Test #1 - Prenatal Factors

Question 1

What is defined as the premature separation of the placenta from the uterus. typically present with bleeding, uterine contractions, and fetal distress?

Answer 1

Abruption Placentae

Question 2

What is an abnormal absence of menstruation?

Answer 2

Amenorrhea

Question 3

What is painful menstruation, typically involving abdominal cramps?

Answer 3

Dysmenorrhead

Question 4

What is difficult or painful sexual intercourse?

Answer 4

Dyspareunia

Question 5

What is the failure to conceive following twelve months of unprotected intercourse?

Answer 5

Infertility

Question 6

What refers to the poor growth of a baby while in the mother’s womb during pregnancy. Specifically, it means the developing baby weighs less than 90% of other babies at the same gestational age?

Answer 6

Intra-uterine growth retardation (IUGR)

Question 7

What are birth defects of the brain, spine, or spinal cord. They happen in the first month of pregnancy, often before a woman even knows that she is pregnant. The two most common defects are spina bifida and anencephaly. In spina bifida, the fetal spinal column doesn’t close completely?

Answer 7

Neural Tube Defects

Question 8

What is an agent or factor that causes malformation of an embryo?

Answer 8

Teratogens

Question 9

What are some forms of birth controls?

Answer 9

Abstinence

Natural:
Sympothermal Method, Interruptus

Barrier Methods:
Condoms, Diaphragms, Cervical Caps

Medical:
Oral contraceptives, Vaginal Rings, Patches, Injectsions, Implants Intrauterine devices

Sterilization:
Bilateral tubal ligation, Vasectomy

Question 10

When is infertility diagnosed?

Answer 10

After 12 months of unprotected sex

Question 11

What days of the cycle are women most fertile?

Answer 11

11-21

Question 12

What are some signs of ovulation to teach someone being assessed for infertility?

Answer 12

Wet Slippery Discharge

Higher basal temp

Question 13

How does a female get checked for infertility?

Answer 13

Thyroid

Diabetes check

Hormonal SA’s

Ultrasounds

Profilactin

Hysterosalpingography
-Dye is injected and goes to uterus and fallopian tubes and shows any physical abnormalities

Question 14

What are some factors of Infertility?

Answer 14

Waiting til later in life

Prolonged use of BC

Diet

Question 15

How do we check male/female for infertility? Who is checked first?

Answer 15

Women checked 1st

Then Male

Question 16

What are some treatment options for infertility?

Answer 16

Medications

Surgical

• May be useful in correcting obstructions
• Therapeutic Insemination
• Invitro Fertilization

Psychological Factors
- Ineffective coping, distress, self-esteem

Question 17

Why is Folic Acid needed?

Answer 17

To Make DNA/RNA

Question 18

What are some risks of being Folic Acid Deficiency?

Answer 18

Neural Tube Defects

Spina Bifida

Anencephaly

Meningocele

Question 19

What foods can you get folic acid from?

Answer 19

Enriched Cereals

Pasta

Bread

Fresh Green leafy veggies

Red and Organ Meats

fish

Poultry

Question 20

What are some Teratogens that can effect the baby during pregnancy?

Answer 20

Pesticides/Chemicals- work hazards

Radiation = x-rays, radioactive iodine, spills

Infections= Rubella, Syphilis, HSV 2, Toxoplasmosis, Cytomegalovirus

Altitude- women who live in higher altitudes may have increased risk of SGA babies

Medications- Most likely OTC meds.
These can be just as dangerous as scripts. May take teratogenic medication before realizes she is pregnant.

• Greatest risk for gross abnormalities in 1st trimester due to fetal organs developing

Question 21

What are the FDA drug classifications?

Answer 21

A-Very few drugs in this category

B - Penicillin’s fall into this category

C -Many drugs fall into this category

D -But benefits in certain situations outweigh the risks to fetus

Ex. Tetracycline, Lithium

X -Accutane= acne medication which causes many CNS, facial, and cardiovascular anomalies

“If the mother takes a drug in the D or X category she should be informed of the risks with the drug and also be informed of her alternatives.

A mother taking drugs in other safer categories may need reassurance.

Teratogenic effects most crucial in first trimester However they can also occur in the 2nd andjrd.

Question 22

What are some caffeine consideration and what does it do during pregnancy?

Answer 22

Caffeine

Decreases iron absorption, predisposing to anemia

No significant data links consumption to birth defects however, heavy consumption (>300 mg/day) has been linked to lowered birth weight

Caffeine intake of >6oo mg/day linked to IUGR, Spontaneous abortion, Increased incidence of cleft palate, and other anomalies are suspected

Constant motion in newborn can often be assessed

Question 23

What are some things that cigarette smoke does during pregnancy?

Answer 23

Cigarette smoke = cyanide gas.

Decreases amount of O2 consumed by mother

Dec. maternal appetite = poor nutrition

Increase risk of abortion, abruptio placentae, preterm labor, and intrauterine growth retardation (IUGR).

Avoid secondary smoke.

Increased risk of SIDS

Increased risk of resp. illness and chronic resp. disease to newborn

Question 24

What does alcohol do during pregnancy?

Answer 24

Ethanol passes freely through the placenta

Incidence- Highest in ages 20-40 and teenagers

Effect on fetus in each trimester- 1st alters embryonic development. 2nd effects cell division and growth (all) 3rd CNS development altered growth retardation

C. FETAL ALCOHOL SYNDROME- Incidence in 1-2 live births/1000

1. Mental retardation, microcephaly, hyperactivity
2. Decreased weight, length, head circumference, persistent postnatal growth deficiency, head circumference and linear growth most effected
3. Epicanthal folds, broad nasal bridge, short upturned beaklike nose, abnormally small lower jaw, thin upper lip
4. Heart, septal and valvular defects, eyes, kidneys, skeletal system especially joints

Question 25

What does cocaine do to the mother and the fetus?

Answer 25

**Affects on mother** AMI's Cardiac arrhythmias Seizures CVA's Sudden death **Affects on fetus** First trimester abortion Abruptio placentae Stillbirth PROM- premature rupture of membranes & premature birth Low birth weight Extreme irritability or depression Increased risk of SIDS Anomalies- heart & kidney defects, CNS, and limb reduction Learning disabilities as a child

Question 26

What are some nursing diagnosis for mother with cocaine use?

Answer 26

Alteration in nutrition Injury, high risk for Ineffective family coping Altered fluid status Alteration in parenting Assessment- Patients last drug intake, if intake was close to labor. Increase dose= Increase effect on newborn. This assessment can indicate what effects neonate will exhibit. Plan- Treatment, psychological support, and interventions to correct health problems.

Question 27

What are some symptoms of a newborn where the mother did cocaine?

Answer 27

Exaggerated mouthing behaviors (rooting, nonnutritive sucking), Abdominal distention Sleeplessness, Excessive arousal states, & Inconsolable crying, Irritable Abnormal reflexes-startle, gag Hyperactivity with little ability to maintain alertness and attentiveness to environment Jittery throughout first month of life but may last longer Dependence is physiologic NOT psychologic in the infant

Question 28

What are some interventions for a baby born from a cocaine mom?

Answer 28

Dimly lit Cluster care, provide care on infants schedule avoid overstimulation, calmness imperative to effectiveness of interventions feeding techniques, comforting measures, recognize newborn cues, appropriate parenting responses parents can anticipate mild jitteriness and irritability in the newborn persistent up to 8-16 weeks The nurse should follow up on missed appointments. This can bring parents back into the health care system, which improves overall outcomes

Question 29

What is PID?

Answer 29

Pelvic Inflammatory Disease (PID) PATHOPHYSIOLOGY Infection involving the lining of the uterus, the fallopian tubes(salpingitis), ortheovaries(oophoritis). The same organisms responsible for bacterial STD's (such as chlamydia, gonorrhea, staph, strep) cause 90-95% of all cases of PID.

Question 30

What are some complications of PID?

Answer 30

Pelvic Abscess or generallized peritonitis Thrombophlebitis Inc risk for ectopic pregnancy Infertility risks also increase

Question 31

How do you prevent PID?

Answer 31

Following safer sex behaviors. Yearly PAP smear. Following the PCP's recommendations after gynecological events or procedures Getting prompt treatment for sexually transmitted diseases Do not forget the treatment of sexual partners.

Question 32

what are some assessments of PID?

Answer 32

* Vaginal discharge- abnormal odor, color, or consistency. * Irregular menstraul bleeding or spotting * Increased menstraul cramping, lower back pain * Amenorrhea * Increased pain during ovulation * Dyspareunia * Bleeding after intercourse * Fever/ Chills /Fatigue/ N/V

Question 33

What are some diagnostics/labs for PID?

Answer 33

* Abdominal Pain * WBC , ESR (sed rate) * A wet prep or wet mount microscopic examination. * Serum HCG * C&S -endocervical culture for all organisms * A laparoscopy may be indicated

Question 34

What are some nursing care items for PID?

Answer 34

Goal: To prevent the spread and extension of the infection. Bed rest Medical asepsis Provide frequent perineal care Provide psychological support • Encourage expression of feelings Explain factors related to long term management

Question 35

What are some medications and teachings for PID?

Answer 35

Antibiotics= aimed at removing or destroying the causative organism. Analgesics Surgical Treatment-if pharmacologic treatment is not effective • Teach- Discuss general hygiene and sexual measures to help prevent new infections. Emphasize importance of prevention to decrease chances or chronic PID.

Question 36

What is Cystocele and assessments?

Answer 36

A hernia-like disorder in women that occurs when the wall between the bladder and the vagina weakens, causing the bladder to drop or sag into the vagina. Assessments: Stress incontinence, chronic UTI's

Question 37

What is Rectocele and assessments?

Answer 37

A bulge of the front wall of the rectum into the vagina. Assessment findings: Feeling of heaviness in bowel and bladder, backache.

Question 38

What are some risk factors for Cystocele and Rectocele?

Answer 38

Obesity Chronic coughing Constipation or straining to defecate Heavy lifting or abdominal straining Multiple pregnancies-Childbirth

Question 39

What is some diagnostics for Cystocele/Rectocele?

Answer 39

Bimanual pelvic examination Incontinence, UTI's, and urinary retention Client with may complain of vaginal pressure with or without discomfort.

Question 40

What is a treatment for Cystocele?

Answer 40

Pessary- pelvic support device or incontinence pessary can help correct a "fallen" bladder, uterus, and urethra by adding support. A doughnut shaped device made of silicone. The pessary is inserted into the vagina and rests against the cervix, similar to a diaphragm used in birth control.

Question 41

What is a treatment when you have Cystocele and Rectocele?

Answer 41

A&P REPAIR Anterior vaginal wall repair for surgical treatment of urinary incontinence Women with this procedure have approx 60% rate of success in relieving symptoms. Posterior repair corrects rectocele. A&P- involves both procedures at the same time.

Question 42

What are some interventions/teachings for cystocele/rectocele surgery?

Answer 42

Ensure client understanding of surgery Prevent wound infection Prevent pressure on suture Instruct importance of perineal cleanliness Avoid activities that cause straining Tighten pelvic muscles when coughing/sneezing to support the bladder. Bowel & Bladder habits

Question 43

What is Endometriosis?

Answer 43

Occurs when tissue that lines the inside of the uterus grows outside the uterus, usually on the surfaces of organs in the pelvic and abdominal areas. The tissue growth typically occurs in the pelvic area on the ovaries, bowel, rectum, bladder, and the delicate lining of the pelvis. The tissue responds to hormonal stimulation by bleeding into

Question 44

What is the Etiology of Endometriosis?

Answer 44

Unknown etiology One theory suggests that part of the endometrial tissue flows backwards during menstrual flow into the fallopian tubes and abdomen where it attaches and grows. Another states that either a presence or absence of unknown substances may stimulate the growth of endometriosis from multi-potential cells. One final theory is that endometrial tissue may travel to areas outside the uterus through blood vessels or the lymph system.

Question 45

What are some assessments of Endometriosis?

Answer 45

Dysmenorrhea Extremely painful menstrual cramps; pain may get worse over time. Chronic pelvic pain (includes lower back pain) Pain during or after sex Intestinal pain Painful BM's or painful urination during menstrual periods Heavy menstrual periods and Infertility

Question 46

What are some diagnostics of Endometriosis?

Answer 46

Culdoscopy- endoscopic examination, can only look • Laparoscopy-To remove the diseased tissue

Question 47

What are some meds and treatment for endometriosis?

Answer 47

NSAIDS Birth control- Depo-Prevera, Micronor Danocrine (Danazol) - a synthetic androgen Gonadotropin- releasing hormone (GNRH) agonist (Lupron) Surgical: -Excision of endometrial tissue in the extrauterine sites - Panhysterectomy- removal of the uterus, cervix, fallopian tubes, and ovaries and is often referred to as a total abdominal hysterectomy with bilateral salpingoectomy, and oophorectomy (TAH-BSO).

Question 48

What are some teachings about Endometriosis?

Answer 48

Teach client about disease process. Assist client to understand the implication of the disease process and measures to maintain health. Provide emotional reassurance Initial pre & post op teaching Hormone replacement therapy \*\*