Pedi/OB Exam 1 OB ONLY

what valves in the heart close after birth in the baby

1. foramen ovale

2. ductus arterious

3. ductus venosus

at what week in fetal development is there the full and only amount of eggs in the lifespan

week 30

weeks of development: cardiovascular

weeks 5-6

weeks of development: respiratory (lungs)

weeks 5-8

weeks of development: genitourinary

week 10

weeks of development: neuro tubes

week 4

weeks of development: spinal cord/brain

weeks 10-12

weeks of development: gastrointestinal

weeks 5-10

weeks of development: musculoskeletal (bone)

weeks 6-7

when should there be a heart beat by

week 4

when should you be able to hear a heartbeat on an US by

week 8

for the menopausal client, you would expect to see:

1. decreased skin elasticity

2. decreased bone density

what is there a defiency of in menopause

estrogen

decreased estrogen in the menopausal client can lead to

bone density loss

nursing intervention to prevent osteoporosis in menopausal client

estrogren supplementation to prevent osteoporosis

estrogren and progresterone therapy is for:

women with a uterus

estrogen and progresterone therapy prevents

uterine hyperplasia

just estrogen therapy is for

women without a uterus

contraindications for hormone replacement therapy

1. smoking

2. HTN

3. DM

4. CVD

5. renal/liver disease

thickening of breast tissue and tenderness before menses:

is very normal, reassure the client that nothing is particularly wrong with this

relieving symptoms of PMS: diet

1. 2000ml of water daily

2. avoid salty foods

3. avoid simple sugars (cake, etc)

4. reduce intake of caffiene

relieving symptoms of PMS: exercise

1. increase activity to release tension and relieve depression

2. aerobic activity multiple times a week

relieving symptoms of PMS: sleep

1. adhere to regular sleep schedule

2. glass of milk before bedtime

3. schedule workouts in morning or early afternoon

4. relaxing activities before bedtime

when is the embryiotic phase

3-8 weeks after conception

importance of embryotic phase

basic structures of major body organs are being completed during this period (especially vulernable)

teratogens during embryotic phase

during this period can cause major structural and functional damage to the developing organs

examples of teratogens in embryotic phase

1. alcohol

2. radiology

3. certain chemicals

4. certain drugs

recommended total weight gain in pregnancy

25-35 pounds

how much weight gain in first trimester

2-4 pounds per week

how much weight gain in second/third trimester

1 pound/week

excessive weight gain in pregnancy leads to

1. labor complications

2. abnormal fetal growth

inadequate weight gain in pregnancy leads to

low birth weight

how much caloric increase in 2nd trimester

340 calories/day

folic acid supplementation in pregnancy:

prevents neural tube defects

how much folic acid supplementation when trying to be pregnant

400mcg

how much folic acid supplementation when you ARE pregnant

600mcg

calcium supplementation in pregnancy is good for:

developing fetus bone/teeth formation

no more than ____ mg of caffeine in pregnancy

300

the placenta produces what hormone during pregnancy

progesterone

what does the progesterone from the placenta do

maintains endometrial walls and attachment

what are the three main functions of placenta

1. metabolic production

2. transfers substances between mother and fetus

3. endocrine HcG production

does the placenta produce RBCs

no

what metabolic functions does placenta have

1. produces fatty acids

2. produces cholesterol

3. produces glycogen

healthy people 2030 goals

1. reduce rate of mother-to-child HIV transmission

2. ensure clients who have HIV can get treatment and prevent HIV infections in children

if a client came to you and said they haven't had their period in 3 months, what's the first thing you're going to ask about

ask about weight changes

oral contraceptives: progesterone only pills

for women who cannot have estrogen (breastfeeding, high bp, hx of blood clots)

trade off of POP/mini pills

1. less side effects

2. ahve to be taken more

combined OC (estrogen and progesterone) function

1. suppresses ovulation

2. makes mucus thicker

3. makes it harder for the sperm to reach the egg

what is classified as infertility

inabiliity to conceive/sustain pregnancy after 12 months of unprotected intercourse

causes of infertility in males

1. exposure to hazardous teratogenic materials in work or place of employment

2. radiology exposure

3. exposure of scrotum to high temperatures

4. sittting during employment

risk factors of infertility in males

1. endocrine disorders

2. low testosterone

3. congenital issues

4. infections

5. testicular trauma

6. heat exposure

7. SSRI's/hypertensives

tests of interfility for men

1. semen analysis

2. ultrasound of testes/ducts

why do we usually check the male first for inferility

it is easier to test fertility in males

first question to ask males regarding fertility

what is your line of work?

steps of IVF-ET

1. collect the client's egs from the ovaries

2. fertilize the eggs in the lab with sperm

3. transferring the embryo to the uterus

you can still do IVF even without:

fallopian tubes

nursing intervention regarding infertility

provide information regarding assisted reproductive therapies

what are the common assisted reproductive therapies

1. in vitro fertilization

2. embryo transfer

3. intrafallopian gamete transfer

4. surrogate parenting

5. adoption

what to remind the client about infertility

it is not TRUE infertility unless they have been trying to concieve for a year

combined OC adverse effects

1. headache

2. nausea/vomiting

3. breakthrough bleeding

4. breast tenderness

progesterone only adverse effects

1. breakthrough/irregular/vaginal bleeding

injectible progesterone side effects

1. decreased bone and mineral density

2. weight gain

3. increased depression

4. annorhea

5. irregular vaginal bleeding or spotting

IUD adverse effect

fever

Naegele's Ruler

first day of the last menstural period (LMP), subtract three months and add seven days, then change the year

when is fundal height typically measured

between 20 and 36 weeks

how should fundal height match

cm from the pubic bone should match their weeks: at 20 weeks fundal height should be 20 cm

things to assess about your client earlier in the pregnancy

1. substance use

2. sexually transmitted infections

3. economic, physical, social, and emotional changes

4. referrals to social work, CPS, or other community resources

5. mental health history

key concept of early pregnancy assessment

the provider performs a physical assessment and updates the history at each appointment to ensure pregnancy is progressing appropiately and to identify complications

what are the three most basic concepts of pregnancy physical assessment for the mother

1. weight/nutritional counseling

2. blood pressure

3. urine sample

what is normal fetal HR

110-160 bpm

how many weeks do you start labratory testing

15-20 weeks

what does a prenatal panel include

1. CBC, blood type RH screening, HIV, STI

2. urine culture for bladder infections

3. Rh factor screening

Rh factor screening for incompatibility

the client'sb body produces antibodies against and begins attacking Rh fetal positive blood, treating it as an invader

nursing intervention for Rh incompatiblity

give rhogam to try to prevent

at what points do you get rhogam for incompatibility

1. 1st pregnancy right after delivery (unless there is already mixing of blood prior)

2. 28 weeks gestation for all following pregnancies

what is chorionic villus sampling (CVS)

done between 10-13 weeks for clients who have an unexpected result in another genetic screening or those who have a higher risk pregnancy

you can STILL get IVF even if:

you have no fallopian tubes, or only 1 of the tubes

when technically is fertilization

when the nucleus of the ovum and the sperm come together and form

what are mechanical barriers

devices places over the penis or cervix to prevent sperm from entering the uterus

condoms

best protection available other than abstience including STDs and HIV

diaphragm

1. must be fitted by provider

2. insert up to 6 hours before intercourse

3. must stay in place 6 hours after intercourse but no more than 24 hours

cervical cap

1. must be fitted by provider

2. cap should not be removed for 6 hours after the last intercourse

3. stays in place for up to 48 hours

4. should not be used during menses or with a hx of toxic shock syndrome

5. have to get resizes after birth if over 10lb weight change

sponge

1. must remain in place for 6 hours after intercourse but no more than 30 hours

2. 24hr contraception protection

3. using during menses increases the risk of toxic shock syndrome

4. does NOT protect against STDs

side effects are

EXPECTED negative outcomes

complications are

UNEXPECTED negative outcomes

STI antibiotics patient education

entire course of medication must be completed even if symptoms subside

which STI's require reporting in the state of texas

1. hepatitis C

2. HIV/AIDS

3. syphillis

4. chlamydia

5. gonorrhea

what STIs cannot be cured, and treatment is just management of symptoms

1. herpes

2. genital warts

3. HIV

nursing education for a client with STIs

1. take entire course of abx

2. treat all sexual partners

3. retest 3-4 weeks after abx completion

what are the two abx for STI's that you can't use during pregnancy

1. doxycycline

2. levofloxacin

what age for oral contraceptives

childbearing age (15-35)

whos indicated for injectable progesterone

for women that are lactating

how often does a client do injectable progesterone

every 11-13 weeks

number one thing to educate about methods of contraception

nothing is ever truly 100% preventable

warning signs in first trimester

1. abdominal cramping and vaginal bleeding (miscarriage)

2. diarrhea/fever/burning (infection)

if a pt in the first/second trimester comes up to you and says they have severe lower abdominal pain, what are you worried about

ectopic pregnancy

warning sign in second trimester: vaginal bleeding. indicator of what?

placenta problem such as abruption of previa

warning sign in second trimester: abdominal pain

sign of premature labor, placental abruption, ectopic pregnancy

pain and bleeding can also be a sign of what

ovarian cancer

BRCA gene indicators

1. lumps

2. dimpling in the breast