Family Health Exam 1-1

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When does the fetus produce IgG?: At the end of the first trimester.
Dizygotic Twins: Fraternal twins
What is not produced by the fetus but is present in colostrum?: IgA
What immunoglobulin (Ig) can cross the placenta? What does it provide?: IgG. It provides passive acquired immunity to specific bacterial toxins.
What is lanugo? When is it present?: It's very fine hairs. This is at 12 weeks.
When is the vernix thick? And scant?: Thick by 24 weeks. Scant by term.
What is the purpose of the vernix?: It protects the skin of the fetus.
What is the integumentary system derived from and when?: It's derived from the ectoderm at about 4 weeks.
When do spontaneous muscle movements begin?: The seventh week.
What part of the muscularoskeletal system are the first to develop? What happens if there is a lack of folic acid?: The spinal cord and column develop first. Without folic acid spina bifida may occur.
Where does the muscularoskeletal system develop from?: The mesoderm.
When does oogenesis start for females?: The 16th week.
When does the secretion of testosterone begin in males?: By the end of the embryonic period.
What is the infant of an uncontrolled diabetic mother at risk for?: Macrosomia: a large-sized fetus. It can also block lung maturation (resp distress) and hypoglycemia when the glucose source is lost at birth.
Does the fetus produce its own glucose? Insulin?: Not glucose, but insulin.
What is the screening test for hypothyroidism? What can result from this?: When screened for PKU after birth. Hypothyroidism can cause/result in severe mental retardation.
When can the fetus move all of its extremities? When does "quickening" occur? When does the fetus respond to sound and other senses?: * 11 or 12 weeks
* 16-20 weeks
* 24 weeks
When does the nueral tube form?: During the fourth week.
When is the GI system mature?: 36 weeks; digestive enzymes are present.
When does the fetus start to swallow amnionic fluid? What else occurs?: The beginning of the 5th month. Gastric emptying and peristalsis occurs. Meconium starts to accumulate as the fetus nears term.
Why is Vitamin K given to newborns?: b/c coagulation factors cannot be synthesized in the fetal liver b/c of the lack of Vitamin K synthesis in the sterile fetal gut.
How large is the embryonic and fetal liver? Why?: Hematopoiesis requires that the liver be large. At term, glycogen stores are twice those of the adult.
What is the major source of energy for the fetus?: Glucose.
When does hematopoiesis begin and where?: It first occurs in the yolk sac at 3 weeks and in the liver at week 6.
What is hematopoiesis?: The formation of blood.
What is the normal fetal heart rate?: 110-160 bpm
How much hemoglobin does fetal hemoglobin carry versus maternal Hgb?: 20-30% more
Where is the most oxygenated blood shunted?: The heart, head, neck, and arms.
When is the heart developmentally complete?: By the end of the embryonic stage.
What is the first organ system to function in the developing human?: The cardiovascular system.
How much amnionic fluid gets squeezed out in a vaginal birth?: 1/3
When can fetal breathing be seen?: 11th week
When are the lungs mature?: At 35 weeks.
When is sufficient surfactant available in the lungs?: after 32 weeks
When does development of the respiratory tract start?: Week 4
What is survival outside the uterus dependent upon?: CNS and oxygen capacity of the lungs.
When is a fetus viable?: 20-22 weeks after the last menstrual period (LMP) or fetal weight 500g or more.
When does the heart begin to beat?: The end of the third week.
What is the fetus less vulnerable to than the embryo?: teratogens, except those that affect the CNS
When does the fetal stage start?: At 9 weeks
What protein hormone can be detected in the maternal serum by 8-10 days after conception and is the basis for pregnancy tests?: Human Chorionic Gonadotropin (hCG)
Placenta function: - Hormone production
- Metabolic function: resp, nutrition, excretion, storage
- Viruses, some protozoa and bacteria can cross
- Drugs, caffeine, alcohol, nicotine, carbon monoxide, readily cross
- No direct link between maternal and fetal blood
Where does maternal/embryonic or fetal exchange occur?: In the intervillous spaces area.
When is the maternal-placental-embryonic circulation established by?: Day 17 after conception
Placenta structure: - Forms after implantation
- Taps into the uterine capillaries
- Chorionic villi grow, creating an inner and outer layer for the placenta
- Maternal-placental-embryonic circulation established by day 17 after conception
- Intervillous spaces area for maternal/embryonic or fetal exchange
Umbilical cord: Made up of one big vein and 2 smaller arteries. Occurs during the 5th week. 2cm in diameter and 30-90 cm in length. Average is 55cm. Whorton's Jelly prevents cord compression. Arteries carry blood to the chorionic villi from the embryo.
Yolk sac: Aids in transferring maternal nutrients and oxygen, which have diffused through the chorion to the embryo.

Becomes part of the digestive system.

Incorporated into embryo's digestive system by 5-6th week of pregnancy.
Amnionic fluid: Contains albumin, urea, uric acid, creatine, lecithin, bilirubin, fructose, sphingo myelin, fat, leukocytes, proteins, epithelial cells, enzymes, and lanugo hair. 800 - 1200mL. Maintains temp, cushions fetus, and keeps it from getting tangled. Olig < 300mL Poly > 2000mL
Amnion: Develops from the interior cells of the blastocyst, becomes the covering of the umbilical cord.
Endoderm: Lower layer: epithelial lining
Chorion: Develops from the trophoblast, covers the fetal side of the placenta; contains major umbilical blood vessels.
When do the primary germ layers form?: During the third week after conception.
At the time of implantation, what 2 fetal membranes will begin to surround the developing embryo?: The chorion and amnion.
Mesoderm: Middle layer: bones and teeth, muscles, dermis, and connective tissue.
How long does embryo development last?: Cycle day 15 to 8 weeks. This is a critical time for development.
What are the primary germ layers?: Ectoderm
Mesoderm
Endoderm
Ectoderm: Upper layer: skin, hair, nails, central and peripheral nervous system
What happens on day 6 after fertilization?: implantation
What happens on day 4 after fertilization?: blastocyst forms
What happens on day 3 after fertilization?: The morula is formed.
What happens on day 1 after fertilization?: Cleavage; there are now 2 cells.
Embryoblast: The second part of the morula which gives rise to the embryo.
Trophoblast: The blastomeres separate into 2 parts. This part gives rise to the placenta.
Blastomere: The small cells that make up the fertilized egg.
Morula: Composed or 16 cells; a solid ball of cells, is produced within 3 days and is still surrounded by the protective zona pellucida.
Zona Reaction: The process by which the membrane surrounding the sperm and ovum becomes impenetrable to other sperm.
Where does fertilization occur?: It takes place in the ampulla (the outer third) of the uterine tube (AKA fallopian tube).
Phenylketonuria (PKU): An uncommon disorder caused by autosomal recessive genes. A deficiency in the liver enzyme phenylalanine hydroxylase results in failure to metabolize the amino acid phenylalanine, allowing its metabolites to accumulate in the blood.
Autosomal Recessive Genes: Those disorders in which both genes of a pair must be abnormal for the disorder to be expressed.
Autosomal Dominant Inheritance: Those disorders in which the abnormal gene for the trait is expressed even when the other member of the pair is normal.
What genetics test is available to patients doing in-vitro fertilization?: Pre-implantation genetic diagnoses (PGD)
Types of infections: - Superficial
- Deep incisional
- Infection of the organ or space
Classifications of surgical wounds: Class I - clean wounds
Class II - Clean-contaminated wounds
Class III - Contaminated wound (nonpurulent inflammation)
Class IV - dirty or infected wounds.
How can SSI's be prevented?: - Correct perioperative antibiotics
- removing hair appropriately
- maintaining blood glucose control
- maintaining normothermia
What are SSI's: Surgical site infections
Stats about SSI's: - 40% of all hospital-associated infections
- Twice as likely to die
- 60% more likely to spend time in the ICU
- 5X more likely to be readmitted
- 40-60% of SSI's can be prevented
Post-op nursing management considerations: - surgical wounds
- integument
- GI complications
- Potential alt. in temp.
What are patients at risk for if they have nausea and vomiting?: aspiration and FVD
What does a person's temp have to be below for hypothermia?: Core temp below 96.8
What is normally given for nausea/vomiting?: antiemetics

ex: Zofran
When is a rectal temp taken?: Only if PO or axillary is greater than 100 degrees.
PERRLA: Pupils equal, round, reactive to light and accommodation
Potential alt. in neuro function, 2 types: 1. Emergence delirium: restlessness, agitation, disorientation, hypoxia, shouting, pain, bladder distention.

2. Delayed awakening: prolonged drug action; detrimental in elderly patients.
How do you know if a patient is headed for shock?: Patient is hyposenstitive with rapid pulse and is cold, clammy, and pale.
VS Monitoring: - Compare preop and interop VS to post-op VS
- Pulse <60 or >120 means there's a problem
- Assess diff between apical and radial pulses
- Temp
- Assess pedal pulses if surgery was on lower extremities
Arrhythmias: - Problem with electrical conduction in the heart
- Alt. in acid-base balance
- Hypokalemia, hypoxemia, or pre-exisitng heart condition
Hypertension: Increased b/p.

Response to pain, anxiety, distended bladder, or resp compromise.
Hypotension: Decreased b/p

Dehydrated
Potential alt. in cardiac fx: - hypotension
- hypertension
- arrhythmias (electrical problems)
Potential alt in resp fx: - Airway obstruction
- Hypoxemia
- Atelectasis (lung collapse)
- Bronchospasm
- hypoventilation
- pulmonary edema (fluid in lungs)
Potential alt/problems in post-op: - alt in resp fx
- alt in cardiac fx
- alt in neuro fx
- pain & discomfort
- Hypothermia
- nausea and vomiting
- wound:
* is the wound clean, dry, and intact (CDI)?
* Is it bloody?
Adjuvants (serving to help or assist) to anesthesia: - opiods
- benzodiazepines
- neuromuscular blocking agents
- antiemetics
Conscious sedation: Decreased level of consciousness, maintain own airway. Loss of sensation to a region, not unconscious.

Ex: Epidural, spinal
Local anesthesia: Loss of sensation without loss of consciousness.

Ex: Lidocaine
General anesthesia: Inhaled or IV. Loss of sensation, consciousness, and muscle relaxation.
What are the classifications of anesthesia?: 1. general
2. local
3. conscious sedation
4. regional anesthesia
3 areas to the surgical suite: Preanathesia
OR
PACU
What is important for wound healing?: Albumin
Hemostasis: The stoppage of bleeding; stagnation of blood in a part.
What is the myometrium of the uterus uniquely designed to do?: To expel a fetus and promote hemostasis after birth.
What is the decreased level of folic acid linked to? What is the suggested daily amount of folic acid?: NTDs (neural tube defects)
400mg/dl
abcess: A localized collection of pus in the tissues of the body, often accompanied by swelling and inflammation and frequently caused by bacteria.
Fistula: A narrow passage or duct formed by disease or injury, as one leading from an abcess to a free surface, or from one cavity to another.
The ovarian cycle: - Estrogen starts to go up first.
- Progesterone increases at ovulation and stays elevated until the end of cycle.
Hypothalamic-pituitary cycle: - Occurs at the same time as the endometrial cycle.
- FSH (follicle stimulating hormone) and LH (luteinizing hormone) spike at ovulation.
Endometrial cycle: - Endometrium = lining
- Endometrial lining gets very thick

Cycle day 1 = 1st day of period
Cycle day 4 = 1st day of ovulation
What is the menstrual cycle controlled by? What are they?: 3 Cycles:

1. Endometrial cycle
2. Hypothalamic-pituitary cycle
3. The ovarian cycle
What is the first cause of infertility?: age
Menopause age range: 35-60yrs. Average age is 51.4yrs.
Menstrual cycle: - occurs approximately every 28 days (normal is 25 - 35).
- menstrual flow lasts approximately 5 days
- average blood loss is 50mL
When is the best day to perform a breast self-exam?: At the end of the menstrual cycle, at day 7.
Mastitis: Inflammation of the breasts
Breast fx: - main fx is lactation
- sexual arousal in adults
- changes in breasts occur during the menstrual cycle

68% BH
85% BWH
Cephalic pelvic disproportion (CPD): A condition in which a maternal pelvis is small in relation to the size of the fetal head.
When does menstruation first occur? What can a pregnancy before age 20 cause?: At 12 yrs of age, the pelvis is not formed yet. During delivery the baby can get stuck and cephalic pelvic disproportion (CPD) can result.
Bony pelvis: - Protects pelvic structures
- accommodates growing fetus during pregnancy
- anchors pelvic support structures
- complete ossification does not occur until about 20 years of age.
Ectopic pregnancy: The development of a fertilized ovum outside the uterus, as in a fallopian tube.
Nursing interventions for pain (children): - sucrose prior to painful procedure
- pain prevention protocol in most pediatric units
- PCA pump
- Minimize painful situations
- non-pharmacological interventions
- distractions
- diversion
Pain in children: Children think that pain is a form of punishment

use face scale and FLACC
Additional methods for administering analgesics: 1. patient-controlled analgesic (PCA)
2. epidural analgesic
3. local anathesia
Pharmacological pain relief measures: 1. non-opioid analgesia (motrin)
2. opioid/narcotic analgesia (morphine)
3. adjuvant drugs (torodol)
Nursing diagnoses: pain as the etiology: - fatigue r/t lack of relief from chronic pain
- self-care deficit r/t painful movements of the joints
- risk for injury r/t decreased pain sensation
vaso-occlusive crisis: relating to, resulting from, or caused by, occlusion (closed, shut, or stopped up) of a blood vessel.
Nursing diagnoses: pain as the problem: - pain r/t surgical procedure
- pain r/t vaso-occlusive crisis
Physical indications of pain: Increased b/p, pale and flushed skin, cold and clammy, skin eruptions and swelling, increased perspiration, nausea/vomiting, headaches, dizziness, anxiety.
What is considered when assessing pain?: Patient history, location, onset, duration, aggravating factors, quality (descriptive), intensity, functional status (ADLs), desired pain/activity level (patient's expectations), analgesic history (what works and what doesn't).
Gate control theory of pain: It describes the transmission of painful stimuli and recognizes a relation between pain and emotions. The exciting and inhibiting signals at the gate in the spinal cord determine the impulses that eventually reach the brain. When too much info is sent through, certain cells in the spinal column interrupt the signal as if closing a gate.
Intractable pain: When pain is resistant to therapy and persists despite a variety of interventions.
Exacerbation: When (chronic pain) symptoms reappear.
Chronic pain: Pain that may be limited, intermittent, or persistent but lasts for 6 months or longer and interferes with normal functioning.
Acute pain: Rapid onset, varies in intensity from mild to severe, and may last up to any period less than 6 months. It's protective in nature. After the underlying cause is resolved, acute pain disappears.
Ischemia: Local anemia resulting from poor circulation.
Idiopathic pain: A diagnosis of exclusion in which pain is suffered by a patient for longer than 6 months, for which there is no physical cause and no specific mental disorder.
Neuropathic pain: It's the result of an injury or malfunction in the peripheral or CNS. The pain is often triggeres by an injury.

Pain may persist for months or years. Pain no longer triggers the receptors, instead the alarm system itself is malfunctioning. Frequently the pain is chronic. It doesn't usually respond well to opioids but to antiseizure and anti-anxiety meds.
Nociceptive pain: Nociceptors are the nerves which sense and respond to parts of the body which suffer from damage. This is usually time-limited (exception is arthritis). Usually responds well to treatment with opioids.
Mechanisms of pain: 1. nociceptive
2. neuropathic
3. idiopathic
4. phantom pain
5. ischemic pain
3 Hierarchical levels of pain: 1. sensory - doscriminative component
2. motivation-affective component
3. cognitive-evaluation component
What is the pain process?: 1. Transduction - activation of pain receptors
2. Transmission - conduction along pathways. Nerve endings receive painful stimuli.
3. Modulation - initiation of the protective reflex response.
4. Perception of pain - awareness of the characteristics of pain
What is the first reason people seek healthcare?: Pain.

Pain is what the patient says it is.
Acculturation: blending of cultures
What is the goal of the health belief model?: To reduce cultural and environmental barriers that interfere with access to health care.
Family genogram: A family tree depicting relationships of family members over at least 3 generations.
Reconstituted/blended family: When a widowed or divorced person with children remarries. Includes step-parents and step-children.
Binuclear family: Family after divorce.

Child is a member of both families.
Dyad: 2 people living together without children
What is the primary unit of socialization?: The family
In a mulitfetal pregnancy reduction, when is the number of babies reduced?: At 8 weeks gestation
NIC: Nuring interventions classification (Univ. of Iowa)
Integrative medicine: Combines modern technology with ancient healing practices (body, mind, and spirit)
How long are hospital stays for vaginal and cesarean sections?: Vaginal - 24-48 hours
Cesarean - 5 days
Who ranks worst among industrialized nations in infant mortality?: The US

26th in the world.

6.9 per 1000 live births.
In maternity nursing, what does the nurse's resp include?: Assessment, diagnosis, planning, implementation, and evaluation.

It focuses on women and their infants and families during the childbearing cycle.
Evidence-based practice: Providing care based on evidence gained through research and clinical trials.
What problems are patients at risk for during the postoperative care period?: Hemorrhage, shock, Thrombophlebitis, pulmonary embolus, resp. complications (pneumonia, atelectasis)
What type of an assessment/intervention is needed postoperatively?: Elimination needs, meeting fluid and nutrition needs, comfort and rest needs
What types of issues will arise for patients in the preoperative period?: Developmental considerations, past medical history, medications, previous surgery, nutrition, use of drugs or smoking, support systems, teaching about the procedure.
Roles and responsibilities of the perioperative nurse.: Itâ€™s the nurseâ€™s resp. to identify factors that affect the risk of a surgical procedure. Assessing the physical and psychosocial needs of the patient and family and establishing a plan of care and to facilitate the patientâ€™s recovery.
The neurotransmitters responsible for pain.: Prostaglandins, substance P, and serotonin
The difference between opioids and nonopioids: Opioids produce analgesia by attaching to opioid receptors in the brain. They are for moderate to severe pain. Nonopioid analgesics are usually the drugs of choice for mild to moderate pain.
What affects drug absorption?: If a drug binds with another substance in the GI tract, such as milk and antacids. This is the chelation effect. Food and laxatives may also affect it.
What drug interactions affect drug distribution?: 2 Types of interactions: The first is competitive protein binding. The second way is when a drug alters the extracellular pH.
What drug interactions affect metabolism of the drug?: Some drugs either enhance induce or inhibit the P-450 system.
What drug interactions affect excretion of the drug?: Drugs can alter renal filtration, renal absorption, or renal secretion. In doing so they may alter the excretion of other drugs. Drugs that decrease cardiac output decrease the amount of circulating blood that is sent to the kidneys.
What are the three embryonic/fetal shunts?: - Ductus Venosus
- Foramen Ovale
- Ductus Arteriosus

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