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617 eyes > NP611 Modul 8, 9, 10 > Flashcards

NP611 Modul 8, 9, 10 Flashcards

1
Q

Which is an accurate statement about DV

A

Its associated with higher death rates than in a non-pregnant state.

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2
Q

If a history of childhood sexual abuse….

A

the client may need to dictate when you can do a pelvic exam

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3
Q

Pregnant smoker of 1-1.5 packs per day

A

Is at risk for placental abruption

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4
Q

Is alcohol ok during pregnancy, even if just one glass??

A

No alcohol is best

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5
Q

Which group is a primary concern for drinking during pregnancy

A

binge drinkers

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6
Q

what is true about alcohol during pregnancy

A

Even one drink/week has been shown to cause problems

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7
Q

what is not associated with pregnancy and smoking

A

pre-eclampsia

childhood asthma

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8
Q

First approach to smoking cessation during pregnancy

A

the 5 A’s

  • ask
  • advise
  • assess
  • assist
  • arrange
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9
Q

When a person uses marijuana during pregnancy

A

She should be asked about other substance use

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10
Q

Meth is associated with

A

placental abruption

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11
Q

Smoking during pregnancy is associated with

A

spntaneous abortion, abnormal placetation (abruptio or previa), constricture of uterine vessels and placental vessels, low birth weight, decreased birth length, and preterm delivery

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12
Q

Infants of women who smoke have higher incidence of

A

IDS and apnea

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13
Q

Alcohol is associated with 2nd trimester spontaneous abortion

A

and nutritional deficiency.

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14
Q

cocaine during pregnancy is associated with

(cold-turkey)

A

spontaneous abortion, preterm labor, abruptio placentae, rapid labor and delivery, and low birth weight and fetal death.
Withdrawal exists for the newborn

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15
Q

cocaine in infants- do not breastfeed while using cocaine

A

may be at risk for congenital malformations, behavioral abnormalities

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16
Q

Amphetamines

A

withdrawal exists

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17
Q

narcotics/opiates

(heroin) usually need to wean-methadone candidate

A

withdrawal exists. Discuss with physician about taking methadone

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18
Q

Stimulants

A

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.

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19
Q

relaxants

A

cause withdrawal symptoms

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20
Q

screening tools-routine screening should occur all through the pregnancy
verbal and written-need to do both
what percentage admit to use-40%

A

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)

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21
Q

women are more motivated to make changes while they are pregnant

A

because of baby

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22
Q

DV

A

more deadly during pregnancy

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23
Q

childhood sexual abuse-25%

A

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
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24
Q

understand medical conditions for these women

A

miscarriages
stillbirth
physical symptoms

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25
Q

FAS- physical and cognitive damage

specific birth defects
more advanced

A

FAE-not a full syndrome
More subtle
May have trouble with socialization or school

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26
Q

Minimum amount of alcohol recommended in pregnancy

A

ZERO

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27
Q

DV- survivor friendly

A

routine screen everyone
Make it the norm
Get information out so client does not have to ask

28
Q

How to get client alone

and why client would not say she is being abused

A

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

29
Q

Tools

A 
TACE
TWEAK
AUDIT
4P's
TQDH (ten question drinking history)
30
Q

benefits of breastfeeding

A

Fewer ear infections
less risk of SIDS
lower costs

31
Q

6 week PP exam should include

A

Abdominal diastasis
bimanuel exam
assess for cystocele

32
Q

discomforts of PP include

A

excessive diaphoresis
uterine pains
breast engorgement

33
Q

Related to breastfeeding

A

Oxytocin promotes bonding and establishes milk ejection

34
Q

Breastfed babies should be fed

A

8-12 times in 24 hours

35
Q

Breastfeeding is advised for 1 year

A

To increase milk supply:
frequent feedings
early initiation
night feedings on demand

36
Q

Not enough milk may be seen by:

A

a woman who nurses for only 5 minutes a side every 6 hours

37
Q

Maternal benefits include

A

lower incidence of uterine and breast cancer and reduced risk of osteoporosis

38
Q

Breastfeeding may be beneficial for the baby in

A

decreasing the incidence of otitis media, decreasing respiratory infections, and possibly even dental malocclusion.

39
Q

The benefits to the mother besides the psychosocial ones may include the association with

A

decreased breast cancer rates, rapid uterine involution, and in some women, a more rapid return to their pre-pregnant weight

40
Q

Breastfeeding requires approximately 500 calories more for a total of 2700 calories/day,

A

May help to return to pre-pregnancy weight faster

41
Q

Why diaphoresis and urinary frequency pp?

A

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.

42
Q

Painful cramping after delivery

A

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
-

43
Q

Bleeding increased at 10 days pp lasting 1-2 hours

A

placental eschar
(scab from where the placenta was attached sloughing off)
Bleeding like a period. Bright red and can occur more than once

44
Q

What about sex after pregnancy

A

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

45
Q

Baby crying and won’t latch on

A

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!!!

46
Q

Mastitis is an infection that often attacks a woman at her weakest point, in this case her breasts,

A

nipple candida can present challenges to the nurse practitioner as she supports the breastfeeding client.

47
Q

The diagnosis of subinvolution is made clinically.

A

At 2 weeks postpartum, the uterus is already a pelvic organ and by 6 weeks has returned to normal size.

48
Q

Subinvolution occurs when the normal shrinking of the uterus has slowed or stopped.

A

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.

49
Q

short-lived mood change, called “postpartum blues”

A

occurs in about 50 to 80% of new mothers in our culture between three and five days after birth

50
Q

postpartum blues

A

Symptoms often comprise several of the following: dysphoric mood, crying, anxiety, insomnia, irritability, loss of appetite, and mood swings.

51
Q

Postpartum depression (PPD) occurs in 10-15% of pregnancies

A

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.

52
Q

The depressed woman frequently does not have perspective on her situation, and often may be unable to reach out.

A

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.

53
Q

The Edinburg Postpartum depression Scale and Beck’s Postpartum Depression Screening Scale (PDSS) have been well validated

A

screening tools and that is all. Not diagnostic tools

54
Q

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.

A

Postpartum thyroid problems can mimic postpartum depression and so thyroid studies should be done when a woman seems depressed.

55
Q

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.

A

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.

56
Q

Symptoms of nipple candida

A

sharp shooting pain in the nipple and red color

57
Q

Management of nipple candida

A

Start nursing on the least sore side
good handwashing
nurse frequently for shorter periods of time

58
Q

uterine involution

A

The uterus is non-palpable abdominally by 2 weeks pp

59
Q

Signs of sub-involution

A

enlarged uterus and heavy period like bleeding

60
Q

Treatment for sub-involution

A

po .2mg q4hrs for 3 days

61
Q

Postpartum depression

A

All women should be screened by 2 weeks

62
Q

Pain with calf pressure

A

sign of postpartum thrombophlebitis

63
Q

signs of mastitis

A 
fever
malaise
tachy
chills
painful breast with reddened area
64
Q

warm compress, nurse more often

A

if client calls with a mild pain in one breast and made worse when baby nurses

65
Q

Prevention of mastitis

A

nurse more and prevent engorgement

66
Q

5 principles about drug use

A
  1. Find an approach that is comfortable to you
  2. Be non-judgemental
  3. Make screening a part of your routine care
  4. Know how to respond
  5. Be positive
67
Q

The acronym SAVER is a useful way to remember key aspects of the screening process:

A

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

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