Test 1 Flashcards
What is the least effective contraception with a 22% rate within the first year?
Coitus Interupptus (withdrawl method)
What is the calendar method?
Also known as natural family planning/fertility based awareness, it is a method of contraception where couples have periodic abstinence during the fertile periods
What are the 3 phases for natural family planning/fertility based awareness?
3 phases are identified:
Infertile phase-before ovulation
Fertile phase-Approximately 5 to days into the cycle
Infertile phase-After ovulation
What are the guidelines for someone who wants to implement natural family planning?
1) Accurately record the number of days in each cycle counting from the first day of menses for a period of at least 6 cycles
2) The start of the fertile period is figured by subtracting 18 days from the number of days in a woman’s shortest cycle
3) The end of the fertile period is established by subtracting 11 days from the number of days of the longest cycle
What is the relationship between basal body temperature and ovulation?
Before ovulation, a woman’s basal body temperature is often less than 98.6.
The progesterone after ovulation causes basal body temperature
How can basal body temperature be used for conception/contraception?
By measuring oral temperature prior to getting out of bed each morning each morning to monitor ovulations
What are the advantages to natural family planning?
What are the disadvantages to natural family planning?
Inexpensive, convenient, and no adverse effects
Reliability can be influences by many variables that impact temperature change (stress, fatigue, illness, alcohol, and warmth of sleeping environment). It also does not protect against STDs
What is the consistence of cervical mucous during ovulation?
During ovulation the cervical mucous becomes thin and flexible under the influence of estrogen and progesterone to allow sperm viability and motility.
What is a Spinnbarkeit’s sign?
The ability of the cervical mucous to stretch between fingers, almost the consistency of an egg white.
What is mittelschmerz?
Pain in the lower abdomen upon ovulation
What is the nursing education for a patient who wants to use the cervical mucus method of contraception?
Ensuring good hand hygiene, begin examining mucus from the last day of the menstrual cycle. Mucous is obtained from the vaginal introitus.
What are the disadvantages of a diaphragm?
Not recommended for women with a history of toxic shock or frequent urinary tract infections
Must be replaced every two years or 20% weight fluctuation, pregnancy, or pelvic surgery
Inconvenient, interfere with spontaneity, and requires reapplication with spermicidal cream, gel or foam with each act of coitus to be effective
What are the clinical findings of TSS?
High fever
Faint feeling,
Drop in BP
Watery Diarrhea
Headache
Muscle Aches
What reduces the risk of TSS from a diaphram?
proper handwashing and removing diaphragm within 6 hours of coitus
What is the client education for cervical caps?
It can be inserted up to six hours before intercourse and needs to be left in place at least 6 hours afterwards but for no more than 48 hours at a time.
Must be replaced every two years and refitted after any major gyn surgery, birth, or major weight fluctuation
Cap should be washed with mild soap and warm water for each use
What are the disadvantages of cervical caps?
Possible risk of TSS
Risk of allergic reaction
Does not protect against STIs
Contraindicated in women with abnormal paps or history of TSS
What is a contraceptive sponge?
A small round, polyurethane sponge with one concave side containing N-9 spermicide
How is a contraceptive sponge used?
The contraceptive sponge is moistened before insertion, concave side is placed near the cervix, and needs to be left in place for at least 6 hours after intercourse
How long can a contraceptive sponge provide protection for?
up to 24 hours
However it should not be left in for longer than 24-30 hours or it places the woman at risk for TSS
What are combined oral contraceptives?
Hormonal contraception containing estrogen and progestin, which acts by suppressing ovulation, begining the cervical mucus to block semen, and altering the uterine decidua to prevent implantation.
What is the patient education points for combined oral contraceptives?
Instruct client to observe with adverse effects and danger signs of medication
If they miss a dose, instruct pt that if one pill is missed, take one as soon as possible. If 2 or 3 are missed-refer to manufacturers instructions, but the client should use alternitive forms of birth control until regular dosing is resumed
What are the serious complications of oral birth control pills?
ACHES
Abdominal pain
Chest pain/shortness of breath
Hedache
Eye problems
Severe leg pain
What are the advantages of oral birth control pills?
Due to no direct relation to sexual acts, acceptability may be increased.
Can help control cramping, menstrual cycles, treat endometriosis, acne, ovarian cancer, ovarian cysts, etc.
What are the disadvantages of birth control pills?
Do not protect against STIs
Increased risk of thromboembolism, stroke, heart attack, hypertension, gallbladder disease, liver tumor.
Exasperates conditions affected by fluid retention (migrane, epilepsy, asthma, kidney or heart disease)
What are the patient education points for progesterone only contraception?
Take the pill at the same time everyday
Do not miss a pill
Must use alternate BC for the first month to prevent pregnancy q
What are the advantages/disadvantages of progesterone only birth control?
Advantages:
-Less adverse effects
-Considered safe with breast feeding
Disadvantages:
-Less effective in supressing ovulation
-Increase risk of ovarian cysts
-No STI protection
-Contraindicated in pts that have had bariatric surgery, lupus, severe cirrhosis, liver tumors, or current/past breast cancer
What are the forms of emergency contraception?
levonorgestrel-releasing intrauterine system, high doses of estrogen, or insertion of a copper IUD
What is a transdermal contraceptive patch?
A patch containing norelgestromin (progesterone) and ethinyl estradiol which is delivered at continuous levels through skin into subq tissue.
What is the patient education for the transdermal contraceptive patch?
Apply the patch to dry skin overlying subq tissue of the buttock, abdomen, upper arm, or torso excluding breast area.
One patch per week, with no application on the 4th wekk
What are the disadvantages of the transdermal contraceptive patch?
Risk of DVT or venous thromboemolism is much higher due to the hormones entering directly into the bloodstreams
Rash or lesion can appear on patch site
What is Medroxyprogesterone?
an intramuscular or subcutaneous injection given to a female client every 11 to 13 weeks.
How is a diaphragm used?
It is inserted over the cervix with spermicide jelly applied to the cervical side of the dome and around the rim up to 6 hours before intercourse, and taken out 6-24 hours after
You should empty bladder before placement
What are the advantages of medroxyprogesterone?
Very effective and requires only 4 injections per year.
Does not impair lactation.
Possible absence of periods and decreased and bleeding.
Decreased risk of uterine cancer if used long-term.
What are the disadvantages of medroxyprogesterone?
Adverse effects include decrease in bone mineral density, weight gain, increase in depression, and irregular vaginal spotting or bleeding.
Does not protect against STI’s.
Return to fertility can be delayed as long as up to 18 months after discontinuation.
Should only be used as a long-term method of birth control if other birth control methods are in adequate.
What education should the nurse give to a patient who has received a medroxyprogesterone injection?
Avoid massaging injection site following administration to avoid accelerating medication absorption, which will shorten the duration of its effectiveness.
What are the advantages of implantable progestin?
Mistake
What are the disadvantages of implantable progestin?
Etonogestrel can cause irregular menstrual bleeding.
Does not protect against STI’s.
Adverse effects include irregular and unpredictable menstruation, new changes, headache, acne, depression, decreased bone density, and weight gain.
What are the contraindications of implantable progestin?
Contraindications include unexplained vaginal bleeding, lupus, severe cirrhosis, liver tumors, and breast cancer.
What is Transcervical sterilization?
Insertion of small flexible agents through the vagina and cervix into the fallopian tubes.
This results in the development of scar tissue in the tubes preventing contraception.
Examination must be done after three months to ensure fallopian tubes are blocked.
What are the advantages of transcervical sterilization?
Quick procedure that requires no general anesthesia.
Nonhormonal means of birth control. 99.8 % effective in preventing pregnancy.
Rapid return to normal activities of daily living.
What are the disadvantages?
Not reversible. Not intended for use in the client to us postpartum.
Delay ineffectiveness for three months. An alternative means of birth control should be used until confirmation of blocked fallopian tubes occurs.
Changes in menstrual patterns. Does not protect against STI’s.
What is bilaterial tubal ligation (female sterilization)?
A surgical procedure consisting of severance and/or burning or blocking the fallopian tubes to prevent fertilization
What is a vasectomy?
The cutting of the vas deferens in the male as a form of permanent sterilization.
What education should be given to a patient that has just received a vasectomy?
Reinforce the need for alternate forms of birth control for approximately 20 ejaculations or one week to several months to allow all the sperm to clear the vas deferens.
Following the procedure, scrotal support and moderate activity for a couple of days is recommended to reduce discomfort.
Follow-up is important for sperm count.
Which STI is an aerobic gram-negative diplococcus, is the oldest communicable disease in the US, and women are often asymptomatic?
Gonorrhea
What is Syphilis?
A STI that is caused by treponema pallidum and manifests in 3 distinct stages.
What are the stages of syphilis?
Primary: 5 to 90 days after exposure
Secondary: 6 weeks to 6 months
Tertiary: develops in one third of women infected
What is the treatment for syphilis?
Penicillin G
What is pelvic inflammatory disease?
An infectious process that most commonly involves the fallopian tubes, uterus, and occasionally the ovaries and peritoneal surfaces
Multiple organisms have been found to cause PID
If visible HSV lesions are present in a full term pregnant patient, what is advised?
Cesarean birth is recommended because material infection with HSV-2 can have adverse effects on mother and fetus
Which STI is most threatening to the fetus and neonate?
Hep B, because of the risk of liver disease
Which STI exhibits a ‘fish-like’ odor?
Bacterial vaginosis
What normal protocols must be avoided if pregnant mother has HIV?
No breastfeeding
No scalp electrode
Decrease the amount of time ruptured
What special precautions have to be taken with a baby that has an HIV + mother?
Ensure that baby is cleaned with soap and water prior to invasive procedures
Ex Vitamin K shot
Administer Zidovudine begining at 8-12 hours after delivery for the next 6 weeks
What is not technically an STD, but it the leading cause of neonatal morbidity/mortality in the US?
GBS
What are the risk factors for GBS?
LBW
Pre-term birth
Previous pregnancy with GBS+
When is GBS screening performed?
36-37 weeks
What is the treatment for GBS?
intrapartum IV prophylaxis
What are TORCH infections?
Acquired in utero or during birth/transplacental transmission
What does the T in TORCH stand for?
toxoplasmosis
What does the O in TORCH stand for?
Others, such as syphilis, varicella-zoster, parvovirus
What foes the R in TORCH stand for?
Rubella
What does the C in TORCH stand for?
Cytomegalovirus (CMV)
What does the H in TORCH stand for?
Herpes Simplex Virus
How is Toxoplasmosis transmitted?
Touching cat liter
Undercooked meats
What is the treatment for Toxoplasmosis?
Pyrimethamine & Sulfadiazine
If a mom is not immune to Rubella, what do we do?
Vaccinate immediately post partum
How is CMV transmitted?
Through breastmilk, blood, sexual fluids, in utero during birth, contact with children transfer
DO NOT BREASTFEED
How is CMV treated?
Ganciclovir
How is Herpes Simplex treated?
Acyclovir medication at 36 prophylactically
What is infertility? What are the categories?
A prolonged time to conceive (after trying for 1 year 2-3 times per week)
Primary: Never conceived
Secondary: Conceived once before
What are the female contributing factors to infertility?
Ovulation disorders
Abnormalities to uterine tubes
Cervical abnormalities
Uterine abnormalities
What could cause abnormalities to uterine tubes that could result in infertility?
Chlamydia can cause damage to the uterine tubes
What type of cervical abnormality could cause infertility?
Acidic mucous
What uterine abnormalities could cause infertility?
Endometriosis
Bicornuate uterus
What are the male contributing factors to infertility?
Structural/hormonal abnormalities
Substance use
Enviromental
Advanced Age
What types of structural/hormonal abnormalities can contribute to infertility?
Undescended testes
Hypospadias
Variocele
Seminal fluid abnormalities
Low testosterone
What are some of the seminal fluid abnormalities that can contribute to infertility?
Increased Scrotal Heat
Sperm Abnormalities
-Azoospermia (no sperm)
-Oligospermia (few sperm)
What do marijuana, alcohol and cocaine within two years of intended conception do to male fertility?
Depresses sperm count
Depresses testosterone
What do cigarettes do to male fertility?
Decreases motility
What environmental factors can contribute to infertility?
Lead and pesticides can reduce count
What is sterility?
Inability to conceive
When a male gets a sperm analysis done, what must he do before?
Abstain from sex for 2-5 days before procedure
What does an endometrial biopsy show us?
An endometrial biopsy 2-3 days before menses shows us how well the endometrium responds to the progesterone released from corpus lutem after ovulation
What are some non-invasive ways to test fertility?
Basal body temperature (not super reliable)
Hormonal Assessment
Pelvic Ultrasound
Spinnbarkeit (egg white appearance = max fertility)
What are the contributing factors to the nausea and vomiting experienced during pregnancy?
Increased HCG
Increased pressure could contribute
What are the contributing factors to the constipation that can be experienced during pregnancy?
Due to the increased transit time or increased absorption of water
High fiber diet can prevent this
What happens to respiration and lung capacity during pregnancy?
Respiratory rate increases while total lung capacity decreases because the uterus pushes up into the diaphragm giving little room for lungs to expand
(Diaphragm can raise as much as 4 cm)
What is the relationship between fundal height and gestation?
The cm correlate to how many weeks gestation from 18-30 weeks
What are some of the skin changes experienced during pregnancy?
Cholasma (increased pigmentation in the face)
Linea Nigra (dark line of pigmentation from umbilicus to pubic area)
Striae Gravidarum (stretch marks)
Describe the action of estrogen during the pregnancy
Estrogen rises in late pregnancy, supressing progesterone, and induces the oxytocin receptors preparing the uterus for birth
What is the action of progesterone during pregnancy?
Supports the endometrium
Suppresses contractility of the uterus (blocked by estrogen late in pregnancy)
What are the presumptive signs of pregnancy?
Amenorrhea
Fatigue
N/V
Breast Changes
Quickening
Uterine Enlargement
What is ‘quickening’?
Light fluttering movements felt at 16-20 weeks
What are the 8 probable signs of pregnancy?
Abdominal enlargement
Hegar’s Sign
Chadwick’s sign
Goddell’s sign
Ballottment
Braxton Hicks Contractions
Positive pregnancy test
Fetal Outline
What is Hegar’s sign?
softening and compressibility of the lower uterine segment due to increased blood flow
What is Goddell’s sign?
softening of cervical tip
What is Chadwick’s sign?
Deepened violet-bluish color of the cervix
What is ballottement?
rebound of unengaged fetus
What are Braxton’s hicks contractions
False contractions that are painless, irregular, and usually relieved by walking
What are the 3 positive signs of pregnancy?
Fetal Heart sounds
Ultrasound
Fetal movement (by experienced practioner)
What is Nagele’s rule?
First day of LMP
Subtract 3 months
Add 7 days
Adjust for year
What is Gravida?
The number of pregnancies
What is Parity?
The number of pregnancies that reach 20+ weeks
In GTPAL-
What does T stand for?
Term
The number of pregnancies that made it to 37+ weeks
In GTPAL-
What does P stand for?
Parity
The number of preterm pregnancies 20-38 weeks
In GTPAL-
What does A stand for?
Abortions
Spontaneous or induced 19.6 weeks and below
In GTPAL-
What does L stand for?
Number of living children
What does the standard prenatal lab work consist of?
CBC
Blood type/rh Factor
UA
Heb B screening
Rubella Titer
Pap (gonorrhea and chlamydia)
HIV
VDRL (syphilis)
What are the danger signs in the first trimester?
Vaginal Bleeding
Fever/chills
Diarrhea
Severe Vomiting
Burning on urination
Abdominal cramping
What are some of the recommendations for the nausea and vomiting in the first trimester?
Eat dry carbs (cracker) before lifting head in the morning
Do NOT drink lots of fluids in the morning
High protein snack and prenatals at bedtime
What are the recommendations for heartburn during pregnancy?
Small frequent meals
Sleep on incline/sit upright after meals
Decrease liquids while eating
Reduce liquid intake at bedtime
Medication
How much water should you drink while pregnant?
Drink 8-10 glasses of water per day
What are the recommendations to decrease constipation during pregnancy?
Increase fiber
Plenty of Fluids
Exercise
IRON may cause constipation
What are the recommendations for decreasing leg cramps?
Extend leg straight
Dorsiflexion of foot
Heat is ok (if you are sure it’s not a blood clot)
Notify provider if it happens frequently or if there is swelling in one leg but not the other
What is supine hypotension aka vena cava syndrome?
Uterus is on vena cava and reduces blood to the fetus, looks like shock, with low BP (lightheadness, fainting, SOB), and is avoided by never laying flat on back
What a normal BMI?
18.5-24.9 BMI
What is the recommendation of weight gain through pregnancy for someone with a normal BMI?
25-30lb
2.2-4.4 in first trimester
1lb per week in last 2 trimesters
What are the recommendations for weight gain for someone with a underweight BMI?
<18.5
28-40lb
What are the recommendations for weight gain for someone with a overweight BMI?
> 25
15-25lb
What types of food have good folic acid content?
Leafy veggies
Dried peas/beans
Seeds
Orange juice
Iron is best absorbed with?
Vitamin C
What are high iron foods?
Beef liver
Red meats
Fish
Poultry
Dried peas and beans
fortified cereals and breads
What are the 5 P’s?
Passenger
Passageway
Powers
Position of mother
Psychological response
5 P’s:
What are the components of ‘passenger’?
Fetal presentation
Fetal lie
Fetal attitude
Fetal Position
What does fetal presentation mean?
Part of fetus entering canal first
What does fetal lie mean?
Relationship between maternal and fetal spine (longitudinal axis0
What does fetal attitude mean?
Flexion or extension (fetal chin towards or away from chest)
What does fetal position mean?
Four maternal quadrants
5 P’s:
What are the components of ‘passageway’?
Shape of pelvis
Vagina
Pelvic floor muscles
Introitus (opening that leads to vaginal canal)
5 P’s:
What are the components of ‘powers’?
Effacement: shortening, thinning, upward movement of cervic
Dilation: widening of cervix
Ferguson reflex: urge to bear down
5 P’s:
What are the components of ‘position of mother’?
Gravity can help
Reposition as needed for comfort
5 P’s:
What are the components of ‘psychologic response’
Anxiety and stress can hinder labor
What are the components of fetal station?
-5 to +5 (- is towards mother)
0 is at ischial spinal process
What is true labor **
Cervical change
What are the 7 cardinal movements of labor in order?
1: Engagement-passes 0 station
2: Descent-progress through cervix
3: Flexion-fetal head meets resistance of cervix, brings chin towards chest
4: Internal rotation-corkscrew through pelvis
5: Extension-Passes under symphysis pubis and chin is away from chest
6: External rotation
7: Expulsion-birth
What are the two opioids given during birth and why?
Nubian and stadol
They provide pain relief without respiratory depression
When can opioids be given during birth?
Only before 6 cm or it can risk respiratory depression in baby.
Medication should be given at the peak of contraction (acme)
Why should pain medication be given at the peak of contraction?
It minimizes the effect on the baby, and you should wait to push the rest until the next contraction
What is a pudendal block?
Exerts its effects only in the vaginal vault, covering perineum and vagina.
It does take away the ferguson reflex, but has not maternal/fetal systemic effects
When is a pudenal block given?
10-20 min before delivery
What is a epidural?
The only form of anesthesia that can take the pain away and only allow them to feel pressure
What are the risks of an epidural?
Maternal hypotension, so administer a 1000mL bolus before placement
How is fetal monitoring altered by the administration of a epidural?
The decreased perfusion to uterus can cause placental insufficency which can appear as late decels
What would not allow someone to get an epidural?
if their platelet count if <100,000 they can’t have an epidural
Where is a spinal block administered?
In the OR
What are the components of the umbilical cord?
two umbilical arteries
a single umbilical vein
an obliterated allantois duct
Which are all surrounded by Wharton’s jelly and contained within an outer layer of amnion
What are the functions of the two umbilical arteries?
The umbilical arteries carry deoxygenated blood from fetal circulation to the placenta.
The two umbilical arteries converge together about at 5 mm from the insertion of the cord, forming a type of vascular connection called the Hyrtl’s anastomosis.
The primary function of Hartl’s anastomosis is to equalize blood flow and pressure between the umbilical and placental arteries.
What are leopold manuvers?
Consists of 4 moves to determine:
Number of fetuses
Presenting part, fetal lie, and fetal attitude
Degree of descent of the presenting part into the pelvis
Location of the fetus’s back to assess for fetal heart tones.
What is the order of leopold manuvers?
ID the fetal part in the fundus.
Locate and palpate the fetal back.
ID the presenting part.
Determine the descent of the presenting part.
Where is an epidural administered?
within the epidural space at the 4th or 5th vertebrae.
What is the difference between the primary and secondary ‘powers’?
Primary powers=contractions
Secondary powers=bearing down
When the cervix is 100% effaced, how would it be described?
Paper thin
What Hgb counts are considered to be low during pregnancy?
Hgb less than 11 mg/dL in the 1st & 3rd trimesters is considered low
Hgb less than 10.5 mg/dL in the 2nd trimester is considered low
Why are iron supplements often added to the prenatal plan?
plan to facilitate an increase of the maternal RBC mass
What are the caffeine limitations during pregnancy?
No more than 200 mg of caffeine a day which is the equivalent of 500 to 750 ml/day of coffee. Increased caffeine intake can increase the risk of spontaneous abortion or fetal intrauterine growth restriction.
What weeks make up the first trimester?
1-13.6
What weeks make up the second trimester?
14-27.6
What weeks make up the third trimester?
28-40.6
What are the test performed in the 2nd trimester?
CBC
1 hour glucose screen
Antibody screen for rh
May repeat STI testing
What are the test performed in the third trimester between 35-37 weeks?
GBS Culture
May repeat CBC
What are the tests performed in the third trimester between 40-42 weeks?
Non stress tests every 3 days
AFI (amniotic fluid index)
Ultrasound to monitor fetal wellbeing every week
