NURS 629 Exam 1(OBGYN)2022

Routine office visit times every 4 weeks until 28 weeks every 2 weeks until 36 weeks every week from 36 to delivery Biweekly after 40 weeks First Trimester Normal findings breast pain, enlargement, changes in pigmentation, constipation, excessive salivation and bad taste in mouth, fatigue, flatulence, headache, hemorrhoids, nausea and vomiting, urinary frequency and incontinence, varicosities of vulva and legs. Second Trimester Normal findings backache, dyspnea, epistaxis, leukorrhea, ligament pain, muscle cramps in the calf, thigh, or buttocks, PICA, syncope. Third Trimester Normal findings Braxton-hick's contractions, discomfort in the upper extremities, edema, heartburn, insomnia, joint pain/ pelvic girdle pain. First Trimester Danger Signs spotting or bleeding, cramping, painful urination, severe vomiting and/ or diarrhea, fever higher than 100.4F, symptoms of vaginal infection or STIs, persistent or severe low abdominal pain, lightheadedness, dizziness, abdominal trauma. Second Trimester Danger Signs regular uterine contractions (6 or more per hour), unilateral leg or calf pain, edema, pain with movement, redness, heat, and tenderness or coldness, numbness and paleness to extremity, sudden gush or consistent leaking of fluid, absence of fetal movement for more than 24 hours after quickening, sudden weight gain, significant edema of the face and/ or hands, severe upper abdominal pain, headache with visual changes and/ or photophobia. Third Trimester Danger Signs decrease in daily fetal movement, after 37 weeks gestation, when contractions are 3-5 minutes apart if a primipara or 5-8 minutes apart if a multipara lasting 45-60 seconds and strong in intensity or with the characteristics of true labor. What oral contraceptive can be given to breast feeding women Progestin-only pills What immunizations can be given during pregnancy Hepatitis B, inactivated influenza, Tdap at 27-36 weeks How do we screen for gestational diabetes 50 gram oral glucose with a blood draw 1 hour later to determine glucose levels. If the glucose level is greater than 130-140 then a 3 hour 100 gram oral glucose tolerance test is performed. When do we screen for gestational diabetes 24 weeks What plasma glucose levels would indicate gestational diabetes Fasting /= 95 1 hour /= 180 2 hour /= 155 3 hour 140 What is the treatment for mild pregnancy induced hypertension? Lifestyle modification: smoking cessation, healthy diet, regular exercise. Implement close observation Signs and symptoms of mastitis Flu-like symptoms including malaise, fever, and chills. Tender, hot, red, painful area, or lump in the breast. Fever is often high, tachycardia, breast exam reveals warmth, redness, tenderness, and swelling. Nipple may be cracked or abraded and breast distended with milk. What is the first line therapy for mastitis Dicloxacillin 250-500mg every 6 hours for 10-14 days. Erythromycin 500mg every 6 hours for 10 days if PCN allergy. Tylenol as needed. Ice or warm packs. Continue to nurse infant on both breasts but begin on unaffected side. Increase fluid intake. What antibiotic cannot be given if an infant is nursing and less than 1 month Sulfa When should you suspect a breast abscess If there is no resolution of symptoms after several days of antibiotics. Pitting edema is possible and fluctuation may be felt over the affected area. This usually requires both abx and drainage. Refer to physician. Culture and sensitivity of breast milk. S/S of gestational hypertension BP greater than 140/90 after mid-pregnancy but no proteinuria Fundal Height at 12 weeks Symphysis pubis Fundal Height at 16 weeks between symphysis pubis and umbilicus Fundal height at 20 weeks umbilicus and measures 20 cm Fundal Height at 36 weeks just below the xiphoid process and measures 36 cm How does fundal height increase in a linear fashion at about 1 cm per week What is the variation in fundal height 1-2 cm. Make sure woman has emptied her bladder as this can elevate the fundus. Positive signs of pregnancy Auscultation of fetal heart sounds Palpation of fetal movements Radiologic and/or US verification of gestation Fetal development at 4-5 weeks gestational sac within the decidualized endometrium Fetal development at 5.5 weeks secondary yolk sac fetal development at 6 weeks Visible embryo and heart motion fetal development at 7-8 weeks fetal limbs are identifiable and fetal head is proportionately larger than the body fetal development at 9-12 weeks fetal movement, the stomach, bladder, umbilical cord, and spine can be seen fetal development at 11-14 weeks most normal fetal anatomic features can be identifiable by sonography