Womens Health Exam 3

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foxyt14
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269322
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Womens Health Exam 3
Updated:
2014-04-05 21:36:45
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Exam OB
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Health, pain, adaptations to pregnancy
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  1. Recommended weight gain for a normal weight woman that is pregnant
    • Plus or minus 3lbs/month
    • 25-35 lbs total
  2. Recommended weight gain if you have
    twins
    underweight
    overweight
    obese
    • twins-37-54
    • under-28-40
    • over-15-25
    • obese-11-20
  3. Total calories a day for a pregnant woman?
    2500/day

    300-450 calorie increase in 2nd/3rd trimesters
  4. Examples of Aspartame
    • sucralose
    • saccharin
    • Sweet n low
    • Equal
    • NutraSweet
  5. What does Aspartame do to the fetus?
    • brain damage
    • mental retardation
  6. What do you find Phenylanine in
    Diet soda....causes same problems as aspartame
  7. What is the problem with Aspartame, Phenylalanine?
    Can cause a decreased sensitivity to insulin, so body produces more insulin
  8. What is a good sugar substitute that is not a chemical?
    Stevia
  9. What does protein do?
    How much should it be increased, and the total consumption amount?
    support growth of fetal and maternal tissues and expands blood volume

    increase 25g/day up to a total of 71g
  10. What vitamin should not be increased? 
    What does it cause if you have too much?
    • Vitamin A
    • craniofacial, CNS and cardiac defects....as well as spontaneous abortions
  11. Med that has a lot of vitamin A
    Accutane
  12. Supplements needed are:
    • Calcium
    • Iron
    • Folic Acid
  13. Things to teach prego mom about taking her iron supplements
    • take on an empty stomach
    • at night
    • 1/2 hr before or 2 hours after meals
    • with v. C or OJ
  14. If mom is low on iron tell her not to
    drink coffee, tea, soda
  15. How much water should a prego drink per day
    8-12 glasses
  16. What does folic acid do?
    helps the neural tube close
  17. Foods rich in folic acid
    • BEANS
    • LEGUMES
    • ORANGE JUICE
    • GREEN LEAFY VEGETABLES
    • PAPAYA
    • shell fish
    • breads
    • grains
    • cereals
    • poultry
    • pork
  18. Pre conception counseling includes
    folic acid
  19. What test dx NTD?
    When given?
    Confirmation test
    • Alpha Fetal Protein
    • 16 weeks
    • Amnio
  20. Define neural tube defects
    congenital absence of spinal bones with no exposure of the internal structures like meninges or neural tissue
  21. occulta
    defect in the bony structures with swelling of the meninges, no clinical relevance and usually found with an x ray
  22. meningocele
    defect in the bones of the spine with distention of the meninges, spinal cord is in tact and it can be treated with surgery
  23. Encephalocele
    cerebral tissue herniation thru the skull...prognosis is dependent on level of involvement, but can be fatal
  24. anencephaly
    defect in brain development resulting in small or missing brain hemispheres.

    Incompatible with life
  25. Potential complications of NTD's
    • sensory/motor problems with lower limbs
    • bowel/bladder issues
    • mental capacity dependent
  26. How much folic acid should all women of child bearing age take?
    .4mg/day
  27. What is the recommended amt of folic acid for a woman who has already given birth to a baby with NTD?
    4mg per day beginning 1-3 months preconception and continuing through the first trimester (when neural tube closes)
  28. Vegeterians are at risk for developing
    anemia
  29. Describe anemia seen in pregos
    • physiologic anemia from dilution of blood in increased plasma
    • usually seen 2nd trimester
  30. Smoking causes
    IUGR
  31. Caffeine causes
    • spontaneous abortion risk
    • pre term labor
    • SGA
  32. Deficiency in calcium=
    bone and tooth loss
  33. Deficiency in zinc=
    CNS malformations
  34. 3 things folic acid does
    • produces RBC
    • cellular division
    • xfer of genetic code
  35. Men with low folic acid=
    unhealthy sperm
  36. V. B helps people with
    • knowing
    • thinking
    • learning
    • judgment
  37. Myelomeningocele
    • most serious form of spina bifida
    • spinal cord is protruding through the back
    • prognosis depends on level of spinal involvement
  38. Sodium and prego
    needs to be increased to provide for expanded blood volume....but not too much
  39. Fluids/Fruits/Veggies
    • 8-10 cups of fluids/day
    • 3 cups of fruits/vegetables
  40. Food safety during pregnancy and lactation
    • Don't eat fish, meat, poultry or eggs raw or undercooked
    • avoid luncheon meats and hot dogs unless reheated until steaming hot
    • No soft cheese unless made with pasteurized milk
    • Don't eat anything that is unpasteurized
  41. A meds
    no risk to fetus-nasal spray
  42. B meds
    animal studys only, no documented risk to fetus, but no adequate trials done in pregos

    penicillin, Tylenol
  43. C Meds
    • animal studies have shown adverse effects on fetus, but no adequate trials in humans....
    • POTENTIAL BENEFITS MAY WARRANT USE

    Asthma Inhalers/Imitrex/Digoxin
  44. D Meds
    Positive evidence of human fetal risk based on adverse reaction date, but potential benefits may warrant use

    • Tetracycline
    • Depacote
    • Dilantin
    • Aspirin
    • Coumadin
  45. X Meds
    positive evidence of human fetal risk based on adverse data...Risks clearly outweigh potential benefits

    • Accutane
    • Statins
  46. Accutane causes
    • severe facial birth defects
    • malformed thymus gland
    • mental retardation
    • heart defects
  47. External defects  you will see from Accutane
    • deformed or absent ears
    • wideset eyes
    • depressed bridge of nose
    • enlarged head
    • small chin
  48. What does nicotine do to the fetus?
    • it causes blood vessels to constrict so less oxygen and nutrients reach the fetus.
    • causes problems with the way the placenta attaches to the uterus

    SGA, still birth, neuro development affected
  49. Why are babys affected by mom drinking alcohol?
    fetus liver cant process alcohol
  50. Result of alcohol on fetus
    • Low birth weight
    • flattened features
    • heart and kidney abnormalities
    • deaf
    • brain damage
    • ADHD
    • Poor coordination
  51. What does AFP look for?
    plasma proteins produced by the fetus and excreted from the urine into the amniotic fluid
  52. Elevated AFP=
    • NTD
    • Anencephaly
    • Spina Bifida
  53. Low levels of AFP=
    Down syndrome (chromosomal tirsomies)
  54. Gate theory of pain
    neural mechanism in the dorsal horn of the spinal cord can control the flow of neural impulses to the brain
  55. Non pharmacologic management of pain
    • relaxation
    • massage
    • pressure
    • hot/cold therapy
    • visual imagery
    • focal point/distraction
  56. Analgesia
    • raises pain threshold without loss of consciousness
    • works on the CNS

    Opioids
  57. Example of opioid analgesia used during labor ir post c section
    Nubain

    IV or IM
  58. A/E of Nubain
    • sedation
    • n/v
    • tachy
    • decreased bp
    • dry mouth
    • pruritus
    • decreased respiration in mom and baby
    • decreased variability
  59. Nursing considerations for patient on Nubain
    • FHR-variability or decels put on o2 at 10L via mask
    • assess contractions
    • watch for respiratory depression
    • if deliver within 4 hrs of dose, check respiratory depression of baby
  60. What do I do if I notice mom or baby after delivery are experiencing respiratory depression
    O2  and give Narcan
  61. Anesthesia
    allows lack of pain with or without loss of consciousness

    • Spinal block
    • Epidural block
  62. Where is the epidural block placed in the spine?
    between L3-L5
  63. Nursing considerations for patients with epidural and spinal blocks
    • timing-is labor well established?
    • bolus IV fluid to prevent hypotension
    • **monitor BP***
    • monitor O2 sats
    • monitor FHR
    • monitor effect of epidrual
    • monitor for bladder distention-cath if needed
  64. How often do I take BP for a patient who just got an epidural?
    q 5 min for first 15 min then q 30 min after that
  65. Adverse effects of epidurals
    • maternal hypotension
    • fetal distress
    • bladder distension
    • prolonged stage II
    • Impaired mobility
    • Subarachnoid injection
    • Inadvertent spinal block puncturing dura
    • intravascular injection
  66. How does an epidural cause hypotension
    causes vasidilation and then hypotension....likely to occur within first 15 min
  67. What is the result of an inadvertent spinal block puncturing the dura?
    leaking CSF will cause mom to have a spinal headache
  68. If a patient had an intravascular injection with the epidural what would we assess?

    Interventions?
    • numbness of the tongue and lips
    • lightheadedness
    • dizzy
    • tinnitus

    Call Dr. and remove catheter...I can only do this if I have a doctor's order
  69. Non anesthetis RN should NOT
    • rebolus an epidural by injecting meds in to the catheter or increase infusion
    • don't increase/decrease infusion rate
    • don't re initiate an infusion once it's been stopped
    • Can witness consent but cant obtain consent-MD must do
  70. General anesthesis and the laboring mom
    • used in emergency
    • given by IV or inhalation
    • causes uterine muscle relaxation
    • **patient at risk for aspiration of stomach contents
    • maternal/fetus respiratory depression
  71. Why don't some facilities use prostaglandins to ripen the cervix?
    risk of hyperstimulation which is bad for the fetus
  72. What is Cytotec used for? (2)
    • stimulate uterine contractions
    • stop post partum hemorrhage
  73. Nursing considerations for Cytotec and PGE2
    • monitor for hyperstimulation
    • have tocolytic on hand
  74. Dosage of Pitocin to stimulate uterine contractions
    10 units in 1000mL
  75. Dosage of Pitocin to contract uterus postpartum to prevent hemorrhage
    20units in 1000mL
  76. Nursing considerations for Pitocin for the laboring mom
    • slow titration using infusion pump 2 units
    • monitor for uterine hyperstimulation
    • have tocolytic on hand
  77. Med given to contract uterus to terminate pregnancy or induction of a non viable fetus?

    Side effect?
    Hemabate

    Nausea
  78. Med given as treatment/prevention of PP/post abortion hemorrhage caused by uterine atony?

    Monitor?
    Methergine

    BP...watch for HTN.  Hold if >136/90
  79. What is given to a mom who is having HTN during labor?

    Monitor?
    Apresoline

    monitor BP...hypotension
  80. What is given to a baby during neonatal CPR?

    Monitor
    Epinephrine....stimulates contractility of the heart

    monitor VS
  81. What is given to a mom who is anticipated to have pre term delivery? (fetus at 25-34 weeks gestation)
    How?
    What does it do?
    Betamethasone

    12mg IM q24h x 2 doses

    • Acceleration of fetal lung maturity to reduce incidence and severity of RDS
    • Greatest benefit is when given within 24 hours of delivery of a premie
  82. When is surfactant given and what do I assess?
    post delivery thru ET tube

    Assess respiratory function
  83. Terbutaline
    Tocolysis to stop PTL in patients <34 weeks
  84. What do I monitor when I have given Terbutaline?
    • maternal and fetal tachycardia
    • termors
    • jitters
    • apprehension
    • SOB
    • hyperglycemia
  85. When is progesterone given?
    when a woman has had multiple losses or pregnancy...will promote implantation of the embryo
  86. 3 uses of magnesium sulfate
    PTL-tocolysis via smooth muscle relaxation

    HTN-lowers BP via CNS depression

    Provides neuro protection in an infant with anticipated preterm imminent delivery
  87. Antidote for magnesium sulfate
    calcium gluconate
  88. S/E of magnesium sulfate
    mom-lethargy, headache, visual blurring, nausea, vomitting

    fetus-tachy/brady
  89. What do I monitor after I have given a patient magnesium sulfate?
    • output
    • deep tendon reflexes
    • respiratory depression
    • BP
    • Pulse
  90. If I give the tocolytic Indocin what do I need to monitor and why?
    decrease in amniotic fluid....cuz can lead to cord compression, seen as variables
  91. What is the Calcium Channel blocker that is given as a tocolytic that relaxes smooth muscles?
    Nifedipine
  92. After I give Nifidepine to a patient to stop contractions what do I need to monitor?
    • decreased BP
    • Tachycardia
    • flushing
  93. What is Clomid?
    it is an ovarian stimulant to hyperstimulate the dropping of eggs
  94. Positive indications of pregnancy
    • Auscultation of fetal heart sounds
    • (10 weeks/Doppler and 18/10 weeks/fetoscope)

    • Fetal movements by examiner
    • Visualization of the fetus by US or X ray
  95. Presumptive indications of pregnancy
    • SUBJECTIVE
    • amenorrhea
    • n/v
    • fatigue
    • increased urination
    • weight change
    • breast change
    • vaginal change
  96. Probably indications of pregnancy
    • OBJECTIVE-documented by examiner related to physical changes
    • abdominal enlargement
    • Chadwicks sign
    • Goodell's sogm
    • Hegar's sign
    • McDonald's sign
    • Pregnancy Test
    • Change in skin pigmentation
  97. When is test for GDM done?
    24-28 weeks
  98. What is an elevated BG for a prego?
    2nd test?
    • >140
    • 3 hr GTT
  99. Antibody testing is done at
    27 weeks
  100. When is Rhogam given?
    28 weeks
  101. When is a vaginal culture for B Strep done?
    34-36 weeks
  102. When is n/v a problem with prego?

    What causes it?
    in am between 4-8 weeks gestation and disappears by 14-16 weeks

    caused by increased HCG and estrogen
  103. When will prego experience urinary frequency?
    third trimester

    teach kegel exercises to help with bladder control
  104. What hormone causes constipation?
    progesterone
  105. Why do pregos get leg cramps at night?
    cuz the muscles are relaxes and there is an imbalance of serum calcium and phosphorous and low levels of mag

    venous congestion in the legs 3rd trimester contributes to it as well
  106. baths or ok unless
    ROM
  107. Avoid hot tubs and saunas
    • during 1st trimester
    • and then only for 15 min in sauna
    • 10 min in hot tub
  108. Breast care while prego
    • no soap
    • supportive bra
    • no breast stimulation
  109. If traveling....
    • walk q 1/2 hr
    • empty bladder
    • drink fluids
  110. Live virus vaccines while prego are
    contraindicated
  111. Signs of preeclampsia
    • pounding headache
    • visual disturbances
  112. In the 3rd trimester the baby should move....
    10 times in a 2-3 hr period.  If not drink juice or a beverage high in sugar and position yourself on your side and see if the baby starts to move
  113. Self statements during different trimesters
    • 1st- I am prego
    • 2nd-I am going to have a baby
    • 3rd- I am going to be a mom

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