NR 327 CMS STUDY GUIDE 2023/2024 LATEST UPDATE

Diaphragm: - Education: o Should be fitted per provider o Replaced every 2 years and refitted for a 20% fluctuation in weight (15lbs), after abdominal or pelvic surgery, and after every pregnancy, second term abortion o Spermicide applied with each act of coitus (sex) o Remain in place for 6hrs after coitus, no longer than 24hrs Hormonal Contraceptives: - Adverse effects: o Chest pain, SOB, leg pain from possible clot, HA, eye problems from a stroke, and HTN - Contraindications: o Hx of thromboembolic disorder, stroke, heart attack, CAD, gallbladder disease, HTN, breast or estrogen-related cancers, smokers Depo-Provera: - Injectable contraceptive - Can cause decrease bone mineral density or calcium (want to make sure that have adequate calcium and Vitamin D intake) IUDs: - Can increase the risk of pelvic inflammatory disease, can cause uterine perforation or ectopic pregnancy - Increases risk of ectopic pregnancy - Look out for: change in string length, fowl smelling vaginal discharge, pain with intercourse Infertility: - Inability to conceive after trying for 12 months - Work up: usually start with the male (sperm analysis), then if clear then turn attention to woman - Look at test for female Male Sterilization - Need to use form of birth control until said to be sterile, follow up - 20 ejaculations before deemed sterile, permanent Transcervical Sterilization - Need to continue use of birth control until about 3 months Tubal Ligation - Permanent - Surgery - Does not affect sexual activity Ch. 3: Signs of Pregnancy - Presumptive o Amenorrhea, fatigue, nausea, vomiting, urinary frequency, breast changes, quickening, uterine enlargement - Probable o Abdominal enlargement, Hegar’s sign, Chadwick’s sign, Goodell’s sign, Ballottement, Braxton Hicks contractions, positive pregnancy test, fetal outline - Positive o Fetal heart sounds, visualization of fetus by ultrasound, fetal movement Naegel’s Rule - Minus 3 months, plus 7 days GTPAL - G=how many pregnancies - T=term (/=37 wks) - P=pre-term (37 wks) - A=abortion (less than 20 wks) - L=living children Ch. 4 - FHR: can be detected at early appts by US. Can be heard by doppler late in the first trimester. Listen at the midline, right above the symphysis pubis Ch. 5 & 6: Weight gain during pregnancy: - Normal weight gain 25 to 35lbs - If someone is overweight then less 15-25 - Underweight 28-40lbs - During first trimester: no more than 2.2 to 4.4lbs for entire trimester - 1lb per week for 2nd and 3rd trimester - Extra calories of 340 calories per day for 2nd trimester - Extra calories of 452 per day for 3rd trimester - If breastfeeding need an 450 to 500 extra calories per day - Folic acid prevents fetal neural tube defects 400mcg for childbearing and 600mcg for women that become pregnant(sources of folic acid: dark green leafy veggies, OJ, dried peas and beans, and seeds, breads, cereals, grains) - Drink 2 to 3 L of water per day - No more than 200 mg of caffeine - No alcohol Diagnostic tests: - Ultrasound o Bladder full (helps sound waves) - Amniocentesis o Empty bladder prior o Done around 14 weeks o Checking for genetic abnormalities o AFP: alpha-feta protein if high, associated with neural tube defects o If AFP low associated with chromosomal disorder-such as Downs o Check LS ratio testing for fetal lung maturity o Complications: amniotic fluid embolic, hemorrhaging, infection, leaking of amniotic fluid, ruptured membranes, miscarriage - Biophysical profile (BPP) o Score between 0 and 10 (8 to 10 is normal healthy baby) o Measures 5 areas: reactive HR, breathing, body movements, fetal tone, amniotic fluid volume (each area gets a score of 2) - Non-stress test o Non-invasive o Measures fetal well-being within last trimester o Measures response of FHR to fetal movement o Give mom a button to press when feels fetal movement o Reactive normal: if FHR is a normal baseline rate with moderate variability, accelerates at least 15/min (10/min prior to 32weeks) for at least 15 seconds and occurs two or more times during a 20 min period o Non-reactive is abnormal (bad) - Contraction Stress Test o Bring on a contraction by giving Pitocin o Monitor FHR to see if late decelerations occur o If no decelerations occur that is a negative result for CST and that is good o If late decels occur that’s positive and a bad result - Chorionic-villus sampling o Can be done between 10 to 12 wks o Test for genetic abnormalities o Advantages: done earlier, identify abnormalities earlier o Can be done instead of amniocentesis