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OB > Chapter 8: Infections > Flashcards

Chapter 8: Infections Flashcards

1
Q

What is HIV?

A
  • Retrovirus
  • attacks and destroys T lymphocytes (WBC)
  • causing immunosuppression
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2
Q

How can HIV be transmitted?

A
  • perinatally through placenta

- Postnatally through breast milk

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3
Q

When should testing for HIV be done?

A
  • Early prenatal period
  • Third trimester

-Rapid testing during labor if HIV status is unknown

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4
Q

What procedures should be avoided to prevent maternal blood exposure if patient is HIV positive?

A
  • aminocentesis

- episiotomy (vaginal incision)

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5
Q

What procedures should be avoided to prevent fetal bleeding if fetus is HIV positive?

A
  • internal fetal monitors
  • vacuum extraction
  • forceps
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6
Q

Risk factors for HIV/AIDS?

A
  • IV drug use
  • multiple sex partners
  • maternal hx of STIs
  • blood transfusions (rare)
  • men who have sex with men
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7
Q

Expected findings of someone who has HIV/AIDS:

A

-fatigue + flu-like sxs

  • fever, diarrhea, weight loss
  • anemia
  • lymphadenopathy (swelling of lymph nodes)
  • rash
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8
Q

Tests that screen for HIV?

A

Antibody screening such as:

  • immunoassay
  • confirmation of positive results is confirmed by Western blot test or immunofluorescence assay
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9
Q

What additional lab testing should be done to check for infections?

A

-STIs (gonorrhea, chlamydia, syphilis, and Hep B)

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10
Q

What lab tests should be done frequently throughout pregnancy?

A
  • viral load levels (amount of HIV In blood)

- CD4 cell counts (WBC, T cells)

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11
Q

What immunizations are contraindicated in patients with HIV?

A
  • Hep B
  • Pneumococcal Infection,
  • Haemophilus Influenza Type B
  • Viral Influenza
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12
Q

What type of barrier could be used to minimize the transmission of HIV?

A

Condoms

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13
Q

What does viral load refer to?

A

The amount of HIV in the blood

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14
Q

A C-section maybe necessary for a viral load of more than….

A

1000 copies/mL

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15
Q

You should bathe the infant after birth before remaining with mother. True/false?

A

True

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16
Q

When can blood testing and administration of injections be done on a newborn?

A

After his/her first bath

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17
Q

What would most likely be administered to a patient with HIV?

A
  • antiviral prophylaxis
  • triple medication antiviral
  • highly active antiretroviral
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18
Q

What is Retrovir?

A

-Antiretroviral agent

Nucleoside reverse transcriptase Inhbitor

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19
Q

When should Retrovir be administered?

A
  • At 14 weeks gestation
  • Throughout pregnancy
  • Before onset of labor or c-section

For infant:

  • At delivery
  • for 6 weeks after birth
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20
Q

It is the responsibility of the provider to report cases of HIV to their local health department.

True/False?

A

True

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21
Q

A patient who is positive for HIV is still able to breastfeed. True/False

A

False

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22
Q

HIV is a commonly reported condition. True/false?

A

True

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23
Q

What are TORCH infections?

A
  • Group of infections
  • Able to cross placenta
  • teratogenic effects on fetus
Toxoplasmosis
Other infections (hepatitis A/B, syphilis, varicella-zoster, mumps, parvovirus B19)
Rubella Virus
Cytomegalovirus 
Herpes simplex
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24
Q

What is toxoplasmosis?

A
  • parasitic infection

- caused eating raw or undercooked meat; handling cat feces

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25
Q

S/S of toxoplasmosis includes:

A

-Flu-like sxs:
(fever, sore throat, cough, muscle ache, fatigue, chills, diarrhea)

-Lymphadenopathy
(swollen lymph nodes, night sweats)

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26
Q

Other infections such as Hep A/B, syphilis, varicella-roster, mumps, and parvovirus B19 is associated w/

A

congenital anomalies (birth defects)

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27
Q

Rubella is also known as the

A

German Measels

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28
Q

Rubella is contracted through

A
  • children w/ rashes

- neonates born to women who had rubella “during” pregnancy

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29
Q

Cytomegalovirus is a member of what family of viruses?

A

herpes

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30
Q

How is cytomegalovirus transmitted? Where is found?

A
  • droplet
  • found in semen/cervical + vaginal mucus, breast milk, placental tissue, urine/feces, and blood
  • latent virus can be reactivated
  • can cause disease to fetus in utero or during passage through birth canal
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31
Q

How is herpes simplex virus (HSV) transmitted

A
  • direct contact w/ oral or genital lesions

- transmission greatest during vag birth if woman has active lesions

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32
Q

S/S of Rubella includes

A
  • rash
  • joint + muscle pain
  • mild lymphedema
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33
Q

S/S of cytomegalovirus includes

A
  • asymptomatic

- mononucleosis-like manifestations

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34
Q

S/S of herpes simplex virus (HSV) includes

A
  • painful blisters

- tender lymph nodes

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35
Q

Fetal consequences of Rubella includes

A
  • congenital anomalies
  • miscarriage
  • death
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36
Q

Fetal consequences of the the herpes simplex virus (HSV) includes

A
  • preterm labor
  • miscarriage
  • intrauternine growth restriction (IUGR)
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37
Q

It is recommended that patients in labor who have active genital herpes or exhibit sxs of impeding outbreak such as vulvar pain and itching, should consider delivering through a

A

c-section

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38
Q

Medication to for toxoplasmosis

A
  • sulfonamides
  • pyrimethamine and sulfadiazine combo

*potentially harmful for fetus but parasitic tx is ESSENTIAL!

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39
Q

Most torch infections can be treated with

A

ABXs

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40
Q

Treatment for cytomegalovirus

A

None

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41
Q

What is GBS?

A

Group B strep
-bacterial
-can be passed down to
fetus during L&D

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42
Q

Risk factors for GBS includes

A
  • Positive with previous/current pregnancy
  • <20yrs old
  • African American, Hispanics
  • low birth weight
  • preterm delivery
  • use of intrauterine fetal monitoring
  • prolonged rupture of membranes
  • intrapartum maternal fever >100.4 F
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43
Q

Expected findings inpatients with GBS

A
  • premature rupture if membranes
  • preterm labor and delivery
  • chorioaminonitis
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44
Q

Medication to for toxoplasmosis

A
  • sulfonamides
  • pyrimethamine and sulfadiazine combo

*potentially harmful for fetus but parasitic tx is ESSENTIAL!

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45
Q

Expected findings inpatients with GBS

A

-premature rupture if membranes
-preterm labor & delivery
Chorioaninonitis

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46
Q

Risk factors for GBS includes

A

-Positive with previous/current pregnancy
-<20yrs old
-African American & Hispanics
-low birth weight
-preterm delivery
-use of intrauterine fetal monitoring
-prolonged rupture of membranes
-intrapartum maternal
Fever greater than 100.4 F

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47
Q

What is GBS?

A

Group B strep

  • bacterial infection
  • can be passed down to fetus during L&D
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48
Q

When should GBS testing be done?

A

vag + rectal cultures @ 35-37 weeks

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49
Q

Administration of intrapartum abx prophylaxis is given to the following clients with GBS:

A
  • during pregnancy
  • unknown GBS status delivering at <37 weeks
  • fever >100.4 F
  • rupture of membranes for 18 hrs or longer
50
Q

Drug commonly prescribed to clients w/ positive GBS?

A

-penicillin or ampicillin

Penicillin: 5 mil. Units initially IV bolus followed by 2.5 mil. Units intermittent IV bolus q4h

Ampicillin: 2g IV bolus initially, followed by 1g q4h

51
Q

Most commonly reported bacterial STI in American women.

A

Chlamydia

52
Q

Chlamydia can be difficult to diagnose because it is often asymptomatic.

True/False

A

True

53
Q

Recommendations for chlamydia screening:

A

-yearly if sexually active (<25 yrs, older women)

  • 1st prenatal visit
  • 3rd trimester (if at continued high risk)
54
Q

Risk factors of chlamydia includes:

A
  • multiple sex partners

- unprotected sex

55
Q

Expected findings of chlamydia in men

A
  • Dysuria

- mucoid/watery discharge

56
Q

Expected findings of chlamydia in women

A
  • Dysuria
  • Urinary frequency
  • Spotting or postcoital bleeding
  • Mucopurulent endocervical discharge
  • Easily induced endocervical bleeding
57
Q

Lab testing for chlamydia in men and women:

A
  • urine culture (men)

- endocervical culture (women)

58
Q

Medications used to treat chlamydia during pregnancy

A
  • Azithromycin

- Amoxicillin

59
Q

What should be given to ALL infants following delivery to treat ophthalmia neonatorum which also provides prophylaxis against Neisseria gonorrheae (gonorrhea) and Chlamydia trachomatis (chlamydia)?

A

Erythromycin

60
Q

Azithromycin or amoxicillin is a

Broad/narrow spectrum abx
Bactericidal /bacteriostatic action

Bactericidal = kills bacteria
Bacteriostatic = prevents growth
A

Broad-spectrum

Bactericidal

61
Q

When using azithromycin or amoxicillin, there is a possibility that it can decrease the effectiveness of:

A

Oral contraceptives

62
Q

Educating clients about Chlamydia

A
  • safe sex practices
  • condoms
  • importance of mutual monogamous relationships
63
Q

What is gonorrhea and how is it spread?

A
  • bacterial infection
  • genital/ora/anal - to genital contact
  • to newborns during delivery
64
Q

Untreated gonorrhea in women can cause

A

-PID (pelvic inflammatory disease) –> infertility

65
Q

Expected findings of gonorrhea in women

A
  • dysuria
  • yellow/greenish discharge
  • easily induced endocervical bleeding
66
Q

Expected findings of gonorrhea in men

A
  • dysuria

- urethral discharge

67
Q

Lab testing for gonorrhea in men and women

A
  • urine culture (men)

- endocervical culture (women)

68
Q

Recommendations for gonorrhea screening:

A

-yearly if sexually active (<25 yrs or older women)

  • 1st prenatal visit
  • 3rd trimester (if continued high risk)
69
Q

Medication to treat gonorrhea

A
  • Ceftriaxone (IM)

- Azithromycin (PO)

70
Q

Ceftriaxone and azithromycin is a

broad/narrow spectrum abx

w/ bacterialcidal/bacteriostatic action

A

broad-spectrum

bacterialcidal

71
Q

Syphilis is and STI cause by what bacteria

A

Treponema pallidum

72
Q

Risk factors for gonorrhea

A
  • multiple sex partners

- unprotected sex

73
Q

How is syphilis transmitted?

A
  • oral
  • vag
  • anal

-to unborn child

74
Q

Black, Hispanics, and other racial/ethnic minorities are disproportionately affected by syphilis.

True/False

A

True

75
Q

Risk factors for STIs such as chlamydia, gonorrhea, and syphilis

A
  • unprotected sex

- multiple sex partners

76
Q

Stages of syphilis:

A
  • Primary: presence of chancre (ulcer)
  • Secondary: skin rashes on palms of hands, soles of feet
  • Tertiary: damage to internal organs
77
Q

Expected findings of syphilis

A
  • Primary: chancre/sore in genital area
  • Secondary: rashes on palms of hands, soles of feet
  • Tertiary: damage to internal organs (manifestations include difficulty coordinating muscle movements and blindness)
78
Q

Lab testing for syphilis:

A

Serology tests:

1) nontreponemal- used for screening (VDRL and rapid plasma reagin)
2) treponemal - test for antibodies specific for syphilis to confirm diagnosis (enzyme immunoassay, immunoassays)

79
Q

Medications to treat syphilis

A

Penicillin G (IM) in a single dose

80
Q

Client education about syphilis

A

-no sexual contact until sores have completely healed

  • safe sex practices
  • condoms
  • importance of mutual monogamous relationships
81
Q

Most common STI in both men and women

A

HPV (Human papilloma virus)

82
Q

HPV can cause

A
  • genital warts (aka condyloma acuminata)

- cancers

83
Q

HPV is spread through

A

-oral
-vag
-anal
(vag + anal most common)

84
Q

Complications of vaginal delivery is usually d/t to presence of ____________ in clients with HPV therefore, a c-section can be recommended

A

warts

85
Q

Lab testing for HPV`

A
  • Pap-smears w/ or w/o HPV co-testing
  • 21-29: Pap smear q 3 years
  • 30 - 65: Pap smear + HPV q 5 years (preferred) or pap smear alone q 3 yrs
  • 65+: should not be screened if client has had regular screenings w/ normal unless they have cervical precancer in which they should continue to be screened for 20 years after the precancer diagnoses
86
Q

Genital warts are diagnosed by the provider based on

A

appearance

87
Q

Based on the Pap test result, a colposcopy and biopsy can be performed to diagnose _________-

A

cervical pre-cancer and cancer

88
Q

Medications to treat genital warts

A
  • imiquimod (client-applied cream)

- trichloroacetic acid (provider-administered therapy)

89
Q

Treatments that can be performed for precancerous changes on the cervix (HPV)

A
  • laser therapy
  • cone biopsy
  • otherwise, tx can be deferred until after birth
90
Q

Client education on HPV

A

-recommend vaccinations to protect against low + high risk types of HPV (ages 9-26; ideally age 11-12 yr olds)

  • safe sex practices
  • correct use of condoms
  • importance on mutual monogamous relationships
91
Q

At what age can the HPV vaccine be given?

A

9-26 yrs old

11-12 years old (ideal)

92
Q

What is trichomoniasis?

A
  • protozoan parasite

- spreads from penis/vagina - to - vagina

93
Q

Untreated trichomoniasis can lead to

A

-PID (pelvic inflammatory disease) –> infertility

94
Q

Risk factors for trichomoniasis

A
  • unprotected sex

- multiple sex partners

95
Q

Expected findings of trichomoniasis in men and women

A

MEN:

  • dysuria
  • discharge
  • penile itching or irritation

WOMEN:

  • dysuria
  • yellow/green, frothy vag discharge (in vag. vault) w/ foul odor
  • itching
  • dyspareunia (painful sexual intercourse)
  • strawberry spots on cervix (petechiae)
  • cervix that bleeds easily
96
Q

Lab testing for trichomoniasis

A

sample of discharge applied to pH paper, and wet mount + whiff test performed

97
Q

Interpreting lab results for trichomoniasis

A

positive for trichomoniasis

  • pH >4.5
  • presence of trichomonads on wet mount w/ saline prep
  • whiff (smell) test “positive” for foul odor
98
Q

Medications to treat trichomoniasis

A
  • Metronidazole
  • Tinidazole

(PO in a single dose; anti-infective)

99
Q

Client education about taking Metronidazole or tinidazole

A
  • DO NOT take w/ alcohol d/t disulfiram-like rxs (N/V)
  • take medication as prescribed
  • decreases effectiveness of oral contraceptives
  • treat all sexual partners
100
Q

Client education on trichomoniasis

A
  • safe sex practices
  • condoms
  • importance of monogamous relationships
101
Q

Bacterial vaginosis is cause by what bacterias?

A

-Haemophilus + gardnerella vaginalis

102
Q

Bacterial vaginosis is a common/uncommon vag. infection in women ages __________ and is related/not related to_____________.

A

15-44 years old

not related to sexual activity

103
Q

Type of bacterial infection NOT related to sexual activity

A

bacterial vaginosis (haemophilus, gardnerella)

104
Q

Untreated bacterial vaginosis can cause

A

-PID (pelvic inflammatory disease) –> infertility

105
Q

Why is it important that bacterial vaginosis be treated especially in pregnant women

A

can cause preterm labor + low birth weight (<5.5 lbs)

106
Q

Risk factors for bacterial vaginosis

A
  • multiple sex partners
  • unprotected sex

-altered pH balance of vagina (caused by douching)

107
Q

Expected findings of bacterial vaginosis

A

-thin, white/gray discharge w/ fish-like odor esp. after sex

108
Q

Lab testing for bacterial vaginosis

A
  • sample of discharge applied to pH paper
  • wet mount
  • whiff test
109
Q

Interpreting lab results for bacterial vaginosis

A

positive for bacterial vaginosis if

  • pH >4.5
  • wet mount w/ saline prep indicates presence of clue cells
  • “positive” whiff test
110
Q

Medications to treat bacterial vaginosis

A

Metronidazole (anti-infective)

111
Q

Client education on bacterial vaginosis

A
  • avoid tight-fitting clothes
  • wear cotton-lined underwear
  • avoid douching
  • treatment not indicated for men
  • safe sex practices
  • condoms
  • importance of monogamous relationships
112
Q

What is Candidiasis (candidiasis albicans)?

A

-yeast/fungal infection or vulvovaginal candidiasis

113
Q

Second most common type of vaginal infection in the U.S?

A

candidiasis (yeast infection)

114
Q

Risk factors for candidiasis

A
  • pregnancy
  • obesity, DM, diet high in refined sugars
  • oral contraceptives
  • recent abs tx
115
Q

Expected findings in candidiasis

A
  • vulvar and vaginal pruritus (itching), erythema + inflammation
  • thick, creamy, white cottage-cheese-like vag. discharge
  • white patches on vag. wall
  • gray-white patches on the tongue and gums (neonates)
116
Q

Lab testing for candidiasis

A
  • sample of discharge to pH paper
  • wet mount
  • whiff test
117
Q

Interpreting lab results for candidiasis

A
  • pH <4.5 (normal pH)
  • wet mount w/ potassium hydroxide indicates presence of yeast buds, hyphae, and pseudo-hyaena
  • “negative” whiff test
118
Q

Medications to treat candidiasis

A

Fluconazole

  • single low dose
  • topical (recommended for pregnant-women)
  • antifungal agent
  • fungicidal action
119
Q

OTC treatments for candidiasis

A

Clotrimazole

*important for provider to diagnose candidiasis initially

120
Q

Client education on candidiasis

A
  • avoid tight-fitting clothing
  • wear cotton-lined underwear
  • avoid douching
  • limit wearing damp clothing
  • increase dietary intake of yogurt w/ active cultures

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