OB EXAM 1 Flashcards
Barriers to care
- High cost of care-caused by amount of NICU babies, high prices, readily accessible technology and greater obesity are the causes (nurses must become involved in the politics of cost because they can provide solutions to many health care problems at a low cost)
- Limited access to care- inability to pay- ACA has improved the ability to pay
- Lack of transportation and dependent child care
- Lack of insurance
- Lack of providers for low income women- physicians refuse to take Medicaid patients
Infant mortality
one reason ours is so high is because of amount of LBW infants in the united states compared to other countries- Increase amount of infants who are breastfed, increase infants who are put on their back to sleep, make sure parents are receiving early adequate care
Maternal mortality-
prevention methods- improving access to skilled attendants at birth, providing postabortion care, improving family planning services and providing adolescents with better reproductive services
Social media- ANA published six principles regarding social media;
- nurses must not transmit or place online individually identifiable patient information
- nurses must observe ethically prescribed professional patient nurse boundaries
- nurses should understand that patients, colleagues, institutions and employers can view their postings
- nurses should take advantage of privacy settings and seek separate personal and professional info online
- nurses should bring content that could harm a patient’s privacy, rights or welfare to the authorities nurses should participate in developing institutional policies governing online contact
Interviewing client with limited English
- Interacting with family members present during caregiving is important. Using active listening skills and asking about those who may be absent is important
- Important to avoid generalizing that every person practices every cultural belief in a group
- Culture determines viewpoint
- nurse must assess the beliefs and practices of patients
- May need an interpreter in some instances- the interpreter must be mature enough to be trusted with private information- may be necessary to use family members
- Questions should be addressed to the women and not the interpreter, quiet private location should be used
Partner violence/ escape plan
- Nurse should provide services and telephone numbers of a hotline and a battered women’s shelter
- Safety plan should be put in place if woman goes back to abuser
- Don’t use the word victim when speaking with the patient- it connotes powerlessness and hopelessness- use the word “survivor” as it seems more powerful
- Male person should be asked to leave the room before interviewing
- Pocket cards listing emergency numbers should be given
- Communicating- Do not ask “why”, do not talk negatively about the abuser, she may become defensive
- Do not talk directly to the abuser about your suspicions
- Say things like “ I believe you” “ I am here for you “ “It is a crime” “You are not alone” “ you deserve better” “It will get worse”
Smoking and alcohol use during Pregnancy
- Women who are problem drinkers are often depressed, have motor vehicle accidents and higher incidence of attempted suicide.
- Cigarette smoking impairs fertility in both women and men, reduces the age of menopause, and causes low birth weight
- Interventions for smoking cessation- the five A’s- Ask (when did you start, do you want to quit) Advise (give info on effects on pregnancy), Assess ( does anyone else smoke at home, have you tried quitting before), Assist (provide support, encourage, reach), arrange follow up (make a phone call around the time of her quit date)
Primary/ tertiary Prevention
Prim. Prev:
- Sexual counseling: Practice safe sex, limit the number of partners, avoid contact with high risk partners, delay the onset of sexual activity until older than 16 yrs.
- bariers and oral contraceptices reduce the risk for developing PID.
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Sec. Prev:
- Screening for infections in high risk
-rapid dx and effective treatment of STD and lower urinary tract infections.
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Ter. prev:
-Early intervention & compete treatment.
-HIV AIDS-
• Risk factors- IV drug use, multiple sexual partners, maternal history of multiple STIs, blood transfusion, men who have sex with men
• C section
• Plan of care-
Provide counseling prior to and after testing
Refer client for mental health consultation, legal assistance and financial resources
Use standard precautions
Administer antiviral prophylaxis, triple medication antiviral or highly active antiretroviral therapy as prescribed
Encourage immunization for Hep B, pneumonia, HIB and influenza
Encourage use of condoms to minimize exposure if partner is the source of infection
Review plan for schedule c section at 38 weeks for maternal viral load of more than 1,000 copies/ml
Infant should be bathed after birth before remaining with the mother
No breastfeeding
Provider must report cases to local health department
Administer Retrovir at 14 weeks gestation, throughout pregnancy and before onset of labor
Administer Retrovir to the infant at delivery and for 6 weeks following birth
-HPV-
years can provide early detection. Should screen even during pregnancy
• Small warts with cauliflower like appearance, and abnormal changes to cervix that can be detected by a pap test
• Teaching- Client applied cream- such as imiquimod, or trichloroacetic acid application
Vaccines are recommended to protect against low risk types of HPV that cause genital wartsand high risk types of HPV that cause cancer. Vaccine for clients ages 9- 26 years of age, educate clients regarding safe sex- monogamy and correct consistent condom use
• Avoid any interventions during labor and delivery that could cause bleeding and increase risk of newborn transmission, such as : Episiotomy, forceps, internal fetal monitoring
-Genital Herpes-
- Spread by direct contact with oral or genital lesions. Transmission to the fetus is greatest during vaginal birth if woman has active lesions
- Symptoms- painful blisters and tender lymph nodes
- Fetal consequences- miscarriage, preterm labor and intrauterine growth restriction
- C section recommended for all women in labor with active genital herpes lesions or early symptoms of impending breakout such as vulvar pain and itching
- Treat with Acyclovir
STI protection
- Correct use of latex condoms
- Sexual partners selected with great care
- Partners should be asked about history of STIs
- Preexposure vaccination is one of the most effective methods for preventing transmission of some STIS- hep A, hep B and HPV
- Abstinence when being treated for an STI
IUDS
Inserted through the cervix and placed in the uterus. The most effective contraceptive method at preventing pregnancy.
• Device must be monitored monthly by clients after menstruation to ensure the presence of the small string that hangs from the device
IUD Benefits
- Effective for 1-10 years
- Can be used while breastfeeding
- Reversed with immediate return to fertility
- Decrease menstrual pain and heavy bleeding if hormonal IUD
- Copper IUD- no hormones- safe for women who can’t use hormonal BC
IUD Risks-
- Risk of STIs
- Can cause irregular bleeding
- Risk of bacterial vaginosis, uterine perforation or uterine expulsion
- Must be removed if pregnant
- Can increase risk of pelvic inflammatory disease or ectopic pregnancy
- Watch for abnormal bleeding, abdominal pain, pain during intercourse, foul smelling vaginal discharge, fever or chills and change in string length
IUD Risks-
- Risk of STIs
- Can cause irregular bleeding
- Risk of bacterial vaginosis, uterine perforation or uterine expulsion
- Must be removed if pregnant
- Can increase risk of pelvic inflammatory disease or ectopic pregnancy
- Watch for abnormal bleeding, abdominal pain, pain during intercourse, foul smelling vaginal discharge, fever or chills and change in string length
Barrier Methods
Male condom- protects against STIs and involves the male in the BC method, high rate of noncompliance, herpes can still be spread with use of condoms , only use water soluble lubricants
Female condom- closed end of pouch is inserted into the vagina and open ring covers labia- offers protection against STIs
Diaphragm- client needs to be fitted, replaced every 2 years or if gained 15 lbs and after every pregnancy, must remain in place for 6 hours after sex, must use with spermicide for each act of coitus, doesn’t protect against STIs. CONTRAINDICATED- history of TSS, or UTIs
Hormonal Methods
Contraindicated- history of clots, stroke, cardiac problems, estrogen related cancers or if smoker
Report any chest pain, shortness of breath, leg pain, headache, hypertension or eye problems because of clot and stroke risk
- If client misses dose, instruct client that one pill can be taken as soon as possible. If missed 2 or 3 doses, follow manufactures instructions which usually includes starting a new pack
- Common side effects- nausea, headache, breast tenderness, fluid retention
- Effectiveness decreases when taken with antibiotics and anticonvulsants
Hormonal Methods
Injectable progestins/Depo
- Very effective and requires 4 injections per year
- Return to fertility can be delayed up to 18 months after discontinuation
- Should be used for maximum of 2 years
- Avoid massaging injection site following administration
Hormonal Methods
Transdermal Patch
- Apply patch to dry skin on buttock, abdomen, upper arm, torso. No breast area
- Change patch every week
- Apply patch same day of week for 3 weeks with no application on 4th week
- Risk of DVT
- Less effective in women weighing over 200 lbs
-Infertility-
- Defined as unable to conceive for 12 months
- Risk factors- Age 35 or greater, pelvic and abdominal surgical history, history of STIs, hormonal issues or adrenal gland disorders, exposure to hazardous materials, overweight or underweight, history of substance abuse
- Assessment- female- anatomy anomalies, check hormones- FSH, LH, progesterone and thyroid, evaluate coital technique, ultrasound to visualize reproductive organs, hysterosalpingography- dye injected to check patency of fallopian tubes (check for allergy to shellfish or iodine). Male- semen analysis- generally the first test because less expensive and less invasive
- Teaching- encourage couples to express and discuss feelings and recognize infertility as a major life stressor, advise that the use of medications to treat female infertility can increase the risk of multiple births by more than 25%, make referrals to grief and infertility support groups.
