NF215 Unit 2
zona pellucida
the thick transparent membrane surrounding a mammalian ovum before implantation
oligohydramnios
too little amniotic fluid
Normally, implantation occurs in the
upper uterus (aka: fundus)
positive pregnancy
- ultrasound (nuchal translucency) - Fetal Heart Rate - active fetal movement confirmed
A woman comes to the clinic for her first prenatal visitation. As part of the assessment, the woman is screened for rubella antibodies. The nurse determines that a client has immunity against rubella based on which rubella titer? 01:04 01:08 01:06 01:00
01:08 A rubella antibody titer of 1:8 or greater proves evidence of immunity. Women with titers of less than 1:8 should be immunized
When is amniocentesis performed?
Amniocentesis is performed in the second trimester, usually between 15 and 18 weeks gestation. Over 40 different chromosomal abnormalities, inborn errors of metabolism, and neural tube defects can be diagnosed with amniocentesis. It can replace a genetic probability with a diagnostic certainty, allowing the woman and her partner to make an informed decision about their options. Rh incompatibility and HIV status are both evaluated by blood tests.
hCG levels for pregnancy
An hCG level lower than 5 mIU/mL (5 IU/l) is considered negative for pregnancy, and anything higher than 25 mIU/mL (25 IU/l) is considered positive for pregnancy.
Rh disease
An incompatibility between Rh positive fetus and Rh negative mothers, Rh factor is protein in the blood, can kill the next baby mother has if it is not treated.
Fetal stage
Differentiation and structures specialize by end of the eighth week until birth.
Normal FHR
During pregnancy, heart rate increases by 10 to 15 beats per minute between 14 and 20 weeks of gestation, and this elevation persists to term. Therefore, a prepregnancy heart rate of 72 would increase by 10 to 15 beats per minute to a rate of 82 to 87 beats per minute.
Embryonic layers of cells
Ectoderm, mesoderm and endoderm
A nurse is conducting a prenatal class for a group of primipara women in their first trimester. When describing the changes that occur in the uterus, the nurse identifies which hormone as responsible for uterine growth? Estrogen Human chorionic gonadotropin (hCG) Oxytocin Progesterone
Estrogen
When is Rhogam given?
If indicated, Rho(D) immune globulin should be given at 28 weeks for prophylaxis and again following birth if the infant is Rh+.
premature rupture of membranes
Spontaneous rupture of the amniotic membranes, 1 hr or more prior to the onset of true labor (37 weeks)
main concern in PROM
infection
what to assess in hydramnios
is there SOB
ambivolence
mom feels happy and scared at the same time due to pregnancy may change based on famailial feelings
treatment for placenta privia
no abdominal exam pelvic rest
The primary oocyte completes its first meiotic division before
ovulation
The secondary oocyte begins its second meiotic division just before
ovulation
A nurse is explaining how hormones affect the pregnancy. Which hormone would the nurse describe as being responsible for stimulating uterine contractions during labor and birth? estrogen progesterone oxytocin prolactin
oxytocin
__________ is responsible for milk ejection during breast-feeding. Its secretion is stimulated by stimulation of the breasts via sucking or touching.
oxytocin
placenta previa s/s
painless vaginal bleeding bright red
gestational hypertension
potentially life-threatening disorder that usually develops after the 20th week of pregnancy and is characterized by edema and proteinuria 140/90 x2 4-6hrs apart
placental abruption
premature separation of the placenta
severe eclampsia
seizures and hyperreflexia
Visual symptoms such as blurred vision and blind spots suggest
severe preeclampsia
Blastocyst
stage of early development in mammals that consists of a hollow ball of cells
Primary and secondary spermatocytes undergo meiosis while
still in the testes
How much weight gain during pregnancy for overweight BMI?
15 - 25 pounds
A client who is in her first trimester is anxious to have an ultrasound at each visit. The nurse explains that it is not necessary and schedules a second ultrasound to be performed when she is about: 24 to 26 weeks pregnant. 18 to 20 weeks pregnant. 15 to 17 weeks pregnant. 21 to 23 weeks pregnant.
18 to 20 weeks There are no hard-and-fast rules as to how many ultrasounds a woman should have during her pregnancy; however, the first ultrasound is usually performed during the first trimester to confirm the pregnancy. A second scan may be performed at about 18 to 20 weeks to look for congenital malformations. A third one may be done at around 34 weeks to evaluate fetal size and verify placental position.
Fertilization usually takes place during
2 weeks after the last normal menstrual period in a 28-day cycle
How many sperm are contained in ejaculated semen?
200 million sperm per mL
Fundal height at 20 weeks
20cm
Measures to alleviate nausea during pregnancy
eating small, frequent meals that are bland and low in fat, eating dry crackers, Cheerios, or cheese before getting out of bed, avoiding any strong food odors, limiting the intake of fluids and soups during meals, and eating a high-protein snack before going to bed.
if there is fetal compromise in oligohydramnios
emergency c section
Zygotic stage
fertilization of sperm and egg through the second week.
What can hot tubs cause in pregnant women?
fetal tachycardia
ectoderm
forms the central nervous system, special senses, skin, and glands.
endoderm
forms the respiratory system, liver, pancreas, and digestive system.
mesoderm
forms the skeletal, urinary, circulatory, and reproductive organs.
How much weight gain during pregnancy for underweight BMI?
28 - 40 pounds
acceptence
2nd trimester biggest physical changes reality hits
Duration of pregnancy
40 weeks or 266 days
Which hormones are secreted by the placenta?
hCG, relaxin, estrogen
HELLP stands for
hemolysis, elevated liver enzymes, low platelets
Cytomegalovirus (CMV)
herpes-type virus that usually causes disease when the immune system is compromised. Most common
treatment for polyhydramnios
provide comfort measures amniocentesis - only momentary relief
Percutaneous umbilical blood sampling
rapid chromosomal analysis
main symptom of PROM
respiratory distress syndrome
Rogam is given when mother is
rh negative
drug for rh disease
rogam
A pregnant client has tested positive for hepatitis B virus. When discussing the situation with the client, the nurse explains that her newborn will be vaccinated with an initial HBV vaccine dose at which time? within 48 hours of birth within 36 hours of birth within 12 hours of birth within 24 hours of birth
within 12 hours of birth If a woman tests positive for HBV, the newborn will receive HBV vaccine within 12 hours of birth. The second dose will be given at 1 month and the third dose at 6 months.
presumptive pregnancy
- Quickening, or movement felt by mother - amenorrhea - mom thinks she's pregnant - fatigue - urinary pregnancy -skin hyperpigmentation - breast enlargement
probable pregnancy
- positive pregnancy test. - chadwicks sign, or blue cervix & vagina. - hCG test - Goodell sign - softening of cervix - Ballottment - rebounding of fetus against fingers - Braxton Hicks - Hegar's sign - softening and thickening of lower uterus
How much weight is gained during second trimester
1 lb per week
How much weight gain during pregnancy for obese BMI?
11 - 20 pounds
The diagonal conjugate of a pregnant woman's pelvis is measured. Which measurement would the nurse interpret as presenting a potential problem? 12.5 cm 13.5 cm 13.0 cm 12.0 cm
12 cm The diagonal conjugate, usually 12.5 cm or greater, indicates the anteroposterior diameter of the pelvic inlet. The diagonal conjugate is the most useful measurement for estimating pelvic size because a misfit with the fetal head occurs if it is too small.
second trimester
14-26 weeks
When discussing the many changes the woman's body undergoes during pregnancy, the nurse may include that the woman's total blood volume will increase by approximately how much by the 32nd week gestation? 2,000 mL 500 mL 1,500 mL 1,000 mL
1500 (50% more than before pregnancy)
When to screen for alpha-fetoprotein analysis?
16 to 18 weeks
Severe preeclampsia is characterized by a blood pressure of
160/110
How much weight gain during pregnancy for normal BMI?
25 - 35 pounds
A 23-year-old female has come to the clinic for her first prenatal visit. After the examination reveals no concerns and potential low-risk pregnancy, the nurse discusses nutritional needs for her and her growing baby. As per the Institute of Medicine, the nurse suggests the client take which amount of ferrous iron daily? 40 mg 10 mg 20 mg 27 mg
27 mg The dietary reference intakes as per the Institute of Medicine are for 27 mg of ferrous iron and 400 to 800 mcg of folic acid per day. Women with a previous history of fetus with a neural tube defect are often prescribed a higher dose.
third trimester
27-40 weeks
During pregnancy a woman's blood volume increases to accommodate the growing fetus to the point that vital signs may remain within normal range without showing signs of shock until the woman has lost what percentage of her blood volume? 30% 20% 40% 50%
40% Vital signs can be within normal range, even with significant blood loss, because a pregnant woman can lose up to 40% of her total blood volume without showing signs of shock.
How long does the process of conception take?
5 hours
Proteinuria in severe preeclampsia is greater than
500 mg per 24 hours
normal amount of amniotic fluid
500-1200 ml
morula
A solid ball of cells (16) that makes up an embryo; in humans, this stage occurs within 72 hours of fertilization.
The nurse is putting together information for a nutritional class for nullipara women. Which information would be most important for the nurse to include? Select all that apply. Avoid the intake of alcohol. Decrease intake of saturated fats, trans fats, and cholesterol. Consume at least one quart of water daily. Increase caloric intake. Increase consumption of fruits, vegetables, and whole grains.
Avoid the intake of alcohol., Decrease intake of saturated fats, trans fats, and cholesterol., Increase consumption of fruits, vegetables, and whole grains.
first trimester
1-13 weeks
polyhydramnios
excessive amniotic fluid 2000ml
Which medication would the nurse prepare to administer if prescribed as treatment for an unruptured ectopic pregnancy? methotrexate ondansetron promethazine oxytocin
methotrexate Methotrexate, a folic acid antagonist that inhibits cell division in the developing embryo, is most commonly used to treat ectopic pregnancy. Oxytocin is used to stimulate uterine contractions and would be inappropriate for use with an ectopic pregnancy. Promethazine and ondansetron are antiemetics that may be used to treat hyperemesis gravidarum.
What happens during the embryonic stage?
Basic structures of all major body organs and the main external features are completed during this time period
Embryonic stage
Major organs and structures begin to emerge by end of the second week through the eighth week
A pregnant client at 14 weeks' gestation calls the clinic. When talking with the nurse, the client reports continued, frequent nausea and vomiting. She states, "This has been happening since I got pregnant and now I cannot keep anything down." Which intervention would be the priority for this client? Initiating intravenous access for fluids Stopping all intake of food and drink Obtaining serum electrolyte levels Administering an antiemetic
Stopping all intake of food and drink Hyperemesis gravidarum is nausea and vomiting in early pregnancy that prevents the woman from ingesting adequate nutrition. IV fluids may be required for rehydration, but the priority is to stop all intake of food and fluid for a period of time until vomiting has stopped. Once this is done, IV access and fluids, antiemetics, and laboratory tests can be done.
Office visits while pregnant
The recommended follow-up visit schedule is every 4 weeks up to 28 weeks, every 2 weeks from 29 to 36 weeks, and then every week from 37 weeks to birth.
tidal volume during pregnancy
Tidal volume or the volume of air inhaled increases by 40% (from 500 to 700 mL) as the pregnancy progresses.
Blastocyst stage
Zygote divides into a solid ball of cells which attaches to the uterus.
stages of fetal development
Zygotic, blastocyst, embryonic, fetal
ductus arteriosus
a blood vessel in a fetus that bypasses pulmonary circulation by connecting the pulmonary artery directly to the ascending aorta
Placenta accreta
a condition where the placenta attaches itself too deeply into the wall of the uterus. According to the literature, a cesarean birth increases the possibility of a future placenta accreta; the more cesarean births that are done, the greater the incidence.
Chorionic villus sampling (CVS)
a procedure for obtaining a sample of the chorionic villi for prenatal evaluation of chromosomal disorders, enzyme deficiencies, fetal gender determination, and to identify sex-linked disorders such as hemophilia, sickle cell anemia, and Tay-Sachs disease.
Coombs test
a test for the presence of anti-Rh factor antibodies in the blood (this is often given to pregnant women that are Rh- to see if they will mount an immune response against the blood of their fetus)
The outer layer of cells surrounding the blastocyst cavity is called
a trophoblast
preeclampsia
abnormal condition associated with pregnancy, marked by high blood pressure, MARKED (3+) proteinuria, edema, and headache at risk for cerebral hemorrhage 160/110
treatment for oligohydramnios
add fluids - amniofusion
Low-lying placenta
aka placenta previa
The nurse is concerned that a client is not obtaining enough folic acid. Which test would the nurse anticipate being used to evaluate the fetus for potential neural tube defects? Doppler flow study amniocentesis triple-marker screen alpha-fetoprotein analysis
alpha-fetoprotein analysis
The embryonic stage of development begins
at day 15 after conception and continues through week 8
mood swings
back and forth feelings
assessment of PROM
check for labor check for infection - the moment membranes rupture, perfect entryway for bacteria monitor cervical status check for foul odor - indicates infection (nitrogen test - pH, if blue, amniotic fluid in urine). fern test - vaginal fluid under microscope for amniotic fluid
A client is in her second trimester, and the health care provider has recommended she undergo an amniocentesis. The nurse explains that the procedure is used to diagnose which conditions? Select all that apply. HIV chromosomal abnormalities Rh incompatibility inborn errors of metabolism neural tube defects
chromosomal abnormalities, inborn errors of metabolism, neural tube defects
foramen ovale
connects the two atria in the fetal heart
ductus venosus
connects the umbilical vein to the inferior vena cava, bypassing the liver
rh disease test
coombs test
body acceptance
coping with changes
good food sources for folic acid
dark green vegetables, such as broccoli, romaine lettuce, and spinach; baked beans; black-eyed peas; citrus fruits; peanuts; and liver.
placental abruption s/s
dark red blood, painful, emergency, hard belly from bleeding
Which effect would the nurse identify as a normal physiologic change in the renal system due to pregnancy? decrease in glomerular filtration rate reduction in kidney size shortening of the ureters dilation of the renal pelvis
dilation of the renal pelvis The renal pelvis becomes dilated during pregnancy, possibly due to the effect of progesterone on smooth muscle. The glomerular filtration rate increases during pregnancy. The kidneys enlarge during pregnancy. The ureters elongate, widen, and become more curved above the pelvic rim.
A woman is being closely monitored and treated for severe preeclampsia with magnesium sulfate. Which finding would alert the nurse to the development of magnesium toxicity in this client? elevated liver enzymes serum magnesium level of 6.5 mEq/L diminished reflexes nseizures
diminished reflexes Diminished or absent reflexes occur when a client develops magnesium toxicity. Elevated liver enzymes are unrelated to magnesium toxicity and may indicate the development of HELLP syndrome. The onset of seizure activity indicates eclampsia. A serum magnesium level of 6.5 mEq/L would fall within the therapeutic range of 4 to 7 mEq/L
A client has been admitted with placental abruption. She has lost 1,200 mL of blood, is normotensive, and ultrasound indicates approximately 30% separation. The nurse documents this as which classification of abruptio placentae? grade 1 grade 2 grade 3 grade 4
grade 2 The classifications for abruptio placentae are: grade 1 (mild) - minimal bleeding (less than 500 mL), 10% to 20% separation, tender uterus, no coagulopathy, signs of shock or fetal distress; grade 2 (moderate) - moderate bleeding (1,000 to 1,500 mL), 20% to 50% separation, continuous abdominal pain, mild shock, normal maternal blood pressure, maternal tachycardia; grade 3 (severe) - absent to moderate bleeding (more than 1,500 mL), more than 50% separation, profound shock, dark vaginal bleeding, agonizing abdominal pain, decreased blood pressure, significant tachycardia, and development of disseminated intravascular coagulopathy. There is no grade 4.
Gestational hypertension characterized by
hypertension without proteinuria after 20 weeks of gestation resolving by 12 weeks postpartum. It is defined as systolic blood pressure of greater than 140 mm Hg and/or diastolic of greater than 90 mm Hg on at least two occasions at least 6 hours apart after the 20th week of gestation, in women known to be normotensive prior to this time and prior to pregnancy.
The nurse is providing care to a neonate. Review of the maternal history reveals that the mother is suspected of having a heroin use disorder. The nurse would be alert for which finding when assessing the neonate? hypertonicity low, feeble cry vigorous sucking easy consolability
hypertonicity Newborns of mothers with heroin or other narcotic use disorder display irritability, hypertonicity, a high-pitched cry, vomiting, diarrhea, respiratory distress, disturbed sleeping, sneezing, diaphoresis, fever, poor sucking, tremors, and seizures.
Abnormal amniocentesis results
include positive bilirubin suggestive of hemolytic disease in the fetus and negative phosphatidylglycerol suggestive of pulmonary immaturity
Secretion of follicle-stimulating hormone is ____________ during pregnancy.
inhibited
When is screening for gestational diabetes performed?
is best done between 24 and 28 weeks' gestation, unless screening is warranted in the first trimester for high-risk reasons. If the initial screening is elevated, then further testing should be conducted to confirm the diagnosis.
Indications for Rho(d) immune globulin (rhogam)
isoimmunization, ectopic pregnancy, chorionic villus sampling, amniocentesis, prenatal hemorrhage, molar pregnancy, maternal trauma, percutaneous umbilical sampling, therapeutic or spontaneous abortion, fetal death, or fetal surgery.
if there is no compromise to fetus in oligohydramnios
keep monitoring
A pregnant woman with chronic hypertension comes to the clinic for evaluation. The last several blood pressure readings have been gradually increasing. On today's visit her blood pressure is 166/100 mm Hg. The health care provider prescribes an antihypertensive agent. The nurse anticipates which agent as likely to be prescribed? ipratropium hydroxychloroquine labetalol albuterol
labetalol Medications used to treat chronic hypertension with pregnancy include labetalol hydrochloride (Trandate), hydralazine hydrochloride (Apresoline), and nifedipine (Procardia). Hydroxychloroquine would be used to treat rheumatoid arthritis. Albuterol and ipratropium would be used to treat asthma.
treatment of eclampsia
magnesium sulfate oxytocin - induce labor if seriously ill - straight down for c-section
fetal tachycardia
telltale sign of infection in amniotic fluid
Morula will become
the blastocyst
The trophoblast will eventually become
the chorion, and helps to form the placenta
The inner layer of a blastocyst will form
the embryo and amnion
Normal amniocentesis results
the fluid is clear with white flecks from vernix caseosa, the L/S ratio is greater than 2, and the glucose level is less than 45 mg/dl (2.50 mmol/l).
what is placenta privia
the placenta is in the wrong place. Low in the uterus, or over the cervical opening
eclampsia
true toxemia of pregnancy characterized by high blood pressure, albuminuria, edema of the legs and feet, severe headaches, dizziness, convulsions, and coma once seizures start
When the ovum is fertilized by the sperm it is called a
zygote
