Ob nurs 306 ob final study guide west coast
university
, 1
Chapter 3 Genetics, Conception, Fetal Development, and Reproductive Technology
o
personalizing treatment plans
30,000 genes in the human genome complete set of DNA)
46 chromosomes; 22 homologous pairs of chromosomes and one pair of sex chromosomes
recessive genetic disorders sickle cell anemia, cystic fibrosis, thalassemia, Tay-Sachs disease
carrier testing identify individuals who carry one copy of a gene mutation that, when present in two copies causes a genetic disorder; used
when there is a family history of genetic disorder
preimplantation testing/preimplantation genetic diagnosis used to detect genetic changes in embryos that are created using assisted
reproductive techniques
prenatal testing early detection of genetic disorders
risks for conceiving child with genetic disorder maternal age older than 35, man/woman who has genetic disorder; family history of genetic
disorder, history of previous pregnancy resulting in a genetic disorder or newborn
sickle cell anemia
o most common of African ancestry
o sickle-cell hemoglobin forms rigid crystals that distort and disrupt RBCs; oxygen-carrying capacity of blood is diminished
cystic fibrosis
o most common genetic disease of European ancestry
o production of thick mucus clogs in bronchial tree and pancreatic ducts
o most severe effects are chronic respiratory infections and pulmonary failure
Tay-Sach disease
o Most common among Jewish ancestry
o Degeneration of neurons and nervous system results in death by the 2 years old
PKU
o Lack of enzyme to metabolize the amino acid phenylalanine leads to severe mental and physical retardation
o Effects may be prevented by use of a diet at beginning of birth that limits phenylalanine
Disease
o Uncontrollable muscle contractions between 30-50 years followed by memory loss and personality
o No treatment that can delay mental deterioration
Hemophilia (X-linked)
o Lack of factor 8
o Can be controlled with factor 8 from donated blood
Musclular Dystrophy
o Replacement of muscle by adipose or scare tissue with progressive loss of muscle function; often fatal before age 20 due to involvement
of cardiac muscle
teratogens any drugs, viruses, infections, or other exposures that can cause embryonic/fetal developmental abnormality
degree or types of malformation vary on length of exposure, amount of exposure, and when it occurs during human development
exposure after 13 weeks may cause fetal growth restriction or reduction of organ size
toxoplasma is a protozoan parasite found in cat feces and uncooked/rare beef and lamb
o can cause fetal demise, mental retardation, blindness when fetus is exposed
o avoid contact with cat feces and eating rare beef or lamb if pregnant or attempting pregnancy
rubella increased risk for heart defects, deafness and/or blindness, mental retardation, fetal demise
cytomegalovirus increased risk for hydrocephaly, microcephaly, cerebral calcification, mental retardation, hearing loss
herpes varicella/chicken pox increased risk for hypoplasia of hands and feet, blindness/cataracts, mental retardation
syphilis increased risk for skin, bone and/or teeth defects, fetal demise
cocaine increased risk for heart, limbs, face, GI/GU tract defects, cerebral infarctions, placental abnormalities
, 2
Chapter 4 Physiological Aspects of Antepartum Care
, 3
G/P System
o Gravida: # times a woman has been pregnancy including current pregnancy
o Para: # of births after 20 gestation whether live or stillbirths
o Abortions are not accounted for in this system
GTPAL
o G: # times pregnancy
o T: # of term infants born after 37 weeks
o P: # of preterm infants between 20 and 37 weeks
o A: # of abortions either spontaneous or induced before 20 weeks
o L: # of living children
Nulligravida: woman who has never been pregnant or given birth
Primigravida: woman who is pregnant for the first time
Multigravida: someone who is pregnant for at least the second time
Prenatal period entire time period during which a woman is pregnant through birth of baby
Nurse places emphasis on health education and health promotion
Family-centered maternity care is a model of obstetrical care based on a view of pregnancy and childbirth as a normal life event, a life transition
that is not primarily medical but rather developmental
Low-risk population should have approximately 14-16 prenatal visits per pregnancy
First trimester
o Woman learns frequency of follow-up visits and what to expect from pregnancy visits as pregnancy progresses during initial visit
o Comprehensive health and risk assessment; currently pregnancy history; complete physical and pelvic examination; nutrition assessment;
psychosocial assessment; assessment for intimate partner violence
o Fetal heart tones are auscultated with US Doppler, initially by 10 and 12 weeks
o At end of first trimester, fetus is 3 inches in length and weights 1-2 ounces, all organ systems are present
o Assessment of uterine growth after 10-12 weeks is measured by height of fundus with centimeter measuring tape; zero point of tape is
placed on the symphysis pubis and tape is extended to top of fundus; MEASUREMENT SHOULD EQUAL # OF WEEKS PREGNANT
o Certain types of fish (king mackerel, shark, swordfish, tilefish) should be avoided due to high levels of methylmercury
Second trimester
o Chart review; interval history; focused physical assessment; pelvic exam/sterile vaginal exam if indicated; confirm EDD
o Triple/quad screen (neural tube defect); US; screening for gestational diabetes; hemoglobin and hematocrit; antibody screen if
Rh-negative (Administration of RhoGAM if Rh-negative and anti-body screen negative)
Administered prophylactically at 28 weeks to prevent isoimmunization from potential exposure to Rh- positive fetal
blood during normal course of pregnancy
Adverse reaction pain at IM site; fever
o Slight decrease in blood pressure toward end of second trimester
o Assess for quickening when the woman feels baby move for first time
o maneuvers to identify position of fetus
o Slight lower body edema is normal due to decreased venous return
o At 20 weeks, fetus is 8 inches long and weights 1 pound
o Increase in calorie intake by 340 kcal/day
Third trimester
o Chart review; interval history; nutrition follow-up; focused physical assessment; pelvic exam/sterile vaginal exam if indicated
o Group B Strept at 35-37 weeks; H&H if not done in second trimester; repeat GC, chlamydia, RPR, HIV HbSAg; 1- hour glucose
challenge test at 24-28 weeks
o Record fetal movement count 10 distinct fetal movements within 2 hours is considered reassuring OR 4
movements in 1 hour
o At term, fetus is 17-20 inches long, 6-8 pounds
o Increase in calorie intake by 452 kcal/day
Chapter 6 Antepartal Tests
Chorionic villus sampling aspiration of a small amount of placental tissue for chromosomal, metabolic, or DNA testing
o Between 10 and 12 weeks to detect fetal abnormalities caused by genetic disorders
o Tests for cystic fibrosis but not neural tube defects
o Supine position for transabdominal aspiration with US to guide placement
o Lithotomy for transvaginal aspiration with US to guide placement
o Small biopsy of chorionic (placental) tissue is removed
o Assess fetal and maternal well-being post-procedure; FHR is auscultated twice in 30 minutes
university
, 1
Chapter 3 Genetics, Conception, Fetal Development, and Reproductive Technology
o
personalizing treatment plans
30,000 genes in the human genome complete set of DNA)
46 chromosomes; 22 homologous pairs of chromosomes and one pair of sex chromosomes
recessive genetic disorders sickle cell anemia, cystic fibrosis, thalassemia, Tay-Sachs disease
carrier testing identify individuals who carry one copy of a gene mutation that, when present in two copies causes a genetic disorder; used
when there is a family history of genetic disorder
preimplantation testing/preimplantation genetic diagnosis used to detect genetic changes in embryos that are created using assisted
reproductive techniques
prenatal testing early detection of genetic disorders
risks for conceiving child with genetic disorder maternal age older than 35, man/woman who has genetic disorder; family history of genetic
disorder, history of previous pregnancy resulting in a genetic disorder or newborn
sickle cell anemia
o most common of African ancestry
o sickle-cell hemoglobin forms rigid crystals that distort and disrupt RBCs; oxygen-carrying capacity of blood is diminished
cystic fibrosis
o most common genetic disease of European ancestry
o production of thick mucus clogs in bronchial tree and pancreatic ducts
o most severe effects are chronic respiratory infections and pulmonary failure
Tay-Sach disease
o Most common among Jewish ancestry
o Degeneration of neurons and nervous system results in death by the 2 years old
PKU
o Lack of enzyme to metabolize the amino acid phenylalanine leads to severe mental and physical retardation
o Effects may be prevented by use of a diet at beginning of birth that limits phenylalanine
Disease
o Uncontrollable muscle contractions between 30-50 years followed by memory loss and personality
o No treatment that can delay mental deterioration
Hemophilia (X-linked)
o Lack of factor 8
o Can be controlled with factor 8 from donated blood
Musclular Dystrophy
o Replacement of muscle by adipose or scare tissue with progressive loss of muscle function; often fatal before age 20 due to involvement
of cardiac muscle
teratogens any drugs, viruses, infections, or other exposures that can cause embryonic/fetal developmental abnormality
degree or types of malformation vary on length of exposure, amount of exposure, and when it occurs during human development
exposure after 13 weeks may cause fetal growth restriction or reduction of organ size
toxoplasma is a protozoan parasite found in cat feces and uncooked/rare beef and lamb
o can cause fetal demise, mental retardation, blindness when fetus is exposed
o avoid contact with cat feces and eating rare beef or lamb if pregnant or attempting pregnancy
rubella increased risk for heart defects, deafness and/or blindness, mental retardation, fetal demise
cytomegalovirus increased risk for hydrocephaly, microcephaly, cerebral calcification, mental retardation, hearing loss
herpes varicella/chicken pox increased risk for hypoplasia of hands and feet, blindness/cataracts, mental retardation
syphilis increased risk for skin, bone and/or teeth defects, fetal demise
cocaine increased risk for heart, limbs, face, GI/GU tract defects, cerebral infarctions, placental abnormalities
, 2
Chapter 4 Physiological Aspects of Antepartum Care
, 3
G/P System
o Gravida: # times a woman has been pregnancy including current pregnancy
o Para: # of births after 20 gestation whether live or stillbirths
o Abortions are not accounted for in this system
GTPAL
o G: # times pregnancy
o T: # of term infants born after 37 weeks
o P: # of preterm infants between 20 and 37 weeks
o A: # of abortions either spontaneous or induced before 20 weeks
o L: # of living children
Nulligravida: woman who has never been pregnant or given birth
Primigravida: woman who is pregnant for the first time
Multigravida: someone who is pregnant for at least the second time
Prenatal period entire time period during which a woman is pregnant through birth of baby
Nurse places emphasis on health education and health promotion
Family-centered maternity care is a model of obstetrical care based on a view of pregnancy and childbirth as a normal life event, a life transition
that is not primarily medical but rather developmental
Low-risk population should have approximately 14-16 prenatal visits per pregnancy
First trimester
o Woman learns frequency of follow-up visits and what to expect from pregnancy visits as pregnancy progresses during initial visit
o Comprehensive health and risk assessment; currently pregnancy history; complete physical and pelvic examination; nutrition assessment;
psychosocial assessment; assessment for intimate partner violence
o Fetal heart tones are auscultated with US Doppler, initially by 10 and 12 weeks
o At end of first trimester, fetus is 3 inches in length and weights 1-2 ounces, all organ systems are present
o Assessment of uterine growth after 10-12 weeks is measured by height of fundus with centimeter measuring tape; zero point of tape is
placed on the symphysis pubis and tape is extended to top of fundus; MEASUREMENT SHOULD EQUAL # OF WEEKS PREGNANT
o Certain types of fish (king mackerel, shark, swordfish, tilefish) should be avoided due to high levels of methylmercury
Second trimester
o Chart review; interval history; focused physical assessment; pelvic exam/sterile vaginal exam if indicated; confirm EDD
o Triple/quad screen (neural tube defect); US; screening for gestational diabetes; hemoglobin and hematocrit; antibody screen if
Rh-negative (Administration of RhoGAM if Rh-negative and anti-body screen negative)
Administered prophylactically at 28 weeks to prevent isoimmunization from potential exposure to Rh- positive fetal
blood during normal course of pregnancy
Adverse reaction pain at IM site; fever
o Slight decrease in blood pressure toward end of second trimester
o Assess for quickening when the woman feels baby move for first time
o maneuvers to identify position of fetus
o Slight lower body edema is normal due to decreased venous return
o At 20 weeks, fetus is 8 inches long and weights 1 pound
o Increase in calorie intake by 340 kcal/day
Third trimester
o Chart review; interval history; nutrition follow-up; focused physical assessment; pelvic exam/sterile vaginal exam if indicated
o Group B Strept at 35-37 weeks; H&H if not done in second trimester; repeat GC, chlamydia, RPR, HIV HbSAg; 1- hour glucose
challenge test at 24-28 weeks
o Record fetal movement count 10 distinct fetal movements within 2 hours is considered reassuring OR 4
movements in 1 hour
o At term, fetus is 17-20 inches long, 6-8 pounds
o Increase in calorie intake by 452 kcal/day
Chapter 6 Antepartal Tests
Chorionic villus sampling aspiration of a small amount of placental tissue for chromosomal, metabolic, or DNA testing
o Between 10 and 12 weeks to detect fetal abnormalities caused by genetic disorders
o Tests for cystic fibrosis but not neural tube defects
o Supine position for transabdominal aspiration with US to guide placement
o Lithotomy for transvaginal aspiration with US to guide placement
o Small biopsy of chorionic (placental) tissue is removed
o Assess fetal and maternal well-being post-procedure; FHR is auscultated twice in 30 minutes
