Peds Study guide Exam 1 (antepartum and sexuality only)

Calculation of EDD

Use Nägele’s rule: First day of LMP → subtract 3 months, add 7 days, adjust year if needed.

Self-care in pregnancy

Daily prenatal vitamin with folic acid (400–800 mcg), avoid alcohol/smoking, moderate exercise, 8–10 cups water/day, avoid litter boxes/raw meat (toxoplasmosis), limit caffeine (

Rh factor & RhIG

If mother is Rh-negative and baby/father is Rh-positive → give RhIG (RhoGAM) at 28 weeks and within 72 hrs postpartum if infant Rh+. Also after any bleeding or invasive procedure.

Diet/weight gain

Normal BMI: gain 25–35 lb; 1st tri 1–4 lb total, then ~1 lb/week. Extra 300 kcal/day in 2nd/3rd tri. Protein 60 g/day, iron 30 mg/day, folate 600 mcg/day.

Increased fetal surveillance (NST/BPP)

NST: Reactive = ≥2 accelerations (15 bpm ×15 sec) in 20 min. BPP: 5 components (NST, breathing, movement, tone, fluid); 8–10 = normal.

Fetal kick counts

Begin at ~28 weeks. Expect ≥10 movements in 2 hrs or at least 4/hr. Report ↓ movement.

Fundal height

From 20–36 wks ≈ cm = weeks of gestation (±2 cm).

Hypertensive disorders

Gestational HTN: BP ≥140/90 after 20 wks, no proteinuria. Preeclampsia: HTN + proteinuria and/or organ signs. Eclampsia: preeclampsia + seizures. Mg sulfate for seizure prophylaxis.

Diabetes in pregnancy

Screen 24–28 wks (1-hr GTT). Maintain fasting

Bleeding in pregnancy

1st tri: threatened/missed abortion, ectopic. 2nd/3rd tri: placenta previa (painless), abruption (painful).

Probable, presumptive, positive signs

Presumptive (subjective): amenorrhea, nausea, breast changes. Probable (objective): Goodell’s, Hegar’s, Chadwick’s signs, positive pregnancy test. Positive: fetal heart tones, ultrasound of fetus, fetal movement felt by examiner.

Postural hypotension / vena cava syndrome

Cause: gravid uterus compresses inferior vena cava when supine → ↓ venous return. Intervention: left side-lying or wedge under right hip.

Prenatal labs & testing

CBC, type & screen, Rh, rubella titer, Hep B, HIV, RPR/VDRL, urine culture, Pap, GBS (35–37 wks), glucose screen (24–28 wks).

GTPAL

Gravida (total pregnancies), Term births (≥37 wks), Preterm (20–36 wks), Abortions (

Menstrual disorders

Dysmenorrhea: NSAIDs, heat, OCPs. Endometriosis: OCPs, GnRH agonists, surgery. PMS/PMDD: lifestyle changes, SSRIs.

Abnormal uterine bleeding

Evaluate for structural causes (fibroids, polyps). Tx: hormonal therapy, IUD, ablation.

Safe sexual activity to prevent STI

Condoms every time, mutual monogamy, regular screening, avoid alcohol/drug use before sex, vaccines (HPV, Hep B).

Care of patient with STI

Bacterial: Chlamydia (azithro/doxy), Gonorrhea (ceftriaxone + doxy/azithro), Syphilis (penicillin). Viral: Herpes (acyclovir), HIV (ART). Parasitic: Trichomonas (metronidazole). Notify partners, abstain until treatment complete.

Medications for menstrual disorders

NSAIDs (ibuprofen, naproxen), combined OCPs, progesterone-only, GnRH agonists (leuprolide), tranexamic acid for heavy bleeding.

Safe contraceptive use

Oral: take same time daily, contraindicated in smokers >35 & clotting disorders. Barrier: condoms, diaphragm with spermicide. Behavioral: fertility awareness, withdrawal (least effective).

Perimenopause/menopause care

Symptoms: hot flashes, vaginal dryness, mood changes. Tx: lifestyle (cool env, exercise), HRT if no contraindications, Ca/Vit D for bone health.

Risk factors for STI

Multiple partners, unprotected sex, adolescents, men who have sex with men, previous STI, substance use.

STI in pregnancy

Screen early & 3rd tri if high risk. Syphilis, chlamydia, gonorrhea can cause neonatal infection; treat during pregnancy. HSV: if active lesions at labor → C-section.

Term / Topic

Key Points & Nursing Focus

Amenorrhea

Primary: No menses by age 15 or >3 yrs after breast development. Secondary: Absence ≥3 months in a previously menstruating woman. Causes: pregnancy, stress, weight loss, PCOS, thyroid. Evaluate hCG, TSH, prolactin.

Primary dysmenorrhea & interventions

Painful menses from prostaglandins → uterine contractions. Tx: NSAIDs (start 1–2 days before menses), heat, exercise, low-fat diet, OCPs if not contraindicated.

Oral contraceptive pills—candidates

Healthy, non-smoking women

Perimenopause/Menopause & CV risk

↓ Estrogen ↑ LDL, ↓ HDL → ↑ risk for CAD & osteoporosis. Advice: heart-healthy diet, exercise, calcium/vit D, stop smoking. HRT only if benefits > risks, lowest dose/shortest duration.

S/S uterine fibroids (leiomyomas)

Heavy/prolonged bleeding, pelvic pressure, urinary frequency, infertility, anemia. Tx: OCPs, GnRH agonists, myomectomy, hysterectomy.

Endometriosis

Endometrial tissue outside uterus → cyclic pelvic pain, dysmenorrhea, dyspareunia, infertility. Tx: OCPs, NSAIDs, GnRH agonists, laparoscopy.

PMS

Physical + mood symptoms 1–2 wks before menses, resolve with onset. Tx: exercise, balanced diet, limit caffeine/alcohol, NSAIDs, SSRIs for severe PMDD.

PCOS & treatment

↑ Androgens, insulin resistance. S/S: irregular menses, hirsutism, obesity, infertility. Tx: weight loss, metformin, OCPs/progesterone for cycle control, clomiphene for fertility.

STIs requiring barrier contraception

HIV, gonorrhea, chlamydia, trichomonas, syphilis, herpes, HPV—condoms recommended to reduce transmission.

STI-risky behaviors

Multiple partners, unprotected sex, inconsistent condom use, sex under influence of drugs/alcohol, anonymous partners.

HPV / Warts / HIV (testing)

HPV: genital warts, cervical Ca risk; vaccine (9–26 yrs). HIV: ELISA/4th-gen Ag/Ab test, confirm with Western blot or PCR.

Gonorrhea—risks to baby

Ophthalmia neonatorum → blindness; give erythromycin eye ointment within 1 hr of birth.

Genital herpes S/S

Painful vesicular lesions, burning/tingling prodrome, recurrent. No cure; acyclovir/valacyclovir shorten outbreaks. C-section if active lesions at delivery.

GTPAL

Gravida (total pregnancies), Term (≥37 wks), Preterm (20–36 wks), Abortions (

Positive signs of pregnancy

Fetal heart tones, ultrasound visualization, fetal movement felt by provider.

Souffle sound

Uterine souffle: maternal blood flow—matches maternal pulse. Funic souffle: fetal blood flow—matches fetal HR.

Gestational age by palpation/tape

Leopold maneuvers to assess fetal size/position. Tape: fundal height (cm) ≈ weeks 20–36.

Fundal height

At 12 wks: symphysis pubis; 20 wks: umbilicus; then ≈ weeks of gestation (±2 cm).

Kick counts

Begin ~28 wks. Expect ≥10 movements in 2 hrs or 4 in 1 hr; report decrease.

Nutrition in pregnancy & teens

Extra ~300 kcal/day, 60 g protein, folic acid 600 mcg, iron 30 mg. Teen focus: ↑ calories, calcium, iron. Culture: ask about dietary customs, support preferred foods that meet nutrient needs.

Weight gain

Normal BMI: 25–35 lb (1st tri 1–4 lb, then ~1 lb/wk). Adjust for under/overweight.

Prenatal screening tests

Initial: CBC, type & screen, Rh, rubella, Hep B, HIV, syphilis, urine culture. 24–28 wks: GDM screen. 35–37 wks: GBS culture. Ultrasounds as indicated.

Rhogam

Rh-negative mom with Rh-positive fetus: give at 28 wks & within 72 hrs postpartum or after bleeding/procedures.

Vena cava syndrome

Supine position → uterus compresses inferior vena cava → hypotension. Intervention: left side-lying or wedge under right hip.

Vomiting in pregnancy

Mild (N/V) common; Hyperemesis → dehydration, electrolyte imbalance, weight loss. Monitor ketones, give IV fluids, antiemetics.

Bleeding late pregnancy

Placenta previa (painless, bright red) vs abruption (painful, dark). Priority: assess FHR, no vaginal exam, prepare for C-section if previa.

Gestational HTN / Preeclampsia

BP ≥140/90 after 20 wks. Preeclampsia: + proteinuria or organ involvement. Monitor BP, reflexes, urine protein, Mg sulfate for seizure prophylaxis.

Placenta previa—nursing actions

Monitor bleeding & FHR, no vaginal exams, bed rest, prepare for possible C-section, IV access, type & crossmatch.

Maternal diabetes—effect on baby

Macrosomia, hypoglycemia, RDS, congenital anomalies if uncontrolled. Monitor newborn glucose after birth.

Preterm labor management