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95 Cards in this Set
- Front
- Back
breast self exam pt teaching
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staring at age 20
should be performed 1 week after onset of menses client should notify provider is discharge or bleeding |
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where is ovum fertilized
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outer third of fallopian tube
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nutrient that can reduce incidence of neural tube defect
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folic acid
0.4mg daily recommended for prevention 1 mg daily for treatment |
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what hormonne maintains the corpus luteum during early preg.
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human chorionic gonadotropin (hCG)
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what is goodell's sing
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softening of cervix
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what is chadwick's sign
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blue-purple discoloration of cervix
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describe function of hCG
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produced by the developing embryo, hCG's function is to prevent the disintegration of the corpus luteum and thus maintain progesterone (and estrogen) production that is critical for pregnancy. hCG may affect the immune tolerance of the pregnancy. Early pregnancy testing measures hCG level.
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when does the corpus luteum disintegrate
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@ about 4 months when the placenta takes over
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what does the corpus luteum secrete in early preg.
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progesterone to maintain the endometrium until the placenta takes over
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vaginal secretions pH during preg.and normal reproductive years
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acidic; 3.5-6
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tidal volume during pregnancy
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increases through preg. by 30-40%
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vital capacity during preg.
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increases
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O2 consumption during preg.
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↑15-20%
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breathing pattern during preg.
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thoracic, shallow is common
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estrogen induced edema and vascular congestion during preg. results in
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rhinnitis, epistaxis,
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blood volume change in preg.
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↑40-45%, peaks in 3rd trimester
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vascular resistance change during preg
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↓
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cardiac output change during preg.
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↑
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pulse change during preg.
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↑10-15 bpm
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BP change in preg.
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↓ in 1st & 2nd trimester- returns to pre- preg by 3rd trimester
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what is physiologic anemia of pregnancy
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↑ rbc by 30% and ↑ of plasma by 50%
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iron absorption change during preg.
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moderately ↑
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t/f pregnancy is hypercoaguable state
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true b/c ↑ plasma fibrinogen
↑ RISK OF DVT |
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GI changes in preg
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slowed peristalsis and slow gall bladder emptying and hemorrhoids b/c of smooth muscle relaxation from progesterone
↑ RISK OF GALLSTONES |
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what is the mask of preg.
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chloasma
ACCENTUATED BY SUN EXPOSURE |
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pigmentation changes in preg. client
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chloasma, linea nigra, striae
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normal weight gain during preg. for normal weight client
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25-35 lbs
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normal weight gain during preg. for under weight client
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25-35 lbs
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normal weight gain during preg. for over weight client
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15-25 lbs
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weight gain by trimester in lbs
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st-3.5-5
2nd- 12-15 3rd- 12-15 |
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subjective signs of preg.
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aka presumptive: amenorrhea, n.v,fatigue, breast tenderness, urinary frequency, quickening
IT'S WHAT THE CLIENT FEELS |
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objective signs of preg.
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aka probable: changes in pelvic organs, Goodell, Chadwick, Hegar, and McDonald's signs, uterine souffle, abd. enlargement, BALLOTMENT, Hcg TEST . IT' S WHAT THE PROVIDER OBSERVES
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positive signs of preg.
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aka objective: fetal heart beat (10 weeks ega w/ doppler & 17 weeks w/ fetoscope), fetal movement (20 weeks), ultrasound visualization of fetus
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psych. tasks of preg. (Rubin's)
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1-ensuring safe passage
2-seeking acceptance of baby by others 3-seeking commintment and acceptance of self as mother (binding-in) 4-learning to give of onself on behalf of one's child |
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what is couvade
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unintentional development of physical symptoms similar to preg. in the male (↑ appetite, backache, diff. sleeping)
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Hegar's sign
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softening of the lower uterine segment (isthmus)
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McDonald sign
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uterus becomes flexible at the uterocervical junction-easing of flexing of body of uterus against cervix
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define abortion
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birth before 20 weeks
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define term preg.
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normal duration of preg. (38-42 weeks)
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define preterm
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birth after 20 before 37 weeks gestation
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quickening
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fetal movement felt by mom can be felt as early as 16 weeks as late as 22 weeks
multiparous usually report earlier than primigravida |
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McDonald's method of fundal height assessment
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used to determine the age of gestation by measuring from the fundus (obtaining the fundal height) to the symphysis pubis. The distance in centimeters will determine the age of gestation from 22-34 (=/- 2cm is WNL) weeks.
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danger signs during preg.
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1-sudden gush of fuid
2-vag. bledding 3-abd. pain 4-temp above 101F 5-dizziness, blurred vision, double vision, seeing spots 6-persistent vomiting 7-severe HA 8-edema of face, hands, legs, feet 9-epigastric pain 10-oliguria 11-dysuria 12-absence of fetal movement |
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common discomforts in preg
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N and V d/t ↑ hCG, gastric overloading, slowed peristalsis,
Usually resilved by 16 weeks |
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PT TEACHING for N/V management
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-small frequent meals
dry crackers before getting out of bed avoid strong odors restrict fats accupressure wristbands vit. B6 (pyridoxine) ginger |
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exercise during preg.- pt teaching
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-low impact, keep HR below 140 bpm, avoid hot tubs
use perceived rate of exertion is more reliable than HR : if unable to talk or has difficulty breathing effort is too high |
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constipation during pt teaching
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↑ fiber, ↑ fluids, prunes and prune juice (start slowly), exercise, good posture, colace
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hemorrhoids during preg. pt teaching
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avoid straining, warm bath, prevent constipation, witch hazel cpmresses, epsom salt compresses, analgesic ointment, iron tablets may be constipating
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Round ligament pain pt teaching
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shooting pain in inguinal area, worsened by activity,
To relieve:flex knees on abdomen , warm bath and heating pads, rest, change positions, |
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breast care
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clean with warm water, no drying soap, supportive bra
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what is the Cardiff count to 10 method
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Beginning at 27-28 weeks
Mom can monitor's her unborn child's well-being Begin at the same time each day (usually in the morning, after breakfast) Lie quietly ON SIDE Count each fetal movement, noting how long it takes to count 10 fetal movements ( Expected findings – 10 movements in 1 hour or less Warning signs -no movements in morning - more then 1 hour to reach 10 movements less then 10 movements in 3 hours(non-reactive- fetal distress) longer time to reach 10 FMs than on previous days movement are becoming weaker, less vigorous Movement alarm signals < 3 FMs in 8 hr warning signs should be reported to care provider immediately; often require further testing. |
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fetal activity monitoring methods
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Cardiff count to ten
non stress test |
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Possible effects of DM on fetus
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congenital anomalies
macrosomia IUGR, if vascular damage ↑ risk of fetal death r/t uncontrolled glucose ↑ risk of poly hydramnios |
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Anemia feect on mom and fetus
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MOM: ↑ risk of infection, fatigue, ↑ risk of PIH, ↑ risk of PP hemorrhage, delayed tissue healing, cardiac failure w/ severe anemia
Fetus:↑ risk of low birth weight, stillbirth, and neonatal death |
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PT teaching r/t anemia
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iron supplement 27mg
if anemic dose should be higher (60-120 mg daily) take iron on empty stomach with orange juice may have tarry stools, keep iron pills away from children-could be fatal |
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Sickle Cell pt teaching
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folic acid supplement
avoid dehydration, high temperatures, treat infections early, infection prevention, |
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Thalassemia pt teaching
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folic acid supplement
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HIV patient teaching
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asymptomatic pt: pregnancy does not accelerate disease
symptomatic: preg. does accelerate disease w/o prophylactic rate of transmission to newborn id 15-25% best option for HIV+: ZDV treatment, C?S at 38 weeks before ROM, no breastfeeding (rate of transmission drops below 2%) |
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AIDS in infants
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90% encephalopathy (↓ in cognitive abilities)
delayed development, fail to thrive neuro issues hepatosplenomegaly, recurring infections( esp pneumonia) |
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CD recs for HIV screening
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recommend that all preg.pt be screened
screening is voluntary and informed |
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Recommended caloric increase in preg.
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Calories
300 calories/day above the prepregnancy daily requirement to maintain ideal body weight and meet energy requirement to activity level - Begin increase in second trimester - Use weight – gain pattern as an indication of adequacy of calorie intake. - Failure to meet caloric requirements can lead to ketosis as fat and protein are used for energy; ketosis has been associated with fetal damage. |
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classification of cardiac functional capacity
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Class I: cardiac disease but no limitations of physical activity and no sx of cardiac insuff.
Class II:cardiac disease w/ slight limitations of physical activity , ordinary phys activity may cause fatigue, dyspnea, anginal pain Class III:cardiac disease w/ marked limitations of physical activity and less than ord. phys activity can cause dyspnea, anginal pain, fatigue Class IV:cardiac disease w/o ability to carry out any phys. activity.SX of cardiac insufficiency even at rest ANEMIA AND INFECTION WILL WORSEN CARDIAC CONDITION |
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clinical Tx of cardiac disorders
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Class I & II: spntaneous labor w/ pain management, careful monitoring recommended
Class III & IV: hospitalization prior onset of labor, vag. delivery possible epidural anesthesia to reduce stress, maybe low forceps and vacuum assistance ** treat anemia and infection early **may need to limit weight gain and sodium intake **screen monthly for asymptomatic bacteruria ** home BP monitoring **adequate rest drug tx: diuretics, antihypertensives (esp if BP>150-16-/100-110), antiarrhythmics, anti-coagulants |
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SX of hypovolemic shock
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pallor, clammy skin, diaphoresis, dyspnea, restlessness, confusion, anxiety, tachycardia, ↓ urine output, ↓ BP
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Tx hypovolemic shock
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O2, IV therapy, type and cross match blood, elevate legs to help heart and brain perfusion, position pt on left side to improve placental perfusion
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causes of bleeding and hemorrhage during preg
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placenta precia, placenta abruptio, ectopic preg., gestational trophoblastic disease, molar preg (rare), preterm labor, spontaneous abortion
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what is gestational trophoblastic disease
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group of rare tumors that involve abn. growth of cells in woman's uterus. GTD does not develop from cells of the uterus like cervical cancer or endometrial (uterine lining) cancer do. Instead, these tumors start in the cells that would normally develop into the placenta during preg. This disease begins in the layer of the trophoblast that normally surrounds an embryo. (Tropho- means "nutrition," and -blast means "early developmental cell.") Early in normal development, the cells of this layer form villi. These villi grow into the lining of the uterus. In time, the trophoblast layer develops into the placenta.
Most GTDs are benign & don't invade deeply into body tissues or spread to other parts of the body. But some are cancerous. B/c not all of these tumors are cancerous, this group of tumors may be referred to as gestational trophoblastic disease, gestational trophoblastic tumors, or gestational trophoblastic neoplasia. All forms of GTD can be treated. And in most cases the treatment produces a complete cure. (source: cancer.org) |
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causes of spontaneous abortion:
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faulty implantation, teratogens, placental abnormalities, weak cervix, hormonal imbalance (↓ hCG, ↓ estrogen, ↓ progesterone), maternal infection
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Tx for spontaneous abortion
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bed rest
pelvic rest maybe D&C Rh immune globulin if Rh neg |
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Sx of ectopic preg
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one-side lower abd. pain
referred right shoulder pain adnexal tenderness/mass bleeding rigid abd. lower hCG |
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TX of ectopic preg
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menstrual HX, esp LMP
pelvic exam ultrasound labs ( will show ↓H&H, , ↑ leukocytes, lower hCG*) laparoscopy methotrexate IM if pt desires future preg if fertilized ovum is unruptured and < 3.5 cm and pt condition is stable surgical removal Rhogam if Rh neg. * in normal preg. hCG doubles Q 48hrs from3 to 6 weeks' gestation |
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care of D&C pt
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someone should remain w/ discharged pt for 1st 24-48 hours
report any heavy bleed, fever, chills, foul smelling vag. discharge, abd. tenderness |
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Sx of placenta previa
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Painless vagina bleed after 20 weeks
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Nursing implications of placenta previa
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NO VAG EXAMS
draw labs sonogram |
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Sx of abruptio placenta
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pain disproportionate to the strength of contractions, may or may not be accompanied by bleed
may necessitate C?S in moderate or severe cases |
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what is hydatidiform mole (molar peg. and what are sx
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type of gestational trophoblastic disease (GTD)
placenta characterized by fluid-filled, grape-like clusters 2 types of molar preg.: partial and complete unclear cause Sx:prune juice-like vag. bleed. anemia uterine enlargement > than expected no FHT hCG> than expected very low maternal serum alpha-fetoprotein (MSAFP) hyperemesis gravidum b/c of ↑ hCG preeclampsia DIC infection (late sx) |
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how is molar preg diagnosed
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w/ ultrasound
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TX of molar preg
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evacuation and curettage
oxytocin to keep uterus contracted and prevent hemorrhage typed and cross match blood monitor urine output hysterectomy if older pt has completed childbearing to ↓ chances of future malignancy |
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what is incompetent cervix and what are sx
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incomp. cervix is painless dilation of cervix w/o contractions
sx: low back pain, pelvic pressure, changes in vag. discharge |
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hyperemesis DX and TX
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intractable vomiting in 1st half of preg that causes dehydration and ketonuria and weight↓ of 5% pre-pregnancy weight
tx: restore 'lytes, hydrate, control vomiting (antiemetics, IV), small meals, simple carbs TPN if necessary, B6, B!, D5W, ginger syrup, acupuncture |
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herbs to avoid in preg
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blue cohosh, black cohosh, chamomille, valeria, comfrey, dong quai, ephedra, goldenseal, gingko, ginseng, horehound, horseradish (fresh)
caution w/ garlic, ginger, turmeric |
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Immunization during preg
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Inactivated viruses:
Influenza: after 1st trimester Hep A & B |
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Contraindicated immunization during preg
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Measles, rubella, mumps, varicella zoster, smallpox, polio, yellow fever (unless in high-risk area),
typhoid, |
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Gestational Diabetes (GD) definition
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Carb intolerance of variable severity w/ onset or 1st recognition during pregnancy
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GD- screening
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50g- 1hr glucose test
done b/w 24 and 28 weeks if plasma glucose >140 do 3-hr diagnostic test |
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3-hr 100g glucose test
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done if 1-hr glucose test result is >130-140
pt eats unrestricted diet that includes 150g minimu of carbs for 3 days prior Pt ingests 100g oral glucose solution in moring after an overnight fast plasma glucose is measured at1,2,3 hours Pt should remain seated, not smoke throughout the test GD is DX is 2= values are met or exceeded: fasting: 95mg/dL 1hr:180mg/dL 2hr:155mg/dL 3hr:140mg/dL |
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normal fasting and 2hr blood glucose
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non-pregnant:
fasting:70-80 2hr postprandial60-110 pregnant: fasting:65 2hr postprandial:<140 |
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normal preg H&H
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Hgb:11-15 (1g less than nonpreg.)
Hct:32-42 %(5% less than nonpreg) anemia is < 11mg/dL in preg |
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fetal assessment of diabetic mother
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MSAFP
fetal activity monitoring NST BPP Ultrasound |
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what is NST
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non-stress test
usual baseline fetal heart rate is between 120 and 160 beats per minute. Once monitor is in place, practitioner will look for certain measurements to see how the baby is faring, including if his heart rate rises when he moves. An NST is considered reassuring if there are accelerations of the fetal heart rate of at least 15 beats per minute over the baseline, lasting at least 15 seconds, occurring within a 20-minute time block. This is called a reactive NST. If these accelerations don't occur, the test is said to be nonreactive. In addition, since many women have mild contractions that they may not even notice, your practitioner will note any of the baby's responses to contractions or if the fetal heart rate dips below baseline. (source: drspock.com) |
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what is 1st NST is non-reactive
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prolong test for another 20 minutes
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what is nitrazine paper used for
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assessment of luid with ROM
blue=alkaline=amniotic fluid nitrazine paper can yeild false positive if sample is contaminated w/ semen, urine, blood, soap, bact vaginosis, soap |
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what is pre-term labor (PTL)
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labor before 37 completed weeks of preg.
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Risk Factors of PTL
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uterine/cervical problems
hx of cone biopsy low weight undernourished chronic illness:HTN< renal, cardiac) previous PTL previous pre-termbirth febrile illness subs abuse 2nd trimester abortion more than 2 1st trimester abortions |
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neonatal risks associated with maternal anemia <6g/dL
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low birth weight
prematurity stillbirth neonatal death |