childbearing midterm..docx

Course Lecture   Exam Questions  Foundations to Maternity woman, and child Health  3 The Nurses Role in Maternity Women's Health and  Pediatric Nursing 3 Infant Parent Mental Health 1 Conception and Prenatal Development 5 Nutrition for Childbearing Families 9 Reproductive Anatomy and Physiology 2 Pr...

Course Lecture   Exam Questions  Foundations to Maternity woman, and child Health  3 The Nurses Role in Maternity Women's Health and  Pediatric Nursing 3 Infant Parent Mental Health 1 Conception and Prenatal Development 5 Nutrition for Childbearing Families 9 Reproductive Anatomy and Physiology 2 Prenatal Care & Diagnostic 6 The Childbearing Family with special needs 1 Adaptions to pregnancy normal Prenatal Changes in Pregnancy 9 Concurrent Disorders during pregnancy and Pregnancy -related Complications 5 Labor and Giving Birth 3 Pain management for childbirth 3 Specific topics   Chadwicks sign Occurs in the probable stage, blue cervix and vulva Goodells Sign Softening of cervix 6-8 weeks Hegars sign Softening of the cervix Intrauterine growth restriction TORCH : congenital infections T: toxoplasmosis. O: other (syphilis, hep. B). R: rubella. C: cytomegalovirus. H: Herpes simplex Genetic Disorder (x- linked, Autosomal Dominant and Recessive disorders). X-linked: dad: 100% daughters 0% sons. Mom: 50% daughters 50% sons. Autosomal recessive: 25% inheritance 50% carriers. (SCP) sickle cell, CF, PKU Autosomal dominant: 50% inheritance. (NAH) neurofibromatosis, achondroplasia, Huntington’s. Multifactorial: environmental and genes. cleft palate, neural tube defects. Hormones in Pregnancy  HPL HCG Progesterone Estrogen Expulsion of placenta= decrease in estrogen and progesterone lactation is initiated. Prolactin falls after delivery suckling triggers prolactin Ovaries secrete progesterone for 6-7 weeks, the placenta acts as a temporary endocrine gland and produces large amounts of estrogen and progesterone by 1-12 weeks of pregnancy, maintains growth of uterus. Parathyroid gland: increases slightly to meet increased need of calcium for fetal growth. Posterior pituitary: oxytocin secreted to initiate labor Anterior pituitary: prolactin secreted at birth. Progesterone: inhibits smooth muscle in uterus from contracting, increased levels affect other smooth muscles in the body. Increased progesterone= low esophageal tone thus GERD. Decreased GI tone and motility. Increased gastric emptying time. Estrogen: increased vascularity in mm in upper respiratory tract. Edema in nose, pharynx, larynx, and trachea. Nasal and sinus stuffiness, epistaxis, voice changes. Increased estrogen= hyperemia leading to gingivitis, bleeding gums, vascular hypertrophy of gums and darkening in color. Ptyalism (excess saliva) Thyriod hormones: slight increase in hormones and size, BMR is up 20-30%. Insulin: decrease in insulin sensity due to high blood glucose levels due to fetal glucose demand. Umbilical Cord Normal Anatomy  2 arteries, 1 vein Protected by Whartons jelly Ductus venosus: by passes liver and enters at inferior vena cava Foramen ovale: right and left atria supply blood to head, upper and lower extremities Ductus arteriosus: bypasses lungs returning blood. 55cm long. Hemodynamic Changes in Pregnancy  Blood volume increases by 30-50% Causes decreased concentrations of RBC and HGB. At end of pregnancy body compensates to show normal levels. Cardiac output increases by 30% during 1st and 2nd trimester. Increase in HR by 10BPM No BP change. Venous return is inhibited: swelling in feet and legs at end of pregnancy, vena cava syndrome (supine hypotension): place patient in left lying lateral recumbent position , dizzy, weakness, nausea. Positive, presumptive and probable signs of pregnancy  Presumptive: amenorrhea, NV, fatigue, urinary frequency, excessive salivation, breast and skin changes, fetal movement (quickening). Probable: abdominal enlargement, pos. HCG. Changes in cervix: Chadwick’s sign (blue cervix and vulva), Hegars: softening of cervix. Goodells sign: softening of cervix 6-8 weeks. Changes in uterus: Braxton hicks, fetal outline: Leopold’s maneuver. Uterine souffle: soft blowing sounds on auscultation. Pregnancy tests: HCG urine and serum. Positive: auscultation of fetal heart tones: 110-160. Fetal movement felt by examiner. Visible on ultrasound, MRI, x-ray. Anemia In pregnancy Iron deficiency anemia cause 75% of anemias.   Weight changes in pregnancy  Underweight: <38 weeks, low birth weight Overweight: >42 weeks, macrosomia >9lbs, difficult labor and trauma, higher risk for neural tube and heart defects Nutrition in pregnancy Folate supplements: 0.4mg. during pregnancy 0.6mg daily Iron: women <50yrs 18mg, men and woman >50yrs 8mg, vegetarians need 1.8x recommended amount. During pregnancy: 27mg. B12 during pregnancy: 2.6mcg Zinc during pregnancy: 12mg Foods rich in folate, iron, protein etc.  Zinc makes parts of DNA and RNA, synthesis of heme, sperm and fetal development. Phytates and fiber inhibit absorption. Deficiency= growth retardation and sexual immaturity. – protein rich foods Iron aids in the release of energy in cell metabolism, synthesis of myoglobin and hemoglobin. – legumes, enriched grains, dark leafy vegetables. MFP, vitamin c, and some acids help in absortion of iron. Folate and B12 involved in DNA synthesis and making new cells. B12 is mainly involved maintaining nerve cells and reforming folate. B12 only comes from animal sources. B12: meat, fish, poultry, milk, cheese, eggs, fortified cereal. Folate: legumes, tomato’s, oranges, broccoli, asparagus. Preeclampsia   Preexisting DM can contribute to preeclampsia, UTI, ketoacidosis, dystocia (large fetal size.) Post partum depression, blues etc.  Postpartum blues: 50-75%. Crying for the first few days after birth. Postpartum depression: 10-13%. Onset a few days- 2 weeks after birth. Lasting for 2 weeks. Postpartum psychosis: 1-2/1000. Occurs- 1-2 weeks after birth. Suicide infanticide. Ultrasound High frequency sound waves. Measure crown to rump for fetus 7-12 weeks. Vtells, amniotic fluid volume, location of placenta, abnormalities, estimated gestation ages, fetal presentation. Doppler ultrasound blood flow assessment Ultrasound is used to perform doppler shift. Used in pregnancies complicated by hypertension, fetal growth retardation, and placental insufficiency. Measures systolic to diastolic ratio Alpha-fetoprotein (AFP) screening A blood sample from maternal serum or amniotic fluid to determine neural tube defects, or trisomy 21. Performed at 16-18 weeks. Multiple marker screening HCG, unconjugated estriol. Increases detection of trisomy 18 and 21. If testing is positive amniocentesis is suggested. Chorionic villus sampling Performed between 10-13 weeks. Cannot be used to diagnose neural tube defects but can diagnose chromosomal and metabolic disorders. Women who undergo this are offered maternal alpha- fetoprotein screening done at 20-25 weeks gestation. Amniocentesis Amniocentesis is obtained for genetic analysis, tell fetal lung maturity, and evaluation for hemolytic disease of fetus. 15-20 weeks (2nd tri) chromosomal and biochemical abnormalities are tested for. Third trimester: lung maturing an dfetal hemolytic disorder. Percutaneous umbilical blood sampling Aspiration of blood from umbilical cord near the placenta uses to detect acid-base imbalance, infection blood disorders, and fetal genetic diseases. Nonstress test (NST) Evaluates fetal heart rate accelerations with or without fetal movement using vibroacoustic stimulation. FHR reactivity is a good sign that is associated with adequate oxygenation and intact neural pathways. May not develop until 32 weeks. Contraction stress test Oxytocin challenge, used to determine fetal heart response to contraction and temporary decrease in placental blood flow. Using low dose oxytocin or nipple stimulation. Biophysical profile BPP NST Fetal breathing movements Fetal tone Amniotic fluid volume (using AFI to measure as visualized by ultrasound) Maternal assessment of fetal movement Fetal movements as monitored by mother 10per 12hr or 5-10 per hour.