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What are some signs of abuse?
- 1. has unexplained injuries
- 2. seems to be "sick" often, but w/o specific sx: 2/2 depresison or anxiety
- 3. seems consumed w/ keeping partner from getting angry
- 4. may constantly apologize for things
- 5. is hyper-vigilant
- 6. has low self-esteem
- 7. can demonstrate obsessive/compulsive behaviors
- 8. seems shut off from their family & friends: no social supports
- 9. has children who cling protectively
When asking about abuse, you should phrase your questions in general terms.
True or False?
False. Disclosure is rare unless victim is asked directly & specifically. I.E: has he hit you?
What are some danger signs during L&D?
- 1. Contractions: Hypertonic: strong, every 2 minutes or less lasting > 90 seconds
- 2. Poor relaxation between contractions
- 3. Abrupt pain
- 4. marked vaginal bleeding
- 5. Decreased FHR: late decel, prolonged decel, bradycardia
- 6. Tachycardia: either bleeding (hypotension) or maternal temp is high
- 7. Maternal hypotension
Childbearing age women need to be on what kind of supplement to prevent neural tube defect? Obesed pt needs to be on an increased dose for this
What is the period of organogenesis? What's the period of time where mothers should avoid taking any kinds of drugs to prevent birth defects.
14 days- 8 weeks
Fetus is most susceptible up to 8 weeks post conception
What are some herbs that are considered likely unsafe or unsafe during pregnancy?
- 1. Dong Quai
- 2. Passion Flower: caused increased clotting time. contrain during pregnancy & BREASTFEEDING
- 3. Black cohosh - can induce labor. Could stimulate contractions & result in miscarriage
- 4. Blue cohosh
- 5. Roman Chamomile: uterine stimulant
Can pregnant women use ibuprofen during the last 3 months of pregnancy?
Even though ibuprofin is category B, pregnant women should not take ibuprofen during the last 3 mos of pregnancy
List some drugs in category C
- 1.prochlorperzaine (Compazine): for n/v
- 2. Sudafed: relief nasal discomfort
- 3. fluconazole Diflucan
- 4. Ciprofloxacin
- 5. Some antidepresssants
- 6. Sacchryn (sweet-n-low)
List some category X drugs
- 1. Tetracyclines: can cause hearing loss & teeth turning yellow
- 2. for psoriasis (tegison (Etretinate) or Soriatane): can cause birth defects. Can cause pregnancy problems up to 6 months after discontinuuing it
- 3. thalimonide( sedative)
- 4. DES
List some category D drugs (clear health risks for fetus)
- 1. Dilantin: control types of seizures
- 2. Chemo drugs
- 3. Lithium
What drug when taken late in pregnancy, causes respiratory depression in newborn & baby withdrawals (irritability, shaking, exaggerated reflexes, jittery)
Diazepam (Valium) : category D
What are the 2 abx that can cause damage to fetus's ear, resulting in deafness?
Kanamycin & Streptomycin
Are ACE inhibitors & beta blockers safe during pregnancy? Why or why not?
No. Ace inhibitors, when taken in late pregnancy, can cause possible kidney damage to fetus & decreases amniotic fluid.
Beta blockers can cause fetal low BS & poor fetal growth
Pt. with a BMI of 31. How many lbs are they allowed to gain during their pregnancy?
11-20 (new standard)
1. Pt. w/ a BMI of 26. How many lbs are they allowed to gain during his/her pregnancy?
2. Pt. w/ a BMI of 16.
3. Pt. w/ a BMI of 23.9
- 1. 15-25 LBS
- 2. 28-40 LBS
- 3. 25-35 LBS
What is Braxon-Hicks contractions?
They are irregular contractions that do not change cervix. They facilitate uterine blood flow, usually go away w/ change in activity level
At 24-28 weeks, what lab works should be done on the mother, & what is it testing for?
Diabetic test to look for gestational diabetes
GBS is tested at what point during pregnancy? If positive, what's going to happen?
36 weeks. If +, we cannot treat at that point, but put on prenatal record. If baby gets exposed, strep meningitis. Administer abx during labor (usually 2 doses) to protect the baby.
When is entry to prenatal care system considered adequate prenatal care?
Entry to health care is considered adequate if initiated before 20 weeks, although practitioners would like to see women during 1st trimester
Trichomoniasis, or "strawberry cervix" can be treated w/ what?
What must the patient avoid when taking this rx?
You put a hand on the mother's abdomen & it's intense & feels hard like a rock. What does that indicate?
Placenta is torn off from the uterus
When would be the most preferred time to administer epidural?
What are the tests performed to diagnose syphillis? What's the rx for syphillis?
- 1. RPR & FTA-ABS (to confirm)
- 2. Rx for syphillis: Penicillin G
What are clinical manifestations of secondary syphillis?
- 1. rosy rash typically on palms of hands & soles of feet
- 2. white patches on inside of mouth
- 3. moist warts in the groin
- 4. swollen lymph glands
Is syphilllis bacterial or viral STI? Is it painless or painful?
Bacterial. Painless chancre
what are single dose rx for chlamydia? for gonorrhea? (in a case for a pregnant woman)
- 1. rx for chlamydia: azithromycin
- 2. rx for gonorrhea: ceftriaxone
What are the CM of gonorrhea? (a bacterial STI).
If untreated, gonorrhea can be systemic, spreads to blood & joints & cause arthritis
- 1. Burning w/ urination
- 2. White/yellow/green discharge 1-14 days after infxn
What are the rx for HPV (most prevalent viral STI)?
hint: 2 categories:
1. pt. applied & 2. hcp applied
- 1. Imiquimod
- 2. Cryotherapy, Tri-Chloro Acetic Acid
What is Hep B post-exposure prophylaxis?
HB immune globulin given < 24 hrs after exposure
What are CM for vaginitis?
pruritis, erythema, classic thick white curd
What are the 3 phases of the cycle of violence? At which point should we intervene?
- 1. Tension-build up: start. Feel like they're on edge or walking on eggshells. Avoid the problem
- 2. Acute incident: end up w/ physical injuries. INTERVENE HERE!
- 3. Honeymoon/remorse: gives hope that he can change, but he's choosing not to if he goes back to abusive behaviors
What does marked variability? What does it indicate?
- 1. Amplitude >/ 25 BPM.
- 2. Hypoxia. Acidosis. 2nd stage of labor: pushing phase.
Is moderate variability reassuring? How is it presented on the monitor?
1. Yes, it's reassuring. It means that fetus has good oxygen reserve. Its amplitude range 6-25 BMP.
Why focus on infant mortality?
B/c it measures the overall health of a country
- *used as evaluative statistic r/t adequacy of healthcare in a country
- * evaluate the adequacy of prenatal care of a country
What are some causes of bradycardia? N.I?
- *Structural defects of fetal heart
- * Maternal Hypoglycemia
- *Maternal Hypothermia
N.I dependent on cause
T or F
Primigravida engagement precedes labor lightening