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NUR 106 MOD A Study Guide Exam 1 -
Wallace Community College Questions
With Answers.
Presumptive SIGNS OF PREGNANCY - ANSWER- WHAT SYMPTOMS and WHEN START Amenorrhea (4 wks) Nausea and vomiting (4-14 wks) Frequency of urination (6-12 wks) Tenderness and fullness of breasts (3-4 wks) "Quickening" (16-20 wks) Chadwick's sign (6-12 wks) Skin changes Pigmentation -Linea nigra Chloasma Darkened nipple and areola Vascular spiders Striae gravidarum Increased sweat and sebaceous gland activity Fatigue Positive SIGNS OF PREGNANCY - ANSWER- Fetal heart sounds (8-17 wks) Fetal movement felt by examiner (19-22 wks) Fetal X-ray Ultrasound (8 - 10 wks) looking for evidence of conception - "all products of conception" Fetal Anatomy Ultrasound - 20 weeks Naegle's Rule - ANSWER- 1st day of LNMP
- 7 days + 1 year G_ T_ P_ A_ L_(M) - ANSWER- Gravida Term Preterm Abortion Living Multiples FIRST PRENATAL EXAM - ANSWER- • Vitals signs; BP, P, R, T
- Height and weight
- Fundal height and fetal heart rate
- Urine - Protein/Glucose/Ketones/Bacteria
- Speculum exam: Visualize cervix and obtain cultures
- Pelvic measurements
- Laboratory data: Look at lab data pg 132 ANTEPARTAL TEACHING - ANSWER- General Hygiene Smoking, drugs and alcohol Douching Clothes Exercise Rest and relaxation Employment Travel Teeth Sexual relations Immunizations and vaccines DANGER SIGNALS OF PREGNANCY - ANSWER- Vaginal bleeding Swelling of face and hands Severe continuous headache Dimness or blurred vision Flashes of light or dots in vision Pain in abdomen Persistent vomiting Chills and fever Sudden escape of fluid from vagina NUTRITION - ANSWER- Decreased appetite early if nausea Needs increased quality(protein, Carbs) not quantity Increased appetite 2nd and 3rd trimester Pressure on stomach decreases amount of food eaten at a time, heartburn Should not gain more than 25 -35 lbs for woman with normal BMI. See book for other ranges. Extra Calories -75,000 calories for the life of pregnancy or 350-450 a day Need extra Iron and calcium Things to stay clear of: Shark - mercury Any raw fish Cold cut meats -listeria Certain fruits and salad as their is high exposure to listeria Presumptive signs of pregnancy are a positive indicator of pregnancy. - ANSWER- false Elevated hCG levels are a positive sign of pregnancy - ANSWER- false
General to specific Embryonic Period - ANSWER- From beginning of 3rd wk through 8th wk after conception. Critical stage for organ development- by end of 8th wk all major organ systems in place. Chromosomal defects can develop during this time that causes miscarriage or certain fetal development to not form correctly During the embryonic period organs are... - ANSWER- Developing rapidly / highly vulnerable to teratogens. Such as specific drugs & diagnostic procedures, as well as inadequate intake of beneficial substances such as folic acid. Also exposure to cigarette smoke and polutents. Embryonic Period: WEEK 3 - ANSWER- WEEK 3 May miss first menstrual period. Brain, spinal cord, heart begins developing. GI tract begins. Neural tube forms-later spinal cord. Leg/arm buds. Teeth buds Early heart begins beating at 21-22 days. Embryonic Period: WEEK 4 - ANSWER- Week 4 Embryo folds at head & tail end-resembles c-shaped cylinder by end of 4th wk. "Tail" apparent as brain & spinal cord develop more rapidly than other systems. Neural tube closes. Stomach, pancreas, and liver begin to form. Partitioning of heart into 4 chambers begins during 4th wk /completed by end of 6th wk. Embryonic Period: WEEK 5 - ANSWER- Week 5 Head large b/c brain grows rapidly this wk. Heart beating regular rhythm. Beginning structures eyes/ears. Some cranial nerves visible. Muscles innervated. Embryonic Period: WEEK 6 - ANSWER- Week 6 Head prominent /bent over chest. Heart reaches final four chambered form. Beginning formation of lungs. Fetal circulation established. Liver produces RBC. Primitive skeleton forms. Brain continues to develop-brain waves detectable. Central nervous system forms.
Embryonic Period: WEEK 7 - ANSWER- Week 7 Straightening of trunk. Nipples/hair follicles form. Elbows/toes visible. Arms/legs move. Diaphragm formed. Fetal heartbeat can be heard. Mouth w/ lips and early tooth buds. Embryonic Period: WEEK 8 - ANSWER- Week 8 Rotation of intestines. Heart development complete. Embryo has definite human form. Facial features continue to develop. Fetal Period - ANSWER- Begins 9 wks after conception & ends w/birth. Period of growth & refinement in structure /function of organ systems. Less vulnerable to teratogens. Central nervous system vulnerable to damaging agents throughout pregnancy. Fetal Period: Weeks 9-12 - ANSWER- Weeks 9- Head half total length of fetus-face/neck well formed. Digestive system shows activity. Limbs long & thin-digits well formed. 1st movement begins, but too slight for maternal detection. Eyes close at 9 wks- reopen at 26 wks. Fetal gender may be determined by end of week 12. Has buds for all 20 temporary teeth. Sucking begins kidneys begin to produce urine 12th week heartbeat detected by doplar at 12th week Fetal Period: Weeks 13-16 - ANSWER- Weeks 13- Lanugo develops. Skin transparent. Bones harder. Head still dominant. Sucking motions made with the mouth. Amniotic fluid is swallowed. Fingernails/toenails present. Progressively gaining weight. Movements strengthen & some women may feel "quickening". Fetal Period: Weeks 17-20 - ANSWER- Weeks 17- Rapid brain growth. Fetal heart tones w/stethoscope.
Mother supplies fetus with antibodies against disease. Fetus considered full term at 38 weeks. Fetus fills uterus. Changes After Birth-Foramen Ovale - ANSWER- Infant breathes. Blood flow to lungs increase. Pressure in right heart falls. Foramen ovale closes. Teratogen - ANSWER- Anything that adversely affects normal development in embryo/fetus. Factors that affect fetal development - ANSWER- Teratogens. Maternal Health Habits/ Lifestyle: Can limit amount of beneficial nutrients needed for optimal growth and development. Paternal Influence: Health habits, Lifestyle practices, Exposure to environmental influences. Mons Pubis - ANSWER- Fleshy prominent part over the symphis pubis-- protects during sexual intercourse. Labia Majora - ANSWER- function to protect vaginal opening-contain sweat/sebaceous glands Labia Minora - ANSWER- inner folds-- surrounds openings to vagina and urethra Clitoris - ANSWER- located anterior junction of labia/erectile tissue and nerves/very sensitive/very vascular/function sexual stimulation Vestibule - ANSWER- Area inside labia minora/contains urethral opening, the vagina, two sets of glands—bartholins/both side of introitus (secrete mucus for lubrication during intercourse) and Skenes/both side of urethral opening (secrete small amt mucus to keep moist and passage of urine) Perineum - ANSWER- located between vulva—which is all of the above—and anus— may become lacerated or incised during childbirth Vagina - ANSWER- tubular, with mucus membranes that lie in folds—rugae—provides for expansion during childbirth—acidic environment—protects against infections What are some things that can affect the pH levels of the vagina? - ANSWER- antibiotic therapy, douches, perineal hygiene sprays alter pH balance; increase risk for infections Uterus - ANSWER- Pear shaped; full bladder tips backward; full rectum tilts forward. It has three layers.
The inner most layer of the uterus is the what? - ANSWER- Endometrium. It varies in thickness, abundance of glands, and vessels. What is the middle layer of the uterus? - ANSWER- Myometrium What is the outer most layer of the uterus? - ANSWER- Perimetrium What is the fundus? - ANSWER- Top aspect of the uterus. (convex above the tubes) What is the corpus? - ANSWER- Central portion or body of the uterus. What is the cervix? - ANSWER- Lower part of the uterus (neck) opens into the vagina has a central channel that allows sperm to enter and menstrual blood to exit. Covered in mucosa. Smooth firm and doughnut shaped. What does the cervix do? - ANSWER- Dilates during labor/delivery. Serves as a barrier to infection. Prior to child birth (nulliparous) the cervical os is... - ANSWER- Small and oval. Fallopian Tubes - ANSWER- flared end to capture released ovum; cilia propel thru tube. Fertilization occurs here; remains in tube 3-4 days. Ovaries - ANSWER- Almond shaped; suspended from several ligaments; primary function—release ovum and secretion of hormones-estrogen and progesterone. Breasts - ANSWER- Accessory organ of reproduction; divided into lobes containing glands and ducts; following childbirth prolactin begins excretion for milk production; colostrum produced prior to milk; contains maternal antibodies—especially immunoglobulin A—protects against enteric pathogens. Ova - ANSWER- Follicle or egg. Graafian Follicle - ANSWER- Sac that encloses the ovum or follicle Corpus Luteum - ANSWER- Is a temporary endocrine structure in female ovaries that is involved in the production of relatively high levels of progesterone and moderate levels of estradiol and inhibin. After ovulation it develops in the ovary from the enlarged ovarian follicle that released the ovum. What are some of the actions the corpus luteum does? - ANSWER- It is colored as a result of concentrating carotenoids (including lutein) from the diet and secretes a moderate amount of estrogen to inhibit further release of gonadotropin-releasing
LH surges from the anterior pituitary and signals the final development and rupture of the mature follicle. Ovulation happens at what estimated day? - ANSWER- Day 14. (estimated) What happens during ovulation? - ANSWER- Estrogen drops Occurs approximately 10-12 hours after the LH surge and 24-36 hours after estrogen peaks. Menstruation occurs when? - ANSWER- Menstruation ALWAYS occurs 14 days after ovulation and lack of fertilization. When does the luteal phase happen? - ANSWER- Day 15 to 28. Begins at ovulation and lasts until the menstrual phase of the next cycle. What happens during the luteal phase? - ANSWER- After the follicle ruptures as it releases the egg it closes and forms the corpus luteum; which secretes increasing amounts of progesterone, which prepares the endomentrium for implantation. What are some signs and symptoms of ovulation? - ANSWER- Mittelschmerz: Pain on one side of abdomen at egg release Vaginal spotting Increased libido Increased desire Increased vaginal discharge: Cervix produces thin, clear, stretchy, slippery mucus Lower abdominal cramping Slight rise in basal body temperature Endometrial Phase (Uterine) - ANSWER- Consists of four phases: Proliferative Phase Secretory Phase Ischemic Phase Menstrual Phase What happens during the proliferative phase? - ANSWER- Corresponds w/ follicular phase. Approx day 5 of menstrual cycle Endometrial glands enlarge in response to estrogen. Blood vessels dilate and cause thickening of the endometrium. Cervical mucus becomes thin, stretchy, and more alkaline (EWCM). What happens during the secretory phase? - ANSWER- Begins at ovulation and lasts until approx. 3 days before menstruation. Coincides with the luteal phase. Progesterone is released by the corpus luteum at ovulation causing the endometrium to continue to thicken and become more vascular in preparation for fertilization. If fertilization does not occur the corpus luteum breaks down and progesterone levels begin to fall causing the endometrium to begin to break down.
What happens during the ischemic phase? - ANSWER- Occurs on the absence of fertilization. Estrogen and Progesterone drop sharply signaling a spasm of the arterioles causing ischemia of the basal layers of the endometrium. What happens during the menstrual phase? - ANSWER- Begins at the arteriole rupture secondary to ischemia. Blood is released into the uterus and the sloughing of the endometrium begins. The start of menstrual flow signals the end of one cycle and the beginning of another. Menstruation - ANSWER- Uses a circadian rhythm. Defined as the normal, predictable process whereby the inner lining of the uterus (endometrium) is expelled from the body. Typically occurs monthly. Menarche - ANSWER- Start of menstruation. What is the average age of menarche? - ANSWER- Avg age is 12 years but can occur anytime between 8-18. Can be irregular for first two years. What are some factors that contribute to age of menarche? - ANSWER- Genetics is the MOST important factor in determining the age at which menstruation begins. Geographic location, weight, health, culture, and social practices etc impact menstruation. What occurs in girls Pre-menarche - ANSWER- Development of breast buds What happens just before menarche starts approx a year out? - ANSWER- Appearance of pubic and axillary hair-followed by growth spurt Penis - ANSWER- Outlet for sperm and urine, becomes engorged with blood during arousal. Composed of three sinuses of erectile tissue Scrotum - ANSWER- Thermal regulator for testes—slightly cooler than body temp for normal sperm development. Thin skined. Cremaster muscles in the scrotal wall relax or contract to allow the testes to hang further from the body to cool or heat. Testes - ANSWER- Testes—produce sperm/synthesize testosterone (analogous to ovaries) Sperm is produced in the seminiferous tubules. Ant pituitary releases FSH/LH stimulate the testes to produce testosterone which increases sperm production by the tubules and stimulates the production of seminal fluid (spermatogenesis) Epididymis - ANSWER- Coiled tube lying against the testes that is approx. 20ft long collects sperm from the testes and allows for maturation
Cushions fetus from trauma Promotes fetal movement Provides source of oral fluid Receptacle for fetal substances Maintains intrauterine temperature Week 4 - ANSWER- Skin development, neural tube closes, tooth buds and taste buds develop Week six - ANSWER- Heart divides into four chambers Week eight - ANSWER- Cranial nerves, develop fingers and toes distinct by end of this week 8-10 wk - ANSWER- When is the first ultrasound scheduled, it is not required but it is the most accurate assessment of the date of conception if she does not know her last menstruated period, calculated by only measurements. Also confirms pregnancy. Week 10 - ANSWER- 2 inches CRL, eyelids closed and fused, digestive track patent from mouth to anus, tooth buds begin Week 12 - ANSWER- 2 1/2 inch CRL, 1 1/2 ounce, nasal septum and palate complete, Lanugo begins, sucking reflex present, kidneys begin producing urine, genitalia can be distinguished by appearance, heartbeat should be detected by Doppler, size of golf balls 16 weeks gestation - ANSWER- 4 1/2 inches CRL, 4 ounces, urine excreted into amnionic fluid, fetus swallows in the amniotic fluid and produces meconium, some women begin to feel fetal movements week 20 - ANSWER- 6 1/4 inch CRL, 1 pound, Able to hear sounds anatomy scan scheduled, fetal movements felt by mother and possibly by examiner Week 24 - ANSWER- 9 inches, 1 1/2 to 2 pounds, surfactant production begins, respirations possible, fetus is active; also noticeable by examiner Week 28 - ANSWER- 10 inches CRL, 2 1/2 to 3 pounds, Begins to develop subcutaneous fat When do most women gain their weight - ANSWER- Last 8 to 10 weeks Week 32 - ANSWER- 12 inches CRL, 4 1/2 pounds, maturation of parasympathetic and sympathetic nervous system's (variability), surfactant nears mature levels, lanugo disappears
Week 38 - ANSWER- 14 inches CRL, 7 1/2 pounds, visual acuity at birth 20/600, smooth skin, vernix and lanugo present First trimester - ANSWER- 1 to 12 weeks Second trimester - ANSWER- 13 to 26 weeks Third trimester - ANSWER- 27 weeks till end 25 to 35 pounds - ANSWER- What is the normal weight gain for pregnant women 350 to 450 cal per day - ANSWER- What increasing calories should a pregnant woman take Hematuria, protein urea, some medications, tumors that produce HCG, - ANSWER- What are some other causes of A positive pregnancy test When does nausea and vomiting start and resolve - ANSWER- starts 4-8wkS AND ends 10-12wka chadwick sign - ANSWER- bluish purple discoloration of the cervix, vagina, and labia during pregnancy as a result of increased vascular congestion quickening - ANSWER- the first movement of the fetus felt by the mother braxton hicks contractions - ANSWER- irregular usually mild contractions that occur throughout pregnancy and become stronger in the last trimester (false labor) term - ANSWER- 38-42 wks colostrum - ANSWER- secreted as early as 16 weeks, thick yellowish that subs the nipples first morning void - ANSWER- when should the woman take a home pregnancy test 3-7 days - ANSWER- after conception, when will the pregnancy test be positive when can fetal heart sounds be heard - ANSWER- fetoscope 18-20 wk doppler 10-12wk what is the normal hr of a fetus - ANSWER- 110- what is important to take to prevent rural tube defects - ANSWER- folic acid women is or has been pregnant - ANSWER- gravida
abnormally small amounts of amniotic fluid, reduces the cushion surrounding the fetus and may result in deformities such as clubfoot; it can delay fetal lung development; may be a result of another anomaly; may be a sign of reduced placental blood flow - ANSWER- oligohydraminos what is the embryos weekly development like - ANSWER- cehaloclaudal central to peripheral simple to complex general to specific fertilization age is based on what - ANSWER- date of conception gestational age is based on what - ANSWER- LMP what is amniotic fluid composed of - ANSWER- fetal urine and fluid transported from maternal blood across the amnion what can cause oligohydraminos - ANSWER- poor placental blood flow, preterm membrane rupture, failure of kidney development, blocked urinary excretion amniotic fluid exceeding 2000ml is called what - ANSWER- hydraminos or polyhydraminos What is important to establish during the first antepartum examination - ANSWER- Establish trust and report with the child very family, verify or rule out pregnancy, evaluate the women's physical health relevant to childbearing, assess the growth and health of the fetus, establish baseline data for comparison with future observations, evaluate the psychosocial needs of the women and her family, assess the need for counseling or teaching, negotiate a plan of care to ensure a healthy mother and healthy baby Gonadotropin-Releasing Hormone - ANSWER- Produced by: Hypothalamus Target organ: Anterior pituitary Action in Female:Stimulates release of FSH* and LH, initiating puberty and sustaining female reproductive cycles; release is pulsatile. Action in Male:Stimulates release of FSH and LH, initiating puberty; release is pulsatile. Follicle-Stimulating Hormone - ANSWER- Produced by: Anterior pituitary Target organ: Ovaries (female),Testes (male)
Action in Female: Stimulates final maturation of follicle. Stimulates growth and maturation of graafian follicles before ovulation. Action in Male: Stimulates Leydig cells of testes to secrete testosterone Luteinizing Hormone - ANSWER- Produced by: Anterior pituitary Target organ: Ovaries (female),Testes (male) Action in Female: Stimulates final maturation of follicle. Surge of LH about 14 days before next menstrual period causes ovulation. Stimulates transformation of graafian follicle into corpus luteum, which continues secretion of estrogens and progesterone for about 12 days if ovum is not fertilized. If fertilization occurs, placenta gradually assumes this function. Action in Male:Stimulates Leydig cells of testes to secrete testosterone. Estrogens - ANSWER- Produced by: Ovaries and corpus luteum (female), Placenta (pregnancy), Formed in small quantities from testosterone in Sertoli cells of testes (male); other tissues, especially liver, produce estrogen in male Target organ: Internal and external reproductive organs, Breasts (female), Testes (male) Action in Female: Breasts: induce growth of glandular and ductal tissue; initiate deposition of fat at puberty. Stimulate growth of long bones but cause closure of epiphyses, limiting mature height. Pregnancy: stimulate growth of uterus, breast tissue; inhibit active milk production; relax pelvic ligaments. Reproductive organs: a. Maturation at puberty b. Stimulation of endometrium before ovulation Action in Male:Necessary for normal sperm formation. Progesterone - ANSWER- Produced by: Ovary, corpus luteum, placenta Target organ: Uterus, female breasts Action in Female: Stimulates secretion of endometrial glands; causes endometrial vessels to become dilated and tortuous in preparation for possible embryo implantation. Pregnancy: induces growth of cells of fallopian tubes and uterine lining to nourish embryo; decreases contractions of uterus; prepares breasts for lactation but inhibits prolactin secretion.
Estrogen - ANSWER- What is the most important hormone in the leutal phase? Page 137 - too many to list - ANSWER- Discomforts of pregnancy pintrest pic - ANSWER- Physiological changes during pregnancy - Know the big differences between not pregnant and pregnant. Look at the pintrest pic First day of LMP - 3 months + 7 days + 1 year - ANSWER- Calculate Due Date by Nagle's Rule
- Vital signs
- Weight
- Urine - look for protein, glucose, keytones
- Leopold's - series of hand move to determine position of fetus and locate the back of fetus to monitor fetal heart beat.
- Fetal Heart Rate
- Fetal activity
- What to report - ANSWER- What is typically conducted at each visit?
