NP611 Modul 8, 9, 10 Flashcards
Which is an accurate statement about DV
Its associated with higher death rates than in a non-pregnant state.
If a history of childhood sexual abuse….
the client may need to dictate when you can do a pelvic exam
Pregnant smoker of 1-1.5 packs per day
Is at risk for placental abruption
Is alcohol ok during pregnancy, even if just one glass??
No alcohol is best
Which group is a primary concern for drinking during pregnancy
binge drinkers
what is true about alcohol during pregnancy
Even one drink/week has been shown to cause problems
what is not associated with pregnancy and smoking
pre-eclampsia
childhood asthma
First approach to smoking cessation during pregnancy
the 5 A’s
- ask
- advise
- assess
- assist
- arrange
When a person uses marijuana during pregnancy
She should be asked about other substance use
Meth is associated with
placental abruption
Smoking during pregnancy is associated with
spntaneous abortion, abnormal placetation (abruptio or previa), constricture of uterine vessels and placental vessels, low birth weight, decreased birth length, and preterm delivery
Infants of women who smoke have higher incidence of
IDS and apnea
Alcohol is associated with 2nd trimester spontaneous abortion
and nutritional deficiency.
cocaine during pregnancy is associated with
(cold-turkey)
spontaneous abortion, preterm labor, abruptio placentae, rapid labor and delivery, and low birth weight and fetal death.
Withdrawal exists for the newborn
cocaine in infants- do not breastfeed while using cocaine
may be at risk for congenital malformations, behavioral abnormalities
Amphetamines
withdrawal exists
narcotics/opiates
(heroin) usually need to wean-methadone candidate
withdrawal exists. Discuss with physician about taking methadone
Stimulants
Cause tachy, increase temp, high blood pressure will cause decreased blood supply to baby, and can cause placental abruption. Any stimulant can do that even if inhaled.
relaxants
cause withdrawal symptoms
screening tools-routine screening should occur all through the pregnancy
verbal and written-need to do both
what percentage admit to use-40%
5A’s-In the stage of change to quit you can use these
5R’s-when you identify the person who is not ready to quit (pre-contemplation)
women are more motivated to make changes while they are pregnant
because of baby
DV
more deadly during pregnancy
childhood sexual abuse-25%
Caring for her while pregnant
- kinetic memories
- changes in self-image (modesty, privacy
- can have disassociation or you may not know.
- routine screen
- ask for permission, etc. This should be for all women
- counseling if possible, check mental screening issues
- be aware of the cycle of violence
understand medical conditions for these women
miscarriages
stillbirth
physical symptoms
FAS- physical and cognitive damage
specific birth defects
more advanced
FAE-not a full syndrome
More subtle
May have trouble with socialization or school
Minimum amount of alcohol recommended in pregnancy
ZERO
DV- survivor friendly
routine screen everyone
Make it the norm
Get information out so client does not have to ask
How to get client alone
and why client would not say she is being abused
Doesn’t want him to hear
May need financial support
routine time where woman is screened privately
get the people back together after you screen
look at state laws
Tools
TACE TWEAK AUDIT 4P's TQDH (ten question drinking history)
benefits of breastfeeding
Fewer ear infections
less risk of SIDS
lower costs
6 week PP exam should include
Abdominal diastasis
bimanuel exam
assess for cystocele
discomforts of PP include
excessive diaphoresis
uterine pains
breast engorgement
Related to breastfeeding
Oxytocin promotes bonding and establishes milk ejection
Breastfed babies should be fed
8-12 times in 24 hours
Breastfeeding is advised for 1 year
To increase milk supply:
frequent feedings
early initiation
night feedings on demand
Not enough milk may be seen by:
a woman who nurses for only 5 minutes a side every 6 hours
Maternal benefits include
lower incidence of uterine and breast cancer and reduced risk of osteoporosis
Breastfeeding may be beneficial for the baby in
decreasing the incidence of otitis media, decreasing respiratory infections, and possibly even dental malocclusion.
The benefits to the mother besides the psychosocial ones may include the association with
decreased breast cancer rates, rapid uterine involution, and in some women, a more rapid return to their pre-pregnant weight
Breastfeeding requires approximately 500 calories more for a total of 2700 calories/day,
May help to return to pre-pregnancy weight faster
Why diaphoresis and urinary frequency pp?
Getting rid of excess fluids. Hormonally is caused from no longer being pregnant. A shift in estrogen, progesterone, etc. Going to have night sweats like no other! Output high for the same reason. Pedal edema make take up to 4-5 weeks to go away. Depends on what medications they had during labor.
Painful cramping after delivery
Involution, afterbirth pain. It can get worse with every baby.
-empty bladder (which displaces the uterus)
She would bleed more because she could not contract down.
-NSAID
-warm compresses (heating pad)
-lay on her belly
-
Bleeding increased at 10 days pp lasting 1-2 hours
placental eschar
(scab from where the placenta was attached sloughing off)
Bleeding like a period. Bright red and can occur more than once
What about sex after pregnancy
Just say NO!
Wait until you are ready
Physiology she needs to wait until lochia is completely gone. 2,4,6,8 weeks, whatever it takes
If breastfeeding may be covered for awhile. Can ovulate so does she want birth control??
Should have a discussion at 36-40 weeks so she knows what to do.
If breastfeeding she may have vaginal dryness and it could be uncomfortable to have sex.
Contraception-no bleeding-prepare for discomfort
Important to have communication with partner if possible
Baby crying and won’t latch on
engorged
Milk comes in 3-5 days.
Nipples flatten out. Baby won’t latch
Position is important-Is baby sucking well?
Pump, boobs in warm water, get some milk out so the baby can latch
Communication with client, teach!!!
Mastitis is an infection that often attacks a woman at her weakest point, in this case her breasts,
nipple candida can present challenges to the nurse practitioner as she supports the breastfeeding client.
The diagnosis of subinvolution is made clinically.
At 2 weeks postpartum, the uterus is already a pelvic organ and by 6 weeks has returned to normal size.
Subinvolution occurs when the normal shrinking of the uterus has slowed or stopped.
caused by retained placental fragments, infection, or fibroids. It is characterized by bleeding that increases or persists longer than the normal course of postpartum lochia. Examination may reveal a soft, boggy uterus that is larger than it should be for time postpartum. Subinvolution is treated with Ergotrate, or Methergine, and rest. A lochia culture should be taken to rule out concomittent endometritis, or uterine infection. If infection and/or retained products are implicated, you will need to consult.
short-lived mood change, called “postpartum blues”
occurs in about 50 to 80% of new mothers in our culture between three and five days after birth
postpartum blues
Symptoms often comprise several of the following: dysphoric mood, crying, anxiety, insomnia, irritability, loss of appetite, and mood swings.
Postpartum depression (PPD) occurs in 10-15% of pregnancies
Depression can begin during the antepartum with subtle signs such as fatigue, anxiety, or change in sleep or appetite habits. Depression may only become recognized when exacerbated in postpartum. Infant attachment and bonding may be affected by the mother’s lack of response to infant cues such as cooing or crying.
The depressed woman frequently does not have perspective on her situation, and often may be unable to reach out.
She may be anxious or have a flat affect. She may sleep a lot or have insomnia. She may be overly concerned about her baby, or may not be fully cued into the needs of her baby. With the poor follow-up we have in our country in the postpartum period, many cases of postpartum depression go unrecognized. This can have sad and serious consequences.
The Edinburg Postpartum depression Scale and Beck’s Postpartum Depression Screening Scale (PDSS) have been well validated
screening tools and that is all. Not diagnostic tools
This scale should be given to and discussed with EVERY postpartum client at 4-6 weeks on a routine basis, and to any client that exhibits any of the s/s of PPD.
Postpartum thyroid problems can mimic postpartum depression and so thyroid studies should be done when a woman seems depressed.
Psychosis is florid and not likely to be missed, as the woman is out of touch with reality, and often is not able to sleep at all.
It usually appears fairly shortly after the birth, but may develop up to a few weeks postpartum. Treatment involves medical management, usually from a psychiatrist, medication, and frequently hospitalization.
Symptoms of nipple candida
sharp shooting pain in the nipple and red color
Management of nipple candida
Start nursing on the least sore side
good handwashing
nurse frequently for shorter periods of time
uterine involution
The uterus is non-palpable abdominally by 2 weeks pp
Signs of sub-involution
enlarged uterus and heavy period like bleeding
Treatment for sub-involution
po .2mg q4hrs for 3 days
Postpartum depression
All women should be screened by 2 weeks
Pain with calf pressure
sign of postpartum thrombophlebitis
signs of mastitis
fever malaise tachy chills painful breast with reddened area
warm compress, nurse more often
if client calls with a mild pain in one breast and made worse when baby nurses
Prevention of mastitis
nurse more and prevent engorgement
5 principles about drug use
- Find an approach that is comfortable to you
- Be non-judgemental
- Make screening a part of your routine care
- Know how to respond
- Be positive
The acronym SAVER is a useful way to remember key aspects of the screening process:
Screen all female patients for violence
Ask direct questions in a nonjudgmental way
Validate the patient
Evaluate survivors and educate all female patients
Refer survivors
