NURS 4150 EXAM MASTER GUIDE – FULL QUESTION SET, CORRECT ANSWERS, AND DETAILED SOLUTIONS

1. Safety promotion and prevention with toddlers - ANSWER Second highest rates of accidental death behind adolescents Motor vehicle safety - read manufacturers guide lines for car seats - children stay rear facing until the age of 2 -don't let them play around cars!! Drowning - most common is 0-4 but biggest concern is bathtub and larger buckets Burns - oven and stoves Accidental poisoning -800-222-1222 (poison control) - poisons should be locked up high and out of reach completely Falls - prevent as much as possible - toddlers have decrease depth perception and higher center of gravity, toddlers will have lots of bruises Aspiration and suffocation - cut up foods and nothing circular or small by mouth - KNOW CPR Bodily injury - show the toddlers how to carry items, have wall anchors so they don't climb up on dressers - store guns in safes and leave them unloaded - BABY PROOF HOUSE 2. Genetics - ANSWER provides the tools to determine the hereditary component of many diseases Improves our ability to predict susceptibility, onset, progression, and response to trx advances in genetic testing and genetically based trx have altered care 3. A gradual shift from genetics to genomics genome - ANSWER entire set of genetic information that an organism carries in its DNA 4. Genes - ANSWER inherited traits from parents, contain info to specify traits 5. Nursing Expertise in Genetics and Genomics - ANSWER expanded roles -preconception counseling and testing -neonatal genetic screening and testing -palliative care for infants with life threatening conditions -the identification and care of individuals with genetic conditions -specialized care of women with genetic conditions during pregnancy --congenital heart disease ◼ Cystic fibrosis ◼ Factor V Leiden 6. Clinical Genetics(chromosomal abnormalities) - ANSWER aa major cause of reproductive loss, congenital problems and gynecologic disorders 7. Can occur during mitosis(somatic cells) or meiosis(sex cells - chromosome number: Down Syndrome(trisomy 21) - Single gene controlling a trait, disorder, or defect - Sex chromosome abn 8. Clinical Genetics (Multifactorial) - ANSWER most common genetic mutation 9. Combination of env and genetic factors - Cleft lip and palate - Congenital heart disease - Neural tube defects - Pyloric stenosis 10. Genetic counseling - ANSWER Standard practice in obstetrics Goal is to identify risk Genetic hx should be obtained using a questionnaire or checklist Genetic counseling -info -EDU Support 11. Process of implantation - ANSWER endometrium becomes thick and vascular Decidua-after implantation -Special area of blastocyst called the trophoblasts make contact with the endometrium -Maternal side of placenta develops 12. Morula and blastocyst develops the trophoblast which ultimately becomes the chorion 13. This layer produces preg hormone HCG which causes a positive pee test 14. Chorionic villi develop out of the trophoblast and extend into the blood-filled spaces of the endometrium(very vascular and rich in glycogen) 15. Ovum or Preembryonic Stage - ANSWER conception to 14 days 16. Embryonic stage - ANSWER Lasts from day 15 until 10 wks gestational age 17. Most critical time with teratogens 18. Fetal stage - ANSWER lasts from 9-10 weeks until delivery 19. Intrauterine development stages - ANSWER 1. ovum stage: conception to day 14 2. embryo stage: day 15 to 8 weeks 3. fetal stage: 9 weeks to birth 20. Amniotic fluid - ANSWER serves numerous functions Volume is important to fetal well-being Constantly changing to protect baby 21. yolk sac - ANSWER becomes primitive digestive system 22. Umbilical Cord - ANSWER supplies the embryo with maternal nutrients and O2 Lifeline 23. two membranes of amniotic fluid - ANSWER chorion and amnion 24. chorion - ANSWER Outermost layer of the two membranes surrounding the embryo; it forms the fetal part of the placenta. 25. Amnion - ANSWER Innermost membranous sac surrounding the developing fetus 26. Functions of amniotic sac - ANSWER Provides space for movement and growth Maintains consistent temp protects from pressure, impact Barrier against ascending infection Cushions the umbilical cord 27. Composed of water, secreted by the amnion and fetal urine 28. Normal range of amniotic fluid - ANSWER 5-10 cm on Ultrasound 300-1500 ml 29. what does it mean if Amniotic fluid is lower then 5cm or 300 ml - ANSWER oligohydramnios - baby drinking this in but not peeing it out 30. What does it mean if the amniotic fluid is greater than 20 cm or 1500 ml - ANSWER Polyhydramnios - baby peeing out but not drinking DUE TO GI OBSTRUCTION 31. Placenta 32. structure and function - ANSWER structure: maternal-placental embryonic circulation by day 17 33. Function: 34. -Endocrine gland (HCG, placental lactogen and estrogen) 35. -Metabolic function and waste 36. -Nutrient storage 37. Fetal viability - ANSWER capability of fetus to survive outside uterus(22-25 wks usually) 38. Limitations based on CNS function and oxygenation capability of lungs 39. Fetal circulatory system - ANSWER FHR 110 to 160 beats/min 40. Cephalocaudal: most O2 rich blood circulate the heart, head, neck and arms 41. Fetal maturation hematopoietic - ANSWER Hematopoietic system (forms blood in yolk sac during week 3) 42. Fetal maturation with Respiratory system - ANSWER Primary surfactants: prevents lung collapse during exhalation and reduces lung surface tension making breathing easier 43. Also used as a measure of fetal lung maturity - L/S ratio: lecithin to sphingomyelin ratio 2:1 44. Movement by week 11 45. Fetal maturation with GI system - ANSWER fetal nutrition and elimination is taken care of by the placenta - no BM until they are born - Meconium (tarry black and green substance that is the first BM after birth) 46. Fetal maturation Hepatic system - ANSWER prominent liver for blood formation 47. Glycogen and iron stored in liver 48. Fetal maturation in the Renal system - ANSWER urine is the major constituent of amniotic fluid 49. Don't filter a lot 50. Fetal Maturation-Neurologic System - ANSWER Stressors on the fetus and neonate can damage CNS long after embryonic stage 51. Sensory awareness (taste, sound, purposeful movement) 52. Fetal maturation Reproductive system - ANSWER differentiation starts at 7 wks and fully differentiation at 12th, 28th wks testes descent 53. high estrogen=mamamory gland engorgement (witch's milk) 54. Fetal maturation integumentary system - ANSWER 2 layers of cells at the 7th week, superficial layer slough and mix with sebaceous to form white cheesy Vernix Caseosa (THIS PROTECTS SKIN OF FETUS AND IS THICK/SCANT) 55. Fetal Maturation Immunologic system - ANSWER IgG crosses placenta, IgA in colostrum after birth, fetus produces IgM 56. Dizygotic twins - ANSWER twins who are produced when two separate ova are fertilized by two separate sperm at roughly the same time Fraternal Twins 57. monozygotic twins - ANSWER identical twins formed when one zygote splits into two separate masses of cells, each of which develops into a separate embryo 58. Conjoined twins - ANSWER Monozygotic twins who are born physically joined to one another. 59. Teratogens - ANSWER agents, such as chemicals and viruses, that can reach the embryo or fetus during prenatal development and cause harm 60. Maternal conditions - ANSWER Diabetes and PKU and malnutrition 61. folic acid - ANSWER important to consider before conception 62. helps grow the neural tube which is the start of the normal spinal cord 63. Gravida - ANSWER pregnant 64. multigravida - ANSWER woman who has been pregnant more than once 65. nulligravida - ANSWER a woman who has never been pregnant 66. parity - ANSWER Pregnancy that resulted in a viable birth 67. Multiparity - ANSWER multiple births 68. nullipara - ANSWER a woman who has never borne a viable child 69. primigravida - ANSWER first pregnancy 70. primipara - ANSWER first birth 71. Preterm - ANSWER 20-37 weeks gestation 72. Term - ANSWER 38-42 weeks gestation 73. Postdate or postterm pregnancy - ANSWER beyond 42 74. Possible signs of pregnancy - ANSWER amenorrhea(4wks) 75. N/V (4-14wks) 76. Fatigue(12wks) 77. Breast changes (3-4 wks) 78. Urinary symptoms(6-12 wks) 79. Weight gain(small at first) 80. Quickening(16-20wks) 81. Probable/highly likely signs - ANSWER Hegars sign: 6-12 wks, softening of lower uterine segment 82. Goodell's sign: 5 wks, softening of cervix 83. Chadwick's sign: 6-8 wks, bluish purplish color of the cervix (inc blood flow to cervix) 84. Abd changes: may show after 14 wks, 16 wks braxton hicks 85. Ballotment:16-28 wks, tapping on cervix and feeling something move 86. Positive signs for pregnancy - ANSWER heart tones (2 of them) 87. Visualizing the fetus via US 88. Palpating fetal movements 89. uterus adaptations with pregnancy - ANSWER Enlargement 90. braxton hicks 91. uteroplacental blood flow 92. Cervix adaptations with pregnancy - ANSWER Goodell and chadwick signs 93. Mucus plug-seals off uterus from vaginal canal 94. Mucus inc in amount and thickness 95. Bloody show: usually sign of cervical changes 96. Friability: bleeds easily when scraped or touched 97. multipara: some dilation, oval shaped cervix 98. Nullipara: no dilation, more round 99. Leukorrheaa - ANSWER thick white acidic discharge, prevents pathogenic infections - response to cervical stim by estrogen and progesterone 100. vaginal adaptations to pregnancy - ANSWER Leukorrhea 101. Glycogen stores inc 102. Inc vascularity(everywhere): edema, varicosities of vulva 103. Perineum: inc vascularity, hypertrophy of skin and m. loosening of connective tissue 104. Adaptations breasts with pregnancy - ANSWER inc fullness and size due to inc levels of progesterone and estrogen 105. Pigmentation changes 106. Montgomery's tubercles: keeps nipple lubricated for breastfeeding 107. Straie gravidarum 108. Colostrum: thick yellow fluid can be expressed from 2nd trimester 109. CV adaptations with pregnancy - ANSWER slight cardiac hypertrophy 110. Apical pulse shifts (heart getting bigger) 111. HR inc 10-15 bpm between 14-20 wks 112. Murmurs may be present 113. Undiscovered anomalies - BMR is higher so mom is burning more calories 114. BP modifiable factors with pregnancy - ANSWER Anxiety(''you're gonna be a mom") 115. Position - Supine hypotensive syndrome(inferior vena cava compressed from baby) - Promote leakage of fluid from capillaries into intracellular spaces-- lower extremity edema is frequent in late pregnancy 116. Trends of BP in pregnancy in first trimester - ANSWER remain same BP as pre pregnancy level 117. Trends of BP in pregnancy in second trimester - ANSWER Dec in BP r/t blood vessel tone dec and dec peripheral vascular resistance 118. -syncope episodes here 119. Trends of BP in pregnancy in third trimester - ANSWER Returns to first trimester levels 120. How many L of blood in body? - ANSWER 4 L 121. Blood adaptations with pregnancy - ANSWER hemodilutional effect of inc plasma 122. Inc in WBC's 2nd and 3rd trimester 123. Inc in clotting factors - greater tendency to clot 124. -Protective fx, to combat childbirth blood loss 125. -more vulnerable to DVT 126. INC by 1-2 L - meets inc circulatory needs of maternal/fetaal unit during preg (protective mechanism) 127. CO inc 30-50% above baseline 128. adaptation of the respiratory system with pregnancy - ANSWER inc maternal O2 requirements 129. Diaphragm displaced(rises 4cm) 130. Dyspnea (physiological) 131. Inc in vascularity(from estrogen stim) - nasal and sinus stuffiness, nose bleeds 132. RR slightly inc 133. Inc O2 requirement- 10-20% as a result of inc BMR 134. Adaptation of the Renal System with pregnancy - ANSWER anatomic changes r/t - hormonal activity - pressure from uterus - inc blood volume 135. Fx changes - inc GFR - urinary stasis - inc susceptibility to UTi's 136. Ethnocentrism - ANSWER Belief in the superiority of one's nation or ethnic group. 137. cultural relativism - ANSWER the practice of judging a culture by its own standards 138. Childbearing beliefs and practices - ANSWER -Communication 139. -Use of interpreters or translators 140. -Personal space 141. -Time orientation 142. -Family roles 143. Developing Cultural Competence - ANSWER act in ways the meet needs of pts and are respectful of ways and traditions different from one another 144. Primary prevention - ANSWER immunizations, exercise, nutrition 145. Secondary prevention - ANSWER target population 146. Tertiary prevention - ANSWER rehabilitation 147. Vulnerable populations in the community - ANSWER minorities, Teens, incarceration, immigrant, Rural, homeless, 148. Breasts(structure) - ANSWER mammary gland composed of a number of lobes divided into tubules 149. Breasts(fx) - ANSWER lactation 150. organs for sexual arousal 151. Physiological alterations in size reach level about 5-7 days after menstruation stops - breast self exams best carried out during this phase of menstrual cycle 152. 3 cycles of menstrual cycle - ANSWER endometrial cycle 153. hypothalmic-pituitary cycle 154. ovarian cycle 155. All happen at same time 156. endometrial cycle (phases) - ANSWER proliferative phase 157. secretory phase 158. ischemic phase 159. menstrual phase 160. proliferative phase of endometrial cycle - ANSWER uterine lining grows from all the estrogen and around day after prior menstruation is LH surge and is when a women should have sex to get preg 161. Secretory phase of endometrial cycle - ANSWER Progesterone stimulated by LH is the dominant hormone during this phase to prepare the corpus luteum and the endometrium for possible fertilized ovum implantation 162. Ischemic phase of endometrial cycle - ANSWER blood vessels constrict and start shedding 163. bleeding occurs from prostaglandins 164. Menstruation phase of endometrial cycle - ANSWER (Phase of Menstrual Cycle) Corpus luteum loses stimulation from LH and progesterone production declines. 165. Progesterone decline results in the lack of endometrial maintenance, and the endometrium degrades and is shed. 166. Hypothalamic-pituitary cycle of menstruation - ANSWER stimulates release of gonadotropin-releasing hormone and follicle stimulating hormone; FSH stimulates development of graafian follicles and their production of estrogen; ovum expelled (Peak of FSH and LH around day 14) - FSH is the first 14 days of the cycle - LH is the last days of the cycle 167. Ovarian cycle - Menstrual phase - ANSWER releases eggs/hormones in ovaries - FSH stims growth of eggs - LH stims maturation of eggs 168. Prostaglandins and effects on? - ANSWER oxygenated fatty acids classified as hormones 169. Effects: 170. ovulation 171. fertility 172. changes in cervix and mucus 173. Tubal and uterine motility 174. Sloughing of endometrium(menstruation) 175. Onset of abortion (spontaneous and induced) 176. Onset of labor(term and preterm) 177. Climacteric - ANSWER transitional phase during which ovarian fx and hormone production decline 178. Spans the years from onset of premenopausal to postmenopausal time when symptoms stop 179. menopause - ANSWER last menstrual cycle 180. Dated with certainty 1 year after menstruation ceases 181. avg age: 51.4 182. Ranges: 35-60 183. Sexual response (both sexes) - ANSWER both sexes reach physical maturity at 17 184. both are the same in sexual in excitement and orgasm - stim leads to inc in blood flow - venous congestion is primarily in the genitals and somewhat in the breasts - myotonia(involuntary contraction of m.) is having an orgasm 185. 4 phases of sexual response cycle - ANSWER excitement, plateau, orgasm, resolution 186. uTime, intensity, and duration for cyclic completion vary for individuals and situations 187. excitement phase of sexual response cycle - ANSWER marked by changes in the pelvic region, general physical arousal, and increases in heart rate, muscle tension, blood pressure, and rate of breathing 188. plateau phase (Sexual Response Cycle) - ANSWER respiration and heart rate continue at an elevated level, genitals secrete fluids in preparation for coitus 189. orgasmic phase of sexual response cycle - ANSWER This phase is the climax of the sexual response cycle. It's the shortest of the phases and generally lasts only a few seconds. General characteristics of this phase include the following: Involuntary muscle contractions begin 190. resolution phase of sexual response cycle - ANSWER physiological signs of arousal reverse themselves, physiological arousal subsides and full resolution takes 15 min(in men it can take longer) 191. Female health promotion for adolescents - ANSWER first enter healthcare system for purpose of contraception or health exams 192. Teenage pregs: 90% chance of conception in first year without use of contraception 193. Female health promotion for young and middle adulthood - ANSWER contraception 194. Pelvic and breast exams 195. Female health promotion for late reproductive age - ANSWER inc risks of pregs, emergence of chronic disease 196. Risk factors with pregnancy substances - ANSWER prx and illicit drugs 197. alc 198. Cigs 199. caffeine 200. Nutritional problem risk factors with pregnancy - ANSWER nutritional deficiencies 201. obesity 202. eating disorder(anorexia, Bulimia nervosa) 203. Lack of exercise(150min/week) 204. General Risk factors with pregnancy - ANSWER stress, mental health, sleep disorders, env and work place hazards 205. risky sex practices 206. female genital mutilation 207. Human traficking 208. Phases of Intimate partner violence - ANSWER 1. Tension building 209. 2. Violence 210. 3. Reconciliation 211. *stay due to isolation, finance, self-esteem, divorce as wrong, kids may suffer 212. *more services for women than men 213. intimate partner violence (IPV) - ANSWER physical or emotional abuse - pregnancy inc risk 214. sex assault 215. isolation 216. controlling of money, shelter, time, food, reproduction coercion 217. assessment of the women with pregnancy - ANSWER hx 218. physical exams 219. Pelvic exams - ext inspection and palpation - vulvar self-exam - Papanicolaou test 220. Women with special needs/disabilities 221. Pap smears - ANSWER Inspect externally 222. STARTS AT 21, "take spatula and scrape cells off cervcix) 223. This is different than a pelvic exam 224. Used to look for normalcy of cell on cervix (cervical cancer) 225. Health screening for women across the lifespan - ANSWER fasting BG (ages 45+) 226. Total Blood cholesterol 227. Lipids 228. Urinalysis 229. STI(age25 and as needed if active sexually) 230. Mammogram (age 40) 231. Clinical breast exam (20+) 232. TB skin test (needed for high risk pts) 233. Pap test (21-65) 234. Pelvic exam (until 70) 235. Colon CA screening (50+) 236. Bone mineral density (DEXA scan 65) 237. amenorrhea - ANSWER absence of menstruation 238. 4 weeks 239. primary problems for amenorrhea - ANSWER anatomic (2 uteri) 240. Endocrine 241. Chronic disease 242. Eating disorders(estrogen likes fat so less body fat=less cycles) 243. Meds 244. 16 yr olds should be having their periods 245. Secondary reasons for amenorrhea - ANSWER Pregnancy 246. Clinical sign of a variety of disorders (PCOS) 247. Hypogonadotropic amenorrhea - ANSWER -Problem in central hypothalamic-pituitary axis 248. -Results from hypothalamic suppression 249. Management for hypogonadotropic amenorrhea - ANSWER counseling/edu regarding stress, exercise, and weight loss 250. Calcium and vitamin D 251. Dysmenorrhea - ANSWER pain during or shortly before menstruation 252. Primary dysmenorrhea - ANSWER biochemical basis 253. arises from release of prostaglandins 254. Abn inc uterine activity 255. Alleviating dysmenorrhea - ANSWER meds 256. heat 257. alt modalities (acupuncture) 258. Secondary dysmenorrhea - ANSWER acquired menstrual pain associated with pelvic patho 259. Dx/treatment of secondary dysmenorrhea - ANSWER pelvic exam 260. US exam, dilation and curettage, endometrial biopsy, laparoscopy 261. Trx: removal of underlying patho 262. premenstrual syndrome (PMS) - ANSWER cyclic symptoms occurring in luteal phase(right before period to start) 263. Cluster of physical, psychologic, and behavioral s/s 264. most women experience this 265. Many trx modalities 266. Premenstrual dysphoric disorder and trx - ANSWER cyclic s/s occurring in the last 7-10 days of the menstrual cycle - Severe mood variant, week before period starts having psychotic tendencies - affect less then 10% of women 267. Trx: similar to PMS - counseling, meds(prozac), alt therapies(hypnosis, acupunture) 268. Endometriosis - ANSWER presence and growth of endometrial tissue outside of uterus 269. Endometriosis 270. s/s - ANSWER Dysmenorrhea 271. Deep pelvic dyspareunia (painful intercourse) 272. Endometriosis 273. Trx - ANSWER Drugs 274. Surgery 275. Alteration in cyclic bleeding - ANSWER oligomenorrhea 276. hypomenorrhea 277. Menorrhagia 278. metrorrhagia 279. Oligomenorrhea - ANSWER infrequent menstruation(PCOS) 280. Hypomenorrhea - ANSWER scanty menstruation 281. (IUD people have this) 282. menorrhagia - ANSWER excessive menstrual bleeding 283. Tamp and pad people have to change q2hrs 284. metrorrhagia - ANSWER bleeding from the uterus at any time other than normal menstruation 285. prevention of STIs - ANSWER knowledge of partner, reduce partners 286. Lower.-risk sex 287. Condom use 288. Vaccination 289. Chlamydia - ANSWER most frequent sti 290. silent and destructive infection 291. Difficult to dx 292. -can cause infertility because it scares the fallopian tubes 293. Screening/Dx/trx for chlamydia - ANSWER screening of asymptomatic and pregnant women 294. Comparisons of dx procedures 295. Trx: drugs 296. Gonorrhea - ANSWER oldest communicable disease 297. women are often asymptomatic 298. Trx with antibiotics 299. Drug-resistant strains on the rise 300. Syphilis - ANSWER transmission by entry in subq tissue through microscopic abrasions 301. Transplacental transmission may occur at any time during pregnancy 302. Syphilis primary and secondary cm timeframes - ANSWER Prime: 5-90 days 303. 2ndary: 6 wks -6 months 304. Syphilis 305. Screening and dx - ANSWER pregnant women 306. Serologic tests 307. false positives 308. Syphilis management - ANSWER Penicillin 309. Sexual abstinence during treatment 310. Pelvic inflammatory disease (PID) - ANSWER results from ascending spread of microorganisms from vagina and endocervix to upper genital tract 311. involves: - uterine tubes - uterus 312. unidentified pain, not treated clap or syphilis goes up fallopian tubes 313. inc risk for with PID - ANSWER ectopic pregnancy 314. infertility 315. chronic pelvic pain 316. Screening and dx for PID - ANSWER hx 317. CDC routine criteria 318. Management of PID - ANSWER Prevention 319. Oral and parenteral therapy 320. Bedrest 321. Edu 322. HPV - ANSWER most common STI 323. Genital warts 324. more common in preg women - cervical dysplasia or warts - Can still have vaginal birth 325. S/S of HPV - ANSWER irritating vaginal dc with itching 326. Dyspareunia, postcoital bleeding 327. HPV screening/dx - ANSWER hx of known exposure 328. Physical inspection 329. Pap smear 330. HPV management - ANSWER No therapy has been shown to eradicate 331. Meds for discomfort 332. counseling and edu 333. HSV-1, HSV-2 - ANSWER -HSV-1: oral lesions 334. -HSV-2: perineal lesions 335. Hep A - ANSWER acquired primarily through fecal-oral route 336. Ingestion of contaminated food 337. Person to person contact 338. vaccination is most effective means preventing HAV transmission 339. Hep B - ANSWER Most threatening to fetus 340. Disease of liver; often a silent infection 341. transmitted parenterally perinatally, orally, and intimate contact 342. Vaccine series 343. Hep C - ANSWER blood borne 344. Risk factors for pregnant women is hx of injecting IV drugs 345. no vaccine but is aa cure 346. HIV - ANSWER human immunodeficiency virus 347. NO CURE ONLY TESTING 348. Bacterial Vaginosis (BV) - ANSWER most common vaginitis 349. "fishy odor" 350. preterm birth 351. Brownish dc - from overgrowth of normal flora 352. Candidiasis(yeast) - ANSWER vaginal pruritus 353. Cheese-curd dc - diaper rash 354. Candidiasis (yeast) 355. Screening/dx/management - ANSWER physical exam 356. Vaginal pH 357. management: OTC agents 358. Trichomoniasis 359. Dx/management - ANSWER STI 360. Dx: specular exam, Pap smear 361. management: Sexual transmission must be communicated to infected partner 362. Group B streptococci - ANSWER Associated with poor pregnancy outcomes 363. An important factor in neonatal morbidity and mortality 364. Screening at 35 to 37 weeks of gestation decreases risk 365. won't hurt mom but will hurt the baby 366. Infertility incidence - ANSWER Affects about 10% to 15% of reproductive-age couples 367. Dx after 1 yr of unprotected intercourse when woman is 35 or after 6 months of unprotected intercourse when woman is 5 368. 4 goals when providing care of infertile people - ANSWER provide couple with accurate info 369. assist in identifying the cause of infertility 370. Provide emotional support 371. guide and edu about forms of trx 372. Factors associated with female infertility - ANSWER ovarian factors 373. Tubal and peritoneal factors 374. Uterine factors 375. Vaginal-cervical factors 376. Test or examination for assessing female infertility - ANSWER evaluation of the female anatomy 377. Detection of ovulation 378. Hormone analysis 379. Ultrasonography 380. endometrial sonography 381. Hysterosalpingography (patency of fallopian tubes and uses dye) 382. Laparoscopy(into abd cavity, endometriosis, visualize/lyse endometria outside uterus) 383. Factors associated with male infertility - ANSWER hormonal factors(semen analysis: swimmers swim right?) 384. Testicular factors( US, formed correctly, structural issues) 385. Sperm transport("is the subway working") 386. Idiopathic male infertility 387. semen analysis - ANSWER microscopic examination of ejaculated fluid 388. Basic test of maale inferitlity 389. scrotal ultrasound (US) - ANSWER Transrectal US evals ejaculatory ducs, vas deferens, and seminal vesicles) 390. Plan of Care and implementation - ANSWER Psychosocial considerations: - major life stressors - exhibit grieving behaviors 391. Nonmedical treatments - Herbal alternative methods - not good evidence 392. Medical therapy - make eggs mature, make women shed endometrium at appropriate time 393. Surgical therapies - Assisted reproductive therapies (ART) - general, fertility trx are more successful in producing a live birth for women35 - sex at timed intervals isn't fun - desire to have a baby has taken a life of its own 394. Reproductive alternatives - ANSWER -Surrogacy 395. -Adoption 396. -Cryopreservation of human embryos 397. -Moral and ethical dilemmas may exist for ARTs 398. --preimplantation genetic dx 399. Contraception - ANSWER Intentionally preventing pregnancy from occurring 400. Contraception - ANSWER •Family planning is the conscious decision on when to conceive or avoid pregnancy 401. •May still be at risk for pregnancy 402. •Nearly half of all U.S. pregnancies are unplanned 403. •A multidisciplinary approach to assist the woman in choosing an appropriate contraceptive method 404. •Ideally the method should be safe, readily available, economical, acceptable, and simple to use 405. •Contraceptive choice must meet personal, social, cultural, and interpersonal needs 406. Coitus interruptus (withdrawal) - ANSWER pull out method 407. Fertility Awareness Methods (FAMs) - ANSWER -Rely on avoidance of intercourse during fertile periods 408. -FAMs combine charting menstrual cycle with abstinence or other contraceptive methods 409. --Natural family planning (period abstinence) 410. --Calendar rhythm method 411. --Standard days method 412. --Basal body temperature method 413. --Cervical mucus ovulation-detection method 414. --Symptothermal method: BBT + Cervical mucus 415. Predictor test kits for ovulation: LH surge 416. --TwoDay method: "Did I note secretions today or yesterday?" 417. --Breast-feeding: LAM, prolactin inhibits estrogen; infant 6 months of age, exclusive, feeds approx q4hrs 418. barrier methods - ANSWER those who use barrier methods should be edu on emergency contraception options in the event of barrier failure 419. Spermicides - ANSWER frequent use of N-9 or the use of N-9 During anal intercourse may inc HIV transmission and leisons 420. Reduces mobility of sperms, effectiveness depends on consistent use, highest failure rate of contraceptives 421. Condoms (STI protection) - ANSWER Non-Spermicidal latex condoms provide barrier against STIs and HIV 422. Polyurethane=thinner and stronger 423. Latex perfect use better to prevent pregnacy 424. Vaginal Sheath (female condom) - ANSWER Can be nosy 425. Cannot use concurrently with male condoms 426. Diaphragm - ANSWER mechanical(device shape) and chemical barrier(holds spermicide against cervix) 427. poor choice for those with poor vaginal muscle tone 428. UP against cervix for 6 hrs after sex, contraindicated with pelvic floor issues 429. Cervical cap - ANSWER effectiveness less than diaphragm 430. Contraindicated for those with abn pap test results 431. toxic shock can occur with diaphragm and cervical cap 432. Contraceptive sponge - ANSWER Left in place for 6 hrs after sex 433. a contraceptive device made of polyurethane sponge that contains enough spermicide to be effective for 24 hours after being inserted into the vagina 434. Hormonal methods of contraception - ANSWER -oral contraceptives 435. -an injection, implant or patch 436. combined estrogen-progestin contraceptives - ANSWER leads to insufficient amounts of FSH/LH meaning follicles don't occur and the ovaries are turned off, 90% 437. oral contraceptives and side effects - ANSWER ovulation inhibited 438. Contra: clotting disorders, liver disease, Breast cancer, Pregnancy, smoking, and older than 35, HTN, diabetes, migraines with aura 439. Transdermal contraceptive system - ANSWER Delivers continuous levels of progestin and estradiol through the dermis 440. vaginal ring - ANSWER hormone releasing barrier that is placed in the vagina once a month for 3 weeks to prevent ovulation, keep out for 1 week and restart 441. Progestin only contraceptives - ANSWER inhibit ovulation, thicken cervical mucus, aalter tubal cilia, thin endometrium 442. Less contraindications due to lack of estrogen 443. used with breastfeeding, less effective than COC 444. Oral progestins (minipill) - ANSWER taken every day at same time, not protected if missed after 3 hrs 445. Injectable progestins - ANSWER administered every 11-13 weeks 446. 4x a year 447. Implantable progestins (Norplant) - ANSWER minor surgical procedure 448. emergency contraception (EC) - ANSWER used with 72 hrs of unprotected sex 449. given before ovulation, inhibits follicular development 450. Contraceptive counseling should be provided to women requesting EC 451. -discuss behavior modification 452. Five methods in the United States - Higher doses of estrogen or COCs(3 options) - two days of levonogestrel - Insertion of Copper intrauterine device (IUD) 453. Sterilization - ANSWER strict regulation 454. pt must be 21 if federal fund is used 455. female sterilization - ANSWER tubal occlusion and tubal ligation 456. tubal occlusion - ANSWER the blocking of the fallopian tubes with bag clip to prevent pregnancy 457. Tubal Ligation - ANSWER a surgical sterilization procedure in which the fallopian tubes are sealed or cut to prevent sperm from reaching a mature ovum 458. cut and tie them or cut section out of them 459. Vasectomy - ANSWER bilateral surgical removal of or part of the vas deferens 460. Tubal reconstruction (female) - ANSWER procedure used to restore tubal continuity (reanastomosis) after sterilization procedure 461. inc risk of ectopic pregnancy 462. Tubal Reconstruction (male) - ANSWER Reanastomosis of vas deferens 463. Abortion - ANSWER purposeful interruption of pregnancy before 20 wks of gestation 464. -elective: requested 465. -Therapeutic: for reasons of fetal or maternal health 466. Contributing factors for abortion - ANSWER preservation of the life of the mother 467. Genetic disorders of the fetus 468. Rape or incest 469. Pregnant women's request 470. AWHONN - ANSWER Association of Women's Health, Obstetric and Neonatal Nurses 471. lets nurses abstain from being involved in participation abortion procedures to keep their beliefs 472. first trimester abortion - ANSWER - Induced abortion performed in the first trimester is safest and less complex 473. Surgical(aspiration) abortion - ideally 8-12 wks from last menstrual period 474. Medical abortion 475. -Methotrexate and misoprostol(placed vaginally) - Mifepristone(7wks from last menstruation) and misoprostol (48hr after mifepristone) 476. Second Trimester Abortion - ANSWER dilation and evacuation (13-16wks) 477. Cervical preparation of prostaglandins 478. Emotional considerations - guilt, anxiety, emotional distress - BE THERE FOR MOM, DON'T judge decision 479. Common abortion complications - ANSWER infection 480. retained products of conception 481. Excessive vaginal bleeding 482. Nursing edu on abortion complications should focus on informing women to report - ANSWER fever 100.4 483. chills 484. bleeding more than one peripad/hour or heavy bleeding for 3days 485. Foul-smelling vaginal dc 486. Severe abd pain, cramping or backache 487. Abd tenderness with applied pressure 488. Why are children more vulnerable? - ANSWER toddlers don't understand danger or risks and just wanna explore 489. Feed them at least 2 hrs 490. No sunscreen on new borns until they are 6 months 491. Tantrums to express feelings or pointing and verbalize different 492. Reasons for hospitalization and or ER visits with children - ANSWER Accidents - sports playgrounds, home injuries, bike, MVA, violence, water, poison 493. Respiratory issues - asthma, pneumonia, acute bronchitis, infections 494. Fluid and Electrolyte disorders - dehydration(kidneys don't work) 495. Appendicitis 496. Affective or mood disorders 497. -depression, bipolar, anxiety 498. -Nurses should be the main edu to parents to prevent accidents 499. Specific groups of children have inc morbidity (illness) - ANSWER homeless 500. Living in poverty 501. Low birth weight 502. Chronic illness 503. Foreign born adopted children 504. Children in day care centers 505. Why are foreign born adopted children at higher risk for inc morbidity - ANSWER don't get care and nurturing in the first few months 506. Role of the Pediatric Nurse - ANSWER Therapeutic Relationship 507. Family Advocacy and Caring(stand up for the family) 508. Disease Prevention and Health Promotion 509. Health Teaching 510. Injury Prevention 511. Support and Counseling 512. Coordination and Collaboration 513. Ethical Decision Making 514. -listen to parent because they are above 18 but they have no say with birth control/anti anxiety/antidepressants and right saving treatment 515. Repeat stuff many times to parents so they understand 516. Growth - ANSWER an inc in number and size of cells as they divide and synthesize new proteins; results in inc size and weight of whole or any of its parts 517. Development - ANSWER a gradual change and expansion; advancement from lower to more advanced stage of complexity; inc capacity through growth, maturation and learning 518. Maturation - ANSWER inc in competence and adaptability, usually described as a qualitative change to fx as higher level 519. Differentiation - ANSWER process by which early cells and structures are systematically modified and altered 520. Infant stage - ANSWER birth - 1 year 521. Toddler stage - ANSWER 1-3 years 522. Preschool stage - ANSWER 3-6 yrs 523. School age - ANSWER 6-12 years 524. Adolescence - ANSWER 13-19 years 525. Cephalocaudal - ANSWER learn from head to toe 526. Proximodistal - ANSWER "inside-to-outside rule" motor skills emerge in a sequence of center moving outward - big arm movement to fine motor movements 527. General to specific - ANSWER crawl-walking-running 528. growth charts - ANSWER sets standards by which all children are measured 529. Ranges in percentiles - Aren't worried until they are in the 95th and 5th percentile but they are still normal, further tests are needed to see what else is happening - Concern is a big change, going from 5th % at month 6 to 8th in month 7 530. Nutrition with Peds - ANSWER single most important influence on growth 531. appetite fluctuates related to growth periods 532. What age group is most picky - ANSWER toddlers, physiological anorexia 533. Which age group has the highest nutritional requirement - ANSWER infants weight doubles in 6 months 534. teens are second fastest 535. How does someone's socioeconomic status impact their nutrition? - ANSWER Formula is expensive 536. Social character of play - ANSWER solitary 537. onlooker 538. parallel 539. Associative 540. Cooperative - play is how they learn 541. solitary play - ANSWER egocentric play, doesn't care about others 542. onlooker play - ANSWER watching others play 543. parallel play - ANSWER no common goal, toddlers 544. associative play(house play) - ANSWER friend over and playing together, preschool, and play no rules 545. Cooperative play - ANSWER play in which children genuinely interact with one another, taking turns, playing games, or devising contests 546. have rules and goals, think soccer 547. Functions of play - ANSWER Sensorimotor development 548. Intellectual development 549. Socialization 550. Creativity 551. Self-awareness 552. Therapeutic value 553. Morality 554. Erikson's Psychosocial Theory - ANSWER trust vs mistrust 555. autonomy vs shame and doubt 556. initiative vs guilt 557. industry vs inferiority 558. identity vs role confusion 559. intimacy vs isolation 560. generativity vs stagnation 561. integrity vs despair - need to have a crisis and need to overcome it to be successful in the next crisis 562. Trust vs. Mistrust (Erikson) - ANSWER 0-1 years. Erikson's first stage during the first year of life, infants learn to trust when they are cared for in a consistent warm manner 563. Can you trust caregiver, if you don't then you go into next stage questioning it 564. Autonomy vs. Shame and Doubt - ANSWER 1.5-3 yrs 565. control over environment and independency 566. Initiative vs. Guilt - ANSWER 3-6 years 567. Industry vs. Inferiority - ANSWER 6-12 years 568. identity vs identity confusion - ANSWER 13-21 569. Piaget Cognitive Development - ANSWER 1. sensorimotor 570. 2. pre-operational 571. 3. concrete operational 572. 4. formal operational 573. Sensorimotor - ANSWER birth to 2 years 574. Object permanence 575. using senses to explore the world (mainly through mouth) 576. preoperational stage - ANSWER 2-7 yrs, symbolic thinking 577. Egocentric, magical thinking 578. Concrete operational - ANSWER 7-11 yrs, logical thought 579. Thought process becomes logical, inductive reasoning 580. formal operational stage - ANSWER 11-adult, abstract thought 581. Become adaptable and flexible 582. Toddlers - ANSWER the terrible two's 583. 12-36 months 584. intense period of environmental exploration 585. Temper tantrums/obstinacy/negativism 586. DETERMINED, STRONG-WILLED, VOLATILE LITTLE TYRANTS 587. proportional changes with toddlers - ANSWER weight gain slows to 4-6 lbs/yr 588. Birth weight should quadrupled by age 2.5 yrs 589. Height inc about 3 inches/year 590. ELONGATION OF LEGS/ARMS RATHER THAN TRUNK 591. growth is step-like raather than linear 592. Sensory changes with toddlers - ANSWER visual acuity of 20/40 is acceptable 593. hearing, smell, taste, and touch cont developing 594. All senses are used to explore environment 595. Gross and Fine motor development for toddlers - ANSWER walking expected around 12-13 months 596. Improved manual dexterity ages 12-15 months 597. Throwing balls by 18 months 598. Running(with frequent falls) by 18 months 599. Climb stairs at 21-24 months 600. Fine motor development refinement of coordination between ages 2-3 yrs 601. rides tricycle by age 3 602. Improved hand-eye coordination (understanding how to catch) 603. Maturation of systems in toddlers - ANSWER most physiologic systems are relatively mature by the end of toddlerhood 604. -Upper respiratory infections, otitis media, and tonsillitis are common among toddlers 605. -Antibodies 606. -body temp is maintained 607. -Child is physiologically able to control elimination(potty training) 608. -Defense mechanisms of skin are intact 609. Psychosocial development - ANSWER Developing sense of autonomy(erikson) - autonomy vs shame and doubt - Negativism - Ritualization that provides sense of comfort 610. Cognitive development(sensorimotor and preoperational phases) - ANSWER Sensorimotor (0-2) - cognitive processes develop rapidly between ages 12-24 months - tertiary circular reactions 611. --Active experimentation (trial and error-dropping a toy) 612. --applying knowledges to new situations 613. --Learning spatial relationships (searching for lost toys) - Invention of new means through mental combinations 614. --find sensorimotor stages: 19-24 months 615. --imitation of behaviors 616. --DOMESTIC MIMICRY(mimic older older same gender person) 617. --Object permanence 618. --can begin to visualize things mentally (EX: if ball rolls under a table) 619. Cognitive development (preoperational phase 2-7yrs) - ANSWER preconceptual phase 620. --begins about age 2 621. --lasts about age 4 - iS the transition between self-satisfying behavior and socialized relationships - Preoperational thought implies children cannot think in terms of operations 622. -THINK SYMBOLICALLY - egocentrism/animism 623. -TODDLER BEGINS TO PROBLEM SOLVE, USE CREATIVE THINKING, AND BEGINS TO UNDERSTAND CAUSE AND EFFECT 624. Body image with toddlers - ANSWER development of body image parallels 625. child refers to body parts by name (they name them) 626. Child recognizes words used to describe appearance 627. -Ex: oh your pigtails are cute (no negative labels, positive body image only) 628. CHILD RECOGNIZES GENDER DIFFERENCES BY AGE 2 629. Gender identity with toddlers - ANSWER exploration of genitalia is common - use correct terms don't shame their exploration 630. -ask them to do it privately 631. Parental reaction should be accepting 632. gender roles are understood by toddler 633. Playing "house" 634. gender identity is formed by age 3 635. Separation and individualism - ANSWER differentiation of self from mother (prime caregiver) and significant others 636. Rapprochement: toddler goes and explores their own world then comes back to mom for approval - moms reaction is huge, promote exploration safely 637. Object permanence 638. Transitional objects: going somewhere new aand could be frightening so they use safe objects to help them transition to this new env 639. Language social development - ANSWER level of comprehension inc 640. Ability to understand inc 641. Comprehension is much greater than the number of words a toddler can say 642. at age 1, child uses holophrases - EX: up, 643. By age 2, child uses multiword sentences 644. Personal social behavior social development - ANSWER Toddler develop skills of independence (terrible 2s) 645. Skills for independence may result in determined, strong willed, volatile behaviors 646. Skills include feeding, playing, dressing, and undressing self 647. Toddlers develop concern for the feelings of others (at the end of the toddler phase) 648. 3 major signs to start toilet training - ANSWER waking up from nap dry 649. Aware of urge (they're in the corner) 650. Communicate they gotta go or have gone, able to go 2 hrs before staying dry 651. Sibling rivalry with toddlers - ANSWER oldest one doesn't like change (from ritualism), don't get attention (dethronement), - prep kids closer to birth 652. -Explain sleeping arrangements with baby, changing diaper the baby with oldest , have extra family around to help with the baby 653. Regression - ANSWER Toddler will regress because of stress from new person in family and will revert back to what is easier (more accidents) 654. Tantrums with toddlers - ANSWER do these when children don't know how to express themselves, know your child's limit, set timers and limits (set them up to dec tantrums), remain calm and help them find ways to express emotions 655. EX: 5 more rides down the slide until we leave, okay two more times down the slide 656. Discipline with toddlers - ANSWER avoid physical punishment, threats and criticisms, Time out - all about positive reinforcement 657. CONSISTENCY IS KEY 658. Time out with toddlers - ANSWER Limit it to 1min/age, make rules clear and the area uninteresting, praise them for sitting quietly in time out, consistency is key 659. Nutrition with toddlers - ANSWER 18 months = physiological anorexia 660. nutritional counseling (picky, ritualism, control) 661. Dietary guidelines 662. Positive experiences - give them small portions, cut it up into small pieces 663. Sleep and activity with toddlers - ANSWER sleep problems 664. Consistency 665. Attention seeking - behavior (one more drink) 666. "one more" - keep sleeping habits as consistent as possible 667. --transitional object 668. --acknowledge their fears - need 12-14 hrs and no more naps by the age of 5 669. Dental health with toddlers - ANSWER Regular dental exams - teeth come in by age 1 670. Deciduous teeth are usually all present by age 3 671. Removal of plaque 672. "i'll do it myself" 673. - 674. Help them brush their teeth and it may be a fight 675. Slow them into dentist because they don't understand the process 676. Fluoride helps tooth decay, and they need more usually 677. -Oral(help new teeth coming in) and topical(for teeth already out) 678. Diet: have low sugar diet, and no gummy vitamins because of the sugar, flinstones vitamins 679. ECC: early childhood cavities, usually seen in toddlers who take bottles to bed (milk sitting on teeth=cavities) 680. Definition of family depends on? - ANSWER frame of reference 681. values 682. Discipline area 683. Beliefs 684. primary unit of socialization 685. Potent support system for its members 686. Family plays a pivotal role in health care decisions 687. Family-centered care is the target of health delivery for maternal and newborn nurses 688. Family organization and structure - ANSWER Nuclear family 689. Multigenerational family 690. No-parent families 691. Married-parent families 692. Married-blended families 693. Single-parent families 694. Cohabitating parent families 695. Homosexual families 696. Social Dynamics - ANSWER social roles are learned in pairs (parent-child, brother-sister) 697. Family uses its resources to provide a safe, intimate env for development of fam members 698. provides for nurturing of newborn and gradual socialization of growing child 699. parent-child relationships influence self-worth and ability to form later relationships 700. Fam provides the growing child with identify that identify possess both a past and sense of future 701. Culture values and rituals are passed from one gen to next via fam 702. power reflects the fam's concepts of male or female dominance and cultural practices, social customs, and community norms 703. Family nursing 704. How would you share info - ANSWER nurses assist fams as they incorporate new additions 705. Treat all fams with respect and dignity 706. Sharing info in ways that are: - positive - useful - complete - accurate - timely 707. Family systems theory - ANSWER focuses on interaction among components of the system (elastic band) 708. between system and env 709. Problems do not lay in one person, rather the interaction of the people 710. Developmental theory - ANSWER correlated to erikson's developmental theory and roger's role theory 711. changes in structure, function and roles of members based on stage 712. Stage identified with eldest child - Criticism: assumes a 2 parent family, modifications to theory have been made - Strength: provides framework for looking at fam 713. Family Stress Theory - ANSWER explains how families react to stressful events and suggests factors that promote adaptation to stress 714. Stressors: puts fam at risk, can be cumulative 715. Resiliency: fam can adapt to situations, can grow from stress event 716. Calgary Family Assessment Model (3 categories) - ANSWER structural 717. developmental 718. functional 719. Family Genogram - ANSWER family tree format depicting relationships of family members over at least three generations 720. Ecomap - ANSWER a graphic portrayal of social relationships of the women and family 721. Family in a cultural context - ANSWER acculturation 722. assimilation 723. ethnocentrism 724. Cultural relativism 725. Acculturation - ANSWER (n.) the modification of the social patterns, traits, or structures of one group or society by contact with those of another; the resultant blend 726. Assimilation - ANSWER interpreting our new experiences in terms of our existing schemas 727. Bladder irritability, nocturia, frequency, urgency occurs in early pregnancy and returns near term 728. Bladder has inc capacity walls hypertrophy in later pregnancy, more susceptible and trauma at birth 729. adaptation of integumentary system with pregnancy - ANSWER hyperpigmentation - linea nigra - nipples - vulva - axillae 730. accelerated nail growth 731. Palmar erythema (red hands) 732. Mechanical stretching - stretch marks are from genetics of collagen 733. adaptation of musculoskeletal system - ANSWER alterations in posture(lordosis) 734. musculoskeletal discomforts - uterine ligament stretching - legs cramping 735. Relaxation and inc mobility of pelvic joints - change in gait - Relaxin and progesterone 736. Diastasis recti abdominus 737. adaptations of neurologic system - ANSWER compression of nerves or vascular stasis 738. Dorsolumbar lordosis 739. Carpal tunnel syndrome 740. Acroesthesia (numbness and tingling of hands) 741. Tension HA 742. Lightheadedness, faintness, syncope 743. adaptation of GI system with pregnancy - ANSWER appetite and food intake fluctuate - morning sickness, N/V - alterations in sense of taste and smell 744. Mouth - epulis and ptyalism 745. Esophagus, stomach, and intestines - inc progesterone 746. causes dec tone and motility(pyrosis, constipation) - displaced appendix 747. epulis - ANSWER nontender, fibrous nodule of the gum 748. pytalism - ANSWER excessive salivation 749. Abdominal discomfort - ANSWER pelvic heaviness or pressure, round ligament tension, flatulence, distention and bowel cramping and uterine contractions 750. Estrogen - ANSWER Promotes enlargement of genitals, uterus, breasts 751. inc in size and number of myometrial cells 752. produced by corpus luteum until 14 days, then the placenta 753. Relaxation of pelvic ligaments and joints 754. Inc vascularity and vasodilation 755. Water retention 756. Dec maternal ability to use insulin 757. Progesterone - ANSWER produced by corpus luteum until 14 days, then the placenta produces it 758. inc significantly and is essential in maintaining the preg 759. Relaxes smooth m. 760. Dec maternal ability to use insuln 761. Relaxin - ANSWER Placental hormone 762. affects tone 763. makes every joint relaxed 764. Prolactin - ANSWER Produced by the anterior pituitary 765. Begins to rise early in the first trimester progressively to term 766. RESPONSIBLE FOR INTIAL LACTATION - high levels of progesterone and estrogen inhibit lactation by blocking the binding of prolactin to breast tissue until after birth 767. Oxytocin - ANSWER Produced by the posterior pituitary 768. inc amount as the fetus matures 769. Stims uterine contractions during preg - progesterone prevents contractions until near term 770. Stims let-down or milk-ejection reflex after birth 771. Timeframe with pregnancy - ANSWER spans 9 calendar months - 10 lunar months of 28 days (280) 772. Trimesters (1,2,3) - ANSWER 1st: weeks 1-13 773. 2nd: weeks 14-26 774. 3rd: weeks 27-40 775. Estimated date of birth (edb) - ANSWER formulas for calculating EDB but none infallible 776. Nägele rule - ANSWER -Determine first day of last menstrual period (LMP), subtract 3 months, add 7 days plus 1 year 777. -Alternatively add 7 days to LMP and count forward 9 months 778. -Most women give birth from 7 days before to 7 days after EDB 779. Maternal adaption to pregnancy - ANSWER accepting the pregnancy 780. Identifying with the mother role 781. reordering personal relationship 782. Establishing a relationship with fetus - emotional attachment 783. Preparing childbirth 784. Paternal Adaptation to Pregnancy - ANSWER couvade syndrome 785. Accepting pregnancy - 3 phases (announcement, moratorium, focus) 786. Identifying with father role 787. Reordering personal relationships 788. Establishing relationship with fetus 789. Preparing childbirth 790. -sibling adaptation 791. -Grandparent adaption 792. Care Management with prenatal care - ANSWER Goal is to promote the health and well-being of the pregnant woman, the fetus, the newborn and family 793. Emphasis on preventative care and optimal self-care 794. Prenatal care is sought routinely by women of middle of Higher SES 795. Women in poverty or lacking health insurance may not have access to public or private care - lack of culture and communication interfere with cares 796. -immigrant women may not seek prenatal care - Birth outcomes are less positive, with higher rates of maternal and newborn complications - Problems with low birth rate and infant mortality associated with inadequate prenatal care 797. Barriers to obtaining prenatal care - ANSWER Lack of motivation to seek care 798. Inadequate finances 799. Lack of transportation 800. Unpleasant clinic personnel 801. Unpleasant facilities or procedures 802. Inconvenient clinic hours 803. Problems with child care 804. Personal and cultural attitudes 805. interview portion with prenatal care - ANSWER reasons for seeking 806. current pregnancy 807. Childbearing and reproductive hx 808. Health Hx 809. Nutrition hx 810. Hx of drug/herbal preparations 811. Fam Hx 812. Social, experimental and occupational hx 813. hx of physical abuse(IPV is the highest with preg women) 814. Review of systems 815. Physical exams 816. Lab tests 817. Follow up visits with prenatal care - ANSWER interview 818. physical exam 819. Fetal assessment 820. Fetal assessment - ANSWER fundal height, gestational age, health status 821. Lab tests - multiple marker or triple-screen blood test - Other blood tests (RPR/VDRL, CBC, Anti-Rh) 822. -Other tests 823. --US, amniocentesis 824. Education for self-management with prenatal care - ANSWER Nutrition - wash foods, can't eat certain fish, unpasteurized cheese sushi and mayo - gotta eat steaming hot deli meat (listeria) 825. Personal hygiene (higher BMR)(change deodorant) 826. Prevention of UTI 827. Kegel exercises (dec prostatitis in males) 828. Preparation for breast feeding newborn 829. Dental Health (estrogen changes everything) - if you don't take care of your teeth it can put you at risk for preterm birth 830. Edu for self management prenatal care (2) - ANSWER Physical Activity(walk) - cont all physical activity going if you're 831. Posture and body mechanics - center of gravity changes be careful 832. Rest and relaxation - if the body needs to sleep mom shouldn't force the body 833. Employment 834. Clothing - wear the bigger girl clothings, NO SKINNY JEANS 835. Travel - seatbelts, be careful 836. Edu for self management prenatal care(3) - ANSWER meds and herbal preparations 837. Immunizations - no live vaccines, varicella can cause neuro damage to baby 838. Rh immune globulin 839. Alc, smoke, caffeine (less than 200 mg) and drugs 840. Normal discomfort 841. Recognizing potential complications 842. Recognizing preterm labor 843. Sex counseling - using the hx - countering misinformation - suggest alt behaviors - 2nd trimester the moms will want all the baby gravy 844. -3rd trimester she doesn't want sex but it helps induce labor 845. Cultural Influences of prenatal - ANSWER normal process of life 846. Don't seek care until illness 847. Cultural prescriptions/proscriptions (taboos) 848. Age with prenatal care - ANSWER adolescents-risks, access to care (denial they are pregnant usually) 849. Older than 35 risks(htn popping up for the first time) 850. Multifetal pregnancy - ANSWER -Twin pregnancies often end in prematurity(before 38 weeks) 851. -Rupture of membranes before term common 852. -Congenital malformations twice as common in monozygotic twins as in singletons 853. -No increase in incidence of congenital anomalies in dizygotic twins 854. -prenatal care given women with multifetal pregnancies includes changes in: 855. --pattern of care ◼ amount of weight gain 856. --Nutritional intake observed 857. -Uterine distention can cause severe backache 858. Probability inc of multifetal pregnancy - ANSWER hx of dizygous twin in female lineage 859. use of of fertility drugs 860. Rapid uterine growth for weeks of gestation 861. Polyhydramnios 862. Palpation of more small or large parts than expected 863. Asynchronous fetal heartbeats or more than one fetal electrocardiographic tracing 864. Ultrasonographic evidence of more than one fetus - uterine grown is measured higher than what it should be 865. EX: feels like 12 weeks but should be 4 866. polyhydramnios - ANSWER excessive amniotic fluid 867. Prenatal edu goals - ANSWER assist individuals and their fams to make informed, safe decisions about childbirth 868. Assist to comprehend the long-lasting effects an empowering birth experience can have 869. Ideally this begins in the preconception period 870. Perinatal choices - ANSWER physicians 871. nurse-entry midwives 872. Independent midwives 873. Doulas (emotional support) 874. Birth plans 875. Birth setting choices - birth centers - home birth - Hospital