Metro Community College Nursing Program NURS 2410 Unit 1 Study Guide Directions: Study guides should be typed (single space). All study guides are due on the day of the exam over that/those unit(s). Each unit study guide is worth 25 points. 1. For each type of single gene abnormality, describe the conditions necessary for a child to be affected and specify any sex differences a. Autosomal recessive: offspring both female and male have 25% chance of getting the abnormal gene from carrier parents (both parents being carriers). b. Autosomal dominant: offspring both female and males have 50% chance of getting the abnormal gene from the affected parent. c. X- linked recessive: no male-to-male transmission. Offspring male and female have 50% chance of getting the abnormal gene from a carrier mother. Female offspring will be carrier while male offspring will be affected by the abnormal gene. 2. When and why should a rubella immunization be administered to a woman of childbearing age? A woman of childbearing age should have immunization 3 months before getting pregnant to allow time for the virus to be inactive before the pregnancy or right after birth if the women showed a low titer. Women a childbearing age should be immunize for rubella to prevent the women from being infected during the pregnancy which could have serious teratogenic effects on the fetus. 3. Explain the differences between the amnion and the chorion. The amnion develops from blastocyst in the pre-embryonic phase while chorion develops from the trophoblast during the same phase. The amnion is the inner membrane that surrounds the embryo while the chorion which is on the mother side surrounds the amnion and other membranes. 4. List factors that may impair the ability of sperm to fertilize the ovum. -Disturbance in spermatogenesis (production of sperm cells) -Inadequate production of FSH and LH in the pituitary, which stimulates the production of sperm -Obstruction in the seminiferous tubules, ducts, or vessels, which prevent the movement of spermatozoa -Qualitative or quantitative changes in the seminal fluid, which prevent sperm motility. -Development of autoimmunity, which immobilizes sperm -Problems in ejaculation or deposition, which prevents spermatozoa from being placed close enough to a woman’s cervix to allow ready penetration and fertilization -Chronic or excessive exposure to X-rays or radioactive substances, general ill health, poor diet, and stress, all of which may interfere with sperm production. -Past trauma to the testes or surgery on or near the testicles that has resulted in impaired testicular circulation -Overheating the testicles and hormonal imbalances. 5. List factors that may disrupt the hormonal secretions a woman needs to achieve pregnancy. - Genetic abnormality such as Turner syndrome, which can cause hypogonadism. -Hypothyroidism that interferes with hypothalamus-pituitary-ovarian interaction. -Ovarian tumors or poly cystic ovary syndrome due to feedback stimulation on the pituitary gland. -General ill health, poor diet, and stress also contribute to hormone imbalance. 6. List factors that may impair structure and function of the fallopian tubes. -Viable particles of endometrium, can enter the tube, begin to proliferate, and cause tubal obstruction -Growths on the ovaries can displace fallopian tubes away from the ovaries, preventing the entrance of ova into the tubes. - Peritoneal macrophages, which are drawn to nodules of endometrium, can destroy sperm. -Complete tubal obstruction dur to tubal ligation. 7. Describe the nursing interventions/ patient teaching associated with each of the listed diagnostic tests for infertility. a. Semen analysis: For this test the client is educated/teaching to: -Abstain from intercourse or masturbation for about 3 days. -Use a clean, dry plastic or glass container with a secure lid to collect the sample. -Collect the specimen as close as possible to your usual time of sexual activity. -Avoid using any lubricants before you collect the specimen. -After you’ve collected the specimen in the container, close it securely and write down the time you collected it. -Take the specimen to the laboratory or healthcare provider’s office immediately so it can be analyzed within 1 hour of collection. -Semen specimens should be kept at body temperature during transportation. Patients can be advised to carry the specimen next to the body in an inside pocket to accomplish this goal. b. Basal body temperature: The client is taught to: -To take her body temperature either orally or with a tympanic thermometer (use consistent method) each morning after waking up and before rising from bed or before any activity. -A woman who works nights should take her temperature after awakening from her longest sleep period, no matter what the time of day. -A slight dip followed by an increase in temperature signifies ovulation. - The daily basal body temperature should be recorded for at least 4 months, and plotted on a monthly graph c. Post coital test: This test evaluates the adequacy of sperm and the receptivity of the cervical mucus, and the client teaching is to: -Abstain from intercourse for two days before ovulation. -Have intercourse 2-8 hours prior to the office visit for the postcoital test. -No lubricant during sex. -No douche or bath after sex d. Hysterosalpingogram: Is an X-ray test to outline the internal shape of the uterus and show whether the fallopian tubes are blocked. Th client is educated to: -Schedule the test 7-10 days after the beginning of last menstrual period. To take NSAID (Ibuprofen) one hour before the procedure to ease the mild to moderate pain from cramping from the procedure. -Vaginal discharge or slight vaginal bleeding may happen after the procedure. -It is advised to use a pad instead of a tampon to avoid infection. -Dizziness and nausea may be experienced following the test, the client I advised to rest for 1530min before leaving. e. Endometrial biopsy This test may be used to reveal an endometrial problem, such as a luteal phase defect. -The test is done 2or 3 days before and expected menstrual flow -Mild to moderate discomfort can be experienced from maneuvering of test instruments. -Sharp pain can be experienced when the biopsy specimen is taken from the anterior or posterior uterine wall. -Possible complications include pain, excessive bleeding, infection, and uterine perforation. - woman that she might notice a small amount of vaginal spotting after the procedure. The provider should be notified of the next menstrual flow because this helps “date” the endometrium and the accuracy of the analysis 8. Complete a table with the description, advantages and disadvantages of the following: Procedures Description IVF (In Vitro 0ne or more mature oocytes are removed from a woman’s Fertilization) ovary by laparoscopy and fertilized by exposure to sperm in a laboratory. About 40 hours after fertilization, the laboratory-grown fertilized ova are inserted into a woman’s uterus, where, ideally, one or more of them will implant and grow. GIFT (gamete 0ne or more mature oocytes are removed from a woman’s intrafallopian ovary by laparoscopy, then both ova and sperm are transfer) instilled, within a matter of hours, using a laparoscopic technique, into the open end of a patent fallopian tube. Fertilization then occurs in the tube, and the zygote moves to the uterus for implantation. It requires at least one patent fallopian tube Advantages Disadvantages -It helps people with complications such as damaged or missing fallopian tubes, oligospermia, absence of cervical mucus to be able to conceive. Ability to conceive although obstructed or damaged fallopian tubes. -The embryo is tested before implantation lowering the chances of abnormalities. It may be a preferred procedure by some couples because conception occurs in the fallopian tube and so is not contradictory to their religious beliefs. -Very stressful process -Is expensive and only available in specialized center. -Risk for maternal infection that can occur during the transfer. -Requires extensive laparoscopic technique -It requires at least one patent fallopian tube 9. What teaching is needed for the woman having methotrexate therapy for an early ectopic? -Methotrexate is the medication to treat early ectopic pregnancy. -The client will need to have a dose of injection, monitor hCG 3 times for first week, then the provider will decide if they need a second dose. From there the client will get 1 hCG test each week until negative. -Mild cramping, light bleeding, pass gray-pink tissue are normal. -No folic acid or prenatal vitamin, no alcohol, no NSAIDs, no sexual intercourse for first 2 weeks. -Fatigue, Nausea and vomiting, cold symptoms, headache are some side effects, these are acceptable. 10. List the typical signs and symptoms of a hydatidiform mole (gestational trophoblastic disease) -Vaginal bleeding which may begin as spotting of dark-brown blood resembling prune juice or as a profuse fresh flow. As the bleeding progresses, it is accompanied by discharge of the clear fluid-filled vesicles. -Positive pregnancy test due to hCG produced by the trophoblast cell -Nausea and vomiting similarly to early pregnancy -Fast expansion of the uterus, but no fetal heart sounds because there is no viable fetus. - Symptoms of gestational hypertension, such as increased blood pressure, edema, and proteinuria, are ordinarily not present before week 20 of pregnancy -Symptoms of gestational hypertension: increased blood pressure, edema, and proteinuria 11. What is the significance of epigastric pain in a woman with pre eclampsia? The epigastric pain signifies a decreased perfusion to the pancreas. 12. List signs of magnesium toxicity. What is the antidote? Decreased urine output, reduced consciousness, decreased deep tendon reflex, respiratory depression, cardiac arrythmias and cardiac arrest can occur. The antidote for magnesium toxicity if calcium gluconate. 13. Why are labor and the immediate postpartum period especially dangerous for a woman who has heart disease? The labor period is dangerous for a woman who has heart disease because during lab the cardiac output increases 40%–50% from pre-labor levels and should be closely monitored for hemorrhage which could dangerously increase the heart rate. Blood pressure may rise with pain response and, due to work of the system during contractions, by an average systolic rise of 15 mmHg per contraction. Therefore, the woman should be monitored for hypertensive episodes. 14. The patient is 23 years old with a 15 year history of Type I diabetes mellitus. She has come to the clinic because she has a positive pregnancy test. She is currently using an insulin pump and her glucose levels have been under adequate control. She is excited but also nervous about being pregnant. She shares that one of her great aunts died during pregnancy because of diabetes. a. What nursing plan would be appropriate for this patient? The nursing plan for this patient will include: Close blood glucose monitoring Insulin pump therapy and the need for insulin adjustment due to changes in insulin need during pregnancy Patient should be educated on the signs of hypoglycemia and how to address it (such as carrying a carbohydrate snack). Dietary consult to ensure proper nutrition for the mother and the growing fetus and for optimum blood sugar level. Promote activity to help overall health and decreased the insulin need during the pregnancy. b. What nursing diagnosis will be appropriate in this case? Risk for Unstable Blood Glucose Levels due to increased resistance of cells to insulin during pregnancy. c. What information can the nurse share with this patient to reassure her about a successful pregnancy and birth? (be specific about a care protocol that might be used- include data to be gathered) Inform the patient that due to her condition more frequent prenatal visits will be needed to ensure close monitoring of their condition and that of the fetus. During pregnancy: -HBA1c level will be use for optimal monitoring of the insulin level during the pregnancy -A urine analysis: may be done each trimester to detect asymptomatic UTIs as the increased glucose concentration in urine may lead to increased infection. -An ophthalmic examination should be done each trimester for women with known diabetes because background retinal changes that are common in diabetes, such as increased exudate, dot hemorrhage, and macular edema, can progress or originate during pregnancy. -Because women with diabetes tend to have infants with a higher than normal incidence of birth anomalies, a woman will have a serum α-fetoprotein level obtained at 15 to 17 weeks to assess for a neural tube defect and an ultrasound examination performed at approximately 18 to 20 weeks to detect gross abnormalities. -The patient creatinine should be monitored because good clearance rate suggests a woman’s vascular system is intact with normal kidney function which signifies that uterine perfusion is also adequate. -Placental functioning may also be assessed by a weekly nonstress test or biophysical profile during the last trimester of pregnancy if a woman is in good control, or a daily nonstress test if her regulation is poor. -The client should be educated on self-monitoring of daily fetal kicks and movements. -An ultrasound examination may be taken at week 28 and then again at weeks 36 to 38 to determine fetal growth, amniotic fluid volume, placental location, and biparietal diameter if need there is. During birth: -Today, when an accurate assessment of fetal age is available by amniocentesis and the pregnancy can be maintained within safe limits by the use of nonstress testing for a longer period, the last weeks of pregnancy are not as hazardous as before, and the timing and type of birth is much more individualized. - Both labor contractions and fetal heart sounds can be continuously monitored during labor to ensure early detection of placental dysfunction -A woman’s glucose level is regulated during labor by an intravenous infusion of short-acting or regular insulin with frequent blood glucose assays to prevent hypoglycemia in the mother or rebound hypoglycemia in the newborn. -If there is need for an epidural anesthetic, Lactated Ringer’s or 0.9% saline will be used as plasma volume expander instead of the intravenous glucose solution. Postpartum: -During the postpartum period, a woman who came into pregnancy with diabetes must undergo yet another readjustment to insulin regulation. With insulin resistance gone, often she needs no insulin during the immediate postpartum period; in another few days, however, she will return to her prepregnant insulin requirements: -She requires careful observation, however, during the immediate postpartum period because if polyhydramnios was present during pregnancy, she is at risk of hemorrhage from poor uterine contraction. -The client mother should be assured that the newborn will be closely monitored for hypoglycemia following birth and can safely be breastfed because insulin does not cross into the breastmilk. Reference Silbert-Flagg, J. A., & Silbert-Flagg, J. A. (2022). Maternal & Child Health Nursing. Lippincott Williams & Wilkins.
