NR 602 Midterm Study Guide

Signs of preg. (presumptive, probable, (+)) Presumptive Signs: least obj. or subj. signs;can also be caused by many other conditions Presumptive signs include:  Amenorrhea: o Highly suggestive of preg. in a healthy fem w/ regular & predictable period. Difficult to determine in a fem w/ irregular periods or in those who do not keep track of their menstrual cycles  Nausea & vomiting: o Common symptom (~50% of pregnancies) typically occurring between 2- 16 wks. gest  Breast engorgement & darkening of areolas: o Occurs as early as 6-8 wks. gest  Breast tenderness  Fatigue  Urinary Frequency  Slight increase in body temperature: o Rise in temp. coincides w/ luteal phase & is the result of  progesterone  “Quickening”: o Mother feels baby’s movements for 1st time; starts @ 16 wks. Probable Signs: a high likelihood of preg. but there are still other conditions that may cause the findings. Preg. tests are considered probable because β-hCG also presents in molar pregnancies & ovarian cancer Probable signs include:  Goodell’s sign: o Cervical softening (around 4 wks.)  Chadwick’s sign: o Blueish coloration of the vagina & cervix (6-8 wks.)  Enlarged uterus  (+) urine or blood preg. test (β-hCG) [+] Signs of Preg.: The most reliable & most obj. signs of (+) preg. are those where the provider can confirm the presence of a fetus (+) signs include: o Palpation of the fetus by HCP o US & visualization of the fetus o Fetal Heart Tones auscultated by the HCP Preg. & fundal height measurement Schuiling, pg. 774 & Wk. 1 Lecture 12 wks. gestation:  the fundus is located @ the level of the symphysis pubis. 16 wks. gestation:  fundus rises to midway between symphysis pubis & the umbilicus 20 wks. gestation:  the fundus is typically @ the same height as the umbilicus 20 wks. gestation: the fundus enlarges approx. 1cm/wk. As the time for birth approaches, the fundal height drops slightly.  This process, which is commonly called lightening, occurs for a woman who is a primigravida around 38 weeks’ gestation but may not occur for the woman who is a multigravida until she goes into labor 25-35 wks. gestation: Measure the distance between the upper edge of pubic symphysis & the top of the uterine fundus w/ a tape measure. Fundal height in centimeters equals the number of gestational weeks (+/- 2cm). For example, a 28- wk. gestation fetus should have a fundal height that measures between 26 & 30cm. Naegele’s rule The due date or expected date of confinement (EDC) can be calculated using Naegele’s Rule  Begin on the 1st day of the last menstrual period (LMP), subtract 3 mos., add 7 days, & then add 1 yr. Example LMP: February 14, 2015 Subtract 3 mos. (Great Scott x 3): November 14, 2014 Add 7 days (N-A-E-G-E-L-E): November 21, 2014 Add 1 bear (year): November 21, 2015 Hematological Nonpregnant Fem., Ages 19–65 changes during preg. Schuiling, pg. 778 TABLE 29-3 Lab Value Changes in Preg. o Hgb: 12–16 g/dL o Hct: 37–47% o RBC: 3.5–5.5/mm3 o WBC: 4.5–11/mm3 1 st Trimester o Hgb: 11.6–13.9 g/dL o Hct: 31–41% o RBC: 3.4–5.2/mm3 o WBC: 4–13/mm3 2 nd Trimester o Hgb: 9.7–14.8 g/dL o Hct: 30–39% o RBC: 2.8–4.5/mm3 o WBC: 6–14/mm3 3 rd Trimester o Hgb: 9.5–15 g/dL o Hct: 28–40% o RBC: 2.7–4.4/mm3 o WBC: 6–17/mm3 Indications & contraindications for prescribing combined estrogen vs. progesteroneonly birth control Combined Hormonal Contraceptives (COCs)  Most COCs contain 10-35 mcg of ethinyl estradiol & 1 of several different progestins.  Drospirenone has a mild K+ -sparing diuretic effect; K+ levels checked during the 1st cycle in fem. using ACE inhibitors, chronic daily NSAIDs, angiotensin-II receptor antagonists, K+ -sparing diuretics, heparin, or aldosterone antagonists.  Fem. w/ conditions that predispose them to hyperkalemia should not use drospirenone. COC Disadvantages:  Increase the risk of VTE.  May  BP in some through an  in plasma angiotensin.  HTN is a cofactor in the dev of CV disease  development of benign hepatocellular adenomas, this SE is very rare w/ low-dose pills.  a slightly  risk of develop breast cancer;  in the incidence of cervical cancer  Mood changes, depression, anxiety, irritability  Decreased libido & anorgasmia is unusual, but possible  No protection against STDs or HIV  N/V especially in the first few cycles  Breast tenderness or pain; HA may increase Estrogen Specific SEs include :  nausea  cervical ectopy & leukorrhea  telangiectasis  chloasma (darkening of sun-exposed skin)  growth of breast tissue (ductal tissue or fat deposition)  increased cholesterol content w/in the bile (can lead to gallstones)  benign hepatocellular adenomas/changes in the clotting cascade. Effects specific to the androgenic impact of progestins include   appetite & subsequent weight gain; mood changes & depression  fatigue; complexion changes; changes in carb metabolism   LDL &  HDL cholesterol;  libido; pruritus. Effects that can be either estrogen or progestin related include  HA; HTN; breast tenderness. COC Benefits   risk of ovarian cancer (by 20% for each 5 yrs. of COC use)   risk of endometrial cancer by approximately 50%.   rates of PID requiring hospitalization, fewer ectopic pregnancies, &  incidence of endometriosis.  may Tx or improve anemia; Increased bone mineral density  Decreased pain & frequency of sickle cell disease crises  Reduces risk of ectopic preg.  Effective to treat acne, hirsutism & other androgen excess/sensitivity states  Reduced vasomotor symptoms & effective contraception in perimenopausal fem.  Decreased menstrual cramps & pain w/ more predictable menses  Can be used to manipulate the timing of menses  Effective Tx for mittelschmerz, dysmenorrhea, endometriosis, premenstrual symptoms, Progestin-only contraceptives: include the progestin-only pill (POP), injection/implant/ 3 progestin-IUD  are used continuously; no hormone-free interval  Minimal effects on coagulation factors, BP, or lipid levels & are generally considered safer for fem. w/ contraindications to estrogen, such as CV risk factors, migraine w/ aura, or a hx of VTE  do not provide the same cycle control as methods containing estrogen, & unscheduled bleeding is common w/ all progestin-only methods.  unscheduled bleeding occurs most frequently during the first 6 mos., w/ a substantial number of users becoming amenorrheic by 12 mos.  Overall blood loss decreases over time  protective against iron-deficiency anemia.  All are likely to improve menstrual symptoms, including dysmenorrhea, menorrhagia, premenstrual syndrome, & anemia  The thickening of cervical mucus is protective against PID. Progestin-Only-Pills (POP)  contain 0.35 mg of norethindrone. Each pill contains active ingredients; there is no hormone-free interval  Must be taken @ the same time each day; BC effect ends immediately upon d/c  have the fewest contraindications of all hormonal methods.  combo w