COTC NURS 215 OB Module 2 Exam Complete Study Guide

True Labor -Regular contraction pattern -Progressive dilation and effacement -Contractions do not stop with rest -Contraction intensity increases with walking -Discomfort felt in the back and Front False Labor -Irregular contractions -Little or no change in contraction interval and duration -Minimal to no cervical change -Contraction not affected by walking -Rest decreases contraction -Discomfort only felt in the front Regular contraction pattern -Intervals shorten -Duration and intensity increase When should a patient come to hospital -any suspected or known leakage of fluid vaginally -bright red bleeding vaginally -decrease in fetal movement -Contractions are 5 minutes apart for 1 hours if primipara -Contractions are 6-8 minutes apart for 1 hour if multipara -patient cannot walk or talk through contractions -other intense pain or gut feeling that something is wrong Assessment upon admission includes Labor Status Status of membranes Status of Cervix Status of contraction patterns Pain EDD/Prenatal care history and risks Leopold's for fetal position confirmation Labs/Consents Nursing Priorities Membrane Rupture Cord prolapse assessment and fetal well-being Nurses 1st priority is to monitor for NRFHT NRFHT Non-Reassuring Fetal Heart Rate SROM Spontaneous Rupture Of Membranes AROM Artificial Rupture Of Membranes PROM Premature Rupture of Membranes Sign of membrane rupture Leakage of amniotic fluid before labor at any gestational age Cervical Assessment -Effacement, dilation, and station -Membrane status and fluid characteristics -Sterility critical once membranes rupture -Multiple contraindications to digital exam/no exam schedule-look for clues. Contraction assessment TOCO (external) versus IUPC (Internal) Duration-begininning of contraction to the end Frequency- beginning of contraction to the beginning of the next. TOCO External contraction monitor IUPC Intrauterine Pressure Catheter: -A device placed into the amniotic space during labor in order to measure the strength of uterine contractions. Descent and Engagement Passage of the widest diameter fetal presenting part below the plane of the pelvic inlet Downward movement Station -4 High Head head is ballotable Station -2/-3 Flexion and decent Zero Station Engaged babies head is at the ischial spines Station +2 Deeply engaged Station +4 On pelvic floor and rotating Station +5 Rotation into A.P. External monitoring Device placed over upper fetal back for fetal heart tones and fundus for contractions Breech external monitoring Device typically placed around maternal umbilicus Internal monitoring FSE placed by skilled person-membranes must be ruptured IUPC for contraction monitoring Baseline Variability The beat to beat fluctuation of the heart from the baseline average up and down -Marked -Moderate/Normal -Minimal -Absent Marked variability Greater than 25 beats/min can be from early, mild hypoxia or fetal stimulation Moderate Variability Normal 6-25 beats per minute Minimal variability Detectable, but less than 5 beats per minute Absent Variability undetectable Accelerations transient increases in the FHR normally caused by fetal movement onset to peak <30 seconds and lasts <2 minutes Acceleration must be a minimum of 15X15 to count Considered a Positive sign of labor Early Decelerations Lowest point consistently at or before midpoint of contraction. Cause is pressure on the fetal head *Not representative of a nonreassuring status Nursing Actions Early Deceleration This pattern may indicate cervical changes and advancing labor. Check patient's cervix and question her regarding feelings of pressure Monitor patient Late Decelerations Lowest point consistently After the peak of contraction -Considered consistent if happening with 50% or more of the contractions *Non-reassuring pattern* Probable causes of Late Decelerations Poor uteroplacental perfusion Nursing actions Late Decelerations Position patient on left side increase IV fluids Oxygen via face mask if minimal or no variability STOP Pitocin Monitor maternal BP and pulse Alert care provider Support family Prepare for possible Cesarean Variable Decelerations Have a U or V shape An abrupt onset and return to normal; usually correlate with contractions Most concerning when heart below 70 and lasts for greater than 60 seconds or if slow return to baseline. Cause of Variable Decelerations umbilical cord compression thought to be vagus nerve firing from the cord compression. Nursing Action Variable Decelerations Facilitate position changes to see if pattern corrects Report to care provider Possible treatment for variable decelerations Amnioinfusion to cushion cord VEAL CHOP V- Variable C- Cord Comphression E- Early Decels H- Head Compression A- Accelerations O - OK L-Late Decels P - Placental insufficiency Fetal Presentation -Fetal part that enters the maternal pelvis first -Three major categories: Cephalic Breech variations Shoulder Labor First stage Latent Active Transition Latent 0-3 cm; contractions every 10-30 minutes duration 30 seconds Active 4-7 cm; contractions every 2-5 minutes duration 40-60 seconds Transition 8-10 cm; contractions 1.5-2 minutes duration 60-90 seconds Labor Second Stage Pushing stage-Birth -begins with complete dilation and ends with birth of baby. -takes 1-2 hours average in primipara Assessment during Labor second stage Maternal HR and BP FHT assessed every 5-15 minutes Labor Third Stage Placenta From birth of neonate until complete delivery of the placenta Should take no more than 30 minutes after birth of baby. Signs and symptoms of Placental separation Globular shaped uterus rise of the fundus in the abdomen sudden gush of blood vaginally elongation of the cord Labor Fourth Stage Immediate recovery period that lasts between 1-4 hours following birth Focussed assessments to watch for hemorrhage Fourth Stage of labor expected outcomes -Typically 250-500 mL of blood lost from delivery -Fundus between symphysis pubis and umbilicus at first -N & V usually cease -Shaking chill is thought to be caused from exertion of labor -Urinary retention not atypical assist with emimination as needed. Nurses’ Role Immediate recovery Mom -admin oxytocin IV as ordered -Assess vitals, fundus, loch every 15 minutes the first 1-2 hours per policy -HR, BP, loch and fundal assessment -Assess LOC, pain, bladder distention -Maintain cold packs frequently Nurses Role Immediate recovery Baby -Assessment APGAR at 1 and 5 minutes -Facilitation of cardiopulmonary status/thermoregulation/blood glucose -Admin Vitamin K, erythromycin ophthalmic ointment, ID bands, bonding Women's Breast Health -Breast Self Awareness -Breast Self Exam -Clinical Breast Exams -Mammography Breast Self Awareness BSA Being aware of how breasts normally look and feel Breast Self Exam BSE BSA with inspection and palpation at end of menstruation monthly; in front of mirror, lying down, in shower Clinical Breast Exams CBE -Exams done by trained Provider -Recommended annually at age 40 Mammography -Screening tool for Breast CA -Should start annually at age 45 Common Breast Diseases Fibrocystic Breast Changes Other common diseases: -Fibroadenoma -Intraductal Papilloma -Duct Ectasia Fibrocystic Breast Changes -Common, benign, tenderness, Lumpiness, Influenced by the menstrual cycle -Most prevalent in women 20-50 -Sometimes this can be associated with Methhylxanthines (caffeine products) Methylxanthines Caffeine Products Coffee Tea Cola Chocolate Some meds BSE Inspection Three different positions Look at the size, symmetry, shape contours and direction, look for changes in the skin, check the nipples BSE Palpation While lying down, then repeat while sitting -Press lightly feeling for abnormalities or changes ACOG American College of Obstetrics and Gynecology ACOG recommendations CBE Every 1-3 years for women aged 25-39 years Every year for women aged 40 years and up ACOG BSA and BSE ACOG believes that BSE is part of BSA and supports BSA USPTF United States Preventive Services Task Force USPTF recommends/doesn't USPTF does not recommend BSE based on studies ACS American Cancer Society ACS Breast screening Does not recommend BSE but stresses BSA Recommend: 40-44 years give option to start screening with a mammogram yearly 45-54 should get mammograms every year 55 and older can switch to mammography every other year or continue annually Breast CA 2nd leading cause of cancer death in women -women have a 1 in 8 chance of developing breast CA -Breast CA is most common in Non-hispanic white women. Treatment Breast CA Tx will depend on: -Stage of CA -Optimal tx for that stage -Personal preferences -Risks and benefits of treatment -Tx may include sx, chemo, radiation, or a combo Breast CA risk factors -Age -Sex(female) -Hx of breast CA -BRCA1 ro BRCA2 gene mutation -Family Hx (first degree relative) -HRT -Obesity -alcohol consumption -Nullipara -first pregnancy post 30 years -never breast feeding -longer reproductive phase -high dose radiation to chest -physical inactivity -smoking Breast CA Nursing Considerations -Emotional, psychological support of the patient -Teach, clarify, allow questions -Remember to include the family-support, education -Encourage women to take action to reduce modifiable risk factors Pelvic infections Lower genital tract infections Upper genital tract infections Lower genital tract infections Vaginitis BV Yeast infections STD's Upper genital Tract Infections Pelvic inflammatory disease PID Urinary Tract Infections UTI Asymptomatic Bacteruria Lower UTI Upper UTI Asymptomatic BActeruria Bacteria in the urine without any clinical symptoms Lower UTI Cystitis Urethritis Upper UTI Pyelonephritis: acute and chronic Interstitial nephritis Renal abscess and perirenal abscess Risk factors UTi wiping front to back sexual ax diabetes Pregnancy catheterization suppressing urination advancing age Other Pelvic health problems/concerns Vulvitis Bartholin gland cyst cervicitis cervical CA Overian masses uterine masses endometrial CA endometriosis PCOS Pelvic health test Pap smear Common Pelvic/Gynecologic sx procedures -Hysterectomy -Dilation and Curettage -Uterine Ablation -Salpingectomy-BPS -Oophorectomy -LEEP LEEP loop electrosurgical excision procedure Infertility IUI DI IVF IUI Intrauterine insemination DI Donor Insemination IVF In Vitro Fertilization Perimenopause This is the time before menopause during which a woman moves from normal ovulatory cycles to the cessation of menses -on average lasts around 5 years -Contraception is a major concern Perimenopause signs and symptoms -Mensrual irregularities -changes in hormones-estrogen, FSH -vasomotor symptoms-hot flashes -mood changes -difficulties with memory Menopause One full year without mentruation Usually occurs between 45 and 58 years of age *51 is the average age in the US Onset is influenced by overall health, weight, nutrition, lifestyle, culture, and genetic factors Menopause Physical changes Breasts lose density vasomotor changes Increased risk of Osteoporosis changes in lipid and lipoprotein levels increased risk for CVD, HTN, and stroke changes in cognitive function uterine lining thins and atrophies fallopian tubes and ovaries atrophy vaginal mucosa loses elasticity and becomes thinner vaginal itchy and dryness loss of pelvic tone Nursing considerations for menopause HRT/MHT Complementary approaches HRT/MHT -estrogen best for post hysterectomy patients increased risk of uterine and breast CA -Estrogen/Progesterone Complementary approaches Menopause -Black cohosh -phytoestrogens -DHEA dietary supplementation -hypnotherapy -meditation -acupuncture -yoga Menopause and Cardiovascular Disease CVD is the #1 killer of women in the US Change in lipid and lipoprotein levels during and after menopause -this puts women at risk for CVD, HTN, HLD, CVA Risk factors for CVD Family hx advancing age obesity HTN Diabetes elevated cholesterol race Nursing Considerations Menopause: CVD Risk factors for CVD in women increase around the time of menopause CVD is responsible for the death of 1 in 3 women fewer women than men survive and initial heart attack MIs present differently in women than in men CVD is largely preventable Menopause and Osteoporosis diminished bone density and bone quality leads to decreased bone strength major health concerns for women, after menopause because of decreased estrogen women who go through menopause at a younger age will have the most bone loss osteoporosis causes and increased risk for fractures Risk factors for osteoporosis hx of fx post age 50 low bone mass being thin/small framed advanced age family hx use of certain meds abnormal absence of menses Early onset menopause anorexia nervosa low intake of Ca+ Vit D deficiency Cigarette smoking Excessive alcohol use inactive lifestyle being Caucasian or asian Nursing considerations Menopause Osteoporosis -there is a direct relationship bt lack of estrogen and development of osteoporosis -osteoporosis is largely preventable Osteoporosis Prevention Calcium vitamin D regular weight bearing exercises smoking cessation moderate intake of alcohol fall prevention strategies bisphosphonates Violence Against women Stats -35% of women have had experiences of IPV -38% of female murders are committed by an intimate partner -Sexual assaults are one of the most underreported violent crimes in the US -9 out of 10 rape victims are female Forms of Abuse physical emotional sexual isolation economic coercion intimidation using others male privilege stalking Contributing Factors to Domestic Violence childhood experiences male dominance in the family marital conflict unemployment or low socioeconomic status traditional masculinity or hypermasculinity internalized homophobia Common myths about DV Domestic violence is uncommon the abused person has provoked the abuser in some way alcohol and drugs causes battering battered women can easily leave the situation-This can be DANGEROUS DV is a low income or minority issue Battered women are safer when they are pregnant Cycle of Violence Tension building phase Act of violence Honeymoon phase Calm phase