Final

Question 1

Definition of infertility:

Answer 1

no PG in 1 year of unprotected intercourse
* seek tx after 6 mos of trying if over 35yrs, irreg menses, hirsutism, sterilization, prostate infx, 2+ miscarriages, endometriosis

Question 2

Male fertility support - semen:

Answer 2

vit C
Avena sativa
ginseng

Question 3

Male fertility support - testosterone:

Answer 3

saw palmetto
damiana
nux vomica (sm dose, short term)

Question 4

3 parts of sperm analysis:

Answer 4

count
morphology
motility

Question 5

What is Clomid (pharmaceutical)?

Answer 5

estrogen antagonist - not good for a woman 40+ yrs

Question 6

2 herbs for ovulation:

Answer 6

vitex
aletris farinose (true unicorn root)

also supplement beta carotene

Question 7

3 herbs to support luteal phase for progesterone:

Answer 7

wild yam
vitex
smilax officinale (sarsaparilla)

supplement: oral micronized progesterone p.v. throughout 1st trimester

Question 8

Naturopathic tx for infertility:

Answer 8

F: vitex, increased protein intake
M: saw palmetto, avena, Vit C, ginseng

Question 9

What are mechanical infertility modes:

Answer 9

sperm motility/delivery issues
impotence
retrograde ejaculation
F has sperm antibodies
anatomical cervical issues
endometriosis

Question 10

How to deliver a baby in an emergent situation:

Answer 10

1. counter pressure to keep head from popping out too fast
2. flex head
3. head will deliver, check for cord around neck (pull over)
4. baby : moves : restitution
5. shoulder comes out
6. keep infant warm! dry off, skin to skin
7. no crying: rub back, stimulate kidney-1 on feet, mouth to mouth
8. keep cord - uterus rises in abdomen, cord gets longer
9. deliver placenta - rub abdomen to push out clots

Question 11

What amount is considered hemorrhage during labor?

Answer 11

over 500mL of blood

stop bleeding with Trendelenberg maneuver

Question 12

When is the most important time to nurse?

Answer 12

the first hour - d/t hormones, adrenaline (baby is awake!) nurse 8-12x in a 24 hr period

Question 13

3 advantages of colostrum:

Answer 13

high in minerals
high in protein
high fat soluble vitamins
antibodies
helps establish gut flora
laxative effects

Question 14

Advantages of breast feeding:

Answer 14

provides baby with antibodies
mom loses weight
keeps uterus contracting

Question 15

nursing timing:

Answer 15

q 2 hrs, or 8-12x per 24 hours

Question 16

2 functions of prolactin as it relates to nursing:

Answer 16

stimulates mammary glands to produce milk

causes enlargement of mammary glands

Question 17

2 functions of oxytocin as it relates to nursing:

Answer 17

stimulated by infant suckling, helps let down milk

causes contraction of mammary glands

Question 18

how is milk supply regulated in the body?

Answer 18

supply and demand
when it comes - enough for 2-3 babies
in a premie, milk makeup is different than full term

Question 19

When does milk typically come in?

Answer 19

day 3

Question 20

Formula options:

Answer 20

cows milk
soy milk
partial whey hydrolysate formulas
extensive casein or whey hydrolysate formula
amino acid based

Question 21

How big is a neonate stomach?

Answer 21

size of an almond - don’t need to feed before mom’s milk arrives

Question 22

Positions for breast feeding:

Answer 22

belly to belly
baby’s mouth aligned with nipple
neck slightly extended
ear, shoulder, and hip aligned

Question 23

What do you do to support labor?

Answer 23

position changes
massage
counter pressure
warm water
encouragement

Question 24

2 good positions for 2nd stage labor:

Answer 24

squatting
pull legs up
hands and knees

Question 25

How long is an average labor?

Answer 25

12 hours normal to have contractions on and off for 7 days, then 12 hours of active labor to delivery

Question 26

Definition of labor:

Answer 26

contractions that increase in intensity that ultimately result in birth

Question 27

Normal term is how many weeks?

Answer 27

37-42 Preterm - before 37 weeks

Question 28

Physiology of starting labor:

Answer 28

Prostaglandins: increase, esp PGE2/PGF2 near initiation of labor Estrogen: up regulates receptors on uterus, increasing contractility

Question 29

First stage of labor: | latent, active, and transition phases

Answer 29

Onset to full cervical dilation Latent phase: * 0-4 cm * slow dilation * contractions 5-10 mins apart, 30-45 seconds Active phase: * faster rate of dilation * 4-6 cm * contractions 2-4 mins apart, 60 seconds Transition phase * 7-10 cm * mix of cervical dilation and descent of fetus

Question 30

Second stage of labor:

Answer 30

interval btw full cervical dilation and delivery descent of fetus through pelvis ends with delivery

Question 31

Third stage:

Answer 31

delivery of placenta | avg 5-6 mins (90% by 15 mins, 97% by 30 mins)

Question 32

What is restitution?

Answer 32

baby flips on side to get out of vaginal canal | anterior -> extends -> shoulder rotates

Question 33

Do you help the baby during restitution?

Answer 33

No! you don't know which way the baby wants to rotate. Don't touch the baby while it's turning.

Question 34

Reasons you can't get the baby out:

Answer 34

* contractions aren't strong enough * pelvis size / shape * position (breech)

Question 35

Amniotic fluid should be (color)?

Answer 35

clear if green - meconium

Question 36

After the water breaks, why can't you put anything in the vagina?

Answer 36

risk of infx

Question 37

Monitoring during labor:

Answer 37

``` vitals q 4 hours (normal) or 1-2 hours (abN) assessment of uterine contractions cervical examinations * on admission * 1-4 hr intervals during 1st stage * 1 hr intervals during 2nd stage * when pt feels urge to push * with any fetal HR abN ```

Question 38

Pushing techniques:

Answer 38

Valsalva - * pull back knees * tuck chin * deep breath and hold * push! Physiologic - * follow mom's lead * she pushes when she feels the need * tends to have shorter pushes without a closed glottis

Question 39

Basic anatomy of breast tissue and ducts:

Answer 39

``` suspensory ligament fat glandular tissue duct pectoralis muscle ```

Question 40

What is "tongue tied"?

Answer 40

``` short tongue due to attached frenulum mb assoc with folate deficiency * talking difficult * painful to nurse * easier to cut when very young ```

Question 41

Mgmt of excessive baby wt loss with lactation (7+%):

Answer 41

``` reasons * inadequate milk production * poor milk transfer * disease of newborn encourage frequent and full feedings * baby to breast q 2-3 hrs for 10-15 mins each breast * stimulate sleepy babies to finish feeding Follow breastfeeding with 10 mins of pumping Feed baby any pumped milk Galactagogue herbs * trigonella * foeniculum ```

Question 42

Breast pain - causes:

Answer 42

engorgement nipple injury plugged ducts infection (staph, candida)

Question 43

Breast pain - mgmt:

Answer 43

correct latch let nipples air dry cool or warm compresses apply lanolin or nipple butter to nipples consider frenotomy if ankyloglossia present

Question 44

Mastitis can lead to:

Answer 44

abscess tx with * hepar sulph * phytolacca oil topically