NUR 211
EXAM 3 3
STUDY GUIDE
Health Care Concepts
Forsyth Technical Community College
This Document Description:
❖ This study guide for NUR 211 at Forsyth Technical
Community College focuses on Exam 3 content from the
Health Care Concepts course.
❖ It includes essential topics.
❖ The material is clearly organized to help students understand complex
systems and prepare effectively for exam questions.
, UNIT 3 TEST
Grief and Loss:
Perinatal loss:
Death of a fetus or neonate from the time of conception through the end of the
newborn period (28 days after birth)
Antepartum fetal deaths account for about half of all perinatal mortality in the US.
About 70-90% of all stillbirths occur before the onset of labor
More than half of these occur between 20-28 weeks gestation
USA: 6.05 FETAL DEATHS PER 1000 BIRTHS
Common causes:
o Can be unknown- 25%
o May be related to fetal factors such as chromosomal disorders, birth defects,
exposure to teratogens, infections, complications of multiple gestation or fetal
growth restriction
o Maternal factors such as chronic hypertension, preeclampsia or eclampsia,
diabetes, advanced maternal age, Rh incompatibility, uterine rupture, ascending
maternal infection
o Placental factors such as placenta previaa, abruption placentae, cord accident
o Occurs more frequently in monochorionic twins and in pregnancies conceived by
assisted reproductive technologies
o Certain genetic tsting procedures such as amniocentesis and chorionic villus
sampling
o In industrialized countries: Maternal obesity, advanced maternal age, maternal
smoking, maternal substance abuse, primimparity, small-for-gestational-age
fetuses, abruptions, maternal hypertension, diabetes are the most common
etiologies of stillbirth
o In developing countries: infection plays significant role. Bacterial organisms such
as E. coli, group B streptococci, and ureaplasma urealyticum
Can occur either before or ater membranes have ruptured
o Viral causes include parvovirus and coxsackievirus
o Toxoplasma gondii, listeria monocytogenes, and organisms that cause
leptospirosis, Q fever, and lyme disease also are ccausative factors
o Untreated syphilis
o Malaria infections
o Women with acquired and immune thrombophilia have higher rates of
mischarriage
, Maternal Physiologic Implications:
Prolonged retention of the dead fetus may lead to development of disseminated
intravascular coagulation (DIC)
o AKA consumption coagulopathy
o The fetal tissues are degenerating and release thromboplastin into the maternal
bloodstream. This causes the activation of the extrinsic clotting system, thus
triggering the formation of multiple tiny blood clots
o Fibrinogen and factors V and VII are depleted, and the woman begins to show
the signs of DIC.
o By week 3 and 4 after the death of the fetus, the fibrinogen levels begin the
linear descent and continue to decrease without the roer medical intervention
Prolonged retention of fetus may also lead to infection
o Infection can lead to endometritis or sepsis
o The longer the pregnancy is, the higher the incidence of infection
Mother may refuse the induction of birth for the dead fetus. There also may be multiple
gestation so this also would cause the delay. In these causes, fibrinogen levels are
monitored weekly or biweekly to recognize and prevent progressive coagulopathy from
occuring
PERFUSION: CONGENITAL HEART DEFECTS
Ductus arteriosus normally constricts and closes within 10-15 hours after birth in response to
higher oxygen sat levels
- Permanent closure occurs 10-21 days after birth UNLESS oxygen
sats remain low.
Rt. Vent is larger than left at birth
- The higher systemic vascular pressure of the left forces it to
develop quickly and soon match the size of the right.
Oxygen arterial saturation: the amount of oxygen that can potentially be delivered to the
tissues.
Desaturated blood results when oxygenated and unoxygenated blood mix because of a
congenital heart defect.
Cyanosis- indicated hypoxemia: which is lower than normal amounts of oxygen in the blood:
results from a decreased concentration of oxygenated hemoglobin.
POLYCYTHEMIA: The child’s BONE MARROW responds to chronic hypoxemia by producing an
excess number of red blood cells
o A HCT of 50% or higher is common in children who have heart defects causing
cyanosis
EXAM 3 3
STUDY GUIDE
Health Care Concepts
Forsyth Technical Community College
This Document Description:
❖ This study guide for NUR 211 at Forsyth Technical
Community College focuses on Exam 3 content from the
Health Care Concepts course.
❖ It includes essential topics.
❖ The material is clearly organized to help students understand complex
systems and prepare effectively for exam questions.
, UNIT 3 TEST
Grief and Loss:
Perinatal loss:
Death of a fetus or neonate from the time of conception through the end of the
newborn period (28 days after birth)
Antepartum fetal deaths account for about half of all perinatal mortality in the US.
About 70-90% of all stillbirths occur before the onset of labor
More than half of these occur between 20-28 weeks gestation
USA: 6.05 FETAL DEATHS PER 1000 BIRTHS
Common causes:
o Can be unknown- 25%
o May be related to fetal factors such as chromosomal disorders, birth defects,
exposure to teratogens, infections, complications of multiple gestation or fetal
growth restriction
o Maternal factors such as chronic hypertension, preeclampsia or eclampsia,
diabetes, advanced maternal age, Rh incompatibility, uterine rupture, ascending
maternal infection
o Placental factors such as placenta previaa, abruption placentae, cord accident
o Occurs more frequently in monochorionic twins and in pregnancies conceived by
assisted reproductive technologies
o Certain genetic tsting procedures such as amniocentesis and chorionic villus
sampling
o In industrialized countries: Maternal obesity, advanced maternal age, maternal
smoking, maternal substance abuse, primimparity, small-for-gestational-age
fetuses, abruptions, maternal hypertension, diabetes are the most common
etiologies of stillbirth
o In developing countries: infection plays significant role. Bacterial organisms such
as E. coli, group B streptococci, and ureaplasma urealyticum
Can occur either before or ater membranes have ruptured
o Viral causes include parvovirus and coxsackievirus
o Toxoplasma gondii, listeria monocytogenes, and organisms that cause
leptospirosis, Q fever, and lyme disease also are ccausative factors
o Untreated syphilis
o Malaria infections
o Women with acquired and immune thrombophilia have higher rates of
mischarriage
, Maternal Physiologic Implications:
Prolonged retention of the dead fetus may lead to development of disseminated
intravascular coagulation (DIC)
o AKA consumption coagulopathy
o The fetal tissues are degenerating and release thromboplastin into the maternal
bloodstream. This causes the activation of the extrinsic clotting system, thus
triggering the formation of multiple tiny blood clots
o Fibrinogen and factors V and VII are depleted, and the woman begins to show
the signs of DIC.
o By week 3 and 4 after the death of the fetus, the fibrinogen levels begin the
linear descent and continue to decrease without the roer medical intervention
Prolonged retention of fetus may also lead to infection
o Infection can lead to endometritis or sepsis
o The longer the pregnancy is, the higher the incidence of infection
Mother may refuse the induction of birth for the dead fetus. There also may be multiple
gestation so this also would cause the delay. In these causes, fibrinogen levels are
monitored weekly or biweekly to recognize and prevent progressive coagulopathy from
occuring
PERFUSION: CONGENITAL HEART DEFECTS
Ductus arteriosus normally constricts and closes within 10-15 hours after birth in response to
higher oxygen sat levels
- Permanent closure occurs 10-21 days after birth UNLESS oxygen
sats remain low.
Rt. Vent is larger than left at birth
- The higher systemic vascular pressure of the left forces it to
develop quickly and soon match the size of the right.
Oxygen arterial saturation: the amount of oxygen that can potentially be delivered to the
tissues.
Desaturated blood results when oxygenated and unoxygenated blood mix because of a
congenital heart defect.
Cyanosis- indicated hypoxemia: which is lower than normal amounts of oxygen in the blood:
results from a decreased concentration of oxygenated hemoglobin.
POLYCYTHEMIA: The child’s BONE MARROW responds to chronic hypoxemia by producing an
excess number of red blood cells
o A HCT of 50% or higher is common in children who have heart defects causing
cyanosis
