Define: Braxton Hicks contractons
irregular, usually mild uterin contractions that occur through out preg and become stronger in the last trimester. May be confused with true or false labor
Define: Chadwick’s sign
bluish purple color of the the cervix, vagina and labia during pregnancy, increased vascular congestion
Define: Chloasma
A condition in which brown patches appear on the face due to hormonal changes during pregnancy
Define: Goodell’s signs
softening of cervix during pregnancy
Define: quickening
first movements of fetus mother feels
Define: striae gravidarum
irregular pink to purple streaks on the abdomen, breasts or buttocks resulting from tears in the connective tissue (stretch marks)
Define: trimester
division of pregnancy one of three equal parts of 13 weeks each
process of fertilization
spermatozoon enters the ovum and the two nuclei containing the parents chromosomes merge. 23 from the sperm and 23 from chromosomes from the ovum. Ovum now called zygote is ready for the first mitotic cell divison
process of implantation
upper uterus (fundus) rich supply of blood and optimal gas exchange and nutrition uterine lining is thick in fundus preventing placenta from attaching so deeply that it does not easily detach upper uterus limits blood loss after birth due to strong interlacing muscle fibers
role of the following in pregnancy and labor:
Human chorionic somatomammotropin (hCS)
Promotes normal nutrition and growth for the fetus, maternal breast development, decrease insulin sensitivity making more glucose available for the fetus
role of the following in pregnancy and labor:
Progesterone
causes the endrometrium to change into the decidua (the thick layer of modified mucous membrane which lines the uterus during pregnancy and is shed with the afterbirth), reduces uterine contractions, suppresses maternal reactions to fetal antigens, with other hormones causes growth of the breast
role of the following in pregnancy and labor:
Estrogen
causes infringement of the uterus and breasts, enhances uterine activity as term approaches
role of the following in pregnancy and labor: pelvic shape and size
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Differentiate between the hormonal levels of a pregnant and nonpregnant woman
Pregnant:
Nonpregnant:
Identify the functions of the amniotic fluid
protects growing fetus and promotes normal prenatal development by:
cushioning
stable temp
symmetric development of fetus as body surfaces fold toward midline
keeping membranes from adhering to fetal parts
providing room and buoyancy for movement
Explain the functions of the placenta
metabolic
transfer of substances between mother and fetus
endocrine
Describe the physical development of the fetus given a specific time during normal pregnancy
Embryonic period
Embryonic period: beginning of 3rd week through 8th week after conception ?????
Describe the physical development of the fetus given a specific time during normal pregnancy
Fetal period
Fetal period: begins 9 weeks after conception. 9th-38th weeks
Fetal period: 9-12 weeks
begins to produce urine
fetal sex is apparent
intestines enter abdomen
Fetal period: 13-16 weeks
Fetus grows rapidly in length, head becomes smaller, “quickening” movements felt
face looks human
Fetal period: 17-20 weeks
vernix and lanugo cover skin
eyebrows and head appear
Fetal period: 21-24 weeks
lungs produce surfactant
may survive if born now
Fetal period: 25-28 weeks
subcutaneous fat is deposited under skin.
Usually head down.
Fetal period: 29-32 weeks
Toenails are present, finger nails extend to tips. more subcutaneous fat. survival rate good with neonatal care
Fetal period: 33-38 week
growth of all body systems. full term is 38-42 weeks gestational age
Identify the physiological changes that occur in the various body systems during pregnancy
Uterus
Weight and size increase Fibrous connective tissue Cervical softening Mucus plug Under goes Braxton Hicks Blood flow rises
Identify the physiological changes that occur in the various body systems during pregnancy
Cerix
Color and consistency
Estrogen causes hyperema
Collagen fibers decrease causing softening (Goodell’s)
mucus plugs cervical canal and blocks the ascent of bacteria
Bloody show- disruption of cervical capillaries
Identify the physiological changes that occur in the various body systems during pregnancy
Vagina and Vulva
Estrogen influence
Hypertrophy
Hyperplasia of lining
Thick white secretions
Identify the physiological changes that occur in the various body systems during pregnancy
Cardiovascular
Increase heart rate Blood volume increases Cardiac output increases up to 50% Palpitations Murmurs lower serum plasma protein Diastolic BP decrease by 24 weeks but returns by term Supine hypotension
Distinguish between positive, probable, and presumptive signs of pregnancy
PRESUMPTIVE
Amenorrhea N/V Fatigue Urinary frequency Breast/skin changes Vaginal/cervical color changes Fetal movement
Distinguish between positive, probable, and presumptive signs of pregnancy
PROBABLE
Abdominal enlargement Cervical softening (Goodell's) Bluish vagina (Chadwick's) Softening of uterus (Hegar's) Fetus rebound (Ballottement) Braxton Hicks contractions Pregnancy test
Distinguish between positive, probable, and presumptive signs of pregnancy
POSITIVE
Auscultation of fetal heart sounds
Fetal movement felt by examiner
Visualization of the fetus, ultrasound
Compute the expected date of delivery using Naegel’s Law
First day of last period, subtract 3 months, add one year, add 7 days
Define: Gravida
refers to a woman who is or has been pregnant regardless of the duration of pregnancy
Define: Primigravida
woman who is pregnant for the first time
Define: Multigravida
woman who has been pregnant more than once
Define: Para
Number of pregnancies that have ended at 20 or more weeks regardless of whether the infant was born alive or was stillborn
Define: Nullipara
woman who has never completed a pregnancy beyond 20 weeks of gestation because she has never been pregnant or has had a spontaneous or elective abortion
Define: Primipara
woman who has delivered one pregnancy at 20 or more weeks of gestation
Define: Multipara
woman who had delivered two or more pregnancies at 20 or more weeks of gestation
Assess the prenatal patient for appropriate weight gain
general recommendation of increments of 1.1-4.4 lbs during the first trimester.
2nd and 3rd trimester 0.8-1 lb weekly
Three germ layers: developing structures
ECTODERM
brain/spinal cord peripheral nervous system pituitary gland sensory epithelium of eye/ear/nose epidermis hair nails subcutaneous glands mammary gland tooth enamal
Three germ layers: developing structures
MESODERM
cartilage bone connective tissue muscle tissue heart blood vessels blood cells lymphatic system spleen kidneys adrenal cortex ovaries testes reproductive system lining membranes (pericardial, pleural, peritoneal)
Three germ layers: developing structures
ENDODERM
gastrointestinal/respiratory tracts lining tonsils thyroid parathyroid thymus liver pancreas urinary bladder/urethra lining ear canal lining
two fetal membranes of the amniotic sac
Amnion is the inner membranes
Chorion is the outer membrane
Nutrition during pregnancy
Energy: carbs, fats, nutrient density calories
Protein
Vitamins
Folic Acid: neural tube deficit preventative
Minerals: iron, sodium, calcium (lactose intolerance)
Nutritional supplements (disadvantages/dangers)
Water
Foods to avoid
Raw fish Under cooked eggs Under cooked meat Excessive amounts of caffeine Alcohol Certain types of fish
Foods to eat
Oatmeal Approved tatty fish Leafy greens Nuts Beans/Lentils Yogurt Avocados Lean meats
Adaptations to pregnancy
FIRST TRIMESTER
Uncertainty
Ambivalence
Self as primary focus
Focus on mom
Adaptations to pregnancy
SECOND TRIMESTER
Physical evidence of pregnancy Fetus as primary focus Narcissism and introversion Body image Changes in sexuality
Adaptations to pregnancy
THIRD TRIMESTER
Vulnerability
Increasing dependence
Preparation for birth
Family adaptation
FATHER
Struggling for recognition as a parent
Creating role of involved father
Family adaptation
SIBLINGS
Toddlers unaware of changes
Older children realize a baby is being born benefit from being included in preparation
Adolescents some are embarrassed, others may be indifferent unless it affects them
Family adaptation
GRANDPARENTS
Age: older grand parents react with joy
Relationships with grand parents second in importance only to their parent child relationship
Erickson’s stage
INFANCY
Trust VS Mistrust
Development of a sense that the self is good and the world is good when consistent, predictable, reliable car is received; characterized by hope
Erikson’s stage
ADOLESCENCE
Identity VS Role confusion
Begins to develop a sense of “I”; this process is lifelong; peers become of paramount importance; child gains independence from parents; characterized by faith in self
Erkson’s stage
ADULTHOOD
Intimacy VS isolation
development of the ability to lose the self in genuine mutuality with another; characterized by love