NP611 Modul 8, 9, 10

Question 1

Which is an accurate statement about DV

Answer 1

Its associated with higher death rates than in a non-pregnant state.

Question 2

If a history of childhood sexual abuse….

Answer 2

the client may need to dictate when you can do a pelvic exam

Question 3

Pregnant smoker of 1-1.5 packs per day

Answer 3

Is at risk for placental abruption

Question 4

Is alcohol ok during pregnancy, even if just one glass??

Answer 4

No alcohol is best

Question 5

Which group is a primary concern for drinking during pregnancy

Answer 5

binge drinkers

Question 6

what is true about alcohol during pregnancy

Answer 6

Even one drink/week has been shown to cause problems

Question 7

what is not associated with pregnancy and smoking

Answer 7

pre-eclampsia

childhood asthma

Question 8

First approach to smoking cessation during pregnancy

Answer 8

the 5 A’s

• ask
• advise
• assess
• assist
• arrange

Question 9

When a person uses marijuana during pregnancy

Answer 9

She should be asked about other substance use

Question 10

Meth is associated with

Answer 10

placental abruption

Question 11

Smoking during pregnancy is associated with

Answer 11

spntaneous abortion, abnormal placetation (abruptio or previa), constricture of uterine vessels and placental vessels, low birth weight, decreased birth length, and preterm delivery

Question 12

Infants of women who smoke have higher incidence of

Answer 12

IDS and apnea

Question 13

Alcohol is associated with 2nd trimester spontaneous abortion

Answer 13

and nutritional deficiency.

Question 14

cocaine during pregnancy is associated with

(cold-turkey)

Answer 14

spontaneous abortion, preterm labor, abruptio placentae, rapid labor and delivery, and low birth weight and fetal death.
Withdrawal exists for the newborn

Question 15

cocaine in infants- do not breastfeed while using cocaine

Answer 15

may be at risk for congenital malformations, behavioral abnormalities

Question 16

Amphetamines

Answer 16

withdrawal exists

Question 17

narcotics/opiates

(heroin) usually need to wean-methadone candidate

Answer 17

withdrawal exists. Discuss with physician about taking methadone

Question 18

Stimulants

Answer 18

Cause tachy, increase temp, high blood pressure will cause decreased blood supply to baby, and can cause placental abruption. Any stimulant can do that even if inhaled.

Question 19

relaxants

Answer 19

cause withdrawal symptoms

Question 20

screening tools-routine screening should occur all through the pregnancy
verbal and written-need to do both
what percentage admit to use-40%

Answer 20

5A’s-In the stage of change to quit you can use these

5R’s-when you identify the person who is not ready to quit (pre-contemplation)

Question 21

women are more motivated to make changes while they are pregnant

Answer 21

because of baby

Question 22

DV

Answer 22

more deadly during pregnancy

Question 23

childhood sexual abuse-25%

Answer 23

Caring for her while pregnant

• kinetic memories
• changes in self-image (modesty, privacy
• can have disassociation or you may not know.
• routine screen
• ask for permission, etc. This should be for all women
• counseling if possible, check mental screening issues
• be aware of the cycle of violence

Question 24

understand medical conditions for these women

Answer 24

miscarriages
stillbirth
physical symptoms

Question 25

FAS- physical and cognitive damage specific birth defects more advanced

Answer 25

FAE-not a full syndrome More subtle May have trouble with socialization or school

Question 26

Minimum amount of alcohol recommended in pregnancy

Answer 26

ZERO

Question 27

DV- survivor friendly

Answer 27

routine screen everyone Make it the norm Get information out so client does not have to ask

Question 28

How to get client alone | and why client would not say she is being abused

Answer 28

Doesn't want him to hear May need financial support routine time where woman is screened privately get the people back together after you screen look at state laws

Question 29

Tools

Answer 29

``` TACE TWEAK AUDIT 4P's TQDH (ten question drinking history) ```

Question 30

benefits of breastfeeding

Answer 30

Fewer ear infections less risk of SIDS lower costs

Question 31

6 week PP exam should include

Answer 31

Abdominal diastasis bimanuel exam assess for cystocele

Question 32

discomforts of PP include

Answer 32

excessive diaphoresis uterine pains breast engorgement

Question 33

Related to breastfeeding

Answer 33

Oxytocin promotes bonding and establishes milk ejection

Question 34

Breastfed babies should be fed

Answer 34

8-12 times in 24 hours

Question 35

Breastfeeding is advised for 1 year

Answer 35

To increase milk supply: frequent feedings early initiation night feedings on demand

Question 36

Not enough milk may be seen by:

Answer 36

a woman who nurses for only 5 minutes a side every 6 hours

Question 37

Maternal benefits include

Answer 37

lower incidence of uterine and breast cancer and reduced risk of osteoporosis

Question 38

Breastfeeding may be beneficial for the baby in

Answer 38

decreasing the incidence of otitis media, decreasing respiratory infections, and possibly even dental malocclusion.

Question 39

The benefits to the mother besides the psychosocial ones may include the association with

Answer 39

decreased breast cancer rates, rapid uterine involution, and in some women, a more rapid return to their pre-pregnant weight

Question 40

Breastfeeding requires approximately 500 calories more for a total of 2700 calories/day,

Answer 40

May help to return to pre-pregnancy weight faster

Question 41

Why diaphoresis and urinary frequency pp?

Answer 41

Getting rid of excess fluids. Hormonally is caused from no longer being pregnant. A shift in estrogen, progesterone, etc. Going to have night sweats like no other! Output high for the same reason. Pedal edema make take up to 4-5 weeks to go away. Depends on what medications they had during labor.

Question 42

Painful cramping after delivery

Answer 42

Involution, afterbirth pain. It can get worse with every baby. -empty bladder (which displaces the uterus) She would bleed more because she could not contract down. -NSAID -warm compresses (heating pad) -lay on her belly -

Question 43

Bleeding increased at 10 days pp lasting 1-2 hours

Answer 43

placental eschar (scab from where the placenta was attached sloughing off) Bleeding like a period. Bright red and can occur more than once

Question 44

What about sex after pregnancy

Answer 44

Just say NO! Wait until you are ready Physiology she needs to wait until lochia is completely gone. 2,4,6,8 weeks, whatever it takes If breastfeeding may be covered for awhile. Can ovulate so does she want birth control?? Should have a discussion at 36-40 weeks so she knows what to do. If breastfeeding she may have vaginal dryness and it could be uncomfortable to have sex. Contraception-no bleeding-prepare for discomfort Important to have communication with partner if possible

Question 45

Baby crying and won't latch on

Answer 45

engorged Milk comes in 3-5 days. Nipples flatten out. Baby won't latch Position is important-Is baby sucking well? Pump, boobs in warm water, get some milk out so the baby can latch Communication with client, teach!!!

Question 46

Mastitis is an infection that often attacks a woman at her weakest point, in this case her breasts,

Answer 46

nipple candida can present challenges to the nurse practitioner as she supports the breastfeeding client.

Question 47

The diagnosis of subinvolution is made clinically.

Answer 47

At 2 weeks postpartum, the uterus is already a pelvic organ and by 6 weeks has returned to normal size.

Question 48

Subinvolution occurs when the normal shrinking of the uterus has slowed or stopped.

Answer 48

caused by retained placental fragments, infection, or fibroids. It is characterized by bleeding that increases or persists longer than the normal course of postpartum lochia. Examination may reveal a soft, boggy uterus that is larger than it should be for time postpartum. Subinvolution is treated with Ergotrate, or Methergine, and rest. A lochia culture should be taken to rule out concomittent endometritis, or uterine infection. If infection and/or retained products are implicated, you will need to consult.

Question 49

short-lived mood change, called “postpartum blues"

Answer 49

occurs in about 50 to 80% of new mothers in our culture between three and five days after birth

Question 50

postpartum blues

Answer 50

Symptoms often comprise several of the following: dysphoric mood, crying, anxiety, insomnia, irritability, loss of appetite, and mood swings.

Question 51

Postpartum depression (PPD) occurs in 10-15% of pregnancies

Answer 51

Depression can begin during the antepartum with subtle signs such as fatigue, anxiety, or change in sleep or appetite habits. Depression may only become recognized when exacerbated in postpartum. Infant attachment and bonding may be affected by the mother’s lack of response to infant cues such as cooing or crying.

Question 52

The depressed woman frequently does not have perspective on her situation, and often may be unable to reach out.

Answer 52

She may be anxious or have a flat affect. She may sleep a lot or have insomnia. She may be overly concerned about her baby, or may not be fully cued into the needs of her baby. With the poor follow-up we have in our country in the postpartum period, many cases of postpartum depression go unrecognized. This can have sad and serious consequences.

Question 53

The Edinburg Postpartum depression Scale and Beck’s Postpartum Depression Screening Scale (PDSS) have been well validated

Answer 53

screening tools and that is all. Not diagnostic tools

Question 54

This scale should be given to and discussed with EVERY postpartum client at 4-6 weeks on a routine basis, and to any client that exhibits any of the s/s of PPD.

Answer 54

Postpartum thyroid problems can mimic postpartum depression and so thyroid studies should be done when a woman seems depressed.

Question 55

Psychosis is florid and not likely to be missed, as the woman is out of touch with reality, and often is not able to sleep at all.

Answer 55

It usually appears fairly shortly after the birth, but may develop up to a few weeks postpartum. Treatment involves medical management, usually from a psychiatrist, medication, and frequently hospitalization.

Question 56

Symptoms of nipple candida

Answer 56

sharp shooting pain in the nipple and red color

Question 57

Management of nipple candida

Answer 57

Start nursing on the least sore side good handwashing nurse frequently for shorter periods of time

Question 58

uterine involution

Answer 58

The uterus is non-palpable abdominally by 2 weeks pp

Question 59

Signs of sub-involution

Answer 59

enlarged uterus and heavy period like bleeding

Question 60

Treatment for sub-involution

Answer 60

po .2mg q4hrs for 3 days

Question 61

Postpartum depression

Answer 61

All women should be screened by 2 weeks

Question 62

Pain with calf pressure

Answer 62

sign of postpartum thrombophlebitis

Question 63

signs of mastitis

Answer 63

``` fever malaise tachy chills painful breast with reddened area ```

Question 64

warm compress, nurse more often

Answer 64

if client calls with a mild pain in one breast and made worse when baby nurses

Question 65

Prevention of mastitis

Answer 65

nurse more and prevent engorgement

Question 66

5 principles about drug use

Answer 66

1. Find an approach that is comfortable to you 2. Be non-judgemental 3. Make screening a part of your routine care 4. Know how to respond 5. Be positive

Question 67

The acronym SAVER is a useful way to remember key aspects of the screening process:

Answer 67

Screen all female patients for violence Ask direct questions in a nonjudgmental way Validate the patient Evaluate survivors and educate all female patients Refer survivors