Midwifery, 3rd Edition questions from textbook And Answers Graded A+!!!

Midwifery, 3rd Edition questions from textbook And Answers Graded A+!!! in particular. Name four social determinants that can and do influence women's health. - ANS sex and gender, racism, life stages, access to resources and diversity. Provide three questions each on cardiac health and pulmonary health used in an antenatal booking assessment that would determine whether further referral is required. - ANS (1) Have you been told you have had rheumatic fever? Do you suffer from joint pain/and or chest pain? Do you take medication for your heart? (2) Does it hurt when you breathe? Do you get breathless easily? Do you have a persistent cough for which you see the Dr regularly? When and why would you perform a full 'hands-on' breast examination? - ANS The midwife should complete a full hands-on breast examination in early pregnancy following a comprehensive history, before physiological changes are pronounced, as early detection is vital. The hands-on examination can highlight any skin abnormalities, nipple changes /discharge, lumps or other abnormalities and the midwife can refer to other services early if need be. What are the effects of obesity on pregnancy and birth? - ANS Infertility, miscarriage, fetal anomaly, gestational diabetes, preeclampsia, sleep apnoea, increased incidence of IOL, slow progress in labor, instrumental delivery, LSCS shoulder dystocia, PPH, increased risk of infection postnatally, DVT, postnatal depression. How much exercise is safe in pregnancy? - ANS Regular moderate to vigorous prenatal exercise has been shown to provide maternal health benefits. How would you screen for perinatal depression in midwifery practice? Why would mental health screening be an important role for the midwife? - ANS Use of antenatal psychosocial assessment tools and other tools increases midwives' awareness of potential perinatal depression, and regular support and intervention as well as reassessment can ensure that women are supported through the emotional time that the postnatal period is. What are the estimated rates of family (intimate) violence in pregnant women in Australia and New Zealand? Why are they only 'estimated'? - ANS 42 % of women experienced violence during their pregnancy, with 20% assaulted for the first time during their pregnancy. These are estimated numbers as the stigma and fear around reporting family violence still prevent women from actively reporting. Give two benefits and two disadvantages of routine screening for family violence in pregnancy. - ANS Benefits—allows women to know that there is support and allows them access to it; raises general awareness in the community which has long term benefits for all sections of the community. Disadvantages—women who experience family violence may not attend antenatal appointments and therefore will miss out on screening; fear about reporting and what happens next prevents them from being honest. Name three adverse effects related to smoking cigarettes in pregnancy for (a) the mother and (b) the baby. - ANS a) Hypertension in pregnancy, antepartum hemorrhage, asthma. B) Low birth weight, SIDS, lung disease. What are some of the adverse effects of using heroin in pregnancy? - ANS Miscarriage, preterm labor, IUGR, stillbirth. What are the signs and symptoms of chlamydia infection in women? - ANS Vaginal discharge or abnormal bleeding, abdominal pain, fever due to PID or infection, infertility or ectopic pregnancy, dysuria. What are the main characteristics of a profession and why is it important for midwifery to be a profession? - ANS Midwives are a disciplined group of individuals who adhere to high ethical standards and uphold themselves to, and are accepted by, the public as possessing a unique body of knowledge and skills that are derived from specialized education, Outline the action of the combined estrogen/progesterone contraceptive pill with reference to the hypothalamic-pituitary-ovarian (HPO) axis. - ANS Hormonal contraceptives contain levels of estrogen and/or progesterone that cause feedback control on the HPO axis to prevent follicle development and ovulation. Some contraceptives use the cervical mucus-changing properties of progesterone (e.g. the mini pill). List three physiological factors that promote successful fertilization. - ANS (1) The oocyte secretes a chemical that attracts sperm (Sun et al., 2005). (2) Progesterone released after ovulation stimulates the acrosomal reaction (Shah et al., 2003). (3) Increased estrogen levels at this time have many effects, such as: increasing the contractility of the fallopian tube, which assists sperm transport. Explain why teratogens tend to cause more severe developmental problems when exposure occurs in the first 8 weeks of pregnancy. - ANS The embryo is vulnerable to developmental disruption from a wide range of teratogens— environmental agents such as infections, hyperthermia, drugs and radiation exposure, and nicotine and narcotics exposure, leading to major congenital abnormalities. Name each of the vessels that transport blood from the fetus to the placental circulation and back. - ANS Deoxygenated blood leaves the fetus via two umbilical arteries to the placenta, and oxygenated blood comes from the placenta via the umbilical vein. Explain why oedema may occur in pregnancy. - ANS Plasma proteins also increase but haemodilution lowers the concentration, particularly of albumin, which lowers the osmotic pressure of the plasma. This means there is a greater tendency for fluid movement to the interstitial compartment, and this coupled with the increased water retention mediated by estrogen leads to an increased possibility of oedema (Blackburn, 2013). Describe four key changes to the structure of myometrial cells that occur during activation of the myometrium. - ANS Four main events occur during activation: the ratio of hormones changes, electrical activity increases, myometrial cells become more responsive, and there is an increase in numbers of ion channels. Describe the lymph system and drainage within the breast. - ANS The lymph vessels are extensive, flowing alongside the ductal tissue and converging towards the nipple where they form a plexus beneath the areola. Lymph drainage from within the breast follows two main pathways. The first pathway sees lymph being drained to the axillary nodes and the second to the internal mammary nodes. Lymph glands drain into axillary nodes (Geddes, 2007). Describe the composition of colostrum - ANS Colostrum is a viscous, concentrated yellow, white or brown liquid of relatively low volume and lower calorific content value than mature breast milk. It is high in protein, sodium and minerals however relatively low in lactose, carbohydrates, fats and vitamins. In addition to nutritive factors, colostrum also contains a high concentration of protective constituents, such as immunoglobulins, macrophages, lymphocytes, neutrophils, antibodies and immune cells that assist in the protection of a newborn's fragile mucous membranes against microbes and viruses by preventing their entry, transport and/or proliferation (Ballard & Morrow, 2013). What is the aim of the WHO 1981 International Code of Marketing of Breast-Milk Substitutes? - ANS The aim of the WHO Code was to contribute to the provision of safe and adequate nutrition for infants, through the protection and promotion of breastfeeding and by ensuring the proper use of breast-milk substitutes, when these are necessary, on the basis of adequate information and through appropriate marketing and distribution (WHO, 1981). Summarize some of the benefits of breastfeeding for mother and infant. - ANS For the mother: • Hastens involution, with reduced blood loss and less anemia • Reduces fertility/increases child spacing • Reduces risk of ovarian and breast cancer • Reduces osteoporosis • Possibility of improved return to prepregnancy weight • Enhances maternal-infant bonding • Enhances calmness and social responsiveness • Decreases maternal anxiety. For the infant: • Reduces gastrointestinal infections • Reduces incidence and duration of diarrhoeal illness • Reduces occurrence of otitis media • Protects against respiratory infection and reduces risk of childhood asthma • Protects against SUDI • Reduces the incidence of NEC • Enhances cell-mediated and humoral responses to antigens (allergies) • Enhances cognitive development • Improves visual acuity • Reduces the incidence of obesity. At 10 weeks pregnant, Neve is unable to eat any food without vomiting and feels nauseated all day. What actions will you take? - ANS Requires physical and psychological care. • Immediate assessment by midwife—center on questions related to frequency and severity of the vomiting, risk factors, other symptoms such as pain or pyrexia and tolerance of food and fluids. • Refer as required. • Needs a diagnosis—nausea and vomiting in pregnancy to hyperemesis gravidarum. • Hospitals need hydration and correction of any electrolyte imbalance—prevent weight loss. • If severe, a PICC line may be required (care of PICC line). • Minimize stimuli (light, noise, odors). • Identify whether there are any particular triggers for her. • Pharmacological treatment versus non-pharmacological treatment (acupressure, ginger). • Let Neve talk about how she is feeling and actively listen. • Support. Beth is 8 weeks pregnant and rings you to say she has had some fresh vaginal bleeding. What advice will you give her? - ANS Take history that includes the amount of bleeding (color of blood), pain. Ask her to come to the hospital for assessment. Discuss with her potential outcomes—bleeding may cease and pregnancy continue, bleeding continues and she has a miscarriage. Victoria is 22 weeks pregnant. She comes to your clinic complaining of feeling unwell and with lower abdominal crampy pain. What other information do you require? What will you do? - ANS History: How long has she had the pain? Describe the nature of the pain. Any blood loss? Refer to an obstetrician for diagnostic tests and medical management. Possibly ectopic pregnancy. Isabella's first pregnancy has progressed normally. However, at her 36-week antenatal check, Isabella has a blood pressure recording of 140/98 mmHg and + protein on dipstick. What actions do you take? - ANS needs to recognise hypertension early. Need to monitor women for progression of disease. Check BP an hour after she has been in clinic (assess whether she had been resting prior to coming to clinic). If still high, I need a referral to a doctor for collaborative management. She may be able to return home and reduce activity. She can keep a daily log of symptoms and assessment, e.g. how she is feeling, examine own urine with a dipstick, fetal movements. Combine with clinic visit and BP check and any escalating reason for delivery. At 32 weeks pregnant, Joanna rings you, saying that her skin feels very itchy, especially on her palms. She tells you that she has no rash. What do you advise? - ANS She will require close monitoring of herself and her fetus as she probably has obstetric cholestasis. Collaborative care. Regular CTG and ultrasound assessment for fetal growth. Rest and appropriate diet. Frequent cool baths and use of lotion to relieve the itch. Wearing loose fitting cotton clothing. Medication management—. Dexamethasone and vitamin K administration may be helpful. Portia has a fundal height of 15 weeks at her 12-week antenatal visit. A subsequent ultrasound scan confirms a twin pregnancy. Portia is very keen for you to continue to provide midwifery care for the remainder of her pregnancy. Under what conditions could this be provided? What plan for care and ongoing management will you negotiate with Portia? - ANS Collaborative maternity care arrangement. Support the parents as they prepare for parenthood. Identify any complications that may arise in the pregnancy and refer as appropriate. Potentially more frequent antenatal visits. Prepare the family for birth. Rae is 37 weeks pregnant with her first baby. She rings you at 2 am and says she has heartburn, can't stop vomiting and 'feels most unwell'. Her pregnancy has proceeded normally so far. What will you suggest? - ANS Admission to hospital for assessment. What are some of the factors associated with poorer postpartum health? - ANS Health Environment and housing Poverty Nutrition Emotional/mental health Unresolved health issues from previous pregnancy List some of the barriers women face in accessing professional assistance for healthcare - ANS Access to the professional, e.g. distance, travel and inaccessibility for women in rural and remote areas Women's acceptance that what is happening is 'normal' Woman too embarrassed to seek professional assistance Finance Isolation Describe the symptoms and treatment of endometritis. - ANS Will commonly present between 2 and 7 days postpartum Fever of more than 38°C Uterine tenderness—subinvolution Lower abdominal pain Purulent and foul-smelling lochia Treatment: Consultation, Swabs for culture Antibiotics—usually broad spectrum What assessment data would you need to determine whether a woman was experiencing a secondary postpartum hemorrhage? - ANS History—this will include the history of the birth, especially examination for completeness of placenta and membranes. When did bleeding start? How much blood was lost? Where is the pain? Objective assessment: Vital signs—as any deterioration will signify an acute hemorrhage. Lochia—smell. Abdominal—tenderness, cramping, where is fundus. Describe the initial treatment for a woman admitted to hospital via ambulance reporting that she is 12 days postpartum and bleeding heavily. - ANS Following assessment as above, treatment will depend on clinical findings Resuscitation as indicated Administration of uterotonic agent Antibiotics Possible surgical evacuation of uterus or repair of lacerations Emotional/psychological support Communication and collaboration What are the factors that place women at risk for postpartum emotional distress? - ANS Not being able to discuss their birth experience Financial hardship Being single English as second language Association with three or more stressful life events Baby may not be the sex that the wanted Social isolation Poor partner relationship Previous history of depression What advice would you give a woman who reported she was experiencing urinary incontinence after the birth of her child? - ANS Advise that a large number of women have urinary incontinence following childbirth. Assessment by midwife or continence specialist—collaborative care. Recommend pelvic floor muscle training. Reassure her, communication and emotional support. Briefly describe the effect of social support in relation to postnatal depression. - ANS Accessing social support will allow woman to talk to someone about her feelings. Can help the mother stay positive. May provide support for woman to undertake physical activity. May assist with sleep patterns and relaxation. Describe best practice in maternity care to specifically prevent emotional distress for postpartum women. - ANS Antenatal preparation. Identify risk factors in the antenatal period and manage—identify antenatal depression. Discuss with women the 'normal' postpartum blues (when to expect, how long they will last and what the woman will feel). Early diagnosis and treatment in the postpartum period. Identify between anxiety and depression. What, if any, differences do you think that differing countries of origin for sample groups might have on research findings about bereavement stages and phases? - ANS Every person will have their own beliefs about bereavement stages and phases. Bereavement will be influenced by the woman and her family, culture, religion and gender. Potentially there could be slight differences in findings; however, all women regardless of where they are from are likely to experience the stages and phases of grief. The order that they experience them could be quite different. How is the diagnosis of preterm labour made? - ANS Begins after 20 weeks and before 27 weeks. Clinical tests—transvaginal ultrasonography to measure the length of endocervix. The cervicovaginal fetal fibronectin.