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859-III
Methergine (IP only), Magnesium Sulfate for PTL, PMS/PMDD, Osteoporosis, Dr. Ryan PP Lecture
32
Nursing
Graduate
02/14/2012

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Cards

Term
What is the appropriate dose and route of methergine for treatment of PPH?
Definition
0.2 mg IM x1 (never IV)
Term
What are common maternal side effects of magnesium sulfate therapy?
Definition
Flushing, N/V, HA, lethargy
Term
T or F: Magnesium sulfate is an effective therapy for the treatment of preterm labor.
Definition
False. Although it does show benefit for fetal neuroprotection (reduced rate of CP) in the event of preterm birth.
Term
What are major risk factors for development of osteoporosis?
Definition
1. Personal h/o fracture as adult
2. H/o fracture in parent or sibling
3. Low body weight
4. Smoking
5. >3mos corticosteroid therapy
Term
How would you counsel a patient to help decrease her risk of osteoporosis in the postmenopausal period?
Definition
Increase: intake of calcium and Vitamin D, activity level (30 mins 3x/week), weight-bearing excercise
Decrease: Caffeine, salt, alcohol, Vitamin A intake. Do not smoke and limit secondhand smoke exposure.
Term
A T-score of -3 indicates what diagnosis?
Definition
Osteoporosis.
Higher than -1 = Normal
-1 to -2.5 = Osteopenia
less than -2.5 = Osteoporosis
-2.5 with h/o fracture = Severe osteoporosis
Term
In what instance would it be ideal to use Evista (raloxifene) for the treatment of osteoporosis?
Definition
Pt with a high risk of breast cancer, who is not troubled by hot flashes.
Term
What is the most common sign/symptom of osteoporosis?
Definition
Usually asymptomatic, not diagnosed until a fracture occurs. Sometimes pts c/o back pain.
Term
What is the incidence of osteoporosis-related fractures in postmenopausal women?
Definition
40-50%
Term
When is it appropriate to begin screening for osteoporosis?
Definition
All women 65+ with no risk factors
Screen earlier if risk factors, high risk medication/condition, or postmenopausal and stopping HRT.
Term
What criteria need to be met for a diagnosis of PMS or PMDD?
Definition
-Affective and somatic symptoms
-Present during the luteal phase of menstrual cycle with clear symptom-free interval (approx. days 4-12)
-Severe enough to interfere with usual activities
Term
What are treatment options for patients with PMS/PMDD?
Definition
1. Lifestyle changes (diet, excercise, stress relief
2. SSRIs (Prozac, Zoloft- continously or just during luteal phase)
3. OCPs- shorter pill free interval (Yaz, Loestrin 24) or continuously to eliminate withdrawal bleed (No period, no PMS)
Term
How do you accurately diagnose PMS/PMDD?
Definition
Record symptoms prospectively for at least 2 months. Record symptoms on a calendar in relation to days menstrual cycle.
Term
What are the "core symptoms" for a diagnosis of PMDD according to DSM IV criteria?
Definition
Need 1 of the following: depressed mood, anxiety/edginess/nervousness, Moodiness, Anger/irritabilty
Term
What are major differentials for a diagnosis of PMS/PMDD?
Definition
Other depression/anxiety/psych disorder, pregnancy, & thyroid abnormalities
Term
What is the major difference between PMS and PMDD?
Definition
PMDD representas a small subset of women experiencing PMS with an emphasis on increased severity of mood symptoms.
Term
How does the WHO FRAX tool work?
Definition
-Calculated 10 year risk of major osteoporotic fracture
-Combines DXA T-score of femoral neck with other major risk factors: age, weight, height, sex, h/o fx, family hx, smoking, steroid use, RA, secondary osteoporosis, alcohol intake, and country of origin
Term
What pharmacologic therapy can be used for both the treatment and prevention of osteoporosis?
Definition
-Bisphosponates: Actonel, Fosamax, Boniva, Reclast (Reduce bone turnover and increase bone mass)
-Selective Estrogen Receptor Modulators: inc. osteoblasts, dec. osteoclasts (less favorable-risk of uterine ca & DVTs)
-Evista (raloxifene)-mimic estrogen's effects on bones
Term
What are common sites of osteoporotic fractures?
Definition
Vertebrae, distal radius, femoral neck, proximal humerus
Term
What pharmacologic therapies for osteoporosis should be used as treatment only?
Definition
-Calcitonin (inhibits resorption, no real benefit, don't use it)
-HRT: Premarin or estradiol patches (use only if fx risk is greater than CVD/breast cancer risk)
-Forteo (parathyroid hormone-promotes new bone formation)
-Prolia (bone-modifying agent, prevents osteoclasts formation, decreased bone resorption and increased mass)
Term
What are the RDA for calcium and Vitamin D for postmenopausal women?
Definition
age 51+:1200 mg/400 IU
age 71+:1200 mg/600 IU
Osteopenia/osteoporosis/postmenopausal and No HRT: 1500mg/800-1300 IU
Term
Define puerperium
Definition
The time between the birth of the newborn and the return of the reproductive organs to the nonpregnant state
Term
Define autolysis
Definition
The self-destruction of hypertrophied tissue (what happens to the uterine tissue during involution, cells reduce in size but not in #)
Term
Define subinvolution
Definition
The failure of the uterus to return to a nonpregnant state
Term
What are the different phases of lochia during the puerperium?
Definition
Rubra: 2-3 days PP (dark red, clots)
Longer if not breastfeeding(24 days???), shorter if Cesarean

Serosa: 3-10 days PP (pinkish brown, old blood, serum, tissue debris)
Alba: days 10+ PP (white/yellow, mucus, leukocytes, bacteria, epithelial cells)
Term
What kind of glands are mammary glands?
Definition
Exocrine glands: secrete substances to the outside of the body through a duct
Term
What is the purpose of the lactiferous sinus?
Definition
Serves as temporary storage of the milk in the mammary ducts near the nipple
Term
Describe the timeline of uterine involution.
Definition
Immediately PP: 1/2way between umbilicus and symphysis
Day 1 PP: @ umbilicus
1 week PP: 500g
2 weeks PP: 350g
6 weeks PP: 50-60g (nonpregnant size)
Term
How long does it take the placental implantation site to heal?
Definition
6-7 weeks
Term
How long does it take the vaginal tissues to heal completely? (i.e. episotomy, renewed pelvic muscle tone)
Definition
6 months
Term
What changes would you expect to the hematologic system during the PP period?
Definition
RBCs: normally increase 25-30% during pregnancy, return to prepregnant levels by 4-6 PP
H&H: normally decreases after birth (1 point for every 500ml blood loss?), stablizes by 2 days PP
WBC: normal increased 25-30 thousand during IP period, returns to normal by 4-7 days
Platelets: decrease 30% immediately PP, gradual increase to days 3-4 PP, then gradual return to prepregnant levels
Term
What is the difference in "baby blues" and PP depression?
Definition
Baby blues is considered a normal finding 3-5 days PP due to fluctuating hormones levels and new role expectations. PP depression or psychosis is not normal- involves rejection of infant,thoughts of self harm or harming infant, and inability to carry out self care and infant care. tasks
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