-
Contraception
strategies that reduce the risk of fertilization or implatation in an attempt to prevent pregnancy
-
Natural Family Planning
-Abstinence
-Withdrawl(Coitus Interruptus)
-Calendar Method(Rhythum Method)
-Basal Body Temp(BBT)
-Cervical Mucus Method
- Ovulation begins 14 days before the onset of her period. and avoids intercourse during that period.
- Following ovulation mucus because thinner to allow sperm viability.avoid intercourse then.
-
Barrier Method
-Condoms
-Diaphram and Spermicide
- Must be used correctly in order to prevent pregnancy.
- do not use diaphram if had hx of TTS
- do not use latex condoms if have latex allergy.
-
Hormonal Methods
-Combined Oral Contraceptives
- contain estrogen and progestin which suppresses avulation thicken mucus and alter uterine decidua
- -highly effective if taken correctly
- -decrease effectiveness if taken with antibiotics, anticonvulsants and meds that effect liver enzymes
-
Hormonal Methods
-Minipill
- May need another form of Birthcontrol for first month of use.
- Safe to take while breastfeeding
- Increases occurence of ovarian cysts
- increases appetite
- -decrease effectiveness with antibiotics, anticonvulsants and those that effect liver enzymes
- -irregular vaginal bleeding, increased appitite, lowered libido
-
Hormonal Methods
-Emergency Oral contraceptive
Morning After Pill
- Take within 72 hours of unprotected coitus
- Px fertilization
- does not terminate an established pregnancy
- if menstration does not start with in one week of taking then the patient may be pregnant.
-
Hormonal methods
-transdermal contraceptive patch
- contains norelgestromin(progesterone) and ethinyl estradiol delivered in continuous levels through the skin into subcu tissue.
- -do not put on breast or brusises skin lesions.
- -avoids liver metabolism sincce not absorbed in gi tract
-
Hormonal Methods
-Injectable Progestins
-Depo Provera
- injection given to client every 11-13 weeks
- maintain adequate intake of calcium and Vit D
- does not impair lactation
- use greater then 2 years
- decreases bone density
- -do not massage injection site.
-
Hormonal Methods
-Contraceptive Vaginal Ring
-Nuvaring
- contains etonogestrel and ethinyl estradiol delivered vaginally continuously
- -some patients report discomfort during intercourse.
- -Bolood clots, stroke, HTN, heart attack, weight gain, nausea
-
Hormonal Methods
-Implantable Progestin Etonogestrel
- subdermal inner side of upper arm
- continuous for three years.
- -increased risk of ectopic pregnancy.
-
Hormonal Methods
-Intrauterine device
- inserted through the cerivix into the uterus. damages sperm in transit to uterine tubes
- -monitored monthly by client by palpating small string that hangs from device.
- -can maintain effectiveness for 10 years.
- -increased risk for ectopic pregnancy, pelvic inflammatory disease, uterine perforation
- -report signs of infection, bleeding, pain during intercourse.
- -risk for bacterial vaginosis uterine perforation or uterine expulsion.
- - contra in those who have not had a baby or are not in mongamous relationship
-
Transcervical Sterilization
-ESSURE
- small flexible agents inserted into the fallopian tubes
- -not effective for three months,
- -not reversible and requires no anesthesia
-
Sterialization
-Bilateral tubal ligation salpingectomy(female)
vasectomy(male)
- permanent
- ectopic pergnancy risks if get pregnant.
- sexual fxn not impaired.
- alternate form of birth control must be used until vas deferens is clear
-
Common Side effects of Oral Contraceptives
- -reduced menstral flow(amenorrhea)
- -weight gain breast tenderness
- -mild HTN or headache
-
Infertility
Risk Factors
- Age >35
- DX after 1 year of unprotected sex with no pregnancy
- Endocrine disorders(abnormal body fat, abnormal hair growth)
- Hx of abd. surgery, spontaneous abortion, alot of sex partners, STDs
- Over and under weight
- Environmaental exposures(teratogenic)
-
Interventions for Infertility
- encourage counseling, expressing of feelings, support groups.
- genetic counseling, provide information
-
Signs Of Pregnancy
-Presumptive signs=changes that the woman experiences that would make her think she is pregnant
amenorrhea, fatigue, N/V, urinary freq., breast changes, quickening(fluttering by fetus)uterine enlargment, linea nigra, chlosma( mask of pregancy) Striae gravidarum.
-
Signs of Pregnancy
-probable Signs=changes the examiner sees that would make them think she is pregnant.
- -Abd. enlargement, cervical changes, Hegars sign(softening of the lower uterus)
- Chadwicks sign(violet blue color of the vaginal mucosa
- Goodells softening of the cervical tip
- Ballottment(rebound of unengaged fetus)
- fetal outline palpated by examiner
-
Signs of pregnancy
-Positive signs=can oly be explained by pregnancy
fetal heart sounds, US visualization, fetal movement.
-
Serum and Urine Pregnancy testing
- hCG(human chorionic gonadotropin)
- can be detected 6-11 days in serum and 26 days in urine. following implantation
- peaks at 60-70 days and declines to 80 days then increases again to term
- some meds can cause false positive.(anticonvulsants, diuretics, tranquilizers)
- use forsst voided specimen of morning
-
Nageles Rule to determine due date
first day of last menstrual period subtract 3 months then add 7 days and one year
-
Mcdonalds method to determine due date
- measure fundal height in cm from symphysis to top
- gestational age is =to fundal height
-
Gravidity
=number of pregnancies
- nulligravida=never pregnant
- Primigravida=first pregnancy
- Multigravida=2 or more pregnancies
-
Parity
=number of viable pregnancies
>20-24 weeks and 500g wether fetus is born alive or not
- nullipara=no pregancy beyond viability
- primipara= one beyond
- multipara=2 or more beyond
-
GTPAL
- Gravidity=#of pregnancies
- Term Births=38 weeks or more
- Preterm births=20-37 weeks
- Abortions/miscarriage=<20 weeks
- Living children
-
Physiological Status of Pregancy
- Cardiovascular:increases 45-50% HR increases
- Respiratory:Increases resp, decrease lung capacity
- Musculoskeletal:pelvic joints relax
- GI:constipation, N/V,
- Renal:filtration rate increases, urinary rate increases.
-
Expected Vitals during pregnancy
- BP same as prepregnancy for 1st tri
- -decreases 5-10 in 2nd
- -returns to prepreg after 20 weeks
- Pulse:increases 10-15 around 20 weeks
- Resps; increase 1-2
-
Rountine Labs in prenatal Care
- Blood type, Rh factor(clients Rh- Coombs test repeated 24-28 weeks
- CBC, Hgb and Hct
- UA-pH specific gravity color, sediment protein, glucose, albumin, rbcs, wbcs,
- glucose tests.
- Pap, rubella titer, hepB STDs and HIV
-
Common discomforts of Pregnancy
N/V, breast tenderness, urinary freq, UTI, Fatigue, Heartburn, constipation, hemorrhoids, backaches, SOB, leg cramps, varicose veins and lower edema, gingivitis, nasal stuffiness, supine hypotension, braxton hicks
-
Danger signs of pregnancy
-report to PCP immediately
- gush of fluid(membrane rupture)
- vaginal bleeding
- Abd. pain
- changes in fetal activity
- persistant vomiting
- severe headache
- elevated temp
- dysuria
- blurred vision
- edema of face and hands
- epigastric pain
- flushed dry skin fruity breath(hyperglycemia)
- clammy pale skin, weakness tremors
- (hypoglycemia)
-
Chapter 6
Assessment of Fetal Well Being
-Diagnostic procedures
Ultrasound
- Ultrasound:hi freq. sound waves
- -external and internal transvaginal
- -doppler flow(measures blood flow)
- Reasons for US:confirm pregnancy, gest age, maternal structures, placental grading, use with amniocentesis and biophysical profile
- :if patient has vaginal bleeding, decreased fetal movement, preterm labor, rupture of membranes
- Prep: have client drink 1-2 qts of fluid prior
-
Chapter 6
-Dx procedures
Biophysical Profile
- Biophysical Profile Use of real time US to visualize fetus amd observe responses to stimuli
- Use point system of 0-2 2 being good
- tests:FHR to nonstress test, breathing movements, gross body movements, fetal tone, amniotic fluid volume
-
Chapter 6
-Dx procedures
Non stress Test
- noninvasive procedure, doppler is used to monitor FHR and a tocotransducer used to monitor contractions when mom feels fetus move she pushes a buttin and then the trace is marked on the contraction sheet to determine FHR to Fetal movement
- Findings:reactive:if FHR is a normal baselinerate with moderate variablity accelerates 15 bpm for at least 15secs and occurs 2 or more times in 20min period
- Prep: semi fowlers position.
- anticipate CST(contraction stress test)
- , or BPP if nonreactive
-
Chapter 6
-Dx procedures
Contraction stress test
- nipple stimulated for 2-3 minutes which causes pituitary gland to release oxytocin, stop nipple stim when experiences contraction
- -do not hyperstim uterus
- NEGATIVE CST is NORMAL FINDING
- =no late decelerations
- POSITIVE CST is ABNORMAL FINDING
- =late decelerations
-
Chapter 6
-Dx procedures
Amniocentesis
- The aspriation of amniotic fluid
- preformed after 14 weeks
- reasons:maternal age >35
- previous birth with a chromosome abnormality
- parent is acarrier of chromosomal anomaly
- :L/S ratio is 2:1 =lung maturity
- reasons:
- meconium in fluid
- lung maturity assessment
- alpha fetoprotien
-
Chapter 7
Bleeding during pregnancy
-Spontaneous abortion/Miscarriage
- Pregnancy terminated by week 20
- Types: threatened, inevitablem incomplete, complete, and missed
- Risks:maternal age, DM, chromosomal (50%)Trauma, injury, substance abuse, maternal infections
- Dx Procedures:US, Exam of cervix, D&C D&E
- refrain from sex for 2 weeks avoid pregnancy for 2 months
-
Chapter 7
Bleeding during pregnancy
-Ectopic
- abnormal implantationof the fertilized ovum outside of the uterus
- 2nd most leading cause of bleedig early in pregnancy
- Risks:pelvic inflammatory disease and IUD
- S/S: unilateral stabbing pain, dark red/brown in LAQ
- referred shoulder pain., N/V, shoch, hemorrhage, elevated WBC
- Meds:methotrexate:avoid alcohol consumption and folic acid to px toxicity
-
Chapter 7
Bleeding during pregnancy
-Molar Pregnancy
- grapelike clusters that makes the placenta swollen, fluid filled and the embryo fails to develop beyond a primitive state.
- rapid metastasizing malignancy
- types:Complete:paternally derived
- no genetic material, no placenta, 20%progress towards choriocarcinoma
- Partial:both materal and paternal fertilized by 2 or 1 sperm in which meiosis or chromosome reduction and divison do not occur
- 6% progress into choriocarinoma
- Risks:low protein intake, <18, >35
- S/S vag bleeding at 16 weeks.N/V
-
Chapter 7
Bleeding during pregnancy
-Placenta Previa
- occurs when placenta implants in the lower segment of the uterus. the abnormal implantation results in bleeding during the thrid trimester. as the cervix begins to dilate and efface
- Types: complete or total, incomplete or partial, marginal or low lying.
- Risks:Hx of placenta previa, uterine scarring, age>35, multifetal gestation, closely spaced pregnancies
- S/S painless bright red bleeding, soft relaxed uterus, fundal ht greater then usual, palpable placenta, decreasing urinary output
- Meds:corticosteroids(fetal lung maturation) anticipate cesearen birth.
- bedrest, blood replacement, nothing inserted into vagina
-
Chapter7
Bleeding during pregnancy
-Abruptio placenta
- premature separation of the placenta. occurs after 20 weeks, significant maternal and fetal morbidity, leading cause of maternal death
- Risk:maternal HTN, blunt trauma, cocaine abuse, smoking, short umbilical cord, multifetal prgnancy, high parity, advanced maternal age.
- S/S: sudden onset of intense localized uterine pain and bright red vaginal bleeding, board like abd. firm rigid uterus, hypovolumic shock.
- Tx:IV fluids, O2 8-10 via mask.
- give bllod and corticosteriods to develop fetal lungs.
-
Chapter 7
Bleeding during pregnancy
-Vasa Previa
- presence of fetal blood vessels crossing the amniotic membranes over the cervical os. high mortality fetal hemorrhage when cervix dilates,
- S/S:painless heavy bleeding, fetal brady.
- Tx:iv fluids, o2 8-10 mask, c
|
|