Maternity Final Exam 2024

How often do you have a prenatal appointments before 28 weeks? - once every 4 week how often do you have prenatal appointments from 28-36 wks? - once every 2 weeks What might be part of the first prenatal appointment? - health history , medications, blood type, HIV, ghonnorhea, chlamydia what are some things that would occur during 3rd trimester appointment? - leopards, Hgb/Hct, Group B strep testing @ 36wks, STI , rescreen for chlamydia if less than 25 yrs of age? At what point of the pregnancy can you first begin to hear the fetal heart rate? - 9 wks What is the definition of hyperemesis gravidarum? - unusually acute N/V, usually diagnosed between the weeks of 11-20wk Patients with hyperemesis gravidarum are at risk for........ - weightloss , malnutrition, dehydration, ketonuria, electrolyte imbalances What is treatment that is recommended for hyperemesis gravidarum ? - rest, antiemetics , IV fluids, parenteral nutrition What would you do for a patient with carpal tunnel syndrome acquired during pregnancy? - splinting Why can nosebleeds occur during pregnancy? - engorged capillaries can cause nose bleed Why does congestion and stuffiness occur during pregnancy? - due to increased estrogen What would you recommend for patients with varicose veins? - do not stand or sit for long periods of time, compression stockings What two hormones can improve the mobility of the pelvis during pregnancy? - relaxin/progesterone What does GTPAL stand for? - 1. Gravidity (number of pregnancies including present one 2. Term births (longer than 37 weeks) 3. Preterm births (before 37 weeks) 4. Abortions or miscarriages before 20 wks 5. Living children when would you give rhogam? - if mom is - and baby is +, give rhogham to mother For a baby to be at risk for developing Rh+, what must the parents be ? - Mom - dad + What is the MOA of combined oral contraceptives? - increases viscosity of cervical mucus, suppress ovulation, thinning of uterine lining What is contraindicated in combined oral contraceptives? - breastfeeding, migraine, smoker greater than 35 yrs, history of blood clots, hypertension Which oral contraceptive can be used during breastfeeding? - POP those on POP must take within a _______ hour window to be effective - 3 what can happen to your pregnancy if you become pregnant while taking POP and why? - ectopic, due to slowing of cilia in Fallopian tube What two hormones are in the contraceptive ring? - estrogen progestin True or False Contraceptive Rings can become dislodged during a bowel movement - True Where can contraceptive patches be placed? - upper back , upper arm, upper buttock, lower abdomen What education should you provide if your patient is on contraceptive patches? - rotate sites to avoid irritation What are permanent methods of contraception? - tubal ligation vasectomy When can you take Plan B for it to be effective? - 72 hrs does plan B effect a preexisting pregnancy? - no Who does Plan B not have a good effect one? - those who weigh more than 165 lbs When can you take Ella for it to be effective? - within 120hr of unprotected sex what is Ella MOA? - progestin blocker can Ella effect a preexisting pregnancy ? - yes which emergency contraceptive works better for a patient who is 225 lbs? - Ella What hormone is in the depo shot? - progestin How often is the depo shot given? - 13 What is the depo shot MOA? - suppress FSH and LH, inhibits follicle maturation and ovulation When should you begin your next depo shot in relation to your menstrual cycle? - within 7 days of your lMP What is a side effect of the depo injection? - weight gain What hormone is in nexaplanon? - estrogestrel How long can nexaplanon be used for ? - 3 yrs What is the MOA of nexaplanon? - changes cervical mucus and fallopian time mobility that impedes fertilization Who is nexaplanon less effective for? - BMI greater than 30 what is the MOA of copper IUD? - inhibits sperm mobility and survival True or False Getting a copper IUD can be used for emergency contraception of a pregnancy - true , used within 5-7 days True or False Copper IUD can cause heavier bleeding - True What may acute cramping indicate if your patient has an IUD? - it slipped What hormone is in a hormonal IUD ? - progestin True or False hormonal IUD can increase menstrual bleeding - FAlse can decrease bleeding but increase spotting what is the MOA of hormonal IUD? - changes cervical mucus to make it inhospitable endometrial atrophy What is natural family planning? - relies on the predictability of female cycle and timing intercourse if you are using the natural family planning on what day would you avoid intercourse? - day 8-19 on menstrual cycle what are signs of ovulation? - slight decrease in body temperature just before, thinning of cervical mucus ,small rise in temperature just after ovulation, Medical abortions can be performed within _______ days of contraception - 70d How are medical abortions done? what meds are given? - 200 mg mifepristone 600 ug of misoprostol 6 hrs later What is done in a surgical abortion? - dilation and curettage What is done with a later abortion? - dilation and evacuation What are some considerations with an abortion? - take history to see if abortion is from coercion, know state laws, observe for signs of hemorrhaging , vital signs for at least 30 minutes, What is the difference between postpartum blues and depression? - blues: self limiting mood disorder, started 2-3 days resolves within 2 weeks, insomnia, dysphoria , impaired concentration depression: major depression, can occur during pregnancy or within 4 wks of delivering , increased risk if hx of depression, low socieoeconomic status What are some signs of postpartum psychosis ? - hallucinations, thought disorganizations, delusions True or False Postpartum Psychosis is a medical emergency - True What is priority of care for postpartum psychosis ? - safety of mom and infant What is the diagnostic criteria for preeclampsia? - 140/90 2 times more than 4 hrs apart with protein in the urine or 140/90 2 times more than 4 hours apart with or without protein in the urine with platelets less than 100, 000, or creatinine greater than 1.1, increased liver enzymes, pulmonary edema, new onset visual problems What pharmacological treatment would you give a woman with preeclampsia? - labetalol, hydralazine, magnesium sulfate to prevent seizures corticosteroids what would you assess for a patient with preeclampsia - BP, DTR ( would be hyper), oliguria, headache, RUQ pain What would you do for the fetus if the mom is preeclamptic? - corticosteroids or magnesium sulfate( fetal Nueroprotection) NST and BPP What falls into category 1 FHR tracing? - normal FHR, access or early decals What is category 3 FHR tracing? - absent variability + recurrent late or variable decels, bradycardia What is in category 2 FHR tracing? - whatever does not fit in 1 or 2 What are interventions for category 2 FHR tracings? - position change oxygen increased fluids sterile exam oxytocin off notify provider how many contractions do you want in 10 minutes? How many is considered tachysystole? - you want 4-5/10 tachysystole more than 5 in 10 min What is the only way to measure the strength of contractions? - IUPC What would you need to consider an acceleration? - 32 wks 10bmp for 10 sec 32 wks 15bmp for 15bpm What is VEAL CHOP? - V;Variable Decel ---reposition mom---C;Cord Compression E; Early Decel----------Expected-------H; Head Compression A; Accels----reassuring----------------O;O2 adequate (okay) L; Late decel-O2, no pitocin, MD, reposition-P; Placental Insufficieny (problem) earl decels __________ contractions - mirror variable decels are _________ drops - abrupt late decels occur __________ contraction - after What is the definition of postpartum hemorrhage? - An estimated blood loss ≥ 500 mL after vaginal birth or ≥ 1000 mL after cesarean delivery what are the main causes of PPH? - uterine atony , blood coagulopathies, trauma What is treatment for PPH? - massage the boggy fundus, and give oxytocin to contract the uterus , check for bladder , check for lacerations What is oxytocin used for? - augment contraction frequency and pattern , labor induction, prevent pph, delivery of placenta How is oxytocin administered? - IV piggy back 10-40mu/min What is your goal contraction frequency/duration? - every 2-3 minutes 80-90 sec what are adverse effects to oxytocin? - tachysystole, pph, placental abruption, N/V What are contraindications to indomethican? - ulcer, bleeding disorder, renal , asthma , aspirin allergy Which tocolytic affects ductus arteriosis? - indomethican What are adverse effects of nifedipine? - slow HR headache hypotension Reflex tachy Edema Dizziness Flushing What are the adverse effects for terbutaline? - tachycardia, SOB, palpitations, tremors Wha are contraindications to terbutaline ? - heart disease, DM, placenta previa, placental abruption, What would you monitor for in patients with terbutaline? - chest pain, I&O, glucose and K levels What is the dosing for mag sulfate? - loading 4-6g maintenance 1-2 g What would you give for magnesium toxicity? - calcium gluconate 1g IV What are signs of magnesium toxicity? - Decreased or absent deep tendon reflexes. Respiratory depression. Decreased urine output. True or False Epidural Can only be given within the first 30 minutes of labor - False, can be given at any time what are some meds that can be given for epidural anesthesia? - lidocaine, fentanyl, morphine True or False Epidurals can only be given for vaginal birth - False Both vaginal and c section What are some contraindications to a spinal epidural? - spinal abnormalities, cord injury, heart disease, coagulation defects, infection, hypovolemia What are adverse effects of epidurals? - N/V, decreased BP, fever, pruritus , RD What would you give someone before an epidural ? - IV bolus to prevent hypertension What can an epidural cause? - increased labor duration What is a contraindication for 15 Methyl? - astma and hypertension How would you administer misoprostol? - 800mu-1000mu, intravaginally What is a contraindication for methylargine ? - heart disease What is the definition of PPROM? - premature ROM before 37 wks What are the things that PPROM can cause? - increased risk of infection, cord prolapse How would you assess PPROM? - nitrizine ph ( dark green/blue indicates AF) , ferning test What are treatments that would be used for PPROM? - tocolytics, corticosteroids, ABX , Mag Sulfate What is the definition of preterm labor? - contractions and cervical change *before 37 weeks gestation* What treatment would you give to a patient with preterm labor? - suppress labor with tocolytics, can give progesterone to extend pregnancy, corticosteroids Which is common to occur in newborns after vaginal delivery? - molding, caput When should the first passage of meconium occur? - within 24 hr How many wet diapers a day is normal, how many should be reported to the provider? - 6-8 wet diapers a day report fewer than 5 When should circumsisions be performed? - between 1-8 days What must happen prior to a baby having a circumcision? - vitamin K must be give must void prior parental consent pain relief What is care for a baby with a circumsision? - wrap with petroleum gauze, change with diaper change What is a contraindication to circumcision? - penile anomalies, bleeding disorders Why are babies at risk for thermoregulation? - high body surface to mass ratio, vessels are superficial Babies metabolize _____________ for heat, they do not shiver. - brown fat How does evaporation occur? What would you implement to avoid ? - evaporating liquid, KEEP BABY DRY AND WARM REPLACE WET TOWELS How does conduction occur? What would you implement to avoid? - contact with cooler object, PREWARM SURFACES How does convection occur? What would you implement to avoid? - heat transfer to air, AVOID DRAFTS CLOSE DOORS AND WINDOWS How does radiation occur? What would you implement to avoid? - transfer to nearby surfaces , keep away from windows walls If mom is Hep B positive, what would you give the baby and when? - give vaccine and IgG within 12 hours If mom is Hep B negative, what would you give the baby and when? - give vaccine within 24 hrs How long should a baby be breast-fed or formula fed for? - 6 months True or False Feed babies on a schedule, even if they are hungry - False, FEED ON DEMAND