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 (pain during intercourse), 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

Presumptive signs of pregnancy

Amenorrhea

Nausea and vomiting

Fatigue

Urinary frequency

Breast and skin changes

Vaginal and cervical color changes

Fetal movement

Probable signs of prenancy

•Abdominal enlargement

•Cervical softening

•Uterine changes

•Pregnancy tests

Positive signs of pregnancy

•Auscultation of fetal heart sounds

•Fetal movements felt by examiner

•Visualization of fetus

kick counts

•At least 10 fetal movements within 12 hours

•5–10 movements per hour

BPP

Provides info on 5 parameters:

NST

Fetal breathing movements

Gross fetal movements

Fetal tone

Amniotic fluid volume

Contraction stress test (CST)

Oxytocin challenge test

Used to determine how the fetal heart responds to uterine contractions that temporarily decrease placental blood flow

Cannot be done if stimulated uterine contractions are contraindicated

Nipple stimulation or low-dose oxytocin

Nonstress Test (NST)

evaluates fetal heart rate (FHR) accelerations, with or without fetal movement.

FHR reactivity with accelerations is a reassuring sign.

Reactivity is associated with adequate fetal oxygenation and intact neural pathways.

FHR reactivity may not develop until 32 weeks in the fetus.

Food precautions

Avoid soft cheeses.

Do not consume pâté or meat spreads or raw (unpasteurized) milk products.

Weight gain for Normal weight [BMI 18.5-24.9]

11.5-16 kg (25-35 lbs)

Weight gain for Underweight [BMI less than 18.5]

12.5-18 kg (28-40 lbs)

Weight gain for Overweight [BMI 25-29.9]

7-11.5 kg (15-25 lbs)

Weight gain for Obese [BMI more than 30]

5-9 kg (11-20 lbs)