MVU NURS 629 EXAM 1 WITH COMPLETE SOLUTION LATEST UPDATE(A+ exam)

MVU NURS 629 EXAM 1 WITH COMPLETE SOLUTION LATEST UPDATE(A+ exam) Three trimesters of pregnancy 1st: week 1-13 2nd: weeks 14-27 3rd: weeks 28 to delivery Naegeles rule of EDB First day of LMP- subtract 3 months, add 7 days and one year Ultrasound to determine EDB 1st trimester: accurate within 7 days 2nd trimester: accurate within 10-14 days The sooner a woman gets an ultrasound the better estimate we can give for weeks gestation and tracking of fetal growth and development. Prenatal visit schedule for low-risk pregnancies -Preconception visit: up to 1 yr before conception -1st prenatal visit: 6-8wks after missed menses Up to 28 weeks- every 4 weeks 28 to 36 weeks - every 2 weeks 36 weeks and on -every week or more as necessary First prenatal visit should include • Confirmation of pregnancy 1. Pregnancy test and ultrasound • History • Menstrual history (LMP) and obstetric history • Past medical history • Nutrition and habits: tobacco, alcohol, drugs • Genetic history: mom, father and 1st relative • Social history including work, abuse, coping • Current symptoms • Physical exam and labs 1. Pelvic exam and pap smear 2. Blood type and antibody screen 3. Rubella and hepatitis B titer 4. GC, RPR, HIV, Hep C 5. CBC 6. Urinalysis with culture 7. UDS (?) Prenatal visits 12-21 weeks Quad Marker screening, discuss newborn feeding options Prenatal visit 18-22 weeks Anatomy OB ultrasound Prenatal visit 24-28 weeks 1 hour glucose test, RH neg type and screen Prenatal visit 28-34 weeks RhoGam administration, STI testing if indicated, review newborn feeding discussion, administer Tdap, preterm labor assessment and education at each visit Prenatal visit 34-36 weeks Group B strep swab, review s/s of labor and review labor plan Prenatal visit 36-40+ weeks fetal position assessment, cervical exam, review s/s of false labor vs true contractions Quad screening Test performed at 16-18 weeks. Tests levels of Inhibin A, MSAFP, unconjugated estriol, and HCG. Has increased accuracy in screening for DS for women under 35. 1st trimester typical symptoms • Breast pain, enlargement, and changes in pigmentation: wear a supportive bra, avoid caffeine use • Constipation: large amount of circulating progesterone cause decreased GI motility - use bulk-forming laxatives or Colace, exercise regularly, elevate feet on a stool while defecating to prevent straining, high fiber foods, increase fluids, drink warm fluids • Excessive salivation (ptyalism) and bad taste in mouth: good oral hygiene, good diet and adequate hydration, suck hard candy, breath mints, chewing gum • Fatigue: supplemental iron if anemic (30mg/day if not anemic, 120mg/day if anemic for at least 6 weeks), adequate sleep and rest, mild exercise • Flatulence: avoid constipation, avoid smoking, avoid large meals • Headaches: usually tension, Tylenol, avoid stress, smoking, blinking lights, sleeping late, neck and shoulder massage, regular balanced diet, stay hydrated • Hemorrhoids: OTC topical anesthetics (Preparation H, Anusol), avoid constipation, warm or cool sitz baths with Epsom salts, tucks witch hazel pads, ice packs or cool compresses, Kegel exercises • Nausea and vomiting: may use Benadryl, Dramamine, Compazine, Phenergan, reglan, Zofran, avoid triggers (certain foods), rest, avoid stress, avoid tight clothing, hypnosis, acupuncture, relaxation techniques, small frequent meals, high carb, sipping carbonated drinks, eating crackers on arising, drinking fluids between meals, avoid spicy and fatty foods, sit upright after eating, adequate hydration, vitamin B6, ginger • Urinary frequency and incontinence: resting and sleeping in the lateral recumbent position, kegals, adequate water intake, decrease water intake 2-3 hours before bed • Varicosities of vulva and legs: support hose and compression stockings, lie flat and raise legs to drain veins, avoiding crossing legs, elevate the legs as much as possible, kegals, mild exercise, warm tub baths 2cd trimester typical symptoms • Backache: enlarging uterus causes lordosis - Tylenol, good posture, low-heeled shoes, pelvic tilt exercises, proper body mechanics, avoid heavy lifting, twisting, maternity girdle or belt, good bra, avoid gaining excessive weight, pregnancy pillow • Dyspnea - no constrictive clothing, sit up straight, raise arms over head while taking a breath, elevate head with pillows