Womens Health Exam 3
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Recommended weight gain for a normal weight woman that is pregnant
- Plus or minus 3lbs/month
- 25-35 lbs total
Recommended weight gain if you have
Total calories a day for a pregnant woman?
300-450 calorie increase in 2nd/3rd trimesters
Examples of Aspartame
- Sweet n low
What does Aspartame do to the fetus?
- brain damage
- mental retardation
What do you find Phenylanine in
Diet soda....causes same problems as aspartame
What is the problem with Aspartame, Phenylalanine?
Can cause a decreased sensitivity to insulin, so body produces more insulin
What is a good sugar substitute that is not a chemical?
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
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
Med that has a lot of vitamin A
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
If mom is low on iron tell her not to
drink coffee, tea, soda
How much water should a prego drink per day
What does folic acid do?
helps the neural tube close
Foods rich in folic acid
- ORANGE JUICE
- GREEN LEAFY VEGETABLES
- shell fish
Pre conception counseling includes
What test dx NTD?
- Alpha Fetal Protein
- 16 weeks
Define neural tube defects
congenital absence of spinal bones with no exposure of the internal structures like meninges or neural tissue
defect in the bony structures with swelling of the meninges, no clinical relevance and usually found with an x ray
defect in the bones of the spine with distention of the meninges, spinal cord is in tact and it can be treated with surgery
cerebral tissue herniation thru the skull...prognosis is dependent on level of involvement, but can be fatal
defect in brain development resulting in small or missing brain hemispheres.
Incompatible with life
Potential complications of NTD's
- sensory/motor problems with lower limbs
- bowel/bladder issues
- mental capacity dependent
How much folic acid should all women of child bearing age take?
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)
Vegeterians are at risk for developing
Describe anemia seen in pregos
- physiologic anemia from dilution of blood in increased plasma
- usually seen 2nd trimester
- spontaneous abortion risk
- pre term labor
Deficiency in calcium=
bone and tooth loss
Deficiency in zinc=
3 things folic acid does
- produces RBC
- cellular division
- xfer of genetic code
Men with low folic acid=
V. B helps people with
- most serious form of spina bifida
- spinal cord is protruding through the back
- prognosis depends on level of spinal involvement
Sodium and prego
needs to be increased to provide for expanded blood volume....but not too much
- 8-10 cups of fluids/day
- 3 cups of fruits/vegetables
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
no risk to fetus-nasal spray
animal studys only, no documented risk to fetus, but no adequate trials done in pregos
- animal studies have shown adverse effects on fetus, but no adequate trials in humans....
- POTENTIAL BENEFITS MAY WARRANT USE
Positive evidence of human fetal risk based on adverse reaction date, but potential benefits may warrant use
positive evidence of human fetal risk based on adverse data...Risks clearly outweigh potential benefits
- severe facial birth defects
- malformed thymus gland
- mental retardation
- heart defects
External defects you will see from Accutane
- deformed or absent ears
- wideset eyes
- depressed bridge of nose
- enlarged head
- small chin
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
Why are babys affected by mom drinking alcohol?
fetus liver cant process alcohol
Result of alcohol on fetus
- Low birth weight
- flattened features
- heart and kidney abnormalities
- brain damage
- Poor coordination
What does AFP look for?
plasma proteins produced by the fetus and excreted from the urine into the amniotic fluid
- Spina Bifida
Low levels of AFP=
Down syndrome (chromosomal tirsomies)
Gate theory of pain
neural mechanism in the dorsal horn of the spinal cord can control the flow of neural impulses to the brain
Non pharmacologic management of pain
- hot/cold therapy
- visual imagery
- focal point/distraction
- raises pain threshold without loss of consciousness
- works on the CNS
Example of opioid analgesia used during labor ir post c section
IV or IM
A/E of Nubain
- decreased bp
- dry mouth
- decreased respiration in mom and baby
- decreased variability
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
What do I do if I notice mom or baby after delivery are experiencing respiratory depression
O2 and give Narcan
allows lack of pain with or without loss of consciousness
- Spinal block
- Epidural block
Where is the epidural block placed in the spine?
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
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
Adverse effects of epidurals
- maternal hypotension
- fetal distress
- bladder distension
- prolonged stage II
- Impaired mobility
- Subarachnoid injection
- Inadvertent spinal block puncturing dura
- intravascular injection
How does an epidural cause hypotension
causes vasidilation and then hypotension....likely to occur within first 15 min
What is the result of an inadvertent spinal block puncturing the dura?
leaking CSF will cause mom to have a spinal headache
If a patient had an intravascular injection with the epidural what would we assess?
- numbness of the tongue and lips
Call Dr. and remove catheter...I can only do this if I have a doctor's order
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
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
Why don't some facilities use prostaglandins to ripen the cervix?
risk of hyperstimulation which is bad for the fetus
What is Cytotec used for? (2)
- stimulate uterine contractions
- stop post partum hemorrhage
Nursing considerations for Cytotec and PGE2
- monitor for hyperstimulation
- have tocolytic on hand
Dosage of Pitocin to stimulate uterine contractions
10 units in 1000mL
Dosage of Pitocin to contract uterus postpartum to prevent hemorrhage
20units in 1000mL
Nursing considerations for Pitocin for the laboring mom
- slow titration using infusion pump 2 units
- monitor for uterine hyperstimulation
- have tocolytic on hand
Med given to contract uterus to terminate pregnancy or induction of a non viable fetus?
Med given as treatment/prevention of PP/post abortion hemorrhage caused by uterine atony?
BP...watch for HTN. Hold if >136/90
What is given to a mom who is having HTN during labor?
What is given to a baby during neonatal CPR?
Epinephrine....stimulates contractility of the heart
What is given to a mom who is anticipated to have pre term delivery? (fetus at 25-34 weeks gestation)
What does it do?
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
When is surfactant given and what do I assess?
post delivery thru ET tube
Assess respiratory function
Tocolysis to stop PTL in patients <34 weeks
What do I monitor when I have given Terbutaline?
- maternal and fetal tachycardia
When is progesterone given?
when a woman has had multiple losses or pregnancy...will promote implantation of the embryo
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
Antidote for magnesium sulfate
S/E of magnesium sulfate
mom-lethargy, headache, visual blurring, nausea, vomitting
What do I monitor after I have given a patient magnesium sulfate?
- deep tendon reflexes
- respiratory depression
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
What is the Calcium Channel blocker that is given as a tocolytic that relaxes smooth muscles?
After I give Nifidepine to a patient to stop contractions what do I need to monitor?
- decreased BP
What is Clomid?
it is an ovarian stimulant to hyperstimulate the dropping of eggs
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
Presumptive indications of pregnancy
- increased urination
- weight change
- breast change
- vaginal change
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
When is test for GDM done?
What is an elevated BG for a prego?
Antibody testing is done at
When is Rhogam given?
When is a vaginal culture for B Strep done?
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
When will prego experience urinary frequency?
teach kegel exercises to help with bladder control
What hormone causes constipation?
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
Avoid hot tubs and saunas
- during 1st trimester
- and then only for 15 min in sauna
- 10 min in hot tub
Breast care while prego
- no soap
- supportive bra
- no breast stimulation
- walk q 1/2 hr
- empty bladder
- drink fluids
Live virus vaccines while prego are
Signs of preeclampsia
- pounding headache
- visual disturbances
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
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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