Ch. 8: Infections Flashcards
How can HIV be transmitted to the infant from the mother?
Perinatally through the placenta and postnatally through the breast milk
T/F: Early identification and treatment significantly decreases the incidence of perinatal transmission
True
How is confirmation of positive HIV results confirmed?
Western blot test or immunofluorescence assay
What lab test is done for a client in labor who may have HIV?
Rapid HIV antibody tetst ( blood or urine sample)
What precautions are used for HIV patients?
Standard precautions
Nursing care: Review plan for scheduled c-section birth at 38 weeks for maternal viral load of more than ______
1000 copies/mL
Should we bathe the infant after birth before remaining with the mother?
Yes
What is a med we give for HIV?
Retrovir (Zidovudine)
When do we give Retrovir (zidovudine)?
Administer 14 weeks of gestation, throughout pregnancy, and before the onset of labor or c-section birth
Should the infant get retrovir following delivery?
Yes, infant gets it at delivery and for 6 weeks following birth
Is it ok if mom with HIV breastfeeds? What else is contraindicated to HIV+ moms during and after labor?
Do not breastfeed!!
Amniocentesis Episiotomy Internal fetal monitors Vacuum extraction Forceps during labor
*all due to increased risk of maternal blood exposure
TORCH is an acronym for a group of infections that can negatively affect a woman who is pregnant. These infections can cross the placenta and have teratogenic affects on the fetus. What are the TORCH infections?
Toxoplasmosis Other (Hep A, Hep B, syphilis, mumps, parovirus, varicella) Rubella Cytomegalovirus HSV
What TORCH infection is this:
Caused by consumption of raw or undercooked meat or handling cat feces
Toxoplasmosis
What are symptoms of toxoplasmosis?
Similar to flu or lymphadenopathy
What TORCH infection: Contracted through children who have rashes or neonates who are born to mothers who had rubella during pregnancy
Rubella (german measles)
What TORCH infection: Transmitted by droplet infection from person to person, a virus found in semen, cervical and vaginal secretions, breast milk, placental tissue, urine fees, and blood. Latent virus may be reactivated and cause disease to the fetus in utero or during passage through the birth canal
Cytomegalovirus
What TORCH infection: Spread by direct contact with oral or genital lesions; transmission to fetus is greatest during vaginal birth if woman has active lesions
HSV
What symptoms would be associated if mom has rubella?
Joint and muscle pain
How does cytomegalovirus present?
Asymptomatic or mononucleosis-like manifestations
What are manifestations of toxoplasmosis?
Fever and tender lymph nodes
What are manifestations of rubella?
Rash, mild lymphedema, fever, and fetal consequences (miscarriage, congenital anomalies, death)
How does HSV present?
Initially with lesions and tender lymph nodes
Fetal consequences include miscarriage, preterm labor, intrauterine growth restriction
What is a TORCH screen?
An immunologic survey that is used to identify the existence of these infections in the mother (to identify fetal risk) or in her newborn (detection of antibodies against infection)
What should we educate the client about to prevent TORCH infections?
- Correct hand hygiene
- Cooking meat properly
- Avoid contact with contaminated cat liter
What is treatment for toxoplasmosis?
Sulfonamides or combo of pyrimethamine and sulfadiazine (potentially harmful to fetus, but parasitic treatment is essential)
For rubella, vaccination of women who are pregnant is _______ because rubella infection may develop. What should these women do?
Contrainindicated; avoid crowds of young children
Women with low titers prior to pregnancy should receive the immunizations
Is there treatment for cytomegalovirus?
No, prevent exposure by frequent hand hygiene before eating and avoiding crowds of young children
A bacterial infection that can be passed to a fetus during L&D
Group B streptococcus b-hemolytic (GBS)
Positive GBS may have maternal and fetal effects, including what? (5)
- Premature ROM
- Preterm L&D
- Chorioamnionitis
- Infection of urinary tract
- Maternal sepsis
When are lab tests done for GBS?
Vaginal and rectal cultures are performed at 36-37 weeks gestation
GBS: Who would get intrapartum antibiotic prophylaxis?
- Moms who delivered previous infant with GBS
- Client who has GBS bacteriuria during current preg
- Client who had GBS+ during screening
- Client who has unknown GBS and is delivering less than 37 weeks
- Client who has maternal fever of 38C
- Client who has ROM for 18h+
What meds are most commonly prescribed for GBS?
Penicilling G or ampicillin
What is used to destroy the GBS?
Bactericidal antibiotic
A bacterial infection that is the most common STI; often difficulty to diagnose because it is typical asymptomatic
Chlamydia
What is subjective data for chlamydia?
Vaginal spotting
Vulvar itching
Postcoital bleeding and dyruria
What are objective findings for chlamydia?
White, watery vaginal discharge
What is the lab test for chlamydia?
Endocervical culture
Chlamydia: What are the meds prescribed during pregnancy?
Azithromycin and amoxicillin
Chlamydia: What is administered to the infant following delivery?
Erythromycin
A bacterial infection that is primarily spread by genital-to-genital contact; it can also be spread by anal-to-genital contact or oral-genital contact; it can be transmitted to newborn during delivery; women are frequently asymptomatic
Gonorrhea
Gonorrhea: What is subjective data in male? female?
Male: urethral discharge, painful urination, frequency
Female: lower abdominal pain; dysmenorrhea
Gonorrhea: What is the objective data?
Urethral discharge
Yellowish-green vaginal discharge
Reddened vulva and vaginal walls
If left untreated, it can cause PID, heart disease, and arthritis
What are lab tests for gonorrhea?
Urethral and vaginal cultures
Urine cultures
What med is given for gonorrhea?
Ceftriaxone and azithromycin PO
A fungal infection caused by candida albicans
Candida albicans
What are risk factors for candida albicans?
Diabetes
Oral contraceptives
Recent antibiotic treatment
Candida albicans: subjective data?
Vulvar itching
Candida albicans: Objective data?
Thick, creamy, white vaginal discharge
Vulvar redness
White patches on vaginal walls
Gray-white patches on the tongue and gums of the neonate
What is the lab test for candida albicans?
Wet prep
What is the diagnostic procedures for candida albicans?
Potassium hydroxide prep (KOH)..presence of hyphae and pseuudophyphae indicates + findings
What med is given for candida albicans?
Fluconzaole
What is client education for candida albicans?
- Avoid tight fitting clothes
- Wear cotton lined underpants
- Limit wearing damp clothing
- Void before and after intercourse and avoid douching
- Increase dietary intake of yogurt with active cultures
A nurse on the obstetrical unit is admitting a client who is in labor. The client has a positive HIV status. The nurse is aware that which of the following is contraindicated for this client? (SATA)
A. Episotomy B. Vacuum extraction C. Forceps D. C-section birth E. Internal fetal monitoring
A, B, C, E
A nurse in an antepartum clinic is providing care for a client. Which of the following clinical findings are suggestive of a TORCH infection? (SATA)
A. Joint pain B. Malaise C. Rash D. Urinary frequency E. Tender lymph nodes
A, B, C, E
A nurse is caring for a client who has a diagnosis of gonorrhea. Which of the following medications should the nurse anticipate the provider will prescribe?
A. Ceftrazone
B. Fluconzaole
C. Metrondiazole
D. Zidovudine
A
A nurse is caring for a client who is in labor. The nurse is aware that which of the following conditions have medications that cab be prescribed as prophylactic treatment during labor or immediately following delivery? (SATA)
A. Gonorrhea B. Chlamydia C. HIV D. GBS E. TORCH
A, B, C, D
A nurse manager in a prenatal clinic is reviewing ways to prevent a TORCH infection during pregnancy with a group of newly licensed nurses during an education program. Which of the following statements by a nurse indicated understanding of the teaching?
A. Obtain a vaccination against rubella early in pregnancy
B. Seek prophylactic treatment if cytomegalovirus is detected
C. A women should avoid handling dog feces
D. A woman would avoid consuming undercooked meat
D
