MVU Nurse 629 exam 1

MVU Nurse 629 exam 1 Three trimesters of pregnancy - ANSWER-1st: week 1-13 2nd: weeks 14-27 3rd: weeks 28 to delivery Naegeles rule of EDB - ANSWER-First day of LMP- subtract 3 months, add 7 days and one year Ultrasound to determine EDB - ANSWER-1st trimester: accurate within 7 days 2nd trimester: accurate within 10-14 days The sooner a woman gets an ultrasound the better estimate we can give for weeks gestation and tracking of fetal growth and development. Prenatal visit schedule for low-risk pregnancies - ANSWER--Preconception visit: up to 1 yr before conception -1st prenatal visit: 6-8wks after missed menses Up to 28 weeks- every 4 weeks 28 to 36 weeks - every 2 weeks 36 weeks and on -every week or more as necessary First prenatal visit should include - ANSWER-· Confirmation of pregnancy 1. Pregnancy test and ultrasound · History · Menstrual history (LMP) and obstetric history · Past medical history · Nutrition and habits: tobacco, alcohol, drugs · Genetic history: mom, father and 1st relative · Social history including work, abuse, coping · Current symptoms · Physical exam and labs 1. Pelvic exam and pap smear 2. Blood type and antibody screen 3. Rubella and hepatitis B titer 4. GC, RPR, HIV, Hep C 5. CBC 6. Urinalysis with culture 7. UDS (?) Prenatal visits 12-21 weeks - ANSWER-Quad Marker screening, discuss newborn feeding options Prenatal visit 18-22 weeks - ANSWER-Anatomy OB ultrasound Prenatal visit 24-28 weeks - ANSWER-1 hour glucose test, RH neg type and screen Prenatal visit 28-34 weeks - ANSWER-RhoGam administration, STI testing if indicated, review newborn feeding discussion, administer Tdap, preterm labor assessment and education at each visit Prenatal visit 34-36 weeks - ANSWER-Group B strep swab, review s/s of labor and review labor plan Prenatal visit 36-40+ weeks - ANSWER-fetal position assessment, cervical exam, review s/s of false labor vs true contractions Quad screening - ANSWER-Test performed at 16-18 weeks. Tests levels of Inhibin A, MSAFP, unconjugated estriol, and HCG. Has increased accuracy in screening for DS for women under 35. 1st trimester typical symptoms - ANSWER-· Breast pain, enlargement, and changes in pigmentation: wear a supportive bra, avoid caffeine use · Constipation: large amount of circulating progesterone cause decreased GI motility - use bulk-forming laxatives or Colace, exercise regularly, elevate feet on a stool while defecating to prevent straining, high fiber foods, increase fluids, drink warm fluids · Excessive salivation (ptyalism) and bad taste in mouth: good oral hygiene, good diet and adequate hydration, suck hard candy, breath mints, chewing gum · Fatigue: supplemental iron if anemic (30mg/day if not anemic, 120mg/day if anemic for at least 6 weeks), adequate sleep and rest, mild exercise · Flatulence: avoid constipation, avoid smoking, avoid large meals · Headaches: usually tension, Tylenol, avoid stress, smoking, blinking lights, sleeping late, neck and shoulder massage, regular balanced diet, stay hydrated · Hemorrhoids: OTC topical anesthetics (Preparation H, Anusol), avoid constipation, warm or cool sitz baths with Epsom salts, tucks witch hazel pads, ice packs or cool compresses, Kegel exercises · Nausea and vomiting: may use Benadryl, Dramamine, Compazine, Phenergan, reglan, Zofran, avoid triggers (certain foods), rest, avoid stress, avoid tight clothing, hypnosis, acupuncture, relaxation techniques, small frequent meals, high carb, sipping carbonated drinks, eating crackers on arising, drinking fluids between meals, avoid spicy and fatty foods, sit upright after eating, adequate hydration, vitamin B6, ginger · Urinary frequency and incontinence: resting and sleeping in the lateral recumbent position, kegals, adequate water intake, decrease water intake 2-3 hours before bed · Varicosities of vulva and legs: support hose and compression stockings, lie flat and raise legs to drain veins, avoiding crossing legs, elevate the legs as much as possible, kegals, mild exercise, warm tub baths 2cd trimester typical symptoms - ANSWER-· Backache: enlarging uterus causes lordosis - Tylenol, good posture, low-heeled shoes, pelvic tilt exercises, proper body mechanics, avoid heavy lifting, twisting, maternity girdle or belt, good bra, avoid gaining excessive weight, pregnancy pillow · Dyspnea - no constrictive clothing, sit up straight, raise arms over head while taking a breath, elevate head with pillows · Epistaxis - loosen clothing around the neck, sit with head tilted forward, pinch nostrils for 10-15 minutes, apply ice packs to the nose, avoid overheated air, avoid excessive exertion, avoid nasal sprays · Leukorrhea - hyperplasia of vaginal glandular tissue and mucosa result in white or yellow, thin, acidic discharge - keep vulva clean and dry, avoid pantyhose or other tight clothing, wear cotton underwear, remove underwear at night, avoid douching and tampon use, no powders or feminine sprays, avoid large amounts of carbs, probiotics · Ligament pain - ligaments in the pelvis stretch - change position slowly, fingertip massage, warm bath, heat for not more than 15 minutes, avoid excessive exercise, standing, or walking, frequent, short rest periods, Tylenol when pain is severe · Muscle cramps in the calf, thigh, or buttocks - changes in serum calcium and phosphate levels - avoid stretching legs, pointing toes, walking excessively, and lying on her back, wear low-heeled shoes, calf stretches, adequate hydration · Pica - iron supplements in anemic · Syncope - expansion of blood volume and pooling of blood in the lower extremities - change position slowly, avoid stress, hold on to something when rising, compression stockings, frequent small meals with adequate fluids and protein intake 3rd trimester typical symptoms - ANSWER-· Braxton-Hicks contractions - start at 6 weeks - empty bladder frequently, stay hydrated, lateral recumbent position, walk, exercise lightly · Discomfort in upper extremities - wear wrist splint, avoid aggravating movements, wear well-supporting bra, avoid slumping · Edema - lie in lateral recumbent position, maternity support hose, avoid excessive salt, plenty of fluids · Heartburn - Calcium carbonate, H2 blockers, do not lie down, bend, or stool for 2 hours after eating, sleep with HOB elevated, no restrictive clothing, no smoking, avoid hot spicy fatty gassy acidic foods, eat small frequent meals · Insomnia - Avoid caffeine, exercise, relaxation techniques, high fluid intake during the day, avoid high-sugar diet · Joint pain/ache - Tylenol, avoid excessive walking, high-heeled shoes, jarring movement, high-impact activities, heating pad, warm moist heat, cold packs, maintain good posture concerning symptoms during pregnancy - ANSWER-· Fever · Vaginal discharge that is large amount, odor, with irritation/itching · Vaginal bleeding · Palpitations · Breathlessness at rest · Swelling of upper extremities or face · Oliguria Decreased or absent fetal movement · 1st trimester: heavy bleeding · 3rd trimester: headache, blurred vision what contraceptives can be giving to breastfeeding women - ANSWER-Nothing with estrogen -Oral contractive after 6 weeks - progestin only - Diaphragm - IUD/Intradermal - Depo Provera what immunizations can be given during pregnancy - ANSWER-No live vaccinations such as MMR or varicella Gestational diabetes screening - ANSWER-· At 24-28 weeks gestation: 1-hour glucose testing (non-fasting) · If above 130-140 then 3-hour glucose testing (fasting) pregnancy-induced hypertension (PIH) - ANSWER-potentially life-threatening disorder that usually develops after the 20th week of pregnancy and is characterized by edema and proteinuria symptoms of PIH - ANSWER--headache; visual disturbances; facial, ankle, and finger edema; or severe heartburn with abdominal pain Education and treatment for PIH - ANSWER-· Prevention is key 1. Regular exercise 2. Increase protein diet 3. 8 glasses of water a day 4. Rest · Treatment of PIH or chronic HTN during pregnancy 1. Labetalol, nifedipine, or methyldopa (only severe PIH, systolic 180, diastolic 110) 2. Close monitoring 3. Kick counts 4. Non stress test (NST) 5. Weekly OB visits Fundal height at different stages - ANSWER-10 weeks- baseball size FHT via doppler b/t 10-12 weeks 12 weeks- softball size Fundus rising above symphysis pubis, palpable at this time 16 weeks- halfway between pubis and umbilicus Quickening first noted: earlier with 2nd or subsequent pregnancies: about 18-20 weeks with 1st pregnancy 20-36 weeks- 1 cm increase weekly. Uterine fundus at the umbillicus, fundal height is the same as gestational age give or take one cm Term- fundal height drops r/t fetal head engagement into pelvis Positive signs of pregnancy - ANSWER-Presumptive/Subjective · Amenorrhea · N/V · Excessive fatigue · Urinary frequency · Breast changes · Quickening · Enlarged abdomen Probably/Objective · Positive pregnancy test · Hegar's sign · Chadwick's sign · Goodell's sign · Ballottement · Fetal outline Positive/Diagnostic · Fetal heart tones · Fetal movements · Fetal sonography Hegar's sign - ANSWER-softening and compressibility of lower uterus