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Reproductive Health > OB: Test 2 > Flashcards

OB: Test 2 Flashcards

1
Q
  1. Review family history and culture impact on health, p. 78:
    a. Familial diseases
A

i. May be detected by assessing family hx
ii. DM, breast, colorectal, and ovarian cancer, heart disease, asthma, and allergies are examples of disease risks inherited from family members

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2
Q
  1. Review family history and culture impact on health, p. 78
    b. Race
A

i. Osteoporosis is more prevalent in light- or yellow-skinned women
ii. SCD (Sickle Cell Disease) is found in AA
iii. G-6-PD deficiency occurs more often in people of Mediterranean descent
iv. AA women are excessively prone to chronic illness and disability, regardless of their socioeconomic status
v. Early health insults r/t the stress of living in a race-conscious society has been cited as a potential cause of this increased risk and structural factors r/t racism can’t be ignored when considering epigenetic effects of such stress

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3
Q
  1. Review family history and culture impact on health, p. 78
    c. Ethnic, cultural, and religious influences
A

i. May be associated with unhealthy practices includes eating uncooked meat, prolonged fasting, refusing to see a HCP, or lack of health-directed behaviors
ii. Religiosity has been positively associated with mental health in women with cancer & reduced anxiety in a group of pregnant women
iii. Sensitivity to a client’s culture, religion, and ethnic influences is essential in trying to assist client with any health behavior changes, because these variables strongly affect health beliefs

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4
Q

Review family history and culture impact on health, p. 78
d. Current or past medical problems

A

i. Particular concern are the risks of prior problems as well as the potential or real effects of current and past illness on new disease conditions
ii. i.e. research indicates a PMH of smoking increases the risk of multiple myeloma and colon cancer
iii. other medical problems include polypharmacy, as multiple drug interactions may cause increased risks and confusing presentations, and past PID increases the risk of ectopic pregnancy or infertility

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5
Q
  1. Review screening and dietary recommendations for women. Don’t memorize immunization schedule.
A

a. Screenings in healthy adult women – BSE, Pap, Immunizations, Dental, Eye exams, BP, Cholesterol, CAGE, BMI, Skin cancer, STDs
i. alcohol misuse, drug use, dietary/nutrition, injury prevention, skin cancer, cancers (general), activity/exercise, STI, unplanned pregnancy, tobacco, depression, hepatitis B & C, G & C, intimate partner violence, TB, lipids, obesity, osteoporosis, HTN

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6
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7
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8
Q
  1. Review and understand BMI classifications p. 87 Table 5-3
A
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9
Q
  1. Review tables 5-5 pp. 91-92: Screening Examinations and Tests for Healthy Nonpregnant Adult Women
A
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10
Q

Review tables 5-6 pp. 91-92: Recommendations for Breast Cancer Screening Examination

A
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11
Q

Review tables 5-7 pp. 91-92: Recommendations for Other cancer screenings in Healthy Asymptomatic Women per USPSTF ans ACS

A
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12
Q

Prenatal/Pregnancy/Postpartum:
1. Understand common discomforts in pregnancy and which hormone(s) cause them.
o Back pain

A

upper back pain in first trimester 2/2 increased breast size. Lower back pain in 2nd half of pregnancy 2/2 increasing weight of uterus, relaxing of sacroiliac ligaments. Exaggerated lordosis of pregnancy strains back muscles and causes pain

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13
Q
  1. Understand common discomforts in pregnancy and which hormone(s) cause them.
    o Breast tenderness-
A

progesterone

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14
Q

Understand common discomforts in pregnancy and which hormone(s) cause them.
o Constipation

A

progesterone; pressure of enlarging uterus. May be exacerbated by iron supplements. Occurs in first trimester and usually resolves by 2nd.

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15
Q
  1. Understand common discomforts in pregnancy and which hormone(s) cause them.
    o Dyspareunia
A

physiologic changes that cause pelvic/vaginal congestion. Most likely in 2nd half of pregnancy

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16
Q
  1. Understand common discomforts in pregnancy and which hormone(s) cause them.
    o Dyspnea
A

etiology not clear; may be 2/2 altered respiratory center sensitivity (progesterone) and diaphragm displacement

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17
Q
  1. Understand common discomforts in pregnancy and which hormone(s) cause them:
    o Edema
A

dependent edema 2/2 impaired venous circulation & increase venous pressure in the lower extremities from the enlarged uterus. Appears in the 3rd trimester

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18
Q
  1. Understand common discomforts in pregnancy and which hormone(s) cause them:
    o Fatigue
A

increased energy requirements, weight gain, and disrupted sleep may be present. Common in 1st & 3rd trimesters

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19
Q
  1. Understand common discomforts in pregnancy and which hormone(s) cause them:
    o Flatulence & gas pain
A

decreased GI motility & uterine displacement of intestines. First develops in 1st trimester and may occur at any time

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20
Q
  1. Understand common discomforts in pregnancy and which hormone(s) cause them:
    o Gingivitis
A

pregnancy changes in oral mucosa increase the likelihood of gingivitis. Appears in 2nd trimester

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21
Q
  1. Understand common discomforts in pregnancy and which hormone(s) cause them:
    o Heartburn (pyrosis)
A

progesterone-induced relaxation of LES, slower emptying of gastric contents, smaller capacity stomach. Appears in 3rd trimester

22
Q
  1. Understand common discomforts in pregnancy and which hormone(s) cause them:
    o Heart palpitations/short period of ST
A

etiology may be a pregnancy-induced increase in blood volume and pulse; enlarged heart is more arrhythmogenic

23
Q
  1. Understand common discomforts in pregnancy and which hormone(s) cause them:
    o Hemorrhoids
A

progesterone-induced relaxation of veins walls in rectum, along with enlarged uterus, causes pelvic venous congestion. Appears any time but most likely in 3rd trimester

24
Q
  1. Understand common discomforts in pregnancy and which hormone(s) cause them:
    o Insomnia
A

may be 2/2 frequent waking from back pain, heartburn/nocturia

25
Q
  1. Understand common discomforts in pregnancy and which hormone(s) cause them:
    Leg Cramps
A

may be linked to changes in Ca, Mg, & phosphate levels or ability of Ca to enter muscles, but causes haven’t been proven. 2nd/3rd trimester

26
Q

1.Understand common discomforts in pregnancy and which hormone(s) cause them: Leucorrhea

A

2nd/3rd trimester

27
Q
  1. Understand common discomforts in pregnancy and which hormone(s) cause them: Nasal congestion
A

hyperemia & increased blood flow in nasal passages (estrogen effect)

28
Q
  1. Understand common discomforts in pregnancy and which hormone(s) cause them: N/V
A

HCG, estrogen, progesterone, placental prostaglandin E2. Exact etiology unknown. Presents & peaks in 1st trimester.

29
Q
  1. Understand common discomforts in pregnancy and which hormone(s) cause them: Ptyalism (excessive salivation)
A

etiology unknown; often assoc. with N/V

30
Q
  1. Understand common discomforts in pregnancy and which hormone(s) cause them: Round ligament pain
A

ligaments increase in length as uterus rises in abd; pain probably from stretching of ligaments. Often worsens/is elicited with exercise/turning the torso. Appears early in 2nd trimester; usually unilateral

31
Q
  1. Understand common discomforts in pregnancy and which hormone(s) cause them: Sciatica
A

pressure on sciatic nerve from joint laxity, often elicited by twisting, lifting, or moving the leg. Typically appears in 3rd trimester & is unilateral

32
Q
  1. Understand common discomforts in pregnancy and which hormone(s) cause them: Syncope (supine hypotensive syndrome)
A

enlarged uterus impairs venous return & causes hypotension; typically, 3rd trimester

33
Q
  1. Understand common discomforts in pregnancy and which hormone(s) cause them: Tingling & numbness of fingers
A

kyphosis places pressure/traction on nerves in arm; often occurs at night

34
Q
  1. Understand common discomforts in pregnancy and which hormone(s) cause them: Urinary frequency & nocturia
A

mechanical pressure from enlarging uterus in 1st trimester results in decreased bladder capacity; frequently 1st & 3rd trimesters

35
Q
  1. Understand common discomforts in pregnancy and which hormone(s) cause them: Varicosities
A

2/2 venous distension from increased venous pressure & vasodilation. Familial tendency may increase risk. Most common in legs/vulva; appears in 2nd & 3rd trimesters

36
Q
  1. Nutrition in pregnancy by the trimester, weight gain: Supplement
A

Folic acid in MVI 1 mo prior to and 3 months after conception (400 mcg/day)

37
Q
  1. Nutrition in pregnancy by the trimester, weight gain: Diet
A
  1. 3 meal & 2 snacks; avoid prolonged fasting
  2. 5 fruits & veggies MINIMUM/day
  3. Whole-grain carbs- limit high sugar desserts, juices, sodas
  4. Adequate protein, choosing more plant-based sources like nuts/beans
38
Q

Nutrition in pregnancy by the trimester, weight gain: Diet

A
  1. At least 2 servings best-choices fish weekly/ 1 serving good-choices
    a. Best choices: catfish, clam, crab, flounder, Pollock, salmon, sardines, shrimp, sole, trout, whitefish
    b. Good choices: bluefish, carp, Chilean sea bass, halibut, snapper, tuna (albacore, white tuna, canned & fresh/frozen, yellowfin) Limit canned tuna to twice/wk
39
Q

Nutrition in pregnancy by the trimester, weight gain: Diet- Water

A

8-10 glasses of water/day

40
Q

8-10 glasses of water/day

A

a. Limit caffeine to 200 mg/day (2 cups coffee/4 cups black tea)
b. Avoid all alcoholic beverages
c. Limit sweetened drinks

41
Q

Nutrition in pregnancy by the trimester, weight gain: Diet- Ensure adequate intake of micronutrients

A

a. Vit A as beta-carotene; limit food sources with preformed Vit A such as liver (<4 oz./wk) or cod liver oil
b. Vit D from exposure to sunlight. If not feasible, consider Vit D3 supplements
c. Folic acid through MVI supplement
d. Strict vegans need Vit B12 supplement/consume B12-fortified products
e. Iodine through diet (dairy & fish) or a MVI with iodine (preferably potassium iodine)
f. Iron through diet, MVI, or addtl low-dose supplement if anemic
g. Calcium through diet with supplementation suggested for women at risk for preeclampsia
h. Choline-rich food sources such as meat, poultry, eggs (not typically incl in prenatal vitamins)

42
Q

Foods to avoid:

A

i. Soft cheeses unless they clearly state they are made from pasteurized milk incl Brie, feta, Camembert, blue-veined cheeses, and Mexican-style cheeses such as queso blanco, queso fresco, & queso panela
ii. Uncooked meats or refrigerated pates or meat spreads
iii. Raw eggs, cookie dough
iv. Raw fish
v. Mercury-containing fish: king mackerel, marlin, orange roughy, shark, swordfish, tilefish (Gulf of Mexico), tuna (big-eye)
vi. Deli meat salads/smoked seafood
vii. Raw sprouts
viii. Raw unpasteurized fruit juice, raw/unpasteurized dairy products
ix. Refrigerated perishable foods that have not been consumed in 3 days

43
Q

Food handling:

A

i. Wash cutting boards and equipment used to cut raw meat with hot soap and water
ii. Wash & peel raw fruits & vegetable before eating
iii. Wash hands after handling hot dogs, luncheon meats, or deli meats

44
Q

Food processing:

A

i. Cook all deli meats, hot dogs, smoked meats, pates, and luncheon meats to steaming before eating
ii. Cook meat and eggs to 71.1 C (160 F)
iii. Cook seafood to 62.8 C (145 F)

45
Q

Plan for daily supplementation intake

A

i. Recommended daily intake of iron in pregnancy is 27mg
1. All pregnant women are advised to add supplemental iron during pregnancy, esp after the 1st trimester when the iron needs are the greatest
2. Most PNV contain adequate amounts of iron for supplementation
3. Women with iron-deficiency anemia may need up to 60mg or more of daily iron supplementation
4. Encourage a diet that includes foods high in iron (i.e. kale, spinach, lentils, beans, lean meats, fortified breads and cereals, and blackstrap molasses)
5. Calcium and magnesium if given with iron decreases absorption while vitamin C enhances absorption

46
Q

Estimated 50% of NTDs (neural tube defects) can be prevented with 400 ug of folic acid daily starting before conception and continuing in early pregnancy

A
  1. Women with a hx or a child with NTD are recommended to increase their folic acid intake to 4mg daily starting 1 month prior to conception and continuing through 1st trimester
  2. Smoking & alcohol use decreases folate levels
47
Q

Women may choose to follow a vegetarian, vegan, or macrobiotic diet for health, personal, philosophical, ethical, and/or religious reasons

A
  1. For most of these women, a PNV or multivitamin supplement is recommended that contains adequate amounts of vitamin B 12
48
Q

Recommended vitamin D for pregnant women who are on a dietary allowance is 600 IU of vitamin D daily (most PNV contain at least 400 IU)

A
  1. Supplementation with 1,000 – 2,000 IU of vitamin D daily is considered safe in pregnancy for women with vitamin D deficiency
  2. Vitamin D can also be obtained through limited sun exposure and consumption of certain fish (i.e. salmon, tuba) or fish with oils, fortified milk, cheese, and egg yolks
49
Q

Fatty acids are a vital component of cell membranes, they can’t be synthesized by the body, and DHA (omega-3 docosahexaenoic acid) and EPA (eicosapentaenoic acid) are esp vital for fetal growth and development and subsequent visual and cognitive function

A
  1. Omega-3 fatty acids are often lacking in most Americans diet
  2. Recommended consumption in pregnancy is 200-300 mg of DHA plus EPA, which can be found in fish, purified fish oils, or algal oil supplements
  3. Care should be taken to avoid those fish highest in mercury content (i.e. shark, swordfish, tilefish, king mackerel) and to limit consumption to two 6 oz servings/ week of fish lower in mercury content (i.e. salmon, canned light tuna, shrimp)
50
Q

Vitamin A deficiency is a global health issue in underdeveloped countries

A
  1. Supplementation is not recommended in the U.S. and high intake of vitamin A (10,000-50,000 IU) as retinol, not beta-carotene should be avoided to reduce risk of birth defects
  2. Prevention of foodborne illnesses such as listeriosis and toxoplasmosis is of special importance in pregnancy
  3. All pregnant women should be advised to avoid soft cheeses; unpasteurized dairy products and other “raw” foods including apple cider and sprouts; cold deli meats; and raw, uncooked, or undercooked eggs or meat
51
Q

Weight gain:

A
52
Q
  1. Teratogenic medications in pregnancy. Which are contraindicated? Table 19.1 p. 447
A

Reproductive Health (2 decks)

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