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CHAPTER 18
For healthy normal-weight woman—What is the recommended wt gain for normal, underweight and overweight?
25-35 pounds
 For underweight—28 to 40 pounds
 For overweight—15-25 pounds
what are the Risks for prepregnancy weight: for underweigt and overweight
 Underweight—low birth weight
 Overweight—htn, gestational DM,premature, congenital malformity
PREGNANCY IS NOT TIME TO DIET & SEVERE CALORIC RESTRICTIONS CAN CAUSE?
maternal ketosis-
Maternal wt gain distributed by?
Fetus, placenta & amnio=11lb
Uterus: 2Llb
↑ bld vol=4 lb
Breast tissue= 3lb
Maternal stores=5-10 lb
B. Maternal age –
C. Maternal pariety –
expectant adolescent must meet the nutritional neds for her own growth in addition the nutritional needs of HCG

mother’s nutritional needs & outcome of her HCG are influenced by the # of HCG she has had and intervals b/w them.
Dietary recommendations and the nutritional requirements of pregnancy for Calories?
recommended for breastfeeding? pregant with twins?
1st trimester: 0, 2nd trimester 300 3rd trimester 300

BF-5oo
Twins-600+300
what affect the caloric requirement
pre-pregnanct wt, ht, maternal age, activity, health status
What is carbohydrate for?
Increases during HCG
primary source of energy
promote wt gain and growth of fetus, plaenta, & others

dairy, veggies, grains, fruits
Ptotein=increased because?
fetal developments,
bld vol expanion
growth of maternal tissue
what is the recommended protein
60 g base on quality-animal(complete protein & plant w/c is imcomplete) as well as dairy
Fat are valuable in what way
source of energy, w/c r more completly absorbed during HCG result in
increse serum, lipoprotein & cholesterol
what is the fat deposit % in fetus
from 2%-12% at term
is fat requirement increase, decrease or unchange? and account for how much total caloric intake
unchnge only 30% total daily cal. dietary guidelines: <10& saturated fat
recommend lean meat, fish & poultry
Calcium & phosphorus involved in
mineralization of fetal bones & teeth, energy and cell production and acid base buffer
when does calcium ossification occur in the fetus
during the last 2-3 mos
what is the recommended AI for CA for 19 or older
and for <18 y.o
1000 mg/d
1300 mg/d
AI met by consuming 3-4
servings of dairy products daily.
food is preferred and sources includes
dairy, Legumes, dark leafy veggies
recommended RDA for phosphorus 19 or older is?
females age 18 or younger is
700 mg/d
1250
Phos readily supplied in
protein, rich food-milk, eggs, and meat
why is iodine essential?
thyroid hormone , inorganic is excreted in urine during HCG, enlargement may occyr if deficient and can cause
imapaired development
how can women met Iodine
220 mg by using ionized salt,
seafood
plant source
why is Na+ important
proper metabolism and regulation of fl balance
how can woman obtain moderate Na intake
2-3 g by using fresh food lightly season
avoid extra salt and salty food-potato chips, ham, sausage & Na base seasoning
what zinc for
protein metabolism and synthesis of RNA & DNA
essential for normal fetal groth and development and milk production
what is the RDA
incrse to 11 g 19 or older
source
meat
shellfish
poultry, grain legume
MG is essential for? RDA? source
cell metabolism & structural growth
320 mg RDA

milk
whole grain
dark veggi, nuts and legume
IRON incrase because of
growth of fetus and expansion of maternal bld vol
what is mainly caused by low iron?
Anemia and may result by decrease in B6&12, folic,zn,Cupper.
who are are risk
poor diet
frequent conception
prior iron depletion
With Fe deficiency assoiated with what in infants?
LBW=low birth weight
PReterm
reduce the hem
IRon is also required for
what is the RDA recommendation?
hemoglobin synthesis.
Iron deficiency common during pregnancy.
Low iron stores common in women of child-bearing age.
Hgb under 11 g/dl during 1st and 3rd trimester, under 10.5 g/dl during 2nd
Although iron absorption increases and losses are decreased, RDA increased form 18 mg to 27 mg/day.
Food sources are red meats and fortified cereals. Citrus fruit and meat increase absorption.
what helps women with depleted irion iron reserlve
prenatal iron supplements
how is Fe deficiency treated
Ferrous gluconate, ferrous fumarate, or ferous sulfate to 60-120 mg
what do you tell the woman who is taking prenatal iron vitamin
consume sufficient fluids
what vit have - effect on the fetus
Vit ADC &B6
which fat soluble Vit can lead to toxicity
A &D
what are the symptoms
nause, GI upset, dryness, cracking of the skin and loss of hair
what vitamin are not common on deficiency
Vit A
what are the effect of inadequate maternal intake
preterm baby
intrauterine growth
decrease birth wt
what is known role of VIt D
absorption and utilization of Calcium and phosphorus
what should pregant woman have in Vit D intake
5 ug
what can cause of overintake of Vit D
hypercalcermia or high blod calcium due to withdrawal of Ca
what are the symptoms of toxicity
thirst
loss of appetite
vomitint
wt loss
irritability
high bld cal
CHAPTER 14
WHAT ARE THE SX OF TSS?
Sudden onset, can be fatal
Severe disease with F, shock, & problems with function of several organs, N/V/D, red rash-skin peel in 1-2 weeks, redness of eyes/mouth, throat, confusion, HA, seizures, hypotension, organ failure
HOW U TREAT TSS
IV Fl., antibiotics, BP meds & dialysis if needed
what type of treatment use for dysmenorrhea (PRIMARY)
Treat: NSAID, oral contraceptive, exercise, heat and and good nutritio
TREATMENT FOR SECONDARY ARE
Dysmenorrhea
Primary:
Prostaglandins- no underlying disease- cramps
Treat: NSAID, oral contraceptive, exercise, heat and and good nutrition
Secondary:
Pathology-endometriosis, PID, cysts,IUD, anatomic anomalies
Treatment:
Vitamin B (discomfort),
Vitamin E (discomfort & prostaglandin inhibitor)
Vitamin B6( bloating,irritability),
exercise, heat (increase bld flow)
Premenstrual Syndrome
Sx between ovulation and menses
Moody(P), emotional, migraine(N), N/V, constipation(G), acne(D),retention(U) swelling &tenderness(M)
Dg: Diary of menstrual calendar for 2 mos
Tx:
Decrease methylxanthines(caffeine), salt, sugar, alcohol, read meat, animal fats…
Increase Vitamin B6(anxiety & depression) & E(breast tenderness), calcium(1200 mg), exercise, serotonin fall
TREATMENT FOR PMS
Tx:
Decrease methylxanthines(caffeine), salt, sugar, alcohol, read meat, animal fats…
Increase Vitamin B6(anxiety & depression) & E(breast tenderness), calcium(1200 mg), exercise, serotonin fall
SX FOR PERIMENOPAUSE ARE
hot flashes, night sweats, coldness, irreg. periods, difficulty sleeping, mood changes, dry skin, hair loss, decreased libido, vaginal dryness, incontinence (? thyroid d/o)
Decrease in bone density
WHAT OTHER ALTERNATIVE TREATMENT FOR MENOPAUSEBlack cohosh c dong quai and sage-s
Primrose oil-
Gingko-
Flaxseed-
Soy protein
Progesterone
Black cohosh c dong quai and sage-hot flashes
Primrose oil-mood swings/irritability
Gingko-memory
Flaxseed-breasts, dryness
Soy protein
Progesterone cream-skin
Balance diet and exercise -30 m/4 wk
calcium., Vit EDB, weight bearing
wHAT ARE THE Treatment FOR OSTEO?
Biophosphonates:
Calcitonin:
injected or nasal spray use to treat women 5 yr postmenopause
ET: add progestin to dec endometrial ca, modest inc in risk of breast ca, stroke, & heart attack
Treatment
Raloxifene: (Evista)
-Selective Estrogen Receptor Modulators (SERMs)-benefits of estrogen without disadvantages
Bone forming meds: Parathyroid hormone-Forteo, stimulates new bone fromation and significantly increases bone mineral density-daily injection
Fosamax (px & tx), Boniva (p & t), Actonel (p & t)-dec bone loss & fx, inc bone density

Treatment
Raloxifene: (Evista)
-Selective Estrogen Receptor Modulators (SERMs)-benefits of estrogen without disadvantages
Bone forming meds: Parathyroid hormone-Forteo, stimulates new bone fromation and significantly increases bone mineral density-daily injection
what is long actin depo does
and advantages
Depo-Provera: 3 mos, IM, supresses ovulation, safe, convenient, private, & relatively inexpensive, nursing mothers,
what are the sx of depo
SE: HA, menstrual irreg, weight gain, breast tenderness, depression, 9 mos-fertility
Sterilization
Vasectomy:
Tubal Ligation:
vas deferens bilaterally, 4-6 weeks, 6-36 ejaculations, recheck!!!!!!!
postpartum-easy to locate tubes, fallopian tube,
what is morning after pill for
Morning After Pill
Preven (levonorgestrel & ethinly estradiol)
Plan B (levonorgestrel)-progestin only, less N/V-suppresses ovulation if you haven’t, px sperm & egg unite/implantation
2 pills and 2 more 12 hours later
Must be initiated within 72 hours
Copper IUD within a week
Pharmacy-over 18, no RX, online
medical abortion used what type of meds and when is it done
Medical abortion: Mifepristone (Mifeprex), RU 486—first 7 weeks
surgical is done and called
D &C up to 15 wks
minisuction, vauum and curettege
during 2nd trimester what type of pregnancy interuption is done
D&E up to 21 wks
2nd trimester-late, D & E (up to 21 weeks), hypertonic saline, systemic prostaglandins, intrauterine prostaglandins
D & E (after 21 weeks)-partial birth-viability
what type of changes occur in the uterus?
CHAPTER 14
Increase dimension 5000 ml,
hypertrophy
wall is thicker
irregular contraction of the uterus that occur intermittently througout & consider false labor is called
braxton hicks w/c stimulate the mov't of blood through intervillous space
what hormone stimulate the cervix
estrogen =increase cell hyperactive
thick tenacious mucus w/c accumulates & thickens and prevent bacteria is called
mucous plug
expelled when dilation start
what othr changes in the cervix
increase vascularization due to hypertrophy
softning of cervix due to increse vascularization is called
goodells sign
blue purple discoloration of the cervis is
chadwicks sign
ovaries what are the changes or what hormones
egg production cease
hCG maintain corpus luteum w/c secrete progesterone to maintain endometrium
vagina's changes includes
increase bld flow, vaginal secretion
hyperplasia
loose CT-smooth muscle-hypertrophy
what type of secretions found in the vagina at this time
thick white and acidic
what is the significant role of acid
prevent infection, though favor yeast result in moliaisi
breast changes includes
hyperplasia & hypertropy
areola-darker, bigger
nipple are erect
striae
colustrum
purplish stretch mark turn silver after birth is called
striae
an antibody rich yellow secretions expressed manually by 12the wk is called
colustrum
what type of respiratory changes
diaghragm is elevated & subcostal ange is increased as a result of pressure from enlarging uterus
rib cage flare

increase O2,=dyspnea
what other signs occur with respiratory system
nasal stuffiness , congestion=rhinitis
epixtaxis due to estrogen
cardio system changes includes & what can u hear in 90% of pregnant women?
murmur
bld volume increase, cardiac output, pulse, &B/P decrease
and bld flow increases
during pregnancy the enlarge uterus may put pressure on the vena cava when women is in supine which causes
supine hypotension syndrome-have women lie of left side
due to femoral venous pressure in lower extremities what can occut
edema; test for homans sign=dvt
what are the common complaints for GI
Nausea &vomiting
taste and smell
saliva increase
heartburn
bloating & constipation
hemorrhoid
due to prolonged emptying tume what is _____that predispose women to gallstone formation
hypercholesteromia
pruritus may also occur
urinary tract changes includes
increase urinary frequency
GFR increase, renal function
the presence of AA and glucose in the urine in the ureters may increase risk of
UTI
skin & hair changes includes
pigmentation of areola, nipples, vulva
linea nigra
choalasma
striae
vascular spider-small bright red
hair notice shedding postpartum but replace 6-12 mos
muskoloskeletal
good calcium for teeth
waddling
aches in neck, shoulder due to lordosis and paresthesia(occur in late pregnancy)
diastasis recti
produed to pressure in abd muscle enlarging uterus on abdominal mscle that cause rectus to separate
eyes chages includes
intaocular pressure decrease; slight thickening due to fl retention
cns
memory deficit. decrease sleep
weight gain for normal, Owt, UnderWt
25-35;15-35;ideal+25-35
1st tri wt gain is
3.5-5.0 lb; 12-15lb for 2nd &3rd
time b/w conception &labor=prenatal
antepartum
Time fr onset of labor to birth is called
intrapartum
time from bith until 6 wk postpartum is called
postpartum
number of week from LMP is called
gestation
birth occur <20 wks called
abortion
normal duration of pregnancy from 38-42 gestation is called
term
labor occur>20 wks or before 37 wks is called
preterm
labor occur after 42 wks is called
postterm
any pregnancy regardless of duration, including present pregnancy is called
gravida
a woman who has never been pregnant
nulligravida
pregnant for the 1st time
primigavida
mutigravida
pregnant more than 1
para
birth after 20 wks either dead or alive(infant)
nullipara
never been given birth
primipara
one birth
woman who had one birth>20 wks gestation
primipara
woman who has had two or more births >20 wks
multipara
stillbirth
fetus born dead >20 wk
acronym commonly use is
tpal
term
preterm
abortion
living
clitnt profile
current pregnancy(LMP)
past pregnancy, history
bld type
GYN HISTORY-pap
current medical history:weight bld type
any meds
past medical history-childhod illness
family mdication history-diabetes
religious beliefs
occupational
parner history-genetic
personal info-age, educaition, race
-----are any findinges that have been shownn to to have - effect on pregnancy outcome is called
risk factors
what are the social high risk factors
low income, poor diet, multiparity>3 underwt, overwt,<16yo,>35yo smoking, drugs
rsik factors for preexisting medical D/O are
DM, cardiac, HTN, Thyroid d/o hypo & hyper,DES-diethletillesdirol,
obstetrics consideration
previous HCG
stillborn
habitual abortion
caesarian
RH
large baby
current HCG
rubella, hepees T2, syphyllis, abruptio
what type of information do we need to obtain during first prenatal assestment?
current pregnacy
past pregnancy
GYN history
current medical history
past medical history
religious/cultural history
occupational history
partners history
personal information
how do you obtain data
by questionnaire and direct interview
how are risk factors assesed?
intra and post partally
perinatal health team also needs to evaluate such psychosocial factors as
ethnic background
occupation & education
financial stat
envt,
determination of due date:technique that are used are?
evaluating uterine size
determine when quickening occur
use ultrasound
auscultate fetal heart rate
know LMP
how do you use nagels rule
start with LMP subtract 3 months and add 7 days
when is Nageles' rules is of NO USE when calculating EDB
irregular period with one or more ammenorrhea
women who are amennorheic but ovulating and conceive while breastfeeding
3. womne who conceive before regular mentruation is established following oral contraceptive or termination of pregnancy
what are the initial prenatal assestment guide includes
VS
WEIGHT
SKIN
BREAST & PREGNANCY CHANGES-(striae, colustrum, areola)
Heart-normal rate, rythm, heart sounds
Abdomen-(changes striae maybe present, size, fetal heart rate, fetal movement)
extremities-edema
pelvic area- cervix-pink color and os closed-Pregnancy changes: goodell, softening of istmus of uterus, chadwick)
Laboratory-Hemoglobin-12-16
ABO RH typing
Syphillis test, Glucose, HepB, HIV,pap smear
culturatl assestment
family functioning
during physical assessment of the uterine, how is it assessed?
using the fundal height -used as an indicator of uterine size to see if baby is growing
what is used in the fundal ht?
cetimeter tape measure to measure distance from the top of symphysis pubic over the curve of the abdomen to the top of the uterine fundus(mcdonald sign)
Fundal ht should correlater well with
weeks of gestation b/w 24-34 weeks
the method of dating pregnancy can be accurate when doing fundal height with the following situations
obese women
women with uterine fibroids
women with hydramios
During fetal development-quickening may be experienced b/w ?
16-22 weeks
this is not accurate because multi birth may experience it earlier
What type of device use to listen to fetal heartbeat?
ultrasonic doppler devise-fetal heartbeat
how many weeks can doppler detect fetal heartbeat
10-12 weeks
if doppler is not available, what other device can be used
FETOSCOPE-detected as early as 16 weeks
except in the case of obese and twins
How soon can ultrasound scanning detect gestational sac
as early as 5-6 weeks after LMP
fetal hear 6-7 weeks
fetal breathing 10-11 wks
what are the subsequent prenatal assestment includes
VS-BP
WEIGHT GAIN
FETAL HEARTBEAT-120-160
HEMOGLOBIN-TRIPPLE SCEEN
INDIRECT COMBS TEST- RH - WOMEN
UA
PROTEIN
GLUCOSE
STREP GBS
CULTURAL ASSESTMENT
PSYCHOSOCIAL ASSESTMENT
WITH CULTURALA ASSESTMENT WHAT TYPE OF QUESTIONS DO YOU ASKED?
determine the mother's attitude about the sex of the ubnorn child
Ask about the womans expectations of childbirth.
what type of psychosocial assestment should be done w/ the expectant mother during the 1st treimester
may feel ambivalent -1s tri
baby feel more real to woman-2nd tri
begins to think as separate being -3rd tri
what are the psychologic status for expectant father
1st tri- excitement over confirmation of HCG & virility, for financial nees
3rd trimester-feel rivalry with fetus, esp during sexual activit; fantasize about child but usually imagines older child; fears multilation and death of woman and child
During subsequent prenatal assestment what are generally the recommended frequency of prenatal visit?
1)q 4 wks (0nce a month) for the 1st 28 wks of geatation
2) q 2 wks until 36 wks
3) >36 wks- every week until birth
CHAPTER 16
HOW TO CARE FOR PREGNANT CLIENT, HOME CARE,
HOME CARE=especially effective in removing barriers for those who have difficulty assesing healthcare
home assestment should include?
current history, vital, weight, UA, physical activity, dietrary intake
Anticipatory teaching-what to expect?
focus on the now, and what is going to happen from first trimester to the next by explaining and more teaching should be done in the office to reduce question by phone
when caring of the pregnant woman what else should be included?
Support system-father (gay- single), older children, siblings(encourage to antepartal visits, grandparents (in-laws)
If dad is NOT part of the family structure it is IMPORTANT TO assess support system-WHO will play major role in this childbirth experience
what should be considered with siblings?
depend on level of prepareness- some agency provides class, tour and geared to different ages and levels of understanding
assess cultural considereation by
respecting what they want unless its harmful ie teratogens or pica (considerations-assess and incorporate, unless harmful)
what else can you do with a different culture to get through with them
have someone else from the family
PROMOTION OF SELF CARE ACTIVITY;
MANY CAREGIVERS ENCOURAGE PREGNANT WOMEN TO MONITOR THEIR UNBORN CHILD BY REGULARLY ASSESING FETAL ACTIITY BEGINNNING WHEN?
Monitoring
28 weeks-same time each day,1 hour after meals due to ingestion - side lying position

Cardiff’s Count to Ten-27 weeks, side-lying
Contact physician: >10 movements in 3H, slowing & longer to count, no movements in the am
Breast Care
Supportive bra, clean
Inverted nipples-shield
Breast feeding prep-roll, pull, braless, partner
Avoid soap
What other methods for assessing fetal activity called
FETAL MOVEMENT RECORD- (non invasive technique that enables the pregnant woman to monitor and record fetal well being earily and w/o expense)CARDIFF COUNT TO TEN
METHOD
what other factors that can affect the fetal activity?
Effects: sound,loud-startle
cigarette smoking,
fetal sleep state,
time of day
how do you do Cardiff’s and what gestation?
Count to Ten-27 weeks- anytime of day same time, side-lying
when do you contact the physician about the baby's movement
Contact physician: >10 movements in 3H-, slowing & longer to count,
KNOW -no movements in the am-when you wake up in the morming
what provides reassurance that the the fetal well being is okey
vigorous fetal activity-make sure baby move
with breast care waht should you tell patient about breast care?
Proper support is important
wear a comfortable supportive bra, clean breast-important esp when start to have colostrum


Inverted nipples-shield
Breast feeding prep-roll, pull, braless, partner
Avoid soap
what should you use to clean nipple with
warm water; DO NOT USE SOAP due to drying effect
Breast Care
Inverted nipples-
INITIALLY look normal
what should woman wear with inverted nipple and how long
breast shild for 3 months
absorb moisture
A woman with h/o preterm labor is adviced not to do what with the nipple?
do not stimulate can cause contraction, release oxytocin
During 3rd trimester Nipple preparation is done how
avoid lubrication(rubbing)- role nipple, braless, oral stimulation by partner except with h/o preterm
daily bathing is important but when should woman caution during tub baths because
Bathing-tub (unless bleeding or ruptured membranes),
avoid hot tubs why?
avoid hot tubs & saunas
due to hyperthermia and can cause vasodilation due to faintness
what is containdicated with tub baths to avoid infection
presence of vaginal bleeding or when the membranes are ruptured
what type of clothing should be worn?
should be loose & nonconstricting
avoid tihgt leg band girdle
avoid hot tubs & saunas
Clothes-loose, comfortable, avoid nylon panties, cotton
Employment- WHAT CAUSES PROLONGED STANDING
jobs that require prolonges standing higher incidence of PRETERM BIRTH -NURSES , HAZARADOUS- CHEMOTHERAPY (TERATOGENS)
WHEN TRAVELING IN THE CAR WHAT SHOULD YOU DO?
Travel-car, stop q 2H and walk 10 min, wear seatbelt(ABOVE HIP-SHOULDER STRAP), plane up to 36 weeks unless contraindicated
WHAT TYPE OF SEATBELT USE AND HOW?
3 POINT; wear both a lap, and shoulder belt
lap belt position under abdomen and across the upper thight
shoulder belt should be positiones snugly b/w breasts
regular exercise can continue and is encourage throughout uncomplicated pregnancy and what should be avoided
strenous sports, horsback riding, skiing; high risk acitivities, skydivigng, mountain climbing, ice skating, surfing, raquetball
what other method should be avoided as far as exercise
Avoid strenous, belly landing, supine position, exhaustion, heat, P of 140 plus, any complications
what are the benefits of Exercise?
Benefits: maintains fitness and muscle tone, improved self-image, relieves tension, control weight, promotes BM, improved postpart, may improve complications (preeclampsia, gestational diabetes,…)
Avoid strenous, belly landing, supine position, exhaustion, heat, P of 140 plus, any complications
Exercises
Pelvic tilt
Abdominal exercises-partial sit up
Kegel exercises
Cross-legged (Indian style)
Benefits: maintains fitness and muscle tone, improved self-image, relieves tension, control weight, promotes BM, improved postpart, may improve complications (preeclampsia-walk HTN, gestational diabetes
what type of exercise whould woman do to prepare for childbirth
Pelvic tilt-prevent back strain, & strenthen ab muscle
Abdominal exercises-partial sit up (stregnthen abdominal muscle tone and done according to individual comfort level)
Kegel exercises
Cross-legged (Indian style)
what should be done before and after exercise
stretch
why dont u not want women to do kegel exercise when urinating
UTI, urinary stasis and u want them to fully empty bladder
sex unless ?
contraindication; may have increase libido due to hormone
dental care
Dental care-heavy work p baby if possible
avoid extensive dental work done ; maintain good oral hygiene
what are the recommended immunization that are contraindicated during pregnanct
Immunizations-no attenuated live viruses: MMR, varicella-zoster, poliomyelitis, yellow fever (high risk only), smallpox, influenza-, typhoid
avoid live virus
when is influenza not recommended
after 12 weeks
a little ginger help
nausea & vomiting
Herbs: cohosh, gingko, ginseng, fresh horseradish
what herbs should be avoided
Caution: garlic, ginger, turmeric
what is homeopathy?
base on the theory that a miniscule aount of a substance can cure symptoms
herbal medicine
uses therapies derived from plants
teratogens
substance that adveresely affect the normal growth and development of the fetus
what are known teratogens
chemicals, viruses, environmental factors, physical factors, & drugs
what are example of teratogenic
Teratogenics: medications, infections (rubella, syphilis, herpesvirus thep 2, toxoplasmosis-cat litter, cytomegalovirus (CMV)
what medication should you avoid?Medications: A (vit C), B, C, D, X:
x-teratogenic
Medications: A (vit C), B, C, D, X: which category has no associate fetal risk?
category A
accutane is what category?
d
if woman has take category d or x what should you tell a woman
informed of risk assoiciated with drug and her alternatives
____is associated with CNS defect
warfarin
what med is safe and does not cros the placenta which is safer than fetus than warfarin and other anticoagulants is
heparin
smoking during HCG is one of the most important modifiable and causes of poor prenancy what are the risk factors?
Tobacco: low birth weight, infertility, abortion, IUGR, previa, abruptio, premature ROM, preterm birth, cleft lip/palate, SIDs, later-

second hand related to:
ear infections, respiratory infections, decreased lung function…-patch (category D)
primary teratogens in western world is
alcohol
women who are heavy drinker incrrease risk of what to the fetus
FAS-fetal alchohol syndrome
caffeine should be limited
1-2
Cocaine can cause
MI, arrhythmias, CVA, HTN, bowel ischemia, sudden death, abruptio, preterm,….meth babies
after 35 what is fetus more high risk of and, significantly after 40?
down syndrome
couple may choose to have to gain infor about health of fetus is
amnio or chrionic villus sampling
what is the risk of fetus if the paternal age is over 50
Paternal age-especially after 50, increase chance of late fetal death
CHAPTER 1 ADDITIONAL INFOR
Empowerment is an importatn concept for nurses & client today; what are the processes for an empowered self develop
control
competetence
credibility
comfidence
comfort
professional nurse who can care for women with low to average low risk pregnancy are
CNM
______orifessuibak byrse wgi gas recieved soecuakuzed education in either a master's degree program or a continuing education program
NP
professional nurse graduated from accredited nursing program & currently licensed is
RN
what was the self care practice act for
by assuming responsibility of ones own health
a comprehensive model of healthcare that uses a multidisciplinary team in health professional to provide cost effective, high quality care is called
collaborative practice
what are the primary care involeved in the community base nursing care
focus on health promotion,
illness prevention
individual responsibility to ones health
who is charge of leading the nursing agenda for the future and guiding the implementation of the plan
AWHONN-VERY IMPORTANT
____ommitting or committing an act that a reasonably prudent person whould not omit or commit under the same or similar situation is
negligence:
duty to provide care
duty breach
injury occured
breach cause the injury
what are the client right
informed consent, privacy & confidentiality
self supporting adoleschent under 18 years old not subject to prenatal control is called
emancipated minor
nurse has to respect rights
WHAT ARE THE ETHICAL ISSUES WITH CORD BLOOD BANKING
who owns the bld? how will informed consent be obtained & by who? Confidentiality?how can harvested bld available to everyone?
refers to the # of live birth/1000 is & US birth rate 14.5?
birth rates
the # of death <1 per 1000
is called-? 6.9 in US
the number of death of infant <28 d is ?
include both neonatal death & fetal death /1000 is called?
death in utero at 20 wks gestation is called
infant mortality rate
neonatal
perinatal
fetal death
the number of death from any cause during the pregnancy cycle is called
maternal mortality rate
CHAPTER 2 ADDITIONAL INFO
WHAT IS CULTURAL COMPETENCY
skill and knowledge necessary to appreciate, understand, and work with individuals from different culturesw
when do you include a religious assestment
when assesing contemporary family
what tool provide an in depth tool to collect pertinent family life information that can assist the nurse in planing care
family assestment tool
what culture believe of feeding the baby and influences infant feeding practices
Hispanic mostly
african american
ADDITION FOR CHAPTER 4
MEDICAL THERAPY USE FOR MENOPUASE INCLUDED:
WHAT HRT USE FOR WOMAN WITHOUT UTERUS? AND FOR WOMEN WITH UTERUS
W/O=ESTROGEN
W/=ESTROGEN & PROGESTIN
VERY IMPORTANT
WHAT ARE THE PREVENTION FOR OSTEO
adequate calicum don't exceed 500 mg per & should be taken with meal=1200/day
vit d
wt bearing
modest OH
stop smoking
what is the best choice for osteo treatment?
SERMS- RALOXIFENE-EVISTA SAME BENEFITS AS ESTROGEN W/O DISADVANTAGE
BIPHOSPHATES INCLUDES
FOSAMAX, BONIVA, ACTONEL
CALCITONIN INCLUDES
MIACLACIN, CALCIMAR, OR FORTICAL SLOS BONE LOSS