Steffy Greel HESI Patient Review, HESI Maria Pratt, HESI Lily Larson, Hesi Case Study Susan Wilson #2 MNB, Trans Test 2 with Complete Solutions

Steffy Greel HESI Patient Review, HESI Maria Pratt, HESI Lily Larson, Hesi Case Study Susan Wilson #2 MNB, Trans Test 2 with Complete Solutions Important to Know 1. Your first answer is the one that counts towards your score, but you'll be prompted to try again if you get the wrong answer. When you get the right answer, you'll go to the next section. 2. If you choose to re-take a Patient Review, you will no longer be able to see your previous score. -Answer-Section 1 You work in a prenatal clinic as a patient educator for mothers with substance abuse problems.Your caseload includes Steffy Greel, a 30-year-old multigravida who is two months pregnant. Steffy has a history of heroin addiction and repeated failures to stay drug-free.However, married about a year ago, Steffy decided to "turn her life around." She was placed on methadone during detoxification treatment of heroin addiction. At the recommendation of her treatment team, she continued on methadone maintenance for her addiction after initial detoxification. Steffy's pregnancy was planned, and it was agreed that it was in Steffy's best interest to continue methadone treatment during pregnancy, despite risks to the fetus. You know that methadone is a common treatment for heroin addiction. After initial detoxification, methadone provides a legal substitute drug that is long-acting (can be taken once a day) and can be taken orally. With actions similar to heroin, methadone has been found effective in preventing readdiction to heroin. Because pregnant women on methadone receive the drug on a regular basis, they exhibit more predictable and reliable behaviors than those on heroin, who focus on getting and using heroin.Pregnant women on methadone are more likely to have supervised prenatal care and more successful outcomes of their pregnancies. Infants of methadone users are also less likely to be stillborn, generally grow better in utero, and weigh more at birth, than those born to heroin users. However, methadone crosses the placenta and can affect the fetus. Withdrawal symptoms in newborns of methadone-maintained mothers (neonatal abstinence syndrome) may be severe and prolonged. Steffy is being followed closely as part of her methadone maintenance program, and receives counseling on an ongoing basis.At this prenatal vi 1. You provide Steffy with a great deal of information about smoking and pregnancy. This includes the fact that cigarette smoking during pregnancy is associated with: Select all that apply An increased risk for low birth weight babies An increased risk for preterm labor A higher incidence of ophthalmia neonatorum A higher incidence of newborn HIV infection -Answer-An increased risk for low birth weight babies Nicotine is a drug found in tobacco; it has a vasoconstrictive effect, reducing oxygen and nutrient supplies to the fetus and contributing to a low birth weight (LBW) infant. Carbon monoxide is one of many compounds found in cigarette smoke; it is released in the mother's circulation, passes through the placenta to the fetus, and attaches to maternal and fetal red blood cells, further reducing oxygen content, and also contributing to risk for a LBW infant. An increased risk for preterm labor Nicotine is a drug found in tobacco; it has a vasoconstrictive effect, reducing blood supply to the placenta. This can ultimately lead to miscarriage, fetal death, or premature labor. Carbon monoxide, a by product of smoking, is one of many compounds found in cigarette smoke; it is released in the mother's circulation, passes through the placenta to the fetus, and attaches to maternal and fetal red blood cells, further reducing oxygen content, and also contributing to risk for miscarriage, fetal death, or premature labor. You also teach Steffy that children born to women who smoked during pregnancy have an increased tendency to develop allergies, ear infections, respiratory infections, and childhood asthma. In addition, infants born to smokers are twice as likely to die of sudden infant death syndrome (SIDS).Steffy seems interested and concerned as you review the dangers of smoking with her, and asks you to tell her more. -Answer- 2. You tell Steffy that each time she smokes, her baby is affected. Which vital sign changes are likely to occur within minutes of Steffy smoking a cigarette? Select all that apply A decrease in her blood pressure and pulse An increase in her blood pressure and pulse A decrease in the fetal heart rate An increase in the fetal heart rate -Answer-An increase in her blood pressure and pulse Blood pressure and pulse increase with cigarette smoking. Nicotine raises blood pressure and diminishes oxygen supply to tissues through its vasoconstricting effect on blood vessels. Carbon monoxide further reduces oxygen supply. Pulse rate increases as a compensatory response to meet circulatory needs for oxygen. An increase in the fetal heart rate Smoking causes both fetal blood pressure and pulse to increase. Nicotine levels in fetal serum are higher than in maternal serum. 3. With regard to smoking, Steffy asks whether "cutting back now" would help her baby. You correctly inform her that: cutting back may improve the chances that her baby would be of normal weight at delivery the nicotine in cigarettes is addictive and cutting back or quitting is difficult you would first need to determine the tar content of the brand of cigarettes she smokes - Answer-cutting back may improve the chances that her baby would be of normal weight at delivery This information would be appropriate. Although the risk of congenital anomalies associated with smoking (such as cleft lip and cleft palate) have already affected Steffy's baby, decreasing the amount of cigarettes smoked per day (or quitting altogether) now would significantly reduce other risks associated with smoking, including intrauterine growth restriction (IUGR), preterm delivery, and abruptio placentae. Steffy seems genuinely interested in stopping smoking, although she admits it will be hard since her husband and all her friends smoke. -Answer- 4. Which of the following approaches would initially be useful in helping Steffy quit smoking? Select all that apply Recommending the use of a nicotine patch to satisfy her craving for cigarettes Providing her with literature about the dangers of smoking and encouraging her to "just quit" Encouraging her husband to stop smoking Referring her to a self-help support group -Answer-Encouraging her husband to stop smoking Steffy's husband is a smoker. As long as he continues to smoke, it will probably be difficult for Steffy to stop smoking. In addition, Steffy's exposure to second hand smoke also puts her at risk for giving birth to a low birth weight baby. Referring her to a self-help support group A support group specifically designed for pregnant women who want to stop smoking would be helpful. Support and encouragement from other women in her same situation would increase the chances of successful smoking cessation. Smoke Enders for Pregnant Women is one such group. You provide Steffy with some literature about smoking and pregnancy, which further explains some of things you have been discussing. Steffy agrees to read the literature you provide her, and will consider joining a support group, which would actively help her to stop smoking. Steffy says that she wants to try to cut back or quit smoking now, but wonders about smoking again after her baby is born. She wants to breastfeed. You explain to Steffy that nicotine is excreted in breast milk for up to two hours after a breastfeeding mother has smoked. In addition, smoking mothers may have problems with supplying their infants with enough milk. It will be best for Steffy to give up smoking entirely if she plans to breastfeed.Also, passive exposure to smoke can increase risk for respiratory problems in an infant, and sudden infant death syndrome (SIDS). You go on to discuss with Steffy the implications of drinking alcohol durin -Answer- 5. You go on to explain to Steffy that alcohol consumption can be especially damaging to her baby during: