WVC OB Obsterics Lecture
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| Naegele: Who, Rule? | show 🗑
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| show | 40 Weeks, 280 days after fertilization, 10 lunar months, 9 calendar months.
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| show | 1. Egg and sperm formation 2. Ovulation 3. Union of egg and sperm 4. Implantation of embryo in uterus
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| show | 24 hours, ovulation. Sperm, degenerates, reabsorbed.
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| Ovulation occurs when? | show 🗑
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| Ejaculation during intercourse propels how much semen containing how many sperm into the vagina? How long do they stay viable within the women? | show 🗑
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| As sperm travel where, what aids in their capacitation? | show 🗑
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| show | Most sperm become lost in the vagina, with cervical mucus, in endometrium, or they enter a tube that contains no ovum.
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| show | Where: distal third of fallopian tube (ampulla). When: nuclei of ovum and sperm come together to form a new cell. What: a new cell zygote with 46 chromosomes.
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| show | Sex determined at fertilization. XX = female, XY = male.
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| show | Mitosis. Begins to divide, differentiate, and grow.
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| The fertilized ovum forms a what, which is….? This moves through where into where? How long does this take. | show 🗑
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| The outer cells of the morula secrete fluid creating a sac of cells called a ________. The inner solid mass of cells develop into ___1_____, and ______2_________, aka_______? | show 🗑
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| The inner layer of cells of the morula become the ________. Which the (2) develop from? Acronym. | show 🗑
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| ductus arteriosus | show 🗑
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| foramen ovale | show 🗑
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| show | between umbilical vein and inferior vena cava (bypassing the liver)
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| show | Uterine endometrium. Endometrial blood vessels erode. Very slight spotting. During time of 1st menstral period.
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| Chorionic Villi: What? Develop out of? Extend into? Secrete, which is? Dispose of (2), where? | show 🗑
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| HCG:. what, detected when? | show 🗑
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| show | ”Bag of Waters”, Inner=Amnion, Outer=Chorion, 1. Maternal Blood 2. Fetal secreations, 800-1200mL @ birth, Replaced every 3 hours, Moves back & forth across placental membranes, 1.Protection 2. Fetal Motion 3.Oral Fluids.
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| show | Too much amniotic fluid, > 2L, Associated with fetal GI problems.
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| show | Too little amniotic fluid, <300cc, Associated w/fetal renal problems, fetal hypoxia.
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| Chorion develops into (2)? | show 🗑
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| show | 3, 2 arteries carry deoxygenated blood, 1 vein carries oxygenated blood, wharton’s jelly.
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| show | Does not mix, babies blood does not mix with mother’s.
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| show | Up to 14 weeks, Pre-embryonic (up to 2 wks) Embryonic (2-8 wks), Fetal (8-40 wks), conception begins @ 14 days/2 wks, fetal systemic deficts, all basic systems forming.
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| show | 17days, doppler, 10-12 weeks.
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| 2nd trimester is when, systems…, 1st…, viable when (% that survive this early delivery)? | show 🗑
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| 3rd trimester is when, least likely time…,_______ __________ produced know, key to _____ ________, allows for ______ & ________? | show 🗑
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| show | Environmental substances or exposures that cause adverse effects to the fetus 1. Drugs 2. Chemicals 3. Infections 4. Maternal Hyperthermia 5. Radiation 6. Maternal disorders (diabetes mellitus, phenylketornuria).
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| Acronym for infectious teratogens? | show 🗑
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| Gravida: definition, includes, twins? | show 🗑
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| show | Number of pregnancies where fetus has reached age of 20 wks (age of viability), …baby did not survive past 20 wks.
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| GTPAL? | show 🗑
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| Multigravida, Primigravida Nullipara, Grand Multipara? | show 🗑
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| show | 1Fetal Heart Tone 110-160, 2Fetal Kick, 3Non-Stress Test (Reactivity/Variability is good,^ in FHT w/ fetal movement), 4Mom Wht Gain (25-35) 5. Ultrasound (due date, placental positioning), 6.AFP (alpha fetoptotein), bl test for neural tube deficits.
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| 7 presumptive signs of pregnancy? | show 🗑
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| 8 proabable signs of pregnancy? | show 🗑
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| show | 1.Auscultation of fetal heart sounds 2.Fetal Movements felt by examiner 3. Visulaization of the fetus by ultrasound
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| show | About 20% due to growing fetus, placenta, fetal membranes, amniotic fluid, uterus, breast, ^ blood volume, extravascular fluids, and fat reserves.
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| Gestational diabetes: why, management? | show 🗑
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| Fasting blood sugar during pregnancy? | show 🗑
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| show | 1. Decrease in albumin 2. Increase in fibrinogen 3. Decrease in immunoglobin
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| show | 1. Iron needs increase 2. Calcium levels decrease in maternal serum because they are being retained in maternal bone for use by fetus late in pregnancy.
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| Blood volume changes during pregnancy (3)? | show 🗑
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| show | 1. SOB from pressure on diaphragm and lungs due to englarged uterus late in pregnancy 2. Rib cage flares out and results in decrease lung capacity.
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| 3 GI changes of intestines and stomach + risk for…? | show 🗑
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| show | 1.Increase frequency of heartburn 2.Increase frequency of gastroesophageal reflux due to decrease of intraesophageal pressure 3.Increase intragastric pressure and slowed esophageal peristalsis.
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| Pregnancy and the mouth? | show 🗑
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| show | 1st trimester a decrease in appetite due to Nausea. 2nd/3rd Tri and increase in appetite.
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| show | 1. Decrease in gallbladder tone. 2. Contents thicken can cause itching (pruritis). 3. Increase in distention 4. Mom predisposed for gallstone formation.
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| show | 1…, can….?
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| show | The placenta. 1.Human Chorionic Gonadotropin 2.Human Placental Lactogen 3.Estrogen 4.Progesterone
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| Progesterone during pregnancy: Maintains…., Prevents (2), Stimulates…, Facilitates…? | show 🗑
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| show | Raises the respiratory sensitivity to CO2 thus stimulating increased ventilation, increasing the amount of air entering the lungs.
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| Musuloskeletal System and Pregnancy(2)? | show 🗑
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| Lab Tests during Pregnancy (what do they screen for): blood grouping, Hgb/Hct, CBC, Rh factor/antibody, VDRL, Rubella Titer, PPD, Genetic Testing, Hep B, HIV, UA, Pap, Cervical Culture, Mulitple Marker Screen,Glucose? | show 🗑
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| show | Hct: 37-47, Hgb: 12 – 16.
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| show | Rh factor is a type of protein, 85% of people have it/15% do not, causes the production of antibodies to attach Rh proteins, Rh- mom has Rh+ baby and comes into contact with blood increasing risk of harm to subsequent children.
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| Rh factor attach on baby: called, what happens, causes? | show 🗑
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| Rh sensitization can occur when (5), because…? | show 🗑
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| show | Rhogam. How: IM. Where: Deltoid/Buttocks.
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| No Rh issues if (2)? | show 🗑
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| show | 1st:1Uncertainty 2Ambivalence 3Focus on Self, 2nd:1Wonder 2Increased Narcissism 3Introversion 4Concern about body chgs/sexuality, 3rd:1Vulnerability 2Increased Dependence 3Acceptance that fetus is separate yet totally
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| show | 1st: no obvious signs of fetal growth, 2nd:Quickening and enlarging abdomen, 3rd: Obvious fetal growth, discomfort, decreased maternal activity.
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| show | 1st:May begin to seek safe passage for self and fetus, 2nd:seeks acceptance of fetus and her role as a mother, 3rd: Prepares for birth.
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| show | 1.Chills/Fever 2.Vomiting 3.Burning w/urination 4.Diarrhea (Flu) 5.Abdominal Cramping 6.Vaginal bleeding.
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| show | 1Change in fetal movements 2Contractions 3Visual Disturbances 4Swelling of hands/feet/face (pitting lower extremity edema) 5Muscle irritability/convulsions 6Epigastric pain
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| show | 1.Physiologic aspects of pregnancy and birth. 2.Relaxation techniques 3. Breathing techniques 4. Teambuilding w/dad and other support persons.
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| show | 1.Posture/Body Mechanics 2.Exercise 3.Nutrition 4.Transition to parenthood.
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| Recommended maternal weight gain, weight gain before pregnancy and during…? | show 🗑
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| The 4 stages of labor? | show 🗑
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| show | 1.Passenger 2.Passageway 3.Powers 4.Position 5.Psyche
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| show | Fetus + membranes + placenta, Palpate fontanels and sutures during vaginal exam to identify fetal presentation, fetal position, fetal attitude.
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| show | The part of the baby that is coming first, Cephalic (head, AKA vertex) 96% (can also be brow of mentum (chin)), Breech (buttocks or feet) 3% (complete = bottom first, footling = 1 or 2 feet), Shoulder 1%.
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| Fetal position: what, labeled how (3)? | show 🗑
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| How can you change fetal position? | show 🗑
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| show | Whether head is flexed or extended, Flexed = eaier delivery, extension = difficult delivery.
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| Fetal lie: what, two types? | show 🗑
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| show | When biparietal diameter of fetal head reaches level of maternal ischial spines.
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| Fetal station: what, 0, +4, -4? | show 🗑
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| show | Nurses/ARNP’s/MD’s, Nursing students, risk of infection.
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| show | 1.Engagement/descent 2.Flexion 3.Internal Rotation 4.Extension 5.External Rotation/Restitution 6. Expulsion.
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| show | 1.Size of bony pelvis 2.Shape of pelvis 3.False pelvis 4.Ture pelvis
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| 4 shapes of pelvis and % of women that have them? | show 🗑
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| show | What: broad area between iliac crests, Helps support pregnant uterus.
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| 3 main parts of the true pelvis? | show 🗑
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| show | 1. Effacement (cervical thinning/shortening): measured in 0-100%. 2. Dilation (size of opening): measured in 0-10cm.
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| 2 passageway related reasons for a C-section? | show 🗑
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| show | Powers = contractions. 1.Voluntary (abdominal muscles that mom controls) 2.Involuntary contractions (uterine muscle that mom wishes she could control).
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| show | 1.Frequency: beginning of one cx to beginning of next 2.Duration: beginning of one cx until end of that cx. 3.Intensity: strength of cx (strong = non identable, moderate = identable, milk = barely palpable.
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| show | Electronic fetal monitoring (can be internal or external).
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| Gravity and position of mom: assists…, beneficial to…, decreases…, assists…? | show 🗑
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| True labor cx’s vs. Braxton-Hicks cx? | show 🗑
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| 9 nursing actions following rupture of membranes? | show 🗑
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| SROM vs. AROM? | show 🗑
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| show | 1.Induce labor 2.Speed up a very slow labor 3.Move along labor that is risky to mom (Hypertensive mom, etc.) 4.Fetal demise.
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| show | 1. Intercourse to increase production of prostaglandins 2.Enema 3.Tea 4.Nipple stimulation.
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| show | 1.Changes in uterus 2.Increse in estrogen and prostaglandins 3.Decrease in progesterone levels 4. Pituitary gland 5.Aging placenta
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| Baby does this to produce onset of labor? | show 🗑
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| show | Dilation of cervix from 0 to 10 cm.
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| 3 phases of Stage 1 of labor: Phase name – time length - cervix dilation – cx’s? | show 🗑
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| Late descent may mean what, nursing action? | show 🗑
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| Variable decelartion: why (2)? | show 🗑
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| show | Decreased.
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| Leopold’s maneuvers: what, why (4)? | show 🗑
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| show | Where is the pain (location determines treatment).
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| Major cause of pain (2)? | show 🗑
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| show | 1.Relaxation 2.Preparation
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| Effleurage? | show 🗑
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| 4 alternative measure for pain relief? | show 🗑
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| 3 universal worries that women have about pregnancy? | show 🗑
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| 3 givens about labor? | show 🗑
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| show | No loss of consciousness.
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| show | Loss of consciousness. Sedatives seldom used.
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| Problem w/analgesic pain relief? | show 🗑
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| Pure Opioid Agonists (Analgesics): What, so, problem with this? | show 🗑
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| Inhaled Analgesics: Tx, Example, Effect? | show 🗑
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| Local blocks: two types, adverse effect? | show 🗑
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| show | 1.Pudendal (perineum block), seldom used, decrease HR in newborn 2.Paracervical, not used, decfetal heart rate 3.Saddle Block, notused, decreased HR & R/headache 4.Epidural, used often, use of effective -caine drugs 5.Intrathecal, used, dec. HR, N/V.
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| Interthecal opioid analgesics: two types, administered how, 4 side effects, counteract some SE with…? | show 🗑
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| show | 1.Those who believe that women can cope with pain without drugs and know how to support they through the pain but also when drugs are to be used. 2.The professionals who believe it is foolish to undure pain that drugs can do away with.
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| Endorpins: what, from where, pain relieving strength, release interrupted by….? | show 🗑
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| show | 1.The best pain relief possible and its possible side effects. 2.How far dilated she is.
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| show | What: incision of the perineum just before birth. Why: need to speed expulsion, need for increased room for baby. Types: midline, mediolateral, Asses: hemorrhage, healing, infection.
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| Epistiotomy RN interventions: 1st 12 hrs, then, teach…, meds, before sitting, do not use, suture is, asses…? | show 🗑
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| show | 1.Poor prognosis 2.Fetal distress 3.Occiput posterior position 4.Maternal exhaustion 5.Tight fit, Int: 1.FHT Q5min 2.Assess for cerebral trauma, Teach: 1.Inform parent of progress 2.Inform caput will resolve in a few hours.
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| Forceps: uses (4), assess for (3), complications (3)? | show 🗑
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| show | Potent drug, Pitocin, 1.Induction of labor 2.Speed up labor that is progressing very slowly. 3.Move a along a risky labor (hypertensive mom) 4.Start labor when there is a fetal demise.
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| 6 nursing interventions for the use of oxytoxics? | show 🗑
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| Stage III of labor = ? | show 🗑
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| Placental delivery: occurs w/…, focus of mom at this time, typical minutes? | show 🗑
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| Stage IV of labor: when, crucial to monitor, 24 hr guideline, should be no heavier then…? | show 🗑
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| show | =50-80 mL of blood loss.
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| Immediate assessments to perform after birth (4)? | show 🗑
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| Fundus: palpated when, then, where, should be…, important to also…?D | show 🗑
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| show | Vaginal birth after caesarean (cannot occur after a classic/vertical incised caesarean).
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| Two types of c-sections? | show 🗑
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| 10 indications for a C-section? | show 🗑
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| Post operative (anesthetic used) C-section Nursing Interventions: 1.Side Effects: Tx 2.Potential for (2) 3.Patient teaching (4)? | show 🗑
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| show | Maintain open airway and cardiopulmonary fx, Prevent postpartum hemorrhage, Pain control from incision/gas retention, 1.If epidural ane, assess dermatomes to signal return of motor/sensory fx 2.Assess RR for R depression.
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| 3 interventions for post C-section incisional pain? | show 🗑
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| 6 interventions for post C-section gas retention pain? | show 🗑
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| 6 people on hand for newborn post C-section? Priority? | show 🗑
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| show | BUBBLE HE: Breasts, Uterus, Bladder, Bowels, Lochia, Episiotomy, Humans, Emotional.
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| show | Must check initially within 30 minutes, then at one hour, then every four hours for the first 24 hours, and then every 12 hours.
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| Postpartum bladder: Nursing action, why, can increase…? | show 🗑
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| show | Calf tenderness, redness, swelling, signs and symptoms of infection.
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| Taking in? | show 🗑
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| Taking hold? | show 🗑
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| show | Period from the end of childbirth until involution of the reproductive organs is complete, approxiametly 6 weeks.
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| show | Retrogressive changes that return the reproductive organs, particularly the uterus, to their nonpregnant size and conition.
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| show | About 12 days.
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| U@U, U/1, 1/U? | show 🗑
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| Breastfeeding speeds…., causes an increased production of…., and an increase in…, these are called, more noticeable in…? | show 🗑
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| 3 types of lochia, their color, and their timeline? | show 🗑
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| show | 1 gram = 1cc/mL.
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| Less locia after, more lochia after (2)? | show 🗑
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| Urinary retention can be secondary to? | show 🗑
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| Expulsion of placenta causes 2 hormonal changes, @ 1 week? | show 🗑
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| show | 1.Decrease in cortisol (adrenocorticol hormone). 2.Decrease in insulinase, implication: if diabetic they need less insulin.
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| Increase in prolaction postpartum causes….? | show 🗑
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| Most women menstruate again by…? | show 🗑
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| show | Causes dieresis and diaphoreses (body is ridding itself of extracellular fluid), 2-3 days postpartum.
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| First lactation after childbirth? | show 🗑
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| show | Engorgement occurs about 2-3 days after birth (indicates milk has come in, does not happen to all women). 1.Hand express milk 2.Warm packs 3.Increase feedings 4.Non nursing moms: ice packs and decrease in H20.
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| show | Breastfeeding can delay menses but is not a reliable form of birth control.
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| Average blood loss for vaginal birth, C-section? | show 🗑
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| show | It increases slowly, over 4 days. Normal RR will return within 6 months.
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| show | 1.Hgb concentration 2.Dehydration.
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| Postpartum risk for developing deep vein thrombosis because of (3)? | show 🗑
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| Average postpartum Hgb count? | show 🗑
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| show | 1.Have baby nurse (oxytocin released) 2.Give synthetic oxytoxics as ordered by MD.
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| Postpartum check up appointment timeline (2)? | show 🗑
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| 3 phases of maternal adaptation? | show 🗑
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| show | 1.160bpm 2.Irregular
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| Engrossment? | show 🗑
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| show | At birth: 80/40. At 2 weeks: 100/50.
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| show | Normal at birth, increases over the 1st day, infection does not markedly incresase WBC, Sepsis will show a decrease in WBC’s (particulary neutophils).
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| show | Hemoglobin 14.5-22.5 at birth. Hematocrit is 44-72%. Within one month they will reach the levels of an adult.
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| APGAR? | show 🗑
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| APGAR scores: range, normal, intermediate, low? | show 🗑
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| show | Initiation of respiration, usually begins within 1 minute after birth. Surfactant.
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| Breath reflex triggered by (5)? | show 🗑
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| show | Nose breathers, breath out of mouth, mouth breath @ 3 weeks.
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| show | 1.Flaring 2.Grunting 3.Tachypnea 4.Retractions.
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| How is newborn lung surfactant levels measured? A mature level is…? | show 🗑
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| Surfactant aids breathing by….? | show 🗑
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| show | Narrow range. 700cc/day. GFR is decreased therefore urine is more dilute and infant is unable to concentrate it (the leads to a decreased ability to remove waste products from the blood. Within 24 hours, then 6x/day.
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| show | Normal. AKA: brick dust.
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| Newborn and complex carbs: what, when, why? | show 🗑
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| Where should mom first place her nipple and why? | show 🗑
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| show | 30cc-90cc.
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| Meconium stool by newborn within…? | show 🗑
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| show | Thin and slimy. Formula fed and gree-brown. Breast fed are yellow/loose/non-irritating. Breastfed babies are less fragrant than formula fed.
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| show | Store Fe as 5 month supply. Synthesizes Vik K to conjugate bilirubin. Unconjugated free-bound bilirubin cross blood/brain barrier causing necrosis of brain cells.
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| Jaundice: why (general), normals (3)? | show 🗑
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| Physiologic Jaundice: normal? And bile? Med term? Intervention? | show 🗑
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| Breastmilk jaundice: occurs when, why, common, tx? | show 🗑
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| show | Hemolytic disease (Rh incompatibility). KERNICTERUS: necrosis of brain cells.
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| Immunity: passive for, 2 ways to increase? | show 🗑
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| Acrocyanosis? Lanugo? Caput: what, when? Cephalohematoma: what, when? | show 🗑
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| Cephalhematoma does not…? | show 🗑
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| 4 integumentary adaptations without tx’s? | show 🗑
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| show | White cysts, 1 to 2 mm in size caused by distention of sebaceous glands. Occur on the face (forehead, nose, chin). Disappear within the first few weeks.
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| Stork bites: what, AKA (2), where, disappear when? | show 🗑
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| show | What: Thick white substance that protects the fetal skin in utero. Who: usually little vernix on a full term infant: premmie.
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| show | Breast secretions of the newborn caused as a normal function of maternal hormones.
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| show | Pseudo menses due to mom’s estrogen.
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| Evaporation? | show 🗑
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| show | Movement of heat away from the body occurs when newborns come into direct contact with objects that are cooler than their skin.
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| Convection? | show 🗑
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| Radiation? | show 🗑
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| show | 1.Less insulation 2.Greater body surface area to weight ratio 3.Greater ability to vasoconstrict blood vessels + Nonfunctional sweat glands.
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| show | Increased O2need, Inceased respiratory rate. Keep warm to prevent metabolic acidosis.
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| Brown fat: what, purpose? | show 🗑
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| Head at birth (size)? | show 🗑
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| Moro reflexes? | show 🗑
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| show | Refers to the posture assumed by newborns when in a supine position. The infant extends the arm and leg on the side to which the head is turned and flexes the extremities to the other side
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| Palmer grasp reflex? | show 🗑
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| show | When the infant’s check is touched near the mouth on only one side the head turns toward the side that has been stroked (important for feeding, best done when infant is hungry).
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| show | When stroking the lateral sole of the infant’s foot from the heel forward and across the ball of the foot, the toes flare outward and the big toe dorsiflexes.
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| Stepping reflex? | show 🗑
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| show | Apgar score,Temp: dry baby/warm blankets, ID/Name, Eye Drops, Vitamin K, Breastfeeding/Bonding, Physical Assessment of baby, Weight baby, Measure head and chest circumference.
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| Normal newborn sleep time, crying time? | show 🗑
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| 3 abnormals for a newborn? | show 🗑
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| Infant behavior during the first 6-8hr of age: who studied, what period, periods of…, first 15-30 minutes…, 30minutes to 2 hrs, 2-6hrs? | show 🗑
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| Birth weight lost immediately after birth, regained by? | show 🗑
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| show | Doubles @ 4-5 months. Triples @ 1 year.
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| show | 110Kcal/kg/day.
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| show | 1.Flouride 2.Fe
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| When are solids introduced, why? | show 🗑
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| show | 40-50%carbs, 50%fat, 5-10% Protein.
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| Type of nipples that help breast feeding? | show 🗑
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| show | 300cc more fluids a day. More protein intake per day.
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| show | GI problems, Ear Infections, Upper Respiratory problems.
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Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
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