Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Fall 2020 Sexual and Reproductive Health > Pregnancy Options: Counseling and Abortion Care > Flashcards

Pregnancy Options: Counseling and Abortion Care Flashcards

1
Q

Objectives

A
  1. Understand key aspects of pregnancy options counseling
  2. Review BhCG in determining normal pregnancy vs. ectopic pregnancy vs. early pregnancy loss
  3. Identify abortion care options
  4. Engage in values clarification regarding sexual and reproductive health and abortion care
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

NP/CNM Role

  1. Pt ______ Options Counseling
    • ​​R_______ for Patients
    • Non-d______, Non-j_______, un______
      • ​(1): Evaluate conflicts between personal beliefs and professional responsibilities
  2. Pregnancy related clinical ______
    • ​​Pregnancy d_____/c_____, r/o _____, prenatal ____, ab_____, mis_____ mngmt, ______ referrals, federal and state laws
A
  1. Centered
    • Resources
    • directive, judgemental, unbiased
      • ​​Value Clarification
  2. services
    1. diagnosis/confirmation, ectopic, care, abortion, miscarriage, abortion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Options Counseling

  • Explore _____: How do you ____ about the pregnancy test result? What are your ____ about being a parent?
  • Identify _____: Do you know what your options are? What options would you like more info about?
  • Identify _____ systems: assess risk: parters, family- who can you talk to who could be supportive?
A
  • Feelings: feel, thoughts
  • Options
  • Support
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Values Clarification Exercise for Health Professionals

  • What are your _____ values around sex, birth control, pregnancy, adoption and abortion?
  • Do your current values around sex, birth control, pregnancy, adoption and abortion ____ from the values you grew up with?
  • Do your ______ or _____ beliefs influence your beliefs about sex, birth control, pregnancy, adoption and abortion?
  • Think about your ____ and how your attitudes toward sex, pregnancy, birth control, adoption and abortion might have _____ for you at different ____ of your life.
  • What personal _______ do you think might influence your comfort level with client issues around sex, birth control, pregnancy, adoption and abortion?
A
  • family/s
  • differ
  • religious, spiritual
  • age, changed at diff stages
  • experiences
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Pregnancy Confirmation (BhCG)

  • Serum __-__ days/urine __-__ days after fertilization
  • Qualitative vs. Quantitative hCG tests
    • ​False pos = ______
  • Predictable rise and peak over course of pregnancy
    • Non pregnant = ___ mIU/mL
    • HS UPT can detect ___ mIU/mL
    • Peaks __-__ wks, ____-____ mIU/mL
    • Undetectable ___-____ wks s/p pregnancy
A
  • 8-10d, 12-14d
  • Qualitative is just +/-
    • RARE
  • Predictable rise and peak
    • <5
    • 25
    • 9-12 wks, 25,000-30,000
    • 4-12 wks post pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

BhCG

  • Serial BhCG levels =
    • Normal Pregnancy
      • Minimum increase by (__%) ___% in 48 hrs
      • Mean Doubling time: ___ hrs (> 90% double by 72 hrs)
    • Slow rate of rise, plateau, or decline suggests: e_____, non-_____ IUP, E__
  • Disciminatory zone
    • BhCG = ___-___ mIU/mL
    • Level at which IUP should be _____ on sono (Gestational sac)
A
  • 2-3 measures over time -> we use BhCG to confirm pregnancy and serial measures to determine is pregnancy is progressing normally
    • Normal
      • (35%) 50%
      • 48hrs
    • Slow, plateau, decline: ectopic, non-viable IUP, EPL
  • 1500-2000
  • visible on sono
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

**ECTOPIC Pregnancy**

  • **R/O Ectopic:
    • ​HIGH RISK: ___ of ectopic, _____ damage (surgery/infx), I _ _, ___ exposure, use of ____
    • Consider: All women w/ + _____ and ______ and/or abdominal ___/_____
    • Exam: ____ signs, abdmnl, pelvic (_____), s___, _____ quantiative BhCGs q48-72hr
    • Tx: (2)
A
  • Hx, tubal, IUD, DES, ART (assistive reproductive technology)
  • +UPT, bleeding and/or pain/cramping
  • VS, bimanual, sono, serial BhCG
  • Inpatient methotrexate or surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Early Pregnancy Loss (1st trimester up to 12 6/7 weeks EGS): Terminology

ED discharge papers often say: Threatened abortion - just means there was some _____ but now its fine and you can follow with BhCG

A

Bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

US: Intraauterine Pregnancy

Gestational sac: ___ wks (__-__mm)

York sac: ___ wks

Embryo = _____ _____: __ wks (__-__mm)

Cardiac motion: __-__wks

A

5 wks (8-10mm)

5.5 wks

Fetal Pole 6 wks (5-7mm)

5.5-6wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Management and F/U of EPL (1st trimester)

  • **_______ management (up to 4 wks)** or intervention (mediacl or surgical)
    • ​Danger sx: severe _____, severe ______, sx of ____
  • Follow up
    • ​Confirmation of complete _____
    • Preconception and/or contraception ______
    • R_____ as indicated
    • R_____ for recurrent pregnancy loss
    • Counseling re ______ aspects of EPL
A
  • Expectant management (up to 4 wks)
    • ​bleeding, cramping, infx
  • Follow up
    • expulsion
    • counseling
    • Rhogam
    • Referrals
    • emotional
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is your diagnosis? What is your plan?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

NASEM Consensus Study Report 2018

The Safety and Quality of Abortion Care in the US

A

“Both trained physicians and advanced practice clinicians (APCs) (PAs, certified nurse midwives (CNMs), and NPs can safely and effectively provide medication and aspiration abortions”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Abortion within APC Scope of Practice

More and more states are allowing NPs to provide?

Abortion care is going to increase in what setting?

A

Medication abortion

Primary Care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Abortion in the US

  • In 2017
    • ​862,000 _____ of abortions
    • 13.5 abortion ____ (the number of abortions per 1,000 women 15-44)
    • 18.4 abortion ____ (the number of abortions per 100 pregnancies ending in either abortion or live birth)
A
  • number
  • rate
  • ratio
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

The Turnaway Study

  • 1000 women, 30 clinics nationwide, interviews over 5 yrs, compared trajectories of women who received a wanted abortion to those who were turned away bc they were past the facilities gestational age limit
  • Having an abortion
    • ​Did not increase (2)
    • Increased (1)
    • Is considered the _____ decision by 95% of participants
  • Being denied an abortion​
    • ​Increased odds of being ______ or living below the _____ level
    • Increased likelihood of staying in a _____ relationship
    • Increased risk of serious _____ problems
    • Existing children are less likely to be on time _______
A
  • mental health problems, substance abuse
  • positive outlook on the future and likelihood of having achieved life goals within 1 yr
  • right decision
  • unemployed, poverty
  • violent
  • health
  • developmentally
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Medication Abortion

Evidence Based Regimen

  • Gestational age: < ___ days from LMP
  • ____ at initial visit
  • _______ 200mg, dispensed in _____
  • _______ 800mcg, used at home __-__ hrs after taking mifepristone
    • _____ up to 77d or ____ up to 63d
    • (2nd dose __ hrs after 1st if >63d)
  • ______I 600mg po q4-6 prn), ______ prn (_____ 4mg po q8)
  • f/u visit __-__d
  • Test is ____ or _____
  • Contraception: (2) same day, (3) same day as miso or after bleeding (1wk), ____ at f/u w/in 7-14d (after sono or betas confirm complete)
A
  • < 77
  • Ultrasound
  • Mifepristone, office
  • Misoprostol, 24-48 after
    • buccal, vaginal
    • 4
  • Ibuprofen, Antiemetic (zofran)
  • 7-14
  • Sono or Serial hCG
  • Implant or depo, pills/patch/ring, IUD

Essentially blocks progesterone to cause uterus to contract and push out the baby

17
Q

Aspiration Abortion

  • to __-__ wks
  • Cervical _______: osmotic dilators, at > 12 wks give with?
  • _____ or ______ attached to _____ source (manual or electric)
  • Local (paracervical ____) + minimal, mod, or deep______
  • Prophylactic _____ (100mg/200mg)
  • When can you start Conception?
  • __-__ visits
A
  • 14-16
  • Dilation, misoprostol (pv, po)
  • Vacuum or Cannula, suction
  • block + sedation
  • Doxy
  • All methods you can start day of
  • 1-2
18
Q

Medication Abortion CIs

  1. Known _____ to Meds
  2. Unable to follow ______ or ___-__
  3. Severe H__. C__, L___, R____ disease
  4. Severe A______
  5. _____pathy
  6. Long Term Oral ______ Use
  7. ___ in situ
  8. > ___ wks EGA (estimated gestational age)
  9. ______ contraindicated
A
  1. Allergies
  2. instructions, follow up
  3. HTN, CHD (congenital heart defects), Liver, Renal
  4. Anemia
  5. Coagulopathy
  6. IUC (intra-auterine contraception device)
  7. 11
  8. Surgical
19
Q

Surgical Abortion CIs

  • Uncontrolled D__, H___
  • Current ______ Compromise
  • Severe _____
  • >__ wks: Hx of c-sec or myomectomy AND placenta previa or overlying scar (must be done in _____)
  • > __ wks
A
  • DM, HTN
  • Respiratory
  • Anemia
  • 14
  • 24
20
Q

Medication AB: Possible Complications

(5)

A

Problematic Bleeding

Continuing Pregnancy

Incomplete

Infection

Hemorrhage

21
Q

Surgical AB: Possible Complications

(5)

A

Abnormal Bleeding

Continuing Pregnancy

Incomplete

Infection: Post Abortal Endometritis <3%

Hemorrhage <1%/Uterine Performation <1%

Fall 2020 Sexual and Reproductive Health (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions