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Questions and Answers
What is a common sign of respiratory distress in a preterm newborn?
What is the first step in managing a preterm newborn requiring oxygen?
Which of the following is a risk factor for developing breast cancer?
At what age should women begin to receive Pap smear screenings?
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What medication is commonly given to a preterm infant to assist with lung development?
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What could indicate a complication such as Intraventricular hemorrhage (IVH) in a preterm newborn?
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How often should women aged 40-75 undergo mammogram screenings?
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Which sign is indicative of Intimate Partner Violence (IPV)?
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What metabolic change occurs during cold stress when blood vessels constrict?
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Which treatment method is NOT recommended for managing cold stress?
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Physiological jaundice in newborns can be caused by what factor?
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Which characteristics are commonly associated with Fetal Alcohol Syndrome (FAS)?
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What does a Direct Coombs test check for in newborns?
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What is a significant risk factor for large-for-gestational-age (LGA) infants?
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What does SGA stand for, and what does it indicate?
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Which condition typically leads to pathological jaundice?
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What complication is NOT typically associated with postterm infants?
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What is the purpose of phototherapy in newborns with jaundice?
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What is the main risk associated with Rh alloimmunization during pregnancy?
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What immediate management is typically required for an infant with mild hypoglycemia?
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What is a potential consequence of intrauterine growth restriction (IUGR)?
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What prenatal intervention is used to prevent Rh alloimmunization?
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How does prematurity affect a newborn's thermoregulation?
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Which of the following statements about postterm infants is true?
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Who should be screened annually for chlamydia and gonorrhea?
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What is a recommended screening for men who have sex with men regarding syphilis?
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Which group is specifically advised to be screened for Hepatitis B?
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What type of exercise qualifies as moderate activity according to the guidelines?
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Which dietary assessment method is NOT mentioned for evaluating patient nutrition?
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What is a common symptom of endometriosis?
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At what age does significant loss of bone mass typically begin?
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Which treatment option is NOT indicated for endometriosis?
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Which contraception method is specifically noted as safe for breastfeeding mothers?
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What is a requirement for the effective use of Progestin only pills?
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What is one of the complications associated with Combined oral contraceptives?
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Which method of contraception involves tracking the menstrual cycle to avoid intercourse during fertile days?
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Which site is NOT recommended for the placement of hormonal patches?
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What symptom should prompt a patient using Progestin only pills to seek emergency help?
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Which of the following is a method for determining ovulation in natural family planning?
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What is a common side effect of hormonal rings?
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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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