Mat. Final (Lec 17-19)

Impaired Infertility

Inability to acheive preganncy after 1 year of frequent unprotected intercorse

Primary infertility

man or woman who has never been able to concieve

Secondary Infertility

Previous pregnancy and unable to conceive again

Fecundity

The potential reproductive capacity

Incidence of infertility

1/6

Risk fo infertility does increase with

age

What are some causes of female infertility?

Ovulatory problems

Infections

Tubal problem \n Genetic condition \n Irregular egg production \n Smoking, durgs, alcochol \n Antisperm antibodies \n Congential abnormalities

What are some causes of male infertility?

Sprem production

Abnormal morphology \n STI \n Ejactulation dysfucntion \n Premature ejactulation \n Drug use \n Difficulty with erections

Basal Body Temp recording

The lowest body temp of a healthy person taken immediately after waking and before getting out of bed

Take it frequently to see ovulating pattern

When should you record your basal body temperature?

Upon waking

Same time each day

What does basal body temperature recording detect changes in?

It identifies an increase in progesterone (occurs with successful ovulation)

Fertile period

Day of 1st temp drop

OR \n First elevation, through 3 consecutive days of high temp

During ovulation

the discharge is stretchy and white

endometrial biopsy

removal of a sample of uterine endometrium for microscopic study

hysterolsalpingography

Useful for idetifing tubual abstruction and for the release of blockage

hysteroscopy

Visual exam of the uterus

semen analysis

microscopic examination of ejaculated fluid

Post-coital test

a clinical test done within 24 hours after intercourse to assess sperm motility in cervical mucus

Methods of managing infertility

Cryosurgery

Meds \n Hormone Treatment (Clomid) \n Surgery \n Lifestyle changes \n Herbal remedies

Intrauterine Insemination (IUI)

introduction of semen into female's uterus

In-vitro fertilization

The most common assisted reproduction procedure, in which a woman's eggs are mixed with sperm in culture dishes (in vitro) and then carefully inserted into a woman's uterus.

Gamete intrafallopian transfer (GIFT)

procedure in which the sperm and ovum are placed directly in a fallopian tube

Which test used to diagnose the basis of infertility is done during the late follicular or early proliferative phase of the menstrual cycle?

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Hysterosalpingogram \n Endometrial biopsy \n Laparoscopy \n Follicle-stimulating hormone (FSH) level

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Hysterosalpingogram

2. A man smokes two packs of cigarettes a day. He wants to know if smoking is contributing to the difficulty he and his wife are having getting pregnant. What information is the basis for the nurse's response?

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Indicating that the first sperm count seems okay \n Informing that only marijuana cigarettes affect sperm count \n Providing information about smoking and lung cancer and its lack of effect on \n sperm \n Providing education that smoking can reduce the quality of sperm

Providing education that smoking can reduce the quality of sperm

3. A couple comes in for an infertility appointment, having attempted to get pregnant for 2 years. The woman, 37, has always had irregular menstrual cycles but is otherwise healthy. The man has fathered two children from a previous marriage and underwent a vasectomy reversal 2 years ago. The man has had two normal semen analyses, but the sperm seem to be clumped together. What additional test is needed?

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Testicular biopsy \n Antisperm antibodies \n Follicle-stimulating hormone (FSH) level \n Examination for testicular infection

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Follicle-stimulating hormone (FSH) level

5. A woman inquires about herbal alternative methods for improving fertility. Which information provides the basis for the nurse's response when instructing the patient about which herbal preparations to avoid while trying to conceive?

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Avoid nettle leaf, dong quai, and vitamin E while you are trying to get pregnant. \n Avoid licorice root, lavender, fennel, sage, and thyme while you are trying to \n conceive. \n Avoid vitamin E, calcium, and magnesium as they may make you infertile. \n Herbs have no bearing on fertility.

Avoid licorice root, lavender, fennel, sage, and thyme while you are trying to \n conceive.

6. In vitro fertilization-embryo transfer (IVF-ET) is a common approach for women with blocked fallopian tubes or unexplained infertility and for men with very low sperm counts. A husband and wife have arrived for their preprocedural interview. The husband asks the nurse to explain what the procedure entails. What information is the basis for the nurse's response?

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Eggs from the wife's ovaries are fertilized in the lab with the husband's sperm and \n the embryo is transferred to her uterus. \n A donor embryo will be transferred into your wife's uterus. \n Donor sperm will be used to inseminate your wife. \n Donor eggs are used and fertilized in the lab with donor sperm

Eggs from the wife's ovaries are fertilized in the lab with the husband's sperm and the embryo is transferred to her uterus.

7. When working with patients who are experiencing infertility, which should the nurse be aware of related to infertility?

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Infertility is perceived differently by women and men. \n Fertility has a relatively stable prevalence throughout a woman's reproductive \n years. \n Infertility is more likely the result of a physical deviation in the woman than one in \n the man. \n Infertility is the same thing as sterility.

Infertility is percieved differntly amoung men and women

10. Which issue would need to be addressed by an infertile couple before treatment?

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Risk of multiple gestations \n Ways to avoid disclosing the facts of conception to offspring \n Inability to freeze embryos for later use \n Financial ability to cover the cost of treatment

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Risk of multiple gestations

11. A woman has chosen the calendar method of conception control. During the assessment process, what is most important for the nurse to do?

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Obtain a history of menstrual-cycle lengths for the past 6 months. \n Determine the patient's weight gain and loss pattern for the previous year. \n Examine skin pigmentation and hair texture for hormonal changes. \n Explore the patient's previous experiences with conception control.

Obtain a history of menstrual-cycle lengths for the past 6 months.

12. A woman is using the basal body temperature (BBT) method of contraception. She calls the clinic and tells the nurse, "My period is due in a few days, and my temperature has not gone up." How should the nurse respond?

Inform the patient that she is probably pregnant. \n Assure the patient that this is nothing to worry about. \n Ask the patient if she has been sick this month. \n Tell the patient that she probably did not ovulate during this cycle.

Tell the patient that she probably did not ovulate during this cycle.

What is the most important adaptation for the newborn transiting from intrauterine to extrauterine life?

Respiratory/ circulatory

Circulation before birth

Blood enters fetal body through umbilical vein \n About half goes to the liver, remainder enters inferior vena cava through the ductus venosus, then goes through foramen ovale, then ductus arteriosus \n Blood containing waste products is returned to placenta through umbilical arteries

What is involved in fetal circulation before birth

1 umbilical vein \n 2 umbilical arteries \n 3 Shunts

What are the 3 shunts

ductus venosus, foramen ovale, ductus arteriosus

Before birth we don’t

use lungs

Fetal circulation after birth

\-fetal shunts are not needed after the infant breathes & blood is circuclated to the lungs \n -FORAMEN OVALE closes within 2 hours after birth, permanently by 3 months \n -DUCTUS VENOSUS closes when the umbilical cord is cut, permanently in 1 week \n -DUCTUS ARTERIOSUS closes within 15 hours, permanently in 3 weeks..cuz O2 concentration increases \n \*\*\*after permanent closure the ductus venosus & ductus arteriosus become ligaments

What are some advantages of delayed cord clamping?

Increase RBC’s

Helpful for preterms

What are some disadvantages of delayed cord clamping?

Liver is still immature, may get hyperbilliruemia

Reproductive adaptations

Psuedomenstruation \n Testes descend into scrotum \n Breast engorgement

IGG

Most abundant circulating antibody \n Crosses placenta \n Gives passive protection for first 3 months

IGA

2nd most common \n Found in breast milk \n Protects resps and GI

IGM

Found in blood and lymph \n Doesn't cross placenta \n First responder to infection

Uric acid crystals indiacte

Early signs of dehyration

What is the expected weight loss of the newborn?

5-10%

When does the newborn start producing their own RBC's again

8-10 weeks

What should the temperature be of the nursery

22-26 degrees

Best sleeping postion

On back

Supine

When do you complete apgar scores

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1 min and 5 min after birth

APGAT score 0-3

severe distress

APGAR score of 4-6

Mod difficulty

APGAR score of 7-10

Normal

Ballard scale

Used to determine gestational age POSTNATALLY(after birth)

Ways to determine gestational ages

Maternal menstural history \n Ultrasound \n Ballard scale \n Lens vascularity

Common problems of preterm newborn

Lack surfactant production (resp. distress) \n Lack transfer of maternal antibodies \n Thin skin

Common problems of post term newborn

Dry cracked skin \n Hypoxia \n LGA \n Meconium aspiration syndrome \n Hypoglycmeia \n Jaundice \n Polycythemia

Inital period of reactivity

First 30 mins \n Alert, active, desire to suck \n Stretgthen bonds, skin to skin \n \n Golden hour

Relative inactivity

2-3 hrs after birth \n Falls asleep \n Good time for rest

Second period of reactivity

Lasts 4-6 hrs \n Alert and responsive \n May pass 1st meconium \n Ready for feeding again

Postnatal screening

Glucose test \n New metabloic screening (PKU) \n Hearing test \n Cystic firbosis screening \n Post discahrge follow up (48 hrs)

PKU Newborn screening

Do test after food is in babies system

Nursing care of circumisiion

1\. Alleviate pain \n 2. Prevention of infection

 A newborn is placed under a radiant heat warmer, and the nurse evaluates the infant’s body temperature every hour. Maintaining the newborn’s body temperature is important to prevent which event from happening?

a. Respiratory depression

b. Cold stress

c. Tachycardia

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d. Vasoconstriction

B

An African-Canadian woman notices some bruises on her newborn girl’s buttocks. She asks the nurse who spanked her daughter. The nurse explains that these marks are referred to as what?

a. Lanugo

b. Vascular nevi

c. Nevus flammeus

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d. Mongolian spots

D

A new mother states that her infant must be cold because the baby’s hands and feet are blue. What is the proper term for this common and temporary condition?

a. Acrocyanosis

b. Erythema neonatorum

c. Harlequin colour

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d. Vernix caseosa

A

The parents of a newborn ask the nurse how much the newborn can see. The parents specifically want to know what type of visual stimuli they should provide for their newborn. What is the basis for the nurses’ response?

a. Infants can see very little until about 3 months of age.

b. Infants can track their parent’s eyes and distinguish patterns; they prefer complex

patterns.

c. The infant’s eyes must be protected. Infants enjoy looking at brightly coloured

stripes.

d. It’s important to shield the newborn’s eyes. Overhead lights help them see better.

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B

While assessing the integument of a 24-hour-old newborn, the nurse notes a pink, papular rash with vesicles superimposed on the thorax, back, and abdomen. What should the nurse do?

a. Notify the physician immediately.

b. Move the newborn to an isolation nursery.

c. Document the finding as erythema toxicum.

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d. Take the newborn’s temperature and obtain a culture of one of the vesicles.

C

 Which is true about the neonatal period?

a. It consists of four phases, two reactive and two of decreased responses.

b. It lasts from birth to day 28 of life.

c. It applies to full-term births only.

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d. It varies by socioeconomic status and the mother’s age.

B

Which statement is an inaccurate description of the first phase of the transition period?

a. It lasts no longer than 30 minutes.

b. It is marked by spontaneous tremors, crying, and head movements.

c. It often includes the passage of meconium.

d. It may involve the infant suddenly sleeping briefly.

D

What should the nurse be aware of with regard to the respiratory development of the newborn?

a. The positive pressure created by crying aids in keeping the alveoli open.

b. Newborns must expel the fluid from the respiratory system within a few minutes of

birth.

c. Newborns are instinctive mouth breathers.

d. Seesaw respirations are no cause for concern in the first hour after birth.

A

What should the nurse know about variations in infants’ blood count to explain to new parents?

a. A somewhat lower than expected red blood cell (RBC) count could be the result of delay in clamping the umbilical cord.

b. The early high white blood cell (WBC) count is normal at birth and should decrease rapidly.

c. Platelet counts are higher than in adults for a few months.

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d. Even a modest vitamin K deficiency means a problem with the ability of the blood to clot properly.

B

What would the nurse be aware of with regard to the functioning of the renal system in newborns?

a. The pediatrician should be notified if the newborn has not voided in 24 hours.

b. Breastfed infants likely will void more often during the first days after birth.

c. “Brick dust” or blood on a diaper is always cause to notify the physician.

d. Weight loss from fluid loss and other normal factors should be made up in 4 to 7

days.

A

Which statement is true about jaundice?

a. Neonatal jaundice is not common, but kernicterus occurs frequently.

b. The appearance of jaundice during the first 24 hours indicates a pathological

process.

c. Jaundice will most likely appear before discharge.

d. Breastfed babies have a lower incidence of jaundice.

B

What is the term given to the cheeselike, whitish substance that fuses with the epidermis and serves as a protective coating for the fetus?

a. Vernix caseosa

b. Surfactant

c. Caput succedaneum

d. Acrocyanosis

A

The nurse caring for the newborn should be aware that which sensory system is least mature at the time of birth?

a. Vision

b. Hearing

c. Smell 

d. Taste

A

During life in utero, oxygenation of the fetus occurs through transplacental gas exchange. When birth occurs, four factors combine to stimulate the respiratory centre in the medulla. The initiation of respiration then follows. Which contributes to the dynamic sequence of events that occur with the infants’ first breath?

a. Warm air temperature

b. Oxygen pressure increases

c. Carbon dioxide pressure decreases

d. Arterial pH decreases

D

A collection of blood between the skull bone and its periosteum is known as a cephalhematoma. What should the nurse be aware of with regard to cephalhematoma in order to reassure the new parents whose infant develops such a soft bulge?

a. It may occur with spontaneous vaginal birth.

b. It only happens as the result of a forceps or vacuum delivery.

c. It is present immediately after birth.

d. It will gradually absorb over the first few months of life.

A

 What is the mode of heat loss in the newborn? a. Perspiration

b. Diuresis

c. Urination

d. Evaporation

D

 A new father wants to know what medication was put into his infant’s eyes and why it is needed. What does the nurse explain to the father about the purpose of the erythromycin ophthalmic ointment?

a. It destroys an infectious exudate caused by Staphylococcus that could make the

infant blind.

b. It prevents gonorrheal and chlamydial infection of the infant’s eyes that is

potentially acquired from the birth canal.

c. It prevents potentially harmful exudate from invading the tear ducts of the infant’s

eyes, leading to dry eyes.

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d. It prevents the infant’s eyelids from sticking together and helps the infant see.

B

The nurse is using the Ballard scale to determine the gestational age of a newborn. Which is consistent with a gestational age of 40 weeks?

a. Flexed posture

b. Abundant lanugo

c. Smooth, pink skin with visible veins

d. Faint red marks on the soles of the feet

A

A newborn is jaundiced and receiving phototherapy via ultraviolet bank lights. Which is an appropriate nursing intervention when caring for an infant with hyperbilirubinemia and receiving phototherapy?

a. Apply an oil-based lotion to the newborn’s skin to prevent dying and cracking.

b. Limit the newborn’s intake of milk to prevent nausea, vomiting, and diarrhea.

c. Place eye shields over the newborn’s closed eyes.

d. Change the newborn’s position every 4 hours.

C

 Early this morning, an infant boy was circumcised using the PlastiBell method. When should the nurse tell the mother that she and her infant can be discharged?

a. The bleeding stops completely.

b. Yellow exudate forms over the glans.

c. The PlastiBell rim falls off.

d. The infant voids.

D

Which range, in g/L, represents the normal hemoglobin of a healthy full-term infant? 

a. 50 to 95

b. 120 to 150

c. 140 to 240

d. 160 to 260

C

 What is the main reason that nurses wear gloves when handling the newborn at birth?

a. To protect the baby from infection

b. It is part of the Apgar protocol.

c. To protect the nurse from contamination by the newborn

d. Because the nurse has primary responsibility for the baby during the first 2 hours

C

At 1 minute after birth, the nurse assesses the infant and notes a heart rate of 80 beats/min, some flexion of extremities, a weak cry, grimacing, and a pink body but blue extremities. On the basis of these data, what would the nurse calculate as the Apgar score?

a. 4

b. 5 

c. 6 

d. 7

B

In the classification of newborns by gestational age and birth weight, which is the appropriate for gestational age (AGA) weight?

a. It falls between the twenty-fifth and seventy-fifth percentiles for the infant’s age.

b. It depends on the infant’s length and the size of the head.

c. It falls between the tenth and ninetieth percentiles for the infant’s age.

d. It should be modified to consider intrauterine growth restriction (IUGR).

C

Which type of blood should be used for genetic screening?

a. Maternal venous

b. Maternal cord blood

c. Fetal cord blood

d. Infant capillary blood

D

A postpartum woman telephones about her 6-day-old infant. She is not scheduled for a weight check until the infant is 10 days old, and she is worried about whether breastfeeding is going well. Which is an indication of effective breastfeeding?

a. Newborn sleeps for 6 hours at a time between feedings

b. Newborn has at least one breast milk stool every 24 hours

c. Infant gains 30 to 60 grams per week

d. Infant has at least six wet diapers per day

D!

Macrosomia

Large baby greater than 9 lbs

LGA Baby risk factors

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Excessive weight gain in pregnancy \n Fetal exposure to high estrogen levels \n High maternal birth weight \n LGA in previous infants \n Maternal Diabetes \n Maternal pre-pregnancy obesity \n Multiparity

Complications associated with LGA baby

Birth Trauma; Hypoglycemia; and Congenital anomalies

What percentile of intrauterine growth chart would a LGA baby typically be?

above 90th

What percentile of intrauterine growth chart would a SGA baby typically be?

Below 10th

Risk factors for SGA baby

Anemia, diabetes, malnutrtion, smoking \n \n Abruotio placentae, placnta pervia, infcetion \n \n Birth defects, muktiple gestaions

A SGA are Similar to preterm infants except if the term will have

no problems with coordinated suck/swallow reflex

Develops from inadequate oxygen transfer during labor and birth. Requires immediate assessment and intervention

Birth asphyxia

What do you do?? \n - Preterm (at least 29 weeks) doesnt breath sponteansly HR less than 100

Stimulate (dry) to get more active

What do you do?

Cynotic

Do + pressure ventillation (PPV) for 30 seconds

What do you do?

HR less than 60

Chest compressions and incubation

Too much oxygen to baby =

Retinopathy of Prematuirty