N306 Exam 1 Study Guide

N306 Exam 1 Study Guide Antepartum Assessments & Care 1. Reproductive Cycle & Fertilization A nurse is teaching a woman about her menstrual cycle. The nurse states that Proliferation of the endometrium is the most important change that happens before the secretory phase of the menstrual cycle. The clinic nurse knows that the part of the endometrial cycle occurring from ovulation to just prior to menses is known as the secretory phases occurs from the time of ovulation to the period just prior to menses, or approximately days 15 to 26. The secretory phases occurs from the time of ovulation to the period just prior to menses, or approximately days 15 to 26. Amniotic fluid first appears at about 3 weeks. There are approximately 30 mL of amniotic fluid present at 10 weeks’ gestation, and this amount increases to approximately 800 mL at 24 weeks’ gestation. After that time, the total fluid volume remains fairly stable until it begins to decrease slightly as the pregnancy reaches term. Reproductive Cycle: Menstrual Cycle 28 days MENSTRUAL CYCLE ● Ovarian Cycle: the maturation of the ova consisting of 1. Follicular Phase - (from the 1st day of menstruation to 12-14 days) LH & FSH cause graafian follicle to mature producing Estrogen 2. Ovulatory Phase - (begins when estrogen levels peak until oocyte released from graafian follicle) = OVULATION ^LH 3. Luteal Phase - (begins after ovulation and lasts 14 days) ^ estrogen & progesterone If pregnant, know that the corpus luteum secretes estrogen & progesterone until placenta matures and assumes this function If pregnant, corpus luteum will continue to secrete estrogen & progesterone until placenta matures If NOT pregnant, corpus luteum degenerates = in progesterone and beginning of menstruation ● Endometrial “Uterine” Cycle: changes in the endometrium of the uterus in response to the ovarian cycle 1. Proliferative Phase - (occurs following menstruation ending with ovulation) endometrium preparing for implantation =more THICK & VASCULAR 2. Secretory Phase - (after ovulation and ends with onset menstruation) = continues to THICKEN ^progesterone 3. Menstrual Phase - sloughing off of the endometrium = PERIOD . Fertilization: “Conception” occurs when the sperm nucleus enters the nucleus of the oocyte within the outer third of the fallopian tube. ● The fertilized egg is then called a ZYGOTE and contains a diploid number of chromosomes = 46 2. Infertility Both male & female need to be evaluated TX: ● Males: ○ Hormonal Therapy ○ Lifestyle changes ■ Stress reduction, improved nutrition, smoking cessation, eliminating drugs ■ Corticosteroids to TX antibodies ■ Antibiotics to TX infection ■ Repair of inguinal hernia or obstruction A client is to take Clomiphene Citrate for infertility. Which of the following is the expected action of this medication? Stimulate release of FSH and LH Infertility: the inability to conceive or maintain a pregnancy after 12 months of unprotected sexual intercourse ● 6 months for women older than 35 y.o Causes ● 1/3 Male Factor ○ Endocrine - in LH, FSH, Testosterone ○ Spermatogenesis - effects of gonadotoxins Gonadotoxins include: drugs, infections, systemic illness, heat exposure, pesticides and radiation to the pelvic region. ○ Sperm Antibodies - in sperm motility ○ Sperm Transport - blocked transport ■ Vasectomy ■ Prostatectomy ■ Inguinal hernia ■ Absence of Vas Deferens ○ Disorders of Intercourse ■ Erectile Dysfunction ● 1/3 Female Factor ○ Ovulatory Dysfunction ■ Anovulation ■ Inconsistent Ovulation ○ Tubal & Pelvic Pathology ■ Damage to the Fallopian tubes ● ENDOMETRIOSIS ■ Uterine Fibroids: benign growth of uterine wall ○ Cervical Mucus Factor ■ Surgical surgeries: cryotherapy (TX cervical dysplasia) ■ Infection not allowing sperm to enter ● 1/3 Both Male and Female Factors DX Testing: ● Screening for STI’s and STD’s ● Labs assessing levels of LH, FSH, TSH, testosterone ● Semen Analysis ● Assessment of Ovulatory Dysfunction ○ Daily Morning Body Basal Temp ○ Day 3 of menstrual cycle = FSH & estradiol test taken ○ Detecting LH surge 36hrs before ovulation ● Endometrial Biopsy at end of menstrual cycle ● Hysterosalpingogram radiological exam testing tubal problems ● Laparoscopy -visualize/inspect ovaries TX: ● Females: ○ Same lifestyle changes as men ○ Surgery to open tubes if abnormal ○ Myomectomy - removal of uterine fibroids ○ Antibiotics to TX infection ○ Medication stimulating egg production ■ CLOMIPHENE CITRATE: stimulates release of FSH & LH A couple who has sought infertility counseling has been told that the man’s sperm count is very low. The nurse advises the couple that spermatogenesis is impaired when which of the following occur? The testes are overheated. A nurse working with an infertile couple has made the following nursing diagnosis: Sexual dysfunction related to decreased libido. Which of the following assessments is the likely reason for this diagnosis? The couple has established a set schedule for their sexual encounters. Couples who “schedule” intercourse often complain that their sexual relationship is unsatisfying. A couple is undergoing an infertility workup. The semen analysis indicates a decreased number of sperm and immature sperm. Which of the following factors can have a potential effect on sperm maturity? - The man rides a bike to and from work each day. - The man takes a calcium channel blocker for the treatment of hypertension The daily riding of a bike can be the cause of prolonged heat exposure to the testicles. Prolonged heat exposure is a gonadotoxin. A number of medications, such as calcium channel blockers, can have an effect on sperm production ● PO cycle Day 3-7 S/E: hot flashes, breast discomfort, headaches, insomnia 3. Physiological changes pregnancy by system (pg 54) CHADWICKS SIGN: BLUISH DISCOLORATION OF THE CERVIX Cardiovascular system: 10-15bmp increase heart rate (Woman feels palpitations at second trimester, assessed low blood pressure) NORMAL Pregnant woman’s blood volume increases by: 40% to 45% Blood volume expansion during pregnancy leads to Physiological anemia of 4. Psychological & Developmental Tasks Psychological: Developmental Tasks The events of pregnancy and childbirth are considered a developmental “maturational” crisis is the life of a family ● All family members are affected ■ Acquiring knowledge and plans for the specific needs of pregnancy, childbirth, and early parenthood ■ Preparing to provide for the physical care of the newborn ■ Adapting financial patterns to meet increasing needs ■ Realignment of tasks and responsibilities ■ Adjusting patterns of sexual expression to accommodate pregnancy ■ Expanding communication to meet emotional needs ■ Reorienting of relationships with relatives ■ Adapting relationships with friends and community to take account of the realities of pregnancy and the anticipated newborn Nursing Tasks ■ Assess knowledge related to pregnancy, childbirth, and early parenting. ■ Assess progress in developmental tasks of pregnancy. ■ Explore patterns of communication related to emotional needs, responsibilities, and new roles. ■ Include the entire family; assessments and interventions must be considered in a family-centered perspective. ■ Provide education and guidance related to pregnancy, childbirth, and early parenting 5. Fetal & Placental Development The fetal circulatory structure that connects the pulmonary artery with the descending aorta is known as which of the following? Ductus arteriosus An ultrasound of a fetus’ heart shows that “normal fetal circulation is occurring.” Which of the following statements is consistent with the finding? A right to left shunt is seen between the atria known as foramen ovale (after 3 months after delivery the the foramen ovale closes n response to increased blood return to the L atrium. Information provided by the nurse that addresses the function of the amniotic fluid is that the amniotic fluid helps the fetus to maintain a normal body temperature and also Cushions the fetus from mechanical injury The perinatal nurse explains to the student nurse that in the fetal circulation, the lowest level of oxygen concentration is found in the umbilical arteries = TRUE, The highest oxygen concentration (PO2 = 30–35 mm Hg) is found in the blood returning from the placenta via the umbilical vein; the lowest oxygen concentration occurs in blood shunted to the placenta where reoxygenation takes place. The blood with the highest oxygen content is delivered to the fetal heart, head, neck, and upper limbs, and the blood with the lowest oxygen content is shunted toward the placenta. After birth, the perinatal nurse explains to the new mother that prolactin is the hormone responsible for stimulating milk production. During prenatal class, the childbirth educator describes the two membranes that envelop the fetus. The amnion contains the amniotic fluid, and the chorion is the thick, outer membrane. The perinatal nurse is teaching nursing students about fetal circulation and Embryo and Fetal Development: first 8 wks= Organogenesis Ectoderm Mesoderm Endoderm After 9th wk = Fetus ● Fetus Circulation: ^ levels of oxygenated blood enter the fetal circulatory system from the Placenta - Umbilical Vein ● Ductus Venosus connects Umbilical Vein to Inferior Vena Cava ● Foramen Ovale (opening between L & R atrium) ○ after delivery shunt closes within 3 months from blood returning to the L atrium ● Ductus Arteriosus (connects Pulm Artery to Descending Aorta) ○ after delivery it constricts in response to ^ blood oxygen levels and prostaglandins