Family Nursing OB Exam 1 Blueprint Answers (Herzing University) PDF

lOMoARcPSD|22876375 Family Nursing OB Exam 1 Blueprint Answers Family Nursing (Herzing University) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by S. Elissa ([email protected])...

lOMoARcPSD|22876375 Family Nursing OB Exam 1 Blueprint Answers Family Nursing (Herzing University) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by S. Elissa ([email protected])  lOMoARcPSD|22876375 NSG222 Family Nursing Exam 1 Blueprint Dysmenorrhea, etiology NSG222.01.01.01 Painful menstruation common problem in adolescence Usually pain starts along with the start of bleeding and lasts for 48 to 72 hours is a symptom, not a full diagnosis classified as primary (spasmodic) or secondary (congestive) ○ Primary dysmenorrhea refers to painful menstrual bleedings in the absence of any detectable underlying pathology caused by increased prostaglandin production by the endometrium in an ovulatory cycle causes contraction of the uterus levels are highest during the first 2 days of menses, when symptoms peak ○ Secondary dysmenorrhea is painful menstruation due to pelvic or uterine pathology may be caused by endometriosis, adenomyosis, fibroids, pelvic infection, an intrauterine system (IUS), cervical stenosis, or congenital uterine or vaginal abnormalities Infertility, therapeutic management NSG222.01.01.02 defined as the inability to conceive a child after 1 year of regular sexual intercourse unprotected by contraception Secondary infertility is the inability to conceive after a previous pregnancy main causes ○ female-factor (e.g., anovulation, tubal damage, endometriosis, ovarian failure) ○ male-factor (e.g., low or absent numbers of motile sperm in the ejaculate, erectile dysfunction), or unexplained majority cases are treated with drugs or surgery ○ options include lifestyle changes ex. weight loss and smoking cessation; taking clomiphene to promote ovulation; hormone injections to promote ovulation; intrauterine insemination; and IVF ○ Various ovulation-enhancement drugs and timed intercourse might be used for woman with ovulation problems If the woman’s reproductive organs are damaged, surgery can be done to repair them Barrier methods NSG222.01.01.03 physical or chemical devices that prevent pregnancy by preventing the sperm from reaching the ovum ○ Physical barrier are placed over penis or against cervix to block the passage of sperm Condom male and female Only contraception that protects against STIs Diaphragm may be inserted up to 2 hours before intercourse and must be left in place for at least 6 hours afterward soft latex dome surrounded by a metal spring Used in conjunction with a spermicidal jelly or cream May need to get refitted Cervical cap covers only the cervix held in place by suction smaller than the diaphragm 1 Downloaded by S. Elissa ([email protected])  lOMoARcPSD|22876375 used with spermicide may be inserted up to 36 hours before intercourse provides protection for 48 hours must be kept in the vagina for 6 hours after sex should be replaced every year of use. Sponge is a nonhormonal, nonprescription device that includes both a barrier and a spermicide. soft concave device that prevents pregnancy by covering the cervix and releasing spermicide Is made of polyurethane saturated with 1 g of nonoxynol-9, releases 125 mg of the spermicide over 24 hours of use can be used for more than one coital act within 24 hours without the insertion of additional spermicide, and it does not require fitting or a prescription from a health care provider less effective does not offer protection against STIs To use, the woman first wets it with water, squeezes it until it is thoroughly wet and foamy, and then inserts it into the vagina with a finger, using a cord loop attachment ○ can be inserted up to 24 hours before intercourse and should be left in place for at least 6 hours following intercourse ○ provides protection for up to 12 hours, but should not be left in for more than 30 hours after insertion to avoid the risk of TSS ○ Chemical barriers called spermicides may be used along with mechanical barrier devices come in creams, jellies, foam, suppositories, and vaginal films chemically destroy the sperm in the vagina Medical abortion NSG222.01.01.04 Abortion is defined as the expulsion of an embryo or fetus before it is viable achieved through administration of medication either vaginally or orally administration of medication occurs in the clinic or doctor’s office may require more than one office visit Involves the use of 2 different medications, mifepristone and misoprostol ○ Mifepristone blocks progesterone, which is essential to the development of pregnancy ○ Misoprostol, taken 24-48 hours later, works to empty the uterus by causing cramping and bleeding follow-up visit is scheduled later to confirm the pregnancy was terminated via ultrasound or blood test Complications: incomplete expulsion of uterine contents, uterine infection, and heavy bleeding Menopause effects on body systems NSG222.01.01.05 Brain and central nervous system: ○ hot flashes, disturbed sleep, mood, and memory problems Cardiovascular: ○ lower levels of high-density lipoprotein (HDL) and increased risk of CVD Skeletal: ○ rapid loss of bone density that increases the risk of osteoporosis Breasts: 2 Downloaded by S. Elissa ([email protected])  lOMoARcPSD|22876375 ○ replacement of duct and glandular tissues by fat Genitourinary: ○ vaginal dryness, stress incontinence, cystitis Gastrointestinal: ○ less absorption of calcium from food, increasing the risk for fractures Integumentary: ○ dry, thin skin and decreased collagen levels Body shape: ○ more abdominal fat; waist size that swells relative to hips STI, nursing management NSG222.01.02.01 convey a willingness to discuss sexual habits. Provide effective guidance that promotes sexual health so that primary and/or repeat infections can be avoided. Encourage the client to complete the antibiotic prescription Prevention of STIs is critical Adapt the style, content, and message to the adolescent’s developmental level Identify risk factors and behaviors ○ guide the adolescent to develop specific individualized actions of prevention. nurse’s interaction and conversation needs to be direct and nonjudgmental Encourage adolescents to postpone initiation of sexual intercourse for as long as possible, but if they choose to have sexual intercourse, explain the necessity of using barrier methods ex. male and female condoms ○ teens who have already had sexual intercourse, clinician can encourage abstinence at this point ○ If sexually active, they should be directed to teen clinics where contraceptive options can be explained. In areas where specialized teen clinics are not available, nurses should feel comfortable discussing sexuality, safety, and contraception with teens Encourage adolescents to minimize their lifetime number of sexual partners, to use barrier methods consistently and correctly, and to be aware of the connection between drug and alcohol use and the incorrect use of barrier methods Preventing vaginitis, box 5.2 NSG222.01.02.02 Vaginitis is a generic term that means inflammation and infection of the vagina Avoid douching to prevent altering the vaginal environment. Use condoms to avoid spreading the organism. Avoid tights, nylon underpants, and tight clothes. Wipe from front to back after using the toilet. Avoid powders, bubble baths, and perfumed vaginal sprays. Wear clean cotton underpants. Change out of wet bathing suits as soon as possible. Become familiar with the signs and symptoms of vaginitis. Choose to lead a healthy lifestyle Chlamydia, Therapeutic Management, Nursing assessment NSG222.01.02.03 most commonly reported bacterial STI in the United States highest rates of infection are among those aged 15 to 19 years most common risk factors 3 Downloaded by S. Elissa ([email protected])  lOMoARcPSD|22876375 ○ age less than 25 years ○ recent change in sexual partner or multiple sexual partners ○ poor socioeconomic conditions ○ exchange of sex for money ○ nonwhite race ○ single status ○ lack of use of barrier contraception most common infectious cause of infertility in women Therapeutic Management ○ Antibiotics are the only treatment currently available CDC treatment options doxycycline 100 mg orally twice a day for 7 days azithromycin 1 g orally in a single dose ○ common coinfection of chlamydia and gonorrhea, a combination regimen of ceftriaxone with doxycycline or azithromycin is prescribed frequently ○ annual screening of all sexually active women and all high-risk people ○ treatment with antibiotics effective against both gonorrhea and chlamydia for anyone diagnosed with a gonococcal infection Nursing Assessment ○ Assess the health history for significant risk factors Being an adolescent Having multiple sex partners Having a new sex partner Engaging in sex without using a barrier contraceptive (condom) Using oral contraceptives Being pregnant Having a history of another STI ○ Assess the client for clinical manifestations majority of women are asymptomatic Asymptomatic infection is common among both men and women If the client is symptomatic Mucopurulent vaginal discharge Urethritis Bartholinitis Endometritis Salpingitis Dysfunctional uterine bleeding Herpes Simplex Virus (HSV) Nursing assessment NSG222.01.02.04 Assess the client for clinical manifestations ○ manifestations can be divided into the primary episode and recurrent infections first or primary episode is usually the most severe, with a prolonged period of viral shedding is a systemic disease characterized by multiple painful vesicular lesions, mucopurulent discharge, superinfection with candida, fever, chills, malaise, dysuria, headache, genital irritation, inguinal tenderness, and lymphadenopathy ○ lesions are frequently located on the vulva, vagina, and perineal areas ○ vesicles will open and weep and finally crust over, dry, and disappear 4 Downloaded by S. Elissa ([email protected])  lOMoARcPSD|22876375 without scar formation usually takes up to 2 weeks to complete Recurrent infection episodes are usually much milder and shorter in duration Tingling, itching, pain, unilateral genital lesions, and a more rapid resolution of lesions are characteristics of recurrent infections is a localized disease characterized by typical HSV lesions at the site of initial viral entry lesions are fewer in number and less painful and resolve more rapidly Diagnosis of HSV is often based on clinical signs and symptoms and is confirmed by viral culture of fluid from the vesicle ○ Papanicolaou (Pap) smears are an insensitive and nonspecific diagnostic test for HSV and should not be relied on for diagnosis Human papillomavirus (HPV), Therapeutic Management NSG222.01.02.05 no medical treatment or cure focuses heavily on prevention through the vaccine and education and the treatment of lesions and warts caused by HPV CDC recommends children start receiving 2 doses of the vaccine around 11 or 12 years old ○ 2 doses are needed for those vaccinated before 15 ○ 3 are recommended for older people vaccine is administered intramuscularly ○ first dose may be given to any individual 9-14 years old prior to infection ○ second dose is administered within 6-12 months later For those 15-45 years of age, Gardasil 9 is given using a 3-dose schedule ○ second dose should be given 2 months after the first dose ○ third dose should be given 6 months after the first injection deltoid region of the upper arm or anterolateral area of the thigh may be used most common vaccine side effects: pain, fainting, redness, and swelling at the injection site; fatigue; headache; muscle and joint aches; and gastrointestinal distress If the woman doesn’t receive primary prevention with the vaccine, then secondary prevention would focus on education about the importance of receiving regular Pap smears including an HPV test to determine whether the woman has a latent high-risk virus that could lead to precancerous cervical changes no single treatment is ideal for all patients or all warts goal of treating genital warts is to remove the warts and induce wart-free periods for the client Treatment should be guided by the preference of the client and available resources genital warts can proliferate and become friable during pregnancy, they should be removed using a local agent ○ A cesarean birth is not indicated solely to prevent transmission of HPV infection to the newborn, unless the pelvic outlet is obstructed by warts Mastitis, nursing assessment NSG222.01.03.01 Mastitis is an infection or inflammation of the connective tissue in the breast that occurs primarily in lactating or engorged women ○ 2 types Lactational typically occurs in the first 2-3 weeks of lactation, but can occur at any stage of lactation 5 Downloaded by S. Elissa ([email protected])  lOMoARcPSD|22876375 One or more of the ducts drain poorly or become blocked, resulting in milk stasis and bacterial growth in the retained milk Nonlactactional can be caused by duct ectasia, occurs when the milk ducts become congested with secretions and debris, resulting in periductal inflammation Assess health history for risk factors ○ poor hand hygiene ○ ductal abnormalities ○ nipple cracks and fissures ○ lowered maternal defenses due to fatigue ○ tight clothing ○ poor support of pendulous breasts ○ failure to empty the breasts properly while breastfeeding ○ missing breast-feedings diagnosis is made clinically on the basis of a localized, unilateral area of erythema with associated fever ○ made based on history and examination Assess for clinical manifestations ○ flu-like symptoms of malaise, nausea, headache, leukocytosis, fever, fatigue, and chills. Physical examination of the breasts reveals increased warmth, swollen area of one breast, redness, tenderness, and swelling ○ nipple is usually cracked or abraded ○ breast is distended with milk ○ lactating woman, severe engorgement can be differentiated from mastitis engorgement is bilateral with general involvement of the whole breast Ultrasound scans can be undertaken to differentiate between the types of mastitis or abscesses Breast cancer, Risk Factors NSG222.01.03.02 Breast cancer is a neoplastic disease in which normal body cells are transformed into malignant ones ○ Invasive Ductal Carcinoma malignant tumor that occurs in epithelial tissue; it tends to infiltrate and give rise to metastases spreads rapidly to axillary and other lymph nodes, even while small ○ Invasive Lobular Carcinoma Invasive or infiltrating lobular carcinomas originate in the terminal lobular units of breast ducts presents as an area of ill-defined thickening rather than a palpable mass frequently located in the upper outer quadrant of the breast incidence rates are higher in non-Hispanic White women Risk Factors ○ divided into those that cannot be changed (nonmodifiable risk factors) and those that can be changed (modifiable risk factors) Nonmodifiable risk factors Gender (female) Aging (older than 50 years old) Genetic mutations (BRCA1 and BRCA2 genes) Personal history of ovarian or colon cancer Increased breast density increases the risk three- to fivefold 6 Downloaded by S. Elissa ([email protected])  lOMoARcPSD|22876375 Family history of breast cancer Personal history of breast cancer (three- to fourfold increase in risk for recurrence) Race/ethnicity (higher in White women, though African American women are more likely to die of breast cancer) Previous abnormal breast biopsy (atypical hyperplasia) Exposure to chest radiation (radiation damages DNA) Previous breast radiation (12 times normal risk) Early menarche (younger than 12 years old) or late onset of menopause (older than 55 years old), which represents increased estrogen exposure over the lifetime Modifiable risk factors related to lifestyle choices Not having children at all or not having children until after age 30; this increases the risk of breast cancer by not reducing the number of menstrual cycles Postmenopausal use of estrogens and progestins; the Women’s Health Initiative study reported increased risks with long-term (longer than 5 years) use of HRT Failing to breast-feed for up to a year after pregnancy; increases the risk of breast cancer because it does not reduce the total number of lifetime menstrual cycles Alcohol consumption; boosts the level of estrogen in the bloodstream Smoking; exposure to carcinogenic agents found in cigarettes Obesity and consumption of high-fat diet; fat cells produce and store estrogen, so more fat cells create higher estrogen levels Sedentary lifestyle and lack of physical exercise; increases body fat, which houses estrogen Breast Cancer Assessment and Immediate postoperative care NSG222.01.03.04 x 2 Assessment ○ symptoms may include a lump in the breast that is usually nontender, fixed, and hard with irregular borders ○ take a thorough history of the problem and explore the risk factors for breast cancer ○ Assess for clinical manifestations changes in breast appearance and contour, become apparent with advancing breast cancer changes include: Continued and persistent changes in the breast A lump or thickening in one breast Persistent nipple irritation Unusual breast swelling or asymmetry A lump or swelling in the axilla Changes in skin color or texture Nipple retraction, tenderness, or discharge ○ Complete a breast examination to validate the clinical manifestations and findings of the health history and risk factor assessment Immediate Postoperative Care ○ Assess respiratory status by auscultating the lungs and observing breathing pattern ○ Assess circulation ○ note vital signs, skin color, and skin temperature 7 Downloaded by S. Elissa ([email protected])  lOMoARcPSD|22876375 ○ Observe neurologic status by evaluating the level of alertness and orientation ○ Monitor wound for amount and color of drainage ○ Monitor intravenous lines for patency, correct fluid, and rate ○ Assess drainage tube for amount, color, and consistency of drainage ○ Pain management ○ Wound care ○ Elevate the affected arm on a pillow to promote lymph drainage ○ Make sure no treatments are performed on the affected arm Place a sign above the bed to warn others not to touch the affected arm ○ Increase mobility ○ Assist with turning, coughing, and deep breathing every 2 hours ○ Emotional Care and Referrals Assess coping strategies Encourage to help with care ○ education Pelvic Inflammatory disease, Nursing Management NSG222.01.04.01 If hospitalized, maintain hydration via intravenous fluids, if necessary and administer analgesics as needed for pain. Semi-Fowler positioning facilitates pelvic drainage education to prevent a recurrence a risk assessment should be done to ascertain what interventions are appropriate to prevent a recurrence ○ explain the various diagnostic tests needed ○ Discuss the implications and risk factors for the infection sexual partner should be included if possible Sexual counseling should include practicing safer sex, limiting number of sexual partners, using barrier contraceptives consistently, avoiding vaginal douching, considering another contraceptive method if she has an intrauterine system (IUS) and has multiple sexual partners, and completing course of antibiotics prescribed Review the serious sequelae that may occur if the condition is not treated or if the woman does not comply with treatment plan Ask the woman to have her partner go for evaluation and treatment to prevent a repeat infection stress importance of barrier contraceptive methods and follow-up care Preventing PID ○ Advise sexually active girls and women to insist their partners use condoms. ○ Discourage routine vaginal douching, as this may lead to bacterial overgrowth. ○ Encourage regular STI screening. ○ Emphasize importance of having each sexual partner receive antibiotic treatment Comparison chart 7.1 urge incontinence versus stress incontinence NSG222.01.04.02 Urge Incontinence ○ What is it: Precipitous loss of urine that is preceded by a strong urge to pee with increased pressure and detrusor contraction Overactive bladder caused by detrusor muscle contractions ○ Cause Neurological, idiopathic or infectious 8 Downloaded by S. Elissa ([email protected])  lOMoARcPSD|22876375 ○ S/S Urgency, frequency, nocturia and a large amount of urine loss Stress Incontinence ○ What is it Accidental leakage of urine that occurs with increased pressure on the bladder from coughing, sneezing, laughing or physical exertion Inadequate urinary sphincter function ○ Cause Develops commonly in women in their 40s and 50s usually as a result of weakened muscles and ligaments in the pelvis due to childbirth ○ S/S Involuntary loss of small amounts of urine in response to physical activity that increases intra-abdominal pressure Hysterectomy NSG222.01.04.03 surgical removal of the uterus most effective treatment for symptomatic fibroids with no recurrence top 3 conditions associated are fibroids, endometriosis, and uterine prolapse ○ fibroids it eliminates both the symptoms and the risk of recurrence terminates the woman’s ability to bear children 3 types ○ vaginal hysterectomy uterus is removed through an incision in the posterior vagina Advantages: shorter hospital stay and recovery time and no abdominal scars Disadvantages: limited operating space and poor visualization of other pelvic organs ○ laparoscopically assisted vaginal hysterectomy uterus is removed through a laparoscope, through which structures within the abdomen and pelvis are visualized Advantages: better surgical field, less pain, lower cost, and a shorter recovery time Disadvantages: potential injury to the bladder and the inability to remove enlarged uteruses and scar tissue ○ abdominal hysterectomy uterus and other pelvic organs are removed through an incision in the abdomen used when a malignancy is suspected or the woman has a very large uterus Disadvantages: need for general anesthesia, a longer hospital stay and recovery period, more pain, higher cost, and a visible scar on the abdomen ○ Complications vary based on route of surgery and technique most common include infection, venous thromboembolism, genitourinary and gastrointestinal injuries, and hemorrhage PCOS, Therapeutic Management NSG222.01.04.04 Medical management of PCOS is aimed at the treatment of metabolic derangements, anovulation, hirsutism, and menstrual irregularity ○ includes both drug and nondrug therapy, along with lifestyle modifications Oral contraceptives to treat menstrual irregularities and acne often prescribed to suppress gonadotropin levels Mechanical hair removal (shaving, waxing, plucking, or electrolysis) to treat hirsutism Glucophage (metformin), improves insulin uptake by fat and muscle cells, to treat 9 Downloaded by S. Elissa ([email protected])  lOMoARcPSD|22876375 hyperinsulinemia thiazolidinediones (Actos, Avandia) to decrease insulin resistance Ovulation induction agents (Clomid) to treat infertility Lifestyle changes (weight loss, exercise, balanced low-fat diet) Referral to support groups to help improve emotional state and build self-esteem Pain medication is prescribed if needed surgery ○ Goals of therapy focus on reducing the production and circulating levels of androgens, protecting the endometrium against the effects of unopposed estrogens, supporting lifestyle changes to achieve ideal body weight, lowering the risk of cardiovascular disease, avoiding the effects of hyperinsulinemia on the risk of cardiovascular disease and diabetes, and inducing ovulation to achieve pregnancy if desired. Providing Emotional Support for Cancers of the Reproductive Tract NSG222.01.05.01 Once the diagnosis is made Validate the client's feelings and provide realistic hope, using a nonjudgmental approach and therapeutic communication skills during all interactions Nurses need to focus on the physical, psychosocial, and economic concerns, from diagnosis through treatment and, if applicable, until the end of life, for all whom they care Educating the client Ovarian Cancer NSG222.01.05.02 involves risk reduction and health promotion ○ Teach about risk reduction strategies Pregnancy use of oral contraceptives breastfeeding reduce the risk of ovarian cancer Instruct to avoid using talc and hygiene sprays on genitals use of oral contraceptives for 3 years or longer maintaining a healthy weight range pregnancy and breastfeeding before the age of 30 bilateral tubal ligation removal of the ovaries ○ Review lifetime risks related to BRCA1 and BRCA2 genes and options available should they test positive for these genes Instruct about the importance of healthy lifestyles ○ Stress the importance of maintaining a healthy weight to reduce risk ○ Encourage women to eat a low-fat diet describe in simple terms tests, treatment modalities, and follow-up needed ○ if having surgery, nurse needs to provide thorough teaching about what to expect before, during, and after surgery ○ Outline treatment options and implications of choices ○ Assist in deciphering the large amount of information related to staging, tests, and treatments. ○ Teach about additional treatment measures ex. radiation therapy or chemotherapy, including how to handle the common adverse effects of treatment. Endometrial Cancer Nursing Assessment NSG222.01.05.03 Obtain a thorough history, finding out primary complaint Most commonly, major initial symptom is abnormal and painless vaginal bleeding 10 Downloaded by S. Elissa ([email protected])  lOMoARcPSD|22876375 Obtain menstrual history and inquire if taking any hormones Find out if she has a personal or family history of breast, ovarian, or colon cancer ○ key pieces of information will assist in identifying women at high risk for endometrial cancer. Assess for additional manifestations ○ dyspareunia, low back pain, purulent genital discharge, dysuria, pelvic pain, weight loss, and change in bladder and bowel habits may suggest advanced disease. Perform a physical examination or assist with a pelvic examination as appropriate ○ Observe for vaginal discharge ○ Note any changes in size, shape, or consistency of uterus or surrounding structures or client reports of pain during examination ○ Anticipate the need for transvaginal ultrasound to identify endometrial hyperplasia (usually greater than 4 mm) and endometrial biopsy if needed to identify malignant cells Cervical Cancer Nursing Management NSG222.01.05.04 involves primary prevention by educating about risk factors and ways to prevent cervical dysplasia. ○ advocate for clients by making sure that the Pap smear is sent to an accredited laboratory for interpretation to reduce risk of false-negative results. ○ Prevention measures should include: educating that the risk of infection can be reduced by delaying onset of sexual activity, decreasing number of sexual partners, using condoms consistently, receiving HPV vaccine, and never smoking Secondary prevention focuses on reducing or limiting the area of cervical dysplasia Tertiary prevention focuses on minimizing disability or spread of cervical cancer ○ Explain in detail all procedures that might be needed ○ Encourage client who has undergone any cervical treatment to allow pelvic area to rest for approximately 1 month Discuss rest period with client and partner to gain cooperation Outline alternatives to vaginal intercourse ○ Remind about any follow-up procedures that are needed and assist with scheduling if necessary. ○ involves diagnosis and treatment of confirmed cases of cancer Treatment is typically through surgery, radiotherapy, and, frequently, chemotherapy Palliative care is provided when the disease has already reached an incurable stage Refer to appropriate community resources and support groups as indicated Vulvar Cancer Nursing Assessment NSG222.01.05.05 no single specific clinical symptom indicates this disease important to review history for risk factors such as: ○ Exposure to HPV type 16 ○ Age over 50 years ○ HIV infection ○ vulvar intraepithelial neoplasia (VIN) ○ Lichen sclerosus (a patchy skin disorder) ○ Melanoma or atypical moles ○ Exposure to HSV type 2 ○ Multiple sex partners ○ Smoking 11 Downloaded by S. Elissa ([email protected])  lOMoARcPSD|22876375 ○ Herpes simplex ○ History of breast cancer ○ Immune suppression ○ Hypertension ○ Diabetes mellitus ○ Obesity vulvar itching, burning, and edema that do not improve with the use of creams or ointments history of condyloma, gonorrhea, and herpes simplex are some of the factors for greater risk for VIN. During physical examination, observe for any masses or thickening of the vulvar area ○ vulvar lump or mass is most often noted ○ vulvar lesion is usually raised and may be fleshy, ulcerated, leukoplakic (looking like white patches), or warty ○ can appear anywhere on the vulva, though about 3/4 arise primarily on the labia ○ Less commonly, may present with vulvar bleeding, discharge, dysuria, and pain The cycle of violence NSG222.01.06.01 Phase 1: Tension-building ○ Verbal or minor physical abuse occurs. ○ longest phase where tensions increase between partners ○ Excessive drinking, jealousy, etc. might lead to name-calling, hostility, and friction ○ woman might sense that partner is reacting to more negatively, that they are on edge and react heatedly to any trivial frustration ○ will often accept partner’s building anger as legitimately directed toward them internalizes what she perceives as her responsibility to keep the situation from exploding Phase 2: Acute battering/physical abusive ○ explosion of violence Characterized by uncontrollable discharge of tension ○ abuser loses control physically and emotionally ○ victim may be assaulted or murdered often deny the seriousness of their injuries and may refuse to seek medical treatment Phase 3: Honeymoon/reconciliation ○ period of calm, loving behavior from abuser may be genuinely sorry for the pain caused to the partner attempt to make up for the brutal behavior and believe they can control the violence and will never hurt them again ○ abuser is ashamed of the behavior. The abuser tries to minimize the abuse and blame it on the partner. ○ victim wants to believe that partner really can change feels responsible, at least in part, for causing the incident, and feels responsible for their partner’s well-being cycle increases in intensity over time ○ honeymoon phase gradually shortens and eventually disappears altogether Box 9.2 SAVE model NSG222.01.06.02 SCREEN all of your clients for violence by asking ○ Within the last year, have you been physically hurt by someone? ○ Do you feel you are in control of your life? ○ Within the last year, has anyone forced you to engage in sexual activities? 12 Downloaded by S. Elissa ([email protected])  lOMoARcPSD|22876375 ○ Can you talk about your abuse with me now? ○ In general, how would you describe your present relationship? ASK direct questions in a nonjudgemental way ○ Begin by normalizing the topic with the woman ○ Make continuous eye contact with the woman ○ Stay calm, avoid emotional reaction to what she tells you ○ Never blame the woman, even if she blames herself ○ Do not dismiss or minimize what she tells you even if she does ○ Wait for each answer patiently. Don’t rush to the next question ○ Don’t use formal, technical, or medical language ○ Avoid using leading questions be direct and to the point ○ Use a non-threatening, accepting approach VALIDATE the client by telling her ○ You believe her story ○ You don’t blame her for what happened ○ It is brave of her to tell you this ○ Help is available ○ Talking with you is a hopeful sign and a first big step EVALUATE, educate, and refer the client by asking her ○ What type of violence it was? ○ Is she now in any danger? ○ How is she feeling now? ○ Does she know that there are consequences to violence? ○ Is she aware of community resources available to help her? Nursing Management of Rape victims NSG222.01.06.03 sexual assault nurse examiners (SANE), a registered nurse specially trained to conduct sexual assault evidentiary examinations for rape victims collection of forensic evidence provide access to crisis intervention, STI testing, and emergency contraception provided with a safe and comfortable environment for a forensic examination. focus on providing supportive care, collecting and documenting evidence, assessing for STIs, preventing pregnancy, and assessing for PTSD ○ Once initial treatment and evidence collection have been completed ○ follow-up care should include counseling, medical treatment, and crisis intervention early intervention and immediate counseling can accelerate a rape survivor’s recovery. means implementation in the initial hours, days, or weeks after the traumatic event Human Trafficking NSG222.01.06.04 United Nations defines human trafficking as the recruitment, transportation, transfer, harboring, or receipt of persons by means of the threat or use of force, abduction, fraud, or deception to achieve the consent of a person having control over another person for the purpose of exploitation traffickers coerce victims, using rape, torture, starvation, imprisonment, threats, or physical force, into prostitution, pornography, sex trade, forced labor, or involuntary servitude. Victims are exposed to serious and numerous health risks ○ Rape ○ physical injury such as cigarette burns, fractures, and bruises 13 Downloaded by S. Elissa ([email protected])  lOMoARcPSD|22876375 ○ Tuberculosis ○ Pregnancy ○ Torture ○ HIV/AIDS ○ STIs ○ cervical cancer ○ Violence ○ hazardous work environments; ○ Malnourishment ○ drug and alcohol addiction no one sign can demonstrate with certainty when someone is being trafficked, clinicians should be aware of certain indicators. If you suspect a trafficking situation, notify local law enforcement and a regional social service organization that has experience in dealing with trafficking victims Embryonic stage/amniotic fluid NSG222.02.01.01 development begins at day 15 after conception and continues through week 8 Basic structures of all major body organs and the main external features are completed in this stage Amniotic fluid surrounds the embryo and increases in volume as the pregnancy progresses ○ reaching approximately 1 L at term ○ derived from 2 sources: fluid transported from the maternal blood across the amnion fetal urine ○ volume changes constantly as the fetus swallows and voids ○ Sufficient amounts help maintain a constant body temperature for the fetus, permit symmetric growth and development, cushion the fetus from trauma, allow the umbilical cord to be relatively free from compression, and promote fetal movement to enhance musculoskeletal development ○ volume is important in determining fetal well-being Alterations can be associated with problems in the fetus Too little (2,000 mL at term), termed hydramnios ○ associated with maternal diabetes, neural tube defects, chromosomal deviations, and malformations of the central nervous system and/or gastrointestinal tract that prevent normal swallowing of amniotic fluid by the fetus ○ may threaten premature rupture of membranes due to uterine over distention grows rapidly as all organs and structures are forming ○ growing embryo is most susceptible to damage from external sources Multifactorial Inheritance disorders NSG222.02.01.02 Attributes to many common congenital malformations ○ Cleft lip ○ Cleft palate ○ Spina bifida ○ Pyloric stenosis 14 Downloaded by S. Elissa ([email protected])  lOMoARcPSD|22876375 ○ Clubfoot ○ Congenital hip dysplasia ○ Cardiac defects Thought to be caused by multiple genes and environmental factors ○ A combination of genes from both parents and unknown environmental factors results in the condition Box 10.2 those who may benefit from genetic counseling NSG222.02.01.03 Maternal age 35 years or older when the baby is born Paternal age 50 years or older Previous child, parents, or close relatives with an inherited disease, congenital anomalies, metabolic disorders, developmental disorders, or chromosomal abnormalities Consanguinity or incest Pregnancy screening abnormality, including alpha-fetoprotein, triple/quadruple screen, amniocentesis, or ultrasound Stillborn with congenital anomalies Two or more pregnancy losses Exposure to drugs, medications, radiation, chemicals, or infection Teratogen exposure or risk Concerns about genetic defects that occur frequently in their ethnic or racial group (e.g., those of African descent are most at risk for having a child with sickle cell anemia) Abnormal newborn screening Couples with a family history of X-linked disorders Carriers of autosomal recessive or dominant diseases Child born with one or more major malformations in a major organ system Child with abnormalities of growth Child with developmental delay, intellectual disability, blindness, or deafness Box 11.1 Signs and symptoms of pregnancy NSG222.02.02.01 x 2 Presumptive can be caused by something else other than pregnancy (subjective) ○ Fatigue (12 weeks) ○ Breast tenderness (3 to 4 weeks) ○ Nausea and vomiting (4 to 14 weeks) ○ Amenorrhea (4 weeks) ○ Urinary frequency (6 to 12 weeks) ○ Hyperpigmentation of skin (16 weeks) ○ Fetal movements (quickening) (16 to 20 weeks) ○ Uterine enlargement (7 to 12 weeks) ○ Breast enlargement (6 weeks) Probable are seen by provider on physical exam but can still be caused by something else other than pregnancy-Objective ○ Braxton Hicks contractions (16 to 28 weeks) ○ Positive pregnancy test (4 to 12 weeks) conditions other than pregnancy can also elevate hCG levels which pregnancy tests detect ○ Abdominal enlargement (14 weeks) ○ Ballottement (16 to 28 weeks) ○ Goodell sign (5 weeks) 15 Downloaded by S. Elissa ([email protected])  lOMoARcPSD|22876375 Goodell sign: softening of the cervix ○ Chadwick sign (6 to 8 weeks) Chadwick sign: bluish-purple coloration of the vaginal mucosa and cervix ○ Hegar sign (6 to 12 weeks) Hegar sign: softening of the lower uterine segment or isthmus Positive are only caused by fetus ○ Ultrasound verification of embryo or fetus (4 to 6 weeks) ○ Fetal movement felt by experienced clinician (20 weeks) ○ Auscultation of fetal heart tones via Doppler (10 to 12 weeks) Reproductive system adaptations, through figures 11.1 and 11.2 NSG222.02.02.02 Uterus grows into abdomen as pregnancy progresses ○ Pushes liver up ○ Compresses stomach ○ Compresses bladder leading to increase urinary frequency ○ remains in the pelvic cavity for the first 3 months of pregnancy before it gradually ascends into the abdomen Supine Hypotensive Syndrome ○ heavy gravid uterus in the last trimester can fall back against the inferior vena cava in the supine position, resulting in vena cava compression, reduces venous return and decreases cardiac output and blood pressure, increasing orthostatic stress Orthostatic stress occurs when the woman changes her position from recumbent to sitting to standing ○ acute hemodynamic change causes the woman to experience symptoms of weakness, light- headedness, nausea, dizziness, or syncope ○ reversed when the woman is in the side-lying position, as it displaces the uterus to the left and off the vena cava Cardiovascular system, integumentary system NSG222.02.02.03 x 2 Cardiovascular System Changes ○ occur early during pregnancy to meet the demands of the enlarging uterus and placenta for more blood and more oxygen ○ increase in heart rate (25%) ○ increase in cardiac output by 30-50% ○ peaks at 25-30 weeks’ gestation ○ reduced total peripheral resistance ○ increased blood volume ○ increased plasma volume, leads to physiologic anemia ○ Blood Volume Changes increases by approximately 1,500 mL, or up to 50% above nonpregnant levels made up of 1,000 mL plasma plus 450 mL red blood cells (RBCs) by the 32nd week of gestation and remains more or less constant thereafter increase is needed to provide adequate hydration of fetal and maternal tissues, to supply blood flow to perfuse enlarging uterus, and provide a reserve to compensate for blood loss at birth and the postpartum period maternal blood volume expansion occurs at a larger proportion than the increase in RBC mass resulting in physiologic anemia and hemodilution Termed physiologic anemia of pregnancy 16 Downloaded by S. Elissa ([email protected])  lOMoARcPSD|22876375 ○ reflected in a lowered hematocrit and hemoglobin cannot be prevented by giving iron supplementation considered a normal adaptation of pregnancy necessary to meet increased metabolic needs of the mother and meet the need for increased perfusion of other organs, especially the woman’s kidneys since she is excreting waste products for both herself and fetus ○ Cardiac Output and Heart Rate Changes Cardiac output, the product of stroke volume and heart rate, is a measure of the functional capacity of the heart increases from 30-50% over the nonpregnant rate by the 32nd week of pregnancy declines to about a 20% increase at 40 weeks’ gestation The increase is associated with an increase in venous return and greater right ventricular output, especially in the left lateral position Heart rate increases by 10-15 bpm between 14-20 weeks’ gestation, and this persists to term slight hypertrophy or enlargement of the heart ○ Blood Pressure Changes especially diastolic pressure, declines slightly result of peripheral vasodilation caused by progesterone usually reaches a low point mid-pregnancy and increases to pre-pregnancy levels after mid-pregnancy until term ○ second trimester, decreases 5-10 mm Hg and thereafter returns to first- trimester levels Decrease begins at about 7 weeks’ gestation and continues until 32 weeks’ gestation, when it begins to rise to prepregnancy levels Any significant rise in blood pressure should be investigated to rule out gestational hypertension a clinical diagnosis defined by the new onset of hypertension (systolic of 140 mm Hg or higher and/or diastolic of 90 mm Hg or higher) after 20 weeks’ gestation ○ Blood Components Changes number of RBCs increases to a level that is 20-30% higher than nonpregnant values, depending on the amount of iron available necessary to transport the additional oxygen required plasma increase exceeds the increase of RBC production normal hemoglobin and hematocrit values decrease, resulting in physiologic anemia of pregnancy fibrin and plasma fibrinogen levels increase as does various blood clotting factors make pregnancy a hypercoagulable state ○ Combined with venous stasis secondary to venous pooling, which occurs during late pregnancy after long periods of standing in the upright position with the pressure exerted by the uterus on the large pelvic veins, contribute to slowed venous return, pooling, and dependent edema increase the risk for venous thrombosis Integumentary System ○ Includes changes in pigment, vascular supply, connective skin tissue, hair growth, nail structure, and gland functions hyperpigmentation during pregnancy, typically generalized and mild 17 Downloaded by S. Elissa ([email protected])  lOMoARcPSD|22876375 mainly seen on the nipples, areola, umbilicus, perineum, and axilla ○ increased pigmentation that occurs on the breasts and genitalia develops on the face to form the “mask of pregnancy,” which is called facial melasma genetic predisposition, which is exacerbated by the sun tends to recur in subsequent pregnancies blotchy, brownish pigment covers the forehead and cheeks in dark-haired women ○ skin in the middle of the abdomen may develop a pigmented line called the linea nigra, which extends from the umbilicus to the pubic area ○ Striae gravidarum, or stretch marks, are irregular reddish streaks that appear on the abdomen, breasts, and buttocks most prominent by 6-7 months Maternal weight gain NSG222.02.02.04 Healthy weight BMI: 25 to 35 lb ○ First trimester: 3.5 to 5 lb ○ Second and third trimesters: 1 lb/wk BMI 25: 15 to 25 lb ○ First trimester: 2 lb ○ Second and third trimesters: 2/3 lb/wk Pregnancy and sexuality NSG222.02.02.05 Sexuality is an important part of health and well-being Sexual behavior modifies as pregnancy progresses, influenced by biologic, psychological, and social factors way a pregnant woman feels and experiences her body during pregnancy can affect her sexuality pregnancy changes and discomforts result in increased physical and emotional demands can produce stress on the sexual relationship with partner sexual desire may change throughout the pregnancy ○ 1st trimester, may be less interested in sex because of fatigue, nausea, and fear of disturbing the early embryonic development ○ 2nd trimester, interest may increase because of the stability of the pregnancy ○ 3rd trimester, enlarging size may produce discomfort during sexual activity Potential complications of sex during pregnancy ○ preterm labor ○ pelvic inflammatory disease ○ antepartum hemorrhage in placenta previa ○ venous air embolism Generally, sex are considered safe in pregnancy ○ Abstinence is usually only recommended for women who are at risk for preterm labor or for antepartum hemorrhage due to placenta previa woman’s sexual health is intimately linked to her own self-image Sexual positions to increase comfort as the pregnancy progresses and alternative noncoital modes of sexual expression (cuddling, caressing, and holding) should be discussed Giving permission to talk about and then normalizing sexuality can help enhance the sexual experience during pregnancy and ultimately the couple’s relationship 18 Downloaded by S. Elissa ([email protected])  lOMoARcPSD|22876375 ○ communication are open regarding sexuality during pregnancy, any fears and myths the couple may have can be dispelled First prenatal visit NSG222.02.03.01 focus of prenatal care is to reduce the risk of adverse health effects for the woman, fetus, and newborn by addressing modifiable risk factors and providing education about having a healthy pregnancy Once a pregnancy is suspected or confirmed by a home pregnancy test, the woman should seek prenatal care to promote a healthy outcome ○ most opportune window (preconception) for improving pregnancy outcomes may be missed, appropriate nursing management starting at conception and continuing throughout the pregnancy can have a positive impact on the health of pregnant women and their unborn children ideal time to screen for factors that might place the woman and her fetus at risk for problems optimal time to begin educating the client about changes that will affect her life Prenatal care can be delivered in 1 of the 2 methods ○ Individually ○ group format termed centering incidence of gestational diabetes is growing ○ Is recommended screening at the first prenatal visit for women who over 25 years old Overweight have polycystic ovary syndrome history of gestational diabetes positive family history of diabetes ○ Normoglycemia is the goal in all aspects of pregnancy and offers the benefits of decreased short- and long-term complications of diabetes First Prenatal Visit Comprehensive Health History Comprehensive health history is obtained ○ Age ○ menstrual history ○ prior obstetric history ○ past medical and surgical history ○ psychological screening ○ family history ○ genetic screening ○ dietary habits ○ lifestyle and health practices ○ medication or drug use ○ history of exposure to STIs typically includes questions about 3 major areas ○ reason for seeking care ○ client’s past medical, surgical, and personal history, including that of the family and her partner ○ client’s reproductive history establish the foundation of a trusting relationship and jointly develop a plan of care for the pregnancy ○ tailor plan to the client’s lifestyle as much as possible and focus primarily on education for overall wellness during the pregnancy ultimate goal for the 1st prenatal visit is to collect baseline data about the woman and her partner and 19 Downloaded by S. Elissa ([email protected])  lOMoARcPSD|22876375 to detect any risk factors that need to be addressed to facilitate a healthy pregnancy First Prenatal Visit Comprehensive Health History Reason for Seeking Care commonly comes for prenatal care based on the suspicion that she is pregnant may report she has missed her menstrual period or has had a positive result on a home pregnancy test ○ Ask the woman for the date of her last normal menstrual period (LMP) ○ ask about any presumptive or probable signs of pregnancy that she might be experiencing urine or blood test to check for evidence of human chorionic gonadotropin (hCG) is done to confirm First Prenatal Visit Comprehensive Health History Past History Ask about the woman’s past medical and surgical history ○ important as conditions the woman experienced in the past may recur or be exacerbated during pregnancy ○ chronic illnesses can increase the risk for complications during pregnancy for the woman and her fetus ○ Ask about any history of allergies to medications, foods, or environmental substances ○ Ask about any mental health problems ○ Gather similar information about the woman’s family and her partner. ○ woman’s personal history is important as well First Prenatal Visit Comprehensive Health History Reproductive History includes a menstrual, obstetric, and gynecologic history begins with a description of the woman’s menstrual cycle, including her age at menarche, number of days in her cycle, typical flow characteristics, and any discomfort experienced use of contraception is also important, including when the woman last used it. Ask the woman the date of her last menstrual period (LMP) to determine the estimated due date (EDD) Common laboratory and diagnostic tests 12.2 NSG222.02.03.02 Tests generally conducted for all pregnant women include urinalysis and blood studies ○ Urinalysis for albumin, glucose, ketones, and bacteria casts ○ Blood studies usually include complete blood count (hemoglobin, hematocrit, red and white blood cell counts, and platelets) Evaluates hemoglobin (12-14g) and hematocrit 42% +/-5%) levels and RBC (4.2- 5.4 million/mm3) to detect the presence of anemia Identifies WBC level (5000-10000million/mm-3) ○ If elevated may indicate infection Determines platelet count (150000-45000mL3) to assess clotting ability blood typing and Rh factor Determine the women's blood type and Rh status to rule out any blood incompatibility issues early Rh- mother will likely receive RhoGAM at 28 weeks gestation and again within 72 hours after childbirth if she is Rh sensitive glucose screening for high-risk women Detect gestational diabetes or monitor diabetes in those with the condition rubella titer Detect antibodies for the virus that causes German measles 20 Downloaded by S. Elissa ([email protected])  lOMoARcPSD|22876375 If titer is 1.8 or less the women is not immune and requires immunization after birth and should be advised to avoid people with undiagnosed with rashes hepatitis B surface antibody antigen Determines if the mother has Hep B by detecting the presence of the Hep antibody surface antigen (HbsAg) in her blood HIV Detects HIV antibodies If positive she requires more specific testing, counseling and treatment during pregnancy with antiretroviral medications to prevent passing to fetus venereal disease research laboratory (VDRL) Detects STIs so treatment can be started if positive to prevent passing to fetus STI Screening rapid plasma reagin (RPR) tests Detects STIs so treatment can be started if positive to prevent passing to fetus STI Screening cervical smears to detect STIs Detects abnormalities ex. Cervical cancer (Pap test) or infections ex. Gonorrhea, chlamydia or group B streptococcus so treatment can be started if positive ○ Ultrasound Fetal movement determination and Nursing procedure 12.1 measuring fetal heart rate NSG222.02.03.03 x 2 Perception of fetal movement typically begins in the 2nd trimester ○ occurs earlier in multiparous women than nulliparous women mother’s first perception of fetal movement, termed “quickening,” is commonly described as a gentle fluttering ○ most often related to trunk and limb motion and rollovers, or flips Maternal perception is an important screening method for fetal well-being ○ decreased fetal movement is associated with a range of pregnancy pathologies and poor pregnancy outcomes may indicate asphyxia and FGR If compromised, fetus decreases its oxygen requirements by decreasing activity may be related to other factors maternal use of central nervous system depressants fetal sleep cycles hydrocephalus bilateral renal agenesis stillbirth placental dysfunction bilateral hip dislocation Fetal movement counting is a method used by the mother to quantify her fetus’s movement Instruct client about how to count fetal movements, reasons for doing so, and the significance of decreased fetal movements ○ Urge the client to perform the counts in a relaxed environment and a comfortable position Provide the client with detailed information concerning fetal movement counts, and stress the need for consistency in monitoring (at approximately the same time each day) and the importance of informing the health care provider promptly of any reduced movements Providing clients with “fetal kick count” charts to record movement helps promote adherence to instructions 21 Downloaded by S. Elissa ([email protected])  lOMoARcPSD|22876375 woman needs to be aware of a decrease in the number of movements when last assessed most common method used is “Count to 10,” with which a woman focuses her attention on her fetus’s movement and records how long it takes to document 10 movements ○ If it takes longer than 2 hours, the woman should contact her health care provider for further evaluation The purpose of assessing fetal heart rate is to determine the rate and rhythm ○ normal fetal heart rate range is 110 to 160 bpm ○ assess fetal well-being Measuring Fetal Heart Rate Steps ○ Assist the woman onto the examining table and have her lie down. ○ Cover her with a sheet to ensure privacy, and then expose her abdomen. ○ Palpate the abdomen to determine the fetal lie, position, and presentation. ○ Locate the back of the fetus (the ideal position to hear the heart rate). ○ Apply lubricant gel to the abdomen in the area where the back has been located. ○ Turn on the handheld Doppler device and place it on the spot over the fetal back. ○ Listen for the sound of the amplified heart rate, moving the device slightly from side to side as necessary to obtain the loudest sound. Assess the woman's pulse rate and compare it to the amplified sound. If the rates appear the same, reposition the Doppler device. ○ Once the fetal heart rate has been identified, count the number of beats in 1 minute and record the results. ○ Remove the Doppler device and wipe off any remaining gel from the woman's abdomen and the device. ○ Record the heart rate on the woman's medical record normal range is 110-160 bpm. ○ Provide information to the woman regarding fetal well-being based on findings BPP scoring and interpretation NSG222.02.03.04 biophysical profile (BPP) uses a real-time ultrasound and NST to allow assessment of various parameters of fetal well-being that are sensitive to hypoxia ○ includes ultrasound monitoring of fetal movements, fetal tone, and fetal breathing as well as ultrasound assessment of amniotic fluid volume with or without assessment of the fetal heart rate BPP primary objectives are to reduce stillbirth and to detect hypoxia early enough to allow delivery in time to avoid permanent fetal damage resulting from fetal asphyxia Each parameter is controlled by a different structure in the fetal brain: ○ fetal tone by the cortex ○ fetal movements by the cortex and motor nuclei ○ fetal breathing movements by the centers close to the fourth ventricle ○ NST by the posterior hypothalamus and medulla Biophysical Profile Scoring is a scored test with 5 components, each worth 2 points if present total score of 10 is possible if the NST is used 30 minutes are allotted for testing ○ less than 10 minutes is usually needed following criteria must be met to obtain a score of 2; anything less is scored as 0 ○ Body movements: 3 or more discrete limb or trunk movements ○ Fetal tone: 1 or more instances of full extension and flexion of a limb or trunk 22 Downloaded by S. Elissa ([email protected])  lOMoARcPSD|22876375 ○ Fetal breathing: 1 or more fetal breathing movements of more than 30 seconds. ○ Amniotic fluid volume: 1 or more pockets of fluid measuring 2 cm ○ NST: normal NST = 2 points; abnormal NST = 0 points Biophysical Profile Interpretation Interpretation of the BPP score can be complicated, depending on 7 fetal and maternal variables is indicated as a result of a nonreassuring finding from previous fetal surveillance tests, this test can be used to quantify the interpretation, and intervention can be initiated if appropriate maximum score of 10 can be achieved and the test is complete once all of the variables have been observed For the test to be abnormal and a score of zero awarded for the absence of fetal movement, fetal tone, or fetal breathing movements, a period of more than 30 minutes must have elapsed a score of 8 to 10 is considered normal if the amniotic fluid volume is adequate score of 6 or below is suspicious, possibly indicating a compromised fetus ○ further investigation of fetal well-being is needed Teaching guidelines 12.1, teaching to manage the discomforts of pregnancy NSG222.02.03.05 Urinary Frequency or Incontinence ○ Try pelvic floor exercises to increase control over leakage. ○ Empty your bladder when you first feel a full sensation. ○ Avoid caffeinated drinks, which stimulate voiding. ○ Reduce your fluid intake after dinner to reduce nighttime urination. Fatigue ○ Attempt to get a full night's sleep, without interruptions. ○ Eat a healthy balanced diet. ○ Schedule a nap in the early afternoon daily. ○ When you are feeling tired, pause and rest. Nausea and Vomiting ○ Avoid an empty stomach at all times. ○ Eat dry crackers/toast in bed before arising. ○ Eat several small meals throughout the day. ○ Avoid brushing teeth immediately after eating to avoid gag reflex. ○ Acupressure wristbands can be worn daily. ○ Drink fluids between meals rather than with meals. ○ Avoid greasy, fried foods or ones with a strong odor, such as cabbage or Brussels sprouts. Backache ○ Avoid standing or sitting in one position for long periods. ○ Apply heating pad (low setting) to the small of your back. ○ Support your lower back with pillows when sitting. ○ Use proper body mechanics for lifting anything. ○ Avoid excessive bending, lifting, or walking without rest periods. ○ Wear supportive low-heeled shoes; avoid high heels. ○ Stand with your shoulders back to maintain correct posture. Leg Cramps ○ Elevate legs above heart level frequently throughout the day. ○ If you get a cramp, straighten both legs and flex your feet toward your body. ○ Ask your health care provider about taking additional calcium supplements, which may reduce 23 Downloaded by S. Elissa ([email protected])  lOMoARcPSD|22876375 leg spasms. Varicosities ○ Walk daily to improve circulation to extremities. ○ Elevate both legs above heart level while resting. ○ Avoid standing in one position for long periods of time. ○ Don’t wear constrictive stockings and socks. ○ Don’t cross the legs when sitting for long periods. ○ Wear support stockings to promote better circulation. Hemorrhoids ○ Establish a regular time for daily bowel elimination. ○ Avoid constipation and straining during defecation. ○ Prevent straining by drinking plenty of fluids and eating fiber-rich foods and exercising daily. ○ Use warm sitz baths and cool witch hazel compresses for comfort Constipation ○ Increase your intake of foods high in fiber and drink at least eight 8-oz glasses of fluid daily. ○ Ingest prunes or prune juice which are natural laxatives. ○ Consume warm liquids (tea) on rising, to stimulate peristalsis. ○ Exercise each day (brisk walking) to promote movement through the intestine. ○ Reduce the amount of cheese consumed. Heartburn/Indigestion ○ Avoid spicy or greasy foods and eat small frequent meals. ○ Sleep on several pillows so that your head is elevated 30 degrees. ○ Stop smoking and avoid caffeinated drinks to reduce stimulation. ○ Avoid lying down for at least three hours after meals. ○ Try drinking sips of water to reduce burning sensation. ○ Avoid foods that trigger symptoms—fried foods, citrus, soda, chocolate. ○ Take antacids sparingly if burning sensation is severe. Braxton Hicks Contractions ○ Keep in mind that these contractions are a normal sensation. Try changing your position or engaging in mild exercise to help reduce the sensation. ○ Drink more fluids if possible Nursing Management and Childbirth education NSG222.02.03.06 education is less about methods than about mastery overall aim of any method is to promote an internal locus of control that will enable each woman to yield her body to the process of birth Nurses play a key role in supporting and encouraging each couple’s use of the techniques taught in childbirth education classes most effective support a nurse can offer a couple using prepared childbirth methods is encouragement and presence ○ measures must be adapted to each individual throughout the labor process Offering encouraging phrases helps reinforce their efforts and at the same time empowers them to continue Using eye contact to engage the woman’s total attention is important if she appears overwhelmed or appears to lose control during the transition phase of labor Nurses play a significant role in enhancing the couple’s relationship by respecting the involvement of the partner and demonstrating concern for their needs throughout labor ○ Offering to stay with the woman to give the partner a break periodically allows them to meet 24 Downloaded by S. Elissa ([email protected])  lOMoARcPSD|22876375 their needs while at the same time still actively participating Offer anticipatory guidance to the couple and assist during critical times in labor Demonstrate coping techniques to the partner and praise their successful use to increase self-esteem Focus on strengths and the positive elements of the labor experience Congratulating the couple for a job well done is paramount Throughout the labor experience, demonstrate personal warmth and project a friendly attitude nurse’s touch may help prevent a crisis by reassuring the mother she is doing well 3 most common childbirth methods ○ Lamaze (psychoprophylactic) method Focus on breathing and relaxation techniques ○ Bradley (partner-coached childbirth) method Focus on exercise and slow, controlled abdominal breathing ○ Dick-Read (natural childbirth) method Focus on fear reduction via knowledge and abdominal breathing techniques 25 Downloaded by S. Elissa ([email protected])