Exam (elaborations)
OB NURS 306- OB Final Study Guide 2021-Latest
- Course
- Institution
OB NURS 306- OB Final Study Guide 2021-LatestOB NURS 306- OB Final Study Guide 2021-LatestOB NURS 306- OB Final Study Guide 2021-Latest
[Show more]
Seller
Follow
NURSINGUNIVERSITYWALDEN
Reviews received
Content preview
! 1!Chapter 3 Genetics, Conception, Fetal Development, and Reproductive Technology
! Genetics " study of heredity
! Genomics " addresses all genes and their interrelationships in order to identify their combined influence on growth and
development of the organism
o Providing better methods for preventing disease and abnormalities, diagnosing diseases, predicting health risks,
personalizing treatment plans
! 30,000 genes in the human genome (organism’s complete set of DNA)
! 46 chromosomes; 22 homologous pairs of chromosomes and one pair of sex chromosomes
! genotype " person’s genetic makeup
! phenotype " how genes are outwardly expressed (eye color, hair color, height)
! 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
abnormalities
! refer to support group whether they wish to terminate/continue with pregnancy
! 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
! Huntington’s 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
! Duchenne’s 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
! developing human is most vulnerable to effects of teratogens within first 8 weeks of gestation (organogenesis)" can
cause gross structural defects
! 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
Chapter 4 Physiological Aspects of Antepartum Care
,! 2!
! G/P System
o Gravida: # times a woman has been pregnancy including current pregnancy
o Para: # of births after 20 weeks’ 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 Leopold’s 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
, ! 3!
o Instruct woman to report abdominal pain/cramps, leaking of fluid, bleeding, fever, chills
o Results within 1 week
! Amniocentesis
o Needle is inserted through maternal abdominal wall into uterine cavity to obtain amniotic fluid
o Genetic testing, fetal lung maturity, assessment of hemolytic disease in fetus or for intrauterine disease
# Fetal lung maturity, monitor for L/S RATIO, PG, LBC
o Usually performed 14-20 weeks gestation
o Results within 2 weeks
o FULL BLADDER MAY BE REQUIRED FOR ULTRASOUND VISULIZATION IF WOMAN IS LESS THAN 20
WEEKS
! Delta OD 450
o Evaluation of amniotic fluid obtained via amniocentesis to predict life-threatening anemia in fetus during second and
third trimester
o Used in a lab to determine if there is a deviation of optical density at 45 nm
! Fetal blood sampling/percutaneous umbilical blood sampling (CORDOCENTESIS)
o Removal of fetal blood from umbilical cord " used to test for metabolic and hematological disorders, fetal infection,
fetal karyotyping
o may be done as early as 11 weeks but usually done in second trimester
o results within 48 hours
o POSITION WOMAN IN LATERAL/WEDGED POSITION TO AVOID SUPINE HYPOTENSION DURING FETAL
MONITORING TESTS
o Have terbutaline ready as ordered in case uterine contractions occur during procedure
o Assess fetal well-being post-procedure 1-2 hours via external fetal monitoring
! Alpha-fetoprotein (AFP)
o Done at 15-20 weeks gestation
o Assessed in maternal blood to screen for certain developmental defects in the fetus (NTD, ventral abdominal wall
defects)
o Increased levels associated with NTDs, anencephaly, omphalocele, gastroschisis
o Decreased levels associated with Down syndrome
o Abnormal findings require additional testing " amniocentesis, VNS, US
! Multiple marker screen
o Combination of AFP, human chorionic gonadotropin (hCG), estriol levels
o Detects for some trisomies and NTDs
o done at 15-16 weeks gestation
o maternal blood is drawn and sent to lab
o low levels of maternal serum alpha-fetoprotein and unconjugated estriol levels suggest an abnormality
o hCG and inhibin-A levels are twice as high in pregnancies with trisomy 21 (Down’s Syndrome)
o decreased estriol levels are an indicator of NTDs
! Daily fetal movement
o Proposed as primary method of fetal surveillance after 28 weeks gestation
o Instruct woman to palpate abdomen and track fetal movements daily for 1-2 hours
o 10 distinct fetal movements within 2 hours is normal
# once movement is achieved, counts can be d/c for the day
o 4 movements in 1 hour is reassuring
# if decreased, have woman eat, rest and focus on fetal movement for 1 hour
o FEWER THAN 4 FETAL MOVEMENTS IN 2 HOURS SHOULD BE REPORTED
o LIE ON SIDE WHILE COUNTING MOVEMENTS
! Non-stress test
o Uses electronic fetal monitoring to assess fetal condition/well-being
o Looking for accelerations; baby is nice and active
o Used in women with complications such as HTN, diabetes, multiple gestation, trauma and/or bleeding, woman’s
report of lack of fetal movement, placental abnormalities
o Heart rate of normal fetus with adequate oxygenation and intact autonomic nervous system accelerates in
response to movement
o Monitored with external FHR until reactive (up to 40 minutes) while running FHR contraction strip for interpretation
o Considered reactive when FHR increases 15 beats above baseline for 15 seconds twice or more in 20
minutes
o In fetuses less than 32 weeks, two accelerations peaking at least 10 bpm above baseline and lasting 10
seconds in a 20-minute period is reactive
o Nonreactive NST is one without sufficient FHR accelerations in 40 minutes " followed up for further testing
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller NURSINGUNIVERSITYWALDEN. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $18.49. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
85169 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now