OU ABSN N3143 Family Focus Konrad Exam 1

Turner Syndrome

(45,XO) Monosomy that is compatible with life Verbal IQ exceeds performance IQ No pubertal growth spurt, and girls with this are generally infertile Growth decline is usually around 3 years of age May administer growth hormones around puberty to enhance secondary sex characteristics

Triple-X female

(47,XXX) Relatively common Normal phenotype with increase risk for learning disabilities Delayed menarche and premature menopause

Klinefelter syndrome

(47,XXY) Most common Physical abnormalities: decreased masculinization and long legs Cognitive difficulties: expressive language, auditory processing, and auditory memory

XYY syndrome

(47,XYY) May be at an increased risk for autism Extra Y from the father

Trisomy 21

(Down Syndrome) Male: 47,XY, +21 Female: 47, XX, +21

Unifactoral inheritance

(aka Unifactoral Mendelian or Single-gene inheritance) A single gene controls a particular trait or disorder 4 types (autosomal dominant and recessive, x-linked dominant and recessive)

What occurs during the Menstrual phase

(days 1-6) Menstruation occurs Estrogen levels are low. Cervical mucus is scant, viscous, and opaque. Endometrium is shed. Some of the remaining tips of the endometrial glands begin to regenerate. The endometrium is in a resting state following menstruation.

What occurs during the Secretory phase

(days 15-26) Estrogen level drops sharply, and progesterone dominates. Vascularity of the entire uterus increases, providing a nourishing bed for implantation Tissue glycogen increases, and the uterus is made ready for implantation. If implantation occurs, the endometrium, under the influence of progesterone, continues to develop and become even thicker.

What occurs during the Ischemic phase

(days 27-28) Occurs if fertilization does not occur. Both estrogen and progesterone levels drop Spiral arteries undergo vasoconstriction Endometrium becomes pale Blood vessels rupture Blood escapes into uterine stromal cells, gets ready to be shed

What occurs during the Proliferative phase

(days 7-14) Endometrium and myometrium thickness increases. Endometrial glands enlarge. Blood vessels become prominent and dilated. Estrogen peaks just before ovulation Cervical mucus at ovulation is clear, thin, watery, and alkaline, is more favorable to sperm, has spinnbarkeit (increased elasticity) greater than 5 cm, and shows ferning pattern on microscopic examination. Just before ovulation, body temperature may drop slightly, then at ovulation basal body temperature increases 0.3C to 0.6C (0.5F to 1.0F), and mittelschmerz and/or midcycle spotting may occur.

3 HR glucose tolerence test (GTT)

-3 Hr glucose tolerance test (GTT) *fasting blood glucose *100 g oral glucose load *BG tested at hour intervals -3 hour Glucose Tolerance Test (GTT) abnormal results •Fasting: greater than 95 mg/dL (5.3 mmol/L) •1 hour: greater than 180 mg/dL (10.0 mmol/L) •2 hour: greater than 155 mg/dL (8.6 mmol/L) •3 hour: greater than 140 mg/dL (7.8 mmol/L)

Developmental tasks of the father during pregnancy

-Announcement phase -Moratorium phase -Focusing phase

autosomal recessive

-Carrier parents -25% chance of passing on abnormal gene -25% chance of an affected child -If child is clinically normal, 50% chance child is carrier -Males and females equally affected ie cystic fibrosis, sickle cell anemia

Multifactorial (non- Mendelian) mode of inheritance

-Caused by an interaction of many genes and environmental factors -Many common congenital malformations -Malformations vary from mild to severe, where: -The more severe the defect, the more genes present for that defect -Often there is a sex bias

Calgary Family Assessment Model

-Focuses on interactions among the individuals in the family *Three major categories are -Structural assessment -Developmental assessment -Functional assessment

autosomal dominant

-Multigenerational -50% chance of passing on the gene -Males and females equally affected -Varying degrees of presentation ie: huntington's disease, dwarfism

X-linked recessive

-No male-to-male transmission (carrier mother transmits to male son) -50% chance carrier mother will pass the abnormal gene to sons (affected) -50% chance carrier mother will pass the normal gene to sons (unaffected) -50% chance carrier mother will pass the abnormal gene to daughters (carrier) ie: Hemophilia A, color blindness

Initial pregnancy visit interview

-OB/reproductive health hx -health hx -nutritional hx -drug hx -herbal hx -family hx -social hx -intimate partner violence

complete abruption

-Requires an emergency C-section. -Fluid replacement -Possible need for blood transfusion.

ectopic pregnancy nursing managment

-determine level of HcG -check vital signs q15m -18g IV (in case blood is needed) -admin O2, pain meds as needed

glucose screening in pregnancy

-early screening if obsessed, hx of DM, known impairment of glucose metabolism -1 hr glucose tolerance test (GTT) @ 24-28 weeks *50 gram oral glucose load *blood glucose above 140 need 3 hour GTT

fetal assessment during pregnancy

-fetal heart tones (routine check: fetoscope or Doppler (most common) -fetal movement: routine check -fundal height: routine check, determine fetal growth -ultrasound: growth & organ development scan at 11-18 weeks (usually only need one)

initial pregnancy visit physical exam

-vital signs -height/weight -head to toe exam (including pelvic exam- cervical & uterine changes)

Maternal physical assessment on follow up visits (after initial visit)

-vital signs, especially BP -weight, is gain appropriate? -urine, protein, glucose, leukocytes -fundal height

incidence of twins

1 in 43 births

4 phases of sexual response cycle

1. Excitement 2. Plateau 3. Orgasm 4. Resolution

Eight Stages of Family Life Cycle (Duvall, from Family Developmental and Life Cycle Theory)

1. Married couples (no children) 2. Childbearing families 3. Families with preschool children 4. Families with school-age children 5. Families with teenagers 6. Families launching young adults 7. Middle-aged parents 8. Aging family members

Placenta previa patho

1. Most common cause of BLEEDING in the later months (Usually the 7th!) d/t detachment of villi sinus w/ practice contraction 2. The placenta has implanted wrong (too close to the cervix)

When is the placenta an organ?

14 weeks

Mother's response to pregnancy by trimester

1st Trimester: Baby doesn't seem real, so woman focuses on herself & pregnancy 2nd Trimester: Quickening occurs (fetal movement) and helps the woman think of her baby as a separate person. Becomes introspective and evaluates life, plans, and child's future. 3rd Trimester: Woman feels pride about pregnancy and anxiety about labor and birth. Physical discomforts increase and the woman is eager for the pregnancy to end. Fatigue increases, sexual activity decreases.

father's response to pregnancy

1st Trimester: Seeing the baby on an ultrasound is important in seeing the baby is real 2nd Trimester: Feels more involved when feeling baby movements 3rd Trimester: Adapts to alternative methods of sexual contact. Becomes concerned with financial responsibility. Envisions the baby as an older child, not a newborn. Couvade: the observance of certain rituals and taboos by the male to signify the transition to fatherhood.

sequential integrated screening (SIS) step 1

1st trimester blood test: multiple marker screen (blood draw) 10-13.6 weeks -Human chorionic gonadotropin (hCG) -Pregnancy-associated plasma protein-A (PAPP-A)

Traditional pregnancy visit schedule

1st visit in 1st trimester monthly visits between 16-28 weeks Every 2 weeks between 29-36 weeks Weekly between 36 weeks and birth

Centering Pregnancy Schedule

1st visit in 1st trimester (before 12 weeks) Every 4 weeks between 16-28 weeks Every 2 weeks between 29-40 weeks

Preterm pregnancy

20-37 weeks

How long does human gestation last?

280 days after last menstrual period or 266 days after conception

trisomy

3 copies of a chromosome a chromosome is added to a pair (n=47). Normal gamete that pairs with a gamete that has an extra chromosome. Most occur during oogenesis (egg production) Most not born, except for trisomy 21, 18, and 13

Late preterm pregnancy

34 wks 0 days - 36 weeks 6 days

early term pregnancy

37 wks 0 days- 38 wks 6 days

full term pregnancy

39 wks 0 days- 40 wks 6 days

late term pregnancy

41 wks 0 days- 41 weeks & 6 days

post term

42 weeks & >

When does implantation occur?

6 days after fertilization

Wharton's jelly

A gelatinous tissue that remains when the embryonic body stalk blends with the yolk sac within the umbilical cord.

Aneuploidy

Abnormal number of chromosomes.

Developmental tasks of Families with adolescents

Adapt to changes in family communication, power structure and decision making as teen increases autonomy Help teen develop as individual and as a family member

Health belief model

Addresses the relationship between a person's beliefs and behaviors model reduces cultural and environmental barriers to healthcare, used in research

Developmental tasks of Childbearing families with infants

Adjust to pregnancy and then birth of infant Learn new roles as mother and father Maintain couple time, intimacy, and relationship as a unit

Developmental tasks of Aging parents

Adjust to retirement, death of spouse, and living alone Adjust to new roles (i.e., widow, single, grandparent) Adjust to new living situations, changes in health

Developmental tasks of Families launching young adults

As young adult moves in and out of the home, allocate space, power, communication, roles Maintain couple time, intimacy, and relationship

Role of the nurse regarding genetic testing beyond the assessment

Be able to illicit family hx and when feasible document it in pedigree format -Get a minimum of 3 generations Skillful interviewing Is necessary to obtain info Identification and Referral --so that you can be alert to situations in which families could benefit from genetic evaluation and counseling --be familiar with facilities/services to recommend --call family before to relieve anxiety (ie tell them about the visit will they draw blood, should the child go/not go to visit?) --assess for guilt in parents about carrying bad genes --if families have a positive diagnosis, be in contact with the family for therapies/treatments the child may need

sequential integrated screening (SIS) step 3

Blood draw, 15-20 weeks- Quad screen -alpha-fetoprotien (AFP) -human chorionic gonadotropin (hCG) -Unconjugated estriol -Inhibin-A

marginal abruptio placentae

Blood passes between the fetal membranes and the uterine wall and escapes vaginally

Velamentous insertion

Blood vessels in the umbilical cord separate and leave the cord prior to insertion into the surface of the placenta. Occurs 1% of the time. Dangerous, rupture of membranes may also rupture a fetal blood vessel. Vessels are also liable to compression which would cause fetal anoxia.

Sibling Response to pregnancy

Bringing a new baby home often marks the beginning of sibling rivalry Many women find it helpful to bring their children to prenatal visits to help the new baby become more real to the other child.

abruptio placentae treatment & nursing management

C-section possible hysterectomy nursing management: monitor strip

Probably signs of pregnancy

Changes observed by an examiner -uterine enlargement -Braxton hicks contractions -placental soufflé -ballottement -positive pregnancy test (presence of HcG)

monosomy

Chromosomal abnormality consisting of the absence of one chromosome from the normal diploid number Failure of a chromosome to separate. n=45 The only monosomy compatible with life is monosomy X (Turner syndrome), but most spontaneously miscarry

Classes of cardiac disease

Class I: asymptomatic without limitation of physical activity Class II: symptomatic with slight limitation of activity Class III: symptomatic with marked limitation of activity Class IV: symptomatic with inability to carry on any physical activity without discomfort

triploid cells

Contain 3 copies of each chromosome n=69

Gestational Trophoblastic Disease treatment

D/C or Suction monitor for signs of hemorrhage elective hysterectomy

Embryo stage duration

Day 15 until 8 weeks after conception (most critical time for development

Fetal circulatory system includes what? (These are the ducts that close after birth.)

Ductus arteriosus Ductus venosus Foramen ovale

Human chorionic gonadotropin (HcG)

Earliest biochemical marker for pregnancy. production begins as early as day of implantation. Can be detected in maternal serum or urine as soon as 7-8 days before the expected menses

Gestational Trophoblastic Disease nursing care

Educate about importance of follow up. Educate about not getting pregnant for a year (birth control methods) d/t cancer risk.

Trisomy 18

Edwards syndrome Severe cognitive impairment and physical abnormalities

Psychological tasks of the mother while pregnant

Ensure safe passage through pregnancy, labor, and birth Seeking acceptance of this child by others Seeking commitment and acceptance of herself as mother to the infant Learning to give of oneself on behalf of ones child

Developmental tasks of married couples (without children)

Establish relationship as a family unit, role development Determine family routines and rituals

Four approaches to family nursing

Family as context or structure - individual first and family second. Family as client - the family is first and the individuals are second. Family as system - family as client, family is viewed as an interacting system in which the whole is more than the sum of its parts. Family as a component of society - one of many institutions in society.

family stress theory

Family response to & coping with stressful events family's reaction to stress is the focus

Estrogens role in reproduction

Female: Reproductive organs: maturation at puberty, stimulation of endometrium before ovulation. Breast: induce growth of glandular and ductal tissue, initiate deposition of fat at puberty. Stimulate growth of long bones but cause closure of epiphyses, limiting mature height. Pregnancy: stimulate growth of uterus, breast tissue, inhibit active milk production, relax pelvic ligaments Male: Necessary for normal sperm formation

Testosterone role in reproduction

Female: Small quantities of androgenic (masculinizing) hormones from adrenal glands cause growth of pubic and axillary hair at puberty; most androgens, such as testosterone are converted to estrogen Male: Induces development of male sex organs in fetus; induces growth and division of the cells that mature sperm; Induces development of male secondary sex characteristics

FSH (follicle stimulating hormone) role in reproduction

Female: Stimulates final maturation of follicle; Stimulates growth and maturation of graafian follicles before ovulation Male: Stimulates Leydig cells of testes to secrete testosterone

GnRH (gonadotropin-releasing hormone) role in reproduction

Female: Stimulates release of FSH and LH, initiating puberty and sustaining female reproductive cycles; release is pulsatile Male: Stimulates release of FSH and LH, initiating puberty; release is pulsatile

Progesterone role in reproduction

Female: Stimulates secretion of endometrial glands, causes endometrial vessels to become dilated and tortuous in preparation for possible embryo implantation; Pregnancy: induces growth of cells of fallopian tubes and uterine lining to nourish embryo, decrease contractions of uterus, prepares breasts for lactation but inhibits prolactin secretion Male: n/a

Prolactin role in reproduction

Female: Stimulates secretion of milk; estrogen and progesterone from placenta have an inhibiting effect on milk production until after placenta is expelled at birth, sucking of newborn stimulates prolactin secretion to maintain milk production Male: n/a

oxytocin role in reproduction

Female: Uterus: stimulates contractions during birth and stimulates postpartum contractions to compress uterine vessels and control bleeding. Stimulates let-down, or milk-ejection reflex during breastfeeding Male: n/a

X-linked recessive inheritance

Females are either heterozygous or homozygous, males are hemizygous since they only have one X chromosome. The male receives the abnormal allele from his carrier mother on her affected X chromosome. An affected male can pass the abnormal allele on to his daughters, but not his sons—they get the X from their mother.

Placental function

Fetal respiration Nutrition Excretion Endocrine functions Immunologic proporties To carry out these functions the placenta is involved in metabolic and transfer activities.

Daily calorie increases for pregnancy & lactation

First trimester: 0 Second trimester: +340 Third trimester: +452 Lactation first 6 mo: +330 Lactation 2nd 6 mo: +400

vaccinations during pregnancy

Flu Tdap

Grandparents Response to pregnancy

Grandparents may react differently due to their age and how active their lives are. Conflict may occur and could be related to retirement, financial concerns, menopause, or death of a friend.

GTPAL

Gravida, Term (births after 37 weeks), Preterm births, Abortions (any pregnancy losses before 20 weeks which includes miscarriage, ectopic, elective/induced abortion), Living (total # of living children)

Immunologic properties of the placenta

Homografts- The placenta and embryo are transplants of the living tissue within the same species. Exempt from immunologic reactions by the host.

How is pregnancy detected with a pregnancy test?

Human chorionic gonadotropin (HcG).

hyperemesis gravidarum treatment

IV fluids: electrolytes nursing duties daily weights monitor I/O vital signs hydration status admin antiemetics/antihistamine, Vit B6

Rh incompatibility

If mother is Rh- and baby is Rh+, than mother may develop antibodies against the infant's blood

Anemias in pregnancy

In pregnancy they result from dilution. •Iron-deficiency •Folic acid deficiency •Sickle cell neonatal risks prematurity stillbirth

Placenta previa risk factors

Increased maternal age, multiple gestation, history of placenta previa, uterine scarring/tumors, and closely spaced pregnancies.

What occurs with the placenta at 20 weeks?

It becomes thicker but not wider

What is the perinatal continuum of care?

It begins with family planning and continues until the infant is 1 year old. It takes place both at home and in health care facilities. The perinatal continuum does not end with the birth. The perinatal continuum begins before conception and continues after the birth. Home care is one delivery component; health care facilities are another.

What is the placenta size at 40 weeks?

Itis about 15-20cm in diameter and 2.5-3.0 in thickness weighing about 400-600 grams (14-21 oz)

Sex chromosome aneuploidies

Klinefelter syndrome (has 47, XXY), XYY syndrome (47, XYY), triple-X syndrome (47, XXX), turner syndrome (45, X0)

Role of the nurse in genetic testing regarding assessment

Know the assessment clues to a genetic disorder ie major or minor birth defects: Growth abnormalities Skeletal abnormalities Visiaul or hearing loss Metabolic disorders Sexual development abnorm. Skin disorders Recurrent infection or immunodeficiency Speech/developmental/cognitive delays Behavioral disorders

Developmental tasks of Families with school-aged children

Learn to open family boundaries as child increases amount of time spent with others outside of the family Manage time demands in supporting child's interest and needs outside of the home Establish rules, new disciplinary actions Maintain couple time

Mother's response to pregnancy overall

Many women commonly experience feelings of ambivalence during early pregnancy. These feelings may be related to timing, worries, relationships, career plans, fears, and emotional conflicts. These feelings may be more pronounced if the pregnancy is unplanned or unwanted. Indirect expressions of ambivalence include complaints about considerable physical discomfort, prolonged or frequent depression, dissatisfaction with changing body shape, excessive mood swings, and accepting life changes resulting from the pregnancy. An unintended pregnancy can be a risk factor for depression. Lower acceptance tends to be related to an unplanned pregnancy and greater evidence of fear and conflict.

abruptio placentae complications

Maternal Renal failure (shock) DIC Hemorrhage Infant hypoxia shock

Maternal adaptation tasks of pregnancy

Maternal adaptation •Accepting the pregnancy •Identifying with the mother role •Reordering personal relationships •Establishing relationship with fetus: attachment process of the mother •Preparing for childbirth

ABO incompatibility in pregnancy

Most common cause of hemolytic disease (25% incidence). Resulting anemia is usually mild. It occurs if the fetal blood type is A, B, or AB, and the maternal type is O. It occurs rarely in infants with type B blood born to mothers with type A blood. The incompatibility arises because naturally occurring anti-A and anti-B antibodies are transferred across the placenta to the fetus. Unlike the situation that pertains to Rh incompatibility, first-born infants can be affected because mothers with type O blood already have anti-A and anti-B anti- bodies in their blood *COmmon cause of Hyperbilirubinemia

Folate (folic acid) is important for pregnancy in order to decrease what?

Neural Tube Defects -spina bifida -anencephalus *Fortified since 1990s in flour/cereal: adequate amount to prevent 1/2 of NTD Recommended dosages: -400mcg before pregnancy -600mcg during pregnancy -1000-4000mcg if previous baby born with NTD

What are the major anomalies that can occur during fetal development?

Neural tube defects TA, ASD, VSD Amelia/Meromelia Cleft lip low-set malformed ears & deafness microphthalmia, cataracts, & deafness enamel hypoplasia & staining cleft palate masculinization of female genetalia

Calcium recommendations in pregnancy compared to non-pregnant & lactation

Nonpregnant: 1000-1300mg pregnant: 1000-1300mg Lactation: 1000-1300mg

Iron recommendations in pregnancy compared to non-pregnant & lactation

Nonpregnant: 15-18mg pregnant: 27mg Lactation: 9-10mg If anemic: 60-120mg/day

Fiber recommendations in pregnancy compared to non-pregnant & lactation

Nonpregnant: 25g pregnant: 28g Lactation: 29g

Vitamin C recommendations in pregnancy compared to non-pregnant & lactation

Nonpregnant: 65-75mg pregnant: 80-85mg Lactation: 115-120mg

X-linked dominant inheritance

Occur in males and heterozygous females, but females are usually less severely affected than affected males Variant (abnormal) allele is usually lethal in affected males, since they have no normal gene like females do. Very few disorders identified

Peripartum cardiomyopathy

Occurs during the last trimester of pregnancy or the first 5 months after delivery Occurs in women with no previous hx of heart disease 50% die from this. dyspnea orthopnea angina palpatations weakness edema normal presentation is anemia & infection

Trisomy 13

Patau syndrome Most severe of the three trisomies

Fetal blood flow from the placenta through maternal circulation & back to placenta

Placenta Umbilical Vein ductus venosus Inferior Vena Cavactus venosus Inferior Vena Cava R. Atrium (bypass the R. Ventricle) Foramen ovale 🡪 L. Atrium 🡪 L. Ventricle 🡪 Aorta Systemic circulation ubilical arteries placenta OR Placenta Umbilical Vein ductus venosus Inferior Vena Cavactus venosus Inferior Vena Cava R. Atrium R. Ventricle Pulmonary trunk Ductus Arteriosus Aorta Systemic circulation ubilical arteries placenta *Can also travel through the pulmonary circulation to the lungs (even though gas exchange occurs here)

Metabolic activities of the placenta

Placenta continuously produces glycogen, cholesterol, and fatty acids for fetal use and hormone production. Also produces numerous enzymes (sulfatase- enhances excretion of fetal estrogen precursors) and (insulinase- increases the barrier to insulin) required for fetoplacental transfer. Placenta breaks down substances such as epi and histamine. Placenta stores glycogen and iron.

battledore placenta

Placenta with the umbilical cord inserted into the border

Developmental tasks of Middle-aged parents

Refocus on couple time, intimacy, and relationship Maintain kinship ties Focus on retirement and the future

Transport function of the placenta

Simple diffusion- water, O2, CO2, Na and Cl, insulin, steroids, cocaine and heroin etc. Facilitated transport- glucose, galactose, some O2. Glucose in the fetal bld is 20-30% lower than maternal due to the fetus metabolizing glucose more rapidly Active transport- amino acids, Ca2++, iron, iodine, water-soluble vitamins and glucose. Other- Fetal RBCs pass into maternal circulation through breaks in capillaries and placental membrane during labor and birth. Viruses (ex: HIV), microorganisms, maternal leukocytes cross under their own power. Some infect placenta by causing lesions and then entering the fetal bld system.

McGill Model of Nursing

Strength-based approach identification feedback on strengths assistance to develop strengths and use resources

acrocyanosis

Temporary cyanotic condition, usually in newborns resulting in a bluish (dusky) color in the hands and fingernails, feet and toenails. May last for a few hours and disappear with warming.

What forms the fetal portion of the placenta?

The Chorionic villi in contact with the decidua basalis covered by the amnion giving it a shiny, gray appearance (Shiny Shultz).

If pregnancy occurs, what happens in the ovaries?

The corpus luteum does not decline into the corpus albicans but continues to secrete progesterone to maintain pregnancy until the 11th week. The corpus luteum secretes enough progesterone to maintain pregnancy until the placenta operates.

follicular phase

The first phase of the ovarian cycle, during which a follicle (an oocyte and its surroudning cells) enlarges and matures. This phase is under the control of FSH from the anterior pituitary, and typically lasts from day 1 to day 14 of the menstrual cycle. The follicle secretes estrogen during this time period.

Endocrine functions of the placenta

The placenta produces hormones vital to the survival of the fetus- hCG, hPL, estrogen and progesterone.

Decidua capsularis

The portion of the Decidua that covers the blastocyst

luteal phase

The third phase of the ovarian cycle, during which a corpus luteum is formed from the remnants of the follicle that has ovulated its oocyte. The corpus luteum secretes progestrone and estrogen during this time period, which typically lasts from day 15 to day 28 of the menstrual cycle. Formation of the corpul luteum is triggered by the same LH surge that triggers ovulation, however in the absence of LH (levels quickly decline after the surge) the corpus luteum begins to degenerate.

chorion

This thick membrane develops from the trophoblast and has fingerlike projections called chorionic villi on its surface. These villi can be used for early genetic testing of the embryo at 8-11 weeks. These villi degenerate as the pregnancy progresses except for those just under the uterine wall which form the fetal portion of the placenta.

sequential integrated screening (SIS) definition

Three step program screening for Down syndrome (trisomy 21), trisomy 18, & neural tube defects (anencephaly & spina bifida), abdominal wall defects (gastrochesis & omphalocele), Smith-Lemli-Optiz syndrome (SLOS)

Developmental tasks of Families with preschool children

Understand growth and development, including discipline Cope with energy depletion Arrange for individual time, family time, and couple time

weight gain goals during pregnancy

Underweight (BMI: <18.5) Goal gain: Singleton: 28-40# Goal gain: Twins: ? Normal (BMI: 18.5-24.9) Goal gain: Singleton:25-35# Goal gain: Twins: 37-54# Overweight (BMI: 25-29.9) Goal gain: Singleton: 15-25# Goal gain: Twins: 31-50# Obese (BMI: 30+) Goal gain: Singleton: 11-20# Goal gain: Twins: 25-42#

anticoagulants in pregnancy

Warfarin is contraindicated in pregnancy. Heparin or low-molecular weight heparin is preferred.

People who could benefit from genetic counseling

Women over the age of 35 (advanced maternal age) Already had a child with a chromosomal abnormality Family hx of known or suspected chromosomal disorder The parent themselves has a chromosomal disorder Ethnic groups Hx of two or more first trimester spontaneous abortions

circumoral cyanosis

a bluish gray discoloration around the mouth (not a good sign). Can check tongue if face if bruised.

family life cycle

a series of stages determined by a combination of age, marital status, and the presence or absence of children stages of life, common theory

couvade

a sympathetic pregnancy in which a man experiences a variety of symptoms associated with pregnancy or childbirth while his partner is pregnant

Family systems theory

a theory that views the family as a system of interacting parts whose interactions exhibit consistent patterns and unstated rules family as a unit

Gestational Trophoblastic Disease patho

abnormal growth of topoblastic tissue, includes chorion & placenta, but does not include any genetic material *choriocarcinoma is something the mother will be at risk for in the future

The completion of the maternal-placental-fetal circulation occurs when?

about 17 days after conception when the embryonic heart begins to function

Naegele's rule

add 7 days to LMP, subtract 3 months, add 1 year *Assumes that the woman has a 28-day cycle & that fertilization occurred on the 14th day

Nutritional risk factors during pregnancy

adolescent pregnancy; abuse of nicotine, alcohol, or drugs; bizarre or faddish food habits; a low or high weight for height; frequent pregnancies; poverty/food insecurity; multifetal pregnancy; diabetes; chronic illness; low hemoglobin &/or hematocrit values

yolk sac purpose

aids in transferring maternal nutrients and oxygen for the first 5-6 weeks

Amniotic fluid contents

albumin, urea, uric acid, creatinine, lecithin, sphingomyelin, bilirubin, fructose, fat, leukocytes, proteins, epithelial cells, enzymes, and lanugo hair

Describe placental development and circulation in early pregnancy (timing of development & hormones released).

begins at the third week. The placenta produces HCG, HPL (human placental lactogen), estrogen and progesterone.

umbilical cord function week 3

blood vessels develop, supplying fetus with oxygen and nutrients

Autosomal recessive inheritance

both genes must be abnormal for the characteristic/disorder to be expressed. Two carriers must pass on the variant (abnormal) allele to the offspring for it to be expressed. Heterozygous people are unaffected clinically and known as carriers. Horizontal pattern of inheritance (usually seen in one or more siblings, but not in earlier generations). Males and females equally affected Most recessive disorders are severe.

Gestational Trophoblastic Disease s/s

brown bleeding (looks like prune juice) pass hydronic vessels greater than expected uterine growth (fundal height) no fetal HR higher than expected HcG (so severe nausea & vomiting) lower levels of MSAFP Ultrasound: snowstorm

Presumptive signs of pregnancy

changes felt by the woman -amenorrhea, n/v, breast tenderness, urinary frequency, fatigue -Quickening

What 2 fetal membranes surround the developing embryo?

chorion amnion

abruptio placentae risk factors

cocaine use abdominal trauma smoking HTN premature rupture of membranes

Pica

consumption of nonfood substances •Most common: dirt/clay (geophagia), inedible starch (amylophagia), ice (pagophagia) •Cause unknown •Possibly iron deficiency: pagophagia tends to stop when Iron deficiency is treated •Should be discouraged: has caused intestinal obstruction, parasite infestation of gastrointestinal tract, lead poisoning

Diploid

containing two complete sets of chromosomes, one from each parent. 2n=46

monozygotic

developed from a single fertilized ovum that divides, as identical twins

nonheme iron

dietary iron not associated with hemoglobin; the iron of plants and other sources (legumes, raisins, fortified cereals, food cooked in iron skillet) Not well absorbed: 0-10%

umbilical cord function week 5

embryo curves, stalk becomes compressed, forms umbilical cord. Two arteries move blood from embryo to chorionic villi, one vein brings blood back to embryo. Cord begins to lengthen. Wharton's jelly develops to protect vessels (prevents compression). Blood vessels should spread out from central location of umbilical cord.

umbilical cord function day 14

embryonic disk, amniotic sac, and yolk sac attach to the chorionic villi via the connecting stalk

When does the organ system & external features develop?

embryonic period (3rd-8th week after fertilization)

non-linear model of female sexual response

emotional intimacy, sexual stimuli, & relationship satisfaction affect female sexual response

Primary germ layers within the embryo

endoderm, mesoderm, ectoderm

Decidua

endometrium after implantation

What are nongenetic factors influencing development of the fetus?

environmental factors poor maternal nutrition teratogen exposure inadequate folic acid

succenturiate placenta

extra lobe of the placenta that is implanted at some distance away from the rest of the placenta

human developmental theory

family as microsystem

Symptoms of iron deficiency

fatigue, pallor, shortness of breath

If pregnancy occurs, what happens in the uterus?

fertilized egg implants in uterus and begins to secrete HCG (human chorionic gonadotropin) to maintain to corpus luteum. With implantation, the endometrium, under the influence of progesterone, continues to develop and become even thicker and more vascular, in preparation for nourishment of the ovum.

amniotic fluid description & how it is generated

fluid within the amniotic sac that surrounds and protects the fetus generated from maternal plasma until the fetal kidneys start to contribute volume with urine around 16 weeks

phases of ovarian cycle

follicular phase, ovulation, luteal phase

Where should the embryo implant?

fundus (preferably posterior fundus)

Hydatidiform Mole (Molar Pregnancy)

gestational trophoblastic neoplasm usually resulting from fertilization of an egg that has no nucleus or an inactivated nucleus High Risk: -previous molar pregnancy -early teen pregnancy -maternal age older than 40 years S/S -significantly larger uterus than what is expected -vaginal bleeding Complications: anemia preeclampsia hyperthyroidism Treatment: suction curettage Teaching: -postpone subsequent pregnancies -Follow up assessments usually last a year

RhoGAM shot

given to mother soon after the first delivery, miscarriage, or abortion so that antibody binds to fetal RBC and removed it from the body before the mother makes Rh antibody

what occurs during the fetal period?

growth and maturation of existing organs, refinement of structure & function

Haploid

having a single set of unpaired chromosomes n=23 in germ cells (the male and female gametes, sperm and ova)

Ectopic Pregnancy Risk Factors

history of infertility, salpingitis (PID), ruptured appendix, prior tubal surgery

Ectopic pregnancy

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

Folic acid deficiency anemia

inability to produce sufficient red blood cells (RBCs) due to the lack of folic acid, a B vitamin essential for erythropoiesis *results in babies with neural tube defects

Factors that affect family functioning (high risk families)

inadequate resources (teen parents, below poverty level) inadequate support of family members unexpected problems with infant at birth unhealthy habits: smoking, substance abuse Immaturity in decision making

function of Progesterone produced by the placenta

increases secretions of the fallopian tubes and uterus to provide nutritive matter for the developing morula and blastocyst. Also aids in ovum transport through fallopian tube. Must be present in high layers for implantation to occur in the uterine endometrium. It decreases the contractility of the uterus preventing contractions (thus abortions). Maintains the endometrium for pregnancy. Develops breast tissue to prep for breastfeeding. Production by the corpus luteum reaches peak 7-10 days after ovulation. 16 days after ovulation, levels btw 25-50mg per day continues to rise slowly until week 11 when the placenta takes over production of progesterone and secretes >250mg per day late in pregnancy.

partial placenta previa

internal os is partially covered by the placenta

What develops at the same time as the ears?

kidneys (so if ears are abnormal, they will do a work-up on the kidneys to check for problems)

food sources of folate

liver, enriched grains, asparagus, spinach, lentils, orange juice, nuts, whole grains

amniotic fluid function

maintain consistent body temp, source of PO fluid, repository for waste (urine, not meconium), helps keep fluids/electrolytes balanced, freedom of movement, cushion, infection barrier, fetal lung maturity, prevents entanglements with membranes

Noninvasive prenatal testing (NIPT)

maternal blood draw at 10 weeks of later. genetic test for trisomies 18, 21, 13 sex chromosome abnormalities detects fetal DNA circulating in maternal blood (cell-free DNA) from breakdown of fetal cells -positive results indicate a need for amniocentesis

fundal height

measurement of the size of the uterus, measured from pubic symphysis to fundus Measurement should match the week of pregnancy

What are the phases of the menstrual cycle & the days associated with each phase?

menstrual phase: days 1-6, proliferative phase: days 7-14, secretory phase: days 15-26, ischemic phase: days 27-28

the zygote undergoes what type of division?

mitotic divisions, creating 16-cell morula

conjoined

monozygotic but cleavage incomplete

Uterine Souffle

mothers pulse heard just above the symphysis pubis during last months of pregnancy. Caused by the augmented bld flow entering the dilated uterine arteries.

tetraploid cells

n=96 chromosomes

sequential integrated screening (SIS) step 2

nuchal translucency ultrasound, 11-14 weeks -preliminary test for trisomy 21 & 18 -early test for congenital defects

Vasa previa

occurs when the intramembranous vessels course across the internal cervical os

Autosomal dominant inheritance

only need one copy of the gene to express the characteristic/disorder Usually many generations have said characteristic/disorder An affected parent who is heterozygous for the trait has a 50% chance of passing it to each child Vertical pattern of inheritance (aka no skipping of generations) Males and females equally affected Severity varies

amnion

originates from the ectoderm. It is a thin protective membrane and the embryo is the amniotic cavity. This cavity surrounds the embryo and yolk sac, except where the developing embryo attaches to the trophoblast via the umbilical cord. As the embryo grow the amnion expands until it comes into contact with the chorion. These form the fluid-filled amniotic sac or bag of waters (BOW)- Protects the floating embryo.

ovulation phase

ovarian cycle, phase 2 Occurs on day 14 stimulated by surge in LH b/c estrogen stops having negative feedback effects at certain threshold -- begins having positive feedback effects

hallmark sign of placenta previa

painless, vaginal bright red bleeding

Total placenta previa

placenta completely covers internal cervical os **Always a C-section

central abruptio placentae

placenta separates centrally, blood trapped between placenta and uterine wall, concealed bleeding

gravida

pregnancies

ectopic pregnancy treatment

pregnancy test, transvagianal ultrasound, priority is to control bleeding, no action, treatment with methotrexate, surgery to remove pregnancy from the tube (salpingostomy)

abruptio placentae patho

premature separation of the placenta from the uterine wall *placenta is properly implanted prior to abruption

function of hCG produced by the placenta

prevents the normal involution of the corpus luteum at the end of the menstrual cycle. If the corpus luteum stops working before the 11th week of pregnancy a spontaneous abortion occurs. Also causes the corpus luteum to secrete more estrogen and progesterone. After the 11th week the placenta produces enough progesterone and estrogen to maintain pregnancy. In male fetus, hCG exerts an interstitial cell-stimulating effect on the testes = production of testosterone 🡪 causes male sex organs to grow. hCG may have a role in the ability to exempt the placenta and embryo from rejection from mothers system. hCG is the base for pregnancy test, present 8-10 days after conception. After 50-70 days gestatin hCG begins to decrease as placental hormone production increases.

Chorionic villi

process of the lining of the uterus thickens below the implanted blastocyst and the cells of the trophoblast grow down into the thickened lining.

Spontaneous abortion S/S, Treatment & Nursing management

s/s -decrease in HcG, estrogen, & progesterone -pelvic pain, cramping, bleeding -avoid sexual activity -may see the passage of clots/tissue -ultrasound Procedures that might be needed: -Dilation & curettage (D&C) OR -Suction/evacuation Interventions: -Assess -Monitor vital signs -Provide emotional support, refer to support groups -Give medication as ordered *Rhogam

hyperemesis gravidarum patho

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

Positive signs of pregnancy

signs attributed only to the presence of the fetus -fetal HB distinct from maternal HB, fetal movements detected by someone other than mother, visulizatoin of the fetus (ultrasound)

Funic souffle

soft blowing sound over the umbilical cord in late pregnancy sounding like the fetal heartbeat and fetal bld flow through the arteries.

function of hPL or hCS production by the placenta

stimulates changes in the mothers metabolic processes to ensure more protein, glucose and minerals are available for the fetus. Increases mother's resistance to insulin (to make glucose available to the fetus). Stimulates breast development. Usually detected by week 4.

placenta abnormalities

succenturiate placenta battledore placenta

Where does the maternal part of the placenta develops from?

the decidua basalis and its circulation. Surface is red and fleshlike (dirty Duncan), which contains large numbers of bld vessels.

heme iron

the iron in foods that is bound to the hemoglobin and myoglobin proteins; found only in meat, fish, and poultry. Well absorbed (20-25%)

Placental Functions

the means of metabolic and nutrient exchange btwn the embryonic and maternal circulations. This does not occur until the 3rd week of embryonic development. Expansion continues into the 20th week covering ~ ½ of the uterus internal surface.

low lying placenta previa

the placenta is implanted in the lower uterine segment and is near the internal os but does not reach it

decidua basalis

the portion directly under the implanted blastocyst

decidua vera (parietalis)

the portion that lines the rest of the uterine cavity

variations in chromosomal structure (3)

translocation deletion addition

dizygotic

twins from two separate zygotes, fraternal twins

What vessels are in the umbilical cord?

two arteries and one vein

multifactoral inheritance

two or more genes on different chromosomes acting together. Combination of genetic and environmental factors. Common congenital malformations result from this (e.g., cleft lip, cleft palate, congenital heart disease, etc.). Severity based on number of genes involved or the environmental presence.

Estimating Date of Birth (EDB)

ultrasound Naegele's rule

Initial pregnancy lab tests

urine: check for infection (leukocytes - culture if present), presence of HcG, protein, glucose Cervical: pap smear Blood: CBC (H&H, WBC), blood type, rubella titer, RPR (syphilis), HIB antibodies, Hep B surface antigen, toxoplasmosis, others as indicated

Physiological sexual response processes

vasocongestion (engorgement of blood vessels) myotonia (muscle tension)

How does the fetus obtain O2?

via diffusion from maternal circulation due to gradient difference of PO2 of 50mmHg in maternal bld and 30mmHg in fetal *Most of the bld supply bypasses the fetal lungs bc they don't carryout respiratory gas exchange. The placenta assumes this function to supply O2 and excrete CO2 into the maternal bld stream.

When is the full placental structure completely developed?

week 12

function of Estrogen produced by the placenta

week 7 placenta produces more than 50% in the maternal circulation. Needed for maintaining placental function and growth. Has proliferative function causing enlargement of the uterus, breasts, and breast granular tissue. Increases vascularity and vasodilation especially toward the end of pregnancy usually 30 times the daily production in the middle of a normal monthly menstrual cycle. Increase towards end of pregnancy to help with myometrial contractility. Primary estrogen by the placenta is Estriol and estrogen secreted by the ovaries estradiol. DHEA-S precursor from the fetal adrenal glands and processed by liver to the placenta coverts to estrone, estradiol and estriol since placenta cant make estrogen on its own.

protein recommendations for pregnancy

•1-20 weeks: 0.8 g/kg/day •21-42 weeks: 1.1 g/kg/day •+ 25 g/day for additional baby From Lowdermilk: Nonpregnant: 46g pregnant: 1st trimester same as above, 2nd & 3rd trimester 71g Lactation: non pregnant needs +25g

Paternal Adaptation to Pregnancy

•Accepting the pregnancy -Couvade syndrome •Developmental tasks experienced by the expectant father -Announcement phase -Moratorium phase -Focusing phase •Identifying with the father role •Reordering personal relationships •Establishing relationship with the fetus •Preparing for birth

Cardiac Disorders in Pregnancy

•Congenital heart disease •Peripartum cardiomyopathy

fat recommendations for pregnancy

•No overall goal (limit to 5-6 tsp/day) •Docosahexaenoic Acid (DHA) supports fetal brain development: 300 mg/day average (1-2 fish meals per week)

Warning signs in 2nd trimester

•Persistent, severe vomiting •Sudden vaginal discharge •Fever/chills/diarrhea •Severe backache •Flank pain •Abdominal cramping •Visual disturbances •Headache •Seizures •Loss of fetal movement

warning signs 3rd trimester

•Persistent, severe vomiting •Sudden vaginal discharge •Fever/chills/diarrhea •Severe backache •Flank pain •Abdominal cramping •Visual disturbances •Headache •Seizures •Loss of fetal movement •Uterine contractions

Attachment process of the mother (3 phases)

•Phase 1: She accepts the biologic fact of pregnancy •Phase 2: She accepts the growing fetus as distinct from herself •Phase 3: She prepares realistically for the birth and parenting of the child

warning signs in the 1st trimester

•Severe vomiting •Chills, fever •Burning on urination •Diarrhea •Abdominal cramping •Vaginal bleeding

Types of Spontaneous Abortion

•Threatened: cramping, bleeding, undilated cervix •Imminent/inevitable: cramping, bleeding, dilated cervix •Incomplete: bleeding, cramping, & expulsion of part of the products of pregnancy (maternal hemorrhage is possible complication •Complete: bleeding, cramping, all of the products of conception expelled; cervix has closed afterward •Missed: decreasing signs of pregnancy but no product expulsion •Recurrent pregnancy loss (habitual): consecutive (3 or more spontaneous abortions) •Septic: abortion in the presence of an infection (premature rupture of membranes- prolonged), inadequate

umbilical cord abnormalities

•Vasa previa •Absence of artery •Velamentous insertion