last exam presentations.powerpoint

Question 1

smoking increase risk of

Answer 1

1st trimester miscarriage
ectopic 
low birth weight
placenta previa/abruption 
fetal growth restriction 
preterm birth/labor 
SIDS 
chronic asthma in children

Question 2

Is quitting smoking by the end of the first trimester….

Answer 2

reverse the adverse effects on the fetus

Question 3

5 A’s approach smoking cessation

Answer 3

Ask about tobacco use
advise to quite
assess willingness to make an effort to quit
assist attempt to quit
arrange follow up

Question 4

what is the first line of treatment (smoking) in pregnant women

Answer 4

behavioral

Question 5

when does pharmacotherapy recommended for pregnant women

Answer 5

those who smoke more than 1 pack / day

Question 6

Is woman is more likely to quit smoking during pregnancy than any other time in her life

Answer 6

yes

Question 7

Nicorette

Answer 7

MOA:cholinergic-receptor agonist that replaces nicotine to reduce withdrawal symptoms
S/E- indigestion, nausea, hiccups traumatic injury to oral mucosa and/or teeth, irritation and/or tingling of the tongue, mouth, and throat, oral mucosal ulceration, jaw-muscle ache, eructation, gum sticking to teeth, unpleasant taste, dizziness, lightheadedness, headache, insomnia
Contraindications: known allergy to nicotine or methol, patients with TMJ
Prescription: Nicorette Gum 2mg pieces, chew 1 piece gum prn nicotine cravings. not to exceed 9 pieces daily.

Question 8

what amount of Alcohol is approved during pregnancy

Answer 8

NO AMOUNT is allow

Question 9

Alcohol uses increase risk of

Answer 9

miscarriage
stillborn
developmental delay
preterm birth
physical delay

Question 10

what decrease alcohol comsumption

Answer 10

assessment of alcohol

Question 11

T-ACE screening tool

Answer 11

How many drinks does it take to feel high? (TOLERANCE)
Have ppl ANNOYED you by criticizing your drinking?
Have you ever felt that you needed to CUT DOWN on your drinking?
Have you ever had a drink first thing in the morning to steady your nerves or get ride of hang over (EYE OPENER)

Question 12

What are the criteria to dx Fetal Alcohol Syndrome

Answer 12

3 facial features:
smooth ridge between the nose and upper lip (smooth philtrum)
Thin upper lip
short distance between the inner and outer corners of the eyes, giving the eyes an wide-spaced appearance
Growth deficits
CNS problems

Question 13

Cyanocobalamin (Vitamin B12)

Answer 13

MOA: coenzyme for various metabolic functions, including fat and carbs metabolism and protein synthesis, used in cell replication and hematopoiesis
S/E: dizziness, headache, nervous, and excitable, upset stomach or throwing up, loose stools (diarrhea)
contraindications: hypersensitivity to cyanocobalamin, cobalt, or any component of the formulation
Prescription: 1mL (1000mcg) IM daily for 7 days, then inject 1mL monthly

Question 14

Physical Abuse Facts

Answer 14

men are 5 times more likely than women to be the abuser in a relationship
men use abuse as form of coercion or control, while women often use it in self defense
studies show that younger women (20 y.o and younger) are more at risk of domestic violence)
pregnant women suffering from domestic abuse more likely to abuse drugs, alcohol, and tobacco. Depression and anxiety are commonly seen in pregnant women experiencing domestic abuse
pregnant women suffering from domestic violence more likely to get late or no prenatal care d/t their partner’s controlling behavior
providers much educate all women and domestic abuse does occur, the detrimental physical and emotional consequences, and where to get help if they are being abused now or in the future.

Question 15

Cocaine

Answer 15

coke blow or crack can be snorted, injected or smoked

slow metabolism of drug in fetal blood stream causes prolonged fetal exposure

Question 16

Cocaine increases risk of

Answer 16

miscarriage

placental abruption

Question 17

how does Cocaine easily crosses the placenta

Answer 17

simple diffusion

Question 18

Fetal/neonatal problem with Cocaine uses

Answer 18

PTB
LBW
respiratory distress
bowel and cerebral infarctions
FGR 
seizures 
**long-term effects may not be seen for years and includes cognitive behavioral and learning disorders.

Question 19

Buspirone (Buspar)

Answer 19

anti-anxiety agent
buspar has a attraction to serotonin 5 HT & dopamine receptors
off label: antidepressant
side effects: dizziness, fatigue, anxiety, headache, or dyspepsia
contraindications: renal or hepatic disease, breastfeeding.
Pregnancy cat. B

Question 20

sexual abuse

Answer 20

a person is sexually abused when one person engages another person in any action which the perpetrator anticipates will be sexually stimulating. this can include intercourse, touching, exposure of genital organs, showing pornographic material or talking about sexual thing in an erotic ways.

Question 21

incidence of sexual abuse

Answer 21

18-25% before age of 16

all socio economic and educational background

Question 22

how sexual abuse affects women’s life

Answer 22

all relationship
how she handles hardships, 
daily difficulties
children and friends
how she take care of neglets her own health and how she feels about herself. many women of sexual abuse turn to abusive substance use or behaviors include suiide ideation in order to cope with situation or memories.

Question 23

how sexual abuse effect pregnancy

Answer 23

pregnancy can trigger for feelings of alarm and humiliation. flashbacks and anxiety attacks are common during vaginal exams and labor and delivery. women of sexual abuse may experience intense somatic and psychosocial reaction to labor and delivery.

Question 24

how women’s response to sexual abuse

Answer 24

guilt
responsible for abuse
do not report d/t fear of being judged or blamed
fear of repercussions from perpetrator
fear of changes this may bring to their lives.
most victims wish they could tell someone what has happened to them, but the need to be asked straightforward

Question 25

midwifery care for sexual abuse women

Answer 25

** screen all women ** help identify trigger that may cause distress ** allow the women to feel control during exam labor birth ** allow her to dissociate in order to allow exams and labor to continue midwife needs to allow the woman to handle her exams and labor in a way will most helpful to her build trust and show non-judgement with the client so that she can plan the best approach to her pregnancy labor birth be patient give time to make decisi0n know your state & local law about mandatory reporting document all conversation. she should not have to repeat her story anticipate emotional difficulty after baby is born

Question 26

SAVER

Answer 26

(S)creen all women (A)Ssist in acknowledging her story and help her wok through emotional resonse. (V)alidate her by believing and not judging her (E)valuate for current safety and suicide risk (R)efer to specialist.

Question 27

Heroin

Answer 27

synthetic opioid that is injected snorted or smoke

Question 28

complications associated with heroin

Answer 28

malnutrition sexually transmitted infections and infectious diseases during and outside pregnancy heroin is also associated with preeclampsia and placental abruption as well as intrauterine fetal death, fetal growth restriction and prematurity

Question 29

fetal effects on heroin use

Answer 29

withdrawal symptoms may be life-threatening risk of developmental delay and behavioral problems increase of SIDS

Question 30

IV drug use is associated with increase in ....

Answer 30

HIV and hepatitis which may be transmitted before or during birth

Question 31

methadone treatment

Answer 31

standard care in pregnancy that allows pregnant women to discontinue using heroin while mitigating withdrawal symptoms.

Question 32

methadone

Answer 32

MOA: inhibits ascending patin pathways by binding to CNS opiate receptors change perception response to pain

Question 33

indications for methadone

Answer 33

management of moderate to severe pain standard of care in pregnant women with opiate additction Pregnancy cat. C

Question 34

methadone side effects

Answer 34

arrhythmia cardiac arrest hypotension sedation/disorientation, dizziness, physical psychological dependence rash abdominal pain, nausea anorexia biliary tract spasm constipation urinary retention or hesitancy weakness pulmonary edema respiratory depression or arrest

Question 35

contraindications for methadone

Answer 35

hypersensitivity respiratory depression paralytic ileus simultaneous selegine

Question 36

special consideration for methadone

Answer 36

regulation on dispensation vary by state may require referrals to substance abuse and mental health specialist exception: inpatient admission for condition other than opiod addiction short course <3 days while appropriate care is secured opioid withdrawal syndrome in neonate may be fatal

Question 37

substance abuse risk factors

Answer 37

``` late to prenatal care hx. miscarriage, preterm birth poverty infection decrease fetal movement smoker multiple partners poor dental health low BP increase BP ```

Question 38

thrombophlebitis

Answer 38

inflammation of a vein caused by a blood clot (thrombosis)

Question 39

superficial thrombophlebitis

Answer 39

localized heat, pain, or tenderness, inflammation, palpable knot

Question 40

Deep thrombophlebitis

Answer 40

unilateral edema, generalize warmth and redness, mild tachycardia, abrupt onset, severe leg pain, worsening with motion or standing, pain with calf pressure.

Question 41

risk for venous thrombosis and embolism

Answer 41

4-6 times higher during pregnancy pregnancy= hypercoagulability in pregnancy venous thrombosis is often in the deep veins of the lower extremities (usually the left leg) ``` cesarean delivery diabetes hemorrhage immobility multiparity multifetal preeclampsia over 35 y.o dehydration smoking obesity ```

Question 42

Virchow's triad

Answer 42

stasis hypercoagulate state vascular trauma

Question 43

pulmonary embolism

Answer 43

25% of untreated venous thrombosis in pregnancy thrombosis r/t pulmonary embolism often originates in the iliac veins anticoagulation decreases risk of pulmonary embolism to less than 5% pulmonary embolism cause 10% of maternal death.

Question 44

low molecular weight heparin

Answer 44

enoxaparin aka lovenox MOA: anticoagulant : inhibits formation of blood clots. DVT prophylaxis & treatment S/E: bleeding, nausea, diarrhea, thrombocytopenia, anemia, bruising, increase AST/ALT, irritation at injection site, fever

Question 45

contraindication for heparin

Answer 45

sensitivity to enoxaparin pork products benzyl alcohol (in multiple dose vials, thrombocytopenia associated with a positive in vitro test for antiplatelet antibodies in the presence of enoxaparin, active major bleeding

Question 46

what is compression ultrasound

Answer 46

gold standard for rule out DVT

Question 47

hypothyroidism

Answer 47

second most common endocrine disease that affects women of reproductive age. characterized by increase TSH decrease T4 levels

Question 48

maternal risk of untreated hypothyroidsm

Answer 48

``` anemia miscarriage preeclampsia gestational hypertension abruption and postpartum hemorrhage ```

Question 49

fetal risk of untreated hypothyroidism

Answer 49

fetal loss preterm birth low birth weight potential cognitive delays postnatal

Question 50

Labs draws for hypothyroidism

Answer 50

every 4 weeks until the second half of pregnancy and then at least once in the third trimester it typically takes 4 weeks for the thyroxine medication to impact the TSH levels, thus the rationale for lab draws every 4 weeks

Question 51

Fetus effect by hypothyroidism mom

Answer 51

the fetus is completely dependent on the mom first 10-12 weeks of pregnancy for the thyroid hormone. after the first trimester the fetus's thyroid will begin making the thyroid hormone on its own.

Question 52

Levothyroxine (Synthroid, Eltroxin)

Answer 52

MOA: thyroid hormone replacement S/E: signs of allergic rx hives itching rash swelling of face, wheezing tight chest heartbeat that doesn't feel normal chest pain hair loss in the first few months Contraindications: hypersensitivity to levothyroxine thyrotoxicosis, adrenal insufficiency that is uncorrected

Question 53

Appendicitis

Answer 53

common non-obstetric indication for surgery during pregnancy

Question 54

what does Appendicitis mimic

Answer 54

constipation, morning sickness preterm labor placental abruption

Question 55

dx appendicitis | Rovsing's sign

Answer 55

pain in RLQ when deep pressure is applied then withdrawn in LLQ

Question 56

Psoas signs (appendicitis)

Answer 56

client raises right thigh against counter pressure of CNM's hand on knee

Question 57

Obturator sign (appendicitis)

Answer 57

internal rotation of right leg with flexion of knee and hip

Question 58

why pregnancy can delay diagnosis appendicitis

Answer 58

appendix location has shifted d/t growing uterus difficulty to visualizing via U/S N/V frequently associated with normal pregnancy some leukocytosis is common in normal pregnancy

Question 59

ruptured appendix is more common in which trimester

Answer 59

8% in 1st 12% in 2nd 20% in 3rd

Question 60

Morphine Sulfate

Answer 60

to relieve severe acute pain or moderate to severe, chronic pain it is also used as a supplement to anesthesia parenerally and for analgesia during labor MOA: depresses pain impulse transmission at the spinal cord level by interacting with opioid receptors to effectively relieve pain w/o producing loss of consciousness

Question 61

Side effects of MOrphine sulfate

Answer 61

REspiratory depression, respiratory arrest, apnea, thrombocytopenia, flushing, rash, pruritus, dizziness , visual disturbances, euphoria, mental clouding or depression, N/V, constipation, cardiac arrest, tachycardia, MI , Urinary retention, oligura, bradycardia, palpations.

Question 62

contraindications of morphine sulfate

Answer 62

``` hypersensitivity addiction (opioid) hemorrhage bronchial asthma increased intracranial pressure pregnancy cat. C ```

Question 63

Rhesus Factor Antigen

Answer 63

there are five RBC Rhesus factor antigens: C, c, D, E, and e; BIG "D" is the most common and the most immunogenic of them all

Question 64

D-antigen

Answer 64

present of D-antigen means you have a "positive" blood type

Question 65

racial origins for D-antigens

Answer 65

``` Native American Inuits Asian are 99% positive African Americans are 93% D-positive Caucasians are 87% D-positive ```

Question 66

what are the major concern with isoimmunization

Answer 66

erythroblastosis fetalis in future pregnancies this occurs when the maternal immune system develops anti-D antibodies which can across the placenta and lyse the fetal RBC

Question 67

why Isoimmunization is quite rare

Answer 67

low prevalance of incompatible RBC antigens variable immune response to antigen by mother insufficient transplacental passage of maternal antibodies or fetal antigens variable antigenicity

Question 68

Rho(D) immune Globulin (Rhogam)

Answer 68

MOA: suppresses immune response and antibody formation by Rh negative individuals to Rh positive RBCs thereby preventing isoimmunization

Question 69

Side effects of Rh(D) Immune Globulin (Rhogam)

Answer 69

discomfort, pain, swelling or redness at the injection site, hyper/hypotension, pallor, vasodilation, chills, dizziness, fever, HA, malaise, somnolence, abdominal pain, diarrhea, nausea, vomiting, back pain, myalgia, weakness, , anaphylaxis, diaphoresis, shivering rash or pruritis doses: 300mcg IM

Question 70

Tuberculosis

Answer 70

latent phase- asymptomatic Active phase symptoms: chronic cough, blood tinged sputum, night sweat, wt loss, fever weakness, chest pain, shortness of breath

Question 71

high risk employment area (TB)

Answer 71

``` hospitals homeless shelters correctional facilities nursing home drug rehabilitation centers. ```

Question 72

diagnostic testing for TB

Answer 72

``` chest Xray gram stain & culture of sputum CBC baseline liver and renal function hepatitis panel ```

Question 73

PPD interpretation | 5mm

Answer 73

HIV infections, close contact with newly dx active scars on chest x-rays suggest prior active infection, organ transplant recipients, immunosuppressed

Question 74

PPD interpretation | 10mm

Answer 74

immigrants from areas with high TB prevalence, low-income/medically underserved IV drug users, resident and employees of high risk facilities, lab personnel, chronic illness, infants, young children

Question 75

PPD interpretation: | 15mm

Answer 75

no known risk factors.

Question 76

Medications for treatment of TB

Answer 76

INH Rifampin Rifampin with Pyrazinamide Recommend B6 supplements with drug therapy

Question 77

Isoniazid (INH)

Answer 77

use for latent and active TB | 5mg/kg daily for 6-9 months (dependent upon chest radiograph)

Question 78

side effect of Isoniazid (INH)

Answer 78

``` flushing rash hypertension tachycardia dizziness memory impairment slurred speech n/v hyperglycemia hepatic enzyme elevation hepatitis peripheral neuropathy mild CNS effects ``` take 1 hour before and 2 hours after eating (empty stomach) Pregnancy cat C small amounts excreted in breastmilk, but breastfeeding is not contracindicated

Question 79

Liver function test

Answer 79

monthly while on INH

Question 80

Risk of hepatitis

Answer 80

increase with age and alcohol use

Question 81

vitamin B6 (pyridoxine)

Answer 81

prevent peripheral neuropathy and CNS effects while taking INH

Question 82

Depression & pregnancy

Answer 82

one of the common disorders that occur in pregnancy pregnancy is believed to change brain chemistry, due to hormonal changes, possibly causing triggers for more severe depression

Question 83

why depression are undertreated

Answer 83

due to hesitancy from patients and providers, the majority of patients diagnosed with depression are either not treated at all or undertreated.

Question 84

SSRI is associated wit what

Answer 84

pulmonary HTN in the newborn and preterm labor

Question 85

untreated depression in pregnancy was been related to what kind of perinatal complications

Answer 85

substance abuse miscarriage preeclampsia and low birth weight

Question 86

what are the first line treatment for depression in pregnancy and lactation

Answer 86

SSRI | though Paxil is category D medication.

Question 87

Anxiety

Answer 87

no valid screening tool for anxiety in pregnancy poor screening and poor disclosure by patients = increased morbidity and mortality 85% of all depressed women have one or more anxiety disorder Perinatal anxiety increases with life stress r/t pregnancy and postpartum

Question 88

s/sx of anxiety

Answer 88

anxiousness, fatigue, fluctuation in mood, these are often seen as normal in pregnancy and there fore are not reported until debilitating

Question 89

4 types of anxiety

Answer 89

GAD PTSD OCD panic disorder

Question 90

treatment in pregnancy

Answer 90

SSRI then SNRI | TCA and lastly benzos

Question 91

first line drug for anxiety

Answer 91

Zoloft | MOA : antidepressant with selective inhibitory effects a presynaptic serotonin (5HT) reuptake and only very

Question 92

sx/s zoloft

Answer 92

s/x

Question 93

Bariatric surgery

Answer 93

pregnant patients with hx of bariatric surgery are at risk of calcium, iron, and fat soluble vitamin deficiencies ***best to wait 1-2 years after surgery to conceive

Question 94

what are the risks of being pregnant post surgery (and at a healthy weight)

Answer 94

are lower than the risk of being obese and pregnant !!! so lose weight before getting pregnant :o)

Question 95

what to confirm healthy fetal growth for post bariatric surgery

Answer 95

serial U/S to confirm

Question 96

ABO incompatibility

Answer 96

ABO incompatibility is the most common cause of hemolytic anemia in newborns it most commonly occurs with maternal blood type 0 and new born blood type A. Mothers with an O blood type already have anti-A and anti-B antibodies, even prior to their first pregnancy. Exposure to fetal blood of a different blood type can initiate and immune response. Most of these antibodies do not across the placenta but some can remain in fetal blood after delivery. This is why the effects are seen after the baby is born.

Question 97

ABO incompatibility vs Rh isoimmunization

Answer 97

frequently seen in first born babies (ABO incompatibility) | ABO incompatibility rarely become more severe with each pregnancy

Question 98

tests and treatment of ABO incompatibility

Answer 98

There are no prenatal tests for ABT incompatibilty management includes testing cord blood for neonatal blood type, direct coombs testing, and monitoring for neonatal hyperbilirubinemia.

Question 99

Asthma

Answer 99

up to 8% pregnant women in U.S are asthmatic and this number may be increasing Pregnant women's lungs have less functional residual capacity so are more susceptible to the potential hypoxia caused by asthma's inflamation

Question 100

Pregnancy and asthma

Answer 100

more severe or uncontrolled the asthma is prior to conception, the more likdly the woman is to have an exacebation during pregnancy There is a slightly increased risk of preterm labor and pre-eclampsia, with severe disease and poor control increasing these risks

Question 101

respiratory alkalosis & asthma

Answer 101

severe asthma affect mom's oxygenation, the fetus may be affected (ie hypoxemia or fetal growth restriction) women should continue their current medication regimen throughout pregnancy because of the risk of worsening symptoms outweights any potential risk (no direct link between asthma medications and fetal anomalies has been found)