Maternal Child Exam 1

MCH Study Guide Test 1/50 questions 1. Women’s health encompasses breast care, GYN exams, and assessments. Be comfortable with the parameters of education for Self breast exams, and what is normal for a woman to note when doing breast exam? Lumps bumps do your own breast exam 10 days after menstrual 2. What is the most common complaint with the menstrual cycle? Dysmenorrhea = painful menstrual teach heat diet exercise pharmacology NSAIDS and complications; stress, diet, body fat medication, drugs, alcohol STI’s- some are bacterial and we treat with antibiotics some are viral we treat symptomsstart retroviral to prevent issues with baby and risks you have decreased immune system in pregnancy 3. If a patient finds a breast lump how will you advise her? Call health care provider make an appointment 4. What is your role in the GYN exam 5. Contraception - Forms of birth control – IUD- must be monogamous, nuvaring, patch, depo- take calcium, condoms, pills- take same time every day, nexplanon, diaphragm, OTC Remember birth control choice should be based on a patient’s lifestyle – if she cannot swallow pills do not offer oral contraception – right? Women who breast feed DO NOT need estrogen based birth control it depletes prolactin 6. Emergency contraception – take within 72 hrs. take not birth control don’t cause abortion N/V don’t protect against STI’sfollow up 7. Preconceptual care is provided for a meansto identify risks and discuss lifestyle provide nutrition, genetic issues prenatal vitamins, community resources. 8. Pregnancy – understand the structure and function of the external and internal genitalia. The uterus- is to hold the fetus and menstrual cycle Ovaries- house eggs and produce estrogen (growth hormone) and progesterone (helps women maintain pregnancy) Fallopian tubestransports eggs they are fertilized in the ampulla (largest part opening) Know the purpose of each in the process of pregnancy. 9. Please identify pregnancy history – G, TOTAL PREGNACIES F, FULL TERM P, PRE-TERM A, ABORTIONS L, LIVING 10. What is fetal well- To assess fetal development use fundal height fetal heart rate and fetal movement. When are fetal heart tones audible with a Doppler? Fetal heart rate can be identified at 10-12 weeks. Fetal movement starts in prima- first time mom @ 18weeks more than one child 16-20 weeks. The uterus becomes an abdominal organ and is palpated at 12-14 weeks and at 20 weeks it is at the umbilicus. Can you measure fundal height? To measure place the 0 on tape measure at the pubis symphysis and measure up. Can you date a pregnancy using Naegele’s Rule? Subtract the Last menstrual period month by 3 at 7 to the day EX LMP 02-01-18 = EDD of 11-08-18 Know the normal parameters of fetal growth. What are the parameters and what does it mean if the fetus falls outside those parameters? 11. Fetal development from the conception through the embryonic (critical) period, to the placental development and beyond. – It is all about the placenta. What risk factors will impede placental perfusion to the baby. 12. Know normal discomforts of pregnancy and what is not normal and how do nurses educate their patients on the difference. Look at each system. What a normal change means to her and what education you would give. 13. What activity is appropriate for the pregnant patient? Low impact 14. Placenta is the ‘work horse’ organ of pregnancy – what does it provide/what it doesn’t provide. 15. Amniotic fluid what is the purpose? What is the issue with oligohydramnios, and polyhydramnios. 16. Nutrition is a key factor in pregnancy outcome – what is essential to include. What do most women need additional supplements for? Explore the vegetarian diet. Explore the problem of generalized nausea and vomiting – not severe – explore food fads. What are the risks to the fetus if mom does not gain weight or does not eat properly? And keep in mind the questions regarding the use of alcohol in pregnancy – it is never acceptable. 17. Prenatal testing - multiple tests are completed - recognize the difference between a screening exam and a diagnostic exam. Include diagnostic testssuch as ultrasounds too. Glucose done at 24-28 weeks When do we provide them and why? Specifically the labs drawn in the early pregnancy – MSAFP/ quad screen looks for opening in the body of the yet it has high false positive result. baby or the Triple screen when and why drawn, and we know Folic Acid is used to help prevent the development of the Neural Tube and the absence of openings, also the existence of some chromosomal abnormalities – ie: Down syndrome. 18. Complications of pregnancy – bleeding can be normal or abnormal – what are the causes of both? Know the difference between placenta previa/ placental abruption. What are the risk factors for both? Previa is a bleeding disorder and is painless has attached itself to the lower part of the uterus and will deliver first. When bleeding stops teach pelvic rest no sex fingers NOTHING in vagina. If she starts back bleeding because she is dilating MUST START C-SECTION. An abruption is painful the placenta is tearing away from the uterus (painful) the uterus fill with blood causing a tense abdomen CSECTION NOW!! 19. Preterm labor – know signs Contractions before 37 weeks WITH CERVICAL CHANGE 2cm or 80% effaced fetal fibronectin test used to detect if it is positive then she is AT RISK for preterm labor if neg then she has a less risk also fetal monitoring causes DEHYDRATION and VAGINAL INFECTION Terbutaline stops or slows contractions -side effects tachycardia HR MUST BE UNDER 120 BEFORE MED GIVEN if it dosent work GIVE MAGNESIUM SULFATE START WITH 4G follow up with 2g maintenance dose it relaxes smooth muscles MONITOR RESPIRTORY (INTERVENTIONS) q1hr vitals, foley, bed rest, lung sounds q1hr may recommend betamethasone to doctor if pt is 24-34 weeks it increases lung maturity of baby 20. Pre – eclampsia not a real syndrome until after 24wks– signs and symptoms objective- edema, hypertension proteinuria subjective- headache, blurred vision epigastric pain, feeling puffy, not urinating much. Treatment- Give magnesium sulfate it relaxes smooth muscles and lower B/P MONITOR BP 4G initial dose 2g maintenance to prevent seizures continue mag 24hr after baby born to prevent rebound nursing interventions- LOC, IV placement, q1hr vitals and lung sounds, bed rest, foley, fetal monitoring, DTR, dim light, seizure precautions, neuro checks 21. Know the medications used in pregnancy both the normal supplementation and those used to manage preterm labor and pre eclampsia. IUGR- baby smaller than should be with no body fat two babies 5lb look different no body fat head bigger wrinkly skin 22. Know specifically magnesium sulfate It is the first line defense in pre-eclampsia….not to prevent hypertension but to prevent.......?? SEIZURS!!! 23. Diabetes in pregnancy- Type 1- insulin dependent, autoimmune main concern FETAL ANOMOLIES because mom is already on insulin if glucose is uncontrolles sugar goes to baby they become MACROSOMIA (head and chest = LARGE BABY!) lungs immature Type 2- dietary issue may need insulin if diet remains uncontrolled if insulin is given then baby at risk for issues Gestational- pregnancy only dietary problem once insulin is started it is now a vascular issue now the differences of fetal surveillance with Type 1 vs Type 2, vs Gestational DM – what is the risk to the baby once baby is born they be jittery, hypoglycemic possible respiratory problems. 24. Hyperemesis Gravidarum - a problem of extreme nausea and vomiting causing electrolyte imbalance , dehydration and severe weight loss – what is the nursing intervention? Hospitalize to replace fluid 25. Do you understand the concept of perfusion, oxygenation, the hormone feedback system, and the responses of the body under the hormone influences? You will do well.