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443-SRH and MSK > Pre + Postpartum care > Flashcards

Pre + Postpartum care Flashcards

1
Q

preconception care promotes healthy lifestyles in men and women of ____ age

A

18-44

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2
Q

what nutritional supplements may be recommended in the peripartum time frame

A

folic acid
calcium

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3
Q

how should you take folic acid when trying to get pregnant

A

start taking 2-3mths before pregnancy + continue for 4-6wks after or as long as breastfeeding

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4
Q

how much folic acid is recommended for a patient with no RFs

A

0.4mgd

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5
Q

how much folic acid is recommended for a patient with FHx of neural tube defects

A

1mg

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6
Q

how much folic acid is recommended for a patient that takes medication increasing their risk for neural tube defects

A

1mg

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7
Q

how much folic acid is recommended for a patient that has had a previous neural tube defect in pregnancy or either them/ their partner has a neural tube defect

A

4mg/d

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8
Q

how much calcium should one be taking why trying for pregnancy

A

1000mg elemental calcium - usually in diet but can add supplements

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9
Q

what is the recommendation for immunizations in pregnancy

A

get all live/ live attenuated before, then avoid in pregnancy

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10
Q

what is normal weight gain in pregnancy

A

5lb in first 10wks, then 1lb/ wk after

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11
Q

how many lb do women usually gain a pregnancy

A

25-35lb

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12
Q

hypertension in pregnancy is defined as

A

BP =>140/90

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13
Q

what is nonsevere HPTN in preg/ what about severe?

A

> 160/110 = severe

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14
Q

why might BP decrease in first trimester

A

decreased peripheral vascular resistance

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15
Q

what is the target BP in pregnancy

A

<85mmHg

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16
Q

what is preeclampsia

A

pregnancy spec onset of HPTN that involves new onset proteinuria
Multisystem, occurs after 20wks of gestation + resolves after delivery + no seizure yet

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17
Q

preeclampsia occurs after _______ of gestation and _____ seizures

A

20wks
does not include seizures

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18
Q

what is eclampsia

A

HPTN + proteinuria + seizure has occured

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19
Q

what is HPTN in pregnancy with new onset proteinuria

A

preeclampsia

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20
Q

how to treat eclampsia

A

IV antiHPTN tx with hydralazine or labetalol
seizure prophylaxis with magnesium sulfate

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21
Q

what is HELLP syndrome

A

severe form of preeclampsia that includes hemolysis, elevated liver enzymes, low platelets

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22
Q

DBP >90 mmHg <20 wks gestation is probably

A

chronic/ prepreg HPTN (at risk of developing superimposed preeclampsia)

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23
Q

DBP >90 mmHg >20 wks gestation with no target organ involvement is probably

A

gestational hypertension

24
Q

DBP >90 mmHg >20 wks gestation with target organ involvement is probably

A

preeclampsia

25
Q

1st line antihypertensive meds in pregnancy

A

labetalol, methyldopa, long acting oral nifedipine, other BB

26
Q

2nd line AHA in pregnancy

A

clonidine, hydralazine, thiazide diuretics

27
Q

when should prophylaxis for thromboembolism be considered for pregnant women

A

prior VTE, inherited thrombophilia

28
Q

what is the drug of choice for thromboembolism prophylaxis in pregnant women

A

LMWH

29
Q

what meds are used for cervix ripening

A

PGE2 like dinoprostone
misoprostol (PGE1)

30
Q

what med is used to stimulate uterine contractions

A

oxytocin IV

31
Q

what treatments may be used to prevent preterm labour

A

progesterone
17-hydroxyprogesterone caproate

32
Q

if the pt has a short cervix, _____ may be given to prevent preterm labour

A

vaginal progesterone

33
Q

if a pt has a hx of preterm labour _____ may be given

A

IM or vaginal progesterone

34
Q

postpartum care is a period of _____ after delivery

A

6wks

35
Q

perineal pain usually resolves by

A

6wks

36
Q

typically a ____ will be done to prevent tearing to the anus

A

mediolateral

37
Q

tx for perineal pain from vaginal deliveries

A

sitz baths, rinse area with warm water, kegel exercises to prevent, hamamelis (witch hazel), acetaminophen/ NSAIDs

38
Q

treatments for cracked nipples

A

ensure correct latching
warm compress before feeding
lanolin to nipple
acetaminophen/ NSAIDs
applying few drops of breast milk on nipple before/ after
oi massage

39
Q

how to treat painful engorged breasts

A

warm showers just before feeding, cold compress in between feeds

40
Q

how to treat mastitis from blocked milk duct

A

Warm wet towels/ massage before feeding
Increase fluids
More BF on affected side
Acetaminophen and NSAIDs for pain
If no improvement in 24hrs or fever develops see HCP

41
Q

how to treat mastitis from infection

A

Sim sx to blocked milk duct + sx like fever and flu like sx
Encourage milk flow from affected breast either BF or pump + continue while on tx
Hot compresses
Usual pathogen: staph aureus
Oral abx: cloxacillin, cephalexin, (clindamycin if beta lactam allergy or MRSA), IV abx if severe

42
Q

what antibiotics are used for mastitis from infection

A

cloxacillin, cephalexin, (clindamycin if beta lactam allergy or MRSA), IV abx if severe

43
Q

PPD is sx of depressed mood/ loss of interest for a minimum of ____

A

2wks

44
Q

list 2 RF of PPD

A

hx prev PDD (40%), dep/anx during pregnancy, hx/FHx prev MDD, poor social supports, poor marital relationship, stressful life events, OB complications- almost like PTSD

45
Q

postpartum blues onset + lasts

A

onset 3-4d
lasts 2-4wks

46
Q

sx of postpartum blues

A

mood changes- from happy to feeling uncontrollably sad, and may have inexplicable spells of irritability, weepiness, and anxiety

47
Q

postpartum depression onset

A

4-12wks after delivery

48
Q

what syndrome has the following symptoms: Nonpsychotic depression that occurs shortly after birth- depressed mood, anxiety, not sleeping well (not able to sleep the entire time baby sleeps), fatigue, lower concentration and inability to think recurrent thoughts of death/ suicide

A

post partum depression

49
Q

in postpartum depression
1. some pts are primarily anxious
2. may have rapidly fluctuating mood
3. typically resolves in 2-4wks after delivery
4. requires immediate intervention

A

1

50
Q

how long should SSRI/SNRIs be continued in PPD

A

at least 6mths after remission to prevent relapse

51
Q

how to start SSRI/SNRI dosing in PPD

A

Some start at ½ dose, then ↑ in 2-3wks as those who just gave birth may be more sensitive

52
Q

which AD has the most passage into breast milk

A

fluoxetine, citalopram

53
Q

which AD has lower release into breast milk

A

sertraline, fluvoxamine, paroxetine

54
Q

most studied AD in BF

A

sertraline, paroxetine

55
Q

monitoring pts with PPD - AD should be reassessed in ___

A

2-4wks

56
Q

what to monitor for in infants once mother starts AD

A

colic, fussiness, changes in sleep, difficulty feeding- LT effects on children exposed to AD in breast milk remain unknown

57
Q

if a pt was on fluoxetine during pregnancy for MDD, should we switch her AD during BF?

A

no- if it were a new dx in BF, would not choose fluvoxamine but since she’s already on it, it’s fine

443-SRH and MSK (24 decks)

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