people, whereas diagnostic tests are intended for those showing symptoms in need of a diagnosis. Screening: Ultrasound, first trimester screening (Nuchal translucency, HCG urine stample, ultrasound), Cell Free Fetal DNA, second trimester screening (Multiple Marker Quad Screen- estriol, human chorionic gonadotropin (hCG), alpha-fetoprotein (AFP) and, if you're having a quad screen, inhibin-A.) Diagnostic: Percutaneous Umbilical Blood Sampling, Amniocentesis

Explain the maternal tasks of pregnancy

Seeking safety/safe passage Securing acceptance in new roll, Learning to give of themselves- accepting more traditional roles in the home as nurturer Committing themselves to their unknown child

Describe the responses of prospective grandparents and siblings to pregnancy

Siblings can have a multitude of responses, literature supports siblings being at birth when possible Grandparents will need to accept their children as parents themselves

Describe the characteristics of single gene traits and their transmission from parent to child

Single gene traits are mathematically predictable and have a fixed rate of occurrence Patterns of inheritance are either autosomal dominant, autosomal recessive, or X-linked Autosomal Dominant: produced by a dominant gene on a non-sex chromosome Autosomal Recessive: occurs when a person receives two copies of a recessive gene carried on an autosome X-Linked: x-linked recessive traits are more common than x-linked dominant traits. Males are the only ones to show full effects of an x-lined recessive disorder because their x chromosome is inactivated randomly in a normal female embryo

Describe the development and management of hemorrhagic conditions of early pregnancy

Spontaneous Abortion 1. Threatened abortion: bleeding uder 20 weeks 2. Inevitable - membrane breaks 3. Incomplete- tissie is left behind leading to infection 4. Complete- fetus and placenta expelled 4. Missed- DIC, fetus dies but remains inureto 5. Recurrent- 3 of more miscarriages Ectopic Pregnancy * tubal damage, hemorrhage, infection and DEATH Gestational Trophoblastic Disease * trophoblasts develop abnormally *cancerous pregnancy *evacuate tissue ASAP *Placenta abnormal, fatal chromosomal defects

List the goals of perinatal education

Teach health behaviors Teaching necessary lifestyle behaviors Teaching signs of possible complications Providing resources

Identify environmental factors that can interfere with prenatal development and ways to prevent or reduce their negative effects

Teratogens!! know them and avoid them. Avoid endocrine disrupters and plastics Prevention of exposure would ideally begin before conception Immunizations reduce the risk that the mother will contract infections during pregnancy Avoiding drugs and alcohol and smoking of any kind

Apply the nursing process to the care of the antepartum patient

The antepartum or pre-natal period starts when the woman's pregnancy is diagnosed and ends just before the baby is delivered. Antepartum care promotes patient education and provides ongoing risk assessment and development of an individualized patient management plan Initial Prenatal Assessment: vitals signs, assess cardiovascular system, musculoskeletal system, height and weight, abdomen, neurological system, urinary system, breasts, pelvic measurements, labs, risk assessment, gastrointestinal system, external reproductive organs

Explain structure and function of the placenta, the umbilical cord and fetal membranes with amniotic fluid

The placenta, umbilical cord, and amniotic sac protect and provide nutrients to the fetus. The placenta is a fetomaternal organ that enables the selective transfer of nutrients and gases between mother and fetus. The placental barrier limits direct contact between the embryo and maternal blood, thus protecting both mother and child from potentially harmful substances (e.g., blood cell antigens of the unborn, bacteria from the mother). In addition, the placenta produces hormones that mediate maternal adaptation to pregnancy and maintain pregnancy. Establishing uteroplacental circulation involves several steps, including endovascular trophoblast invasion and uterine vascular remodeling. The 50-70 centimeter long umbilical cord connects the placenta with the fetus and contains one umbilical vein that carries oxygenated, nutrient-rich blood supply and two umbilical arteries that carry deoxygenated blood from fetus to the placenta and the maternal circulation. The amniotic sac surrounds the fetus and contains the amniotic fluid providing mechanical protection to the developing fetus. Overview of placental hormones The most important placental hormones are HC, HPL, CRH, estrogen, and progesterone. Other important hormones during pregnancy include thyroid hormones oxytocin and prolactin Function of hormones: Continuation of pregnancy Maternal adaptation to the pregnancyRegulation of uterine circulationFetal development and growthInducing labor

Describe prenatal circulation and the circulatory changes after birth

The umbilical cord has one vein with that beings oxygenated blood to the fetus from the mother. The umbilical cord has two arteries that bring deoxygenated blood and waste from the fetus back to the mother. Has 3 shunts: foramen ovale in the heart, ductus venosus in the liver, and ductus arteriosus connecting the left pulmonary artery to the descending aorta Oxygenated blood enters the fetal circulatory system through the umbilical vein. 1/3 of the blood goes to the liver. 2/3 of the blood goes through the ductus venosus to the superior vena cava. Blood enters the right arium and flows through the foramen ovale into the left atrium. Blood passes into the left ventricle and into the aorta and goes to the brain and msucles. Blood returns via the superior vena cava to the right atrium and goes to the right ventricle where it is pumped into the pulmonary artery. Blood is then shunted through the ductus arteriosus to the descending aorta. Blood enters the umbilical arteries and flows to the placenta. Released from the placenta into the maternal circulatory system. Fetal circulatory shunts are not needed after birth. As infant breathes and lungs expand, pressure in the right side of the heart falls and closes the foramen ovale. Basically the afterload is higher than the preload. The ductus arteriosus constricts as arterial oxygen levels rise. The ductus venosus contricts when flow of blood from the umbilical cord stops.

Describe various types of education for childbearing families

There are many childbirth classes available to pregnant people and their partners. Examples include introduction to parenthood, baby and me classes, what to expect during labor classes, support groups for first time parents, and even classes on techniques for how to relax during labor. Taking these classes given pregnant patients additional resources and support so they can make informed decisions throughout their pregnancy and postpartum.

Describe common discomforts of pregnancy in terms of causes and measures to prevent or relieve them

Urinary frequency and loss of urine restrict fluids in the evening but drink throughout the day Varicosisities rest frequently with legs elevated Constipation increase fluid intake and use stool softener Fatigue adequate rest Hemorrhoids avoid straining with bowel movements avoid constipation Leg Cramps elevate legs frequently to improve circulation Dependent Edema apply support stockings before bed Nausea and vomiting avoid triggering odors and foods, eat smaller bland portions Round Ligament Pain rest, stretch

Describe the physiologic changes that occur during pregnancy

Uterine hyperplasia and hypertophy More prone to yeast infections Breasts grow Blood volume increases by 30-45% Blood pressure affected by position Increased edema Nausea and vomiting Increased frequency and urgency of urination Pituitary gland increases in size and production of prolactin and oxytocin

Discuss the maternal, fetal and neonatal effects of the most common infections that may occur during pregnancy

Viral Rubella: German Measles, make sure mom has Mmr vaccine prior to conception HSV Type I: Oral lesions HSV Type II: genital lesions Hepatitis B: leads to preterm labor or fetal hepatitis HIV: IUGR, preterm labor, less than 2% NonViral Toxoplasmosis: raw meat and kitty litter can cause this, 30% transmission to fetus, work on prevention Group B Strep: leading cause of life threatening perinatal infections in US. Screen at 36 weeks. Will be treated with antibiotics in labor to prevent transmission to fetus. Can cause sepsis in baby

Describe normal prenatal development from conception through birth

Week 2: Implantation is complete Week 3: Embryonic disc develops three layers and CNS system beings developing creating a thickened neural plate Week 4: Neural tubes close, formation of the face and upper respiratory tract begin Week 5: Brain grows rapidly, heart is beating and lower limbs form Week 6: heart reaches its final four chambered form, eyes continue to develop Week 7-8: General growth and refinement of organs Week 9-12: Eyes close at 9 weeks, first fetal movements begin but are too small to detect, internal differences between males and females begin to be more apparent. By end of week 12 external genitalia are visible Week 13-16: Fetus grows rapidly in length, termed quickening. Fetal movements may be felt at this time. Weeks 17-20: Fetal movements may feel like fluttering, vernix caseosa a fatty cheese like substance covers the skin to protect fetus, lanugo a fine hair covers the fetal body. Brown fat is located on the back of the neck and kidneys Weeks 21-24: Lungs begin to produce some surfactant. Other systems begin to gradual mature Weeks 25-28: Fetus is more likely to survive if born at this time. Fetus assumes a head down position Weeks 29-32: Fetus develops subcutaneous fat, toenails and fingernails present Weeks 33-38: Fetus gains weight, pulmonary system matures, all other organ systems develop. Considered full term after 38 weeks

Explain the process of human conception

is the union of a human egg and sperm, usually occurring in the ampulla of the fallopian tube. The result of this union is the production of a zygote cell, or fertilized egg, initiating prenatal development. The process of fertilization involves a sperm fusing with an ovum. Gametogensis is the development of the ova in the woman and the sperm in the man. Oogenesis is the formation of the female gametes within the ovary. Sperm Transport: The transport of sperm depends on several factors: The sperm must be capable of propelling themselves through the environment of the female vagina and cervix. This environment, which is under cyclic hormonal control, must be favorable to admit the sperm without destroying them. The sperm must possess the capability of converting to a form that can penetrate the cell membrane of the egg (capacitation). Egg Transport: Egg transport begins at ovulation and ends once the egg reaches the uterus. Following ovulation, the fimbriated, or finger-like, end of the fallopian tube sweeps over the ovary. Adhesive sites on the cilia, which are located on the surface of the fimbriae, are responsible for egg pickup and movement into the tube. The cilia within the tube, and muscular contractions resulting from the movement of the egg, create a forward motion. Transport through the tube takes about 30 hours. Conditions such as pelvic infections and endometriosis can permanently impair the function of the fallopian tubes, due to scarring or damage to the fimbriae. Fertilization and Embryo Development: Following ovulation, the egg is capable of fertilization for only 12 to 24 hours. Contact between the egg and sperm is random. Once the egg arrives at a specific portion of the tube, called the ampullar-isthmic junction, it rests for another 30 hours. Fertilization — sperm union with the egg — occurs in this portion of the tube. The fertilized egg then begins a rapid descent to the uterus. The period of rest in the tube appears to be necessary for full development of the fertilized egg and for the uterus to prepare to receive the egg. Defects in the fallopian tube may impair transport and increase the risk of a tubal pregnancy, also called ectopic pregnancy. A membrane surrounding the egg, called the zona pellucida, has two major functions in fertilization. First, the zona pellucida contains sperm receptors that are specific for human sperm. Second, once penetrated by the sperm, the membrane becomes impermeable to penetration by other sperm. Following penetration, a series of events set the stage for the first cell division. The single-cell embryo is called a zygote. Over the course of the next seven days, the human embryo undergoes multiple cell divisions in a process called mitosis. At the end of this transition period, the embryo becomes a mass of very organized cells, called a blastocyst. Implantation: Once the embryo reaches the blastocyst stage, approximately five to six days after fertilization, it hatches out of its zona pellucida and begins the process of implantation in the uterus. In nature, 50 percent of all fertilized eggs are lost before a woman's missed menses. In the in vitro fertilization (IVF) process as well, an embryo may begin to develop but not make it to the blastocyst stage — the first stage at which those cells destined to become the fetus separate from those that will become the placenta. The blastocyst may implant but not grow, or the blastocyst may grow but stop developing before the two week time at which a pregnancy can be detected. The receptivity of the uterus and the health of the embryo are important for the implantation process.

Name types of ultrasound performed during pregnancy

transvaginal vs abdominal