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74 Cards in this Set

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what is the rate of uterine growth during pregnancy?
1 cm per week after 20 weeks gestation
what is lightening?
descent of the uterus into the pelvic cavity that occurs late in pregnancy; the fetus is said to have dropped
what is Hegar's sign?
Hegar's sign is an indication of pregnancy, specifically the compressibility and softening of the cervical isthmus;
It is a "probable" sign of pregnancy
what is chadwick's sign?
Chadwick's sign is a bluish discoloration of the cervix, (cyanotic cervix) vagina, and labia caused by the hormone estrogen which results in venous congestion
what is Goodell's sign?
a softening of the vaginal cervix; another probable sign of pregnancy
what is a presumptive sign of pregnancy?
the changes felt by the woman that may indicate pregnancy:
amenorrhea
fatigue
nausea
vomiting
breast changes
what is a probable sign of pregnancy?
changes in a woman observed by the examiner that indicate pregnancy:
hegars sign, pregnancy test, ballottement
what is a positive sign of pregnancy?
signs that are attributed only to the presence of a fetus:
fetal heart sounds
visualization of the fetus
palpating fetal movements
what are braxton hicks contractions?
light, usually painless, irregular uterine contractions during pregnancy, gradually increasing in intensity and frequency and becoming more rhythmic during the third trimester; they begin around the 4th month of pregnancy
what is Ballottement?
finger is used to displace the fetus upward and a tap is felt on the finger as the fetus returns
what is quickening?
fetal movement perceived by the mother at about the 14th to 16th week in the multipara and later in the primipara;
can be confused for peristalsis
what is leukorrhea?
a normal whiteish or grayish discharge from the vagina in a pregnant woman; there is no associated itching
what is an important vaginal change in a pregnant woman?
Vaginal pH decreases, which protects against infection, but also makes the woman more prone to yeast infections
what is an anemia dx in a pregnant woman?
hemoglobin less than 10 and a hematocrit less than 35%
what are some circulation changes in the pregnant woman?
Increased tendency for blood coagulation
Heart rate increases 10-15 beats/min
BP declines in mid-pregnancy and then increases to first timester levels
BMR increases 25 %
what is chloasma?
the "mask" of pregnancy;
it is a hyperpigmentation of the cheeks, nose and forehead
what is diastasis recti?
it is a separation of the rectus abdominal muscles that can occur in pregnancy;
normally the rectus abdominal muscles are held together by the linea alba
what is ptyalism?
excessive drooling; occurs in women who are experiencing hyperemesis gravidum, excessive nausea and vomiting far worse than normal morning sickness
what is the appropriate amount of weight a woman should gain during her pregnancy?
Normal – 24-35 lbs
Underweight – 28-40 lbs
Overweight – 15-25 lbs
Obese – 15 lbs
what amount of protein does a pregnant woman require?
Increase in protein from 60 to 80 g per day
what amount of iron should a pregnant woman consume?
Increase in Iron from 18 to 24 g per day
what amount of folate should a pregnant woman consume?
Increase in Folate from 400 to 600 mcg per day
how many calories should a pregnant woman consume?
Increase 300 calories over intake of 1800 to 2200 per day
what are come cat X drugs?
Accutane, Coumadin, Cancer radiation Therapy, Tegison or Soriatane for psoriasis, streptomycin for tuberculosis, thalidomide for insomnia, diethylstilbestrol (DES) for menstrual disorders and mercury from contaminated food
what is fetal variability?
Irregular fluctuations of FHR of two cycles or greater per minute;
Can be described as long term or short term;
Absent or undetected- less than 2 bpm
Minimal 3-5 bpm
Moderate 6-25
Marked greater than 25 bpm
what is considered fetal tachycardia?
FHR > 160 bpm for greater than 10 minutes
what is considered fetal bradycardia?
FHR less than 100-110 for 10 minutes or longer
what are fetal accelerations?
Indicate fetal well being;
Rise over BL of FHR 15 bpm for 15 seconds or longer (15 by 15)
In preterm fetus, 10 by 10
Can occur as a result of fetal scalp stimulation
what are early decelerations?
Related to head compressions as fetal head is compressed during a contraction;
Occurs with the start of the contraction and usually ends with the end of the contraction
what is a reassuring FHR?
a baseline between 110-160 with good accelerations
what are the interventions for a nonreassuring FHR?
Pitocin off
Position changes, LL or RL
Oxygen 10L via NRFM
IV fluid bolus
Placement of FSE if unable to maintain continuous monitoring
Determine underlying cause and correct, ex. hypotension, maternal temp
Inform CNM or MD
what are the components of a post partum assessment BUBBLE-HEB
Breasts
Uterus
Bladder- should be able to void by 6-8 hours post delivery
Bowel
Lochia
Episiotomy
Homan's sign
Emotional status
Bonding
what are the components of the Apgar score?
HR: 0= absent, 1= <100, 2= >100
Respiratory effort: 0=absent, 1=slow irregular, 2= regular/crying
reflex irritability: 0=no response, 1= grimace/frown, 2=good cry/cough
muscle tone: 0=limp, 1= some motion/flexion/resistance, 2= active/spontaneous flexion/good tone
color: 0=cyanotic or pale, 1= body pink/extremity cyanosis, 2= completely pink
what is the focus of midwifery?
to be with woman through out the pregnancy and assist the family in childbirth;
she can care for any low risk pregnancy
what are the 10 ethical principles used in clinical practice?
1.respect
2.autonomy
3.beneficence
4.nonmaleficence
5.veracity
6.fidelity
7.justice
8.confidentiality
9.informed consent
10. universality: same principles apply to everyone, everytime
what are the 4 elements of informed consent?
disclosure of information (teaching)
comprehension
voluntary agreement
competency to make decisions
what is a hysterosalpingogram (HSG)?
a diagnostic test in which radiopaque dye is instilled into the uterus and fallopian tubes via a catheter inserted through the cervix; used to detect uterine or tubal anomalies
***Ask if the woman is allergic to shellfish!
***Ask when her LMP was- dont want to inturrupt and early pregnancy!!
what is estrogen responsible for?
development of secondary sex characteristics at puberty, and peaks at the follicular phase in the menstrual cycle;
it also inhibits FSH and LH production
what is the corpus luteum?
it is the ovum once its released from the ovaries in the fallopian tubes;
it disintigrates if fertilization doesnt take place in 24 hours, or creates progesterone if it becomes fertilized
what changes occur in cervical mucus during ovulation?
becomes thinner, more plentiful, and has a more stretchy consistency (spinbarkket);
this is to help the sperm move into the uterus
what is a septate uterus?
a heart shaped uterus (a dividing membrane down the middle that can be mild or completely separate the uterus into 2 pieces);
if fertilization occurs it makes it harder for this baby to be carried to term
what is a bicornate uterus? what problems does this pose to a pregnancy?
two banana shaped uteri, side by side, curving away from eachother; they may end at one cervix, or each have their own cervix and own vagina;
the woman may have a normal mesntrual cycle if both horns are fully developed
***getting pregnant isnt really a problem but carrying the baby to term is an issue
if a woman is following a BBT method for tracking fertility, how will she know when she is ovulating?
when her temp drops slightly THEN rises 0.5-1.0 F
this temperature spike rises with 24 hours of ovulation
what is mittelschmerz?
old term for midcycle pain experienced at the time of ovulation; may last 1-2 days, and may be accompanied by pressure, aching felt into the rectum, or distention
what chemical is typically used in spermicide?
nonoxynol-9 and oxynol-9
what components should you teach when counseling about contraceptives? (BRAIDED)
Benefits
Risks
Alternatives
Inquiries (let her ask questions)
Decisions (let her decide or change her mind)
Explanations = how to use the selected method
Documentation
what are the goals of family planning?
assist with reproductive decision making, enabling the person to prevent pregnancy, limiting the number of children, spacing time between pregnancies, and voluntary interrupting pregnancy as desired;
**has NOTHING to do with fertility treatments, or dx procedures
why is informed consent with contraceptives?
because of the potentially serious complications associated with so many contraceptive methods
what should you teach to a patient that wants to follow the cervical mucus method effects its consistency?
douches
semen
blood and discharge from vaginal infections
contraceptive gels, foams, films, or suppositories
antihistamines
what should a couple using a diaphragm, a male or female condom, or a cervical cap all avoid?
oil based lubricants!! breaks down the material = increases chances of contraceptive failure
what are the warning signs and symptoms associated with an IUD? (PAINS)
Period late (pregnancy), abnormal spotting and bleeding
Abdominal pain, pain with intercourse
Infection exposure (STD), abnormal vaginal discharge
Not feeling well, fever>100.4, chills
String missing, or shorter or longer than usually felt
what are the warning signs and symptoms associated with oral contraceptives? (ACHES)
Abdominal pain
Chest pain, cough, and/or shortness breath
Headaches, dizziness, weakness or numbness
Eye problems (blur or change in vision) and speech problems
Severe
what are the warning signs and symptoms associated with a diaphragm, cervical cap and the sponge?
Toxic shock syndrome:
-elevated temp>101.4F
-diarrhea and vomiting
-weakness and fainting
-muscle aches
-sore throat
-sunburn type rash
-difficulty urinating
-abdominal or pelvic fullness
-foul-smelling vaginal discharge
what are some contraindications to a diaphragm?
a hx of UTIs
a hx of toxic shock syndrome
who is a candidate for an IUD?
parous woman in stable monogamous relationships (low risk for STDs) with NO hx of PID, and normal uterine anatomy
what should a patient do if she misses a progesterone-only contraception pill (mini pill)?
take the pill as soon as remembered, and take the next pill at the regular time
any time a pill is missed the pt should use an ADDITIONAL form of contraception through out the end of the cycle the
what should a patient do if she missed a combination oral contraceptive pill?
take the pill as soon as remembered and take the next pill at the regular time
with combination pills NO BACK UP is needed unless:
more than 2 pills consecutively are missed- use additional contraception for a week
what kind of twins run in the family?
Dizygotic/fraternal/non identical twins
the pregnancy results from the fertilization of two separate eggs by two separate sperm cells
the zygotes develop separately and do not share placentas or amniotic sacs
what is the optimal time to have intercourse in relationship to ovulation is a couple desires to get pregnant?
sex can take place no earlier than 24 hours before ovulation, and no later than 12 hours after to achieve fertilization
what is a morula?
what a fertilized egg is called by the time it reaches the uterus and is ready to implant
first 2 weeks after fertilization?
cellular multiplication and implantation
weeks 2-8
rapid cell growth and differentiation:
ectoderm, mesoderm and endoderm form
by the end of the 8th week every organ system and external structure is present!
what is the function of the amniotic fluid?
cushions the embryo and fetus
controls temp
promotes symmetrical growth of the fetus
prevents fetal adherence to the amnion
allows freedom of movement within the amniotic cavity
what is oligohydramnios?
a condition of diminished amniotic fluid often related to renal system mlfunction, intrauterine growth restrictions, and post maturity;
it can cause skin and skeletal abnormalities, pulmonary hypoplasia, and cord compression
what is wharton's jelly?
a gelatinous connective tissue that serves as a protective layer around the umbilical vessels
what hormones are produced during pregnancy and what functions do they serve?
progesterone: maintains pregnancy
estirol: stimulates uterine growth and mammary glands
homan chorionic gonadotropin (hCG): siminlar to luteinizing hormone
homan plancental lactogen (hPL): causes decreased insulin sensitivity = diabetogenic effect in the mother = stimulates breast development
what is significant in the 4th week of gestation?
fetal heart begins to beat
what is significant in the 8th week of gestation?
all body organs are fully formed
what is significant in the 8-12th weeks of gestation?
fetal heart tones can be heard by doppler
what is significant in the 16th week of gestation?
baby's sex can be seen, although thin, the fetus looks like a baby
what is significant in the 20th week of gestation?
heartbeat can be heard with fetoscope.
mother feels quickening/movements
baby develops a regular schedule of sleeping, sucking, and kicking (!!!)
hands can grasp
baby assumes a favorite position in utero
vernix protects the body and lanugo keeps oil on the skin
head hair, eyebrows and eyelashes are present
what is significant in the 24th week gestation?
activity is increasing, respiratory movements begin
what is significant in the 28th week gestation?
eyes begin to open and close, baby can breathe, surficant needed for breathing is formed, baby is 2/3 full size
what is significant in the 32th week gestation?
baby has fingernails and toenails, SQ fat is being made, baby appears less red and wrinkled