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2011-02-21 09:20:31
Maternal child

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  1. Contraception
    strategies that reduce the risk of fertilization or implatation in an attempt to prevent pregnancy
  2. Natural Family Planning
    -Withdrawl(Coitus Interruptus)
    -Calendar Method(Rhythum Method)
    -Basal Body Temp(BBT)
    -Cervical Mucus Method
    • Ovulation begins 14 days before the onset of her period. and avoids intercourse during that period.
    • Following ovulation mucus because thinner to allow sperm viability.avoid intercourse then.
  3. Barrier Method
    -Diaphram and Spermicide
    • Must be used correctly in order to prevent pregnancy.
    • do not use diaphram if had hx of TTS
    • do not use latex condoms if have latex allergy.
  4. Hormonal Methods
    -Combined Oral Contraceptives
    • contain estrogen and progestin which suppresses avulation thicken mucus and alter uterine decidua
    • -highly effective if taken correctly
    • -decrease effectiveness if taken with antibiotics, anticonvulsants and meds that effect liver enzymes
  5. Hormonal Methods
    • May need another form of Birthcontrol for first month of use.
    • Safe to take while breastfeeding
    • Increases occurence of ovarian cysts
    • increases appetite
    • -decrease effectiveness with antibiotics, anticonvulsants and those that effect liver enzymes
    • -irregular vaginal bleeding, increased appitite, lowered libido
  6. Hormonal Methods
    -Emergency Oral contraceptive
    Morning After Pill
    • Take within 72 hours of unprotected coitus
    • Px fertilization
    • does not terminate an established pregnancy
    • if menstration does not start with in one week of taking then the patient may be pregnant.
  7. Hormonal methods
    -transdermal contraceptive patch
    • contains norelgestromin(progesterone) and ethinyl estradiol delivered in continuous levels through the skin into subcu tissue.
    • -do not put on breast or brusises skin lesions.
    • -avoids liver metabolism sincce not absorbed in gi tract
  8. Hormonal Methods
    -Injectable Progestins
    -Depo Provera
    • injection given to client every 11-13 weeks
    • maintain adequate intake of calcium and Vit D
    • does not impair lactation
    • use greater then 2 years
    • decreases bone density
    • -do not massage injection site.
  9. Hormonal Methods
    -Contraceptive Vaginal Ring
    • contains etonogestrel and ethinyl estradiol delivered vaginally continuously
    • -some patients report discomfort during intercourse.
    • -Bolood clots, stroke, HTN, heart attack, weight gain, nausea
  10. Hormonal Methods
    -Implantable Progestin Etonogestrel
    • subdermal inner side of upper arm
    • continuous for three years.
    • -increased risk of ectopic pregnancy.
  11. Hormonal Methods
    -Intrauterine device
    • inserted through the cerivix into the uterus. damages sperm in transit to uterine tubes
    • -monitored monthly by client by palpating small string that hangs from device.
    • -can maintain effectiveness for 10 years.
    • -increased risk for ectopic pregnancy, pelvic inflammatory disease, uterine perforation
    • -report signs of infection, bleeding, pain during intercourse.
    • -risk for bacterial vaginosis uterine perforation or uterine expulsion.
    • - contra in those who have not had a baby or are not in mongamous relationship
  12. Transcervical Sterilization
    • small flexible agents inserted into the fallopian tubes
    • -not effective for three months,
    • -not reversible and requires no anesthesia
  13. Sterialization
    -Bilateral tubal ligation salpingectomy(female)
    • permanent
    • ectopic pergnancy risks if get pregnant.
    • sexual fxn not impaired.
    • alternate form of birth control must be used until vas deferens is clear
  14. Common Side effects of Oral Contraceptives
    • -reduced menstral flow(amenorrhea)
    • -weight gain breast tenderness
    • -mild HTN or headache
  15. Infertility
    Risk Factors
    • Age >35
    • DX after 1 year of unprotected sex with no pregnancy
    • Endocrine disorders(abnormal body fat, abnormal hair growth)
    • Hx of abd. surgery, spontaneous abortion, alot of sex partners, STDs
    • Over and under weight
    • Environmaental exposures(teratogenic)
  16. Interventions for Infertility
    • encourage counseling, expressing of feelings, support groups.
    • genetic counseling, provide information
  17. Signs Of Pregnancy
    -Presumptive signs=changes that the woman experiences that would make her think she is pregnant
    amenorrhea, fatigue, N/V, urinary freq., breast changes, quickening(fluttering by fetus)uterine enlargment, linea nigra, chlosma( mask of pregancy) Striae gravidarum.
  18. Signs of Pregnancy
    -probable Signs=changes the examiner sees that would make them think she is pregnant.
    • -Abd. enlargement, cervical changes, Hegars sign(softening of the lower uterus)
    • Chadwicks sign(violet blue color of the vaginal mucosa
    • Goodells softening of the cervical tip
    • Ballottment(rebound of unengaged fetus)
    • fetal outline palpated by examiner
  19. Signs of pregnancy
    -Positive signs=can oly be explained by pregnancy
    fetal heart sounds, US visualization, fetal movement.
  20. Serum and Urine Pregnancy testing
    • hCG(human chorionic gonadotropin)
    • can be detected 6-11 days in serum and 26 days in urine. following implantation
    • peaks at 60-70 days and declines to 80 days then increases again to term
    • some meds can cause false positive.(anticonvulsants, diuretics, tranquilizers)
    • use forsst voided specimen of morning
  21. Nageles Rule to determine due date
    first day of last menstrual period subtract 3 months then add 7 days and one year
  22. Mcdonalds method to determine due date
    • measure fundal height in cm from symphysis to top
    • gestational age is =to fundal height
  23. Gravidity
    =number of pregnancies
    • nulligravida=never pregnant
    • Primigravida=first pregnancy
    • Multigravida=2 or more pregnancies
  24. Parity
    =number of viable pregnancies
    >20-24 weeks and 500g wether fetus is born alive or not
    • nullipara=no pregancy beyond viability
    • primipara= one beyond
    • multipara=2 or more beyond
  25. GTPAL
    • Gravidity=#of pregnancies
    • Term Births=38 weeks or more
    • Preterm births=20-37 weeks
    • Abortions/miscarriage=<20 weeks
    • Living children
  26. Physiological Status of Pregancy
    • Cardiovascular:increases 45-50% HR increases
    • Respiratory:Increases resp, decrease lung capacity
    • Musculoskeletal:pelvic joints relax
    • GI:constipation, N/V,
    • Renal:filtration rate increases, urinary rate increases.
  27. Expected Vitals during pregnancy
    • BP same as prepregnancy for 1st tri
    • -decreases 5-10 in 2nd
    • -returns to prepreg after 20 weeks
    • Pulse:increases 10-15 around 20 weeks
    • Resps; increase 1-2
  28. Rountine Labs in prenatal Care
    • Blood type, Rh factor(clients Rh- Coombs test repeated 24-28 weeks
    • CBC, Hgb and Hct
    • UA-pH specific gravity color, sediment protein, glucose, albumin, rbcs, wbcs,
    • glucose tests.
    • Pap, rubella titer, hepB STDs and HIV
  29. Common discomforts of Pregnancy
    N/V, breast tenderness, urinary freq, UTI, Fatigue, Heartburn, constipation, hemorrhoids, backaches, SOB, leg cramps, varicose veins and lower edema, gingivitis, nasal stuffiness, supine hypotension, braxton hicks
  30. Danger signs of pregnancy
    -report to PCP immediately
    • gush of fluid(membrane rupture)
    • vaginal bleeding
    • Abd. pain
    • changes in fetal activity
    • persistant vomiting
    • severe headache
    • elevated temp
    • dysuria
    • blurred vision
    • edema of face and hands
    • epigastric pain
    • flushed dry skin fruity breath(hyperglycemia)
    • clammy pale skin, weakness tremors
    • (hypoglycemia)
  31. Chapter 6
    Assessment of Fetal Well Being
    -Diagnostic procedures
    • Ultrasound:hi freq. sound waves
    • -external and internal transvaginal
    • -doppler flow(measures blood flow)
    • Reasons for US:confirm pregnancy, gest age, maternal structures, placental grading, use with amniocentesis and biophysical profile
    • :if patient has vaginal bleeding, decreased fetal movement, preterm labor, rupture of membranes
    • Prep: have client drink 1-2 qts of fluid prior
  32. Chapter 6
    -Dx procedures
    Biophysical Profile
    • Biophysical Profile Use of real time US to visualize fetus amd observe responses to stimuli
    • Use point system of 0-2 2 being good
    • tests:FHR to nonstress test, breathing movements, gross body movements, fetal tone, amniotic fluid volume
  33. Chapter 6
    -Dx procedures
    Non stress Test
    • noninvasive procedure, doppler is used to monitor FHR and a tocotransducer used to monitor contractions when mom feels fetus move she pushes a buttin and then the trace is marked on the contraction sheet to determine FHR to Fetal movement
    • Findings:reactive:if FHR is a normal baselinerate with moderate variablity accelerates 15 bpm for at least 15secs and occurs 2 or more times in 20min period
    • Prep: semi fowlers position.
    • anticipate CST(contraction stress test)
    • , or BPP if nonreactive
  34. Chapter 6
    -Dx procedures
    Contraction stress test
    • nipple stimulated for 2-3 minutes which causes pituitary gland to release oxytocin, stop nipple stim when experiences contraction
    • -do not hyperstim uterus
    • =no late decelerations
    • =late decelerations
  35. Chapter 6
    -Dx procedures
    • The aspriation of amniotic fluid
    • preformed after 14 weeks
    • reasons:maternal age >35
    • previous birth with a chromosome abnormality
    • parent is acarrier of chromosomal anomaly
    • :L/S ratio is 2:1 =lung maturity
    • reasons:
    • meconium in fluid
    • lung maturity assessment
    • alpha fetoprotien
  36. Chapter 7
    Bleeding during pregnancy
    -Spontaneous abortion/Miscarriage
    • Pregnancy terminated by week 20
    • Types: threatened, inevitablem incomplete, complete, and missed
    • Risks:maternal age, DM, chromosomal (50%)Trauma, injury, substance abuse, maternal infections
    • Dx Procedures:US, Exam of cervix, D&C D&E
    • refrain from sex for 2 weeks avoid pregnancy for 2 months
  37. Chapter 7
    Bleeding during pregnancy
    • abnormal implantationof the fertilized ovum outside of the uterus
    • 2nd most leading cause of bleedig early in pregnancy
    • Risks:pelvic inflammatory disease and IUD
    • S/S: unilateral stabbing pain, dark red/brown in LAQ
    • referred shoulder pain., N/V, shoch, hemorrhage, elevated WBC
    • Meds:methotrexate:avoid alcohol consumption and folic acid to px toxicity
  38. Chapter 7
    Bleeding during pregnancy
    -Molar Pregnancy
    • grapelike clusters that makes the placenta swollen, fluid filled and the embryo fails to develop beyond a primitive state.
    • rapid metastasizing malignancy
    • types:Complete:paternally derived
    • no genetic material, no placenta, 20%progress towards choriocarcinoma
    • Partial:both materal and paternal fertilized by 2 or 1 sperm in which meiosis or chromosome reduction and divison do not occur
    • 6% progress into choriocarinoma
    • Risks:low protein intake, <18, >35
    • S/S vag bleeding at 16 weeks.N/V
  39. Chapter 7
    Bleeding during pregnancy
    -Placenta Previa
    • occurs when placenta implants in the lower segment of the uterus. the abnormal implantation results in bleeding during the thrid trimester. as the cervix begins to dilate and efface
    • Types: complete or total, incomplete or partial, marginal or low lying.
    • Risks:Hx of placenta previa, uterine scarring, age>35, multifetal gestation, closely spaced pregnancies
    • S/S painless bright red bleeding, soft relaxed uterus, fundal ht greater then usual, palpable placenta, decreasing urinary output
    • Meds:corticosteroids(fetal lung maturation) anticipate cesearen birth.
    • bedrest, blood replacement, nothing inserted into vagina
  40. Chapter7
    Bleeding during pregnancy
    -Abruptio placenta
    • premature separation of the placenta. occurs after 20 weeks, significant maternal and fetal morbidity, leading cause of maternal death
    • Risk:maternal HTN, blunt trauma, cocaine abuse, smoking, short umbilical cord, multifetal prgnancy, high parity, advanced maternal age.
    • S/S: sudden onset of intense localized uterine pain and bright red vaginal bleeding, board like abd. firm rigid uterus, hypovolumic shock.
    • Tx:IV fluids, O2 8-10 via mask.
    • give bllod and corticosteriods to develop fetal lungs.
  41. Chapter 7
    Bleeding during pregnancy
    -Vasa Previa
    • presence of fetal blood vessels crossing the amniotic membranes over the cervical os. high mortality fetal hemorrhage when cervix dilates,
    • S/S:painless heavy bleeding, fetal brady.
    • Tx:iv fluids, o2 8-10 mask, c