Exam 2 Health Promotions in Pregancy

Question 1

Promoting Healthy Behaviors during pregnancy helps to assure

Answer 1

maternal well-being
Fetal well- being
Best chance for good pregnancy outcome

Question 2

NP role: Anticipatory guidance for pregnant women

Answer 2

provide factual information, dispel "old wives tales"
Explain risks/benefits
Promote healthy behaviors
Provide referrals as needed

Question 3

Desired Weight Gain During Pregnancy

Answer 3

25-35lbs- women with normal pre-pregnancy BMI (singleton Pregnancy)
multiple births- recommended weight gain is higher

Question 4

Recommendations for wt gain in pregnancy based on prepregnancy BMI

Answer 4

BMI                    Recommended wt gain
low (less than 19.8) 28-40 lbs
Normal (19.8-26) 25-35lbs.
High (26-29)   15-25lbs
Obese (>29)    15+ lbs.

Question 5

Distribution & amount of Maternal Wt Gain

Answer 5

Breast 1.5-3lbs
Fetus 7.5 lbs
Uterus 2.5 lbs
Body fluid 4 lbs
Placenta 1.5 lbs
Amniotic fluid 2 lbs
Body fat 7 lbs
blood volume 4 lbs

Question 6

Nutrition- Research - factors affecting fetal growth

Answer 6

prenatal malnutrition, smoking, maternal dz
When 2 factors- smoking & maternal dz are controlled - difference in birth wt are directly related to nutrition during pregnancy

Question 7

Maternal factors that have been shown to relate to birth wt are

Answer 7

prepregnancy wt.

wt gain during pregnancy

Question 8

Correlation with birth wt

Answer 8

poor maternal wt gain associated with low birth wt

Question 9

low birth wt has been shown to correlate with increased incidence of

Answer 9

perinatal morality (stillbirth, neonatal death)
small head circumference
mental retardation
cerebral palsy
learning problems/disabilities
visual and hearing defects
neurologic defects
poor infant growth & development

Question 10

health promotion in pregnancy Exercise

Answer 10

Generally, pregnant woman does not have to limit exercise, however avoid
becoming excessively fatigued
doing any activity that may risk injury to herself or her fetus

Question 11

Aerobic exercise

Answer 11

women accustomed to aerobic exercise prepregnancy should be allowed to continue but should not begin new activity or increase their level or intensity

Question 12

Women that continue prepregnancy exercise have been found to have

Answer 12

shorter active labor
fewer cesarean births
less fetal distress in labor

Question 13

Women who have been sedentary before pregnancy

Answer 13

should not take part in aerobic exercise that is any more strenuous than walking
should consult with their primary care provider before starting

Question 14

All pregnant women & exercise

Answer 14

avoid exercise that involves extended time in the supine position in the 2nd & 3rd trimester.
Discontinue exercise if they have any signs of oxygen deprivation- extreme fatigue, dizziness, extreme shortness of breath
should not exercise if exercise might adversely affect any obstetrical or medical condition, such as incompetent cervix, risk factors for PTL, PIH

Question 15

Travel

Answer 15

No contraindication to travel for pregnant women, unless they have medical or obstetrical complications

Question 16

Contraindicated for travel

Answer 16

May be contraindicated for women with

cardiovascular conditions complicated by pregnancy,
congenital or acquired heart dz,
multiple gestations after 22wk, or incompetent cervix.

Question 17

long distant travel

Answer 17

may not be advisible when pregnancy is complicated by threatened abortion,
vaginal bleeding,
history of preterm labor,
or other obstetrical complications

Question 18

Travel by car

Answer 18

car travel often tiring

frequent rest stops necessary to assist with maintenance of circulation to extremities

Question 19

Travel by air

Answer 19

ACOG, 2002 can fly safely up to 36 wks
to decrease risk for thrombophlebitis during flights 1. wear support hose, 2. periodically exercise the legs & ankles- walking in the aisles if possible

Question 20

Wearing seat belts

Answer 20

should wear lap & shoulder seatbelts to decrease any risk for maternal injury

Place lap portion of the seatbelt over the upper portion of thigh, under abdomen.

Position shoulder harness between breast

Both belts should be snugly applied

Seatbelts also will decrease exaggerated flexion of the women’s torso, which may lessen the risk for placental separation

Question 21

Dental care

Answer 21

Good dental care is important

Studies show that active periodontal dz increases client’s risk for pre-eclampsia

Schedule dental checkup in early pregnancy & tell dentist to assist in avoiding teratogenic substances

Dental x-ray ok if lead apron fully covers abdomen

Question 22

Sexual Issues

Answer 22

Although there is no reason why the healthy woman need abstain from intercourse or orgasm during pregnancy, some sources suggest that women should avoid coitus and orgasm in the last 4 weeks of pregnancy.

Question 23

Sexual issues

Answer 23

Intercourse or orgasm is contraindicated in cases of known placenta previa, or ruptured membranes.
Amniotic sac provides protection from infection; once it has ruptured → risk for infection ↑.

Question 24

Sexual issues

Answer 24

Women who are predisposed to preterm labor or threatened abortion may choose to avoid intercourse.
Nipple stimulation, vaginal penetration, or orgasm may cause uterine contractions secondary to the release of prostaglandins and oxytocin.

Question 25

sex in late pregnancy

Answer 25

In later stages of pregnancy as the abdomen is significantly enlarged, alternate positions for sexual intercourse may be more comfortable for some women. Positions that may increase comfort include the woman in the superior position or a side-by-side position. If woman experiences discomfort from vaginal penetration, the couple may find alternative methods of sexual expression, such as cuddling, masturbation, or oral sex.

Question 26

Sexual issues contraindication

Answer 26

It is important for the partner to refrain from blowing into the pregnant woman's vagina because doing so may cause an air embolism, which has been shown to be fatal.

Question 27

Employment

Answer 27

Working during pregnancy generally not contraindicated. | May be individualized instances in which it is not recommended.

Question 28

Contraindication for employment

Answer 28

In a high-risk area → ie, an occupation that is physically or emotionally hazardous → additional precautions may be necessary, or she may need to transfer to another area.

Question 29

Factors about employment

Answer 29

Need to take the opportunity to rest periodically throughout the day whenever possible. Women whose work requires prolonged standing should be especially conscious of sitting frequently. Prolonged standing has been found to increase the risk for preterm labor.

Question 30

Assessment of Substance Abuse

Answer 30

Maternal assessment should include the use of: Cigarettes. Alcohol. Illicit, prescribed, and over-the-counter drugs, including amounts and types consumed. Important for pregnant woman to understand the effects of her behavior on her health and on that of her fetus.

Question 31

Smoking & pregnancy

Answer 31

Smoking/exposure to secondhand smoke increase the risk for: Spontaneous abortion. SGA Low birth weight. Placental abnormalities. Sudden infant death syndrome (SIDS). Birth defects including congenital urinary tract anomalies

Question 32

Alcohol

Answer 32

``` Alcohol use during pregnancy increases risk for: Fetal alcohol syndrome. Spontaneous abortion. Low birth weight. Low Apgar scores Alcohol-related teratogenic effects put fetus at risk for: Mental retardation. Microcephaly. Hypoplastic philtrum and maxilla. ADHD. ```

Question 33

Characteristic Facial Features of Fetal Alcohol Syndrome

Answer 33

``` Discriminating Features Short palpebral fissures flat midface short nose indistinct philtrum thin upper lip Associated Features Epicanthal folds low nasal bridge minor ear anomalies micrognathia ```

Question 34

Drug Use

Answer 34

The use of drugs like cocaine and narcotics during pregnancy is associated with: Congenital anomalies. SGA. Risk for placenta abruption. Premature labor. Intrauterine fetal demise. Neonatal withdrawal and potential complications.

Question 35

Marijuana use

Answer 35

increased risk for: Preterm birth. Decreased birth weight and length. Possible delays in growth and development.

Question 36

Heroin use

Answer 36

``` increased risk for: IUGR. SGA. SIDS. Newborn withdrawal. Poor feeding. Dehydration and electrolyte imbalance due to vomiting and diarrhea ```

Question 37

Cocaine use

Answer 37

``` increased risk for: Congenital anomalies of the brain, kidneys, and urogenital tract. SGA. IUGR. Prematurity. Necrotizing enterocolitis. Birth asphyxia secondary to placental abruption. Brain infarcts. Neurobehavioral abnormalities. ```

Question 38

medications

Answer 38

Rx & OTC medications used during pregnancy must be chosen for their safety with a complete understanding of the risks/benefits of the chosen medication. Some medications may be a Category X in early or late pregnancy but may be used safely at other times during the gestation period.

Question 39

US Food & Drug administration Categories of drugs taken during pregnancy

Answer 39

Category A Aqeduate & well-controlled studies have failed to demonstrate a risk to the fetus during the 1st trimester of pregnancy and no evidence of risk in later trimester Category B animal reproduction studies have failed to demonstrate a risk to the fetus, but there are no adequate and well- controlled studies of pregnancy women

Question 40

US Food & Drug administration Categories of drugs taken during pregnancy

Answer 40

Category C Animal reproduction studies have shown an adverse effect on the fetus, but there are no adequate and well controlled studies in humans. potential benefits might warrant use of the drug for pregnant women despite potential risks

Question 41

US Food & Drug administration Categories of drugs taken during pregnancy

Answer 41

Category D There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies of humans, but potential benefits might warrant use of the drug for pregnant women despite potential risk

Question 42

US Food & Drug administration Categories of drugs taken during pregnancy

Answer 42

Category X Studies of animals or humans beings have demonstrated fetal abnormalities or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience. The risk involved in use of the drug for pregnancy women clearly outweighs the potential benefits.

Question 43

1st trimester discomforts

Answer 43

``` Urinary Frequency Etiology Pressure of growing uterus on bladder. Comfort Measures Decrease fluid intake at night. Maintain fluid intake during day.Void when feel the urge. ```

Question 44

1st trimester discomforts

Answer 44

``` Fatigue Etiology Possibly, increased metabolic requirements or nocturia. Comfort Measures Rest frequently.Go to bed earlier. ```

Question 45

1st trimester discomforts

Answer 45

Breast Enlargement & Sensitivity Etiology Effect of hormones, especially estrogen and progesterone. Comfort Measures Wear good supporting bra with wide shoulder straps.Assess for other conditions.

Question 46

1st trimester discomforts

Answer 46

``` Nasal Stuffiness & Epistaxis Etiology Elevated estrogen levels. Comfort Measures Avoid decongestants.Use humidifiers, cool mist vaporizers, and normal saline drops. ```

Question 47

1st trimester discomforts

Answer 47

``` Ptyalism Etiology Unknown. Comfort Measures Perform frequent mouth care.Chew gum or suck hard candies ```

Question 48

1st trimester discomforts

Answer 48

Nausea & Vomiting Etiology Unknown. Comfort Measures Avoid food or smells that exacerbate condition.Eat dry crackers or toast before rising in morning.Eat small, frequent meals. Vitamin B6 (pyridoxine) and ginger → two natural/herbal products that have been studied for the treatment of NVP with promising results.

Question 49

Medications used to treat NVP:

Answer 49

``` Dimenhydrinate (Dramamine) Trimethobenzamid (Tigan) Hydroxyzine (Vistaril) Promethazine (Phenergan) Prochlorperazine (Compazine) Metoclopramide (Reglan) Meclizine (Bonine) Diphenhydramine (Benadryl) Ondansetron (Zofran) → used for the treatment of N&V after chemotherapy → becoming more popular in treatment of NVP. ```

Question 50

2nd & 3rd Trimester discomforts

Answer 50

Urinary Frequency Etiology After lightening, pressure of fetal head on bladder. Comfort Measures Void when feel the urge.Decrease fluid intake at night.Maintain fluid intake during day.

Question 51

2nd & 3rd Trimester discomforts

Answer 51

Shortness of Breath Etiology Growing fetus→ puts pressure on diaphragm. Comfort Measures Use extra pillows at night to keep more upright.Limit activity during day.

Question 52

2nd & 3rd Trimester discomforts

Answer 52

Heartburn Etiology Displacement of stomach by growing fetus Relaxation of cardioesophageal sphincter. Comfort Measures Eat small, more frequent meals.Use antacids.Avoid overeating and spicy foods.

Question 53

2nd & 3rd Trimester discomforts

Answer 53

Dependent Edema Etiology Impeded venous return from pressure of fetus on pelvic area. Comfort Measures Avoid standing for long periods.Elevate legs when laying or sitting.Avoid tight stockings.

Question 54

2nd & 3rd Trimester discomforts

Answer 54

Varicosities Etiology Weight of uterus → causes pooling and engorgement of veins in lower extremities. Heredity, age, obesity. Comfort Measures Rest in Sims' position.Elevate legs regularly.Avoid crossing legs.Avoid tight stockings.Avoid long periods of standing.

Question 55

2nd & 3rd Trimester discomforts

Answer 55

Hemorrhoids Etiology Constipation. Pressure of enlarging uterus on pelvic and rectal veins. Comfort Measures Maintain regular bowel habits.Use prescribed stool softeners.Apply witch hazel compresses and topical or anesthetic ointments to area.

Question 56

2nd & 3rd Trimester discomforts

Answer 56

Constipation Etiology Pressure of growing fetus on intestine, causing decreased peristalsis. Possibly, ingestion of iron. Comfort Measures Maintain regular bowel habits.Increase roughage in diet.Increase fluids.Find iron preparation that is least constipating.

Question 57

2nd & 3rd Trimester discomforts

Answer 57

``` Leukorrhea Etiology Response to increased estrogen levels. Comfort Measures Take a daily bath or shower.Do not douche or use tampons.Wear cotton underwear. ```

Question 58

2nd & 3rd Trimester discomforts

Answer 58

Backache Etiology Lumbar lordosis that develops to maintain balance in later pregnancy. Comfort Measures Wear shoes with low heels.Walk with pelvis tilted forward.Use firmer mattress.Perform pelvic rocking or tilting.

Question 59

2nd & 3rd Trimester discomforts

Answer 59

Leg Cramps Etiology Decreased serum calcium level & Increased serum phosphorus level. Interference with circulation. Comfort Measures Extend affected leg and dorsiflex the foot.Elevate lower legs frequently.Apply heat to muscles.Evaluate diet.

Question 60

2nd & 3rd Trimester discomforts

Answer 60

Balance Alterations Etiology Growing uterus → throws off woman's center of gravity. Comfort Measures Wear shoes with low heels.Walk with pelvis tilted forward. Use good body mechanics.

Question 61

2nd & 3rd Trimester discomforts

Answer 61

Round Ligament Pain Etiology Tension on round ligament from enlarging uterus. Comfort Measures Rise slowly from sitting to standing or lying to sitting.Apply a warm heating pad to abdomen or take a warm (not hot) bath.Bring knees up toward abdomen.

Question 62

2nd & 3rd Trimester discomforts

Answer 62

Flatulence Etiology Decreased gastric motility. Pressure of growing uterus on large intestine. Comfort Measures Avoid gas-forming foods.Chew food thoroughly.Engage in regular daily exercise.Maintain regular bowel routine.

Question 63

2nd & 3rd Trimester discomforts

Answer 63

Carpal Tunnel Syndrome Etiology Compression of medial nerve in carpal tunnel of wrist. Weight gain and edema may contribute. Comfort Measures Avoid aggravating hand movements.Elevate affected arm.Wear splint.

Question 64

2nd & 3rd Trimester discomforts

Answer 64

``` Syncope Etiology Pooling of blood in lower extremities. Anemia. Comfort Measures Rise slowly from sitting to standing.Evaluate hemoglobin and hematocrit.Avoid hot stuffy environments. ```