There are 65 questions on this last testWord格式文档下载.docx

There are 65 questions on this last testWord格式文档下载.docx

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Testingfetuses:

3questions:

NSTs,amnioticfluidvolume,andamniocentesis

HighRiskantepartum:

12questions.Knowabouthyperemesisgravidarum,,riskfactorsforPTL,whattocolyticsareusedandhow,majorriskfactorforapreterminfant,BPchangesinpregnancy.

Badstuffthathappensearlierinthepregnancy:

6questions.Knowabouthydatiformmoles,theLMPquestion!

ectopicpregnancy,treatmentoptionsforectopic,kindsofmiscarriages.

Domesticviolence:

4questions:

theeffectsabusecanhaveonapregnancy,askingaquestionthatfacilitatesdisclosureofDV,ourroleindocumenting.（Iknowwehaven’tcoveredthisyet,butthequestionsarebasic）

Contraception:

6questions.Whattodoifawomanmisses3birthcontrolpills,emergencycontraceptiontiming,IUDrisks,basalbodytemperaturemethod,andgeneralthingsyouwanttoaskawomanwhencounselingheronatypeofcontraceptive（only1question）.

STIs:

6questions.RiskfactorsforSTIs,complicationsofGCinpregnancy,mostcommonbacterialandviralSTIs,theSTIhealthcareprovidersaremostatriskforgetting（NOTapersonalquestion!

）,treatmentforPIDinpregnancy.

10questions.

KnowaboutTPAL,

Gravida-pregnantwoman;

Para-numberofpregnancieswherethefetusreached20wks,orthathave,“reached20weeks.”Tosayawomanisgravida1,para1,meansshe’seitherhadonekidormaybetripletsb/cyou’recountingpregnancies.Onlysaysyoucarriedakid（orseveralatonce）past20weeks.

Whatdotheterms:

G,T,P,AandLmean?

GTPAL=gravidity,termbirths;

pretermbirths;

abortions/miscarriage;

livingchildren

∙Gravidity:

numberoftimespregnant,includingacurrentpregnancy,nomatterwhattheoutcome

∙Term:

termbirths:

withkidsthatcookeduntil38-42weeksgestation

∙Parity-numberofpregnancieswherethefetusorfetusesreached20weeksorbeyond.Outcomealsodoesn’tmatterhere—ifthekidwasbornterm,preterm,stillborn,etc.Butifyouhadanabortionbefore20weeks,thatwouldn’tcountintheparitysection.However,youcandistinguishpretermbirthsifyouaccountforallthesenumbers.WhenyoustartusingGTPAL,itseemsthat“P”reallymeans“preemies”

∙Abortions/Miscarriages:

whetherintentionalornot.

∙Living:

kidsstillalive.

Whatwoulditmeanifawomanwas3-0-2-0-3?

∙3pregnancies-0termbirths-2preemies-0abortions-3livingchildren

Nagel’srule

Howlongareyapregnant?

280days,38-42weeks,etc.Countfrom1stdayofLMP-whichisalsoridiculous.

DescribeNagel’sRule.Ifawoman’sLMPwas10/23/07whatisherEDC,EDBorEDD?

∙Nagele’srule-fromthe1stdayofLMPsubtract3calendarmonths,add7daysand1yearORadd7daystoLMP&

countforward9months（assumingthatshehas28daycycle）

∙LMP（lastmenstrualperiod）:

10/23/07（-3+7+01）

∙EDC（estimateddateofconfinement）

∙EDB（estimateddateofbirth）07/30/08

∙EDD（estimateddateofdelivery）

Signsofpregnancy

HowsooncananhCGbepositive?

Whatcaninterferewiththeresults?

∙hCGis:

Humanchorionicgonadotropin,beginssecretionatconception,reachingdetectablelevelsbyday7-10.

∙Itistheearliestbiomarkerforpregnancy

∙Detectedasearlyas7-10daysafterconception;

increases&

peaksat60-70daysthendeclinesat80days,remainingstabluntil30weeksandthenincreasestillterm.

∙Higherlevels:

meantwins,abnormalities[likeDowns’sydrome]

∙Lowordecreasinglevelsmaymeanectopicpregnancy,impendingmiscarriage.

∙Besturinecollection:

firstofthemorning.

Interference:

doingthetesttooearly;

substanceabuseormedications-anticonvulsants&

tranquillizerscausefalse-positiveresults,diuretics&

promethazinecancausefalse-negativeresults;

Impropercollectionofspecimen;

hormoneproducingtumors&

laboratoryerrors=falseresults

3.Whatarepresumptiveandprobableindicatorsofpregnancy?

（Idon’tknowwhyanyonecareswithhCGtestsbeingsoaccurate,butitisoneofthoseoldproceduresthatrefusestodie.Kindalikeclinicalpelvimetry!

）p336-table14.2

∙Presumptiveindicator-changesfeltbythewoman-amenorrhea,fatigue,n/v,breasts,peeingallthetime,fatigue.Quickening[fetalmovements].

oOtherthings:

objectivesignslikeabdenlargment,changesinvagina,striaegravidarum,darkareola,lineanigra,chloasma[pregnancymask].

∙Probableindicators-observedbyexaminer-stillaren’tperfectpositives[likeapregnancytestisn’talwaysright]

outerineenlargement

oPregnancytest（Hcg）

oBHctx

oUterinesoufflé

:

soundslikeamurmurinyouruterusonascultation,fromincreasedbloodflow.

oBallottement（Amethodofdiagnosingpregnancy,inwhichtheuterusispushedwithafingertofeelwhetherafoetusmovesawayandreturnsagain）,

oGoodellSign

oChadwickSign

oHegarsign（@6wksgestation-softening&

compressibilityoftheloweruterinesegment（isthmus）

Positiveindicators-presenceoffetalsigns-heartbeat,palpatingorseeingfetalmovement,USimages

Whyisn’tHcgapositivesignofpregnancy?

It’snotperfect,anditcanindicateamolarpregnancy.

Toxoplasmosis

What’saTORCHscreen?

∙TORCHinfectionscanaffectapregnantwomanandherfetus.Toxoplasmosis,otherinfections,rubella,cytomegalovirus,andherpesformacollectionoforganismscapableofcrossingtheplacentaandadverselyaffectingfetaldevelopment.Generally,alltheseorganismsproduceflu-likesymptomsinthemother,butmoreseverefetalandneonataleffects.

∙Toxoplasmosis:

protozoalinfectionassociatedwiththeingestionofinfestedraworundercookedmeatandwithpoorhandwashingafterhandlinginfectedcatlitter.Miscarriagemayoccur.Treatmentwithmedicationsarepotentiallyharmfultothefetus,butworththerisk.

∙JKFromlecture:

livesincatfeces—it’savirus（she’swrong）,itsurvivescatguts.Prenatalteachingisgoodhere,youdon’twantmomgettingthevirusforthe1sttimeduringpregnancy（probablyalsowrong）—causeslearning,hearing,visualdisabilities.Ifyougetitin1sttri,30%affect,butin3rdtri60%backwardsfromthenorm.Mostpeoplearealreadyimmunetoit.It’sairborneafterabout3daysinfeces,sodon’tinhale.Alsoweargloveswhengardening.

∙Other:

Hepatitis,GBS,varicella,andHIV

∙Rubella:

transmittedbydroplets.Rash,muscleaches,jointpain,andmildlymphedema.Miscarriage,congenitalanomalies,anddeathoccurinfetus.Vaccinationofapregnantwomaniscontraindicatedduetolivevaccine.Postpartumvaccineisgivenwithinstructionstousecontraceptionforatleast1monthafter.

∙CMV:

similartomono,transmittedbyclosecontactorbodyfluidsandplacentaltissues.Fetalinfectioncancausemicrocephaly,eye,ear,anddentaldefects,andmentalretardation.Notreatmentisavailableduringpregnancy.

∙Hisforherpessimplex.

Exercise

Kegelsaregoodforstrengtheningpelvicfloor,improvesstretchingandcontractionattimeofdelivery.AlsohelpspreventPPurinaryincontinenceandimprovessexualgratification.Deliberatecontraction&

relaxationofpubococcygeusmuscle:

strengthensmusclesofpelvicfloor:

vagina&

urethra

Physicalactivitypromotescirculation,relaxation,counteractsboredom,helpsw/lowbackpainespin2tri.Weightbearingexerciseisn’tsogood,butswimming,cycling,andstretching,andwalkingarebest.Exercisealittleeverydaytocreatestamina—30mins.Don’tpushit—decreaseyouractivityaspregnancyprogresses.Layonyoursidefor10minstorelaxafterworkout.Otherstretchestopreparefordeliveryincludesquattingstretches.

Culturalstuffonexercise:

differentgroupshavedifferentideas:

Filipinosencouragewomentodonothingbutincubatethekid,someasianandnativeAmericanskeepheratworkuntilneardelivery.InJapan,Iunderstandwomenarenotallowedevennearsewingmachinesandoftenliveatmom’sduringpregnancydoinglittleactivity.

Culturalconsiderations

PrenatalcareasweknowitisaUSphenomenathatisradicallyforeigntomanymoms.Somewomenaremoremodest—andneedfemalecareproviders.Somethinkdoctorsareforsickpeople,notpregnantpeople.

Eachculturehasitsprescriptionsandproscriptionsaboutprenatalcare—youshouldknowthemforyourclients.Theseincludediet,sex,exercise,etc.

Food:

Youcangainthesameamountofweightinpregnancyeatinggoodfoodsorbadfoods—onemomwillbehealthier.Thekidgetswhatyougiveit.

TheHispanicparadox:

LatinawomentendtofallinlowerSES,buttheirpregnancyoutcomesareoftenasgoodorbetterthanCaucasianwomen’s.There’ssomethingaboutthedietthatreallyworks.Unlesswe’retalkingLatinawomenwhoareDM.It’salsooften1stgenerationLatinasand3rdgenLatinasthatdowell,butthe2ndgenareintoMcDonald’sandstuff.

Warningsignsinthefirsttrimester

Commondiscomfortsofpregnancy:

thinkabouttheseandthenlookforsomew/pathological