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HEHI 2 Exam 1

VUSN HEHI Study Guide

What are some risk factors for suicide? Acute risks? Impulsivity Hopelessness Substance abuse History of abuse during childhood Head injury, chronic illness Monday Late spring/early summer Acute- anxiety, insomnia, substance abuse
Primary suicide interventions can be best described as_______________. Secondary suicide intervetnions can be described as _________. And tertiary suicide interventions can be described as__________. Primary- Preventing individuals from every considering suicide by improving social supports Secondary- recognizes and treats immediate suicide risk Tertiary- care provided to at risk individuals who display suicidal tendencies/behaviors
Secondary suicide interventions consist of psycho-social, pharmacological, and resource care. Briefly describe and give examples of each. Psychosocial- therapeutic relationship, reaffirm hope Resources- use the client's personal protective resources (history, social supports, PCP, effective coping skills) Pharmacological- SSRI's, ECT...
A client would be deemed inappropriate for outpatient treatment for suicidal ideation if... -Intact support system -Unable to control impulses -Uses alcohol -Has history of seeking help -Suicide attempt -Lives alone -Low levels of stress Unable to control impulses Suicide attempt Lives alone Mood altering substances (alcohol)
Suicide: It's about the (_______) not the (_____)! Chemistry/ Character
List the most common causes in order of occurrence for completed suicide. 1) Mental illness 2) ETOH/drug use 3) Being overwhelmed 4) Control
One neurobiological theory of the etiology of suicide finds that this neurotransmitter tends to be lower in individuals who have attempted or completed suicide than in those who have not. Serotonin (5-HT, 5-hydroxytryptamine)
When assessing a client, what direct signs and symptoms should indicate that your client may be a suicide risk? Suicidal ideation/threat/plan/attempt Intentional self-harm behavior Hopeless/helpless Anhedonia
When assessing a client, what indirect signs and symptoms may indicate that your client is suicidal? Sudden behavioral changes Unexplained physical changes (weight loss, pain, sleep disturbances) Emotional alterations (ambivalence, irritability) An extreme loss has occurred
Using the SAD-PERSONS suicide assessment tool, describe the risk factors. What score would indicate that a patient needs admission? What score indicates they need consultation? Sex (male) Age (<19 or >45) Depression Previous attempts ETOH/Drugs Rational thinking loss Social support lack Organized plan/serious attempt No spouse Sickness 0-5 D/C w/ follow up 6-8 Psychiatric consultation 8+ Hospitalization
When assessing the potential lethality of a suicide plan, what would be considered "hard"? Soft? Why? Hard- more likely to result in death -car crash -carbon monoxide -jumping -hanging Soft- less likely to result in death/easy to reverse -Natural Gas -Pills/OD -Wrist cutting
Hospitalized patients may require certain suicide precautions. Explain 1:1, safety observation, and seclusion/restraint and when each is appropriate. 1:1- Within arms reach at all times Safety observation- find and observe patient q15 minutes Seclusion/restraint- when doing self-harm (only after all other options are exhausted)
T/F- You cannot discharge someone on suicide precautions. True
Describe and discuss the mental health continuum Typical: Anxiety that aids in the work of living Mild-Moderate: Psycho-physiologic factors affecting medical conditions Moderate-Severe: Anxiety, personality, eating, dissociative disorders. Psychosis: Depressive Bipolar Schizophrenic Cog. disorders
Identify examples of preventative treatment and maintenance interventions for suicde/addiction. Preventative treatment- Attending AA groups for addiction, learning new coping skills Maintenance intervention- Receiving ECT or taking your meds regularly
Describe the purpose of the DSM-V. Provides diagnostic characteristics and categories used in the classification of mental disorders. Significant interference in person's life, doesn't meet other criteria, time criteria, not due to substance abuse or other medical condtition
Discuss legal guidelines for safe practice as they relate to treatment and hospitalization of the mentally ill person. Can only hold a patient against their will for 72 hours, then must appeal to the court to hold longer. Requires recognition of 2 Doctors that the patient still meets the criteria.
T/F- Mental illness is a relatively rare occurrence in the US. False- 1/3 American adults will meet the diagnostic criteria for a mental disorder in their lifetime.
You are more likely to develop this mental illness in your life-time if a family member also suffered from this. -Bipolar -Schizophrenia -Panic -Generalized Anxiety -Depression Bipolar (25%) followed by schizophrenia (18%) then panic, GAD, and depression
When treating a mentally ill person, what are your goals? Identify the illness correctly Decrease the time of active illness Halt the progression or severity Decrease the likelihood of relapse (tertiary treatment)
What are the classification differences between DSM 4 and 5? DSM 4 has 5 Axis (1- Clinical disorders, 2- Personality disorders, 3- Medical conditions, 4- Psychosocial problems, 5- GAF) and DSM 5 has 3 condensed Axis (1- Clinical disorder, personality disorder, medical condtion, 2-environmental stressor, 3- GAF)
Describe the difference between Voluntary, Involuntary, Observational and Indeterminate inpatient admissions. Voluntary- Patient can leave at will Involuntary- 72 hour hold then court system if meet criteria (danger to self/others, inability to care for self) Observational- psych evaluation for forensic clients (30 day) Indeterminate- court says can hold +30
T/F- Most psychiatric inpatients do not receive therapy. True- mostly long-term and severely ill patients.
Describe Short-term focused therapy, Interpersonal therapy, Supportive therapy, Behavioral therpy, and Cognitive therapy. Short-term: Let's talk it out Interpersonal: Like Dr. Phil Supportive: Validate patient's experiences Behavior: Modify anxiety Cognitive: How to think differently
What is the difference between a Milieu group and a Self-help group? Milieu groups- activity groups run by professionals Self-help groups- run by a member of the group
What is the primary function of the Parietal/Occipital lobe? Attends to stimuli
What is the primary function of the Temporal lobe? Identifies stimuli Major part of the Limbic system (emotional brain) Responsible for short term memory, Judgment, Language/Stimuli interpretation and Emotional expression via Limbic system
What is the primary function of the Frontal lobe? Plans appropriate responses to stimuli. Responsible for higher order thinking including abstract reasoning, motivation, concentration, and purposeful movement.
If your frontal lobe is not functioning properly, you can expect... If the frontal lobe is working slowly you can expect... Labile affect (extreme and quick mood changes) Slow- flat negative symptoms (depression)
What do the basal ganglia do? regulate and mediate motor activity, help express and regulate emotions and cognition Use dopamine to control motor activity (if block too much dopamine with schizophrenia treatment, can lead to motor movement complications like Parkinson's.)
Where are the highest concentrations of dopamine found? In the basal ganglia
What is the Limbic system? What are it's part? Responsible for emotional response of the brain. Consists of the Temporal lobe, Hippocampus and Amygdala (fear response) which help to experience, regulate, and integrate emotion memory and sensory data. Also consists of the Fornix or bridge.
What is dopamine? What does it do? You can expect increased levels in this mental illness and decreased levels in these. A neurotransmitter, generally excitatory which affects motor coordination/movement Motivation/Judgment Integration of thoughts and emotions Plays a part in hormone release Increased in Schizophrenia (mania) Decreased in depression and Parkinsons
What is norepinephrine (NE)? What does it do? You can expect decreased levels to contribute to _____ and increased or overactivity to contribute to _________. A neurotransmitter that can be excitatory OR inhibitory. Has many responsibilities within the CNS and is found throughout the brain. Has major effects on MOOD. Under active- Depression Overactive- Mania, anxiety, schizophrenia
What is serotonin (5-HT)? What does it do? You can expect underactivity to contribute to ________ and over activity to contribute to _________. A neurotransmitter that, similar to norepinephrine, is a general modulator with multiple roles. Can be excitatory OR inhibitory. Underactivity- depression Overactivity- anxiety May play a role in psychosis.
What is acetylcholine? What does it do? You can expect underactivity to contribute to ________ while overactivity contributes to_____. A neurotransmitter excitatory or inhibitory. effects MEMORY, muscle coordination, some mood regulation, and has many effects in the peripheral nervous system (blocked, anticholinergic effect) Underactive- Alzheimers, Parkinsons Overactive- depression
What is GABA? What does it do? You can expect decreased GABA activity to lead to ______. An INHIBITORY amino acid (GABA calms) which decreases the excitability of the brain. Decreased GABA activity -> anxiety and association with schizophrenia. Alcoholizm destroys receptors
What is Glutamate? What does it do? You can expect decreased Glutamate to contribute to ______ and increased to __________. An EXCITATORY amino acid that affects learning and memory and helps relay sensory information. Decreased is associated with schizophrenia. Increased is associated with improvement in dementia
What is Corticotropin-Releasing Hormone (CRH)? What does it do? What does an overactive system lead to? Part of the stress response, secreted by Hypothalamus leading to pituitary release of corticotropin which stimulates adrenal glands lead to release of cortisol. Too much?- Depression and anxiety
If a patient is taking Beta Blockers or Antihypertensives, it is important to know that they may exhibit _______- symptoms. Depressive
What is the neuroregulation Kindling Hypothesis? Similar to seizures, dysregulated neurotransmitter systems lead to more frequent and more intense episodes of illness (schizophrenia) with less required stimulation because the affected cells recruit surrounding cells.
Why is chronic, uncontrolled stress such a problem for neurotransmitters? It leads to chronic, maladaptive alterations in the neurotransmitters which makes treatment harder.
There is a genetic predisposition to schizophrenia. Describe it and how stress can contribute. If a sibling has schizophrenia, you have an 8% chance as opposed to a 1.3% chance in the general population. Higher if twin or child of schizophrenic parent. Prenatal stress (viral) can increase the genetic vulnerability
Describe the relationship between schizophrenia, dopamine, and frontal lobe activity. In schizophrenia, you have high dopamine levels and activity with decreased frontal lobe activity which contributes to psychosis (delusions, flat affect). 5 known subtypes of dopamine.
Describe how associated neurotransmitters are affected in schizophrenia. ^ Dopamine, Serotonin, and NE GABA unable to control Dopamine, Serotonin and NE Glutamate may be reason males develop schizophrenia earlier than females
Describe the structural abnormalities common in schizophrenics. Small frontal lobe (hypofrontality) with enlarged ventricles on MRI, Temporal lobe is overactive causing abnormal movements and information processing, Memory is impacted
Describe the (+) symptoms of schizophrenia. Overactivity, Hallucinations, delusions, bizarre/disorganized behavior, formal thought disorder
What is a hallucination? Most common type? Sensation occurring without an external stimuli, Auditory most common
What are delusions? Types? Fixed, false belief not validated in related that is contrary to the person's educational/cultural background. Persecution, Grandeur, Ideas of Reference, Somatic, Control
Describe the negative symptoms of schizophrenia. 5 A's Affective flattening Alogia- impoverished thinking Anhedonia- inability to experience pleasure Attentional impairment Avolition- lack of energy
What are some common cognitive symptoms of schizophrenia? Concrete, illogical thinking Impaired judgement/memory Inattention Anosognosia Loss of ego boundaries Depersonalization- I have changed Derealization - environment has changed
There are 4 symptom groups or domains of Schizophrenia which may need to be targeted. Name them Positive Negative Cognitive Affective
What are the common affective disturbances in schizophrenia? Restricted/constricted Blunt- sever restriction Flat Inappropriate Labile- extremes Aggressive
What is schizophrenia? breakdown in the relation between thought, emotion, and behavior, -> faulty perception, inappropriate actions/feelings, withdrawal from reality and personal relationships into fantasy/delusion/sense of mental fragmentation
Describe the risk between schizophrenia and suicide. 50% attempt suicide with 10-15% success Highest risk for males <30, college education, unemployed, recently hospitalized and history of depressive episode
T/F- Women tend to develop schizophrenia later in life than men (though they are equally likely to develop it) and have better outcomes. True b/c women develop around 25 whereas men develop around 15. Women have more time to develop better coping skills> better outcomes
T/F- Individuals with schizophrenia are likely to have a dual diagnosis of ETOH dependence, Marijuana/Cocaine/Nicotine because they are trying to treat their symptoms. False- likely but because they are trying to have a social group
What are the 3 phases of Schizophrenia? Briefly describe each. Prodromal- before active phase (up to 1 year) with gradual development of symptoms/loss of social skills Acute- Full blown schizophrenic episode Residual- lingering affective flattening (negative symptoms more common), may be interrupted with active
What are the assessment criteria for Schizophrenia (Acute Phase) 2 or more within one month -Delusions* -Hallucinations* -Disorganized speech* -Grossly disorganized/catatonic behavior -Negative symptoms (5A's) -Dysfunction in major life areas (must include one of first 3) Duration >6mos cont. signs >1mo sympt.
What are the Schizophrenia (Subtypes)? Dimensions (Paranoid Catatonic Disorganized Undifferentiated Residual) Symptom severity level, #symptoms, Duration symptoms, Course of illness
What is Schizophreniform disorder? 2+ Characteristic symptoms present Episode (including prodromal, active, and residual) lasts at least 1 month but less than 6 months
What is Schizoaffective disorder? (more common in women) Meets criteria for schizophrenia and depression/bipolar at same time. Major mood episode present for majority of duration, 2+ weeks of delusions/hallucinations w/o mood symptoms Mood symptoms present for most of active/residual periods of illness.
What is a delusional disorder? When does is occur? What are the 5 subtypes? Generally in middle/late adult Non-bizarre delusions for 1+ month Never met Schizophrenia criteria Behavior/function not odd or impaired (Erotomanic, Grandiose, Jealous, Persecutory, Somatic)
When treating a patient with Schizophrenia, it is important to... Be calm (anxiety contributes to hallucinations) Deserve trust (follow through, short frequent interactions) Do not pretend to understand loose associations, refocus Ask about Hallucinations, focus on reality Be open about delusions, describe/dont dwel
If a patient/family member asks about the adverse effects of antipsychotics, be honest and tell them... Extrapyramidal side effects (^motor activity) Anticholinergic side effects (see, pee, spit, poop) Cardiovascular effects Potential toxicity Weight gain
Review the process of fertilization. Oocyte ovulated-> fertilization by sperm-> Zygote formation-> Morula -> Blastocyst (implants in the uterus) -> Embryo (first 8 weeks)-> Fetus
Describe development, structure, and functions of the placenta. Develops from the chorion, grows and surrounds the baby and amniotic sac produces hormones. Acts as a filter for gasses, water, electrolytes, glucose, AA, minerals Leakage may lead to blood mixing
Describe amniotic fluid and its corresponding functions. What is it called if you have too little? Too much? clear, yellowish fluid surrounds fetus. About 1000 ml average <300 ml (Oligohydramnios- fetal renal issues) >2 L (Poly Hydramnios- GI malformations) Allows movement, surrounds/cushions/protects Maintains temperature Measure kidney function
Describe the development of the fetus and embryo. Weeks 1-2 (dividing zygote, implantation) 3- CNS/heart 4-5-eye/heart/limbs 6- ear/kidneys/teeth 7-teeth/palate 8-ear/palate/genitalia 9-genitalia 9-16-Brain 20-36- Lungs/Brain 37- Full term
T/F- The Umbilical Cord has pain receptors which is why babies go into distress if it becomes knotted. False, no pain receptors. Distress b/c can't get oxygen and nutrients needed from 2 Arteries and 1 vein
An embryo is most likely to die during this time. Early conception, weeks 0-3
An embryo is most likely to have malformation of organs during this time. Weeks 3-8
An embryo is most likely to have functional disturbances during this time. Weeks 8-38
At this time, the baby is 1/4 inch long, is developing heart, digestive system, backbone, spinal cord, and placenta. It is 10,000 times larger than at conception. End of 4 weeks (One month)
At this time, the baby is 1-1/8 inch long, has a functioning heart, eyes,nose, lips, tongue, ears and teeth are forming, penis is developing and baby is starting to move (but you can't feel it yet). End of 8 weeks (Two months)
At this time, the baby is 2 1/2 inches long and weighs about a 1/2 to 1 oz. It looks like a baby! Its nails are forming and earlobes are there. Arms, hands, fingers, legs, feet and toes are there. Eyes are mostly developed as well as most other organs End of 12 weeks (Three months)
At this time, the baby is 6 1/2-7 inches long, weighs about 6-7 oz. Reflexes are developing and he may suck his thumb.Tooth buds and sweat glands developing.Fingers, toes & sex is there. Skin is pink, transparent and covered in hair. CANNOT surivive. End of 16 weeks (Four months)
At this time, the baby is 8-10 inches long, weighs 1 lb. Hair is growing on head. covered in lanugo. You can feel him move! Internal organs maturing. Eyebrows, eyelids, eyelashes appear. End of 20 weeks (Five months)
At this time, the baby is 11-14 inches long, weighs 1.75-2 lbs. Eyelids part and eyes open sometimes. Skin covered in vernix (petroleum jelly substance). Baby can hiccup/ End of 24 weeks (Six months)
At this time, the baby is 14-16 inches long, weighs 2.5-3.25 lbs. Taste buds there, fat layers forming, organs maturing, skin wrinkled and red. Premature. Size of butternut squash. End of 28 weeks (Seven months)
At this time, the baby is 16.5-18 inches long, weighs 4-6 lbs. Growth is RAPID. Brain grows. Most organs developed EXCEPT lungs, kidneys good. Kicks are visible! Skin less wrinkled. Fingernails beyond fingertips. Cabbage size. End of 32 weeks (Eight months)
At this time, the baby is 19-20 inches long, weighs 7-7.5 lbs. Lungs mature! Can survive outside of mom's body. Skin pink and smooth. Baby settles in lower abdomen to prepare for birth. Small watermelon. End of 36 weeks (Nine months) 37 weeks is full term.
When does the respiratory system develop? 24 weeks to birth.
When does the cardiovascular system develop? What is an appropriate Fetal Heart Rate? First system to develop. FHR- 110-160/min Can hear FHR at 10-12 weeks.
Explain the umbilical cord and it's function/ Made up of 2 arteries and 1 large vein. Vein carries oxygenated blood. :) Transports O2 and nutrients as well as waste products and CO2
What are the fetal circulatory adaptations? Describe each. Ductus venosus- shunts some Oxygenated blood directly to inferior vena cava from Vein, bypassing Liver Foramen Ovale- Shunts blood from right to left atrium Ductus Arteriosus- connects pulmonary artery to Aorta to bypass lungs
When does the hepatic system begin to function? When is it fully functional? 4-6 weeks starts, fully after birth
When are the bones and muscles developing? When does the fetus start to have arm/leg movements? What is a fontanel? Start 4 weeks Move 7-8 weeks Fontanels- 2 bones meet
When does the GI system form? What is an Omphalocele? Meconium? Forms during the 4th week. Omphalocele forms if the intestines do NOT return from the umbilical cord at the 10th week as expected. Meconium is the dark tarry waste of the fetal intestines, first poop
When do the kidneys form? Function? Form in the 5th week, function in the 9th. Void into the amniotic fluid. Low amniotic fluid indicates renal dysfunction.
When does the neurological system form? When will the following reflexes occur: Respiratory effort, Swallowing, Sucking, Movement (quickening that can be felt)? Forms during 3rd week Respiratory 18.5 weeks Swallowing 12.5 weeks Sucking 29 weeks Quickening- 16-20 weeks
When does the fetus begin producing insulin? 20 weeks
How do you calculate Gestational age? What is viability? Time since last menstrual period. Ability to survive outside of uterus at the earliest gestational age 22-24 weeks depending on maturity of CNS and lungs
What does EDC< EDD< and EDB mean? Estimated Delivery Date
When should a baby be born? 280 days after last menstrual period, 266 days after fertilization, 38-40 weeks, 8.75-9 calendar months 9.5-10 lunar months
Why does a fertilized ovum stay in the Fallopian tube for 3 days? Promotes fertilized ovum's normal implantation in top portion of uterus.
T/F- Two arteries carry oxygenated blood and nutrients while one vein carries deoxygenated blood and waste products. False- Two arteries carry deoxygenated blood and waste and one vein carries oxygenated blood
What is the purpose of the placenta? To provide the baby with food and oxygen
Describe common anatomic and physiologic changes during pregnancy by system.
Discuss nursing responses to common discomforts of pregnancy.
When can a pregnancy test tell if pregnant? how dies it work? 7-10 days after conception, analyze blood/urine for HCG (hormone produced by trophoblastic cells of developing placenta) Follow the directions closely
What is included in Presumptive evidence of pregnancy? Amenorrhea NV Bladder irritability Breast tenderness/nipple tingling Fatigue
What are probable signs of pregnancy? Goodell sign- softening cervix Chadwick sign- bluish cervix Hegar sign- softening lower uterine segment + Pregnancy test Braxton Hicks contraction Ballottement (fetal floating)
What are the positive signs of pregnancy? 5-6 weeks vaginal ultrasound 6 weeks Fetal Heart Tones by ultrasound 16 weeks, ultrasound 17-19 weeks, Fetal heart sounds by fetoscope 19-22 weeks, fetal movements
Patient is 43 yo femal at estimated gestational age of 21 5/7 weeks and no prenatal care. She has vaginal bleeding and reports fetal movement. What do you assess first? Obtain fetal heart tones to ensure pregnancy is real
What is GPTPAL? Gravidty- # pregnancies Parity- # pregnancies reaching 20 weeks Term- # pregnancies reaching at least 37 weeks Preterm- # pregnancies reaching 20-36 6/7 weeks Abortion- # miscarriage/elective termination before viability (22-25 week or 500 g) Living
What is the GTPAL of Amelia. She has one spontaneous abortion, one elective abortion, one C-section, twins at 29 weeks, still birth at 36 weeks and is currently pregnant. G5 T0 P2 A2 L2
What is Naegele's rule? Used to tell you the due date. First day of last menstrual period, subtract 3 calendar months, add 7 days.
Hormones change during pregnancy. How/why do estrogen and progesterone change? Decrease production of prostaglandin which causes smooth muscle to relax and prevent uterine constriction. Also relaxes vessel walls (potential for hypotension) Affect uterus, cervix, vagina, vulva
A pregnant woman presents to your office complaining of "nipple lumps". These may be... and you tell her... Montgomery's tubercles- hypertrophy of sebaceous oil glands in areola Totally normal
During pregnancy, the cardiovascular alterations mean that there is ___ flow and ___ resistance and it is hyperdynamic. What happens to BP during pregnancy? High flow Low resistance BP decreases and is LOWEST at 2nd trimester (24-32 weeks), affected by maternal position Woman at risk for DVT
A woman pregnant with one baby can expect to have a blood volume increase of ______ while a woman pregnant with twins can expect ________. By 4-6 weeks a __% increas, 32 weeks a ___% and a ___% decrease by 2 weeks postpartum. Single- 1200-1500 mL Twins- 2000 mL 4-6= 11% increase 32= 40-45% increase 2 weeks post=33% decrease
Describe the hemodilutional effect of pregnancy? What is a normal Hematocrit of a pregnant woman? Your RBCs increase by 20-30% while your plasma increase by 40-45% which dilutes the Hematocrit and leads to decreased blood viscosity. Totally normal. Hematocrit of normal pregnant woman is 34.7 (as opposed to 38.2 nonpregnant)
A pregnant woman comes in complaining that her heart beat is faster. Usually her heart rate is 65. Currently it is 80. You tell her... What bout stroke volume? Not to worry, it is normal for a HR to increase by 10-15 bpm during pregnancy. Stroke volume also increases 25% by 20-24 weeks and 50% by term
Normal non-pregnant CO is about 5 liters per minute. What is a normal pregnant CO? In what position should a woman sleep to ensure optimal cardiac output? When does a woman have low CO 6-7 L/min baseline Sleep knee chest or on the Right side, Left is ok too Lowest Co Sitting, lying on back (uterus impedes venous return) and Very lowest (5.4L/min) is standing
All that extra blood in pregnancy has to go somewhere. What organs recieve the extra blood? Kidneys have 30% increase Uterus has 50mL/min at 10 weeks and 500 mL/min at term Skin gets extra CO
T/F- Pregnancy is dangerous for women because of the inherent risk of bleeding out so they should be extra cautious not to harm themselves. False- pregnant women actually have an increase in clotting factors and are hypercoagulable with puts them at risk for DVT This is great for delivery to prevent woman from bleeding to death. Note: Assess for DVT and add heparin to saline locks
What anatomic and physiologic pulmonary alterations can you expect during pregnancy? -Diaphragm pushed up 4 cm -Ribs flare -APL decreases -RR decreases -Tidal volume increases by 33% -Total lung capacity increases -Diaphragm is pushed up -Ribs do flare -APL ratio INCREASES -RR may increase slightly -Tidal volume does increase -Lung capacity is UNCHANGED or slightly DECREASED
What changes in basal metabolic rate can a pregnant woman expect? How will these affect her life? BMR increases 10-20% by 3rd trimester due to increased O2 demands and consumption Pregnant women are heat intolerant, have peripheral vasodilation, sweat more, are tired easily and need more sleep
T/F- Slight respiratory alkalosis is typical for pregnant women. True ABG shows pO2 of mom (104-108) nonpregnant is (80-100) and PCO2 of mom (27-32) is normal but nonpregnant is (35-45)
T/F- Serum creatinine, BUN and uric acid levels are expected to increase during pregnancy due to increased renal perfusion and GFR 50%. False- levels should decrease due to increased perfusion and GFR
Why are pregnant women more susceptible to UTI? Urinary stasis grows microorganisms, glucose in urine increase pH of urine making environment better
T/F- Glucose in the urine during pregnancy always indicates diabetes. False- Glycosuria is common during pregnancy
A pregnant woman presents with blotchy, brownish hyperpigmentation of tthe skin over her cheeks nose and forehead. you recognise this as... Chloasma- totally normal
What is a linea nigra? What are striae gravidarum? Pigmented line that extends from the fundus to the symphysis pubis. Totally normal Stretch marks, common in 50-80% of pregnant women
A pregnant woman is 4 weeks pregnant and has horrible nausea and vomiting you tell her... This is common in 50-90% of women, caused by estrogen, HCG and relaxation of smooth gastric muscle. Usually resolves by 12-16 weeks but peaks around 8-12 weeks
T/F- Pregnant women are at risk for constipation due to decreased smooth muscle tone and motility. True b/c decreased gastric emptying allows for increased absorption of water from intestines
T/F- The liver maintains its normal size, histology, blood flow and function in pregnancy but has some mechanical displaement True
In what trimester should you screen for maternal risk/problems, fetal genetic abnormalities, ectopic pregnancy, HTN and comorbid disorders? 1st trimester
In what trimester should you screen for fetal phenotype abnormalities and monitor maternal/fetal health. This is also when you do gender screening and anatomy ultrasound 2nd trimester
In what trimester should you monitor for pregnancy-induced hypertension as well as monitor fetal health? You will also do diabetes testing, GBS testing, repeat HIV and STI and give RhoGam if needed. 3rd trimester
The first prenatal visit is very important. What type of medical history, maternal exam and testing can you expect? What education should you provide? Complete maternal history (OB and GYN) Paternal history, Psychosocial and SES Physical exam, Rule out Ectopic pregnancy, size and shape of pelvis CBC (blood type, Rh, antibodies) STI's, Rubella, CF screening, Urine culture Educate
What should pregnant women know about vaccines? No live vaccines Get TDaP every pregnancy and the Flu vaccine
This is the most common and fastest spreading STI. It is often silent and highly destructive. Who should be screened? What is the preferred diagnostic method? How do you treat it? Chlamydia Client younger than 25 or high risk Pregnant? First visit test Diagnose with culture Treat w/ Doxycycline (teratogenic) -mycin, Amoxicillin Erythromycin ointment in newborn eyes
This is the oldest communiccable disease in the US, second only to chlamydia in reported cases. Highest rates in teens, young adults and AA. Asymptomatic usually. Who should be screened? Diagnosis? Treatment? Gonorrhea (aerobic gram - diplococcus) Screen all women @ risk, test during first trimester and at 36 weeks Culture of cervix Treat with Ceftriaxone Note: Concomitant treat w/ Chlamydia
T/F- You should treat a pregnant woman with Gonorrhea with Ceftriaxone as well as Amoxicillin b/c you should also treat for chlamydia b/c they travel together. True
This is the earliest described STI. It is transmitted by entry through microscopic abrasions in sexual intercourse, kissing, biting, and oral-genital sex. It can cross the placenta. Syphilis
T/F- Syphilis can lead to death. It has 3 stages (Primary 5-90 days after exposure, Secondary 6 weeks -6 months, Tertiary- develops in 1/3 of infected women) True
Who should be screened for Syphilis? How do you test? How accurate are test? How do you treat? All women with another STI or HIV Pregnant women Use serologic tests to diagnose False positives are common Treat with Penicillin and abstinence
T/F- HIV + mothers can have vaginal delivery of healthy, non HIV babies. T/F- HIV + mothers can breastfeed as long as they take antiretrovirals True False- cannot breastfeed
Herpes simplex virus 1 is transmitted __________ while Herpes simplex virus 2 is transmitted ______. Many with herpes are asymptomatic. what are some symptoms? Treatment? 1- nonsexually 2- sexually Symptoms include painful lesions, fever, chills, malaise, dysuria, crusty ulcers No cure for Herpes, Acyclovir can help prevent outbreaks
T/F- The CDC recommends that all sexually active individuals be tested for Herpes simplex virus. False- it is unclear whether testing leads to better health outcomes
T/F- A mother known to have Herpes Simplex Virus 2 can have a vaginal birth, even if they have lesions, as long as they have taken acyclovir. False- cannot deliver vaginally with lesions
What are TORCH infections? A group of infections that can cross the placenta and adversely affect the fetus. Toxoplasmosis Other such as Hepatitis Rubella virus Cytomegalovirus Herpes simplex virus
What should a pregnant mom expect during a normal prenatal visit? Maternal Concerns BP Weight Fundal height (1cm per week from 18-36 weeks) Fetal heart tones (after 10-12 weeks) Education
What is Group B strep? What type impact does this have on a newborn? Screening? Treatment? GBS is part of normal vaginal flora in 20-30% women but can cause neonatal MM from respiratory issues, sepsis, or death. Screen at 35-37 weeks Give IV penicillin to prevent spread of GBS to newborn
Who recieves RhoGam? When? Rh- women who are carrying an Rh+ fetus Give anytime the mom starts bleeding, @ 28 weeks, and following birth of baby
What are symptoms of pre-term labor? Contractions >5/hour Backache Pelvic pressure
T/F- Ultrasound, blood draws, hormone screening and MAFP (leaked from fetus w/ open neural tube defect) are diagnostic for fetal abnormalities. False, non invasive tests are not definitive, only invasive tests like amniocentesis or Chorionic Villii Sampling are
How much weight should a pregnant woman who is currently Underweight, Normal weight, overweight and obese gain during pregnancy? Underweight- 28-40 lbs Normal weight- 25-35 lbs Overweight- 15-25 lbs Obese- 11-20 lbs
Women want to lose the baby weight. What is an appropriate weekly weight loss in non lactating women? lactating women? Non-lactating- 0.5-0.9 kg/week Lactating women- 1 kg/month
What is the most common medical complication in pregnancy? Hypertension (affects 10%) 2nd leading cause of maternal mortality in US 15% die from HTN
What puts you at risk for HTN during pregnancy? First pregnancy or new partner Teens and over 35 Increased placental size (twins, diabetes) AA/Hispanic Family/Personal history OBESITY
What are the 4 classifications of HTN? Chronic HTN (begins prior to 20 weeks, doesn't resolve w/in 12 weeks post BP>140/90) Gestational HTN (BP>140/90 after 20 weeks, W/O proteinuria) Preeclampsia/eclampsia CHTN w/ preeclampsia
What are the criteria for preeclampsia? Begins after 20 weeks gestation, BP >140/90 twice, 4 hours apart AND Proteinuria (>300 mg/24hr urine colletion) OR Thrombocytopenia, Renal insufficiency, Impaired liver function, pulmonary edema, Cerebral/visual symptoms
What is the classic preeclampsia triad? BP >140/90 Proteinuria >300mg in 24 hr urine or >1+ in urine dipstick Edema
When would someone be diagnosed with preeclampsia with severe features? SBP >160 DBP>110 Thrombocytopenia Renal insufficiency Impaired liver function Pulmonary edema or Cerebral disturbance
What is Eclampsia? Meets criteria for preeclampsia (BP>140/90, Proteinuria(>300) or Edema, Thrombocytopenia, renal insufficiency, Impaired liver function, Cerebral/visual symptoms ++++ Grand mal seizure activity Leads to increased maternal mortality
What is CHTN with superimposed preeclampsia? Had HTN before 20 weeks gestation +++ New onset of Proteinuria Sudden increase in well controlled BP Any severe features of preeclampsia
What is the cure for preeclampsia? Delivery
What is the pathophysiology of preeclampsia? Vasospasm leads to decreased blood flow and tissue/cellular hypoxia Leads to endothelial damage (leaky vessels>edema and hypovolemia >decreased CO) Leads to platelet aggregation/clot formation (microvascular obstruction and further cellular hypoxia)
You suspect a pregnant patient with hypertension has pulmonary edema. You want to know... Is it cardiogenic (due to congestive heart failure) or is it non-cardiogenic (damaged vessels allow fluid to move into alveoli)
How does preeclampsia affect the renal system? Decreased urine output (<30mL/hour) > decreased GFR > decreased clearance of uric acid Severe vasospasm can damage endothelium leading to oliguria of pfogdinufiz
A woman with preeclampsia complains of RUQ pain and nausea and vomiting. Your first action is... Check for liver functioning, assume hepatic ischemia R/T preeclampsia May also indicate HELLP syndrome
How does preeclampsia affect the placenta and thus the fetus? High resistance and low blood flow leads to restricted gas exchange which can lead to intrauterine growth restriction Also Oligohydramnos, Pre-Term labor, Placental abruption, Infarction or intrauterine fetal demise
What is HELLP syndrome? WHat are the SS? Severe form of preeclampsia, diagnosed by lab values, hard to detect and increases maternal death. SS Tired, NV, RUQ pain, visual changes, Proteinuria, increased BP? Bruising under BP cuff? Hemolysis Elevated Liver enzymes Low platelets
T/F- after delivery, the risk for eclampsia disappears? False, there is a risk for eclampsia at anytime during and postpartum
What does Magnesium Sulfate have to do with Preeclampsia? What are indicators of Mag Sulfate toxicity? How do you treat? When a mom with preeclampsia is gong to deliver, give high loading doses (4-6 gm) and maintenance doses (1-3gm) to prevent seizures through 24 hours postpartum Toxicity: RR<12, Urine output <30mL/hr, Lethargy, change in LOC Treat with Calcium gluconate
What are the common medications for preeclamptic mothers in acute hypertensive crisis? Hydralazine, Labetolol, Nifedipine
Describe the delivery timing and management for a mother with Preeclampsia WITHOUT severe features. <37 weeks- bedrest, assessments 37-40 weeks- close assessments, risks vs. benefits, MgSO4 and delivery 40+ weeks- MgSO4 and delivery
Describe the delivery timing and management for a mother with Preeclampsia WITH severe features. <23 weeks- consider termination 24-32 weeks- steroids, close assessment, delivery? 32-34 weeks- MgSO4, antihypertensives, steroids, deliver in 24-48 hours, counsel risks/benefitys >34 weeks- MgSO4, antihypertensives, delivery
Which DTR is most indicative for preeclampsia which may lead to eclampsia? Hyperreflexia of the patella
When do you need to notify the physician about a patient with preeclampsia? -SBP>160, DBP >110 -UOP<30 mL/hr -Worsening Headache, RUQ pain, visual changes, edema, changed LOC -Quick clotting -Improving lab values -RR<12, loss of DTR's All except fast clotting (notify if prolonged bleeding) and improving labs (notify if worsening)
White lists two classifications of diabetes in pregnancy, A1 and A2. Describe each. A1- blood glucose levels are diet controlled A2- Blood glucose levels require medication
T/F_ Insulin and glucose cross the placenta to maintain blood sugar in the fetus. False- glucose crosses, insulin does NOT
In which trimester(s) does insulin requirements increase? Decrease? Decrease during first trimester (mom isn't eating as much, baby is taking more of the glucose, hormones are working) Increase during second and 3rd trimester
Congenital malformations are a major concern in babies born to mothers with pregestational diabetes. What are the major ones? Intrauterine fetal demise CNS malformations Big babies or growth restricted baby if poor placental blood flow
How common is Gestational DM? What are the risks to the fetus? Complicates 3-9% of all pregnancies Obese women who develop GDM are at increased risk to birth infant with CNS defect
Who gets screened for Gestational DM? When? Risk assessment performed at first visit for ALL women Screen ALL women at 24-28 weeks (may need earlier screening if history of diabetes or history of poor OB outcomes)
How do you screen for Gestational DM? 1-hour 50gram oral glucose tolerance test ->normal care +(>130)> 3 hour 100 gram test ->normal care + if 2+ values met positive for GDM Fasting-95 1hr-180 2hr-155 3hr-140
T/F- Hypoglycemia is a concern for baby of GDM mom. True- baby may have low blood sugar after born because excess blood glucose is removed. Usually not major problem b/c baby is fed within 6 hours
Part of the fetal surveillance in the 3rd trimester involves fetal kick counts. How many should you expect? 10 fetal movements ever 2 hours
How are insulin requirements affected in the 24 hours postpartum? Insulin requirements decrease dramatically Risk for infection and hemorrhage increases due to uterine distention due to baby size/extra amniotic fluid
How likely is it for a woman who had GDM to develop Type 2 diabetes? 50%
What are the target Blood Glucose levels during pregnancy? Fasting- 60-99 1 hour post meal- 100-129 2 hours postmeal- <120
Created by: destinylagarce