MCH NUR2633 Maternal Child Exam 1 Study Guide

1. Women’s health encompasses breast care, GYN exams, and assessments. Be comfortable with the parameters of education for Self breast exams, and what is normal for a woman to note when doing breast exam. Know normal menstrual cycle - what is the most common complaint with the menstrual cycle, and complications; (dysmenorrhea) Know STI’s and risks. a. The most common compliant women have with menstrual cycle is abnormal bleeding, painful menses (dysmenorrhea), treatment is heating pad and NSAIDs. Other OBGYN complaints are fibroids, ovarian cysts, and endometriosis. Self-breasts exams monthly 7- 10 days after the cycle. Two hormones with women's health are Estrogen(growth hormone makes everything bigger), Progesterone(slows things down, makes lining thicker, the pregnancy will not survive without enough of this hormone) 2. If a patient finds a breast lump how will you advise her? a. It’s never normal to feel a lump, make sure you follow up and have other testing, discharge is not normal unless it's a milk discharge after pregnancy b. web-x all women should be doing breast exams once they start menses (10 days after) c. if a lump is found make an appointment d. ultrasound, mammography e. breast cancer at all ages 3. What is your role in the GYN exam a. Our role in the GYN exam assisting the physician and the patient, explain to her what is happening so she is not nervous, pap smears are never down in the E 4. Contraception - Forms of birth control – good subject for your postpartum patients as well – know them, know the risks and some of the educational points to share with them regarding each type. Remember birth control choice should be based on a patient’s lifestyle – if she cannot swallow pills do not offer oral contraception – right? Etc… a. Types of birth control- diaphragm, IUD, the pill, condoms, depo shot(12 week injection), patches, sponge, cervical cap, nuva ring, rod in arm, abstinence, withdrawal, sterilization b. web-x c. patient education: does not prevent std d. same-time everyday e. for depo take ca because it depletes mineralization of bones f. based on lifestyle g. IF BREAST FEEDING DO NOT TAKE ANYTHING ESTROGEN BASED BC IT WILL IMPEDED THE BREAST MILK. The prolactin will be affected by the estrogen because they work against each other h. When the estrogen levels are high. The prolactin is depleted and vice-vers 5. Emergency contraception – know education. a. Plan B used as soon as possible up to 72 hours, doesn't cause abortion, if your pregnant it won't hurt the baby, high dose birth control, bad side effects-N/V, headache. b. web-x does not cause abortions-spotting n/v c. does not protect from sti d. follow- up for cultures for sti e. messes with menstrual cycle f. OTC 6. Preconceptual care is provided for a means to identify risks and provide nutrition – not to establish who should become pregnant. a. Identify risk factors, is it safe for them to become pregnant. Healthy nutrition and lifestyle. Weight and folic acid. Immunizations. Are they smoking or drinking? b. web-x genetics/ genetic counseling c. starting prenatal vitamins d. community referrals 7. Pregnancy – understand the structure and function of the external and internal genitalia. Know the purpose of each in the process of pregnancy. You must understand the changes that occur to each system – a. Uterus has two functions that are to house the baby and expel it (menses). Vagina is a collapsible tube that stretches to deliver baby. Cervix is usually closed but will thin and open to 10cm to allow baby to come out. b. Ovaries are egg storage, you start with all the eggs you have, and you don't make new ones. If the Bladder is inflamed, or UTI can cause preterm labor. Bowel, if you have diarrhea, if you use enema or laxative, can start preterm labor. Illegal drugs can also can use preterm labor. Three things uterus needs are food, fluids and rest if it doesn't have these things if can cause muscle irritation and preterm labor. c. web-x d. ovaries house eggs & produce hormones: estrogen- growth hormone and progesteroneacquiescent/quieting hormone e. Progesterone better than estrogen because it progestation/ pro-life hormone. without, it many women have multiple loses f. synthetic progesterone to maintain pregnancy g. Fallopian tubes transport. Gets the egg from one place to the other h. Egg & sperm fertilized in the ampula of the tube. largest, most distal part of the tubegoes through tube and ends up in the endometrial lining i. Bladder if the bladder is infected, spasming, or is distended can cause a lot of problems with pregnancy. If we see issues with preterm labor, or with bleeding, n/v, prone to uti. uti can cause problems. 8. Please identify pregnancy history – G, F, P, A, L – know how to complete this given each women’s obstetrical history. a. Only for delivery, doesn't matter how many times went into labor even if went into labor. doesn't matter if pre/post term if baby survived, or didn't survive b. Gravida- Number of pregnancies c. Full term pregnancies- Live or dead 37-40 weeks d. Pre term pregnancies-Live or dead 20-37 weeks e. Abortion/Miscarriages- Prior to 20 weeks f. Living- children that are living g. Twins are one pregnancy 9. What is fetal well- being and how do we measure it. Can you date a pregnancy using Naegele’s Rule? Can you measure fundal height? Know the normal parameters of fetal growth. When are fetal heart tones audible with a Doppler? What are the parameters and what does it mean if the fetus falls outside those parameters? a. Naegele's Rule is first day of last missed period subtract 3 months add 7 days and add one year b. Fetal well-being is fetal movement, fetal heart tones and fundal height. All moms can feel the baby movement first between 16-20 weeks, primigravida feel it first at 18-20 weeks, it is a butterfly feeling low in the abdomen. Multigravida is 16-18 weeks. c. web-x d. Fetal well-being e. 3 assessment fx to complete a fetal assessment (since we cannot see the baby) f. 1. fundal height- 1st palpate of the uterus- uterus becomes an abdominal organ by 12-14 weeks g. 2. Fetal heart rate. h. 3. fetal movement-not position in 16-20 weeks i. We can identify fetal hr. in 10-12 weeks. We can hear heart tones with Doppler’s. j. -we can see baby heartbeat much earlier on the ultrasound k. First pregnancy can feel babies in 18 weeks, if you had a baby b4 you feel the baby much earlier in like 16 weeks when you feel the butterflies. l. someone on the outside trying to feel the baby- doesn't feel until 24-26 weeks m. primigravida- mom can feel baby within 18-20 weeks n. multiparish- 16-18 weeks o. at 20 weeks we can find the baby at the umbilicus p. entire parameter is 16-20 weeks q. if a mom comes and says i am 7 mts pregnant, how many weeks pregnant is she? 28 weeks fundal- height 28 cm r. we place the tape measure: 0 goes at the symphysis, and pull tape measure to the top of the fundus s. When can we hear fetal heart tones with a Doppler? By 12 weeks because the uterus is coming outside of the pelvis at this time. t. With the Doppler stethoscope, FHT may be auscultated by 10 to 12 weeks able to hear heart tones or by 17 to 19 weeks with the fetal stethoscope. u. Fundal height starts at 14 weeks, it grows with the weeks’ gestation, we don't use cm till after 20 weeks, if a mommy is 16 weeks where would we see fundal height? Halfway between the symphysis pubis and the umbilicus, 20 weeks is the umbilicus and 12-14 weeks is the symphysis pubis. We start at the symphysis pubis and measure cm to the top of the uterus. Give or take 2 cm. So if its 28 weeks it could be 26 or 30. If the measure is wrong by more than 2cm the date could be wrong or twins or something else is growing in the uterus. If it is less than 2 cm the date could be wrong, the baby isn't growing. v. The fetal heart rate (FHR) is heard most clearly directly over the fetal upper back (the maternal right or left lower abdominal quadrants) in a vertex presentation. The intensity of the fetal heart tones (FHT) varies according to the fetal position (Fig. 9-7). With a breech presentation, the fetal heart tones may be best heard in the patient's right or left upper abdominal quadrants w. The normal heart rate for a fetus is approximately 110 to 160 beats per minute (bpm). x. even after the baby is born it is 110-160 10. Fetal development from the conception through the embryonic (critical) period, to the placental development and beyond. – It is all about the placenta. What risk factors will impede placental perfusion to the baby? a. A baby is completely developed by 12 weeks, the embryonic/critical stage where you need to be the most cautious about what you put into your body. The pregnancy is tucked away in the pelvis for 12 weeks protecting the baby from trauma. b. web-x c. If something happens to the baby during the embryonic period, or if there is some kind of insult at any kind, you're going to find anomalies (genetic insult, environment insult) because of infection, or moms lifestyle choices. we can pinpoint that to the weeks of gestation, so during the 1st 12 weeks the baby stays in the pelvic organ to try to protect it somewhat from trauma, after that once it becomes and abdominal organ it is cushioned by amniotic fluid: cushions the baby from injury, cushions the cord from being collapsed, or restricted, helps the lungs from sticking- temp control free movement, so the muscles can dev. so they can get stronger and when they are born have the ability suck/swallow/push/pull d. Oligohydramnios- too little fluid e. polyhydramnios- when the fluid is too much( diabetes in mom) f. oligo- look for renal issues in baby g. The placenta is the work organ of pregnancy, if something happens to the placenta it happens to the baby as well. IT’S ALL ABOUT PERFUSION. It's all about the blood flow to and from the placenta. Baby's blood does not come in contact with mother's blood. A gas exchange takes place at the chorionic villi, where nutrients and oxygen are given to the baby then the baby gives back carbon dioxide. Carbon dioxide is given to the mother's lungs to be expelled this makes the mother breathe a little bit faster/deeper. Mother needs more lung capacity, diaphragm pushes on the lungs, so she uses a lateral lung expansion (arches back to receive more lung capacity). h. The kidneys need to work harder because the filtration rate is greater because they can't filter all the extra fluids/salts/proteins. i. PREGNANCY IS ALL ABOUT PERFUSION j. The placenta is a huge filtering organ and everything has to go placenta for the baby. Bad/good things go through the placenta 11. Know normal discomforts of pregnancy and what is not normal and how do nurses educate their patients on the difference. Look at each system. What a normal change means to her and what education you would give. a. Headaches in pregnancy are NOT normal. A lot of times it is preeclampsia. 12. What activity is appropriate for the pregnant patient? a. Walking is best to get heart rate up b. also swimming, bicycling c. as long as Heart rate doesn't go up over 140 d. Don't start a new exercise you didn't do before pregnancy e. be careful with bending/ supine position because of blood flow- heavy uterus sits on superior vena cava and causes hypertension for mom and decrease blood flow to baby