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NURS 714 Maternal/Newborn > Test 1 > Flashcards

Test 1 Flashcards

1
Q

What is the least effective contraception with a 22% rate within the first year?

A

Coitus Interupptus (withdrawl method)

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2
Q

What is the calendar method?

A

Also known as natural family planning/fertility based awareness, it is a method of contraception where couples have periodic abstinence during the fertile periods

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3
Q

What are the 3 phases for natural family planning/fertility based awareness?

A

3 phases are identified:
Infertile phase-before ovulation
Fertile phase-Approximately 5 to days into the cycle
Infertile phase-After ovulation

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4
Q

What are the guidelines for someone who wants to implement natural family planning?

A

1) Accurately record the number of days in each cycle counting from the first day of menses for a period of at least 6 cycles

2) The start of the fertile period is figured by subtracting 18 days from the number of days in a woman’s shortest cycle

3) The end of the fertile period is established by subtracting 11 days from the number of days of the longest cycle

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5
Q

What is the relationship between basal body temperature and ovulation?

A

Before ovulation, a woman’s basal body temperature is often less than 98.6.
The progesterone after ovulation causes basal body temperature

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6
Q

How can basal body temperature be used for conception/contraception?

A

By measuring oral temperature prior to getting out of bed each morning each morning to monitor ovulations

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7
Q

What are the advantages to natural family planning?

What are the disadvantages to natural family planning?

A

Inexpensive, convenient, and no adverse effects

Reliability can be influences by many variables that impact temperature change (stress, fatigue, illness, alcohol, and warmth of sleeping environment). It also does not protect against STDs

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8
Q

What is the consistence of cervical mucous during ovulation?

A

During ovulation the cervical mucous becomes thin and flexible under the influence of estrogen and progesterone to allow sperm viability and motility.

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9
Q

What is a Spinnbarkeit’s sign?

A

The ability of the cervical mucous to stretch between fingers, almost the consistency of an egg white.

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10
Q

What is mittelschmerz?

A

Pain in the lower abdomen upon ovulation

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11
Q

What is the nursing education for a patient who wants to use the cervical mucus method of contraception?

A

Ensuring good hand hygiene, begin examining mucus from the last day of the menstrual cycle. Mucous is obtained from the vaginal introitus.

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12
Q

What are the disadvantages of a diaphragm?

A

Not recommended for women with a history of toxic shock or frequent urinary tract infections

Must be replaced every two years or 20% weight fluctuation, pregnancy, or pelvic surgery

Inconvenient, interfere with spontaneity, and requires reapplication with spermicidal cream, gel or foam with each act of coitus to be effective

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13
Q

What are the clinical findings of TSS?

A

High fever
Faint feeling,
Drop in BP
Watery Diarrhea
Headache
Muscle Aches

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14
Q

What reduces the risk of TSS from a diaphram?

A

proper handwashing and removing diaphragm within 6 hours of coitus

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15
Q

What is the client education for cervical caps?

A

It can be inserted up to six hours before intercourse and needs to be left in place at least 6 hours afterwards but for no more than 48 hours at a time.

Must be replaced every two years and refitted after any major gyn surgery, birth, or major weight fluctuation

Cap should be washed with mild soap and warm water for each use

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16
Q

What are the disadvantages of cervical caps?

A

Possible risk of TSS
Risk of allergic reaction
Does not protect against STIs
Contraindicated in women with abnormal paps or history of TSS

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17
Q

What is a contraceptive sponge?

A

A small round, polyurethane sponge with one concave side containing N-9 spermicide

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18
Q

How is a contraceptive sponge used?

A

The contraceptive sponge is moistened before insertion, concave side is placed near the cervix, and needs to be left in place for at least 6 hours after intercourse

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19
Q

How long can a contraceptive sponge provide protection for?

A

up to 24 hours

However it should not be left in for longer than 24-30 hours or it places the woman at risk for TSS

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20
Q

What are combined oral contraceptives?

A

Hormonal contraception containing estrogen and progestin, which acts by suppressing ovulation, begining the cervical mucus to block semen, and altering the uterine decidua to prevent implantation.

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21
Q

What is the patient education points for combined oral contraceptives?

A

Instruct client to observe with adverse effects and danger signs of medication

If they miss a dose, instruct pt that if one pill is missed, take one as soon as possible. If 2 or 3 are missed-refer to manufacturers instructions, but the client should use alternitive forms of birth control until regular dosing is resumed

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22
Q

What are the serious complications of oral birth control pills?

A

ACHES
Abdominal pain
Chest pain/shortness of breath
Hedache
Eye problems
Severe leg pain

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23
Q

What are the advantages of oral birth control pills?

A

Due to no direct relation to sexual acts, acceptability may be increased.

Can help control cramping, menstrual cycles, treat endometriosis, acne, ovarian cancer, ovarian cysts, etc.

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24
Q

What are the disadvantages of birth control pills?

A

Do not protect against STIs
Increased risk of thromboembolism, stroke, heart attack, hypertension, gallbladder disease, liver tumor.

Exasperates conditions affected by fluid retention (migrane, epilepsy, asthma, kidney or heart disease)

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25
What are the patient education points for progesterone only contraception?
Take the pill at the same time everyday Do not miss a pill Must use alternate BC for the first month to prevent pregnancy q
26
What are the advantages/disadvantages of progesterone only birth control?
Advantages: -Less adverse effects -Considered safe with breast feeding Disadvantages: -Less effective in supressing ovulation -Increase risk of ovarian cysts -No STI protection -Contraindicated in pts that have had bariatric surgery, lupus, severe cirrhosis, liver tumors, or current/past breast cancer
27
What are the forms of emergency contraception?
levonorgestrel-releasing intrauterine system, high doses of estrogen, or insertion of a copper IUD
28
What is a transdermal contraceptive patch?
A patch containing norelgestromin (progesterone) and ethinyl estradiol which is delivered at continuous levels through skin into subq tissue.
29
What is the patient education for the transdermal contraceptive patch?
Apply the patch to dry skin overlying subq tissue of the buttock, abdomen, upper arm, or torso excluding breast area. One patch per week, with no application on the 4th wekk
30
What are the disadvantages of the transdermal contraceptive patch?
Risk of DVT or venous thromboemolism is much higher due to the hormones entering directly into the bloodstreams Rash or lesion can appear on patch site
31
What is Medroxyprogesterone?
an intramuscular or subcutaneous injection given to a female client every 11 to 13 weeks.
32
How is a diaphragm used?
It is inserted over the cervix with spermicide jelly applied to the cervical side of the dome and around the rim up to 6 hours before intercourse, and taken out 6-24 hours after You should empty bladder before placement
33
What are the advantages of medroxyprogesterone?
Very effective and requires only 4 injections per year. Does not impair lactation. Possible absence of periods and decreased and bleeding. Decreased risk of uterine cancer if used long-term.
34
What are the disadvantages of medroxyprogesterone?
Adverse effects include decrease in bone mineral density, weight gain, increase in depression, and irregular vaginal spotting or bleeding. Does not protect against STI’s. Return to fertility can be delayed as long as up to 18 months after discontinuation. Should only be used as a long-term method of birth control if other birth control methods are in adequate.
35
What education should the nurse give to a patient who has received a medroxyprogesterone injection?
Avoid massaging injection site following administration to avoid accelerating medication absorption, which will shorten the duration of its effectiveness.
36
What are the advantages of implantable progestin?
Mistake
37
What are the disadvantages of implantable progestin?
Etonogestrel can cause irregular menstrual bleeding. Does not protect against STI’s. Adverse effects include irregular and unpredictable menstruation, new changes, headache, acne, depression, decreased bone density, and weight gain.
38
What are the contraindications of implantable progestin?
Contraindications include unexplained vaginal bleeding, lupus, severe cirrhosis, liver tumors, and breast cancer.
39
What is Transcervical sterilization?
Insertion of small flexible agents through the vagina and cervix into the fallopian tubes. This results in the development of scar tissue in the tubes preventing contraception. Examination must be done after three months to ensure fallopian tubes are blocked.
40
What are the advantages of transcervical sterilization?
Quick procedure that requires no general anesthesia. Nonhormonal means of birth control. 99.8 % effective in preventing pregnancy. Rapid return to normal activities of daily living.
41
What are the disadvantages?
Not reversible. Not intended for use in the client to us postpartum. Delay ineffectiveness for three months. An alternative means of birth control should be used until confirmation of blocked fallopian tubes occurs. Changes in menstrual patterns. Does not protect against STI's.
42
What is bilaterial tubal ligation (female sterilization)?
A surgical procedure consisting of severance and/or burning or blocking the fallopian tubes to prevent fertilization
43
What is a vasectomy?
The cutting of the vas deferens in the male as a form of permanent sterilization.
44
What education should be given to a patient that has just received a vasectomy?
Reinforce the need for alternate forms of birth control for approximately 20 ejaculations or one week to several months to allow all the sperm to clear the vas deferens. Following the procedure, scrotal support and moderate activity for a couple of days is recommended to reduce discomfort. Follow-up is important for sperm count.
45
Which STI is an aerobic gram-negative diplococcus, is the oldest communicable disease in the US, and women are often asymptomatic?
Gonorrhea
46
What is Syphilis?
A STI that is caused by treponema pallidum and manifests in 3 distinct stages.
47
What are the stages of syphilis?
Primary: 5 to 90 days after exposure Secondary: 6 weeks to 6 months Tertiary: develops in one third of women infected
48
What is the treatment for syphilis?
Penicillin G
49
What is pelvic inflammatory disease?
An infectious process that most commonly involves the fallopian tubes, uterus, and occasionally the ovaries and peritoneal surfaces Multiple organisms have been found to cause PID
50
If visible HSV lesions are present in a full term pregnant patient, what is advised?
Cesarean birth is recommended because material infection with HSV-2 can have adverse effects on mother and fetus
51
Which STI is most threatening to the fetus and neonate?
Hep B, because of the risk of liver disease
52
Which STI exhibits a 'fish-like' odor?
Bacterial vaginosis
53
What normal protocols must be avoided if pregnant mother has HIV?
No breastfeeding No scalp electrode Decrease the amount of time ruptured
54
What special precautions have to be taken with a baby that has an HIV + mother?
Ensure that baby is cleaned with soap and water prior to invasive procedures Ex Vitamin K shot Administer Zidovudine begining at 8-12 hours after delivery for the next 6 weeks
55
What is not technically an STD, but it the leading cause of neonatal morbidity/mortality in the US?
GBS
56
What are the risk factors for GBS?
LBW Pre-term birth Previous pregnancy with GBS+
57
When is GBS screening performed?
36-37 weeks
58
What is the treatment for GBS?
intrapartum IV prophylaxis
59
What are TORCH infections?
Acquired in utero or during birth/transplacental transmission
60
What does the T in TORCH stand for?
toxoplasmosis
61
What does the O in TORCH stand for?
Others, such as syphilis, varicella-zoster, parvovirus
62
What foes the R in TORCH stand for?
Rubella
63
What does the C in TORCH stand for?
Cytomegalovirus (CMV)
64
What does the H in TORCH stand for?
Herpes Simplex Virus
65
How is Toxoplasmosis transmitted?
Touching cat liter Undercooked meats
66
What is the treatment for Toxoplasmosis?
Pyrimethamine & Sulfadiazine
67
If a mom is not immune to Rubella, what do we do?
Vaccinate immediately post partum
68
How is CMV transmitted?
Through breastmilk, blood, sexual fluids, in utero during birth, contact with children transfer DO NOT BREASTFEED
69
How is CMV treated?
Ganciclovir
70
How is Herpes Simplex treated?
Acyclovir medication at 36 prophylactically
71
What is infertility? What are the categories?
A prolonged time to conceive (after trying for 1 year 2-3 times per week) Primary: Never conceived Secondary: Conceived once before
72
What are the female contributing factors to infertility?
Ovulation disorders Abnormalities to uterine tubes Cervical abnormalities Uterine abnormalities
73
What could cause abnormalities to uterine tubes that could result in infertility?
Chlamydia can cause damage to the uterine tubes
74
What type of cervical abnormality could cause infertility?
Acidic mucous
75
What uterine abnormalities could cause infertility?
Endometriosis Bicornuate uterus
76
What are the male contributing factors to infertility?
Structural/hormonal abnormalities Substance use Enviromental Advanced Age
77
What types of structural/hormonal abnormalities can contribute to infertility?
Undescended testes Hypospadias Variocele Seminal fluid abnormalities Low testosterone
78
What are some of the seminal fluid abnormalities that can contribute to infertility?
Increased Scrotal Heat Sperm Abnormalities -Azoospermia (no sperm) -Oligospermia (few sperm)
79
What do marijuana, alcohol and cocaine within two years of intended conception do to male fertility?
Depresses sperm count Depresses testosterone
80
What do cigarettes do to male fertility?
Decreases motility
81
What environmental factors can contribute to infertility?
Lead and pesticides can reduce count
82
What is sterility?
Inability to conceive
83
When a male gets a sperm analysis done, what must he do before?
Abstain from sex for 2-5 days before procedure
84
What does an endometrial biopsy show us?
An endometrial biopsy 2-3 days before menses shows us how well the endometrium responds to the progesterone released from corpus lutem after ovulation
85
What are some non-invasive ways to test fertility?
Basal body temperature (not super reliable) Hormonal Assessment Pelvic Ultrasound Spinnbarkeit (egg white appearance = max fertility)
86
What are the contributing factors to the nausea and vomiting experienced during pregnancy?
Increased HCG Increased pressure could contribute
87
What are the contributing factors to the constipation that can be experienced during pregnancy?
Due to the increased transit time or increased absorption of water High fiber diet can prevent this
88
What happens to respiration and lung capacity during pregnancy?
Respiratory rate increases while total lung capacity decreases because the uterus pushes up into the diaphragm giving little room for lungs to expand (Diaphragm can raise as much as 4 cm)
89
What is the relationship between fundal height and gestation?
The cm correlate to how many weeks gestation from 18-30 weeks
90
What are some of the skin changes experienced during pregnancy?
Cholasma (increased pigmentation in the face) Linea Nigra (dark line of pigmentation from umbilicus to pubic area) Striae Gravidarum (stretch marks)
91
Describe the action of estrogen during the pregnancy
Estrogen rises in late pregnancy, supressing progesterone, and induces the oxytocin receptors preparing the uterus for birth
92
What is the action of progesterone during pregnancy?
Supports the endometrium Suppresses contractility of the uterus (blocked by estrogen late in pregnancy)
93
What are the presumptive signs of pregnancy?
Amenorrhea Fatigue N/V Breast Changes Quickening Uterine Enlargement
94
What is 'quickening'?
Light fluttering movements felt at 16-20 weeks
95
What are the 8 probable signs of pregnancy?
Abdominal enlargement Hegar's Sign Chadwick's sign Goddell's sign Ballottment Braxton Hicks Contractions Positive pregnancy test Fetal Outline
96
What is Hegar's sign?
softening and compressibility of the lower uterine segment due to increased blood flow
97
What is Goddell's sign?
softening of cervical tip
98
What is Chadwick's sign?
Deepened violet-bluish color of the cervix
99
What is ballottement?
rebound of unengaged fetus
100
What are Braxton's hicks contractions
False contractions that are painless, irregular, and usually relieved by walking
101
What are the 3 positive signs of pregnancy?
Fetal Heart sounds Ultrasound Fetal movement (by experienced practioner)
102
What is Nagele's rule?
First day of LMP Subtract 3 months Add 7 days Adjust for year
103
What is Gravida?
The number of pregnancies
104
What is Parity?
The number of pregnancies that reach 20+ weeks
105
In GTPAL- What does T stand for?
Term The number of pregnancies that made it to 37+ weeks
106
In GTPAL- What does P stand for?
Parity The number of preterm pregnancies 20-38 weeks
107
In GTPAL- What does A stand for?
Abortions Spontaneous or induced 19.6 weeks and below
108
In GTPAL- What does L stand for?
Number of living children
109
What does the standard prenatal lab work consist of?
CBC Blood type/rh Factor UA Heb B screening Rubella Titer Pap (gonorrhea and chlamydia) HIV VDRL (syphilis)
110
What are the danger signs in the first trimester?
Vaginal Bleeding Fever/chills Diarrhea Severe Vomiting Burning on urination Abdominal cramping
111
What are some of the recommendations for the nausea and vomiting in the first trimester?
Eat dry carbs (cracker) before lifting head in the morning Do NOT drink lots of fluids in the morning High protein snack and prenatals at bedtime
112
What are the recommendations for heartburn during pregnancy?
Small frequent meals Sleep on incline/sit upright after meals Decrease liquids while eating Reduce liquid intake at bedtime Medication
113
How much water should you drink while pregnant?
Drink 8-10 glasses of water per day
114
What are the recommendations to decrease constipation during pregnancy?
Increase fiber Plenty of Fluids Exercise IRON may cause constipation
115
What are the recommendations for decreasing leg cramps?
Extend leg straight Dorsiflexion of foot Heat is ok (if you are sure it's not a blood clot) Notify provider if it happens frequently or if there is swelling in one leg but not the other
116
What is supine hypotension aka vena cava syndrome?
Uterus is on vena cava and reduces blood to the fetus, looks like shock, with low BP (lightheadness, fainting, SOB), and is avoided by never laying flat on back
117
What a normal BMI?
18.5-24.9 BMI
118
What is the recommendation of weight gain through pregnancy for someone with a normal BMI?
25-30lb 2.2-4.4 in first trimester 1lb per week in last 2 trimesters
119
What are the recommendations for weight gain for someone with a underweight BMI?
<18.5 28-40lb
120
What are the recommendations for weight gain for someone with a overweight BMI?
>25 15-25lb
121
What types of food have good folic acid content?
Leafy veggies Dried peas/beans Seeds Orange juice
122
Iron is best absorbed with?
Vitamin C
123
What are high iron foods?
Beef liver Red meats Fish Poultry Dried peas and beans fortified cereals and breads
124
What are the 5 P's?
Passenger Passageway Powers Position of mother Psychological response
125
5 P's: What are the components of 'passenger'?
Fetal presentation Fetal lie Fetal attitude Fetal Position
126
What does fetal presentation mean?
Part of fetus entering canal first
127
What does fetal lie mean?
Relationship between maternal and fetal spine (longitudinal axis0
128
What does fetal attitude mean?
Flexion or extension (fetal chin towards or away from chest)
129
What does fetal position mean?
Four maternal quadrants
130
5 P's: What are the components of 'passageway'?
Shape of pelvis Vagina Pelvic floor muscles Introitus (opening that leads to vaginal canal)
131
5 P's: What are the components of 'powers'?
Effacement: shortening, thinning, upward movement of cervic Dilation: widening of cervix Ferguson reflex: urge to bear down
132
5 P's: What are the components of 'position of mother'?
Gravity can help Reposition as needed for comfort
133
5 P's: What are the components of 'psychologic response'
Anxiety and stress can hinder labor
134
What are the components of fetal station?
-5 to +5 (- is towards mother) 0 is at ischial spinal process
135
What is true labor ********
Cervical change
136
What are the 7 cardinal movements of labor in order?
1: Engagement-passes 0 station 2: Descent-progress through cervix 3: Flexion-fetal head meets resistance of cervix, brings chin towards chest 4: Internal rotation-corkscrew through pelvis 5: Extension-Passes under symphysis pubis and chin is away from chest 6: External rotation 7: Expulsion-birth
137
What are the two opioids given during birth and why?
Nubian and stadol They provide pain relief without respiratory depression
138
When can opioids be given during birth?
Only before 6 cm or it can risk respiratory depression in baby. Medication should be given at the peak of contraction (acme)
139
Why should pain medication be given at the peak of contraction?
It minimizes the effect on the baby, and you should wait to push the rest until the next contraction
140
What is a pudendal block?
Exerts its effects only in the vaginal vault, covering perineum and vagina. It does take away the ferguson reflex, but has not maternal/fetal systemic effects
141
When is a pudenal block given?
10-20 min before delivery
142
What is a epidural?
The only form of anesthesia that can take the pain away and only allow them to feel pressure
143
What are the risks of an epidural?
Maternal hypotension, so administer a 1000mL bolus before placement
144
How is fetal monitoring altered by the administration of a epidural?
The decreased perfusion to uterus can cause placental insufficency which can appear as late decels
145
What would not allow someone to get an epidural?
if their platelet count if <100,000 they can't have an epidural
146
Where is a spinal block administered?
In the OR
147
What are the components of the umbilical cord?
two umbilical arteries a single umbilical vein an obliterated allantois duct Which are all surrounded by Wharton's jelly and contained within an outer layer of amnion
148
What are the functions of the two umbilical arteries?
The umbilical arteries carry deoxygenated blood from fetal circulation to the placenta. The two umbilical arteries converge together about at 5 mm from the insertion of the cord, forming a type of vascular connection called the Hyrtl's anastomosis. The primary function of Hartl's anastomosis is to equalize blood flow and pressure between the umbilical and placental arteries.
149
What are leopold manuvers?
Consists of 4 moves to determine: Number of fetuses Presenting part, fetal lie, and fetal attitude Degree of descent of the presenting part into the pelvis Location of the fetus’s back to assess for fetal heart tones.
150
What is the order of leopold manuvers?
ID the fetal part in the fundus. Locate and palpate the fetal back. ID the presenting part. Determine the descent of the presenting part.
151
Where is an epidural administered?
within the epidural space at the 4th or 5th vertebrae.
152
What is the difference between the primary and secondary 'powers'?
Primary powers=contractions Secondary powers=bearing down
153
When the cervix is 100% effaced, how would it be described?
Paper thin
154
What Hgb counts are considered to be low during pregnancy?
Hgb less than 11 mg/dL in the 1st & 3rd trimesters is considered low Hgb less than 10.5 mg/dL in the 2nd trimester is considered low
155
Why are iron supplements often added to the prenatal plan?
plan to facilitate an increase of the maternal RBC mass
156
What are the caffeine limitations during pregnancy?
No more than 200 mg of caffeine a day which is the equivalent of 500 to 750 ml/day of coffee. Increased caffeine intake can increase the risk of spontaneous abortion or fetal intrauterine growth restriction.
157
What weeks make up the first trimester?
1-13.6
158
What weeks make up the second trimester?
14-27.6
159
What weeks make up the third trimester?
28-40.6
160
What are the test performed in the 2nd trimester?
CBC 1 hour glucose screen Antibody screen for rh May repeat STI testing
161
What are the test performed in the third trimester between 35-37 weeks?
GBS Culture May repeat CBC
162
What are the tests performed in the third trimester between 40-42 weeks?
Non stress tests every 3 days AFI (amniotic fluid index) Ultrasound to monitor fetal wellbeing every week

NURS 714 Maternal/Newborn (3 decks)

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