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NURS 5432 FNP 1 Exams Study Notes: UT Arlington Guide, Exams of Advanced Education

Comprehensive study notes for nurs 5432 fnp 1 at the university of texas, arlington. It covers the entirety of the course, including modules on vaccinations, women's health, and developmental milestones. The notes are organized by topic and include key concepts, definitions, and questions for review. This resource is valuable for students preparing for exams and seeking a structured approach to learning.

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Vaccinations >>
NURS 5432 FNP 1 All Exams Study Notes (This document covers the entirety of the
class) University of Texas, Arlington
UTA – NURS 5432 – FNP 1 – Exam Study Notes
I won’t be making another one of these for FNP2 or FNP3 – so don’t bother looking for it. This took too much time to create.
Recommend your notes utilize the following format –
Disease name –
What are signs and symptoms? –
Special considerations for this disease? –
How do you manage disease? –
When do you refer to specialist(s)?
Mid-term Exam – modules 1-4 –
Module 1 -
should not be delayed due to minor illnesses, even if they illicit low-grade fever. However, for
moderate to severe infections, vaccinations could be postponed. Premature infants should
follow a schedule for immunizations based on their chronological age, not their gestational
age. Vaccine doses should not be adjusted (reduced) for premature or low-birthweight
patients. Chronic diseases are not outright contra-indications; however, vaccination with DTaP
should be deferred until the neurologic condition has been clarified and/or is stable.
Rotavirus vaccines –
Rotarix –doses s/b given 28 days apart – for infants, given at age 2 mo and 4 mo.
– completed by 24 weeks.
Rotateq – 3 doses completed by 32 weeks of age.
Immunodeficient children should not be given live-virus vaccines. These include –
Oral polio vaccine [OPV, not available in the United States]
Rotavirus
MMR
VAR
This document covers the entirety of the class – consisting of a midterm and the comprehensive final. Don’t waste
your time watching all those videos, they are horribly low yield. By following this document, I just saved you a
dozen or so hours of studying – you’re welcome. All highlighted, red, italicized text are those focused questions that
appear in those outlined summaries of each module. Double check these against your current semester taking this
course. That said, I can’t really make any of these modules high yield as anything could be on the exams from
these modules; and in all honesty, that was the case for me. However, think about it this way - since you are
only going to get 150 questions (between the midterm and the final) and there’s over 100 pages in this
document summarizing the entirety of the course, comprised of I-don’t-know-how-many-data-points, focus
on that topics/categories that you are most likely to be tested on; or, to put it another way, what do you think
you are going to be absolutely, 100% be tested on? That answers I’m going for are – pharmacology, diagnostics,
physical assessment, patho, etc. I would tackle each topic in this manner. I highly recommend to focus on these
categories of each topic first – as it is basically impossible to simply review everything covered in the course and
properly retain everything. For instance, focus on (and memorize) all the pharmacology for each topic covered in
the course (anki maybe); then do the same for diagnostics, and so on. Doing this, you may not cover every possible
question you could get, but you would at least ace the questions you are for sure going to be asked in each of those
categories. Trust me, you will be. Any italicized text is my own note/addition/snarky comment and did not come from
lecture material. I would suggest cross-referencing all these topics w/ Osmosis videos (if you have time) and
chatgpt (ask your question, followed by the prompt “please explain in advanced medical terminology.” Be cognizant
of possible AI hallucinations). Also, you must get 100% on everything else in the course. Good luck.
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Vaccinations >>

NURS 5432 FNP 1 All Exams Study Notes (This document covers the entirety of the

class) University of Texas, Arlington

UTA – N URS 5432 – FNP 1 – Exam Study Notes I won’t be making another one of these for FNP2 or FNP3 – so don’t bother looking for it. This took too much time to create. Recommend your notes utilize the following format – Disease name – What are signs and symptoms? – Special considerations for this disease? – How do you manage disease? – When do you refer to specialist(s)? Mid-term Exam – modules 1-4 – Module 1 - should not be delayed due to minor illnesses, even if they illicit low-grade fever. However, for moderate to severe infections, vaccinations could be postponed. Premature infants should follow a schedule for immunizations based on their chronological age, not their gestational age. Vaccine doses should not be adjusted (reduced) for premature or low-birthweight patients. Chronic diseases are not outright contra-indications; however, vaccination with DTaP should be deferred until the neurologic condition has been clarified and/or is stable. Rotavirus vaccines –

• Rotarix –doses s/b given 28 days apart – for infants, given at age 2 mo and 4 mo.

- completed by 24 weeks.

• Rotateq – 3 doses completed by 32 weeks of age.

Immunodeficient children should not be given live-virus vaccines. These include –

  • Oral polio vaccine [OPV, not available in the United States]
  • Rotavirus
  • MMR
  • VAR This document covers the entirety of the class – consisting of a midterm and the comprehensive final. Don’t waste your time watching all those videos, they are horribly low yield. By following this document, I just saved you a dozen or so hours of studying – you’re welcome. All highlighted, red, italicized text are those focused questions that appear in those outlined summaries of each module. Double check these against your current semester taking this course. That said, I can’t really make any of these modules high yield as anything could be on the exams from these modules; and in all honesty, that was the case for me. However, think about it this way - since you are only going to get 150 questions (between the midterm and the final) and there’s over 100 pages in this document summarizing the entirety of the course, comprised of I-don’t-know-how-many-data-points, focus on that topics/categories that you are most likely to be tested on; or, to put it another way, what do you think you are going to be absolutely, 100% be tested on? That answers I’m going for are – pharmacology, diagnostics, physical assessment, patho, etc. I would tackle each topic in this manner. I highly recommend to focus on these categories of each topic first – as it is basically impossible to simply review everything covered in the course and properly retain everything. For instance, focus on (and memorize ) all the pharmacology for each topic covered in the course (anki maybe); then do the same for diagnostics, and so on. Doing this, you may not cover every possible question you could get, but you would at least ace the questions you are for sure going to be asked in each of those categories. Trust me, you will be. Any italicized text is my own note/addition/snarky comment and did not come from lecture material. I would suggest cross-referencing all these topics w/ Osmosis videos (if you have time) and chatgpt (ask your question, followed by the prompt “please explain in advanced medical terminology.” Be cognizant of possible AI hallucinations). Also, you must get 100% on everything else in the course. Good luck.

Developmental >>

• MMRV

  • yellow fever
  • LAIV (live attenuated)
  • Live-bacteria vaccines (BCG or live typhoid fever vaccine). If malignancy is in remission or chemo hasn’t been administered within 90 days they can receive live virus vaccine. Known allergies and vaccines – MMR, IPV, and VAR contain microgram quantities of neomycin , and IPV also contains trace amounts of streptomycin and polymyxin B ; children with known anaphylactic responses to these antibiotics should not be given these vaccines. Trace quantities of egg antigens may be present in both inactivated and live influenza and yellow fever vaccines. Guidelines for influenza vaccination in children with egg allergies have recently changed. The trace amounts of egg protein are generally considered below the threshold needed to induce an allergic reaction and there has been no increased risk of anaphylaxis documented in children with severe egg allergies. Therefore, children with severe egg allergy can be vaccinated with influenza vaccine with no special precautions beyond those for any other vaccine. RV vaccine – Rare incidence (1 in 20k-100k) of intussusception. Med should be avoided in pt’s w/ hx of chronic GI issues (Hirschsprung’s dz, hx of intussusception, or immune conditions. RV1 should not be given to infants with a severe latex allergy; container for RV1 med has latex. Both vaccines (RV1 + RV5) are contraindicated in infants with severe combined immunodeficiency (SCID). RV vaccines should be avoided in infants whose mother received a biologic response modifier (eg, etanercept) during pregnancy. Vaccination should be deferred in infants with acute moderate or severe gastroenteritis. Hospitalized children should wait until post discharge to receive their first dose. Typical things children should be able to do, by age –
  • They can lift their heads with good control at 3 months.
  • Sit independently at 6 months – question involved a 4mo.
  • What can they do at 4mo?? _- Roll over from front to back by 6 months?
  • Hand to hand transfer 5-6 months.
  • Pincer grasp 8-10 months._
  • crawl at 9 months. - Pinch grasp at 12 months.
  • walk at 1 year. o The child learning to walk has a wide based gait at first. Next, he or she walks with legs closer together, the arms move medially, a heel toe gait develops, and the arms swing symmetrically by 18–24 months. _- Feed self by 15 months.
  • Scoop with a spoon, throw ball at 18 months._
  • run by 18 months.

Autism – none Set of symptoms that typically present prior to 3 years of age. OB – This classification system pairs AUB with descriptive terms denoting the bleeding pattern (ie, heavy, light and menstrual, intermenstrual) and etiology. Module 2 – Women’s Health PAP screening guidelines Abnormal PAP tests, cervical cancer, vaginal candidiasis, and Bartholin's gland cyst. What do the guidelines state the age is for the first PAP? Last PAP? How do you manage abnormal PAPs? Pt will have HPV testing to determine sub-type of HPV. Pt may also have colposcopy if they test positive for high-risk type. Routine surveillance is recommended based on age, and the governing body recommended frequency (typically between every 3-5 years). What is the treatment for vaginal candidiasis and Bartholin's gland cyst? Vaginal Candidiasis – none

  • Antifungals – topical vs oral o Flagyl PO 150mg once o Clotrimazole, miconazole, terconazole – vary from one-time doses to 3–7- day courses. Bartholin’s gland cysts – none
  • I+D o Word catheter inserted – 4-6 weeks to allow for drainage.
  • Abx therapy The second lecture covers abnormal uterine bleeding. What does the acronym PALM/COEIN stand for? The acronym PALM-COEIN standing for possible causes of AUB… none.
  • Polyp
  • Adenomyosis – occurs when the tissue that normally lines the uterus (endometrial tissue) grows into the muscular wall of the uterus.
  • Leiomyoma - a group of benign smooth muscle tumors commonly present in premenopausal women.
  • Malignancy and hyperplasia
  • Coagulopathy – up to 18% of women w/ AUB have underlying dz. o Consider von Willebrand panel in blood tests.
  • Ovulatory dysfunction
  • Endometrial – involving the lining of the uterus.
  • Iatrogenic o Caused by medical device/medication.
  • Not yet classified.

The third lecture covers PCOS. Polycystic ovarian syndrome. 4 possible methods to have diagnosis – Androgen excess + ovulatory dysfunction (commonly seen in adolescents). Androgen excess + polycystic ovarian morphology (aka ovarian cysts) Ovulatory dysfunction + polycystic ovarian morphology Androgen excess + ovulatory dysfunction + polycystic ovarian morphology DON’T NECESSARILY HAVE TO HAVE OVARIAN MORPHOLOGY TO HAVE DX. Patho? Excess androgens d/t hyperandrogenism. (Unopposed estrogen??). Familial link. Possibly induced by high calorie intake early on in life. What are the signs and symptoms of PCOS? This disease presents as –

  • menstrual disorders/irregularity (amenorrhea to heavy vaginal bleeding) and infertility
  • androgen excess – acne and hirsutism (females have male hair patterns – facial hair, male pattern baldness).
  • Insulin resistance is also common ; this leads to obesity, DMT2 and metabolic syndrome, and acanthosis nigricans. Preg pt have increased risk for complications – GD and preeclampsia.
  • Differentiate from a virilizing tumor – while PCOS has a slow onset, a virilizing tumor typically causes a rapid onset of hirsutism and acne. (a hormone-producing tumor on adrenal gland that produces androgens.) How do you diagnose PCOS? Serum tests, high ratio of LH:FSH, high levels of serum androstenedione. Pelvic US (not necessary for diagnosis) will find follicles in ovaries that look like cysts; these are because of delayed/abnormal menstrual cycles due to hormone irregularities in the disease. Assess for –
  • (see above s/s)
  • Define the onset period – fast or slow. o If onset was rapid – suspect tumor, also confirm w/ serum DHEA-S >
  • THEN – measure testosterone and other labs Labs to assess – none.
  • Avoid ordering serum ‘total testosterone’ as this is specific for males. Order free testosterone level, or testosterone level specific for female patients.
  • Normal PCOS level of testosterone is 29-150. o >200 suspect virilizing tumor. o Get this early in AM, 0800 if possible, or if drawn at time later in day and is normal, have it repeated by 0800.
  • DHEA-S o Is a precursor sex hormone, needed for synthesis of steroid hormones, including testosterone/estrogen – is produced by adrenal glands. Polycystic Ovarian Syndrome (PCOS) >>

o Pharm - none. ▪ Metformin

  • Start w/ 500mg XR daily (generic is cheap)
  • Multimodal efficacy – o Insulin sensitizer, and does not ↑ insulin production o ↓ hepatic glucose production, ↓ intestinal absorption of glucose o ↑ glucose utilization, ↑ basal/postprandial glucose
  • Monitor renal status, and for lactic acidosis.
  • Educate pt they may begin to have periods, become pregnant. ▪ Estrogen/Progestin
  • Estrogen – review contraindications o Increased risk of uterine CA, save for hx of hysterectomy.
  • Progestin – o Given to induce regular periods again. o Helps reduce possible development of ovarian CA from unopposed estrogen.
  • Mono/tri/multiphasic pills – may need to notify pharmacy that it isn’t for contraception, but to treat medical condition (PCOS) o Monophasic – same dose in every pill. ▪ Preferred, most stabilizing dose. ▪ Consider using this over a 6-month period to get irregular patients stabilized. o Biphasic – increasing progestin level to thicken endometrium, dose changes midway through the cycle. o Triphasic – different hormone levels each week, designed to mimic a normal cycle. In obese patients with PCOS, weight reduction and exercise are often effective in reversing the metabolic effects and in inducing ovulation. For women who do not respond to weight loss and exercise and do not desire pregnancy, combined hormonal contraceptives are first-line treatment to manage hyperandrogenism and menstrual irregularities. Intermittent or continuous progestin therapy or a hormonal IUD may be used for endometrial protection in women who cannot or choose not to use combined hormonal contraceptives. Metformin therapy may be used as a second-line therapy to improve menstrual function. Metformin has little or no benefit in the treatment of hirsutism, acne, or infertility. For women who are seeking pregnancy and remain anovulatory, letrozole (first line), clomiphene, or other medications can be used for ovarian stimulation (see section on Infertility below). Women with PCOS have increased risk for twin gestation with ovarian stimulation. For women who are seeking pregnancy and remain anovulatory, letrozole (first line), clomiphene, or other medications can be used for ovarian stimulation (see section on Infertility below). Women with PCOS have increased risk for twin gestation with ovarian stimulation. Lecture four covers vulvar disorders.

For a lot of these vaginal/labial d/o, have malignancy as part of differential.

  • For any disease process that doesn’t respond to treatment, malignancy should be considered. Labial adhesions
  • Found in 20% of female population. Vulvovaginal Candidiasis
  • Possible to have candida infx w/o discharge.
  • Can commonly have ‘satellite lesions’.
  • Can occur d/t recent PO ABX
  • Treat w/ PO Diflucan – can be a 1x dose to treat. o 150mg PO table once o Repeat dose in 7 days if high risk or continues ABX.
  • Possible to cover it with anti-yest cream. o Not all OTC rx can cover all types of yeast. o Terazole or Gynazole will cover all types of yeast. How do you manage atrophic vaginitis in post-menopausal women? Lack of estrogen will thin out the tissue of vagina / labia - none.
  • Uncomfortable sexual activity, tearing possible of vaginal walls. Treatment –
  • Topical estrogen – different forms: cream, tablets
  • Vaginal moisturizer applied daily.
  • Cleanse w/ water.
  • Keep any sex toys clean. How do you manage vulvar lichen sclerosis? Typically, problem for older women – >30yo Causes –
  • Associated w/ autoimmune disease o DMT o Autoimmune thyroiditis Dx –
  • Punch biopsy. TX –
  • High potency steroids o Elsewhere in these modules, it states that high potency steroids should only be prescribed by MD, so these patients would have to be referred out to derm.
  • Refer to specialty (derm) if don’t feel comfortable w/ steroid rx Lichen Planus – none Pt can present w/ -

▪ Progestin –

  • Amenorrhea / irreg bleeding is common.
  • Can be used to treat heavy menses. ▪ Copper –
  • Acts of spermicide, causes instability of uterine lining.
  • Heavier bleeding and cramping but will have regular periods.
  • Useful for non-hormonal method o Even if positive for C+G, do not have to remove IUD.
  • Injectable (Depo-Provera)
  • Patches
  • Pills
  • May need to monitor BP when starting these…
  • Will not need to have a PAP. How do they work? –
  • Estrogen – do not give to breastfeeding mother, it will stop lactation. o ↓ FSH o Prevents release of egg o Stabilizes thickness of endometrium, prevents shedding. o Estrogen alone doesn’t prevent pregnancy, though progestin does.
  • Progestin – progestin only ok for breastfeeding mother (called POP, progestin only pill) o Can be given by itself to menopausal women, for some symptoms. ▪ Good for women to have contraindications for estrogen. o Prevents LH surge. o Thickens the cervical mucus. o Thins out the endometrium. o Will have irregular menses, common to have breakthrough bleeding. ▪ Will have to take at the same time every day, cannot be late. o Depo-Provera (medroxyprogesterone) ▪ IM injection q 3 mo ▪ Notorious for causing amenorrhea. ▪ Bone density changes, which reverse after it is stopped. Major s/e –
  • Estrogen – o Increased coagulation – DVT, PE ▪ MI, CVA, clods are contraindications for use o Increased blood glucose levels o Can allow hepatic adenoma to grow (which is a benign tumor) ▪ Hx of CA would be a contraindication.
  • Progestin – o Think changes in pregnancy (weight gain, mood swings, inc appetite, irreg bleeding) ACHES pneumonic – what symptoms pt should report to provider.
  • Abd pain

o Active gallbladder dz is a contraindication.

  • Chest pain o Hypercoagulability thing.
  • Headaches – one of the contraindication options?
  • Eye prob (vision changes)
  • Severe leg pain (DVT) Mono vs Bi vs triphasic – none
  • Monophasic – same dose in every pill. o Preferred, most stabilizing dose. o Consider using this over a 6-month period to get irregular patients stabilized.
  • Biphasic – increasing progestin level to thicken endometrium, dose changes midway through the cycle.
  • Triphasic – o May be able to feel change in dose each week, may not like that. LARC – long-acting reversible contraception - none Non hormonal?
  • Surgical intervention – o Tubal ligation
  • Condoms
  • Diaphragm
  • ‘Fertility Awareness’ o Tracking ovulation
  • Spermicide How do you determine which form of contraception to use for your patient?
  • This will be based upon personal preference as well as CDC recommendations, see that chart, which will be based on medical history. What are contraindications for estrogen use in menopausal women?
  • Blood clot hx – MI/CVA/DVT
  • CAD hx – MI, arth dz – d/t increased clotting risk
  • Known or suspected breast CA
  • Ovarian CA
  • Liver dz – general or active gallbladder dz o Estrogen is heavily dependent upon liver metabolism,
  • Hx of estrogen-dependent tumors – BRCA, ovarian CA The last lecture covers menopause. Defined as –
  • 12 consecutive months of amenorrhea in nonpregnant woman, >40 years of age.
  • Perimenopause o Menopausal transition – period from onset of irregular menses to final menstrual cycle. Begins roughly 4 years prior to final menstrual cycle.
  • Associated with CVD and osteoporotic fx - none

o Any of these any they need to see oncologist prior to initiating therapy – o Breast CA (BRCA1 and BRCA2) ▪ This risk not seen until after 5 years of therapy. o Ovarian CA o Uterine CA

  • Unexplained uterine bleeding
  • Hx of VTE/CVA o Higher doses of estrogen can cause hypercoagulability.
  • CAD o Should not be given for cardio-protective benefits. o Higher doses of estrogen can induce htn
  • Active liver dz o Higher doses of estrogen can induce gallbladder disease. Genitourinary Syndrome – vulvar/vaginal atrophy –
  • Topical estrogen therapy (ET) – reverses vaginal atrophy, enhances blood flow, and reduces UTI. o Start with daily application (for 1-2 weeks) and then decreased to few times a week. o No difference in efficacy between different vaginal preparations
  • Ospemifene 60mg PO qd – SERM for moderate to severe dyspareunia o Will not help w/ frequent UTIs. When do you use estrogen and progesterone? This will be based upon whether or not pt has had a hyst previously. Estrogen alone? - none
  • Determined by hx of hysterectomy – if no uterus they do not need progesterone to offset effects of estrogen. Lecture 7 – breast d/o Fibroadenoma - none Unk etiology but thought to occur d/t cyclic hormonal stimuli. Classified as either simple or complex – Complex will have the following –
  • Cysts >3mm diameter
  • Sclerosing adenosis
  • Epithelial calcifications
  • Papillary changes Upon palpation, mass will have a smooth, rubbery with well-defined borders. Pt will describe slow growing mass. If >5cm are considered ‘giant fibroadenomas’ No nipple discharged. Diagnostics –
  • U/S to differentiate cyst from solid mass.
  • Mammography or possible MRI
  • If mass identified, pt will need to have a fine needle aspiration biopsy to r/o CA. Management –
  • <3cm – observe.
  • 3cm, pt is symptomatic or dx is questionable – refer for sx Fibrocystic Breast dz - none Spectrum of breast tissue dz – incl cyst formation, columnar cell changes, mastalgia, epithelial hyperplasia, etc. Common is premenopausal women ages 30-50. In US, 50% of women have some type of fibrocystic breast dz. No known risk factors. 30% of all women with breast CA develop in women with benign breast dz (BBD). Assessment –

  • Smooth, movable masses variable in size
  • Breast pain, tenderness that diminishes after menses while symptoms worsen prior to menses.
  • Nipple discharge of varying color + consistency Management –
  • Cold compresses
  • Reduce dietary fat.
  • Reduce caffeine.
  • Sodium restriction 10 days prior to onset of menstruation
  • r/o malignancy via imaging Rx –
  • Vitamin D 2000 IU / day
  • Consider – o Spironolactone for swelling, 25-200mg daily PO, typically begin at 100mg/daily. o Vitamin E 200 IU BID or 500IU daily o Evening primrose oil 2-4 grams/day o PO contraceptives Nipple discharge – none Typically benign, but all need to be referred to a surgeon. Spontaneous discharge is more of a concern. Unilateral discharge –
  • Ductal ectasia – nonblood, dark green/brown
  • Papilloma – red, rusty, brown, green Bilateral discharge – less concerning
  • Physiologic galactorrhea
  • Check TSH (to assess for hypothyroidism)
  • Prolactin (pituitary tumor)
  • Review pt’s medication list – o H2 receptor antagonists o Antihypertensives o Spironolactone o Antidepressants (chlorpromazine) o Antidopaminergics

Dx –

  • Pregnancy test
  • U/A
  • Tumor marker – CA-125 in postmenopausal women
  • TVUS (2nd^ line) Treatment of physiologic cysts in premenopausal women with oral contraceptives or estrogen therapy may help them resolve more rapidly. Ovarian CA – none Genetic link –
  • Usually associated w/ BRCA1 and BRCA2 (tumor suppressor gene) mutation
  • Lynch syndrome – autosomal dominant inheritance. Anyone w/ family hx should get genetic testing. Risk factors –
  • Family hx (ovarian, breast) is the most significant r/f but overall is sporadic and not inherited.
  • Older age
  • White
  • Infertility
  • Null gravidity
  • Early menarche or late menopause
  • BMI> Prevention factors –
  • PO contraceptive 5 years dec by 20%, 15 yr dec risk 50% Diagnostics –
  • Abdominal mass (omental caking)
  • Pelvic mass
  • ‘fluid wave’ ascites
  • Pleural effusion - dyspnea
  • Lymphadenopathy
  • Cachexia
  • Hirsutism (for androgen-secreting tumors)
  • Lab work – CBC, LFT, albumin, u/a
  • Tumor markers – o Epithelial tumors – ▪ CA-125 – not useful for r/o, just further testing once CA is confirmed.
  • 90% of malignant nonmucinous tumors will have this elevated, but –
  • 50% of stage 1 ovarian cancers will have a falsely negative marker.
  • Common conditions for falsely positive – o PID, endometriosis, fibroids, pregnancy, menstruation ▪ CA-19-9 – better indicator ▪ CEA – better indicator
  • TVUS

Module 3 – pregnancy and lactation Lecture one covers medications during pregnancy and preconception and intra-natal care. During 3 rd^ trimester of pregnancy renal flow is doubled, which accelerates renal excretion; however, mobility and tone of bowel decreased, which can prolong drug effects. To some extent, all medications can cross the placenta – some medications do more easily and will then have more ‘bioavailability’ for the fetus than others. First trimester –

  • 0 to 12 weeks
  • Amenorrhea, nausea, vomiting, fatigue, breast tenderness, urinary frequency
  • FHT are typically found around 10-12 weeks. Second trimester –
  • 13 to 27 weeks
  • Fetal movement
  • Abd discomfort d/t stretching.
  • Change in skin pigmentation – striae.
  • Syncope
  • Leopold maneuver possible after 20 weeks
  • Fundus palpable at umbilicus at 20 weeks gestation and gros approx. 1cm/wk thereafter Third trimester –
  • 28 to 40 weeks
  • Abd growth
  • Braxton-hicks contractions o Can be d/t dehydration, have pt drink 16 oz of water to see if contractions resolve. o Easy to have dehydration, they will need to drink more than non-pregnant person (up to 16 8oz glasses of water/day). o They should be able to feel the abd become firm with actual contractions.
  • Can loose mucus plug approx 1 wk prior to labor.
  • If rupture of membranes occurs – they must deliver w/in 24-48 hours. Fundal height measurement – none “The fundus is palpable at the umbilicus at 20 weeks gestation, and it grows approximately one centimeter per week thereafter. So, you can get a pretty good idea of gestation by measuring fundal height at this point in the pregnancy.” Half-way to fundus – 16 weeks. What medications are safe during pregnancy? - Folic acid – 0.4mg/day to reduce change of neural tube defects. - Tylenol When is the most critical time during pregnancy to avoid medications?
  • The embryonic period – o Week 3 through week 8 – fetus can develop gross malformations produced by teratogens. o This is the period where organs are being developed.

Immunizations during pregnancy >> o This can also be given w/in 72 hours after delivery. o Or w/ any episodes of vaginal or intrauterine bleeding What is appropriate weight gain during pregnancy? This will be determined by BMI prior to pregnancy (BMI <18.5, mother could gain more; BMI

25, mother could gain less) Normal weight – BMI 18.5 to 24.9 – 25-35 pounds for single gestation pregnancy What medications are contraindicated?

_- ACE inhibitors – can cause fetal death, but are not category X, are category C. To limit exposure to baby to medications in breast milk, advise the following –

  • Take rx immediately after breastfeeding.
  • Avoid rx that have long half-life.
  • Choose rx that tend to be excluded from like and that are least likely to affect the infant.
  • Avoid rx known to be hazardous._
  • Inactivated vaccines (IAV) can be administered during pregnancy.
  • Live attenuated vaccines (LAV) should not be given during pregnancy, and pregnancy should not be attempted within 28 days of administration of a LAV.
  • Vaccines SAFE to give during pregnancy – there’s only 3 o Flu vaccine – has to be inattenuated, so not a live vaccine. ▪ There are two types, the IAV is the one to give. ▪ Nasal spray vaccine is a LAV, do not give to pregnant patients. o TDaP – given with every pregnancy ▪ Is a IAV, ok to give ▪ Will provide short term protection for newborn against pertussis (whooping cough) ▪ Therefore, should be given between 27-36 weeks gestation. o COVID-19 vaccine
  • Vaccines that should be given only based upon material risk – o Hepatitis A – ▪ Given w/ significant risk of infx. o Hepatitis B
  • Vaccine NOT SAFE to give during pregnancy –Any LAV o MMR ▪ Rubella not safe to give during pregnancy, will be given after delivery in hospital. o Varicella (chickenpox) o HPV o IPV – polio vaccine o VZV o Any meningococcal or pneumococcal vaccine ( o Smallpox
  • Performed in 2 nd^ trimester. o If pt agrees, will be performed between 15-20 weeks of pregnancy, most accurate results in 16-18 weeks.
  • Assessment for 4 substances in blood – o Assesses for trisomy 21 (down syndrome), trisomy 18 (Edwards syndrome) o NTD (neural tube defects) o AFP (alpha-fetoprotein) – ▪ Elevated – poss NTD ▪ Could be false-positive/elevated by multiple gestations, or fetus is older than previously believed. ▪ Depressed – poss down syndrome o UE (unconjugated estriol) – uE ▪ Depressed – poss down syndrome or Edwards syndrome o HCG – ▪ Elevated – poss down syndrome ▪ Depressed – poss Edwards syndrome o Inhibin A – ▪ Elevated – poss down syndrome Lecture two covers common complaints during pregnancy and pregnancy complications. What are the common discomforts during pregnancy and how are they managed? Ankle edema –
  • d/t increased venous pressure secondary to vena cava and iliac veins compression from uterus.
  • and reduced plasma colloid oncotic pressure and obstruction of lymphatic flow o This reduces reabsorption of fluid into vascular compartment – increased third spacing.
  • altered sodium level (↑)
  • Management – o Limit sodium intake. o Ensure optimal caloric and protein intake. o Elevate legs when at rest. ▪ BID – rest for 1 hour w/ feet higher than that of heart. o Wear supportive leg wear for venous return but avoid restrictive bands/clothing. Back pain –
  • Enlarging uterus alters curvature of lumbosacral vertebrae.
  • Relaxin hormone released, which relaxes ligaments in multiple areas of lower back/pelvis – o This may induce muscle aches.
  • Management – o Rest o Proper body mechanics o Hot compresses to areas of pain Quad testing >>