RNSG 1538 Exam II Questions {2020} – San Antonio College | RNSG1538 Exam II Questions – {A Grade}

San Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 1 DM 07/05/2020 RNSG 1538 Exam II Questions – San Antonio College # Objecti ve Concept/Focus Area 1 5, 6 Reproduction/Maternal Adaptation during Pregnancy/Presumptive Signs Subjective (Presumptive) Signs Presumptive signs are those signs that the mother can perceive. The most obvious presumptive sign of pregnancy is the absence of menstruation. Skipping a period is not a reliable sign of pregnancy by itself, but if it is accompanied by consistent nausea, fatigue, breast tenderness, and urinary frequency, pregnancy would seem very likely. 2 5, 6 Reproduction/Maternal Adaptation during Pregnancy/Probable Signs Objective (Probable) Signs Physical SignsSan Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 2 DM 07/05/2020 # Objecti ve Concept/Focus Area Probable signs of pregnancy are those that can be detected on physical examination by a health care provider. Common probable signs of pregnancy include softening of the lower uterine segment or isthmus (Hegar’s sign), softening of the cervix (Goodell’s sign), and a bluish-purple coloration of the vaginal mucosa and cervix (Chadwick’s sign). Other probable signs include changes in the shape and size of the uterus, abdominal enlargement, Braxton Hicks contractions, and ballottement (the examiner pushes against the woman’s cervix during a pelvic examination and feels a rebound from the floating fetus). Pregnancy Tests Along with these physical signs, pregnancy tests are also considered a probable sign of pregnancy. In-home pregnancy testing became available in the United States in late 1977. In-home testing appealed to the general public because of convenience, cost, and confidentiality. Several pregnancy tests are available (Table 11.1). The tests vary in sensitivity, specificity, and accuracy and are influenced by the length of gestation, specimen concentration, presence of blood, and the presence of some drugs. Human chorionic gonadotropin (hCG) is detectable in the serum of approximately 5% of clients 8 days after conception and in more than 98% of clients by day 11 (Shields, 2015). At least 25 different home pregnancy tests are currently marketed in the United States. Most of these tests claim “99% accuracy” according to a U.S. Food and Drug Administration (FDA)San Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 3 DM 07/05/2020 # Objecti ve Concept/Focus Area guideline or make other similar statements on the packaging or product insert. The 99% accuracy statement in reference to the FDA guideline is misleading in that it has no bearing on the ability of the home pregnancy test to detect early pregnancy (Shields, 2015). The limitations of these tests must be understood so that pregnancy detection is not delayed significantly. Early pregnancy detection allows for the commencement of prenatal care, potential medication changes, and lifestyle changes to promote a healthy pregnancy. TABLE 11.1 SELECTED PREGNANCY TESTS Type Specimen Example Remarks Agglutination inhibition tests Urine Pregnosticon, Gravindex If hCG is present in urine, agglutination does not occur, which is positive for pregnancy; reliable 14– 21 days after conception; 95% accurate in diagnosing pregnancy Immunoradiometric assay Blood serum Neocept, Pregnosis Measures ability of blood sample to inhibit the binding of radiolabeledSan Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 4 DM 07/05/2020 # Objecti ve Concept/Focus Area hCG to receptors; reliable 6–8 days after conception; 99% accurate in diagnosing pregnancy Enzyme-linked immunosorbent assay (ELISA) Blood serum or urine Over-the-counter home/office pregnancy tests; precise Uses an enzyme to bond with hCG in the urine if present; reliable 4 days after implantation; 99% accurate if hCG specific Human chorionic gonadotropin (hCG) is a glycoprotein and the earliest biochemical marker for pregnancy. Many pregnancy tests are based on the recognition of hCG or a beta subunit of hCG. hCG levels in normal pregnancy usually double every 48 to 72 hours until they peak approximately 60 to 70 days after fertilization. At this point, they decrease to a plateau at 100 to 130 days of pregnancy. The hCG doubling time has been used as a marker by clinicians to differentiate normal from abnormal gestations. Low levels are associated with an ectopic pregnancy and higher-than-normal levels may indicate a molar pregnancy or multiple-gestational pregnancies (Zinaman, Johnson, & Marriott, 2015).San Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 5 DM 07/05/2020 # Objecti ve Concept/Focus Area This elevation of hCG corresponds to the morning sickness period of approximately 6 to 12 weeks during early pregnancy. Although probable signs suggest pregnancy and are more reliable than presumptive signs, they still are not 100% reliable in confirming a pregnancy. For example, uterine tumors, polyps, infection, and pelvic congestion can cause changes to uterine shape, size, and consistency. And although pregnancy tests are used to establish the diagnosis of pregnancy when the physical signs are still inconclusive, they are not completely reliable, because conditions other than pregnancy (e.g., ovarian cancer, choriocarcinoma, hydatidiform mole) can also elevate hCG levels. 3 1, 6 Reproduction/Maternal Adaptation during pregnancy/General Body System Adaptations Third-Trimester DiscomfortsSan Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 6 DM 07/05/2020 # Objecti ve Concept/Focus Area As women enter their third trimester, many experience a return of the first-trimester discomforts of fatigue, urinary frequency, leukorrhea, and constipation. These discomforts are secondary to the ever-enlarging uterus compressing adjacent structures, increasing hormone levels, and the metabolic demands of the fetus. In addition to these discomforts, many women experience shortness of breath, heartburn and indigestion, swelling, and Braxton Hicks contractions. Shortness of Breath and Dyspnea Dyspnea is a common complaint in pregnant women. Physiologic and hemodynamic changes can result in a significant dyspnea in such cases. In some women, dyspnea in normal daily activities can be a sign of heart and lung disease and may be associated with poor perinatal and cardiac outcome in which early detection can prevent adverse events. The increasing growth of the uterus prevents complete lung expansion late in pregnancy. As the uterus enlarges upward in the second and third trimesters, the expansion of the diaphragm is limited. Dyspnea can occur when the woman lies on her back and the pressure of the gravid uterus against the vena cava reduces venous return to the heart (Tara et al., 2015). Explain to the woman that dyspnea is normal and will improve when the fetus drops into the pelvis (lightening). Instruct her to adjust her body position to allow for maximum expansion of the chest and to avoidSan Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 7 DM 07/05/2020 # Objecti ve Concept/Focus Area large meals, which increase abdominal pressure. Raising the head of the bed on blocks or placing pillows behind her back is helpful too. Under normal circumstances, resting with the head elevated while taking slow, deep breaths reduces shortness of breath symptoms. In addition, stress to her that lying on her left side will displace the uterus off the vena cava and improve her breathing. Having the woman periodically stand up and stretch her arms above her head and take a deep breath is helpful to relieve dyspnea. Also, advise the woman to avoid exercise that precipitates dyspnea, to rest after exercise, and to avoid overheating in warm climates. If she still smokes, encourage her to stop. Heartburn and Indigestion Heartburn and indigestion result when high progesterone levels cause relaxation of the cardiac sphincter, allowing food and digestive juices to flow backward from the stomach into the esophagus. Irritation of the esophageal lining occurs, causing the burning sensation known as heartburn. It occurs in up to 70% of women at some point during pregnancy, with an increased frequency seen in the third trimester (King et al., 2015). The pain may radiate to the neck and throat. It worsens when the woman lies down, bends over after eating, or wears tight clothes. Indigestion (vague abdominal discomfort after meals) results from eating too much or too fast; from eating when tense, tired, or emotionally upset; from eating food that is too fatty or spicy; and fromSan Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 8 DM 07/05/2020 # Objecti ve Concept/Focus Area eating heavy food or food that has been badly cooked or processed (Nagtalon-Ramos, 2014). In addition, the stomach is displaced upward and compressed by the large uterus in the third trimester, thus limiting the stomach’s capacity to empty quickly. Food sits, causing heartburn and indigestion. Review the client’s usual dietary intake and suggest that she limit or avoid gas-producing or fatty foods and large meals. Instruct the woman to pay attention to the timing of the discomfort. Usually it is heartburn when the pain occurs 30 to 45 minutes after a meal. Encourage the client to maintain proper posture and remain in the sitting position for 1 to 3 hours after eating to prevent reflux of gastric acids into the esophagus by gravity. Urge the client to consume small, frequent meals, to eat slowly, chewing her food thoroughly to prevent excessive swallowing of air, which can lead to increased gastric pressure. Instruct the client to avoid foods that act as triggers such as caffeinated drinks, greasy, gas-forming foods, citrus, spiced foods, chocolate, coffee, alcohol, and spearmint or peppermint. These items stimulate the release of gastric digestive acids, which may cause reflux into the esophagus. Avoid late-night or large meals and gum chewing. Avoid lying down within 3 hours after eating. Finally, elevate the head of the bed by 10 to 30 degrees. Dependent EdemaSan Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 9 DM 07/05/2020 # Objecti ve Concept/Focus Area Swelling is the result of increased capillary permeability caused by elevated hormone levels and increased blood volume. Sodium and water are retained and thirst increases. Edema occurs most often in dependent areas such as the legs and feet throughout the day due to gravity; it improves after a night’s sleep. Warm weather or prolonged standing or sitting may increase edema. Generalized edema, appearing in the face, hands, and feet, can signal preeclampsia if accompanied by dizziness, blurred vision, headaches, upper quadrant pain, or nausea (Rigby, 2015). This edema should be reported to the health care provider. Appropriate suggestions to minimize dependent edema include: Elevate your feet and legs above the level of the heart periodically throughout the day. Wear support hose when standing or sitting for long periods. Change position frequently throughout the day. Walk at a sensible pace to help contract leg muscles to promote venous return. When taking a long car ride, stop to walk around every 2 hours. When standing, rock from the ball of the foot to the toes to stimulate circulation. Lie on your left side to keep the gravid uterus off the vena cava to return blood to the heart. Avoid foods high in sodium, such as lunch meats, potato chips, and bacon. Avoid wearing knee-high stockings.San Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 10 DM 07/05/2020 # Objecti ve Concept/Focus Area Drink six to eight glasses of water daily to replace fluids lost through perspiration. Avoid high intake of sugar and fats, because they cause water retention. Braxton Hicks Contractions Braxton Hicks contractions are irregular, painless contractions that occur without cervical dilation. Typically they intensify in the third trimester in preparation for labor. In reality, they have been present since early in the pregnancy but may have gone unnoticed. They are thought to increase the tone of uterine muscles for labor purposes (Grant, Strevens, & Thornton, 2015). 4 4, 5 Sexuality/Sexually Transmitted Diseases/Clinical Manifestations TABLE 5.2 SEXUALLY TRANSMITTED INFECTIONS COMMON IN ADOLESCENTS Disease Causative Organism Transmiss ion Mode Diagnostic Testing and Recommen Female Symptoms Male Symptoms Recommen ded TreatmentSan Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 11 DM 07/05/2020 # Objecti ve Concept/Focus Area ded Screening for Sexually Active Adolescent Chlamydia Curable STI Seen frequently among sexually active adolescents and young adults Chlamydia trachomatis(bact eria) Vaginal, anal, and oral sex and by childbirth Culture fluid from urethral swabs in males or endocervica l swabs for females Noninvasiv e, non– cultureMay be asymptomatic Dysuria, urinary frequency. dyspareunia Cervical discharge (mucus or pus) Endocervicitis May lead to pelvic May be asymptom atic Dysuria, urethral itching Penile discharge (mucus or pus) Azithromyci n (Zithromax ) Doxycycline (Vibramyci n) Erythromyc in (EES)San Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 12 DM 07/05/2020 # Objecti ve Concept/Focus Area based testing is available using nucleic acid amplificatio n and testing (NAAT) from urine— single test can test for chlamydia and gonorrhea inflammatory disease, ectopic pregnancy, infertility Can cause inflammation of the rectum and conjunctiva Can infect the throat from oral sexual contact with an infected partner Urethral tingling May lead to epididymit is and sterility Can cause inflammati on of the rectum and conjunctiv a Can infect the throat from oral Levofloxaci n Ofloxacin (Floxin) Sexual partners need evaluation, testing, and treatment also Abstinence from sexual activity until therapy completeSan Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 13 DM 07/05/2020 # Objecti ve Concept/Focus Area Conjunctiva l secretions in neonates Females: screen annually Males: screen high-risk adolescents sexual contact with an infected partner and symptoms no longer present Retesting in 3 months to rule out recurrence Gonorrhea Curable STI Adolescent often coinfected with Chlamy Neisseria gonorrhoeae(bact eria) Vaginal, anal, and oral sex and by childbirth Gram stain - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - , andSan Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 17 DM 07/05/2020 # Objecti ve Concept/Focus Area been diagnosed There is no cure handwashi ng of infected person or oralgenital contact HSV-2 is spread by having sexual contact (vaginal, oral, or anal) with someone stage of lesion— optimum is during vesicular stage) Polymerase chain reaction is more sensitive than culture Serologic tests, such as antibodyover and gradually heal. Recurrence episodes are usually milder than the initial episode Dysuria, dyspareunia, and urine retention Fever, headache, malaise, muscle aches Famciclovir mainstay in treatment Does not cure; just controls symptoms Counseling important to help adolescent cope and to prevent transmissio nSan Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 18 DM 07/05/2020 # Objecti ve Concept/Focus Area who is shedding the herpes virus either during an outbreak or during a period with no symptoms ; can be spread to an infant through childbirth based testing (herpes Western blot assay is the most sensitive) Type specific laboratory testing important Routine screening not Sexual partners benefit from evaluation and counseling. If symptomati c, need treatment If asymptoma tic, offer testing and educationSan Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 19 DM 07/05/2020 # Objecti ve Concept/Focus Area recommend ed Syphilis Treponema pallidum(spiroch ete bacteria) Sexual contact with an infected person Serologic testing mainstay for diagnosis Venereal Disease Research Laboratory (VDRL), rapid plasma reagin (RPR), and Course of disease divided into stages Primary infection: • Chancre on place of entrance of bacteria (usually vulva or vagina but can develop in other parts of the body) Course of disease divided into stages Primary infection: • Chancre on place of entrance of bacteria (usually on penis but can develop in Benzathine penicillin G injection (if penicillin allergy, doxycycline , tetracycline , or erythromyci n) Sexual partners needSan Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 20 DM 07/05/2020 # Objecti ve Concept/Focus Area treponemal tests (e.g., fluorescent treponemal antibody absorbed [FTA-ABS]) can lead to a presumptiv e diagnosis and are useful for screening. Use of 2 Secondary infection: • Maculopapula r rash (hands and feet) • Sore throat • Lymphadenop athy • Flu-like symptoms Latent infection: • No symptoms • Can be infective during other parts of the body) Secondar y, latent, and tertiary infection s: All similar to female symptoms evaluation and testingSan Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 21 DM 07/05/2020 # Objecti ve Concept/Focus Area tests required Darkfield examinatio n and direct fluorescent antibody tests of lesion exudate or tissue provide definitive diagnosis of early syphilis first 1–2 years of latency • Many people if not treated will suffer no further signs and symptoms Some people will go on to develop tertiary or late syphilis Tertiary infections: • Tumors of skin, bones, and liverSan Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 22 DM 07/05/2020 # Objecti ve Concept/Focus Area New tests are in developmen t such as enzyme immunoass ay Screen based on epidemiolo gy and personal risk factors • Central nervous system symptoms • Cardiovascula r symptoms • Usually not reversible at this stage 5 4, 5 Sexuality/Sexually Transmitted Diseases/ Clinical ManifestationsSan Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 23 DM 07/05/2020 # Objecti ve Concept/Focus Area INFECTIONS CHARACTERIZED BY CERVICITIS Cervicitis is a catchall term that implies the presence of inflammation or infection of the cervix. It is used to describe everything from symptomless erosions to an inflamed cervix that bleeds on contact and produces quantities of purulent discharge containing organisms not ordinarily found in the vagina. Cervicitis is usually caused by gonorrhea or chlamydia, as well as almost any pathogenic bacterial agent and a number of viruses. The treatment of cervicitis involves the appropriate therapy for the specific organism that has caused it. Chlamydia Chlamydia is the most commonly reported bacterial STI in the United States. The CDC (2014b) estimates that there are 2.8 million cases in the United States annually; the highest predictor for this infection is age. The highest rates of infection are among those aged 15 to 19 years, mainly because their sexual relations are often unplanned and are sometimes the result of pressure or force, and typically happen before they have the experience and skills to protect themselves. The rates are highest among this group regardless of demographics or location (CDC, 2014a). The young have the most to lose from acquiring STIs, since they willSan Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 24 DM 07/05/2020 # Objecti ve Concept/Focus Area suffer the consequences the longest and might not reach their full reproductive potential. The most common risk factors associated with chlamydia are age less than 25 years, recent change in sexual partner or multiple sexual partners, poor socioeconomic conditions, exchange of sex for money, nonwhite race, single status, and lack of use of barrier contraception. Worldwide, it is likely the most common infectious cause of infertility in women. An estimated 106 million cases of chlamydia occur globally among both men and women each year, so the global burden is substantial (Brunham, 2015). Asymptomatic infection is common among both men and women. Men primarily develop urethritis. In women, chlamydia is linked with cervicitis, acute urethral syndrome, salpingitis, ectopic pregnancy, PID, and infertility (Qureshi, 2015). Chlamydia causes half of the 1 million recognized cases of PID in the United States each year, and treatment costs run over $701 million yearly. The CDC (2014a) recommends yearly chlamydia testing of all sexually active women aged 25 years or younger, older women with risk factors for chlamydial infections (those who have a new sex partner or multiple sex partners), and all pregnant women. Chlamydia trachomatis is the bacterium that causes chlamydia. It is an intracellular parasite that cannot produce its own energy and depends on the host for survival. It is often difficult to detect, and this can poseSan Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 25 DM 07/05/2020 # Objecti ve Concept/Focus Area problems for women due to the long-term consequences of untreated infection. Moreover, lack of treatment provides more opportunity for the infection to be transmitted to sexual partners. Newborns delivered to infected mothers may develop conjunctivitis which occurs in 25% to 50% of all newborns. Ophthalmia neonatorum is an acute mucopurulent conjunctivitis occurring in the first month of birth. It is essentially an infection acquired during vaginal delivery. The most frequent infectious agents involved in are Chlamydia trachomatis and Neisseria gonorrhea (Thomas, Bates, & Mathew, 2015). Therapeutic Management Antibiotics are usually used in treating this STI. The CDC treatment options for chlamydia include doxycycline 100 mg orally twice a day for 7 days or azithromycin 1 g orally in a single dose. Because of the common coinfection of chlamydia and gonorrhea, a combination regimen of ceftriaxone with doxycycline or azithromycin is prescribed frequently (CDC, 2015a). Additional CDC guidelines for client management include annual screening of all sexually active women aged 20 to 25 years old; screening of all high-risk people; and treatment with antibiotics effective against both gonorrhea and chlamydia for anyone diagnosed with a gonococcal infection (CDC, 2014a). Except in pregnant women, test-of-cure (repeat testing 3 to 4 weeks after completing therapy) is not recommended for women treated with the recommended or alterative regimens, unless therapeutic compliance is in question, symptoms persist, or reinfection is suspected (CDC, 2015a).San Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 26 DM 07/05/2020 # Objecti ve Concept/Focus Area Nursing Assessment Assess the health history for significant risk factors for chlamydia, which may include: Being an adolescent Having multiple sex partners Having a new sex partner Engaging in sex without using a barrier contraceptive (condom) Using oral contraceptives Being pregnant Having a history of another STI (King et al., 2015). Assess the client for clinical manifestations of chlamydia. The majority of women (70% to 80%) are asymptomatic (CDC, 2014a). If the client is symptomatic, clinical manifestations include: Mucopurulent vaginal discharge Urethritis Bartholinitis EndometritisSan Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 27 DM 07/05/2020 # Objecti ve Concept/Focus Area Salpingitis Dysfunctional uterine bleeding The diagnosis can be made by urine testing or swab specimens collected from the endocervix or vagina. Culture, direct immunofluorescence, enzyme immunoassay (EIA), or nucleic acid amplification methods such as GenProbe or Pace2) are highly sensitive and specific when used on urethral and cervicovaginal swabs. They can also be used with good sensitivity and specificity on first-void urine specimens (Qureshi, 2015). The chain reaction tests are the most sensitive and cost-effective. The CDC (2015b) strongly recommends screening of asymptomatic women at high risk in whom infection would otherwise go undetected. Chlamydia is an important preventable cause of infertility and other adverse reproductive health outcomes. Effective prevention interventions are available to reduce the burden of chlamydia and its sequelae, but they are underutilized. Although many prevention programs are available, improvements can be made in raising awareness about chlamydia, increasing screening coverage, and enhancing partner services. In addition, nurses can focus their efforts on reaching disproportionately affected racial/ethnic groups. To break the cycle of chlamydia transmission in the United States, health care providers should encourage annual chlamydiaSan Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 28 DM 07/05/2020 # Objecti ve Concept/Focus Area screening for all sexually active females aged >25 years, maximize use of effective partner treatment services, and rescreen infected females and males 3 months after treatment (CDC, 2015b). Gonorrhea Gonorrhea is a serious, and potentially very severe, bacterial infection. It is the second most commonly reported infection in the United States, and is an urgent problem globally because it is now capable of developing resistance to multiple antibiotic classes. Gonorrhea is highly contagious and is a reportable infection to the health department authorities. Gonorrhea increases the risk for PID, infertility, ectopic pregnancy, and HIV acquisition and transmission (CDC, 2015f). It is rapidly becoming more and more resistant to cure. In the United States, an estimated 800,000 new gonorrhea infections occur annually (CDC, 2015f). In common with all other STIs, it is an equal-opportunity infection—no one is immune to it, regardless of race, creed, gender, age, or sexual preference. The cause of gonorrhea is an aerobic gram-negative intracellular diplococcus, Neisseria gonorrhoeae. The site of infection is the columnar epithelium of the endocervix. Gonorrhea is almost exclusively transmitted by sexual activity. In pregnant women, gonorrhea is associated with chorioamnionitis, premature labor, PROM, and postpartum endometritis (Ross et al., 2015). It can also be transmitted to the newborn in the form ofSan Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 29 DM 07/05/2020 # Objecti ve Concept/Focus Area ophthalmia neonatorum during birth by direct contact with gonococcal organisms in the cervix. Ophthalmia neonatorum is highly contagious and if untreated leads to blindness in the newborn. Therapeutic Management Gonorrhea can be cured with the right treatment. CDC now recommends dual therapy (i.e., using two drugs as the treatment for gonorrhea). Dual therapy is recommended to prevent drug resistance and is also effective against chlamydia. The treatment of choice for uncomplicated gonococcal infections is azithromycin 1 g orally in a single dose and ceftriaxone 250 mg intramuscular (IM) in a single dose (CDC, 2015a). Azithromycin orally or doxycycline should accompany all gonococcal treatment regimens if chlamydial infection is not ruled out (CDC, 2015a). Pregnant women with gonorrhea should not be treated with quinolones or tetracyclines. Pregnant women with a positive test for gonorrhea should be treated with the same recommended dual therapy of ceftriaxone with either azithromycin or amoxicillin (CDC, 2015a). To prevent gonococcal ophthalmia neonatorum, a prophylactic agent should be instilled into the eyes of all newborns; this procedure is required by law in most states. Erythromycin or tetracycline ophthalmic ointment in a single application is recommended (King et al., 2015). With use of recommended treatment, follow-upSan Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 30 DM 07/05/2020 # Objecti ve Concept/Focus Area testing to document eradication of gonorrhea is no longer recommended. Instead, rescreening in 2 to 3 months to identify reinfection is suggested (CDC, 2015a). Nursing Assessment Assess the client’s health history for risk factors, which may include low socioeconomic status, living in an urban area, single status, inconsistent use of barrier contraceptives, age under 20 years old, and multiple sex partners. Assess the client for clinical manifestations of gonorrhea, keeping in mind that between 50% and 90% of women infected with gonorrhea are totally symptom-free (Wong, 2015). Because women are so frequently asymptomatic, they are regarded as a major factor in the spread of gonorrhea. If symptoms are present, they might include: Abnormal vaginal discharge Dysuria Cervicitis Enlarged lymph glands locally Abnormal vaginal bleeding Bartholin abscessSan Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 31 DM 07/05/2020 # Objecti ve Concept/Focus Area PID Neonatal conjunctivitis in newborns Mild sore throat (for pharyngeal gonorrhea) Rectal infection (itching, soreness, bleeding, discharge) Perihepatitis (King et al., 2015) Sometimes, a local gonorrhea infection is self-limiting (there is no further spread), but usually the organism ascends upward through the endocervical canal to the endometrium of the uterus, further on to the fallopian tubes, and out into the peritoneal cavity. When the peritoneum and the ovaries become involved, the condition is known as PID. The scarring to the fallopian tubes is permanent. This damage is a major cause of infertility and is a possible contributing factor in ectopic pregnancy (Heller, 2015). If gonorrhea remains untreated, it can enter the bloodstream and produce a disseminated gonococcal infection. This severe form of infection can invade the joints (arthritis), the heart (endocarditis), the brain (meningitis), and the liver (toxic hepatitis). Figure 5.4 shows the typical appearance of gonorrhea.San Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 32 DM 07/05/2020 # Objecti ve Concept/Focus Area The CDC recommends screening for all women at risk for gonorrhea. Pregnant women should be screened at the first prenatal visit and again at 36 weeks of gestation. Nucleic acid hybridization tests (GenProbe) are used for diagnosis. Any woman suspected of having gonorrhea should be tested for chlamydia also because coinfection (45%) is extremely common (CDC, 2015f).San Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 33 DM 07/05/2020San Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 34 DM 07/05/2020 # Objecti ve Concept/Focus Area FIGURE 5.4. Gonorrhea. (From Jensen, S. (2015). Nursing Health Assessment: A Best Practice Approach, 2nd ed. Philadelphia, PA: Wolters Kluwer.) Nursing Management of Chlamydia and Gonorrhea The prevalence of chlamydia and gonorrhea is increasing dramatically, and these infections can have longterm effects on people’s lives. Sexual health is an important part of a person’s physical and mental health, and nurses have a professional obligation to address it. Be particularly sensitive when addressing STIs because women are often embarrassed or feel guilty. There is still a social stigma attached to STIs, so women need to be reassured about confidentiality. The nurse’s knowledge about chlamydia and gonorrhea should include treatment strategies, referral sources, and preventive measures. It is important to be skilled at client education and counseling and to be comfortable talking with, and advising, women diagnosed with these infections. Provide education about risk factors for these infections. High-risk groups include single women, women younger than 25 years, African American women, women with a history of STIs, those with new or multiple sex partners, those with inconsistent use of barrier contraception, and women living in communities with high infection rates (Wong, 2015). Assessment involves taking a health history that includes a comprehensiveSan Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 35 DM 07/05/2020 # Objecti ve Concept/Focus Area 6 2, 6 Reproduction/Nursing management during pregnancy/Risk factors for adverse pregnancy outcomes 7 4, 5 Sexuality/Sexually Transmitted Diseases/Syphilis Syphilis Syphilis is a chronic, multistage, curable bacterial infection caused by the spirochete Treponema pallidum that is typically transmitted sexually with an infected partner or congenitally from an infected mother to her fetus. It is a serious systemic disease that can lead to disability and death if untreated. Rates of syphilis in the United States are increasing. Of primary and secondary syphilis cases, 75% occur in men who have sex with men (CDC, 2015k). It continues to be one of the most important STIs both because of its biologic effect on HIV acquisition and transmission and because of its impact on infant health. Because there is no vaccine to prevent syphilis, control is mainly dependent on the identification and treatment of infected individuals and their contacts with penicillin G, the first-line drug for all stages of syphilis (Stamm, 2015). The- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - appropriate teaching points for the client with genital ulcers.San Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 42 DM 07/05/2020 # Objecti ve Concept/Focus Area Teaching Guidelines 5.3 CARING FOR GENITAL ULCERS Abstain from intercourse during the prodromal period and when lesions are present. Wash hands with soap and water after touching lesions to avoid autoinoculation. Use comfort measures such as wearing nonconstricting clothes, wearing cotton underwear, urinating in water if urination is painful, taking lukewarm sitz baths, and air-drying lesions with a hair dryer on low heat. Avoid extremes of temperature such as ice packs or hot pads to the genital area as well as application of steroid creams, sprays, or gels. Use condoms with all new or noninfected partners. Inform health care professionals of your condition. 8 5 Reproduction/Nursing management during pregnancy/Obstetric History Terms BOX 12.5 OBSTETRIC HISTORY TERMS: GTPAL OR TPAL G = gravida, T = term births, P = preterm births, A = abortions, L = living childrenSan Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 43 DM 07/05/2020 # Objecti ve Concept/Focus Area G—the current pregnancy to be included in count T—the number of term gestations delivering between 38 and 42 weeks P—the number of preterm pregnancies ending >20 weeks or viability but before completion of 37 weeks A—the number of pregnancies ending before 20 weeks or viability L—the number of children currently living Consider this example: Mary Johnson is pregnant for the fourth time. She had one abortion at 8 weeks’ gestation. She has a daughter who was born at 40 weeks’ gestation and a son born at 34 weeks. Mary’s obstetric history would be documented as follows: Using the gravida/para method: gravida 4, para 2 Using the TPAL method: 1112 (T = 1 [daughter born at 40 weeks]; P = 1 [son born at 34 weeks]; A = 1 [abortion at 8 weeks]; L = 2 [two living children]) 9 2, 6 Reproduction/Nursing management during pregnancy NURSING MANAGEMENT TO PROMOTE SELF-CARESan Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 44 DM 07/05/2020 # Objecti ve Concept/Focus Area Pregnancy is considered a time of health, not illness. Health promotion and maintenance activities are essential to promoting an optimal outcome for the woman and her fetus. Pregnant women commonly have many questions about the changes occurring during pregnancy: how these changes affect their usual routine, such as working, traveling, exercising, or engaging in sexual activity; how the changes influence their typical self-care activities, such as bathing, perineal care, or dental care; and whether these changes are signs of a problem. Women may have heard stories about or been told by others what to do and what not to do during pregnancy, leading to many misconceptions and much misinformation. Nurses can play a major role in providing anticipatory guidance and teaching to foster the woman’s responsibility for self-care, helping to clarify misconceptions and correct any misinformation. Educating the client to identify threats to safety posed by her lifestyle or environment - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - -- - - - - - - - - - 2, 5 Sexuality/Sexually Transmitted Diseases See question #7 INFECTIONS CHARACTERIZED BY GENITAL ULCERS In the United States, the majority of young, sexually active clients who have genital ulcers have genital herpes, syphilis, or chancroid. The frequency of each condition differs by geographic area and client population; however, genital herpes is the most prevalent of these diseases. More than one of these diseases can be presentSan Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 51 DM 07/05/2020 # Objecti ve Concept/Focus Area in a client who has genital ulcers. All three of these diseases have been associated with an increased risk for HIV infection. Not all genital ulcers are caused by STIs. Genital Herpes Simplex Genital herpes is a recurrent, lifelong viral infection that has the potential for transmission throughout the lifespan. The CDC estimates that one out of six people 14 to 49 years old have genital herpes simplex (HSV) infection, with 500 million worldwide new cases annually (CDC, 2015e). Two serotypes of HSV have been identified: HSV-1 and HSV-2. Today, a smaller portion of genital herpes infections are thought to be caused by HSV-1 and the bulk of them by HSV-2. HSV-1 mostly causes the familiar fever blisters or cold sores on the lips, eyes, and face. HSV-2 typically invades the mucous membranes of the genital tract and is known as herpes genitalis. Most people infected with HSV-2 have not been diagnosed. The herpes simplex virus is transmitted by contact of mucous membranes or breaks in the skin with visible or nonvisible lesions. Most genital herpes infections are transmitted by individuals unaware that they have an infection. Many have mild or unrecognized infections but still shed the herpes virus intermittently. HSV is transmitted primarily by direct contact with an infected individual who is shedding the virus. Kissing, sexual contact, including oral sex, and vaginal birth are means of transmission. The virus replicates at the site ofSan Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 52 DM 07/05/2020 # Objecti ve Concept/Focus Area infection, then travels to the dorsal root ganglia and remains latent until stimuli such as fever, stress, ultraviolet radiation, or immunosuppression occurs and reactivates it (Selim et al., 2015). Having sex with an infected partner places the individual at risk for contracting HSV. After the primary outbreak, the virus remains dormant in the nerve cells for life, resulting in periodic recurrent outbreaks. Recurrent genital herpes outbreaks are triggered by precipitating factors such as emotional stress, menses, and sexual intercourse, but more than half of recurrences occur without a precipitating cause. Immunocompromised women have more frequent and more severe recurrent outbreaks than normal hosts (Silasi et al., 2015). Living with genital herpes can be difficult due to the erratic, recurrent nature of the infection, the location of the lesions, the unknown causes of the recurrences, and the lack of a cure. Further, the stigma associated with this infection may affect the individual’s feelings about herself and her interaction with partners. Potential psychosocial consequences may include emotional distress, isolation, fear of rejection by a partner, fear of transmission of the disease, loss of confidence, and altered interpersonal relationships (Alexander et al., 2014).San Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 53 DM 07/05/2020 # Objecti ve Concept/Focus Area 1 1 2, 5 Sexuality/Sexually transmitted diseases/Prevention measures for PID PELVIC INFLAMMATORY DISEASE PID is an infection-induced inflammation of the female upper reproductive tract. PID rates remain unacceptably high. PID may involve the uterine lining (endometritis), the connective tissue adjacent to the uterus (parametritis), the Fallopian tubes (salpingitis), or the serous membrane that lines part of the abdominal cavity and viscera (peritonitis), or it may manifest as tubo-ovarian abscess (Brunham, Gottlieb, & Paavonen, 2015). PID results from an ascending polymicrobial infection of the upper female reproductive tract, frequently caused by untreated chlamydia or gonorrhea (Fig. 5.7). An estimated 750,000 women are diagnosed annually, resulting in over 250,000 hospitalizations (CDC, 2015n). Complications include ectopic pregnancy, pelvic abscess, subfertility, recurrent or chronic episodes of the disease, chronic abdominal pain, pelvic adhesions, and depression (Gilbert, 2015). Because most PID cases are secondary to STIs, especially chlamydia, the most effective approach to control it is prevention. Because of the seriousness of the complications of PID, an accurate diagnosis is critical Healthy People 2020.San Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 54 DM 07/05/2020 # Objecti ve Concept/Focus Area FIGURE 5.7. Pelvic inflammatory disease. Chlamydia or gonorrhea spreads up the vagina into the uterus and then to the fallopian tubes and ovaries.San Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 55 DM 07/05/2020 # Objecti ve Concept/Focus Area HEALTHY PEOPLE 2020 STD-5 objective Significance Reduce the proportion of females who have ever required treatment for pelvic inflammatory disease (PID) Educate women that abstinence is the only way to completely avoid contracting sexually transmitted infections Reduce the proportion of childless females with fertility problems who have had a sexually transmitted disease or who have ever required treatment for PID. Encourage women always to use condoms if participating in any sexual act Provide an open and confidential environment so women will report symptoms and seek treatment earlier Therapeutic Management Broad-spectrum antibiotic therapy is generally required to cover chlamydia, gonorrhea, and/or any anaerobic infection. A parenteral cephalosporin in a single injection with doxycycline 100 mg twice a day for 14 days is the current CDC recommendation (CDC, 2015a). PID in pregnancy is uncommon, but a combination ofSan Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 56 DM 07/05/2020 # Objecti ve Concept/Focus Area cefotaxime, azithromycin, and metronidazole for 14 days may be used. The client is treated on an ambulatory basis with a single-dose injectable antibiotic or is hospitalized and given antibiotics intravenously. The decision to hospitalize a woman is based on clinical judgment and the severity of her symptoms (e.g., severely ill with high fever, a tubo-ovarian abscess is suspected, woman is immunocompromised or presents with protracted vomiting). Treatment then includes intravenous antibiotics, increased oral fluids to improve hydration, bed rest, and pain management. Follow-up is needed to validate that the infectious process is gone to prevent the development of chronic pelvic pain. Nursing Assessment Nursing assessment of the woman with PID involves a complete health history and assessment of clinical manifestations, physical examination, and laboratory and diagnostic testing. Health History and Clinical Manifestations Explore the client’s current and past medical health history for risk factors for PID, which may include: Adolescence or young adulthood Non-White femaleSan Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 57 DM 07/05/2020 # Objecti ve Concept/Focus Area Having multiple sex partners Early onset of sexual activity History of PID or STI Sexual intercourse at an early age Alcohol or drug use Having intercourse with a partner who has untreated urethritis Recent insertion of an intrauterine contraceptive (IUC) Nulliparity Cigarette smoking Recent termination of pregnancy Lack of consistent condom use Lack of contraceptive use Douching Prostitution (Hay et al., 2015) Assess the client for clinical manifestations of PID, keeping in mind that because of the wide variety of clinical manifestations of PID, clinical diagnosis can be challenging. To reduce the risk of missed diagnosis, the CDCSan Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 58 DM 07/05/2020 # Objecti ve Concept/Focus Area has established criteria to establish the diagnosis of PID. Minimal criteria (all must be present) are lower abdominal tenderness, adnexal tenderness, and cervical motion tenderness. Additional supportive criteria that support a diagnosis of PID are: Abnormal cervical or vaginal mucopurulent discharge Oral temperature above 101°F Cervical motion tenderness Elevated erythrocyte sedimentation rate (inflammatory process) Elevated C-reactive protein level (inflammatory process) N. gonorrhoeae or C. trachomatis infection documented (causative bacterial organism) White blood cells on saline vaginal smear Prolonged or increased menstrual bleeding Dysmenorrhea Dysuria Painful sexual intercourse Nausea Vomiting (CDC, 2015n)San Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 59 DM 07/05/2020 # Objecti ve Concept/Focus Area Physical Examination and Laboratory and Diagnostic Tests Inspect the client for presence of fever (usually over 101°F) or vaginal discharge. Palpate the abdomen, noting tenderness over the uterus or ovaries. However, the only way to diagnose PID definitively is through an endometrial biopsy, transvaginal ultrasound, or laparoscopic examination. p. 194 p. 195 Nursing Management If the woman with PID is hospitalized, maintain hydration via intravenous fluids, if necessary and administer analgesics as needed for pain. Semi-Fowler’s positioning facilitates pelvic drainage. A key element to treatment of PID is education to prevent recurrence. Depending on the clinical setting (hospital or community clinic) where the nurse encounters the woman diagnosed with PID, a risk assessment should be done to ascertain what interventions are appropriate to prevent a recurrence. To gain the woman’s cooperation, explain the various diagnostic tests needed. Discuss the implications of PID and the risk factors for the infection; her sexual partner should be included if possible. Sexual counseling should include practicing safer sex, limiting the number of sexual partners, using barrier contraceptives consistently, avoiding vaginal douching,San Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 60 DM 07/05/2020 # Objecti ve Concept/Focus Area considering another contraceptive method if she has an intrauterine system (IUS) and has multiple sexual partners, and completing the course of antibiotics prescribed (Shepherd, 2015). Review the serious sequelae that may occur if the condition is not treated or if the woman does not comply with the treatment plan. Ask the woman to have her partner go for evaluation and treatment to prevent a repeat infection. Provide nonjudgmental support while stressing the importance of barrier contraceptive methods and follow-up care. Teaching Guidelines 5.4 gives further information related to PID prevention. Teaching Guidelines 5.4 PREVENTING PELVIC INFLAMMATORY DISEASE Advise sexually active girls and women to insist their partners use condoms. Discourage routine vaginal douching, as this may lead to bacterial overgrowth. Encourage regular STI screening. Emphasize the importance of having each sexual partner receive antibiotic treatment. 1 2 5 Reproduction/Nursing management during pregnancy/Vaccines during pregnancySan Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 61 DM 07/05/2020 # Objecti ve Concept/Focus Area Immunizations and Medications Vaccines are among the greatest public health achievements of the 21st century, credited with significant reduction of morbidity and mortality from many diseases caused by bacteria and viruses (Senie, 2014). Ideally, clients should receive all childhood immunizations before conception to protect the fetus from any risk of congenital anomalies. If the client comes for a preconception visit, discuss immunizations such as measles, mumps, and rubella (MMR), hepatitis B, and diphtheria/tetanus (every 10 years); administer them at this time if needed. The risk to a developing fetus from vaccination of the mother during pregnancy is primarily theoretical. Routine immunizations are not usually indicated during pregnancy. However, no evidence exists of risk from vaccinating pregnant women with inactivated virus or bacterial vaccines or toxoids. A number of other vaccines have not been adequately studied, and thus theoretical risks of vaccination must be weighed against the risks of the disease to mother and fetus (CDC, 2015f). Advise pregnant women to avoid live virus vaccines (MMR and varicella) and to avoid becoming pregnant within 1 month of having received one of these vaccines because of the theoretical risk of transmission to the fetus (CDC, 2015f).San Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 62 DM 07/05/2020 # Objecti ve Concept/Focus Area CDC guidelines for vaccine administration are highlighted in Box 12.6. Little is known about the effects of taking most medications during pregnancy. Less than 10% of medications approved by the FDA since 1980 have enough information to determine their risk for birth defects (CDC, 2015g). Based on this lack of evidence, it is best for pregnant women not to take any medications during their pregnancy. At the very least, encourage them to discuss with the health care provider their current medications and any herbal remedies they take so that they can learn about any potential risks should they continue to take them during pregnancy. Generally, if the woman is taking medicine for seizures, high blood pressure, asthma, or depression, the benefits of continuing the medicine during pregnancy outweigh the risks to the fetus. The safety profile of some medications may change according to the gestational age of the fetus. Embryogenesis is completed by the end of the first trimester, when all fetal organs are complete. Thus, to cause a malformation, fetal drug exposure must occur in the first 12 weeks of gestation (Gadot & Koren, 2015). BOX 12.6 CDC GUIDELINES FOR VACCINE ADMINISTRATION DURING PREGNANCY Vaccines That Should be Considered if Otherwise IndicatedSan Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 63 DM 07/05/2020 # Objecti ve Concept/Focus Area Hepatitis B Influenza (inactivated) injection Tetanus/diphtheria (Tdap) Meningococcal Rabies Vaccines Contraindicated During Pregnancy Influenza (live, attenuated vaccine) nasal spray Measles Mumps Rubella Varicella BCG (tuberculosis) Meningococcal Typhoid Adapted from Centers for Disease Control and Prevention [CDC]. (2015f). Vaccines for pregnant women. Retrieved from Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 64 DM 07/05/2020 # Objecti ve Concept/Focus Area (2015h). Vaccinations during pregnancy. Retrieved from The FDA has developed a system of ranking drugs that appears on drug labels and package inserts. These risk categories are summarized in Box 12.7. Always advise women to check with the health care provider for guidance. A common concern of many pregnant women involves the use of over-the-counter medications and herbal agents. Many women consider these products benign simply because they are available without a prescription (King et al., 2015). Although herbal medications are commonly thought of as “natural” alternatives to other medicines, they can be just as potent as some prescription medications. A major concern about herbal medicine is the lack of consistent potency in the active ingredients in any given batch of product, making it difficult to know the exact strength by reading the label. Also, many herbs contain chemicals that cross the placenta and may cause harm to the fetus. BOX 12.7 FDA PREGNANCY RISK CLASSIFICATION OF DRUGSSan Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 65 DM 07/05/2020 # Objecti ve Concept/Focus Area Category A: These drugs have been tested and found safe during pregnancy. Examples: folic acid, vitamin B6, and thyroid medicine. Category B: These drugs have been used frequently during pregnancy and do not appear to cause major birth defects or other fetal problems. Examples: antibiotics, acetaminophen (Tylenol), aspartame (artificial sweetener), famotidine (Pepcid), prednisone (cortisone), insulin, and ibuprofen. (Ibuprofen should not be used after 36 weeks of pregnancy to avoid increased blood loss during parturition and to avoid premature closure of the ductus arterious in the fetus.) Category C: These drugs are more likely to cause problems and safety studies have not been completed. Examples: prochlorperazine (Compazine), fluconazole (Diflucan), ciprofloxacin (Cipro), and some antidepressants. Category D: These drugs have clear health risks for the fetus. Examples: alcohol, lithium (treats bipolar disorders), phenytoin (Dilantin); all chemotherapeutic agents used to treat cancer. Category X: These drugs have demonstrated positive evidence of fetal abnormalities and are contraindicated in women who are or may become pregnant. Examples: Accutane (treats cystic acne), androgens (treat endometriosis), Coumadin (prevents blood clots), antithyroid medications for overactive thyroid; radiation therapy (cancer treatment), Tegison or Soriatane (treats psoriasis), streptomycin (treats tuberculosis);San Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 66 DM 07/05/2020 # Objecti ve Concept/Focus Area thalidomide (treats insomnia), diethylstilbestrol (DES) (treats menstrual disorders), and organic mercury from contaminated food. Adapted from King, T. L., Brucker, M. C., Kriebs, J. M., Fahey, J. O., Gegor, C. L., & Varney, H. (2015). Varney’s midwifery (5th ed.). Burlington, MA: Jones & Bartlett Learning; and Rigby, F.B. (2015). Common pregnancy complaints and questions. eMedicine. Retrieved from Nurses are often asked about the safety of over-the-counter medicines and herbal agents. Unfortunately, many drugs have not been evaluated in controlled studies, and it is difficult to make general recommendations for these products. Therefore, encourage pregnant women to check with their health care provider before taking anything. Questions about the use of over-the-counter and herbal products are part of the initial prenatal interview. 1 3 5, 6 Reproduction/Nursing management during pregnancy/Breastfeeding Preparation for Breast-Feeding or Bottle-FeedingSan Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 67 DM 07/05/2020 # Objecti ve Concept/Focus Area Pregnant women are faced with a decision about which method of feeding to choose. Educate the pregnant client about the advantages and disadvantages of each method, allowing the woman and her partner to make an informed decision about the best method for their situation. Providing the client and her partner with this information will increase the likelihood of a successful experience regardless of the method of feeding chosen. As part of health promotion/evidence-based interventions, nurses should be encouraging and educating all women on breast-feeding. Breast-Feeding Substantial scientific evidence exists documenting the health benefits of breast-feeding for newborns. Current evidence cited by the American Academy of Pediatrics (AAP) showed improved outcomes for breast-fed infants with regard to otitis media, lower respiratory infections, gastroenteritis, atopic dermatitis, childhood asthma, childhood obesity, type 1 and type 2 diabetes, childhood leukemia, sudden infant death syndrome, and cognitive development and for their mothers with regard to breast cancer, ovarian cancer, and type 2 diabetes. The AAP recommends that infants be breast-fed exclusively until the age 6 months, and continue to be breastfed for a year and for as long as it is mutually desired (2012). In addition, a lack of breast-feeding has a negative impact on the health care system by increasing the number of client visits, hospital admissions, rateSan Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 68 DM 07/05/2020 # Objecti ve Concept/Focus Area of obesity, and health care costs. Most researchers agree that the duration of breast-feeding is inversely associated with overweight risk. Breast-feeding is a cost-effective, natural, and effective prevention strategy for reducing childhood obesity. A recent study estimates that $13 billion a year would be saved and 1,000 deaths prevented each year if 90% of infants in the United States were exclusively breast-fed until 6 months (Office on Women’s Health, 2014). Human milk provides an ideal balance of nutrients for newborns (ACOG, 2015h). Breast-feeding is advantageous for the following reasons: p. 438 p. 439 Human milk is digestible and economical and requires no preparation. Bonding between mother and child is promoted. Cost is less than purchasing formula. Ovulation is suppressed (however, this is not a reliable birth control method). The risk of ovarian cancer and the incidence of premenopausal breast cancer are reduced for the woman. Extra calories are used, which promotes weight loss gradually without dieting.San Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 69 DM 07/05/2020 # Objecti ve Concept/Focus Area Oxytocin is released to promote more rapid uterine involution with less bleeding. Sucking helps to develop the muscles in the infant’s jaw. Absorption of lactose and minerals in the newborn is improved. The immunologic properties of breast milk help prevent infections in the baby. The composition of breast milk adapts to meet the infant’s changing needs. Constipation in the baby is not a problem with adequate intake. Food allergies are less likely to develop in the breast-fed baby. The incidence of otitis media and upper respiratory infections in the infant is reduced. Breast-fed babies are less likely to be overfed, thus reducing the risk of adult obesity. Breast-fed newborns are less prone to vomiting (American Academy of Family Physicians (2015); AAP (2015); ACOG (2015h); and Women, Infant & Children [WIC], 2015). One could say that lactation and breast-feeding are so natural that they should just happen on their own accord, but this is not the case. Learning to breast-feed takes practice, requires support from the partner, and requires dedication and patience on the part of the mother; it may be necessary to work closely with a lactation consultant to be successful and comfortable when breast-feeding (Fig. 12.14 shows the different positions thatSan Antonio College Department of Nursing Education Career Mobility Online Level 2 RNSG 1538 Health Care Concepts III Exam 2-Student Blueprint • 70 DM 07/05/2020 # Objecti ve Concept/Focus Area may be used for breast-feeding). Nurses can encourage breast-feeding for all mothers except those who are HIV+, and are untreated, have active tuberculosis, use illicit drugs, or take prescribed cancer chemotherapeutic agents. Breast-feeding also has some side effects. These include breast discomfort, sore nipples, mastitis, engorgement, milk stasis, vaginal dryness, and decreased libido (Alekseev, Vladimir, & Nadezhda, 2015). The most common cause of nipple pain is an improper latch and such