Final Exam Maternal Study Guide PDF

**Final Exam Study Guide** **[Comprehensive portion ]** **Ch. 2 Family Structures (1 question)** - **Nuclear:** husband, wife, children (can be biological/adopted) - **Extended:** grandparents, aunts, uncles, other relatives that live nearby or in the same household - **Multigeneratio...

**Final Exam Study Guide** **[Comprehensive portion ]** **Ch. 2 Family Structures (1 question)** - **Nuclear:** husband, wife, children (can be biological/adopted) - **Extended:** grandparents, aunts, uncles, other relatives that live nearby or in the same household - **Multigenerational:** consist of 3 or more generations - **Non-biological:** adopted, foster, or kinship (close relative) - **Married-blended:** stepsiblings - **Cohabitating:** unmarried parents **Ch.3 Breast Self-Exam (1 question)** - Best time to do self-breast exam is 5-7 days post period - Observe for lumps, inversion of nipples, dimpling, redness, pain - Do it lying and standing with arm raised, using opposing hand in circular motion **Ch. 4 Amenorrhea (3 questions)** **-primary:** has not have period yet (usually until age 13) **-secondary:** w/out menstrual flow for 2 cycles, 6+ months cessation - \#1 cause is pregnancy - Other causes include eating disorders, low body weight, strenuous exercise, oral contraceptive use, hyper/hypothyroidism, birth control use **Ch. 4 Sexually transmitted infections & pelvic inflammatory disease treatment (3 questions)** **Bacterial:** - **Chlamydia** - s/s: - Usually asymptomatic - Dysuria - Vuvular itching - Gray/white discharge - Tx: Azithromycin 1x or doxycycline 7 days - Okay for breastfeeding or pregnant women (azithromycin) - **Gonorrhea** - s/s: - Dysuria - Pain in lower pelvic area - Purulent green/yellow discharge - Endocervical bleeding - Tx: ceftriaxone IM 1x - **Syphilis** - s/s: - Chancre (painless lesion) - Skin rashes on palms and soles of feet - Lymph node edema - tx: Penicillin G IM 1x - **Pelvic Inflammatory Disease (PID)** - Risk factors: - Multiple partners - IUD - HX STDs - s/s: - Pain - Fever - n/v - Chills, fever - Tx: - Semi-fowler\'s position (bed rest) - Ceftriaxone IM 1x and doxycycline 7-14 days, with/without metronidazole **Viral (incurable)** - **Human papillomavirus (HPV)** - s/s: - Cauliflower-like genital warts - Bleeding after sex (postcoital bleeding) - Dyspareunia (painful intercourse) - Tx: - Cryotherapy for removal of warts - Trichloroacetic acid (TCA) chemical treatment - Prevention: - Gardasil vaccine - **Herpes simplex virus (HSV-2)** - s/s: - Painful genital lesions - Itching - Fever, malaise - Tender lymph nodes - Tx: Acyclovir oral antiviral - C-section for active lesions - **Human Immunodeficiency Virus (HIV)** - s/s: - Weight loss - Night sweats - Fatigue/malaise - Lymphadenopathy - Diarrhea - Sore throat - Tx: - C-section/breastfeeding depends on viral load - Life long antiviral meds (zidovudine) **Vaginal Infections** - **Bacterial Vaginosis** - s/s: - Fishy odor - Tx: - Flagyl (oral metronidazole) - **Candidiasis: yeast infection** - s/s: - Vaginal itching - Thick, cottage cheese discharge - tx: Monistat (antifungal cream) - **Trichomoniasis** - s/s: - Yellow-greenish discharge w/foul odor - Strawberry petichae on cervix - Tx: - Metronidazole oral 1x dose, okay for pregnancy - **Group B Strept** - Test between 35-37 weeks of pregnancy - Tx w/IV abx - **TORCH infections** - Toxoplasmosis - Other (Hep B) - Rubella - Cytomegalovirus (CMV) - Herpes simplex **Ch. 5 Contraceptive methods, benefits of each (1 question)** - **Coitus interruptus** - Pull-out method - Does not protect against STDs - **Fertility awareness methods (FAMs)** - Tracking ovulation times, basal body temperature, cervical mucous - May not be accurate - **Barrier methods** - **Spermicides:** - Non-hormonal - No STD protection - **Condoms:** - Protects from STDs - May tear - **Diaphragm, cervical cap, sponge** - No hormones, can be used multiple times, - Contains latex, 85% effective, does not protect against STDs - **Hormonal methods** - **Combined estrogen-progesterone contraceptives (COCs)** - **Oral contraceptives:** - Does not protect against STDs - Do not take if: - Increased risk of thrombolytic events - Cardiac history - Estrogen-dependent tumors - Pregnancy - Impaired liver - Smoking - DM - Effectiveness of COCs are decreased if these meds are taken: - Anti-convulsant - Anti-fungals - Antibiotics - Anti-TB - Anti-HIV - **Transdermal:** - Once a day for 3 weeks, then 1 week w/out patch - Does not protect against STDs - **Vaginal ring:** - Worn for 3 weeks, then 1 week without - **Progestin-only contraception** - **Oral (minipill)** - Less effective than COCs, taken at same time everyday - **Injectable (depo)** - Admin every 11-13 weeks (4x/year) - No protection against STDs - **Implantable (Nexplanon)** - Last for 3 years - More effective than IUDs - Does not protect against STDs - **Emergency contraceptives** - Use w/in 72 hours of intercourse - No STD protection - **Intrauterine Devices (IUDs)** - 99% effective - No STD protection - Has to have consent - **Sterilization** - Female: tubal ligation (permanent)/occlusion (may be reversed) - No STD protection - Male: vasectomy **Ch. 6 (it is actually Ch. 10) Fetal movement and kick counts (2 questions)** - Fetal movement can be felt around 16-20 weeks gestation (2^nd^ trimester) (quickening) - Count 1x/60 mins - Count fetal activity 2-3x/day (after meals/before bedtime) for 2 hours or until 10 movements are counted - If no fetal movements/kicks are felt w/in 12 hours, call provider **Ch. 6 Function of the placenta, amniotic fluid (2 questions)** - **Placenta** - Endocrine (produces HcG, human placental lactogen (human growth hormone)), progesterone, steroid hormones - Metabolic function (oxygen to fetus from umbulical, CO2 away from fetus) - Circulatory function - **Amniotic fluid** - Maintain fetal temp - Oral fluid and repository waste - Barrier to infection **Ch.6 Polyhydraminios, oligohydramnios causes (2 questions)** - **Oligohydramnios:** - \2L=GI abnormalities **Ch. 7 Calculating GTPAL (3 questions)** - **Gravidity:** \# of pregnancies - **Term:** pregnancies \>37 weeks - **Preterm:** \# of pregnancies between 20-36.7 weeks - **Abortion:** \# of pregnancies before \>20 weeks - **Living:** \# of living children **Ch. 7 (Actually Ch. 8, p.187) Terminology: Viability, term, preterm, postdates (3 questions)** - Viability: 22-24 weeks, ability for fetus to survive outside of placenta - Term: anything after 37 weeks to 41.6 - Preterm: 20 weeks to 36.6 weeks - Postdates: anything greater than 42 weeks **Ch. 7 Physiological changes of pregnancy to the body systems (3 questions)** **[Reproductive]** - **Uterus:** increase of estrogen and progesterone, size, and vascularity - Lightening: fundal height decreases at 40 weeks for descend of fetus - Hegar's sign: softening of cervical isthmus - Braxton Hick's - Ballottment: fetal movement w/tap at 16-18 weeks - Quickening: feeling baby move at 14-16 weeks - **Cervix** - Goodell sign: softening of cervix at 6-8 weeks - **Vagina/vulva:** - Chadwick: purple/bluish color at 6-8 weeks - Leukorrhea: white/gray vaginal discharge - **Breasts** - Fullness, colostrum can start leaking around 16 weeks **[Cardiovascular]** - Blood volume, CO, RBC all increase - Hct/Hgb may decrease - Supine hypotension can occur d/t vena cava compression **[Respiratory]** - Epistaxis (nosebleeds) and sinus problems are common - Increase in O2 consumption **[Gastrointestinal]** - **Mouth** - Epulis (gum bleeding) can occur - Ptyalism (excessive salivation) can occur - **Stomach** - Pyrosis (heartburn) is commong - Constipation - N/v **[Urinary]** - Kidneys enlarge - Susceptible to UTIs, incontinence - Decrease in BUN/Cr, increase in GFR - Increase in sodium in body, which can create thirst and leg edema - Increase in urine and albumin in protein **[Integumentary]** - Melasma (darkening/hyperpigmentation of skin) - Linea nigra (dark line from umbilicus to symphysis pubis) - Striae gravidarium (stretch marks) - Angiomas (spider web like marks) - Palmary erythema (pinkish blotches over palmar surfaces) **[Musculoskeletal]** - Increase in weight - Lordosis, waddling gait - Diastasis rectis abdominis **[Neuro]** - Lightheadiness/syncope d/t postural hypotension - Fatigue/change in sleep patterns - Carpal tunnel syndrome - Ocular/olfactory changes **[Endocrine]** - Increase in thyroid gland (T3/T4) - Increase in pituitary gland (cortisol, ACTH) - Increase in pancreas Langerhans cells for increase in insulin needs **Ch. 8 Pregnancy warning/danger signs (4 questions)** **First trimester** - Severe vomiting (hyperemesis gravidarium) - Chills, fever, burning w/urination, diarrhea (infection) - Abdominal cramping, bleeding (miscarriage, ectopic pregnancy) **Second/third trimester** - Sudden discharge of vaginal fluid before 37 weeks (PPROM) - Vaginal bleeding (miscarriage, placenta previa, placenta abruption) - Visual disturbances, swelling of face, HAs, seizures, epigastric pain (pre-e) - Positive glucose tolerance test reaction (gestational diabetes) **Ch. 8 Alcohol used in pregnancy (4 questions)** No safe amount of alcohol is recommended during pregnancy **Ch. 8 Due date calculation (4 questions)** Naegel's rule: Last date of menstrual cycle: - \- 3 months - \+ 7 days - \+ 1 year **Ch. 10 Kick counts** - Fetal movement can be felt around 12 weeks gestation - Count 1x/60 mins - Count fetal activity 2-3x/day (after meals/before bedtime) for 2 hours or until 10 movements are counted - If no fetal movements/kicks are felt w/in 12 hours, call provider **Ch. 10 BPP (Biophysical Profile)** - Assesses the well-being of the fetus, normally done late 2^nd^ trimester/3^rd^ trimester - Fetal breathing movements: 0=absent, 2= 1 episode in 30 secs - Fetal movements: 2=3 trunk/limb movements in 30 secs, 0= fewer than 3 - Fetal tone: 2= at least 1 episode of extension to flexion, 0= absence - Amniotic fluid: 2=vertical pocket \>2cm, 0= vertical pocket \60 or \20 secs -central cyanosis (late sign) **Transient tachypnea of the newborn** -usually occurs in babies that were born via C-section, where some lung fluid retention occurs, usually resolves w/in 24-48 hours, but it involves breaths greater than 60/min **Acrocyanosis** -bluish discoloration of hands/feet w/in 24 hours of birth, normal finding **Types of newborn heat loss and ways to prevent** -convection (from cool air): place away from a/c vents, fans, or windows, place cap or blanket around baby -radiation (from surrounding cooler objects): avoid placing baby near cold surfaces such as windows -evaporation (water loss from skin): dry off newborn, replace wet blankets -conduction (from cold surfaces): avoid placing baby on cold surfaces **Normal newborn stools (meconium, how many stools should breastfed/bottle fed baby have)** -meconium: first stool that usually occurs w/in 24 hours of birth, sometimes 48 hours, dark, olive green, sticky, tar-like -first day- 1 stool -2^nd^ day: 2 stools -transitional stools usually occurs by 3^rd^ day of feeding, which is greenish/brown to yellowish brown, less sticky than meconium -breastmilk: yellow to golden, seedy -formula: pale yellow to light brown, firmer, stronger odor **Newborn voids** **-**Day 1: 1 wt diaper -Day 2: 2 wet diapers, etc, etc -Day 4: should have 6-8 wet diapers per day **Care of circumcision** -bleeding is assess every 15-30 mins for 1^st^ hour, then hourly for next 4-6 hours -if bleeding occurs, apply gentle pressure with sterile gauze -Gelfoam powder/sponge can be applied to help control bleeding -parental education: -wash hands before touching area -check circumcision site w/every diaper change for bleeding -if bleeding occurs, use gauze. If bleeding does not stop, call provider -Day 3-4, clean w/water only. No use of baby wipes **Care of umbilical cord stump** **-**cleanse w/water during routine bathing -plastic cord clamp will be removed once stump is dry, usually 24-48 hours -keep area clean, dry, and lose w/clothing -assess for redness, edema, purulent drainage w/each diaper change -if soiled, cleanse w/water and dry -will dry, shrivel, and blacken by day 2-3 -average time of cord separation is 10-14 days, can take up to 3 weeks. Some blood may be present when cord drops off, if bleeding is persistent, call provider **Vitamin K administration and erythromycin eye ointment (why given, what prevents?)** -vitamin K IM shot: promotes formation of clotting factors in liver to prevent hemorrhages -erythromycin eye ointment: to prevent gonorrhea infection from mother and ophthalmia neonatorum (neonatal conjunctivitis that can lead to blindness), 1-2cm ribbon is applied to lower conjunctival sac 1-2 hours after birth **Normal newborn reflexes** **-**Rooting/sucking (touching infant's lips/cheek) -Palmar/plantar grasp -Moro (falling) -Babinksi/plantar **Newborn skin conditions (vernix caseosa, mongolian spots, erythema toxicum, milia, nevi)** **-**vernix caseosa: cheese-like substance that serves as protective covering (anti-microbial/heat loss) -Mangolian spots: usually seen in darker skinned individuals -erythema toxicum: transient rash, appears 24-72 hours after birth, can last up to 3 weeks, no treatment required -milia: distended, white sebaceous glands, normal, do not try to pop -nevi: "stork bites" seen on nape of neck, forehead, nose, face, easily blanchable, no treatment **Newborn head abnormalities (caput, cephalhematoma, subgaleal hemorrhage)** -caput succedaneum: generalized edematous of scalp, usually disappears w/in 3-4 days, can be from vaginal birth, vacuum/forceps -cephalhematoma: collection of blood between skull bone and peristeoum, does not cross suture lines, firmer and better define, usually resolves in 2-8 weeks -subgaleal hemorrhage: bleeding into subgleal compartment, blood loss, hemorrhage, death can occur, boggy scalp, pallor, tachycardia, increasing head circumference **Hyperbilirubinemia of newborn (risks, pathologic vs physiologic, signs, treatment)** -most newborns have benign/physiologic jaundice, usually occurs 24 hours after birth and last 3-5 days, maybe 1-2 weeks (physiological jaundice d/t increased levels of unconjugated bilirubin, usually no treatment, but sometimes need phototherapy) Risks: -pathologic jaundice: higher levels of unconjugated bilirubin that requires treatment -if left untreated, can lead to neurotoxicity, acute bilirubin encephalopathy, or kernicterus (irreversible, life long hypotonia, hearing loss, cerebral palsy, gaze abnormalities) -assessment: every 8-12 hours, palpated areas will appear yellowish before capillaries refill, conjunctival sacs/buccal mucosa -total serum bilirubin (TcB) -prevention: feed early (w/in 1-2 hours of birth) and often (8-12 times/24 hours) -treatment: **Newborn pain (signs of pain, interventions for pain)** s/s: -high pitched cry -grimacing -quivering tongue -open mouth -interventions: -non-pharm: swaddling, breastfeeding/breastmilk, skin to skin, oral sucrose, pacifier -pharm: topical anesthetic, non-opioids, opiods **APGAR scoring (what do scores mean, be able to calculate the newborns APGAR)** -APGAR scores are taken at 1 and 5 mins post-birth -An 8-10 means that the newborn is adjusting to life outside of the womb well, below an 8 means interventions will need to be done Appearance/skin color: blue/pale = 0, acrocyanosis = 1, pink = 2 Pulse: absent = 0, \100 = 2 Grimace: no response = 0, grimace = 1, cry = 2 **Newborn safe sleep** -swaddle on back -no extra toys/blankets -do not prop bottles, can have pacifier -sleep in own bassinet/crib, no co sleeping **Bulb syringe use** -suction mouth then nose -compress before inserting **Newborn feeding cues** -random hand to mouth -sucking fingers -drooling/opening mouth, searching for breast/bottle -licking lips **Breastfeeding (American Academy of Pediatric recommendations for breastfeeding, benefits of breastfeeding, how do we know it is effective, signs of poor/effective latch, how often to breastfeed)** -exclusively breastfeed for the 1^st^ 6 months up to 2 years of age -benefits include: -reduce infant mortality -reduced risk for GI problems -NEC -Crohn's/UC -Respiratory tract infection -Type 2 Diabetes -Obesity -Signs of poor latch = painful **Bottle feeding/formula feeding (teaching for parents)** -best to avoid bottle feeding until breastfeeding is well established, around 3-4 weeks old -breast milk can be at room temp for up to 4 hours -in fridge for 4 days -in freezer for 6 months to 1 year **Macrosomic infant (interventions, what to monitor for)** **-**birth weight greater than 4000-4500g -blood sugars -hyperbilirubia -hyperglycemia -heat loss -birth injuries **Surfactant (why is administered)** -may be administered at birth as a preventive or prophylatic measure in terms of RDS (respiratory distress syndrome), allows for proper expansion of alveoli **Kangaroo care (what is it, what are benefits)** **-**skin to skin -effective way to comfort infant, prevent heat loss **NEC (what is it, how do we prevent it)** -Necrotizing enterocolitis: acute inflammatory disease of bowel, increased incidence w/preterm babies, damage to mucousal cells causes for the bowel wall to be broken down and causing ischemia -s/s: -abdominal distention -feeding intolerance -lethargy -bilious vomitus -Prevention: **Retinopathy of Prematurity (what is it, what causes to occur)** -abnormal blood vessels grow in retina of preterm babies, can cause blindness -direct exposure to light, supplemental oxygen **Newborn sepsis (prevention, causes, signs, treatment)** -early onset/congenital: w/in 72 hours of birth -late onset: 7-30 days after birth s/s: -respiratory: -apnea -grunting -retractions -cardio: -decreased CO -tachy/bradycardia -hypotension -delayed capillary refill, poor peripheral pulses, cold, clammy, mottled skin -neuro: -poor feeding -decreased LOC -lethargy -bulging fontanelles -GI: -n/v/d -abdominal distention -Prevention: hand hygiene, prophylactic abx: Treatment: depends on causative agent **Signs of fetal alcohol syndrome** -small eyes -thin upper lip -flat midface -indistinct philtrum (vertical indent above lip) -growth restriction -neurodevelopmental deficits **Neonatal abstinence syndrome (Signs of withdrawal, treatment)** -s/s: -Neuro: -irritability/jitteriness/tremors -seizures -high pitched cry -Resp: -tachypnea, nasal flaring -GI: -poor feeding, n/v/d -Misc: -diaphoresis, fever, mottled skin, temp. Instability -Treatment: -ESC model (eat, sleep, consolability); treatment depends on if the baby can do these things, if not, interventions for each thing will occur