mod 3 maternal Flashcards
sources of pain assoicaited with birth
tissue ischemia, cervical dilation, pressure/pulling on pelvic structures, distention of vagina and perineum
What factors affect tolerance and perceptions of pain
labor intensity, cervical readiness, fetal position, pelvic readiness, fatigue/hunger, caregiver interventions
Where in the spine does pain stimulus from the cervical dilation enter the spine
t10,11,12,L1
where does pain stimuli enter the spinal cord when It stems from the vagina and perineum
prudential nerve, S2/3/4
psychosocial factors of childbirth
culture, anxiety/fear, previous experiences, preparation, support system
What effects of medication do we monitor during labor
effect on fetus, maternal physiological alteration, complications, interactions
parenteral analgesics
opiods
demerol
stadol
nalbuphine
adverse effects of epidural
hypotensive, bladder distention, prolong labor, Cath migration, maternal fever, pruritus, Repritory depression, metallic taste
before choosing a birth control what should you consider
pt overall health, height, history
sex frequency
number of partners
want children?
withdrawl (coitus interruptus) pro and con
pro- free 99
con- can’t help myself, no STI protection
fertility awareness or cycle/ovulation tracking pros and cons
tracking basal body temp, cervical mucus, calendar method, abstinence
pro-free 99
cons- limits spontaneous sexy time :( 25% get pregnant still, can be hard if you have irregular cycles
Pro and con for use of diaphragm
16% get pregnant still
pro- inexpensive (lasts 2 yr)
con- needs to be fitted, no std protections, can’t be used on period, may cause irritation
pro and con of spermicide
can come in foam, jell, cream or film
pro- cheap and easy
con- can increase risk of STD due to skin irritation, 28-29% still get pregnant
cervical cap pro and con
pro- can stay in place for 48hr
con-must be fitted by doc, can’t be used during period
pro and con to female condom
pro- protections against sTI, conducts heat better then male condom
con- noisy?, 21% get pregnancy, cannot be used with Male condom
what Is something important to know as a health care provider when dealing with an Orth Evra Patch
HIGH RISK FOR DVT even over oral
change q7day s
success rate and potential risk associated with NUVA ring
99% effectice, 9% failure
risks- HTN, stroke, MI, Thrombosis
Depo is more elective in preventing pregnancy then the pill what are some pros and cons
pro- four times per year, highly effective
cons- cost is high, may cause spotting or other S/E, no protection against STD, increased risk of osteoporosis and mental irregularities
inplanon/nexplanon lasts up to 3 years after being implanted in the the upper arm. What are some pro and cons to discuss with the client
pro- last 3 years, highly effective
con- very expensive 400-800, may cause S/E, irregular bleeding, not STD protection
IUD pro and con
pro- long-lasting low maintaince
cons- irregular/heavy periods, more expensive, may cause S/E like uterine perforation, ectopic pregnancy and PID
check placement monthly
Transcervical sterilization is when an implant is placed into the Fallopian tubes that causes scare tissue to form around it to block it off. What are the pros and cons to this procedure
Pro- permanent, 100% effective
Con- takes months to become effective, may risk Pelvic infections, reversible, expensive, increased risk for ectopic pregnancy
list the contraptions choices from most to least effective
Implant, IUD, vasectomy, tubal methods- 99%
Birth control shot- 97%
Pill, Vag ring- 92-95%
condom, diaphragm, cervical cap, sponge - 84-89%
True or False? breastfeeding can inhibit ovulation
TRUE
Infertility is defines as unable to conceive. despite unprotected sex for 12 months. what are some common factors for this
alteration in sperm production
endometriosis
ovulation disorder
tubal occlusion
Females causes of infertility
age, weight, medical, surgical, gynecological, sexual Hx, occupational and environmental exposure
Male causes for infertility
mumps during adolescence, SUD, exposure to teratogenic material
how is infertility determined
lab test ect.
semen analysis, pelvic exam, hormone analysis, endometrial biopsy, postcoital test (see interactions of sperm and cervical mucus, US
Nursing interventions for infertility
encouragement, explain role of specialist, monitor for S/E of infertility meds, provide info, make referrals for grief and infertility support groups
When and what is lactogenosis I
16-18 weeks (2nd trimester), preparing for milk production, produces prepartum milk or colostrum
When and what is Lactogenosis II
after delivery (4th trimester), 3-5 days after birth, nicknamed the “transitioning” period from colostrum to mature milk
lactogenosis III
10 Days after Lactogenesis II, mature milk is established
Describe colostrum
thin clear to yellow, produced from time of birth until mature milk comes in
describe engorgement
happens 24-48 hours after birth, happens because of an increase in blood and lymphatic fluid as milk production increases, the breast will be hard and tender, uncomfortable possible fever. May make it harder for baby to latch because the nipple can invert
What happens 72-96 hrs after birth
mature milks comes in (lactogenosis II) breast become full
When will nonbreastfeeding mothers “Dry Up”
1-2 weeks if breast are not stimulated. they still exp engorgement but resolves 3 days after delivery
The AAP and WHO both recommend breastfeeding EXCLUSIVLY until what age
6 months, after this you can introduce purees and breast feed up to 1 year (AAP) or 2 years (WHO)
What does breastfeeding decrease the risk of for the newborn
GI infection (NEC), celiac disease, crohns, asthma, otitis media, obesity, SID, DM, constipation, acute lymphocytic and myeloid leukemia, infection
breastfeeding benefits for the mother
decreased PP bleeding, more rapid involution of uterus, decreased risk for : ovarian/breast cancer, DM, HTN, HLD, CVD, RA, Osteoporisis
other benefits to breastfeeding
think more holistic aspects of care
less expensive, convent, reduces annual health care cost, environmentally friendly, specifically for infant, easily digested, promotes bonding
steps to breast feeding
place infant tummy to tummy
nose to nip
sad which breast to express milk or colostrum
touch that to the infant’s lips
make sure the nose is not covered
contraindication to breastfeeding
HIV, HSV (active lesion on breast), active varicella, zoster on breast, lead >40mcg/dl
HEPATITIS IS NOT A CONTRAINDICATION
Tip for moms in regard to breastfeeding
delay offering pacifier until breastfeeding is well established, use warm compress to engorge breast, room in with infant to promote breast feeding, stimulate breast q3hrs,
is nipple soreness considered normal?
NO, but possible first few days
what can cause nipple soreness
poor positioning/latching
treatment for nipple soreness or breakdown
creams (organic, lanolin wool allergy)
breast shells,
proper fitting bra
Ice
breast shield temp
lube nip with milk
S/S for mastitis
erythema, fever, warmth, painful/tender breast, flu like symptoms
Tx for ,mastitis
Abx, pumping and breastfeeding, massage, Ice or heat, cabbage
how often should the mother pump If away from the baby
q3hr to keep stimulating to breast for 15 minute. add 5 minute for every newborn
how often should breastfeeding or feeding happen
the baby should be woken up every 2-3 hrs until back to birth weight. after that no more than 6 hours should pass between each feed
How much extra calories should the mom consume when breastfeeding
450-500 and hydrate
how long is breast milk good for at room temp, cooler, refrigerator, freezer, and deep freezer
room temp- 5-6 hrs
cooler- 24hr
refrigerator- 5-8 days
freezer- 6 month
deep freeze- 12 month
how many diapers should the baby have after DC
5-6 wet diapers
average loss of blood during mental cycle
20-80 ml
phases of mentration
proliferative phase- endometrium thickens
secondary phase- endometrium prepares for implantation
menstrual phase- if no implantation occurs, endometrium is excreted
What is amenorrhea
absence of menses during reproductive tears
what is primary amenorrhea
absence of menses by 16.5 without normal secondary sexual characteristics
absense of both menarche and sexual characteristics
causes for amenorrhea
pregnancy, hormones, breastfeeding, BMI (eating disorders, poor nutrition), endocrine disorders, stress from major life events, athletes, PCOS, medication
what is secondary amenorrhea
absence of menses for 3 cycles or 6 months in women who previously had normal menses
nursing considerations for amenorrhea
nutritional status, weight, height, V/S, androgen levels (acne, face hair), delayed puberty (no face hair or axillary hair), educate over possible infertility, nutritional counseling, emphasize healthy lifestyle
lab test for amenorrhea
US, CT, pregnancy test, hormone, laparoscopy
treatment of amenorrhea
underlying cause, HRT, sugary, cyclic progesterone, GnRH(hypothalamic failure), Thyroid RH
What is primary dysmenorrhea
painful menses/pelvic pain, from increase prostaglandin production (cramping) by endometrium which causes contraction of uterus. Highest level of pain are experience for first 2 days
what is secondary dysmenorrhea
painful menstration from pelvic or uterine pathology
what are some causes of dysmenorrhea
endometriosis, adenomiosis, fibroids, pelvic inflammation, IUD, cervical stenosis, vag or uterine abnoramilities
manifestation of dysmenorrhea
sharp intermittent spasm in suprapubic area
pain radiates to back of eg or lower back
N/V/D
fatigue
fever
HA/dizzy
assessment for primary and secondary dysmenorrhea
primary- cramping pain with menstration and physical exam is normal
secondary- Hx shows cramping pain starting after 25 year old with pelic abnormality, hx of infertility, heavy mental flow, irregular cycle, little to no response to NSAIDs
assessment that is done for both dysmenorrhea
sexual hx, assess for inflammation and scarring
bimanual pelvic exam in non mental phase of cycle, CBC, UA, pregnancy test, cervical culture, ESR, pelvic/vag US, laparoscopy
treatment for dysmenorrhea
NSAIDs, hormonal contraceptive, life style change, daily exercise, weight loss, smoking cessation, relaxation technique
hypomenorrhea
scanty menses
oligomenorrhea
infrequent menses, more than 35 days apart
menorrhagia
excessive menses
metrorrhagia
bleeding between periods
menometorrhagia
heavy bleeding during and between mental period
etiology of irregular uterine bleeding
pregnancy, hormones, fibroid, endometrial polyps or cancer, morbid obesity, steroid therapy, hypothyroidism
assessment for abnormal uterine bleeding
Hx, pelvic exam, CBC, pt, BHCG, TSH, transvaginal/pelvic US, endometrial biopsy, D&C
treatment for abnormal uterine bleeding
oral contraceptive, NSAIDs, iron replacement, D&C, endometrial ablation, hysterectomy
What is PMS or premenstrual syndrome
painful swollen breast, bloating/abd pain, HA, backache, depression, anxiety, irritability, behavioral changes before menses start and is it relieved when menses begin (less common teen and 20s more so in late 20 early 30)
What is PMDD premenstrual dysphoric disorder
(psychiatric) when symptoms are so bad that they interfere with ADLs
assessment of PMDD
symptoms clusters that last 3 months. compete Hx and physical to eliminate other factors, thyroid hormone
treatment for PMDD
lifestyle change (exercise 3-5x)
reduce stress
avoid caffeine
a diet with high carb and water
limit alcohol
smoking cessation
multivitamin, vitamin E, Ca++, Mg+
NSAIDs, oral contraceptive, diuretics
What is perimenopause
when ovarian function deminishes (4-5 yrs), stops after menopause, mid 40s through early 50s, decreased estrogen,
what is menopause
permanent cessation of menses, ovarian function
defines as no menses for 1 year
happens between ages 45-55
health issues associated with perimenopause and menopause
vasomotor symptoms (hot flash, vag dry, bad sleep), increased loss of bone and osteoporosis, increase risk for CVD, GU symptoms (UTI)
management of menopauses
HRT, botanical replacement, activity, lube, hydration
Osteoporosis s/s and treatment
loss of height, back pain, dowager hump
Dx- H&P, dexa, bone density
tx- med, Ca++ w/ Vit D, excersize
