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Questions and Answers

What is a common sign of respiratory distress in a preterm newborn?

  • Hypotension
  • Hypertension
  • Cyanosis (correct)
  • Bradycardia
  • What is the first step in managing a preterm newborn requiring oxygen?

  • Use a mechanical ventilator
  • Administer antibiotics
  • Keep O2 levels above 90% (correct)
  • Increase fluid intake
  • Which of the following is a risk factor for developing breast cancer?

  • Family history (correct)
  • Early menopause
  • Excessive physical activity
  • High fiber diet
  • At what age should women begin to receive Pap smear screenings?

    <p>Age 21</p> Signup and view all the answers

    What medication is commonly given to a preterm infant to assist with lung development?

    <p>Surfactant</p> Signup and view all the answers

    What could indicate a complication such as Intraventricular hemorrhage (IVH) in a preterm newborn?

    <p>Lethargy</p> Signup and view all the answers

    How often should women aged 40-75 undergo mammogram screenings?

    <p>Every 1-2 years</p> Signup and view all the answers

    Which sign is indicative of Intimate Partner Violence (IPV)?

    <p>Bruises in different phases</p> Signup and view all the answers

    What metabolic change occurs during cold stress when blood vessels constrict?

    <p>Increased oxygen consumption</p> Signup and view all the answers

    Which treatment method is NOT recommended for managing cold stress?

    <p>Rapidly immerse in warm water</p> Signup and view all the answers

    Physiological jaundice in newborns can be caused by what factor?

    <p>Immaturity of the liver</p> Signup and view all the answers

    Which characteristics are commonly associated with Fetal Alcohol Syndrome (FAS)?

    <p>Skin folds at the corner of the eye</p> Signup and view all the answers

    What does a Direct Coombs test check for in newborns?

    <p>Presence of antibodies in cord blood</p> Signup and view all the answers

    What is a significant risk factor for large-for-gestational-age (LGA) infants?

    <p>Maternal obesity</p> Signup and view all the answers

    What does SGA stand for, and what does it indicate?

    <p>Small for Gestational Age; infants are smaller than expected for their gestational age</p> Signup and view all the answers

    Which condition typically leads to pathological jaundice?

    <p>Underlying disease</p> Signup and view all the answers

    What complication is NOT typically associated with postterm infants?

    <p>Hyperglycemia</p> Signup and view all the answers

    What is the purpose of phototherapy in newborns with jaundice?

    <p>To convert bilirubin into a water-soluble form</p> Signup and view all the answers

    What is the main risk associated with Rh alloimmunization during pregnancy?

    <p>Severe hemolysis of fetal RBCs</p> Signup and view all the answers

    What immediate management is typically required for an infant with mild hypoglycemia?

    <p>Early feedings</p> Signup and view all the answers

    What is a potential consequence of intrauterine growth restriction (IUGR)?

    <p>Delayed developmental milestones</p> Signup and view all the answers

    What prenatal intervention is used to prevent Rh alloimmunization?

    <p>Administering Rhogam at 28 weeks</p> Signup and view all the answers

    How does prematurity affect a newborn's thermoregulation?

    <p>Increased risk of hypothermia</p> Signup and view all the answers

    Which of the following statements about postterm infants is true?

    <p>They can present with dry, cracked skin due to an aging placenta.</p> Signup and view all the answers

    Who should be screened annually for chlamydia and gonorrhea?

    <p>All sexually active women under 25</p> Signup and view all the answers

    What is a recommended screening for men who have sex with men regarding syphilis?

    <p>Annually</p> Signup and view all the answers

    Which group is specifically advised to be screened for Hepatitis B?

    <p>All pregnant women at their first visit</p> Signup and view all the answers

    What type of exercise qualifies as moderate activity according to the guidelines?

    <p>Brisk walking</p> Signup and view all the answers

    Which dietary assessment method is NOT mentioned for evaluating patient nutrition?

    <p>Weekly cooking journal</p> Signup and view all the answers

    What is a common symptom of endometriosis?

    <p>Dysmenorrhea</p> Signup and view all the answers

    At what age does significant loss of bone mass typically begin?

    <p>35 years</p> Signup and view all the answers

    Which treatment option is NOT indicated for endometriosis?

    <p>Weight loss supplements</p> Signup and view all the answers

    Which contraception method is specifically noted as safe for breastfeeding mothers?

    <p>Progestin only pills</p> Signup and view all the answers

    What is a requirement for the effective use of Progestin only pills?

    <p>Must be taken within a 3 hour window every day</p> Signup and view all the answers

    What is one of the complications associated with Combined oral contraceptives?

    <p>Thromboembolism</p> Signup and view all the answers

    Which method of contraception involves tracking the menstrual cycle to avoid intercourse during fertile days?

    <p>Natural family planning</p> Signup and view all the answers

    Which site is NOT recommended for the placement of hormonal patches?

    <p>Breasts</p> Signup and view all the answers

    What symptom should prompt a patient using Progestin only pills to seek emergency help?

    <p>Chest pain and shortness of breath</p> Signup and view all the answers

    Which of the following is a method for determining ovulation in natural family planning?

    <p>Basal body temperature tracking</p> Signup and view all the answers

    What is a common side effect of hormonal rings?

    <p>Possibility of dislodgement during bowel movements</p> Signup and view all the answers

    Study Notes

    Identification of the Newborn at Risk

    • Preterm Infants: Born before 37 weeks gestation
    • Post Term Infants: Born after 42 weeks gestation
    • APGAR Score under 7: Indicates potential need for intervention
      • APGAR is a scoring system used to assess a newborn's overall well-being

    Intrauterine Growth Restriction (IUGR)

    • Baby doesn't grow to normal weight during pregnancy

    Small for Gestational Age (SGA)

    • Infants may be normal based on ethnicity or height and weight of parents
    • Could be due to environmental or pathologic genetic reasons
    • At risk for hypoglycemia, polycythemia, hypocalcemia

    Large for Gestational Age (LGA)

    • Infants are at high risk for birth injury, perinatal asphyxia, and hypoglycemia
    • Common in infants of mothers with obesity, diabetes, and excessive weight gain in pregnancy

    Impact of Diabetes Mellitus (DM) on the Newborn

    • Mothers with diabetes may have babies with hypoglycemia, respiratory distress syndrome, and congenital anomalies

    Hypoglycemia Management

    • Infants with mild hypoglycemia: early feedings
    • Monitor as per facility protocol
    • Give IV dextrose for symptomatic newborn or Total Parenteral Nutrition (TPN)

    Postterm/Postmaturity Syndrome

    • Post term infants are born over 42 weeks gestation
    • Post term infants may be macrosomia or SGA due to aging placenta
    • Complications: birth injuries, oligohydramnios, low APGAR, cerebral palsy, meconium aspiration
    • Almost leather-like, dry, cracked skin with insignificant vernix caseosa

    Prematurity

    • Risks: Infection, fetal anomalies, preeclampsia/eclampsia
    • Characteristics:
      • Immature respiratory system with potential respiratory distress
      • Difficulty maintaining body temperature
      • Immature digestive system and feeding difficulties
    • Thermogenesis:
      • Premature infants may require supplemental heat to maintain body temperature
    • Feeding Methods:
      • May require specialized feeding methods, such as gavage or IV feeding
    • Complications:
      • Respiratory distress syndrome (RDS)
      • Intraventricular hemorrhage (IVH)
      • Hypothermia, hypoglycemia
      • Jaundice
      • Feeding difficulties

    Care of the Family with an At-Risk Newborn

    • Provide education, support, and resources to the family
    • Encourage family involvement in the care of the newborn

    Fetal Alcohol Syndrome (FAS)

    • Characteristics:
      • Skin folds at the corner of the eye
      • Low nasal bridge, short nose
      • Indistinct philtrum (groove between nose and upper lip)
      • Small head circumference
      • Small eye opening
      • Small midface
      • Thin upper lip
    • Nursing Care:
      • Social work consultation
      • Occupational, physical, and speech therapy referral
      • Allow extra time for feeding

    Cold Stress

    • Occurs with uncontrolled hypothermia, causing blood vessels to constrict and conserve heat
    • Metabolic rate increases as does oxygen consumption, leading to potential complications
    • Treatment:
      • Monitor for skin pallor with mottling and cyanotic trunk, tachypnea
      • Warm slowly over 2-4 hours
      • Give oxygen     - Skin-to-skin contact with mother or under prewarmed heater

    Jaundice

    • Physiological Jaundice:
      • Appears after 24 hours of life    - Due to shortened RBC lifespan and breakdown of fetal RBCs
      • Live immaturity
    • Pathological Jaundice:
      • Appears within 24 hours of life
      • Results from underlying disease
      • Caused by blood group incompatibility (ABO), infections, or RBC disorders
    • Hemolytic Jaundice:
         - Direct Coombs test is used to determine the cause and is performed on the baby's cord blood to detect antibody positive RBCs
    • Phototherapy:
      • Used in hospital or home to expose infants' skin to particular wavelength of light    - Converts bilirubin to a water-soluble form, excreted in bile or urine
      • Bili blanket or single/double banks are used for phototherapy
    • Tests:
      • Direct Coombs test
      • Transcutaneous bilirubin (TcB) measurements    - Total serum bilirubin (TSB) measurements

    Rh Alloimmunization

    • Rh-negative women carrying an Rh-positive fetus
    • At delivery, fetal RBCs invade maternal circulation, stimulating production of Rh antibodies
    • In following pregnancies, Rh antibodies cross the placenta and enter fetal circulation
    • Hemolysis of RBCs in the fetus can occur
    • Prevention:
      • ABO incompatibility    - Administer Rhogam if the mother is Rh-negative at 28 weeks and within 72 hours after birth

    Preterm Newborn

    • Presents 2 hours after birth with signs of respiratory distress
    • Characteristics:    - Tachypnea, nasal flaring, expiratory grunting, retractions, cyanosis
      • Breath sounds typically clear    - Symptoms usually clear in 24-48 hours, but can stay up to 72 hours
    • Management:
      • If oxygen is required, keep oxygen saturation above 90% via hood or nasal cannula
      • Keep in a thermal-neutral environment
      • If tachypnea is present and the infant is unable to feed, use an NG tube    - Restrict fluids for the first 24 hours if severe distress is present
    • Complications:    - Respiratory distress syndrome (RDS)
      • Intraventricular hemorrhage (IVH)    - Hypothermia, hypoglycemia    - Jaundice    - Feeding difficulties

    Medications Given to Preterm Infants

    • Surfactant to help with lung development
    • Antibiotics to help with infection if present
    • Diuretics to manage excess fluid

    Breast Cancer

    • Screening/Examination:
      • Mammogram every 1-2 years, ages 40-75   - Women should have mammograms based on shared decision-making (SDM) after age 75
      • Clinical breast exam every 1-3 years, ages 29-39 and annually after
    • Risk Factors:    - Family history
      • Radiation to the chest between ages 10-30
      • First birth after age 30
      • Never given birth
      • Dense breasts
      • History of benign biopsy
      • Use of exogenous estrogen

    Pap Smear

    • Screening Recommendations:
      • First screening at age 21
      • Every 3 years until age 30    - After age 30, women should receive a Pap test and HPV testing every 5 years until 65, or Pap test alone every 3 years
      • Screening may end at age 65
      • Pelvic exam yearly
           - If the test is abnormal, a colposcopy is performed for further examination of the cervix

    Intimate Partner Violence (IPV) Signs

    • Bruises in different phases
    • Frequency of injuries (face, head, neck)
    • Reported history of the injury is inconsistent with the presenting problem
    • Depression, anxiety, substance abuse

    Sexually Transmitted Infections (STIs) Screenings

    • Chlamydia & Gonorrhea:
      • Annually for all sexually active women under 25
      • Women 25+ with new sex partners, more than one partner, or a partner with a known STI    - Pregnant women
    • Syphilis:
      • Pregnant women at the first visit
      • Annually for men who have sex with men
    • HIV:
      • All adolescents    - Pregnant women at the first visit
      • Annually for men who have sex with men
    • Hepatitis B:
      • All pregnant women at their first visit
      • Past and current drug users
    • Hepatitis C:
      • All pregnant women with current or past injection use, unregulated tattoo, or long-term hemodialysis
      • Past and current drug users
      • Individuals who test positive for HIV

    Physical Activity Guidelines

    • 2.5 hours of moderate aerobic activity per week or 1 hour and 15 minutes of vigorous exercise
    • Moderate Exercise Examples: Walking briskly, water aerobics, bicycling, dancing, general gardening
    • Vigorous Exercise Examples: Swimming laps, jogging, aerobic dancing

    Nutrition Assessment

    • Dietary evaluation to identify where the patient might need education or interventions
    • Can help diagnose anorexia, bulimia nervosa, and binge eating
    • Assessment Strategies:    - 24-hour diet recall interview
      • Food diary or online food tracker
      • Formal questionnaire
    • Diets high in fiber may reduce heart disease, type 2 diabetes, and colon cancer
    • Vegans need supplemental vitamin B

    Osteoporosis

    • Loss of bone mass after the age of 35

    Fibrocystic Breast Changes

    • Treatment:
      • No treatment needed once a doctor verifies no cancer is present
      • Wear a good-fitting bra both day and night if pain is present

    Endometriosis

    • Symptoms: dysmenorrhea (painful periods), dyspareunia (painful intercourse), infertility, pelvic mass, pelvic pain/cramping
    • Treatment and Implications:    - NSAIDs, combined oral contraceptives or medroxyprogesterone acetate (MPA), Danazol, gonadotropin-releasing hormone (GnRH) agonist (Lupron) (category X)    - Laparoscopy for definitive diagnosis and removal of endometrial lesions (electrocautery) or hysterectomy

    Contraception: Types, Pros/Cons, Contraindications, Complications

    • Long-Acting Reversible Contraception (LARC): Includes implants
    • Combined Oral Contraceptives (COCs):
    • Relief of menstrual symptoms, lessened cramps, decreased flow, improved cycle regularity
    • Side effects: weight gain, depression, breakthrough bleeding, thromboembolism    - Contraindications: migraine with aura, history of deep vein thrombosis (DVT), hypertension, >35 years old, diabetic retinopathy
    • Progestin-Only Pills (POPs):
      • Safe for breastfeeding mothers
      • Must be taken within a 3-hour window every day to be effective
      • Side effects: less regular period and more breakthrough bleeding, clots
      • Patients reporting chest pain and shortness of breath should go to the ER
    • Hormonal Patches:    - Rotate site placement weekly to avoid skin irritation: upper back, upper arm, upper buttock, lower abdomen (not on breasts)
      • Applied weekly for 3 weeks
    • Hormonal Rings:
    • The ring can be dislodged during a bowel movement; learn to check placement
    • The ring can be removed for intercourse and left out for up to 3 hours a day
    • Barrier Methods:
    • Condoms, diaphragms, cervical caps
    • Spermicide:
      • Used with other barrier methods.
    • Natural Family Planning:
      • Calendar method: Tracks menstrual cycle to determine ovulation
      • Basal body temperature (BBT) method: Tracks temperature changes throughout the cycle, including a slight dip just before ovulation and a sharp rise after ovulation    - Billings or cervical mucus method: Tracks cervical mucus changes, which are thinner and clearer during ovulation
    • Withdrawal:
      • Coitus interruptus
    • Contraceptive Injections:    - Depo-Provera
    • Sterilization:    - Bilateral tubal ligation (BTL)
      • Vasectomy

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