Exam 4 Flashcards
5 examples of women who would benefit from genetic counseling
Maternal age >35
Family history of genetic disorder
History of multiple spontaneous abortions
Unexplained stillbirth
Exposure to teratogens
4 risks for the occurrence of a multi factorial disorder
Close relatives with the disorder
Close relative(s) with a severe form of the disorder
The defect occurs in a female
Geographic location where the disorder is more likely to occur
Examples of 2 multi factorial disorders and why they may have happened
Spina bifida: genetic predisposition and mother who took a folic acid antagonist while pregnant
Pyloric stenosis: genetic predisposition and a mother who had an infection while pregnant that she took antibiotics for
Environmental factors that could contribute to multifactorial disorders
Alcohol
Teratogens
Tobacco
Drug use
Folic acid antagonists
Infection
Mercury
Metals
Calories needed by breastfed infants
Calories needed by formula fed infants
85-100 cal/kg of body weight
100-110 cal/kg of body weight
How can parents determine if infant is eating enough?
3 wet diapers and 3 stools by the 3rd day
At least 6 wet diapers by day 4
Weight gain
What is the milk like during Lactogenesis I?
Begins during pregnancy to early days after giving birth
Colostrum - thick, yellow, high in protein and vitamins/minerals
What is the milk like during lactogenesis II?
Begins 2-3 days after birth
Transitional milk - gradually changes from colostrum to mature milk for about 10 days
Amount increases, immunoglobulins and proteins decrease, lactose, fat, calories increase
What is the milk like during lactogenesis III?
Mature milk - bluish, not as thick
Which vitamins is Breastmilk high in?
A, E, and C
Low in vitamin D
Which immunoglobulin does breast milk contain?
IgA, which helps prevent viral or bacterial invasion of intestinal mucosa
What are the main differences between Breastmilk and formula?
Breastmilk contains immunologic components
Formula contains more casein which is harder to digest, causing larger stools and more protein to go undigested
Less iron absorbed with formula
Formula has higher calorie content
Risks to the infant by not breastfeeding
More likely to develop allergies
Increased risk for infection
Increased risk of SIDS
Nutrients not absorbed as well
Can be improperly and potentially dangerously diluted
Risks to the mother by not breastfeeding
Does not release oxytocin, which enhances uterine involution
Resumes ovulation earlier
Balanced maternal diet that improves healing is less likely
Less frequent skin to skin which can be detrimental to bonding
Expensive
Where is Breastmilk made in the breast?
Alveoli
What causes the release of Breastmilk?
Loss of placental hormones at birth (estrogen and progesterone) increasing prolactin, and the release of oxytocin which causes the milk to let down
What things are scored when determining the latch score?
Latch
Audible swallowing
Type of nipple
Comfort (breast or nipple)
Hold (positioning)
What should be heard when the infant is latched?
Swallow, but not other noises
Good hold during breastfeeding for c/s patients
Football hold
Patient teaching for breastfeeding
- Cradle, football, or cross-cradle holds
-vInfants mouth fully open, aim at roof of mouth, nipple drawn to back of mouth - Tongue should be forward, under breast and over lower gums, lips flared out
Reasons a male may have infertility
Abnormal sperm
Fluid doesn’t have proper nourishment to keep sperm going
Past chemo or radiation
Reasons a female may have infertility
Not ovulating
PCOS (egg doesn’t pop out of ovary wall)
Fallopian tube disorder (chronic STD causing scarring)
Endometriosis causing abnormal bleeding or extra endometrium that does not slough off
Abnormalities of cervix due to surgeries or incompetent cervix
Egg white consistency cervical mucous
Spinnbarkeit
What should you teach patients who are undergoing infertility evaluation and treatment?
Simple therapies done before more costly and complex ones
Evaluations and therapy done more quickly if woman is >35
Typically require more time, energy, discomfort and risk for the woman than the man
What does clomid do?
Stimulate follicle development leading to ovulation
What does hCG medication do?
Induce release of several ova
What occurs with IVF?
Ova removed by U/S, mixed with sperm
Life starts in Petri dish
Fertilized oocytes returned to uterus (or can wait until embryo develops and then is returned to uterus)
Example of health people 2020 goals for women’s health
Lower breast cancer deaths
Reduce cervical cancer deaths
Increase cervical cancer screening
Increase proportion of adults who receive a colorectal screening
Reduce hip fracture hospitalizations amount women 65 and older
When should mammograms begin and how often?
As needed for women 40-45
Yearly at 45
Every other year at 55
Drug treatment for endometriosis
Lupron - creates pseudo menopause
Name of HRT (estrogen and progesterone)
Prevarin
Pt teaching for menopause
Average age is 51.5
Whole time period for the climacteric phase is 3-5 yr
Symptoms (hair loss, fatigue, pelvic floor disorders, vaginal atrophy)
Management for menopause
HRT (progesterone and estrogen): inc risk of breast cancer and heart disease
ERT increases risk of stroke (only ok for pts without uterus)
Water soluble lube
Botanical preparations to replace estrogen
Kegels
Drink at least 8 glasses of water per day
Anterior vaginal wall prolapse
Cystocele
Prolapse of upper posterior vaginal wall between vagina and rectum
Enterocele
Prolapse of posterior vaginal wall, rectum protrudes into vagina
Rectocele
