NUR244 EXAM PREP, (ANSWERED) WITH COMPLETE VERIFIED SOLUTION 2023/2024

NUR244 EXAM PREP, (ANSWERED) WITH COMPLETE VERIFIED SOLUTION 2023/2024 What is pregnancy? Events that occur from fertilization until infant is born; the period in which a fetus develops inside a woman's womb or uterus. What is preconception care and why is it important? Involves obtaining a complete health history and physical examination of the woman and their partner. improve pregnancy outcomes and women's health in general through prevention of disease and management of risk factors that affect pregnancy outcome and the health of future generations. What topics would be discussed during a preconception appointment? 1. Immunisation status of mother 2. Underlying medical conditions 3. Reproductive health data - pelvic exam, contraceptives, STIs 4. Sexuality and sexual practices - safer sex practices and body image issues 5. Nutrition history and present status 6. Lifestyle practices including occupation and recreational activities 7. Psychosocial issues - stress and exposure to abuse/violence 8. Medication and drug use - tobacco, alcohol, prescription medications and illicit drugs 9. Support system - family, friends, and community What are the different trimesters? and when do they occur? First trimester - 1-12 weeks Second trimester - 13-27 weeks Third trimester - 28-40 weeks Physiological changes during pregnancy: Weight gain due to fetus, amniotic fluid Increased storage of proteins, triglycerides and minerals Marked breast enlargement Lower back pain - lordosis Psychological changes during pregnancy: First trimester: - Pleasure, excitement, elation - Dismay, disappointment - Ambivalence, emotional lability - Increased femininity Second trimester: - A feeling of wellbeing - A sense of increased attachment to the fetus; - Stress and anxiety - Feelings of the need for increasing detachment from work commitments Third trimester: - Loss of or increased libido - Altered body image - Psychological effects from physiological discomforts such as backache and heartburn - Anxiety about labour (e.g. pain) - Anxiety about fetal abnormality, which may disturb sleep and cause nightmares. - Increased vulnerability to major life events such as financial status, moving house or lack of supportive partner Cardiovascular changes during pregnancy: Increased blood volume - 45% increase in plasma - 25% increase in erythrocytes Better circulation of blood Haemodilution Increased cardiac output - stroke volume and HR increase Increased blood flow to placenta Can lead to decrease in BP - diastolic Hypertension in pregnancy: Systolic BP around 140mmHG and/or Diastolic BP around 90mmHg - Essential HTN - Gestational HTN - Pre-eclampsia Pre-eclampsia: Hypertension arising after 20 weeks of gestation - Proteinuria - renal insufficiency - liver involvement - epigastric pain - neurological - convulsions, headaches, visual disturbances - haematological disturbances - pulmonary oedema - dyspnoea and agitation - fetal growth restriction Anaemia in pregnancy: Hb (g/L) <110 in first and third trimesters <105 in second trimester Serum ferritin of <30 mcg/L is diagnostic of iron deficiency Anaemia management in pregnancy: Encourage an iron rich diet Oral iron Haemoglobin should increase within 2 weeks Intravenous iron Common discomforts in pregnancy: - Gastro-oesophageal reflux/heartburn - Pelvic girdle and lower back pain - Varicose veins and leg oedema - Carpel tunnel syndrom - Haemorrhoids - Leg cramps - Nausea and vomiting - Sleep disturbances - Vaginal discharge Bleeding in pregnancy: Can occur at any stage during pregnancy - prior to 20 weeks -> spontaneous abortion - after 20 weeks -> antepartum haemorrhage (APH) - Cervicitis, vaginitis, polyps - Haemorrhoids, vulval varicosities, UTIs - Coitus Types of Misscarriages: Threatened abortion Inevitable abortion Complete and Incomplete Abortion Missed abortion Placental abruption... Premature separation of the normally situated placenta Partial or complete Causes are largely unknown- Trauma, Hypertensive disorders Placenta Previa... Part of or the entire placenta is abnormally sited in the lower uterine segment Test to assess maternal wellbeing: Maternal assessment Test to assess fetal wellbeing: Fetal assessment What are the recommended follow-up schedules for pregnant women? - Every 4 weeks up to 28 weeks gestation - Every 2 weeks from 29 weeks to 36 weeks gestation - Every week from 37 weeks gestation to birth What are routine blood tests performed at booking? - Blood group and antibody screening - Full blood count - Rubella - Hepatitis B and C -> can be passed to baby - Human immunodeficiency virus (HIV) -> can be passed to baby - Syphilis - Varicella immunoglobulin G (IgG) - Vitamin D -> low vitamin D levels = harder to form baby bones - Fasting blood glucose - Additional screening as indicated by history RhD negative in pregnancy: Rhesus D (RhD) - Test offered at first pregnancy visit - Used to determine if mother's blood has the Rh factor - Most women (85%) have Rh factor in their blood - Rh D positive - If mother is RhD negative they will be given preventative treatment with an injection of RhD Immunoglobulin - Anti-D at 28-34 weeks Vitamin K for newborn babies: During pregnancy the doctor or midwife should ask whether the mother wants their baby to have Vitamin K by injection or mouth. - Second oral dose can be given when baby has had newborn screening test at the hospital - Third dose when baby is between 3 and 4 weeks old Hepatitis B for newborn babies: Hepatitis B vaccine can protect baby from life-long illness, serious liver disease and liver cancer. - Vaccine is recommended within 24 hours of birth to prevent spread of Hepatitis B from mother to baby - Reduce risk of baby developing hepatitis B - The vaccine can be given within first 7 days of life - for lasting protection additional doses are given as part of routine infant immunisation schedule What is the significance of measuring blood pressure during pregnancy? Enables comparison and monitoring of BP changes in pregnancy. - Early baseline measurement will differentiate chronic HTN in pregnant woman from gestational HTN to pre-eclampsia. Assessments performed to evaluate maternal wellbeing during pregnancy: - Edinburgh Post Natal Depression Scale (EPDS) - Chlamydia and Gonorrhoea screening - Ultrasound screening - Fetal morphology ultrasound - Genetic services - Family and domestic violence screening - Diabetes screening - Methicillin Resistance Staphylococcus Aureus (MRSA) screening - Diet assessment - Oral health assessment - Antenatal assessment Parent education - when to phone or come to hospital - parent education classes - healthy dietary advice and dietician services - minor discomforts in pregnancy - exercise in pregnancy - smoking and alcohol in pregnancy - illicit drug use in pregnancy - risk of food-acquired infections e.g. listeria, salmonella - dental health - breast feeding policy recommendations and breast care - frequency of antenatal visits - health services available including physiotherapy, psychological services, aboriginal liaison service, social worker services - prevention of ligament/muscle strains - life-style issues e.g. air travel, working, sexual intercourse, seat-belt safety. What are some causes of iron deficiency in pregnancy? - Inadequate iron intake - need 27 mg of iron daily - vitamin B12 deficiency - Gastrointestinal absorption reasons - Blood loss - Bleeding disorders What could proteinuria indicate in pregnancy? - UTI - Infection - Kidney disease - Gestational diabetes - Dehydration - After 20 weeks - pre-eclampsia Newborn screening: Detects.. - Congenital Hypothyroidism - Cystic fibrosis - Amino Acid Disorders Stages of Labour: (a) The first stage is that of dilatation of the cervix and is finished when the uterine cavity and vagina are no longer separated by a rim of cervix (full dilatation) (b) The second stage is from full dilatation of the cervix to delivery of the fetus (c) The third stage is completed with the delivery of the placenta and membranes (secundines) What are the main signs of labour starting? - Contractions - Mucous blood-tinged vaginal discharge - Waters breaking First stage of labour... Latent phase: •Generally, this stage is the longest and the least painful part of labour. •The cervix thins out and dilates from zero up to four-six centimetres. •This may occur over days or hours and be accompanied by mild contractions. •The contractions may be regularly or irregularly spaced, or the woman may not notice them at all. First stage of labour... Active phase: •The next phase is marked by strong, painful contractions that tend to occur three or four minutes apart, and last from 30 to 60 seconds. •The cervix dilates from four-six to eight centimetres. Transition: •The cervix dilates from eight to 10 centimetres (that is, fully dilated). •These contractions can become more intense, painful and frequent. The woman may feel as though the contractions are no longer separate but running into each other. •It is not unusual for the mother to feel out of control and even a strong urge to go to the toilet as the baby's head moves down the birth canal and pushes against the rectum. Second stage of labour...