Nur 140 Exam 1

What are the phases of the menstrual cycle?

Menstrual Phase (Days 1-5) - Shedding of the uterine lining.

Follicular Phase (Days 1-13) - Follicle development, estrogen rises. ESTROGEN PREPARES UTERUS IN THE FOLLICULAR PHASE.

Ovulation (Day 14) - Egg release from ovary, surge in LH, kicks egg out.

Luteal Phase (Days 15-28) - Corpus luteum produces progesterone to prepare for pregnancy.

What hormones regulate the menstrual cycle?

FSH (Follicle-Stimulating Hormone) - Stimulates follicle growth

LH (Luteinizing Hormone) - Triggers ovulation

Estrogen - Builds the uterine lining

Progesterone - Maintains the uterine lining for pregnancy

Corpus Lutem

The empty follicle where the egg released. hCG keeps it alive, and it continues to produce progesterone until the placenta takes over wk 12

Chadwick's sign

probable info, blueish cervix.

Goodell's sign

Probable sign, softening of the cervix

Fundal measurement

From pelvis to the top of the uterus. Should be equal or within (2) of each other. (ex. Fundus is 34cm, pt is 35wks pregnant=GOOD) (Fundus is 28cm, pt is 33wks=BAD)

GTPAL

Gravida (# of pregnancies), Term (how many 37+wks), Preterm (how many 20-36wks), Abortions (less than 20wks), Living children

How much weight should be gained based on BMI?

Underweight (BMI <18.5): Gain 28-40 lbs.

Normal Weight (BMI 18.5-24.9): Gain 25-35 lbs.

Overweight (BMI 25-29.9): Gain 15-25 lbs.

Obese (BMI ≥30): Gain 11-20 lbs.

Layers of the germ and what they become

Ectoderm - Brain and Spinal cord

Mesoderm - Skeletal

Endoderm - Organs

Prenatal Care: 1st trimester

Prenatal vitamins, genetic screening, morning sickness management.

Prenatal care: 2nd trimester

Glucose screening, fetal movement monitoring, anatomy scan.

prenatal care: 3rd trimester

Birth planning, fetal positioning, signs of labor education.

Physiologic Changes in Pregnancy - CV

- CO increased by 40-50% by 24th week (due to increased HR, increased blood volume, inotropic effect of estrogen, prepares for blood loss during labor)

- plasma volume increase by 50%

- decreased hemoglobin from increased BV

- HR increased 10-15 bpm 3rd trimester

- SBP dec 5-15 mmHg in second trimester

- Supine Hypotensive Syndrome

Physiologic Changes in Pregnancy - Resp

Increased O2 need, RR STAYS THE SAME, decreased lung capacity, chest widens to give the lungs more room.

Physiologic Changes in Pregnancy - GI

Nausea from hCG, vomiting, constipation (relaxin causes waste to take longer to pass through, more water is absorbed from stool, causing constipation), heartburn

Physiologic Changes in Pregnancy - GU

Filtration rate increases, while output stays the same. Displacement and pressure on the bladder lead to increased urinary frequency 3rd trimester.

Physiologic Changes in Pregnancy - Musculoskeletal

Fluid accumulation causes carpal tunnel syndrome (tingling)

Increased nerve sensitivity and spinal curvature.

Relaxin "relaxes" the pelvic muscles

Nutrition Needs/Restrictions

Increase folic acid, calcium and iron supplements.

NO unheated deli meat, raw meat, mercury (seafood), caffeine limit 200mg/day, unpasteurized dairy.

How much weight should be gainer per trimester?

Underweight (BMI <18.5): Gain 28-40 lbs

Normal weight (BMI 18.5-24.9): Gain 25-35 lbs

Overweight (BMI 25-29.9): Gain 15-25 lbs

Obese (BMI ≥30): Gain 11-20 lbs

Common Discomforts of Pregnancy & Relief Measures - Nausea and Vomiting

Cause: Hormonal changes (hCG)

Relief: Eat small, frequent meals, avoid greasy foods, ginger, vitamin B6

Common Discomforts of Pregnancy & Relief Measures - Heartburn

Cause: Relaxed esophageal sphincter

Relief: Sit upright after meals, avoid spicy foods, small frequent meals

Common Discomforts of Pregnancy & Relief Measures - Constipation

Cause: Increased progesterone slows motility

Relief: Increase fiber & fluids, exercise regularly

Common Discomforts of Pregnancy & Relief Measures - Leg Cramps

Cause: Pressure on nerves, low calcium/magnesium

Relief: Stretching, hydration, magnesium supplements

Common Discomforts of Pregnancy & Relief Measures - Back pain

Cause: Center of gravity shift

Relief: Proper posture, pelvic tilt exercises

Describe the Pre-Embryonic Stage

Wks 1-4. Fertilization->zygote->morula->blastocyte(what implants)->trophoblast(becomes placenta)

Describe the Embryonic Stage and the 3 layers

wks 5-10.

Ectoderm - Brain and Spinal Cord

Mesoderm - Skeletal System

Endoderm - Internal Organs

Wk 3

Egg fertilized

Wk 4

Egg implants

Wk 4-5

Neural tube closes

Wks 5-6

Heart begins to beat (110-120)

Wks 6-7

Lungs begin to develop

Wk 9

Breathing seen

Wk 10

Kidney function

Wk 11

Swallowing

Wks 11-14

Pancreas secretes insulin

Wk 14

Liver filters blood

Wk 18

Fetal movement

Wk 24

Bone Marrow blood

Wk 24

Surfactant

Wk 32

Kidneys fully formed

Placenta

Function: Oxygen, nutrient, and waste exchange

Produces hormones (hCG, estrogen, progesterone)

Acts as a protective barrier (but some substances cross)

Takes over wk 12

Umbilical Cord

Contains 2 arteries (carry deoxygenated blood) & 1 vein (carries oxygenated blood)

Provides connection between fetus & placenta

Warton's Jelly - Protects the cord

Ductus Venosus

Bypasses liver → Blood goes directly to inferior vena cava

Foramen Ovale

Connects right & left atria (bypasses lungs)

Ductus Arteriosus

Connects pulmonary artery to aorta (bypasses lungs)

Hormones produced by the placenta

• Chorionic gonadotropin

• Prolactin

• Estrogen

• Progesterone

• Relaxin

RhoGAM

Prevents an immune response to Rh positive blood in people with an Rh negative blood type.

IM, IV

Fever, chills, back pain, red/pink urine, shaking, weakness, Increased RR and HR.

Assess vitals, monitor renal failure and anemia. Explain the med is to protect fetus from an immune response.