ATI Maternal Exam 1 Study Guide

infant mortality congenital malformations and abnormalities are the number one cause of complications of preterm births respiratory disorders cerebral palsy vision and hearing disorders developmental and learning delays greater than 4000 grams high birth weight grams normal birth weight 2500 grams low birth weight less than 1500 grams very low birth weight physical behavioral cognitive fetal alcohol spectrum disorders (FASD) can have what effects in pregnancy infant mortality is an indicator of maternal health, community health status and availability of quality health care services first birthday infant mortality is the death before their maternal mortality death of a women during pregnancy or within 1 year of the end of pregnancy from pregnancy complications. beneficence to do good -•Educating your patient about interventions and behaviors that benefit both her and her fetus. nonmaleficence the obligation to do no harm to either the woman or fetus - Helping a mother understand the potential consequences of drug abuse or alcohol ingestion during pregnancy. fidelity being accountable for your responsibilities and loyal to your commitments -ensuring your patient has appropriate care from your relief nurse before going off shift varacity being truthful -•This can mean being honest with your patient about risks and benefits of a cesarean or admitting that you need assistance to give appropriate care. autonomy the right to self determination -•Free choice and personal decisions and is the basis for informed consent in health care. justice allocation of resources and ensure that resources are used equitably -•For example, at the societal level justice relates to which initiatives or programs are funded, whereas at the individual level justice may influence who receives an organ transplant. Utilitarianism The principle of distributing resources to produce the greatest good for the most people. Libertarianism Some people are more valuable to society than others and thus need to be given the resources they require to survive. Egalitarianism The moral principle focuses on the belief that all people are equal. futility of treatment physician recognizes that effect of treatment will be of no benefit to the patient nurses rights AWHONN (Association of Women's Health, Obstetric and Neonatal Nurses) supports the first 8 weeks of gestation (organogenesis). The developing human is most vulnerable to the effects of teratogens during the period of Toxoplasma is a protozoan parasite found in cat feces and uncooked or rare beef and lamb Fetal demise retardation Blindness When an embryo is exposed to Toxoplasma can result in teratogen drugs Ace inhibitors ARBs Carbamazepine Warfarin Teratogen viruses Hep B Rubella Cytomegalovirus (CMV) Herpes Varicella Syphilis Zika 3 phases of ovulation follicular phase ovulatory phase luteal phase follicular phase ‒12-14 days ‒FSH & LH ovulatory phase ‒LH surge 12-36 hours prior to ovulation.* Luteal phase -last 14 days ‒If pregnancy occurs, the corpus luteum releases progesterone and estrogen until the placenta matures enough to assume this function. ‒If pregnancy does not occur, the corpus luteum degenerates, resulting in a decrease in progesterone and the beginning of menstruation. Oogenisis is the formation of a mature ovum (egg) the process is regulated by 2 primary hormones Follicle-stimulating hormone (FSH) Estrogen the two hormones that regulates oogenesis Follicle-stimulating hormone (FSH) is secreted by the anterior pituitary gland and stimulates the growth of the ovarian follicles and stimulates the follicles to secrete estrogen. Estrogen is secreted by the follicle cells and promotes the maturation of the ovum. In the process of Oogenesis- FSH stimulates growth of ovarian follicle, contains a stem cell. In the process of Oogenesis- Mitosis is the process by which a cell divides and forms two genetically identical cells (daughter cells), each containing the diploid number of chromosomes. In the process of Oogenesis- Meiosis is a process of two successive cell divisions that produce cells that contain half the number of chromosomes (haploid). FSH LH Testosterone Spermatogenesis is the formation of mature spermatozoa (sperm), a process regulated by three primary hormones: FSH in males Secreted from the anterior pituitary gland, FSH stimulates sperm production. LH in males Secreted from the anterior pituitary gland, LH stimulates testosterone production. Testosterone Secreted by the testes, testosterone promotes the maturation of the sperm. Organogenesis development of body organs and MOST critical time for development. Embryo from the time of implantation through 8 weeks of gestation the developing human is referred to as an week 9 to birth The developing human is referred to as a fetus from Fetal circulatory structures: •Ductus Venous •Foramen Ovale •Ductus Arteriosus Placental progesterone hormone function Facilitates implantation, decreases contractility Placental estrogen hormone function Stimulates enlargement of breasts and uterus Placental Human Chorionic Gonadotropin (hCG) hormone function stimulates corpus luteum to secrete estrogen and progesterone until placenta takes over Placental Human Placental Lactogen (hPL) hormone function Promotes fetal growth by regulating glucose and stimulates breast development for lactation. 8th and 10th weeks of gestation The placenta becomes fully functional between the amniotic membrane in the first trimester amniotic fluid is produced by fetal kidneys in the 2nd and 3rd trimester amniotic fluid is produced by amniotic fluid peaks at 800-1000ml around 34 weeks movement warmth cushion amniotic fluid functions to provide the baby Polyhydramnios- (too much fluid) mL OR more than 25cm on US. Oligohydramnios- (too little fluid) Less than 500mL OR Less than 5cm on US Amniotic Fluid Index (AFI) Measurement of amniotic fluid in all four quadrants of the uterus added together umbilical cord structure two arteries one vein umbilical cord function nutrition gas exchange infertility is defined as the inability to conceive and maintain a pregnancy after 12 months (6 months for woman older than age 35 years) of unprotected sexual intercourse. Causes of ovulatory dysfunction are Hormonal imbalances, Hyperthyroidism and hypothyroidism, High prolactin levels, Premature ovarian failure (menopause prior to age 40), and Polycystic ovarian syndrome. anovulation or inconsistent ovulation. These factors have a very high success rate with appropriate treatment, these ovulatory dysfunctions include ovulatory dysfunctions risk factors Autoimmune disorders Diabetes Obesity Older age 0.4°F for 3 consecutive days Basal body temperature (BBT) charting: The female partner takes her temperature each morning before rising using a basal thermometer and records her daily temperature. Ovulation has occurred if there is a rise in the temperature by Detecting LH surge A rapid increase in LH 36 hours before ovulation can be tested with urine or serum. The urine test can be performed at home to assist in identifying the ideal time for intercourse when pregnancy is desired. has a sickle cell trait sickle cell anemia clients over the age of 35. Clients who are in need of genetic counseling such as a client who blood pressure decreases in 1st trimester then returns to normal by term Ovaries (hCG) maintains pregnancy first few weeks 15-20 bpm during pregnancy HR increases by left hip when lying on her back to prevent supine hypotension always place a wedge under the clients dyspnea nasal congestion epitaxies during pregnancy women can experience respiratory changes such as Nausea & Vomiting Increased appetite and food intake Cravings (pica) Food avoidance pregnant women often experience gastrointestinal changes such as higher risk for falls pregnant women often experience musculoskeletal changes that alter the posture and center of gravity putting the client at progesterone this hormone causes relaxation that can cause joint discomfort and constipation lordosis abnormal anterior curvature of the lumbar spine (sway-back condition) linea nigra a dark line appearing on the abdomen and extending from the pubis toward the umbilicus Melasma Brownish pigmentation of the face during pregnancy; also called chloasma and "mask of pregnancy" stria stretch marks caused by the effects of estrogen, relaxing and adrenocorticoids varicosities spider veins caused by pressure from enlarged uterus Presumptive signs (subjective) Amenorrhea Nausea & Vomiting Breast changes Quickening Quickening fetal movement/fluttering 18-20 weeks Probable signs (objective) Chadwick's sign Goodell's sign Ballottement Positive pregnancy test Chadwick's sign Bluish purple discoloration of the cervix, vagina, and labia during pregnancy as a result of increased vascular congestion. Goodell's sign softening of the cervix amenorrhea absence of menstruation Positive signs (signs only attributed to fetus) Auscultation of fetal heart sounds Sonographic visualization of fetus Observation or Palpation of fetal movement Ballottement a sharp upward pushing against the uterine wall with a finger inserted into the vagina for diagnosing pregnancy by feeling the return impact of the displaced fetus Higher levels of hCG can indicate multifetal pregnancy, ectopic pregnancy, hydatidiform mole (gestational trophoblastic disease), or a genetic abnormality such as Down syndrome. miscarriage or ectopic pregnancy Lower blood levels of hCG might suggest a Naegele's Rule/EDD-estimated due date First day of last menstrual cycle- subtract 3 months and add 7 days Gestational agenumber of completed weeks of fetal development, calculated from the first day of the last menstrual period early term 37-38 weeks full term 39-40 weeks later term 41 weeks post term 42 weeks and beyond gravidity number of pregnancy nulligravida a client who has never been pregnant primigravida a client in their first pregnancy multigravida a client who has had two or more pregnancies parity number of pregnancies in which the fetus or fetuses reach 20 weeks of pregnancy