last exam presentations.powerpoint Flashcards
smoking increase risk of
1st trimester miscarriage ectopic low birth weight placenta previa/abruption fetal growth restriction preterm birth/labor SIDS chronic asthma in children
Is quitting smoking by the end of the first trimester….
reverse the adverse effects on the fetus
5 A’s approach smoking cessation
Ask about tobacco use advise to quite assess willingness to make an effort to quit assist attempt to quit arrange follow up
what is the first line of treatment (smoking) in pregnant women
behavioral
when does pharmacotherapy recommended for pregnant women
those who smoke more than 1 pack / day
Is woman is more likely to quit smoking during pregnancy than any other time in her life
yes
Nicorette
MOA:cholinergic-receptor agonist that replaces nicotine to reduce withdrawal symptoms
S/E- indigestion, nausea, hiccups traumatic injury to oral mucosa and/or teeth, irritation and/or tingling of the tongue, mouth, and throat, oral mucosal ulceration, jaw-muscle ache, eructation, gum sticking to teeth, unpleasant taste, dizziness, lightheadedness, headache, insomnia
Contraindications: known allergy to nicotine or methol, patients with TMJ
Prescription: Nicorette Gum 2mg pieces, chew 1 piece gum prn nicotine cravings. not to exceed 9 pieces daily.
what amount of Alcohol is approved during pregnancy
NO AMOUNT is allow
Alcohol uses increase risk of
miscarriage stillborn developmental delay preterm birth physical delay
what decrease alcohol comsumption
assessment of alcohol
T-ACE screening tool
How many drinks does it take to feel high? (TOLERANCE)
Have ppl ANNOYED you by criticizing your drinking?
Have you ever felt that you needed to CUT DOWN on your drinking?
Have you ever had a drink first thing in the morning to steady your nerves or get ride of hang over (EYE OPENER)
What are the criteria to dx Fetal Alcohol Syndrome
3 facial features:
smooth ridge between the nose and upper lip (smooth philtrum)
Thin upper lip
short distance between the inner and outer corners of the eyes, giving the eyes an wide-spaced appearance
Growth deficits
CNS problems
Cyanocobalamin (Vitamin B12)
MOA: coenzyme for various metabolic functions, including fat and carbs metabolism and protein synthesis, used in cell replication and hematopoiesis
S/E: dizziness, headache, nervous, and excitable, upset stomach or throwing up, loose stools (diarrhea)
contraindications: hypersensitivity to cyanocobalamin, cobalt, or any component of the formulation
Prescription: 1mL (1000mcg) IM daily for 7 days, then inject 1mL monthly
Physical Abuse Facts
men are 5 times more likely than women to be the abuser in a relationship
men use abuse as form of coercion or control, while women often use it in self defense
studies show that younger women (20 y.o and younger) are more at risk of domestic violence)
pregnant women suffering from domestic abuse more likely to abuse drugs, alcohol, and tobacco. Depression and anxiety are commonly seen in pregnant women experiencing domestic abuse
pregnant women suffering from domestic violence more likely to get late or no prenatal care d/t their partner’s controlling behavior
providers much educate all women and domestic abuse does occur, the detrimental physical and emotional consequences, and where to get help if they are being abused now or in the future.
Cocaine
coke blow or crack can be snorted, injected or smoked
slow metabolism of drug in fetal blood stream causes prolonged fetal exposure
Cocaine increases risk of
miscarriage
placental abruption
how does Cocaine easily crosses the placenta
simple diffusion
Fetal/neonatal problem with Cocaine uses
PTB LBW respiratory distress bowel and cerebral infarctions FGR seizures **long-term effects may not be seen for years and includes cognitive behavioral and learning disorders.
Buspirone (Buspar)
anti-anxiety agent
buspar has a attraction to serotonin 5 HT & dopamine receptors
off label: antidepressant
side effects: dizziness, fatigue, anxiety, headache, or dyspepsia
contraindications: renal or hepatic disease, breastfeeding.
Pregnancy cat. B
sexual abuse
a person is sexually abused when one person engages another person in any action which the perpetrator anticipates will be sexually stimulating. this can include intercourse, touching, exposure of genital organs, showing pornographic material or talking about sexual thing in an erotic ways.
incidence of sexual abuse
18-25% before age of 16
all socio economic and educational background
how sexual abuse affects women’s life
all relationship how she handles hardships, daily difficulties children and friends how she take care of neglets her own health and how she feels about herself. many women of sexual abuse turn to abusive substance use or behaviors include suiide ideation in order to cope with situation or memories.
how sexual abuse effect pregnancy
pregnancy can trigger for feelings of alarm and humiliation. flashbacks and anxiety attacks are common during vaginal exams and labor and delivery. women of sexual abuse may experience intense somatic and psychosocial reaction to labor and delivery.
how women’s response to sexual abuse
guilt
responsible for abuse
do not report d/t fear of being judged or blamed
fear of repercussions from perpetrator
fear of changes this may bring to their lives.
most victims wish they could tell someone what has happened to them, but the need to be asked straightforward
midwifery care for sexual abuse women
** screen all women
** help identify trigger that may cause distress
** allow the women to feel control during exam labor birth
** allow her to dissociate in order to allow exams and labor to continue
midwife needs to allow the woman to handle her exams and labor in a way will most helpful to her
build trust and show non-judgement with the client so that she can plan the best approach to her pregnancy labor birth
be patient
give time to make decisi0n
know your state & local law about mandatory reporting
document all conversation. she should not have to repeat her story
anticipate emotional difficulty after baby is born
SAVER
(S)creen all women
(A)Ssist in acknowledging her story and help her wok through emotional resonse.
(V)alidate her by believing and not judging her
(E)valuate for current safety and suicide risk
(R)efer to specialist.
Heroin
synthetic opioid that is injected snorted or smoke
complications associated with heroin
malnutrition
sexually transmitted infections and infectious diseases during and outside pregnancy
heroin is also associated with preeclampsia and placental abruption as well as intrauterine fetal death, fetal growth restriction and prematurity
fetal effects on heroin use
withdrawal symptoms may be life-threatening
risk of developmental delay and behavioral problems
increase of SIDS
IV drug use is associated with increase in ….
HIV and hepatitis which may be transmitted before or during birth
methadone treatment
standard care in pregnancy that allows pregnant women to discontinue using heroin while mitigating withdrawal symptoms.
methadone
MOA: inhibits ascending patin pathways by binding to CNS opiate receptors
change perception response to pain
indications for methadone
management of moderate to severe pain
standard of care in pregnant women with opiate additction
Pregnancy cat. C
methadone side effects
arrhythmia
cardiac arrest hypotension
sedation/disorientation, dizziness, physical psychological dependence
rash
abdominal pain, nausea anorexia biliary tract spasm constipation
urinary retention or hesitancy
weakness
pulmonary edema respiratory depression or arrest
contraindications for methadone
hypersensitivity
respiratory depression
paralytic ileus
simultaneous selegine
special consideration for methadone
regulation on dispensation vary by state
may require referrals to substance abuse and mental health specialist
exception: inpatient admission for condition other than opiod addiction
short course <3 days while appropriate care is secured
opioid withdrawal syndrome in neonate may be fatal
substance abuse risk factors
late to prenatal care hx. miscarriage, preterm birth poverty infection decrease fetal movement smoker multiple partners poor dental health low BP increase BP
thrombophlebitis
inflammation of a vein caused by a blood clot (thrombosis)
superficial thrombophlebitis
localized heat, pain, or tenderness, inflammation, palpable knot
Deep thrombophlebitis
unilateral edema, generalize warmth and redness, mild tachycardia, abrupt onset, severe leg pain, worsening with motion or standing, pain with calf pressure.
