Ob Bullets

OB BULLETS A couple is having trouble conceiving. You tell them to keep track of the wife’s temperature. When should they have intercourse?  Ovulation causes a 0.4 F rise in a woman’s basal body temperature. Therefore, when the woman’s temperature peaks, it is best time to try to conceive. At what gestational age is amniocentesis performed?  16-18 weeks A radioimmunoassay detects the presence of what hormone?  Human chorionic gonadotropin (hCG) How soon after implantation can hCG be detected?  2-3 days. Is the hCG level high or low in a molar pregnancy? High. Why would you instruct a patient to drink 32 ounces of water within one hour prior to having an ultrasound?  A full bladder will help in visualization of the fetus. After amniocentesis, what symptom should you instruct the patient to report immediately?  Vaginal bleeding When do most women ovulate?  Two weeks before the beginning of the next period. How do oral contraceptives prevent pregnancy?  They suppress FSH (follicle stimulating hormone) and LH (leutinizing hormone) release from the pituitary gland, thereby blocking ovulation. When should the patient take her temperature when using the basal body temperature method of contraception?  Every morning upon awakening and prior to any activity to avoid the temperature being influenced by other factors. How long a diaphragm should be left in the vagina after sexual intercourse? 6-8 hours. What vaccines are contraindicated in the pregnant patient?  Smallpox  Measles  Mumps  Rubella  Varicella What is the most common medical complication of pregnancy?  Urinary tract infections. Why is back pain a common complaint during pregnancy?  The growing fetus causes the woman to develop a swayback, which acts as a counterbalance. This causes stress on the back muscles and therefore increases discomfort. What functions does the placenta serve during pregnancy?  Respiration  Elimination  Nutrition When is RhoGAM used?  When the mother is Rh negative and the father is Rh positive. When should RhoGAM be used?  RhoGAM should be used within 3 days of the birth of a child. Why Rho GAM given? To prevent the mother from developing anti-Rh antibodies that could affects future pregnancies What anticoagulant should be used on pregnant patients?  Heparin, As it does not cross the placenta. What should you say to a patient who wishes to douche during pregnancy? Don’t! Douching is contraindicated in pregnancy. Daily washing of the perineal area with soap and water should be sufficient. Presumptive sign of pregnancy  Breast tenderness  urinary frequency

 fatigue  amenorrhea  nausea and vomiting What measures can help to relieve the early morning nausea of pregnancy?  Eating carbohydrate food, such as crackers or toast. Which foods most often tend to exacerbate morning sickness?  Foods with a high fat content. What food will help the absorption of iron tablets?  Meat, and foods with vitamin C. What types of food are high in iron?  Meats, green vegetables and most seafood. What are some good sources of protein for the pregnant patient?  Meat, fish, eggs, poultry, beans, nuts, milk, cheese, and wheat. What patient teaching can help relieve heartburn during pregnancy?  Eat smaller frequent meals  Avoid fatty foods  Do not eat right before going to bed  Elevate the head of the bed slightly. When can one auscultate the fetal heart?  Ultrasound: 6 weeks  Doppler: 10-12 weeks  Stethoscope: 18-20 weeks What are the characteristic of an inevitable abortion?  Dilated cervix, bright red vaginal bleeding, and cramping. What is the term “missed abortion”?  There is no uterine growth, no cervical dilatation ,no passage of fetal tissue, and minimal cramping or bleeding. Diagnosis is made by the absence of fetal heart tones and an empty gestational sac on the ultrasound. What does the term “missed abortion” mean?  The fetus has died, but has not been expelled from the uterus. What symptoms would the nurse expect if a tubal rupture were to occur from an ectopic pregnancy?  A sharp, severe knife-like pain in the lower quadrant, often associated with referred shoulder pain. Six risk factors for ectopic pregnancy.  Advanced maternal age  PID  prior ectopic pregnancy  History of pelvic surgery or tubal ligation  IUD  In vitro fertilization True or false: A pregnant, insulin-dependent diabetic is at risk for sudden hypoglycemia.  True. Insulin needs and metabolism are affected by pregnancy, making sudden hypoglycemic episodes more common for diabetics. What should you teach a pregnant, insulin dependent diabetic concerning exercise?  Exercise is important, but should always be done with family or friends. What are the some of the complications of pregnant diabetics?  Infection  Polyhydramnios  Ketoacidosis  Large birth weight infants  Congenital abnormalities. Probable (objective) signs of pregnancy?  Goodell’s sign  Chadwick’s sign  Hegar’s sign  abdominal enlargement  positive pregnancy test  braxton-hicks contractions.

What symptoms would lead the nurse to suspect a molar pregnancy?  Absence of fetal heart rate, brownish vaginal discharge, uterine enlargement that is greater that the estimated gestational age, elevated hCG levels, PIH, and the passage of hydropic vessels. What is pregnancy-induced hypertension?  An increased in the systolic pressure >30 mm Hg, or an increased in diastolic pressure >15 mm Hg over base line, measured on two separate occasions at least 6 hours apart. What complications to the fetus are associated with PIH?  Stillbirth  prematurely  intrauterine growth retardation What special precautions should be when admitting a patient with PIH?  Seizure precautions. Is it normal for a patient on magnesium sulfate therapy to feel tired?  Yes. Magnesium Sulfate acts as a central nervous system depressant and often makes the patient drowsy. Before administering Magnesium sulfate, what should you assess?  Maternal respiration. MgSO4 is a CNS depressant and will decrease respiration. If the maternal respiration are below 12-14 breaths/minute, the physician should be notified before starting the infusion. Which 2 drugs are used to treat eclampsia?  Magnesium Sulfate  Hydralazine What is the antidote of choice for magnesium sulfate toxicity?  Calcium gluconate. Why is it important to monitor the patient’s urine output for amount and color when she is receiving an IV of magnesium sulfate?  A decreased in urine output, or pink-tinged urine, can indicate potential renal damage. What is the purpose of ritodrine (Yutopar)?  To stop preterm labor. A patient in ritodrine (yutopar) for pre-term labor begins complaining of jitters and nervousness. What is your best response? Ritodrine (Yutopar) can cause tremors and jittery feelings. You should assess whether the feelings are from the medication or from the pre-term labor. What is the common side effects of ritodrine (Yutopar)  Tachycardia. Positive sign of pregnancy  Fetal heart tones  ultrasound identification  detection of fetal movement What emotions and fears are usually felt during the third trimester?  Feeling of “ugliness,” alterations in body image, and anxiety about the coming labor and delivery. When you notice variable decelerations on a fetal monitor, what should be the first intervention?  Change maternal position, and/or administer oxygen. How can varicose veins be prevented?  Nothing can truly prevent them, but support hose, elevation of the lower extremities, and avoiding constrictive clothing can help. What patient teaching can help relieve leg cramps during pregnancy?  Push up on the toe and down on the knees when a cramp occurs. Elevating the legs and keeping them warm may also help. What are the four stages of labor and delivery?  First stage: onset of labor to complete dilation of the cervix.  Second stage: cervical dilation to birth.  Third stage: birth to delivery of the placenta.  Fourth stage: placenta delivery to stability of the mother. What is the primary cause of pain during the first stage of labor?

 Dilation of the cervix, pressure on adjacent structure, hypoxia of the uterine muscles during contraction, and stretching of the lower uterine segment. A patient expresses the urge to push, but her cervix is not fully dilated. What should you do?  Do not allow her to push and instruct her in the “pant-pant” method of breathing during a contraction. What are the six movements of delivery?  Descent  Flexion  Internal rotation  Extension  External rotation  Expulsion What effect does cocaine have on labor and the fetus?  Preterm labor  increased uterine contractions  intrauterine growth retardation  the potencial for a sick, addicted infant When assessing for abruptio placenta, what should you look for?  A rigid board-like abdomen, with dark red painful vaginal bleeding. Describe the presentation of placenta previa.  Painless, bright red vaginal bleeding. What are the three types of breech presentation?  Frank breech: thighs flexed, legs extended.  Complete breech: at least one leg flexed.  Incomplete breech/ Footling breech: at least 1 foot below the buttocks with both thighs extended. What is the most common cause of post partum hemorrhage?  Uterine atony.  Vaginal / cervical laceratrion  retained placenta or placental fragments Why would you instruct a patient to massage her lower abdomen after delivery?  To maintain a firm uterus, which will aid in the “Clamping down” of blood vessels in the uterus, thereby preventing any further bleeding. When is it safe for a patient to resume sexual activity after vaginal delivery?  When the episiotomy has healed and the lochia had stopped. The vitals of a postpartum patient are: BP 150/100, pulse 72, resp22, temp 99.o F The doctor has ordered Methergine 0.2 mg PO. What is your best response?  Do not give the drug. The patient is hypertensive and Methergine can worsen this symptom. The umbilical cord contains how many veins and arteries?  One vein and two arteries. What are the components of the apgar scoring system?  tone  color  irritability  respiration  heart rate DOH Annual Calendar January 2007 > National Cancer Consciousness Week - January 15 -21 February 2007

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> World Mental Health Day (10) > World Sight Day (10) > Elderly Filipino Week (1-7) > National Health Education Week (1-7) > National Mental Health Week (8-14) > Garantisadong Pambata Week (15-21) (Round 2) November 2007 > National Food Fortification Day - November 7 > World Diabetes Day (14) > Substance Abuse Prevention Week (7-13) > Filariasis Awareness Month > Malaria Awareness Month > Traditional and Alternative Health Care Month December 2007  World Aids Day (1) > Health Emergency Week (2-8) > Firecracker Injury Prevention Month Republic Act Republic Act 9288 - Newborn Screening - An Act Promulgating A Comprehensive Policy and A National System For Ensuring Newborn Screening Republic Act 9257 - Expanded Senior Citizens Act of 2003 An Act Granting Additional Benefits and Privileges to Senior Citizens Amending for the Purpose Republic Act No. 7432 Otherwise Known As "An Act To Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges and for other Purposes" Republic Act 9211 - Tobacco Regulation Act of 2003 An Act Regulating the Packaging, Use, Sale Distribution and Advertisements of Tobacco Products and for other Purposes Republic Act 7883 - Barangay Health Workers Benefits and Incentives Acts of 1995 An Act Granting Benefits and Incentives to Accredit Barangay Health Workers and for Other Purposes. Republic Act 8203 - Special Law on Counterfeit Drugs" An Act of Prohibiting Counterfeit drugs, Providing Penalties for Violations and Appropriating Funds Thereof Republic Act 6425 - Dangerous Drugs Act of 1972 This Act shall be known and cited as "The Dangerous Drugs Act of 1972." Republic Act 6675 - Generics Act of 1988 An Act to Promote, Require and Ensure the Production Of An Adequate Supply, Distribution, Use And Acceptance Of Drugs And Medicines Identified By Their Generic Names Republic Act 4226 - Hospital Licensure Act An Act Requiring the Licensure of all Hospitals in the Philippines and Authorizing the Bureau of Medical Services to Serve as the Licensing Agency Republic Act No. 7876 - Senior Citizens Center Act of the Philippines An Act to Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges

Republic Act 7305 - Magna Carta of Public Health Workers Magna Carta of Public Health Workers (Republic Act No. 7305) Republic Act 7719 - National Blood Services Act of 1994 An Act Promoting Voluntary Blood Donation, Providing For An Adequate Supply Of Safe Blood Regulating Blood Banks And Providing Penal Ties For Violation Thereof Republic Act 7875 - National Health Insurance Act of 1995 An Act Instituting A National Health Insurance Program For All Filipinos And Establishing The Philippine Health Insurance Corporation For The Purpose Republic Act 7432 - Senior Citizen Act of 1992) An Act to Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges Amendment to RA 7170 - Organ Donation Act of 1991 An Act To Advance Corneal Transplantation In The Philippines, Amending For The Purpose Republic Act Numbered Seven Thousand One Hundred And Seventy (R.A. N0. 7170) Otherwise Known As The Organ Donation Act Of 1991 Republic Act 8504 - Prevention and Control of 1988 Promulgating Policies And Prescribing Measures For The Prevention And Control Of Hiv/Aids In The Philippines, Instituting A Nationwide HIV/Aids Information And Educational Program, Establishing A Comprehensive Hiv/Aids Monitoring System, Strengthening The hilippine National Aids Council, And For Other Purposes Republic Act 8423 - Traditional and Alternative Medicine Act (TAMA of 1997) An Act creating the PHILIPPINE INSTITUTE OF TRADITIONAL AND ALTERNATIVE HEALTH CARE (PITAHC) to accelerate the development of traditional and alternative health care in the Philippines, providing for a TRADITIONAL AND ALTERNATIVE HEALTH CARE DEVELOPMENT FUND and for other purposes Republic Act 8749 - Philippine Clean Air Act of 1999 An Act Providing For A Comprehensive Air Pollution Control Policy And For Other Purposes Republic Act 8344 - An Act Prohibiting the Demand of Deposits or Advance Payments An Act Prohibiting The Demand Of Deposits Or Advance Payments For The Confinement Or Treatment Of Patients In Hospitals And Medical Clinics In Certain Cases Republic Act 5921 An Act Regulating The Practice Of Pharmacy And Settings Standards Of Pharmaceutical Education In The Philippines And Other Purposes An Act Instituting The Comprehensive Dangerous Drugs Act Of 2002, Repealing Republic Act No. 6425, Otherwise Known As The Dangerous Drugs Act Of 1972, As Amended, Providing Funds Thereof, And For Other Purposes Republic Act 7394 The Consumer Act Of The Philippines Republic Act 8976

Philippine Food Fortification Act of 2000 Executive Order Executive Order 102 - Redirecting the Functions and Operations of the Department of Health. Executive Order 51 - Adopting a National Code of Marketing of Breastmilk Supplements and related products, penalizing violations thereof, and for other purposes.

Presidential Decree Presidential Decree 881 January 30, 1976 Empowering the secretary of health to regulate the labeling, sale and distribution of hazardous substances