Maternity Module 4 Guide

Question 1

Nutrition during pregnancy, ATI chapter 5

Answer 1

DUH

Question 2

Nutrition to physical activity: box 26.4

Answer 2

light exercise is good if you’re fat. period. everything else is painfully obvious

Question 3

Lactation nutrition and benefits

Answer 3

-drink lots of fluids

Question 4

What foods are okay and not okay to eat during pregnancy? Refer to ACOg guidelines

Answer 4

you know these…love waffles

Question 5

Asthma

Answer 5

Tx goals are to control s/s and limit exacerbations
-continue asthma meds, avoid smoking and triggers..

Causes: preeclampsia, antepartum and postpartum hemorrhage, PE, miscarriage, and cesarean section

Question 6

Epilepsy

Answer 6

-continue to take Antiepileptic drugs regardless of risk
-never be alone or standing with child
-valproic acid can cause fetal anomalies..so take lots of folic acid, preferrably 4mg 3 monthrs prior to conception..
-infant is at increased risk of bleeding
-may require c section to avoid causing seizure by stress

Causes: intrauterine growth restriction, preeclampsia, placental abruption, miscarriage, preterm labor, fetal and maternal death

Question 7

Hypo/hyperthryroidism

Answer 7

HYPOTHYROID:
-take Levothyroxine first thing in morning on empty stomach, don’t eat for an hour for absorption purposes..
-adjust 4 weeks-3 months dosage for hormones, may require adjustments early pregnancy..
-take meds on time and frequently

-causes: preeclampsia, postpartum hemorrhage, and early pregnancy loss

HYPERTHYROID:
-may cause maternal heart failure, pregnancy loss, and low birth weight
-tx with thioamides that cross placenta, may cause fetal anomalies

Question 8

Pregestational diabetes (not tables 19.1 or box 19.1

Answer 8

-encourage achievement of excellent glycemic control prior to conception.
causes: preeclampsia, macrosomic fetus, perinatal death, preterm labor, fetal loss, polyhydramnios, congenital anomalies

Question 9

Non-stress test

Answer 9

Fetal wellbeing in the absence of contractions
* Reassuring results:
* Reactive >32 wks gestation: at least 2(or more) 15x15 accels within
20 minutes
* Reactive <32 wks gestation: at least 2(or more) 10x10 accels within
20 minutes
* Nonreassuring results:
* Nonreactive: Does not meet reactivity standards
* Continue to monitor for up to 120 minutes before determined..

Question 10

Contraction stress test

Answer 10

…Fetal wellbeing in the presence of contractions
* May be induced with nipple stimulation or oxytocin
* Reassuring Results:
* Negative: no late or frequent variable decels
* Nonreassuring results:
* Positive: decels occurring with at least 50% of contractions

Question 11

Biophysical profile (BPP)

Answer 11

..

Question 12

Cardiac decompensation and hemodynamic changes: box 19.2 and 19.3

Answer 12

-rapid, weak pulse
-shortness of breath
-palpitations
-progressive, generalized edema
-crackles in lungs
-cyanosis
-smothering feeling
-EXTREME FATIGUE

Question 13

Table 19.2

Answer 13

..

Question 14

Systemic lupus

Answer 14

-wish mothers not to attempt pregnancy until it has been 6 months since last exacerbation
-have tests run on targeted organs throughout pregnancy
-can cause: thrombocytopenia

Question 15

Chronic hypertension

Answer 15

-BP >140/90 mm Hg PRIOR to pregnancy
-mild = systolic 149-159 and/or diastolic 90-109
-treat with Labetalol, Nifedipine, Methyldopa
-women should be monitored for s/s of preeclampsia and HELLP ( epigastric pain unrelated to fetal movement, excessive or facial swelling, vision changes, )

Question 16

Obesity

Answer 16

• increase risk of preeclampsia, gestational diabetes, labor induction and induction failure, slower first stage of labor, postpartum thromboembolism

> 30 BMI
-may require internal monitoring
-collaborate with nutrition to find food plan and educate about good meals
-encourage healthy eating behaviors

Question 17

All eating disorders

Answer 17

Anorexia: disturbed self perception, fear of weight gain. High risk for miscarriage, antepartum hemorrhage, preeclampsia, preterm delivery, c section…..
-may go into remission during pregnancy, but may be replaced with binge eating or bulimia.

Bulimia:

Binge Eating Disorder: feelings of loss of control, may continue or go into remission during pregnancy

Nursing interventions: interview with diet recall 24hrs

Question 18

Maternal phenylketonuria

Answer 18

-microcephalic, intellectual disabilities,
- avoid

Question 19

Iron deficiency anemia

Answer 19

-treated with iron supplementation.
-Increase fiber and fluids to aid constipation, may require stool softener

Question 20

Intimate partner violence

Answer 20

-women should be screened at prenatal visits, hospitalizations, and postpartum appointments, LOOK AT YOUR PATIENT, continue to keep follow up at postpartum and l&d, keep nurses to minimum for trust

Question 21

Depression

Answer 21

-SSRIs can put baby at risk of withdrawal and NAS after delivery but do not cause anomalies

Question 22

Anxiety

Answer 22

• best to be managed prior to pregnancy

Question 23

UTI

Answer 23

S/S:
-frequency
-feeling of inability to void completely
-dribbling may occur
-dysuria
-may have hematuria

Dx: cystitis with urinalysis/urine culture

PATIENT TEACHING:
-If a UTI is treated with antibiotics, patients should be taught to FINISH THEIR COURSE even if they feel better.
-PHENAZOPYRIDINE helps the symptoms but does not cure it, causes orange urine and staining. Should not take >2 days.

Question 24

Pyelonephritis

Answer 24

S/S:
-fever
-vomiting
-flank and back pain

TREATMENT:
-ciprofloxacin + levofloxacin

Essentially a UTI that has spread to the kidneys

Question 25

Bacterial vaginosis

Answer 25

Occurs with pH more alkaline/basic

Risk factors: pregnancy, frequent sexual activity, and tampon use

S/S:
-thin white/grey discharge,
-fishy, foul odor

Tx:
-oftentimes resolves spontaneously, or oral metronidazole or vaginal cream

Question 26

Candidiasis vulvovaginitis

Answer 26

Risk factors: diabetes mellitus, wearing lots of tight-fitted clothing,

Think: dark, moist environment for yeast growth

S/S:
-intense genital itching/irritation/pain
-cottage cheese discharge
-genital redness/irritation

Question 27

Trichomoniasis

Answer 27

Most common protozoan infection

s/s:
-strawberry cervix
-vulvovaginal erythema, frothy white or green discharge
-fishy, foul odor

Question 28

Chlamydia

Answer 28

Most common bacterial infection

cervicitis and PID

azithromycin and doxycycline, sexual partners must be treated, reevaluate 3 months after tx

can affect fertility due to fallopian tube scarring

Question 29

Gonorrhea

Answer 29

.Ceftriaxone and azithromycin

Female: PID, painful intercourse, vaginal dc and bleeding, can affect fertility and ectopic pregnancy
Male: discharge and swelling of penis, UTI s/s

Question 30

Pelvic inflammatory disease

Answer 30

.early dx is crucial, tx with 2-3 antibiotics,
may cause infertility

Question 31

Syphilis

Answer 31

Treponema Pallidum tx with penicillin G IM

Primary: chancre sore

Secondary: rash

Tertiary: organ failure, aortic dissection
Latent: asymptomatic period

Question 32

Herpes simplex virus

Answer 32

HSV1: oral lesions

HSV2: genital lesions

Both can be on either area and transmitted for both.

Question 33

Viral hepatitis (A, B, C)

Answer 33

A
B
C

Question 34

HIV and defining illnesses

Answer 34

Defining illness: yeast infection (candidiasis) to posterior pharynx, throat, lungs, bronchioles, NOT TOUNGE

Question 35

HPV

Answer 35

.most common viral STI

Question 36

Chapter 16 FETAL MONITORING: interpretation, categories, interventions, etc.

Answer 36

VEAL CHOP MINE
V=VARIABLES, C=cord compression M=move onto side
E=EARLY H=head compression I=identify labor progress (check)
A=ACCELERATIONS O=okay N=nothing
L=LATES P=placental insufficiency E=emergency

Question 37

Substance abuse

Answer 37

-may also partake in risky behaviors such as prostitution.
-may avoid prenatal care due to embarrassment or fear or nonchalant
-all women should be screened for substance abuse during pregnancy
-stopping consumption of alcohol or drugs at any point during pregnancy can help improve outcomes.
-counseling about the negative effects of substance use in pregnancy followed by a referral for treatment should be included in
- stopping cold turkey is not recommended, as infant may withdraw in utero and die.