CU NSG 3010 Exam 1

OB/LD

What assessment is the “kick counts”?

fetal movement assessment

Fetal movement assessment is _____, _____, and ______.

• acceptable

• noninvasive

• cost-effective

Fetal movement assessment purpose —> fetal _______________

surveliance

Coordination of body movement of the fetus requires ____________ ______________ control.

complex neurological

Fetal well being = ___________ fetal ___________

vigorous, movement

___________ or absent fetal movement = _________________ fetal status

decreased, non-reassuring

What is considered “decreased” fetal movement?

less than 5-10 movements w/in 1-2 hour period of the day

Fetal movement monitoring should begin around ____ wks gest.

28

Alarming (fmm):

no movement at ALL for 12 hours

Concern (fmm):

<3 movements in one hour

Reassuring (fmm):

5 or more movements/hour when baby is awake

ACOG says ____ fetal movements in __ hours is expected, when baby is awake

10, 2

Fetal movements are __________ or absent with fetal __________, maternal use of _________ meds, or with ______/________ use.

decreased, sleeping, depressants, alcohol/cigarette

Most common 3rd trimester test

Nonstress Testing (NST)

NST is done for _______ fetal movement or preg. w/ _____ __________.

decreased, risk factors

Use fetal monitor to obtain a _______ of the FHR, while observing for normal ___________ w/ fetal movement (indicates ____ _____-_____ and ANS & adequate fetal oxygenation.

tracing, accelerations, intact fetal-central

NST advantages:

• outpatient

• noninvasive

• relatively inexpensive

• no known contraindications

We want to see a “_________” strip (meaning that the FHR reacts to ____________ of fetus.

reactive, movement

Reactive = two or more accelerations of:

• ____ bpm for at least ___ sec. (of each other)

• During a ____ min. time period

15, 15, 20

If “nonreactive” may use __________ stimulation to “_____” baby

acoustic, wake

Fetal _____. some drugs, ______, _______, and some congenital __________ can blunt the normal response.

sleep, hypoxia, acidosis, anomalies

Disadvantages (NST):

false positives for nonreactivity possible

False positives for NST nonreactivity possible due to:

• fetal _____

• ______________

• fetal ______________

sleep, medications, immaturity

Slightly _____ sensitive in detecting fetal compromise than are the BPP (___________ _________) or CST (____________ _______ ______).

biophysical profile, contraction stress test

OB/Obstetrics

healthcare of a woman during pregnancy, childbirth, and postpartum

GYN/Gynecology

referring to woman/female reproductive health

Gestation

LENGTH of time from 1st day of LMP to delivery

Antepartum

pregnancy (while woman is pregnant)

Intrapartum

labor - birth, while woman is in “true labor”

Postpartum

6 wks after childbirth, woman’s body is returning to normal/non-pregnant state

Neonate

newborn baby - 28 days of life

Infant

1 month - 1 year of life

Gravida

the number of PREGNANCIES, regardless of outcome, include current

Nulligravida

no pregnancies, never been pregnant before

Primigravida

has had one singular pregnancy before, or is in her first pregnancy now

• includes no living children but one miscarriage

Multigravida

has had multiple pregnancies (miscarriage or living)

Para

the number of pregnancies DELIVERED, after 20 wks gestation, regardless whether the baby survives of is stillborn (any method)

Nullipara

0 deliveries

Primipara

1 delivery

Multipara

2+ deliveries

GTPAL

GravidaTermPretermAbortionLiving

Term

pregnancies delivered between 37-42 wks gest.

Preterm

pregnancies delivered between 20-36 wks and 6 days gest.

Abortion

pregnancies delivered between conception and 19 wks and 6 days gest.

Two categories of abortion:

SAB & EAB/TAB

SAB

spontaneous abortion (miscarriage)

EAB/TAB

elective abortion or therapeutic abortion (choice/medical)

Living

the number of LIVING children, delivered (not pregnancy total)

Pt. is now 28wks gest. Delivered twins at 35wks gest. who are now 3 yrs old. She delivered a singleton at 38 wks gest. who is now in kindergarten, she miscarried at 10 wks gest. one year ago.

Provide the GTPAL.

G4T1P1A1L3

Pt. had 2 EAB at 8 & 13wks prior to delivering a baby at 40 wks gest. followed by a baby at 39 wks gest. 2 yrs later. She is now pregnant at 16wks gest.

Provide the GTPAL.

G5T2P0A2L2

Menstrual cycle

menstruations is periodic uterine bleeding that begins approx 14 days after ovulation

Why is it so easy to get unintentionally pregnant?

hard to predict timing of ovulation, end of period is not predictable really

Avg length of entire menstrual cycle

28 days (range 25-32)

First day of menstrual bleeding is designated as ___ ___ (LMP) of cycle

day one

LMP

last menstrual period

avg. duration of flow

5 days (range 2-8 days)

avg. blood loss

40 ml (range 20-80ml)

5ml = ? tsp

1 tsp

15 ml = ? tbsp

1 tbsp

30 ml = ?tbsp

2 tbsp

40 ml = ? tbsp

2 tbsp & 2tsp

During menstruation, the CNS sends a message to the ____________ that the hormones __________ & _____________ levels are ____.

hypothalamus, estrogen, progesterone, low

Day 1 of menstruation starts the _________ phase of the cycle.

follicular

The _________ responds by sending ___________ ________ hormone to the __________ ____________.

hypothalamus, Gonadotrophin Releasing, Anterior pituitary

The anterior pituitary responds by sending ______ ___________ hormone and then ____________ hormone to the ______.

follicle stimulating (FSH), Luteinizing (LH), ovary

The ovary responds to ________ _____________ hormone by selecting a follicle for maturation. The chosen follicle that begins to mature is called the ________ follicle.

Follicle stimulating hormone (FSH), Graafian

______________ hormone stimulates the follicle to release the ______ and ____________ occurs, starting the ________ phase of the menstrual cycle.

Luteinizing, ovum, ovulation, luteal

The Graafian follicle becomes a ______ ________, which produces both the hormones _________ and ____________ until the placenta is established to do so.

corpus luteum, estrogen, progesterone

Conception occurs, what happens to the estrogen and progesterone levels?

If conception DOES occur, the levels continue to rise

Conception does NOT occur, what happens to the estrogen and progesterone levels?

If conception does NOT occur, the levels both gradually decrease as the corpus luteum disintegrates.

Concerning hormones, when does the cycle begin again?

When estrogen levels are low again, cycle repeats.

Gonadotropin-releasing hormone

Produced by:

Target organs:

Action in females:

Action in males:

Hypothalamus

anterior pituitary

stimulates release of FSH and LH, initiating puberty and sustaining females reproductive cycles; release is pulsatile

stimulates release of FSH and LH , initiating puberty; release is pulsatile

Follicle-stimulating hormone

Produced by:

Target organs:

Action in females:

Action in males:

anterior pituitary

ovaries (females)/testes (males)

stimulates final maturation of follicle, stimulates growth and maturation of graafian follicles before ovulation

stimulates Leydig cells of testes to secrete testosterone

Luteinizing Hormone

Produced by:

Target organs:

Action in females:

Action in males:

anterior pituitary

ovaries (female)/testes (male)

stimulates final maturation of follicle, surge of LH approx 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 f ovum is not fertilized. if feralization occurs, placenta gradually assumes this function.

Estrogen

Produced by:

Target organs:

Action in females:

Action in males:

ovaries and corpus luteum (females) placenta (pregnancy)formed in small quantities from testosterone in Sertoli cells of testes (males); other tissues, especially liver, produce estrogen in male

internal and external reproductive organs, breasts (females) testes (males)

reproductive organs (maturation at puberty, stimulation of endometrium before ovulation), breasts: induce growth of glandular and ductal tissue, initiate deposition of fat at puberty, stimulates growth of long bones but cause closure of epiphyses (limiting mature height), pregnancy: stimulates growth of uterus, breast tissue, inhibit active milk production; relax pelvic ligaments

necessary for normal sperm formation

progesterone

Produced by:

Target organs:

Action in females:

Action in males:

ovary, corpus luteum, placenta

uterus, female breasts

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 oby inhibits prolactin secretion

N/A

Prolactin

Produced by:

Target organs:

Action in females:

Action in males:

anterior pituitary

female breasts

stimulates secretion of milk (lactogenesis); estrogen and progesterone from placenta have an inhibiting effect on milk production until after placenta is expelled at birth; suckling of newborn stimulates prolactin secretion to maintian milk production

N/A

Oxytocin

Produced by:

Target organs:

Action in females:

Action in males:

posterior pituitary

uterus, female breasts

uterus: stimulates contractions during birth and stimulates postpartum contractions to compress uterine vessels and control bleeding; Stimulates let-down or milk-ejection reflex, during breastfeeding

N/A

Testosterone

Produced by:

Target organs:

Action in females:

Action in males:

Leydig cells of the testes (male), Adrenal glands (female), ovaries (female)

sexual organs (males) males body conformation after puberty

small quantities of androgenetic (masculinIzing) hormones from adrenal glands cause growth of pubic and axillary hair at puberty; most androgens, such as testosterone, are converted to estrogen

Follicular Phase

period during which an ovum matures

When does the follicular phase start?

first day of menstruation and approx 14 days later in a 28 day cycle (length varies between women)

During the follicular phase, what 2 hormones fall, stimulating what 2 hormones during menstruation?

estrogen & progesterone → FSH & LH

What begins to grow as the FSH & LH levels rise slightly?

• Hint: each (6-12) contains an immature ovum

Graafian follicles

Ovulatory phase

near middle of a 28 day reproductive cycle and about 2 days before ovulation

During the ovulatory phase, what hormone rises markedly?

LH hormone

Menarche, when does it start?

The 1st period of a woman, at puberty

Menopause, when is it?

the last period a woman has/permanent cessation of periods

The “master minds” of reproduction (organs)

hypothalamus & anterior pituitary gland

As follicles grow, releasing estrogen into the blood stream, it acts as a negative feedback system, causing the ________ _________ to create less _______ ___________ hormones.

anterior pituitary, follicle stimulating (FSH)

The dominant follicle continues to secrete ______________, making the pituitary more responsive to _________ _________ hormone from the hypothalamus.

estrogen, Gonadotropin releasing (GnRH)

As estrogen levels in the blood rise, it becomes a positive feedback system, causing the pituitary to secrete a whole lot of ______ ________ hormone & __________ hormone in response to GnRH.

Happens _____ to ____ days before ovulation

follicle stimulating, luteinizing

1-2

For most of the Follicular phase, the pituitary saves its energy, then when it senses that the dominant follicle is ready for _______, the pituitary uses all its energy to secrete enough _______ __________ hormone and ____________ hormone to induce _________.

release, follicle stimulating (FSH), luteinizing (LH), ovulation

Menstrual phase

endometrial lining (functional layer) is shed through the vagaina, producing the monthly occurrence of “menstrual periods”

What phase follows the menstrual phase?

Proliferative phase

During the proliferative phase, high _________ levels stimulate the thickening of the __________, growth of endometrial _______, and the emergence of spiral _______.

estrogen, endometrium, glands, arteries

The rising of what hormone help change the consistency of the cervical mucus (making it more hospitable to incoming sperm)?

estrogen

Optimized days for fertilization

Day 11-15 on an avg 28 day cycle

During the _______ phase, luteinized granulosa cells secrete more _____________ than estrogen.

luteal, progesterone

_____________ acts as a negative feedback system on the pituitary, decreasing release of ________ ____________ hormone & _________ hormone. This process causes the decline of ____________ hormone.

progesterone, follicle stimulating, luteinizing, estrogen

What is the dominant hormone of the luteal phase?

progesterone, due to the decline of estrogen levels